DONOR ROOM EMERGENCIES a NISANTH MENON presentation MD (EM), M.Med (FM) Fellow of Academic College of Emergency Experts (FACEE)

PROBLEM STATEMENT 0.6% 1.3% 1.2% 3.2% 1.6% 2.04% 7.9%

PHLEBOTOMY WAITING TO DONATE BLOOD TESTING RESTING Seemingly healthy False sense of pride Seemingly healthy Anxiety/ Hyperventilation BLOOD TESTING Pain Diagnosing blood dyscrasias PHLEBOTOMY Pain Bleeding RESTING

CARDIAC ARREST ANAPHYLAXIS SEIZURES ANGINA/ ACS TIA/ STROKE SYNCOPE UNRESPONSIVENESS CARDIAC ARREST ANAPHYLAXIS SEIZURES ANGINA/ ACS TIA/ STROKE SYNCOPE

ECG Rhythm/& Defibrillation SpO2/ BP/ IV cannula High Quality CPR ECG Rhythm/& Defibrillation SpO2/ BP/ IV cannula Adrenaline or Atropine Recovery Position ANTICONVULSANT IV Crystalloids Anti-Shock Position Vasopressors Reassure/ Refer

HIGH QUALITY CPR Start early/ check pulse Call for help 30 compressions : 2 breaths Barrier device/ mask – if not, CO-CPR Push Hard/ Push Fast Do not interrupt Get an AED/ Defibrillator ready Early IV line  Adrenaline 1:10000 Defibrillate if pVT/ VF Transfer to ED/ ICU/ higher centre

SEIZURE Left Lateral position Suction n clear airways IV LINE Inj. MIDAZOLAM/ LORAZEPAM 0.1 mg/ kg Transfer to ED/ ICU/ higher centre

ANAPHYLAXIS Propped-up position Oxygen & clear airways Adrenaline 0.3-0.5 mg 1:1000 im/ sc 0.01mg/kg paediatric dose Early IV line  IV crystalloids Inj. HYDROCORTISONE 100-300 mg Defibrillate if pVT/ VF Transfer to ED/ ICU/ higher centre

BLEEDING Compression Ice Pack Limb elevation Tourniquet/ BP Cuff inflation Prevent Hematoma Prevent extravasation  Neurological deficits

Prick Hematoma Nerve Injury Tendon Injury PAIN

IV ANALGESIA Ice Pack Reassurance Lignocaine – L/A Analgesic Creams NSAIDs Vs Opiods IM Analgesic injections IV ANALGESIA

Nerve injuries Arterial Injuries Vein Injuries OTHER INJURIES Nerve injuries Arterial Injuries Vein Injuries

APHERESIS RELATED TETANY ?HYPOCALCEMIA ? HYPERVENTILATION Rebreather Mask Calcium Tablets Calcium gluconate IV

TAKE HOME Low prevalence Emergency – On your toes! Be confident- keep calm ; Be competent – get trained! Rule out a Cardiac Arrest in the unresponsive patient Differentiate Seizure from Syncope Suspect angina – ACS/ Seizure – TIA ECG – Rhythms to rule out deadly bradycardias/ arrythmias Hyperventilation mimics hypocalcemic tetany Bleeding & Pain – Life > Limb – threatening condition Hematoma/ Nerve Injuries/ Tendon injuries Refer appropriately

Thanks! Any questions? You can find me at: Nisanth Menon nnmenonnn@yahoo.co.in