FBO, Anaphylaxis, Inhalation Injuries, Thoracic Emergencies PDF

FOREIGN BODY OBSTRUCTION ========================   Co sc1ous   - Support the victim carefully to the ground - Immediately activate the Emergency Response Service (ERS) obstruction - Approximately...

FOREIGN BODY OBSTRUCTION ========================   Co sc1ous   - Support the victim carefully to the ground - Immediately activate the Emergency Response Service (ERS) obstruction - Approximately 50% of airway obstructions following choking are not relieved by a single technique. - Higher airway pressures can be generated using chest thrusts compared with abdominal thrusts. - Bystander initiation of chest compressions for unresponsive or unconscious victims of choking is associated with improved outcomes. - Therefore, start chest compressions promptly if the victim becomes unresponsive or unconscious. After 30 compressions, attempt 2 rescue breaths, and continue CPR until the victim recovers and starts to breathe normally. 1. persistent cough 2. difficulty swallowing 3. sensation of an object still being stuck in the throat - Choking is characterized by the sudden onset of respiratory distress associated with 1. coughing, 2. gagging, or 3. strider. - 1\. The onset is very sudden - 2\. There are no other signs of illness - 3\. There are clues to alert the rescuer (e.g. a history of eating or playing with small items immediately prior to the onset of symptoms). -- -- -- -- - A se,ated cir kne,elin1g1 re,scuer shou d be able to, - Support the infant\'s he,ad by placing the thumb of one hand at the angle ·Of the I1.owerrj:a:w, and ,one or two1 finge,rs ·from the s,a.me hand at the same po,int on the other s·i1d,eof the Jaw. - 1D101 not compress the,soft tissues under the \'infant\'s, jjaw, as this wi·uex.aoerbatie the a.irway obstructton. - D1eliver up to1 **5 sharp b,ack.b ow.s** with th,e he,ell of., - dent ·fy the, I a,ndm1,a1rk, ·f:or chest: comp e,s.s1on 1(1owe · sternum appiroxi,mat1e,1ly a fin , · s breadth - · Die,iver up t,c 51 c · · ·· **\'t 1h -u, ,t**,**\_**.These are srmillar to, chest 1oom1pre.ssilons lbu·t :sharper t:n nature andl,del1v,ere,d·,at a sl,ower ra-,e. - , The aim is to irell1eve tlh1e obstructio,n Wi\'lh each I this is no possible, suppo1rt: the child iin a ,·o war -leaniing position and deliver the back - If bac \_ bl\'OWS·ai\'I to dislodge, the o\'bject, and he ch Id is still,conscious-us.e chest t- us s for nfrants or abdom·nal thrusts for clh11ildren Do not use abdominal thrus s (Hleimlich manoeuvre) for infan s. - Grasp this hand wrrth you o her han1d and pul1 - :Repe1at up to 4 more,imes - Ensure ha pressur1e s not applied t10 t e xipho\'·d process o · ·the ewer rib cage as ·his may cause abdominal ta ma.  - If the **object has n,ot been expelled** and ihe V\' ctim ls s UI con.s,ciio. s continue the - Do not leav1e I he c1hild al this sta,ge. - If the **ob.·ect i,s expe** I **ed SU!cces.sfully·,** ,a.ss,ess h1,e c:hil s clinica,1 con,difon lit iis poss,iblle that p,art of the obje,ct may r1emain iln tlhe respiira \'1ory ract and cau.se oo,mplica.tion:s - If the child re,gains cons,c:ious\_ess,and is lbre·athing1ei\_-\_e,cUv·ely, place him in ,a safe S\'ide - n·tlhe -c - Call ou1. oir 5,end, fo1r :help iftis,sfll not - D,o n,ot.leave ·.·he chUd a.1 t is st.a.g1e  INHALATION INJURY ================= U hll\'i.C\' Ju, AIRWAY.   -\....-.. s -\...\.... \$ -L\#J\--J t - JCII \--·\-\-\-- - Tachypnea - Dyspnea - Cough - Decreased breath sounds - Wheezing - Roles - Rhonchi - Retractions - carboxyhemoglobin measurements, - chest computed - f iberoptic bronchoscopy FOB), ### nENT  #### -·1\--·- =:-\_+\_=· H- , =\-\-- -+- \-\-\--l\--+-t-l\-\--H-+ \--·\-\--t \-- - 11 11 11 ;\'-+-+ 1P8vmi\"is a i0nverse-r-afio -,, pressure- -ont-r ll dimbde- f ve;ntflation tha,atlio;w!\'**s -ffo;f-::1:::j:::j::::t:::t:** - -+\-\--j- pontan ousjb eathsi.rfihas :been s own t rec uit lveo!i, imprve oxygenations and· m. Of *·v* ll ili\"e- \--t de. I - - - \-- \-- = -· = i 1. Risk for Ineffective Tissue Perfusion 2. Risk for Ineffective Airway Clearance related to:  ANAPHYLAXIS ===========  ##### Signs and Symptoms - Sudden swelling of the face, tongue, lips, neck and eyes - Hoarse voice, \'lump in the throat\', developing into loud pitched noisy breathing (which may stop altogether). - Difficult, wheezy breathing, tight chest (the patient may have the equivalent of an asthma attack as well as a swollen airway). - Rapid weak pulse. - Nausea, vomiting, stomach cramps and diarrhea. - Itchy skin. - Red, blotchy skin eruption - urticaria - Anxiety- a feeling of \'impending doom ##### Signs and Symptoms - Call for emergency medical help. Do not delay in calling for help as time is critical. - Lay the victim in a comfortable position: - If the victim has Airway or Breathing problems they may prefer to sit up as this will make breathing easier - If the victim feels faint, do not sit them up. Lay them down immediately. Raise the legs if they still feel - The patient may carry an auto-injector of Epinephrine (Adrenaline). This can save the casualty\'s life if it\'s given promptly. - If the patient becomes unconscious - check to see if they are breathing normally. If they are not breathing, immediately update the emergency services and commence Cardiopulmonary Resuscitation (CPR).  THORACIC INJURIES ================= ### Tension Pneumothoraax  - 1 way valve air leak - Air is trapped within pleural cavity - Compressing the lungs - Causes displacement of mediastinum - eads to raised intrapleural/\"ntrathorac·c pressure, kinking of great vessels - Reduction of venous return , reduced CO, - Always CLINICA 111 - H\'y1perresonance - Hypotension - Tachycardia - Crepitus - E-FAS : -ve sliding sign , - Principle : de1compression - cornverting tensi1on 1. Needle thoracocentes·s - 2nd lcs, midclav l\"ne VS Safety Tr\"angle( 5th ICS, ant to mid axillary line) 2. Finger Thoracostomy - Safety Tria ·· gle 3. Chest Tube with under wa er seal  **Open Pneumothorax** - ###### Definition: large open chest wal defect creating a di ect communication btwn pleural space and atmosphere, resulting in collapse of the lungs. - If opening is 2/3 size of trachea crossectiona ly, then air will flow thru he chest wall defect. (Sucking chest wound) ### Diagnosis - Open chest wound - Respi, istress - Nisy air movement over chest wall - Dec eased breathing sound o affected side - Hyperresonance - Crepitus, tenderness  - 3 way secure occlusive dressing ( temporary) - Chest tube and seal the opening - dressing - seal 4 ways or repair surgically. **Massive Hemothorax** 1. Rapid accumulation of\> 1.5 L of b ood (initially) or more than 1/3 of patients tota Blood volume in the thoracic intra pleural space chest cavity. 2. Cont\"nuous blood loss of 200 ml/hr for 2-4 hrs  - Pe,n1etrati\'1n,g - InJiu-·-y to interc,ostall ve,ss,,el,, intern,all mamma1ry artery - Thora1ci\',c spin,e  - Br1uises/laceratio1n/con1tusion1to chest wall - D1istendedl neck ve\'in - earll·y - Coll,apse1dl Ne1c.k vein - IRedluced ch,est wa1II 1expansion - Res1pi dlistress - o,e,1crease·1d Spo12 - o,e,,cre.ase,,d breath1ing sound - D1ullln,e1ss - Tachvcardi,a.,.Hvoot1ension. S,ho1ck - Activate MTP\' - **,GXMI**- emergen1cy cross miatch / Safe 0/ ra1nexamic a:c.id - Che,st Tiube - Get P\'ri\'mary( Su1rg-) eam in1volved Early - ndl1catil1on for ur,gent tho1racotomy  Flai Chest & pulmonary contusion --------------------------------  sH um \_ ith each bri  Management ---------- - Analgesia : Iv morphine, CA/regiona bock - Oxygenation Supplement - Ventilafon - Non invasive/ Intubation - w/o hypoxia, co2 retention, reduced breathing leffort  - A**chest tube is a catheter inserted** through the thorax to remove air and fluids from the pleural space, to prevent air or fluid from re­ entering the pleural space, or to Re establish normal intrapleural and intrapulmonic pressures  - Pneumothorax - Hemothorax - Pleural Effusion - Bleeding diathesis - Cardiac temponade - Coagulopathy - atelectasis  - Adul male - 28-38fr - Adul fema e 28fr - Confirm the procedure - Inform Ratient - Check for the consent - Prepare the equipment - Position patient - Observe/monitor patient\'s respiration - Reduce patient\'s anxiety. - Prepare the under water seal. - Connect the closed system fast - Monitor vital signs - - 30mins x 1 hour - 1 hour x4 hours and until stable - Rate Pattern - **Rhythm** - Check saturation - Adm1n1ster oxygen when necessary  - Thoracic surgery - Anterior chest - Posterior chest tube - pneumothorax   - The most commonly used drainage systems are: 1. One bottle / single bottle system 2. Two bottle system 3. Three bottle system  - The simplest dosed dra nage system is the single chamber unit. - The chamber serves asa fluid collector and a water seal. - Dunng normal respiration the fluid in the chamber ascends with inspiration and descends with expiration. - This is used for smaller amounts of drainage such as an empyema  - The use of two chambers permits any fluid to flow into the collection chamber as air flows into the water-sealchamber. - Fluctuations in the water-seal tubeare anticipated. - Two chambers allow for more accurate measurement of chest drainage and are used when larger amounts of drainage areexpected.    Bottle \#2 Bottle \#1  - When avolume of air or fluid needs to be evacuated with controlled suction, allthree chambers are used. - Mark the suction control withcentimeter readings to adjust the amount ofsuction. - Usually 15 to 20 cm of water pressure is used for adults  Intact and taped  - Use rubber tips - Clamped at the bedside - Clamping - Dur ng transfer - Not more than 1 minute - Upon doctor\'s o,rder - Note: clamping chest tu1be will accumulate in the pleural cavity since the air has no means of escape. lhiscan rapidly lead to tension pneumothorax. - Enhances flow from high to low. - Place below patient\'s chest wall - Fill with sterile water. - Rod must be immersed 21cm in - Observe for the fluctuation cf water  - Check forobstruction Tubing -kinked - Intermittent bubbling : normal - Continuous bubbling : abnormal - Check :Wound , Tube Connection - If rapid bubbling without air leak : inform doctor immediately  - 70-100 mis per hour - observe for any change indrainage - Mark theamount  1. Tube 2. Bottle - Encourage patient to change position to promote dra·nage - No need to clamp the tube - Maintain chest tubebel,ow chest wall  - 0 n the first plost op day. - Administer analgesic in the first - Assist patient in daily living activity  - Observe wound dressing - Observe drainage - From insertion site : place a gauze immediately - From connection : clamp chest tube immediately - Observe patient for tersbn pneumothorax. - Place tube in saline immediately.