Download Slide 1 - UnionED

General Medical
Emergencies
SPECIFIC CONDITIONS







REYE’S SYNDROME
GOUT
FEVER
ALLERGIC REACTION
FLUID AND ELECTROLYTE
COMA
HEMATOLOGICAL EMERGENCIES
REYE’S SYNDROME
A 19 month old child with respiratory
distress is seen in the ED. Diagnosis of
croup is made.
The parents must be told that during
the child’s illness, the following meds
should not be administered.
A. Antitussives
B. Acetaminophen
C. Acetylsalicylic acid
D. Decongestants
ANSWER
C
ACETYLSALICYLIC ACID HAS
CORRELATED WITH REYE’S
SYNDROME WHICH CAN CAUSE
FETAL ENCEPHALOPATHY
REYE’S SYNDROME FREQUENTLY
FOLLOWS VIRAL INFECTIONS SUCH
AS CROUP
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
ASSESSMENT
SUBJECTIVE DATA
ONSET
MEDICAL HISTORY
OBJECTIVE DATA



PHYSICAL EXAM
NEUROLOGICAL STATUS
GASTROINTESTIONAL STATUS
DIAGNOSTIC PROCEDURES






AMMONIA LEVEL
EMZYME LEVELS
PT, PTT
CHEM 7
ABG
CSF
PLANNING AND
INTERVENTION





ABC
O2
IV FLUIDS
GIVE DEXTROSE TO COUNTERACT
HYPOGLYCEMIA
MEDS – MANNITOL, STERIODS
GOUT
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
DIAGNOSTIC PROCEDURE



URIC ACID
WBC IN SYNOVIAL FLUID
HYPERCALCEMIA
PLANNING AND
INTGERVENTION




ANTINFLAMMATORY AGENTS
WEIGHT REDUCTION
DIET – AVOID ALCHOL,HIGH PURINE
AVOID THIAZIDE DIURETICS
FEVER
SUBJECTIVE DATA






HISTORY OF PRESENT ILLNESS
PREVIOUS SIMILAR EPISODE
FEVER DEGREE AND PERSISTENCE
OTHER SYMPTOMS
IN CHILDREN FLUID INTAKE
MEDICAL HISTORY
OBJECTIVE DATA


PHYSICAL EXAM
DIANOSTIC PROCEDURES
LABS
X-RAYS
LUMBAR PUNCTURE
PLANNING AND
INTERVENTION





ABC
CONTROL TEMPERATURE > 101
MEDICATIONS
FLUIDS
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



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
FLUID AND ELECTROLYTE
EMERGENCILES
ELECTROLYTE
ABNORMALITIES




SODIUM
POTASSIUM
CALCIUM
MAGNESIUM
SODIUM



NORMAL WATER BALANCE
IMPULSE CONTROL
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

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





CBC
ELECTOLYTE LEVE
CHLORIDE
BUN AND CREATININE LEVELS
UA
PLANNING AND
INTERVENTION





ABC
IV FLUIDS
REPLACE SODIUM ORALLY OR IV
PROTECT FROM INJURY (SEIZURES)
I&O
QUESTION

Which of the following assessment
findings is NOT true commonly
associated with hypernatremia?
A.
B.
C.
D.
Confusion
Decreased cardiac output
Skeletal muscle weakness
Increased urinary output
ANSWER
D
HYPERNATREMIA
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
POTASSIUM ABNORMALITIES
HYPOKALEMIA







LEVEL BELOW 3.5 mEq/L
LOW INTAKE
GASTROINTESTIONAL LOSSES
RENAL LOSSES
DIABETIC ACIDOSIS TREATMENT
BURNS
OVERHYDRATION
SUBJECTIVE DATA






GI UPSET
WEAKNESS AND FATIQUE
SOB
CRAMPS
FREQUENT URINATION
CONSTIPATION
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
OBJECTIVE DATA




MENTAL CONFUSION
WEAKNESSS
DYSRHYTHMIAS
BRADYCARDIA
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 ABNORMALITIES
CALCIUM




LEVELS ARE REGLULATED BY
ENDOCRINE SYSTEM
FACTOR IV IN THE BODY’S
CLOTTING CASCADE
TRANSMISSION OF
NEUROMUCSCLAR IMPULSES
IMPORTANT IN BONE FORMATION
Patients with hypocalcemia
demonstrate which of the following
EKG changes?
A. SHORTENED PR INTERVAL
B. PROLONGED PR INTERVAL
C. PROLONGED QT INTERVAL
D. U WAVE
ANSWER C

IMPARMENT OF CARDIAC
CONTRACTILITY RESULTS FROM
HYPOCALCEMIA. SHOWN IN EKG AS
PRLONGED QT INTERVAL.
PREDESPOSES THE PATIENT OT
VENTRICULAR TACHYCARDIA
(TORSADES DE POINTES)
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
SUBJECTIVE DATA




ANOREXIA,VOMITING AND
DIARRHEA
WEAKNESS
LETHARGY
POLYURIA
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
MAGNESIUM ABNORMALITIES
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
DIAGNOSTIC


LABS
ECG
PLANNING AND
INTERVENTION




ABC
IV
CARDIAC MONITORING
GIVE MAGNESIUM
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
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
DIAGNOSTIC



ABC
LABS
X-RAYS / CT
PLANNING AND
INTERVENTION





ABC
INTUBATION TO PROTECT AIRWAY
IV
NG
VITAL SIGNS
HEMATOLOGIC
EMERGENCIES
CLOTTING ABNORMALITIES



DIC
HEMOPHILIA
THROMBOCYTOPENIA PURPURA
QUESTION
THE MOST SIGNIFICANT CLINICAL
FEATURE OF DIC IS?
A.
B.
C.
D.
HEMOPYUSIS
PETECHIAE
ABNORMAL BLEEDING
HEMATURIA
ANSWER C
THE MOST SIGNIFICANT CLINICAL
FEATURE OF DIC IS ABNORMAL
BLEEDING SUCH AS HEMOPTYSIS,
PETECHIAE, OR HEMATURIA
WITHOUT HISTORY OF A SERIOUS
BLEEDING DISORDER.
DISSEMINATED INTRAVASCULAR
COAGULATION



DIFFUSE MICROVASCULAR
COAGULATION
DEPLETES THE CLOTTING FACTOR
IMPAIRS HEMOSTATIS
SUBJECTIVE DATA





BLEEDING FOR
ANY SITE
DIZZINESS
RASH
EXCESSIVE
BRUISING
MASSIVE BLOOD
TRANSFUSION






ABRUPTIO
PLACENTEA
TRAUMA
NEOPLASM
SNAKE BITE
ARDS
HEPATIC DISEASE
OBJECTIVE DATA







PETECHIEA, PURPURA
ECCHYMOSIS
BLEEDING
HEMATURIA
LOC
HEMATEMESIS
ARDS
DIAGNOSTIC





PLATELET COUNT
PT, PTT
FIBRINOGEN LEVEL
H&H
TYPE AND CROSS
PLANNING AND
INTERVENTION





A LINE
CARDIAC RATE AND RHYTHM
URINE OUTPUT
CLOTTING TIME AND PLATELET
COUNT
REPLACE CLOTTING FACTORS
QUESTION

HEMARTHROSIS ESPECIALL OF THE
KNEES, ELBOWS, AND ANKLES, IS
COMMON FINDING IN HEMOPHILIA
OTHER S & S INCLUDE
A. Bruising and bleeding gums
B. Neuropathy and paresthesia
C. Pain and hematuria
D. All of the above
ANSWER

D
Bleeding near peripheral nerves
causes neuropathy, pain,
paresthesia, and muscle atrophy.
Bleeding gums and hematuria,
unrelated to trauma is very common.
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
SICKLE CELL
SUBJECTIVE DATA



PAIN
IMPAIRED GROWTH PATTERNS
INFECTIONS
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
PLANNING AND
INTERVENTION





O2
IV FLUIDS
ANALGESIC
REVERSE DEHYDRATION
BED REST