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Vital Signs and Resuscitation - part 7

Ngược lại với phương pháp truyền thống trong y học, các bệnh nhân hôn mê hoặc bệnh nhân với một sự thay đổi đáng kể trong mức độ ý thức đòi hỏi phải quản lý ngay lập tức trước khi hoàn tất kỳ thi vật lý và có được lịch sử. | 100 The Vital Signs and Resuscitation 6 Primary Survey Resuscitation A irway C-spine open airway jaw thrust chin lift oxygen secure airway intubation cricothyrotomy pulse oximetry dear c-spine as soon as possible Breathing bag-valve-mask ventilator needle decompression chest tube placement treat pulmonary edema Circulation cardiac monitor immediate IV access pulse treat dysrhythmias shock treat Disability neurological exam Immediate Therapy chemstrip glucose if unavailable D-50 1 amp peds D-25 4 mi kg thiamine 100 mg naloxone 2 mg IV peds 0.1 mg kg other therapy depends on Primary Survey historical information labs also Secondary Survey i.e. therapy for increased intracranial pressure activated charcoal IV fluids packed cells Labs CBC Chem 7 EKG cardiac enzymes ABG chest x-ray if A Foley cath tox screen and ETCH LFT s NHit co head CT other labs as . indicated incl. trauma x-rays Secondary Survey Complete physical exam History Fig. 6.4. Management of the Comatose Patient. Management of Altered Level of Consciousness In contrast to the traditional approach in medicine the comatose patient or the patient with a significant alteration in level of consciousness requires immediate management before completing the physical exam and acquiring the history. The ABCs of resuscitation are followed Fig. 6.4 . When an immobilized patient arrives in the emergency department the cervical collar and backboard Vital Sign 5 Level of Consciousness 101 are left in place until a cause is found for the decrease in level of consciousness. Naloxone Narcan 2 mg and thiamine vitamin B-1 100 mg are administered intravenously. If a fingerstick blood sugar is low or unavailable glucose 50 cc of 50 dextrose is administered after thiamine to reverse hypoglycemia. Naloxone reverses the effects of a narcotic by competitive inhibition at the opioid receptor site. Thiamine prevents Wernicke s Encephalopathy a rare neurological condition caused by thiamine deficiency seen in alcoholics with poor .