Management Of Medical Emergencies

Size: px

Start display at page:

Download "Management Of Medical Emergencies"

Clarence Collins
6 years ago
Views:

1 Management Of Medical Emergencies

2 U.S. Aging Population 35 million people (12%) 65 years or older Number will increase by nearly 75% by year 2030 The number of people more than 85 years old will approach 11 million by 2030

3 Physiologic Studies Aging In general basal function of the major organ systems are relatively uncompromised Functional reserve and ability to compensate for physiologic stress significantly reduces

4 Management Of Medical Emergencies Prevention Recognition Treatment

5 Decreased Level of Consciousness Altered Consciousness Unconsciousness

6 Altered Consciousness Confusion - mental state marked by the mingling of ideas with disturbances of comprehension and understanding -> bewilderment Delirium - mental disturbance characterized by illusions, delusions, cerebral excitement, physical restlessness, and incoherence Derangements of speech, thought, motion, or sensation

7 Mechanisms of Altered Consciousness Inadequate delivery of blood or oxygen to the brain Systemic or local metabolic deficiencies Direct or reflex effects on the CNS Psychic mechanisms

8 Mechanisms of Altered Consciousness Inadequate delivery of blood or oxygen to the brain Myocardial Infarction Congestive Heart Failure Respiratory Failure

9 Mechanisms of Altered Consciousness Systemic or Local Metabolic Deficiencies Hyperglycemia or Hypoglycemia Hyperthyroidism or Hypothyroidism Drug Overdose Acute Allergic Reactions

10 Mechanisms of Altered Consciousness Direct or Reflex Effects on CNS Cerebrovascular Accident Convulsive Episodes Psychic Mechanisms Hyperventilation Vasodepressor Syncope

11 Call for Help Emergency numbers (Internal school number) (Emergency EMS) Bring Emergency Equipment to Site

12 Altered Consciousness Examine Patient Place Supine or Upright PRN Obtain Vital Signs Administer Oxygen Definitive Care based on History and Physical findings

13 Differential Diagnosis Altered Consciousness Skin warm and dry - hyperglycemia Skin cold and moist - hypoglycemia, angina, AMI, severe acute allergic reaction Skin hot and wet - hyperthyroidism Skin cold and dry - hypothyroidism Paresthesia - hyperventilation syndrome, TIA -> CVA Headache - CVA, hypoglycemia

14 Acute Stroke (CVA) Altered consciousness Intense headache, severe neck or facial pain Aphasia or dysarthria One sided sensory loss or motor weakness Ataxia Visual loss mono or binocular Vertigo, double vision, unilateral hearing loss, nausea, vomiting, photo or phonophobia

15 Supportive Treatment Patients are placed in upright position Oxygen supplied by nasal canula (6 L/min) or facemask (15 L/min) CPR prn Vital signs are monitored q5m Transport patient to hospital for definitive treatment CAT scan Fibrinolytic therapy tpa within 3 hrs onset symptoms (not hemorrhagic stroke)

16 Unconsciousness Inadequate Delivery of Blood or Oxygen to the Brain (respiratory &/or cardiovascular failure) Vasodepressor Syncope Orthostatic Hypotension Cardiac Arrest, Major Dysrhythmia, Failure Respiratory Failure Airway Obstruction, Respiratory Depression or Arrest

17 Management of Unconscious Patient Place patient supine with legs elevated Basic Life Support ABCs Airway - Obstruction Breathing Circulation carotid pulse

18 Management of Unconscious Patient Absent Pulse Administer CPR Defibrillate ASAP AED

19 Management of Unconscious Patient Breathing with Pulse Maintain patent airway Administer supplemental oxygen Obtain vital signs - BP, HR & Rhythm, RR and examine patient Differential Diagnosis

20 General Considerations Differential Diagnosis: Neurogenic - Vasodepressor Syncope Vascular - Postural Hypotension Cardiogenic dysrhythmia, CHF Drugs Psychogenic Endocrine - Adrenal Insufficiency

21 Predisposing factors Stress Impaired Physical Status (ASA III or IV) Ingestion of Drugs (Narcotics, Benzodiazepines, Barbiturates, Antidepressants, ETOH)

22 Prevention Both physiologic and psychological stress reduction Acknowledging fear IV sedation Supplemental oxygen/nitrous oxide Supine positioning

23 Vasodepressor Syncope Predisposing factors Fainting 1. Male, under 35 years, and administration of local 2. Psychogenic- fright, pain 3. Physiologic- Upright position, hunger

24 Pathophysiology Fight or flight response Hypotension Bradycardia Resulting in decrease cerebral perfusion

25 Clinical manifestations Presyncope: pale, cold sweat, nausea, yawning, pupils dilate Syncope: convulsive movements, hypotension, bradycardia. Typically lasts seconds to minutes Post syncope: weakness, sweating, nausea, pallor

26 Clinical manifestations If unconsciousness persists for more then 5 minutes, or complete recovery is not achieved in minutes then other causes of unconsciousness must be considered. Especially if patient is over 40

27 Management Stop procedure! Call for help Assess level of consciousness Place in supine position A,B,C s: Airway, Breathing, Circulation Oxygen Vitals Aromatic Ammonia

28 Postural Hypotension A fall in systolic pressure of 20 mm/hg or more upon standing

29 Predisposing factors 1. Age: over 65 population 2. Drugs: AntiHTN, Antidepressants, Antipsychotics, Narcotics, Antiparkinson 3. Prolonged recumbence 4. Hypovolemia 5. Pregnancy 6. Venous defects 7. Post sympathectomy 8. Shy- Drager syndrome (autonomic atrophy)

30 Pathophysiology Normal response to upright position: 1. Arteriole constriction 2. Tachycardia 3. Venous constriction 4. Increase muscle tone

31 Pathophysiology In postural hypotension these reflexes are diminished or delayed. Consciousness will be lost if systolic pressure falls below 70 mm/hg at heart level in a normotensive patient.

32 Clinical manifestations Lightheaded Diaphoretic Hypotension Tachycardia Syncope Upon sitting upright

33 Management Stop procedure! Call for help Assess level of consciousness Place in supine position A,B,C s: Airway, Breathing, Circulation Call EMS Oxygen Vitals Slowly reposition chair

34 Adrenal Insufficiency Adrenal Cortex 1. Glucocorticoids 2. Androgens 3. Aldosterone Normally 20 mg cortisol is produced daily, and increases to over 60 mg when stressed.

35 Endogenous steroids Gluconeogenesis Protein utilization Fat utilization Intravascular volume Electrolytes: Na + K

36 Predisposing factors Primary adrenal insufficiency: Addison s disease, decrease in cortisol Secondary adrenal insufficiency: Decrease in ACTH production Hypothalamus CRF Pituitary ACTH Cortisol Adrenal

37 Exogenous Steroids Rule of two s 20 mg of cortisone or equivalent daily For continuous 2 weeks Within past 2 years After obtaining an adequate history the decision must be made whether supplementation is needed.

38 Clinical manifestations Lethargy Hypotension Hypoglycemia Hyperkalemia Cardiovascular collapse Death

39 Management Stop procedure! Call for help Place in supine position A,B,C s: Airway, Breathing, Circulation Call EMS Oxygen Vitals Definitive Management Administer 100 mg hydrocortisone or equivalent IV/IM immediately

MEDICAL EMERGENCIES HANDBOOK Last Update 1/26/2013

MEDICAL EMERGENCIES HANDBOOK Last Update 1/26/2013 Legal Disclaimer - The information provided here is the opinion of the author,and does not claim to be a substitute for obtaining this knowledge through