emergencies - uniba.sk...•immersion in cold water management •mild: passive rewarming •prevent...
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EmergenciesTomas Hitka
II.KAIM LFUK OUSA
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Treatable causes of cardiac arrest
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Definition
Air in the pleural space
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Etiology
• Spontaneous• Primary- idiopathic- young male
• Secondary- underlying lung disease• Obstructive
• Destructive and cavitatory
• Traumatic• Chest wall
• Lung tissue
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Classification
• Simple• Open
• Closed
• Tension
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Patophysiology
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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
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Investigations
• CXR- should not be requested if tension PNO suspected
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USG
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USG
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Management
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Definition
• Compression of the heart by fluid within the pericardium
Size does not matter
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Etiology
• Trauma
• Iatrogenic- following heart catheterization and cardiothoracic surgery
• Infectious pericarditis
• Cancer
• Uremia
• Systemic autoimmune diseases (SLE, RA)
• Idiopathic
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Patophysiology
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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.
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Clinical picture
• Signs:• Beck’s triad: hypotension, JVD, muffled heart sounds
• Tachycardia
• Pulsus paradoxus
• Oliguria, cold extremities, lactic acidosis
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Pulsus paradoxus
• Drop in SBP during inspiration greater than 10mmHg
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Investigations
• ECG- tachycardia
low voltage QRS
electrical alternans
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Investigations
• CXR- water bottle sign
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ECHO
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ECHO
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Management
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Hypothermia
• a core temperature ≤ 35
• when body’s heat loss exceeds its heat generation
• Causes:• exposure to cold weather
• immersion in cold water
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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
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Hyperkalaemia
K+ > 5 mmol/l
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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
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Clinical picture
• Symptoms: • tiredness or weakness
• nausea or vomiting
• trouble breathing
• chest pain
• palpitations
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Clinical picture
• Signs:
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Management
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CASE