Emergencies in medicine

Published on 02/03/2015 by admin

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Last modified 02/03/2015

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20 Emergencies in medicine

Chapter Contents

Definitions 703
Basic life support 704
Adult advanced life support 705
Acute anaphylaxis 706
Severe upper gastrointestinal bleeding 707
Fulminant hepatic failure 708
Febrile neutropenic patient 709
Hot swollen joint 710
Extreme hyponatraemia with a normal extracellular volume 711
Severe acute hyperkalaemia 711
Central chest pain — cardiac cause likely 712
Acute coronary syndrome —management of STEMI 713
Acute coronary syndrome and management in N-STEMI 714
Heimlich manoeuvre for treatment of inhaled foreign bodies 714
Pneumothorax 715
Acute massive pulmonary embolism 716
Acute severe asthma 717
Shock 718
Severe hypercalcaemia 719
Acute adrenal failure 720
Stroke 721
The comatose patient 722

This chapter consists of algorithms which should be used in conjunction with the appropriate chapters to enable emergencies to be dealt with quickly and effectively.

An assessment and initial resuscitation of the critically ill patient should be undertaken (ABCDE):

• Airway — remove any obstructing material and make sure airway is clear.
• Breathing — look, listen and feel for signs of breathing.
• Circulation — check carotid and peripheral pulses and start external chest compression if cardiac arrest.
• Disability — conscious level — Glasgow Coma Scale (see Table 17.1, p. 624).
• Examination/exposure — to allow a full examination to be carried out.

Recent evidence emphasises that maintaining the circulation is the key factor overall. The order of resuscitation should be CAB, i.e. Circulation, Airways, Breathing.

Definitions

• An emergency is something dangerous or serious, such as an accident which happens suddenly or unexpectedly and needs fast action in order to avoid harmful results.
• Urgent cases need attention very soon (Cambridge Advanced Learners Dictionary).

Basic Life Support

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Fig. 20.1 Basic life support.

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