Download - General Medical Emergencies

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.

• Children

• Salicylate ingestion may be a predisposing factor

• Late winter & early summer higher incidence

ASSESSMENT SUBJECTIVE DATA

ONSET

MEDICAL HISTORY

OBJECTIVE DATA

• PHYSICAL EXAM• NEUROLOGICAL STATUS• GASTROINTESTIONAL STATUS

DIAGNOSTIC PROCEDURES• AMMONIA LEVEL

• EMZYME LEVELS

• PT, PTT

• CHEM 7

• ABG

• CSF

PLANNING AND INTERVENTION• ABC

• O2

• IV FLUIDS

• GIVE DEXTROSE TO COUNTERACT HYPOGLYCEMIA

• MEDS – MANNITOL, STERIODS

SUBJECTIVE DATA• LOCATION OF PAIN

• TIMING /ONSET OF PAPIN

• CHARACTERITICS OF PAIN

• FEVER

• MEDICAL HISTORY

OBJECTIVE DATA• PHYSICAL EXAM

• ERYTHEMATOUS, HYPERTHERMIC EDEMA OF JOINT

• FEVER

• RELUCTANT TO USE EXTREMITY

DIAGNOSTIC PROCEDURE• URIC ACID

• WBC IN SYNOVIAL FLUID

• HYPERCALCEMIA

PLANNING AND INTERVENTION• ANTINFLAMMATORY AGENTS

• WEIGHT REDUCTION

• DIET – AVOID ALCHOL,HIGH PURINE

• AVOID THIAZIDE DIURETICS

SUBJECTIVE DATA• HISTORY OF PRESENT ILLNESS

• PREVIOUS SIMILAR EPISODE

• FEVER DEGREE AND PERSISTENCE

• OTHER SYMPTOMS

• IN CHILDREN FLUID INTAKE

• MEDICAL HISTORY

OBJECTIVE DATA• PHYSICAL EXAM

• DIANOSTIC PROCEDURES

LABS

X-RAYS

LUMBAR PUNCTURE


• CONTROL TEMPERATURE > 101

• MEDICATIONS

• FLUIDS

• DETERMINE SOURCE OF INFECTION

ALLERGIC REACTION

SUBJECTIVE DATA

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

OBJECTIVE DATA• APPEARANCE OF CONTACT SITE

• COMPLAINTS OF DISCOMFORT

• SIGNS AND SYMPTOMS OF ANAPHYLAXIS

PLANNING AND INTERVENTION

• ABC• EPINEPHRINE• O2• IV• ANTIHISTAMINE• HISTAMINE-2BLOCKER• STERIODS• BETA AGONIST OF BRONCHOSPASM• TREAT AREA OF CONTACT

FLUID AND ELECTROLYTE EMERGENCILES

ELECTROLYTE ABNORMALITIES• SODIUM

• POTASSIUM

• CALCIUM

• MAGNESIUM

SODIUM• NORMAL WATER BALANCE

• IMPULSE CONTROL

• REGULATED BY RENIN

ANGEOTENSIN

ALDOSTERONE

HYPONATREMIA

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

HYPONATREMIA

• DILUTIONAL CAUSES

EXCESSIVE WATER INTAKE

FRESHWATER DROWNING

GI LOSSES

HYPERGLYCEMIA

CHF

BURNS

SUBJECTIVE DATA• HISTORY

ALTERED ORAL INTAKE

NAUSEA AND VOMITING

THIRST

EXCESSIVE WATER INTAKE

SKELETAL MUSCLE WEAKNESS

MUSCLE CRAMPS

OBJECTIVE DATA

• PHYSICAL EXAM

• MENTAL STATIS

• SKIN TLURGOR

• SUNKEN FONTANELLE AND EYES

• DRY MUCUS MEMBRANES

• HYPOTENSION AND TACHYHCARDIA

• SEZURES LEVEL < 110 mEq/L

DIAGNOSTIC PROCEDURES• CBC

• ELECTOLYTE LEVE

• CHLORIDE

• BUN AND CREATININE LEVELS

• UA


• IV FLUIDS

• REPLACE SODIUM ORALLY OR IV

• PROTECT FROM INJURY (SEIZURES)

• I&O

HYPERNATREMIA

SUBJECTIVE DATA• HISTORY OF PRESENT ILLNESS

• ANOREXIA, NAUSEA,VOMITING

• DIARRHEA

• ALTERED SODIUM INTAKE

• THIRST

• DEHYDRATION

OBJECTIVE DATA

• PHYSICAL EXAM

• DECREASED URINE OUTPUT

• HYPERREFLEXIA, MUSCLE TWITCHING

• DRY MUCOUS MEMBRANES & SKIN

• MUSCLE WEAKNESS

• ORTHOSTATIC VITAL SIGN CHANGES

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

PLANNING AND INTERVENTION• IV FOR ISOTONOIC SOLUTIONS

• BLOOD SUGER TO RULE OUT HYPOGLYCEMIA

• I & O

• MONITOR FOR SEIZURE ACTIVITY

• LIMIT SODIUM INTAKE

POTASSIUM ABNORMALITIES

HYPOKALEMIA• LEVEL BELOW 3.5 mEq/L

• LOW INTAKE

• GASTROINTESTIONAL LOSSES

• RENAL LOSSES

• DIABETIC ACIDOSIS TREATMENT

• BURNS

• OVERHYDRATION

SUBJECTIVE DATA• GI UPSET

• WEAKNESS AND FATIQUE

• SOB

• CRAMPS

• FREQUENT URINATION

• CONSTIPATION

OBJECTIVE DATA• SHALLOW RESP,WEAK PULSE

• MUSCLE TENDERNESS

• DSYRHYTHMIAS (HEART BLOCKS)

• CONFUSION

• PARALYTIC ILEUS, HYPOACTIVE BS

• POLYURIA

DIAGNOSTIC PROCEDURES

• LABS

• DEPRESSED ST SEGMENTS

• ABG ALKALOSIS

• FLATTENED T WAVES

• U WAVES

• VENTICULAR IRRITABILITY


• IV

• ADMINISTER POTASSIUM CHLORIDE

• CORRECT ACID-BASE IMBALANCE

• MONITOR CARDIAC RHYTHM

HYPERKALEMIA

• K > 5.5 mEq/L

• POSSIBLE CAUSES

EXCESSIVE k INTAKE

DECREASED GLOMELULAR RATE

RENAL FAILURE

SEVERE TISSUE INJURY

ACIDOSIS

INSULIN DEFICENCY

SUBJECTIVE DATA• CONFUSION

• HYPEREXCITABILITY

• MUSCLE WEAKNESS

• AB DESTENTION

• DIARRHEA

• CHRUSH OR BURN INJURY

OBJECTIVE DATA• MENTAL CONFUSION

• WEAKNESSS

• DYSRHYTHMIAS

• BRADYCARDIA

DIAGNOSTIC • ABC

• LABS

• ECC

• PEAKED T WAVES

• DEPRESSED OR FLAT T WAVES

• WIDENING QRS

• PROLONGED PR


• IV

• MEDS

SODIUM BICARB

GLUCOSE 50%

INSULIN

KAEXYLATE

MONITOR CARDIAC STATUS

CALCIUM ABNORMALITIES

CALCIUM • LEVELS ARE REGLULATED BY ENDOCRINE SYSTEM

• FACTOR IV IN THE BODY’S CLOTTING CASCADE

• TRANSMISSION OF NEUROMUCSCLAR IMPULSES

• IMPORTANT IN BONE FORMATION

HYPOCALCEMIA• DEFICITS OF CALCIUM INTAKE

• INHIBITION OF CALCIUM ABSORPTION

• DECREASED VIT D

• LACTOSE INTOLERANCE

• MALABSORPTION SYNDROMES

• BLOOD TRANSFUSIONS

• ENDOCRINE DISTURBANCES

SUBJECTIVE DATA• PARESTHESIA THEN NUMBNESS

• MUSCLE CRAMPS

• ALTERED DIETARY INTAKE

• RENAL FAILURE

• PANCREATITIS

• TOXIC SHOCK

PHYHSICAL EXAM• HYPOTENSION• TACHYCARDIA• DECREACED PERIPHERAL PULSES• MUSCLE WEAKNESS• CARPOPEDAL SPASMS• TETANY• HYPERVENTLATION• SEIZURE• TROUSSEAU’S SIGN• CHVOSKEK’S SIGN

DIAGNOSTIC• LABS

• ABG

• PARATHYROID HORMONE LEVEL

• ECG CARDIAC MONITOR

• PROLONGED QT AND ST

• T-WAVE INVERSION


• IV

• CARDIAC MONITORING

• CONTROL HYPERVENTLATION

• ADMINISTER CALCIUM

• ORAL CALIUM AS NEEDED

HYPERCALCEMIA• DECREASED RENAL FUNCTION

• USE OF THIAZIDE DIURETICS

• INCREASED BONE REABSORPTION OF CALCIUM

HYPERPARATHYROIDISM

MALIGNANCY

HYPERTHYRODISM

SUBJECTIVE DATA• ANOREXIA,VOMITING AND DIARRHEA

• WEAKNESS

• LETHARGY

• POLYURIA

OBJECTIVE DATA• MENTAL STATUS CHANGE

• TACHYCARDIA

• HYPERTENSION

• INCREASED URINE OUTPUT

• PROFOUND MUSCLE WEAKNESS

PLANNING AND INTERVENTION• IV

• I & O KEEP OUTPUT GREATER THAN 500CC HR

• CARDIAC MONITOR

• CVP

• MEDS

• HEMODIALYSIS

MAGNESIUM ABNORMALITIES

HYPOMAGNESEMIA• DECREASED INTAKE

• CHRONIC ALCOHOLLISM

• PROLONGED IV FEEDING

• LOSS THRU GI TRACT

• DRUG THERAPY

SUBJECTIVE DATA• PARESTHESIA

• MUSCLE CRAMPS

• SEIZURE

• CROHN’S DISEASE

• DIABETES

• RENAL INSUFFICIENCY

OBJECTIVE DATA• HYPERTENSION

• BRADYCARDIA

• VENTGRICULAR DSYRTHYMIAS

• HYPERREFLEXIA

• SEIZURES

• CONFUSION

• COMA

DIAGNOSTIC• LABS

• ECG


• IV


• GIVE MAGNESIUM

HYPERMAGNESEMIA• RENAL FAILURE

• ADRENAL INSUFFICIENCY

• OVERDOSE

• RENAL PATIENTS maalox, mom

• ECLAMPSIA

SUBJECTIVE DATA• NAUSEA AND VOMITING

• DROWSINESS LETHARGY

• RENAL INSUFFICIENCY OR FAILURE

• OVERDOSE OF THERAPEUTIC MAGNESIUM

OBJECTIVE DATA• SOMNOLENCE

• SHALLOW RESP

• DEPRESSED OR ABSENT TENDON REFLEXES

• RESPIRAORY OR CARDIAC ARREST


• IV


• ADMINISTER CALCIUM

• SALINE DIURESIS OR LASIX

• HEMODIALYSIS IN EXTREME CASES

COMA

• STRUCTURAL CAUSES

• METABOLIC CAUSES

• TOXIC OR ENZYMATIC INHIBITATION CAUSES

• PSYCHIATRIC CAUSES

SUBJECTIVE DATA

• ONSET• ACTIVITY AT ONSET• PROGRESSION OF SEIZURE • MEDS• SEIZURE DISORDER• BACTERIAL ILLNESS• MEDICAL HISTORY• DEPRESSION OR BEHAVIOR CHANGES• ENVIRONMENTAL EXPOSURE

OBJECTIVE DATA

• LEVEL OF CONSCIOUSNESS• RESPIRATORY RATE• PUPILS• EYE MOVEMENT• GCS• FEVER OR HYPERTHERMIA• TRAUMA• VITAL SIGNS• NEURO SIGNS

DIAGNOSTIC• ABC

• LABS

• X-RAYS / CT


• INTUBATION TO PROTECT AIRWAY

• IV

• NG

• VITAL SIGNS

HEMATOLOGIC EMERGENCIES

CLOTTING ABNORMALITIES• DIC

• HEMOPHILIA

• THROMBOCYTOPENIA PURPURA

DISSEMINATED INTRAVASCULAR COAGULATION• DIFFUSE MICROVASCULAR COAGULATION

• DEPLETES THE CLOTTING FACTOR

• IMPAIRS HEMOSTATIS

• BLEEDING FOR ANY SITE

• DIZZINESS

• RASH

• EXCESSIVE BRUISING

• MASSIVE BLOOD TRANSFUSION

• ABRUPTIO PLACENTEA

• TRAUMA

• NEOPLASM

• SNAKE BITE

• ARDS

• HEPATIC DISEASE

SUBJECTIVE DATA

OBJECTIVE DATA• PETECHIEA, PURPURA

• ECCHYMOSIS

• BLEEDING

• HEMATURIA

• LOC

• HEMATEMESIS

• ARDS

DIAGNOSTIC• PLATELET COUNT

• PT, PTT

• FIBRINOGEN LEVEL

• H & H

• TYPE AND CROSS

PLANNING AND INTERVENTION• A LINE

• CARDIAC RATE AND RHYTHM

• URINE OUTPUT

• CLOTTING TIME AND PLATELET COUNT

• REPLACE CLOTTING FACTORS

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

SUBJECTIVE DATA• UNUSUAL PROLONGED BLEEDING

• SPONTANEOUS HEMORRHAGE

• INTRACRANIAL BLEEDING

• SKIN

• JOINTS PAIN, SWELLING TENDERNESS

DIAGNOSTIC PROCEDURES• PTT PROLONGED

• PT NORMAL

• PLATELET COUNT NORMAL

• FACTOR VIII DECREASED

• FACTOR IX DECREASED

PLANNING AND INTERVENTION• RISK OF VOLUME DEFICIT

• NO IM INJECTIONS

• PRESSUE FOR LACERATIONS AND VENIPUNCTURES

• ICE, IMMOBLIZEMEKEVATE AND COMPRESSIVE DRESSINGS

• AVOID ASA AND NSAIDS

SICKLE CELL

SUBJECTIVE DATA• PAIN

• IMPAIRED GROWTH PATTERNS

• INFECTIONS

OBJECTIVE DATA• CHRONIC ORGAN DAMAGE

• CHF

• SYSTOLIC EJECTION MURMUR

• JAUNDICE

• GALL STONES

• HEMATURIA

• PRIAPISM

DIAGNOSTIC • HEMOLYTIC AMEMIA HCT 20-3O%

• ELEVATED RETICULOCYTES

• SICKLED CELLS

• BILIRUBIN ELEVATED

PLANNING AND INTERVENTION• O2

• IV FLUIDS

• ANALGESIC

• REVERSE DEHYDRATION

• BED REST

Download - General Medical Emergencies

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