You are on page 1of 42

DR.ARUN MANNIKAR. M.D.

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.

7. CORRECT DIAGNOSIS AND CORRECT DECISION SAVES PATIENT &


DOCTOR.

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.

25% DEXT, N.SALINE, R.L., MANNITOL

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

SUB CUTENIOUS BLEED.


PETICHIAE, ECHYMOSES, PURPURA : INDICATES COAGULATION PROBLEM OR THROMBOCYTOPENIA. DISEASES: CLUES:
LEUKAEMIA

-----------------------------------------------SPLENOMEGALY.

HAEMORHAGIC FEVERS :- -----------------DENGUE, F.MALARIA,

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,

HAEMOPTYSIS. 10. POISONING. 11.BITES.

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

STENOTIC VALVULAR DISEASE-A.S/M.S. PERICARDIAL EFFUSION [ NO I.V. FLUIDS STRICTLY.] SYMPTOMATIC :


WITH S/O DEHYDRATION: I.V. N SALINE/RL - FAST

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 :

T.RESTYL 0.25 mg T.CIPLAR 10 mg T/T UNDERLYING DISEASE[THYRO,ANAEMIA]


HEART RATE 120 TO 150/min : REGULAR SAME AS ABOVE.

IRREGULAR- T.AMIADARONE 200mg.


HEART RATE MORE THAN 150/min: T. AMIDARONE 200 mg

REFFERRAL TO ICU. REGULAR : SVT / V.T. IRREGULAR : A.FIB., A.FLUTTER. [PRECAUTION: AVOID I.V. FLUIDS.]

BRADYCARDIA.
HEART RATE LESS THAN 40/min :

I.V. LINE I.V. ATROPIN T. ALUPENT 10 mg. REFFERRAL TO I.C.U.

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.

DIAGNOSIS BY SYMPT. : PAIN.


HEAD ACHE:

HYPTN, I.C. BLEED, SOL, ENCEPHALITIS, MENINGITIS. I. C. ABCESS. CEREBRAL THROMBOPHLEBITIS


VOMITING, BRADYCARDIA, CONVULSIONS, FEVER

CLUES: LOOK FOR ASSOCIATED SYMPTOMS

[ S/O RAISED I.C.P. ]

DIAGNOSIS BY SYMPT : CHEST PAIN


CLUES:

PROFUSE SWEATING, TACHYCARDIA, HYPOTENSION, DYSPNOEA, FEVER, COUGH.

UNDERLYING DISEASES: AC. MYOCARDIAL INFARCTION. AC.PERICARDITIS. PNEUMONIA WITH PLURITIS. PNEUMOTHORAX. AC. PULMONARY EMBOLISM. DISSECTION OF AORTA.

DIAGNOSIS BY SYMPT : AC. ABDOMEN CLUES:


DISEASES :
BLADDER. OBSTRUCTION : INTESTINAL HERNIAL STRANGULATED HERNIA . AC.PANCREATITIS. COLICS. RUPTURED ECTOPIC PREGNANCY. TORSION TESTIS.

VOMITINGS, CONSTIPATION, TACHYCARDIA, HYPOTENSION, AMENORRHOEA, ABD. DISTENSION.

PERFORATION :

DUODENAL ULCER, ILEAL, APPENDICULAR, G.

DIAGNOSIS BY SYMPT : LIMB PAIN.


PAIN IN TOES & / FINGERS :

SYSTEMIC EMBOLISM, RAYNAUDS DISEASE CALF PAIN : UNILATERAL DVT.

CLUES:

DISCOLOURATION OF SKIN SWELLING ABSENT PULSE HOMANS SIGN. LOOK FOR UNDERLYING: RHD, IHD, D.M.

DIAGN.BY SYMPTMS : BREATHLESSNESS


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.

DIAGN.BY SYMPTS : SYNCOPE.


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 :

DIAGN. BY SYMPTMS : DROWSYNESS.


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.

DIAGN. BY SYMPTS : UNCONSCIOUSNESS

ALL CONDITIONS WHICH CAUSE DROWSYNESS IF SEVERE WILL LEAD TO UNCONSCIOUSNESS.

DIAGN. BY SYMPTS : ABNORMAL BEHAVIOUR.


DISEASES:
CEREBRAL STROKE. HEPATIC ENCEPHALOPATHY. URAEMIC ENCEPHALOPATHY. ENCEPHALITIS. HYPOGLYCAEMIA. CLUES:

OLD AGE, HTN, JAUNDICE, OLIGURIA, FEVER, D.M.

DEFINITION.
EMERGENCY:
SERIOUS

AND
UNEXPECTED SITUATION REQUIRING IMMEDIATE ACTION.

DIAGN. BY SYMPTMS : CONVULSIONS


DISEASES: EPILEPSY.

CLUES: ---------------------------------- YOUNG AGE, F/H, NO

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.

------------------ OLIGOURIA, OEDEMA,PUFFY FACE.

THYROTOXICOSIS.-------- GOITRE, TACHYCARDIA,

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.

REFERRAL : TO ENT SURGEON.

HAEMATEMESIS.
BLOOD IN VOMITUS.
TREATMENT :

* I.V. N.SALINE * INJ. OMEZ / RANITIDIN *ICE WATER LAVAGE *ORAL ANTACIDS.

REFERRAL : TO ICU / GASTRO-ENTEROLOGIST. CAUTION : AVOID INJ. STEROIDS

HAEMOPTYSIS.
BLOOD IN SPUTUM.
TREATMENT:

* ANTITUSSIVE- LINCTUS CODEIN * INJ. ANTIBIOTIC * INJ.BOTROPASE. *ALPRAZOLAM 0.25

REFERRAL : TO ICU / PULMONOLOGIST WITH FACILITY OF BRONCHSCOPY. PRECAUTION : AVOID COUGH EXPECTORANT. URGENT REFERRAL TO CENTRE FOR PULM.ART.EMBOLISATION [IF MASSIVE HAEMOPTYSIS. ]

EMERGENCIES CREATED BY G.P.


DRUG REACTIONS :
BY PRICK VASOVAGAL SYNCOPE----- T/T : FOOT ELEVATION, INJ

ATROPIN

MINOR RASH, ITCHING -------- MAJOR ANAPHYLACTIC SHOCK :

T/T: INJ AVIL, EFFCORLINE

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 :

PTOSIS DYSPHAGIA ABD. PAIN LOCAL SWELLING

TREATMENT: * TORNIQUETT *IMMOBALISATION *REFERRAL TO ICU PHC/MCH


*LOCAL XYLOCAINE *I.V. FLUIDS *T.PRAZOCIN *INJ AVIL *INJ *INJ ADRENALINE S.C.

SCORPION :

LOCAL PAIN HYPOTHERMIA ARRHYTHMIAS

HONEY BEES:

RASH ITCHING HYDROCORTISONE ANAPHYLAXIS

APPROACH TO UNCONSCIOUS PATIENT.


SYSTEMATIC APPROACH.
1.BREATHING :

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. :

HYPOTENSION- I.V. FLUIDS, DOPAMIN, STEROIDS. HYPERTENSION- T/T IF 200/110.

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

OR USE MICRO DRIP SET[60 Dr.= 1ml ]

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.

You might also like