Lec 18- Medical Emergencies I

Question 1

Causes of death

Answer 1

• 50M deaths per annum worldwide
• 54% due to the top 10 causes
• IHD and stroke- leading causes of death
• Death from diabetes (extreme glucose levels) rising
• Death from dementia more than doubled between 2000-2015
• Death from diarrhoeal disease almost halved in same period
• HIV/AIDs no longer in the top 10
• RTA- 1.3M deaths in 2015, 3/4 were male

Question 2

Systematic approach

Answer 2

DRABC

• Dangers/Approach to patient
• Response
• Airways
• Breathing
• Circulation

Question 3

Systematic approach

Danger

Answer 3

• Dangers/approach to patient
• Prevent harm to self, patient and others
• Do it consciously
• Consider throughout the event- sharps, electrics, traffic

Question 4

Systematic approach

Response of patient

Answer 4

• A-alert
• V- Voice
• P- pain
• U- unresponsive

Question 5

Glasgow coma scale

Question 6

Systematic approach

Airways

Answer 6

• Clear, partially blocked, occluded
• Triple airways manoeuvre
• Snoring- tounge flap= red flag
• Gargling- needs suction
• Beware- chest might move, but no ventilation
• Foreign body- can’t usually see it if blocking airways

Question 7

Airways blocked by

Answer 7

• Tounge
• Vomit
• Secretions/blood
• Foreign body
• Teeth
• Trauma

Question 8

Breathing

Answer 8

• Normal- 12-20 + chest rise
• Inadequate- <12 or >20 with poor rise
• Respiratory Arrest

Question 9

Signs and symptoms of respiratory distress

Answer 9

• Complaining of difficulty in breathing
• Tachypnoea
• Increased work while breathing
• Use of accessory muscles
• Abnormal breath sounds
• Cyanosis- this should reduce with the use of supplemental oxygen

Question 10

Ventilation

Answer 10

• Mouth-to-mouth
• Bag-valve- mask
• Think rate and depth
• By hand 10-12 per minute

Question 11

Suspected ACS e.g. MI

Answer 11

• Only offer other antiplatelet agents in hospital
• Do not routinely administer oxygen, but monitor oxygen saturation using pulse oximetry as soon as possible, ideally before hospital admission.
• Only offer supplemental oxygen to
  
  • People with oxygen saturation (SpO2) of less than 94% who are not at risk of hypercapnic respiratory failure, aiming for SpO2of 94–98%
  • People with chronic obstructive pulmonary disease who are at risk of hypercapnic respiratory failure, to achieve a target SpO2of 88–92% until blood gas analysis is available.

Question 12

MI

Answer 12

• Monitor people with acute chest pain, using clinical judgement to decide how often this should be done until a firm diagnosis is made
• This should include:
  
  • exacerbations of pain and/or other symptoms
  • pulse and blood pressure
  • heart rhythm
  • oxygen saturation by pulse oximetry
  • repeated resting 12-lead ECGs and
  • checking pain relief is effective.
    *