Emergency - sudden, life threatening Acute biologic crisis + Requires immediate treatment + Prioritize - Trianging - "sort" Airway Breathing Circulation + Utilitarianism - greatest good for the greatest number of people Hospital 1. Red - Emergent - death less than an hour 2. Yellow - Urgent - may survive greater than 1 hour 3. Green - Delayed - simple management and simple first aid Community 1. Red - Emergent - high chance of survival; less resources needed 2. Yellow - Delayed/ Non-urgent - management can be delayed for 1 hour 3. Green - Hysterical/ Walking wounded 4. Black - Expectant - near death/dying} S.T.A.R.T - SIMPLE TRIAGE AND RAPID TREATMENT Airway - obstruction - foreign object - aspiration/asphyxiation >Choking - hands are clenched on neck >Heimlich Maneuver - between xiphoid proces and umbilicus- bronchospasm - asthma - allergies >mast cells from basophil Asthma management - beta 2 agonist Status Asthmaticus/Anaphylaxis - unrelieved by traditional bronchodilators; drug of choice: epinephrine - mucus obstruction - infection - chronic bronchitis - autosomal recessive (25%) - cystic fibrosis Cystic fibrosis management - bronchodilators - "cysteine" >Vitex Negundo - Lagundi - Ascof (asthma cough fever) - mucolytics - CPT - chest physiotherapy - auscultate - crackles (inspiration) and rhonchi (expiration) moderate pitch, popping, rumbling - bronchospasm - stridor (inspiration; UAO) and wheeze (expiration; LAO) high pitch musical - laryngospasm - decreased electrolyte - hypocalcemia Hypocalcemia management - tracheostomy set - Calcium gluconate IV - antidote: Mg SO* - Early sign: Tingling/Tetany - lips and earlobes - communicable disease - rabies (99%) - tracheostomy - Immunoglobulin given first before vaccine; DPT vax Airway Maneuvers - Head tilt chin lift- Jaw thrust - safe for spinal cord injury; rule out neck management SNS + Alpha - smooth muscle - blood vessel - central - dilate - peripheral - constrict + Beta - beta 1 - heart - increased heart rate - beta 2 - bronchodilator Beta Blocker/Antagonist Beta Adrenergics/Agonist Caution in patients with respiratory condition Breathing - problems associated with ventilation >Inhale - O? in >Exhale - CO out Problem with inhalation - decreased O? - blood: hypoxemia - tissues: hypoxia - End result: organ damage Problem with exhalation - increased CO - hypercapnia - End result: Respiratory acidosis - cardiac arrest, coma Atelectasis - lung collapse - pneumothorax - respiratory distress syndrome - infection - PTB, pneumonia Management - mechanical ventilator - PEEP (Positive End Expiratory Pressure) - this reverses alveoli collapse Diaphragmatic weakness/paralysis - CNS failure - C4 phrenic - spinal cord injury (cervical) - problem with breathing - autoimmune disorder - GBS, MG, ALS- trauma - penetration/ blunt Management - mechanical ventilator Metabolic - metabolic acidosis - DM 1/DM 2 - DKA DM 1 - juvenile DM - <30 y/o - heredity - autoimmune - IDDM DM 2 - >30 y/o - sedentary lifestyle - metabolic - Cushing's - GDM - HPL - insulin resistance - NIDDM DKA - Kussmaul's respirations - decreased pH - dehydration - PNSS Emphysema - hereditary, smoking, infection, pollution - irreversible - chronic emphysema, COPD - loss of elastic recoil - overinflated alveoli - CO? ventilation - acidosis Circulation - perfusion (gas exchange) Requirements - blood - hypovolemic - heart - cardiogenic/cardiac arrest - blood vessels - distributive - lungs - pulmonary embolism - obstructive Hypovolemic - causes: >decreased RBC - anemia >Decreased plasma - dehydration >Blood loss - hemorrhageTranexamic Acid (Hemostan) - for hemorrhage Pernicious anemia - only anemia that involves neurologic function Dehydration - vomiting, diarrhea, hyperhydrosis Addisonian crisis - decreased in sugar, salt, sex - adrenal insufficiency - low cortisol & aldosterone - low Na, high K - dehydration - NSS - Isotonic Aldosterone function - Na retention, K excretion Cortisol function - stress hormone, increases sugar in the bloodstream, maintain BP Heart - pump Problem - cardiac arrest - no pulse, no breathing - priority: CAB - ASAP: >CPR - 100 - 120 compression >cardiac monitor - determine the type of rhythm - causes: >MI - clots, obstruction - thrombolytics are given to dissolve clots within 6hrs - substernal pain, radiates to the left jaw, arm, shoulder - pain reliever: opioid >heart failure >trauma >electrolyte (potassium) 3.5 - 5.5 >endocrine - elevated T3 - hyperthyroidism: risk forthyroid storm, tachycardia; given beta blockers - decreased T3 - hypothyroidism: bradycardia, coma; given atropine Cardiac Monitor + Shockable - defibrillation (280 - 365J) - pVeTach & VeTach - Amiodarone - drug of choice for VeTach - given every after 3 shocks (200 - 300J) + Non-shockable - PEA (Pulseless Electrical Activity) - Asystole - epinephrine given every 3-5mins during resuscitation Blood vessels - massive vasodilation Distributive shock - allergy - anaphylaxis (anaphylactic shock) - bronchospams & vasodilation - drug of choice: epinephrine - bronchodilator, peripheral vasoconstriction - infection - bacterial (septic shock) - cytokine storm - antibiotics - antivirals - corticosteroids - neurogenic shock - vasodilation of the lower extremities - modified trendelenburg Obstructive shock - pulmonary embolism - emboli from the right side of the heart - venous clot/DVT- DVT - Homans sign - calf pain on dorsiflexion; increased circumference of one leg + pain Thrombolytics - Dobutamine - Dopamine Oncology - cancer - neoplasia - "new growth of cells" - tmetastasis; invasive Hyperplasia - increased number of cells Hypertrophy - increased in size Dysplasia - abnormal cell growth Cancer - no cure - DNA disorder - genes - oncogenes WBC - lymphocytes - T cells - supresses oncogenes CD8 - cytokine - apoptosis/cell death RBC - 120 days Cell Growth Benign - no metastasis - well differentiated - encapsulated - respects cellular boundaries - cysts Malignant - has metastasis - poorly differentiated - not encapsulated - no respect to cellular boundaries - tumor Prevention Early detection - screening tests - suspect CA growth - confirm: biopsyBSE - 7 days after menstruation - Post menopausal - same day a month - upper outer quadrant - group of lymph nodes (Tail of Spence)