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MOH Pocket Manual in Emergency Medicine PDF
MOH Pocket Manual in Emergency Medicine PDF
Emergency
MOH Pocket Manual in Emergency
COntent
s
cardiac emergency 3
MOH Pocket Manual in Emergency
Contents
• Headache.
• Adult Acute Bacterial Meningitis.
Chapter 4 :Toxicology:
4 conten t
MOH Pocket Manual in Emergency
• Rhabdomyolysis.
• Acute Urinary Retention.
Chapter 8 : Trauma and environmental:
con t en t 5
MOH Pocket Manual in Emergency
6 cardiac emergency
MOH Pocket Manual in Emergency
Chapter
1
CRADIAC
EMERGENCY
cardiac emergency 7
MOH Pocket Manual in Emergency
8 cardiac emergency
MOH Pocket Manual in Emergency
Clinical Presentation
o History
• Chest pain, when it started, what it feels like
(stabbing, crushing, pressure, aching), and if
it radiates to other parts of the body.
• Dizziness, nausea.
• Shortness of breath.
o Physical Examination
• Hemodynamic stability, signs of heart fail-
ure/left ventricular dysfunction.
cardiac emergency 9
MOH Pocket Manual in Emergency
Differential diagnosis
o Heart
Acute coronary syndrome
Pericarditis
Myocarditis
Endocarditis
Valvular disease
o Lungs
Pulmonary embolus
Pneumothorax
Pneumonia
Empyema
Hemothorax
COPD
o Esophagus
Esophagitis
GERD
Spasm
Foreign body
Rupture (Boerhaave’s)
Esophegeal Tear
o Work up
• CBC.
• Electrolytes.
• Coagulation studies.
• Cardiac enzymes.
• ECG.
• Cardiac biomarkers.
10 cardiac emergency
MOH Pocket Manual in Emergency
Management
o Prehospital Care:
• Three goals:
cardiac emergency 11
MOH Pocket Manual in Emergency
• Do ECG.
12 cardiac emergency
MOH Pocket Manual in Emergency
• Unfractionated heparin:
cardiac emergency 13
MOH Pocket Manual in Emergency
Disposition
• Admit to ICU
o Management
• High-risk patient:
:”Early “invasive-
-Early “conservative”:
14 cardiac emergency
MOH Pocket Manual in Emergency
Disposition
• Admit to ICU.
o Alert
cardiac emergency 15
MOH Pocket Manual in Emergency
o Cardiac causes:
• Mitral valve disease.
• Myocardial disease.
• Conduction system disorders.
• Wolff-Parkinson-White syndrome.
• Pericardial disease.
Conditions associated with AF include:
• Thyrotoxicosis.
• Hypothermia.
• Alcohol use.
• Severe infection.
• Hypoxia.
• Pulmonary emboli.
• Pneumonia.
• Kidney disease.
• Obesity.
• Diabetes mellitus.
• Digoxin toxicity.
• Electrolyte abnormalities.
• Intrathoracic surgery, such as cardiac or pulmonary
surgery, or invasive cardiac studies.
16 cardiac emergency
MOH Pocket Manual in Emergency
o History
• Anxiety, palpitations, shortness of breath,
dizziness, chest pain, or generalized fatigue.
Physical Examination
• Vital signs.
• Oxygen saturation.
cardiac emergency 17
MOH Pocket Manual in Emergency
Differential diagnosis
Atrial Ventricular
Rhythm Frequency, Frequency, P-wave
beats/min beats/min
Sinus
Precedes every
tachycar- 100-180 100-180
QRS complex
dia
Atrial irregu� ,60-1900
400-600 Absent
fibrillation larly irregular
regu� ,75-1500
Atrial lar, sometimes
250-350 Sawtooth
flutter alternating
block
Atrioven-
tricular
nodal In QRS complex
180-250 180-250
reentrant )(R
tachycar-
dia
Precedes QRS;
Atrial
P-wave differs
tachycar- 120-250 75-250
from sinus P-
dia
wave
Multifo- or more dif� 3
cal atrial ferent P-wave
100 > 100 >
tachycar- morphologies at
dia different rates
18 cardiac emergency
MOH Pocket Manual in Emergency
Atrial
fibrilla-
tion with with ,180-300
Wolff- wide, bizarre
Parkinson- 400-600 Absent
QRS com-
White plexes
syndrome
Work up
• Electrocardiogram.
• Metabolic panel.
• Coagulation studies.
• A thyroid panel.
• Chest radiography.
cardiac emergency 19
MOH Pocket Manual in Emergency
Management
o Prehospital Care:
• Cardioversion considered if the patient exhibits signs
of hemodynamic compromise or poor coronary artery
perfusion.
o In hospital care:
Unstable Patients: as :
- Hypotension.
• 200-360 J monophasic.
• Anticipate failure.
20 cardiac emergency
MOH Pocket Manual in Emergency
Stable Patients:
o Give: Amiodarone.
If No suspicious of accessory pathway:
Or
cardiac emergency 21
MOH Pocket Manual in Emergency
• Beta blockers as :
Esmolol 0.5 mg/kg over one min loading dose then 0.06-0.2 mg
/ kg/ min
o Disposition
22 cardiac emergency
MOH Pocket Manual in Emergency
o Alert
• ECG abnormalities.
cardiac emergency 23
MOH Pocket Manual in Emergency
Bradydysrhythmias
Overview
Categories of Bradydysrhythmias
• Tachy-brady syndrome
• Chronotropic incompetence
24 cardiac emergency
MOH Pocket Manual in Emergency
Clinical Presentation
History
Assessing the History of the Patient with Bradydysrhythmia
cardiac emergency 25
MOH Pocket Manual in Emergency
Physical Examination
o Differential diagnosis
26 cardiac emergency
MOH Pocket Manual in Emergency
cardiac emergency 27
MOH Pocket Manual in Emergency
Work up
• Cardiac biomarkers.
• CT of the head.
• Chest x-ray.
Management
o Prehospital Care:
• IV access.
28 cardiac emergency
MOH Pocket Manual in Emergency
cardiac emergency 29
MOH Pocket Manual in Emergency
30 cardiac emergency
MOH Pocket Manual in Emergency
Disposition
Hypertension
Overview
Definitions of Hypertension
Hypertensive emergency
Hypertensive urgency
Hypertensive crisis
cardiac emergency 31
MOH Pocket Manual in Emergency
calculated
Essential hypertension
Secondary hypertension
Clinical Presentation
History
Question Comments/Concerns
- Have you ever been told you have high blood pressure?
32 cardiac emergency
MOH Pocket Manual in Emergency
- Have you had high blood pressure in the past that has not re-
sponded to multiple medications?
cardiac emergency 33
MOH Pocket Manual in Emergency
Physical Examination
• A funduscopic examination.
Differential Diagnosis
• Stroke.
• Aortic dissection.
• Renal failure.
• Pheochromocytoma or other.
34 cardiac emergency
MOH Pocket Manual in Emergency
• Tumor.
• Thyroid storm.
Work up
• Serum chemistry.
• Electrocardiogram.
• Chest radiograph.
• Urinalysis.
• Pregnancy test.
o Management
o Prehospital Care
• Evaluated for signs or symptoms of end-
organ damage.
cardiac emergency 35
MOH Pocket Manual in Emergency
In hospital care:
-For those patients who are compliant with their medications but
still have an elevated BP, adjustments must be made.
36 cardiac emergency
MOH Pocket Manual in Emergency
and cau-
cyanide tion
intoxica- with
tion. May high
increase intra-
intracrani- cra-
al pressure nial
pres-
sure
or
azote-
mia
cardiac emergency 37
MOH Pocket Manual in Emergency
isch-
emia
0.1-0.3 < 5 min 30 min Tachy- Most
μg/kg/ cardia, hyper-
min IV headache, ten-
nausea, sive
infu- emer-
sion flushing gen-
cies;
cau-
tion
with
glau-
coma
38 cardiac emergency
MOH Pocket Manual in Emergency
prolonged
use
Enala- 1.25–5 15-30 6-12 hrs Precipi- Acute
prilat mg min tous fall in left
every 6 pressure in ven-
( not tricu-
in the hrs IV high-renin lar
MOH states; fail-
formu- variable ure;
lary )
response avoid
in
acute
myo-
car-
dial
in-
farc-
tion
cardiac emergency 39
MOH Pocket Manual in Emergency
40 cardiac emergency
MOH Pocket Manual in Emergency
infu-
sion;
may
repeat
bolus
after 5
min or
in-
crease
infu-
sion to
300 μg/
min
Phentol- 5–15 1-2 min 10-30 Tachy- Cat-
amine mg IV min cardia, echol-
bolus flushing, amine
headache excess
cardiac emergency 41
MOH Pocket Manual in Emergency
42 cardiac emergency
MOH Pocket Manual in Emergency
cardiac emergency 43
MOH Pocket Manual in Emergency
CHF exacer-
bation
44 cardiac emergency
MOH Pocket Manual in Emergency
bradycardia;
acute
decompen-
sated CHF
exacerbation;
sick sinus
syndrome
a-2 Ago- 0.1 mg 0.3 mg tid Hyper- Poor adher-
nist (eg, bid tension ence to medi-
resistant cal
clonidine)
to other regimen
modalities
cardiac emergency 45
MOH Pocket Manual in Emergency
with CHF
in African
Americans
resistant to
other
modalities
46 cardiac emergency
MOH Pocket Manual in Emergency
Disposition
cardiac emergency 47
MOH Pocket Manual in Emergency
48 cardiac emergency
MOH Pocket Manual in Emergency
cardiac emergency 49
MOH Pocket Manual in Emergency
Clinical Presentation
o History
• Time of onset.
• Symptoms.
• location of pain especially in the (chest, back, or abdomen),
• Character of pain.
• Radiation of pain.
• Alleviating or aggravating factors.
• Other associated symptoms.
• Past medical history.
• History of long-standing hypertension.
• Previous cardiac surgery.
• Previous aortic pathology.
• Medications.
• Information about allergies to intravenous iodinated contrast.
• Family history.
• Social history.
50 cardiac emergency
MOH Pocket Manual in Emergency
Physical Examination
• Pulse deficit.
• Neurological findings.
• Mesenteric ischemia.
• Syncope.
Differential diagnosis
• Aortic Regurgitation.
• Aortic Stenosis.
• Cardiac Tamponade.
• Cardiogenic Shock.
• Cardiomyopathy.
cardiac emergency 51
MOH Pocket Manual in Emergency
• Cerebrovascular Accident.
• Gastrointestinal Bleed.
• Hemorrhagic Shock.
• Hypovolemic Shock.
• Hiatal Hernia.
• Hypertensive Urgency.
• Mediastinitis.
• Myocardial Infarction.
• Myocarditis.
• Pancreatitis.
• Pericarditis.
• Pleural Effusion.
• Pneumonia.
• Pulmonary Embolism.
52 cardiac emergency
MOH Pocket Manual in Emergency
o Work up
• Ultrasound.
• CT.
• MRI.
• Conventional Aortography/Angiography.
• CBC.
• Electrolytes.
• Coagulation studies.
• Cardiac enzymes.
• LFT’S.
• Pancreatic enzymes.
• Urinalysis.
• ECG.
cardiac emergency 53
MOH Pocket Manual in Emergency
Management
o Prehospital Care:
• Rapidly transporting them to the appropriate facility.
• Intravenous access.
• Cardiac monitor.
• Supplemental oxygen.
In hospital care:
54 cardiac emergency
MOH Pocket Manual in Emergency
cardiac emergency 55
MOH Pocket Manual in Emergency
56 cardiac emergency
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cardiac emergency 57
MOH Pocket Manual in Emergency
Disposition
• Close monitoring.
58 cardiac emergency
MOH Pocket Manual in Emergency
Clinical Presentation
o History
• When did the pain start? The time line of pain onset is
important; pain that has been present for weeks without
change is unlikely to be acute DVT. This may lead to
suspicion for other conditions, such as ongoing arterial
insufficiency.
cardiac emergency 59
MOH Pocket Manual in Emergency
60 cardiac emergency
MOH Pocket Manual in Emergency
Physical Examination
Differential diagnosis
• Cellulitis.
• Baker’s Cyst.
• Superficial thrombophlebitis.
cardiac emergency 61
MOH Pocket Manual in Emergency
Work up
• CBC.
• Electrolytes.
• Venography.
• Duplex ultrasound.
• D-Dimer.
Management
o Prehospital Care:
• Primarily supportive.
In hospital care:
62 cardiac emergency
MOH Pocket Manual in Emergency
OR
Disposition
cardiac emergency 63
MOH Pocket Manual in Emergency
64 cardiac emergency
MOH Pocket Manual in Emergency
Chapter
2
PULMONARY
EMERGENCY
cardiac emergency 65
MOH Pocket Manual in Emergency
• Social History.
66 Pulmonary Emergency
MOH Pocket Manual in Emergency
• Comorbidities.
• Cardiovascular disease.
Clinical Presentation
o History
Pulmonary Emergency 67
MOH Pocket Manual in Emergency
Physical Examination
• Diaphoresis.
68 Pulmonary Emergency
MOH Pocket Manual in Emergency
• Wheezing.
Differential diagnosis
Adults
Pulmonary embolism
Pneumothorax
Pneumonia
Cystic fibrosis
Chronic bronchitis
Pulmonary Emergency 69
MOH Pocket Manual in Emergency
Sinus disease
Children
Croup
Bronchiolitis
Tracheomalacia
Work up
70 Pulmonary Emergency
MOH Pocket Manual in Emergency
Management
o Prehospital Care:
• Oxygenation monitoring with pulse oximetry,
In hospital care:
Mild-Moderate Severe
FEV1 or PEFR% >50% Unable or
<50%
Oxygen Maintain SaO2 >90% Maintain
SaO2 >90%
Nebulized solu- 5 mg q20–30 min × 3
tion doses
Salbutamol (ven-
toline)
MDI with spacer: 6–12 puffs q20 min for up Same but
Racemic alb- to 4 hr. (with supervision) may be
uterol unable to do
(90 mg/puff) (with super-
vision)
Pulmonary Emergency 71
MOH Pocket Manual in Emergency
72 Pulmonary Emergency
MOH Pocket Manual in Emergency
Disposition
Pulmonary Emergency 73
MOH Pocket Manual in Emergency
Alert
• Psychological problems.
• Presentation at night.
• Pregnancy.
74 Pulmonary Emergency
MOH Pocket Manual in Emergency
Chapter
3
NEUROLOGICAL
EMERGENCY
cardiac emergency 75
MOH Pocket Manual in Emergency
Acute Headache
Overview
o Tension-Type Headache
• Bilateral location
76 NEUROLOGICAL EMERGENCY
MOH Pocket Manual in Emergency
• Unilateral location.
• Pulsating quality.
Cluster Headache
NEUROLOGICAL EMERGENCY 77
MOH Pocket Manual in Emergency
• Conjunctival injection
• Lacrimation
• Nasal congestion
• Rhinorrhea
• Miosis
• Ptosis
• Eyelid edema
Includes:
• Hypnic headache.
78 NEUROLOGICAL EMERGENCY
MOH Pocket Manual in Emergency
Clinical Presentation
o History
• Detailed account of the current headache.
• Change in vision.
• Change in consciousness.
• Syncope.
• History of malignancy.
• Pregnancy or postpartum.
NEUROLOGICAL EMERGENCY 79
MOH Pocket Manual in Emergency
• The onset.
• Location.
80 NEUROLOGICAL EMERGENCY
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NEUROLOGICAL EMERGENCY 81
MOH Pocket Manual in Emergency
Physical Examination
• Neurologic Examination.
• Ophthalmologic Examination.
82 NEUROLOGICAL EMERGENCY
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NEUROLOGICAL EMERGENCY 83
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84 NEUROLOGICAL EMERGENCY
MOH Pocket Manual in Emergency
Differential diagnosis
• Acute glaucoma.
NEUROLOGICAL EMERGENCY 85
MOH Pocket Manual in Emergency
• Temporal arteritis.
• Carbon monoxide.
o Work up
86 NEUROLOGICAL EMERGENCY
MOH Pocket Manual in Emergency
NEUROLOGICAL EMERGENCY 87
MOH Pocket Manual in Emergency
Management
o Prehospital Care:
Generalized recommendations include the following:
• Adjusting temperature.
88 NEUROLOGICAL EMERGENCY
MOH Pocket Manual in Emergency
In hospital care:
Primary headache:
• Diphenhydramine 25 mg IV
• And
• Prochlorperazine 10 mg IV.
Or
• Metoclopramide 20 mg IV.
Consider
• Dexamethasone 10 mg IV.
NEUROLOGICAL EMERGENCY 89
MOH Pocket Manual in Emergency
• IV Fluid.
• Triptan.
• Uncontrolled hypertension.
• Prinzmetal angina.
• Cardiac arrhythmias.
• Primary vasculopathies.
90 NEUROLOGICAL EMERGENCY
MOH Pocket Manual in Emergency
Acute abortive therapy for cluster headaches falls into two groups:
NEUROLOGICAL EMERGENCY 91
MOH Pocket Manual in Emergency
92 NEUROLOGICAL EMERGENCY
MOH Pocket Manual in Emergency
Disposition
• Change in vision.
• Change in consciousness.
• Syncope.
• History of malignancy.
• Pregnancy or postpartum.
NEUROLOGICAL EMERGENCY 93
MOH Pocket Manual in Emergency
Overview
• Otitis media.
• Sinusitis.
• Mastoiditis.
• Head trauma.
• Recent neurosurgery.
94 NEUROLOGICAL EMERGENCY
MOH Pocket Manual in Emergency
Clinical Presentation
• Fever
Other Signs/Symptoms
• Tripod position with the knees and hips flexed, the back
arched at a lordotic angle, the neck extended, and the
arms brought back to support the thorax.
• Rash.
• Arthritis.
Differential diagnosis
• Encephalitis.
• Aseptic meningitis.
• Intracranial abscess.
• Metabolic encephalopathy.
NEUROLOGICAL EMERGENCY 95
MOH Pocket Manual in Emergency
Work up
• Computed Tomography.
• Lumbar Puncture.
Management
o Prehospital Care:
• Standard personal protective
equipment such as facial masks.
• Pain medication.
96 NEUROLOGICAL EMERGENCY
MOH Pocket Manual in Emergency
In hospital care:
• Dexamethasone.
• Empirical antimicrobial:
Predispos- Common Bacterial Antimicrobial
ing Factor Pathogen Therapy
Age 16-50 Neisseria meningitidis, Vancomycin plus
years Streptococcus pneu- a third-generation
moniae, Haemophilus in- cephalosporin
fluenzae (nonimmunized
)patients
Age > 50 Streptococcus pneumoni- Vancomycin plus
years ae, Neisseria meningitidis, a third-generation
Listeria monocytogenes, cephalosporin and
aerobic gram-negative ampicillin
bacilli
Immu- Listeria monocytogenes, Vancomycin plus
nocom- aerobic gram-negative a third-generation
promised bacilli, Streptococcus cephalosporin and
System pneumoniae, Neisseria ampicillin
meningitidis
Cerebrospi- Staphylococci, aerobic Vancomycin plus
nal Trauma gram-negative bacilli, either a third-gen-
Streptococcus pneu- eration cephalospo-
moniae rin with anti-pseu-
domonal coverage
or meropenem
NEUROLOGICAL EMERGENCY 97
MOH Pocket Manual in Emergency
Disposition
• Admission to hospital.
98 NEUROLOGICAL EMERGENCY
MOH Pocket Manual in Emergency
Chapter
4
TOXICOLOGY
cardiac emergency 99
MOH Pocket Manual in Emergency
100 TOXICOLOGY
MOH Pocket Manual in Emergency
Clinical Presentation
o History
• Dose and time of APAP ingestion.
• Duration of ingestion.
• Concomitant ingestions.
• History of trauma.
TOXICOLOGY 101
MOH Pocket Manual in Emergency
• Coexisting illnesses.
Physical Examination
• ABCs
• Dehydration.
• Blood loss.
• Pain.
• Agitation.
• Pupils
102 TOXICOLOGY
MOH Pocket Manual in Emergency
• Skin
Differential diagnosis
• Ascending cholangitis.
• Biliary disease.
• Hepatorenal syndrome.
• Hypercalcemia.
• Pancreatitis.
• Perforated viscus.
• Reye’s syndrome.
Other toxins.
TOXICOLOGY 103
MOH Pocket Manual in Emergency
o Work up
• CBC
• LFT’S
• URIN ANALYSIS
• Coagulation Studies
• Pregnancy Test
• Electrocardiography
104 TOXICOLOGY
MOH Pocket Manual in Emergency
Management
o Prehospital Care
• Amount of APAP ingested and any congestion.
• Evidence of trauma.
In hospital care
TOXICOLOGY 105
MOH Pocket Manual in Emergency
Admission
Disposition
106 TOXICOLOGY
MOH Pocket Manual in Emergency
Clinical Presentation
o History
TOXICOLOGY 107
MOH Pocket Manual in Emergency
Physical Examination
Differential diagnosis
• Acute respiratory distress syndrome.
• Alcohol toxicity.
• Altitude illness.
• Cluster headache.
108 TOXICOLOGY
MOH Pocket Manual in Emergency
• Cyanide poisoning.
• Depression.
• Diabetic ketoacidosis.
• Encephalitis.
• Gastroenteritis.
• Hypoglycaemia.
• Hypothyroidism.
• Labyrinthitis.
• Lactic acidosis.
• Meningitis.
• Methaemoglobinaemia.
• Migraine.
• Smoke inhalation.
• Tension headache.
• Alcohol toxicity.
• Narcotic toxicity.
TOXICOLOGY 109
MOH Pocket Manual in Emergency
o Work up
• Co-oximetry.
• Cardiac Biomarkers.
• Lactate.
• Pregnancy Testing.
• Chest x-ray.
• Computed Tomography.
• ECG.
Management
o Prehospital Care:
110 TOXICOLOGY
MOH Pocket Manual in Emergency
o In hospital care:
Disposition
TOXICOLOGY 111
MOH Pocket Manual in Emergency
o Alert
• Severe headaches.
• Dizziness.
• Mental Confusion.
• Nausea.
• Fainting.
• Pregnancy.
112 TOXICOLOGY
MOH Pocket Manual in Emergency
Chapter
5
HEMATOLOGICAL
EMERGENCY
Clinical Presentation
o History
-Pain:
Medications-
Physical Examination
• Eyes.
Differential diagnosis
Mesenteric
ischemia
o Work up
• CBC.
• L.F.T.
• Reticulocyte count.
• ALT.
• LDH.
o Management
o Prehospital Care
o In hospital care
Opiate therapy:
• Antihistamines
• Acetaminophen
o Disposition
Admission to hospital if:
• Uncontrolled pain.
• Infections.
Anticoagulation Emergencies
Overview
Drug Effect
Sulfonamides21 Strongest effect of all antibiotics;
inhibits CYP2C9 (hepatic microsomal
metabolism)
Fluoroquino- Including levofloxin, initially thought
lones21,25-27 not to interact. Inhibits CYP2C9
and decreases vitamin K-producing
bacteria
Doxycycline Inhibits warfarin metabolism
Amoxicillin Inhibits warfarin metabolism
Antifungals25 Inhibit CYP2C9
Acetaminophen25 Interferes with vitamin K cycle
Metronidazole Inhibits warfarin metabolism. De-
creases vitamin K-producing bacteria
Amiodarone Inhibits CYP2C9
Clinical Presentation
o History
• Degree of anticoagulation.
• History of medications.
Physical Examination
• Pupillary response.
• Motor examination.
• Sensory examination.
Differential diagnosis
• Retroperitoneal hemorrhage.
• Hemothorax.
• Gastrointestinal bleeding.
• Hemopericardium.
• Compartment syndrome.
• Hematuria.
o Work up
• CBC
• Chemistry Panel.
• Coagulation profile.
• Urinalysis.
o Imaging
According to presentation and possible complications.
o Management
o Prehospital Care:
o In hospital care:
• FFP.
• PCC or rFVIIa*.
o If no bleeding:
INR = 3 to < 5
INR = 5 to < 9
2. Recheck INR
INR = ≥ 9
• FFP.
• PCC or rFVIIa*.
• Repeat CT scan.
• Correct INR
o Disposition
Chapter
6
ENDOCRINOLOGY AND
ELECTROLYTE EMERGRNCY
Overview
Clinical Presentation
o History
• Generalized weakness.
• Flaccid paralysis.
• Respiratory difficulty.
• Gastrointestinal complaints.
• Kidney disease.
• Endocrine disease.
• Recent trauma.
Physical Examination
Renal • Polyuria
Differential Diagnosis
• Diabetes.
• Myocardial infarction.
• Stroke.
• Viral illnesses.
• Myasthenia gravis.
• Botulism.
• Polyneuropathies.
• Cataplexy.
o Work up
• ECG.
• Urine studies.
o Electrocardiogram in Hypokalemia
• Flattened T-waves.
• ST-segment depression.
• U-waves.
o Electrocardiogram in Hyperkalemia
• Peaked T-wave.
• Flattened P-wave.
• Prolonged PR interval.
• Absent P-wave.
• Wide QRS.
• Sine-wave pattern.
Management
o Prehospital Care:
In hospital care:
Management of Hypokalemia
Management of Hyperkalemia
o Absent P-waves.
o Broad QRS.
o Sine wave.
o Bradycardia.
o Ventricular tachycardia.
Start:
• Commence ACLS®
• Consider hemodialysis.
Disposition
• Hypokalemic patients:
• Hyperkalemic patients:
Diabetic Emergencies
Overview
(depends on
underlying
conditions)
Dehydra- Severe Profound
tion
Clinical Presentation
History
• Polyuria.
• Polydipsia.
• Polyphagia.
• Weight loss.
• Abdominal pain.
• Hyperventilation.
Physical Examination
• Sunken eyes.
• Febrile.
Work up
• CBC.
• Full Chemistry.
• VBG’S.
• Serum Glucose.
• Serum Ketones.
• Serum Osmolality.
Management
Prehospital Care:
• Primarily supportive.
• Diabetic Ketoacidosis
Fluids:
Insulin:
Bicarbonate:
Potassium:
• Hold K.
-K 3.3-5.5 mEq/L
• Hold insulin.
• Give K (40 mEq in adults) per hour until K > 3.3 mEq/L.
Careful Monitoring:
• IV fluids—every hour.
Disposition
• hemodynamic instability;
Overview
Clinical Presentation
o History
• Thyroid manipulation?
• Medication changes?
• Recent anesthesia?
• Infectious syndromes?
Menstrual irregularity?
Physical Examination
• Febrile.
• Tremulous.
• Weakness.
• Weight loss.
• Palpitations.
• Skin changes.
• Hypothermia.
• Nonpitting edema.
• Weight gain.
• Hypoglycemia.
• Hypoxia.
• Sepsis.
• Encephalitis/meningitis.
• Hypertensive encephalopathy.
• Alcohol withdrawal.
• Benzodiazepine/barbiturate withdrawal.
• Opioid withdrawal.
• Heat stroke.
• Hypoglycemia
• Hypoxia
• Sepsis
• Cerebrovascular accident
• Intracranial hemorrhage
• Panhypopituitarism
• Adrenal insufficiency
• Hyponatremia
• Gastrointestinal bleeding
• Conversion disorder
o Work up
• Full chemistry.
• Cardiac markers.
• Urinalysis.
• Electrocardiogram.
• Chest Radiography.
• Echocardiography.
Management
o Prehospital Care:
• Vital Sign’s.
In hospital care:
• Empiric glucocorticoids.
Thyroid Storm:
Disposition
Chapter
7
UROLOGICAL
EMERGECY
Clinical Presentation
o History
• Localizing myalgia.
• Muscle stiffness.
• Cramping, swelling.
• Tea-colored urine.
Physical Examination
• Extremity swelling.
• Tenderness.
• Motor weakness.
• Sensory deficits.
Differential diagnosis
o Work up
• Electrolyte evaluation.
• Electrocardiogram (ECG).
Management
o Prehospital Care:
• Rapid recognition.
o In hospital care:
CK < 1000
• Repeat CK in 8 hours
• Recheck CK periodically
CK > 5000
Disposition
Women Men
• Obstructive Causes • Obstructive Causes
Cystocele BPH
Phimosis/ paraphimosis
• Operative causes
Clinical Presentation
History
• Medications.
• Chemical exposure.
Physical Examination
• Enlarged prostate.
Differential diagnosis
• Bladder calculi.
• Bladder clots.
• Meatal stenosis.
• Neurogenic etiologies.
• Paraphimosis.
• Penile trauma.
• Phimosis.
• Prostate cancer.
• Prostatitis.
• Urethral inflammation.
• Urethral strictures.
o Work up
• CBC.
• Renal ultrasound.
Management
o Prehospital Care
• Alleviating pain.
• Correcting hypovolemia.
In hospital care
Disposition
Chapter
8
TRAUMA AND
ENVIRONMENTAL
o Classification:
The most commonly used method for grading the severity of brain
injury is the Glasgow Coma Score (GCS).
1=none posturing
1=none
Clinical Presentation
o History
AMPLE history:
• A- Allergies.
• M- Medications.
• L- Last meal.
• Mechanism of injury.
• Nausea.
• Vomiting.
• Visual difficulty.
Physical Examination
• Neurological examination.
• GCS.
• Pupillary examination.
Differential diagnosis
• Acute Stroke.
• Cerebral Aneurysms.
• Hydrocephalus.
• Prion-Related Diseases.
• Subarachnoid Hemorrhage.
• Subdural Empyema.
• Subdural Hematoma.
• Tonic-Clonic Seizures.
o Work up
• CBC.
• Chemistry profile.
• Coagulation profile.
• ABG.
• Electrocardiogram (ECG).
• Non-contrast CT scan.
Management
o Prehospital Care
• A-B-C-D assessment.
• Degree of disability.
• GCS.
• Oxygen saturation.
• Blood glucose.
• Supplemental oxygen
In hospital care:
• Airway.
• Breathing.
• Fluid Resuscitation.
• Intracranial Pressure Monitoring.
• Medical Therapy for Increased ICP: mannitol 0.25 mg - 1.0
mg/kg.
• Anticonvulsants: phenytoin or fosphenytoin (20 mg/kg or 20
phenytoin equivalents/kg respectively.
Disposition
Alert
• Persistent headache.
Electrical Injuries
Overview
Clinical Presentation
o History
Physical Examination
evidence of ischemia
History of No Yes
loss of con-
sciousness
Type of injury Low-voltage (≤ 1000 High-voltage (> 1000
)volts )volts
Differential Diagnosis
• Chemical burn.
• Ocular burn.
• Thermal burn.
• Intracranial hemorrhage.
• Lightning Injuries.
• Respiratory arrest.
• Rhabdomyolysis.
• Seizures.
• Status Epilepticus.
• Syncope.
• Ventricular Fibrillation.
o Work up
• Electrocardiogram.
• CBC.
• FULL CHEMISTRY.
• CK levels.
Management
o Prehospital Care
Cutaneous Injuries
• Tetanus immunization.
Myoglobinuria
Disposition
• ICU admition.
Heat Injuries
Overview
Clinical Presentation
o History
• Medications.
Physical Examination
• Tachycardia.
• Hypotension.
• Mental status.
• Hydration status.
Differential Diagnosis
• Delirium Tremens.
• Diabetic Ketoacidosis.
• Encephalopathy, Hepatic.
• Encephalopathy, Uremic.
• Hyperthyroidism.
• Meningitis.
• Tetanus.
• Toxicity, Cocaine.
• Toxicity, Phencyclidine.
• Toxicity, Salicylate.
o Work up
• CBC
• Serum Chemistries
• Chest radiograph
• Electrocardiogram (ECG).
• Echocardiography.
Management
o Prehospital Care
• Manual fanning.
In hospital care:
o Heat stroke:
if goal is reached:
• Extracorporeal circuits.
Disposition
Chapter
9
MEDICATIONS LIST
Antiplatelet drugs:
Opioid Analgesic:
Fibrinolytic drugs:
Anticoagulants:
Antiarrhythmic drugs:
Bradydysrhythmias
Hypertension
- Fenoldopam Vial 20 mg / 2 ml
mesylate
544101790 Labetalol hy- Ampole or 5mg/ml –
drochloride Vial 100mg/20ml
544054214 Esmolol hy- Ampoule or 100 mg
drochloride Vial
544104750 Phentolamine Ampoule or 10 mg
Vial
544071450 Hydrochloro- Tablet 25 mg
thiazide
544101747 Lisinopril 10 mg
544101746 Enalapril 10 mg
544101740 Captopril 25 mg
544101745 Perindopril Tablets 4-5 mg
544101738 Fosinopril 10 mg
544101749 Losartan 50 mg
544101750 Valsartan 80 mg
544101757 Irbesartan 150 mg
544101760 Telmisartan Tablet 80 mg
544051207 Metoprolol 50 mg
544051201 Propranolol 10 mg
544051205 Propranolol 40 mg
544051173 Atenolol Tablet 50 mg
544051171 Atenolol 100 mg
544101795 Labetolol 100 mg
544051172 Carvidolol 6.25 mg
544051206 Bisoprolol 2.5 mg
544051180 Carvidolol 25 mg
544051203 Bisoprolol 5 mg
544051208 Metoprolol 50 mg
544051253 Satolol HCL 80 mg
Tablet
544031110 Diltiazem 60 mg
544031112 Diltiazem 90 mg
544031105 )(SR 30 mg
544031120 Nimodipine Tablet 40 mg
544031125 Verapamil 80 mg
544031126 Verapamil 120 mg
Verapamil
544101703 Clonidine Tablet 100 mcg
544101725 Hydralazine Tablet 25 mg
Acute Headache
- Dihydroergotamine Ampoule -
545034510 Chlorpromazine Ampoule 25 mg
- Prochlorperazine - -
540014255 2 gm
540014253 Cefixime Susspension 100 mg/
5 ml
540014135 Ampicillin Vial 500 mg
Sodium
540014140 1 gm
Anticoagulation Emergencies
Diabetic Emergencies
Refrences
Authors
Abdul-Aziz Al-Shotairy
Clinical Pharmacist
King Saud Hospital
Ministry of Health
Jeddah, Saudi Arabia
218
MOH Pocket Manual in Emergency
Illustrations
Reviewed by:
219
M.O.H
DRUG LIST
ALPHAPITICAL
DRUG INDEX
MOH Pocket Manual in General Surgery
atorvastatin carbimazole
carboplatin cyclophosphamide
carboprost tromethamine cycloserine
carboxymethyl-cellulose cyclosporine
carmustine cyprotone acetate + ethinyl estradiol
carteolol hcl cytarabine for injection
carvedilol )D(
caspofungin acetate dabigatran
cafaclor dacarbazine
cefepime hydrochloride dactinomycin
cefixime dalteparin
cefixime sodium danazol
ceftazidime pentahydrate dantrolene sodium
ceftriaxone sodium dapsone
cefuroxime darunavir
celecoxib dasatinib monohydrate
cephalexin monohydrate daunorubicin hcl
cephradine desmopressin acetate
cetuximab dexamethasone
chloral hydrate Dextran (dextran40) + sodium chlorid
chlorambcil dextromethorphan
chloramphenicol dextrose
chlordiazepoxide hcl diazepam
chlorhexidine gluconate diazoxide
chloroquine diclofenac
chlorpheniramine maleate didanosine
chlorpromazine hcl diethylcarbamazine citrate
chlorthalidone digoxin
dihydralazine mesilate or hydralazine
chlorzoxazone
hcl
)cholecalciferol (vitamine d3 diloxanide furoate
cholestyramine )diltiazem hcl (sustainad release
cincalcet hydrochloride dimenhydrinate
cinnararizine dinoprostone
ciprofloxacin diphenhydramine hcl
cispltin )diphetheria,tetanus,pertussis (dpt
citalopam hydrobromide diphetheria,tetanus vaccine for adult
diphetheria,tetanus vaccine for
clarithromycin
children
clindamycin diphetheria antitoxine
cyclophosphamide carboplatin
cycloserine carboprost tromethamine
cyclosporine carboxymethyl-cellulose
cyprotone acetate + ethinyl estradiol carmustine
cytarabine for injection carteolol hcl
(D) carvedilol
dabigatran caspofungin acetate
dacarbazine cafaclor
dactinomycin cefepime hydrochloride
dalteparin cefixime
danazol cefixime sodium
dantrolene sodium ceftazidime pentahydrate
dapsone ceftriaxone sodium
darunavir cefuroxime
dasatinib monohydrate celecoxib
daunorubicin hcl cephalexin monohydrate
desmopressin acetate cephradine
dexamethasone cetuximab
Dextran (dextran40) + sodium chlo-
chloral hydrate
rid
dextromethorphan chlorambcil
dextrose chloramphenicol
diazepam chlordiazepoxide hcl
diazoxide chlorhexidine gluconate
diclofenac chloroquine
didanosine chlorpheniramine maleate
diethylcarbamazine citrate chlorpromazine hcl
digoxin chlorthalidone
dihydralazine mesilate or hydralazine
chlorzoxazone
hcl
corticorelin (corticotrophin-releasing
edrophonium chloride
factor,crf)
efavirenz cromoglycate sodium
electrolyte oral rehydration salt (ors) cyanocobalmin (vit b12)
emtricitabine cyclopentolate hcl
tropicamide vigabatrin
valsartan (Z)
vinorelbine
vitamine B complex
vitamine E
voriconazole
Authors
Illustration