Emergency In Internal Medicine PDF 2024

Emergency in Internal Medicine For Fifth year medical students By Sundus ALmusrati Updated 2024  Contents General basics 3 Acute Exacerbation of Bronchial Asthma 4 Acute Exacerb...

Emergency in Internal Medicine For Fifth year medical students By Sundus ALmusrati Updated 2024  Contents General basics 3 Acute Exacerbation of Bronchial Asthma 4 Acute Exacerbation of COPD 5 Pneumothorax 6 Pulmonary Embolism 7 Acute Respiratory Distress Syndrome 8 Acute Pulmonary Edema 9 ST-elevation Myocardial Infarction 10 Unstable Angina & NSTEMI 11 Narrow Complex Tachycardia 12 Broad Complex Tachycardia 13 Upper GI Bleeding 14 Acute Pancreatitis / Ascending Cholangitis 15 Hepatic Encephalopathy 16 Diabetic Ketoacidosis 17 Hyperosmolar Hyperglycemic State 18 Hypoglycemia / Adrenal Crisis 19 Thyrotoxic crisis / Myxedema Coma 20 Status Epilepticus / Meningitis 21 Ischemic Stroke / Hemorrhagic Stroke 22 Anaphylaxis / Hyperkalemia 23 Sickle Cell Crisis / Obstructive Sleep Apnea 24 Paracetamol Toxicity / Salicylate Toxicity 25 Organophosphorus Poisoning / Scorpion Bite 26 2  General basics assess patient +- admit to ICU & check air way , breathing and give O2 CBC , U&E&C , LFT , ABG , blood glucose , PCR circulation & insert 2 large cannula and send investigation coagulation profile , blood culture , CXR ,ECG Urine and serum toxicology if suspected IF patient have no breathing and no pulse CPR Keep monitoring patient vital signs including temperature , HR , BP , RR and urine input-out put Give I.V fluid to support circulation Gastric lavage and activated charcoal if toxic ingestion ! Assess the patients GCS If patient comatose give glucose 50 ml 50 % IV + Thymine if there is evidence of malnourishment or known to be alcoholic + Naloxone or naltrexone if there is evidence of pinpoint pupil Correct any ABG and electrolyte disturbance Medical surgical Thrombolytic , antidotes PCI , laparotomy , chest tube antibiotics , inotropic agents pericardiocentesis , gastric lavage Causes of coma : Metabolic ( hypo / hyperglycemia , acidosis and alkalosis , hypo / hypernatremia , renal failure ) Toxic ( alcohol , opioid , TCA , atropine , etc. ) Infection ( encephalitis , meningitis , brain abscess , cerebral malaria ) Structural lesion ( ischemic and hemorrhagic stroke , brain tumor ) Encephalopathy ( epileptic , uremic , hepatic , Wernicke’s ) Ṧ SUNDUS ALMUSRATI 3 DD : acute COPD , PTX , pulmonary edema , anaphylaxis , pulmonary Acute Exacerbation Of Bronchial Asthma embolism , pneumonia Assess the patient if it is acute severe attack or near fatal attack Mechanical Ventilation ABG , CBC , CRP , U & E , sputum for C/S , CXR , PEFR Give patient O2 via poly mask , insert 2 large cannula and send investigation Connect patient on pulse oximeter and ECG Oxygen should be maintained at 94% - 98 % , give bronchodilator and steroids Salbutamol 5 mg / 4hr nebulizer AND ipratropium bromide 0.5 mg / 6 hr nebulizer Prednisolone 40 - 50 mg orally OR hydrocortisone 100 – 200 mg IV / 6 hr If there is evidence of infection give antibiotics Purulent sputum , fever or high CRP/WBC , X-ray changes Symptoms , vital signs , ABG , Reassess patient every 15 minute via PEFR , ECG , K level Respond not respond Repeat drugs untill the PEFR up to 75 % repeat drugs in same doses and reassess ? Then discharge pateint on step 5 “ short course of oral steroids “ + inhelar steroids + inhaler bronchodilators and follow up not respond consider Mg sulphate 1.2 – 2 g IV over 20 min not respond consider aminophylline bolus 5 mg / kg over 20 min ( or IV salbutamol ) then maintenance 0.5 mg / KG / hr by infusion pump Causes of exacerbation : Infection , arrhythmia Low dose , improper use not respond do X-ray to exclude PTX & pneumonia and put patient on MV of inhaler Heart failure , stress Ṧ SUNDUS ALMUSRATI 4  DD : acute bronchial asthma , PTX , pulmonary edema , anaphylaxis , Acute Exacerbation Of COPD pulmonary embolism , pneumonia Assess the patient and admit the patient to the ICU if needed ABG , CBC , CRP , U & E , sputum Give patient O2 via venturi mask , insert 2 large cannula and send investigation for C/S , CXR , PEFR Connect patient on pulse oximeter and ECG Oxygen should be maintained at 88% - 92 % , give bronchodilator and steroids Salbutamol 5 mg / 4hr nebulizer AND ipratropium bromide 0.5 mg / 6 hr nebulizer Prednisolone 40 - 50 mg orally OR hydrocortisone 100 – 200 mg IV / 6 hr If there is evidence of infection give antibiotics + physiotherapy Purulent sputum ,fever or high CRP/ WBC , X- Symptoms , vital signs , ABG , ray changes Reassess patient every 15 minute via PEFR , ECG , K level Respond not respond Repeat drugs untill the PEFR up to 75 % repeat drugs in same doses and reassess ? Then discharge pateint on “ short course of oral steroids “ + inhelar steroids + inhaler bronchodilators and follow up not respond consider aminophylline bolus 5 mg / kg over 20 min or ( IV salbutamol ) then maintenance 0.5 mg / KG / hr by infusion pump Causes of exacerbation : Infection , arrhythmia Heart failure , MI not respond do X-ray to exclude PTX & pneumonia and consider Pulmonary embolism , PTX NIPPV if PH less than 7.35 MV if PH less than 7.26 or high CO2 Complications of COPD : Respiratory failure , PTX ,pulmonary Doxapram can be used as RC stimulant in some individuals hypertension , Cor-pulmonale , Recurrent infections Ṧ SUNDUS ALMUSRATI 5  DD : acute bronchial asthma , acute COPD , pulmonary edema , anaphylaxis , Pneumothorax pulmonary embolism , pneumonia Assess patient if it is simple pneumothorax or tension pneumothorax Hypotension , tachycardia Shifted trachea , high JVP Give O2 and send ABG , CXR , and pulse oximeter Give O2 And determine if it is primary or secondary Insert large pore cannula 50 year old / known case of RES disease in 2nd ICS mid clavicular line NO YES insert chest tube connected to underwater seal Rim at in 5th ICS mid axillary line as soon as possible 4th ICS primary secondary SOB and / or rim