RESPIRATORY EMERGENCIES CASE
ASSESSMENT
PATHOPHYSIOLOGY
STA STATUS TUS ASTH ASTHMA MATI TICU CUS S
Onse Onsett Provocation Quality Radiation Severity
Acute asthatic attac! involves air"ay o#struction due to $ %& 'ron 'ronch chos os(a (as s )& S"el S"elli lin* n* o+ o+ uc ucou ous s e#ranes ,& Mucu Mucus s sec secre reti tion ons s
SAMPLE Hx
PULMO4AR6 E8EMA
CHRO4IC O'STRUCTI3E PULMO4AR6 8ISEASE COP8B Chronic 'ronchitis
Provocation$ %& Res( es( In+e In+ect ctio ion n )& Eot Eotio iona nall Stre Stress ss ,& Alle Aller* r*ic ic Rea React ctio ion n Excess 9LUI8 'UIL8 UP in the lun*s o+ten caused #y MI or related heart disease and occasionally #y inhalation o+ so!e and or toxic +ues& Alveoli colla(se due to adhesive (ro(erty o+ H)O&
•
•
•
Pulonary E(hysea
•
Re(eated Re(eated in+ections thic!en and destroy the linin* o+ the #ronchi and #ronchioles causin* narro"in* and #ecoin* o#structive #y too uch MUCUS and E5CESSI3E CO4TRACTIO4S o+ the uscle in their "alls& Alveoli o+ the lun*s #ecoe in0ated or over distended "ith tra((ed air ay #urst and er*e to a!e +e"er #ut lar*er alveoli
SIGNS AND SYMPTOMS %& )& ,& /& 1& 2&
%& )& ,& /& 1& 2& ;& <& =& %?& %?&
Anxiety Patient Patient #reathes #reathes throu*h throu*h (ursed (ursed li(s -hee.in* Ches Chestt ove overi rin0 n0at ated ed Tachy achyca card rdia ia Tri(o ri(od d (ost (ost
RAPI8 API8 HEA HEAR RT RATE RATE Cyanosis 8iste 8istende nded d 4ec 4ec! ! 3eins eins -hee.in* 9rothy rothy or or 0ec! 0ec!ed ed s(ut s(utu u -ater ater :lle :lled d s(on s(on*y *y lun* lun* 8ys(nea 9rothy rothy 0uid 0uid in in #ron #ronchi chi Cool Cool>> Cla Cla y y s!i s!in n Ede Edea a
MANAGEMENT 3E4TILATIO4 O567E4 POSITIO4
%& )&
%&
H i* i* h 9l o" o" O) O) Consider PEEP@CPAP
3enti entila late te "ith "ith %?? O)&
TRANSPORT CONSIDERATION IMME8IATE "hile onitorin* vital si*ns&
IMME8IATE
causin* reduction in the lun*Ds sur+ace areaB Less oxy*en throu*h "alls o+ the alveoli and into the #loodstrea&
Astha
Sae as Status Asthaticus
Hy(erventilation Syndroe
A#noral increase in res(iration rate and tidal volue& Anxiety o+ an eer*ency o+ten leads to hy(erventilation& Could cause acidosis& 9oration o+ #lood clot in a dee( vein due to 3IRCHO-DS TRIA8$ Stasis Hy(ercoa*ulation 'lood vessel endothelial daa*e , chance Pulonary E#olis "ill !ill your (atient&
8A47ER SI74S %& Loss Loss o+ -hee -hee.i .in* n* )& Chan*e Chan*e in in Sensor Sensoriu iu Con Con+us +usion ion>> Irrita#ility> Lethar*yB ,& Hy(oxia
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Prevent Lethal Hy(oxia
8e(endin* on the level o+ hy(oxia&
Reassurance Reassurance and instruct the (atient to slo" do"n #reathin*&
8e(endin* on the severity&
•
8ee( 3enous Thro#osis and PULMO4AR6 EM'OLISM
Onset Provocation Quality Radiation Severity SAMPLE Hx
• • •
'lood clot in dee( veins *oes to the lun*s and interru(t #lood 0o" to the lun*s&
AFected extreity$ Pain+ul S"ollen Red -ar Su(er:cial 3eins En*or*ed
IMME8IATE
• • • • •
Pulonary E#olis %& LOC LOC rest restle less> ss> anxiet anxiety y C %& Ra(i Ra(id d hear heartt rate rate )& Cold Cold cla clay y s!in s!in ,& 9allin* allin* #lood #lood (ressu (ressure re /& 8iste 8istende nded d 4ec 4ec! ! 3eins eins 1& Cyanosis AG' %& )& ,&
Res(iratory In+ections Crou(
Onset Provocation
3iral U((er Air"ay
Shar( Shar( and and sta## sta##in* in* chest chest (ain (ain Sudden Sudden une unex(l x(lain ained ed dys(n dys(nea ea Cou* Cou*h h @ @ #loo #lood d
A*itated and 'ar!in*
3E4TILATE "ith %?? O)
causin* reduction in the lun*Ds sur+ace areaB Less oxy*en throu*h "alls o+ the alveoli and into the #loodstrea&
Astha
Sae as Status Asthaticus
Hy(erventilation Syndroe
A#noral increase in res(iration rate and tidal volue& Anxiety o+ an eer*ency o+ten leads to hy(erventilation& Could cause acidosis& 9oration o+ #lood clot in a dee( vein due to 3IRCHO-DS TRIA8$ Stasis Hy(ercoa*ulation 'lood vessel endothelial daa*e , chance Pulonary E#olis "ill !ill your (atient&
8A47ER SI74S %& Loss Loss o+ -hee -hee.i .in* n* )& Chan*e Chan*e in in Sensor Sensoriu iu Con Con+us +usion ion>> Irrita#ility> Lethar*yB ,& Hy(oxia
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Prevent Lethal Hy(oxia
8e(endin* on the level o+ hy(oxia&
Reassurance Reassurance and instruct the (atient to slo" do"n #reathin*&
8e(endin* on the severity&
•
8ee( 3enous Thro#osis and PULMO4AR6 EM'OLISM
Onset Provocation Quality Radiation Severity SAMPLE Hx
• • •
'lood clot in dee( veins *oes to the lun*s and interru(t #lood 0o" to the lun*s&
AFected extreity$ Pain+ul S"ollen Red -ar Su(er:cial 3eins En*or*ed
IMME8IATE
• • • • •
Pulonary E#olis %& LOC LOC rest restle less> ss> anxiet anxiety y C %& Ra(i Ra(id d hear heartt rate rate )& Cold Cold cla clay y s!in s!in ,& 9allin* allin* #lood #lood (ressu (ressure re /& 8iste 8istende nded d 4ec 4ec! ! 3eins eins 1& Cyanosis AG' %& )& ,&
Res(iratory In+ections Crou(
Onset Provocation
3iral U((er Air"ay
Shar( Shar( and and sta## sta##in* in* chest chest (ain (ain Sudden Sudden une unex(l x(lain ained ed dys(n dys(nea ea Cou* Cou*h h @ @ #loo #lood d
A*itated and 'ar!in*
3E4TILATE "ith %?? O)
E(i*lotitis
Pneuonia
'acterial Quality Radiation Severity SAMPLE Hx
%&
3irus> 'acteria> 9un*i 8evelo(s in days 6oun* 6oun* children and elderly are at hi*h ris! Alveoli in+ected decrease in O) that leads to dys(nea&
S"ellin* cause air"ay o#struction )& 8ROO 8ROOLI LI47 47 SALI SALI3 3A 8ys(nea
CARDIOVASCULAR CARDIOVASCULAR EMERGENCIES CASE
ASSESSME4T
PATHOPHYSIOLOGY
An*ina Pectoris
OPQRSTA
Sudden (ain "hen (ortion o+ the yocardiu is not receivin* enou*h oxy*enated #lood
SIGNS AND SYMPTOMS %& )& ,& /& 1&
JInd JIndi* i*es esti tion onK K Chest Chest (ain (ain that that coe coes s a+ter a+ter exertion Chest Chest (ain (ain that that last lasts s only only +or a +e" inutes Relie Relieve ved d a+te a+terr adin adin o+ nitro*lycerins SO'> SO'> 4ause 4ausea> a> incr increa eased sed (uls (ulse e rate
MANAGEMENT %& )&
,&
4. ACUTE M6OCAR8IAL I49ARCTIO4 Silent MI (atient doesnDt +eel any (ainB
Heart Attac! Portion o+ the yocardiu dies due to de(rived coronary #lood 0o"&
%&
)& ,&
Chest Chest Pain Pain rel rel to to stres stress s and exertion or even at rest& Ori*inates +ro sternu sternu #ut radiate to ar> nec!> and a" and descri#ed as shar(> sNuee.in* or thro##in* (ain Pain Pain lasts lasts ,? ,? inut inutes es to sev sever eral al hours& Acco Acco(an (anie ied d dys(nea dys(nea>> nausea> nausea> dia(horesis> di..iness> and 9EELI47 O9 IMPE48I47 8OOM&
Hi *h *h 0o 0o " O) asa(& A ss ss is is t in nitro*lycerin adin i+ systo 'P is *reater than =? !no" i+ adinistered already and !no" ho" any tiesB Plac Place e in rest rest+u +ull and co+orta#le (osition& Reassure&
Conscious: %& Hi*h Hi*h conc& onc& O) )& ee( ee( (at (atie ient nt cal and still& ,& Ta!e a!e the the Hx and and 3S& /& Hel( Hel( (ati (atien entt "ith (rescri#ed edications 1& Trans rans(o (ort rt iediately in
TRANSPORT CONSIDERATION LI7HTS O4L6 O4L6
Transpor i!!"#ia"$% in sei sittin* (osition& &ui" ranspor little or no use o+ sirenB
/&
Si*ns o+ shoc!
2&
sei sittin* (osition& Quiet trans(ort little or no use o+ sirenB Mo ni ni to to r 3S throu*hout care and trans(ort
Unconscious: %& Esta Esta#l #lis ish h and and aintain Air"ay& )& Provide CPR@8e:# i+ needed& PP3 i+ needed throu*h '3M& ,& Hi*h Hi*h conc& onc& O)& O)& /& Trans rans(o (ort rt iediately in sei sittin* (osition& Quiet trans(ort little or no use o+ sirenB 1& Mo ni ni to to r 3S throu*hout care and trans(o& Aortic Aneurys
OPQRSTA
8ilatation or out(ouchin* o+ a #lood vessel (articularly the aorta&
%&
)&
,&
Sudden Sudden chest chest (ain (ain ri((i ri((in*> n*> tearin*> and shar( that starts #et"een the shoulder #ladesB 'P di discr scre(a e(ancy ncy #et"e #et"een en ar ar or decrease in +eoral or carotid (ulse& Si*n Si*ns s o+ o+ Sho Shoc! c!&&
%&
)&
,&
Cal and reassure the (atient& Adin dinis iste terr %?? O) #y 4RM Pl ac ace i n a
Trans(ort Trans(ort "ithout delay
/& HYPERTENSIVE EMERGENCIES Hy(ertension
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Cardiac Ta(onade
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Pericarditis
Maor contri#utin* cause in any cases o+ MI> CH9> and C3A& Present "hen 'P at rest is consistently *reater than %/?@=? H* Coon co(lication is renal daa*e> heart +ailure and #rain attac!& Accuulation o+ #lood in the (ericardial sac Most coon result in (enetratin* inury&
%& )& ,& /& 1& 2& ;&
Severe headache 4ausea and voitin* Altered Mental Status A(hasia> sudden #lindness Muscle t"itchin* Sei.ures Hei(aresis
%&
%& )& ,& /& 1&
Mued heart sounds 9allin* #lood (ressure 8istended nec! veins Tachycardia Pale> cool> s"eaty s!in&
%& )& ,&
In0aation o+ the (ericardiu inner "all o+ the heart B Idio(athic in+ection Meta#olic +actors Traua
%& )&
Excessive 0uid #uild u( in the lun*s and or other or*ans and in the #ody #ecause o+ inadeNuate (u(in*
%& )&
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,&
•
CH9 Con*estive Heart 9ailureB
,& /& 1& 2& ;& <&
8ys(nea Chest Pain that a**ravates "hile )&%& 'reathin* )&)& Lyin* on le+t side )&,& Turnin* on 'ed 9ever> Chills> 9ati*ue si*n o+ in+ectionB Anxiety or Con+usion En*or*ed> (ulsatin* nec! vein LATE SI74B Cyanosis 4oral@ Elevated 'P Tachycardia Ped al Ed ea 8ys(nea Pulonary Edea "ith rales> soeties cou*hin* o+ 9rothy "hite or (in! s(utu
)& ,&
/& 1&
%&
)&
,& %&
)&
,&
co+orta#le (osition& Trans(ort "ithout delay&
Secure air"ay > adinister O)& Trans(ort "ithout delay Sei.ure (recaution
Sei+o"lerDs O) I ed ia te trans(ort Monitor Sur*eons "ill iediately do a p"ricar#ioc"n "sis
Priority o+ care CA'> Adinister O)& I ed ia te trans(ort in sittin* (osition Monitor Place (atient in a co+orta#le (osition Sei +o"ler or sittin*B 7 ive hi *h concentration O) throu*h 4RM Monitor
Trans(ort "ithout delay
IMME8IATE
Iediate trans(ort in sittin* (osition
Li*hts only
=&
'LEEDING (H"ar) '$oo# V"ss"$s) '$oo#* External 'leedin*
S"+"ri%: %??? cc +or adults 1?? cc +or child %?? )?? cc +or in+ant
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Enlar*ed liver> s(leen "ith a#doinal distention L ATEB
Ar"ria$ , #ri*ht red> s(urtin* V"nous , dar! red> steady 0o" Capi$$ar% , dar! red> slo"ly oo.in*> o+ten clots s(ontaneously
%& )&
S a+ et y 'SI Control #leedin* )&%& 8irect (ressure )&)& Elevation a#ove level o+ heart i+ s"ollen or de+ored 8O 4OTB )&,& Pressure (oints )&/& S(lints )&1& Pressure s(lints )&2& TorniNuet last resortB )&2&%& TorniNuet ust #e at least / inches )&2&)& Put the tourniNuet around t"ice )&2&,& not and (ut a stic! )&2&/& T"ist and secure the stic! or rod until #leedin* sto(s )&2&1& 8ocuent )&2&2& 4E3ER use a "ire )&2&;& 4E3ER reove once
8e(ends on the aount o+ #leedin*&
Internal 'leedin*
Most coon cause $ Inured or daa*ed internal or*ans 9ractured extreities es(& 9eur and Pelvis
%&
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)&
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,& /& 1&
Pain> tenderness> s"ellin*> discoloration o+ site 'leedin* +ro outh> rectu> va*ina> other ori:ce 3oitin* #ri*ht red #lood or #lood coFee *roundB 8ar!> tarry stools "ith #ri*ht red color& Tender> ri*id> distended a#doen&
LATE SI74S$ %& Altered LOC> Anxiety> restlessness> co#ativeness& )& -ea!ness> +aintness> di..iness ,& THIRST /& Si*ns o+ shoc!
SHOC-
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Scene Si.e u( Monitor +or s@sx o+ shoc! throu*h +ocused Hx and PE Esta#lish 3S Mental Status Peri(heral (er+usion
Mental Status$ %& Restlessness )& Anxiety ,& Al tered LOC Peri(heral Per+usion and s!in (er+usion %& Pale> cool> clay s!in )& -ea!> thread> or a#sent (eri(heral (ulses ,& 8elayed ca(illary re:ll in a#ient air te(& 3S %& Increased Pulse rate )& Increased RR dee(> shallo"> la#ored> irre*ular ,& 8ecreased 'PLATEB
secured )&2&<& Leave in OPE4 3IE)&2&=& 4E3ER APPL6 TO OI4T Goa$s: Reco*ni.e (resence o+ internal #leedin* Maintain #ody (er+usion Provide ra(id trans(ort %& S a+ et y 'SI )& O(en air"ay and (rovide O) and ventilation (er S(O) and ETCO) ,& Trans(ort Iediately /& Shoc! treatent %& S a+ et y 'SI )& Maintain o(en air"ay ,& C on tro l an y external #leedin* /& Elevate lo"er extreities a((rox& < to %) inches 1& S(lint sus(ected inuries 2& Use #lan!et to "ar (atient ;& IMME8IATE TRA4SPORT
IMME8IATE
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ADVANCED CARE %& 9luid
IMME8IATE
C$ass I Co(ensatedB 35 67 !$ •
Co(ensates
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+or 'lood loss •
Constricts #lood vessels in eFort to aintain 'P and deliver oxy*en to ALL or*ans
MI T0"ACUTE 2our Sa"s o/ S0oc1 C$ass II C$ass III 8eco(ensate 8eco(ensatedB Other$ dB %&875 8ilated 3)77(u(ils !$ slu**ishB 475 9777 !$ )& Mar!ed thirst 'o#% R"spons" ,& 4ausea and voitin* • Continued Co(ensatory /& Pallor and cyanosis to the li(s vasoconstrictio echanis to aintain #ecoe Rnheart +ailure Pulonary edea #ut Pedal edea overtaxed& L (er+usion heart +ailure ;i0 so!" • 3asoconstrictio #i
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N LOC
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N 3S
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67 !$ enou*h to occu(y a li# or a #ody cavity "hich could cause little #isco!/or) pain) s;"$$in.
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pr"ssur" ris" an# /a$$& May stay the sae on healthy (atients •
D"cr"as"# pu$s" pr"ssur"
C$ass IV Irreversi#leB re(laceent LR@4SS "ar!$ 475 9777 %&%& Lar*e #ore I3 in& 7%2> 7%/ • Co(ensatory ideal vasoconstrictio %&)& Use #lood n #ecoe a tu#in*s co(licatin* %&,& A((ly +actor +urther (ressure to i(airin* #a* to s(eed tissue 'lood is u( in+usion aintain 'P (er+usion 'T is and s0un"# to #e*ins to +all& )& Unless cell availa#le> titrate vital or*ans • 8ecreased CO oxy*enation& 0uid in+usion to 8ecreased 0o" and (er+usion the 'P usin* to intestines> • Patient can still radial (ulse as !idneys> and recover "ith *uide& )1? s!in& pro!p initial until r"a!"n. radial (ulse is E="c on Pai"n (resent then TO • • Restlessness Con+used> Lethar*y> ,& Head inury and con+usion restless> dro"sy> instu(orous systolic =? anxious Pale> cool> dry H* Classic si*ns Si*n o+ shoc! • • s!in due to shuntin* o+ shoc! #ecoe ore a((ears (ronounced Diaso$ic •
Cool clay
Pulse Pressure continues to narro"
•
Sy(hatetic res(onse also causes ra(id HR
•
Increased RR
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8elayed ca(illary re:ll&
Sa"s o/ S0oc1 ANGINA Pain a+ter exertion or stress
Relieved #y Rest Usually relieved #y nitro (ost
•
extreities
Pain o+ten related to stress or exertion 4ot relieved 4itro ay relieve (ain
Continued 'P +all
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Or*an +ailure and death due to insucient #lood 0o"&
• • •
Co!p"nsaor% S0oc1 , aintain (er+usion Pror"ssi+" Sa" , noral co(ensatory "ill "or! only +or so lon* Irr"+"rsi>$" Sa" , cannot #e reversed&
6 Sa"s o/ C"$$ D"a0 %& Nor!a$ C"$$ )& H%po?ia Ischeia Anaero#ic eta#olis lactic acid #uild u( et& Acidosis sodiu (u( +ails ,& Ion S0i/ sodiu rushes into the cell #rin*in* "ater "ith it& /& C"$$u$ar "#"!a 1& Mioc0on#ria$ "#"!a cessation o+ ATP (roduction& 2& Inrac"$$u$ar #isrupion releases lysosoes cell di*estin* en.yesB cell e#rane #rea!do"ns& ;& C"$$ #"srucion lead to cell death&
Car#io"nic S0oc1 H%po+o$"!ic S0oc1
CLASSI2ICATION O2 SHOC- Heart in ori*in Severe 'lood loss Heorrha*ic Shoc! Pro#le in the vascular syste Cardiac ta(onade Tension Pneuo Pulonary e#olis 9luid or #lood in the "ron* (lace S(inal@ 3aso*enic shoc! Se(tic Shoc! Ana(hylactic Shoc! •
O>sruci+" S0oc1
• • •
Disri>ui+" S0oc1
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NEUROLOGICAL EMERGENCIES CASE Transient Ischeic Attac! TIAB
ASSESSMENT
PATHOPHYSIOLOGY •
RECURRE4T neurolo*ical de:cits o+ any ty(e that corres(ond to the disorientation o+ a (articular cere#ral artery and verte#ra #asilar artery and last any"here +ro a 9E- SECO48 to %) HOURS&
SIGNS AND SYMPTOMS %&
Carotid Syste 'loc!a*e %&%& Hei(aresis @ Hei(le*ia %&)& Unilateral 4u#ness %&,& A(hasia %&/& Con+usion> coa %&1& Convulsion %&2& Incontinence> soeties %&;& 4u#ness o+ +ace %&<& Slurred s(eech %&=& 8ys(ha*ia %&%?&Posterior headache %&%%&8i..iness or 3erti*o
MANAGEMENT
TRANSPORT CONSIDERATION
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SEI@URE DISORDERS Tonic Clonic 7rand MalB
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4eurolo*ic exaination #et"een attac!s ay#e E4TIREL6 4ORMAL Soe (atients onset o+ attac! is clearly related to standin* u( a+ter lyin* or sittin* or it occurs on relation to exertion> eotional stress or #out o+ cou*hin*&
Tonic (hase the #ody #ecoes ri*id stiFenin* +or no ore than ,? sec& 'reathin* ay sto(& Patient ay #ite his ton*ue& Incontinence ay result& Clonic (hase #ody er!s a#out violently> usually +or ore than % ) inutes& Patient ay +oa at the outh and drools& 9ace and li(s ay #ecoe cyanotic Postictal (hase re*ains consciousness iediately and enter a sta*e o+ dro"siness and con+usion or he ay reain unconscious&
Ty(es o+ Sei.ures$ %& Si(le (artial sei.ure +ocal otor> +ocal sensory or ac!sonianB tin*lin*> stiFenin* or er!in* in ust one (art o+ the #ody& Aura ay (resent #ri*ht li*hts> crust o+ colors> or a risin* sensation in the stoachB )& Co(lex (artial sei.ure (sychootorB a#noral #ehavior that varies& May involve con+usion> *lassy stare> li( sac!in* or che"in*> ailess ovin* a#out or :d*etin* "ith clothin*&
%&
)& ,&
/&
1&
Protect the (atient +ro inury 7uard air"ay #ut 4PO 8O 4OT restrain (atient& Reove o#ects and *ently *uide a"ay +ro dan*er& Loosen o#structive clothin*& Ta!e vital si*ns and onitor res(irations closely&
Causes o+ sei.ure$ %& 9e#rile )& Id io (a th ic ,& 'r ain tu o r /& Con*enital #rain de:cits 1& Meta #o lic 2& In +ect io n ;& Toxic
A#sence Petit alB
Sro1" (C"r">ro+ascu$ar Acci#"n CVA*
Ischeic Stro!e
Heorrha*ic Stro!e
Sei.ure is #rie+ usualy only % %? sec& There is no draatic otor activity& Person does not slu( on +ace& 7oes unnoticed #y everyone exce(t #y the (erson and !no"led*ea#le e#ers o+ the +aily& Sudden onset o+ +ocal neurolo*ical de:cit caused #y a non trauatic #rain inury resultin* in occlusion or ru(ture o+ the cere#ral #lood vessel&
'loc!a*e in arteries su((lyin* oxy*enated #lood "ill result in daa*e to aFected (arts o+ the #rain& An aneurys or other "ea!ened are o+ an artery ru(tures& O+ten associated "ith arteriosclerosis and hy(ertension T"o eFects$ %& An area o+ the #rain is de(rived o+ oxy*enated #lood )& Poolin* #lood (ush
<& Traua Sae as *rand al
Classi:cation$ %& Transient Ischeic Attac! )& Reversi#le Ischeic 4eurolo*ic 8e:cit ,& Stro!e in Evolution@Co(leted Stro!e
Pa0o$oica$ Proc"ss a((lica#le on ischeic and heorrha*icB$ %& Intrinsic #lood vessel (atholo*y atherosclerosis> li(ohyalinosis> in0aation> ayloid de(osition> arterial dissection> develo(ental al+oration> aneurisal dilation and @or venous thro#osis&B )& Lod*in* o+ e#olus in intracranial vessel +ro a reote (art such as heart or extracranial circulation ,& 8ecreased (er+usion (ressure or increased #lood viscosity "ith inadeNuate cere#ral #lood 0o"&
, Ty(es o+ Cere#ral Edea %& Cyt otoxic )& 3a so *en ic ,& Interstitial I+ 'rain Edea sus(ected$ %& Modest 9luid restriction )& Elevation o+ head o+ #ed )? ,? de*reeB ,& O) and 3entilation su((ort /& Co ntro l o + a*itation and (ain& Conscious: %& Ensure an o(en air"ay )& ee( (atient cal ,& Maintain eye contact and s(ea! SLO- and CLEARL6& /& Hi*h O) 1& Monitor 3S 2& Sei reclined (ost ;& 4PO <& ee( "ar =& Sit in +ront o+ (atient& Unconscious:
LOA8 A48 7O -indo" (eriod 8 0ours #ut 0" /as"r 0" >""r.
increased ICP on the #rain> dis(lacin* tissue and inter+erin* "ith +unction&
Altered Mental Status
Causes$ A Alcohol and other dru*s E (ile(sy> Endocrine@Exocrine I insulin> hy(o@hy(er O oxy*en> overdose and o(iates U Ureia T traua and te( I in+ection Se(sis or Menin*itisB P (oisons and (sychiatric S shoc!> stro!e or s(ace occu(yin* lesion&
/&
3essel ru(ture in su#arachnoid s(ace or intracere#ral tissue&
S@Sx$ %& Con+usion )& Hei(aresis ,& He i( le* ia /& I(aired s(eech 1& 9acial 0accidness and loss ex(ression 2& Headache ;& UneNual (u(il si.e <& I(aired vision =& Cushin*Ds Triad =&%& Hy(ertension =&)& Irre*ular RR =&,& Slo" (ulse %?& Convulsions %%& Coa %)& Incontinence %,& Ina((ro(riate #ehavior %/& StiFed nec! %1& Sta**erin* *ate
%& )& ,& /& 1& 2&
%&
)& ,&
/& 1&
2&
Maintain o(en air"ay Hi*h O) 3entilation i+ needed Monitor 3S Lateral recu#ent (ost& Protective (addin*
Secure air"ay and control res(iration %&%& O) *uided #y S(O) %&)& 3entilation *uided #y ETCO) Protective re0exes @B Io#ili.e s(ine unless a#solutely certain inury not sus(ected Monitor 4euro 3S N 1in Protect (atient eyes on lon* trans(o Treat and reassure accordin*ly
Visua$ M"!or%
Co!pr"0"nsi on Proprioc"pio n V"r>a$ M"!or% Car"$"ssn"ss an# I!pu$si+"n"s s E!oion an# A="c
Ri0 H"!isp0"r" L"sion I(aired Visuo!oor (erce(tion : Loss o+ visual eory Lac! o+ insi*ht and ud*ent 'UT 4OT O'3IOUS #ecause o+ intact ver#al 0uency O- $ 4o de:cit understand and ex(ress $ Ina#ility to assess (osition in s(ace and sa+ely interact "ith the environent O- $ Intact& Perce(tual eory i(aired YES: Careless& O#vious ista!es& I(ulsive "ith decreased a#ility to antici(ate conseNuence o+ #ehavior& : Ina((ro(riate eotion and aFect
L"/ H"!isp0"r" L"sion Una#le to co!!unica" (ro(erly O-: Positive visuootor retention and eory Positive visuootor retention and eory : A(hasia O- $ Uni(aired
: I(aired a#ility to retain ver#al in+oration reote eory i(aired NO: Usually i(aired&
O-: A((ro(riate
6 DBs o/ Sro1" Mana"!"n: %& )& ,& /& 1& 2& ;&
D""cion , reco*nition o+ the s@sx o+ stro!e or TIA and activate EMS& Dispac0 , EMS dis(atcher ust (rioriti.e the call sae as an AMI& D"$i+"r% , trans(ort to stro!e center& Door , hos(ital that can (rovide :#rinolytic thera(y "ithin % hour a+ter arrival& Daa , hos(ital o#tainin* CT scan& D"cision , identi+yin* eli*i#le (atient +or +y#rinolytic thera(y& Dru , treatin* "ith :#rinolytic thera(y&
DIA'ETIC EMERGENCIES noral *lucose 2? to %)? *@dL CASE Hy(er*lyceia
ASSESSMENT •
•
•
•
Hy(o*lyceia
Have you ta!en your eals Have you ta!en your insulin Have you voited your eals Have you done strenuous activities
CAUSES •
• •
•
• •
• •
SIGNS AND SYMPTOMS
Condition has not #een dia*nosed or treated Has not ta!en insulin Over eaten 0oodin* the #ody "ith excess car#s 8ia#etic suFers an in+ection that disru(ts his *lucose@insulin #alance
%& )& ,& /&
7radual onset in days 8ry outh> intense thirst A#d& Pain and voitin* coon 7radually increasin* restlessness> con+usion +ollo"ed #y stu(or and coa 1& -ea!> ra(id (ulse 2& Air hun*er dee( si*hin* res(irations aussalDs #reathin*B ;& Acetone #reath childB <& -ar> red> dry s!in =& 4oral or sli*htly elevated 'P %?& Sun!en eyes %%& 4o hostile or a**ressive #ehavior
Ta!en too uch insulin 4ot eaten enou*h to (rovide 4 su*ar inta!e Over exercised@ exerted 3oited
%& )& ,& /&
Ra(id onset in inutes& Co(ious saliva> droolin* Patient intensely hun*ry& 8i..iness and headache> sudden +aintin*> sei.ures and occasionally coa 1& 9ull ra(id (ulse 2& 4oral res(iration > no odor ;& Cold> clay> (ale s!in& <& 4 'P =& 4 eyes %?& Hostile@a**ressive #ehavior&
MANAGEMENT %& )&
O) via 4RM Trans(ort to edical +acility ,& Arran*e +or ALS interce(t& Ho;"+"r) a$$ !ana"!"n o DM "!"r""nci"s o;ar#s 0%po$%c"!ia.
%&
7ranular Su*ar under ton*ue& %&%& Conscious$ any s"eet solid or liNuid %&)& Unconsciou s$ %&)&%& Avoid *ivin* liNuid %&)&)& Turn head to side or (lace in lateral recu#ent &
CAUSE O2 DEATH %& 8ehydration and (oor nutrition )& Hy(o!aleia ,& Hy(oinsuline ia /& 8A 8ia#etic etoacidosisB !etones in urine acidosis co(ensate s #y aussalDs #reathin* to decrease acidosis 8ia#etic COMA Hy(erinsulineia Insulin Shoc!&
)& ,&
/&
Provide Hi*h O) Trans(ort to edical +acility Arran*e ALS interce(t&
ACUTE A'8OMI4AL EMER7E4CIES CASE All adults "ith a#doinal (ain a$;a%s consi#"r MI. Heart (ro#le o irritates the va*us nerve aFects *astric ucosa (roducin* excess HCl and a#doinal (ain& Causes$ Ulcer o Intestinal o O#struction Cholecystitis o o Hernia eer*ency due to (ossi#ility o+ circulation o#structionB o A#doinal Aortic Aneurys o Pancreatitis A((endicitis o
ASSESSME4T • •
•
•
•
Su(ine nee chest 0exed Exaine last ost (ain+ul (art N a#d& Assess$ 4o (ain> so+t> non ri*id> "ar to touch> not distended
PATHOPH6SIOLO76
SI74S A48 S6MPTOMS %& )& ,& /& 1& 2& ;& <&
Pain@ tenderness Anxiety @ +ear 7uarded (osition Ra(id shallo" #reathin* Ra( id (u ls e 4ausea voitin* or diarrhea Ri*id or tense a#doen Internal #leedin*
MA4A7EME4T %& )& ,&
/&
1& 2& ;& <&
S a+ ety and 'SI CA' ee( air"ay (atient #e alert +or voitin* Place (t& to (osition o+ co+ort 4PO Cal and reassure (t& 'e al er t + or shoc! Trans(ort eciently
TRA4SPORT CO4SI8ERATIO4 Ecient Trans(ort
Urinary Colic
N"p0ro$iiasis +oration o+ stone in the !idney or any"here in the urinary tract #ut calculi #e*in to +or in !idneyB& Stone si.e ay vary in si.e& Renal calculi classi:cation Calciu Phos(hate 21 Calciu Oxalate Ma*nesiu Aoniu Phos(hate straviteB %1 Uric Acid %? Cystine Stone %? •
• •
•
• •
9actors (rootin* to Stone 9oration$ Su(ersaturation o+ Urine stone +oration due to crystalloid Presence o+ 4idus a ust& 4idus or nuclei "hich layer can #e de(osited Stasis +urther (rootion o+ stone +oration (H or solution •
•
•
•
•
•
Pain intensity de(ends u(on the si.e o+ the calculi& Renal colic a *rou( o+ sy(tos associated "ith oveent o+ a calculus throu*h the narro" anatoical (oints in the ureter causin* o#struction o+ urine& Severe costoverte#ral an*le o (ain radiates throu*hout the 0an! area and *roin due to the uscle s(as inured #y the stretchin* and o#struction o+ the ureter #y the calculus
%&
)&
,&
/&
I+ alert> advise to increase 0uid inta!e to over /??? l@)/ hour& Adinister anal*esic@anti s(asodic accordin* to local (rotocol ee( on #ed rest "ith EntonoxB Trans(ort to hos( +or +urther ana*eent&
Trans(ort eciently
O'STETRICS 764ECOLO7ICAL EMER7E4CIES CASE Co!!on G%n"co$oica$ E!"r"nci"s Ecto(ic Pre*nancy
ASSESSME4T
PATHOPH6SIOLO76
8evelo(ent o+ a +etus outside the "o# Causes$ Past ecto(ic (re*nancy Past sal(in*itis Sur*ery o+ the +allo(ian tu#e 9oration o+ ass in the ovary "ith idio(athic cause& •
SI74S A48 S6MPTOMS
3. 9. ,& /& 1& 2&
A!!"nor0"a Pain in 0" LR i$iac r"ion A#noral va*inal #leedin* Lo" #ac! (ain 'reast tenderness 4ausea
3.
S0arp) pi"rcin pain in 0" $o;"r a>#o!ina$ ua#ran. 9ever 4ausea 3oitin* -ea!ness> di..iness or +aintin* Si*ns o+ internal #leedin* 2"+"r Pro+use dischar*e +ro the va*ina Malaise Lo"er a#d (ain 8iculty (assin* urine
•
MA4A7EME4T
%& )& ,& /&
•
Ru(ture o+ Ovarian Cyst
Pelvic In0aatory 8isease PI8B
In+ection +ro the va*ina a!in* the (elvis in0aed& Causes$ Sexually transitted disease •
)& ,& /& 1& 2& 3. )& ,& /& 1&
1& 2&
Ensure o(en air"ay O) as reNuired 4PO 3o it in * (recaution (ositionin*B Mo nit or 3S Shoc! (recaution
TRA4SPORT CO4SI8ERATIO4
ALL LOAD AND GO
8ys+unctional Uterine 'leedin* 8U'B
'leedin* +ro the uterus that is not due to enstrual (eriod Cause$ Estro*en i#alance Meno(ause syndroe 9eale o+ advanced a*e • • •
2& %&
)& ,& /& 1& 2& ;& <&
O0"r : Rap"
Maxiu tact and sensitivity 9eale EMT should #e (resent EMT ust ta!e care o+ ur*ent ed& Pro#les Preserve evidence Protect (atientDs (rivacy 8ocuent I(ortant eleents o+ Assessent$ %& A*e o+ (atient )& LMP ,& AO7 /& 7ravida 1& Parity
Irre*ular va*inal #leedin* Incr"as" PR 97 >p! ;0"n p. sis /ro! supin" posiion. >$oo# $oss o/ !or" 0an 3 uni. A#noral va*inal #leedin* A#noral s(ottin* Metrorrha*ia #leedin* in #@t (eriod Menorrha*ia excessive #leedin* 'leedin* a+ter eno(ause 'leedin* unrelated to (eriods 'leedin* in youn* *irls %&
•
)&
•
,& /&
•
1& 2&
Ensure o(en air"ay O) as reNuired 4PO 3o it in * (recaution (ositionin*B Mo nit or 3S Shoc! (recaution
•
•
•
O'STETRICS o
o
o
o
o
, "ee!s .y*ote@ +ertili.ed ovu ,< "ee!s e#ryo =,< "ee!s +etus 'irth to )< days neonate )= days to % yo in+ant
Criterias$ %& 8ue date )& C on tr act io n
Mech& O+ 8elivery$ En*a*eent 8escent 9lexion Internal Rotation Extension Ex(ulsion
Sx o+ iinent delivery$ %& Ur* et o ( ush )& Presence o+ cro"nin* ,& Increase (ressure in the va*ina
ENui(ents$ %& 7loves )& 8r a"s heet ,& S ucti on 'u l# /& To"els 1& 7au.e 2& Scal(el ;& U#ilical cla(
La#or and 8elivery %& S a+ et y 'S I )& Lie !nee 0exed dra"n u( "ide se(arated> sei+o"lers ,& Create sterile :eld around va*& O(enin* "ith sterile to"els /& Cro"nin* (lace *entle (ressure on (erineu
Iinent delivery$ %& 8o no t a llo " to use toilet )& C on su lt M8 concernin* decision to deliver #a#y at the scene& ,& 8o not cla(@cut cord i+ the #a#y is not #reathin* on
7eneral Ste(s in 4S8 %& Pre(are other +or delivery )& Assist ,& Initial care o+ the ne"#orn
o
o
% yo to %) yo child UTV ost relia#le dx tool
,&
/& 1& 2&
COMPLICATION ON2IRST TRIMESTER A#ortion
9reNuency and 8uration I ncrea se S(ressure in va*ina Ur*e to (ush C ro "n in * ' ro !en #a * o+ "ater
<&
Cotton "ith alcohol
Preature W,< "ee!s@ W)1?? !*B TRA4SPORT to ER +or incu#ator 1?? l noral #leedin* durin* delivery Cord Cuttin* %? incles a"ay +ro u#ilicus
Terination o+ (re*nancy #e+ore )< "ee!s %& )&
T hreat en ed Closed cervix a& Mild (ain #ac! (ain> lo"er a#d&B #& Mild va*inal s(ottin* ,& Inevita#le cannot (reserve (re*nancy a& -ith (lacental@+etal +ra*ents cae out #& Severe #ac! (ain c& Moderate> o#vious #leedin* d& Shoc! /& Inco(lete (lacental@+etal +ra*ents ex(elled 1& C o( lete a#ortus@+etus ex(elled
1&
Once delivered> su((ort the head as it rotates and "i(e neonateDs outh and nose suction outh and nose 2& 7uide head do"n to deliver %st shoulder> then u( to deliver the )nd shoulder su((ort the #a#y ;& 7ras( the +eet :rly "ith one hand <& Clean out the #a#yDs outh "ith *au.e& Suction& T0" >a>% s0ou$# sar o cr%& I+ not> A'C o+ resuscitation& Intervention +or non #reathin* #a#y %& Ru # t he #a c! )& Sna( :n*ers at soles o+ the +eet ,& A'C /& I+ "ith s(ontaneous #reathin*> let neonate #reath roo air 1& I+ AP7AR is lo" /;B *ive O) via #lo"#y
its o"n& I+ ;i0in !inu"s "oan "ill deliver the #a#y> do not load and *o& I+ inside the a#u>sop an# #"$i+"r 0" >a>%.
Pre Ecla(sia
out "ith #leedin* 2& Criinal ;& T her a( eu ti c Hy(ertension& 'P o+ ore than %,?@
%& )& ,& /&
• • •
1& 2&
•
Ecla(sia Su(ine Hy(otension Hole
4eurolo*ical Co(ression o+ the 3ena Cava due to (re*nancy& 4o +etus #ut "ith si*ns o+ (re*nancy
%& )& ,& Excessive voitin* durin* (re*nancy
%& )&
,& /& 8RD TRIANTENATAL COMPLICATIONS A#ru(tio Placenta
Placenta Previa
Preature se(aration o+ the (lacenta #e+ore la#or and delivery
I(lantation o+ the (lacenta over the cervical o(enin*
LI7HTS O4L6
Le+t Lateral Position
Inco(etent Cervix
Hy(ereesis 7ravidu
Tr an s( or t 9HT onitorin* CA' Prevent stiulus O) ( er S (O) Thera(eutic Environent
%&
Mild to oderate va*inal #leedin* )& Sx o+ shoc! ,& C on tin ou s 1ni/" $i1" pain in the a#doen /& Ri*id tender uterus Pain$"ss # ri *h t red va *in al #l eed in *&
Co(lete #ed rest Constant O' su(ervision C ervi ca l Cercla*e Crac!ers on #ed side Sall +reNuent +eedin* Ensure nutrition Maintain hydration
Trans(ort +or Eer*ency CS
%& )&
Tr an s( or t iediately Shoc! (recaution
IMME8IATE
Uterine Ru(ture
Coon to 7, a#ove 8ue to '$un Trau!a& Re(eated stretchin* o+ the uterine "all Old CS Prolon*ed la#or a*ainst O#struction o -ea!ened uterine o "all
• • •
• •
COMPLICATIONS O2 LA'OR an# DELIVERY Prola(sed Cord
9or eer*ency CS Cord co(ressed #et"een the neonateDs head and #irth canal
• •
%& )& ,& /&
T"arin a>#o!ina$ pain Severe hy(ovoleic shoc! 9ir ri*id a#d& 3a*inal #leedin*
No pu$saion o+ the u#ilical cord
,& %& )&
8o not IE CA' Tr an s( or t
%&
Position other to !nee chest (osition Push the neonateDs head to relieve co(ression to cord -ra ( cord "ith oist sterile *au.e to (revent daa*e U(on delivery o+ head loo! +or the cord i+ loo(ed around the nec! 7ently sli( i+ (ossi#le I+ not> cla( the cord and cut (rotocolB
)&
,&
Cord coil@ Cord loo(
%&
)& ,&
Meconiu Stainin*
•
•
Coon in (re ter and (ost ter Lac! o+ O) S(as o+ the lar*e intestines econiu stainin*
Si*n o+ +etal distress %& 4o 9HR )& 9HR W %)? ,& Mother do not +eel #a#y ovin*
IMME8IATE
•
Aniotic 9luid Lea!
•
• • •
NEONATAL CARE Cardio res(iratory chan*es that occur in #irth$ To *et rid o+ the o 0uid :llin* the lun*s so that it can ex(and Closin* o+ the o +oraen ovale and ductus arteriosus
Routine care$ %& -arin* )& Air"ay ,& Position /& Cord cuttin* 1& Preven tio n o+ econiu as(iration
*reenish discoloration o+ the aniotic 0uid Co(lication$ 4eonatal Se(sis o econiu as(iration 4eonatal o res(iratory distress neonate ay not #e a#le to clear lun*s& 8iculty o+ +etus to coe out In+ection Traua Co(lication to other o Lea! to (elvis Aniotic 0uid enter circulation Pulonary E#olis
Ris! +actor +or shoc! and hy(otension %& Lo" #irth "ei*ht )& Maternal se(sis ,& Prola(sed cord /& Acute onset o+ aternal va*inal #leedin*
N neonatal vital si*ns RR ,? 1? c( PR %)? %2? #( 'P 2? H*
HR • •
W 2? CPR %?? #reath on roo air 2? %?? ventilate +ull 1 L( (reature , L(B
APGAR < %? ild distress / ; oderate % , severe M"#ica$ Unconscious or decreasin* level o+ consciousness •
• • • • •
8ilated (u(il 7CS W%? Pediatric traua score W< Persistent 9ever Increase eFort in #reathin*
Trau!a 9all +ro a hei*ht o+ )? +t Involved in an accident "ith +atalities Eected in a car accident Struc! #y a car& • •
• •
NEONATAL SEI@URES
Sa" 3s 9n# 8r#
Caus"s: %& Hy(oxic Ischeic Ence(halo(athy )& Meta#olic 8istur#ance ,& Menin*itis or Ence(halitis /& 8evelo(ental a#noralities 1& 8ru* "ithdra"al 2& Maternal anesthesia ;& Stro!e
Ha$$!ar1 Sins True la#or to +ull cervical dilation 9ull cervical dilatation to #irth o+ neonate 'irth o+ neonate to (lacental delivery
Conracions Pain ra#iaion SIGN A((earance 'luish Pain a$$"+iaion 2r"u"nc%) Duraion) In"nsi% C"r+ica$ Di$aaion
Duraion /or Pri!i %) to %2 hours ,? in -ithin )? in
2a$s" La>or Tru" La>or Irre*ular Re*ular A#doen Lo"er #ac! then 7 3 9 or (ale Pin! trun!> #luea#doen Pin! Alleviated #y 4ot alleviated extreity a#ulation 4o increase Increasin*
4o dilatation
T%p"s: %& Su#tle Head (art ocular> +acial> oral or li*ual oveents and res(iratory ani+estation such as a(nea or stutortorous #reathin* )& Tonic (reter in+ant$ sei.ure a((ear decere#rate or decorticate (osturin* ,& Multi+ocal clonic ter in+ants$ noted in one li# and i*rate to another (art o+ the #ody& /& 9ocal clonic ter in+ants$ locali.e and are acco(anied #y short activity o+ EE7& 1& Myoclonic (reature and ter in+ants$ sin*le ulti(le er! and 0exion o+ the u((er and lo"er extreities
-ith dilatation
APGAR SCORING
Duraion /or Mu$i ,? in Matter o+ inutes -ithin )? in
Pulse Griace
A#sent 4o Res(onse
Activity
Li(
Res(iration
A#sent
W%?? #( Soe otion> *riace Soe 0exion> extreeties Slo" and irre*ular
%?? #( Cry> cou*h> snee.e Active> *ood otion 4oral> cryin*
Ins"r N"onaa$ Circu$aion an# N"onaa$ R"susciaion
'URN EMERGENCIES CASE T%p" %& )& ,& /& 1& 2& ;&
o/ >urns Cheical Ra dia ti on E lectr ica l Theral Scald Contact 9lash
ASSESSMENT
PATHOPHYSIOLOGY
SIGNS AND SYMPTOMS
MANAGEMENT
2acors o consi#"r in "+a$uain >urns %& A*ent o+ #urn )& 8e(th ,& Severity 'SAB a & Ru le o+ nin es #& Pal rule /& A*e under 1 and over 11 adultDs reaction to #urn inury increases a+ter a*e ,1B a& In+ants and children are at hi*her ris! due to ore #ody sur+ace area i& Hy(ovoleic shoc! ii& Air"ay (ro#le iii& Hy(otheria 1& Other illnesses and inuries
T0"r!a$ 'urn: %& E!"r"n P0as" res(onse to (ain catecholaine release& )& 2$ui# s0i/ assive shi+t +ro intracellular to extracellular 0uid ,& H%p"r!"a>o$ic p0as" increase deands +or nutrients /& R"so$uion p0as" scar tissue and reodelin* o+ tissue
Sp"cia$ Consi#"raions: P"#ia: %& Thin s!in )& Lar*e sur+ace volue )&%& Ra(id 0uid loss )&)& Increased heat loss ,& 8ehydration vs& Overhydration /& Iature Iunolo*ical res(onse
Tr"a!"n o/ >urn ;oun# %& Lo" (riority a+ter CA' and I3 )& Do no rupur" #listers& ,& 8ry Sterile 8ressin*s /& Cover "ith #urn sheet
Co!p$icaions$ %& Hy(ovoleia leadin* to shoc! Leadin* )& I n+ ecti on ,& Renal@he(atic +ailure /& 9oration o+ eschar 1& Co(lication o+ circu!/"r"nia$ >urn tourniNuet eFectB 2& Increase catecholaine release> vasoconstriction ;& Ina#ility to aintain #ody te(erature Esc0ar /or!aion:
G"ria: %& 8ecreased Myocardial reserve )& 9luid resuscitation dicult ,& Peri(heral vascular disease /& COP8 1& 8ecreased iune res(onse 2& 5 !ora$i% X a*e o+ 'SA aFected
4 P0as"s o/ >urn !ana"!"n %& E!"r"n P0as" tie o+ inury to structural )& R"susciaion P0as" adin o+ I3 0uids> return o+ ca(illary e#rane to N level )&%& Par!land +orula$ / L@!* Y total 'SA
TRANSPORT CONSIDERATION
%& )& ,& /&
S!in denaturin* S!in constricts over "ound Res(iratory co(roise Circulatory co(roise
Fac1sonBs 'urn T0"or% %& Vone o+ Coa*ulation )& Vone o+ Stasis ,& Vone o+ Hy(ereia Theral
Rapi# PE %& Chec! +or other inuries )& Ra(id estiate #urned "ound ,& Reove restrictin* #and H?: %& )& ,& /& 1& 2& ;&
Ho " l on * a *o -hat has #een done -h at cau se C lo se s (a ce LOC Aller*ies@eds Pa st ed Hx
)&)& %st hal+ in :rst < hrs )&,& )nd hal+ in next %2 hrs& ,& Acu" P0as" heodynaical ly sta#le 4. R"0a>i$iaion P0as" %&
Reove (atient +ro the scene )& Sto( #urnin* (rocess ,& E ns ure o (en air"ay> assess #reathin* /& Loo! +or si*ns o+ air"ay inury> soot #"posis> #urnt nasal hair> +acial #urns 1& Co(lete the intial assessent& 2& Treat +or shoc!& Hi*h O) (er S(O)B& Treat serious inuries& ;& Evaluate #urns #y de(th> extent and severity& <& Do no c$"ar #">ris =& -r a( "it h #r% sterile dressin*& 37. 'urns o+ hands or +eet reove rin*s and e"elry that ay constrict "ith s"ellin*& S"para"
IMME8IATEL6
n"rs or o"s ;i0 au" pa#s. %%& 'urns to eyes do not o(en eyelids i+ #urned& %%&%&'e certain #urn is theral> not cheical& %%&)&A((ly sterile *au.e (ads to #oth eyes to io#ili.e& %%&,&I+ #urn is cheical> 0ush eyes +or a iniu o+ )? inutes& %)& Shoc! (recaution i+ thereDs other inuriesB O0"rs: %& An al* es ic Mor(hine Sul+ate %&%& ), * N %? in titrated to adeNuate ventilation and 'P %&)& ?&% *@!* +or (edia %&,& May reNuire lar*e #ut tolera#le doses& )& Avoid to(ical
a*ent exce(t (er (rotocol SilvadineB ,& 9luid Thera(y ,&%& O#ective$ ,&)& HR W %%? #( ,&,& Urine out(ut$ ,? 1? cc (er hour or ?&1% cc@!*@h r +or (edia Ins"r c0"!ica$ >urn 0an#ou
Cheical
Inhalation
Electrical
Pro>$"!s: %& Hy(oxia )& C O t oxic ity )&%& S(O) could #e eanin*less ,& U((er air"ay inury ,&%& May result to edea o+ (harynx and larynx /& Lo"er air"ay inury /&%& Rare> involves lun* (arenchya> Trans(ort
OhDs la" % X 3@R
Anicipa" r"spiraor% pro>$"!s %& Head> 9ace> 4ec! or Chest #urns )& 4asal@ eye#ro" hairs si*ned ,& Hoarsness> tachy(nea /& Cou*hin* 'lac! s(utu
7enerally *et cheical containated o#ect oF the #ody and 0ush "ith LR@4S exce(t i+ cheical reacts "ith "ater& Air;a%) O9) V"ni$aion: %& 'ronchodilators needed )& 8iuretics are not a((ro(riate Circu$aion: %& Treat +or Shoc! rareB )& I3 access )&%& LR@4S lar*e #ore ulti(le I3Ds )&)& Titrate 0uids to aintain systolic 'P
AC curr"n:
O0"rs: Treat #urns and inuries %& T RA 4S PORT
Radiation
Lo" volta*e 1?? %???3 Hi*h volta*e %???3 u( Li*htnin*B
%&
S"+"ri% #"p"n#s on %& Tissue )& -ith or extent o+ current ,& AC@8C 4. 8uration o+ current contact
9. ,& /& 1& 2&
• •
Tetanic Muscle Contraction %&%& Muscle inury %&)& Tendon ru(ture %&,& oint distraction %&/& 9ractures Car#iac arr0%0!ias A(nea Sei.ure Contact #urn@9lash #urn 9l ae # urn
)& ,& /&
Ma !e s ure current is oF CA' Rha#doyolysi s #rea!do"n o+ uscle :#er that leads to release o+ yo*lo#in to #loodstrea "hich is har+ul to the !idneys&
Al(ha lar*e 'eta sall Ga!!a , !os #an"rous
'urn D"p0 C0arac"risics 3s D"r"" 9n# D"r"" 'urn s"+"ri% 8r# D"r"" D"p0 Minor Mo#"ra" Caus" Sun or Hot liNuids> Cheicals> Sup"rcia$inor 0ash W0ashes 1? or 0ae %1 electricity> 0ae> hot etals Paria$ T0ic1n"ss W%1 %1 ,? S1in Red Mottled red> oist Pearly "hite 2u$$ T0ic1n"ss W) ) %? Co$or and exce(t shiny +or and or +ace> *enitalia> charred hands and +eet translucent and (archentli! e S1in 8ry B B #listers "ith 8ry "ith Sur/ac" #listers "ee(in* thro#osed s #lood vessels S"nsai Pain+ul Pain+ul Anesthetic on H"a$in ,2 days ) / "ee!s ReNuires s!in de(endin* on *ra+tin* de(th
Criica$ All co(licated #y inury o+ so+t tissue and #ones ,? %? Partial +ull thic!ness on hands> *enitalia> circu+erential #urn&
Ins"r Ru$" o/ Nin"s /or A#u$) C0i$# an# P"#ia
POISO4I47 EMER7E4CIES
CASE
ASSESSME4T
Poisons could #e$
Odor
PATHOPH6SIOLO76 •
Poison toxin B
SI74S A48 S6MPTOMS
MA4A7EME4T
%&
G"n"ra$ approac0:
'urns and strains around
TRA4SPORT CO4SI8ERATIO4
In*ested Inhaled A#sor#ed Inected
Level o+ Consciousness 3ital Si*ns H? -hat -hen Ho" uch -hat else "as ta!en> i+ anythin* Antidote 3oited> i+ so ho" lon* a+ter the in*estion -hy Odor Level o+ Consciousness 3ital Si*ns H? -hat -hen Ho" uch -hat else "as ta!en> i+ anythin* Antidote 3oited> i+ so ho" lon* a+ter the in*estion -hy
•
•
su#stance "hich> i+ ta!en into the #ody in sucient Nuantity can cause te(orary or (eranent daa*e Sel+ (oisonin* and (arasuicide deli#erate in*estion o+ ore than the thera(eutic dose o+ a dru* or su#stance not intended +or consu(tion usually #y an adult in a oent o+ distress Accidental (oisonin* non intentional
8 L"a#in caus"s o/ Poisonin: %& Alcoholic intoxication )& Metha(hetaine ,& Isonia.id toxicity Or*ano(hos(hate a*ent ost coonly associated "ith ortality&
)& ,& /& 1& 2& ;& <& =& %?& %%& %)& %,&
outh Unusual #reath@#ody@ clothin*@scene odor A#N #reathin* A#N (ulse rate Pro+use s"eatin*> headache> di..iness Excessive salivation or +oain* at the outh Pain in the outh or throat A#doinal (ain A#doinal tenderness soeties "ith distention 4ausea> voitin* Sei.ures Altered ental status Si*ns o+ shoc!
• • • •
•
•
o o o
Circulation Air"ay 'reathin* Dru* induced C4S de(ression Electrolytes and eta#olic a#noralities Oxy*en (recautions -atusi ParaNuat Vinc (hos(hate
Aci+a"# C0arcoa$ A#sor#s any (oisonous co(ounds to its sur+ace> there#y reducin* their a#sor(tion #y the #ody EFective aon*$ As(irin o o A(hetaines Strychnine o 8ilantin o o Theo(hylline Pheno#ar#itals o IneFective$ Methanol o o Caustic acids Al!alis o Iron ta#les and o lithiu %*@!*
•
•
•
•
• •
S%rup o/ IPECAC Induces voitin* Contraindications Stu(or@Coa o o A#sent *a* re0ex Sei.ures o o Pre*nancy
Acute MI Children W 2 o In*estion o+ o corrosives 3olatile o hydrocar#ons Strycnines or o iodides 8osa*e Children ,1 ts( o +ollo"ed #y a *lass o+ "ater Adults %) ts( o +ollo"ed #y "ater %& Maintain o(en air"ay )& Trans(ort Iediately ,& 9ollo" (rotocol o+ your EMS syste /& ee( (atient on 4PO 1& Position the conscious (atient in sei recu#ent (osition 2& Monitor voitin* ;& Save all voits and endorse to the hos(ital o o
•
In"s"#
In0a$"#
%&
)& ,&
Reove (atient +ro inhaled (oison& Avoid touchin* containated clothin*& Maintain o(en air"ay Provide needed 'LS easures
and adinister O) i+ not contrainidicated B 4RM
In"c"#
%& )&
,&
/& 1& A>sor>"#
%&
)&
,&
Ins"r Ta>$" o/ SS? o/ co!!on poisons.
9ollo" local (rotocol Monitor (atient and aintain o(en air"ay Reove e"elry +ro aFected li#s ee( the li# io#ili.ed Trans(ort iediately Move the (atient +ro the source o+ the (oison "hile avoidin* contact "ith the su#stance Use "ater to iediately 0ood all the areas o+ the (atientDs #ody that has #een ex(osed to the (oison Monitor (atient and trans(ort iediately
COL8 EMER7E4CIES CASE
ASSESSME4T T"!p Con+"rsion: C J 9,)BY1@= 2 X CY1@= ,)
PATHOPH6SIOLO76
•
•
-""pin ;ar!: Thero*enesis Conversion o+ +ood o to ener*y in #ody cells o Muscle activity> voluntary or involuntary Heat a#sor(tion 8urin* cold conditions Constrictin* #lood o vessels at #ody sur+ace to !ee( "ar #lood at the core o Reducin* s"eatin* Erectin* #ody hairs o to Jtra($ the "ar air at the s!in •
•
•
Cor" T"!p Internal te( o+ norotheric huans 8oes not vary %) Z +ro noral te( Eso(ha*eal and ty(hanic te( alost the sae "ith (ulonary artery May cause (eranent disa#ility or death H%po0a$a!us , te( re*ulator center
• •
Losin >o#% 0"a Heat ay#e lost to o Cool surroundin* air Cool o#ects in o contact "ith s!in •
M"c0anis! o/ H"a Loss %& Convection heat loss to surroundin* air )& Conduction heat loss to near#y o#ects throu*h (hysical contact ,& Radiation 'ody heat is lost to near#y o#ects "ithout direct contact /& Eva(oration 'ody heat loss throu*h (ers(iration 1& Res(iration
SI74S A48 S6MPTOMS
MA4A7EME4T
TRA4SPORT CO4SI8ERATIO4
•
Loca$ Co$# Inur% %st de*ree +rost#ite 9rostni(B
)nd de*ree Su(er:cial 9rostB
,rd 8e*ree to / th 8e*ree 8ee( 9rost#iteB
In hot conditions> the #ody reacts to lose heat 'lood vessels in or o near the s!in dilate tin order to lose #lood heat S"eat *lands o #ecoe active& S"eat eva(orates in cooler air& Hairs are 0at o The rate and de(th o+ #reathin* "ill increase
G"n"ra$ SS? %& Sh iver in * )& 4u#ness ,& StiF> ri*id (osture /& 8ro"siness or ina#ility to do even si(lest activity 1& Ra(id #reathin* and ra(id (ulse in early sta*es> La" sa": Slo" (ulse and #reathin*& 2& 8ecrease LOC ;& Cool s!in te( <& Loss o+ otor coordination =& oint> uscle stiFness and ri*idity&
3icti una"are unless he sees hisel+ in the irror and notices unusual (allor and the return o+ the "arth to +rotni((ed area S!in is stiF #ut underlyin* tissue is so+t
Redness and tin*lin* sensation
%& )&
,& %& )& ,&
-axy and "hite 4u#ness As tha"in* occurs ,&%& Area turned ottled #lue ,&)& Stin*in* sensation ,&,& Edea and #lister "ithin a +e" hours %& -hite > ottled #lue or "hite hard cold )& Tissue +eels li!e #loc! o+ "ood ,& -h en th a"ed ,&%& Soothin* (ain ,&)& 'urnin* ,&,& Thro##in* ,&/& Achin* ,&1& Possi#le oint (ains ,&2& 7an*rene "ithin a
/& 1&
2&
3. )&
,& /&
Reove (atient +ro site Reove all o+ the (atientDs clothin* that is "et 8urin* trans(ort> re"ar the (atient Shoc! treatent 7ive "ar 0uid +or conscious and alert (atient ee( (atient at rest&
I/ si$$ /ro"n) $"a+" i /ro"n Pad the inured extreity to (rotect +ro +urther traua Do no !assa" 4o ti +y th e receivin* +acility so that they can start (re(arin*
+e" days reNuirin* a(utation o+ inured (art
H%po0"r!ia
•
•
Prolon*ed ex(osure to cold outdoor es(ecially in "et and "indy conditions 8eath +ro cold "ater iersion ay #e caused #y hy(otheria rather than dro"nin*
and re"arin* #oth& 1& I+ the extreity is (artially tha"ed> re"ar the inured area at ,< /) ZC K. Onc" r";ar!in is co!$"" 2&%& 8ry extreity very *ently and a((ly it *ently to tha"ed (art 2&)& Ta!e care not to ru(ture #listers& 2&,& Use so+t sterile *au.e or cotton to se(arate +rost#iten :n*ers and toes ;& Trans(ort the (atient in su(ine (osition and elevate the inured extreity on so+t (illo"> "ell covered and (rotect +ro cold& %& Reove (atient +ro cold environent )& Reove any "et clothin* and cover the (atient "ith #lan!et ,& Ha nd le th e (atient "ith "?r"!" car"& Avoid rou*h handlin* at all cost /& Adin hi*h 0o" O) "ared and huidi:edB
1&
2& ;&
8o not allo" the (atient to eat or drin! stiulants 8o not assa*e extreities Chec! +or a (ulse +or an extended (eriod o+ ,? to /1 sec #e+ore initiatin* 'LS
Too 0o Too co$# '$oo# 3asodilation 3asoconstriction +"ss"$s P"rspiraio Increase 8ecrease n Car#iac Increase 8ecrease oupu R"spiraor% Increase 8ecrease Ra" H"a 8ecrease 8ecrease pro#ucion Sa"s o/ H%po0"r!ia (ILCOR 977* Pror"ssion o/ H%po0"r!ia C 2 'o#% T"!p"raur" S%!po!s Mi$# ,2 ,/ ZC =2&< =,&) Z9 ,; ,1&1 ZC Shiverin* Mo#"ra ,/ ,? ZC <2 Z9 ,1&1 ,)&; ZC %& 8ecreased shiverin* re(laced " #y stron* uscular ri*idity S"+"r" W ,? ZC W<2 Z9 CASE
ASSESSMENT
Heat Cra(s )=&/ );&; ZC
)2&2 )?&1 ZC
)& Less clear thin!in* HEAT EMERGENCIES PATHOPHYSIOLOGY SIGNS AND is SYMPTOMS ,& 7eneral co(rehension dull Severe uscle cra(s %& E xh au st io n /& Possi#le total anesia )& 8i ..i nes s usually in the le*s and %& Irrational ,& Periods o+ +aintess a#doenB )&
Loses contact "ith envi and dri+ts into stu(orous state
,& /&
Slo" (ulse and res(iration
MANAGEMENT %& )&
,&
Possi#le cardiac dysrhythias Unconscious "ithout re0exes
/&
Move (atient to a near#y cool (lace 7ive the conscious (atient 0uids and electrolytes Massa*e the cra(ed uscle to hel( ease the (atientDs disco+ort& Massa*in* "ith (ressure "ill #e ore eFective than li*ht ru##in* A((ly oist to"els to
TRANSPORT CONSIDERATION
1&
Heat Exhaustion
3olue and electrolytes lost throu*h (ers(iration and is not re(laced dehydration hy(ovoleia decrease #rain (er+usion
%& )& ,& /& 1& 2& ;&
Ra(id> shallo" RR -ea ! ( uls e Cold> clay s!in Heavy (ers(iration Total #ody "ea!ness 8i ..i nes s Po ss i# le unconsciousness
%& )& ,&
/& 1&
2&
;&
<& =&
Heat Stro!e
%& )& ,& /& 1& 2&
8ee( #reaths and shallo" #reathin* Ra(id> stron* (ulse> then ra(id "ea! (ulse& 8ry ho t s! in 8ilated (u(ils Loss o+ consciousness (ossi#le coaB Sei.ures or uscular t"itchin* ay #e seen
%&
)&
,&
the (atientDs +orehead and over cra(ed uscles I+ cra(s (ersists> or i+ ore serious sy(tos and si*ns develo(> ready the (atient and trans(ort Move to cool (lace ee( [ res t Reove enou*h clothin* to cool the (atient "ithout chillin* hi "atch +or shiverin*B 9an the (atientDs s!in 7ive the conscious (atient 0uids "ith electrolytes& 8o not try to adinister 0uids to an unconscious (atient Treat +or shoc! #ut do not cover to the (oint o+ overheatin* (atient Provide hi*h conc& O) I+ unconscious> +ails to recover ra(idly> has other inuries> or has a hx o+ edical (ro#les> trans(ort as soon as (ossi#le Cool the (atient in any anner ra(idly& Reove +ro heat source& Reove (atientDs clothin* and "ra( hi in "et to"els and sheets& Pour cool "ater over these "ra((in*s& 'ody heat ust #e lo"ered ra(idly or >rain c"$$s ;i$$ #i". Treat +or shoc! and
adinister hi*h conc& O)& /& I+ cold (ac!s or ice #a*s are availa#le>"ra( and (lace one under each /&%& Ar(it /& )& nee /&,& 7roin /&/& -rist and an!le /&1& Each side on (atientDs nec! 1& Iediate trans(ort 2& 8elayed trans(ort$ 9ind a tu# or container& Ierse (atient u( to the +ace in cooled "ater& Constantly onitor to (revent dro"nin* ;& Monitor vital si*ns throu*hout (rocess
Con#iion
H"a Cra!ps H"a E?0ausion H"a Sro1"
Musc$" Cra!ps
"a1n" ss
'r"a0in
Pu$s"
S1in
P"rspirai on
3aries
3aries
Heavy
Ra(id shallo"
-ea!
Heavy
Soeties
8ee(> then shallo"
9ull Ra(id
Moist "ar Cold clay 8ryhot
Loss o/ Consciousn "ss Seldo
Little or none
O+ten
I4SECT 'ITES G STI47S EMER7E4CIES
CASE
Ty(ical sources o+ in+ected (oisons or toxins insect> s(ider G scor(ionB
ASSESSME4T •
•
PATHOPH6SIOLO76
7ather in+oration +ro the (atient> #ystanders> at the scene&
SI74S A48 S6MPTOMS
MA4A7EME4T
%&
4oticea#le #ites and stin*s on the s!in 'lotchy s!in Locali.ed (ain or itchin* 4u # nes s Muscle cra(s> chest ti*htenin* G oin* (ains 'urnin* sensation 8iculty o+ #rerathin* and a#noral (ulse rate Excessive saliva +oration> (ro+use s"eatin* -ea!ness@ colla(se
[email protected] Chills and +ever 4ausea and voitin* Redness S"ellin* or #listerin* Anap0%$a?is
%&
'ite on the s!in 8iscoloration> (ain> s"ellin*> at area& Slo" to develo( +ro ,? in to hours Ra(id (ulse and la#ored #reathin* Pro*ressive *eneral "ea!ness 'lurrin* o+ vision 4ausea and voitin* Sei.ures 8ro"siness o+ unconsciousness
%&
)& ,& /& 1& 2& ;&
9ind out "hatever you can a#out the insect or other (ossi#le source o+ the (oisonin*
<& =& %?& %%& %)& %,& %/& 3.
%& )&
Sna1" >i"s
,& /& 1& 2& ;& <&
)&
,& /&
1&
)&
,&
/&
1&
Pit 3i(er Has (it in axillary #one Eli(tical (u(il •
•
Tissu" N"crosis
Minial 4one S"ellin* Pain • • •
%& )& ,&
TRA4SPORT CO4SI8ERATIO4
CA' treat +or shoc! 9ollo" insect #ites and stin* (rotocol in your local EMS Reove e"elry +ro aFected li# Io#ili.ed the aFected (art> i+ allo"ed #y your (rotocol> a((ly cold co(ress Trans(ort in sei sittin* (osition +or conscious (atient and recovery (osition +or unconscious (atient
Locate the +an* ar!s and clean the site "ith soa( and "ater Reove any e"elry +ro the #itten extreity ee( the #itten extreity io#ili.ed A( (l y li* ht contractin* #and a#ove the #itten (art i+ allo"ed #y local (rotocol Trans(ort and onitor the (atient S a+ et y 'S I Su(ine O(en and aintain air"ay
IMME8IATE
•
Trian*ular head
/&
Io#ili.e inured li# and aintain it&
%& )& ,&
C al 3i cti O) Pr oxi al constrictin* #and @B Clean #anda*e "ound Io#ili.e #itten area -atch constrictin* #ands
Moderate Pro*ressive s"ellin* •
Coral Sna!e R"# on %"$$o; !ill a +ello" Red on #lac! veno lac!K Thin Sall rounded •
/&
• •
1& 2&
8o* #ites
3ery coon street eer*ency es(ecially in rural areas Areas o+ the #ody ost coonly #itten$ Head 4ec! U((er Extreities Percenta*e 9ace %% Trun! ; U((er extreity )< Lo"er extreity ,% • •
;& %&
)&
,&
•
•
•
Children W%) yo are usually #itten on the +ace& Most do* #ites occur in 0o ;"a0"r "hen a (erson (rovo!es a do*
/&
1&
Iediately and thorou*hly "ash the "ound "ith soa( and "ater 9lush the "ound "ith "ater and a((ly dressin* Trans(ort the (atient to the hos(ital +or edical care es(ecially i+ the "ound needs stitchin* or occurred in the +ace or nec! 8o not !ill the do* unless it is a#solutely necessary to (revent a +ull scale cri((lin* attac!& I+ you !ill the do*> call +or an anial
'ee Stin* insert #ee scienti:c naeB
Spi#"rs 'lac! -ido" Laro#"cus !acansB
'ro"n recluse Lo?osc"$"s r"c$usaB 9iddle#ac! s(iders 2 eyes 3iolin ar!in*s •
• •
ocer and reNuest that the cor(se #e exained +or ra#ies& 2& Io#ili.e inured (art ;& Patient is usually +ri*htened cal hi@her do"n& %& Reove stin*er #y scra(in* "ith a (lastic card or #lunt ed*e o+ a !ni+e )& Mana*e air"ay ,& O) @ 3entilation /& Shoc! (osition 1& E( in e( hri ne 1&%& 8ilate air"ay 1&)& Constrict 'lood vessels 1&,& As! +or !"#ica$ #ir"cion 1&/& 8osa*e 1&/&%& Adult ?&, * yello" 1&/&)& Child ?&%1 *
Local reaction 'ronchos(as Hy(otension Anap0%$a?is
N"uroo?ic
H"!o$%ic An"!ia 4ecrosis
%&
%&
)&
Muscle S(ass "ithin %1 in to ) hours 'ite o+ % a(art +an* ar!
%& )& ,& /&
4ecrosis Heo*lo#inuria Hy(otension Possi#ility o+ death
Su((ortive care
)& ,&
Lo cal co ld a((lication Sy(toatic care I ed ia te trans(ort
IMME8IATE
%&
Air"ay ana*eent 9. Loo! out +or car#iac #%srr0%!ias %& CA' )& 9lush "ith "ater ,& Ierse in "ar "ater Vin"ar an# 0o ;a"r %& S a+ et y 'S I )& LOC ,& CA' /& O)@ ventilation 1& Ierse "ound ,?/? in as hot as can #e tolerated> re(eat as necessary to control (ain "ithout scaldin* 2& Tr an s( or t
Scorpion ( C"nuroi#"s scu$puraus*
Sin ra%
Hy(otension Stone:sh #ein* the ost (oisonous o+ the
F"$$%s0 ScorpionLionSon" s0 S"a Urc0ins
ATER EMERGENCIES CASE
ASSESSMENT
Dro;nin
Aci+" #ro;nin: Conscious Thrashin* 3ertical in H)O Una#le to call +or hel( 'ody ay#e lo" in H)O
Caus"s: Ri( Currents
PATHOPHYSIOLOGY
o
• • •
o
•
o
•
o
S"p 3 3icti *oes under> "ater enters the air"ay& Cou*hin* and *as(in* victi s"allo"s "ater S"p 9 A sall aount enters the larynx and causes laryn*os(as 'reathin* ceases and eta#olic acidosis occurs& Dr% #ro;nin %?
SIGNS AND SYMPTOMS
MANAGEMENT
Sa"s o/ ;a"r r"scu": %& 6ell )& Reach and (ull ,& Thro" /& To" 1& 7o
Sa"s o/ !ana"!"n o/ #ro;nin %& 8o not enter unless trained in "ater rescue )& Ensure o(en air"ay and atte(t rescue #reathin* ,& C on tin ue rescue #reathin* and reove +ro
2r"s0 ;a"r #ro;nin , not uch (ro#le Sa$ ;a0"r #ro;nin , "ater has hi*h osolarity "hich attracts 0uids "hich results to (ulonary edea
TRANSPORT CONSIDERATION
o
o
o
o
Di+in E!"r"nci"s 'o%$"Bs $a; o As (ressure increase> volue decreases As (ressure o decreases> volue increases Da$onBs $a; P%X PO)B P4)B o P5B o Total (ressure o+ *as
%1 o+ *asesB S"p 8 Laryn*eal uscles #ecae severely hy(oxic and r"$a? allo"in* air and "ater to enter the lun*s& " #ro;ninB Tri**ers (eri(heral air"ay resistance and constriction o+ the (ulonary vessels Si= Lun lun* ceases to #e co(liant& S"p 4 3icteDs hy(ercar#ic@hy(oxi c drive +urther stiulate inhalation o+ "ater "hich ixes "ith air and cheical resident in the lun*s to +or a +roth& 'rain daa*e and death +ollo"s
/&
1& 2&
0a o n# ou a>ou a #i+in "!"r"nc% %& Ty(e o+ divin* and the Ty(e o+ ENui(ent )& 8ivin* activity (hoto*ra(hin*> :shin*B ,& 4u#er o+ dives ade the (ast ;) hours "ith each has /& 8e(th 1& ' ot to ti e 2& Sur+ace Interval ;& 8etails o+ in"ater deco(ression <& In"ater reco(ression a nonoB
the "ater Chec! (ulse> i+ no (ulse> start chest co(ression Tr an s( or t I+ *iven the o((ortunity (ositive (ressure ventilation usin* PEEP to dry the lun*s&
ix is su o+ (artial (ressure o+ itDs co(onents
=& 8ive co(lications> i+ any& %?& Predive and (ostdive activity %%& Onset o+ sy(tos "hen and "hat cae :rstB
H"nr%Bs $a; o Pressure o+ a *as in liNuid is (ro(ortional to itDs (ressure in the atos(here % at ,/ +t "ater o 'arorau!a , co(ression or ex(ansion o+ *as actually in adacent to >o#% air spac"s D"sc"n Ear SNuee.e External Middle Sinus SNuee.e Lun* SNuee.e •
'ody air s(aces atte(ts to eNuili#rate on the outside atos(heric (ressure #loc!a*e #arotraua
• •
Lun Su""" 'reath hold %?? +s" co(ression o+ volue ne*ative (ressure o+ lun*s (ullin* o+ interstitial 0uid and #lood in shrun!en air s(aces
Lun* sNuee.e is ty(ically rare& 9or lun* sNuee.e to occur> a #reathhold diver ust descend to a de(th "hich total lun* volue is si*ni:cantly co(ressed %?? +eetB Lun Su""" 8ys(nea Chest (ain Cou*h Heo(tysis Pulonary edea Pneuoediastinu@ Su#cutaneous e(hysea 9ullness o+ his throat o 8ys(ha*ia o o 8ys(nea Su#sternal chest (ain o Su#cutaneous air (al(a#le o a#ove clavicles o Crunchin* noise synch "ith heart #eat
Lun Su""" %& 4o PP3 or PEEP )& %?? O) 4R M ,& I3 /& ee( (atient sittin* u( 1& TRA4SPORT to hos(
• • • • •
Asc"n POPS (Pulonary Over(ressure SyndroeB 'urs $un
Could cause$ Pneuothorax@Tension Pneuothorax Pneuoediastinu Su#cutaneous e(hysea Arterial Air E#olis •
• •
•
•
D%s>aric Air E!>o$is! Sy(tos occurs "ithin seconds or inutes a+ter sur+acin*& Air #u##les coalesce into lar*er and lar*er #u##les as they travel throu*h the veins
•
•
Pneuoediastinu @ Su#cutaneous e(hysea 'ed rest and o oxy*en thera(y POPS %?? O) o 4RM o DonB i+" PEEP o POPS o !ee( (atient Nuiet o trans(ort hi to hos(ital&
Cornoray arteries MI or o Cere#ral artery ust li!e Stro!e Pneuothorax@Tension Pneuothorax Tracheal deviation o o UneNual #reath sounds Hy(er resonance on the o aFected side o
o
o
•
D"co!pr"ssion Sic1n"ss 4arcosis 4arcs@Ra(ture o+ the dee(B 4ot dan*erous #ut can i(air the diverDs ud*ent& T%p" I DS 8S o+ the s!in
8S o+ the oints usculos!eletalB
Accuulation o+ nitro*en in the tissues in crease (ressure increase aount o+ dissolved nitro*en in the tissues anesthetic eFect artini eFect Most coon #ut least re(orted
I+ in dou#t o+ AIR EM'OLISM *o to hy(er#aric cha#er +acility
Ascend slo"ly to alleviate JartiniK eFect&
%& )& ,& %& )& ,& /&
Pruritis SQ e(hysea Mottled rashes 8ee(> dull aches in uscle@oints Moveent "orsen (ain 9ati*e In0atin* cuF "ill relieve (ain
%&
)& ,&
4.
1&
2&
Ensure AdeNuate Air"ay 7i ve %?? oxy*en S ta rt an I3 "ith LR and *ive as directed 7ive steroids> (re+era#ly M"0%$pr"#ni si$on" 39 ! IV Do no us" nirous o?i#" +or anal*esia Advise hos(ital that you "ill reNuire a use o+ a hy(er#aric cha#er
TYPE II DS 8S o+ the C4S /%? in rule
'rain involveent
CHOES
%& )& ,& /& %& )& ,& /&
Paresthesia Sei.ure S(inal cord involveent Pa ra lys is Chest (ain 8ry cou*h 8ys(nea Pulonary edea
%&
)& ,&
4.
1&
2&
Tr"a!"n o/ Susp"c"# Air E!>o$is!
%& )& ,&
Ensure adeNuate air"ay> es(ecially in the unconscious (atient i+ licensed to do so> INTU'ATE Adin& %?? O) Trans(ort in L Lateral recu#ent "ith %? de*ree 0"a# #o;n i$
/& 1&
I+ licensed esta#lish an I3 li+eline "ith LR
2&
Have the +ollo"in* dru*s ready +or use Un#"r M"#ica$ Dir"cion:
Monitor cardiac rhyt and #e (re(ared to treat dysrhythias
2&%& Dia"pa!) 1* +or Sei.ures 2&)& Dopa!in" in/usion %?*@!*@in +or treatent o+ Hy(otension
;&
Noi/% edical coand@ hos(ital to a!e arran*e +or rece(tion at a hy(er#aric cha#er +acility Tr"a!"n o/ D"co!pr"ssion Sic1n"ss
%& )& ,& /& 1&
Ensure AdeNuate Air"ay 7ive %?? oxy*en Start an I3 "ith LR and *ive as directed 7ive steroids> (re+era#ly M"0%$pr"#nisi$on" 39 ! IV Do no us" nirous o?i#" +or anal*esia
Ensure AdeNuate Air"ay 7i ve %?? oxy*en S ta rt an I3 "ith LR and *ive as directed 7ive steroids> (re+era#ly M"0%$pr"#ni si$on" 39 ! IV Do no us" nirous o?i#" +or anal*esia Advise hos(ital that you "ill reNuire a use o+ a hy(er#aric cha#er
