tailieunhanh - 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 mg kg other therapy depends on Primary Survey historical information labs also Secondary Survey . 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. . 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. . 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 .