Management of medical emergencies Flashcards
What is the sequence for ALS?
Check for danger Airway Assess for signs of life Airway adjuncts Breathing Non re-breath mask 15L/min Chest compressions Shockable rhythms Drugs to consider Reversible causes
What are some reversible causes for stopping breathing?
What is the adult choking treatment?
What is asthma?
A leading cause of death in young adults Cardiac arrest in the asthmatic is often a terminal event due to: Severe bronchospasm and mucous plugging Cardiac arrhythmias due to hypoxia Dynamic hyperinflation due to gas trapping and increased transthoracic pressure Tension pneumothorax – often bilateral.
What are the signs someone’s having an asthma attack?
A – Noisy laboured breathing +/- wheeze May be unable to complete sentences Accessory muscles of respiration
B – RR , if slow may be terminal, PEF < 50%, SpO2
Wheeze on auscultation, ? Tracheal deviation, ? Hyper-resonance
C – Heart rate
D – Initially alert but may deteriorate rapidly
E – Cyanosis = late /terminal event
How should you treat someone with an asthma attack?
O2,
Nebulised salbutamol 5mg
Oral prednisolone 40-50mg
ABG’s
Repeat nebulisers every 15 mins
Consider IV magnesium sulphate 1.2 – 2g over 20 mins
Correct fluid / electrolyte disturbances esp K+
Chest x-ray
Admit
What is anaphylaxis?
Severe, life-threatening, systemic hypersensitivity reaction
Rapid changes in Airway +/- Breathing +/- Circulation
usually with skin and mucosal changes.
What are the signs and symptoms of anaphylaxis?
Airway swelling
Lip and tongue swelling
Difficulty in breathing and swallowing
Globus Hoarse voice
Dysphagia
Stridor
Skin changes often the first feature and are present in over 80% of anaphylactic reactions:
- Erythema patchy, or generalised
- Urticaria (hives) anywhere on the body
- Angioedema swelling of mucosa
- Eyelids, throat, tongue, lips.
What’s the management of anaphylaxis?
IM doses of 1:1000 adrenaline (repeat after 5 min if no better)
- Adult or child more than 12 years: 500 micrograms IM (0.5mL)
- Child 6 ‐12 years: 300 micrograms IM (0.3mL)
- Child 6 months ‐ ?6 years: 150 micrograms IM (0.15mL) •Child less than 6 months: 150 micrograms IM (0.15mL)
Steroids
Antihistamines
Oxygen
IV fluids
500 – 1000 ml IV bolus in adults
20 ml/Kg IV bolus in child
Monitor response – give further bolus as necessary crystalloid (0.9% sodium chloride or Hartmann’s)
Avoid Colloid, if colloid thought to have caused reaction
What are some acute coronary syndromes?
- Unstable Angina
- Non ST elevation MI
- ST elevation MI
How can you assess for acute coronary syndromes?
A – Short of Breath – O2
B – Shallow and fast
C – Tachycardia / BP /Cap refill variable
D – AVPU - A
E – Peripheral oedema
How can you manage acute coronary syndromes?
Morphine – IV
Oxygen – High flow
Nitrates
Aspirin – 300mg orally crushed or chewed
Keep patient sitting up and consider an anti-emetic
What is epilepsy?
Aura/Warning
Immediate loss of consciousness
Rigid (tonic phase)
Widespread jerking (clonic phase)
Incontinence
Flaccid after a few minutes
Consciousness is regained after a variable period
Patient may remain confused
What triggers epliepsy?
Hunger
Some drugs
TCA’s
Alcohol
External stimuli, flashing lights etc
Non compliance with medications
What is the management of epilepsy?
A-Maintain patent airway.
B- Give Oxygen
C
D-U on AVPU scale
E-Convulsions
Prevent patient form damaging themselves
Recovery position after fits have ceased
No medications, await recovery
What should you do if someone is in status epilepticus?
Epileptic seizure or repeated seizures lasting 30 mins + Mortality of 20%
Maintain airway & give oxygen
Call an ambulance, transfer to hospital
Check blood glucose
If seizures persist for 5 mins give 10mg midazolam (buccal/intranasal/IV/IM/PR)
Repeat if no recovery within 10 minutes
Transient convulsions can occur during fainting due to cerebral anoxia
What is hypoglycaemia?
Rapid onset
Irritability
Sweating
Rapid/full pulse
Shaking/fitting
Blood glucose <3mmol/l
Unconsciousness
What is hyperglycaemia?
Slow onset
Drowsy
Dry mouth/skin
SOB
Slow/weak pulse
Ketoacidosis (pear drops)
Blood glucose >10mmol/l
What is the management of hypoglycaemia?
Glucose tablets/powder
“Hypostop” gel
If unconscious give 50ml 50% glucose IV
SC glucagon 1mg
What is choking?
Airway Obstruction (partial/complete)
Coughing and spluttering
Difficulty breathing
Breathing noisy, wheeze or stridor
“Paradoxical “ chest or abdominal movements
Cyanosed
Loss of consciousness
What is the management of choking?
Allow patient to cough vigorously
Removal of any obvious FB’s from mouth/pharynx
5 back slaps followed by 5 abdominal thrusts
If unconscious start CPR
What causes syncope? (fainting)
Pain
Anxiety
Fatigue
Fasting
High temperature and humidity
What happens in syncope?
Caused by a lack of oxygen reaching the brain e.g. overstimulation of IX, hypotension
Premonitory dizziness, weakness & nausea
Pallor and sweating
Cold moist skin
Pulse initially slow & weak, becoming full & bounding
Low blood pressure
Loss of consciousness
What is the management of syncope?
Lay flat & lift legs (the patient’s)
Loosen tight clothing around neck
Monitor pulse
Give sweetened drink on regaining consciousness
Exclude other causes
What is adrenal insufficiency?
Acute deficiency of cortisol and aldosterone when the demand exceeds adrenal glands production. Happens if there’s an abrupt withdrawal of steroids or in periods of physiological stress.
May also be brought about by:
- Infection
- Trauma
- Surgery
- Pregnancy
- General anaesthesia
- Hypermetabolic states
What are the signs and symptoms of adrenal insuffiency?
Hypotension, especially postural Weak/confused
Circulatory collapse may be severe with feeble rapid pulse and soft heart sounds
Pyrexia is common and may be due to underlying infection. Anorexia, nausea, vomiting, acute abdo pain
The patient may show increased motor activity progressing to delirium or seizures
What’s the management of adrenal insufficiency?
Lay flat and raise legs
Give oxygen
Hydrocortisone 200mg IV Fluids ++ IV
Treat the underlying precipitating disorder, e.g. infection, with antibiotics
Ambulance & transfer to hospital
What’s SBAR?
Written/verbal communication of events:
Situation
Background
Assessment/Actions
Response/Recommendations
What is the AVPU scale?
(an acronym from “alert, voice, pain, unresponsive”) is a system by which a first aider, ambulance crew or health care professional can measure and record a patient’s responsiveness, indicating their level of consciousness.
