Medical Emergencies Flashcards
What are the basic symptoms of asthma ?
Wheezing
Breathlessness
Chest tightness
Cough
bronchospasm
Excess mucus secretion and plugging of the airways
3 main categories of asthma, and signs of each?
Signs of moderate asthma exacerbation:
Normal speech
Peak expiratory flow rate (PEFR) > 50% predicted best
No features of severe asthma
Signs of acute severe asthma – any 1 of:
Cannot complete full sentences
Pulse >110 / min
Respiratory Rate >25 / min
PEFR 33-50% predicted best
Signs of life-threatening asthma – any 1 of:
Feeble respiratory effort
‘Silent chest’
Cyanosis
Oxygen saturations <92%
PEFR <33%
Exhaustion, confusion, altered consciousness
How do we manage asthma ?
SABCDE
CALL FOR HELP early
Any life-threatening features – refer to hospital
Sit the patient up
Oxygen - 10-15 L/min via a non-rebreathe mask
Encourage use of athlete’s own inhaler
Nebulisers - Salbutamol 5 mg (Ventolin®) & Ipatropium 500 mcgs (Atrovent®)
Steroids - Prednisolone 40-50mg PO* If necessary, repeat salbutamol nebuliser with partial or no clinical improvement – so called ‘back-to-back’ nebs. This can prove a highly effective treatment. The nebuliser should be driven with oxygen.
Symptoms of hypoglycaemia?
Confusion
Lethargy
Hunger
Aggression
Seizures
Coma
Symptoms and signs of autonomic dysfunction are:
Sweating
Pallor
Tachycardia
Vomiting
Hypoglycaemia mangament
SABCDE +FG (GLUCOSE)
If conscious: provide glucose of 10-20g via any form.
If unconscious:
Remember oxygen
Recovery position
IV 5 mls/kg 10% dextrose
IM glucagon 1 mg
Hypostop®
Use the buccal mucosa as above with any sugary substance available
Seizures: Symptoms and signs?
May be preceded by visual, auditory or olfactory aura - minutes before
Generalised or local tonic +/- clonic activity
Urinary +/- faecal incontinence
Tongue biting
A post-ictal period. The seizure will have stopped and the patient remains sleepy with low GCS. This may last minutes to hours but should be improving over time.
Management of seizures:
SABCDE - airway is priorty for siezures, dont try to restrain.
Most seizures will self-terminate within a few minutes. It is reasonable to use this time to ensure the airway is patent, that oxygen is being delivered to the patient, and to check the capillary blood glucose (CBG). If the CBG is low, this should be corrected as described earlier in the chapter. If the seizure does not self-terminate, it may be necessary to administer drug therapy.
Anaphylaxis: Symptoms and signs?
Sudden onset breathing/ airway or circualtion probelms.
changes to the skin- rash, swelling.
nusea/ vomiting
Anaphylaxis treatment.
SABCDE - Eearly recognisiona nd adrenalin are key.
Remove allergen if possible.
Airway Protect early
Breathing
Nebulised salbutamol 5 mg if wheezy. Repeat if necessary – May require several administrations
Circulation
IM adrenaline 0.5 mls 1:1000 (500 mcg)
IV access and give fluids (may need to be aggressive with fluid resuscitation. Note: NICE guidelines regarding fluid resuscitation do not apply in medical cases)
Minor heat ilness: Catorgisions, sysmptoms, treatment?
Core temperature above normal, but to less than 40°C.
muscle cramps, hyperventilating,Vasodilation & hypotension.
Removed to a cool environment. Actively cool the patient, including fanning, or spraying with lukewarm water.
Major Heat Illness: What is it, Stmptoms, treatment.
Core temp 40c or higher.
Confused and irritable, but this may rapidly progress to collapse with a reduced conscious level, seizures and later decerebrate posturing.
neurological abnormality
Tachycardic and tachypnoeic + Hypotension
Removed to a cool environment. Actively cool the patient, including fanning, or spraying with lukewarm water.
SABCDE
High flow oxygen should be administered via a non-rebreathe mask
Hypothermia - treatment.
SABCDE
remove the patient from the cold environment, remove any wet clothes and gently dry the skin.
re-dress pateints in warm dry clothers, or a bath if avaliable for more severe cases, if acvpu and abcde are clear.
Near Drowning
Treament
Pateint kept supine
SABCDE are done with high flow oxygen.
Be aware of vomiting, as very common issue with near drowing. compounded by breathing mask apparatues.
For non contact medical emergensies, what accronmy do we use to support us through ?
SAMPLE
Signs and symptoms
Allergies
Medication
Past medical history
Last meal
Events
