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IMPORTANCE
.
1.LAW: COMPULSORY TO GIVE PRIMARY T/T. 2.UNAVOIDABLE SITUATION : PATIENT BROUHT IN SERIOUS CONDITION
COLLAPSE,CONVULSION. BECOMES SERIOUS IN YOUR CLINIC eg.
3.REACTION TO YOUR T/T : ANAPHYLAXIS, DRUG RASH. 4. GOOGLIES IN SYMPTOMS : LEADS TO WRONG DIAGNOSIS 5. G.P. : FIRST DR. TO FACE THE EMERGENCY. 6. CORRECT REFFERRAL OF PATIENT : WHEN ? WHICH ? WHERE ? TO
WHOM ? E.g. HEART BURN mistaken as hyperacidity in AC. MYOCARDIAL INFARCTION.
DIAGNOSIS : BY SYMPTOMS
1. PAIN.
2.RESTLESSNESS. 3. BREATHLESSNESS. 4. EXTREME WEAKNESS. 5. SYNCOPE. 6. DROWSYNESS. 7. ABNORMAL BEHAVIOUR. 8. CONVULSIONS. 9. UNCONSCIOUSNESS. 10. TRANSIENT PARALYSIS. 11. HICCOUGHS.
HICCOUGHS.
DISEASES:
RENAL FAILURE ------------------------ G.I.BLEED
CLUES:
OLIGURIA,OEDEMA.
------------------ABD.DISCOMFRT,TACHYCARDIA,HYPOTENSION.
MYOCARDIAL INFARCT ------ CHEST PAIN, ECG CHANGES. BRAIN STEM ISCHAEMIA ---------- DROWSYNESS, N.DEFICIT. LIVER ABSCESS ---------------------- FERVER, RT. HYPOCHONDRIAC
PAIN.
EMERGENCY BAG.
1.INJECTIONS:
ADRENALINE ATROPINE EFFCORLIN WYMASONE AVIL LASIX DERIPHYLLIN MEPHENTIN *DOPAMIN *SODABICARBONATE
* FORTWIN * VOVERON * CONTRAMOL *CYCLOPAM * PARACETAMOL * OMEZ * VOMISET * PERINORM * ETHAMSYLATE *BOTROPASE
EMERGENCY BAG.
TABLETS:
DISPRIN 325 mg SORBITRATE 5 mg
MISCELLANIOUS:
SCALP VEIN SET I.V.SETS- MICRO & REGULAR DISPO.SYRINGES RYLES TUBE, ORAL TUBE,AMBU BAG.
C. DEPIN 1O mg
STEMETIL M.D. I.V. FLUIDS: TORCH.
TYPES OF EMERGENCIES.
DISEASE INDUCED.
POISONINGS BITES : SNAKE, SCORPION, HONEYBEES, DOG.
ELECTRIC SHOCK
ACCIDENTS DROWNING DOCTOR INDUCED : DRUG REACTIONS.
PALPITATIONS.
CHECK PULSE:
REGULAR IRREGULAR FAST ---------- more than 150/min. SLOW -------- less than 40/min. CHECK B.P. : HIGH more than 200/110 mmHg LOW less than 90 mmHg
-----------------------------------------------SPLENOMEGALY.
V.FEVERS.
ANTICOAGULANT OVERDOSE ----------- H/O VALVE REPLACEMENT
COLLAEGEN DISORDERS.---------------- POLY ARTHRITIS, BUTTERFLY
RASH.
SPECIAL SITUATIONS.
1.SEVERE HYPERTENSION.
2.HYPOTENSION. 3.TACHYCARDIA. 4.BRADYCARDIA. 5.TACHYPNOEA. 6.HYPERPYREXIA. 7. UNCONSCIOUS PATIENT. 8.DRUG REACTION : ANAPHYLAXIS. 9.BLEED FROM ORIFICES : EPISTAXIS, HAEMATEMESIS,
SEVERE HYPERTENSION.
B.P. more than 200/110 mmHg.
ASYMPTOMATIC : ORAL ANTI. HTN DEPIN 10, NUMLO 5, T.RESTYL
0.25 SYMPTOMATIC :
*S.L. DEPIN 5mg *I.V. LASIX 1 AMP. *T. ALPRAZOLAM 0.25 mg *NJ.DICLOFENAC IF HEADACHE *INJ. CONTRMOL IF CHEST PAIN.WORD OF WORD OF CAUTION: * AVOID SUDDEN DROP IN BP IF SUSPECT THROMBOTIC STROKE. AVOID ACE INHIBITORS IF SUSPECT RENAL FAILURE, PREGNANCY. AVOID B. BLOCKERS IF COPD, BR.ASTHMA, BRADYCARDIA.
HYPOTENSION.
B.P. LESS THAN 90 mmHg:
ASYMPTOMATIC : HYPOTHYROIDISM
I.V. SODABICARB 10cc FOOT ELEVATION T/T OF CAUSE [ DONT USE 5% DEXTROSE, USE WIDE BORE NEEDLE, USE REGULAR IV SET ].
HYPOTENSION.
WITHOUT S/O DEHYDRATION:
DISEASES:
*MYOCARDITIS *ENDOTOXIC SHOCK *PULM.EMBOLISM *CARDIOGENIC SHOCK TREATMENT : *I.V. SODABICARB *I.V. DOPAMIN INFUSION *I.V. EFFCORLINE *OXYGEN [ USE MICRO DRIP I.V. SET. SPEED OF INF. 30 microDROPS/MIN. ]
TACHYCARDIA.
HEART RATE 100 TO 120/min :
REFFERRAL TO ICU. REGULAR : SVT / V.T. IRREGULAR : A.FIB., A.FLUTTER. [PRECAUTION: AVOID I.V. FLUIDS.]
BRADYCARDIA.
HEART RATE LESS THAN 40/min :
TRANSIENT PARALYSIS.
LOOK FOR UNDERLYING:
VALVULAR HEART DISEASE ----------------------
CLUES:
CARDIAC
MURMER. I.H.D. -------------------------------------------- H/O MYOCARD. INFARCT. CARDIOMYOPATHY ---------------------------S/O C.H.F. AORTO-ARTERITIS ---------------------------- ABSCENT PULSE IN UPP. LIMBS AORTIC ANEURYSM -------------PRECORDIAL PULSATION, TRACHEAL TUG CAROTID ARTERY DISEASE -------------- WEAK CAROTID PULSE.
UNDERLYING DISEASES: AC. MYOCARDIAL INFARCTION. AC.PERICARDITIS. PNEUMONIA WITH PLURITIS. PNEUMOTHORAX. AC. PULMONARY EMBOLISM. DISSECTION OF AORTA.
PERFORATION :
CLUES:
DISCOLOURATION OF SKIN SWELLING ABSENT PULSE HOMANS SIGN. LOOK FOR UNDERLYING: RHD, IHD, D.M.
DISEASEAS: AC.PULM. OEDEMA. ARDS. AC.PNEUMONIAS. PNEUMOTHORAX. AC. PULMONARY EMBOLISM. SEVERE BR. ASTHMA AECB. AC. RENAL FAILURE. DIABETIC KETO-ACIDOSIS. CLUES: PREVIOUS H/O RHD, IHD, COPD, PULM. T.B., D.M. SOB, CALF PAIN, OLIGOURIA, FEVER, COUGH.
DISEASES : VALVULAR HEART DISEASE : A.S., M.S. CARDIAC ARRHYTHMIAS. MASSIVE INTERNAL BLEED. POSTURAL HYPOTENSION. HYPOVOLAEMIA. DRUG INDUCED : NITRATES[ SL], ANTI. HTN. COUGH SYNCOPY. MICTURITION SYNCOPY.
TACHY/BRADYCARDIA, HYPO/HYPERTENSION H/O DRUGS, COUGH, PROLONGED STANDING, RHD, IHD.
CLUES :
SWEATING, OLIGOURIA, PARALYSIS, JAUNDICE, SOB, FEVER. H/O D.M.,HTN, COPD, SEDATIVE CONSUMPTION, STARVATION.
DISEASES : HYPOGLYCAEMIA. HYPERGLYCAEMIA. HEPATIC ENCEPHALOPATHY. URAEMIC ENCEPHALOPATHY. BRAIN STEM ISCHAEMIA. HYPOXIA. DRUG INDUCED. ENCEPHALITIS. HYPONITRAEMIA.
DEFINITION.
EMERGENCY:
SERIOUS
AND
UNEXPECTED SITUATION REQUIRING IMMEDIATE ACTION.
N.DEFICIT I.C. BLEED. ------------------------------------ HEADACHE, HTN, N.DEFICIT. . I.C. SOL. ---------------------------------------,, N. DEFICIT. I.C. THROMBOPHLEBITIS. ------------------ ,, ,, FEVER,SINUSITIS. ENCEPHALITIS. ----------------------------- ,, ,, ,, CARDIAC ARRHYTHMIAS. -------------------- CHEST PAIN, IHD, RHD, DCM. DRUG INDUCED : QUINOLONE, ALCOHOL, RAT POISON SCAR SEIZURES. ------------------------------- H/O CVA.
RESTLESSNESS.
LOOK FOR :
TACHYCARDIA
BRADYCARDIA
HYPOTENSION HYPERTENSION
TACHYPNOEA
FEVER.
EXTREME WEAKNESS
DISEASES: CLUES: D.M. KETOSIS ------ DIABETIC MISSING INSULIN/INFECTION
C.R.F.
TREMORS.
HYPONITRAEMIA. ------- STARVATION,CVA, OLD AGE. HYPOKALAEMIA. --------- DIURETICS- LASIX, DYTOR.
EPISTAXIS.
BLEEDING NOSE .
TREATMENT :
* PINCH NOSE. * APPLY ICE PACK. * LOCAL BOTROPASE. *INJ.LASIX * ANTI HTNSIVE.
HAEMATEMESIS.
BLOOD IN VOMITUS.
TREATMENT :
* I.V. N.SALINE * INJ. OMEZ / RANITIDIN *ICE WATER LAVAGE *ORAL ANTACIDS.
HAEMOPTYSIS.
BLOOD IN SPUTUM.
TREATMENT:
REFERRAL : TO ICU / PULMONOLOGIST WITH FACILITY OF BRONCHSCOPY. PRECAUTION : AVOID COUGH EXPECTORANT. URGENT REFERRAL TO CENTRE FOR PULM.ART.EMBOLISATION [IF MASSIVE HAEMOPTYSIS. ]
ATROPIN
PRESENTS WITH RESTLESSNESS,YAWNING,GIDDINESS, PROFUSE SWEATING,BREATHLESSNESS, TACHYCARDIA, HYPOTENSION. TREATMENT: INJ. ADRENALIN 0.5 CC S.C. INJ EFFCORLINE I.V. INJ AVIL I.V. I.V. N.SALINE BRONCHODILATORS - NEBULISATION
POISONING.
MLCS SO BE CAREFUL TO KEEP PROPER RECORDS.
GENERAL GUIDE LINES :
* STOMOCH WASH * I.V. LINE * SPECIFIC ANTIDOTES * REFERRAL TO ICU/PHC/MCH SPECIFIC T/T : OPP - ATROPINE, PAM. KEROSINE- HIGH DOSE VIT- C. OPIATES - NALORPHINE.
BITES.
SNAKE BITE :
SCORPION :
HONEY BEES:
YES- AUSCULTATE FOR HEART SOUNDS ][ NO RESP & H.SOUNDS ][ C.P.R. 2. HEART SOUNDS : PRESENT FEEL RADIAL PULSE 3. RADIAL PULSE : FEEBLE SHOCK TACHYARDIA = A.F. WITH CEREBRAL T.I.A VENTRICULAR ARRHYTHMIA BRADYCARDIA= ICH, I.C. SOL, HEART BLOCKS [ YOU MAY WRONGLY INTERPRETE YOUR PULSE FOR PTS PULSE.]
UNCONSCIOUS PATIENT.
RECORD B.P. :
MANAGEMENT : * HEAD LOW * TURN ON SIDE * I.V. 25% DEXTROSE - SUSPECTED HYPOGLYCAEMIA. * I.V. MANNITOL SUSPECTED RAISED I.C.P. *I.V. ANTIBIOTICS ,, MENINGO ENCEPHALITIS. * I.V. INJ FALCIGO ,, CEREBRAL MALARIA REFERRAL : TO I.C.U./ NURO. SPECIALIST.
LESSONS TO BE LEARNED.
DO`S.
1. KEEP COOL. 2.ASSESS SERIOUSNESS OF CONDITION. 3.DISCUSS WITH RELATIVES ABOUT SERIOUSNESS OF PT. 4.CALL FOR ADDITIONAL HELP. 5.ARRANGE FOR TRANSPORT WHILE T/T PATIENT. 6.KNOW YOUR LIMITS WHILE T/T. 7.GIVE PROPER PRIMARY T/T. 8.USE SAFE DRUGS WITH MINIMUM SIDE EFFECTS. 9. REFER TO PROPER PLACE. 10.BE HONEST TO RELATIVES.
LESSONS LEARNED.
DONTS.
1.AVOID ARROGANCE. 2.AVOID I.V FLUIDS TO EVERY PT. 3.AVOID SEDATIVES IN NURO PT. 4.AVOID INJ VOVERON,KETOROL IN CHEST PAIN PT. 5.AVOID NPHROTOXIC INJ IN PT. WITH HYPOTENSION. 6. AVOID S.L. DEPIN TO ASYMPTOMATIC SEVERE HTN. 7.DONT USE DRUGS ABOUT WHICH YOU DONT KNOW. 8. DONT MIX TOO MANY INJ IN SAME DRIP. 9. DONT CRITICISE YOUR FELLOW COLLEAGUES. 10. DONT LEAVE RESPONSIBILITY TO YOUR STAFF IN UR ABSENCE.
LESSONS LEARNED.
I.V. FLUID IN EMERGENCY -------- AVOID IF DYSPNOEA
PRESENT
ANTIBIOTICS IN EMERGENCY ------- I.V. CEFTRIAXONE FORTE. ANTIMALARIAL IN EMERGENCY ------ I.V. FALCIGO. STEROIDS IN EMERGENCY ------------- I.V. HYDROCORTISONE. ANAPHYLACTIC SHOCK --------------- DRUG OF CHOICE INJ ADRENALINE [ AND NOT STEROIDS OR AVIL. ]
SUMMARY.
NO ESCAPE FROM EMERGENCY.
PROMPT & PROPER DIAGNOSIS & T/T SAVES LIFE. REFERRAL IN PROPER TIME & TO PROPER PLACE SAVES LIFE. IN NUT SHELL KNOWING DOS & DONTS SAVES PATIENT & YOU.