12. Causes of Human Diseases PATHOLOGY : CONGENITAL, INFECTION, TRAUMA TUMOUR, DEGENERATIVE DISEASES NATURED : ENVIRONMENT, DISASTER MAN MADE : CRIME, WAR, SELF-INFLICT
14. VASCULAR EMERGENCY INVOLVE - ALL PART OF THE BODY - ALL SYSTEMS, ORGANS - SYMPTOMS & SIGN VARIES - SAME ACUTE ONSET-RAPID PROGRESS - SAME PATTERN OF PATHOPHYSIOLOGY
16. VASCULAR EMERGENCY REQUIRE EARLY DIAGNOSIS AND MANAGEMENT ONLY 3-5 MINUTES WILL RESULT IN DISABILITY OR DEATH EARLY CONSULTATION AND TEAM APPROACH IS REQUIRED DETAIL KNOWLEDGE OF PARTICULAR DISEASE REQUIRED METHOD OF DIAGNOSIS AND TREATMENTS VARIED EP SHOULD KNOW ADVANTAGE AND DISADVANTAGE OF EACH EP SHOULD KEEP IN MIND IN EVERY PATIENTS VISITED ER
18. COMMON VASCULAR EMERGENCY IN GENERAL CVA – TIA, STROKE CORONARY ARTERY DISEASES AORTIC DISSECTION RUPTURED AORTIC ANEURYSM THORACIC AORTIC TRAUMA
19. COMMON VASCULAR EMERGENCY IN GENERAL PERIPHERAL VASCULAR TRAUMA MESENTERIC OCCLUSION PERIPHERAL ARTERIAL OCCLUSION VENOUS THROMBOSIS PULMONARY EMBOLISM
20. MANIFESTATION OF VASCULAR EMERGENCIES BY SYSTEMS SYSTEMIC MANIFESTATIONS OF VASCULAR EMERGENCIE CNS - TIA, STROKE CVS - CORONARY, DISSECTION, ANEURYSYM EMBOLISM, THROMBOSIS, VENOUS DIS. THORACIC - DISSECTION, RUPTURED, ANEURYSM
21. MANIFESTATION OF VASCULAR EMERGENCIES BY SYSTEMS SYSTEMIC MANIFESTATIONS OF VASCULAR EMERGENCIE ABDOMINAL - AAA, MESENTERIC OCCLUSION - AORTO-ILIAC OCCLUSION EXTREMITIES - EMBOLISM, THROMBOSIS VENOUS - DEEP VEIN THROMBOSIS, PULMONARY EMBOLISM
22. PATHOPHYSIOLOGY(1): ARTERIAL OCCLUSION : EMBOLI ACUTE ON SET OF SYMPTOMS & SIGN (5Ps) PAIN PALLOR PARESTHESIA PARALYSIS PULSELESSNESS SOURCE – MI, MV with AF, HT ELDERLY MALE > FEMALE NORMAL COLOR SKIN NAIL HAIR IN OPPOSITE EXTREMITY RAPID ONSET SYMPTOMS & SIGNS
35. EMERGENCY MANAGEMENT REDUCE B.P. TO 100 – 120 mmHg PR. TO 60 - 80 Morphine, BETA BLOCKER, NIROPRUSSIDE EARLY CONSULTATION CARDIOLOGIST SURGEON MORTALITY SURGERY 20% MEDICAL Rx. 56% OVERALL MORTILY IN HOSPITAL 30 – 40%
36. VASCULAR EMERGENCY – THORACIC AORTIC & BRANCH BLUNT CHEST TRAUMA – SIDE, FRONT IMPACTED USUAL ASSOC WITH FRACTURE UPPER RIB, STERNUM SCAPULA, SHOULDER, CLAVICLE STEARING WHEEL IMPRINT, FLAIL CHEST MASSIVE HEMOTHORAX > 1500 cc, HYPOTENSIVE UNEQUAL BLOOD PRESSURE AND PULSE OF ARM MORTALITY AT THE SCENE > 30% (TRANSPORTATION)
37. MEDIASTINAL CLUES FOR GREAT VV. INJURY OBLITERATION OF AORTIC KNOB WIDENING OF MEDIASTINUM > 8 cm. DEPRESSION OF LEFT MAIN BRONCHUS > 140 ° LOSS PERIVERTEBRAL PLEURAL STRIPE DEVIATION OF NASOGASTRIC TUBE
39. RUPTURE ANEURYSM – SUBCLAVIAN ACUTE NECK PAIN WITH OR WITHOUT STROKE HOARSENESS, NECK SWELLING AIR WAY OBSTRUCTION, EMBOLISATION DEVIATION OF TRACHEA ACUTE SVC OBSTRUCTION DYSPHAGIA RARE ONLY 1% OF PERIPHERAL ANEURYSM
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42. RUPTURED AAA AAA – DILATATION OF AORTA > 50% OF DIAMETER PREVALENCE 3 – 10% OF PATIENTS AGE OVER 50 PREVALENCE INCREASED BY : FAM HX, ELDERLY, MALE, SMOKING ROUTINE PHYSICAL EXAM : LOW SENSIVITY 29% (3 – 4 cm) 50% (4 – 5 cm) 76% (>5 cm ) MOST ASYMPTOMATIC ARE DETECTED INCIDENTALLY DURING USG FACTORS INCREASED RISK OF RUPTURE : HYPERTENSION SMOKING, COPD, FAMILY HISTORY
43. DIAGNOSIS OF RUPTURED AAA 50% OF PT. ARE UNAWARE OF AAA PRESENT BEFORE SUDDEN ONSET OF ABDOMINAL OR BACK PAIN – HYPOTENSIVE TRANSIENT LOSS OF CONSCIOUS, ABDOMINAL MASS ULTRASONND FOR UNSTABLE OR R/O AAA CT FOR STABLE PATIENT RETROPERITONEAL RUPTURE 80% FREE PERITONEAL 20% MORTALITY FOR RUPTURED AAA 30 – 80%
44. PROBLEMS OF SUPTURED AAA IN ER DIAGNOSIS : KNOWN AND UNKNOWN AAA RESUSCITATION : KEEP B.P. 90 – 100 mmHg IF BP < 80 DO NOT DELAYED IN ER PATIENT GO DIRECTLY TO OR RESUSCITATION ABDOMINAL PAIN – TENDER ANEURYSM OR ELDERLY – HYPERTENSIVE – ABD PAIN + MASS OR