cme shahibaugreen

7/28/2019 CME Shahibaugreen

1/16

Emergencies in OPD/Clinics

Dr.Pankaj Dubey


2/16

Patient come with symptoms

Chest pain

Shortness of breath/Cough

Ghabravan

Abdominal pain/Vomitting /Diarrhoea

Backpain

Headache

Fever Weakness

Overdose,Poisoning,Cardiac arrest


3/16

You could find-Vital sign are VITAL

High Blood pressure/Low B.P

Sugar- High or low

Irregular pulse

Weakness

Altered mental state(A/V/P/U)

Fever- think of Rash and Neck stiffness.


4/16

Ask about

History of angina.

Blood pressure.

Old ECG/CXR

Stones-Gall bladder,Kidney.

Alcohol.

Smoke.


5/16

Take AMPLE history

A= Allergies- Penicillin, Suplha, Food,Contrast

M=Medications taken

P=PMHx

L=Last meal

E=Events- ?What happened


6/16

The G.P bag


7/16


8/16

The Drug kit

Angina :Nitro-glycerine (sublingual tablet or aerosol spray), Aspirin 300mg

Acute asthma- Asthalin Inhaler/Nebulizer every 15 min,Derriphyline-

1amp/infusion,Efcorlin 100mg (or Tab.Wysolone 40mg)

Allergic reaction: Adrenaline: 1 in 1000 ampoule- adult give 0.5ml IM,Avil or

injectable Phenergan.

Hypoglycaemia :Oral glucose (solution,tablet, gel or powder),25%D,50D

Seizures: Midazolam (injectable) Rectal Dizepam

High Fever/Pain:Paracetamol- 1gm IV- Perfalgan/Melidens or Febrinil 2 ampoules

Antibiotic: Ceftriaxone 2gm, Augmentin 1.2 gm, Azithromycin 500mg,Metrogyl

500mg ,anti-malarial.

NVD :ORS:NS,Electral,Perinorm,Loperamide

PSYCHOSIS :Largactil for Psychotic patient.

Nausea/Vomitting- Stemetil,Phenergan

!! Oxygen with positive-pressure administration capability !!


9/16

Who do you not want to manage inyour clinic

Drowsy ones. Can't speak ones.

Those who need repeated measurements.

Unstable- what you do does not work orpatient worsens again.


10/16

The real expenditureMinimum Emergency equipment and supplies:

Pulse oximeter,Thermometer

Blood glucose measurement device.

Spacer device with mask for inhaled bronchodilators.

Single use sterile syringes and needles,Gloves.

Laedral - Pocket mask with oxygen port, viral and

bacterial barrier, low resistance one way valve and

pre inflated cuff.

1 bag NS and IV cannula and IV infusion set.


11/16

Inhaler and spacer device


12/16

Oxygen saturation monitor


13/16

Ambu bag


14/16

Non rebreather mask(O2)


15/16

Oro-pharyngeal airway


16/16

Thank you

Any Questions ?

cme shahibaugreen

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