General Principals of Management of Certain Emergency Condition. vkr;kf;d jksx funku,oa fpfdrlk fl)kur ¼vk/kqfud fpfdrlk fo ys k.

Transcription

1 General Principals of Management of Certain Emergency Condition vkr;kf;d jksx funku,oa fpfdrlk fl)kur ¼vk/kqfud fpfdrlk fo ys k.k lfgr½

2 General Principles in Emergency Medical Management 1-Vital care -Temperature -Pulse -B.P. -Respiration 2-Water intake and urine output care 3-Care of bowel and bladder. 4-Control of bleeding. 5-Water and electrolytes balance.

3 6- Pt. s personal and surraounding hygeine. 7- Warm up or cold sponging of pt. s according to condition required. 8- Wound care and a septic management. 9- No interference in medicolegal conditions of pt s except treating emergency as food poisoning, road side accident,burns etc. 10- Drugs and surgical emergency tray and equipments always fully prepared.

4 óksrlkuqlkj & O;kf/k,oa vkr;kf;d fpfdrlkk 1- Ikzk.k o óksrl dh O;kf/k;kWa Ekq[;r%&izfr ;k;]dkl]loj Hksn] okljksx]fgddk]mj%{kr] jkt{;ek] ys ed Toj vkfn 1-dkl&Bronchitis Û {k;t ¼;{ek½T.B.&Bronchiectasis¼iw; ;qdr jdr Vhou½ Û {krt ¼Stridordh flfkfr½ Û Okkfrd dkl ¼Eosinophelia½ 2- okl ¼Bronchial asthema½ Û Rked okl ¼Status asthmaticus½

5 2& vuuog óksrl dh O;kf/k;kWa& izeq[k O;kf/k;kWa&vfXuekan]vEyfiRr]NfnZ xzg.kh vkfn 1- veyfirr ¼Hyper Acidity PepticUlcer½ Û Ikfj.kke kwy¼duodenal Ulcer½ Û vuu nzo kwy¼gastric Ulcer½ 2- Xkzg.kh ¼Colitis½ 3& iqjh kog óksrl dh O;kf/k;kWa& izeq[k O;kf/k;kWa&vfrlkj]izokfgdk]fccU/k]vYld vkfn 1- ¼Diarrhea & Dysentry½ 2- fo kwfpdk ¼Gastro Enteritis ½ 3- vyld ¼Intestinal Obstruction½

6 4& ew=og óksrl dh O;kf/k;kWa & izeq[k O;kf/k;kWa&ew=d`PN]ew=k?kkr]vLejh]iwoesg]izesg vkfn 1- ew=d`pn ¼U.T.I.½ 2- ew=k?kkr ¼Renal Failure½ 3- vlejh ¼Urinary Calculas½ 5& jlog óksrl dh O;kf/k;kWa & izeq[k O;kf/k;kWa&Toj]eysfj;k]/kkrqxr Toj vkeokr]ân; jksx] kksfk jksx 1- Toj ¼P.U.O.) 2- ân; jksx ¼Cardiac Disease) Û Myocardial Disease Û Valular Disease Û Coronary Disease Û Embolism & Thrombosis vojks/ktu; 3- kksfkjksx ¼Oedema½ 4- vkeokr ¼Orhematide Arthritis)

7 6& jdr og óksrl dh O;kf/k;kWa & izeq[k O;kf/k;kWa&ik.Mq]jDrfiRr]dkeyk]okrjDr]dq B]foliZ vkfn Rod jksx 1- ik.mq ¼Anaemia) 2-dkeyk ¼Zaundice) 3- okrjdr ¼Gout) 7&ekal og óksrl dh O;kf/k;kWa & izeq[k O;kf/k;kWa&vlZ HkxUnj ¼Piles,fisher,fistula) xyx.m]x.mekyk ¼Cervical lymphadenitis) vcqzn ¼Tumour) 8& esnks og óksrl dh O;kf/k;kWa & izeq[k O;kf/k;kWa&esnksjksx]xzfUFk]m:LrEHk]o`f)jksx vkfn

8 9& okrt O;kf/k & izeq[k O;kf/k;kWa&xz/kzlh ¼Sciatica), vfnzr ¼Facial Paralysis), i{kk?kkr ¼Hemi plegia ) f kjksjksx 10& ekul jksx& izeq[k O;kf/k;kWa&mUekn ¼Mania), vilekj ¼Epilepsy), volkn ¼Depression), vfunzk ¼Insomnia), fpurkf/k ¼Anxiety Neurosis), vrrokfhkfues k 11& egk óksrl dh O;kf/k;kWa & izeq[k O;kf/k;kWa&mnj jksx ¼;d`r½]Iyhgk]c) xqnksnj]xqye] kwy jksx rfkk dks B ds vaxks a ân;]clrh o ew= jksx vkfn

9 dkl óksrks vojks/k tu;o;kf/k gs Lo:i es osnuk ds rfkk kq Lo:Ik es a gksrh gsa y{k.k :Ik es a&tyksnj]red okl]ânjksx]jkt;{ek vkfn es aa vkr;kf;d fpfdrlk &funku ifjotzu pw.kz& oklk@duvdkjh@fiiikyh@ gfjnzk@lkhrksiykfn@ jl@ HkLe &lwr ks[kj]caxhkle]jl flunwj dqt dkl es a& kks/kukfkz&oeu vdz yo.k dk iz;ksx {k;tdkl es a & vfxu dh j{kk djsa ]o`ag.k fpfdrlk okfrd dkl es a& lehj iuukx jl]focu/k gks rks lkeku; oflr firrt es a& kq) Vad.k,oa fiiiyh dk iz;ksx

10 okl jksx Û vkek k; leqn~hko O;kf/k gs blesa okr dq dk fo ks k dk;z gsa Û {kqnz]fnuu]å/oz]egk okl rfkk red okl esa dsoy red okl gh fpfdrl; gs vu; vlk/; gsaa Û red okl Bronchial Asthema& nh?kzdky rd jgus ls ok;qdks k@ekxz <hys im+ tkrs gsa ftlls buesa ok;q,oa dq Hkjk jg tkrk gs ;g flfkfr Emphysema dh gs &ok;qdks k@ekxz dk vr;f/kd f kffky gks tkuk ;k mles a ladksp kfdr dk vhkko gks tkuk Bronchiectasis dgykrk gsa Û ;g mrrjksrrj vlk/; volfkk;sa gs ftudk lekos k red okl esa fd;k x;k gsaa

11 okl jksx dh vkr;kf;d fpfdrlk vfxuekan,oa vke dh mrifrr eq[;k?kvuk gs ftlls dq o`f),oa vke jl dh nqf V gksdj izk.kog óksrksa es a vojks/k gksdj izk.kok;q foekxz xkeh gksdj red okl dks mriuu djrh gsa tks y{k.k Hksn ls lured,oa izred :ih y{k.k mriuu djrs gsa oeu }kjk vkek k; kqf)&e/kq$lsa/ko yo.k@vdz yo.k Û yo.k fefjr Lusg ls lhus dk vh;ax@ kq d Losnu Û pw.kz&lkse pw.kz $;od {kkj]fiiiyh pw.kz]e/kq;f V pw.kz] ÛdQ iznku& okl dqbkj jl]lwr ks[kj jl Ûokr iznku&ey flunwj-$-vhkzd HkLe] okl dkl fpurkef.k jl ÛfifPNyrkiw.kZ dq gs rks& kq) u`lkj];odlkj] osr iizvh dk iz;ksx Û bluqqhfy;k gks rks &?k`r Hkz V fu kk pw.kz]lehj iuux pw.kz

12 Rkhoz okl osx ¼Status Asthmeticus ½ dh flfkfr esa Û dq B pw.kz 2 xzke dk /kwe eq[k o ukfldk esa ysuk pkfg, Û lkse pw.kz o ;od lkj e/kq ds lkfk fnu esa 3 ls 4 ckj Û okl dkl o fpurkef.k jl dh nks &nks xksyh fnu esa rhu ckj,oa dudklo dk iz;ksx vk/kqfud erkuqlkj& 1- Use of Bronchodilators& Salbutamol, Aminphylline mg I/V in 10-20minute in dilution of 50 ml. DNS. Total dose in adult shiuld not exceed 2 gm in 24 hours 2. Cortico steroids- THIS IS LIFE SAVING. Dexamethasone or Betamethasone I/V 4 to 8 Mg.Followed by 2-4 mg evrey 6 to8 hours 3. Anti biotics, fluid balanc oxygenation & sedative are very importent

13 Heat Stroke The medical definition of heat stroke is a core body temp. greater then 104 F Heat stroke results from prolonget exposure to high temp. usually in combination with Dehydration which leads to failure of the body s temp. control system Causes 1- Internal body temp. rises, leading to stroke 2- Cooling mechanism of the body fails due to Û Excessive Humidity Û Extreme Heat Û Activity in the hot sun Risk Factors -Dehydration,Infants &Older People,Work long hours out door,cardiovascular disorder,impairment in Sweat Gland Function

14 Symptoms Body temp.more then 104 F, Lack of Consciousness/Coma,Dis orientation, Headache,Rapid Heart Beat,Dizziness,Moist Skin,Confusion,Absence of Sweating, Hot Dry Skin,Irritability & Fatigue Treatment Û Remove the Person to a shady place Û Cold Sponging,Ice Packs in Arm Pids and Groin Û Water Electrolyte should be given Û Preventtion by outdoor activity,splash the body by water,protict by Sun.

15 Anaphylaxis Û Form of hyper sensitivity reaction Symptome & Sign ranging from rashes,urticaria,fever,arthralgia,adenopathy,angio Neuratic odema & Asthema Û Symptoms may come with bronchospasm,oedema of face & glottias,hypotension,circulatry collapse & death Û Ulcerative lesions in the oral cavity, Eyes.Genitalia & Extremities Treatment Û Enqurie about past histroy of adverse reaction of any drug Û Skin Sensitivity test in all penicillin or any kind of serum therapy and radiological studies with iodinated compound Û Reactions may follow even skin test which may fatal

16 Û Emergency tray contains 1-Syringe loaded with 1 ml of solution of Adrenaline Hydrochlorite for deep intramuscular all intravenous injection according to the severity of the reaction 2- Hydrocortisone hemisuccinate 100 mg ordexamethasone 4 mg for intravenous use 3- Also have oxygen cylinder 4- A venesection set, a bottle of 5 per. Dextrose in N 5- Saline with transfusion set and vesopressors

17 dqn lkeku; fpfdrlk 1- rhoz Toj tc Toj 104 F ls vf/kd gks tk, blls eflr dxr Heat regulating sentar ij izhkko im+rk gs ftlls bfunz;ks?kkr (Paralysis) dk Hk; gks tkrk gs rfkk Cerebral haemorrhage ls e`r;q dh lehkkouk gksrh gsa fpfdrlk Û loz ljhr ¼lhus dk i` B ]QsQM+ks a ds Hkkx dks NksM+dj½ BaMs xhys ol+= dk ysiu Û xksnurh fej.k 1 xzke izfr 15 feuv ij 1?kaVs rd nsaa Û ve`rkfj V

18 2- mn;{k; Dehydration Û vfrlkj]xzg.kh]izokfgdk]nx/k vkfn es a kkjhfjd mnd {k; dh volfkk gks tkrh gsa blesa IV Infusion fn, tkrs gasa Û gkbzij ;k gkbiksvkwfud lksy;w ku dk iz;ksx djrs gasa Û lathouh cvh] xaxk/kj pw.kz rfkk vfgqsuklo o kmaxikuh; dk iz;ksx fd;k tkrk gsa 3- rhoznfnzz Vomiting Û blesa butsd ku LVsesfVy],cksfeu]yktZ,fDVy vkfn dk iz;ksx Û dqddqvkurd HkLe] lwr ks[kj]e;wj fipn HkLe]la;ksxkdZ vkfn dk iz;ksx

19 Û dsfksvj dk iz;ksx 3- ew=ksnkozd Retention Urine Û iquzuok Bd DokFk Û punzizhkkovh]iapewy DokFk Û iapr`.kewy DokFk] osr iizvh]punuklo dk iz;ksx Û Heat &cold water reflexes Û Suprapubicpuncture

20 Hyper Tensive Problems Most pt. are a symptomatic Risk fector for cardio vascular disease & stroke Never intervnce on the basis of a simple raised B.P. measurment without associated symptomes and signs Approach 1- No previous history of HTN and other conditions as diabetes,vescular disease, IHD or strok 2-Known to HTN and under treatment 3- Evidence of end organ damege as- ratinal, renal and cardiac impairment 4- HTN with pulmonary oedema

21 Mild/Moderate HTN (Diastolic B. P mmhg) Pt.having HTN history with treatment-examine for retinal changes If the diastolic B.P (moderately elevated)and pt.is symptomatic refer to medical team. Severe HTN (Diastolic B.P.>125mmhg) This may be hypertansive enecphalo pathy and search it. Headach,Nausia,Vomating,Confusion,Retinal change (haemarrhages,exudate,papilloe dema) fits readuse canscious leval and ask about taken coramin like drug. Management Refer to pt. in above conditions to meadical team There is a risk of M.I. or stroke complication if the B.P. reduced rapidly

22 ẞ blocker is-atenalol or labetalol or calcium channel blocker es. Nifedipin ẞ blocker are contra indicated in HTN caused by coramine and amphetamines In preganancy- HTN may be the part of eclampsia (Eclampsia= HTN > 140/90,Proteinuria and Oedema lizxu/kk?kuovh&nks ovh 2 ls 3?kaVs ij izfrfnu pkj ls N% ckj punzizhkkovh]vtqzukfj V] osr iizvh vkfn

23 Type- Burn Thermal,chemical,electrical and radiation, History of burn, place, type of explosion and loss of consciousness is important for it. Important problums- If airway burns spinal injury,breathing and circulatory problums. Assessing Depth- This varies with temp. and duration of heat applied. 1- I and II degree (superficial) burns-ranging from minar erythema (Ist degree) through pain full erythema with blistering, to deep partial thickness (II nd degree)burns. 2-Full thickness(iiird degree)burn-it may be white,brown or black and look lethery. They do not blister and have no sensation.

24 Relative % of area affected adults rule of 9 s rules of 5 s in infants Head 9% 20 % Each arm 9% 10 % Each leg 18% 20 % Front of trunk 18% 10 % Back of trunk 18% 10 % Perineum 1% Management Highflow oxygen and cover burns in clean sheets Treat airway obstruction Protection for cervical spine injury by collar I/V infusion with two large peripheral cannulae Blood for x matching Analgesia- I/V morphine according to response Antiemetic- I/V cyclizime 50 mg I/V fluid start with isotonic crystalloid(.9% saline)

25 Check-pulse, B.P.respiration rate at every mint Watch for acute renal failure so may insert aurinary catheter test the urin I/V Colloidal units may prefer or componant of the initial volume replacement (eg. Alvumin) Irrigats chemical burns with warm water Tetaness prophylaxis So a largebolus of I/V fluid to cheque the cardiac arrest is usefull Antibiotics to check secondary infection Antiseptic lotion are applied with proper cleaning and hygine is very important Dressing-ideal is sterile non adherents tkr;kfn rsy] ds kksj xqxxy] vhkzd HkLe vkfn

26 Shock lack of transportation of oxygen and nutrients to the tissues and removal of tissue metabolites are impaired It represents an acute reduction in blood flow throw capillaries with diminish blood supply to vital organs. A clinical state characterized by -a acute fall in B.P.(below 80 mmhg) - tachycardia,feeble pulse(may be imperceptible) -pale cold skin,perspiration,thirst and oliguria. Type of shock- 1-Hypovolaemic shock Results from- massive haemerrhage,multipalinjuries,extensive burns,excessive fluid loss as gastroenteritis,diabitic acidosis and intestinal obstruction

27 2- Cardiogenic shock- Mainly due to impaired cardiac function 3- Septic shock- (caused by sepsis) Mainly by gram negetive as Ecoli and Pseudomonas By its endotoxins in circulation 4- Neurogenic shock- Mainly drug indused as antihypertensive, spinal anaesthesia. 5- Anaphylactic shock- Its suddenly occurs due to antigen- antibody reaction. It mainly by ing. Penicillin G and others. This shock is due to release of histamin and bradykinin.

28 Diagnosis Systolic B.P. falls to 80mmhg or less with above symptoms. Management Pt. should lie in supine position with elevated legs. Airway should clear (endotrachial tube) Oxygen therapy with secretion aspiration Urine output Regular pulse and B.P. recording to note the pt. s progress..

29 Restoration of blood volume- Whole blood,plasma,colloid solution (dextran 40 in saline) Rappid infusion of NS and 5% glucose (according to fluid loss up to 3-6 lit.). Ing. Mephentine. Vasodilator- Isoproprinol 1-2mg in 500ml of 5% glucose. Corticosteroids- Hydrocortisone mg. Dexamethasone 4 mg I/V in every 6-8 hours for 24 hours. In case of septic shock- Antibiotics should be given in large dose as gentamycin 80mg every 6 hourly and ampicillin.5gm IM/IV 6 hourly. fp0&;ksxsunz jl]o`gnokr fpurkef.k jl]eqdrkizoky iapke`r]vhkzd HkLe1000 iqvh vkfna

30 Thank you Dr. O.P. Bahukhandi S.M.O. Doon Hospital (Ayush wing)