Medical Emergencies

1. Medical Emergencies Dr. BanushreePhysician

2. Medical Emergencies • large volumes surgeries are being done on patients with complicated / multi systemic problems • Fear of retrobulbar block • Problems due to draping

3. Clinical Scenario Case 1 • A 25 year old female operated for Cataract surgery is taken for post operative check up. As soon as she sits infront of the slit lamp she becomes unconscious. Pulse is feeble. What is your diagnosis and how will you manage this patient

4. Syncope • Brief period of unconsciousness due to reversible disturbances in cerebral function Causes: • Vasovagal • Due to pain, anxiety, fear • Common in young people • Sitting and standing position • Has prodromal symptoms • Treatment • Supine position

5. Cardiac: • Heart block • Tachy arrhythmias • Organic Heart diseases – Aortic Stenosis • Cerebal vascular disease • Postural Syncope • Hypoglycemia • Cough/Micturition syncope • Hyper ventilation

6. Case 2 • 50 year old diabetic Female is taken for fluroscein angiogram. After FFA patient complains of generalised itching, develops breathlessness, swelling of lips and fall in blood pressure. What is your diagnosis? Drug of Choice?

7. Anaphylaxis Anaphylactoid (Director mediator release) - Contrast dyes - NSAIDS - Salicylates • Anaphylatic (IGE) • Pencillin • Bee stings • Local anaesthetics

8. Clinical features • Mild - Uticaria, Vomiting • Severe - Hypotension, Angioedema, Laryngospasm

9. Treatment: • Mild – Antihistamines • Severe – Airway maintenance Drug of choice – Adrenaline • 0.3 – 0.5ml of 1:1000 Solution SC or IM • Volume expansion • Antihistamines – diphenhydramine 25-50mg oral or IM 16th hourly

10. Steroids – only to prevent recurrence: • Hydrocortisone 100mg 8th hourly • Bronchospasm – Salbutmol nebuilization • Refractory / beta blocker patients – treatment with glucagon • Repeat radio contrast studies in sensitive individual can be done only under steroids cover

11. Case 3 • 60 year old diabetic comes to the OP while you are examining him he has profuse sweating and looks disoriented. • What is the investigation you would like to do? • What is your line of treatment?

12. Insulin induced Hypoglycemia OHA Hypoglycemia • Blood sugar < 60mgms • Precipitating factors •  Food intake •  Drug dosage •  Physical activity

14. Signs • Tachycardia • Moist skin Treatment • Conscious patient – sugar containing fluids • Unconscious / severe hypoglycemia – 25- 50ml of 50% or 25% dextrose • Maintenance with 10% dextrose drip

15. Case 4 • Middle aged hypertensive female patient is taken for cataract surgery. Pre-operative BP is normal. Surgery is started patient complains of breathlessness, starts coughing & tries to set up. How will you manage this patient?

16. Cardiogenic  Pulm. Venous pressure – mitral stenosis Acclerated hypertension Non – Cardiogenic Acute ARDS Infection, Toxins Lymphatic Insuffiency Neurogenic pulmoary edema Actue Pulmonary Edema

17. Precipitating Factors • Infections • Tachy arrhythmias • Electrolyte disturbances • Clinical Features • Symptoms • Sudden cough •  Sweating • Pink frothy sputum

18. Signs • Dyspneic • Tachycardia • BP • Bilateral coarse creps Treatment • O2 supplementation – 100% • Sitting position –  venous return • Sedation – inj. Morphine 2-5 mg IV

19. IV diuretics – inj.Lasix 40 – 200mg • Blood pressure– IV Nitroglycerin drip 20 – 30 micrograms / min • Aminophylline to reduce broncho constriction

20. Thank You