Targeting a continuous learning process, this presentation helps ER workers to react with positive impacts applied, focusing at the patient for a better quality service

1. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
HEAT STROKEHEAT STROKE
HEMORRHAGEHEMORRHAGE

2. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
HEAT STROKEHEAT STROKE

3. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
DEFINITIONDEFINITION
Heat stroke is an acute medical emergencyHeat stroke is an acute medical emergency
caused by failure of the heat-regulating mechanismscaused by failure of the heat-regulating mechanisms
of the body.of the body.
People at risk are elderly and very young people,People at risk are elderly and very young people,
those unable to care for themselvesthose unable to care for themselves
and those with chronic andand those with chronic and
debilitating diseases anddebilitating diseases and
those taking medications.those taking medications.

4. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
OBJECTIVEOBJECTIVE
1.1. To reduce high temperature as quickly as possible.To reduce high temperature as quickly as possible.
2.2. To monitor fluid losses and weight loss.To monitor fluid losses and weight loss.

5. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICYPOLICY
1.1. Heat stroke causes thermal injuryHeat stroke causes thermal injury
at the cellular level,at the cellular level,
resulting in damage to the heart,resulting in damage to the heart,
liver, kidney and blood coagulation.liver, kidney and blood coagulation.

6. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
2.1 Exposure to elevated temperature2.1 Exposure to elevated temperature
2.1 Exercise during extreme heat2.1 Exercise during extreme heat
2.3 Profound CNS dysfunction (manifested by confusion,2.3 Profound CNS dysfunction (manifested by confusion,
delirium, bizarre behavior, coma)delirium, bizarre behavior, coma)
2.4 Hot, dry skin2.4 Hot, dry skin
2.5 Tachypnea, hypotension and tachycardia2.5 Tachypnea, hypotension and tachycardia

7. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3.3. The patient is monitored carefully for vital signsThe patient is monitored carefully for vital signs
and ECG and level of responsiveness.and ECG and level of responsiveness.
4.4. Oxygen is administered and patient may requireOxygen is administered and patient may require
endotracheal intubation and mechanical ventilation.endotracheal intubation and mechanical ventilation.
5.5. Intravenous infusion is initiated as prescribed andIntravenous infusion is initiated as prescribed and
administered carefully becauseadministered carefully because
of dangers of myocardial injuryof dangers of myocardial injury
from high body temperature and poor renal function.from high body temperature and poor renal function.

8. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
6.6. Urine output is measured frequentlyUrine output is measured frequently
because tubular necrosis is a complicationbecause tubular necrosis is a complication
of heat stroke.of heat stroke.
7.7. Blood specimens are obtained for investigations.Blood specimens are obtained for investigations.
8.8. Dialysis maybe done for renal failure.Dialysis maybe done for renal failure.

9. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
MATERIALS & EQUIPMENTMATERIALS & EQUIPMENT
1.1. Cool sheets and towelsCool sheets and towels
2.2. Ice and cool waterIce and cool water
3.3. Cooling blanketsCooling blankets
4.4. Iced saline lavage ofIced saline lavage of
stomach or colonstomach or colon
5.5. ThermometerThermometer
6.6. OxygenOxygen
7.7. I.V. fluids as prescribedI.V. fluids as prescribed

10. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
PROCEDUREPROCEDURE RATIONALERATIONALE
1. Assess the patient for:1. Assess the patient for:
1.11.1 Elevated temperatureElevated temperature
1.21.2 Confusion, delirium, bizarre behaviorConfusion, delirium, bizarre behavior
1.31.3 Hot, dry skinHot, dry skin
.

11. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
1.41.4 Tachypnea, hypotension,Tachypnea, hypotension,
tachycardia.tachycardia.
1. To properly assess and1. To properly assess and
provide measures forprovide measures for
emergency treatmenemergency treatment.

12. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
2. After removing patient's clothes, start2. After removing patient's clothes, start
2. To reduce temperature2. To reduce temperature
cooling measurescooling measures as rapidly asas rapidly as
possible.possible.
Cool sheets and towelsCool sheets and towels
Apply ice packs to neck, groin, axillaApply ice packs to neck, groin, axilla
Iced saline lavage of stomach or colon.Iced saline lavage of stomach or colon.
Immerse patient in cold water.Immerse patient in cold water.

13. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
HEMORRHAGE

14. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
DEFINITIONDEFINITION
It is a loss of more than 500ml. ofIt is a loss of more than 500ml. of
blood, or 30% of estimated totalblood, or 30% of estimated total
volume of blood - which maybevolume of blood - which maybe
internal or external.internal or external.

15. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
OBJECTIVEOBJECTIVE
1.1. To control bleeding.To control bleeding.
2.2. To maintain an adequately circulating bloodTo maintain an adequately circulating blood
volume for tissue oxygenation.volume for tissue oxygenation.
3.3. To prevent shock.To prevent shock.

16. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICY
1. Blood transfusion must be initiated immediately.
2. Intravenous fluid replacement is started as ordered.

17. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3.3. Vital signs are taken and monitored frequently.Vital signs are taken and monitored frequently.
4.4. The patient is maintained in a supine position andThe patient is maintained in a supine position and
monitored closely until hemodynamic circulatorymonitored closely until hemodynamic circulatory
parameters are stable.parameters are stable.

18. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
CBC, blood chemistry, PT, PTT.CBC, blood chemistry, PT, PTT.
Blood grouping, cross- matching.Blood grouping, cross- matching.
Blood gas determination.Blood gas determination.
7.7. Most bleeding can be stopped by applying directMost bleeding can be stopped by applying direct
pressure or a firm pressure dressing.pressure or a firm pressure dressing.

19. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
8.8. A tourniquet is applied as a last resort whenA tourniquet is applied as a last resort when
external hemorrhage cannot be controlled.external hemorrhage cannot be controlled.

20. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
MATERIALS &MATERIALS &
EQUIPMENTEQUIPMENT
1.1. OxygenOxygen
2.2. PressurePressure
dressingdressing
3.3. SuctionSuction
machinemachine
4.4. Blood andBlood and
blood productsblood products
5.5. IntravenousIntravenous
fluidsfluids

21. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
6.6. Blood containers forBlood containers for
blood samplesblood samples
7.7. Medications areMedications are
orderedordered
8.8. SphygmomanometerSphygmomanometer
and stethoscopeand stethoscope
9.9. TourniquetTourniquet
10.10. Large-boreLarge-bore
intravenous cannulaintravenous cannula

22. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
PROCEDURE & RATIONALEPROCEDURE & RATIONALE
1.1. Assess the patient for the following symptoms.Assess the patient for the following symptoms.
1.1. Patients with hemorrhage are at risk for cardiac arrestPatients with hemorrhage are at risk for cardiac arrest
caused by hypovolemia with secondary anoxia.caused by hypovolemia with secondary anoxia.

23. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
1.11.1 Cool, moist skin (resulting from poor peripheralCool, moist skin (resulting from poor peripheral
perfusion).perfusion).
1.21.2 Falling blood pressure.Falling blood pressure.
1.31.3 Increased heart rate.Increased heart rate.

24. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
1.41.4 Delayed capillary refill.Delayed capillary refill.
1.51.5 Decreasing urine volume.Decreasing urine volume.
2.2. Initiate fluid replacement as ordered.Initiate fluid replacement as ordered. 2.2. A loss ofA loss of
circulating blood leads to a fluid volume deficit andcirculating blood leads to a fluid volume deficit and
decreased cardiac output.decreased cardiac output.

25. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3.3. Obtain blood samples for analysis, blood groupingObtain blood samples for analysis, blood grouping
and cross-matching.and cross-matching.
3.3. For blood replacement due to massive blood loss.For blood replacement due to massive blood loss.
4.4. Perform rapid assessment of hemorrhage:Perform rapid assessment of hemorrhage:.

26. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
DISCUSSIONDISCUSSION

27. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

28. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

29. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A