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GENERAL MEDICAL EMERGENCIES
SPECIFIC CONDITIONS
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REYE’S SYNDROME
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GOUT
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FEVER
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ALLERGIC REACTION
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FLUID AND ELECTROLYTE
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COMA
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HEMATOLOGICAL EMERGENCIES
REYE’S SYNDROME
REYE’S SYNDROME
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Acute no inflammatory encephalopathy characterized by hepatic, metabolic & neurological
dysfunction.
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Children
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Salicylate ingestion may be a predisposing factor
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Late winter & early summer higher incidence
ASSESSMENT
SUBJECTIVE DATA
ONSET
MEDICAL HISTORY
OBJECTIVE DATA
• PHYSICAL EXAM
• NEUROLOGICAL STATUS
• GASTROINTESTIONAL STATUS
DIAGNOSTIC PROCEDURES
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AMMONIA LEVEL
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EMZYME LEVELS
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PT, PTT
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CHEM 7
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ABG
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CSF
PLANNING AND INTERVENTION
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ABC
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O2
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IV FLUIDS
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GIVE DEXTROSE TO COUNTERACT HYPOGLYCEMIA
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MEDS – MANNITOL, STERIODS
GOUT
SUBJECTIVE DATA
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LOCATION OF PAIN
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TIMING /ONSET OF PAPIN
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CHARACTERITICS OF PAIN
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FEVER
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MEDICAL HISTORY
OBJECTIVE DATA
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PHYSICAL EXAM
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ERYTHEMATOUS, HYPERTHERMIC EDEMA OF JOINT
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FEVER
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RELUCTANT TO USE EXTREMITY
DIAGNOSTIC PROCEDURE
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URIC ACID
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WBC IN SYNOVIAL FLUID
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HYPERCALCEMIA
PLANNING AND INTERVENTION
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ANTINFLAMMATORY AGENTS
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WEIGHT REDUCTION
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DIET – AVOID ALCHOL,HIGH PURINE
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AVOID THIAZIDE DIURETICS
FEVER
SUBJECTIVE DATA
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HISTORY OF PRESENT ILLNESS
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PREVIOUS SIMILAR EPISODE
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FEVER DEGREE AND PERSISTENCE
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OTHER SYMPTOMS
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IN CHILDREN FLUID INTAKE
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MEDICAL HISTORY
OBJECTIVE DATA
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PHYSICAL EXAM
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DIANOSTIC PROCEDURES
LABS
X-RAYS
LUMBAR PUNCTURE
PLANNING AND INTERVENTION
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ABC
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CONTROL TEMPERATURE > 101
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MEDICATIONS
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FLUIDS
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DETERMINE SOURCE OF INFECTION
ALLERGIC REACTION
SUBJECTIVE DATA
• HISTORY
PRECIPITATING EVENTS IF KNOWN
ELAPSED TIME SINCE CONTACT
• MEDICAL HISTORY
PREVIOUS ALLERGIC REACTIONS
ALLERGIES
MEDICATION
OBJECTIVE DATA
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APPEARANCE OF CONTACT SITE
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COMPLAINTS OF DISCOMFORT
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SIGNS AND SYMPTOMS OF ANAPHYLAXIS
PLANNING AND INTERVENTION
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ABC
EPINEPHRINE
O2
IV
ANTIHISTAMINE
HISTAMINE-2BLOCKER
STERIODS
BETA AGONIST OF BRONCHOSPASM
TREAT AREA OF CONTACT
FLUID AND ELECTROLYTE EMERGENCILES
ELECTROLYTE ABNORMALITIES
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SODIUM
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POTASSIUM
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CALCIUM
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MAGNESIUM
SODIUM
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NORMAL WATER BALANCE
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IMPULSE CONTROL
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REGULATED BY RENIN
ANGEOTENSIN
ALDOSTERONE
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
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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
DIAGNOSTIC PROCEDURES
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CBC
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ELECTOLYTE LEVE
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CHLORIDE
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BUN AND CREATININE LEVELS
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UA
PLANNING AND INTERVENTION
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ABC
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IV FLUIDS
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REPLACE SODIUM ORALLY OR IV
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PROTECT FROM INJURY (SEIZURES)
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I&O
HYPERNATREMIA
SUBJECTIVE DATA
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HISTORY OF PRESENT ILLNESS
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ANOREXIA, NAUSEA,VOMITING
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DIARRHEA
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ALTERED SODIUM INTAKE
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THIRST
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DEHYDRATION
OBJECTIVE DATA
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PHYSICAL EXAM
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DECREASED URINE OUTPUT
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HYPERREFLEXIA, MUSCLE TWITCHING
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DRY MUCOUS MEMBRANES & SKIN
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MUSCLE WEAKNESS
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ORTHOSTATIC VITAL SIGN CHANGES
DIAGNOSTGIC PROCEDURES
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LABS
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INFANTS NORMAL 275 TO 285 mOsm/kg
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ADULT NORMAL 285 TO 295 nOsm/kg
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SYMPTOMS DEVELOP AT 320
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COMA OCCURS AT 360
PLANNING AND INTERVENTION
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IV FOR ISOTONOIC SOLUTIONS
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BLOOD SUGER TO RULE OUT HYPOGLYCEMIA
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I&O
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MONITOR FOR SEIZURE ACTIVITY
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LIMIT SODIUM INTAKE
POTASSIUM ABNORMALITIES
HYPOKALEMIA
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LEVEL BELOW 3.5 mEq/L
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LOW INTAKE
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GASTROINTESTIONAL LOSSES
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RENAL LOSSES
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DIABETIC ACIDOSIS TREATMENT
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BURNS
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OVERHYDRATION
SUBJECTIVE DATA
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GI UPSET
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WEAKNESS AND FATIQUE
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SOB
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CRAMPS
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FREQUENT URINATION
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CONSTIPATION
OBJECTIVE DATA
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SHALLOW RESP,WEAK PULSE
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MUSCLE TENDERNESS
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DSYRHYTHMIAS (HEART BLOCKS)
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CONFUSION
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PARALYTIC ILEUS, HYPOACTIVE BS
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POLYURIA
DIAGNOSTIC PROCEDURES
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LABS
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DEPRESSED ST SEGMENTS
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ABG ALKALOSIS
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FLATTENED T WAVES
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U WAVES
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VENTICULAR IRRITABILITY
PLANNING AND INTERVENTION
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ABC
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IV
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ADMINISTER POTASSIUM CHLORIDE
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CORRECT ACID-BASE IMBALANCE
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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
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CONFUSION
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HYPEREXCITABILITY
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MUSCLE WEAKNESS
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AB DESTENTION
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DIARRHEA
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CHRUSH OR BURN INJURY
OBJECTIVE DATA
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MENTAL CONFUSION
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WEAKNESSS
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DYSRHYTHMIAS
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BRADYCARDIA
DIAGNOSTIC
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ABC
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LABS
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ECC
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PEAKED T WAVES
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DEPRESSED OR FLAT T WAVES
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WIDENING QRS
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PROLONGED PR
PLANNING AND INTERVENTION
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ABC
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IV
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MEDS
SODIUM BICARB
GLUCOSE 50%
INSULIN
KAEXYLATE
MONITOR CARDIAC STATUS
CALCIUM ABNORMALITIES
CALCIUM
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LEVELS ARE REGLULATED BY ENDOCRINE SYSTEM
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FACTOR IV IN THE BODY’S CLOTTING CASCADE
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TRANSMISSION OF NEUROMUCSCLAR IMPULSES
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IMPORTANT IN BONE FORMATION
HYPOCALCEMIA
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DEFICITS OF CALCIUM INTAKE
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INHIBITION OF CALCIUM ABSORPTION
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DECREASED VIT D
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LACTOSE INTOLERANCE
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MALABSORPTION SYNDROMES
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BLOOD TRANSFUSIONS
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ENDOCRINE DISTURBANCES
SUBJECTIVE DATA
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PARESTHESIA THEN NUMBNESS
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MUSCLE CRAMPS
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ALTERED DIETARY INTAKE
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RENAL FAILURE
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PANCREATITIS
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TOXIC SHOCK
PHYHSICAL EXAM
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HYPOTENSION
TACHYCARDIA
DECREACED PERIPHERAL PULSES
MUSCLE WEAKNESS
CARPOPEDAL SPASMS
TETANY
HYPERVENTLATION
SEIZURE
TROUSSEAU’S SIGN
CHVOSKEK’S SIGN
DIAGNOSTIC
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LABS
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ABG
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PARATHYROID HORMONE LEVEL
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ECG CARDIAC MONITOR
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PROLONGED QT AND ST
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T-WAVE INVERSION
PLANNING AND INTERVENTION
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ABC
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IV
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CARDIAC MONITORING
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CONTROL HYPERVENTLATION
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ADMINISTER CALCIUM
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ORAL CALIUM AS NEEDED
HYPERCALCEMIA
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DECREASED RENAL FUNCTION
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USE OF THIAZIDE DIURETICS
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INCREASED BONE REABSORPTION OF CALCIUM
HYPERPARATHYROIDISM
MALIGNANCY
HYPERTHYRODISM
SUBJECTIVE DATA
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ANOREXIA,VOMITING AND DIARRHEA
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WEAKNESS
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LETHARGY
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POLYURIA
OBJECTIVE DATA
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MENTAL STATUS CHANGE
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TACHYCARDIA
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HYPERTENSION
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INCREASED URINE OUTPUT
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PROFOUND MUSCLE WEAKNESS
PLANNING AND INTERVENTION
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IV
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I & O KEEP OUTPUT GREATER THAN 500CC HR
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CARDIAC MONITOR
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CVP
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MEDS
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HEMODIALYSIS
MAGNESIUM ABNORMALITIES
HYPOMAGNESEMIA
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DECREASED INTAKE
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CHRONIC ALCOHOLLISM
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PROLONGED IV FEEDING
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LOSS THRU GI TRACT
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DRUG THERAPY
SUBJECTIVE DATA
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PARESTHESIA
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MUSCLE CRAMPS
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SEIZURE
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CROHN’S DISEASE
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DIABETES
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RENAL INSUFFICIENCY
OBJECTIVE DATA
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HYPERTENSION
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BRADYCARDIA
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VENTGRICULAR DSYRTHYMIAS
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HYPERREFLEXIA
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SEIZURES
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CONFUSION
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COMA
DIAGNOSTIC
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LABS
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ECG
PLANNING AND INTERVENTION
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ABC
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IV
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CARDIAC MONITORING
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GIVE MAGNESIUM
HYPERMAGNESEMIA
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RENAL FAILURE
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ADRENAL INSUFFICIENCY
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OVERDOSE
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RENAL PATIENTS maalox, mom
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ECLAMPSIA
SUBJECTIVE DATA
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NAUSEA AND VOMITING
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DROWSINESS LETHARGY
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RENAL INSUFFICIENCY OR FAILURE
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OVERDOSE OF THERAPEUTIC MAGNESIUM
OBJECTIVE DATA
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SOMNOLENCE
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SHALLOW RESP
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DEPRESSED OR ABSENT TENDON REFLEXES
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RESPIRAORY OR CARDIAC ARREST
PLANNING AND INTERVENTION
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ABC
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IV
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CARDIAC MONITORING
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ADMINISTER CALCIUM
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SALINE DIURESIS OR LASIX
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HEMODIALYSIS IN EXTREME CASES
COMA
COMA
• STRUCTURAL CAUSES
• METABOLIC CAUSES
• TOXIC OR ENZYMATIC INHIBITATION CAUSES
• PSYCHIATRIC CAUSES
SUBJECTIVE DATA
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ONSET
ACTIVITY AT ONSET
PROGRESSION OF SEIZURE
MEDS
SEIZURE DISORDER
BACTERIAL ILLNESS
MEDICAL HISTORY
DEPRESSION OR BEHAVIOR CHANGES
ENVIRONMENTAL EXPOSURE
OBJECTIVE DATA
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LEVEL OF CONSCIOUSNESS
RESPIRATORY RATE
PUPILS
EYE MOVEMENT
GCS
FEVER OR HYPERTHERMIA
TRAUMA
VITAL SIGNS
NEURO SIGNS
DIAGNOSTIC
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ABC
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LABS
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X-RAYS / CT
PLANNING AND INTERVENTION
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ABC
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INTUBATION TO PROTECT AIRWAY
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IV
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NG
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VITAL SIGNS
HEMATOLOGIC EMERGENCIES
CLOTTING ABNORMALITIES
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DIC
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HEMOPHILIA
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THROMBOCYTOPENIA PURPURA
DISSEMINATED INTRAVASCULAR
COAGULATION
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DIFFUSE MICROVASCULAR COAGULATION
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DEPLETES THE CLOTTING FACTOR
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IMPAIRS HEMOSTATIS
SUBJECTIVE DATA
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BLEEDING FOR ANY SITE
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ABRUPTIO PLACENTEA
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DIZZINESS
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TRAUMA
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RASH
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NEOPLASM
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EXCESSIVE BRUISING
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SNAKE BITE
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MASSIVE BLOOD TRANSFUSION
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ARDS
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HEPATIC DISEASE
OBJECTIVE DATA
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PETECHIEA, PURPURA
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ECCHYMOSIS
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BLEEDING
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HEMATURIA
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LOC
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HEMATEMESIS
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ARDS
DIAGNOSTIC
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PLATELET COUNT
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PT, PTT
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FIBRINOGEN LEVEL
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H&H
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TYPE AND CROSS
PLANNING AND INTERVENTION
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A LINE
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CARDIAC RATE AND RHYTHM
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URINE OUTPUT
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CLOTTING TIME AND PLATELET COUNT
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REPLACE CLOTTING FACTORS
HEMOPHILIA
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INHERITED, SEX-LINKED DISORDER ALMOST ALWAYS SEEN IN MALES
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FEMALES CARRY GENE AND PASS TO MALE CHILDREN
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SEVERITY OF DISEASE IS DIRECTLLY RELATED TO ACTILVIEY LEVEL OF FACTOR
VIII
SUBJECTIVE DATA
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UNUSUAL PROLONGED BLEEDING
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SPONTANEOUS HEMORRHAGE
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INTRACRANIAL BLEEDING
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SKIN
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JOINTS PAIN, SWELLING TENDERNESS
DIAGNOSTIC PROCEDURES
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PTT PROLONGED
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PT NORMAL
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PLATELET COUNT NORMAL
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FACTOR VIII DECREASED
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FACTOR IX DECREASED
PLANNING AND INTERVENTION
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RISK OF VOLUME DEFICIT
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NO IM INJECTIONS
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PRESSUE FOR LACERATIONS AND VENIPUNCTURES
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ICE, IMMOBLIZEMEKEVATE AND COMPRESSIVE DRESSINGS
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AVOID ASA AND NSAIDS
SICKLE CELL
SUBJECTIVE DATA
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PAIN
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IMPAIRED GROWTH PATTERNS
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INFECTIONS
OBJECTIVE DATA
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CHRONIC ORGAN DAMAGE
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CHF
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SYSTOLIC EJECTION MURMUR
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JAUNDICE
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GALL STONES
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HEMATURIA
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PRIAPISM
DIAGNOSTIC
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HEMOLYTIC AMEMIA HCT 20-3O%
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ELEVATED RETICULOCYTES
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SICKLED CELLS
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BILIRUBIN ELEVATED
PLANNING AND INTERVENTION
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O2
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IV FLUIDS
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ANALGESIC
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REVERSE DEHYDRATION
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BED REST