General Medical General Medical EmergenciesEmergencies
SPECIFIC CONDITIONSSPECIFIC CONDITIONS
REYE’S SYNDROMEREYE’S SYNDROME GOUTGOUT FEVERFEVER ALLERGIC REACTIONALLERGIC REACTION FLUID AND ELECTROLYTEFLUID AND ELECTROLYTE COMACOMA HEMATOLOGICAL EMERGENCIESHEMATOLOGICAL EMERGENCIES
REYE’S SYNDROMEREYE’S SYNDROME
A 19 month old child with respiratory distress A 19 month old child with respiratory distress is seen in the ED. Diagnosis of croup is is seen in the ED. Diagnosis of croup is
made.made.
The parents must be told that during The parents must be told that during the child’s illness, the following meds the child’s illness, the following meds should not be administered.should not be administered.
A. AntitussivesA. Antitussives
B. AcetaminophenB. Acetaminophen
C. Acetylsalicylic acidC. Acetylsalicylic acid
D. DecongestantsD. Decongestants
ANSWER CANSWER C
ACETYLSALICYLIC ACID HAS ACETYLSALICYLIC ACID HAS CORRELATED WITH REYE’S CORRELATED WITH REYE’S SYNDROME WHICH CAN CAUSE SYNDROME WHICH CAN CAUSE FETAL ENCEPHALOPATHYFETAL ENCEPHALOPATHY
REYE’S SYNDROME FREQUENTLY REYE’S SYNDROME FREQUENTLY FOLLOWS VIRAL INFECTIONS SUCH FOLLOWS VIRAL INFECTIONS SUCH AS CROUPAS CROUP
REYE’S SYNDROMEREYE’S SYNDROME
Acute no inflammatory Acute no inflammatory encephalopathy characterized by encephalopathy characterized by hepatic, metabolic & neurological hepatic, metabolic & neurological dysfunction.dysfunction.
ChildrenChildren Salicylate ingestion may be a Salicylate ingestion may be a
predisposing factorpredisposing factor Late winter & early summer higher Late winter & early summer higher
incidenceincidence
ASSESSMENTASSESSMENT
SUBJECTIVE DATASUBJECTIVE DATA
ONSETONSET
MEDICAL HISTORYMEDICAL HISTORY
OBJECTIVE DATAOBJECTIVE DATA PHYSICAL EXAMPHYSICAL EXAM NEUROLOGICAL STATUSNEUROLOGICAL STATUS GASTROINTESTIONAL STATUSGASTROINTESTIONAL STATUS
DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES
AMMONIA LEVELAMMONIA LEVEL EMZYME LEVELSEMZYME LEVELS PT, PTTPT, PTT CHEM 7CHEM 7 ABGABG CSFCSF
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
ABCABC O2O2 IV FLUIDSIV FLUIDS GIVE DEXTROSE TO COUNTERACT GIVE DEXTROSE TO COUNTERACT
HYPOGLYCEMIAHYPOGLYCEMIA MEDS – MANNITOL, STERIODSMEDS – MANNITOL, STERIODS
GOUTGOUT
SUBJECTIVE DATASUBJECTIVE DATA
LOCATION OF PAINLOCATION OF PAIN TIMING /ONSET OF PAPINTIMING /ONSET OF PAPIN CHARACTERITICS OF PAINCHARACTERITICS OF PAIN FEVERFEVER MEDICAL HISTORYMEDICAL HISTORY
OBJECTIVE DATAOBJECTIVE DATA
PHYSICAL EXAMPHYSICAL EXAM ERYTHEMATOUS, HYPERTHERMIC ERYTHEMATOUS, HYPERTHERMIC
EDEMA OF JOINTEDEMA OF JOINT FEVERFEVER RELUCTANT TO USE EXTREMITYRELUCTANT TO USE EXTREMITY
DIAGNOSTIC PROCEDUREDIAGNOSTIC PROCEDURE
URIC ACIDURIC ACID WBC IN SYNOVIAL FLUID WBC IN SYNOVIAL FLUID HYPERCALCEMIAHYPERCALCEMIA
PLANNING AND PLANNING AND INTGERVENTIONINTGERVENTION
ANTINFLAMMATORY AGENTSANTINFLAMMATORY AGENTS WEIGHT REDUCTIONWEIGHT REDUCTION DIET – AVOID ALCHOL,HIGH PURINEDIET – AVOID ALCHOL,HIGH PURINE AVOID THIAZIDE DIURETICSAVOID THIAZIDE DIURETICS
FEVERFEVER
SUBJECTIVE DATASUBJECTIVE DATA
HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS PREVIOUS SIMILAR EPISODEPREVIOUS SIMILAR EPISODE FEVER DEGREE AND PERSISTENCEFEVER DEGREE AND PERSISTENCE OTHER SYMPTOMSOTHER SYMPTOMS IN CHILDREN FLUID INTAKEIN CHILDREN FLUID INTAKE MEDICAL HISTORYMEDICAL HISTORY
OBJECTIVE DATAOBJECTIVE DATA
PHYSICAL EXAMPHYSICAL EXAM DIANOSTIC PROCEDURESDIANOSTIC PROCEDURES
LABSLABS
X-RAYSX-RAYS
LUMBAR PUNCTURELUMBAR PUNCTURE
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
ABCABC CONTROL TEMPERATURE > 101CONTROL TEMPERATURE > 101 MEDICATIONSMEDICATIONS FLUIDSFLUIDS DETERMINE SOURCE OF INFECTIONDETERMINE SOURCE OF INFECTION
ALLERGIC REACTIONALLERGIC REACTION
SUBJECTIVE DATASUBJECTIVE DATA HISTORYHISTORY PRECIPITATING EVENTS IF KNOWNPRECIPITATING EVENTS IF KNOWN ELAPSED TIME SINCE CONTACTELAPSED TIME SINCE CONTACT MEDICAL HISTORYMEDICAL HISTORY PREVIOUS ALLERGIC REACTIONSPREVIOUS ALLERGIC REACTIONS ALLERGIESALLERGIES MEDICATIONMEDICATION
OBJECTIVE DATAOBJECTIVE DATA
APPEARANCE OF CONTACT SITEAPPEARANCE OF CONTACT SITE COMPLAINTS OF DISCOMFORTCOMPLAINTS OF DISCOMFORT SIGNS AND SYMPTOMS OF SIGNS AND SYMPTOMS OF
ANAPHYLAXISANAPHYLAXIS
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
ABCABC EPINEPHRINEEPINEPHRINE O2O2 IVIV ANTIHISTAMINEANTIHISTAMINE HISTAMINE-2BLOCKERHISTAMINE-2BLOCKER STERIODSSTERIODS BETA AGONIST OF BRONCHOSPASMBETA AGONIST OF BRONCHOSPASM TREAT AREA OF CONTACTTREAT AREA OF CONTACT
FLUID AND ELECTROLYTE FLUID AND ELECTROLYTE EMERGENCILESEMERGENCILES
ELECTROLYTE ELECTROLYTE ABNORMALITIESABNORMALITIES
SODIUMSODIUM POTASSIUMPOTASSIUM CALCIUMCALCIUM MAGNESIUMMAGNESIUM
SODIUMSODIUM
NORMAL WATER BALANCENORMAL WATER BALANCE IMPULSE CONTROLIMPULSE CONTROL REGULATED BY RENINREGULATED BY RENIN
ANGEOTENSINANGEOTENSIN
ALDOSTERONEALDOSTERONE
HYPONATREMIAHYPONATREMIA
ACTUAL SODIUM DEFICITS ACTUAL SODIUM DEFICITS DIAPHORESISDIAPHORESIS DIURETIC USEDIURETIC USE WOUND DRAINAGEWOUND DRAINAGE DEC OF ALDOSTERONEDEC OF ALDOSTERONE RENAL DISEASERENAL DISEASE HYPERLIPIDEMIAHYPERLIPIDEMIA
HYPONATREMIAHYPONATREMIA
DILUTIONAL CAUSESDILUTIONAL CAUSES
EXCESSIVE WATER INTAKEEXCESSIVE WATER INTAKE
FRESHWATER DROWNINGFRESHWATER DROWNING
GI LOSSESGI LOSSES
HYPERGLYCEMIAHYPERGLYCEMIA
CHFCHF
BURNSBURNS
SUBJECTIVE DATASUBJECTIVE DATA
HISTORYHISTORY
ALTERED ORAL INTAKEALTERED ORAL INTAKE
NAUSEA AND VOMITINGNAUSEA AND VOMITING
THIRSTTHIRST
EXCESSIVE WATER INTAKEEXCESSIVE WATER INTAKE
SKELETAL MUSCLE WEAKNESSSKELETAL MUSCLE WEAKNESS
MUSCLE CRAMPSMUSCLE CRAMPS
OBJECTIVE DATAOBJECTIVE DATA
PHYSICAL EXAMPHYSICAL EXAM MENTAL STATISMENTAL STATIS SKIN TLURGORSKIN TLURGOR SUNKEN FONTANELLE AND EYESSUNKEN FONTANELLE AND EYES DRY MUCUS MEMBRANESDRY MUCUS MEMBRANES HYPOTENSION AND TACHYHCARDIAHYPOTENSION AND TACHYHCARDIA SEZURES LEVEL < 110 mEq/LSEZURES LEVEL < 110 mEq/L
DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES
CBCCBC ELECTOLYTE LEVEELECTOLYTE LEVE CHLORIDECHLORIDE BUN AND CREATININE LEVELSBUN AND CREATININE LEVELS UAUA
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
ABCABC IV FLUIDSIV FLUIDS REPLACE SODIUM ORALLY OR IVREPLACE SODIUM ORALLY OR IV PROTECT FROM INJURY (SEIZURES)PROTECT FROM INJURY (SEIZURES) I&OI&O
QUESTIONQUESTION
Which of the following assessment Which of the following assessment findings is NOT true commonly findings is NOT true commonly associated with hypernatremia?associated with hypernatremia?
A. ConfusionA. Confusion
B. Decreased cardiac outputB. Decreased cardiac output
C. Skeletal muscle weaknessC. Skeletal muscle weakness
D. Increased urinary output D. Increased urinary output
ANSWER DANSWER D
HYPERNATREMIAHYPERNATREMIA
SUBJECTIVE DATASUBJECTIVE DATA
HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS ANOREXIA, NAUSEA,VOMITINGANOREXIA, NAUSEA,VOMITING DIARRHEADIARRHEA ALTERED SODIUM INTAKEALTERED SODIUM INTAKE THIRSTTHIRST DEHYDRATIONDEHYDRATION
OBJECTIVE DATAOBJECTIVE DATA
PHYSICAL EXAMPHYSICAL EXAM DECREASED URINE OUTPUTDECREASED URINE OUTPUT HYPERREFLEXIA, MUSCLE TWITCHINGHYPERREFLEXIA, MUSCLE TWITCHING DRY MUCOUS MEMBRANES & SKINDRY MUCOUS MEMBRANES & SKIN MUSCLE WEAKNESSMUSCLE WEAKNESS ORTHOSTATIC VITAL SIGN CHANGESORTHOSTATIC VITAL SIGN CHANGES
DIAGNOSTGIC PROCEDURESDIAGNOSTGIC PROCEDURES
LABSLABS INFANTS NORMAL 275 TO 285 INFANTS NORMAL 275 TO 285
mOsm/kgmOsm/kg ADULT NORMAL 285 TO 295 nOsm/kgADULT NORMAL 285 TO 295 nOsm/kg SYMPTOMS DEVELOP AT 320SYMPTOMS DEVELOP AT 320 COMA OCCURS AT 360COMA OCCURS AT 360
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
IV FOR ISOTONOIC SOLUTIONSIV FOR ISOTONOIC SOLUTIONS BLOOD SUGER TO RULE OUT BLOOD SUGER TO RULE OUT
HYPOGLYCEMIAHYPOGLYCEMIA I & OI & O MONITOR FOR SEIZURE ACTIVITYMONITOR FOR SEIZURE ACTIVITY LIMIT SODIUM INTAKELIMIT SODIUM INTAKE
POTASSIUM ABNORMALITIESPOTASSIUM ABNORMALITIES
HYPOKALEMIAHYPOKALEMIA
LEVEL BELOW 3.5 mEq/LLEVEL BELOW 3.5 mEq/L LOW INTAKELOW INTAKE GASTROINTESTIONAL LOSSESGASTROINTESTIONAL LOSSES RENAL LOSSESRENAL LOSSES DIABETIC ACIDOSIS TREATMENTDIABETIC ACIDOSIS TREATMENT BURNSBURNS OVERHYDRATIONOVERHYDRATION
SUBJECTIVE DATASUBJECTIVE DATA
GI UPSETGI UPSET WEAKNESS AND FATIQUEWEAKNESS AND FATIQUE SOBSOB CRAMPSCRAMPS FREQUENT URINATIONFREQUENT URINATION CONSTIPATIONCONSTIPATION
OBJECTIVE DATAOBJECTIVE DATA
SHALLOW RESP,WEAK PULSESHALLOW RESP,WEAK PULSE MUSCLE TENDERNESSMUSCLE TENDERNESS DSYRHYTHMIAS (HEART BLOCKS)DSYRHYTHMIAS (HEART BLOCKS) CONFUSIONCONFUSION PARALYTIC ILEUS, HYPOACTIVE BSPARALYTIC ILEUS, HYPOACTIVE BS POLYURIAPOLYURIA
DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES
LABSLABS DEPRESSED ST SEGMENTS DEPRESSED ST SEGMENTS ABG ALKALOSISABG ALKALOSIS FLATTENED T WAVESFLATTENED T WAVES U WAVESU WAVES VENTICULAR IRRITABILITYVENTICULAR IRRITABILITY
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
ABCABC IVIV ADMINISTER POTASSIUM CHLORIDEADMINISTER POTASSIUM CHLORIDE CORRECT ACID-BASE IMBALANCECORRECT ACID-BASE IMBALANCE MONITOR CARDIAC RHYTHMMONITOR CARDIAC RHYTHM
HYPERKALEMIAHYPERKALEMIA
K > 5.5 mEq/LK > 5.5 mEq/L POSSIBLE CAUSESPOSSIBLE CAUSES
EXCESSIVE k INTAKEEXCESSIVE k INTAKE
DECREASED GLOMELULAR RATEDECREASED GLOMELULAR RATE
RENAL FAILURERENAL FAILURE
SEVERE TISSUE INJURYSEVERE TISSUE INJURY
ACIDOSISACIDOSIS
INSULIN DEFICENCYINSULIN DEFICENCY
SUBJECTIVE DATASUBJECTIVE DATA
CONFUSIONCONFUSION HYPEREXCITABILITYHYPEREXCITABILITY MUSCLE WEAKNESSMUSCLE WEAKNESS AB DESTENTIONAB DESTENTION DIARRHEADIARRHEA CHRUSH OR BURN INJURYCHRUSH OR BURN INJURY
OBJECTIVE DATAOBJECTIVE DATA
MENTAL CONFUSIONMENTAL CONFUSION WEAKNESSSWEAKNESSS DYSRHYTHMIASDYSRHYTHMIAS BRADYCARDIABRADYCARDIA
DIAGNOSTIC DIAGNOSTIC
ABCABC LABSLABS ECCECC PEAKED T WAVESPEAKED T WAVES DEPRESSED OR FLAT T WAVESDEPRESSED OR FLAT T WAVES WIDENING QRSWIDENING QRS PROLONGED PRPROLONGED PR
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
ABCABC IVIV MEDSMEDS
SODIUM BICARBSODIUM BICARB
GLUCOSE 50%GLUCOSE 50%
INSULININSULIN
KAEXYLATEKAEXYLATE
MONITOR CARDIAC STATUSMONITOR CARDIAC STATUS
CALCIUM ABNORMALITIESCALCIUM ABNORMALITIES
CALCIUM CALCIUM
LEVELS ARE REGLULATED BY LEVELS ARE REGLULATED BY ENDOCRINE SYSTEMENDOCRINE SYSTEM
FACTOR IV IN THE BODY’S CLOTTING FACTOR IV IN THE BODY’S CLOTTING CASCADE CASCADE
TRANSMISSION OF NEUROMUCSCLAR TRANSMISSION OF NEUROMUCSCLAR IMPULSESIMPULSES
IMPORTANT IN BONE FORMATIONIMPORTANT IN BONE FORMATION
Patients with hypocalcemia Patients with hypocalcemia demonstrate which of the following demonstrate which of the following
EKG changes?EKG changes?
A. SHORTENED PR INTERVALA. SHORTENED PR INTERVAL
B. PROLONGED PR INTERVALB. PROLONGED PR INTERVAL
C. PROLONGED QT INTERVALC. PROLONGED QT INTERVAL
D. U WAVED. U WAVE
ANSWER CANSWER C
IMPARMENT OF CARDIAC IMPARMENT OF CARDIAC CONTRACTILITY RESULTS FROM CONTRACTILITY RESULTS FROM HYPOCALCEMIA. SHOWN IN EKG AS HYPOCALCEMIA. SHOWN IN EKG AS PRLONGED QT INTERVAL. PRLONGED QT INTERVAL. PREDESPOSES THE PATIENT OT PREDESPOSES THE PATIENT OT VENTRICULAR TACHYCARDIAVENTRICULAR TACHYCARDIA
(TORSADES DE POINTES)(TORSADES DE POINTES)
HYPOCALCEMIAHYPOCALCEMIA
DEFICITS OF CALCIUM INTAKEDEFICITS OF CALCIUM INTAKE INHIBITION OF CALCIUM ABSORPTIONINHIBITION OF CALCIUM ABSORPTION DECREASED VIT DDECREASED VIT D LACTOSE INTOLERANCELACTOSE INTOLERANCE MALABSORPTION SYNDROMESMALABSORPTION SYNDROMES BLOOD TRANSFUSIONSBLOOD TRANSFUSIONS ENDOCRINE DISTURBANCESENDOCRINE DISTURBANCES
SUBJECTIVE DATASUBJECTIVE DATA
PARESTHESIA THEN NUMBNESSPARESTHESIA THEN NUMBNESS MUSCLE CRAMPSMUSCLE CRAMPS ALTERED DIETARY INTAKEALTERED DIETARY INTAKE RENAL FAILURERENAL FAILURE PANCREATITISPANCREATITIS TOXIC SHOCKTOXIC SHOCK
PHYHSICAL EXAMPHYHSICAL EXAM HYPOTENSIONHYPOTENSION TACHYCARDIATACHYCARDIA DECREACED PERIPHERAL PULSESDECREACED PERIPHERAL PULSES MUSCLE WEAKNESSMUSCLE WEAKNESS CARPOPEDAL SPASMSCARPOPEDAL SPASMS TETANYTETANY HYPERVENTLATIONHYPERVENTLATION SEIZURESEIZURE TROUSSEAU’S SIGNTROUSSEAU’S SIGN CHVOSKEK’S SIGNCHVOSKEK’S SIGN
DIAGNOSTICDIAGNOSTIC
LABSLABS ABGABG PARATHYROID HORMONE LEVEL PARATHYROID HORMONE LEVEL ECG CARDIAC MONITORECG CARDIAC MONITOR PROLONGED QT AND STPROLONGED QT AND ST T-WAVE INVERSIONT-WAVE INVERSION
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
ABCABC IVIV CARDIAC MONITORINGCARDIAC MONITORING CONTROL HYPERVENTLATIONCONTROL HYPERVENTLATION ADMINISTER CALCIUMADMINISTER CALCIUM ORAL CALIUM AS NEEDEDORAL CALIUM AS NEEDED
HYPERCALCEMIAHYPERCALCEMIA
DECREASED RENAL FUNCTIONDECREASED RENAL FUNCTION USE OF THIAZIDE DIURETICSUSE OF THIAZIDE DIURETICS INCREASED BONE REABSORPTION OF INCREASED BONE REABSORPTION OF
CALCIUMCALCIUM
HYPERPARATHYROIDISMHYPERPARATHYROIDISM
MALIGNANCYMALIGNANCY
HYPERTHYRODISMHYPERTHYRODISM
SUBJECTIVE DATASUBJECTIVE DATA
ANOREXIA,VOMITING AND DIARRHEAANOREXIA,VOMITING AND DIARRHEA WEAKNESSWEAKNESS LETHARGYLETHARGY POLYURIAPOLYURIA
OBJECTIVE DATAOBJECTIVE DATA
MENTAL STATUS CHANGEMENTAL STATUS CHANGE TACHYCARDIATACHYCARDIA HYPERTENSIONHYPERTENSION INCREASED URINE OUTPUTINCREASED URINE OUTPUT PROFOUND MUSCLE WEAKNESSPROFOUND MUSCLE WEAKNESS
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
IVIV I & O KEEP OUTPUT GREATER THAN I & O KEEP OUTPUT GREATER THAN
500CC HR500CC HR CARDIAC MONITORCARDIAC MONITOR CVPCVP MEDSMEDS HEMODIALYSISHEMODIALYSIS
MAGNESIUM ABNORMALITIESMAGNESIUM ABNORMALITIES
HYPOMAGNESEMIAHYPOMAGNESEMIA
DECREASED INTAKEDECREASED INTAKE CHRONIC ALCOHOLLISMCHRONIC ALCOHOLLISM PROLONGED IV FEEDINGPROLONGED IV FEEDING LOSS THRU GI TRACTLOSS THRU GI TRACT DRUG THERAPYDRUG THERAPY
SUBJECTIVE DATASUBJECTIVE DATA
PARESTHESIAPARESTHESIA MUSCLE CRAMPSMUSCLE CRAMPS SEIZURESEIZURE CROHN’S DISEASECROHN’S DISEASE DIABETESDIABETES RENAL INSUFFICIENCYRENAL INSUFFICIENCY
OBJECTIVE DATAOBJECTIVE DATA
HYPERTENSIONHYPERTENSION BRADYCARDIABRADYCARDIA VENTGRICULAR DSYRTHYMIASVENTGRICULAR DSYRTHYMIAS HYPERREFLEXIAHYPERREFLEXIA SEIZURESSEIZURES CONFUSIONCONFUSION COMACOMA
DIAGNOSTICDIAGNOSTIC
LABS LABS ECGECG
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
ABCABC IVIV CARDIAC MONITORINGCARDIAC MONITORING GIVE MAGNESIUMGIVE MAGNESIUM
HYPERMAGNESEMIAHYPERMAGNESEMIA
RENAL FAILURERENAL FAILURE ADRENAL INSUFFICIENCYADRENAL INSUFFICIENCY OVERDOSEOVERDOSE RENAL PATIENTS maalox, momRENAL PATIENTS maalox, mom ECLAMPSIAECLAMPSIA
SUBJECTIVE DATASUBJECTIVE DATA
NAUSEA AND VOMITINGNAUSEA AND VOMITING DROWSINESS LETHARGYDROWSINESS LETHARGY RENAL INSUFFICIENCY OR FAILURERENAL INSUFFICIENCY OR FAILURE OVERDOSE OF THERAPEUTIC OVERDOSE OF THERAPEUTIC
MAGNESIUMMAGNESIUM
OBJECTIVE DATAOBJECTIVE DATA
SOMNOLENCESOMNOLENCE SHALLOW RESPSHALLOW RESP DEPRESSED OR ABSENT TENDON DEPRESSED OR ABSENT TENDON
REFLEXESREFLEXES RESPIRAORY OR CARDIAC ARRESTRESPIRAORY OR CARDIAC ARREST
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
ABCABC IVIV CARDIAC MONITORINGCARDIAC MONITORING ADMINISTER CALCIUMADMINISTER CALCIUM SALINE DIURESIS OR LASIXSALINE DIURESIS OR LASIX HEMODIALYSIS IN EXTREME CASESHEMODIALYSIS IN EXTREME CASES
COMACOMA
COMACOMA
STRUCTURAL CAUSESSTRUCTURAL CAUSES
METABOLIC CAUSESMETABOLIC CAUSES
TOXIC OR ENZYMATIC INHIBITATION TOXIC OR ENZYMATIC INHIBITATION CAUSESCAUSES
PSYCHIATRIC CAUSESPSYCHIATRIC CAUSES
SUBJECTIVE DATASUBJECTIVE DATA ONSETONSET ACTIVITY AT ONSETACTIVITY AT ONSET PROGRESSION OF SEIZURE PROGRESSION OF SEIZURE MEDSMEDS SEIZURE DISORDERSEIZURE DISORDER BACTERIAL ILLNESSBACTERIAL ILLNESS MEDICAL HISTORYMEDICAL HISTORY DEPRESSION OR BEHAVIOR CHANGESDEPRESSION OR BEHAVIOR CHANGES ENVIRONMENTAL EXPOSUREENVIRONMENTAL EXPOSURE
OBJECTIVE DATAOBJECTIVE DATA LEVEL OF CONSCIOUSNESSLEVEL OF CONSCIOUSNESS RESPIRATORY RATERESPIRATORY RATE PUPILSPUPILS EYE MOVEMENTEYE MOVEMENT GCSGCS FEVER OR HYPERTHERMIAFEVER OR HYPERTHERMIA TRAUMATRAUMA VITAL SIGNSVITAL SIGNS NEURO SIGNSNEURO SIGNS
DIAGNOSTICDIAGNOSTIC
ABCABC LABSLABS X-RAYS / CTX-RAYS / CT
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
ABCABC INTUBATION TO PROTECT AIRWAYINTUBATION TO PROTECT AIRWAY IVIV NGNG VITAL SIGNSVITAL SIGNS
HEMATOLOGIC HEMATOLOGIC EMERGENCIESEMERGENCIES
CLOTTING ABNORMALITIESCLOTTING ABNORMALITIES
DICDIC HEMOPHILIAHEMOPHILIA THROMBOCYTOPENIA PURPURATHROMBOCYTOPENIA PURPURA
QUESTIONQUESTION
THE MOST SIGNIFICANT CLINICAL THE MOST SIGNIFICANT CLINICAL FEATURE OF DIC IS?FEATURE OF DIC IS?
A. HEMOPYUSISA. HEMOPYUSIS
B. PETECHIAEB. PETECHIAE
C. ABNORMAL BLEEDINGC. ABNORMAL BLEEDING
D. HEMATURIAD. HEMATURIA
ANSWER CANSWER C
THE MOST SIGNIFICANT CLINICAL THE MOST SIGNIFICANT CLINICAL FEATURE OF DIC IS ABNORMAL FEATURE OF DIC IS ABNORMAL BLEEDING SUCH AS HEMOPTYSIS, BLEEDING SUCH AS HEMOPTYSIS, PETECHIAE, OR HEMATURIA PETECHIAE, OR HEMATURIA WITHOUT HISTORY OF A SERIOUS WITHOUT HISTORY OF A SERIOUS BLEEDING DISORDER.BLEEDING DISORDER.
DISSEMINATED INTRAVASCULAR DISSEMINATED INTRAVASCULAR COAGULATIONCOAGULATION
DIFFUSE MICROVASCULAR DIFFUSE MICROVASCULAR COAGULATIONCOAGULATION
DEPLETES THE CLOTTING FACTORDEPLETES THE CLOTTING FACTOR IMPAIRS HEMOSTATISIMPAIRS HEMOSTATIS
SUBJECTIVE DATASUBJECTIVE DATA
BLEEDING FOR ANY BLEEDING FOR ANY SITESITE
DIZZINESSDIZZINESS RASHRASH EXCESSIVE EXCESSIVE
BRUISINGBRUISING MASSIVE BLOOD MASSIVE BLOOD
TRANSFUSIONTRANSFUSION
ABRUPTIO ABRUPTIO PLACENTEAPLACENTEA
TRAUMATRAUMA NEOPLASMNEOPLASM SNAKE BITESNAKE BITE ARDSARDS HEPATIC DISEASEHEPATIC DISEASE
OBJECTIVE DATAOBJECTIVE DATA
PETECHIEA, PURPURAPETECHIEA, PURPURA ECCHYMOSISECCHYMOSIS BLEEDINGBLEEDING HEMATURIAHEMATURIA LOCLOC HEMATEMESISHEMATEMESIS ARDSARDS
DIAGNOSTICDIAGNOSTIC
PLATELET COUNTPLATELET COUNT PT, PTTPT, PTT FIBRINOGEN LEVELFIBRINOGEN LEVEL H & HH & H TYPE AND CROSSTYPE AND CROSS
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
A LINEA LINE CARDIAC RATE AND RHYTHMCARDIAC RATE AND RHYTHM URINE OUTPUTURINE OUTPUT CLOTTING TIME AND PLATELET CLOTTING TIME AND PLATELET
COUNTCOUNT REPLACE CLOTTING FACTORSREPLACE CLOTTING FACTORS
QUESTIONQUESTION
HEMARTHROSIS ESPECIALL OF THE KNEES, HEMARTHROSIS ESPECIALL OF THE KNEES, ELBOWS, AND ANKLES, IS COMMON ELBOWS, AND ANKLES, IS COMMON FINDING IN HEMOPHILIA OTHER S & S FINDING IN HEMOPHILIA OTHER S & S INCLUDEINCLUDE
A. Bruising and bleeding gumsA. Bruising and bleeding gums
B. Neuropathy and paresthesiaB. Neuropathy and paresthesia
C. Pain and hematuriaC. Pain and hematuria
D. All of the aboveD. All of the above
ANSWER DANSWER D
Bleeding near peripheral nerves Bleeding near peripheral nerves causes neuropathy, pain, causes neuropathy, pain, paresthesia, and muscle atrophy. paresthesia, and muscle atrophy. Bleeding gums and hematuria, Bleeding gums and hematuria, unrelated to trauma is very common.unrelated to trauma is very common.
HEMOPHILIAHEMOPHILIA
INHERITED, SEX-LINKED DISORDER INHERITED, SEX-LINKED DISORDER ALMOST ALWAYS SEEN IN MALESALMOST ALWAYS SEEN IN MALES
FEMALES CARRY GENE AND PASS TO FEMALES CARRY GENE AND PASS TO MALE CHILDRENMALE CHILDREN
SEVERITY OF DISEASE IS DIRECTLLY SEVERITY OF DISEASE IS DIRECTLLY RELATED TO ACTILVIEY LEVEL OF RELATED TO ACTILVIEY LEVEL OF FACTOR VIIIFACTOR VIII
SUBJECTIVE DATASUBJECTIVE DATA
UNUSUAL PROLONGED BLEEDINGUNUSUAL PROLONGED BLEEDING SPONTANEOUS HEMORRHAGESPONTANEOUS HEMORRHAGE INTRACRANIAL BLEEDINGINTRACRANIAL BLEEDING SKINSKIN JOINTS PAIN, SWELLING JOINTS PAIN, SWELLING
TENDERNESSTENDERNESS
DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES
PTT PROLONGEDPTT PROLONGED PT NORMALPT NORMAL PLATELET COUNT NORMALPLATELET COUNT NORMAL FACTOR VIII DECREASEDFACTOR VIII DECREASED FACTOR IX DECREASEDFACTOR IX DECREASED
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
RISK OF VOLUME DEFICITRISK OF VOLUME DEFICIT NO IM INJECTIONSNO IM INJECTIONS PRESSUE FOR LACERATIONS AND PRESSUE FOR LACERATIONS AND
VENIPUNCTURESVENIPUNCTURES ICE, IMMOBLIZEMEKEVATE AND ICE, IMMOBLIZEMEKEVATE AND
COMPRESSIVE DRESSINGSCOMPRESSIVE DRESSINGS AVOID ASA AND NSAIDSAVOID ASA AND NSAIDS
SICKLE CELLSICKLE CELL
SUBJECTIVE DATASUBJECTIVE DATA
PAINPAIN IMPAIRED GROWTH PATTERNSIMPAIRED GROWTH PATTERNS INFECTIONSINFECTIONS
OBJECTIVE DATAOBJECTIVE DATA
CHRONIC ORGAN DAMAGECHRONIC ORGAN DAMAGE CHFCHF SYSTOLIC EJECTION MURMURSYSTOLIC EJECTION MURMUR JAUNDICEJAUNDICE GALL STONESGALL STONES HEMATURIA HEMATURIA PRIAPISMPRIAPISM
DIAGNOSTIC DIAGNOSTIC
HEMOLYTIC AMEMIA HCT 20-3O%HEMOLYTIC AMEMIA HCT 20-3O% ELEVATED RETICULOCYTES ELEVATED RETICULOCYTES SICKLED CELLSSICKLED CELLS BILIRUBIN ELEVATEDBILIRUBIN ELEVATED
PLANNING AND PLANNING AND INTERVENTIONINTERVENTION
O2O2 IV FLUIDSIV FLUIDS ANALGESICANALGESIC REVERSE DEHYDRATIONREVERSE DEHYDRATION BED RESTBED REST