The document describes the ABCDE assessment approach for critically ill patients. It begins by explaining the ABCDE approach as a structured way to assess patients by evaluating their airway, breathing, circulation, disability, and exposure.
It then provides details on assessing each component: how to check the airway for patency and signs of obstruction; how to evaluate breathing rate, depth, sounds; how to assess circulation by checking pulse, blood pressure, skin signs; how to determine a patient's neurological status; and why exposure is important.
General principles are outlined such as treating life-threatening problems first and continually reassessing. Causes and management of problems in each area are also reviewed. The goal of the ABCDE
1) The document discusses the importance of eyesight and donating eyes after death to help the blind see again. It notes that 1.8 million people in India are blind due to corneal issues.
2) Only the cornea can be donated, which takes 15-20 minutes to remove. Anyone can donate their eyes after death regardless of age or health conditions.
3) Donating eyes gives the gift of sight to others and helps prevent blindness, yet many myths exist about donation that prevent people from pledging to donate. The document urges people to pledge and donate their eyes.
Epididymitis is an inflammation of the epididymis, the coiled tube behind the testicle that stores and carries sperm. It is most common in men ages 20-39 and is usually caused by a bacterial infection spreading from the urinary tract or an STD. Symptoms include testicle pain and tenderness, painful urination, and fever. Doctors evaluate with exams, tests, and imaging to diagnose and rule out other conditions, then treat with antibiotics and anti-inflammatories. Leaving epididymitis untreated can cause permanent damage.
Phimosis is an abnormality associated with the foreskin retraction of the penis. It is usually diagnosed among the male babies up to 3yrs of age. Generally, it is self curable and mostly gets cured by the age of 17yrs in most of the men. In case it does not get cured by its own, circumcision or OTC drugs.
It is necessary to consult the doctor in case there is severe pain, issues or infections.
Retinal detachment refers to the separation of the retinal pigment epithelium (RPE) from the sensory retina. There are four main types: rhegmatogenous, traction, exudative, and a combination. Rhegmatogenous detachment occurs when a hole or tear develops in the sensory retina, allowing fluid to pass through and separate the layers. Risk factors include increasing age, high nearsightedness, eye trauma, and certain eye conditions. Diagnosis involves examination of the eye and sometimes ultrasound imaging. Treatment options are laser photocoagulation to seal retinal breaks, cryotherapy, vitrectomy surgery, or draining subretinal fluids depending on the type and severity of detachment.
Intestinal obstruction occurs when the intestine is blocked, preventing normal movement of its contents. It can be caused by mechanical blockages such as tumors or hernias, or functional issues like neuromuscular problems. Symptoms include abdominal pain, vomiting, distension and constipation. Treatment involves fluid resuscitation, antibiotics, pain management, and sometimes surgery to remove the obstruction. Proper diagnosis and timely treatment are important to prevent complications like perforation and sepsis.
Gastric outlet obstruction has various causes including peptic ulcer disease, gastric cancer, and Crohn's disease. It leads to vomiting of partially digested food, dehydration, and metabolic abnormalities. Diagnosis involves imaging, endoscopy, and biopsy. Management focuses on correcting electrolyte abnormalities and removing the mechanical obstruction endoscopically or surgically via procedures like vagotomy and gastrojejunostomy. Gastric cancer is a common cause and may require total or subtotal gastrectomy depending on location, with postoperative risks of bleeding, leakage, and nutritional deficiencies. Palliative options for inoperable tumors include stenting or bypass procedures.
Mastoiditis is an inflammation of the mastoid process behind the ear that can result from untreated or inadequately treated otitis media. It is classified as either acute or chronic mastoiditis. Acute mastoiditis develops as a complication of acute otitis media, while chronic mastoiditis occurs with chronic suppurative otitis media or cholesteatoma formations. Symptoms include severe pain, swelling and tenderness in the mastoid region, fever, and otorrhea. Diagnosis involves tests like CT scans, ear cultures and audiograms. Treatment consists of antibiotics, analgesics, and may require surgical drainage of pus via procedures like mastoidectomy if infection spreads to
1) The document discusses the importance of eyesight and donating eyes after death to help the blind see again. It notes that 1.8 million people in India are blind due to corneal issues.
2) Only the cornea can be donated, which takes 15-20 minutes to remove. Anyone can donate their eyes after death regardless of age or health conditions.
3) Donating eyes gives the gift of sight to others and helps prevent blindness, yet many myths exist about donation that prevent people from pledging to donate. The document urges people to pledge and donate their eyes.
Epididymitis is an inflammation of the epididymis, the coiled tube behind the testicle that stores and carries sperm. It is most common in men ages 20-39 and is usually caused by a bacterial infection spreading from the urinary tract or an STD. Symptoms include testicle pain and tenderness, painful urination, and fever. Doctors evaluate with exams, tests, and imaging to diagnose and rule out other conditions, then treat with antibiotics and anti-inflammatories. Leaving epididymitis untreated can cause permanent damage.
Phimosis is an abnormality associated with the foreskin retraction of the penis. It is usually diagnosed among the male babies up to 3yrs of age. Generally, it is self curable and mostly gets cured by the age of 17yrs in most of the men. In case it does not get cured by its own, circumcision or OTC drugs.
It is necessary to consult the doctor in case there is severe pain, issues or infections.
Retinal detachment refers to the separation of the retinal pigment epithelium (RPE) from the sensory retina. There are four main types: rhegmatogenous, traction, exudative, and a combination. Rhegmatogenous detachment occurs when a hole or tear develops in the sensory retina, allowing fluid to pass through and separate the layers. Risk factors include increasing age, high nearsightedness, eye trauma, and certain eye conditions. Diagnosis involves examination of the eye and sometimes ultrasound imaging. Treatment options are laser photocoagulation to seal retinal breaks, cryotherapy, vitrectomy surgery, or draining subretinal fluids depending on the type and severity of detachment.
Intestinal obstruction occurs when the intestine is blocked, preventing normal movement of its contents. It can be caused by mechanical blockages such as tumors or hernias, or functional issues like neuromuscular problems. Symptoms include abdominal pain, vomiting, distension and constipation. Treatment involves fluid resuscitation, antibiotics, pain management, and sometimes surgery to remove the obstruction. Proper diagnosis and timely treatment are important to prevent complications like perforation and sepsis.
Gastric outlet obstruction has various causes including peptic ulcer disease, gastric cancer, and Crohn's disease. It leads to vomiting of partially digested food, dehydration, and metabolic abnormalities. Diagnosis involves imaging, endoscopy, and biopsy. Management focuses on correcting electrolyte abnormalities and removing the mechanical obstruction endoscopically or surgically via procedures like vagotomy and gastrojejunostomy. Gastric cancer is a common cause and may require total or subtotal gastrectomy depending on location, with postoperative risks of bleeding, leakage, and nutritional deficiencies. Palliative options for inoperable tumors include stenting or bypass procedures.
Mastoiditis is an inflammation of the mastoid process behind the ear that can result from untreated or inadequately treated otitis media. It is classified as either acute or chronic mastoiditis. Acute mastoiditis develops as a complication of acute otitis media, while chronic mastoiditis occurs with chronic suppurative otitis media or cholesteatoma formations. Symptoms include severe pain, swelling and tenderness in the mastoid region, fever, and otorrhea. Diagnosis involves tests like CT scans, ear cultures and audiograms. Treatment consists of antibiotics, analgesics, and may require surgical drainage of pus via procedures like mastoidectomy if infection spreads to
Αριστοτέλης Γ. Αποστολίδης, Απεικόνιση των Ινομυωμάτων και της Αδενομύωσης, 2016. Υπερηχογραφια τομ.13, τευχ.3, σελ. 111-118
ACOG, Uterine Fibroids. Gynecologic Problems, 2018 (Greek Version: Μπαμπάτσιας Λ.)
ACOG, Uterine Fibroids - Frequently Asked Questions: Gynecologic Problems, December 2018
Aymara Mas et al., Updated approaches for management of uterine fibroids. Int J Womens Health. 2017; 9: 607–617. Published online 2017 Sep 5. doi: 10.2147/IJWH.S138982. PMCID: PMC5592915, PMID: 28919823
Hee Joong Lee, MD, et al., Contemporary Management of Fibroids in Pregnancy. Rev Obstet Gynecol. 2010 Winter; 3(1): 20–27. PMCID: PMC2876319. PMID: 20508779
Ioannis K Thanasas, Maria Boursiani, Rare Localizations of Genital Leiomyomas in Woman’s System, October 2015. ACHAIKI IATRIKI Volume 34, Issue 2
Jessica Shields, D.O., Can uterine fibroids harm my pregnancy?, March 31, 2020
Li H, Du J, Jin L, Shi Z, Liu M. Myomectomy during cesarean section. Acta Obstet Gynecol Scand 2009, 88:183-6.
Sharma JB, Kumar S, Rahman SM, Roy KK, Malhotra N. Non-puerperal incomplete uterine inversion due to large sub-mucous fundal fibroid found at hysterectomy: a report of two cases. Arch Gynecol Obstet 2009, 279:565-7.
WebMD, Uterine Fibroids and Pregnancy: How UF Affects Pregnancy. www.webmd.com
Urinary tract infections are the most common conditions in childhood, affecting the urethra, bladder, and kidneys. Escherichia coli causes 80% of UTIs. Risk factors include female anatomy, urinary stasis, and abnormalities of the urinary tract. Diagnosis involves urine culture and analysis as well as imaging tests. Treatment consists of antibiotic therapy based on the identified pathogen and location of infection, while prevention focuses on hygiene and management of underlying risk factors to avoid recurrence and permanent kidney damage.
This document discusses cataracts, including their definition, risk factors, types, clinical manifestations, diagnostic tests, management, and complications. Cataracts are an opacity of the lens that can impair vision. The most common type is age-related senile cataracts, which usually begin around age 50. Risk factors include aging, UV exposure, diabetes, corticosteroid use, and trauma. Diagnosis involves visual acuity and slit lamp tests. Treatment is surgical removal of the clouded lens and replacement with an intraocular lens. Complications can include infection, bleeding, and posterior capsule opacification.
Surgical Management of Intestinal Obstruction Harsha Yadav
The document discusses the management of intestinal obstruction. It covers supportive management including nasogastric decompression and fluid/electrolyte replacement. Surgical management principles include managing the site of obstruction, distended bowel, and underlying cause. Specific surgical techniques are described for different types of obstructions including adhesions, intussusception, large bowel obstruction, and volvulus in the caecum or sigmoid. Dynamic obstruction management is also outlined for paralytic ileus and pseudo-obstruction.
Epispadias is a rare birth defect where the urethra opens on the upper side of the penis. It occurs in about 1 in 120,000 male births and 1 in 500,000 female births. Epispadias results from defective migration of genital tissues during early embryonic development between 4-5 weeks of gestation. The main treatment is surgical repair during the first 7 years of life to reconstruct the urethra and close the penile shaft. Complications can include recurrence, sexual problems, incontinence, infections, and infertility.
Retinal detachment is a disorder of the eye in which the retina separates from the layer underneath. Symptoms include an increase in the number of floaters, flashes of light, and worsening of the outer part of the visual field
Pelvic inflammatory disease (PID) is an inflammatory or infectious condition of the pelvic cavity that can affect the cervix, uterus, fallopian tubes, and ovaries. It is commonly caused by Neisseria gonorrhea and Chlamydia trachomatis. Symptoms may include vaginal discharge, pain during sex, lower abdominal pain, and fever. Treatment involves antibiotic therapy, with hospitalization needed if oral antibiotics are ineffective. Complications can include recurrent PID, ruptured abscess, chronic pain, ectopic pregnancy, and infertility if left untreated.
This document discusses two congenital conditions: Oesophageal Atresia and Congenital Diaphragmatic Hernia.
Oesophageal Atresia involves a discontinuity in the esophagus that divides it into upper and lower pouches, sometimes associated with a tracheal fistula. It requires surgery to reconnect the esophagus or create an esophagostomy and gastrostomy. Prognosis depends on birthweight, associated anomalies, and pneumonia risk. Long term risks include stenosis and motility issues.
Congenital Diaphragmatic Hernia occurs when the diaphragm fails to fully develop, allowing abdominal organs to enter the chest cavity and impair lung development. It can
The document discusses eye banking and corneal transplantation. It provides a brief history and overview of eye banking milestones. An eye bank collects, stores, and distributes corneal tissue for transplantation. Corneas can be stored short term in a moist chamber or intermediate term in storage media like McCarey-Kaufman medium, K-Sol medium, or Dexol medium to extend the storage period. The eye bank process involves donor selection and screening, tissue retrieval through enucleation or corneo-scleral excision, examination and testing of the corneal tissue, transportation, and storage prior to distribution.
The document discusses various ear procedures including myringotomy, mastoidectomy, and tympanoplasty. Myringotomy involves incising the tympanic membrane to drain fluid from the middle ear, often used to treat acute otitis media. Mastoidectomy clears disease from the middle ear, epitympanum, and mastoid bone, creating a single cavity for drainage. Tympanoplasty aims to reconstruct the hearing mechanism after clearing chronic ear disease, and there are five types involving repair or reconstruction of different parts of the ear.
A group of eye disorders, glaucoma is characterized by high intraocular pressure (IOP) that damages the optic nerve.
Glaucoma is one of the leading causes of irreversible blindness in the world and is the leading cause of blindness among adults in the United States.
Glaucoma may occur as primary or congenital disease or secondary to other causes, such as injury, infection, surgery, or prolonged use of topical corticosteroids.
Primary glaucoma has mainly two forms :
1. Open angle glaucoma ( chronic, simple, or wide angle glaucoma)
2. Angle –closure glaucoma( Acute or narrow angle glaucoma)
Angle –closure glaucoma occurs suddenly and may cause permanent or irreversible vision loss in 48 to 72 hours.
This document provides tips for using a PowerPoint presentation on anal fissures. It recommends:
1. Freely editing, modifying, and adding your name to the slides.
2. Not worrying about the number of slides, as half are blank except for the title to facilitate discussion.
3. Showing blank slides, asking students what they know, and then showing the content slide, in an active learning approach repeated three times.
4. This approach is good for self-study as well.
5. Notes provide the bibliography.
This document provides information about renal calculi (kidney stones). It discusses the definition, causes, signs and symptoms, types, diagnostic procedures, management, and nursing considerations for patients with kidney stones. The main types of stones discussed are calcium oxalate, uric acid, cystine, and struvite stones. Diagnostic tests include blood and urine tests, x-rays, CT scans, and analyzing passed stones. Management involves increasing fluid intake, pain medication, stone removal procedures, diet modification, and patient education on preventing recurrence.
The most common presenting complaint of Ophthalmology in Emergency dept. is Foreign body sensation, so just to recall the basics of Ophthalm in ED, read the following PPT.
Otosclerosis is a metabolic bone disease that causes abnormal bone growth in the ossicles of the middle ear, commonly fixing the stapes bone. It most often presents between ages 15-45 and risk factors include family history and metabolic abnormalities. Symptoms include hearing loss and tinnitus. Diagnosis involves audiometry, otoscopic examination, and CT scan. Treatment options include stapedotomy or stapedectomy surgery as well as hearing aids or fluoride therapy for non-surgical candidates or those who decline surgery. The goal of treatment is to restore hearing by improving sound conduction through the middle ear.
Retinal detachment is a serious condition where the retina peels away from its underlying supportive tissue layer. It can cause permanent vision loss if not repaired soon. The summary examines the risk factors, types, signs and symptoms, diagnosis, and treatment options for retinal detachment. Surgical methods like scleral buckling, cryopexy, laser photocoagulation, pneumatic retinopexy and vitrectomy aim to reattach the retina. Prompt treatment usually leads to vision improvement, though the prognosis depends on factors like macula involvement and presence of proliferative vitreoretinopathy. Post-operative care and home management are important to monitor for complications and aid recovery.
Seminar presentation by 5th-year medical students under the supervision of in house lecturer. He was previously working as a consultant surgeon in Syria. Reference as mentioned in the slides.
This document discusses chronic otitis media, including tubotympanic and atticoantral types. Tubotympanic type is a safe inflammation of the middle ear lining, while atticoantral type involves a cholesteatoma sac. Symptoms include ear discharge and deafness. Examination may reveal perforations or debris in the ear canal. Investigations include culture, endoscopy and imaging. Management involves medical treatment like cleaning or antibiotics, with surgery for more severe cases like mastoidectomy or tympanoplasty.
Early recognition and stabilisation of ill patientsTonyGATEREGA
This document provides information on the ABCDE approach for assessing and stabilizing critically ill patients. It describes the ABCDE assessment method which breaks the assessment into Airway, Breathing, Circulation, Disability, and Exposure. For each component, it outlines how to assess problems, common causes, signs to look for, and initial treatment approaches. The goal of the ABCDE approach is to systematically assess and treat life-threatening problems in a clear and organized manner to stabilize the patient.
Systematic approach to the seriously ill or injured child AGAkshay Golwalkar
This document discusses the systematic approach to evaluating and treating a seriously ill or injured child. It outlines the evaluate-identify-intervene sequence, with evaluation including a primary assessment using the ABCDE model to assess airway, breathing, circulation, disability, and exposure, as well as secondary assessments. Identification involves classifying any respiratory or circulatory problems. Intervention involves appropriate treatment based on the child's identified issues. The primary assessment components of airway, breathing, circulation are described in detail.
Αριστοτέλης Γ. Αποστολίδης, Απεικόνιση των Ινομυωμάτων και της Αδενομύωσης, 2016. Υπερηχογραφια τομ.13, τευχ.3, σελ. 111-118
ACOG, Uterine Fibroids. Gynecologic Problems, 2018 (Greek Version: Μπαμπάτσιας Λ.)
ACOG, Uterine Fibroids - Frequently Asked Questions: Gynecologic Problems, December 2018
Aymara Mas et al., Updated approaches for management of uterine fibroids. Int J Womens Health. 2017; 9: 607–617. Published online 2017 Sep 5. doi: 10.2147/IJWH.S138982. PMCID: PMC5592915, PMID: 28919823
Hee Joong Lee, MD, et al., Contemporary Management of Fibroids in Pregnancy. Rev Obstet Gynecol. 2010 Winter; 3(1): 20–27. PMCID: PMC2876319. PMID: 20508779
Ioannis K Thanasas, Maria Boursiani, Rare Localizations of Genital Leiomyomas in Woman’s System, October 2015. ACHAIKI IATRIKI Volume 34, Issue 2
Jessica Shields, D.O., Can uterine fibroids harm my pregnancy?, March 31, 2020
Li H, Du J, Jin L, Shi Z, Liu M. Myomectomy during cesarean section. Acta Obstet Gynecol Scand 2009, 88:183-6.
Sharma JB, Kumar S, Rahman SM, Roy KK, Malhotra N. Non-puerperal incomplete uterine inversion due to large sub-mucous fundal fibroid found at hysterectomy: a report of two cases. Arch Gynecol Obstet 2009, 279:565-7.
WebMD, Uterine Fibroids and Pregnancy: How UF Affects Pregnancy. www.webmd.com
Urinary tract infections are the most common conditions in childhood, affecting the urethra, bladder, and kidneys. Escherichia coli causes 80% of UTIs. Risk factors include female anatomy, urinary stasis, and abnormalities of the urinary tract. Diagnosis involves urine culture and analysis as well as imaging tests. Treatment consists of antibiotic therapy based on the identified pathogen and location of infection, while prevention focuses on hygiene and management of underlying risk factors to avoid recurrence and permanent kidney damage.
This document discusses cataracts, including their definition, risk factors, types, clinical manifestations, diagnostic tests, management, and complications. Cataracts are an opacity of the lens that can impair vision. The most common type is age-related senile cataracts, which usually begin around age 50. Risk factors include aging, UV exposure, diabetes, corticosteroid use, and trauma. Diagnosis involves visual acuity and slit lamp tests. Treatment is surgical removal of the clouded lens and replacement with an intraocular lens. Complications can include infection, bleeding, and posterior capsule opacification.
Surgical Management of Intestinal Obstruction Harsha Yadav
The document discusses the management of intestinal obstruction. It covers supportive management including nasogastric decompression and fluid/electrolyte replacement. Surgical management principles include managing the site of obstruction, distended bowel, and underlying cause. Specific surgical techniques are described for different types of obstructions including adhesions, intussusception, large bowel obstruction, and volvulus in the caecum or sigmoid. Dynamic obstruction management is also outlined for paralytic ileus and pseudo-obstruction.
Epispadias is a rare birth defect where the urethra opens on the upper side of the penis. It occurs in about 1 in 120,000 male births and 1 in 500,000 female births. Epispadias results from defective migration of genital tissues during early embryonic development between 4-5 weeks of gestation. The main treatment is surgical repair during the first 7 years of life to reconstruct the urethra and close the penile shaft. Complications can include recurrence, sexual problems, incontinence, infections, and infertility.
Retinal detachment is a disorder of the eye in which the retina separates from the layer underneath. Symptoms include an increase in the number of floaters, flashes of light, and worsening of the outer part of the visual field
Pelvic inflammatory disease (PID) is an inflammatory or infectious condition of the pelvic cavity that can affect the cervix, uterus, fallopian tubes, and ovaries. It is commonly caused by Neisseria gonorrhea and Chlamydia trachomatis. Symptoms may include vaginal discharge, pain during sex, lower abdominal pain, and fever. Treatment involves antibiotic therapy, with hospitalization needed if oral antibiotics are ineffective. Complications can include recurrent PID, ruptured abscess, chronic pain, ectopic pregnancy, and infertility if left untreated.
This document discusses two congenital conditions: Oesophageal Atresia and Congenital Diaphragmatic Hernia.
Oesophageal Atresia involves a discontinuity in the esophagus that divides it into upper and lower pouches, sometimes associated with a tracheal fistula. It requires surgery to reconnect the esophagus or create an esophagostomy and gastrostomy. Prognosis depends on birthweight, associated anomalies, and pneumonia risk. Long term risks include stenosis and motility issues.
Congenital Diaphragmatic Hernia occurs when the diaphragm fails to fully develop, allowing abdominal organs to enter the chest cavity and impair lung development. It can
The document discusses eye banking and corneal transplantation. It provides a brief history and overview of eye banking milestones. An eye bank collects, stores, and distributes corneal tissue for transplantation. Corneas can be stored short term in a moist chamber or intermediate term in storage media like McCarey-Kaufman medium, K-Sol medium, or Dexol medium to extend the storage period. The eye bank process involves donor selection and screening, tissue retrieval through enucleation or corneo-scleral excision, examination and testing of the corneal tissue, transportation, and storage prior to distribution.
The document discusses various ear procedures including myringotomy, mastoidectomy, and tympanoplasty. Myringotomy involves incising the tympanic membrane to drain fluid from the middle ear, often used to treat acute otitis media. Mastoidectomy clears disease from the middle ear, epitympanum, and mastoid bone, creating a single cavity for drainage. Tympanoplasty aims to reconstruct the hearing mechanism after clearing chronic ear disease, and there are five types involving repair or reconstruction of different parts of the ear.
A group of eye disorders, glaucoma is characterized by high intraocular pressure (IOP) that damages the optic nerve.
Glaucoma is one of the leading causes of irreversible blindness in the world and is the leading cause of blindness among adults in the United States.
Glaucoma may occur as primary or congenital disease or secondary to other causes, such as injury, infection, surgery, or prolonged use of topical corticosteroids.
Primary glaucoma has mainly two forms :
1. Open angle glaucoma ( chronic, simple, or wide angle glaucoma)
2. Angle –closure glaucoma( Acute or narrow angle glaucoma)
Angle –closure glaucoma occurs suddenly and may cause permanent or irreversible vision loss in 48 to 72 hours.
This document provides tips for using a PowerPoint presentation on anal fissures. It recommends:
1. Freely editing, modifying, and adding your name to the slides.
2. Not worrying about the number of slides, as half are blank except for the title to facilitate discussion.
3. Showing blank slides, asking students what they know, and then showing the content slide, in an active learning approach repeated three times.
4. This approach is good for self-study as well.
5. Notes provide the bibliography.
This document provides information about renal calculi (kidney stones). It discusses the definition, causes, signs and symptoms, types, diagnostic procedures, management, and nursing considerations for patients with kidney stones. The main types of stones discussed are calcium oxalate, uric acid, cystine, and struvite stones. Diagnostic tests include blood and urine tests, x-rays, CT scans, and analyzing passed stones. Management involves increasing fluid intake, pain medication, stone removal procedures, diet modification, and patient education on preventing recurrence.
The most common presenting complaint of Ophthalmology in Emergency dept. is Foreign body sensation, so just to recall the basics of Ophthalm in ED, read the following PPT.
Otosclerosis is a metabolic bone disease that causes abnormal bone growth in the ossicles of the middle ear, commonly fixing the stapes bone. It most often presents between ages 15-45 and risk factors include family history and metabolic abnormalities. Symptoms include hearing loss and tinnitus. Diagnosis involves audiometry, otoscopic examination, and CT scan. Treatment options include stapedotomy or stapedectomy surgery as well as hearing aids or fluoride therapy for non-surgical candidates or those who decline surgery. The goal of treatment is to restore hearing by improving sound conduction through the middle ear.
Retinal detachment is a serious condition where the retina peels away from its underlying supportive tissue layer. It can cause permanent vision loss if not repaired soon. The summary examines the risk factors, types, signs and symptoms, diagnosis, and treatment options for retinal detachment. Surgical methods like scleral buckling, cryopexy, laser photocoagulation, pneumatic retinopexy and vitrectomy aim to reattach the retina. Prompt treatment usually leads to vision improvement, though the prognosis depends on factors like macula involvement and presence of proliferative vitreoretinopathy. Post-operative care and home management are important to monitor for complications and aid recovery.
Seminar presentation by 5th-year medical students under the supervision of in house lecturer. He was previously working as a consultant surgeon in Syria. Reference as mentioned in the slides.
This document discusses chronic otitis media, including tubotympanic and atticoantral types. Tubotympanic type is a safe inflammation of the middle ear lining, while atticoantral type involves a cholesteatoma sac. Symptoms include ear discharge and deafness. Examination may reveal perforations or debris in the ear canal. Investigations include culture, endoscopy and imaging. Management involves medical treatment like cleaning or antibiotics, with surgery for more severe cases like mastoidectomy or tympanoplasty.
Early recognition and stabilisation of ill patientsTonyGATEREGA
This document provides information on the ABCDE approach for assessing and stabilizing critically ill patients. It describes the ABCDE assessment method which breaks the assessment into Airway, Breathing, Circulation, Disability, and Exposure. For each component, it outlines how to assess problems, common causes, signs to look for, and initial treatment approaches. The goal of the ABCDE approach is to systematically assess and treat life-threatening problems in a clear and organized manner to stabilize the patient.
Systematic approach to the seriously ill or injured child AGAkshay Golwalkar
This document discusses the systematic approach to evaluating and treating a seriously ill or injured child. It outlines the evaluate-identify-intervene sequence, with evaluation including a primary assessment using the ABCDE model to assess airway, breathing, circulation, disability, and exposure, as well as secondary assessments. Identification involves classifying any respiratory or circulatory problems. Intervention involves appropriate treatment based on the child's identified issues. The primary assessment components of airway, breathing, circulation are described in detail.
This document provides an overview of the approach to a child presenting with respiratory distress. It begins by defining respiratory distress and listing common signs and symptoms. It then describes how to grade the severity of respiratory distress and features of respiratory failure. The document outlines the pediatric assessment triangle and pentagon for evaluating a
This document provides information on performing a respiratory assessment, including objectives, the process of respiratory assessment, signs and symptoms to assess for, abnormal breath sounds, and common respiratory illnesses like asthma, pneumonia, COPD, and respiratory acidosis and alkalosis. The key steps are to inspect the chest, auscultate breath sounds, assess rate and effort, document findings, and understand common diseases and treatments.
This document provides guidelines for conducting a thoracic and lung assessment, including subjective and objective components. The objective assessment involves inspection, palpation, percussion, and auscultation of the chest. Inspection assesses shape, expansion, respiration, and pulsations. Palpation evaluates tactile vocal fremitus and expansion. Percussion compares resonance between sides. Auscultation listens to breath sounds and altered voice sounds over the lungs. The document also notes variations for pediatric and geriatric populations.
respiratoryassessment and it's examinationwajidullah9551
This document provides information on assessing the chest and lungs through physical examination. It discusses the relevant anatomy, history taking, and examination techniques including inspection, palpation, percussion, and auscultation of the chest. Examination points for different populations like neonates, infants, pregnant women, and older adults are also reviewed. The goal is to evaluate the lungs, breathing, and chest wall in a systematic manner.
This document provides information on assessing the chest and lungs through physical examination. It discusses the relevant anatomy, history taking, and examination techniques. The physical examination involves inspection, palpation, percussion, and auscultation of the chest. Normal and abnormal findings are outlined. Variations in examination based on age are also reviewed.
The document provides information on assessing the respiratory system through physical examination. It discusses the anatomy and physiology of the respiratory system and outlines the key steps in examination, which include inspection, palpation, percussion, and auscultation. The document describes how to perform and evaluate each part of the examination, noting normal and abnormal findings. The goal is to comprehensively assess respiratory system function and identify any potential issues.
This document provides an overview of pediatric respiratory emergencies. It begins with an approach to assessing a child with breathing difficulties, including evaluating the airway, breathing, circulation, disability and exposure. It describes signs of respiratory distress like stridor, wheezing, grunting and retractions. Immediate care focuses on ensuring an open airway, assisting breathing with oxygen, and restoring adequate circulation. Specific conditions that could cause respiratory distress like pneumonia, foreign body, and pneumothorax are discussed. The presentation concludes with an outline of the diagnostic evaluation of a child presenting with respiratory distress.
This document provides guidance on assessing the respiratory system through history, inspection, palpation, percussion, and auscultation. It begins with learning objectives and outlines the basic steps of examination, including positioning the patient. Key points of inspection include checking for chest wall deformities and signs of respiratory distress. During auscultation, the examiner listens for normal breath sounds and their characteristics in different areas of the lung. Palpation techniques like tactile fremitus are also described. The overall document serves as a guide for comprehensively evaluating the respiratory system.
Approach to respiratory distress in childrenWasim Akram
This document provides an overview of pediatric respiratory emergencies. It begins with an introduction to the approach and assessment of a child presenting with breathing difficulties. It then covers the grading of respiratory distress, features of respiratory failure, and the pathophysiology of increased airway resistance and edema. The document further discusses the pathophysiologic approach to various clinical conditions causing respiratory distress. It provides guidance on the initial assessment and immediate care of the child, including airway management, oxygen delivery, circulation support, and diagnostic evaluation. Specific conditions addressed include upper airway obstruction, pneumonia, and wheezing.
This document provides information on assessing and managing various respiratory emergencies. It discusses the anatomy and physiology of breathing and defines conditions such as asthma, chronic obstructive pulmonary disease (COPD), hyperventilation, epiglottitis, and pulmonary embolism. For each condition, it outlines signs and symptoms and guidelines for treatment, including administering oxygen, positioning the patient, and alerting emergency services. The overall goal is to familiarize first responders with respiratory systems and protocols for responding to breathing difficulties.
3. Respiratory presentation.pdf medical surgical nursingakoeljames8543
This document discusses respiratory disorders and the nursing assessment and management of patients experiencing respiratory issues. It covers:
- The importance of assessing respiratory rate and performing an ABCDE assessment for patients presenting with breathing difficulties.
- How the respiratory system is often the first to respond to physiological changes and alterations in respiratory rate can indicate issues remote from the lungs.
- The nursing assessment of patients' respiratory history, physical exam including vital signs, inspection, auscultation and diagnostic tests.
- Common nursing interventions for respiratory disorders like positioning, oxygen therapy and treating pain.
- The causes, signs and symptoms, and management of upper airway obstruction which can quickly lead to respiratory and cardiac arrest without prompt intervention
Systematic approach to the seriously ill or injured (PALS)Hardik Shah
This document outlines the systematic approach to assessing and treating a seriously ill or injured child known as Pediatric Advanced Life Support (PALS). It describes the initial impression, evaluate-identify-intervene sequence, primary assessment using ABCDE, secondary assessment involving history and focused exam, and various diagnostic tests. The primary assessment evaluates airway, breathing, circulation, disability and exposure. Secondary assessment obtains a brief history and focused physical exam. Various diagnostic tests help identify the child's condition and guide treatment.
The document provides details on assessing a patient's oxygenation through nursing history, physical examination, and diagnostic tests. The nursing history focuses on collecting information on symptoms like chest pain, fatigue, dyspnea, cough, wheezing, respiratory infections, allergies, health risks, medications, smoking, and other exposures. The physical examination involves inspection of the skin, breathing patterns, and palpation techniques to examine thoracic excursion, tactile fremitus, thrills, and heaves.
This document provides information on assessing the respiratory system, including:
1. It describes the anatomy of the respiratory system, including the lungs, thoracic cavity, and structures within.
2. It outlines the steps for assessing the respiratory system, including subjective questions to ask the patient and the objective exam of inspection, palpation, percussion, and auscultation of breath sounds.
3. It details normal and abnormal breath sound findings, such as crackles, wheezes, decreased breath sounds, and identifies medical conditions commonly associated with each.
Advance life support refer to a constellation of interventions needed to support the vital physiological process during a critical illness, while we await response with definitive therapy. These life support measures are instituted to prevent cardiac arrest.
To recognise physiological derangements that arise out of multiple etiologies and stabilize them first.
EVALUATE – IDENTIFY – INTERVENE
The steps of evaluation are
1.Initial impression
2. Primary assessment
3. Secondary assessment
4. Diagnostic test
Gives insight to overall physiological status and functioning of the brain.
TICLS
Tone: Look for general posture of the child has adopted
Interactive: Is the child responsive and interacting appropriately, unresponsive or lethargic.
Consolable: Irritable, consolable or inconsolable
Look\Gaze: How is the child looking at mother, any vacant gaze
Speech: Is the child able to speak or vocalise as is appropriate for age or is there a paucity\weak\hoarseness of voice.
IDENTIFY = Abnormality in any of these parameters point towards a brain dysfunction
Impaired consciousness is a significant alteration in the awareness of self and environment with varying degree of wakefulness.
Unconsciousness persisting for at lest 1 hr – Coma.
Younger children more likely to have coma or altered sensorium secondary to non-traumatic etiology, where as traumatic brain injury is more common in older children.
Always rule out reversible causes of coma, like hypoglycemia, hyperglycaemia and electrolyte imbalance.
Any severe systemic illness can cause altered consciousness as a result of hypoxic ischemic insult, which if on-going can aggravate raised ICT.
This document provides an overview of assessing the respiratory system, including:
1) The anatomy and physiology of the respiratory system and descriptions of normal breath sounds.
2) The basic steps of respiratory assessment - Inspection, Palpation, Percussion, and Auscultation (IPPA).
3) Details on inspecting the chest wall, palpating tactile fremitus, percussing the chest, and auscultating breath sounds at different locations.
Early recognition of deteriorating patients is key to preventing cardiac arrest. The ABCDE approach is used to assess airway, breathing, circulation, disability, and exposure. Effective CPR involves high-quality chest compressions at a rate of 100-120 per minute with a depth of 5-6 cm, as well as use of an AED to deliver shocks for shockable rhythms like ventricular fibrillation and ventricular tachycardia. Non-shockable rhythms like asystole and pulseless electrical activity require continued CPR and administration of adrenaline every 3-5 minutes.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
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Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
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Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
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Leveraging Generative AI to Drive Nonprofit Innovation
A-Eapproach
1. B Y G A D I S A D I R I B A
Recognition and Early Management of
Acutely Ill Patients
2.
3. A-E Assessment Approach
ABCDE Assessment Approach :-
A structured way of assessing
patient.
It is used internationally
Used in assessing and treating
trauma patients, in advanced
life support and assessing
critically ill patients.
Useful as it helps you make sure
nothing is missed.
A-E approach is an assessment
approach of critically ill patients
A- Airway
B- Breathing
C- Circulation
D- Disability
E- Exposure
4. ABCDE......
Airway – Check for Patency
Breathing - Check for RR, effort, breath sounds, and oxygen
saturation.
Circulation - Check Pulse, BP, urine output
Disability – Assess level of consciousness (GCS), pupils , blood
glucose
Exposure –Expose a body to assess as a whole: Give attention for
temperature and human dignity.
5. ABCDE Approach…
General Principles of ABCDE Approach:-
1, Follow ABCDE to assess and treat the patient.
2, Treat life threatening problems as they are identified before moving
to the next part of the assessment
3, Continually re-assess starting with airway if there is further
deterioration
4, Assess the effects of any treatment given.
6. ABCDE Approach…
Aims of ABCDE Approach:-
To provide life saving treatment
To break down complex clinical situations into more manageable parts
To serve as an assessment and treatment algorithm
To establish common situational awareness among all treatment providers
To buy time to establish final diagnose and treatment
7. A) Airway Assessment
Assess for airway patency:-
Patent airway?
How we assess airway patency?
Compromised or obstructed airway?
Why Airway Assessed First?
Airway obstruction is an emergency.
Assess for Patency
If he/she is talking the airway is
patent
If air entry diminished or noisy
breathing or no breath sound
airway is not patent -
obstruction
Partial obstruction - if air entry
is diminished and often noisy.
Complete Obstruction - if there
are no breath sounds at the mouth
or nose.
look, listen and feel approach can
detect if the airway is obstructed
8. Airway Assessment…
Assess airway for signs of airway
Obstructions
Paradoxical (Sea-saw movement )
Use of accessory muscles
Central cyanosis
Noisy breathing or absence of noisy
breathing
Added sounds:-
Snoring
Stridor
Gurgling
NB Be aware that the absence of noisy
breathing could mean full obstruction of
the airway.
Look for
Paradoxical (Sea-saw movement )– where
the chest and abdomen move opposite each other.
Use of accessory muscles in the neck and
shoulders
Central cyanosis – late sign
Listen : normal breathing is quit
Noisy breathing or absence of noisy
breathing is sign of obstruction
Added sounds : snoring, gurgling, stridor will
assist you to localize the level of obstruction
Snoring –partially occluded airway at pharynx
level
Stridor – obstruction at the laryngeal level or
above
Gurgling – liquid or semi liquid foreign
material in the upper airway
9. Airway Assessment
Causes of Airway Obstruction :-
Reduced level of consciousness
Loss of protective airway
reflexes (gag and cough reflexes)
Vomit, blood and Retention of
secretions
Tissue swelling
Foreign body
Tongue mal positions
Reduced level of consciousness - If the patient
is unconscious, muscle tone reduces and the tongue
may fall backwards obstructing the pharynx.
Loss of protective airway reflexes (gag and
cough reflexes)
Vomit, blood and Retention of oropharyngeal
secretions
Tissue swelling -Upper airway edema or
inflammation by infection, allergic reaction, trauma,
or burns
Foreign body – laryngeal spasm
Tongue malpositions - is the most common cause of
airway obstruction in a semiconscious or unconscious
patient; relaxation of the muscles supporting the
tongue can result in it falling back and blocking the
pharynx)
10. Management of airway problems
The simple Methods:-
Get help immediately
Encourage the patient to cough
Suction the airway
Adequate oxygenation; Give high flow O2
Maintain SpO2 >94%
Open airway –by head tilt chin lift or jaw trust
maneuver – remove foreign body
Insertion of airway adjunct
Chest physiotherapy
Manual breaths – if patient’s respiratory effort is
ineffective or absent
Consider for advanced Respiratory care
Recovery position:- lateral position
Monitoring the patient’s airway
Airway obstruction is an
emergency!
Treat airway obstruction as a
medical emergency
untreated, airway obstruction
leads to a lowered PaO2 and risks
hypoxic damage to the brain,
kidneys and heart, cardiac arrest,
and even death.
Once airway obstruction has been
identified, treat appropriately.
How we manage airway problems?
11. B) Assessment of Breathing
Assessment of Breathing:-
Begin by counting RR.
RR – is the most sensitive sign of patient
deterioration.
High or Rapidly Increasing is a significant
predictor of deterioration or impending adverse
events
Increased RR- could be triggered by anexiety,
pain, cardiac dysfunction or anemia
Bradypnea is an ominous sign and possible
causes include drugs (e.g. opioids - sedation),
fatigue, hypothermia, head injury/damage to
Respiratory Center and central nervous system
(CNS) depression.
Sudden bradypnea in a patient with respiratory
distress could quickly be followed by respiratory
arrest.
Pattern of breathing – Provides valuable
information.
Once the airway is open it is
important to assess for effective,
spontaneous breathing.
Appropriate management of airway
and breathing is the priority in all
seriously ill children
look, listen and feel approach can be
used to assess breathing, or to detect
signs of respiratory distress or
inadequate ventilation.
12. Assessment of breathing… .
Laboured breathing, use of
accessory or abdominal muscles,
flaring nostrils, and pt gasping
are all indicators of
compromised breathing.
Unilateral chest wall movement
may indicate the presence of
pneumonia, pneumothorax, or
pleural effusion.
Pt who is sweating, distressed,
or cyanosed is likely
experiencing respiratory
difficulties with an increased
work of breathing and a reduced
oxygen uptake.
Look:-Look for the general signs of
respiratory distress: -
Tachypnea(increased RR) – The First
Sign.
Sweating,
Central Cyanosis,
Use Of The Accessory Muscles Of
Respiration,
Abdominal breathing.
13. Assessment of Breathing…
Normal Respiratory Rate
according to age
Age RR
(years) (br/min)
<1 30–40
1–2 26–34
2–5 24–30
5–12 20–24
>12 12–20
Assess chest movement:-
is equal on both sides
(symmetry)
Asynchronous movement of the
chest suggests unilateral disease,
e.g. atelectasis, flail chest,
pneumothorax.
Assess Depth of Breathing:-
Ascertain whether chest movement
is equal on both sides.
14. Assessment of Breathing…
Assess the pattern (rhythm) of breathing
The use of accessory muscles is also a common
sign when the work of breathing is increased.
Another common breathing pattern seen in
severe respiratory distress is ‘see-saw’
breathing; this is the paradoxical movement of
the abdomen during inspiration.
Assess The Position Which The Child Prefers
Children in respiratory compromise will usually
adopt a position that helps their respiratory
capacity.
This position must be supported to maximize
comfort and prevent further upset which may
result in further deterioration.
Listen
1. Listen to the patient’s breath sounds a short
distance from his or her face.
Normal breathing is quiet.
Stridor or wheeze suggests partial, but significant,
airway obstruction.
Grunting: mainly heard in young babies, but can occur
in small children. It is the result of exhaling against a
partially closed glottis.
Grunting is usually associated with ‘stiff’ lungs
and is an indication of severe respiratory
compromise.
2. Auscultate the chest: the depth of breathing and
the equality of breath sounds on both sides of the
chest should be evaluated.
Any additional sounds, e.g. crackles, wheeze and
pleural rubs, should be noted.
15. Assessment of Breathing…
Feel
Perform chest percussion. Causes
of different percussion notes
include the following.
Resonant or hollow : air filled
lung
Dull (medium intensity and
pitch) : atelectasis, consolidation,
pulmonary oedema, pulmonary
haemorrhage
Hyper-resonant (loud low
pitched): pneumothorax,
emphysema
Tympanic (high pitched) :
asthma, large pneumothorax.
Assess Efficacy of Breathing, Work of Breathing
And Adequacy of Ventilation
Efficacy of breathing - can be assessed by:
air entry
chest movement
pulse oximetry
arterial blood gas analysis and
capnography.
Work of breathing - can be assessed by:-
Respiratory Rate And
Accessory Muscle Use, e.g. neck and abdominal
muscles.
Adequacy of ventilation - can be assessed by
Heart Rate,
Skin Color And
Mental Status.
16. Assessment of Breathing…
Causes of compromised breathing
Respiratory illness, e.g. asthma,
pneumonia etc
Compromised airway
Respiratory failure
Heart failure
Lung Pathology, e.g.
Pneumothorax
Pulmonary Edema
CNS Depression
hypovolemia
Drug - Induced Respiratory
Depression.
Treatment of Compromised Breathing
If the patient’s breathing is compromised,
position him or her appropriately (usually upright)
administer oxygen and if possible treat the
underlying cause.
expert help should be summoned.
assisted ventilation by Ambubag or intubation may
be required when breathing is not adequate.
during the initial assessment of breathing, it is
essential to diagnose and effectively treat
immediately life - threatening conditions, e.g. acute
severe asthma, pulmonary edema, tension
pneumothorax or massive haemothorax.
17. Management of Respiratory Problems
Give high flow oxygen
Full and frequent pt observation
Optimize the patient position, sitting
position but not restricted; encourage the
position which a patient prefers
Encourage deep breathing, coughing, and
expectorating.
Assess and treat patient’s pain- prevents
adequate breathing and mobilisation.
Administer nebulizers
Monitoring of oxygen therapy in progress
.
For the acutely unwell pt if oxygen
saturations are below 94% then oxygen is
required.
The method by which O2 is being delivered
should be assessed and the appropriate
delivery method is considered
Assess O2 saturation compared to the
Percentage of O2 being delivered
If no improvement advanced respiratory
support: intubation/ MV considered
Careful and Close Monitoring to ensure
that the most appropriate treatment is
administered and any response to it is
accurately evaluated.
18. C) Circulatory Assessment
Circulatory assessed By
assessing:-
Peripheral perfusion and
capillary refill time
Pulse rate and rhythm
Blood pressure
Urine output and balance
The familiar look, listen and
feel approach can be used
for the assessment of
circulation.
Look -Look at the skin temperature and color,
heart rate, capillary refill time (CRT) and
conscious level.
Signs of cardiovascular compromise
(inadequate circulation/perfusion) include:
cool and pale/cyanosed peripheries.
prolonged CRT ( > 2 s)
Tachycardia
Decreased BP
Decreased urine output
Reduced Conscious Level
The normal urine out put is 0.5 -1ml/kg/hr.
19. Circulatory Assessment….
Normal Blood Pressure
according to age
Age Normal Lower limit
(mmHg) (mmHg)
0–1 month >60 50–60
1–12 months 80 70
1–10 yrs 90+2×age yrs 70+2×age
yrs
>10 years 120 90
Normal Heart Rate according to
age
Age Mean Awake Deep sleep
(beats/min) beats/min) (beats/min)
Newborn to 3 months 140 85–205 80–140
3 months to 2 years 130 100–180 75–160
2–10 years 80 60–140 60–90
>10 years 75 60–100 50–90
Measure the patients Blood Pressure
A low systolic blood pressure suggests shock. However,
even in shock, the blood pressure can still be normal,
because compensatory mechanisms increase peripheral
resistance in response to reduced cardiac output .
A low diastolic blood pressure suggests arterial
vasodilatation (e.g. anaphylaxis or sepsis). A narrowed pulse
pressure, i.e. the difference between systolic and diastolic
pressures (normal pulse pressure is 35 – 45 mmHg), suggests
arterial vasoconstriction (e.g. cardiogenic shock or
hypovolaemia)
20. Causes of Circulatory Compromise
Causes of inadequate circulation/perfusion:-
Excessive loss of fluid :- hemorrhage,
diarrhea or excessive ileostomy or colostomy
output, vomiting, excessive NG tube drainage,
burns, drainages, excessive sweating
Vascular Dilation:- sepsis, anaphylactic
rxns, epidurals (eg. Bupivacaine), spinal cord
injury
Fluid movement out of the systemic
circulation :- electrolyte balance disturbances
(eg. Hyponatraemia), protein demolition,
leaking capillaries due to sepsis or anaphylaxis
Inadequate oral intake
Increased RR or insensible loss of fluid
Failure of the cardiac pump
The most Causes of circulatory
compromise in Children
Hypovolaemia,
Sepsis And
Anaphylaxis
The other common causes are:-
Obstruction of blood flow
e.g. tension pneumothorax,
Anemia or
Carbon monoxide poisoning in
which the oxygen-carrying capacity of the
blood is reduced.
21. Management of Inadequate Circulation
Ensure adequate peripheral or central
venous access
Give IV fluids and monitor for effects
The specific treatment required for
circulatory compromise will depend on
the cause;
If excessive fluid loss/volume depletion -
Fluid/Volume Replacement
if hemorrhage- Hemorrhage Control &
blood transfusion
If inadequate intake – adequate feeding
Restoration of Tissue Perfusion Will
Usually Be Necessary.
Monitoring of the treatment in progress .
hemodynamic Monitoring
Reassessing for inadequacies
Careful and close monitoring of the effects
of the treatment
22. D, Disability
Disability – refers to neurological status
(evaluating CNS function)
Assess conscious level rapidly by AVPU method
(Alert, response to Voice, response to Painful stimuli
or Unresponsive) Or GCS if you have time.
Assess pupils (size, equality and reaction to light)
Assess for pain :- By pain scores ( 0-3 scoring
system: 0- no pain, 1-mild pain, 2-moderate pain, 3-
severe pain
Review ABC to exclude Hypoxemia and
Hypotension
Check the patient’s drug chart for reversible drug
induced causes of altered conscious level
Undertake bedside glucose measurement to
exclude hypoglycemia
Glasgow Coma Score (GCS)
Eye Opening (E)- 4 scores
Spontaneous 4
To Verbal (Voice Or Speech) Stimuli 3
To Pain 2
None 1
Motor Response(M) Verbal Response (V)
6scores 5scores
Obeys Commands 6 Oriented 5
Localizes Pain 5 Confused 4
Withdraws To Pain 4 Inappropriate Words 3
Abnormal Flexion 3 Incomprehensible Sounds 2
Extensor Response 2 None 1
None 1
The Glasgow Coma Score =E+M+V ( 3-15)
The minimum is 3 & the maximum is 15.
23. Disability…
Causes of unconsciousness
(neurological impairment) :-
Profound hypoxia
Hypercapnia
Cerebral hypoperfusion
Recent administration of
sedatives and analgesic drugs
Hypoglycemia/ Hyperglycemia
Infection :- cerebral malaria or
meningitis
Seizures
Low BP
Signs of neurological impairment :-
Confusion
Agitation
Drowsiness
Seizure
Unequal pupils size or stop reacting
to light.
24. Management of Disability
Treatment of altered conscious level
The first priority is to assess ABC: exclude or treat hypoxia and hypotension.
If drug – induced altered conscious level is suspected and the effects are
reversible, administer an antidote,
e.g. naloxone for opioid toxicity.
Administer Glucose if the patient is hypoglycemic.
Pain and agitation should be avoided – give anti pain or sedatives
Position the patient on lateral position - to protect airway from risk of aspiration.
Insert Nasopharyngeal or Oropharyngeal Airway
25. E) Exposure
Exposure :-
Body is examined /assessed as a whole,
paying particular attention to wound sites or other injuries on the body.
In particular, the examination should concentrate on the part of the body that is most
likely to be contributing to the patient’s ill status,
e.g. in suspected anaphylaxis, examine the skin for urticaria.
During examination being mindful of environmental temperature and cover pt with
blanket – heat loss minimized & respect dignity.
Check temperature : hypothermia or hyperthermia
Check all over the body including groin and back for rash, injuries or wounds.
If you feel a pt’s condition is deteriorating assess any clues to explain the condition.
26. Exposure…
In addition:
Undertake a full clinical history.
Review the patient’s case notes, observations chart and medications chart.
Study the recorded vital signs: trends are more significant than one - off recordings.
Ensure that prescribed medications are being administered.
Review the results of laboratory, ECG and radiological investigations.
Keep the environment around the patient as calm and comfortable as
possible
Keep everything that comes into contact with patient clean
Keep the patient clean, especially wounds.
Minimize risk of cross contamination!