MANAGEMENT
OF EMERGENCY
INTRODUCTION
Emergency conditions arises
due to diseases ,accidents,snake bite,drowning,dog
bites or drug reactions.
It requires urgent and immediate medical attention which may save lives,are termed as Emergency Managerment.
COMMON EMERGENCIES
(i) DROWNING
Theduration of hypoxaemia is a very important factor, on which depend vival of the person. For this reason restoration of respiration after removing all water from the lungs is very important for which artifical respiration is given.
As soon as a victim is
taken out of water,his mouth and respiratory passage are cleaned and
mouth to mouth respiration should be started.
If the victim is suspected to be for a long time in water the mouth to mouth respiration can be started by bringing the patient in shallow water and supporting his body by hands.
Mouth to mouth respiration
should be done by putting a
clean handkerchief on victims mouth to prevent the entry of harm ful micro-organisms.
Ater the patient is taken
out of water and respiration as started, the
water swallowed by him during drowning shall be taken out.
This is carried out by
turning the head on one side and giving pressure upper abdomen and the water gushes out of his mouth.
The patient shoulde
quickly transferred to hospital for oxygenation and perfusion.During transportation,an
armbubag should be used to maintain the respiration
(ii) HEAT STROKE OR SUN STROKE
Ours being a tropical
country, in most of the places temperature goes very high upto 45°C under the sun.
(ii) HEAT STROKE OR SUN STROKE
Heat strokes are more common in elderly person and alcoholics.
The main signs and symptoms are
2.Patient becomes restless, difficulty in respiration occurs. Patients blood pressure falls and he becomes unconscious.
Treatment:
Place the patient in shade and remove all clothings. Pour cold water on the body and fan him vigorously till the body temperature comes down.
Pour cold water slowly in the mouth till the temperature is
dropped.
If ORS (Oral rehydration solution) is available,give water with ORS.Continue the treatment,till the patient recovers.
(ili) BURNS
Whenever the skin of the body is damaged by dry heat,steam or electric shock it is called Burns.
Causes of burns:
Causes of burns:
a.Dry heat from fire
b.Moist heat from steam
d.Frictional heat
e.Burns due to acid and alkali.
Types of Burns
ii) 2nd degree- Where both epidermis and dermis are damaged and blisters are produced
iii) 3rd degree - Where both epidermis and dermis are damaged and underlying structures like subcutaneous tissues, blood vessels and nerves are damaged.
Treatment:
a) Immediate treatment is, pouring cold water till the
burning subsides
b) Do not break the blisters. If the blisters are broken, wash it with boiled cold water and bandage it by applying burnol, silver Sulfadiazine ointment. Gention Violet application if ointment is not available
c) Give plenty of water with glucose and transfer to hospital for further treatment.
Burns with acid and alkalis should be washed thoroughly with cold water and bandaged with antiseptic ointment.
Burns in the eyes may occur accidentally by spilling of acids and alkalies.Wash the eye with cold water repeatedly till the burning sensation reduces.Apply Chloromycetin application, and bandage the eye and send him to hospital.
(iv) Snake Bite
In India various types of poisonous or non-poisonous snakes are found in jungles, and near habitation. There are about 200 species of snakes in India. Out of these about 52 are of poisonous variety. About 20,000 people die every year due to snake bite. The common poisonous Indian snakes are Cobra, Krate & Viper.
Treatment:
1.Wash the bite area with
soap and water.
b) Do not break the blisters. If the blisters are broken, wash it with boiled cold water and bandage it by applying burnol, silver Sulfadiazine ointment. Gention Violet application if ointment is not available
c) Give plenty of water with glucose and transfer to hospital for further treatment.
Burns with acid and alkalis should be washed thoroughly with cold water and bandaged with antiseptic ointment.
Burns in the eyes may occur accidentally by spilling of acids and alkalies.Wash the eye with cold water repeatedly till the burning sensation reduces.Apply Chloromycetin application, and bandage the eye and send him to hospital.
(iv) Snake Bite
In India various types of poisonous or non-poisonous snakes are found in jungles, and near habitation. There are about 200 species of snakes in India. Out of these about 52 are of poisonous variety. About 20,000 people die every year due to snake bite. The common poisonous Indian snakes are Cobra, Krate & Viper.
Treatment:
The constrictive bandage about 2"to 4" above the bite to prevent spread of poison
3. Send the patient to hospital for anti venom therapy.
4.Under no condition the constrictive bandage should be loosened before the onset of anti venom therapy.
5.If the hospital is far away, during transportation bandage can be loosened for a few seconds and can be reapplied,to prevent the onset of gangrene due to stoppage of blood circulation
6.After thorough washing, the bite area should be cleaned with a lodine Solution.
7.Reassuring the patient and give him some tea, coffee or sweetened milk.
4.Under no condition the constrictive bandage should be loosened before the onset of anti venom therapy.
5.If the hospital is far away, during transportation bandage can be loosened for a few seconds and can be reapplied,to prevent the onset of gangrene due to stoppage of blood circulation
6.After thorough washing, the bite area should be cleaned with a lodine Solution.
7.Reassuring the patient and give him some tea, coffee or sweetened milk.
(v) FEVER
Normal body temperature is
98.4 degree Fahrenheit or 37 degree centigrade. When the body temperature rises
above normal, it is called fever.
Fever is a body reaction towards infection by virus, bacteria, worms or parasite When the temperature rises above 103 degree F,it is to be control very quickly otherwise it will cause fits in children and brain damage in adults.
It may also cause dehydration
when the temperature crosses 102 degree F,
immediate action should be taken to bring it down.Temperature above 105 degree F may cause death.
Commonest causes of high fever are:-
1.Malaria, Acute Bronchitis, Pneumonia.
2 Viral infection like
Dengue, Japanese Encephalitis, Kalazar etc.
Commonest causes of high fever are:-
1.Malaria, Acute Bronchitis, Pneumonia.
Temperature is measured by thermometer which has got marking from 94 degree F to 110 degree F.It has a portion which contains mercury and the other portions have markings. The mercury portion is placed under the tongue or in the armpit and kept for half minute and then taken out and reading is taken. When the temperature is high the following steps are to be taken:
1.Remove all the clothing and wipe the body with wet towel repeatedly and fan him vigorously. Apply cold compress on forehead.
2.Give Paracetamol syrup or tablet to bring down the temperature.
(vi) FITS (Convulsion)
It is a condition when the patient is semiconscious or unconscious and throw his hands and feet in the air with jerky movements.The patient starts trem bling , teeth may be clinched and tongue may be caught in between, thus causing bleeding. This condition is called fits.
Fits or convulsion may occur due to following causes:
(1) Fits in children due to high fever, round worm infection.
Treatment
(2) In case of other diseases, when fits occurs and condition is serious,send the patient to the hospital.
(vii) ABDOMINAL PAIN
Abdominal pain may occur due to various causes. These causes may be a minor indigestion to a life threatening emergency.So each abdominal pain is to be taken seriously.If the pain does not get relieved by a pain reliever,the patient should be sent to a doctor for a differential diagnosis.The causes of abdominal pain are:
(1) Causes in the stomach-Acute Gastritis,Gastric Ulcer,
(2) Causes in the intestine - Round worm infection, Amoebiasis infection in the intestine, Appendicitis, Intestinal obstruction, Hernia etc.
(3) Gall Bladder infection and Gall stones, Liver infection, Liver abscess.
(4) Pancreas :acute Pancreatits.
(5) Causes in the kidney -Infection in the kidney Renal colic due to stone or infęction.
(6) Infection in ovary, fallopian tube, pregnancy in fallopian tube.
Acute abdomen: Due to injury or due to perforation in stomach and intestine, the intestinal contents spread inside of abdomen resulting a condition called Acute Abdomen- which require immediate surgical intervention.
Signs & Symptoms:
1. Severe pain in the abdomen.
2 Forceful vomiting
3.No bowel movement
4.No sound of the intestine is heard with the Stethoscope.
5.Abdomen feels disturbed, hard and tender.
Treatment:
Nothing by mouth
Send the patient to the hospital as quickly as possible.
(iii) HEAD INJURY -Head Injury usually occurs in an accident.
Automobile accidents like motor, motorcycle or scooter accident. Occasional injury may occur due to fall from a height.
Head injury patients may come with various signs and symptoms
2. Pain in the head
3. External injury with bleeding
4. Watery discharge from nose and ear.
5. Loss of consciousness for a short time.
6 Complete loss of consciousness.
Whatever may be the symptoms, Head injury is a very serious condition.The patient should be carefully lifted and send to hospital for treatment. No attempt should be made to keep the patient at home for treatment.
(ix)
FRACTURE
Definition
Fracture means the breaking of bones into two or more parts leading to discontinuity of the structure of bone.
Types of Fracture:
1).SimpleFracture - It is a type of fracture where the bone breaks into two or more parts.
2).Compound Fracture - It is a type of fracture where the bones not only breaks but the broken parts damage the skin and muscles and come in contact with the outside at mosphere.
Such a fracture is dangerous as it gets infected by bacteria from outside atmosphere.
3) Complicated Fracture- When the fractured parts of bones damages artery, vain or nerve, it is called Complicated Fracture.
4) Comminuted Fracture- When the bone breaks into several parts it is called Comminuted Fracture.
5) Green
stick Fracture - In children, the bones are
soft and can be bend like a green stick without break. When the bone in
children breaks, it does not break completely, one side breaks but the other
side remains intact. It is called Green Stick Fracture.
6) Depressed Fracture - When a fracture occurs in skull bone, the skull bone goes inside and it is called a Depressed Fracture.This is a very serious fracture and it depresses the brain and gives rise to paralysis.
Treatment
1) Simple Fracture- First aid treatment of simple fracture consists of immobilization of the part by a splint. A splint is a piece of flat wood,or stick or even folded paste boards to which the limb is tied by bandage.
6) Depressed Fracture - When a fracture occurs in skull bone, the skull bone goes inside and it is called a Depressed Fracture.This is a very serious fracture and it depresses the brain and gives rise to paralysis.
Treatment
1) Simple Fracture- First aid treatment of simple fracture consists of immobilization of the part by a splint. A splint is a piece of flat wood,or stick or even folded paste boards to which the limb is tied by bandage.
2 In case
of Compound Fracture, a clean and sterilized
dressing is applied and
the part is immobilized by a splint.The patient is send to the hospital as soon as possible
3.In Complicated Fracture, if there is bleeding, the bleeding is stopped by pressure bandage and send the patient to the hospital after applying a splint.
4.In Comminuted Fracture, a splint is applied and send the patient to the hospital.
5. In Green Stick Fracture, a splint is applied and send the patient to hospital
6. In Depressed Fracture of skull, many serious complications may occur. So the patient should be sent to hospital as soon as possible.
DISLOCATION
Dislocation always occurs in a joint. Due to injury the bones at joint gets displaced from its original position. In dislocation the bones lose its function and in the joint no movement takes place. In case of fracture the bones show unnatural movement. In dislocation severe pain occurs. Send the patient to hospital for relieving dislocation.
3.In Complicated Fracture, if there is bleeding, the bleeding is stopped by pressure bandage and send the patient to the hospital after applying a splint.
4.In Comminuted Fracture, a splint is applied and send the patient to the hospital.
5. In Green Stick Fracture, a splint is applied and send the patient to hospital
6. In Depressed Fracture of skull, many serious complications may occur. So the patient should be sent to hospital as soon as possible.
DISLOCATION
Dislocation always occurs in a joint. Due to injury the bones at joint gets displaced from its original position. In dislocation the bones lose its function and in the joint no movement takes place. In case of fracture the bones show unnatural movement. In dislocation severe pain occurs. Send the patient to hospital for relieving dislocation.
(x) CARE
OF PARALYZED PATIENTS
Intensive care of paralyzed
patients are required to maintain personal hygiene. If proper hygiene is not
maintained, the patient will develop various complications and their recovery will be delayed. You
must know that.
1) How to deal with paralyzed patients where institutional care is not avail able.
2) with proper maintenance of personal hygiene, complications becomeless, life expectancy increases and recovery becomes rapid.
Paralysis may occur due to various causes, commonest are:-
i) Cerebral Thrombosis or Haemorrhage
In paralysis, patients are unable to do their own work, so they have to be assisted to do their daily routine. As the patients are lying most of the time, certain special care to be taken to maintain their personal hygiene
1) Cleaning of the mouth and teeth and maintaining the oral hygiene. Applying Boroglycerine from time to time will prevent the infection to grow. If there is fungal growth which is very common specially in children and antifungal liquid like Micorniazole is mixed with Boroglycerine before applying
(2) Care of the skin, specially back skin is very necessary. In paralyzed patients due to pressure constantly at the back, pressure sores develop which are called bedsores. Once the bed sores develop, it is very difficult to cure and the patient health deteriorates very quickly.To prevent this, the patients position is changed every 1-2 hours so that circulation is not hampered due to pressure of the bed. Nowadays,water-bed is used which does not produce much pressure on the back skin, thereby chances of developing bed sores are minimized.
In case of bed sores development, Antibiotics, local dressing by Antiseptics like, Soframycin or silver Sulfadiazine leads rise to quick recovery. Useof air rings at the pressure points help give the speedy recovery from bed sores.
(xi) POISONS
Poisons are substances which when taken internally causes disturbance of body functions and alternately vital functions are affected causing death
1.Identification of poison of possibility
2.If acids or alkali poisoning give plenty of water to drink'to dilute acids or alkalis
Treatment
1.For any ingested poison the first step is to take out the poison as quickly as possible.This can be done by inducing vomiting or giving a stomach wash.Give plenty of salt water to drink.This will induce vomitino.
Organo Phosphorus Poisoning by Tik20 or follidol (a crop spraying insecticide) is very common in villages. By inducing vomiting the poison can be taken out and send the patient to hospital as the poison causes liver damage after absorption
Kerosene poisoning- It causes Broncho Pneumonia which is a common symptom. The patient require O, inhalation and Antibiotic treatment.
Poisoning with alkali or acids by bathroom cleaning agents is very common. If the poison is alkaline, then vinegar is mixed with water and given to the patient to drink.In case of acid poisoning sodium bicarbonate is mixed with water is given to patient to drink.Send him to hospital for further treatment.
Dettol or Phenyl poisoning is fairly common in children. Plenty of water to dilute the poison prevents the damage of stomach and oesophagus.
Milan Tomic
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