general medical emergencies. specific conditions reye’s syndrome gout fever allergic reaction...
TRANSCRIPT
SPECIFIC CONDITIONS• REYE’S SYNDROME
• GOUT
• FEVER
• ALLERGIC REACTION
• FLUID AND ELECTROLYTE
• COMA
• HEMATOLOGICAL EMERGENCIES
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
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
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
PLANNING AND INTERVENTION• ABC
• CONTROL TEMPERATURE > 101
• MEDICATIONS
• FLUIDS
• DETERMINE SOURCE OF INFECTION
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
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
PLANNING AND INTERVENTION• ABC
• IV FLUIDS
• REPLACE SODIUM ORALLY OR IV
• PROTECT FROM INJURY (SEIZURES)
• I&O
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
HYPOKALEMIA• LEVEL BELOW 3.5 mEq/L
• LOW INTAKE
• GASTROINTESTIONAL LOSSES
• RENAL LOSSES
• DIABETIC ACIDOSIS TREATMENT
• BURNS
• OVERHYDRATION
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
PLANNING AND INTERVENTION• ABC
• 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
DIAGNOSTIC • ABC
• LABS
• ECC
• PEAKED T WAVES
• DEPRESSED OR FLAT T WAVES
• WIDENING QRS
• PROLONGED PR
PLANNING AND INTERVENTION• ABC
• IV
• MEDS
SODIUM BICARB
GLUCOSE 50%
INSULIN
KAEXYLATE
MONITOR CARDIAC STATUS
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
PLANNING AND INTERVENTION• ABC
• 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
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
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
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
PLANNING AND INTERVENTION• ABC
• IV
• CARDIAC MONITORING
• 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
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
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
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