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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
) (
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cardiac asthma
DS3
VASODILATORS AS : ACEI
DIURETICS
DIGITALIS
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:
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
)(
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1
2
3
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:causes of acute abdomen
surgical causes:
perforated viscuc
intestinal obstruction
mesentric vascular occlusive disease
ectopic pregnancy
peritonitis
pancreatitis
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medical causes of acute abdomen
inferior myocardial infarction
DKA
familial mediteranian fever
renal failure
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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
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mesentric vascular occlusive disease (mvo):2
AF shocked
ACUTE ABDOMEN , MVO
MVO
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ectopic pregnancy
FEMALE/ MISSED PERIOD/ PALLOR
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pancreatitis
epigastric pain referred to back
serum amylase/MRI abdomen
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MEDICAL CAUSES
inferior MI
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epigastric pain /ECG
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DKA
bl sugar / acetone /ABG
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FAMILIAL MEDITERRANIAN FEVER
DIAGNOSED BY EXCLUSION
8
12 24
FMF MAY LEAD TO RENAL AMYLOIDOSIS & RENAL FAILURE
ACUTE ABDOMEN FMF
COLCHICINE
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RENAL FAILURE
SERUM CEREATININE & ABG
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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
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"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
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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
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hysterical coma
Blinking & escaping eye ball
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poisoning
organophosphorus
history
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Septic coma
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: 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
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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
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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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