The document outlines the ABCDE and SAMPLE history approach for assessing and managing emergency patients, with the ABCDE approach assessing the airway, breathing, circulation, disability, and exposure, while the SAMPLE history collects information on signs/symptoms, allergies, medications, past medical history, last oral intake, events, and examines the patient. It provides detailed guidance on evaluating and treating life-threatening conditions in each area, such as managing an obstructed airway, breathing difficulties, shock, or altered mental status. The goal is to rapidly identify and address critical issues through this systematic approach.
Basics of nursing initial assessment needed to be done when a patient is received in the department. Done by the registered nurse, initial assessment is the basis on which further care is planned.
Safe transfer of patients is of utmost priority to minimize unwanted complications. Patients, especially the critical ones experience some amount of physical stress during the process of transfer which may result in the stress being manifested in altering one or more physical markers or parameters
Basics of nursing initial assessment needed to be done when a patient is received in the department. Done by the registered nurse, initial assessment is the basis on which further care is planned.
Safe transfer of patients is of utmost priority to minimize unwanted complications. Patients, especially the critical ones experience some amount of physical stress during the process of transfer which may result in the stress being manifested in altering one or more physical markers or parameters
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
Catheter-associated Urinary Tract Infections (CAUTI)
A urinary tract infection (UTI) is the most common type of healthcare-associated infection reported to the National Healthcare Safety Network (NHSN). Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed.
This presentation includes the first aid measures one can provide in case of accidental as well as intentional poisoning in order to minimize the morbidity and mortality in victims with poisoning.
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
Catheter-associated Urinary Tract Infections (CAUTI)
A urinary tract infection (UTI) is the most common type of healthcare-associated infection reported to the National Healthcare Safety Network (NHSN). Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed.
This presentation includes the first aid measures one can provide in case of accidental as well as intentional poisoning in order to minimize the morbidity and mortality in victims with poisoning.
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
1. The ABCDE and SAMPLE History Approach
Basic Emergency Care Course
2. Objectives
• List the hazards that must be considered when approaching an ill or injured person
• List the elements to approaching an ill or injured person safely
• List the components of the systematic ABCDE approach to emergency patients
• Assess an airway
• Explain when to use airway devices
• Explain when advanced airway management is needed
• Assess breathing
• Explain when to assist breathing
• Assess fluid status (circulation)
• Provide appropriate fluid resuscitation
• Describe the critical ABCDE actions
• List the elements of a SAMPLE history
• Perform a relevant SAMPLE history.
3. Essential skills
• Assessing ABCDE
• Cervical spine immobilization
• Full spine immobilization
• Head-tilt and chin-life/jaw thrust
• Airway suctioning
• Management of choking
• Recovery position
• Nasopharyngeal (NPA) and oropharyngeal
airway (OPA) placement
• Bag-valve-mask ventilation
• Skin pinch test
• AVPU (alert, voice, pain, unresponsive)
assessment
• Glucose administration
• Needle-decompression for tension
pneumothorax
• Three-sided dressing for chest wound
• Intravenous (IV) line placement
• IV fluid resuscitation
• Direct pressure/ deep wound packing for
haemorrhage control
• Tourniquet for haemorrhage control
• Pelvic binding
• Wound management
• Fracture immobilization
• Snake bite management
4. Why the ABCDE approach?
• Approach every patient in a systematic way
• Recognize life-threatening conditions early
• DO most critical interventions first - fix problems before moving on
• The ABCDE approach is very quick in a stable patient
Goals:
• Identify life-threatening conditions rapidly
• Ensure the airway stays open
• Ensure breathing and circulation are adequate to deliver oxygen to
the body
5. What is a SAMPLE history?
• Categories of questions to obtain a patient’s history
• Signs and Symptoms
• Allergies
• Medications
• Past medical history
• Last oral intake
• Events
• Immediately follows the ABCDE approach
• Allows providers to easily communicate
Goal:
• Rapidly gather history critical to the management of the acutely ill patient
6. ABCDE: Initial Approach
• The most important step is to stay safe!
• Scene safety
• Fire
• Motor vehicle crash
• Building collapse
• Chemical spill
• Violence
• Infections disease
• Personal Protective equipment
• Gloves
• Gown
• Mask
• Goggles
• Hand washing
Personal protective equipment
7. • Scene safety
• Scene hazards
• Violence
• Infectious disease risk
• Use personal protective equipment
• Consider appropriate PPE for situation
• Gloves, eye protection, gown and mask
• Cleaning and decontamination
• Use PPE and wash your hands before and after every patient contact (or alcohol gel cleanser)
• Clean/disinfect surfaces
• Refer to local decontamination protocols for chemical exposures
• Ask for help early
• Multiple patients
• Make arrangements if transfer is needed
• Know who to call for infectious outbreaks or hazardous exposures
Safety considerations
8. Workbook Question 1:
Safety
A person walks into your health post vomiting, bleeding from the
mouth and complaining of abdominal pain
Describe what is needed to safely approach this patient:
9. ABCDE Approach: Elements
• Breathing plus oxygen if needed:
• Ensure adequate movement of air into the lungs
• Airway with cervical spine immobilization:
• Check for obstruction
• If trauma-immobilize cervical spine
• Circulation with bleeding control and IV fluids
• Determine if there is adequate perfusion
• Check for life-threatening bleeding
10. ABCDE Approach: Elements
• Disability: AVPU/GCS, pupils and glucose
• Assess and protect brain and spinal functions
• Exposure and keep warm
• Identify all injuries and environmental threats
• Avoid hypothermia
This stepwise approach is designed to ensure that life-threatening conditions are
identified and treated early, in order of priority.
A problem discovered (A-B-C-D-E) must be addressed immediately
before moving on to the next step.
11. REMEMBER…
Always check for signs of trauma in each of
the ABCDE sections, and reference the trauma
module as needed.
13. Airway Management
• If the patient is unconscious and not breathing normally:
• If no concern for trauma: open airway using HEAD-
TILT/CHIN-LIFT manoeuvre
• If trauma suspected: maintain c-spine immobilization and
use JAW-THRUST manoeuvre
• Consider placing an AIRWAY DEVICE to keep the airway open
• Oropharyngeal airway
• Nasopharyngeal airway
Adult jaw thrust
14. Airway Management: Choking
• If foreign body is suspected:
• Visible foreign body: carefully REMOVE IT
• If the patient is able to cough or make noise, keep the patient calm
• ENCOURAGE to cough
• If the patient is choking (unable to cough/make sounds) use age-appropriate CHEST
THRUSTS/ABDOMINAL THRUSTS/ BACK BLOWS
• If the patient becomes unconscious while choking: follow CPR PROTOCOLS
Chest thrust in adult
Abdominal thrust in late pregnancy
Back blows in infant
Chest thrust in infant
15. Airway Management:
• If secretions are present:
• SUCTION airway or wipe clean
• Consider RECOVERY POSITION if the rest of the ABCDE is normal and no trauma
• If the patient has swelling, hives, or stridor, consider a severe allergic
reaction (anaphylaxis)
• Give intramuscular ADRENALINE
• Allow patient to stay in position of comfort
• Prepare for HANDOVER/TRANSFER to a center capable of advanced airway
management
17. Breathing: Assessment
• Look, listen and feel to see if the patient is breathing
• Assess if the breathing is very fast, very slow or very shallow
• Look for increased work of breathing
• Accessory muscle work
• Chest indrawing
• Nasal flaring
• Abnormal chest wall movement
• Listen for abnormal breath sounds
• REMEMBER with severe wheezes there may be no audible breath
sounds because of severe airway narrowing
18. Breathing: Assessment
• Listen to see if breath sounds are equal
• Check for the absence of breath sounds on one side
• If dull sound with percussion to the same side
• THINK large pleural effusion or haemothroax
• If also hypotension, distended neck veins or tracheal shift
• THINK tension pneumothorax
• Check oxygen saturation
19. Breathing: Management
• If unconscious with abnormal breathing, perform BAG-VALVE-MASK-VENTILATION with OXYGEN and
follow CPR PROTOCOLS
• If not breathing adequately (too slow or too shallow) begin BAG-VALVE-MASK-VENTILATION with OXYGEN
• If oxygen is not immediately available, do not delay ventilation
• Plan for immediate TRANSFER for airway management
• If breathing fast or hypoxia, give OXYGEN
• If wheezing, give SALBUTAMOL
• If concern for anaphylaxis, give intramuscular ADRENALINE
• If concern for tension pneumothorax, perform NEEDLE DECOMPRESSION, give OXYGEN, give IV FLUIDS
• Plan for immediate transfer for chest tube
• If concern for pleural effusion, haemothorax, give OXYGEN
• Plan for immediate transfer for chest tube
• If cause unknown, consider trauma
22. Circulation: Assessment
• Look for internal and external signs of bleeding
• Chest
• Abdomen
• From stomach or intestines
• Pelvic fracture
• Femur Fracture
• From wounds
• Check for pericardial tamponade
• Hypotension
• Distended neck veins
• Muffled heart sounds
• Check blood pressure
23. Circulation: Management
• For cardiopulmonary arrest follow relevant CPR PROTOCOLS
• If poor perfusion: GIVE IV FLUIDS
• If external bleeding: APPLY DIRECT PRESSURE
• If internal bleeding or pericardial tamponade, REFER to centre with
surgical capabilities
• If unknown cause, remember trauma
• Apply BINDER for pelvic fracture or SPLINT for femur fracture with
compromised blood flow
25. Disability: Assessment
• Assess level of consciousness
• AVPU or GCS in trauma
• Check for low blood glucose (hypoglycaemia)
• Check pupils (size, reactivity to light and if equal)
• Check movement and sensation in all four limbs
• Look for abnormal repetitive movements or shaking
• Seizures/convulsions
26. Disability: Management
• If altered mental status, no trauma, ABCDEs otherwise normal
• place in RECOVERY POSITION
• If altered mental status, low glucose (<3.5mmol/L) or if unable to check
glucose
• Give GLUCOSE
• If actively seizing
• Give BENZODIAZEPINE
• If pregnant and seizing
• Give MAGNESIUM SULPHATE
27. Disability: Management
• If small pupils and slow breathing, consider opioid overdose
• Give NALOXONE
• If unequal pupils, consider increased pressure in the brain
• RAISE HEAD OF BED 30 DEGREES if no concern for spinal injury
• Plan for early TRANSFER/REFERRAL
• If unknown cause of altered mental status, consider trauma
• IMMOBILIZE the cervical spine
29. Exposure: Assessment
• Examine the entire body for hidden injuries, rashes, bites or
other lesions
• Rashes, such as hives, can indicate an allergic reaction
• Other rashes can indicate infection
30. Exposure: Management
• If snake bite is suspected
• IMMOBILIZE the extremity
• Take a picture of the snake (if possible) to send to referral hospital
• General exposure considerations
• REMOVE constricting clothing and jewelry
• COVER the patient to prevent hypothermia
• Acutely ill patients may be unable to regulate body temperature
• PREVENT hypothermia
• Remove wet clothing and dry patient thoroughly
• Respect the patient’s modesty
• If cause unknown, remember trauma
• LOG ROLL for suspected spinal cord injury
33. Airway Obstruction: Foreign Body
Signs and Symptoms Management
• Visible secretions, vomit or foreign body
• Abnormal sounds from airway
• Stridor, snoring, gurgling
• Mental status changes -> airway
obstruction from tongue
• Poor chest rise
• REMOVE or SUCTION visible foreign body/fluid if
possible
• Do not push further into airway
• If completely obstructed
• Use age-appropriate CHEST
THRUSTS/ABDOMINAL THRUSTS/ BACK BLOWS
• For obstruction due to tongue
• Open the airway using HEAD-TILT and CHIN LIFT
or JAW THRUST (trauma)
• Place OPA or NPA as needed
• Plan for HANDOVER/TRANSFER
34. Airway Obstruction: Burns
Signs and Symptoms Management
• Burns to head and neck
• Burned nasal hairs/soot
• Abnormal sounds from airway
• Stridor, snoring, gurgling
• Poor chest rise
• Give OXYGEN to all patients with burn
injuries
• Open the airway using HEAD-TILT and
CHIN LIFT or JAW THRUST (trauma)
• Place OPA or NPA as needed
• Maintain c-spine IMMOBILIZATION if
there is trauma
• Plan for HANDOVER/TRANSFER
• Rapid airway swelling
Burns can cause airway swelling due to inhalation injuries!
35. Airway Obstruction: Severe Allergic Reaction
Signs and Symptoms Management
• Mouth, lip and tongue swelling
• Difficulty breathing
• Stridor and/or wheezing
• Rash or hives
• Tachycardia and hypotension
• Abnormal sounds from airway
• Stridor, snoring, gurgling
• Poor chest rise
• MONITOR for airway obstruction
• Give ADRENALINE for airway obstruction,
severe wheezing or shock
• Can wear off in minutes, need additional
doses
• Start IV/ give IV FLUIDS
• REPOSITION AIRWAY as needed
• Sit patient upright (no trauma)
• Give OXYGEN
• If severe or not improving, plan for
HANDOVER/TRANSFER
36. Airway Obstruction: Trauma
Signs and Symptoms Management
• Neck haematoma
• Abnormal sounds from airway
• Stridor, snoring, gurgling
• Change in voice
• Poor chest rise
• SUCTION to remove any blood
• Open airway using JAW THRUST
• Place an OPA as needed
• Do not use NPA with facial trauma
• Maintain SPINE IMMOBILIZATION
• Plan for HANDOVER/TRANSFER
In head/neck injuries obstruction can be from blood or due to the trauma itself
Penetrating wounds to neck cause obstruction from expanding hematoma
37. For any abnormal airway sounds,
REASSESS the airway frequently as
partial obstruction might worsen to
completely block the airway
38. Breathing Conditions: Tension Pneumothorax
Signs and Symptoms Management
• Hypotension with difficulty breathing
and any of the following:
• Distended neck veins
• Absent breath sounds on affected
side
• Hyperresonance with percussion on
affected side
• May have tracheal shift away from
affected side
• Perform NEEDLE DECOMPRESSION, give
OXYGEN and IV FLUIDS
• Plan for HANDOVER/TRANSFER
• Patient needs chest tube
Any pneumothorax can become a tension pneumothorax
39. Breathing Conditions: Suspected Opiate Overdose
Signs and Symptoms Management
• Slow respiratory rate (bradypnea)
• Hypoxia
• Very small pupils
• Give NALOXONE to reverse opiate
medications
• MONITOR closely
• Naloxone may wear off before opiate
• Give OXYGEN
Opioid medications (such as morphine, pethidine and heroin) can decrease the body’s
drive to breathe
40. Breathing Conditions: Asthma/ COPD
Signs and Symptoms Management
• Wheezing
• Cough
• Accessory muscle use
• May have history of asthma/COPD,
allergies or smoking
• Give SALBUTAMOL as soon as possible
• Give OXYGEN if indicated
Asthma and COPD are conditions causing spasm in the lower airway
41. Breathing Conditions: Large Pleural Effusion/
Haemothorax
Signs and Symptoms Management
• Difficulty in breathing
• Decreased breath sounds on affected
side
• Dull sounds with percussion on affected
side
• With large amount of fluid could have
tracheal shift
• Give OXYGEN
• Plan for HANDOVER/TRANSFER
• Patient may need chest tube
Pleural effusion occurs when fluid builds up in the space between the lung and the
chest wall or diaphragm limiting the expansion of the lungs
43. Circulation Conditions: Shock
Signs and Symptoms Management
• Rapid heart rate (tachycardia)
• Rapid breathing (tachypnoea)
• Pale and cool skin
• Capillary refill >3 seconds
• Sweating (diaphoresis)
• May have:
• Dizziness
• Confusion
• Altered mental status
• Hypotension
• LAY FLAT if tolerated
• Give OXYGEN
• STOP and CONTROL any bleeding
• Give IV FLUIDS
• If sign of infection give ANTIBIOTICS
• Plan for HANDOVER/TRANSFER
Poor perfusion: failure to deliver enough oxygen-carrying blood to vital organs
Shock is when organ function is affected which can lead to death
44. Circulation Conditions: Severe Bleeding
Signs and Symptoms Management
• Bleeding wounds
• Bruising around the umbilicus, over the
flanks can be sign of internal bleeding
• Vomiting blood, blood per rectum or vagina
• Pelvic or femur fractures
• Decreased breath sounds on one side
• Signs of poor perfusion
• Hypotension, tachycardia, pale skin,
diaphoresis
• Stop bleeding depending on source
• DIRECT PRESSURE
• Use DEEP WOUND PACKING if large and
gaping
• TOURNIQUET- Only for uncontrolled
bleeding with pressure
• BIND pelvis or SPLINT femur fracture
• Give IV FLUIDS
• REFER for blood transfusion and on-going
surgical management
If severe bleeding is not controlled it can lead to shock
Large amounts of blood can be lost in the chest, pelvis, thigh and abdomen
45. Circulation Conditions: Pericardial Tamponade
Signs and Symptoms Management
• Signs of poor perfusion
• Tachycardia, tachypnea,
hypotension, pale skin, cold
extremities, capillary refill >3
seconds
• Distended neck veins
• Muffled heart sounds
• May have dizziness, confusion, altered
mental status
• Treatment is drainaige by
pericardiocentesis
• IV FLUIDS to counter the pressure from
fluid in heart sac
• Plan for HANDOVER/TRANSFER
• Needs facility capable of draining
fluid
Pericardial tamponade occurs when there is a fluid build-up in the sac around the heart
Pressure build-up keeps the heart from filling properly
46. Disability Conditions: Hypoglycaemia
Signs and Symptoms Management
• Sweating (diaphoresis)
• Altered mental status
• Seizures/convulsions
• Blood glucose <3.5mmol/L
• History of diabetes, malaria or severe
infection
• Responds quickly to glucose
• Give GLUCOSE immediately
• If they can speak/swallow, give oral
GLUCOSE
• If they cannot speak or is unconscious,
give IV GLUCOSE
• If unavailable give buccal (inside of
cheek)
47. Disability Conditions: Increased Intracranial
Pressure
Signs and Symptoms Management
• Headache
• Seizure/convulsions
• Nausea, vomiting
• Altered mental status
• Unequal pupils
• Weakness on one side of the body
• RAISE the head of the bed 30 degrees
• If trauma, MAINTAIN CERVICAL SPINE
IMMOBILIZATION
• Check glucose
• If seizures, give BENZODIAZEPINE
• Plan for HANDOVER/TRANSFER
• Pressure must be reduced as soon as
possible which requires surgery
Can occur from trauma, tumors, increased fluid, bleeding or infection
Any swelling, fluid or mass increases pressure around the brain, limits blood flow
48. Disability Conditions: Seizure/ Convulsions
Signs and Symptoms Management
• Active seizure
• Repetitive movements
• Fixed gaze to one side or alternating
rhythmically
• Not responsive
• Recent seizure
• Bitten tongue
• Urinated on self
• Known history of seizures
• Confusion gradually returning over
minutes or hours
If cause unknown, consider trauma
• Prevent hypoxia and injury
• Protect from falls/dangerous objects
• Do not stick anything in their mouth
• SUCTION as needed
• Give OXYGEN
• Check glucose
• Give GLUCOSE if needed
• Give a BENZODIAZEPINE
• Monitor breathing
• Place in RECOVERY POSITION (if no trauma)
• Give MAGNESIUM SULPHATE if pregnant or recently
pregnant
49. Exposure Conditions: Snake Bite
Signs and Symptoms Management
• History of snake bite
• Bite marks may be seen
• Oedema
• Blistering of skin
• Bruising
• Hypotension
• Paralysis
• Seizures
• Bleeding from wounds
• Limit the spread of venom and the effects
on the body
• IMMOBILIZE THE EXTREMITY
• Take a picture of the snake to send with
the patient if possible (mobile phone)
• Give IV FLUIDS if evidence of shock
• Monitor closely
• Airway
• Signs of shock
• Plan for HANDOVER/TRANSFER
50. Reassess ABCDEs Frequently!
The ABCDE approach is designed to quickly identify reversible life-
threatening conditions
Vital signs should be checked at the end of the ABCDE approach
Once you find an ABCDE problem and manage it, you have to GO BACK
and repeat the ABCDE again to identify any new problems that have
developed and make sure that the management you gave worked
Ideally, the ABCDE approach should be repeated every 15 minutes or
with any change in condition
51. Workbook Question 2
Using the workbook section above, list the management for airway
blocked by a foreign body
53. Paediatric Airway Considerations
Compared to adults, children have:
• Bigger tongues
• Use “sniffing” position
• Shorter necks, softer airway
• Easier to block off
• Avoid over-extending or flexing the neck
• A larger head compared to body
• Watch closely for airway obstruction
• Use jaw thrust
• Correct head position with padding to open airway
• Excessive drooling, stridor, airway swelling, unwillingness to move neck are high-risk signs
in children
54. Paediatric Breathing Considerations
• Look for signs of respiratory distress :
• Nasal flaring
• Head bobbing
• Grunting
• Chest indrawing or retractions
• Cyanosis, a blue/gray discoloration around lips, mouth or fingertips is a danger sign!
• Look at the lower ribs
• Chest indrawing is when the lower chest wall goes IN when the child breathes IN
• In normal breathing the whole chest and abdomen move OUT when the child
breathes IN
55. Paediatric Breathing Considerations
• Listen
• A silent chest is a sign of severe distress in a child
• No breath sounds when you listen
• Severe spasms and airway narrowing cause limited airway movement and few or no breath
sounds may be heard.
• Give SALBUTAMOL and OXYGEN
• Reassess frequently
• Stridor
• Sign of severe airway compromise
• Allow child to stay in position of comfort
• Plan for rapid HANDOVER/TRANSFER
• Nebulized ADRENALINE
• If unable to transfer immediately, consider IM ADRENALINE (Allergic reaction protocol)
56. Paediatric Circulation Considerations
• Consider the cause and condition of child when managing poor perfusion
• Low blood pressure in a child is a sign of severe shock!
• Children will maintain a normal blood pressure longer than adults but
decompensate quickly
• Always monitor other signs of poor perfusion
• Decreased urine output and altered mental status
Remember: Rate and type of fluid administered may be different from adults
depending on the reason for poor perfusion and child’s nutritional status
*Malnourished children have different requirements
*Severe signs: Sunken fontanelle, poor skin pinch, lethargy, altered mental status
57. Paediatric Disability Considerations
• Low blood glucose is a common cause of altered mental status in a sick
child
• When possible, check blood glucose with altered mental status
• When not possible, give GLUCOSE
• Always check blood sugar with seizures/convulsions
• It may be difficult to determine if a small child is acting normally. Ask
family/friends who know the child to provide this information.
58. Paediatric Exposure Considerations
• Infants/children have trouble maintaining temperature
• They can become hypothermic or hyperthermic quickly
• Remove wet clothing and dry skin thoroughly
• Skin-to-skin contact for infants
• If concerned about hypothermia: Cover very small children’s heads
• If concerned about hyperthermia: Unbundle tightly wrapped babies
59. Assess all children for the presence of danger signs
• Signs of airway obstruction
• Increased breathing effort
• Cyanosis
• Altered mental status
• Moves only when stimulated or no
movement (AVPU other than ”A”)
• Not feeding well/ cannot drink or
breastfeed
• Vomiting everything
• Seizures/convulsions
• Low body temperature
(hypothermia)
A child with danger signs needs urgent attention
60. Workbook Question 3
Using the workbook section:
One paediatric airway consideration ______________________________
One paediatric breathing consideration ____________________________
One paediatric circulation consideration ___________________________
One paediatric disability consideration _____________________________
One paediatric exposure consideration ____________________________
61. Airway with cervical spine immobilization
Breathing plus oxygen if needed
Circulation IV fluids and bleeding control
Disability AVPU/GCS, pupils and glucose
Exposure and keep warm
ABCDE Approach: Summary
62. If you find a problem with any of the ABCDEs:
STOP
CORRECT the problem
then
GO BACK to the beginning and REASSESS the ABCDEs again
Remember
63. Elements of the SAMPLE history
S Signs and symptoms
Patient/family’s report of signs and symptoms is an essential
assessment
A Allergies Important to prevent harm; may also suggest anaphylaxis
M Medications Obtain a full list and note recent medication or dose changes
P Past Medical History
May help in understanding current illness and change management
choices
L Last Oral intake
Note whether solid or liquid; vomiting/choking risk for sedation;
intubation or surgical procedures
E Events surrounding
the injury/illness
Helpful clues to the cause, progression and severity of current illness
64. Workbook Question 4
Using the workbook section above, list what the letters in SAMPLE stand for:
S
A
M
P
L
E
65. Disposition Considerations
• After ABCDE approach -> SAMPLE history -> Secondary exam-> Consider
disposition
• If you have to intervene in any of the ABCDE categories, immediately
consider HANDOVER/TRANSFER to a higher level of care
• A good handover includes:
• Brief identification of the patient
• Relevant elements of the SAMPLE history
• Physical exam findings
• Record of interventions given
• Plans for future care
• Things you may be concerned about