A patient W Fever,seizures ,traumatic Brain Injury,Poisoning Flashcards
What is the normal temp of a patient
Abnormal temp is ?
What do you do for a child w abnormally high temperature
What about an adult
What are the causes of fever
What Iv fluids will you give to kids and adults
Why do you give IV fluids
How much fluid does your body need in a day
36.1-37.1 is normal
Above 37.5 is abnormal
Make patient stable by reducing the fever and reducing pain if there’s pain(for a child-tepid sponge and NSAID. For an adult-IV NSAID ) Do ABDCE Assess the patient(physical exam and history ) JACCOL HTN J-Jaundice A-anemia or pallor C-cyanosis C-clubbing O-odema L-lymphadenopathy H-hydration or dehydration T-temperature N-nutrition status Do investigations Give treatment(anti-pyretics,IV fluids and others depending on the symptoms or what you think is causing the fever)
Causes of fever should be grouped jn classifications -Infection Fungal,bacterial,viral,parasitic -trauma -hematological -Idiopathic -Neoplastic -Allergic reactions -CNS injury -Hyperthyroidism -Thromboembolic disease -Inflammatory diseases -drug induced fever
Adults- IV fluids : N/S, R/L, DNS 5%
Kids-1/5th NS in 4.3% dextrose
To replace fluids
To maintain fluids
- 0
- 5
What investigations will you do for a patient w fever,state their normal ranges
-FBC:
ESR shows recent inflammation but isnt a good marker for inflammation
C reactive protein is better in checking acute inflammation
Leukocytes ;
Lymphocytes-indicate a viral infection
Neutrophils-bacteral infection
Eosinophils-parasitic infection
Urine R/E
Stool R/E
BF (blood film)or MPC (malaria parasite count)to check for malaria parasites
Thin- A thin blood smear will identify the species of the malaria parasite.
Thick-Thick blood smears are most useful for detecting the presence of parasites, Or number of parasites
In the blood
How do you calculate maintenance dose of IV fluids for adults and neonates and infants or toddlers
How do you calculate replacement dose?
If you vomit once as a child or an adult how much is estimated to be loss?
If you pass watery stools once as an adult or a child how much fluid is estimated to be lost?
Adults:
You use 70kg so 50mls per kg
Neonates:
60mls per kg
Day 2 of giving fluids increase by 20 mls so it’ll be 80 mls per kg
Day 3,increase by 20 so 100 mls per kg
Day 4,increase by 20 so 120mls and so on
So every day increase by 20mls and your limit should be 180 mls
Infants or toddlers:
100mlsper kg
Replacement dose:
Calculate the loss and replace according to the amount estimated to be lost then after that calculate maintenance dose
Watery stool:
Adult- 500mls
Child-125mls
200 or 250? I’m confused saf
Give four examples of baseline tests or investigations
What are diagnostic tests and definitive tests
Which type of test is done first
A) A complete blood test: it generally includes the red cell count, Hi, hct, and corpuscular values. A white cell count with differential. Blood Urea and Creatinin( as well as Creatinine clearance.
B) Liver function test : (Enzymes, etc)
C)Electrolites( Na, K, Cl, etc)
D) Lipid Studies (HDL, LDL, CHOL.,TRIGS,etc
E) Fasting blood glucose
F) Random Urine
G) general blood chemistry
Diagnostic tests are used to confirm or rule out conditions and diseases.
Definitive: final diagnosis that is made after getting the results of tests, such as blood tests and biopsies, that are done to find out if a certain disease or condition is present
1.Baseline tests
2.Diagnostic tests
3.Definitive tests
A high hematocrit as a marker under FBC means what?
A higher than normal hematocrit can indicate: Dehydration. A disorder, such as polycythemia vera, that causes your body to produce too many red blood cells. Lung or heart disease
Which people are ideally supposed to treat seizures but which people treat it in Ghana What is a seizure What is epilepsy What is a convulsion Classify seizures and explain them What is consciousness Give one sign of seizures in neonates
How long should seizures last?
When will a seizure be an emergency?
What is status epilepticus
Psychiatrists treat seizures in Ghana cuz most epilepsy patients have associated psychiatric problems or signs but ideally it’s to be treated by a neurologist
Seizure:uncontrollable electrical discharges in the brain which could be limited to one hemisphere or both
Epilepsy:recurrent seizures
Convulsions: tonic clonic seizure
Types:
According to the international alliance against seizures:
1. Focal or partial seizures-originate from one hemisphere of t brain
2. Generalized seizures -originates from both hemispheres of the brain
Focal seizures can be dviiddd into 3.simple and 4.complex seizures
Simple you don’t lose consciousness during the seizure but complex you lose consciousness (if a patient is well oriented to person,place and time the person is conscious)
- focal or partial to generalized seizure
- Motor seizure- causes motor activity(increased tone and Increased movements )
- Non motor seizure-patient starts behaving differently during the seizure ,patient senses some peculiar smell before the seizure or a familiar place comes to mind before the seizure comes
- Tonic clonic seizures or grand mal seizure : increased tone with uncontrolled movement
- Tonic seizure: increased tone and patient becomes still then there’s increased tone again without uncontrolled movement
- Clonic seizure: patient gets uncontrolled movements all of a sudden
- Myclonic- groups of muscles get uncontrolled movement not the whole body
- Atonic seizures- lose bilateral muscle control. All muscle groups lose control
- Petit mal or absence seizure: patient becomes absent minded for some secs staring in a particular direction and doesn’t hear whatever is said to them till the seizure is over
Rapid eye blinking
6and7 are based on what is observed by on lookers
Less than 5 minutes
Any seizure that lasts for more than five mins is an emergency
SE- seizure lasts for more than five minutes or within a period of five minutes you’re having multiple seizures and SE is an emergency
What are the causes of Seizures:
VITAMINS
What is the most common cause of seizures in the elderly and in kids
V- vascular causes example hemorrhagic shock,hypoperfusion,hypertensive
Encephalopathy,hypertension
I- infections example meningitis,brain abscess,encephalitis
T-Toxins or trauma example bacterial toxins,drugs ,uremia due to CKD
A- Arteriovenous malformations-problem with arteries and veins in the brain
M-metabolism or metabolic abnormalities Example,electrolyte Imbalance, Hyperglycemia,hypoglycemia I-Idiopathic causes N-neoplastic causes (brain tumors,space occupying lesions )
Elderly- UTI
Kids- infections especially cerebral
Malaria
How do you manage a seizure patient in emergency
(Investigations,other procedures)
Max dose of diazepam is what for an adult
What do you do if RBS is low
What is lymphocytosis
Wha investigations will you do for a seizure patient
- Call for help
- Remove objects around from patient to make environment safe
- To stabilize patient,give 1-3 doses of benzodiazepines which are first line drugs for seizures example lorazepam,diazepam. Thirty minutes between each dose
Give the IV drug through the anus if there’s no line during the seizure
b. Give two doses of barbiturates if the first line doesn’t work
Thirty minutes interval between each dose
C. If barbiturates don’t work, give midazolam
If still give propofol and only in extreme cases and be monitoring this patients airway and make an an anesthesia person give it and monitor the patient
It is not given at home
In an ideal situation it should be given in a theatre cuz you need to monitor the patients vitals
PAs don’t give propofol
So if you give all the drugs and still,refer and make sure patient is referred safely on oxygen,IV lines secure,arrange for an ambulance,let a nurse accompany the patient
4.ABCDE- set line,take samples and send to lab
D- RBS and out patient in recovery position( left lateral side) - Find definite cause and correct it when the investigations come
Put patient on seizure chart to check the number of times the patient gets the seizure and the duration of each seizure and every 15 minutes check if patient gets a seizure
If no seizure, check every thirty minutes
If still no seizure check every one hour
RBS,FBC,BF,BUE,lumbar puncture, Urine RE to check for UTI
CT scan
MRI
High lymphocytes and penia is low
20 mg for adults, give 20 mg diazepam diluted in 500 mls of N/S for kids
Give 50 mls of 50 percent dextrose slowly through IV not fast then flash w normal saline
What is a TBI
Damage to the Brian can be what or what
What processes injure the brain
Swelling can cause what?
A form of acquired brain injury that occurs when a sudden trauma causes damage to the brain . Loss of consciousness does not need to occur
Focal: confined to one area of the brain
Diffuse: involves more than one area of the brain
TBI can result from a. A closed head injury(injury not visible to the eye. Object doesn’t break through skull)
b. Penetrating head injury (object pierces through skull
- bruising (bleeding) : brain tissue is squished against skull and blood vessels may tear . When they tear they release blood into areas of the brain in an uncontrolled
-tearing: part of the brain is taken away. this leads to damage to nerve cells
-Swelling: swollen brain mass pushes against the skull. Fluid accumulation the cells of the brain. primarily form inflammatory response to injury leading to increase ICP
The skull has a fixed space so when there’s swelling of the brain the brain tries to look for an outlet to contain its increased size so it pushes through the foramen magnum ( hole under the skull where the spinal cord meets the skull) . Herniation occurs when the swollen brain push through th foramen magnum . The medulla Oblongata comes down and th vertebrae pushes against the medulla oblongata. Aiding respiratory Centre to shut down
Causes and risk factors of TBI
Due to transportation accidents:
People under 75 get TBI more through the accident
People above 75 ,the brain shrinks causing more space in the skull. When they fall down or there’s a trauma that’ll cause the brain to shake violently,the vessels tear and blood fluid leaks into the epidural space causing epidural hematoma
Violence can cause TBI
Sports injuries
Alcohol use
How will an old TBI patient present
What are the signs of TBI(mild,moderate,severe)
Small children with moderate to severe TBI may show some of these signs as well as signs specific to young children, such as persistent crying, inability to be consoled, and/or refusal to nurse or eat
True or false
Old person falls down,gets confused or disoriented,becomes fine,collapses after he or she is fine
Mild -Consciousness +(-) –Feel dazed or not like himself for days or weeks –Headache –Confusion –Lightheadedness –Dizziness –blurred vision or tired eyes
ringing in the ears •bad taste in the mouth •fatigue or lethargy •a change in sleep patterns •behavioral or mood changes •trouble with memory, concentration, attention, or thinking
moderate-Moderate/Severe: symptoms of mild plus
–headache that gets worse or does not go away
–repeated vomiting or nausea
–convulsions or seizures
–inability to awaken from sleep
–dilation of one or both pupils of the eyes
slurred speech
–weakness or numbness in the extremities
–loss of coordination and/or increased confusion, restlessness or agitation
severe symptoms
Especially injury due to swelling takes time to show so detain patient to observe cuz the signs will show or discharge and educate patient about the danger signs so he rushes to the hospital when the sign is seen
Name the signs seen when the seizure affects the different parts of the brain
Symptoms depends on which part of the brain is affected
•Temporal lobe seizures
–Epigastric discomfort, déjà vu, a smell or taste
•Frontal lobe seizures
–Head turning, jerking of a limb or speech arrest.
•Parietal lobe seizures
–Lateralized sensory symptoms e.g. pain or tingling
•Occipital lobe seizures
–Elementary visual hallucinations (colours and shapes) in the contralateral visual field
Name six ddx for epilepsy and two complications
Syncope (eg, cardiac arrhythmia, vasovagal syncope)
•Metabolic conditions (eg, hypoglycemia)
•Migraine (eg, migrainous aura, migraine equivalent)
•Vascular conditions (eg, transient ischemic attacks, stroke)
•Sleep disorder (eg, cataplexy, narcolepsy, night terror)
Movement disorder (eg, paroxysmal dyskinesia)
•GI conditions (eg, esophageal reflux in neonates and infants)
•Psychiatric conditions (eg, conversion, panic attacks, breath-holding
spells,malingering)
COMPLICATIONS •Status Epilepticus –More than 30 minutes of continuous seizure activity or two or more sequential seizures without full recovery of consciousness between seizures •Social –Social handicap and exclusion –Educational underachievement Unemployment –Inabililty to drive –Parents may have to delegate care –Stigmatization
What are the types of TBI
When do they occur
Concussion
–most minor and the most common type of TBI
–is a short loss of consciousness in response to a head injury
•Contusion
–A contusion is a distinct area of swollen brain tissue mixed with blood released from broken blood vessels
A contusion can also occur in response to shaking of the brain back and forth within the confines of the skull ( look up contrecoup) –Skull fractures –Hematomas: 3 types •Epidural •Subdural •Intracerebral –Anoxia
How do you diagnose TBI:
History
–should be self-evident
–consider trauma with intracerebral pathology in any patient with a coma of unknown etiology
–An eyewitness account may be crucial especially in the initial confused states
•Examination should include
–Thorough neurological exam including cranial nerves
–Glasgow coma score: mainstay of rapid neurologic assessment in acute head injury
