CME : Your SA Journal of CPD - Volume 25, Issue 3, 2007
Volume 25, Issue 3, 2007
Author E.B. KramerSource: CME : Your SA Journal of CPD 25, pp 106 –109 (2007)More Less
The emergency care of morbidly obese acutely ill or injured patients presents special problems both outside and inside the hospital emergency department.
Adequate preparation is required in order to provide adequate care.
Position the morbidly obese patient in the semi-Fowler's or reverse Trendelenburg position at 45º to protect the airway.
Always administer high-flow, high-concentration oxygen to all morbidly obese patients, as they are chronically hypoxic.
Use the 2-person, 4-handed technique during manual bag / valve / mask ventilation.
Use adequately sized cuffs when attempting blood pressure measurements.
Plan intravenous access carefully and use appropriate size needles and cannulas to ensure success and prevent repeated attempts.
Radiological and surgical specialist advice may be necessary for diagnostic procedures that cannot accommodate the patient owing to physical limitations.
Use ideal body weight or adjusted body weight measurements when calculating most emergency dosages and titrate where necessary.
Do not be afraid to ask for advice when necessary.
Author Pat SaffySource: CME : Your SA Journal of CPD 25, pp 110 –113 (2007)More Less
Airway management is the first priority of resuscitation.
Preparation of equipment, training of staff and anticipation of problems will improve management of the patient with a difficult airway.
The flow diagram, as prepared by the Resuscitation Council of Southern Africa and endorsed by Emergency Medicine Society of South Africa, is an easy-to-remember algorithm for airway management.
Aim to achieve oxygenation and then ventilation of the patient via the safest, most effective method available.
Author Charl Van LoggerenbergSource: CME : Your SA Journal of CPD 25, pp 114 –117 (2007)More Less
The ABCs of resuscitation are paramount.
The pursuit of the identity of the toxin should not take precedence over the resuscitation.
Always have access to various poison reference tools.
Facilitate rapid and safe evacuation of potentially harmful toxins.
Source: CME : Your SA Journal of CPD 25, pp 118 –122 (2007)More Less
An increasing number of patients need to be managed in emergency departments worldwide.
The situation in South Africa is exacerbated by HIV and trauma epidemics.
Mechanical ventilation is an important facet of critical care provided in emergency departments.
Indications for mechanical ventilation include failure to breathe in spite of normal lungs and poor gas exchange due to sick lungs.
Each physician should be familiar with the basic modes of ventilation that can be used in emergency units.
The goals of ventilation include oxygenation, lung protection, reduced work of breathing, acid-base balance and that the patient should be comfortable on the ventilator.
Separate ventilation strategies exist for patients with normal lungs, patients with outflow obstruction such as COPD and asthma, and patients with lung infiltrates such as ARDS and pneumonia.
Never ignore a ventilator alarm sounding - it exists for a good reason.
Mechanical ventilation can be discontinued when the patient is stable and the condition necessitating ventilation has been reversed.
Source: CME : Your SA Journal of CPD 25, pp 124 –126 (2007)More Less
High-quality CPR is achieved by:
- pushing hard (½ the depth of the chest)
- pushing fast (almost 2 compressions per second)
- allowing full chest recoil after each compression
- minimising interruptions in chest compressions
- avoiding hyperventilation.
Author Charl J. Van LoggerenbergSource: CME : Your SA Journal of CPD 25, pp 128 –133 (2007)More Less
The emergency doctor is often first in the line of fire in dealing with the medical, surgical and psychiatric consequences of chemical substance abuse.
Supportive management will adequately deal with the bulk of illicit substance overdoses, with meticulous attention to the ABCs.
Common confounding variables to the well-delineated clinical pictures described include polypharmacy and alcohol.
Management should include referral to appropriate rehabilitation agencies once the patient is stable.