EmergenciesTomas Hitka
II.KAIM LFUK OUSA
Treatable causes of cardiac arrest
Definition
Air in the pleural space
Etiology
• Spontaneous• Primary- idiopathic- young male
• Secondary- underlying lung disease• Obstructive
• Destructive and cavitatory
• Traumatic• Chest wall
• Lung tissue
Classification
• Simple• Open
• Closed
• Tension
Patophysiology
Clinical picture
• Symptoms: • dyspnea, pleuritic chest pain
• Signs: • reduced chest wall movements,
reduced breath sounds, hyper-resonance to percussion
• Subcutaneous emphysema
• Shift of trachea to the contralateral side
• Hypoxia, cyanosis
• Tachycardia, hypotension, distended jugular veins
Investigations
• CXR- should not be requested if tension PNO suspected
USG
USG
Management
Definition
• Compression of the heart by fluid within the pericardium
Size does not matter
Etiology
• Trauma
• Iatrogenic- following heart catheterization and cardiothoracic surgery
• Infectious pericarditis
• Cancer
• Uremia
• Systemic autoimmune diseases (SLE, RA)
• Idiopathic
Patophysiology
Clinical picture
• Symptoms:• Anxiety, restlessness, dizziness, and loss of consciousness.
• Weakness
• Chest pain radiating to your neck, shoulders, or back.
• Dyspnoe, tachypnoe
• Discomfort relieved by sitting or leaning forward.
Clinical picture
• Signs:• Beck’s triad: hypotension, JVD, muffled heart sounds
• Tachycardia
• Pulsus paradoxus
• Oliguria, cold extremities, lactic acidosis
Pulsus paradoxus
• Drop in SBP during inspiration greater than 10mmHg
Investigations
• ECG- tachycardia
low voltage QRS
electrical alternans
Investigations
• CXR- water bottle sign
ECHO
ECHO
Management
Hypothermia
• a core temperature ≤ 35
• when body’s heat loss exceeds its heat generation
• Causes:• exposure to cold weather
• immersion in cold water
Management
• Mild: passive rewarming• Prevent heat loss- shelter, dry clothes• Energy supply- sweet drinks to provide energy for shivering and exercise• Active movement
• Moderate: active external rewarming• Prevent heat loss• Rewarming- direct heat to torso (heat packs, water bottles, warming blanket),
ambient T, warm i.v. fluids• Minimal movement
• Severe: active internal rewarming• GI lavage, body cavity lavage, cardio-pulmonary bypass• CPR until warm
Hyperkalaemia
K+ > 5 mmol/l
Etiology
• Increased intake: • blood transfusion
• Redistribution: (AIDST)• Acidosis• Insuline insufficiency (DM)• Drugs: digoxin, B-blockers, SCHJ• Trauma, rhabdomyolysis
• Decreased output:• Renal failure• Adrenocortical insufficiency (low aldosterone)• Drugs: potassium sparing diuretics, ACEi
• False positive:• Hemolysis, leukocytosis, trombocytosis
Clinical picture
• Symptoms: • tiredness or weakness
• nausea or vomiting
• trouble breathing
• chest pain
• palpitations
Clinical picture
• Signs:
Management
CASE