MyCpdZw - Protocols Details

ABDOMINAL AORTIC ANEURYSM

An abdominal aortic aneurysm is an enlarged area in the lower part of the aorta, the major blood vessel that supplies blood to the body.

Diagnosis

Suspect in:

· Sudden collapse/ syncope,

· Male,

· Age > 60 yrs,

· Usually severe abdominal, loin or back pain,

· Hypotension and syncope (40% present with only syncope) but may even be hypertensive initially

80% are asymptomatic prior to diagnosis.

Be VERY cautious diagnosing new renal colic in over 60’s year-olds, it is an aneurysm until proven otherwise!

There may be few clinical findings.

Often appear distressed, pale, sweaty & tachycardic with mottled skin of the lower abdomen

Only 75% are palpable, < 50% are pulsatile.

Exclude other causes.

Management

Involve surgical team ASAP.

Don’t delay surgery while investigating patients- the first line investigation is laparotomy!

1. ABC’s and Resuscitation as indicated,

2. High flow Oxygen,

3. Baseline observations and continuous monitoring,

4. IV access 2 x large bore lines,

5. FBC, U&E’s, LFT’s, Lipase, Coagulation studies, cross match 6 units,

6. Arterial Blood Gases (Arterial line preferable),

7. ECG,

8. IV crystalloid/ Gelofusine to maintain Systolic Blood Pressure at 90mmHg (Don’t aim for normotension),

9. Analgesia IV Morphine 2.5-5 mg increments until comfortable,

11. Nil by mouth,

12. Focused Assessment with Sonography in Trauma (FAST), if available, to look for free fluid in the peritoneum,

13. CXR, CT, USS abdomen- as guided by , time, facilities & clinical stability,

Consider use of pneumatic anti-shock suit (MAST) for transfer.

Recent Protocols

COVID 19

COVID 19 is a disease caused by the most recently discovered coronavirus which is a large family of corona viruses causing illnesses. In humans it causes Respiratory infections for example Severe Acute Respiratory Disease (SARs) PRESENTATION Fever 77-98% Cough 46-82% Myalgia/Fatigue 11-52% Shortness of breath 3-31% Incubation period 14 days, most people develop symptoms between 5-6ays from exposure Stage1 (Early infection). Stage 2. Stage 3(Hyperinflation phase) Viral response---------------------------Pulmonary Phase----------------------Host Response *Anyone presenting with flu like symptoms should be assumed to be a COVID 19 case until proven otherwise*

WARFARIN OVERDOSE/ TOXICITY

Overdose of the oral anticoagulant warfarin (Coumadin), or drug interactions with warfarin, can lead to toxicity. Similarly, toxicity can result from exposure to superwarfarins, which are long-acting anticoagulants used in rodenticides. ... Warfarin is the most common oral anticoagulant in current use

SUICIDAL IDEATION

Suicidal ideation, also known as suicidal thoughts, is thinking about or having an unusual preoccupation with suicide.

SPINAL CORD INJURY

Emergency signs and symptoms of a spinal cord injury after an accident may include: Extreme back pain or pressure in your neck, head or back. Weakness, incoordination or paralysis in any part of your body. Numbness, tingling or loss of sensation in your hands, fingers, feet or toes. Loss of bladder or bowel control.