Snake bites

Snake bites

Snake bites occur when a snake bites the skin. They are medical emergencies if the snake is venomous.

Causes

Venomous snake bites include bites by any of the following:

•             Cobra

•             Copperhead

•             Coral snake

•             Cottonmouth (water moccasin)

•                Rattlesnake

Symptoms

Common symptoms includes,

•             Bleeding from wound

•             Blurred vision

•             Burning of the skin

•             Convulsions

•             Diarrhea

•             Dizziness

•             Excessive sweating

•             Fainting

•             Fang marks in the skin

•             Fever

•             Increased thirst

•             Loss of muscle coordination

•             Nausea and vomiting

•             Numbness and tingling

•             Rapid pulse

•             Tissue death

•             Severe pain

•             Skin discoloration

•             Swelling at the site of the bite

•             Weakness

Investigations

1. Blood tests

2. Urine test

Treatments.

1. Keep the person calm. Keep the affected area below heart level to reduce the flow of venom.

2. Use a pump suction device.

3. Remove any rings or constricting items, because the affected area may swell. Create a loose splint to help restrict movement of the area.

4. Give particular anti venomous.

REFERENCES

• What to do in a medical emergency: Bites and stings. American College of Emergency Physicians. http://www.emergencycareforyou.org/EmergencyManual/WhatToDoInMedicalEmergency/Default.aspx?id=210&terms=snake+bites. Accessed May 09, 2015.

• Tintinalli JE, et al. Reptile bites. In: Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com. Accessed May 09, 2015.

• Venomous snakes. Centers for Disease Control and Prevention. http://www.cdc.gov/niosh/topics/snakes/. Accessed May 09, 2015.

Hypertensive Emergencies

Hypertensive Emergencies

Hypertensive Emergencies is very high blood pressure that comes on suddenly and quickly. The lower (diastolic) blood pressure reading, which is normally less than 80 mmHg, is often above 130 mmHg.

Causes

• high blood pressure
• Collagen vascular disorders (such as systemic lupus erythematosus, systemic  sclerosis,and periarteritis nodosa)

     •       Kidney problems

     •     Toxemia of pregnancy

     •      Kidney failure

     •     Renal hypertension caused by renal artery stenosis

Symptoms

•             Blurred vision

•             Change in mental status, such as: Anxiety, confusion, decreased alertness, decreased ability to concentrate, fatigue, restlessness, sleepiness, stupor, lethargy

•             Chest pain (feeling of crushing or pressure)

•             Cough

•             Headache

•             Nausea or vomiting

•             Numbness of the arms, legs, face, or other areas

•             Reduced urine output

•             Seizure

•             Shortness of breath

•             Weakness of the arms, legs, face, or other areas

Investigations

1. Physical exams - commonly shows:

• Extremely high blood pressure
• Swelling in the lower legs and feet
• Abnormal heart sounds and fluid in the lungs
• Changes in thinking, sensation, muscle ability, and reflexes

2.  Arterial blood gas analysis

3. BUN

4. Creatinine

5. Urinalysis

Treatment

1. Sodium nitroprusside

2. Labetalol

3. Fenoldopam

4. Clevidipine,

REFERENCES

• Hypertensive crisis. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp. Accessed May 09, 2015.
• Tulman DB, et al. Advances in management of acute hypertension: A concise review. Discovery Medicine. 2012;13:375.
• Kaplan NM. Malignant hypertension and hypertensive encephalopathy in adults. http://www.uptodate.com/home. Accessed May 09, 2015.
• Varon J, et al. Management of severe asymptomatic hypertension (hypertensive urgencies) in adults. http://www.uptodate.com/home. Accessed May 09, 2015.
• The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/hypertension/. Accessed May 09, 2015.

Cardiac arrest

Cardiac arrest 

Cardiac arrest is a serious heart condition. The word arrest means to stop or bring to a halt. In cardiac arrest, the heart ceases to beat. It is also known as sudden cardiac death. Heartbeat is controlled by electrical impulses. When these impulses change pattern, the heartbeat becomes irregular. This is also known as an arrhythmia. Some arrhythmias are slow. Others are rapid. Cardiac arrest occurs when the rhythm of the heart stops.

Causes

• Ventricular Fibrillation
• Atrial Fibrillation
• Coronary Heart Disease
• Cardiomegarly
• Irregular Heart Valves
• Congenital Heart Disease
• Electrical Impulse Problems

Risk factors

• smoking
• sedentary lifestyle
• high blood pressure
• obesity
•  family history of heart disease
• history of a previous heart attack
• age over 45 (men) or 55 (women)
• male gender
• substance use

     Signs and Symptoms

• become dizzy
• be short of breath
• feel fatigued or weak
• vomit
• experience heart palpitations
• do not have a pulse
• stop breathing
• have pain in the chest
• lose consciousness
• collapse

Investigations

• Electrocardiogram
• Blood tests - Serum potassium and magnesium levels.
• Echo cardiogram
• Chest X-ray

Treatments

• Cardiopulmonary resuscitation (CPR) is one form of emergency treatment for cardiac arrest. Defibrillation 
• anti-arrhythmic drugs 
• Implantable cardioverter-defibrillator (ICD) 
• Coronary angioplasty. 

REFERENCES

• Siscovick DS, et al. Overview of sudden cardiac arrest and sudden cardiac death. http://www.uptodate.com/index. Accessed May 09, 2015.

• What is sudden cardiac arrest? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/scda/.Accessed May 09, 2015..

• Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed May 09, 2015. 2012.

• About cardiac arrest. American Heart Association. http://www.heart.org/HEARTORG/Conditions/More/CardiacArrest/About-Cardiac-Arrest_UCM_307905_Article.jsp. Accessed May 09, 2015.

Septic shock

Septic shock

Septic shock is a serious condition that occurs when a body-wide infection leads to dangerously low blood pressure.

Causes

1. Weakened immune systems.

2. Any type of bacteria.

3. Fungi, Viruses.

Risk factors

• Diabetes.

• Diseases that weaken the immune system, such as AIDS
• Indwelling catheters
• Leukemia
• Long-term use of antibiotics
• Lymphoma
• Recent surgery or medical procedure

Signs and Symptoms

• Cool, pale arms and legs
• High or very low temperature, chills
• Light-headedness
• Little or no urine
• Low blood pressure, especially when standing
• Palpitations
• Restlessness
• Shortness of breath

Investigations

1. Blood tests  - to check,  

•   Infection around the body

• Low blood oxygen level
• Disturbances in the body's acid-base balance
• Poor organ function or organ failure

2. A chest x-ray to look for pneumonia or pulmonary edema

3. A urine sample to look for infection.

Treatments

• Breathing machine (mechanical ventilation)
• Dialysis
• Drugs to treat low blood pressure, infection, or blood clotting
• Fluids given directly into a vein (intravenously)
• Oxygen
• Sedatives
• Surgery

REFERENCES

• A. Kalil, M. R. Pinsky. (2015, 04 17). Septic Shock . Retrieved 05 09, 2015, from medscape : http://emedicine.medscape.com/article/168402-overview

• D.Hadjiliadis. (2014, 08 02). Septic shock. Retrieved 05 09, 2015, from MedlinePlus: http://www.nlm.nih.gov/medlineplus/ency/article/000668.htm

• Holst LB, Haase N, Wetterslev J, Wernerman J, Guttormsen AB, Karlsson S, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med. Oct 9 2014;371(15):1381-91. [Medline].

• Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. Jan 15 2010;50(2):133-64. [Medline].

AcuteRenal Failure

AcuteRenal Failure

Acute kidney failure is the rapid (less than 2 days) loss of the kidneys' ability to remove waste and help balance fluids and electrolytes in the body.

Causes

•          Acute tubular necrosis (ATN)

•          Autoimmune kidney disease

•          Blood clot from cholesterol (cholesterol emboli)

•          Decreased blood flow due to very low blood pressure, which can result from burns, dehydration, hemorrhage, injury, septic shock, serious illness, or surgery

•          Disorders that cause clotting within the kidney blood vessels

•          Infections that directly injure the kidney, such as acute pyelonephritis or septicemia

•          Pregnancy complications, including placenta abruption or placenta previa

•          Urinary tract blockage

Signs and Symptoms.

•          Bloody stools

•          Breath odour and metallic taste in the mouth

•          Bruising easily

•          Changes in mental status or mood

•          Decreased appetite

•          Shortness of breath

•          Slow, sluggish movements

•          Swelling due to the body keeping in fluid (may be seen in the legs, ankles, and feet)

•          Urination changes, such as little or no urine, excessive urination at night, or urination that stops completely

•          Decreased sensation, especially in the hands or feet

•          Fatigue

•          Flank pain (between the ribs and hips)

•          Hand tremor

•          High blood pressure 

•          Nausea or vomiting, may last for days

•          Nosebleeds

•          Persistent hiccups

•          Prolonged bleeding

•          Seizures

Investigations

• BUN
• Creatinine clearance
• Serum creatinine
• Serum potassium
• Urinalysis
• X-ray, CT scan, or MRI of the abdomen

     Treatments

• Correction of fluid overload with furosemide.

• Correction of severe acidosis with bicarbonate administration, which can be important as a bridge to dialysis.

• Correction of hyperkalemia.

• Correction of hematologic abnormalities (eg, anemia, uremic platelet dysfunction) with measures such as transfusions and administration of desmopressin or estrogens.

• Decreasing the intake of potassium in diet or tube feeds.

• Exchanging potassium across the gut lumen using potassium-binding resins.

• Promoting intracellular shifts in potassium with insulin, dextrose solutions, and beta agonists.

• Instituting dialysis.

   REFERENCES

• B. T Workeneh, V. Batuman. (2014, 09 15). Acute Kidney Injury Treatment & Management. Retrieved 05 08, 2015, from medscape: http://emedicine.medscape.com/article/243492-treatment

• C.Silberberg. (2014, 07 24). Acute kidney failure. Retrieved 05 08, 2015, from MedlinePlus: http://www.nlm.nih.gov/medlineplus/ency/article/000501.htm

supraventricular tachycardia

Supra Ventricular Tachycardia

Supra ventricular tachycardia (SVT) means that from time to time your heart beats very fast for a reason other than exercise, high fever, or stress. (webmed, 2015)

Types of SVT

·         Atrioventricular nodal reentrant tachycardia (AVNRT).

·         Atrioventricular reciprocating tachycardia (AVRT), including Wolff-Parkinson-White syndrome.

Causes

1. Most episodes of SVT are caused by faulty electrical connections in the heart
2. SVT also can be caused by certain medicines. Examples include very high levels of the heart medicine digoxin or the lung medicine theophylline.
3. Some types of SVT may run in families, such as Wolff-Parkinson-White syndrome. Other types of SVT may be caused by certain health problems, medicines, or surgery.

Signs and symptoms

1. Palpitations,

2. A pounding pulse.

3. A dizzy feeling or may feel lightheaded.

4. Syncope.

5. shortness of breath.

 6. chest pain, throat tightness.

 7. sweating.

Investigations

• Electrocardiograph (ECG) - which measures the electrical impulses in the heart. If an electrocardiogram is done while the fast heart rate is occurring, it often provides the most useful information.
• Ambulatory electrocardiogram.
• Electrophysiology study
• Blood tests to check thyroid function and electrolyte levels.
• Chest X-ray and/or pulmonary function tests to check for lung disease.
• Echocardiogram

Treatment

• Vagal maneuvers—such as gagging, holding your breath and bearing down (Valsalva maneuver), immersing your face in ice-cold water (diving reflex), or coughing.

• Beta-blockers.

•  calcium-channel blockers.

•  Anti-arrhythmic medications such as flecainide, propafenone, sotalol, or dofetilide.

REFERENCES

• C.P.Davis. (2014, 05 11). Supraventricular Tachycardia. Retrieved 05 08, 2015, from www.emedicinehealth.com: http://www.emedicinehealth.com/supraventricular_tachycardia/page7_em.htm

• Kenny, T. (2013, 12 10). Supraventricular Tachycardia. Retrieved 05 08, 2015, from www.patient.co.uk: http://www.patient.co.uk/health/supraventricular-tachycardia

• NHSC. (2013, 06 27). Supraventricular tachycardia (SVT) - Treatment . Retrieved 05 08, 2015, from NHS Choices: http://www.nhs.uk/Conditions/Supraventricular-tachycardia/Pages/Treatment.aspx

• webmed. (2015). Heart Disease Health Center. Retrieved May 08, 2015, from www.webmd.com: http://www.webmd.com/heart-disease/tc/supraventricular-tachycardia-overview

Poisoning

Poisoning

Poisoning is the harmful effect that occurs when a toxic substance is swallowed, is inhaled, or comes in contact with the skin, eyes, or mucous membranes, such as those of the mouth or nose.

Possible poisonous substances include prescription and over-the-counter drugs, illicit drugs, gases, chemicals, vitamins, food, mushrooms, plants, and animal venom. (Cunha, 2015)

Signs and symptoms

·         Burns or redness around the mouth and lips

·         Breath that smells like chemicals, such as gasoline or paint thinner

·         Vomiting

·         Difficulty breathing

·         Drowsiness

·         Confusion or other altered mental status

( http://www.gassaferegister.co.uk/images/student%20page%20image.jpg )

Investigations

•        History
•          A toxicology screen
•          Blood test
•          Urinalysis

      Treatment

·         Support vital functions such as breathing, blood pressure, body temperature, and heart rate

·         Prevent additional absorption

·         Increase elimination of the poison

·         Give specific antidotes (substances that eliminate, inactivate, or counteract the effects of the poison), if available

·         Prevent re exposure.

REFERENCES

•        Cunha, J. P. (2015, 02 27). Poisoning. Retrieved 05 07, 2015, from eMedicineHealth: http://www.emedicinehealth.com/poisoning/page5_em.htm 
• 
  
•            Myoclinic. (2015, March 26). Poisoning: First aid. Retrieved May 7, 2015, from www.mayoclinic.org: http://www.mayoclinic.org/first-aid/first-aid-poisoning/basics/art-20056657
• 
  
•            NHSChoices. (2013, 08 23). Poisoning . Retrieved 05 07, 2015, from NHS Choices: http://www.nhs.uk/Conditions/Poisoning/Pages/Treatment.aspx

Hyperglycaemic emergencies

Hyperglycaemic emergencies

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) are diabetes emergencies with overlapping features. With insulin deficiency, hyperglycaemia causes urinary losses of water and electrolytes (sodium, potassium, chloride) and the resultant extracellular fluid volume (ECFV) depletion. (J.Goguen, 2013)

Causes

• Diabetes mellitus
• Insulin omission
• Infection
• Myocardial infarction
• Abdominal crisis
• Trauma
• Possibly, treatment with insulin infusion pumps, thyrotoxicosis, cocaine, atypical antipsychotics.
• Possibly, interferon. 

Signs and Symptoms

• Ketonuria
• Inability to swallow or keep fluids down
• Vomiting
• Persistent diarrhoea
• Persistently raised glucose (>28 mmol/L) despite increasing insulin.
• Ketoacidosis is clinically obvious (dehydration, abdominal pain, intractable vomiting, rapid or
  laboured respirations) 

Investigations

• Elevated plasma and/or urinary ketones

      • Metabolic acidosis (raised H+/low serum bicarbonate)

The presence of the following features should alert you to the possibility of DKA:

      • ketonuria

      • Rapid and deep sighing respirations, smell of ketones

      • Vomiting/abdominal pain

      • Drowsiness/reduced conscious level

      • Intra and extra-vascular volume depletion with reduced skin turgor, tachycardia and hypotension (late features)

• FBS

• Blood test to test ketones level in blood serum.

Treatment

• In the early stages, where patient is fully conscious and able to take adequate oral fluids.
•  Intravenous insulin, fluids and electrolytes is required to restore the metabolic equilibrium.
• Administer IV normal saline initially. If the patient is in shock, give 1–2 L/h initially to correct shock; otherwise, give 500 mL/h for 4 hours, then 250 mL/h for 4 hours.
• Add potassium immediately if patient is normo- or hypokalemic. Otherwise, if initially hyperkalemic, only add potassium once serum potassium falls to <5 to 5.5 mmol/L and patient is diuresing.
• Once plasma glucose reaches 14.0 mmol/L, add glucose to maintain plasma glucose at 12.0–14.0 mmol/L.
• After hypotension has been corrected, switch normal saline to half-normal saline (with potassium chloride). However, if plasma osmolality is falling more rapidly than 3 mmol/kg/h and/or the corrected plasma sodium is reduced, maintain IV fluids at higher osmolality (i.e. may need to maintain on normal saline).

REFERENCES

• Anonymous. (n.d.). Hyperglycaemic Emergencies . Retrieved 05 08, 2015, from www.nhslothian.scot.nhs.uk: http://www.nhslothian.scot.nhs.uk/Services/A-Z/DiabetesService/InformationHealthProfessionals/DiabetesHandbookForPrimaryCare/Hyperglycaemic%20Emergencies.pdf

• D.Candace, M.Naughton,H.Wesley, S.Corey . (2011, April). Diabetes in the Emergency Department: Acute Care of Diabetes Patients. Retrieved May 08, 2015, from clinical.diabetesjournals.org: http://clinical.diabetesjournals.org/content/29/2/51.full

• J.Goguen, J. G. (2013). Hyperglycemic Emergencies in Adults. Retrieved 05 07, 2015, from anadian Diabetes Association : http://guidelines.diabetes.ca/browse/Chapter15

Hypoglycemia

Hypoglycemia

Hypoglycemia is characterized by a reduction in plasma glucose concentration to a level that may induce symptoms or signs such as altered mental status and/or sympathetic nervous system stimulation. This condition typically arises from abnormalities in the mechanisms involved in glucose homeostasis. The most common cause of hypoglycemia in patients with diabetes is injecting a shot of insulin and skipping a meal or overdosing insulin. ( O.Hamdy, R.Khardori., 2014)

Causes

1. Side effect of drugs used for the treatment of diabetes

2. Certain medications, such as quinine

3. Drinking too much alcohol

4. Some medical conditions, such as hepatitis or kidney disorders

5. A tumor that produces excess insulin

6. Endocrine disorders, such as adrenal gland deficiency

( https://s-media-cache-ak0.pinimg.com/originals/2b/38/eb/2b38eb9ee3b05e4da4e7046e51c97093.jpg )

Signs and Symptoms of Hypoglycemia

• Shakiness
• Nervousness or anxiety
• Sweating, chills and clamminess
• Irritability or impatience
• Confusion, including delirium
• Rapid/fast heartbeat
• Lightheadedness or dizziness
• Hunger and nausea
• Sleepiness
• Blurred/impaired vision
• Tingling or numbness in the lips or tongue
• Headaches
• Weakness or fatigue
• Anger, stubbornness, or sadness
• Lack of coordination
• Nightmares or crying out during sleep
• Seizures 

( http://www.diabetesinfo.org.au/webdata/images/hypoglycemia.gif )

Investigations.

          ·         Vital signs

          ·         Head, eyes, ears, nose, and throat

          ·         Cardiovascular

          ·         Glucose and electrolyte levels (including calcium, magnesium)

          ·         Oral glucose tolerance test and/or 72-hour fasting plasma glucose

          ·         Complete blood count

          ·         Blood cultures

          ·         Urinalysis

          ·         Serum insulin, cortisol levels, and thyroid hormone levels

          ·         C-peptide levels

          ·         Insulin radioimmunoassay

          ·         CT scanning

          ·         MRI

          ·         Octreotide scanning

Treatments

           ·         Glucose supplements (eg, dextrose)

           ·         Glucose-elevating agents (eg, glucagon)

           ·         Inhibitors of insulin secretion (eg, diazoxide, octreotide)

           ·         Antineoplastic agents (eg, streptozocin)

           ·         Fasting hypoglycemia: Dietary therapy (frequent meals/snacks preferred, especially at night, with complex carbohydrates); IV glucose infusion; IV octreotide

           ·         Reactive hypoglycemia: Dietary therapy (restriction of refined carbohydrates, avoidance of simple sugars, increased meal frequency, increased protein and fiber)

REFERENCES

• O.Hamdy, R.Khardori. (2014, december 22). Hypoglycemia . Retrieved May 7, 2015, from medscape: http://emedicine.medscape.com/article/122122-overview

• Association, A. D. (2014, September 16). Hypoglycemia (Low Blood Glucose). Retrieved May 7, 2015, from www.diabetes.org: http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html

• R.Nall. (2014, April 21). Low Blood Sugar (Hypoglycemia). Retrieved May 7, 2015, from www.healthline.com: http://www.healthline.com/health/hypoglycemia#Overview1