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Listen to me In this Emergencies

bronchial asthma

)(
wheezes
)(
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dysponeic /cyanosed/ sweaty
cardiac /respiratory/cardiorespiratory failure

-1 : history

-2 chest auscultation
bronchial<<<wheezes
crepitations>>>cardiac
cardiac asthma wheezy
) (
hypoxia

signs of right side heart failure
lower limb oedema/congested neck veins/enlarrged tender liver

long standing B.A PULMONARY HYPERTENSION
right side heart failure

) (
:::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::
cardiac asthma
DS3
VASODILATORS AS : ACEI
DIURETICS
DIGITALIS
:::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::
:
FEV

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mild to moderate-1
life thereatening-3 )
( ventilator
-2 severe B.A
BOLUS OF STEROID +
5-4 ) (

200
DRUG INTER ACTION

)(
:::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::
1
2
3

a case of abdominal pain

: ...
acute abdominal pain acute abdomen
: acute abdominal pain )(acute onset pain
: acute abdomen ...
how to exclude or diagnose acute abdomen
-1 : history

acute abdomen
absolute constipation , repeated vomiting
-2 : abdominal examination
traid of abdominal : tenderness/rigidity / distension:
shock -/+
ryle
analgesic/spasmolytic
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< << <<<<<

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:causes of acute abdomen
surgical causes:
perforated viscuc
intestinal obstruction
mesentric vascular occlusive disease
ectopic pregnancy
peritonitis
pancreatitis
::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::
medical causes of acute abdomen
inferior myocardial infarction
DKA
familial mediteranian fever
renal failure
::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::

perforated viscuc
air under diaphragm cxr

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intestinal obstruction
abdominal x ray erect & supine
erect :for air/ fluid level >>>> more than 3& step ladder appearance
supine : for site of obstruction
""""""""""""""""""""""""""""
mesentric vascular occlusive disease (mvo):2
AF shocked
ACUTE ABDOMEN , MVO
MVO
""""""""""""""""""""""""
ectopic pregnancy
FEMALE/ MISSED PERIOD/ PALLOR
""""""""""""""""""""""""
pancreatitis
epigastric pain referred to back
serum amylase/MRI abdomen
"""""""""""""""""""""""""""""""""""""""
MEDICAL CAUSES
inferior MI

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epigastric pain /ECG
"""""""""""""""
DKA
bl sugar / acetone /ABG
''"""""""""""
FAMILIAL MEDITERRANIAN FEVER
DIAGNOSED BY EXCLUSION
8
12 24

FMF MAY LEAD TO RENAL AMYLOIDOSIS & RENAL FAILURE
ACUTE ABDOMEN FMF
COLCHICINE
"""""""""""""""""""""""""""""
RENAL FAILURE
SERUM CEREATININE & ABG
::::::::::::::::::::::::::::::::::::::::::::::::::
::::::::::::::::::::::::::::::::::::::::::::::::::
ACUTE ABDOMEN



...

Loss of conciousness


abc
A:airway secretions aspiration
B:breathing arrested
C:circulation shocked

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.. .................................................. ..................................................
( )
80/120 shocked shock
shocked 70/90

shock
tissue hypoperfusion to vital organs Shock

Hypoperfusion to brain : drowsiness / confusion/ coma
Hypoperfusion toheart : rapid weak pulse
Hypoperfusion to kidney: oliguria/ anuria
c/p
rr >>tachypnea 2
Hr >>tachycardia
( ( bp ..>> hypotension 2
T >> hypothermia
pale / cold / oliguric
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""""""""""""""""""""""""""""""""""
shock :
The surest sign of shock is oliguria
150-100 oliguria
retained urine
::::::::::::::::::::::::::::::::::::::::::::::::::
::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::
"abc
neurological examination
Pupil: unequal = brain stem lesion
Mouth :deviated to one side sign of lateralization
Upper & lower limb weakness : sign of lateralization
Urine incontinence . sign of lateralization
Babinisky sign sign of lateralization
:
Meningitis : rigid stiff neck/fever/photophopia/repeated vomiting
Vertibrobasilar insufficiency : nystagmus
::::::::::::::::::::::::::::::::::::::::::::::::::
:::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::
abc

signs of system failure

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Heart failure/ respiratory failure/renal failure/liver cell failure
endocrine causes of coma
)
systematic (
Or thyroid dysfunction comas
::::::::::::::::::::::::::::::::::::::::::::::::::
:::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::
hysterical coma

Blinking & escaping eye ball
::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::
poisoning
organophosphorus
history
::::::::::::::::::::::::::::::::::::::::::::::::::
::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::
Septic coma
::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::

: Unexplained coma under investigations

-1
-2 stress ulcer
-3
-4 ) (
-5 brain stimulant
oxypral /nootropil

Diabetic emergencies
diabetic comas

hypoglycemic coma -1
hyper glycemic comas -2
DKA/ LA/HONK

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cerebrovascular stroke -3
end stage renal disease -4
4

""""""""""" """""""""""
Hypoglycemic coma
tachycardia /pallor/ sweaty
) 45
( 45
65
comatosed brain hypoglycemia
tachycardia /pallor/ sweaty
excess catecholamine secretion brain hypoglycemia
concentrated glucose 25%
hypoglycemic coma
retrograde






GLIBENCLAMIDE

GLIBENCLAMIDE PEAKES OF HYPOGLYCEMIA 2

ATTACK

ATTACKS2

:
irreversible brain damage due to prolonged hypoglycemia-1
resistant hypoglycemia as insulinoma -2
stroke-3
end stage renal disease -4
:::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::
Hyper glycemic comas

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(diabetic keto acidosis (dka -1
lactic acidosis -2
(hyper osmolar non ketotic (honk -3
: c/p
Diabetic patient . with repeated vomiting/abd pain/
oliguria/dehydrated/precoma/or comatosed
Random blood sugar (rbs) = >300

acidosis

:
Hyper glycemia
20
dehydration

metabolic acidosis
ph<7.1
4 200
hyperkalemia
diastole
systole
antihyperkalemic measures
-1 100
20-2 200 %25
4 -3 200
hyper glycemic comas



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