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General Medical Emergencies

General Medical Emergencies. SPECIFIC CONDITIONS. REYE’S SYNDROME GOUT FEVER ALLERGIC REACTION FLUID AND ELECTROLYTE COMA HEMATOLOGICAL EMERGENCIES. REYE’S SYNDROME. REYE’S SYNDROME. Acute no inflammatory encephalopathy characterized by hepatic, metabolic & neurological dysfunction.

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General Medical Emergencies

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  1. General Medical Emergencies

  2. SPECIFIC CONDITIONS • REYE’S SYNDROME • GOUT • FEVER • ALLERGIC REACTION • FLUID AND ELECTROLYTE • COMA • HEMATOLOGICAL EMERGENCIES

  3. REYE’S SYNDROME

  4. REYE’S SYNDROME • Acute no inflammatory encephalopathy characterized by hepatic, metabolic & neurological dysfunction. • Children • Salicylate ingestion may be a predisposing factor • Late winter & early summer higher incidence

  5. ASSESSMENT SUBJECTIVE DATA ONSET MEDICAL HISTORY

  6. OBJECTIVE DATA • PHYSICAL EXAM • NEUROLOGICAL STATUS • GASTROINTESTIONAL STATUS

  7. DIAGNOSTIC PROCEDURES • AMMONIA LEVEL • EMZYME LEVELS • PT, PTT • CHEM 7 • ABG • CSF

  8. PLANNING AND INTERVENTION • ABC • O2 • IV FLUIDS • GIVE DEXTROSE TO COUNTERACT HYPOGLYCEMIA • MEDS – MANNITOL, STERIODS

  9. GOUT

  10. SUBJECTIVE DATA • LOCATION OF PAIN • TIMING /ONSET OF PAPIN • CHARACTERITICS OF PAIN • FEVER • MEDICAL HISTORY

  11. OBJECTIVE DATA • PHYSICAL EXAM • ERYTHEMATOUS, HYPERTHERMIC EDEMA OF JOINT • FEVER • RELUCTANT TO USE EXTREMITY

  12. DIAGNOSTIC PROCEDURE • URIC ACID • WBC IN SYNOVIAL FLUID • HYPERCALCEMIA

  13. PLANNING AND INTERVENTION • ANTINFLAMMATORY AGENTS • WEIGHT REDUCTION • DIET – AVOID ALCHOL,HIGH PURINE • AVOID THIAZIDE DIURETICS

  14. FEVER

  15. SUBJECTIVE DATA • HISTORY OF PRESENT ILLNESS • PREVIOUS SIMILAR EPISODE • FEVER DEGREE AND PERSISTENCE • OTHER SYMPTOMS • IN CHILDREN FLUID INTAKE • MEDICAL HISTORY

  16. OBJECTIVE DATA • PHYSICAL EXAM • DIANOSTIC PROCEDURES LABS X-RAYS LUMBAR PUNCTURE

  17. PLANNING AND INTERVENTION • ABC • CONTROL TEMPERATURE > 101 • MEDICATIONS • FLUIDS • DETERMINE SOURCE OF INFECTION

  18. ALLERGIC REACTION

  19. SUBJECTIVE DATA • HISTORY PRECIPITATING EVENTS IF KNOWN ELAPSED TIME SINCE CONTACT • MEDICAL HISTORY PREVIOUS ALLERGIC REACTIONS ALLERGIES MEDICATION

  20. OBJECTIVE DATA • APPEARANCE OF CONTACT SITE • COMPLAINTS OF DISCOMFORT • SIGNS AND SYMPTOMS OF ANAPHYLAXIS

  21. PLANNING AND INTERVENTION • ABC • EPINEPHRINE • O2 • IV • ANTIHISTAMINE • HISTAMINE-2BLOCKER • STERIODS • BETA AGONIST OF BRONCHOSPASM • TREAT AREA OF CONTACT

  22. FLUID AND ELECTROLYTE EMERGENCILES

  23. ELECTROLYTE ABNORMALITIES • SODIUM • POTASSIUM • CALCIUM • MAGNESIUM

  24. SODIUM • NORMAL WATER BALANCE • IMPULSE CONTROL • REGULATED BY RENIN ANGEOTENSIN ALDOSTERONE

  25. HYPONATREMIA • ACTUAL SODIUM DEFICITS DIAPHORESIS DIURETIC USE WOUND DRAINAGE DEC OF ALDOSTERONE RENAL DISEASE HYPERLIPIDEMIA

  26. HYPONATREMIA • DILUTIONAL CAUSES EXCESSIVE WATER INTAKE FRESHWATER DROWNING GI LOSSES HYPERGLYCEMIA CHF BURNS

  27. SUBJECTIVE DATA • HISTORY ALTERED ORAL INTAKE NAUSEA AND VOMITING THIRST EXCESSIVE WATER INTAKE SKELETAL MUSCLE WEAKNESS MUSCLE CRAMPS

  28. OBJECTIVE DATA • PHYSICAL EXAM • MENTAL STATIS • SKIN TLURGOR • SUNKEN FONTANELLE AND EYES • DRY MUCUS MEMBRANES • HYPOTENSION AND TACHYHCARDIA • SEZURES LEVEL < 110 mEq/L

  29. DIAGNOSTIC PROCEDURES • CBC • ELECTOLYTE LEVE • CHLORIDE • BUN AND CREATININE LEVELS • UA

  30. PLANNING AND INTERVENTION • ABC • IV FLUIDS • REPLACE SODIUM ORALLY OR IV • PROTECT FROM INJURY (SEIZURES) • I&O

  31. HYPERNATREMIA

  32. SUBJECTIVE DATA • HISTORY OF PRESENT ILLNESS • ANOREXIA, NAUSEA,VOMITING • DIARRHEA • ALTERED SODIUM INTAKE • THIRST • DEHYDRATION

  33. OBJECTIVE DATA • PHYSICAL EXAM • DECREASED URINE OUTPUT • HYPERREFLEXIA, MUSCLE TWITCHING • DRY MUCOUS MEMBRANES & SKIN • MUSCLE WEAKNESS • ORTHOSTATIC VITAL SIGN CHANGES

  34. DIAGNOSTGIC PROCEDURES • LABS • INFANTS NORMAL 275 TO 285 mOsm/kg • ADULT NORMAL 285 TO 295 nOsm/kg • SYMPTOMS DEVELOP AT 320 • COMA OCCURS AT 360

  35. PLANNING AND INTERVENTION • IV FOR ISOTONOIC SOLUTIONS • BLOOD SUGER TO RULE OUT HYPOGLYCEMIA • I & O • MONITOR FOR SEIZURE ACTIVITY • LIMIT SODIUM INTAKE

  36. POTASSIUM ABNORMALITIES

  37. HYPOKALEMIA • LEVEL BELOW 3.5 mEq/L • LOW INTAKE • GASTROINTESTIONAL LOSSES • RENAL LOSSES • DIABETIC ACIDOSIS TREATMENT • BURNS • OVERHYDRATION

  38. SUBJECTIVE DATA • GI UPSET • WEAKNESS AND FATIQUE • SOB • CRAMPS • FREQUENT URINATION • CONSTIPATION

  39. OBJECTIVE DATA • SHALLOW RESP,WEAK PULSE • MUSCLE TENDERNESS • DSYRHYTHMIAS (HEART BLOCKS) • CONFUSION • PARALYTIC ILEUS, HYPOACTIVE BS • POLYURIA

  40. DIAGNOSTIC PROCEDURES • LABS • DEPRESSED ST SEGMENTS • ABG ALKALOSIS • FLATTENED T WAVES • U WAVES • VENTICULAR IRRITABILITY

  41. PLANNING AND INTERVENTION • ABC • IV • ADMINISTER POTASSIUM CHLORIDE • CORRECT ACID-BASE IMBALANCE • MONITOR CARDIAC RHYTHM

  42. HYPERKALEMIA • K > 5.5 mEq/L • POSSIBLE CAUSES EXCESSIVE k INTAKE DECREASED GLOMELULAR RATE RENAL FAILURE SEVERE TISSUE INJURY ACIDOSIS INSULIN DEFICENCY

  43. SUBJECTIVE DATA • CONFUSION • HYPEREXCITABILITY • MUSCLE WEAKNESS • AB DESTENTION • DIARRHEA • CHRUSH OR BURN INJURY

  44. OBJECTIVE DATA • MENTAL CONFUSION • WEAKNESSS • DYSRHYTHMIAS • BRADYCARDIA

  45. DIAGNOSTIC • ABC • LABS • ECC • PEAKED T WAVES • DEPRESSED OR FLAT T WAVES • WIDENING QRS • PROLONGED PR

  46. PLANNING AND INTERVENTION • ABC • IV • MEDS SODIUM BICARB GLUCOSE 50% INSULIN KAEXYLATE MONITOR CARDIAC STATUS

  47. CALCIUM ABNORMALITIES

  48. CALCIUM • LEVELS ARE REGLULATED BY ENDOCRINE SYSTEM • FACTOR IV IN THE BODY’S CLOTTING CASCADE • TRANSMISSION OF NEUROMUCSCLAR IMPULSES • IMPORTANT IN BONE FORMATION

  49. HYPOCALCEMIA • DEFICITS OF CALCIUM INTAKE • INHIBITION OF CALCIUM ABSORPTION • DECREASED VIT D • LACTOSE INTOLERANCE • MALABSORPTION SYNDROMES • BLOOD TRANSFUSIONS • ENDOCRINE DISTURBANCES

  50. SUBJECTIVE DATA • PARESTHESIA THEN NUMBNESS • MUSCLE CRAMPS • ALTERED DIETARY INTAKE • RENAL FAILURE • PANCREATITIS • TOXIC SHOCK

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