Emergency Station Mohammad Alazemi - PGY3 Chief Resident 20/4/2019.

Slides:



Advertisements
Similar presentations
Emergency Response for School Staff Critical Signs and Symptoms.
Advertisements

GENERAL PHARMACOLOGY.
Presentation Prepared By James L. Dean, AEMT-P and Sean J. Britton, NREMT-P Benjamin J. Krakauer, MPA, NREMT-P.
Which drug (other than Valium) may be used to terminate status epilepticus?
Doug Simkiss Associate Professor of Child Health Warwick Medical School Management of sick neonates.
COPD “Trying to Expire Not Expire” Dr Esyld Watson HST Emergency Medicine.
Diabetes – What is it? Hormone (insulin) needed to regulate blood glucose levels is ineffective; Glucose levels can get too high or too low Type I - patients.
Cardiovascular Emergencies
Copyright 2009 Seattle/King County EMS Overview of CBT 450 Diabetic Emergencies Complete course available at
Algorithm for the Treatment and Management of Hypoglycaemia in Adults with Diabetes Mellitus in Hospital Hypoglycaemia is a serious condition and should.
PCP March 9, 2012 You are dispatched Code 3 for a Diabetic, at 0730….You arrive at a Gold River townhouse and are led by the parents to the upstairs.
Acute severe asthma.
Pediatric Prehospital Seizure Management: Evidence Based Guidelines and State of Care in CO Kathleen Adelgais, MD MPH Pediatric Emergency Medicine Children’s.
Region X Medication Administration CE August, 2006 Albuterol (Proventil) Benzocaine (Hurricaine) Dextrose Glucagon Diphenhydramine (Benadryl) Glucagon.
Dr. Shahzadi Tayyaba Hashmi. MEDICAL EMERGENCIES THAT CAN OCCUR IN THE DENTAL SURGERY Vasovagal attack (faint/syncope) Hyperventilation (panic attack)
CARDIAC ARREST RESUSCITATION-Cardiac arrest is the sudden failure of the heart to supply adequate blood RESUSCITATION-Cardiac arrest is the sudden failure.
SITUATION Hypoglycaemia – blood glucose level
MEDICATIONS. Medications Epinephrine Volume expanders Sodium bicarbonate Naloxone Dopamine.
Case 6 A 54 year old obese person come in emergency with altered consciousness level and increase respiratory rate (tachypnia) for last 4 hours. He is.
Hypoglycaemia Diabetes Outreach (June 2011). 2 Hypoglycaemia Learning outcomes >Can state what hypoglycaemia is >Be able to assess who is at risk of hypoglycaemia.
Diabetes. Glucose n Required as fuel for cellular metabolism n Brain’s need for glucose parallels its demand for oxygen.
General Pharmacology.
Emergency management of complications of thrombolysis C. Roffe The recommendations in this presentation are for guidance only. Guidance based on ASA recommendations.
Anaphylaxis. Severe Anaphylactic Reactions Manifestation Respiratory difficulty Signs of shock/hypotension Involvement of skin/mucosal tissue GI symptoms.
1 Medical Emergencies. 2 Objectives Describe the potential causes and outline the management of seizures in children Discuss the implication of fever.
ACUTE COMPLICATIONS. 18 years old diabetic patient was found to be in coma What questions need to be asked ? Differentiating hypo from hyperglycemia ?
Radiology Life Support: Dealing with Acute Contrast Reactions William H. Bush, Jr., MD, FACR University of Washington.
Management. Goals of emergency management for status epilepticus Ensure adequate brain oxygenation and cardiorespiratory function Terminate clinical and.
Emergencies Dr. P Feldman. Chest pain Causes –MI –Unstable angina –Pulmonary embolism –Pneumothorax –Pericarditis –Pleurisy –Musculoskeltal –Shingles.
Management of hypertensive urgencies & emergencies.
 Triage is from a French word meaning to sort. Emergency services regularly face patient loads that overwhelm resources. To better serve patients and.
Dental management of patient with cardiac disease and hypertension by:DR.SUZAN HASSAN Lecture (3).
DIABETIC KETOACIDOSIS By, Dr. ASWIN ASOK CHERIYAN Chair Person – Dr. JAYAMOHAN A.S.
Management of diabetic ketoacidosis Prof. M.Alhummayyd.
ASSESSMENT OF VITAL SIGNS Marie Bártová, BSN Institute of Nursing Theory and Practice 1 st Faculty of Medicine, Charles University.
Advanced & Primary Care Paramedic Changes to Medical Directives Fall 2005.
Management of diabetic ketoacidosis (DKA) Prof. M.Alhummayyd.
Paediatric Emergencies
Review Questions and Answers Chapters 16-18
Acute Medicine M5 Seminar (Hypoglycaemia) Yeo Xinying 19 Jan 2005.
 Hypoglycemia  Physical Signs  –Sweating  –Tremulousness  –Tachycardia  –Respiratory Distress  –Abdominal Pain  –Vomiting.
June 22, 2011 Washtenaw/Livingston MCA.  Albuterol – 3 unit doses  Aspirin – 4 baby chewable tabs  Hand held nebulizer  Use replacement form.
M ANAGEMENT OF ACUTE SEVERE ASTHMA Dr: MUHAMMED AL,OBAIDY CHEST PHYSCIAN MEDICAL CITY.
Post Anesthesia Care. Post Anesthesia Unit  Specialized critical care area  Also called recovery room or PACU, (post anesthesia care unit)  Usually.
Management of Adult Diabetic Ketoacidosis Adapted from the WHO IMAI District Clinician Manual Vol. 1 Dr. Linda Hawker, June 2014.
Hypo and Hyperglycemia
Medical Emergencies Quiz and summary
Resuscitation of The Newborn Baby Lec
Asthma ED Junior Teaching.
Management of diabetic ketoacidosis and hypoglycemia
HTN Complications of Pregnancy
Foundations of Interprofessional Collaboration (FIPC): An Introduction to TeamSTEPPS® LEVEL 3 Overview of Clinical Management of Anaphylaxis for Respiratory.
Medical Emergencies in dentistry
ESETT Eligibility Overview
Rare ……..But it could be YOU!
ACUTE COMPLICATIONS.
ACUTE COMPLICATIONS.
Management of diabetic ketoacidosis
Management of diabetic ketoacidosis and hypoglycemia
HYPERTENSIVE CRISES Mini-Lecture.
HYPERTENSIVE CRISES.
Dr F Hignett, September 2015 ST4 Paediatrics
Objectives of patients flow map
Patient conscious, orientated and able to swallow
GFR Medication Training
How would you approach this patient?
ຊັອກ (SHOCK).
Endocrine Emergencies
Introduction to Clinical Pharmacology Chapter 16 Opioid Antagonists
50% Dextrose Also Ativan (lorazepam)
Presentation transcript:

Emergency Station Mohammad Alazemi - PGY3 Chief Resident 20/4/2019

ANY REQUIREMNETS FOR THE OSCE Stethoscope. you can ask for any equipment THAT YOU NEED.

WHAT EVER YOUR STATION IS? H A N D W A S H I N G. Call for help and ambulance. Act, Act, Act !! Talk to the patient. Contact with the nurse. When ever you give a medicine, mention the name of the drug, the dose and the route of administration. Always remember ABC.

Initial Assessment ABCD GCS Vitals Pulse, BP, oxygen sats %, Resp Rate

ROLE PLAY

Anaphylaxis Call ambulance. Check: Airways  open airway (intubate if necessary). Breathing  assess effectiveness of ventilation + give O2 10l/min. Circulation  check pulse, BP, fix large bore IV cannula. Disability  assess consciousness level by Glasgow coma scale. Exposure  check skin changes, facial or lip swelling.

Give IM Adrenaline 1:1000 (in the anterolateral aspect – middle 1/3 of the thigh) Repeat after 5 min if no improvement. Start IVF 0.9 % saline (adult 500 ml- 1 L in 5-10 min) / child 20 ml/kg. Give hydrocortisone IM or slow IV: 0.5 ml > 12 y 0.3 ml 6-12 y 0.15 > 6m – 6 y 200 mg > 12 y 100 mg 6y – 12 y 50 mg 6 months – 6 y 25 mg < 6 months

Give chlorphenamine (piriton) IM or slow IV: 10 mg > 12 y 5 mg 6 y – 12 y 2.5 mg 6 months – 6 y 250 Microgram/kg < 6 months

Convulsions Call ambulance. Check: ABCD similar to anaphylaxis. Put the patient in recovery position. Check temperature and blood sugar. If fit does not stop after 5 mins spontaneously  give Diazepam rectally If status epilepticus  repeat same dose every 15 mins until ambulance arrive. 10 mg Elderly 10-20 mg > 10 y 5-10 mg 2 – 10 y 5 mg 1 m – 2 y 1.25-2.5 mg neonates

Myocardial infarction Call ambulance. Check: BP, RR, HR, O2, ECG. GTN 300 Microgram sublingual (avoid if systolic BP < 90 mmHg or HR > 110). Morphine IM/IV 5-10 mg stat (then 1-2 mg/min up to 15 mg until adequate response). If respiratory depression: Naloxone 0.4-2mg) repeat every 2-3 min (max 10 mg). Aspirin 300 mg (if not contraindicated). Metoclopramide IM/IV 10 mg. If bradycardia: Atropine IV 500 Microgram (repeat if necessary to max 3mg).

Hypertensive emergency If systolic BP >/= 180 mmHg and/or Diastolic BP >/= 110 mmHg. Asses ABCD. Examine fundi (papilledema). Do ECG (R/O ischemic change). Do urinalysis if available (check for protein and RBCs).

Hypertensive emergency: If symptomatic with signs of end organ damage: Headache or blurred vision. Increasing chest pain or SOB. Swelling or edema. Confusion. 2. Call ambulance. 3. Open iv access. 4. Refer urgently to hospital to start iv medications to lower BP.

URGENT FOLLOW UP APPOINTMENT FOR BP IN FEW DAYS. Hypertensive urgency: If asymptomatic and no signs of end organ damage. If already on hypertensive medications  check compliance then restart optimize dose and Rx. If not on hypertensive medications  Oral captopril 12.5 mg (do not give if volume overload  edema, pounding pulse, tachycardia, respiratory crackles). Oral furosemide (Lasix) 20 mg (do not give in volume depletion or dehydration  vomiting, diarrhea, excessive sweating, kidney failure). 4. Monitor the patient for drop of BP of 20-30 mmHg then send the patient home with longer acting hypertensive medication. URGENT FOLLOW UP APPOINTMENT FOR BP IN FEW DAYS.

Acute left ventricular failure Be calm and reassuring. Call ambulance. Position the patient upright. Give: Oxygen 100% aim for SpO2 94-98% (if COPD 24% O2 aim for SpO2 88-92%). GTN sublingual (do not give if severe hypotension systolic <90 mmHg). Fix an IV line and give: IV furosemide 20-50 mg. IV morphine 5-10 mg +/- IV mtachlopromide (can be mixed).

Hypoglycemia Conscious: Blood sugar < 4 mmol/l + hypoglycemic symptoms: If the patient is oriented and able to swallow  give fast acting oral glucose juice (75 g dextrose) followed by long acting carbs (biscuits and milk). If the patient is disoriented and unable to cooperate  give IM Glucagon 1 mg (if child weight , 25kg  0.5 mg).

Unconscious: Call ambulance Check ABCDE. Give: IM glucagon 1mg, SE nausea and vomiting  put the patient in recovery position, (if child weight < 25kg  0.5mg). OR iv 50 ml 10% dextrose. OR 20 ml 6g/20ml glucose. Remeasure blood glucose after 15 min and repeat IV until blood sugar > 4 mmol/l. If on sulfonylurea  refer to hospital in spite of correction of blood sugar.

Hyperglycemia Blood sugar > 20 mmol/l. Urine test: if +ve for ketones  DKA, if –ve for ketones  hyperosmolar state. Unconscious: Check ABCD Give 1 L of 0.9 % saline over 0.5-1 hr. (repeat up to 3X if needed. Then 500 ml/hr for the next 2-3 hrs. If child 10ml/kg. Refer by ambulance.

If poor response  refer to medical casualty by ambulance. Asthma exacerbation Check BP, RR, HR, O2. Give: O2 and high dose bronchodilator Salbutamol nebulizer (adult 5 mg = 1ml, child 2.5 mg = 0.5ml). Ipratropium bromide (adult 0.5 mg = 2 ampules, child 0.25 mg = 1 ampule). Assess response  repeat ventoline after 20 min if indicated. 2. Give corticosteroid Oral prednisolone (adult 40-50mg, child soluble 20mg < 2years, soluble 30-40mg 2-5 years0 3. Or give IV hydrocortisone (adult 100mg, child 50 mg <2y, 100mg 2-5 y). If poor response  refer to medical casualty by ambulance.

Thank you