MyCpdZw - Protocols Details

HAEMATEMASIS & MALENA

Haematemesis is the vomiting of blood, either bright or altered blood (so-called 'coffee grounds' vomitus), due to the action of acid on the blood.

Diagnosis

Usually obvious!

History important to establish cause (known ulcers, anticoagulant/ steroid/NSAID’s use, alcoholic,

history of varices) & amount of bleeding etc.

Look for features of shock, chronic liver disease, encephalopathy & don’t forget to do PR.

Management

1. ABC’s Resuscitation as indicated,

2. Oxygen,

3. Continuous monitoring,

4. IV access, 2 x large bore cannulae if shocked,

5. Fluid resuscitation with Hartmann’s/ packed cells/ FFP as indicated,

6. FBC, U&E’s, Coag. Profile, Cross-match packed cells as considered appropriate (2-4

units generally),

7. ECG,

8. CXR,

9. NGT if profuse haemorrhage,

10. Cathterise to monitor urine output,

11. Consider central line & ionotropes if unstable,

12. IV Pantoprazole 40 mg stat,

13. If suspected varices:

· Octeratide infusion (500 mcg in 100 ml N.Saline) 50mcg bolus followed by 50mcg/hr for 24 hours,

· Sangstaken tube, or

· Vasopressin infusion (0.2-0.4 units/min).

Liaise early with medical officer/Surgeon regarding treatment, endoscopy & disposition

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.