general medical emergencies
DESCRIPTION
General Medical Emergencies. SPECIFIC CONDITIONS. REYE’S SYNDROME GOUT FEVER ALLERGIC REACTION FLUID AND ELECTROLYTE COMA HEMATOLOGICAL EMERGENCIES. REYE’S SYNDROME. REYE’S SYNDROME. Acute no inflammatory encephalopathy characterized by hepatic, metabolic & neurological dysfunction. - PowerPoint PPT PresentationTRANSCRIPT
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GENERAL MEDICAL EMERGENCIES
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SPECIFIC CONDITIONS• REYE’S SYNDROME
• GOUT
• FEVER
• ALLERGIC REACTION
• FLUID AND ELECTROLYTE
• COMA
• HEMATOLOGICAL EMERGENCIES
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REYE’S SYNDROME
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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
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ASSESSMENT SUBJECTIVE DATA
ONSET
MEDICAL HISTORY
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OBJECTIVE DATA
• PHYSICAL EXAM• NEUROLOGICAL STATUS• GASTROINTESTIONAL STATUS
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DIAGNOSTIC PROCEDURES• AMMONIA LEVEL
• EMZYME LEVELS
• PT, PTT
• CHEM 7
• ABG
• CSF
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PLANNING AND INTERVENTION• ABC
• O2
• IV FLUIDS
• GIVE DEXTROSE TO COUNTERACT HYPOGLYCEMIA
• MEDS – MANNITOL, STERIODS
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GOUT
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SUBJECTIVE DATA• LOCATION OF PAIN
• TIMING /ONSET OF PAPIN
• CHARACTERITICS OF PAIN
• FEVER
• MEDICAL HISTORY
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OBJECTIVE DATA• PHYSICAL EXAM
• ERYTHEMATOUS, HYPERTHERMIC EDEMA OF JOINT
• FEVER
• RELUCTANT TO USE EXTREMITY
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DIAGNOSTIC PROCEDURE• URIC ACID
• WBC IN SYNOVIAL FLUID
• HYPERCALCEMIA
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PLANNING AND INTERVENTION• ANTINFLAMMATORY AGENTS
• WEIGHT REDUCTION
• DIET – AVOID ALCHOL,HIGH PURINE
• AVOID THIAZIDE DIURETICS
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FEVER
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SUBJECTIVE DATA• HISTORY OF PRESENT ILLNESS
• PREVIOUS SIMILAR EPISODE
• FEVER DEGREE AND PERSISTENCE
• OTHER SYMPTOMS
• IN CHILDREN FLUID INTAKE
• MEDICAL HISTORY
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OBJECTIVE DATA• PHYSICAL EXAM
• DIANOSTIC PROCEDURES
LABS
X-RAYS
LUMBAR PUNCTURE
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PLANNING AND INTERVENTION• ABC
• CONTROL TEMPERATURE > 101
• MEDICATIONS
• FLUIDS
• DETERMINE SOURCE OF INFECTION
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ALLERGIC REACTION
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SUBJECTIVE DATA
• HISTORY PRECIPITATING EVENTS IF KNOWN ELAPSED TIME SINCE CONTACT • MEDICAL HISTORY PREVIOUS ALLERGIC REACTIONS ALLERGIES MEDICATION
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OBJECTIVE DATA• APPEARANCE OF CONTACT SITE
• COMPLAINTS OF DISCOMFORT
• SIGNS AND SYMPTOMS OF ANAPHYLAXIS
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PLANNING AND INTERVENTION
• ABC• EPINEPHRINE• O2• IV• ANTIHISTAMINE• HISTAMINE-2BLOCKER• STERIODS• BETA AGONIST OF BRONCHOSPASM• TREAT AREA OF CONTACT
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FLUID AND ELECTROLYTE EMERGENCILES
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ELECTROLYTE ABNORMALITIES• SODIUM
• POTASSIUM
• CALCIUM
• MAGNESIUM
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SODIUM• NORMAL WATER BALANCE
• IMPULSE CONTROL
• REGULATED BY RENIN
ANGEOTENSIN
ALDOSTERONE
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HYPONATREMIA
• ACTUAL SODIUM DEFICITS DIAPHORESIS DIURETIC USE WOUND DRAINAGE DEC OF ALDOSTERONE RENAL DISEASE HYPERLIPIDEMIA
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HYPONATREMIA
• DILUTIONAL CAUSES
EXCESSIVE WATER INTAKE
FRESHWATER DROWNING
GI LOSSES
HYPERGLYCEMIA
CHF
BURNS
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SUBJECTIVE DATA• HISTORY
ALTERED ORAL INTAKE
NAUSEA AND VOMITING
THIRST
EXCESSIVE WATER INTAKE
SKELETAL MUSCLE WEAKNESS
MUSCLE CRAMPS
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OBJECTIVE DATA
• PHYSICAL EXAM
• MENTAL STATIS
• SKIN TLURGOR
• SUNKEN FONTANELLE AND EYES
• DRY MUCUS MEMBRANES
• HYPOTENSION AND TACHYHCARDIA
• SEZURES LEVEL < 110 mEq/L
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DIAGNOSTIC PROCEDURES• CBC
• ELECTOLYTE LEVE
• CHLORIDE
• BUN AND CREATININE LEVELS
• UA
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PLANNING AND INTERVENTION• ABC
• IV FLUIDS
• REPLACE SODIUM ORALLY OR IV
• PROTECT FROM INJURY (SEIZURES)
• I&O
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HYPERNATREMIA
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SUBJECTIVE DATA• HISTORY OF PRESENT ILLNESS
• ANOREXIA, NAUSEA,VOMITING
• DIARRHEA
• ALTERED SODIUM INTAKE
• THIRST
• DEHYDRATION
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OBJECTIVE DATA
• PHYSICAL EXAM
• DECREASED URINE OUTPUT
• HYPERREFLEXIA, MUSCLE TWITCHING
• DRY MUCOUS MEMBRANES & SKIN
• MUSCLE WEAKNESS
• ORTHOSTATIC VITAL SIGN CHANGES
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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
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PLANNING AND INTERVENTION• IV FOR ISOTONOIC SOLUTIONS
• BLOOD SUGER TO RULE OUT HYPOGLYCEMIA
• I & O
• MONITOR FOR SEIZURE ACTIVITY
• LIMIT SODIUM INTAKE
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POTASSIUM ABNORMALITIES
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HYPOKALEMIA• LEVEL BELOW 3.5 mEq/L
• LOW INTAKE
• GASTROINTESTIONAL LOSSES
• RENAL LOSSES
• DIABETIC ACIDOSIS TREATMENT
• BURNS
• OVERHYDRATION
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SUBJECTIVE DATA• GI UPSET
• WEAKNESS AND FATIQUE
• SOB
• CRAMPS
• FREQUENT URINATION
• CONSTIPATION
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OBJECTIVE DATA• SHALLOW RESP,WEAK PULSE
• MUSCLE TENDERNESS
• DSYRHYTHMIAS (HEART BLOCKS)
• CONFUSION
• PARALYTIC ILEUS, HYPOACTIVE BS
• POLYURIA
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DIAGNOSTIC PROCEDURES
• LABS
• DEPRESSED ST SEGMENTS
• ABG ALKALOSIS
• FLATTENED T WAVES
• U WAVES
• VENTICULAR IRRITABILITY
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PLANNING AND INTERVENTION• ABC
• IV
• ADMINISTER POTASSIUM CHLORIDE
• CORRECT ACID-BASE IMBALANCE
• MONITOR CARDIAC RHYTHM
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HYPERKALEMIA
• K > 5.5 mEq/L
• POSSIBLE CAUSES
EXCESSIVE k INTAKE
DECREASED GLOMELULAR RATE
RENAL FAILURE
SEVERE TISSUE INJURY
ACIDOSIS
INSULIN DEFICENCY
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SUBJECTIVE DATA• CONFUSION
• HYPEREXCITABILITY
• MUSCLE WEAKNESS
• AB DESTENTION
• DIARRHEA
• CHRUSH OR BURN INJURY
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OBJECTIVE DATA• MENTAL CONFUSION
• WEAKNESSS
• DYSRHYTHMIAS
• BRADYCARDIA
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DIAGNOSTIC • ABC
• LABS
• ECC
• PEAKED T WAVES
• DEPRESSED OR FLAT T WAVES
• WIDENING QRS
• PROLONGED PR
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PLANNING AND INTERVENTION• ABC
• IV
• MEDS
SODIUM BICARB
GLUCOSE 50%
INSULIN
KAEXYLATE
MONITOR CARDIAC STATUS
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CALCIUM ABNORMALITIES
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CALCIUM • LEVELS ARE REGLULATED BY ENDOCRINE SYSTEM
• FACTOR IV IN THE BODY’S CLOTTING CASCADE
• TRANSMISSION OF NEUROMUCSCLAR IMPULSES
• IMPORTANT IN BONE FORMATION
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HYPOCALCEMIA• DEFICITS OF CALCIUM INTAKE
• INHIBITION OF CALCIUM ABSORPTION
• DECREASED VIT D
• LACTOSE INTOLERANCE
• MALABSORPTION SYNDROMES
• BLOOD TRANSFUSIONS
• ENDOCRINE DISTURBANCES
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SUBJECTIVE DATA• PARESTHESIA THEN NUMBNESS
• MUSCLE CRAMPS
• ALTERED DIETARY INTAKE
• RENAL FAILURE
• PANCREATITIS
• TOXIC SHOCK
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PHYHSICAL EXAM• HYPOTENSION• TACHYCARDIA• DECREACED PERIPHERAL PULSES• MUSCLE WEAKNESS• CARPOPEDAL SPASMS• TETANY• HYPERVENTLATION• SEIZURE• TROUSSEAU’S SIGN• CHVOSKEK’S SIGN
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DIAGNOSTIC• LABS
• ABG
• PARATHYROID HORMONE LEVEL
• ECG CARDIAC MONITOR
• PROLONGED QT AND ST
• T-WAVE INVERSION
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PLANNING AND INTERVENTION• ABC
• IV
• CARDIAC MONITORING
• CONTROL HYPERVENTLATION
• ADMINISTER CALCIUM
• ORAL CALIUM AS NEEDED
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HYPERCALCEMIA• DECREASED RENAL FUNCTION
• USE OF THIAZIDE DIURETICS
• INCREASED BONE REABSORPTION OF CALCIUM
HYPERPARATHYROIDISM
MALIGNANCY
HYPERTHYRODISM
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SUBJECTIVE DATA• ANOREXIA,VOMITING AND DIARRHEA
• WEAKNESS
• LETHARGY
• POLYURIA
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OBJECTIVE DATA• MENTAL STATUS CHANGE
• TACHYCARDIA
• HYPERTENSION
• INCREASED URINE OUTPUT
• PROFOUND MUSCLE WEAKNESS
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PLANNING AND INTERVENTION• IV
• I & O KEEP OUTPUT GREATER THAN 500CC HR
• CARDIAC MONITOR
• CVP
• MEDS
• HEMODIALYSIS
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MAGNESIUM ABNORMALITIES
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HYPOMAGNESEMIA• DECREASED INTAKE
• CHRONIC ALCOHOLLISM
• PROLONGED IV FEEDING
• LOSS THRU GI TRACT
• DRUG THERAPY
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SUBJECTIVE DATA• PARESTHESIA
• MUSCLE CRAMPS
• SEIZURE
• CROHN’S DISEASE
• DIABETES
• RENAL INSUFFICIENCY
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OBJECTIVE DATA• HYPERTENSION
• BRADYCARDIA
• VENTGRICULAR DSYRTHYMIAS
• HYPERREFLEXIA
• SEIZURES
• CONFUSION
• COMA
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DIAGNOSTIC• LABS
• ECG
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PLANNING AND INTERVENTION• ABC
• IV
• CARDIAC MONITORING
• GIVE MAGNESIUM
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HYPERMAGNESEMIA• RENAL FAILURE
• ADRENAL INSUFFICIENCY
• OVERDOSE
• RENAL PATIENTS maalox, mom
• ECLAMPSIA
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SUBJECTIVE DATA• NAUSEA AND VOMITING
• DROWSINESS LETHARGY
• RENAL INSUFFICIENCY OR FAILURE
• OVERDOSE OF THERAPEUTIC MAGNESIUM
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OBJECTIVE DATA• SOMNOLENCE
• SHALLOW RESP
• DEPRESSED OR ABSENT TENDON REFLEXES
• RESPIRAORY OR CARDIAC ARREST
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PLANNING AND INTERVENTION• ABC
• IV
• CARDIAC MONITORING
• ADMINISTER CALCIUM
• SALINE DIURESIS OR LASIX
• HEMODIALYSIS IN EXTREME CASES
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COMA
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COMA
• STRUCTURAL CAUSES
• METABOLIC CAUSES
• TOXIC OR ENZYMATIC INHIBITATION CAUSES
• PSYCHIATRIC CAUSES
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SUBJECTIVE DATA
• ONSET• ACTIVITY AT ONSET• PROGRESSION OF SEIZURE • MEDS• SEIZURE DISORDER• BACTERIAL ILLNESS• MEDICAL HISTORY• DEPRESSION OR BEHAVIOR CHANGES• ENVIRONMENTAL EXPOSURE
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OBJECTIVE DATA
• LEVEL OF CONSCIOUSNESS• RESPIRATORY RATE• PUPILS• EYE MOVEMENT• GCS• FEVER OR HYPERTHERMIA• TRAUMA• VITAL SIGNS• NEURO SIGNS
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DIAGNOSTIC• ABC
• LABS
• X-RAYS / CT
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PLANNING AND INTERVENTION• ABC
• INTUBATION TO PROTECT AIRWAY
• IV
• NG
• VITAL SIGNS
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HEMATOLOGIC EMERGENCIES
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CLOTTING ABNORMALITIES• DIC
• HEMOPHILIA
• THROMBOCYTOPENIA PURPURA
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DISSEMINATED INTRAVASCULAR COAGULATION• DIFFUSE MICROVASCULAR COAGULATION
• DEPLETES THE CLOTTING FACTOR
• IMPAIRS HEMOSTATIS
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• BLEEDING FOR ANY SITE
• DIZZINESS
• RASH
• EXCESSIVE BRUISING
• MASSIVE BLOOD TRANSFUSION
• ABRUPTIO PLACENTEA
• TRAUMA
• NEOPLASM
• SNAKE BITE
• ARDS
• HEPATIC DISEASE
SUBJECTIVE DATA
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OBJECTIVE DATA• PETECHIEA, PURPURA
• ECCHYMOSIS
• BLEEDING
• HEMATURIA
• LOC
• HEMATEMESIS
• ARDS
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DIAGNOSTIC• PLATELET COUNT
• PT, PTT
• FIBRINOGEN LEVEL
• H & H
• TYPE AND CROSS
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PLANNING AND INTERVENTION• A LINE
• CARDIAC RATE AND RHYTHM
• URINE OUTPUT
• CLOTTING TIME AND PLATELET COUNT
• REPLACE CLOTTING FACTORS
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HEMOPHILIA• INHERITED, SEX-LINKED DISORDER ALMOST ALWAYS SEEN IN MALES
• FEMALES CARRY GENE AND PASS TO MALE CHILDREN
• SEVERITY OF DISEASE IS DIRECTLLY RELATED TO ACTILVIEY LEVEL OF FACTOR VIII
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SUBJECTIVE DATA• UNUSUAL PROLONGED BLEEDING
• SPONTANEOUS HEMORRHAGE
• INTRACRANIAL BLEEDING
• SKIN
• JOINTS PAIN, SWELLING TENDERNESS
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DIAGNOSTIC PROCEDURES• PTT PROLONGED
• PT NORMAL
• PLATELET COUNT NORMAL
• FACTOR VIII DECREASED
• FACTOR IX DECREASED
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PLANNING AND INTERVENTION• RISK OF VOLUME DEFICIT
• NO IM INJECTIONS
• PRESSUE FOR LACERATIONS AND VENIPUNCTURES
• ICE, IMMOBLIZEMEKEVATE AND COMPRESSIVE DRESSINGS
• AVOID ASA AND NSAIDS
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SICKLE CELL
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SUBJECTIVE DATA• PAIN
• IMPAIRED GROWTH PATTERNS
• INFECTIONS
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OBJECTIVE DATA• CHRONIC ORGAN DAMAGE
• CHF
• SYSTOLIC EJECTION MURMUR
• JAUNDICE
• GALL STONES
• HEMATURIA
• PRIAPISM
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DIAGNOSTIC • HEMOLYTIC AMEMIA HCT 20-3O%
• ELEVATED RETICULOCYTES
• SICKLED CELLS
• BILIRUBIN ELEVATED
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PLANNING AND INTERVENTION• O2
• IV FLUIDS
• ANALGESIC
• REVERSE DEHYDRATION
• BED REST