Todays guest speaker 2 Case 1 History A 19-year old male is - - PowerPoint PPT Presentation

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Todays guest speaker 2 Case 1 History A 19-year old male is - - PowerPoint PPT Presentation

Nov 06, 2022 128 likes •309 views

Todays guest speaker 2 Case 1 History A 19-year old male is dropped off at the ambulance ramp outside the emergency department actively bleeding. He is brought into the resuscitation room on a trolley. He has rapid shallow breathing and is

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Today’s guest speaker

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History

A 19-year old male is dropped off at the ambulance ramp

  • utside the emergency department actively bleeding.

He is brought into the resuscitation room on a trolley. He has rapid shallow breathing and is semi- conscious.

Initial observations

HR 140, BP non-recordable, RR 40

ABCDE assessment: stab wound anterior to the chest Our next steps

  • Adult Trauma team activated
  • Major Haemorrhage Protocol activated

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Case 1

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  • Cardiac arrest – ALS algorithm initiated
  • Anaesthetic Registrar intubated the patient
  • Cardiothoracic Registrar in attendance
  • Decision to perform emergency thoracotomy
  • ‘O’ neg blood transfused along with fresh frozen

plasma and platelets.

  • Clam shell thoracotomy done
  • Internal

defibrillation performed along with internal cardiac massage

  • Descending Thoracic Aorta clamped

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What happened next…

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What happened next…

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Indications? Types?

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Emergency thoracotomy

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Clamshell thoracotomy

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Left anterolateral thoracotomy

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History

A 22 year-old male is brought to the emergency department by ambulance. He was found in a night club semi-conscious, hot and sweaty.

ABCDE assessment

GCS E1 V1 M4: increased muscle tone and rigidity Pupils bilaterally 5+

Observations

HR 130, BP 180/120, RR 8, Temp 40

Our next steps

Decision to intubate to protect airway

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Case 2

VBG results pH 7.0 (7.35-7.45) HCO3 (mmol/L) 8 (23-29) K (mmol/L) 8.1 (3.5-5.2)

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  • Active cooling methods initiated
  • Treatment of hyperkalaemia- calcium gluconate and insulin/dextrose
  • Urinary catheterisation and NG tube inserted
  • Cyproheptadine 12mg and sodium bicarbonate given
  • Vascath inserted for urgent haemodialysis
  • Patient transferred to critical care

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What happened next…

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Drug Drug-induc induced d hy hyperpyrexia

  • Drugs?
  • Serotonin syndrome?

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Management

  • Removal of precipitating drugs
  • Provision of supportive care
  • Control of agitation – diazepam
  • The administration of 5HT antagonists – cyproheptadine
  • Control of autonomic instability
  • Control of hyperthermia
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Recap

  • Basics of emergency thoracotomy
  • Importance of ABCDE assessment
  • Drug-induced hyperpyrexia
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Further reading

  • www.RCEMlearning.co.uk
  • www.LITFL.com
  • www.toxbase.org
  • ATLS – www.rcseng.ac.uk
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References

1. Own work by DiverDave (talk) (Transfered by PhilippN/Original uploaded by DiverDave) / CC BY (https://creativecommons.org/licenses/by/3.0)

  • 2. Cothren and Moore; licensee BioMed Central Ltd. / CC BY (https://creativecommons.org/licenses/by/2.0)
  • 3. Saltanat ebli / CC0
  • 4. Mikael Häggström / Public domain
  • 5. Tonyliepert / CC BY-SA (https://creativecommons.org/licenses/by-sa/3.0)
  • 6. James Heilman, MD / CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0)

7. Saltanat ebli / CC0

  • 8. Cancer Research UK / CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0)
  • 9. Stefan Bellini / CC0
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