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General Medical Emergencies

General Medical Emergencies. SPECIFIC CONDITIONS. REYE’S SYNDROME GOUT FEVER ALLERGIC REACTION FLUID AND ELECTROLYTE COMA HEMATOLOGICAL EMERGENCIES. REYE’S SYNDROME. A 19 month old child with respiratory distress is seen in the ED. Diagnosis of croup is made.

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General Medical Emergencies

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  1. General Medical Emergencies

  2. SPECIFIC CONDITIONS • REYE’S SYNDROME • GOUT • FEVER • ALLERGIC REACTION • FLUID AND ELECTROLYTE • COMA • HEMATOLOGICAL EMERGENCIES

  3. REYE’S SYNDROME

  4. A 19 month old child with respiratory distress is seen in the ED. Diagnosis of croup is made. The parents must be told that during the child’s illness, the following meds should not be administered. A. Antitussives B. Acetaminophen C. Acetylsalicylic acid D. Decongestants

  5. ANSWER C ACETYLSALICYLIC ACID HAS CORRELATED WITH REYE’S SYNDROME WHICH CAN CAUSE FETAL ENCEPHALOPATHY REYE’S SYNDROME FREQUENTLY FOLLOWS VIRAL INFECTIONS SUCH AS CROUP

  6. REYE’S SYNDROME • Acute no inflammatory encephalopathy characterized by hepatic, metabolic & neurological dysfunction. • Children • Salicylate ingestion may be a predisposing factor • Late winter & early summer higher incidence

  7. ASSESSMENT SUBJECTIVE DATA ONSET MEDICAL HISTORY

  8. OBJECTIVE DATA • PHYSICAL EXAM • NEUROLOGICAL STATUS • GASTROINTESTIONAL STATUS

  9. DIAGNOSTIC PROCEDURES • AMMONIA LEVEL • EMZYME LEVELS • PT, PTT • CHEM 7 • ABG • CSF

  10. PLANNING AND INTERVENTION • ABC • O2 • IV FLUIDS • GIVE DEXTROSE TO COUNTERACT HYPOGLYCEMIA • MEDS – MANNITOL, STERIODS

  11. GOUT

  12. SUBJECTIVE DATA • LOCATION OF PAIN • TIMING /ONSET OF PAPIN • CHARACTERITICS OF PAIN • FEVER • MEDICAL HISTORY

  13. OBJECTIVE DATA • PHYSICAL EXAM • ERYTHEMATOUS, HYPERTHERMIC EDEMA OF JOINT • FEVER • RELUCTANT TO USE EXTREMITY

  14. DIAGNOSTIC PROCEDURE • URIC ACID • WBC IN SYNOVIAL FLUID • HYPERCALCEMIA

  15. PLANNING AND INTGERVENTION • ANTINFLAMMATORY AGENTS • WEIGHT REDUCTION • DIET – AVOID ALCHOL,HIGH PURINE • AVOID THIAZIDE DIURETICS

  16. FEVER

  17. SUBJECTIVE DATA • HISTORY OF PRESENT ILLNESS • PREVIOUS SIMILAR EPISODE • FEVER DEGREE AND PERSISTENCE • OTHER SYMPTOMS • IN CHILDREN FLUID INTAKE • MEDICAL HISTORY

  18. OBJECTIVE DATA • PHYSICAL EXAM • DIANOSTIC PROCEDURES LABS X-RAYS LUMBAR PUNCTURE

  19. PLANNING AND INTERVENTION • ABC • CONTROL TEMPERATURE > 101 • MEDICATIONS • FLUIDS • DETERMINE SOURCE OF INFECTION

  20. ALLERGIC REACTION

  21. SUBJECTIVE DATA • HISTORY PRECIPITATING EVENTS IF KNOWN ELAPSED TIME SINCE CONTACT • MEDICAL HISTORY PREVIOUS ALLERGIC REACTIONS ALLERGIES MEDICATION

  22. OBJECTIVE DATA • APPEARANCE OF CONTACT SITE • COMPLAINTS OF DISCOMFORT • SIGNS AND SYMPTOMS OF ANAPHYLAXIS

  23. PLANNING AND INTERVENTION • ABC • EPINEPHRINE • O2 • IV • ANTIHISTAMINE • HISTAMINE-2BLOCKER • STERIODS • BETA AGONIST OF BRONCHOSPASM • TREAT AREA OF CONTACT

  24. FLUID AND ELECTROLYTE EMERGENCILES

  25. ELECTROLYTE ABNORMALITIES • SODIUM • POTASSIUM • CALCIUM • MAGNESIUM

  26. SODIUM • NORMAL WATER BALANCE • IMPULSE CONTROL • REGULATED BY RENIN ANGEOTENSIN ALDOSTERONE

  27. HYPONATREMIA • ACTUAL SODIUM DEFICITS DIAPHORESIS DIURETIC USE WOUND DRAINAGE DEC OF ALDOSTERONE RENAL DISEASE HYPERLIPIDEMIA

  28. HYPONATREMIA • DILUTIONAL CAUSES EXCESSIVE WATER INTAKE FRESHWATER DROWNING GI LOSSES HYPERGLYCEMIA CHF BURNS

  29. SUBJECTIVE DATA • HISTORY ALTERED ORAL INTAKE NAUSEA AND VOMITING THIRST EXCESSIVE WATER INTAKE SKELETAL MUSCLE WEAKNESS MUSCLE CRAMPS

  30. OBJECTIVE DATA • PHYSICAL EXAM • MENTAL STATIS • SKIN TLURGOR • SUNKEN FONTANELLE AND EYES • DRY MUCUS MEMBRANES • HYPOTENSION AND TACHYHCARDIA • SEZURES LEVEL < 110 mEq/L

  31. DIAGNOSTIC PROCEDURES • CBC • ELECTOLYTE LEVE • CHLORIDE • BUN AND CREATININE LEVELS • UA

  32. PLANNING AND INTERVENTION • ABC • IV FLUIDS • REPLACE SODIUM ORALLY OR IV • PROTECT FROM INJURY (SEIZURES) • I&O

  33. QUESTION • Which of the following assessment findings is NOT true commonly associated with hypernatremia? A. Confusion B. Decreased cardiac output C. Skeletal muscle weakness D. Increased urinary output

  34. ANSWER D

  35. HYPERNATREMIA

  36. SUBJECTIVE DATA • HISTORY OF PRESENT ILLNESS • ANOREXIA, NAUSEA,VOMITING • DIARRHEA • ALTERED SODIUM INTAKE • THIRST • DEHYDRATION

  37. OBJECTIVE DATA • PHYSICAL EXAM • DECREASED URINE OUTPUT • HYPERREFLEXIA, MUSCLE TWITCHING • DRY MUCOUS MEMBRANES & SKIN • MUSCLE WEAKNESS • ORTHOSTATIC VITAL SIGN CHANGES

  38. DIAGNOSTGIC PROCEDURES • LABS • INFANTS NORMAL 275 TO 285 mOsm/kg • ADULT NORMAL 285 TO 295 nOsm/kg • SYMPTOMS DEVELOP AT 320 • COMA OCCURS AT 360

  39. PLANNING AND INTERVENTION • IV FOR ISOTONOIC SOLUTIONS • BLOOD SUGER TO RULE OUT HYPOGLYCEMIA • I & O • MONITOR FOR SEIZURE ACTIVITY • LIMIT SODIUM INTAKE

  40. POTASSIUM ABNORMALITIES

  41. HYPOKALEMIA • LEVEL BELOW 3.5 mEq/L • LOW INTAKE • GASTROINTESTIONAL LOSSES • RENAL LOSSES • DIABETIC ACIDOSIS TREATMENT • BURNS • OVERHYDRATION

  42. SUBJECTIVE DATA • GI UPSET • WEAKNESS AND FATIQUE • SOB • CRAMPS • FREQUENT URINATION • CONSTIPATION

  43. OBJECTIVE DATA • SHALLOW RESP,WEAK PULSE • MUSCLE TENDERNESS • DSYRHYTHMIAS (HEART BLOCKS) • CONFUSION • PARALYTIC ILEUS, HYPOACTIVE BS • POLYURIA

  44. DIAGNOSTIC PROCEDURES • LABS • DEPRESSED ST SEGMENTS • ABG ALKALOSIS • FLATTENED T WAVES • U WAVES • VENTICULAR IRRITABILITY

  45. PLANNING AND INTERVENTION • ABC • IV • ADMINISTER POTASSIUM CHLORIDE • CORRECT ACID-BASE IMBALANCE • MONITOR CARDIAC RHYTHM

  46. HYPERKALEMIA • K > 5.5 mEq/L • POSSIBLE CAUSES EXCESSIVE k INTAKE DECREASED GLOMELULAR RATE RENAL FAILURE SEVERE TISSUE INJURY ACIDOSIS INSULIN DEFICENCY

  47. SUBJECTIVE DATA • CONFUSION • HYPEREXCITABILITY • MUSCLE WEAKNESS • AB DESTENTION • DIARRHEA • CHRUSH OR BURN INJURY

  48. OBJECTIVE DATA • MENTAL CONFUSION • WEAKNESSS • DYSRHYTHMIAS • BRADYCARDIA

  49. DIAGNOSTIC • ABC • LABS • ECC • PEAKED T WAVES • DEPRESSED OR FLAT T WAVES • WIDENING QRS • PROLONGED PR

  50. PLANNING AND INTERVENTION • ABC • IV • MEDS SODIUM BICARB GLUCOSE 50% INSULIN KAEXYLATE MONITOR CARDIAC STATUS

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