1) The document provides guidance on cardiac arrest treatment, beginning with assessment of an unresponsive patient with no pulse or blood pressure. 2) It outlines the steps of advanced cardiac life support including chest compressions, defibrillation, intubation, medications, and monitoring the patient's rhythm. 3) Specific protocols are provided for ventricular fibrillation, asystole, bradycardia, tachycardia, cardiac failure, bronchial asthma and other conditions that may cause or arise from cardiac arrest.
The document discusses several common medical emergencies including myocardial infarction (heart attack), cardiopulmonary resuscitation (CPR), stroke, hypoglycemia, seizures, asthma, and road traffic accidents. For each emergency, the document outlines symptoms, potential causes, and recommended first aid actions such as calling for an ambulance, giving oxygen, monitoring breathing, providing glucose for low blood sugar, and applying pressure to stop bleeding.
This document discusses methods for triage and assessment in mass casualty situations. It describes evaluating patients based on airway, breathing, circulation, disability and exposure (ATLS methodology). Patients are categorized into triage categories (immediate, delayed, minimal, expectant) based on their injuries and prognosis. Scoring systems like Injury Severity Score (ISS) and Revised Trauma Score (RTS) are used to evaluate patients and compare outcomes between treatment centers using TRISS methodology.
This document provides information and guidelines for managing a Code Blue situation. It defines a Code Blue as indicating a patient requiring resuscitation or immediate medical attention due to respiratory or cardiac arrest. The Code Blue team is described, including roles of nurses, doctors, and other staff. Steps for responding to a Code Blue are outlined, including activating the code, performing CPR, using the crash cart, and giving resuscitation drugs like epinephrine. Responsibilities of nurses during the code are defined. The document provides treatment guidelines for cardiac arrhythmias and discusses resuscitation activities and documentation.
This document provides an overview of emergency medicine as a specialty. It discusses the top causes of death, the reception process in emergency departments, how cases are triaged from life-threatening to non-urgent, and examples of common illnesses and injuries seen in emergency medicine including chest pain, fractures, seizures, and psychiatric illnesses. It also outlines both the appeals and challenges of working in emergency medicine as well as potential career paths within the specialty.
This document provides information and guidelines regarding code blue protocols at King Khalid Hospital in Najran, Saudi Arabia. It outlines the roles and responsibilities of the code blue team members, including physicians, nurses, respiratory therapists and others. It describes how a code blue is initiated when cardiac arrest occurs, including notifying the switchboard to announce the code over the PA system. It provides guidance on termination of resuscitation efforts and responsibilities after the code. Key points covered include adopting standards from the Saudi Heart Association for BCLS and ACLS, requirements for certification in life support protocols, and ensuring the code blue team and crash cart are available 24/7.
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction Fo...Chew Keng Sheng
This document discusses various life-threatening conditions that compromise the airway, breathing, and circulation. It provides examples of conditions such as facial trauma, asthma, pulmonary embolism, myocardial infarction, and cardiac tamponade. It also outlines the signs and symptoms of these conditions, as well as the appropriate first responder care and management, including opening the airway, performing rescue breaths, using an oropharyngeal airway, treating an asthma attack or heart attack, and performing defibrillation or cardioversion as needed. Maintaining an open airway, supporting breathing, and promoting circulation are priorities in managing these critical patients.
The document discusses various types of medical emergencies that may occur during dental procedures, including those involving elderly patients, patients with medical devices or conditions, those on multiple medications, or with a history of drug abuse. It provides details on common emergency situations, the necessary emergency equipment and medications to manage these situations, including oxygen, epinephrine, nitroglycerin, atropine, furosemide, verapamil, diazepam, naloxone, morphine, vasopressin, digoxin, bronchodilators, dextrose, aspirin, anticonvulsants, glucocorticoids, anti
Medications in Crash Trolley ..in PHC OMAN By Elizabeth Joseph KElizabeth Joseph
This document provides information on common emergency medications including indications, dosages, routes of administration, monitoring parameters, and dilution instructions. It includes entries for adenosine, atropine, adrenaline, haloperidol, dopamine, dexamethasone, frusemide, magnesium sulfate, calcium gluconate, naloxone, hydrocortisone, amidarone, procyclidine, glucagon, syntometrine, dextrose 50%, aspirin, glyceryl trinitrate, captopril, morphine, pethidine, and diazepam. For each medication, concise details are given about its use in emergency situations.
The document discusses several common medical emergencies including myocardial infarction (heart attack), cardiopulmonary resuscitation (CPR), stroke, hypoglycemia, seizures, asthma, and road traffic accidents. For each emergency, the document outlines symptoms, potential causes, and recommended first aid actions such as calling for an ambulance, giving oxygen, monitoring breathing, providing glucose for low blood sugar, and applying pressure to stop bleeding.
This document discusses methods for triage and assessment in mass casualty situations. It describes evaluating patients based on airway, breathing, circulation, disability and exposure (ATLS methodology). Patients are categorized into triage categories (immediate, delayed, minimal, expectant) based on their injuries and prognosis. Scoring systems like Injury Severity Score (ISS) and Revised Trauma Score (RTS) are used to evaluate patients and compare outcomes between treatment centers using TRISS methodology.
This document provides information and guidelines for managing a Code Blue situation. It defines a Code Blue as indicating a patient requiring resuscitation or immediate medical attention due to respiratory or cardiac arrest. The Code Blue team is described, including roles of nurses, doctors, and other staff. Steps for responding to a Code Blue are outlined, including activating the code, performing CPR, using the crash cart, and giving resuscitation drugs like epinephrine. Responsibilities of nurses during the code are defined. The document provides treatment guidelines for cardiac arrhythmias and discusses resuscitation activities and documentation.
This document provides an overview of emergency medicine as a specialty. It discusses the top causes of death, the reception process in emergency departments, how cases are triaged from life-threatening to non-urgent, and examples of common illnesses and injuries seen in emergency medicine including chest pain, fractures, seizures, and psychiatric illnesses. It also outlines both the appeals and challenges of working in emergency medicine as well as potential career paths within the specialty.
This document provides information and guidelines regarding code blue protocols at King Khalid Hospital in Najran, Saudi Arabia. It outlines the roles and responsibilities of the code blue team members, including physicians, nurses, respiratory therapists and others. It describes how a code blue is initiated when cardiac arrest occurs, including notifying the switchboard to announce the code over the PA system. It provides guidance on termination of resuscitation efforts and responsibilities after the code. Key points covered include adopting standards from the Saudi Heart Association for BCLS and ACLS, requirements for certification in life support protocols, and ensuring the code blue team and crash cart are available 24/7.
Life Threatening Commonly Seen Medical Conditions in A&E - An Introduction Fo...Chew Keng Sheng
This document discusses various life-threatening conditions that compromise the airway, breathing, and circulation. It provides examples of conditions such as facial trauma, asthma, pulmonary embolism, myocardial infarction, and cardiac tamponade. It also outlines the signs and symptoms of these conditions, as well as the appropriate first responder care and management, including opening the airway, performing rescue breaths, using an oropharyngeal airway, treating an asthma attack or heart attack, and performing defibrillation or cardioversion as needed. Maintaining an open airway, supporting breathing, and promoting circulation are priorities in managing these critical patients.
The document discusses various types of medical emergencies that may occur during dental procedures, including those involving elderly patients, patients with medical devices or conditions, those on multiple medications, or with a history of drug abuse. It provides details on common emergency situations, the necessary emergency equipment and medications to manage these situations, including oxygen, epinephrine, nitroglycerin, atropine, furosemide, verapamil, diazepam, naloxone, morphine, vasopressin, digoxin, bronchodilators, dextrose, aspirin, anticonvulsants, glucocorticoids, anti
Medications in Crash Trolley ..in PHC OMAN By Elizabeth Joseph KElizabeth Joseph
This document provides information on common emergency medications including indications, dosages, routes of administration, monitoring parameters, and dilution instructions. It includes entries for adenosine, atropine, adrenaline, haloperidol, dopamine, dexamethasone, frusemide, magnesium sulfate, calcium gluconate, naloxone, hydrocortisone, amidarone, procyclidine, glucagon, syntometrine, dextrose 50%, aspirin, glyceryl trinitrate, captopril, morphine, pethidine, and diazepam. For each medication, concise details are given about its use in emergency situations.
1) CPR quality should be optimized by minimizing interruptions in compressions, avoiding excessive ventilation, rotating compressors, and using appropriate compression to ventilation ratios.
2) Quantitative waveform capnography and intra-arterial pressure monitoring can help guide CPR improvements if PETCO2 is <10 mm Hg or diastolic pressure is <20 mm Hg.
3) For refractory ventricular fibrillation/pulseless ventricular tachycardia, amiodarone or lidocaine can be considered, but magnesium is not routinely recommended.
This document provides information on basic airway management. It discusses airway obstruction as a medical emergency that can be caused by various factors. Methods for recognizing airway obstruction include identifying inspiratory stridor, expiratory wheeze, or paradoxical chest movement. Airway obstruction can be managed with simple techniques like suctioning secretions, head tilt-chin lift maneuver, or inserting an oropharyngeal or nasopharyngeal airway. Oxygen therapy with a non-rebreathing mask at a 10-15 L/min flow rate can also help treat patients with airway obstruction who are still breathing.
The document provides information about code blue procedures in a hospital setting. It defines a code blue as a medical emergency called when a patient experiences cardiopulmonary arrest. It outlines the roles and responsibilities of the code blue team members who respond. The procedures for initiating a code, performing CPR, documenting the event, and administering appropriate drugs to treat shockable and non-shockable cardiac rhythms are described.
This document provides information on basic life support (BLS). It begins by defining cardiac arrest as the cessation of normal blood circulation due to heart failure. It describes reversible causes of cardiac arrest including pulmonary embolism, tension pneumothorax, and various toxins or electrolyte imbalances. The basics of BLS are then outlined, including chest compressions, opening the airway, rescue breathing, and defibrillation. Steps of BLS like assessing the scene, checking for breathing and pulse are explained. Chest compression techniques, rescue breathing methods like mouth-to-mouth and bag valve mask, and use of an automated external defibrillator are described. Finally, drugs commonly used in cardiac arrest like epinephrine
This document provides information on triage systems and procedures. It defines triage as sorting patients based on treatment priority. The START and JumpSTART triage systems categorize patients as red/immediate, yellow/delayed, green/minor, or black/deceased based on their respiration, pulse, and mental status. It outlines how to rapidly assess and tag patients in a mass casualty event using these criteria in 3 sentences or less per patient to maximize survivability. The document recommends clearing walking patients first and prioritizing life-saving interventions for immediate patients before movement or additional treatment.
The document discusses emergency management and trauma assessment. It explains that emergency management aims to reduce vulnerability to hazards and cope with disasters. It then describes the primary survey process for assessing trauma patients, which follows the mnemonic ABCDE to evaluate the airway, breathing, circulation, disability, and exposure. The summary lists the standard equipment for an emergency tray, including resuscitation equipment like a pocket mask, airways, and ambu bag, as well as evaluation tools, treatment supplies, and common emergency drugs.
Initial assessment and management of traumaVASS Yukon
The document provides guidance on the initial assessment and management of trauma patients. It emphasizes that the golden hour refers to time to definitive treatment, not time in transport or the ED. For critical patients, EMS has just 10 minutes to provide lifesaving interventions. The primary survey involves assessing the patient's airway, breathing, circulation, disability and exposure to identify and treat life threats. Oxygenation and control of hemorrhage are top priorities. Only after life threats are addressed should providers begin the more detailed secondary exam and assessment. Rapid transport to the appropriate facility is critical for trauma patients.
The document discusses the ATLS (Advanced Trauma Life Support) concept for managing trauma. It describes ATLS as an internationally recognized system that teaches a methodical approach to rapidly assess and treat life-threatening injuries in trauma patients. The steps include: (1) conducting a primary survey to evaluate the patient's airway, breathing, circulation, disability and exposure; (2) performing a secondary survey involving a full physical exam and history; and (3) re-evaluating the patient to ensure all injuries are identified and managed. The goal of ATLS and trauma management overall is to prevent death by treating life-threatening conditions as the top priority, especially within the "Golden Hour" period after injury.
This document summarizes the role of nurses in the emergency room resuscitation room of Mubarak Al-Kabeer Hospital in Kuwait. It provides data on 712 trauma patients treated in the resuscitation room over one year, with the majority being victims of road traffic accidents. It describes the nursing interventions performed during the critical "golden hour" period, including airway management, monitoring, procedures, and coordination with other departments. Outcomes were generally positive when the interdisciplinary trauma team was able to intervene within the crucial 60 minute window after injury. Recommendations include increasing public education efforts to reduce accidents and studying quality of care for multi-trauma patients.
This document discusses the management of various medical emergencies. It covers topics like airway management, breathing issues including asthma, COPD, pneumothorax and ARDS. It also discusses circulation emergencies such as cardiac arrest, shock and myocardial infarction. For each topic, it provides guidance on diagnosis, treatment principles and protocols for first responders. The overall aim appears to be educating first responders and medical professionals on best practices for treating common life-threatening conditions in emergency situations.
Mary Corcoran provides an overview of patient assessment for emergency room nurses. ER nurses must be prepared to assess patients with a wide range of medical, surgical, traumatic, social and behavioral complaints spanning all ages. The initial assessment involves a primary survey of the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) followed by a secondary survey of FGHI (Full set of vitals, pain assessment, history, head-to-toe exam, inspection of posterior surfaces). Special populations like children, elderly, obese, and pregnant women require modification of the standard assessment process. Ongoing reassessment is important for patients with changing conditions or receiving certain treatments.
Emergency Nursing of the Trauma PatientKane Guthrie
1) ED nurses should have a sound knowledge of trauma care as EDs are seeing more trauma presentations who are spending more time in the ED.
2) The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach is key for assessing and treating trauma patients in the ED to prevent death, which can occur within hours from hemorrhagic shock or weeks from sepsis.
3) A full trauma assessment from head to toe is important to identify injuries and provide interventions like splinting fractures, inserting chest tubes, or preparing for emergency surgery. Serial monitoring of vital signs and investigations helps guide treatment effectiveness.
Thoracic trauma accounts for 25% of all injury-related deaths and is a contributory factor in 50% more deaths. While most thoracic injuries can be treated without surgery, it is important to recognize life-threatening injuries like tension pneumothorax, massive hemothorax, and cardiac tamponade during the initial assessment. Adjuncts like chest x-rays, ultrasound, and tube thoracostomy can help identify injuries, while interventions like needle decompression and tube insertion treat immediate life threats. A full secondary survey evaluates injuries like rib fractures, lung contusions, and injuries to the heart and great vessels that require monitoring or further investigation.
Pre-hospital care aims to reduce morbidity and mortality for patients outside the hospital by providing immediate medical care at the scene and during transport. It involves various providers like paramedics, nurses, and doctors who are specially trained to treat patients in pre-hospital settings. The philosophy is to intervene appropriately and transport patients safely to definitive care in a timely manner. An effective pre-hospital care system requires coordination between various stakeholders including emergency responders, hospitals, and policymakers to ensure patients receive optimal care from the scene to the hospital.
Triage is the process of prioritizing patients according to the urgency of their need for care. It aims to ensure patients are treated in order of clinical urgency and receive timely care. There are three main types of triage - primary triage in the field, secondary triage in the emergency department, and tertiary triage by specialists. The START and SAVE methods are used for disaster triage in the field to categorize patients into immediate, delayed, or minimal care/expectant groups. In the ED, patients are assigned colors based on their condition - red for most urgent, yellow intermediate, green less urgent, and black for deceased. Documentation, equipment, and designated triage teams are needed to properly conduct triage
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
The document discusses healthcare-associated infections that can occur from invasive medical devices like central venous catheters, including central line-associated bloodstream infections. It covers the epidemiology, etiology, pathogenesis, risk factors, prevention strategies and clinical definitions of central line-associated bloodstream infections. The strategies to prevent CLABSIs include following best practices for catheter insertion and maintenance, hand hygiene, and using bundles that incorporate multiple evidence-based practices.
Triage is the process of prioritizing patients according to the severity of their condition in order to ensure those with the most serious injuries receive care first when resources are limited. It involves classifying patients into categories based on initial assessments and then reassessing as needed. The goal is to do the most good for the most people using available resources. Triage methods like START and SAVE are used in disaster situations to rapidly assess and prioritize patients into categories to determine who should receive immediate care, delayed care, or comfort care only. In the emergency department, a triage team assesses all patients and assigns a color code category of red, yellow, green or black to indicate treatment priority and direct patients to the appropriate care area
This document provides guidelines and algorithms for paramedics on Advanced Cardiac Life Support (ACLS). It outlines the main algorithms for cardiopulmonary resuscitation (CPR), pulseless arrest, tachycardia with a pulse, bradycardia, and return of spontaneous circulation (ROSC). For each condition, it lists the steps for assessment, treatment, and medications. Key treatments include defibrillation, cardioversion, intubation, intravenous access, pacing, epinephrine, amiodarone, atropine, and addressing reversible causes. The goal is to follow standardized procedures to properly diagnose and treat life-threatening cardiac arrhythmias or arrest.
This document provides an overview of algorithms and treatments for common cardiac conditions paramedics may encounter, including:
1. The CPR algorithm outlines the basic steps for assessing and treating a patient in cardiac arrest.
2. The pulseless arrest algorithm details the treatment sequence for a patient without a pulse, including establishing an airway, defibrillation, CPR, IV/IO access, and medication administration.
3. Algorithms are provided for tachycardia with a pulse (stable vs. unstable), narrow vs. wide complex tachycardia, and bradycardia. Treatment options like cardioversion, vagal maneuvers, adenosine, and pacing are discussed.
4
1) CPR quality should be optimized by minimizing interruptions in compressions, avoiding excessive ventilation, rotating compressors, and using appropriate compression to ventilation ratios.
2) Quantitative waveform capnography and intra-arterial pressure monitoring can help guide CPR improvements if PETCO2 is <10 mm Hg or diastolic pressure is <20 mm Hg.
3) For refractory ventricular fibrillation/pulseless ventricular tachycardia, amiodarone or lidocaine can be considered, but magnesium is not routinely recommended.
This document provides information on basic airway management. It discusses airway obstruction as a medical emergency that can be caused by various factors. Methods for recognizing airway obstruction include identifying inspiratory stridor, expiratory wheeze, or paradoxical chest movement. Airway obstruction can be managed with simple techniques like suctioning secretions, head tilt-chin lift maneuver, or inserting an oropharyngeal or nasopharyngeal airway. Oxygen therapy with a non-rebreathing mask at a 10-15 L/min flow rate can also help treat patients with airway obstruction who are still breathing.
The document provides information about code blue procedures in a hospital setting. It defines a code blue as a medical emergency called when a patient experiences cardiopulmonary arrest. It outlines the roles and responsibilities of the code blue team members who respond. The procedures for initiating a code, performing CPR, documenting the event, and administering appropriate drugs to treat shockable and non-shockable cardiac rhythms are described.
This document provides information on basic life support (BLS). It begins by defining cardiac arrest as the cessation of normal blood circulation due to heart failure. It describes reversible causes of cardiac arrest including pulmonary embolism, tension pneumothorax, and various toxins or electrolyte imbalances. The basics of BLS are then outlined, including chest compressions, opening the airway, rescue breathing, and defibrillation. Steps of BLS like assessing the scene, checking for breathing and pulse are explained. Chest compression techniques, rescue breathing methods like mouth-to-mouth and bag valve mask, and use of an automated external defibrillator are described. Finally, drugs commonly used in cardiac arrest like epinephrine
This document provides information on triage systems and procedures. It defines triage as sorting patients based on treatment priority. The START and JumpSTART triage systems categorize patients as red/immediate, yellow/delayed, green/minor, or black/deceased based on their respiration, pulse, and mental status. It outlines how to rapidly assess and tag patients in a mass casualty event using these criteria in 3 sentences or less per patient to maximize survivability. The document recommends clearing walking patients first and prioritizing life-saving interventions for immediate patients before movement or additional treatment.
The document discusses emergency management and trauma assessment. It explains that emergency management aims to reduce vulnerability to hazards and cope with disasters. It then describes the primary survey process for assessing trauma patients, which follows the mnemonic ABCDE to evaluate the airway, breathing, circulation, disability, and exposure. The summary lists the standard equipment for an emergency tray, including resuscitation equipment like a pocket mask, airways, and ambu bag, as well as evaluation tools, treatment supplies, and common emergency drugs.
Initial assessment and management of traumaVASS Yukon
The document provides guidance on the initial assessment and management of trauma patients. It emphasizes that the golden hour refers to time to definitive treatment, not time in transport or the ED. For critical patients, EMS has just 10 minutes to provide lifesaving interventions. The primary survey involves assessing the patient's airway, breathing, circulation, disability and exposure to identify and treat life threats. Oxygenation and control of hemorrhage are top priorities. Only after life threats are addressed should providers begin the more detailed secondary exam and assessment. Rapid transport to the appropriate facility is critical for trauma patients.
The document discusses the ATLS (Advanced Trauma Life Support) concept for managing trauma. It describes ATLS as an internationally recognized system that teaches a methodical approach to rapidly assess and treat life-threatening injuries in trauma patients. The steps include: (1) conducting a primary survey to evaluate the patient's airway, breathing, circulation, disability and exposure; (2) performing a secondary survey involving a full physical exam and history; and (3) re-evaluating the patient to ensure all injuries are identified and managed. The goal of ATLS and trauma management overall is to prevent death by treating life-threatening conditions as the top priority, especially within the "Golden Hour" period after injury.
This document summarizes the role of nurses in the emergency room resuscitation room of Mubarak Al-Kabeer Hospital in Kuwait. It provides data on 712 trauma patients treated in the resuscitation room over one year, with the majority being victims of road traffic accidents. It describes the nursing interventions performed during the critical "golden hour" period, including airway management, monitoring, procedures, and coordination with other departments. Outcomes were generally positive when the interdisciplinary trauma team was able to intervene within the crucial 60 minute window after injury. Recommendations include increasing public education efforts to reduce accidents and studying quality of care for multi-trauma patients.
This document discusses the management of various medical emergencies. It covers topics like airway management, breathing issues including asthma, COPD, pneumothorax and ARDS. It also discusses circulation emergencies such as cardiac arrest, shock and myocardial infarction. For each topic, it provides guidance on diagnosis, treatment principles and protocols for first responders. The overall aim appears to be educating first responders and medical professionals on best practices for treating common life-threatening conditions in emergency situations.
Mary Corcoran provides an overview of patient assessment for emergency room nurses. ER nurses must be prepared to assess patients with a wide range of medical, surgical, traumatic, social and behavioral complaints spanning all ages. The initial assessment involves a primary survey of the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) followed by a secondary survey of FGHI (Full set of vitals, pain assessment, history, head-to-toe exam, inspection of posterior surfaces). Special populations like children, elderly, obese, and pregnant women require modification of the standard assessment process. Ongoing reassessment is important for patients with changing conditions or receiving certain treatments.
Emergency Nursing of the Trauma PatientKane Guthrie
1) ED nurses should have a sound knowledge of trauma care as EDs are seeing more trauma presentations who are spending more time in the ED.
2) The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach is key for assessing and treating trauma patients in the ED to prevent death, which can occur within hours from hemorrhagic shock or weeks from sepsis.
3) A full trauma assessment from head to toe is important to identify injuries and provide interventions like splinting fractures, inserting chest tubes, or preparing for emergency surgery. Serial monitoring of vital signs and investigations helps guide treatment effectiveness.
Thoracic trauma accounts for 25% of all injury-related deaths and is a contributory factor in 50% more deaths. While most thoracic injuries can be treated without surgery, it is important to recognize life-threatening injuries like tension pneumothorax, massive hemothorax, and cardiac tamponade during the initial assessment. Adjuncts like chest x-rays, ultrasound, and tube thoracostomy can help identify injuries, while interventions like needle decompression and tube insertion treat immediate life threats. A full secondary survey evaluates injuries like rib fractures, lung contusions, and injuries to the heart and great vessels that require monitoring or further investigation.
Pre-hospital care aims to reduce morbidity and mortality for patients outside the hospital by providing immediate medical care at the scene and during transport. It involves various providers like paramedics, nurses, and doctors who are specially trained to treat patients in pre-hospital settings. The philosophy is to intervene appropriately and transport patients safely to definitive care in a timely manner. An effective pre-hospital care system requires coordination between various stakeholders including emergency responders, hospitals, and policymakers to ensure patients receive optimal care from the scene to the hospital.
Triage is the process of prioritizing patients according to the urgency of their need for care. It aims to ensure patients are treated in order of clinical urgency and receive timely care. There are three main types of triage - primary triage in the field, secondary triage in the emergency department, and tertiary triage by specialists. The START and SAVE methods are used for disaster triage in the field to categorize patients into immediate, delayed, or minimal care/expectant groups. In the ED, patients are assigned colors based on their condition - red for most urgent, yellow intermediate, green less urgent, and black for deceased. Documentation, equipment, and designated triage teams are needed to properly conduct triage
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
The document discusses healthcare-associated infections that can occur from invasive medical devices like central venous catheters, including central line-associated bloodstream infections. It covers the epidemiology, etiology, pathogenesis, risk factors, prevention strategies and clinical definitions of central line-associated bloodstream infections. The strategies to prevent CLABSIs include following best practices for catheter insertion and maintenance, hand hygiene, and using bundles that incorporate multiple evidence-based practices.
Triage is the process of prioritizing patients according to the severity of their condition in order to ensure those with the most serious injuries receive care first when resources are limited. It involves classifying patients into categories based on initial assessments and then reassessing as needed. The goal is to do the most good for the most people using available resources. Triage methods like START and SAVE are used in disaster situations to rapidly assess and prioritize patients into categories to determine who should receive immediate care, delayed care, or comfort care only. In the emergency department, a triage team assesses all patients and assigns a color code category of red, yellow, green or black to indicate treatment priority and direct patients to the appropriate care area
This document provides guidelines and algorithms for paramedics on Advanced Cardiac Life Support (ACLS). It outlines the main algorithms for cardiopulmonary resuscitation (CPR), pulseless arrest, tachycardia with a pulse, bradycardia, and return of spontaneous circulation (ROSC). For each condition, it lists the steps for assessment, treatment, and medications. Key treatments include defibrillation, cardioversion, intubation, intravenous access, pacing, epinephrine, amiodarone, atropine, and addressing reversible causes. The goal is to follow standardized procedures to properly diagnose and treat life-threatening cardiac arrhythmias or arrest.
This document provides an overview of algorithms and treatments for common cardiac conditions paramedics may encounter, including:
1. The CPR algorithm outlines the basic steps for assessing and treating a patient in cardiac arrest.
2. The pulseless arrest algorithm details the treatment sequence for a patient without a pulse, including establishing an airway, defibrillation, CPR, IV/IO access, and medication administration.
3. Algorithms are provided for tachycardia with a pulse (stable vs. unstable), narrow vs. wide complex tachycardia, and bradycardia. Treatment options like cardioversion, vagal maneuvers, adenosine, and pacing are discussed.
4
1. The document discusses cardiac emergencies and management of cardiac arrest. It covers causes of cardiac arrest, the different phases of cardiac arrest, and guidelines for treatment including chest compressions, defibrillation, airway management, and use of medications like epinephrine.
2. Reversible causes of cardiac arrest include hypoxemia, acidosis, electrolyte abnormalities, tension pneumothorax, and cardiac tamponade. Treatment follows the ABCDE approach with a focus on high-quality chest compressions, early defibrillation when indicated, and addressing reversible causes.
3. Prognosis is best if return of spontaneous circulation occurs within 4 minutes, highlighting the importance of immediate bystander CPR
This document provides algorithms for emergency cardiac care, including adult cardiac arrest and various cardiac arrhythmias. The algorithms outline assessment steps, treatment options including medications and defibrillation, and guides clinicians through treatment decisions based on factors like rhythm, pulse, and blood pressure. Key steps include assessing airway, breathing and circulation, calling a code team, starting CPR, analyzing cardiac rhythms on a monitor, and providing appropriate medications, shocks or pacing depending on the identified rhythm.
The document summarizes information about cardiac arrest, including its definition, diagnosis, causes, symptoms, treatment approach, and medications used. Cardiac arrest is defined as the sudden cessation of heartbeat and cardiac function resulting in loss of effective circulation. The diagnosis is based on a triad of loss of consciousness, loss of normal breathing, and loss of pulse. Causes include issues with the heart like congenital defects as well as heart attacks. Treatment focuses on early access to care, CPR, defibrillation, advanced life support, and follow up care using an ABCDE approach and medications like epinephrine, atropine, amiodarone, and lidocaine. Lifestyle changes like quitting smoking, diet,
This document provides information on cardiopulmonary resuscitation (CPR) and cardiac arrest. It discusses the cardiac arrest rhythms of asystole, pulseless electrical activity, pulseless ventricular tachycardia, and ventricular fibrillation. It outlines the international guidelines for CPR, including recommendations to improve survival from sudden cardiac arrest. The four links in the chain of survival for cardiac arrest are early CPR, early defibrillation, early advanced care, and early access to emergency medical services. Basic life support procedures like checking responsiveness, calling for help, opening the airway, providing rescue breaths, and chest compressions are described. Advanced life support builds upon these with securing the airway, confirming device
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
This document provides information on cardiopulmonary resuscitation (CPR) and protocols for basic life support (BLS) and advanced cardiac life support (ACLS). It outlines the steps for BLS, including chest compressions, airway management, rescue breathing, and use of an automated external defibrillator. It then describes ACLS, which aims to diagnose the cause of cardiac arrest and provide cause-specific treatment while continuing BLS efforts. Key drugs and procedures covered in ACLS are also summarized, such as defibrillation, intubation, vasopressors like epinephrine, and antiarrhythmics like amiodarone and lidocaine. The document emphasizes the importance of high-quality C
CPR is a life saving emergency measure which includes BLS, ALS, prolonged life support
CPR with both compression & rescue breath is critical for victim in emergency situation
BLS includes recognition of signs of cardiac arrest, heart attack, strock, foreign body air way obstruction(FBAO) with activation of EMS
Performed by a medical professional or an ordinary citizen who trained on it
ALS includes BLS & use of defibrillation, drugs to stabilize the victim & done by specially trained medical person
This document provides guidance on assessing and managing cardiac emergencies as an EMT. It discusses signs of cardiac compromise, administering nitroglycerin, performing CPR, and using an automated external defibrillator (AED). Key points covered include indications for nitroglycerin use, delivering shocks with an AED for shockable rhythms, resuming CPR after "no shock" messages, safety practices for AED use, and maintaining AEDs to ensure proper function.
1. A 65-year-old male presents with syncope and chest pain, with a BP of 70/33 and HR of 128.
2. A 45-year-old woman presents with palpitations, lightheadedness and a HR of 150.
3. A 56-year-old diabetic woman presents with dizziness and chest pain, with a BP of 80/60. Her ECG shows a shockable rhythm.
4. A 40-year-old man is found unconscious with no pulse.
Free handy references about Adult Cardiac Arrest Algorithm from the ACLS Certification Institute.
View all ACLS algorithms at http://www.ACLScertification.com/
This document summarizes medications used in advanced cardiac life support (ACLS). It discusses drug classifications and provides indications, dosing, and precautions for oxygen, epinephrine, vasopressin, amiodarone, lidocaine, magnesium sulfate, procainamide, atropine sulfate, and calcium chloride as they relate to treating ventricular fibrillation/pulseless ventricular tachycardia, pulseless electrical activity, and asystole in cardiac arrest patients.
This document provides information on cardiopulmonary resuscitation (CPR). It discusses the chain of survival, including early recognition of cardiac arrest, early activation of emergency services, early chest compressions, early defibrillation, and early advanced care. It reviews international CPR guidelines from 2005 and 2010. It also describes the techniques for performing CPR, including chest compressions, ventilations, use of an automated external defibrillator (AED), securing an airway, confirming device placement, identifying cardiac rhythms, defibrillation, pacing, establishing intravenous access, and administering rhythm-appropriate medications such as epinephrine, vasopressin, atropine, and amiodarone.
This document provides a summary of basic life support (BLS) and advanced cardiovascular life support (ACLS) protocols for treating cardiac arrest. It outlines the key steps in BLS including checking for response, activating emergency services, providing rescue breathing and chest compressions. It emphasizes the importance of high-quality chest compressions during CPR. The document also summarizes ACLS protocols for defibrillation, cardioversion, management of various cardiac rhythms like ventricular fibrillation and asystole, and administering appropriate drug therapies.
Advanced cardiac life support (ACLS) refers to interventions for urgent treatment of cardiac arrest and other life-threatening emergencies, as well as the knowledge and skills to deploy those interventions. ACLS protocols from the American Heart Association are considered the gold standard and get reviewed every 5 years. BLS with high-quality CPR forms the critical foundation for ACLS. For shockable rhythms like ventricular fibrillation, the ACLS treatment involves defibrillation, CPR, and administration of drugs like epinephrine and amiodarone. For non-shockable rhythms like asystole, ACLS focuses on identifying and treating reversible causes through CPR and medications while preparing for transport to a hospital.
Advanced cardiac life support (ACLS) refers to interventions for urgent treatment of cardiac arrest and other life-threatening emergencies, as well as the knowledge and skills to deploy those interventions. ACLS protocols from the American Heart Association are considered the gold standard and get reviewed every 5 years. BLS with high-quality CPR forms the critical foundation for ACLS. For shockable rhythms like ventricular fibrillation, the ACLS treatment involves defibrillation, CPR, and administration of drugs like epinephrine and amiodarone. For non-shockable rhythms like asystole, ACLS focuses on identifying and treating reversible causes through CPR and medications while providing post-cardiac arrest care.
Cardiac arrest is a medical emergency where the heart fails to pump blood effectively. It can be caused by cardiac or non-cardiac issues and requires immediate treatment to potentially reverse it, including cardiopulmonary resuscitation (CPR) and defibrillation. CPR involves chest compressions and rescue breathing to manually circulate blood and oxygen through the body until spontaneous circulation is restored. The appropriate treatment depends on the underlying heart rhythm, with shockable rhythms like ventricular fibrillation treated with defibrillation.
1. History taking provides vital information to arrive at a diagnosis in over 70% of cases by allowing the patient to describe their illness and systematically inquiring about their medical history, presenting complaints, past illnesses, habits, and family history.
2. It is important to build rapport with the patient, have them describe their illness chronologically without interruption, then prompt them for details in key areas before making a systematic inquiry about each body system.
3. A thorough history should explore the patient's presenting complaints, history of present illness, investigation and treatment details, past medical history, personal history, and family history in order to understand how their illness started and progressed and arrive at the most likely diagnostic possibilities based on
1. This document provides a checklist and protocol for evaluating and treating a patient presenting with fever.
2. It includes instructions to check vital signs like temperature, heart rate, respiratory rate, and blood pressure to help determine the potential cause and severity of the fever.
3. Physical examinations of eyes, neck, mouth, heart, lungs, abdomen, and limbs are also outlined to look for signs and symptoms.
4. Potential diagnoses that should be considered include viral infections, pneumonia, meningitis, and urinary infections. Investigations and specific treatments are also recommended depending on diagnosis and symptoms.
This document discusses the clinical evaluation of hemiplegia. It provides details on brain anatomy, physiology, handedness and the contra-lateral control of the brain. It describes the blood supply of the brain including the Circle of Willis. The document examines the pathology of ischemic stroke and discusses assessing features such as the site of lesion localization, whether the deficit is ischemic or hemorrhagic in nature, and if it represents a transient ischemic attack, evolving stroke or completed stroke. Precise neurological examination is emphasized to determine the structures and tracts involved.
This document contains a 46-page guide to interpreting chest x-rays written by Dr. S. Aswini Kumar. It begins by describing the process and proper views for taking a chest x-ray. It then details how to analyze different anatomical structures and pathological findings visible on chest x-rays such as lung opacities, nodules, masses, effusions, pneumothorax, fibrosis, and atelectasis. The guide provides illustrations and explanations for accurately reading and diagnosing conditions from chest radiograph images.
Contains 17 clinical situations of prolonged fever and discussion of various differential diagnosis based on them. Also gives the key points in the diagnosis of a prototype diagnosis and the usefulness of a relevant investigation modality in identifying these conditions. This power point presentaion is based on the chapter in Harrison's Text Book on Internal Medicine chapter on Fever of Unknown Origin
This document contains diagrams of various congenital heart defects including atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA), aortic stenosis, pulmonary stenosis, coarctation of the aorta, and more complex defects such as tetralogy of Fallot and tricuspid atresia. For each defect, a diagram is shown labeling the relevant cardiac chambers, vessels, and abnormalities. Brief descriptions are provided of associated clinical findings, investigations, and surgical specimens for some of the defects.
This document discusses diabetes and its management. It begins by stating that there are two main types of diabetes, IDDM and NIDDM. It then lists common symptoms of diabetes such as frequent urination, thirst, and weight changes. Further, it notes type 2 diabetes can lead to serious complications like kidney disease, foot ulcers, strokes, blindness, and heart attacks if not properly managed. Finally, it emphasizes that exercise is an important part of managing diabetes.
The document discusses the anatomy and physiology of the heart's conducting system. It describes the locations and functions of the sinoatrial node, atrioventricular node, bundle of His, bundle branches, and Purkinje fibers. It then explains different types of heart block including first-, second-, and third-degree heart block and their characteristics as seen on ECG. Treatment options are provided for the various heart block classifications.
Cardiovascular disease is a major risk for those with diabetes.
1) Studies like the Framingham Heart Study and UKPDS found diabetes to be a significant risk factor for cardiovascular mortality and events like heart attacks.
2) Having diabetes poses similar risks as having a heart attack, with endothelial dysfunction, dyslipidemia, and other factors increasing cardiovascular risks.
3) Lifestyle changes like diet, exercise, weight loss and optimal control of blood pressure, cholesterol and blood sugars can help prevent premature cardiovascular events for those with diabetes.
The document summarizes key aspects of ophthalmoscopy, including a brief history of its invention by Hermann von Helmholtz in 1850. It describes the basic structure and components of modern ophthalmoscopes, how they are used to examine the retina, and what various normal and pathological retinal findings appear as during an exam. Key structures that can be visualized include the optic disc, arteries and veins, macula, as well as conditions like diabetes, vascular occlusions, retinal detachments, and more.
This document discusses various respiratory diagnoses and provides details on their symptoms, signs, etiology, diagnosis, and treatment. It covers upper respiratory infections like acute rhinitis, allergic rhinitis, acute sinusitis, acute pharyngitis, acute tonsillitis, and acute laryngitis. It also discusses lower respiratory infections such as acute bronchitis, chronic bronchitis, COPD, bronchial asthma, lobar pneumonia, bronchopneumonia, and interstitial pneumonia. Other conditions covered include acute viral pleurisy, pleural effusions, pneumothorax, tuberculosis, and lung cancers. For each diagnosis, it lists relevant symptoms, physical exam findings, cause, investigations needed and recommended treatment approaches
The document provides guidance on taking patient history and summarizing clinical cases. It emphasizes listening to the patient's description of symptoms and events, only prompting when needed. Key details to document include the patient's identifying information, medical history, presenting symptoms and their duration, relevant risk factors and family history. The summary should concisely restate the important symptoms and chronology of the case without including verbatim details from the history.
The document discusses carotid artery strokes, describing the anatomy of the carotid arteries and causes of stenosis like plaque buildup which can lead to emboli and blockages. Symptoms of carotid artery stenosis or occlusion include transient ischemic attacks (TIAs) or strokes, and treatment options involve lifestyle changes, medications, carotid endarterectomy surgery, or carotid stenting to reopen blocked arteries. Grades of stenosis are defined based on the percentage of blockage.
Acute left ventricular failure is sudden worsening of dyspnea or congestive heart failure caused by conditions that increase left ventricular pressure like aortic stenosis or acute valve regurgitation. It leads to pulmonary edema as hydrostatic pressure in lungs exceeds plasma oncotic pressure, causing fluid to exude into alveoli. Patients experience terrifying breathing difficulties and pink frothy sputum. On exam, they are pale, sweaty and tachycardic with rales and S3 gallop, indicating severe dysfunction. Treatment focuses on oxygen, diuretics, morphine and positioning to relieve anxiety and dyspnea while reducing preload on the heart.
Tetralogy of Fallot is a congenital heart defect characterized by a ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. It was first described accurately by Etienne Fallot in 1888. The right ventricular outflow tract obstruction causes deoxygenated blood to mix with oxygenated blood, resulting in cyanosis. Symptoms usually appear around one year of age and include cyanosis, cyanotic spells where the child loses consciousness, and squatting for relief of symptoms. Physical exam may show a silent precordium and left parasternal heave.
Aortic regurgitation is a condition where the aortic valve leaks, causing blood to flow back into the left ventricle from the aorta during diastole. It can be chronic or acute, with chronic causes including rheumatic heart disease, infections, and connective tissue disorders. Symptoms are usually mild at first and include palpitations and fatigue, but can progress to cardiac failure. Signs include a high-volume pulse, elevated systolic blood pressure with low diastolic pressure, a diastolic murmur heard at the heart base, and signs of left ventricular volume overload. Echocardiography can confirm the diagnosis and severity. Treatment involves managing heart failure symptoms medically, but severe
Aortic stenosis is a narrowing of the aortic valve that obstructs blood flow from the left ventricle to the aorta. It can be congenital due to conditions like bicuspid aortic valve, or acquired through rheumatic heart disease, atherosclerosis or idiopathic hypertrophic subaortic stenosis. Over time, the obstruction causes the left ventricle to hypertrophy to maintain cardiac output, which can lead to heart failure. Symptoms include chest pain, syncope and dyspnea that worsen with exertion. Examination may reveal murmurs, decreased pulses and elevated blood pressure. Echocardiography can diagnose the severity of stenosis. Treatment involves managing symptoms, avoiding
Acute rheumatic fever is a systemic illness that occurs 2-4 weeks after a Group A streptococcal throat infection. It is characterized by fever, polyarthritis affecting large joints symmetrically, and inflammation of the heart (carditis). Without treatment, it can lead to long-term heart damage including chronic rheumatic heart disease. It is diagnosed based on clinical signs and symptoms as well as lab tests showing inflammation. Treatment involves bed rest, aspirin or corticosteroids to reduce joint/heart inflammation, and long-term penicillin to prevent recurrence of streptococcal infection and subsequent rheumatic fever attacks.
Pleural effusion is an abnormal collection of fluid in the pleural space that can be caused by various conditions. It is classified as a transudate or exudate based on the characteristics of the fluid. Investigation of pleural effusion involves examination of blood, chest x-rays, and analysis of pleural fluid obtained via thoracentesis to determine the cause and appropriate treatment. Common causes include cardiac failure, pneumonia, tuberculosis, malignancy, and liver or kidney diseases.
Hypothyroidism is a common endocrine disorder where the thyroid gland produces insufficient hormones. It affects 1.8% of the population and is more prevalent in females and the elderly. The most common cause is Hashimoto's thyroiditis which results in lymphocytic infiltration and thyroid damage. Symptoms of hypothyroidism are non-specific but include fatigue, weight gain, dry skin, and low heart rate. Treatment involves lifelong thyroid hormone replacement therapy with levothyroxine to normalize thyroid levels. Special care is needed in pregnancy, myxedema coma, and avoiding overtreatment.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
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Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
As the world population is aging, Health tourism has become vitally important and will be increased day by day. Because
of the availability of quality health services and more favorable prices as well as to shorten the waiting list for medical
services regionally and internationally. There are some aspects of managing and doing marketing activities in order for
medical tourism to be feasible, in a region called as clustering in a region with main stakeholders groups includes Health
providers, Tourism cluster, etc. There are some related and affecting factors to be considered for the feasibility of medical
tourism within this study such as competitiveness, clustering, Entrepreneurship, SMEs. One of the growth phenomenon
is Health tourism in the city of Izmir and Turkey. The model of five competitive forces of Porter and The Diamond model
that is an economical model that shows the four main factors that affect the competitiveness of a nation and its industries
in this study. The short literature of medical tourism and regional clustering have been mentioned.
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)MuskanShingari
Skin is the largest organ of the human body, serving crucial functions that include protection, sensation, regulation, and synthesis. Structurally, it consists of three main layers: the epidermis, dermis, and hypodermis (subcutaneous layer).
1. **Epidermis**: The outermost layer primarily composed of epithelial cells called keratinocytes. It provides a protective barrier against environmental factors, pathogens, and UV radiation.
2. **Dermis**: Located beneath the epidermis, the dermis contains connective tissue, blood vessels, hair follicles, and sweat glands. It plays a vital role in supporting and nourishing the epidermis, regulating body temperature, and housing sensory receptors for touch, pressure, temperature, and pain.
3. **Hypodermis**: Also known as the subcutaneous layer, it consists of fat and connective tissue that anchors the skin to underlying structures like muscles and bones. It provides insulation, cushioning, and energy storage.
Skin performs essential functions such as regulating body temperature through sweat production and blood flow control, synthesizing vitamin D when exposed to sunlight, and serving as a sensory interface with the external environment.
Maintaining skin health is crucial for overall well-being, involving proper hygiene, hydration, protection from sun exposure, and avoiding harmful substances. Skin conditions and diseases range from minor irritations to chronic disorders, emphasizing the importance of regular care and medical attention when needed.
“Environmental sanitation means the art and science of applying sanitary, biological and physical science principles and knowledge to improve and control the environment therein for the protection of the health and welfare of the public”.The overall importance of sanitation are to provide a healthy living environment for everyone, to protect the natural resources (such as surface water, groundwater, soil ), and to provide safety, security and dignity for people when they defecate or urinate .Sanitation refers to public health conditions such as drinking clean water, sewage treatment, etc. All the effective tools and actions that help in keeping the environment clean come under sanitation. Sanitation refers to public health conditions such as drinking clean water, sewage treatment. All the effective tools and actions that help in keeping the environment clean and promotes public health is the necessary in todays life.
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
2. CARDIAC ARREST EM 01 Assessment Cardiac arrest means No pulse No BP Unresponsive or deeply comatose Respiration gasping; But pupils still reacting Begin immediately Advanced Cardiac Life Support Start external chest compressions Basic Life Support till defibrillation is available Call colleagues for help Call nurse to start medications Call nursing assistants to assist Attach monitor and defibrillator if available Start oxygen by mask Endotracheal intubation Precordial thumb in Unmonitored Cardiac arrest C2b Monitored Cardiac arrest C1 Call attenders to start oxygen Give loud and clear instructions Be the leader of the team Check for shockable rhythm Open the patients airway Clear mouth, Remove dentures Give throat suction Extent neck and intubate Connect oxygen by tube Start artificial ventilation Use ambu bag or machine Delivered to the middle of chest when onset of VT VF is seen It may convert VT VF to NSR Do not delay defibrillation If unmonitored, can be harmful Even precipitate a VT or VF Do not repeat the procedure Shockable VF, PulselessVT Not Shockable Asystole PEA Give one shock and immediately resume CPR Manual biphasic device –specific give 120-200j Monophasic device give 360 joules Immediately resume CPR for 5 cycles Give adrenaline 1mg mg IV repeat 3 doses Or Vasopressin 40 U IV instead of adrenaline Consider Atropine 1 mg IV if asystole or PEA Repeat 3 doses or till recovery Give 5 cycles of CPR and check for shockable rhythm Give 5 cycles of CPR and check for Shockable rhythm Continue CPR while defibrillator is charging Give one shock and resume CPR If indicated try shock Give adrenaline 1mg mg IV repeat 3 doses
3. EXTERNAL CHEST CARDIAC MASSAGE EM 02 Life saver (prolonger) technique Start immediately Continue unremittingly Position the patient on a hard cot, trolley or other surface Remove pillows and put the patient flat supine Higher levelLower head end if previously elevated Open the mouth of the taker Give two breaths If only 1 giver switch to compressions Giver stands at a higher level Elbows kept at 1800 Pressure shall come from shoulders Place the left hand over the lower sternum Place the right hand over the left hand Keep the arms straight and give firm steady compressions Consider endotracheal intubation And assisted ventilation Compressions of 4 cm depth Less will not be sufficient More may be harmful One cycle is 30 chest compressions and two breaths Complications of CPR: # ribs Pneumothorax Hemopneumothorax Hemopericardium An effective CPR should be able to Restore the circulation to the brain And to the vital organs like the lungs and kidneys Never break the cycle of CPR Except for giving DC shocks CPR - not a substitute for defibrillation Should not stand in the way CPR may be continued Indefinitely if indicated Give 5 cycles of CPR or CPR for minimum of 2 minutes Consider discontinuing CPR only after 30 minutes Give adrenaline 1mg mg IV repeat 3 doses
4. VENTRICULAR FIBRILLATION / PULSELESS VT EM 03 Arrive here from Cardiac arrest overview Monitor showing Ventricular Fibrillation/ Tachycardia Adrenaline 1 mg IV 10 ml of 1:10,000 /2 mg 20 ml 1:10,000 ET Fine Ventricular Fibrillation (lesser chance or correction) Coarse Ventricular Fibrillation Defibrillate at 200 joules biphasic 300 joules monophasic Resume attempts to defibrillate Give 2 min CPR between defibrillations LIDOCAINE 1 mg per kg IV Then 0.5mg per kg q 10 minif required to a maximum total dose of 3mg per kg Pulseless Ventricular Tachycardia 5 cycles of Cardiopulmonary Resuscitation Confirm A/W placement Effective oxygenation and ventilation Resume attempts to defibrillate Assess rhythm only after 5 cycles/2m CPR Establish IV Assess rhythm If Torsae des pointes MAGNESIUM IV ASYSTOLE or Pulseless Electrical Activity ASYSTOLE or PEA so shock protocol Resume attempts to defibrillate Sinus Rhythm – OK Fine
5. DEFIBRILLATION EM 04 Rhythm VF or Pulseless VT Maintain airway, Oxygenate Defibrillation is a technique used to counter the onset of VF, the common cause of cardiac arrest, and pulseless VT, which sometimes precedes VF but can be just as dangerous on its own. In simple terms, the process uses an electric shock to stop the heart, in the hope that heart will restart with rhythmic contractions. Sedate Patient is conscious and anxious Press both buttons together One electrode is placed on the right side of the front of the chest just below clavicle and the other electrode is placed on the left side of the chest just below the pectoral muscle or breast. Ensure no one touches the cot Ensure your body does not touch the cot Charge the defibrillator to chosen energy Place both paddles in appropriate position Check monitor for rhythm VF or Pulseless VT It is not effective for asystole (complete cessation of cardiac activity, ) and pulseless electrical activity (PEA). No Improvement? Cardiac arrest protocol
6. CARDIAC ASYSTOLE AND PEA [No shock advised] EM 05 Arrive here from Cardiac arrest protocol Establish IV line, Give 5 cycles of CPR Confirm airway placement, effective oxygenation and ventilation Search forand treat possible causes, hypovolemia, hypoxia, hyperkalemia, hyokalemia, hypothermia, hydrogen ion acidosis Tableta(Drug overdose) tamponade, tension pneumothorax, thrombosis (cardiac and pulmonary) Adrenaline 1 mg IV Endocratheal tube Atropine 1 mg IV if PEA with rate <60 Assess rhythm Cardiac Asystole Ventricular Fibrillation See VF protocol Consider Sodium bicarbonate Only if hyperkalemia
7. STABLE PATIENT WITH NARROW COMPLEX TACHYCARDIA EM 06 Assessment Patient stable/unstable Look for serious signs of instability SERIOUS SIGNS Chest pain Shortness of breath Loss of conciousness Low Blood pressure Cardiogenic shock Pulmonary edema Congestive cardiac failure ATRIAL FIBRILLATION /FLUTTER SINUS TACHYCARDIA SUPRAVENTRICULAR TACHYCARDIA VAGAL COMPRESSION See procedure Look for and treat underlying Causes: Pain, Hypoxia, Dehydration Deteriorating serious signs or symptoms Not successful Try Digoxin + Verapamil SYNCHRONIZED CARDIOVERSION Start at 100 joules Increase to 200, 300, 360 Adenosine 6 mg IV push Repeat the dose and Double the dose
8. STABLE WIDE COMPLEX TACHYCARDIA EM 07 Arrive here from protocol Tachycardia Overview MONOMORPHIC VT POLYMORPHIC VT UNKNOWN SUPPORTIVE CARE TRANSPORT Supportive Care Transport SUPPORTIVE CARE TRANSPORT MAGNESIUM 1 gm IV LIDOCAINE 1 mg per kg IV Then 0.5mg per kg q 10 minif required to a maximum total dose of 3mg per kg LIDOCAINE 1 mg per kg IV Then 0.5mg per kg q 10 minif required to a maximum total dose of 3mg per kg Deteriorating symptoms or signs SYNCHRONIZED CARDIOVERSION Start at 100 joules Increase to 200, 300, 360 TRANSPORT
9. BRADYCARDIA EM 08 Assessment Heart Rate less than 40 per minute BP/Perfusion adequate Sinus Bradycardia or I0 AV block Observe NO Type II second degree A V Block Or III degree Complete A V Block NO Atropine 0.5 mg q 5 min Transcutaneous Pacing if Symptoms develop Temporary Transcutaneouspacing No response or easy reversions to CHB Not Successful NO Permanent Pacemaker Dopamine 5-20 ug/kg/min IV
10. CARDIOGENIC SHOCK EM 09 Assessment of ABCs Oxygen 100% by mask Call for ALS team intercept Endotracheal intubation See airway management protocol Pump versus rate problem IV access X 2 Bradycardia with hypoperfusion SVT or VT with hypoperfusion MI with hypoperfusion Atropine 0.5mg IV push Repeat to maximum 3 mg Normal saline 500 cc bolus SVT Narrow complex VT Wide complex Synchronized cardioversion Normal saline 500 cc bolus STABLE STABLE Dopamine IV Start at 5ug/kg/minute And titrate EXTERNAL PACEMEAKER Vagal manouere Lidocaine Dopamine IV Start at 5ug/kg/minute And titrate Adenosine Adenosine TRANSPORT
11.
12. CARDIAC FAILURE EM 10 Assessment History: MI, HTN, AS Raised JVP,Gallop, Crackles SEVERE Respiratory distress Crackles throughout Oxygen saturation<92 NEAR DEATH Insufficient Respiratory drive Cyanosis Dropping saturation Decreased LOC MILD/ MODERATE Able to speak sentences Crackles base only Oxygen saturation>92 Oxygen to maintain sat >92 High flow qxygen 100% Oxygen Nitroglycerine SL repeat q5m Nitroglycerine SL repeat q5m Nitroglycerine SL repeat q5m IV saline lock Salbutamol [only if wheeze] Salbutamol [only if wheeze] IV Morphine 2.5-5 mg IV Morphine 2.5-5mg Deteriorating IV Frusemide Only if on diuretics IV Frusemide Only if on diuretics Deteriorating
13. BRONCHIAL ASTHMA EM 11 Assessment Less than 50 years History of Asthma Environmental exposure Severe Decreased a/e throughout With expiratory wheeze Expiratory wheeze Oxygen saturation <92% Mild to moderate Decreased a/e throughout Expiratory wheeze Speaking in sentences Oxygen saturation >92% Near Death Decreased level of conciousnes Ineffective respiratory effect Unable to speak Cyanosis Oxygen saturation <92% Oxygen to maintain sat >92% Oxygen 100% BVM prn Oxygen to maintain sat >92% Salbutamol 5mg nebulization Salbutamol 5mg nebulization Epinephrine 0.3mg SC IV Aminophylline 250 mg in 100ml See suspected cardiac origin protocol Ipratropium bromide 0.3mg aerosol IV saline Lock IV Aminophylline 250 mg in 100ml See suspected cardiac origin protocol Adenosine 6 mg IV push Repeat the dose and Double the dose
14. DIABETIC KETOACIDOSIS EM 12 ASSESSMENT: History and PE, RBS, Urea, S Cr, SE, Urine , CBC, ECG Blood gases, CXR Diagnostic criteria for DKARBS >250mg%, Arterial pH < 7.3m, S Bicarbonate < 15mg%, Moderate ketouria Start IV fluid 0.9% Saline 1L per hour initally(15-20 ml/kg/hour Insulin Potassium IV Fluids Determine hydration status IV Route SC / IM route If Serum K+ level is <3.3 meq/L Hold insulin and give K+40meq/hr 2/3rd as Pot Chloride and 1/3rd as Pot phosphate Hypovolemic shock: Administer 0.9% Sodiunm chloride 1L / hour and or plasma expander Administer Regular Insulin 0.5 U /kg as IV bolus Administer 0.3 U /kg as IV bolus And ½ given SC or IM Cardiogenic shock: Hemodynamic monitoring Administer Regular Insulin 0.1 U /kg as IV infusion Administer 0.1 U /kg per hour And ½ given SC or IM If Serum K= level is . 5.5meq/L do not give K+ but check level every 2 h Mild hypotension: Evaluate corrected serum Na level High or Normal: Administer 0.45% Na cl If RBS dose not fall by 50-70mg in the 1st hour If Serum K+ level is >3.3 meq/L but < 5.5meq/L give 20-30 meq in each liter of IV fluid 2/3rd as Pot Chloride and 1/3rd as Pot phosphate Double insulin infusion Hourly until RBS Falls by 50-70mg/h Give hourly IV insulin Bolus until RBS Falls by 50-70mg/h Serum Na low: Administer 0.9% Na Cl Depending on hydration status When Serum Glucose reaches 250mg/Dl[13.3mmol/L Change to 5% Dextrose0.45% Saline administered at 100-200ml per hour, with adequate insulin 0.05-0.1 U/kg/has IV infusion or 10 U SC 2 hours given to keep glucose level between 150 and 200mg% Check chemistry every 4 hours until patient is stable Look again for precipitating causes After resolution of diabetic ketosis obtain blood glucose Every 4 hours and give sliding scale regular insulin
15. ACUTE ISCHEMIC STROKE EM 13 Assessment New onset of Neurological Deficit Stroke or Transient Ischemic Attack Non contrast Head CT scan Acute cerebral edema cause obtundation herniation Peaks on 2nd day but mass effect till 10th day Larger the infarct more the cerebral edema Can directly compress the brainstem Blood pressure to be lowered if Malignant Hypertension Concomitant Myocardial Ischemia Blood Pressure >180/110 mmHg Care of comatose patients Ryles tube feeding Adequate calorie & fluid intake Intravenous Mannitol 100 ml 8 hourly for 3 days Oral Glycerine 30 ml TID orally or via Ryles tube Water restriction but avoiding hypovolemia Start Amlodipine 2.5mg BID or Tablet Nifedipine 10mg BID Titrate to keep BP At 150/90 Consider catheterization Ensure good urine output Frequent change of position Intravenous rtPA 0.9mg/kg to a90mg maximum In selected patients within 3 hours of the onset Attention directed towards Common complications of bedridden patients Respiratory tract infections Urinary tract infections Pressure sores DVT and Pulmonary Embolism Monitor Blood Sugar regularly Keep RBS value below 200mg% Fever detrimental Use antipyretics as indicated If unmonitored, can be harmful Even precipitate a VT or VF Do not repeat the procedure Aspirin 300mg daily The role of Anticoagulation is uncertain Search for evidence of cardioembolic stroke Investigate with ECG, Chest X Ray and Echo Consider anticoagulation with PTT INR control Consider Neuroprotective agents Give adrenaline 1mg mg IV repeat 3 doses Or Vasopressin 40 U IV instead of adrenaline Rehabilitation of stroke patients Physical, speech, and occupational therapy Education of the patient and family Prevention of complications of immobility Search for risk factors for stroke Hypertension, Diabetes, Smoking, Dyslipidemia Asymptomatic or symptomatic carotid stenosis Relative risk reduction with treatment Balloon Angioplasty with Stenting is the alternative Surgical treatment restricted to Carotid Endartectomy
16. ACUTE EMBOLIC STROKE EM 14 Assessment New onset of Neurological Deficit Stroke or Transient Ischemic Attack Non contrast Head CT scan Anticoagulation to keep INR ranging from 2 to 3 Warfarin reduces the risk by 67% 1% risk per year of a major bleeding complication Can directly compress the brainstem Non rheumatic Atrial Fibrillation Chronic Obstructive Lung Disease Essential Hypertension Mitral Valve Prolapse Artery to artery embolic stroke Thrombus formation on Atherosclerotic plaque in carotid Anticoagulation also reduces risk of embolism after acute Anterior wal Q wave MI A three month course is recommended Recent Myocardial Infarction Post Infarction Mural thrombosis Transmural Anteroapical MI Prophylactic anticoagulation Intracranial atherosclerosis In situ thrombosis or embolization Warfarin sodium and aspirin Intravenous Mannitol 100 ml 8 hourly for 3 days Oral Glycerin 30 ml TID orally or via Ryles tube Paradoxical embolization: Venous thromboses migrate to Arterial circulation via Cardiac Right to left shunt Atrial Septal Defect Patent Foramen Ovale Urinary tract infections Valvular Endocarditis Valvular Vegetations Multifocal symptoms and signs Small microscopic infarcts or Large septic infarcts brain abscess Hemorrhagic Infarcts A greater degree of anticoagulation is indicated for Prosthetic valve Thrombosis Combination of antiplatelets advantageous Search for evidence of cardio embolic stroke Investigate with ECG, Chest X Ray and Echo Consider anticoagulation with PTT INR control Confirmation by Trans esophageal Echocardiography Presence of a venous source of embolus of right to left cardiac shunting Rehabilitation of stroke patients Physical, speech, and occupational therapy Education of the patient and family Prevention of complications of immobility Search for risk factors for stroke Hypertension, Diabetes, Smoking, Dyslipidemia Asymptomatic or symptomatic carotid stenosis Relative risk reduction with treatment Balloon Angioplasty with Stenting is the alternative Surgical treatment restricted to Carotid Endartectomy
17. ACUTE HEMORRHAGICIC STROKE EM 15 Assessment New onset of Neurological Deficit Headache, projectile vomiting Non contrast Head CT scan Hypertensive Intra-parenchymal hemorrhage Spontaneous rupture of a small penetrating artery Common sites are basal ganglia, putamen, thalamus Sometimes the pons and the cerebellum Blood pressure to be lowered if Malignant Hypertension Concomitant Myocardial Ischemia Blood Pressure >180/110 mmHg Care of comatose patients Ryles tube feeding Adequate calorie & fluid intake Intravenous Mannitol 100 ml 8 hourly for 3 days Oral Glycerine 30 ml TID orally or via Ryles tube Water restriction but avoiding hypovolemia Start Amlodipine 2.5mg BID or Tablet Nifedipine 10mg BID Titrate to keep BP At 150/90 Consider catheterization Ensure good urine output Frequent change of position 50% of patients die <30ml Good, 30-60ml intermediate, >30ml poor Attention directed towards Common complications of bedridden patients Respiratory tract infections Urinary tract infections Pressure sores DVT and Pulmonary Embolism Monitor Blood Sugar regularly Keep RBS value below 200mg% Fever detrimental Use antipyretics as indicated If unmonitored, can be harmful Even precipitate a VT or VF Do not repeat the procedure Evacuation of hematoma helpful only in cerebellar Sub Arachnoid Hemorrhage Neurosurgical intervention is necessary by craniotomy and external clipping of the bleeding vessel or aneurysm During this waiting period medical treatments to control blood pressure, bed rest, and a quiet environment reduce the risk of rebleed. Nimodipine is an oral calcium channel blocker, that has been shown to reduce the chance of a bad outcome, even if it does not significantly reduce the amount of angiographic vasospasm. Or by interventional radiology (neuroradiology), which employs transfemoral angiography and inserting of metal coils to stem the bleeding (which is especially useful in aneurysmatic hemorrhage). Balloon Angioplasty with Stenting is the alternative Surgical treatment restricted to Carotid Endartectomy
18. ACUTE SUBARACHNOID HEMORRHAGE EM 16 Assessment Sudden onset of severe headache Lethargy, coma, low back pain No focal neurological deficit in the beginning Nuchal rigidity, positive Kerning sign Retinal hemorrhages ( sub-hyaloid) Rebleeding 20% at two weeks Vasospasm and neurological deficits (days 4-14) Blood pressure to be lowered if Malignant Hypertension Concomitant Myocardial Ischemia Blood Pressure >180/110 mmHg Care of comatose patients Ryles tube feeding Adequate calorie & fluid intake Non contrast CT scan head Lumbar puncture: Uniformly blood stained Xanthochromia on immediate centrifugation Start Amlodipine 2.5mg BID or Tablet Nifedipine 10mg BID Titrate to keep BP At 150/90 Consider catheterization Ensure good urine output Frequent change of position Intravenous Mannitol 100 ml 8 hourly for 3 days Oral Glycerine 30 ml TID orally or via Ryles tube Water restriction but avoiding hypovolemia Attention directed towards Common complications of bedridden patients Respiratory tract infections Urinary tract infections Pressure sores DVT and Pulmonary Embolism Ruptured berry aneurysm Fusiform aneurysms secondary to atherosclerosis Mycotic aneurysm Resulting from septic embolism Hypertensive hemorrhage Arteiovenous malformations Contrast CT or MRI useful in demonstrating Cerebral angiography (DSA) needed pre-surgically Neurosurgical intervention is necessary for Berry aneurysm Timing of surgery after SAH is controversial Depends on clinical condition During this waiting period medical treatments to control blood pressure, bed rest, laxatives and a quiet environment reduce the risk of rebleed. Nimodipine is an oral calcium channel blocker, that has been shown to reduce the chance of a bad outcome, even if it does not significantly reduce the amount of angiographic vasospasm. Or by interventional radiology (neuroradiology), which employs transfemoral angiography and inserting of metal coils to stem the bleeding (which is especially useful in aneurysmatic hemorrhage). Nimodipine Dose is 60 mg PO QID Surgical treatment restricted to Carotid Endartectomy
19. SEIZURES EM 17 Assessment ABCs / Vital signs/ Oximetry Continuos ECG monitoring Place a soft plastic airway Administer oxygen by mask Insert a large bore IV line Ideally two one being dextrose free Glucometer <60mg% Administer Thiamine 100mg IV folloewed by 50ml 50% dextrose Laboratory analysis: Blood sugar, Urea, Creatinine Serum Electrolytes Urine analysis, and drug screen Antiepileptic drug levels RBS Parenteral anticonvulsants indicated if status epilepticus Patient pregnant High BP See pre-eclamsia protocol High BP Lorazepam 0.1mg/kg at 2mg Per minute up to 4mg Diazepam 0.2mg/kg at 5mg per minute up to 10 mg OR Short duration of action of These drugs necessitate maintenance anticonvulsants Phenytoin Sodium Preferred maintenance drug Loading dose 20mg/kg Watch for arrhythmias and hypotension Benzodiazepine infusion A preferable option in some maintenance anticonvulsants See shock protocols The maximum rate of infusion is 50mg per minute and a large bore IV line with dextrose free fluid used to prevent precipitation Respiratory depression may require intubation And assisted ventilation Phenobarbitone 20mg/kg at the rate of 50mg/minute