short notes regarding circulatory emergencies - trauma related emergency - ATLS - causes of hemodynamic instability

1. BY
DR. AHMED ABDELTAWAB AZAB
Emergency Consultant
American Heart Association Instructor
Emergency lecturer

3. Cardiovascular system

4. Cardiovascular system
• Heart.
• Blood vessels.
• Bleeding – shock.
• Assessment by:
– Pulse.
– Blood pressure.
– Capillary refill time
– Urinary catheterization.

5. Arrested patient.
• CPR:
– Safety.
– Check Response.
– Pulse detection.
– Code blue – false code blue.
– High quality CPR.

6. Arrested patient.
• High quality CPR:
– Hand position – finger position.
– Depth – 1/3 antero posterior diameter.
– Rate: 100 – 120 / minute.
– Alone: adult – child – infant.
– Two rescue: adult – child – infant.
– After advanced airway: compression – breathing.
– Adequate chest recoil.
– Minimize interruption: 10 second max.
– Shockable VS non – shockable rhythms.

7. Heart Trauma
Cardiac tamponade.
Most critical – reversible cause during CPR

9. Chest pain.
• Acute coronary syndrome:
– Stable angina.
– Unstable angina.
– MI – myocardial infarction.
• Early management:
– Rest – comfortable.
– M – O – N – A.
• Early transfer.

10. Circulation problems:
• Trauma – hemorrhage.
• Burn.
• Sepsis.

11. Trauma – hemorrhage.
• Minimal trauma
– Compression over bleeding site.
• Moderate trauma:
– Stitching.
– Limb tourniquet:
• Upper limb: 1 – 1.5 hours
• Lower limb: 1.5 – 2 hours.

12. Trauma – hemorrhage.
• Massive hemorrhage:
– Internal – external.
– Shock.
– Need rapid surgical intervention

14. Burn.
• Types of burn:
– Dry - flammable
– Wet.
– Electrical.
– Chemical.
– Others: radiation – frostbite.
• Degrees of burn:
– 1st. – superficial.
– 2nd. – deep with papules and pustules
– 3rd. – all skin layers – nerve ending - painless
– 4th. – bone – muscles deep tissues.

15. Burn
• Pre hospital management:
– Safety.
– Stop burning process.
– Assessment.
– Cooling – 10 – 60 minutes + analgesics
– Dressing.
– Transportation.
• Inform receiving hospital – give O2 elevate the head –
elevate the limb – vascular access (once) – ORS.

16. Burn
• Hospital care:
– Admit the patient
– Airway control – early intubation
– Breathing and ventilation – CO poisoning
– Circulation – IV line – CRT – ur. catherization
– Disability – neurological - metabolic
– Exposure with environment control
– Fluid resuscitation – role of 9
– Assess the %, age, degree and type of burn
– Keep the patient in clean environment
– Sedation and proper analgesia.
– Escharotomy.

18. Bone fractures
• Closed fractures:
– pain
– Nerve injury.
– Vascular injury.
– Compartmental syndrome.
• Open fractures:
– The same complications like closed but more
sever.

19. Bone fractures
• Assessment:
– Airway – C- spine.
– Breathing.
– Circulation – shock.
• Limb examination.
• Peripheral pulse.
• Peripheral CRT.
– Disability.
– Exposure – missed fractures.

23. Bone fractures
• Reduction.
• Fixation.

27. Sepsis

28. Sepsis

29. Sepsis
• Management at home:
– Early detection.
– Safety – for me and pt.
– ABC maintenance.
– Early transfer to hospital.

30. Sepsis
• Hospital management:
– 1st 3 hours
• ABC.
• Blood culture and sensetivity.
• Lactate level.
• Broad spectrum antibiotics.
• Fluid resuscitation.
– 2nd 3 hours
• Reassess lactate level – ICU admission – inotropes

31. Capillary refill
time

32. CALL FOR HELP