Professional Documents
Culture Documents
Medical-Surgical Emergencies
Medical-Surgical Emergencies
A Airways
The unobstruction of the respiratory ways;
The removal of foreign bodies from the
oropharyngian region , the head must be
kept in hyperextension and the mandible
will be held backwards with the chin pointig
upwards.
Esmarch maneuver
Toracic blows will be carried out against
the back of the patient or abdominal
compression will be performed
( HEIMLICH manoeuvre) in the case of
foreign bodies aspiration. If the victim is
unable to breathe, the doctor will position
himself behind her back and will place his
fist with the thumb oriented towards the
victims abdomen above the navel and
under the ribs and sternum aria.
He will grab his fist with the other hand
and he will pull both hands 4 times upward
and inward very fast and with an amount
of force.
This manoevre will increase the
pressure in the abdomen, causing the
pushing of the diaphragm upward.
Consequently, the diaphragm will
increase the air pressure in the lungs, and
the positive pressure will push the object
from the trachea through the superior air
ways.
The ribs should not be squeezed
between the arms.
morphopathological myocardial
modifications.
The Initial Diagnosis
A working diagnosis of myocardial infarction has
to be made in the first place.
This is usually based on the history of severe
chest pain that lasts 20 minutes or more and
which doesnt respond to nitroglycerine.
The most suggestive details are linked with an
earlier history of coronary illness, the way the
pain is radiated near the neck aria, in the
mandible or along the left arm.
The pain may not be severe and other
manifestations such as fatigue, dyspnea and
syncope are frequently encountered to older
patients mostly.
During the physical examination the following
aspects occur :
the pacient is anxious and troubled
pallor, cold and humid teguments;
sweating
bradycardial or tachicardic regular or erratic pulse
( arrhythmia)
subcrepitant rales in left ventricular insufficiency
(LVI)
wheezing in LVI
coughing combined with hemoptysis in pulmonary
embolism or acute pulmonary edema
Arterial hypotension appears in 3 circumstances
Arrhythmias
Acute coronary syndrome (IMA)
Poorly controlled arterial hypertension
Discontinuation of dietary salt restriction in
ICC
Strenuous exercise
Clinic:
revealing anamnesis for a suffering cardiac
history
orthopnea and dyspnea with tachypnea
productive cough with foamy sputum, rosy-
like, abundant
cyanosis
profuse sweating
extreme anxiety
EKG
- Paroxysmal arrhythmias
- Changes in ventricular hypertrophy
Acute coronary syndromes
cardio-pulmonary X-ray:
possible cardiomegaly
dilated vessels in the hilum with blurred
boundaries
fog lung fields especially in two thirds lower
infiltrative changes with imprecise edges
located perihilar (in butterfly wings)
any signs of pleural effusion in the pleural cavity
or fissure
dilated vessels in the HILUM with blurred boundaries
fog lung fields especially in two thirds lower
Cardiogenic pulmonary edema
PULMONARY EDEMA TREATMENT
a. half-seated position:
- Is comfortable
- Allows easy breathing
- Facilitate expectoration
- Decreases venous return
- Usually in the EPAC is the only position that a
conscious patient may adopt.
b. the sputum is aspirated and the oropharyngeal
cavity of the patient is cleaned.
c. the preload is reduced by applying the tourniquet
to the limb level (3 of 4) and will be exchanged
within 10-15 minutes
d. Oxygen: it is continuously administered 6-
8 l / min.
e. Venous way stable, safe
f. Nitroglycerin:
- initially may be given 0.5 mg sublingual
every 5 minutes till the hemodynamics is
improved or the arterial hypotension
occurs (SBP <100 mm Hg)
Note that often the application only of
these therapeutic sequences is sufficient.
g. Diuretics:
most of them employed are the loop ones.
furosemide: 40-120 mg i.v.
is relying primarily on its effect venodilatator
which installs more quickly than the diuretic one,
the diuretic effect installs in 20-30 min.
h. The administration of digitalis is useful for EPAC
in atrial fibrillation with rapid ventricular heart
rate for the control of the ventricular allure at a
dose of 0.5 - 2 mg fractioned.
i. In EPAC accompanied by
bronchospasm, Aminophylline 5 mg /
kgcorp (240-480 mg) i.v. in 10 minutes is
administered.