Disability Flashcards
What can cause a reduced level of consciousness? (4)
Things that would be addressed in ABC
- profound hypoxia
- hypercapnia
- hypotension (reducing cerebral blood flow)
Things to be addressed in D:
- drugs - can give antagonists e.g. naloxone
- hypoglycaemia
- head injury
Describe how you would approach the Disability part of the ABCDE assessment.
I would
- Assess AVPU (Alert, responds to voice, responds to pain, unresponsive).
- Examine the pupils; size, equality and reaction to light.
- Head injury? - CT head
- Check the patient’s drug chart.
- Overdose? - antidotes?
- Measure the blood glucose
- Hypoglycaemia - IV 50ml of 10% glucose every minute till consciousness regained (maximum of 250ml)
- Check the temperature.
Pupil size - left side dilated
Light response - left side fixed
left 3rd nerve compression (secondary to uncal herniation if brain injury –> raised ICP)
Pupil size - bilaterally dilated
Light response - bilaterally sluggish and fixed
either:
- poor CNS perfusion
- bilateral 3rd nerve palsy
Pupil size - equal
Light response - right sided RAPD
Diagnosis?
Right sided optic nerve injury
Pupil size - bilaterally constricted
Light reflex - difficult to assess
Diagnosis?
Either:
- Opiates
- Pontine lesions
- Metabolic encephalopathy
How would you treat hypoglycaemia in an unconscious patient?
150ml of 10% glucose over 15 mins
What is hypothermia?
Body temperature <35degrees
What are the risk factros for hypothermia?
- elderly or very young
- alcohol or drug ingestion
- exhaustion
- illness
- injury
- neglect
How should temperature be measured when suspecting hypothermia?
Core temperature needs to measured using a low-reading thermometer which measures the temperature of the lower third of the oesophagus
(Bladder and rectal temperatures lag behind core temperature and are not recommended in patients with severe hypothermia)
What abnormal ECG finding is suggestive of hypothermia?
J waves (positive deflection at the J point (just after the QRS complex), most prominent in the precordial leads. This shown in the ECG below.
As core temp decreases, sinus bradycardia –> atrial fibrillation –> VF –> asystole
Why should you take extra precaution when diagnosing death in a hypothermic patient?
Hypothermia can produce a very slow, small-volume irregular pulse and unrecordable blood pressure
‘no one is dead until warm and dead’
How should you rewarm a mildy hypothermic (35-32) conscious patient?
These patients will be shivering so passive re-warming is suitable:
warm room, using warm blankets, clothing and warmed intravenous fluids
What active internal methods for rewarming can be adopted and when are they used?
severe hypothermia <28 degrees
invasive surgical re-warming techniques - eg, VA-ECMO
haemodialysis can be used where there is no circulatory arrest
What is heat stroke?
Heat stroke is a systemic inflammatory response with a core temperature >40.6degrees accompanied by a change in mental state and varying levels of organ dysfunction.
