Excercises_Prof. Lukšić.pptx
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Excercises – Acute poisoning and first aid Clinical cases Prof. Boris Lukšić, MD., PhD. Clinical Department of Infectious Diseases University Hospital of Split Split, Croatia Case 1. A 54-year-old man Visits doctor in the outpatient medical center (First aid ambulance) because of t...
Excercises – Acute poisoning and first aid Clinical cases Prof. Boris Lukšić, MD., PhD. Clinical Department of Infectious Diseases University Hospital of Split Split, Croatia Case 1. A 54-year-old man Visits doctor in the outpatient medical center (First aid ambulance) because of the eyelid edema and the right side face edema While beeing in the wood a snake has fallen on his head The patient was very scared and was complaing on strong pain over the face His right eye was closed He had nausea and he vomited a coulpe of times Case 1. From clinical examination: cp 110/min RR 110/75 mmHg ECG: synus ritam with occasional ventricular extrasystoles Right eye was closed The visus was normal The right side face was swollen and painful There were finding marks of the snake bite on the right eyelid Case 1. What to do? The localization of the snake bite is head and we have to act as soon as possible Immobilisation is not possible Antivenom should be addministered promptly Case 1. Therapy: Serum antiviperinum (1 dose i.m.) Antitetanic prophylaxis Costicosteroids Antihistamines The patient was reffered to the Clinical Department of Infectious Diseases in the University Hospital Center Split for further treatment Case 1. Case 2. The ambulance registrated a call from the witnesses on the beach – a child was vitally endangered A 10-year-old boy was pulled out of the sea The child was cyanotic and tachypnoic While swimming, the meduse burned his oral cavity Case 2. Objective finding: The child was dyspnoic, cyanotic, unconscious Lips, tongue, throat and pallate were very edemathosus and were blocking the airway Peripheral pulses were weak Case 2. What to do? This is a state of allergic shock We have ensured the airway (with intubation) and provided oxygen therapy Medications: ◦ Adrenaline ◦ (Calcium) ◦ Corticosteroids Case 2. Outcome: Very quickly the child was better Blood pressure became measurable and the peripheral venous drip was put The child was reffered to the hospital for further care Case 3. A 53-year-old fisherman Visitis a general practitioner because of a painful and swollen hand finger He reports that he was stung by the spider-fish The put his arm in to the hot water, but the pain did not vanish Case 3. Objective finding: The forefinger of the edemathosus and painful Therapy: Local injection of the local anaesthetic - lidocaine Antihistamines Corticosteroids right hand in obviously Case 3. Outcome: Immediately after the local injection the pain withdrawn The patient was seen on the second day and the local finding resoluted, so there was no need for further interventions Case 3. Case 4. A 63-year-old man called the Ambulance because of a diffuse muscle pain When the medical staff arrived, the patient was on the bed with painful face He was seriously complaining on the abdominal and precordial pain Case 4. From clinical examination: The patient was afebrile and dyspnoic cp 110/min RR 150/85 mmHg ECG: sinus tachycardia with no other abnormalities Clinical findings of the lungs and heart were normal Abdomen was „hard as a board” Cramps of the whole body were seen There was an erythematosus spot on the forefinger of the right hand Case 4. Detailed anamnesis: Detailed anamnesis revealed that the day before the patient was in the filed and while cutting grass felt a painful sting on the foreringer of the right hand The pain was first present on the finger and then expanded over the arm and the whole body The patient didn’t see the spider or any other animal The doctor suspected it was a black widow spider (Latrodectus spp.) bite Case 4. Therapy: Antivenom Latrodectus was not given because it was unavailable ◦ The antivenom is no longer produced in Croatia The patient received corticosteroids analgetics, antihistamines, The patient was reffered to the Clinical Department of Infectious Diseases in the University Hospital Center Split for further treatment Case 4. Case 5. A 35-year-old diver visitis doctor because of the big tissue defect on the right forearm The patient is very scared because he knows that the murine fish is very poisonous Objective finding: The murine bite wound is localized on the right forearm and measures 10 cm x 5 cm A part of the tissue is missing The wound is bleeding Case 5. Therapy: Wound toilet Haemostasis Do not stitch the bite wounds! Antitetanic prophylaxis Antibiotics orally Outcome: The patient was reffered to the plastic surgery Case 5. Conclusion Detailed anamnesis and Physical examination Are the most important steps For final diagnosis and therapeutic procedures In emergency cases and poisoning conditions Thank You for Your attention
