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‫دکتر راضیه قربانی‬
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1 Injury and illness
2 Infections
3 Cardiac and circulatory
4 Metabolic
5 Neurological and Neurosurgical
6 Psychiatric
7 Ophthalmological
8 Respiratory
9 Shock
10 Obstetrics
11 Urological, andrological, and gynecologic
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Appendicitis (leading to peritonitis)
Ballistic trauma (gunshot wound)
Crohn's disease, severe (possible obstruction, perforation)
Flail chest
Head trauma
Fulminant colitis
Hyperthermia (heat stroke or sunstroke)
Hypothermia or frostbite
Intestinal obstruction
Pancreatitis
Peritonitis
Poisoning
Ruptured spleen
Septic arthritis
Septicemia blood infection
Severe burn (including scalding and chemical burns)
Spreading wound infection
Suspected spinal injury
Traumatic brain injury
acute epistaxis
Spinal disc herniation
Sudden Sensorineural hearing loss (SSHL, or just SHL, which may become permanent unless treated
promptly.)
• Bacterial Meningitis
• Ear infection (can occur with Sudden Sensorineural hearing loss
(SSHL, or just SHL), which may become permanent unless
treated promptly.)
• Lyme disease infection
• Malaria infection
• Necrotizing Fasciitis
• Rabies infection
• Salmonella poisoning
• Neutropenic sepsis
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Aortic aneurysm (ruptured)
Aortic dissection
Air embolism (Arterial)
Bleeding
Hemorrhage
Hypovolemia
Internal bleeding
Cardiac arrest
Cardiac arrhythmia
Ventricular fibrillation
Cardiac tamponade
Hypertensive emergency
Myocardial infarction (heart attack)
ventricular tachycardia
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Acute renal failure
Addisonian crisis (seen in those with Addison's disease)
Dehydration, advanced
Diabetic coma
Diabetic ketoacidosis
Hypoglycemic coma
Electrolyte disturbance, severe (along with dehydration, possible with
severe diarrhea or vomiting, chronic laxative abuse, and severe
burns)
Hepatic encephalopathy
Hypercalcemic crisis
Lactic acidosis
Malnutrition and starvation (as in extreme anorexia and bulimia)
Pheochromocytoma crisis Thyroid storm
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Cerebrovascular accident (stroke)
Subarachnoid hemorrhage
Subdural hematoma,
acute Convulsion or seizure, no history or unusual Status
epilepticus
Meningitis
Acute spinal cord compression
Status migrainosus
Neuroleptic Malignant Syndrome
Serotonin Syndrome
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Psychotic episode
Suicidal ideation
Attempted suicide,
non-fatal Homicidal ideation
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Acute angle-closure glaucoma
Orbital perforation or penetration
Retinal detachment
Giant Cell Arteritis
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Agonal breathing
Asphyxia
Angioedema
Choking
Drowning
Smoke inhalation
Asthma,
acute Epiglottitis or severe croup
Pneumothorax
Pulmonary embolism
Respiratory failure
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Anaphylaxis
Cardiogenic shock
Hypovolemic shock (due to hemorrhage)
Neurogenic shock
Obstructive shock (e.g., massive pulmonary embolism or Cardiac
tamponade)
• Septic shock
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Ectopic pregnancy
Eclampsia
Pre- eclampsia
HELLP syndrome
Fetal distress
Obstetrical hemorrhage
Placental abruption
Prolapsed cord
Puerperal sepsis
Shoulder dystocia
Uterine rupture
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Acute Prostatitis
Ovarian torsion
Gynecologic hemorrhage
Paraphimosis
Priapism
Sexual assault (rape)
Testicular torsion
Testicular infarction
Urinary retention
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Food poisoning
Venomous animal bite
Pharmacological overdose
Botanical
• Acute poisoning is exposure to a poison on one occasion or
during a short period of time.
• Symptoms develop in close relation to the exposure.
• Absorption of a poison is necessary for systemic poisoning.
• many common household medications are not labeled with skull
and crossbones, although they can cause severe illness or even
death.
• Chronic poisoning is long-term repeated or continuous exposure
to a poison where symptoms do not occur immediately or after
each exposure.
• The patient gradually becomes ill, or becomes ill after a long
latent period. Chronic poisoning most commonly occurs following
exposure to poisons that bioaccumulate, or are biomagnified,
such as mercury and lead.
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A burn is a type of injury to flesh or skin caused by heat, electricity, chemicals, friction,
or radiation.[1] Burns that affect only the superficial skin are known as superficial or
first-degree burns. When damage penetrates into some of the underlying layers, it is a
partial-thickness or second-degree burn. In a full-thickness or third-degree burn, the
injury extends to all layers of the skin. A fourth-degree burn additionally involves injury
to deeper tissues, such as muscle or bone.
The treatment required depends on the severity of the burn. Superficial burns may be
managed with little more than simple pain relievers, while major burns may require
prolonged treatment in specialized burn centers. Cooling with tap water may help
relieve pain and decrease damage; however, prolonged exposure may result in low
body temperature. Partial-thickness burns may require cleaning with soap and water,
followed by dressings. It is not clear how to manage blisters, but it is probably
reasonable to leave them intact. Full-thickness burns usually require surgical
treatments, such as skin grafting. Extensive burns often require large amounts
of intravenous fluid, because the subsequent inflammatory response causes
significant capillary fluid leakage and edema. The most common complications of
burns involve infection.
While large burns can be fatal, modern treatments developed since 1960 have
significantly improved the outcomes, especially in children and young
adults.[2] Globally, about 11 million people seek medical treatment, and 300,000 die
from burns each year.[3] In the United States, approximately 4% of those admitted to
a burn center die from their injuries.[4] The long-term outcome is primarily related to
the size of burn and the age of the person affected.
• Injuries are generally classified by either severity or by the
location of damage.[3]
• Trauma may also be classified by demographic group, such as
age or gender.[4]
• It may also be classified by the type of force applied to the
body, such as blunt trauma or penetrating trauma.]
• Major trauma is sometimes classified by body area; injuries
affecting 40% are polytrauma, 30% head injuries, 20% chest
trauma, 10%, abdominal trauma and 2%, extremity trauma[
The symptoms of injury can manifest in many different ways
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Altered mental status
Fever
Increased heart rate
Generalized edema
Increased cardiac output
Increased rate of metabolism
• Pre-hospital
The pre-hospital use of stabilization techniques improves the
chances of a person surviving the journey to the nearest traumaequipped hospital.
Management of those with trauma often requires the help of
many healthcare specialties including physicians, nurses,
respiratory therapists and social workers. Cooperation allows
many actions to be completed at once.
Generally the first step of managing trauma is to perform a
primary survey that evaluates a person's airway, breathing,
circulation, and neurologic status.
• airway obstruction,
• inability to protect the airway, and
• respiratory failure.
• Traditionally, high volume intravenous fluids were given to people
who had poor perfusion due to trauma.[48] This is still appropriate in
cases with isolated extremity trauma, thermal trauma, or head
injuries.[49]
• The current evidence supports limiting the use of fluids for
penetrating thorax and abdominal injuries, allowing mild hypotension
to persist.[4][49]
• Targets include a mean arterial pressure of 60 mmHg, a systolic
blood pressure of 70–90 mmHg, or until adequate ability to think
and peripheral pulses are present.
• As no intravenous fluids used for initial resuscitation have been shown
to be superior, warmed Lactated Ringer's solution, continues to be the
solution of choice.[48]
• If blood products are needed, a greater relative use of fresh frozen
plasma and platelets to packed red blood cells has been found to
improve survival and lower overall blood product use;[53] a ratio of
1:1:1 is recommended.
• Tranexamic acid decreases the mortality rate in people who
are bleeding due to trauma
• positive inotropic medication such as norepinephrine are
sometimes used in hemorrhagic shock
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Aortic aneurysm (ruptured)
Aortic dissection
Air embolism (Arterial)
Bleeding
Cardiac arrest
Cardiac arrhythmia
Cardiac tamponade
Hypertensive emergency
Myocardial infarction (heart attack)
ventricular tachycardia
• Cardiopulmonary arrest occurs as a result of a multitude of
cardiovascular, metabolic, infectious, neurologic, inflammatory,
and traumatic diseases. However, the clinician must be aware of
several specific causes, including drug toxicity or overdose,
myocardial ischemia or infarction, hyperkalemia, torsades de
pointes, cardiac tamponade, and tension pneumothorax.
1. Activate EMS or the designated code team.
2. Perform basic life support (CPR).
3. Evaluate heart rhythm and perform early defibrillation as
indicated.
4. Deliver advanced life support (e.g., intubation, intravenous [IV]
access, transfer to a medical center or intensive care unit).
• A hypertensive emergency is an acute, severe elevation in
blood pressure accompanied by end-organ compromise. In
newly hypertensive patients, a hypertensive emergency is
usually associated with a diastolic blood pressure higher than
120 mm Hg.
• Complications of particular concern include hypertensive
encephalopathy, aortic dissection, and eclampsia.
• IV vasodilator therapy to achieve a decrease in mean arterial
pressure (MAP) of 20% to 25% or a decrease in diastolic
blood pressure (DBP) to 100 to 110 mm Hg in the first 2 hours
is recommended. Decreasing the MAP and DBP further should
be done more slowly because of the risk of decreasing
perfusion of end-organs
• Cardiogenic pulmonary edema results from an absolute in-crease in
left atrial pressure, with resultant increases in pulmonary venous and
capillary pressures.
• Pulmonary edema is diagnosed by the presence of various signs and
symptoms, including tachypnea, tachycardia, crackles (reflecting
alveolar edema), hypoxia (secondary to alveolar edema), and S3 or
S4 heart sounds, or both.
• Mainstays of immediate therapy include improving oxygen delivery
to end organs, decreasing myocardial oxygen consumption, increasing
venous capacitance, decreasing preload and afterload, with careful
attention to MAP, and avoiding hemodynamic embarrassment. All
patients should receive supplemental oxygen to maximize oxygen
saturation of hemoglobin. Administration of continuous positive airway
pressure provides positive airway pressure, increases gas exchange,
and perhaps decreases preload via decreased intrathoracic
pressure.
• acute renal failure
• Generally it occurs because of damage to the kidney tissue caused
by decreased renal blood flow (renal ischemia) from any cause
(e.g. low blood pressure), exposure to substances harmful to the
kidney, an inflammatory process in the kidney, or an obstruction of
the urinary tract which impedes the flow of urine.
• AKI is diagnosed on the basis of characteristic laboratory findings,
such as elevated blood urea nitrogen and creatinine, or inability of
the kidneys to produce sufficient amounts of urine.
• AKI may lead to a number of complications, including metabolic
acidosis, high potassium levels, uremia, changes in body fluid balance,
and effects to other organ systems.
• Management includes supportive care, such as renal replacement
therapy, as well as treatment of the underlying disorder.