Miscellaneous Diseases (1) Flashcards
Exposure/Accidental Hypothermia
MILD CASES
1) Passive rewarming may be sufficient
- warm, dry clothes
- warm drinks
- isometric exercises to increase heat production
- check core temperature ASAP
MODERATE (core temp > 30C)
1) Active rewarming may be required
- warm water baths
- warm blankets
- heating pads
- warm oral fluids when pt. is alert
SEVERE CASES (core temp < 30C)
1) Active rewarming required
2) Administration of
- warm IV solutions
- warm gastric lavage/peritoneal lavage
- inhalation of warm gases
Few degrees per hour for warming to avoid complications
Mechanical ventilation for ventilatory failure
Infectious Disease/Pneumonia (Treatment/Management)
1) Oxygen therapy
2) Pulmonary hygiene therapy
3) Hyperinflation therapy (IS/SMI, IPPB)
4) Mechanical ventilation for ventilatory failure
5) VAP protocol for intubated patients
6) Drug therapy
- antibiotics
- aerosolized antiviral agents
7) Thoracentesis
Thermal Injuries: Burns/Smoke Inhalation/CO Poisoning
1) Immediate assessment of patient’s airway/respiratory/cardiovascular status
- intubation on those who inhaled hot gases or impending upper airway obstruction (marked/severe distress/stridor)
2) Hyperbaric oxygen therapy for severe cases
3) Oxygen therapy at 100%
4) Evaluate depth and % of burns
5) Immediate insertion of an IV line
6) Isolation room
7) Monitor ABG & electrolytes & fluid levels
8) Monitor for signs of infection
9) Bronchoscopy to clear airways of mucus plugs & evaluation of upper airways
10) Mechanical ventilation for ventilatory failure
11) Pulmonary hygiene
12) Hyperinflation therapy (IS/SMI, IPPB)
13) Aerosolized meds
- sympathomimetic & parasympatholytic agents
- mucolytics
- anti-inflammatory agents
Near Drowning (Treatment/Management)
FIRST RESPONDER
1) Remove victim from water & remove clothing
2) Follow BLS algorithm for CPR
3) Oxygen therapy at 100%
4) Cover w/ warm dry blankets
5) Monitor vital signs
6) If victim has been submerged for < 60mins, fixed dilated pupils do not necessarily indicate a poor prognosis
HOSPITAL
1) Intubation & mechanical ventilation w/ PEEP for apneic victims of those who cannot maintain PaO2 of 60 torr on FiO2 of 50% or lower
2) Inotropic agent
3) Diuretics
4) Chest tube insertion for pneumothorax/pneumomediastinum
5) Warming of the victim
- IV administration of heated solutions
- heated lavage
- heated blankets
- warm baths
- ECMO for severe cases
*intubate pt. with flexible bronchoscope if neck injury suspected
Diabetic/Renal Failure (Treatment/Management)
RENAL FAILURE
-carefully monitor I&O, electrolytes, watch for signs of CHF
DIABETIC PATIENTS
-closely monitor blood glucose levels, ABG, watch for signs of respiratory failure
Pickwickian Syndrome/Morbid Obesity
Treatment/Management
1) Monitor for sleep apnea, polysomnography if indicated
2) Use IBW when initiating mechanical ventilation
AIDS
DO NOT ORDER culture & sensitivity tests
1) Standard/Universal Precautions
PNEUMOCYSTIS CARINII PENUMONIA/JIROVECII INFECTION
- treat with penamidine (NebuPent) aerosol therapy
- 1 way exhalation valve w/ bacteria filter
- masks worn by personnel
- semi-fowlers position
- special room/chamber
- observe for bronchospasm
TB
- positive acid fast stain (mycobacterium)
- respiratory isolation
- INH, rifampin, ethambutol, streptomycin (18-24 months)
Pulmonary Emboli
1) Oxygen therapy at 100% to maintain PaO2 > 80 torr
2) Closely monitor vital signs & ABG
3) Coagulation studies
4) Drug therapy
- low dose heparin, coumain, dicumarol
- analgesics to relieve chest pain
- digitalis, digoxin to maintain circulation
- thrombolytic agents-urokinase, streptokinase
5) Active & passive exercises
6) Early ambulation
7) Anti-embolism stockings
8) Intermittent penumatic compressions devices
9) Surgical options
-embolectomy
venca cava interruption w/ sututes
-greenfield filter in IVC
Peripheral Vascular Disease (PVD)
SEVERE
1) Amputation of gangrenous body parts
LESS SEVERE
1) Eliminate contributing factors
- cigarette smoking
- administrating salicylates, anticoagulants
