Transcript به نام خدا
دکتر راضیه قربانی • • • • • • • • • • • 1 Injury and illness 2 Infections 3 Cardiac and circulatory 4 Metabolic 5 Neurological and Neurosurgical 6 Psychiatric 7 Ophthalmological 8 Respiratory 9 Shock 10 Obstetrics 11 Urological, andrological, and gynecologic • • • • • • • • • • • • • • • • • • • • • • Appendicitis (leading to peritonitis) Ballistic trauma (gunshot wound) Crohn's disease, severe (possible obstruction, perforation) Flail chest Head trauma Fulminant colitis Hyperthermia (heat stroke or sunstroke) Hypothermia or frostbite Intestinal obstruction Pancreatitis Peritonitis Poisoning Ruptured spleen Septic arthritis Septicemia blood infection Severe burn (including scalding and chemical burns) Spreading wound infection Suspected spinal injury Traumatic brain injury acute epistaxis Spinal disc herniation Sudden Sensorineural hearing loss (SSHL, or just SHL, which may become permanent unless treated promptly.) • Bacterial Meningitis • Ear infection (can occur with Sudden Sensorineural hearing loss (SSHL, or just SHL), which may become permanent unless treated promptly.) • Lyme disease infection • Malaria infection • Necrotizing Fasciitis • Rabies infection • Salmonella poisoning • Neutropenic sepsis • • • • • • • • • • • • • • Aortic aneurysm (ruptured) Aortic dissection Air embolism (Arterial) Bleeding Hemorrhage Hypovolemia Internal bleeding Cardiac arrest Cardiac arrhythmia Ventricular fibrillation Cardiac tamponade Hypertensive emergency Myocardial infarction (heart attack) ventricular tachycardia • • • • • • • • • • • • Acute renal failure Addisonian crisis (seen in those with Addison's disease) Dehydration, advanced Diabetic coma Diabetic ketoacidosis Hypoglycemic coma Electrolyte disturbance, severe (along with dehydration, possible with severe diarrhea or vomiting, chronic laxative abuse, and severe burns) Hepatic encephalopathy Hypercalcemic crisis Lactic acidosis Malnutrition and starvation (as in extreme anorexia and bulimia) Pheochromocytoma crisis Thyroid storm • • • • • • • • • Cerebrovascular accident (stroke) Subarachnoid hemorrhage Subdural hematoma, acute Convulsion or seizure, no history or unusual Status epilepticus Meningitis Acute spinal cord compression Status migrainosus Neuroleptic Malignant Syndrome Serotonin Syndrome • • • • Psychotic episode Suicidal ideation Attempted suicide, non-fatal Homicidal ideation • • • • Acute angle-closure glaucoma Orbital perforation or penetration Retinal detachment Giant Cell Arteritis • • • • • • • • • • • Agonal breathing Asphyxia Angioedema Choking Drowning Smoke inhalation Asthma, acute Epiglottitis or severe croup Pneumothorax Pulmonary embolism Respiratory failure • • • • • Anaphylaxis Cardiogenic shock Hypovolemic shock (due to hemorrhage) Neurogenic shock Obstructive shock (e.g., massive pulmonary embolism or Cardiac tamponade) • Septic shock • • • • • • • • • • • Ectopic pregnancy Eclampsia Pre- eclampsia HELLP syndrome Fetal distress Obstetrical hemorrhage Placental abruption Prolapsed cord Puerperal sepsis Shoulder dystocia Uterine rupture • • • • • • • • • Acute Prostatitis Ovarian torsion Gynecologic hemorrhage Paraphimosis Priapism Sexual assault (rape) Testicular torsion Testicular infarction Urinary retention • • • • Food poisoning Venomous animal bite Pharmacological overdose Botanical • Acute poisoning is exposure to a poison on one occasion or during a short period of time. • Symptoms develop in close relation to the exposure. • Absorption of a poison is necessary for systemic poisoning. • many common household medications are not labeled with skull and crossbones, although they can cause severe illness or even death. • Chronic poisoning is long-term repeated or continuous exposure to a poison where symptoms do not occur immediately or after each exposure. • The patient gradually becomes ill, or becomes ill after a long latent period. Chronic poisoning most commonly occurs following exposure to poisons that bioaccumulate, or are biomagnified, such as mercury and lead. • • • A burn is a type of injury to flesh or skin caused by heat, electricity, chemicals, friction, or radiation.[1] Burns that affect only the superficial skin are known as superficial or first-degree burns. When damage penetrates into some of the underlying layers, it is a partial-thickness or second-degree burn. In a full-thickness or third-degree burn, the injury extends to all layers of the skin. A fourth-degree burn additionally involves injury to deeper tissues, such as muscle or bone. The treatment required depends on the severity of the burn. Superficial burns may be managed with little more than simple pain relievers, while major burns may require prolonged treatment in specialized burn centers. Cooling with tap water may help relieve pain and decrease damage; however, prolonged exposure may result in low body temperature. Partial-thickness burns may require cleaning with soap and water, followed by dressings. It is not clear how to manage blisters, but it is probably reasonable to leave them intact. Full-thickness burns usually require surgical treatments, such as skin grafting. Extensive burns often require large amounts of intravenous fluid, because the subsequent inflammatory response causes significant capillary fluid leakage and edema. The most common complications of burns involve infection. While large burns can be fatal, modern treatments developed since 1960 have significantly improved the outcomes, especially in children and young adults.[2] Globally, about 11 million people seek medical treatment, and 300,000 die from burns each year.[3] In the United States, approximately 4% of those admitted to a burn center die from their injuries.[4] The long-term outcome is primarily related to the size of burn and the age of the person affected. • Injuries are generally classified by either severity or by the location of damage.[3] • Trauma may also be classified by demographic group, such as age or gender.[4] • It may also be classified by the type of force applied to the body, such as blunt trauma or penetrating trauma.] • Major trauma is sometimes classified by body area; injuries affecting 40% are polytrauma, 30% head injuries, 20% chest trauma, 10%, abdominal trauma and 2%, extremity trauma[ The symptoms of injury can manifest in many different ways • • • • • • Altered mental status Fever Increased heart rate Generalized edema Increased cardiac output Increased rate of metabolism • Pre-hospital The pre-hospital use of stabilization techniques improves the chances of a person surviving the journey to the nearest traumaequipped hospital. Management of those with trauma often requires the help of many healthcare specialties including physicians, nurses, respiratory therapists and social workers. Cooperation allows many actions to be completed at once. Generally the first step of managing trauma is to perform a primary survey that evaluates a person's airway, breathing, circulation, and neurologic status. • airway obstruction, • inability to protect the airway, and • respiratory failure. • Traditionally, high volume intravenous fluids were given to people who had poor perfusion due to trauma.[48] This is still appropriate in cases with isolated extremity trauma, thermal trauma, or head injuries.[49] • The current evidence supports limiting the use of fluids for penetrating thorax and abdominal injuries, allowing mild hypotension to persist.[4][49] • Targets include a mean arterial pressure of 60 mmHg, a systolic blood pressure of 70–90 mmHg, or until adequate ability to think and peripheral pulses are present. • As no intravenous fluids used for initial resuscitation have been shown to be superior, warmed Lactated Ringer's solution, continues to be the solution of choice.[48] • If blood products are needed, a greater relative use of fresh frozen plasma and platelets to packed red blood cells has been found to improve survival and lower overall blood product use;[53] a ratio of 1:1:1 is recommended. • Tranexamic acid decreases the mortality rate in people who are bleeding due to trauma • positive inotropic medication such as norepinephrine are sometimes used in hemorrhagic shock • • • • • • • • • • Aortic aneurysm (ruptured) Aortic dissection Air embolism (Arterial) Bleeding Cardiac arrest Cardiac arrhythmia Cardiac tamponade Hypertensive emergency Myocardial infarction (heart attack) ventricular tachycardia • Cardiopulmonary arrest occurs as a result of a multitude of cardiovascular, metabolic, infectious, neurologic, inflammatory, and traumatic diseases. However, the clinician must be aware of several specific causes, including drug toxicity or overdose, myocardial ischemia or infarction, hyperkalemia, torsades de pointes, cardiac tamponade, and tension pneumothorax. 1. Activate EMS or the designated code team. 2. Perform basic life support (CPR). 3. Evaluate heart rhythm and perform early defibrillation as indicated. 4. Deliver advanced life support (e.g., intubation, intravenous [IV] access, transfer to a medical center or intensive care unit). • A hypertensive emergency is an acute, severe elevation in blood pressure accompanied by end-organ compromise. In newly hypertensive patients, a hypertensive emergency is usually associated with a diastolic blood pressure higher than 120 mm Hg. • Complications of particular concern include hypertensive encephalopathy, aortic dissection, and eclampsia. • IV vasodilator therapy to achieve a decrease in mean arterial pressure (MAP) of 20% to 25% or a decrease in diastolic blood pressure (DBP) to 100 to 110 mm Hg in the first 2 hours is recommended. Decreasing the MAP and DBP further should be done more slowly because of the risk of decreasing perfusion of end-organs • Cardiogenic pulmonary edema results from an absolute in-crease in left atrial pressure, with resultant increases in pulmonary venous and capillary pressures. • Pulmonary edema is diagnosed by the presence of various signs and symptoms, including tachypnea, tachycardia, crackles (reflecting alveolar edema), hypoxia (secondary to alveolar edema), and S3 or S4 heart sounds, or both. • Mainstays of immediate therapy include improving oxygen delivery to end organs, decreasing myocardial oxygen consumption, increasing venous capacitance, decreasing preload and afterload, with careful attention to MAP, and avoiding hemodynamic embarrassment. All patients should receive supplemental oxygen to maximize oxygen saturation of hemoglobin. Administration of continuous positive airway pressure provides positive airway pressure, increases gas exchange, and perhaps decreases preload via decreased intrathoracic pressure. • acute renal failure • Generally it occurs because of damage to the kidney tissue caused by decreased renal blood flow (renal ischemia) from any cause (e.g. low blood pressure), exposure to substances harmful to the kidney, an inflammatory process in the kidney, or an obstruction of the urinary tract which impedes the flow of urine. • AKI is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient amounts of urine. • AKI may lead to a number of complications, including metabolic acidosis, high potassium levels, uremia, changes in body fluid balance, and effects to other organ systems. • Management includes supportive care, such as renal replacement therapy, as well as treatment of the underlying disorder.