Medical Nursing Week 8

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Gia_bella
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178841
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Medical Nursing Week 8
Updated:
2012-10-22 21:13:39
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Emergency Medicine Week
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Emergency Medicine- week 8
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  1. Emergency Medicine
    Principles of first aid
    • stay calm
    • triage
    • assessment
    • A-   airway
    • B-   breathing
    • C-   circulation
    •    Shock- loss of blood pressure and circulation and water
    •    Trauma
    •    Hemorrage
    • Primary and secondary survey of patient
    •    Burns
    •    Fractures
  2. Emergency Medicine
    Principles of first aid
    • Problems that warrant emergencies
    •   Trauma
    •   Profuse Diarrhea
    •   Urethral obstruction
    •   Labored breathing
    •   seizures-status seizures- continuous seizures
    •   loss of consciousness
    • excessive bleeding
    • poisoning
    • prolapse of organs
    • snake bites
    • heat prostration- heat exhaustion
    • open wounds
    • anemia
    • burns
    • dystocia
    • shock
    • Schiff-Sherrington posture is characterized by thoracic limb extension with normal to sometimes decreased tone and reflexes in the pelvic limb
  3. Emergency Medicine
    Specific Emergencies
    Shock
    Causes
    • Decreased blood volume and pressure
    • Trauma  (Hypovolemic)
    • Toxins ans Sepsis (Endotoxic)
    • Cardiac Failure (cardiogenic)
    • Anaphylaxis (Anaphylactic) allergic reaction
  4. Emergency Medicine
    Specific Emergencies
    Shock
    Symptoms
    • Pale to white mucous membrane color
    • Weak pulse pressure
    • Hypothermic
    • Increased Hct
  5. Emergency Medicine
    Specific Emergencies
    Shock
    Treatment
    • IV Fluids- Colloids
    • Keep warm
    • Control cause of problem
    • Corticosteroids
  6. Emergency Medicine
    Specific Emergencies
    Hemorrhage
    Causes
    • Trauma
    • Surgery
    • Toxicity
    • Internal organ rupture
  7. Emergency Medicine
    Specific Emergencies
    Hemorrhage
    Symptoms
    • Bleeding
    • Arterial- squirting and pulsating- more of an emergency
    • Venous- dark and slow
    • Shock
  8. Emergency Medicine
    Specific Emergencies
    Hemorrhage
    Treament
    • Control hemorrhage- clamp
    • Bandages
    • Surgery
  9. Emergency Medicine
    Specific Emergencies
    Wounds
    Causes
    • Trauma
    •    Abrasions
    •    Incisions
    •   lacerations
    •    punctures
    •    abscess
  10. Emergency Medicine
    Specific Emergencies
    Wounds
    Symptoms
    Open wound
  11. Emergency Medicine
    Specific Emergencies
    Wounds
    Treament
    • control hemorrhage
    • clean and flush wound
    • surgery
    • Bandage

    Golden rule is 6 hours to close an open wound
  12. Emergency Medicine
    Specific Emergencies
    Heatstroke
    Cause
    • Prolonged exposure to heat
    • Caught in dryers
    • Left in cars
  13. Emergency Medicine
    Specific Emergencies
    Heatstroke
    Pathophysiology
    • Cellular necrosis and cerebral edema occurs following Hyperthermia.
    • Temperatures above 107 degrees
  14. Emergency Medicine
    Specific Emergencies
    Heatstroke
    Symptoms
    • Temperatures above 107
    • Panting and salivation
    • Tachycardia
    • Brick red mucous membranes
    • Respiratory distress
    • Stupor to seizures
    • Hemorrhagic diarrhea and vomiting
  15. Emergency Medicine
    Specific Emergencies
    Heatstroke
    Treatment
    • Cool body Temperature
    •     Ice bath
    •     alcohol pads
    • IV fluids for shock
    • Corticosteroids
    •  Mannitol- diuretic
    •     cerebral edema
    • Lasix- diuretic
    •    anuria
    •    pulmonary edema
  16. Emergency Medicine
    Specific Emergencies
    Heatstroke
    Patient Monitoring
    • May lead to renal failure
    • metabolic acidosis
  17. Emergency Medicine
    Specific Emergencies
    Heatstroke
    Dissiminated Intravascular coagulation (DIC)
    • Over consumption of coagulation factors causing a hemmorhagic crisis and thrombosis
    • Petechiation, Ecchymosis and bleeding
    • Death usually results
  18. Petechiation
    Ecchymosis
    small purplish spot on a body surface, such as the skin or a mucous membrane, caused by a minute hemorrhage

    passage of blood from ruptured blood vessels into subcutaneous tissue, marked by a purple discoloration of the skin
  19. Emergency Medicine
    Specific Emergencies
    Burns
    Classifications
    • 1st degree superficial
    •    Involves entire epidermis
    •    Painful
    •    Erythematous
    •    Healing is rapid
  20. Emergency Medicine
    Specific Emergencies
    Burns
    Classification 2
    • 2nd degree (Partial thickness)
    •    Involves epidermis and dermis
    •    Painful and hair may be intact
    •    Subcutaneous edema- blistering
    •    Heals slowly after skin slough
  21. Emergency Medicine
    Specific Emergencies
    Burns
    Classifications 3rd
    • 3rd Degree (full thickness)
    • Entire skin is destroyed (epidermis and dermis)
    • Painfulll and hair falls out
    • Skin may be black color
    • Healing is slow and skin grafts needed
  22. Emergency Medicine
    Specific Emergencies
    Burns
    Causes
    • Thermal burns
    •    Heat pads
    •    Stoves
    •    Fire
    •    Scalding fluid
    • Electrical
    • Chemical burns
  23. Emergency Medicine
    Specific Emergencies
    Burns
    Treament or 1st degree
    • If presented within 2 hours, apply cold compresses in chilled saline or water for 30 minutes.
    • 1st degree
    • analgesics
    • clip and clean area
    • Debride necrotic tissue
    • antimicrobial ointments
    •       Silvadeen
    •       Nitrofurazone
    • Bandage wounds
  24. Emergency Medicine
    Specific Emergencies
    Burns
    Treament or 2nd degree
    • 2ns degree
    • Treat shock
    • Analgesics
    • Clean and debride tissue
    • Antimicrobial dressing
    • Skin graft
    • Temperature regulation
  25. Emergency Medicine
    Specific Emergencies
    Burns
    Treament or 3rd degree
    • 3rd degree
    • If extensive damage, prognosis poor
    • Treat as 2nd degree burns
    • Consider euthanasia
  26. Toxicology (poisoning)
    Toxicosis Generalized treatment
    • Prevent absorption- emesis
    • Gastric lavage- stomach pump
    • Induce vomiting
    • Enemia
    • Toxiban- Activated charcoal
    •  Red top of toxiban has sorbitol in it. The sorbitol promotes diarrhea.
    • Blue top has no sorbitol in it
  27. Toxicology (poisoning)
    Toxicosis Generalized treatment
    • Prevent tissue absorption
    •    Intravenous fluid diuresis- flush it out
    • Antidote if present
    • Long term damage 
    •     Blood profile and urinalysis
  28. Toxicology (poisoning)
    Metaldehyde toxiicity (snail bait)
    Action
    • Effects Neuromuscular junctions to cause muscle tremors and seizures
    • Usually occurs 1-4 hours after ingestion
  29. Toxicology (poisoning)
    Metaldehyde toxiicity (snail bait)
    Clinical Signs
    • Anxiety, hyperesthesia and ataxia
    • Muscle tremors to seizures
    • Hyperthermia and tachypnic
    • Metabolic acidosis- condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body
  30. Toxicology (poisoning)
    Metaldehyde toxiicity (snail bait)
    Treatment
    • Induce vomiting
    •   apomorphine 0.3mg/kg IV or 1.5-6mg dissolved into conjunctival sac
    •     Cats- Xylazine 0.44-1.1mg/kg Im or SQ
    •   gastric lavage if unconscious
    •   Enema
    • Activated Charcoal 1-2oz./10lbs
    • Valium
    • Muscle Relaxants
    •    Antidote- Methocarbamol (robaxin) 150mg/kg IV
    •    IV fluids and hospitalization
    • Oxygen as needed
    •  Enema
    •    Toxiban or sorbitol
  31. Toxicology (poisoning)
    Organophasphate Toxicity
    Actions
    • Insecticide agents
    • Mechanism of action is to inhibit acetylcholinesterase activity at the neuromuscular junctions, shich results in excess of acetylcholine and increased parasympathetic activity. (pupillary constriction)
  32. Toxicology (poisoning)
    Organophasphate Toxicity
    Clinical signs
    • S.L.U.D acronym
    • Salivation, lacrimation, urination, defecation
    • Dyspnea
    • Muscle tremors to seizures
    • Severe Depression
    • Death due to respiratory failure
  33. Toxicology (poisoning)
    Organophasphate Toxicity
    Treatment
    • Remove toxin
    •    Bath and wash
    • Ingestion
    •   Emesis
    •    Gastic lavage
    • Activated charcoal (toxiban)
    • enema
    • Anticholinergic Treatment
    •      Antidote- Atropine
    •          0.2-2mg/kg IV,IM, SQ
    •          Give 25% dose IV
    •           Repeat 4-6 hours
    • Pralidoxime chloride (2-PAM)
    •     20mg.kg IV slow over 2 hours
    •     Repeat 12 hours
    •     2-PAM binds OP enzyme complex and then allows the release of cholinesterase
    • Given only in 1st 24 hours of exposure
    • Hospitalization and supportive fluids
    • Sedation for tremors or seizures- diazepam

    Glycopyrrolate- class of medications called anticholinergics
  34. Toxicology
    Rodenticide Anticoagulent Toxicity
    Actions
    • Inhibits the formation of vitamin K which causes the decrease of Vitamin K coagulation factors (2, 7, 9, 10)
    • Warfarin- cause bleeding
    • Bromethalin- (pesticide) cause cerebral Edema (not good)
    • Push Gavage
    • Lavage - pushing out
  35. Toxicology
    Rodenticide Anticoagulent Toxicity
    Clinical signs
    • Depression
    • Anemia
    • Melena and hematuria
    • Epistaxis
    • Bruising and bleeding
    • Respiratory distress
    •    Hemorrage into body cavities
  36. Toxicology
    Rodenticide Anticoagulent Toxicity
    Diagnosis
    • History of ingestion
    • CBC+PVC
    • Coagulation panel (PT, PTT, ACT)
    •    Prolonged values (high)
    • PIVKA- Protein Induced by Vitamin K Absence
    •    High levels indicated coagulopathy factors 2,7,9,10) - Vit K dirivatives.
    •    Will determine coagulopathy in 4-6 hours of ingestion, others as PTT, PT require 12-24 hrs before they become prolonged.
  37. Toxicology
    Rodenticide Anticoagulent Toxicity
    Treatment
    • Induce emesis
    • Activated Charcoal
    • Gastirc lavage
    • Enema
    • Hospitalization and fluid support
    •  Antidote- Vitamin K1
    •     0.25-2.5mg/kg Bid SQ, IM
    •      continue for 2-4 weeks
    • Symptomatic signs
  38. Toxicology
    Ethylene glycol Toxicity (antifreeze)
    Actions
    • Ethylene glycol is metabolized by the liver and kidneys to Toxic metabolites
    • Glycoaldehyde is toxic to CNS
    • Glycolate causes acidosis
    • Oxylates crystals causes renal tubular necrosis and kidney failure
    • Toxic dose
    •   dog-6.6ml/kg
    •   cat- 1.5ml/kg
  39. Toxicology
    Ethylene glycol Toxicity (antifreeze)
    Clinical signs
    • occurs in 3 stages
    • Stage 1 (neurological signs)
    •   depression ans stupor
    •   seizures
    •   Vomiting and anorexia
    •   P/U and P/D
    • Ataxia
  40. Toxicology
    Ethylene glycol Toxicity (antifreeze)
    Clinical signs
    • stage 2
    • Cardiorespiratory
    • Tachypnea (rapid breathing) and tachycardia
    • Occurs 24-72 hours after ingestion

    • Stage 3
    • Renal signs
    • Vomiting and diarrhea
    • Azotemia
    • Renal Failure
  41. Toxicology
    Ethylene glycol Toxicity (antifreeze)
    Diagnosis
    Ethylene Glycol Test- drawing blood
  42. Toxicology
    Ethylene glycol Toxicity (antifreeze)
    Treatment
    • 1. Gastric lavage or induce vomiting
    • 2. Activated charcoal
    • 3. Enema
    • 4. Hospital care and fluid support
    •           Diuresis
    • 5. Antidotes to block metabolism of ethylene glycol by inhibiting alcohol dehydrogenase
    •        20% Ethanol IV
    •            5.5ml/kg IV every 4hours for 5 treatments, then TID for 4TX
    • Antidote is alcohol
    •   4-Methylpyrazole 4-MP
    •         better than alcohol
    •         do not use in cats
    •         antidote does not work well after the first 24 hours after ingestion
    • Supportive care and diuretics if anuric (non passage of urine)
    • Prognosis poor if not caught within first 1-2 hours after ingestion
  43. Toxicology
    Lead Toxicity
    Actions
    • Interferes with hemoglobin synthesis and RBC destruction, causing enemia
    • CNS effects from capillary edema
  44. Toxicology
    Lead Toxicity
    Clinical Signs
    • Occurs 3-5 days after ingestion
    • Gastrointestinal signs
    •      vomiting and diarrhea
    •      anorexia
    •      abdominal pain
    • Neurological signs
    •     ataxia and tremors
    •     blindness and deafness
    •     hysteria and chomping at jaw
    • Anemia
    •     nucleated RBC
    • Blood lead concentration
  45. Toxicology
    Lead Toxicity
    Treatment
    • Gastric lavage or induce emesis
    • Enema
    • surgery to remove foreign body
    • Specific antidote (chelating agents)
    •    Ca EDTA (Versenate)
    •    Penicillamone)
    •    Dimercaprol (BAL)
    • Hospital care and fluid diuresis
    • Supportive Care
  46. Toxicology
    Strychinine
    Action
    Inhibits postsynaptic junctions in the spinal cord and medulla
  47. Toxicology
    Strychinine
    Clinical Signs
    • Nervousness and stiffness
    • Tonic-clonic seizures
    • Extreme muscle rigidity
    • Hypersensitivity to noise
    • Death caused by Hypoxia
  48. Toxicology
    Strychinine
    Treatment
    • Gastric lavage or induce emesis
    • enema
    • IV fluid diuresis
    • Seizure control
    •     Valium
    •    pentobarbital
    •    morphine is contraindicated due to spinal cord stimuli and respiratory depression
  49. toxic agent
    Acetaminophen
    Beta-acetylcysteine
  50. toxic agent
    Amphetamines
    Chlorpromazine
  51. Toxic agent
    arsenic, mercury and other heavy metals except cadmium. lead, silver, selenium and thallium
    Dimercaprol
  52. lead
    • penicillamine
    • Developed for chronic mercury poisoning, now seems most promising drug, no reports on dosage in animals.
  53. Toxic Agent
    Atropine belladonna alkaloids
    Physostigmine salicylate
  54. Barbituates
    Doxapram
  55. Bromides
    Chloride (sodium or ammonium salts
  56. carbon monoxide
    Oxygen
  57. cholinergic agents
    cholinesterase inhibitors
    atropine sulfate
  58. cholinergic agents and cholinesterase inhibitors
    (organophosphates, some carbamates, but not carbaryl, dimethan or carbon piloxime
    pralidoxime chloride (2-PAM)
  59. Copper
    D-Pencillamine (Cuprimine)
  60. Coumarin-derivative anticoagulants
    vitamin K1
  61. Curare
    • Whole blood plasma
    • Neostigmine methylsulfate
  62. Cyanide
    • Edrophonium chloride (Tensilone, Roche), artificial respiration Methemoglobin (sodium nitrate is used to form methemoglobin)
    • Sodium thiosulfate
  63. digitalis glycosides, oleander, and  Bufo toads
    • Potassium chloride
    • Phenytoin
    • Propranolol (beta-blocker)
  64. Fluoride
    Fluoroacetate (Coumpound 1080)
    • atropine sulfate
    • Calcium borogluconate
    • Glyceryl monoacetin (Sigma)
    • Acetamide- Animal mya be protected if acetamide is given prior to or simultaneously with compound 1080 (experimental)

    Pentobarbitol- may protect against lethal dose (experimental)
  65. Halluconogens (LSD, phencyclidine PCP)
    Diazepam (Valium, Roche)
  66. Heparin
    Protamine sulfate
  67. iron salts
    Deferoxamine mesylate
  68. Lead
    • Calcium disodium edetate
    • EDTA and dimercaprol (BAL)
    • D-Penicillamine
    • Thiamine hydrochloride
  69. Metaldehyde
    • Diazepam
    • Triflupromazine
    • Pentobarbitol
  70. Methanol and ethylene glycol
    • ethanol
    • 4-Methylpyrazole
  71. Methemoglobinemia- producing agents (nitrates, chlorates)
    Methylene blue
  72. Morphine and related drugs
    Naloxene chloride
  73. Oxalates
    calcium
  74. Phenothiazine
    • Methamphetamine hydrochloride
    • Diphenhydramine hydrochloride
  75. phytotoxins and botulin
    antitoxins not available commercially
  76. Plants
    red squill
    Atropine sulfate, propranolol, potassium chloride
  77. Snake bite, rattlesnake, copperhead, water moccasin
    Antivenim
  78. Coral snake
    antivenin
  79. Spider bite (black widow)
    • Antivenin
    • Dantrolene sodium
  80. Strontium
    • Calcium salts
    • Ammonium chloride
  81. Strychnine and brucine
    • pentobarbitol
    • Amobarbital
    • Methocarbamol
    • Glycerl guaiacolate
    • diazepam
  82. Thallium
    • Diphenylthiocarbazone
    • Prussion blue
    • Potassium chloride
    • give simultaneously with thiocabazone or Prussian blue

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