tailieunhanh - Essential Guide to Acute Care - part 8

Tất cả bệnh nhân bất tỉnh không đặt nội khí quản (ví dụ như sau ictal bệnh nhân) nên được chăm sóc ở vị trí phục hồi, gắn liền với màn hình và nhận được đánh giá lâm sàng thường xuyên. Naloxone . có một thời gian bán hủy ngắn. | 146 Chapter 8 a respiratory acidosis. All unconscious patients who are not intubated . post-ictal patients should be nursed in the recovery position attached to monitors and receive frequent clinical assessments. Naloxone . has a short half-life. Repeated doses or an infusion may be used in this case. 2 In the first instance manage ABC - fluid challenge s . In D check a capillary glucose and assess pupils for equal size and reactivity. In E ask the paramedics what the empty bottle of tablets contained. These vital signs and neurological examination are characteristic of tricyclic poisoning. Sinus tachycardia with a broad QRS complex and hypotension is common in serious tricyclic poisoning and can sometimes be difficult to distinguish from ventricular tachycardia on a rhythm strip. Tricyclic poisoning accounts for half of the admissions to ICU with poisoning in the UK and it is a leading cause of death from drug overdose. Patients with a QRS width on the ECG of more than 160 ms are most at risk of cardiac arrhythmias and convulsions. The development of arrhythmias is potentiated by tachycardia hypoxaemia and acidosis. Bradyarrythmias can also occur. Sodium bicarbonate . acts as an antidote. Current recommendations are that 50-100 ml boluses of sodium bicarbonate are given when the QRS duration is greater than 120 ms if there are serious arrhythmias or persistent hypotension after securing the airway giving oxygen and . fluid 25 . A CT scan of the brain is not indicated when there is a clear history and signs consistent with poisoning. 3 This patient should be managed by a team experience in Advanced Trauma and Life Support ATLS . Management of A airway includes cervical spine control in this case. Tracheal intubation is indicated and the team will pay attention to preventing secondary brain injury using the measures outlined in Fig. . Once this patient is stable he will be taken to CT scan and then either to a neuro-ICU or to a neurosurgical .