By Anthony F. T. Brown
The 6th variation of this overseas bestselling emergency drugs guide has been thoroughly redesigned, revised and extended to incorporate the very most modern evidence-based instructions for interns, SHOs and junior medical professionals who're new to the emergency care surroundings. The textual content follows a logical, commonplace, transparent and good set out strategy designed to maximise the sensible supply of care on the bedside.
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Additional info for Emergency Medicine: Diagnosis and Management
3 Causes of non-haemorrhagic shock from fluid loss include: (i) External: (a) vomiting, diarrhoea, polyuria from renal disease, diabetes insipidus or diabetes mellitus, burns, extensive skin disease including erythroderma, hyperthermia, fistulae. Critical Care Emergencies 19 SHOCKED PATIENT (ii) Internal: (a) pancreatitis ‘third spacing’, bowel obstruction. 4 Ask about external bleeding, previous episodes of bleeding, chest, abdominal or back pain, drugs taken including non-steroidal anti-inflammatory drugs (NSAIDs) or warfarin, allergies, alcohol use and travel abroad.
Confusion, oliguria, raised lactate). (iv) Septic shock Subset of severe sepsis with sepsis-induced hypotension (SBP <90 mmHg), or hypoperfusion abnormality such as lactate ≥4 mmol/L persisting despite adequate fluid resuscitation (20–30 mL/kg). 3 Initial symptoms are non-specific and include malaise, fever or rigors, myalgia, nausea or vomiting and lethargy. (i) Ask specifically about focal features such as headache, neck pain, sore throat, ear ache, cough, breathlessness, abdominal pain, frequency, dysuria, joint or skin changes.
I) Resume CPR if the pulse is absent or difficult to feel. (ii) Begin post-resuscitation care when a strong pulse is felt, or the patient shows signs of life suggesting ROSC. See page 11. v. access (c) review all potentially reversible causes. See the ‘4 Hs’ and the ‘4 Ts’ below (Section 7). ✓ Tip: if venous access is impossible, insert an intraosseous cannula, particularly in children (see p. 480). v. after the third shock, repeated once at a dose of 150 mg for recurrent or refractory VF/VT. v.