general medical emergencies

General Medical General Medical EmergenciesEmergencies

SPECIFIC CONDITIONSSPECIFIC CONDITIONS

REYE’S SYNDROMEREYE’S SYNDROME GOUTGOUT FEVERFEVER ALLERGIC REACTIONALLERGIC REACTION FLUID AND ELECTROLYTEFLUID AND ELECTROLYTE COMACOMA HEMATOLOGICAL EMERGENCIESHEMATOLOGICAL EMERGENCIES

REYE’S SYNDROMEREYE’S SYNDROME

A 19 month old child with respiratory distress A 19 month old child with respiratory distress is seen in the ED. Diagnosis of croup is is seen in the ED. Diagnosis of croup is

made.made.

The parents must be told that during The parents must be told that during the child’s illness, the following meds the child’s illness, the following meds should not be administered.should not be administered.

A. AntitussivesA. Antitussives

B. AcetaminophenB. Acetaminophen

C. Acetylsalicylic acidC. Acetylsalicylic acid

D. DecongestantsD. Decongestants

ANSWER CANSWER C

ACETYLSALICYLIC ACID HAS ACETYLSALICYLIC ACID HAS CORRELATED WITH REYE’S CORRELATED WITH REYE’S SYNDROME WHICH CAN CAUSE SYNDROME WHICH CAN CAUSE FETAL ENCEPHALOPATHYFETAL ENCEPHALOPATHY

REYE’S SYNDROME FREQUENTLY REYE’S SYNDROME FREQUENTLY FOLLOWS VIRAL INFECTIONS SUCH FOLLOWS VIRAL INFECTIONS SUCH AS CROUPAS CROUP

REYE’S SYNDROMEREYE’S SYNDROME

Acute no inflammatory Acute no inflammatory encephalopathy characterized by encephalopathy characterized by hepatic, metabolic & neurological hepatic, metabolic & neurological dysfunction.dysfunction.

ChildrenChildren Salicylate ingestion may be a Salicylate ingestion may be a

predisposing factorpredisposing factor Late winter & early summer higher Late winter & early summer higher

incidenceincidence

ASSESSMENTASSESSMENT

SUBJECTIVE DATASUBJECTIVE DATA

ONSETONSET

MEDICAL HISTORYMEDICAL HISTORY

OBJECTIVE DATAOBJECTIVE DATA PHYSICAL EXAMPHYSICAL EXAM NEUROLOGICAL STATUSNEUROLOGICAL STATUS GASTROINTESTIONAL STATUSGASTROINTESTIONAL STATUS

DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES

AMMONIA LEVELAMMONIA LEVEL EMZYME LEVELSEMZYME LEVELS PT, PTTPT, PTT CHEM 7CHEM 7 ABGABG CSFCSF

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

ABCABC O2O2 IV FLUIDSIV FLUIDS GIVE DEXTROSE TO COUNTERACT GIVE DEXTROSE TO COUNTERACT

HYPOGLYCEMIAHYPOGLYCEMIA MEDS – MANNITOL, STERIODSMEDS – MANNITOL, STERIODS

GOUTGOUT

SUBJECTIVE DATASUBJECTIVE DATA

LOCATION OF PAINLOCATION OF PAIN TIMING /ONSET OF PAPINTIMING /ONSET OF PAPIN CHARACTERITICS OF PAINCHARACTERITICS OF PAIN FEVERFEVER MEDICAL HISTORYMEDICAL HISTORY

OBJECTIVE DATAOBJECTIVE DATA

PHYSICAL EXAMPHYSICAL EXAM ERYTHEMATOUS, HYPERTHERMIC ERYTHEMATOUS, HYPERTHERMIC

EDEMA OF JOINTEDEMA OF JOINT FEVERFEVER RELUCTANT TO USE EXTREMITYRELUCTANT TO USE EXTREMITY

DIAGNOSTIC PROCEDUREDIAGNOSTIC PROCEDURE

URIC ACIDURIC ACID WBC IN SYNOVIAL FLUID WBC IN SYNOVIAL FLUID HYPERCALCEMIAHYPERCALCEMIA

PLANNING AND PLANNING AND INTGERVENTIONINTGERVENTION

ANTINFLAMMATORY AGENTSANTINFLAMMATORY AGENTS WEIGHT REDUCTIONWEIGHT REDUCTION DIET – AVOID ALCHOL,HIGH PURINEDIET – AVOID ALCHOL,HIGH PURINE AVOID THIAZIDE DIURETICSAVOID THIAZIDE DIURETICS

FEVERFEVER

SUBJECTIVE DATASUBJECTIVE DATA

HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS PREVIOUS SIMILAR EPISODEPREVIOUS SIMILAR EPISODE FEVER DEGREE AND PERSISTENCEFEVER DEGREE AND PERSISTENCE OTHER SYMPTOMSOTHER SYMPTOMS IN CHILDREN FLUID INTAKEIN CHILDREN FLUID INTAKE MEDICAL HISTORYMEDICAL HISTORY

OBJECTIVE DATAOBJECTIVE DATA

PHYSICAL EXAMPHYSICAL EXAM DIANOSTIC PROCEDURESDIANOSTIC PROCEDURES

LABSLABS

X-RAYSX-RAYS

LUMBAR PUNCTURELUMBAR PUNCTURE

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

ABCABC CONTROL TEMPERATURE > 101CONTROL TEMPERATURE > 101 MEDICATIONSMEDICATIONS FLUIDSFLUIDS DETERMINE SOURCE OF INFECTIONDETERMINE SOURCE OF INFECTION

ALLERGIC REACTIONALLERGIC REACTION

SUBJECTIVE DATASUBJECTIVE DATA HISTORYHISTORY PRECIPITATING EVENTS IF KNOWNPRECIPITATING EVENTS IF KNOWN ELAPSED TIME SINCE CONTACTELAPSED TIME SINCE CONTACT MEDICAL HISTORYMEDICAL HISTORY PREVIOUS ALLERGIC REACTIONSPREVIOUS ALLERGIC REACTIONS ALLERGIESALLERGIES MEDICATIONMEDICATION

OBJECTIVE DATAOBJECTIVE DATA

APPEARANCE OF CONTACT SITEAPPEARANCE OF CONTACT SITE COMPLAINTS OF DISCOMFORTCOMPLAINTS OF DISCOMFORT SIGNS AND SYMPTOMS OF SIGNS AND SYMPTOMS OF

ANAPHYLAXISANAPHYLAXIS

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

ABCABC EPINEPHRINEEPINEPHRINE O2O2 IVIV ANTIHISTAMINEANTIHISTAMINE HISTAMINE-2BLOCKERHISTAMINE-2BLOCKER STERIODSSTERIODS BETA AGONIST OF BRONCHOSPASMBETA AGONIST OF BRONCHOSPASM TREAT AREA OF CONTACTTREAT AREA OF CONTACT

FLUID AND ELECTROLYTE FLUID AND ELECTROLYTE EMERGENCILESEMERGENCILES

ELECTROLYTE ELECTROLYTE ABNORMALITIESABNORMALITIES

SODIUMSODIUM POTASSIUMPOTASSIUM CALCIUMCALCIUM MAGNESIUMMAGNESIUM

SODIUMSODIUM

NORMAL WATER BALANCENORMAL WATER BALANCE IMPULSE CONTROLIMPULSE CONTROL REGULATED BY RENINREGULATED BY RENIN

ANGEOTENSINANGEOTENSIN

ALDOSTERONEALDOSTERONE

HYPONATREMIAHYPONATREMIA

ACTUAL SODIUM DEFICITS ACTUAL SODIUM DEFICITS DIAPHORESISDIAPHORESIS DIURETIC USEDIURETIC USE WOUND DRAINAGEWOUND DRAINAGE DEC OF ALDOSTERONEDEC OF ALDOSTERONE RENAL DISEASERENAL DISEASE HYPERLIPIDEMIAHYPERLIPIDEMIA

HYPONATREMIAHYPONATREMIA

DILUTIONAL CAUSESDILUTIONAL CAUSES

EXCESSIVE WATER INTAKEEXCESSIVE WATER INTAKE

FRESHWATER DROWNINGFRESHWATER DROWNING

GI LOSSESGI LOSSES

HYPERGLYCEMIAHYPERGLYCEMIA

CHFCHF

BURNSBURNS

SUBJECTIVE DATASUBJECTIVE DATA

HISTORYHISTORY

ALTERED ORAL INTAKEALTERED ORAL INTAKE

NAUSEA AND VOMITINGNAUSEA AND VOMITING

THIRSTTHIRST

EXCESSIVE WATER INTAKEEXCESSIVE WATER INTAKE

SKELETAL MUSCLE WEAKNESSSKELETAL MUSCLE WEAKNESS

MUSCLE CRAMPSMUSCLE CRAMPS

OBJECTIVE DATAOBJECTIVE DATA

PHYSICAL EXAMPHYSICAL EXAM MENTAL STATISMENTAL STATIS SKIN TLURGORSKIN TLURGOR SUNKEN FONTANELLE AND EYESSUNKEN FONTANELLE AND EYES DRY MUCUS MEMBRANESDRY MUCUS MEMBRANES HYPOTENSION AND TACHYHCARDIAHYPOTENSION AND TACHYHCARDIA SEZURES LEVEL < 110 mEq/LSEZURES LEVEL < 110 mEq/L

DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES

CBCCBC ELECTOLYTE LEVEELECTOLYTE LEVE CHLORIDECHLORIDE BUN AND CREATININE LEVELSBUN AND CREATININE LEVELS UAUA

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

ABCABC IV FLUIDSIV FLUIDS REPLACE SODIUM ORALLY OR IVREPLACE SODIUM ORALLY OR IV PROTECT FROM INJURY (SEIZURES)PROTECT FROM INJURY (SEIZURES) I&OI&O

QUESTIONQUESTION

Which of the following assessment Which of the following assessment findings is NOT true commonly findings is NOT true commonly associated with hypernatremia?associated with hypernatremia?

A. ConfusionA. Confusion

B. Decreased cardiac outputB. Decreased cardiac output

C. Skeletal muscle weaknessC. Skeletal muscle weakness

D. Increased urinary output D. Increased urinary output

ANSWER DANSWER D

HYPERNATREMIAHYPERNATREMIA

SUBJECTIVE DATASUBJECTIVE DATA

HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS ANOREXIA, NAUSEA,VOMITINGANOREXIA, NAUSEA,VOMITING DIARRHEADIARRHEA ALTERED SODIUM INTAKEALTERED SODIUM INTAKE THIRSTTHIRST DEHYDRATIONDEHYDRATION

OBJECTIVE DATAOBJECTIVE DATA

PHYSICAL EXAMPHYSICAL EXAM DECREASED URINE OUTPUTDECREASED URINE OUTPUT HYPERREFLEXIA, MUSCLE TWITCHINGHYPERREFLEXIA, MUSCLE TWITCHING DRY MUCOUS MEMBRANES & SKINDRY MUCOUS MEMBRANES & SKIN MUSCLE WEAKNESSMUSCLE WEAKNESS ORTHOSTATIC VITAL SIGN CHANGESORTHOSTATIC VITAL SIGN CHANGES

DIAGNOSTGIC PROCEDURESDIAGNOSTGIC PROCEDURES

LABSLABS INFANTS NORMAL 275 TO 285 INFANTS NORMAL 275 TO 285

mOsm/kgmOsm/kg ADULT NORMAL 285 TO 295 nOsm/kgADULT NORMAL 285 TO 295 nOsm/kg SYMPTOMS DEVELOP AT 320SYMPTOMS DEVELOP AT 320 COMA OCCURS AT 360COMA OCCURS AT 360

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

IV FOR ISOTONOIC SOLUTIONSIV FOR ISOTONOIC SOLUTIONS BLOOD SUGER TO RULE OUT BLOOD SUGER TO RULE OUT

HYPOGLYCEMIAHYPOGLYCEMIA I & OI & O MONITOR FOR SEIZURE ACTIVITYMONITOR FOR SEIZURE ACTIVITY LIMIT SODIUM INTAKELIMIT SODIUM INTAKE

POTASSIUM ABNORMALITIESPOTASSIUM ABNORMALITIES

HYPOKALEMIAHYPOKALEMIA

LEVEL BELOW 3.5 mEq/LLEVEL BELOW 3.5 mEq/L LOW INTAKELOW INTAKE GASTROINTESTIONAL LOSSESGASTROINTESTIONAL LOSSES RENAL LOSSESRENAL LOSSES DIABETIC ACIDOSIS TREATMENTDIABETIC ACIDOSIS TREATMENT BURNSBURNS OVERHYDRATIONOVERHYDRATION

SUBJECTIVE DATASUBJECTIVE DATA

GI UPSETGI UPSET WEAKNESS AND FATIQUEWEAKNESS AND FATIQUE SOBSOB CRAMPSCRAMPS FREQUENT URINATIONFREQUENT URINATION CONSTIPATIONCONSTIPATION

OBJECTIVE DATAOBJECTIVE DATA

SHALLOW RESP,WEAK PULSESHALLOW RESP,WEAK PULSE MUSCLE TENDERNESSMUSCLE TENDERNESS DSYRHYTHMIAS (HEART BLOCKS)DSYRHYTHMIAS (HEART BLOCKS) CONFUSIONCONFUSION PARALYTIC ILEUS, HYPOACTIVE BSPARALYTIC ILEUS, HYPOACTIVE BS POLYURIAPOLYURIA

DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES

LABSLABS DEPRESSED ST SEGMENTS DEPRESSED ST SEGMENTS ABG ALKALOSISABG ALKALOSIS FLATTENED T WAVESFLATTENED T WAVES U WAVESU WAVES VENTICULAR IRRITABILITYVENTICULAR IRRITABILITY

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

ABCABC IVIV ADMINISTER POTASSIUM CHLORIDEADMINISTER POTASSIUM CHLORIDE CORRECT ACID-BASE IMBALANCECORRECT ACID-BASE IMBALANCE MONITOR CARDIAC RHYTHMMONITOR CARDIAC RHYTHM

HYPERKALEMIAHYPERKALEMIA

K > 5.5 mEq/LK > 5.5 mEq/L POSSIBLE CAUSESPOSSIBLE CAUSES

EXCESSIVE k INTAKEEXCESSIVE k INTAKE

DECREASED GLOMELULAR RATEDECREASED GLOMELULAR RATE

RENAL FAILURERENAL FAILURE

SEVERE TISSUE INJURYSEVERE TISSUE INJURY

ACIDOSISACIDOSIS

INSULIN DEFICENCYINSULIN DEFICENCY

SUBJECTIVE DATASUBJECTIVE DATA

CONFUSIONCONFUSION HYPEREXCITABILITYHYPEREXCITABILITY MUSCLE WEAKNESSMUSCLE WEAKNESS AB DESTENTIONAB DESTENTION DIARRHEADIARRHEA CHRUSH OR BURN INJURYCHRUSH OR BURN INJURY

OBJECTIVE DATAOBJECTIVE DATA

MENTAL CONFUSIONMENTAL CONFUSION WEAKNESSSWEAKNESSS DYSRHYTHMIASDYSRHYTHMIAS BRADYCARDIABRADYCARDIA

DIAGNOSTIC DIAGNOSTIC

ABCABC LABSLABS ECCECC PEAKED T WAVESPEAKED T WAVES DEPRESSED OR FLAT T WAVESDEPRESSED OR FLAT T WAVES WIDENING QRSWIDENING QRS PROLONGED PRPROLONGED PR

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

ABCABC IVIV MEDSMEDS

SODIUM BICARBSODIUM BICARB

GLUCOSE 50%GLUCOSE 50%

INSULININSULIN

KAEXYLATEKAEXYLATE

MONITOR CARDIAC STATUSMONITOR CARDIAC STATUS

CALCIUM ABNORMALITIESCALCIUM ABNORMALITIES

CALCIUM CALCIUM

LEVELS ARE REGLULATED BY LEVELS ARE REGLULATED BY ENDOCRINE SYSTEMENDOCRINE SYSTEM

FACTOR IV IN THE BODY’S CLOTTING FACTOR IV IN THE BODY’S CLOTTING CASCADE CASCADE

TRANSMISSION OF NEUROMUCSCLAR TRANSMISSION OF NEUROMUCSCLAR IMPULSESIMPULSES

IMPORTANT IN BONE FORMATIONIMPORTANT IN BONE FORMATION

Patients with hypocalcemia Patients with hypocalcemia demonstrate which of the following demonstrate which of the following

EKG changes?EKG changes?

A. SHORTENED PR INTERVALA. SHORTENED PR INTERVAL

B. PROLONGED PR INTERVALB. PROLONGED PR INTERVAL

C. PROLONGED QT INTERVALC. PROLONGED QT INTERVAL

D. U WAVED. U WAVE

ANSWER CANSWER C

IMPARMENT OF CARDIAC IMPARMENT OF CARDIAC CONTRACTILITY RESULTS FROM CONTRACTILITY RESULTS FROM HYPOCALCEMIA. SHOWN IN EKG AS HYPOCALCEMIA. SHOWN IN EKG AS PRLONGED QT INTERVAL. PRLONGED QT INTERVAL. PREDESPOSES THE PATIENT OT PREDESPOSES THE PATIENT OT VENTRICULAR TACHYCARDIAVENTRICULAR TACHYCARDIA

(TORSADES DE POINTES)(TORSADES DE POINTES)

HYPOCALCEMIAHYPOCALCEMIA

DEFICITS OF CALCIUM INTAKEDEFICITS OF CALCIUM INTAKE INHIBITION OF CALCIUM ABSORPTIONINHIBITION OF CALCIUM ABSORPTION DECREASED VIT DDECREASED VIT D LACTOSE INTOLERANCELACTOSE INTOLERANCE MALABSORPTION SYNDROMESMALABSORPTION SYNDROMES BLOOD TRANSFUSIONSBLOOD TRANSFUSIONS ENDOCRINE DISTURBANCESENDOCRINE DISTURBANCES

SUBJECTIVE DATASUBJECTIVE DATA

PARESTHESIA THEN NUMBNESSPARESTHESIA THEN NUMBNESS MUSCLE CRAMPSMUSCLE CRAMPS ALTERED DIETARY INTAKEALTERED DIETARY INTAKE RENAL FAILURERENAL FAILURE PANCREATITISPANCREATITIS TOXIC SHOCKTOXIC SHOCK

PHYHSICAL EXAMPHYHSICAL EXAM HYPOTENSIONHYPOTENSION TACHYCARDIATACHYCARDIA DECREACED PERIPHERAL PULSESDECREACED PERIPHERAL PULSES MUSCLE WEAKNESSMUSCLE WEAKNESS CARPOPEDAL SPASMSCARPOPEDAL SPASMS TETANYTETANY HYPERVENTLATIONHYPERVENTLATION SEIZURESEIZURE TROUSSEAU’S SIGNTROUSSEAU’S SIGN CHVOSKEK’S SIGNCHVOSKEK’S SIGN

DIAGNOSTICDIAGNOSTIC

LABSLABS ABGABG PARATHYROID HORMONE LEVEL PARATHYROID HORMONE LEVEL ECG CARDIAC MONITORECG CARDIAC MONITOR PROLONGED QT AND STPROLONGED QT AND ST T-WAVE INVERSIONT-WAVE INVERSION

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

ABCABC IVIV CARDIAC MONITORINGCARDIAC MONITORING CONTROL HYPERVENTLATIONCONTROL HYPERVENTLATION ADMINISTER CALCIUMADMINISTER CALCIUM ORAL CALIUM AS NEEDEDORAL CALIUM AS NEEDED

HYPERCALCEMIAHYPERCALCEMIA

DECREASED RENAL FUNCTIONDECREASED RENAL FUNCTION USE OF THIAZIDE DIURETICSUSE OF THIAZIDE DIURETICS INCREASED BONE REABSORPTION OF INCREASED BONE REABSORPTION OF

CALCIUMCALCIUM

HYPERPARATHYROIDISMHYPERPARATHYROIDISM

MALIGNANCYMALIGNANCY

HYPERTHYRODISMHYPERTHYRODISM

SUBJECTIVE DATASUBJECTIVE DATA

ANOREXIA,VOMITING AND DIARRHEAANOREXIA,VOMITING AND DIARRHEA WEAKNESSWEAKNESS LETHARGYLETHARGY POLYURIAPOLYURIA

OBJECTIVE DATAOBJECTIVE DATA

MENTAL STATUS CHANGEMENTAL STATUS CHANGE TACHYCARDIATACHYCARDIA HYPERTENSIONHYPERTENSION INCREASED URINE OUTPUTINCREASED URINE OUTPUT PROFOUND MUSCLE WEAKNESSPROFOUND MUSCLE WEAKNESS

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

IVIV I & O KEEP OUTPUT GREATER THAN I & O KEEP OUTPUT GREATER THAN

500CC HR500CC HR CARDIAC MONITORCARDIAC MONITOR CVPCVP MEDSMEDS HEMODIALYSISHEMODIALYSIS

MAGNESIUM ABNORMALITIESMAGNESIUM ABNORMALITIES

HYPOMAGNESEMIAHYPOMAGNESEMIA

DECREASED INTAKEDECREASED INTAKE CHRONIC ALCOHOLLISMCHRONIC ALCOHOLLISM PROLONGED IV FEEDINGPROLONGED IV FEEDING LOSS THRU GI TRACTLOSS THRU GI TRACT DRUG THERAPYDRUG THERAPY

SUBJECTIVE DATASUBJECTIVE DATA

PARESTHESIAPARESTHESIA MUSCLE CRAMPSMUSCLE CRAMPS SEIZURESEIZURE CROHN’S DISEASECROHN’S DISEASE DIABETESDIABETES RENAL INSUFFICIENCYRENAL INSUFFICIENCY

OBJECTIVE DATAOBJECTIVE DATA

HYPERTENSIONHYPERTENSION BRADYCARDIABRADYCARDIA VENTGRICULAR DSYRTHYMIASVENTGRICULAR DSYRTHYMIAS HYPERREFLEXIAHYPERREFLEXIA SEIZURESSEIZURES CONFUSIONCONFUSION COMACOMA

DIAGNOSTICDIAGNOSTIC

LABS LABS ECGECG

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

ABCABC IVIV CARDIAC MONITORINGCARDIAC MONITORING GIVE MAGNESIUMGIVE MAGNESIUM

HYPERMAGNESEMIAHYPERMAGNESEMIA

RENAL FAILURERENAL FAILURE ADRENAL INSUFFICIENCYADRENAL INSUFFICIENCY OVERDOSEOVERDOSE RENAL PATIENTS maalox, momRENAL PATIENTS maalox, mom ECLAMPSIAECLAMPSIA

SUBJECTIVE DATASUBJECTIVE DATA

NAUSEA AND VOMITINGNAUSEA AND VOMITING DROWSINESS LETHARGYDROWSINESS LETHARGY RENAL INSUFFICIENCY OR FAILURERENAL INSUFFICIENCY OR FAILURE OVERDOSE OF THERAPEUTIC OVERDOSE OF THERAPEUTIC

MAGNESIUMMAGNESIUM

OBJECTIVE DATAOBJECTIVE DATA

SOMNOLENCESOMNOLENCE SHALLOW RESPSHALLOW RESP DEPRESSED OR ABSENT TENDON DEPRESSED OR ABSENT TENDON

REFLEXESREFLEXES RESPIRAORY OR CARDIAC ARRESTRESPIRAORY OR CARDIAC ARREST

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

ABCABC IVIV CARDIAC MONITORINGCARDIAC MONITORING ADMINISTER CALCIUMADMINISTER CALCIUM SALINE DIURESIS OR LASIXSALINE DIURESIS OR LASIX HEMODIALYSIS IN EXTREME CASESHEMODIALYSIS IN EXTREME CASES

COMACOMA

COMACOMA

STRUCTURAL CAUSESSTRUCTURAL CAUSES

METABOLIC CAUSESMETABOLIC CAUSES

TOXIC OR ENZYMATIC INHIBITATION TOXIC OR ENZYMATIC INHIBITATION CAUSESCAUSES

PSYCHIATRIC CAUSESPSYCHIATRIC CAUSES

SUBJECTIVE DATASUBJECTIVE DATA ONSETONSET ACTIVITY AT ONSETACTIVITY AT ONSET PROGRESSION OF SEIZURE PROGRESSION OF SEIZURE MEDSMEDS SEIZURE DISORDERSEIZURE DISORDER BACTERIAL ILLNESSBACTERIAL ILLNESS MEDICAL HISTORYMEDICAL HISTORY DEPRESSION OR BEHAVIOR CHANGESDEPRESSION OR BEHAVIOR CHANGES ENVIRONMENTAL EXPOSUREENVIRONMENTAL EXPOSURE

OBJECTIVE DATAOBJECTIVE DATA LEVEL OF CONSCIOUSNESSLEVEL OF CONSCIOUSNESS RESPIRATORY RATERESPIRATORY RATE PUPILSPUPILS EYE MOVEMENTEYE MOVEMENT GCSGCS FEVER OR HYPERTHERMIAFEVER OR HYPERTHERMIA TRAUMATRAUMA VITAL SIGNSVITAL SIGNS NEURO SIGNSNEURO SIGNS

DIAGNOSTICDIAGNOSTIC

ABCABC LABSLABS X-RAYS / CTX-RAYS / CT

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

ABCABC INTUBATION TO PROTECT AIRWAYINTUBATION TO PROTECT AIRWAY IVIV NGNG VITAL SIGNSVITAL SIGNS

HEMATOLOGIC HEMATOLOGIC EMERGENCIESEMERGENCIES

CLOTTING ABNORMALITIESCLOTTING ABNORMALITIES

DICDIC HEMOPHILIAHEMOPHILIA THROMBOCYTOPENIA PURPURATHROMBOCYTOPENIA PURPURA

QUESTIONQUESTION

THE MOST SIGNIFICANT CLINICAL THE MOST SIGNIFICANT CLINICAL FEATURE OF DIC IS?FEATURE OF DIC IS?

A. HEMOPYUSISA. HEMOPYUSIS

B. PETECHIAEB. PETECHIAE

C. ABNORMAL BLEEDINGC. ABNORMAL BLEEDING

D. HEMATURIAD. HEMATURIA

ANSWER CANSWER C

THE MOST SIGNIFICANT CLINICAL THE MOST SIGNIFICANT CLINICAL FEATURE OF DIC IS ABNORMAL FEATURE OF DIC IS ABNORMAL BLEEDING SUCH AS HEMOPTYSIS, BLEEDING SUCH AS HEMOPTYSIS, PETECHIAE, OR HEMATURIA PETECHIAE, OR HEMATURIA WITHOUT HISTORY OF A SERIOUS WITHOUT HISTORY OF A SERIOUS BLEEDING DISORDER.BLEEDING DISORDER.

DISSEMINATED INTRAVASCULAR DISSEMINATED INTRAVASCULAR COAGULATIONCOAGULATION

DIFFUSE MICROVASCULAR DIFFUSE MICROVASCULAR COAGULATIONCOAGULATION

DEPLETES THE CLOTTING FACTORDEPLETES THE CLOTTING FACTOR IMPAIRS HEMOSTATISIMPAIRS HEMOSTATIS

SUBJECTIVE DATASUBJECTIVE DATA

BLEEDING FOR ANY BLEEDING FOR ANY SITESITE

DIZZINESSDIZZINESS RASHRASH EXCESSIVE EXCESSIVE

BRUISINGBRUISING MASSIVE BLOOD MASSIVE BLOOD

TRANSFUSIONTRANSFUSION

ABRUPTIO ABRUPTIO PLACENTEAPLACENTEA

TRAUMATRAUMA NEOPLASMNEOPLASM SNAKE BITESNAKE BITE ARDSARDS HEPATIC DISEASEHEPATIC DISEASE

OBJECTIVE DATAOBJECTIVE DATA

PETECHIEA, PURPURAPETECHIEA, PURPURA ECCHYMOSISECCHYMOSIS BLEEDINGBLEEDING HEMATURIAHEMATURIA LOCLOC HEMATEMESISHEMATEMESIS ARDSARDS

DIAGNOSTICDIAGNOSTIC

PLATELET COUNTPLATELET COUNT PT, PTTPT, PTT FIBRINOGEN LEVELFIBRINOGEN LEVEL H & HH & H TYPE AND CROSSTYPE AND CROSS

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

A LINEA LINE CARDIAC RATE AND RHYTHMCARDIAC RATE AND RHYTHM URINE OUTPUTURINE OUTPUT CLOTTING TIME AND PLATELET CLOTTING TIME AND PLATELET

COUNTCOUNT REPLACE CLOTTING FACTORSREPLACE CLOTTING FACTORS

QUESTIONQUESTION

HEMARTHROSIS ESPECIALL OF THE KNEES, HEMARTHROSIS ESPECIALL OF THE KNEES, ELBOWS, AND ANKLES, IS COMMON ELBOWS, AND ANKLES, IS COMMON FINDING IN HEMOPHILIA OTHER S & S FINDING IN HEMOPHILIA OTHER S & S INCLUDEINCLUDE

A. Bruising and bleeding gumsA. Bruising and bleeding gums

B. Neuropathy and paresthesiaB. Neuropathy and paresthesia

C. Pain and hematuriaC. Pain and hematuria

D. All of the aboveD. All of the above

ANSWER DANSWER D

Bleeding near peripheral nerves Bleeding near peripheral nerves causes neuropathy, pain, causes neuropathy, pain, paresthesia, and muscle atrophy. paresthesia, and muscle atrophy. Bleeding gums and hematuria, Bleeding gums and hematuria, unrelated to trauma is very common.unrelated to trauma is very common.

HEMOPHILIAHEMOPHILIA

INHERITED, SEX-LINKED DISORDER INHERITED, SEX-LINKED DISORDER ALMOST ALWAYS SEEN IN MALESALMOST ALWAYS SEEN IN MALES

FEMALES CARRY GENE AND PASS TO FEMALES CARRY GENE AND PASS TO MALE CHILDRENMALE CHILDREN

SEVERITY OF DISEASE IS DIRECTLLY SEVERITY OF DISEASE IS DIRECTLLY RELATED TO ACTILVIEY LEVEL OF RELATED TO ACTILVIEY LEVEL OF FACTOR VIIIFACTOR VIII

SUBJECTIVE DATASUBJECTIVE DATA

UNUSUAL PROLONGED BLEEDINGUNUSUAL PROLONGED BLEEDING SPONTANEOUS HEMORRHAGESPONTANEOUS HEMORRHAGE INTRACRANIAL BLEEDINGINTRACRANIAL BLEEDING SKINSKIN JOINTS PAIN, SWELLING JOINTS PAIN, SWELLING

TENDERNESSTENDERNESS

DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES

PTT PROLONGEDPTT PROLONGED PT NORMALPT NORMAL PLATELET COUNT NORMALPLATELET COUNT NORMAL FACTOR VIII DECREASEDFACTOR VIII DECREASED FACTOR IX DECREASEDFACTOR IX DECREASED

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

RISK OF VOLUME DEFICITRISK OF VOLUME DEFICIT NO IM INJECTIONSNO IM INJECTIONS PRESSUE FOR LACERATIONS AND PRESSUE FOR LACERATIONS AND

VENIPUNCTURESVENIPUNCTURES ICE, IMMOBLIZEMEKEVATE AND ICE, IMMOBLIZEMEKEVATE AND

COMPRESSIVE DRESSINGSCOMPRESSIVE DRESSINGS AVOID ASA AND NSAIDSAVOID ASA AND NSAIDS

SICKLE CELLSICKLE CELL

SUBJECTIVE DATASUBJECTIVE DATA

PAINPAIN IMPAIRED GROWTH PATTERNSIMPAIRED GROWTH PATTERNS INFECTIONSINFECTIONS

OBJECTIVE DATAOBJECTIVE DATA

CHRONIC ORGAN DAMAGECHRONIC ORGAN DAMAGE CHFCHF SYSTOLIC EJECTION MURMURSYSTOLIC EJECTION MURMUR JAUNDICEJAUNDICE GALL STONESGALL STONES HEMATURIA HEMATURIA PRIAPISMPRIAPISM

DIAGNOSTIC DIAGNOSTIC

HEMOLYTIC AMEMIA HCT 20-3O%HEMOLYTIC AMEMIA HCT 20-3O% ELEVATED RETICULOCYTES ELEVATED RETICULOCYTES SICKLED CELLSSICKLED CELLS BILIRUBIN ELEVATEDBILIRUBIN ELEVATED

PLANNING AND PLANNING AND INTERVENTIONINTERVENTION

O2O2 IV FLUIDSIV FLUIDS ANALGESICANALGESIC REVERSE DEHYDRATIONREVERSE DEHYDRATION BED RESTBED REST