Emergency Medicine: Best Practices at CMC (EMAC) KPP Abhilash
INDEX
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer to table.
A
ABCD2 score 185t
Abdomen
examination of 333
ultrasonography 310
Abdominal aortic aneurysm 325
clinical presentation 325
diagnosis 325
management 325
Abdominal injury 347
Abdominal pain 490
acute 304
in adults, causes of acute 304t
Abdominal tenderness, lower 268
Abscess 37, 303
Absolute neutrophil count 229
Acalculous cholecystitis 309
Accessory muscles 386
Acenocoumarol 236
Acetaminophen 107, 108
Acid-base
abnormalities 62
disturbances 57
causes of 64fc
problems 62
Acquired clotting disorders 242
Acquired coagulation disorders 241
Acquired hemolytic anemias 225
Acquired methemoglobinemia, precipitating agents of 136t
Acquired platelet defects 240
Activated charcoal 106, 399
contraindications for 106
Acute appendicitis 306, 307, 307t
clinical manifestations 306
investigations 307
management 308
physical examination 306
Acute asthma 385
classification of 167
management of 169, 386
mild-to-moderate 386
moderate-to-severe 386
Acute attack, treatment of 203
Acute cholangitis 221
clinical features 221
investigations 221
management 222
Acute cholecystitis 70, 309
history 310
investigations 310
management 310
physical examination 310
Acute coronary syndromes, spectrum of 139fc
Acute deep vein thrombosis
clinical features 327
investigations 327
management 327
risk factors for 327
Acute gastroenteritis 69, 88, 396
in children 396
management 397
Acute hepatic encephalopathy, management of 219
Acute intoxication, management of 128, 129
Acute limb ischemia 326
clinical features 326
examination 326
investigations 326
management 326
Acute otitis externa 395
etiology 395
signs 395
symptoms 395
treatment 395
Acute otitis media 394
etiology 394
management 394
Acute pancreatitis 215, 489
classification of 215
etiology of 215
initial management 216
investigations 216
severity of 215t
Acute red eye, management of 447t
Acute scrotal pain in adults, differential diagnosis for 294
Acute watery diarrhea, management of 397t
Acyclovir 71, 399, 453
Adenosine 17, 157, 158, 399
Adhesion formation 270
Adrenal disease, primary 254
Adrenal hormones 253
Adrenal insufficiency 253
causes 253
clinical symptoms 254
diagnosis 254
primary 253
secondary 253
treatment 254
Adrenaline 16, 19, 32, 399, 405
infusion 35
nebulizations 280
Adrogue-Madias formula 53
Adult basic life support algorithm 11fc
Adult bradycardia algorithm 20fc
Adult tachycardia algorithm 23fc
Advanced airway 23
Advanced cardiac life support 1, 15
Aedes aegypti disease 73
Air under diaphragm 305f
Airway 25, 378, 423
adjuncts 378
adjuncts, basic 8, 8f
assessment of 38
management 38
in emergency department 38
maneuvers 7
Albendazole 69, 227, 399, 453
Albumin 50
Alcohol withdrawal 441
management of 442
Alcohol-related emergencies 441
Alkaline phosphatase levels 310
Allegra 453
Allergic conjunctivitis 447
Allergic manifestations 468
Allergic reaction 27, 245
treatment of 469
Allis technique 364f
Aluminum 116
Amantadine 433
Amaurosis fugax 443
Amenorrhea
history of 263
period of 263
American Heart Association 3
Amikacin 102, 399, 453
Aminophylline 400
Amiodarone 16, 152, 158, 400
Amitriptyline 110, 203
Amlodipine 109, 147, 453
Amnesia 458
Amoxicillin 71, 99, 392, 400, 452
Amoxicillin-clavulanate 71, 81, 100, 280
Amphetamine 128
Ampicillin 99, 400, 452
Amputated part, preservation of 352
Anal fissure 322
treatment 323
Anaphylaxis 25, 27
diagnosis of 27t
management of 28
Androgens 253
Anemia 225, 226
cause of 226t
evaluation of 228fc
kinetic approach of cause of 225t
management 227
severe 78
Angina equivalents 140
Angina pectoris 139
Angiotensin-converting-enzyme inhibitor 55
Angiotensin-receptor blockers 55
Anicteric form 72
Animal insecticides 111
Animal reservoirs 84
Ankle 374
block 465
injection sites 468f
Ankylosing spondylitis 456
Ankylostoma 69
Anorectal abscess 323
intersphincteric 324
ischiorectal 324
management 324
perianal 324
submucosal 324
supralevator 324
symptoms 324
types of 324
Anorectal problems 322
Antacids 453
Antibiotic 28, 99t, 172, 280, 397
antimicrobial spectrum 99t
doses 99
protocol 69
therapy 37
indications for 217
Anticoagulants 115, 236
oral 236
parenteral 237
treatment 115
Anticoagulation, therapeutic goals of 237t
Antidotes, common specific 107t
Antiemetic agents 432
Antiepileptic 192, 453
drugs, doses of 199t
route and dose 384t
Antifibrinolytic therapy 193
Antihistamines 453
Antihypertensives 453
Anti-inflammatory drugs 321
Antiphospholipid syndrome 242
Antisnake venom 28, 121123
dose of 122
Anxiolysis 458
Aortic regurgitation, acute 161
Apathy 58
Aplastic crisis 234
Appendicitis, cases of 307
Arrhythmias 157
Artemether 453
Arterial blood gas 63, 490
Arteriovenous malformation 203
Arthritis
acute 455
reactive 456
Arthropod-borne disease 73
Ascaris 69
Ascites 74
Ascitic fluid 482, 483
acid-fast bacilli culture 483
albumin 483
creatinine 483
culture 483
cytology 483
lipase 483
triglyceride 483
Ascitic tap 482
indications 482
investigations 483
technique 482
Ascorbic acid 136
Aspiration, risk of 106
Aspirin 187
Asthma 46
acute exacerbation of 385
acute severe 167
classification of 385t
exacerbation 490
primary treatment of 387
life-threatening 167
mild 385t
moderate 385t
severe 385t
Asymptomatic bacteriuria 91
Atarax 403
Atenolol 454
Atovaquone 79
Atrial fibrillation 151, 160, 314
causes 151
clinical presentation 151
investigations 151
management 151
Atrial flutter 154, 154f, 156
clinical manifestations 154
electrocardiogram characteristics of 154, 155t
management 155
Atrioventricular block
first-degree 18f
third-degree 17, 19f
Atropine 17, 19, 20, 400
Attacks
mild-to-moderate 203
moderate-to-severe 203
Auditory meatus, external 395
Augmentin 452
Automated external defibrillator 5
Autonomic hyper-reactivity 97
Avil 394, 453
Azithromycin 69, 72, 77, 101, 400, 452
Azotemia 82
B
Bacillary dysentery 69
Bacillus cereus 88, 89
Baclofen 204
Bacteria 396
Bacterial conjunctivitis 447
Bacterial meningitis, acute 72
Bacterial rhinosinusitis, acute 71
Bacteriology 221
Bag-mask
two rescuers 10
ventilation 9, 10, 389
Barbiturates 108
Basic life support 1, 3, 11, 12
steps of 4, 4t
Bee sting 125
management 125
removal, technique of 125f
Bell's palsy 205
differential diagnosis for 205
management 205
Benadryl 207, 453
Benzathine 400
penicillin 71
Benzodiazepines 107, 108, 128, 129, 207, 433, 442
Benztropine 207
Bernard-Soulier syndrome 240
Beta-blocker 108, 147
Betadine solution 319, 320, 369
Bilevel positive airway pressure 42, 44
Biliary pancreatitis 216
Biphasic defibrillators 13
Bisphosphonates 57, 59
Bleeding
disorders 240
obvious 225
per vagina 265
causes 265
investigations 265
management 265
treatment 266
Blood
ammonia concentration 219
borne virus screen 213, 269, 273, 313, 351, 490
components 245
loss 225, 335, 335t
products 245
sugar, general random 259
volume lost 335
Blood pressure 35, 153
control 192
fluctuating 97
Blood transfusion 28, 245, 274
protocol 214
complications of 245
Bloody diarrhea 396
Body fluids 449
Bone cortex, penetration of posterior 475
Bone marrow
disorders 225
suppression 225
Bony cortex, incomplete penetration of 475
Bowel perforation 70
Bradyarrhythmias 17
management of 19
Bradycardia 157
rhythms 18t
Brain function, abnormalities in 94
Breath sounds 345
Breathing 377t, 378, 393, 423
Bromocriptine 433
Bronchial asthma 167
clinical features 167
investigations 168
Bronchiectasis 180
Bronchiolitis 391
Bronchitis
acute 71
chronic 171
Bronchodilators 28
Bronchogenic carcinoma 180
Bronchospasm 27
and obstruction, treat 172
Budd-Chiari syndrome 483
Bupivacaine 461, 468
Burns 436
back of trunk 436
by rule of 9, percentage of 436t
evaluation of
depth of 436t
extent of 436
front of trunk 436
head and neck 436
lower limbs 436
patient, arrival of 436
perineum 436
upper limbs 436
Buscopan 403
C
Calcium 57
channel blockers 109, 157
gluconate 400
Cannabis 128
Capillary refill time 335, 396
Carbamates 107, 113, 114
clinical features 113
management 113
Carbamazepine 106, 199, 204, 453
Carbapenems 317
Carbon monoxide
poisoning 133
severe 133
Cardiac arrest
algorithm 16fc
drugs used in 16t
recognition 3, 4
Cardiac conditions 391
Cardiac disease 180
underlying 151
Cardiac dysrhythmia 480
management of 469
Cardiac emergencies 137
Cardiac puncture 480
Cardiac tamponade 345
Cardiogenic shock 30
Cardio-protective effect 56
Cardiopulmonary resuscitation 3, 5
for adults 3
for children 11
for infants 12
Cardiovascular abnormalities 251
Cardiovascular bradycardia 111
Cardiovascular manifestations 468
Cardiovascular symptoms 249
Cardiovascular system 468
Cardioversion 12, 13t
Carotid massage 157
Carotid pulse check 5f
Casts 366
Catabolism 232
Catecholamine-secreting tumors 260
Cefalexin first generation oral 100
Cefazolin 71, 321, 401, 452
first generation IV 100
Cefixime 401
third generation oral 100
Cefoperazone 401
Cefoperazone-sulbactam 70, 99, 218
Cefotaxime 401
Ceftazidime 401, 452
third generation IV 100
Ceftriaxone 71, 72, 280, 392, 401, 452
third generation IV 100
Cefuroxime 401
Cell, malignant 483
Cellulitis 70, 301, 490
etiology 301
investigations 301
management 301
Centipede bite 125
management 125
Central bed management system 491
Central nervous system 131
dysfunction 429
infection 383
acute 94
manifestations 468
Central pontine myelinolysis 53
Central retinal
artery occlusion 443
vein occlusion 444
Central venous access 470
Cephalexin 70, 401, 452
Cerbera thevetia 118
Cerebral edema, delayed 193
Cerebral infarction 234
Cerebral venous thrombosis 189
clinical features 189
CT brain 190
diagnosis 190
management 190
MRI brain 190
risk factors 189
signs of 189
symptoms of 189
Cerebrospinal fluid 194
analysis 95
Cerebrovascular accidents 185, 490
investigations 186
Cervical collar in situ 340
Cervical motion tenderness 268
Cervical spine 340f, 373
Cetirizine 453
Chadsvasc score 153t
Chemical ocular injury 446
Chest
crisis 234
pain 146
wall movement 345
Chest compression 5, 6
in children, technique of 12f
technique of 12, 6f
Chest tube insertion 472
complications 473
bleeding 473
improper placement 473
infection 473
procedure 472
requirement 472
Chickenpox 71
Child's consciousness 377
Chlamydia trachomatis 268, 295
Chloramphenicol 70, 401
Chlorhexidine-based solution 479
Chloroquine 70, 453
Chlorpheniramine 394, 453
maleate 122
Chlorpromazine 207
Chlorpyrifos 111
Cholangitis 70
Cholecystectomy 310
Cholera 69
Cholestyramine 250
Chronic liver disease, decompensated 490
Chronotropic agent infusion 20
Chvostek's sign 58
Ciprofloxacin 69, 101, 401, 453
Circulation stroke, posterior 187
Cisplatin 57
Clavicle 373
Clavulanate 452
Clavulanic acid 400
Cleistanthus collinus 119
Clindamycin 71, 81, 102, 401, 453
Clobazam 199, 401, 453
Clonidine 106
Clopidogrel 187
Clostridial myonecrosis 316
Clostridium perfringens 88
Clostridium species 316
Clotting disorders 240
Cloxacillin 70, 71, 99, 320, 321, 402
Co-amoxiclav 392
Cocaine 129
Colchicine 106
Colles fracture 353
reduction of 353f
reduction technique 353
Colloid 50
Coma 271, 434
Combustion, gas products of 133
Commence bimanual massage 274
Common drug overdose, management of 108t
Common snakes in India and syndromes 121t
Common thoracic injuries, management of 345t
Community-acquired pneumonia 80
antibiotic management of 81t
clinical features 80
etiology 80
setting of care 81
Compartment syndrome 371
causes of 371
common sites 372
diagnosis 372
investigations 372
signs of 371
symptoms of 371
treatment 372
Complete blood count 74, 198, 213, 313
Complete heart block 19f
Complex febrile seizures 383
Compression depth 11
Compression technique 11
Compression-ventilation ratio 11
Confusion 58
Congenital platelet disorders 240
Conjunctival foreign body 447
Conjunctivitis 446
Consciousness 377t
impaired 78
Continuous positive airway pressure 44, 150
Control blood pressure 278
Copper sulfate 109
Coronary syndrome, acute 139, 490
Coronary vessel injury 480
Correct severe metabolic acidosis 258
Corrosive poisoning 130, 490
investigations 130
management 130
Corrosive, commonly used 130
Corticosteroids 59, 280
Cotrimoxazole 70, 402
Cough 174
Coumaphos 111
Creatinine 74
Cricothyroid arteries 477
Cricothyroid membrane, anatomy of 476
Cricothyroidotomy 476
indications 476
surgical 478f
Cricothyrotomy, surgical 478
Crossed syndromes 188
Cryoprecipitate 245
Cryptic shock 30
Crystalline penicillin 72, 99, 302, 402
Crystalloids, profile of 50t
Cyanide
binding, direct 135
sources of 134
Cyanide poisoning 134
clinical features 134
management 135
Cystitis 92
acute uncomplicated 93
D
Dantrolene 433
Dapsone 106
Datura 120
management 120
Deep vein thrombosis 238, 327
thromboprophylaxis for 235
Deep venous thrombosis, symptoms of 174
Defibrillation 12, 13t
Dehydration, classification of 396t
Delirium tremens 441
symptoms of 441
Dengue 73
fever 73, 74
investigations 74
management 74
signs of 74
warning signs in 74
hemorrhagic fever 73, 74
management of 73
shock syndrome 75
compensated 73
uncompensated 73
Denosumab 57
Depression 58
Desflurane 430
Desipramine 110
Deworm 227
Dexamethasone 95, 389, 402
Dextran 50
Dextrose 50
normal saline 50
Diabetic emergencies 255
Diabetic foot 37, 71
Diabetic ketoacidosis 50, 63, 256
clinical features 256
diagnostic triad 257
management 257
precipitating cause 256
Diaphoresis 97
Diarrhea
pathogenesis of 88
severity of 396
Diastolic blood pressure 33, 335
Diazepam 384
Diazinon 111
Dichlorvos 111
Diclofenac 454
Dicyclomine 265
Diffusion-weighted imaging 208
Digital nerve block 461
contraindications 461
precautions 462
technique 461
Digitalis glycosides 107
Digitoxin 106, 107
Digoxin 107, 152, 402
Diltiazem 109, 152, 157, 453
Diphenhydramine 207, 453
Diphtheria 383
Diplopia 202
Disability 379
assessment 379
Disaster 409
external 410
internal 410
management 407, 409
research on epidemiology of 409
Disease modifying treatment 195
Dislocation 356
inferior 357
investigations 356
reduction of posterior 364f
role of X-ray 356
signs 356
symptoms 356
Disseminated intravascular coagulation 241, 429
Dissociative anesthesia 457
Distal tibial nerve 466
Dix-Hallpike maneuver 283
Dobutamine 32, 402
Dopamine 17, 19, 32, 36, 402
infusion 35
Doxycycline 72, 79, 101, 402, 453
Drowning 439
Drug overdose 107
general management of 107
Drug-induced dystonia 207
Drugs during pregnancy, list of 452t
Dry nonfatal drowning 439
Dumb rabies 84
Duodenal ulcer 490
perforation 304
clinical manifestations 304
investigations 305
management 305
Dysphagia 97
Dyspnea 27, 174, 177
Dystonia, acute 207
clinical presentation 207
treatment 207
Dystonic reaction, acute 207
E
Early anaphylactic reaction, treatment of 122
E-C clamp technique 10t
Eclampsia 271
clinical presentation 271
diagnosis 271
management 271
Ectopic pregnancy 263
clinical presentation 263
nonruptured 264
ruptured 264
Elbow 373
Electric shock 434
Electrical energy dosage 160t
Electrical injuries 434
investigation 434
management 435
Electrocardiogram 490
basics of 163
Electrolyte 74
abnormalities 151, 258
imbalance 151
toxicity 245
Elevated blood pressure 271
Emergency airway management 487
Emergency department 411
management in 388t
burns, steps in 437
mass casualties in 410
pain protocol in 492
referral protocol 491
registrars and nurses 412
Emergency laparotomy, indications for 348
Emergency pericardiocentesis 479
Emphysema 171
Empyema thoracis 81
empiric antibiotic 81
etiology 81
Enalapril 453
Encephalitic rabies 84
Encephalitis 94, 95
Encephalopathy 189
End organ effects 439
cardiovascular 439
management 439
metabolic 439
neurological 439
pulmonary 439
renal 439
Endocrine
disorder 60
emergencies 247
Endotracheal intubation
indications for 45
preparation for 39
Endotracheal tube 15, 478
Endovascular treatment 191
End-tidal carbon dioxide 430
Enflurane 430
Enoxaparin 454
ENT emergencies 275
Entamoeba histolytica 88
Enterobius 69
Enteropathic arthritis 456
Enzyme-linked immunosorbent assay 74
Epididymis, inflammation of 295
Epididymitis 295
Epididymo-orchitis 295
clinical features 295
diagnosis 295
etiology 295
treatment 296
Epiglottitis 388, 476
acute 71, 389
clinical features 390
diagnosis 390
etiology 389
management 390
Episodic disorder 202
Epistaxis 277
anatomy 277
anterior bleeds 277
management 277
posterior bleeds 277
Epley's maneuver 284, 284f, 285t
Epstein classification 363f
Epstein-Barr virus 241
Ertapenem 71, 102, 453
Erythromycin 71, 402
Eschar of scrub typhus 77f
Escherichia coli 221, 229, 286
Esmolol 147
Ethanol, metabolism of 132f
Ethylene glycol 107
Ethylenediaminetetraacetic acid tube 246
Exacerbation
moderate 167
severe 387
Extensor digitorum longus tendons 465
Extracellular fluid 50
Extremity
examination of 333
injuries 350
F
Falciparum malaria 78
Fasciitis 303
Febrile illness 69
acute 489
Febrile neutropenia 229, 490
investigations 229
microbiology 229
timing of antibiotics 229
Febrile reaction, mild 246
Febrile seizures 383, 384t
simple 383
Femoral line 470
Femur 374
fractures, shaft of 355
neck of 355
Fentanyl 402, 458, 487
dose 458
side effects 458
Fever 245
Fexofenadine 453
Finger web space block 461
Finger, buddy taping of 352f
Flail chest 345
Flexor hallucis longus, tendons of 465
Fluconazole 402
Fluid
and electrolytes 47
aspiration of 479
compartments in body 49f
replacement 216
resuscitation 257, 274
therapy 49
type of 257
Flunarizine 203
Fluphenazine 207
Focal syndrome 189
Folate deficiency 227
Fondaparinux 238
dose of 238t
Food poisoning 88
etiology of 89
Foot 374
cutaneous nerve supply of 467f
Foscarnet 57
Fracture 350
basic principles of 350
classification 341
common 352
Gustilo-Anderson classification 350
hand 352
hip 354
treatment 355
investigations 351
management of 350
open vs. closed 350
pelvic 354
treatment 354
signs 350
symptoms 350
Fresh frozen plasma 245, 336
Frisium 199
Fungal infections 180
Furious rabies 84
Furosemide 402
Furunculosis 70
G
Gabapentin 204, 454
Gait ataxia 442
Gallbladder, inflammation of 309
Gamma-glutamyl transpeptidase 311
Gas gangrene 316
clinical features 316
diagnosis 316
management 317
Gastric lavage 105
indications 105
technique 106
Gastroenterology 489
Gastrointestinal disorder 60
Gastrointestinal emergencies 211
Gastrointestinal nausea 111
Gastrointestinal tract, infections of 396
General surgery 494
Genetic syndromes 391
Genitourinary urinary continence 111
Gentamicin 102, 402
Giardia lamblia 69
Giardiasis 69
Glands excessive salivation 111
Glanzmann's thrombasthenia 240
Glasgow coma scale 333, 338, 339t, 423
Glaucoma 448
acute angle closure 448
Glenohumeral dislocation
anterior 357, 357f
posterior 357
Glucocorticoid 253
therapy 37
Glucose 442
containing crystalloids 50
Gout 456
Gram-negative 102
bacteria 455
Gram-positive 102
Grievous injuries 418
Guillain-Barré syndrome 45, 84, 194
clinical features 194
diagnosis 194
management 195
variants 194
Gustilo open fracture classification 351t
H
Haemophilia, mild-to-moderate 243
Haloperidol 207
Halothane 430
Hand 373
cutaneous nerve supply of 465f
Hanging 196
complete 196
examination 197
history 197
incomplete 196
investigations 197
management 197
nonjudicial 196
pathophysiology 196
Hazard 409
Head and face, examination of 332
Head injury 338
management 338
Head tilt–chin lift 7
and jaw thrust 7f
Headache 202, 434
approach to patient with 202
Heart rate 18, 335
calculate 163
variable 97
Heat cramps 427
Heat exhaustion 427
Heat stroke 427
classic 427
exertional 428
types of 427
Heat-related illnesses 427
diagnosis 427
differential diagnosis 428
investigations 428
management 428
Helminthiasis 69
Hematemesis 213
Hematochezia 213
Hematologic manifestations 468
Hematological emergencies 223
Hemodynamic compensation 335t
Hemodynamic stability, assessment of 347
Hemodynamic status 479
monitoring of 349
Hemodynamically stable 175, 487
Hemodynamically unstable 152, 155, 175, 487
abdominal injuries 421
pelvic injuries 421
Hemoglobin 198
Hemolytic transfusion reactions, acute 245
Hemoperitoneum 473
Hemophilia 243
A 243
B 243
investigations 243
treatment 243
Hemoptysis 174, 180
causes 180
initial management 180
Hemorrhage 270, 273
life-threatening 75
Hemorrhagic look 481
Hemorrhagic shock 335, 335t
Hemorrhagic stroke 185
management of 186
Hemorrhoids 322
external 322
internal 322
treatment 322
Hemostasis 369
Hemothorax 481
Hemotoxic bite 122
Hepatic emergencies 211
Hepatic encephalopathy 219
acute therapy 219
grading of 219
Hepatic injury, without 493
Hepatic sequestration 234
Hepatitis
B
immune globulin 451
protocol for pep for 450, 450t
surface antigen 451
virus 451
C, protocol for pep for 451
Herpes simplex virus 405
High-serum osmolality 52
Hip dislocation 361
anterior 361, 363f
complications 364
examination 361
posterior 361, 363f
reduction of posterior 364
treatment 364
types of 362t
Hospital Disaster Management Center 409
Hospital disasters, classification of 410
Hospital preparedness 409
Human immunodeficiency virus
after exposure, test for 449
protocol for pep for 450
Humeral head 358
Hydration 292
Hydrochlorothiazide 147, 148, 453
Hydrocortisone 250, 402
Hydroxycobalamin 135
Hydroxyzine 403
Hygiene-related problems 322
Hyoscine 403
Hypercalcemia 58, 59
causes of 58, 59t
clinical features 58
management 59
severe 58
Hypercarbia 393
Hyperemesis gravidarum 267
investigations 267
management 267
Hyperemia, flame-shaped hemorrhages 444
Hyperglycemia, management of 37
Hyperkalemia 19, 55, 233, 488
causes 55
clinical features 56
ECG changes 56
management 56
treat 118
treatment of 56t
Hypernatremia 53, 383
causes of 53, 53t
correction, goal of 53
management of 53
Hyperosmotic hyperglycemic nonketotic state 258
Hyperphosphatemia 232, 233
Hypersensitivity reaction 27
Hypertension
severe 146
treatment of 271
Hypertensive emergency 146
management 147
Hypertensive urgency 146, 148
Hypertensives, treated 148
Hyperthermia, malignant 430
diagnosis 430
management 431
Hypertonic saline 53
Hyperuricemia 233
Hypocalcemia 57, 233
causes 57
clinical features 58
management 58
severe 58
symptomatic 58
Hypoglycemia 199, 251, 255
causes 255
management 255
symptoms 255
Hypokalemia 54
causes 54
clinical features 54
therapy 55
Hypokalemic periodic paralysis 55
Hypomagnesemia 60
causes 60
ECG changes 60
symptoms 60
treatment of 60, 61t
Hyponatremia 51, 199, 251, 383
causes of 51t
management of 51, 51t, 52
symptoms 52
true 51
Hypothermia 245, 251
Hypoventilation 251
Hypovolemia 31
Hypovolemic shock 30
Hypoxemia 27
Hypoxia, hypokalemia 19
I
Iatrogenic pneumothorax 177
Ibuprofen 454
Ice pack application 429f
Idiopathic thrombocytopenic purpura 240
Imipenem 453
Imipramine 110
Immune mediated 253
reactions 245
Immunization, active 98
Immunologic lung diseases 180
Impending respiratory failure, signs of 393
Inadequate fluid intake 53
Incubation period, age based on 89
Ineffective erythropoiesis 225
Infection 69, 475
antibiotic for 122
type I 302
type II 302
type III 302
type IV 302
Infectious diseases 67
Infectious exposures 449
Inflammatory diarrhea 88
Influenza
and H1N1 82
complications of 83
virus, vaccination for 83
Inhalation injuries 133
Inherited clotting disorders 242
Inherited hemolytic anemias 225
Injection crystalline penicillin 98
Injection hydrocortisone 254
Injection metronidazole 98
Injection tetanus immunoglobulin 98
Inorganic rodenticides 115
Inotropes 31, 31t
Insect envenomation 124
Insecticide poisoning 111
Insulin administration 257
sliding scale for 259
Insulin infusion 257
sliding scale for 259t
Intermediate syndrome 112
Intermediately toxic 111
Internal jugular line 470
Interpret urinalysis 91
Intertrochanteric fractures 355
Intestinal obstruction 312
causes of 312, 312t
examination 312
history 312
investigations 313
management 313
Intestinal pseudo-obstruction 313
Intra-abdominal abscess 70
Intracellular fluid 50
Intraosseous line 474
complications 475
procedure 474
Intraosseous needle insertion 475f
Intravenous digoxin 152
Intravenous fluids 50, 175
Intravenous immunoglobulin 195
Intravenous thyroxine preparation method 252
Intravenous verapamil 152
Intubation protocol 487
Invasive ventilation 44
Iron 109
deficiency anemia 227
Ischemic stroke 185
management of 186
Isoflurane 430
Isolated finger injuries 352
Isolated intracranial hypertension syndrome 189
J
Jaundice 78
Jaw thrust 7
Jugular venous pressure 33
K
Kayexalate 403
Kerosene poisoning 133
clinical features 133
investigations 134
management 133, 134
Ketamine 403, 454, 457
contraindications 457
dose 457
side effects 457
Kidney 490
disease, chronic 488, 490
injury, acute 429
Kiesselbach's plexus 277, 278f
Klebsiella spp 221, 229, 286
Knee 374
splint for femur fracture 356
Kocher's technique 359
for shoulder reduction 360f
Korsakoff's psychosis 442
L
Labetalol 147
Lactate dehydrogenase 481
Lamotrigine 204
Laryngotracheobronchitis 388
Le Fort fractures 341
Leptospirosis 72
Leukemia, acute 230
clinical presentation 230
management 231
types of 230, 230t
Leukocyte esterase 91
Leukopenia 82
Levetiracetam 199, 403, 453
Levofloxacin 101, 453
Levothyroxine 252
Lidocaine 278, 403
Lignocaine 158, 461, 468
infiltration 493
without adrenaline 318
Limb injuries with vascular compromise 421
Linezolid 101, 453
Liothyronine 252
Lipid emulsion therapy 469
Lithium 109
Liver 473
disease 241
chronic 442
failure, acute 429
function test 74, 198, 307, 481
LMN facial palsy, causes of 205
Local anesthetic 136
characteristics of 461t
infiltration 493
systemic toxicity of 468
Lofepramine 110
Loratadine 453
Lorazepam 128, 384, 403, 442
Losartan 147, 148, 453
Low-molecular-weight heparins 238
Ludwig's angina 71, 287
Lung abscess 81
Lymphoid leukemia 232
acute 230
Lymphoma 59
Lysergic acid diethylamide 129
M
Macrocytic anemia 226
Magnesium 60, 157
sulfate 17, 158, 403
Magnetic resonance angiography 209
Magnetic resonance imaging stroke protocol 208
Maintain airway 28, 280, 437
patency 378
Malaria 78, 79
management 79
severe 79
Malathion 111
Mannitol 403
Manual defibrillator 14
Marijuana 128
Mask ventilation assessment, difficult 38
Mass casualty
incident 409411
management 411, 411fc
Massive hemoptysis 180
cause of 180
Massive transfusion
problems with 337
protocol 336, 336fc
Maternal hypoxia and trauma, prevention of 271
Matsen's traction 361f
countertraction method 360
Maxillofacial trauma 341
McBurney's point 307f, 482
McBurney's sign 306
Mean arterial pressure 35
Measles, mumps and rubella 383
Mebendazole 227
Mechanical ventilation 172
Media problems 443
Median nerve block 463, 464f
anatomy 463
procedure 463
Medical records department 411
Medications for vertigo 285
Medicine, general 489
Medicolegal case 415
list of common 417
Mefenamic acid 265
Mefloquine 79
Melena 213
Meniere disease 283
Meningitis 94
Meningoencephalitis 94
Menstrual blood loss, heavy 266
Mental state 335
Mental status, altered 427
Meropenem 71, 102, 315, 403, 453
Mesenteric arterial
embolism 314
thrombosis 314
Mesenteric ischemia 314
clinical features 314
investigations 315
management 315
physical examination 314
Mesobuthus tamulus 124
Metabolic acidosis 62, 78, 151
Metabolic acidosis/alkalosis, primary 62
Metabolic problem, primary 62
Metanephrine 260
Metered dose inhaler technique via spacer 173
Methanol 107
metabolism of 132f
poisoning 131
clinical features 131
management 132
Methemoglobinemia 65, 135, 136
acquired type 135
clinical features 135
congenital type 135
induction of 135
types of 135
Methergine 274
Methicillin-resistant S. aureus 102
Methotrexate 454
Methyl alcohol poisoning 131
Methylene blue 136
Methylergometrine 274
Metoclopramide 267, 310, 453
Metoprolol 147, 148, 152, 454
Metronidazole 102, 323, 404, 452
Microcytic anemia 226
Midazolam 45, 128, 384, 404, 458, 487
dose of 458, 488
side effects 458
Migraine 202
start prophylaxis for 203
Mineralocorticoids 253
Mitral regurgitation, acute 161
MLC, death of 418
Mobitz type, second-degree 18
Monoarthritis, acute 455
causes 455
examination 455
Monophasic defibrillators 13
Morphine 222, 315, 404
Mucosal exposure 450
Multidose activated charcoal 106
Multifocal atrial tachycardia 156
Murphy's sign, ultrasonic 310
Myelodysplastic syndrome 230
Myeloid leukemia
acute 230
chronic 231
treatment 231
Myocardial infarction 139, 153, 490
score, thrombolysis in 145t
Myoglobinuria 434
Myxedema coma 251
clinical presentation 251
diagnosis 252
treatment 252
N
Nail bed
emergencies 318
injuries 318
management 318
Nail trephination 319, 319f
Naloxone, intravenous dose of 127
Naproxen 454
Nasal decongestants 394, 453
Nasal fractures 341
Nasal packing 278
Nasogastric tube 334
Nasopharyngeal airway 8, 8f, 9
Native valve emergencies 161
investigations 161
management 161
Natural absorbable sutures 367, 368
Nebulized adrenaline 389
Nebulizer 172
Neck space infections, deep 286
Necrotizing fasciitis 71, 301, 302, 490
investigations 302
management 302
microbiology 302
Needle by marrow, blockage of 475
Needle cricothyroidotomy 477, 477f
Needle thoracostomy 178f
Needlestick injuries 449
Neisseria gonorrhoeae 268, 295, 455
Nephrolithiasis 291
Nerve
around ankle 468f
blocks 461
level of ankle, plane of 467f
Neurocognitive disorders 391
Neurogenic symptoms 255
Neuroglycopenic symptoms 255
Neuroleptic agents 432
highly potent neuroleptics 432
low potency neuroleptics 432
newer antipsychotics 432
Neuroleptic malignant syndrome 432
clinical manifestations 432
diagnosis 432
management 433
Neurologic manifestations 251
Neurological emergencies 183
Neuropsychiatric syndrome 133
Neurosurgery 494
Neurotoxic bite 122
Nicotinic receptors 111
Nifedipine 109, 147, 148, 192, 323, 404, 453
Nitrite 136
test 91
Nitrofurantoin 102
Nitroglycerin 147
Nongrievous injuries 418
Nonimmune reactions 245
Noninflammatory diarrhea 88
Noninvasive positive pressure ventilation 42
discontinuation of 43
Noninvasive ventilation 42, 172, 378
contraindications of 43
monitoring during 44
Nonoperative management 349
candidates for 349
Nonpoisonous snake 121
Nonsteroidal anti-inflammatory drugs 296, 324, 493
Non-ST-segment elevation myocardial infarction 145t
Nontrauma 421
Noradrenaline 31, 36, 404
Normetanephrine 260
Normocytic anemia 226
Nucleic acids 232
Nutrients, lack of 225
Nystagmus 202
central 283
peripheral 283
O
Obstetric and gynecological emergencies 261
Obstructive pulmonary disease, chronic 171, 490, 491
Obstructive valve thrombus, acute 162
Occult loss 213
Oculomotor dysfunction 442
Oduvanthalai 119
clinical presentation 119
management 119
poisoning, management of 119fc
Odynophagia, clinical features of 287
Oleander 107, 118
clinical presentation 118
management 118
Omeprazole 453
Ondansetron 325, 453
Open pneumothorax 344, 345
Opening airway, methods of 7t
Opiates 324
Opioids 107, 127
management 127
signs of overdose 127
symptoms of overdose 127
Optic neuritis 444
Oral
chlordiazepoxide 442
iron therapy 227
tramadol 493
trauma 8
Organ dysfunction 34
Organochloride 114
compounds 113
clinical presentation 113
management 113
Organophosphates 107, 114
Organophosphorus compounds 111
diagnosis 112
management 112
neurological manifestations 112
Organophosphorus poisoning 111t
clinical features of 111
symptoms of 111t
Oropharyngeal airway 8, 8f, 9
Oropharynx 388
Orthopaedics 494
Orthostatic hypotension 213, 273
Oseltamivir 83
Osteomalacia 310
Osteomyelitis 303
acute 71
Ovarian torsion 269
clinical presentation 269
investigations 269
management 270
surgical evaluation 269
Oxcarba-zepine 199
Oxidizing agent, powerful 109
Oxygen 41
saturation 379
therapy
cytotoxic damage 41
dangers of 41
functional risks 41
physical risks 41
Oxymetazoline 278
phenylephrine 453
Oxytocin 274
P
Pacitane 207
Packed red cells 245, 337
Paget's disease 310
Pain relief 438
discharge plan for 493
Pain, scale to assess severity of 492
Painful crisis 234
Palamnaeus swammerdami 124
Palpate tibial tuberosity 474
Pamidronate 59
Pancreaticobiliary drainage, anatomy of 309f
Pancreatitis, diagnose acute severe 215
Pancuronium 45, 404
Pantoprazole 267, 325, 404, 453
Papilledema 146
Paracetamol 222, 493
Paraffin gauze 438
Parainfluenza virus type 1 388
Paralysis
acute 112
type I 112
type II 112
Paralytic (dumb) rabies 84
Paralytic causes 312
Paraphimosis 297, 298f
management 297
Parathyroid hormone, excess 59
Paravalvular regurgitation 162
Paronychia 320
drainage 320, 320f
management 320
Paroxysmal positional vertigo
benign 283
right-sided benign 284f
Paroxysmal supraventricular tachycardia 156, 156f
management 156
Patellar dislocation 365
attitude 365
reduction of 365f
treatment 365
Pathologic phimosis 297
Patient during intubation, positioning of 40f
Peak expiratory flow rate 170
Pediatric basic life support algorithm 13fc
Pediatric emergencies 375
dosages in 399, 399t
drugs in 399, 399t
Pediatric resuscitative equipment 381t
Pelvic compression test 354
Pelvic inflammatory disease 268
etiology 268
treatment 268
Pelvic injury 347
Pelvis with hip 374
Penetrating ocular trauma 421
Penicillin 400, 452
allergic patients 71
Peptic ulcer disease 304, 312
Perforation 37
Perianal hematoma 334
Pericardiocentesis 479, 480f
complications 480
indications 479
non-emergency 479
technique 479
Perineal abscess 323
Peripheral neuropathy 434
Peripheral pulses 146
Peripheral vertigo, treatment of 284
Peritoneal puncture 480
Peritonitis 270
secondary 70
Peritonsillar abscess 287
Pernicious anemia 227
Peroneal nerve block
deep 465
superficial 466
Perphenazine 207
Pertussis 383
Pharyngitis 286
acute 71
Phenergan 207, 453
Pheniramine maleate 404
Phenobarbitone 106, 199, 404
Phenylephrine 394
Phenytoin 106, 199
phenobarbitone 453
sodium 404
Pheochromocytoma 260
laboratory investigations 260
management 260
Phimosis 297, 298f
management 297
Phosphorus compounds 116
clinical features 116
management 116
Piles 322
Pilonidal abscess 323
etiology of 323
treatment 323
Pilonidal cysts 323
Piperacillin-tazobactam 37, 70, 71, 99, 133, 220, 302, 303, 315, 323, 404, 440, 453
Plant poisons 118
Plasmodium falciparum
antibiotic therapy for 79t
gametocytes 78
parasitemia 78
Plasmodium vivax 78
antibiotic therapy for 79t
Plastic surgery, referral to 438
Platelet 245
abnormalities, qualitative 241
destruction, increased 240
loss 241
production, decreased 240
transfusion, indications for 75
Pleural effusion 74
Pleural fluid
analysis, interpreting 481
protein 481
Pleural tap 481
investigations 481
Pleuritic pain 174
Pneumonia 391, 392
in children 391
severe 392
Pneumothorax 177, 480
diagnosis 177
signs 177
symptoms 177
treatment 178
Poisonings 489
Polyarthritis, acute 456
causes 456
Polytrauma 494
Pontine tumors 205
Positioning pacing electrodes/pads 21
Postcardiac arrest 23
care 3
Posterior circulation stroke, treatment of 188
Posterior wall myocardial infarction 141
Postexposure prophylaxis 83, 85, 86, 449451
Postpartum hemorrhage 273
clinical features 273
investigations 273
management 274
Potassium 54
correction 258
needed, amount of 54
Potential triggers 430
Potentially infectious exposures 449
Povidone-iodine solution 319, 320
Prazosin 124, 148, 454
Precipitating cause, treat 258
Prednisolone 205
Pregnancy
and lactation, safety rating of drugs in 452
drugs in 452
fatty liver of 273
Preoxygenate 487
Preshock 30
Priapism 234
Primary respiratory problem, rules of compensation for 63, 63t
Procedural sedation 457
Prochlorperazine 207
Progestogens 266
Projectile vomiting 202
Prokinetics 214
Prolonged hypercalcemia, mild 58
Promethazine 453
Prompt delivery, evaluation for 272
Prophylaxis 383, 450t
of malaria, drugs for travelers for 79
Propranolol 203, 404, 454
Prostate, high riding 334
Prosthetic valve emergencies 162
Prothrombin time 273
Prothrombotic states 327
Proton pump inhibitor 267
Protozoa 396
Pseudohyperkalemia 55
Pseudomonas aeruginosa 221, 229
Psoriatic arthropathy 456
Psychosis 58
Psychotic adults 105
Pulmonary contusion 345
Pulmonary edema 146, 149
investigations 149
management 149
Pulmonary embolism 174, 238
acute 174
clinical assessment of suspected 174t
clinical presentation 174
investigations 175
management 175
Pulmonary function tests 171
Pulse
check 12
oximetry 379
Pulseless electrical activity 17
Pyelonephritis 92
Pyogenic meningitis 94, 95
Pyrethroids 113, 114
management 114
Q
qSOFA criteria 35
Quinidine 106
R
Rabies 84
clinical features 84
immunoglobulin 86
management 84
vaccine 86
Radial nerve block 463, 463f
anatomy 463
procedure 463
Ramped position 40f
Ramsay hunt syndrome 205
Ranitidine 404, 453
Rapid sequence intubation 389, 487
protocol 487, 487t
RBC
destruction, increased 225
production, decreased 225
Recreational drug, evidence of 105
Red blood cell 245
Red eye, acute 446
causes 446
examination 446
history 446
Reduced peak expiratory flow 27
Reflex spasms 97
Refractory asthma 169
Reiter syndrome 456
Relative water deficit 53
Renal disease 241
Renal failure 78, 434
Renal loss 54, 60
Renal replacement therapy 233
Reperfusion therapy 187
Rescue breaths 5, 9
Respiratory
alkalosis 62
effort, signs of increased 379
emergencies 165
failure, impending 387
infections 391
monitoring, close 195
rate 335
by age, normal 378t
rhinorrhea 111
support 41
Resuscitation 335
Reticulocyte count 226
Retina problems 443
Retinal detachment 444
Retropharyngeal abscess 286
causes 286
clinical features 286
investigations 286
management 287
Reversible causes 16t
Rhabdomyolysis 429
Rheumatoid arthritis 456
Rhythm disorder 17
Rib 373
Rifampicin 453
Rigidity 97
Ringer's lactate 267, 446
Rodenticides 115
types of 115
Rovsing's sign 306
Ruptured abdominal aortic aneurysm 325
S
Saccular aneurysm 203
Salbutamol 172, 404, 405
Salicylate 106
Saline, normal 50, 446
Salmonella 88, 89
Saphenous nerve block 466
Sarcoidosis 59
Scalp lacerations 369
management 369
wound closure 369
Scorpion sting 124
clinical features 124
investigations 124
management 124
Scrub typhus 72, 76
classical finding 76
clinical features 76
complications 77
diagnostic test 77
epidemiology 76
investigations 76
meningoencephalitis 95
pathogenesis 76
treatment 77
Secure venous access 437
Seizure 198, 434
active 272
evaluation of 198t
management of 198, 198t
suppression 469
Septic arthritis 71, 303, 455
management 456
Septic focus, control of 37
Septic shock 34, 303
management of 36
Septicemia 273
Seronegative arthritis 456
Serum
ascites albumin gradient 483
osmolality 52
protein 481
Severe sepsis, management of 36
Sevoflurane 430
Sexually active age group 295
Sheehan's syndrome 273
Shenton's line 355f
Shigella spp. 69, 88, 89
Shock 25, 30, 65
compensated 75
distributive 30
management, clinical algorithm to 32t
mechanism of 31f
obstructive 30
overview of 30
stages of 30
type of 30, 32
unexplained 494
Shoulder 373
dislocation 356
clinical examination 357
treatment 358
types of 358t
Sick child in emergency department, assessment of 377
Sick children, steps to 377
initial assessment 377
primary assessment 377
secondary assessment 380
tertiary assessment 381
Sickle cell crisis 234
clinical presentation of 234
management 234
Silver sulfadiazine 438
Sintrom 236
Sinus
bradycardia 17, 18, 18f
tachycardia 175
Skin infections 301
Smoke inhalation 133
Snake bites 121
examination 121
first aid 121
investigations 121
management 122
Sodium 51
bicarbonate 405
nitrite 135
polystyrene sulfonate 403
thiosulfate 135
valproate 199, 453
SOFA score 35t
Sofra-tulle 438
Soft tissue infections 301
Spinal injuries
classification of 340
evaluation of 340
Spine stabilization 340
Spirometry, interpretation of 168fc
Spironolactone 405
Spleen injury 473
Splenic sequestration 241
Splints 366
Spontaneous bacterial peritonitis 70, 217, 490
clinical features 217
etiology 217
management 218
Spontaneous circulation, return of 23
Spontaneous gangrene 316
Spontaneous pneumothorax
primary 177, 178
secondary 177
Spontaneous spasms 97
Standard ventilator, initial settings in 45
Staphylococcus aureus 278, 286, 320, 392, 455
Statins 454
Status asthmaticus 385
Status epilepticus 200, 272
etiology 200
management of 200
patient with 200fc
Stimson's technique 359
for shoulder 359f
Stone 58
type of 291
major cause 291
minor causes 291
Streptococcus spp 102, 286, 320, 455
Stridor 27, 279
acute 388
causes of 388, 388t
classification of 388t
etiology 279
in adults 279
in children 279
management 280
Stroke 157
protocol, acute MRI 208
types of 185
ST-segment elevation myocardial infarction, management of 142, 144
Subarachnoid hemorrhage 192
clinical presentation 192
diagnosis 192
management 192
Subclavian line 470
Subcostal approach 479
Subglottis 388
Submersion injuries 439
Substance abuse 127
Subungual hematomas 318
Subxiphoid approach 479, 480f
Succinylcholine 405, 430, 487, 488
Sulbactam 401
Sulfamethoxazole 453
Sulfur donors 135
Suprasternal retractions 386
Supratherapeutic international normalized ratio, management of 237t
Supraventricular tachycardia 22, 160
Sural nerve block 466
Surgical cricothyroidotomy, complications of 478
Surgical emergencies 299
Surgical pearls 471
Susceptibility weighted imaging 209
Suture materials
absorbable 367
nonabsorbable 368
Swimmers' ear 395
Symptomatic bradycardia 19
therapeutic agents for 20t
Synchronized cardioversion 158
Synovial fluid analysis 455
Synthetic braided sutures 367, 368
Synthetic cannabinoids 128
Synthetic monofilament sutures 367, 368
Syrup amoxicillin 394
Systematic postcardiac arrest 23
Systemic inflammatory response syndrome 34
Systemic toxicity, management of 469
Systolic blood pressure 24, 33, 187, 335
hypotension by 379t
T
Tachyarrhythmia 22
classification of 22t
initial management of 22
Tachycardia 213
Tachypnea 246
Tardive dyskinesia 207
Tardive dystonia 207
Temporal arteritis 444
Temporary pacemaker insertion 20
Temporomandibular joint 341
dislocation 341, 342f
Tension pneumothorax 178f, 344, 345
Tetanus 97, 383
immunoglobulin 98
prophylaxis 86, 98, 98t
score 97t
severity of 97
toxoid 98, 383
Tetra-ethyl pyrophosphates 111
Tetralogy of Fallot 405
Theophylline 106
Therapeutic paracentesis 482
Therapeutic range 110
Thiamine 442
Thiopental 405
Thioridazine 207
Thompson and Epstein classification 363f
Thoracic injuries 344
Thorax, examination of 333
Throbbing headache, severe 202
Thrombin inhibitors, direct 239
Thrombolysis, contraindications for 175, 186
Thrombotic thrombocytopenic purpura 241
Thyroid
hormone replacement 252
stimulating hormone 249
storm
medical management of 249t
symptoms of 249
Thyronorm/eltroxin 252
Thyrotoxic crisis 249
management 249
Tibia fractures 356
shaft of 355
Tibial nerve block, posterior 466
Tinidazole 69, 227
Todd's paresis 384
Tonic-clonic seizure, generalized 271
Torsades de pointes 158, 159f
Torsion testis 293
treatment 293
Toxic shock syndrome, risk of 278
Toxicology 103
Trachea 388
Tracheal tube length 382
Tracheostomy tube 478
Tramadol 222, 315, 405
Tranexamic acid 265, 266, 337, 405
continue 266
Transaminitis, mild 82
Transcutaneous pacing 20, 21, 21f
technique of 21
Transfusion reaction, management of suspected 246
Transfusion-related acute lung injury 245
Transient ischemic attack 153, 157, 185
Transient paralysis 434
Transudates 481
Transvenous pacing 20
Trauma 329, 421
coordinator 411, 412
role of 495
early management of 331
nurse coordinator 411, 412
primary assessment 331
resuscitation 331
secondary assessment 332
team
activation protocol 494
call out procedure 494
members of 494
X-rays in 373, 373t
Traumatic gas gangrene 316
Traumatic injury 316
Traumatic pneumothorax 177
Traveler's diarrhea 397
Triage priorities 421
Trichlorfon 111
Tricyclic antidepressants 106, 107, 313
Trifluoperazine 207
Trigeminal neuralgia 203
etiology 203
neuroimaging 204
treatment 204
Trihexyphenidyl 207
Triiodothyronine 252
Trimethoprim 453
Trousseau's sign 58
Tube thoracostomy 179f
Tuberculosis 180
Tumor lysis syndrome 232
clinical 232
manifestations 232
investigations 233
laboratory 232
prevention 233
treatment of 233
Typhoid fever 70
U
Ulnar nerve block 464, 464f
anatomy 464
procedure 464
Underwater seal 179f
Unfractionated heparin 237
Universal pain assessment tool 492f
Unstable angina 139, 145t
Upper airway obstruction 378
Upper gastrointestinal bleed 213, 489
common causes of 213
examination 213
history 213
management 214
symptoms 213
Urea 74
Uremia 63
Ureters 490
Uric acid 232
Urinary catheter 334
Urinary tract infection 90
antibiotic for 93t
complicated 92
diagnosis of 90fc
lower 90
management of 90fc
complicated 92
uncomplicated 92
signs of 91
symptoms of 91
upper 90
Urine
alkalinization of 233
osmolality 52
output 335
spot sodium 52
white blood cell count 91
Urological emergencies 289
Urology consultation 292
Ursodeoxycholic acid 405
Urticarial rash 246
V
Valacyclovir 71, 453
Valproate 405
Valve regurgitation 162
Valvular emergencies 161
Valvular heart disease 314
Valvular thrombus, acute 162
Vancomycin 71, 72, 101, 405
Vascular disease 180
Vascular emergencies 325
Vaso-occlusive
crisis 234
phenomena 234
Vasopressin 17
Vasopressors 31, 31t, 175
Vecuronium 405
Venous blood gas 63
Ventilation 8
assisted 169
Ventricular dysrhythmias 440
Ventricular ectopics 17
Ventricular fibrillation 17, 158, 159, 159f, 160
Ventricular tachycardia 158, 159f, 160
Ventricular, left 153
Verapamil 106, 109, 152, 157, 453
Vertigo 281
benign paroxysmal positional 281
causes of 281t
central causes 281
common causes of 283t
evaluation of patient with 282fc
peripheral causes 281
Very low birth weight baby 405
Vestibular migraine 283
Vestibular neuritis 283
Vibrio cholera 69, 89
Vincent's angina 71
Viral conjunctivitis 447
Viral meningitis 94, 95
Virus 396
Visible blood 396
Vision, painless loss of 443
Visual field deficits 188
Visual loss
acute persistent 443
acute transient 443
sudden 443
Visual pathway problems 443
Vitamin
B12 226
deficiency 227
D, excess 59
K dependent, synthesis of 115
K1 405
Vitreous hemorrhage 444
von Willebrand disease 243, 244
clinical features 244
diagnosis 244
treatment 244
W
Warfarin 106, 115, 236, 454
Warm sitz baths 322
Warrant neuroimaging 202
Wasp sting 125
Web space block 462f
Wellens’ syndrome 142, 142f
patterns of 142
type A 142f
type B 142f
Wenckebach 18f
Wernicke's encephalopathy 441, 442
Wet nonfatal drowning 439
Wheeze 27, 386
Whooping cough 383
Wide complex tachycardia 17, 158
characteristics of 158t
management 158
Withdrawal seizures 441
Withdrawal symptoms, minor 441
Wound
care 85
classification of 84, 85t
debridement 369
management 367, 438
suture materials 367
suture needles 368
Wrist 373
block 462
contraindications 462
indications 462
X
Xa inhibitors, direct factor 239
Xylometazoline nasal drops 394
Y
Yellow oleander 118
Yellow phosphorus 117
clinical features 117
management 117
Yersinia enterocolitica 88, 89
Yersinia pseudotuberculosis 89
Z
Zinc
phosphides 116
supplementation 397
Zoledronic acid 59
×
Chapter Notes

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1Basic Life Support and Advanced Cardiac Life Support
CHAPTERS
  1. Basic Life Support
  2. Advanced Cardiac Life Support
2

Basic Life Support1

 
INTRODUCTION
Basic life support (BLS) is the component of the immediate care provided for the victims of life-threatening conditions, leading to cardiac arrest and injuries till the patient can be shifted to a hospital. It can be given by doctors, nurses, paramedics, or even by the trained bystanders.
The brain is very sensitive to hypoperfusion. Therefore, the main objective of BLS is to restore cerebral perfusion at the earliest.
Survival after a cardiac arrest depends on the effective implementation of the following steps called chain of survival.
  1. Prompt recognition of cardiac arrest and immediate activation of emergency response system.
  2. Early initiation of cardiopulmonary resuscitation (CPR) with particular emphasis on chest compressions.
  3. Rapid defibrillation.
  4. Initiation of advanced life support.
  5. Effective postcardiac arrest care.
The American Heart Association (AHA) periodically revises the guidelines for BLS and advanced cardiac life support (ACLS). The 2015 AHA guidelines laid emphasis on the following:
  • Sequence of BLS: Circulation–Airway–Breathing (C–A–B)
  • High-quality CPR
  • Use of naloxone intramuscular or intranasal in suspected opioid overdose
  • Use of defibrillator for witnessed cardiac arrests as soon as possible.
 
BASIC LIFE SUPPORT/CARDIOPULMONARY RESUSCITATION FOR ADULTS
Basic life support consists of the following main parts:
  • Chest compressions
  • Airway4
  • Breathing
  • Defibrillation.
 
Overview of Initial Basic Life Support Steps (Table 1.1)
  1. Assessment and scene safety.
  2. Remove victim from the hazardous environment to a place where care may be provided without putting the victim or BLS provider at a risk of harm.
  3. Look for response and breathing pattern. If there is no response and the victim is not breathing or gasping, shout for help.
  4. Check the victim's carotid pulse (take at least 5 seconds but no more than 10 seconds) (Fig. 1.1).
  5. Activate the emergency response system and get an automatic external defibrillator (AED) if available and return to the patient.
  6. Start CPR. Perform five cycles of chest compressions and breaths (30:2), starting with compressions (C–A–B sequence).
Table 1.1   Steps of basic life support.
Step 1
Assessment and scene safety
  • Make sure that the scene of the incident is safe for you and for the victim.
  • Relocate victim from hazardous environment.
Step 2
Recognize the cardiac arrest
Look for response and breathing
  • Tap the victims shoulder and shout, “Are you all right?”
  • If there is no response and breathing or normal breathing, shout for help.
Check the victims pulse
  • Take at least 5s but no more than 10s to check for pulse.
  • Locate the trachea using two or three fingers.
  • Feel the carotid pulse between trachea and the muscles of the neck (lateral to the thyroid cartilage). If no pulse is felt, activate the emergency response system.
Step 3
Activate the emergency response system
  • If you are alone with an unresponsive victim and do not have a mobile phone: activate the emergency response system, get an AED if available and then begin the CPR.
  • If you have help at hand: send them to get the AED and begin CPR.
5
Step 4
Start CPR with 30 chest compressions and 2 breaths
Chest compressions
  • Position yourself beside the victim.
  • Keep the victim in supine position and on a firm surface.
  • Place the heel of one hand on the lower half of the victim's sternum.
  • Place the heel of the other hand on the top of the first hand and interlock your fingers.
  • Straighten your elbows and position your shoulders directly over your hands.
  • Push hard and fast.
  • Allow for complete chest recoil.
  • Minimize interruptions.
Rescue breaths
  • Head tilt, chin lift to open the airway.
  • Use only jaw thrust in case of suspected cervical spine injury. Avoid head tilt and chin lift.
  • Provide two rescue breaths keeping the nose pinched after every 30 compressions.
  • Use an improvised mask device if available.
  • Look for a chest rise with each rescue breath.
  • If unable to provide breaths, continue with chest compressions.
Abbreviations: AED: Automated external defibrillator; CPR: Cardiopulmonary resuscitation.
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Fig. 1.1: Carotid pulse check.
6
 
Chest Compressions
High-quality CPR improves a victim's chance of survival. The BLS provider should follow these critical characteristics of chest compressions while providing high-quality CPR (Fig. 1.2):
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Fig. 1.2: Technique of chest compressions.
  • Start compressions within 10 seconds of recognition of cardiac arrest.
  • Push hard, push fast: Compress at a rate of at least 100–120/min with a depth of at least 5 cm (2 inches) for adults, approximately 5 cm (2 inches) for children, and approximately 4 cm (1½ inches) for infants.7
  • Allow complete chest recoil after each compression.
  • Minimize interruptions in compressions (try to limit interruptions to <10 seconds).
  • In case of lay rescuer or sole rescuer present, compression only CPR is sufficient.
  • Give effective breaths that make the chest rise.
 
Airway Maneuvers
In an unresponsive patient, the airway may be occluded due to the decreased tone of the tongue and pharyngeal muscles. There are two methods of opening the airway to provide rescue breaths (Table 1.2 and Figs. 1.3A and B).
Table 1.2   Two methods of opening the airway.
Method
Description
Head tilt–chin lift
This maneuver lifts the tongue off the posterior pharynx thus opening up the airway. Avoid in cases of suspected cervical injury.
  • Place your palm on the victim's forehead and apply downward pressure thus, tilting the head backwards.
  • Place the tips of the index and middle fingers at the mentum of the mandible and lift the chin upwards.
Jaw thrust
Jaw thrust is indicated if the victim has a head or neck injury
  • Place one hand on each side of the victim's head, resting the elbows on the surface on which the victim is lying.
  • Place the fingers under the angles of the victim's mandible and lift with both the hands, displacing the jaw forward.
The jaw thrust displaces the mandible and tongue anteriorly, thus preventing the lax tongue from occluding the airway.
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Figs. 1.3A and B: Head tilt–chin lift, and jaw thrust.
8  
Caution
  • Avoid pressing deeply into the soft tissue under the chin as this may block the airway
  • Avoid using the thumb to lift the chin
  • Do not close the victim's mouth completely.
 
Ventilation
Respiratory arrest is a condition where the patient's respiratory efforts are either inadequate to maintain oxygenation or completely absent.
Management of a respiratory arrest includes the following components:
  • Administering oxygen
  • Keeping the airway open using basic airway adjuncts
  • Suctioning if necessary to clear secretions
  • Providing basic ventilation using bag mask equipment
  • Securing an advanced airway
  • Identifying the cause.
 
Basic Airway Adjuncts
In unresponsive patients, the tongue can fall back and obstruct the airway due to loss of tone of the throat muscles. This can be prevented by the basic airway opening techniques (head tilt–chin lift or jaw thrust). In addition to this, two basic airway adjuncts (oropharyngeal airway or nasopharyngeal airway) can be used to facilitate ventilation during resuscitation (Fig. 1.4).
These are indicated only in unconscious patients and come in various sizes. The correct size should be chosen for each patient for maximum benefit and to minimize complications like oral trauma.
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Fig. 1.4: Basic airway adjuncts: oropharyngeal airway and nasopharyngeal airway.
9  
Oropharyngeal airway
  • Choose the correct size: It should be the distance between the first incisor and the angle of the mandible.
  • If it is too large, it may close the glottis and close the airway.
  • In adults: insert the tube with the concavity upwards and then rotate it to 180° when it touches the back of the throat.
  • In children and infants: insert the tube with the concavity downwards while using a tongue depressor to hold the tongue forward.
  • It is contraindicated in conscious patients as it can induce a gag resulting in vomiting.
 
Nasopharyngeal airway
  • Choose the correct size: It should be the distance between the tip of the nose and the earlobe.
  • It is inserted through one of the nostrils after lubricating it with an anesthetic jelly. Push it till the flared end is at the nostril.
  • It can be inserted in semiconscious patients.
  • It is contraindicated in patients with base of skull fractures and nasal bleeds.
 
Rescue Breaths
  • Ventilation may be provided mouth-to-mouth or mouth-to-nose
  • A mask or an improvised device (such as a rolled up board) may be used
  • Give two rescue breaths after every 30 compressions
  • Give sharp rescue breaths, each over not more than 1 second
  • Provide enough tidal volume to see the chest rise, avoid excessive ventilation
  • In an in-hospital setting, get a bag-mask for ventilation, if available.
 
Bag-mask Ventilation
Bag-mask ventilation is a very efficient method of temporarily providing positive pressure ventilation.
This device consists of:
  • Self-inflating reservoir bag along with a mask;
  • A one-way valve which prevents rebreathing the exhaled air
  • Oxygen port for supplying supplemental oxygen.
Use the E–C clamp technique to bag-mask a patient (Table 1.3). If done properly, it is as effective as a secured airway. Bag-mask ventilation can be done by one or two people (Fig. 1.5).10
Table 1.3   E–C clamp technique.
Single rescuer
  • Use your thumb and first finger to form a C around the mask and place your third, fourth, and fifth finger under the bony part of the mandible forming an E to lift the jaw. Use the other hand to bag-mask.
Two rescuers bag-mask
  • One person stands at the head-end of the patient and holds the mask firmly with both hands over the patient's face using the E–C technique. The other rescuer slowly squeezes the bag over for 1s to provide an effective chest rise.
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Fig. 1.5: E–C clamp technique: single rescuer and double rescuer.
The following are the steps involved in bag-mask ventilation:
  1. Place mask on the victim's face. Use an airway adjunct if available.
  2. The nasal end of the mask should cover the bridge of the nose, not extending over the eyes; the body of the mask should cover the nose and mouth, and the other end not extending beyond the chin.
  3. Hold the mask using a single hand E–C technique or with both the hands (preferred) if an additional rescuer is present.
  4. Apply firm pressure, forming a good mask seal.
  5. Ventilate using a volume just sufficient to cause chest rise (not more than 8–10 mL/kg).
  6. Squeeze the bag steadily over a second. Avoid explosive squeezing.
  7. Connect bag mask device to reservoir bag with O2 supply if available.
  8. Give two ventilations after every 30 compressions for patients without an advanced airway.
  9. Give asynchronous ventilation every 8–10 seconds (6–8 per minute) to patients with an advanced airway in place.
Basic life support for adults is explained in Flowchart 1.1.11
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Flowchart 1.1: Adult basic life support algorithm.
 
BASIC LIFE SUPPORT/CARDIOPULMONARY RESUSCITATION FOR CHILDREN (CHILDREN FROM 1 YEAR OF AGE TO PUBERTY)
The child BLS sequence is similar to the sequence in adults. Following are the key differences:
  • Compression-ventilation ratio for two rescuer CPR is 15:2 and for lone rescuer is 30:2
  • Compression depth: Compress at least one-third of the depth of the chest, approximately 5 cm (2 inches).
  • Compression technique: Can use one- or two-handed chest compressions for very small children.
  • Defibrillation dose: 2 J/kg.
  • To activate the emergency response system, following points are to be considered:
    • In case of unwitnessed arrest and if the rescuer is alone, provide 2 minutes of CPR before leaving the child to activate the emergency response system and get the defibrillator.
    • In case of sudden and witnessed arrest, leave the child to activate the emergency response system and get the defibrillator.12
 
BASIC LIFE SUPPORT/CARDIOPULMONARY RESUSCITATION FOR INFANTS
The key points for infant BLS are:
  • Pulse check: Feel the brachial artery in infants to check pulse.
  • Technique of chest compressions: Two fingers for single rescuer and two thumb encircling hand technique for two rescuers (Fig. 1.6).
  • Compression depth: At least one-third the chest depth, approximately 4 cm (1½ inches).
  • Compression–ventilation ratio for two rescuer CPR is 15:2 and for lone rescuer, 30:2.
  • Defibrillation dose: 2 J/kg.
  • To activate the emergency response system, follow the same steps as followed for children.
Basic life support for infants is explained in Flowchart 1.2.
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Fig. 1.6: Technique of chest compression in children.
 
Defibrillation and Cardioversion
  • Defibrillation is the nonsynchronized delivery of a shock that depolarizes the entire cardiac tissue into a refractory period, making it unable to sustain or propagate an aberrant circuit. It is performed during a cardiac arrest in a pulseless patient.
  • Cardioversion is the delivery of energy that is synchronized to the QRS complex, thus only depolarizing the active circuit causing arrhythmia. It is used to revert arrhythmias in awake patients (Table 1.4).13
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Flowchart 1.2: Pediatric basic life support algorithm.
Table 1.4   Differences between cardioversion and defibrillation.
Cardioversion
Defibrillation
Elective procedure
Emergency procedure
Victim is awake but frequently sedated
Victim is unconscious
Shock is synchronized with QRS
Shock is not synchronized
Indications
  • Refractory supraventricular tachycardia
  • Unstable atrial fibrillation/flutter
  • Unstable ventricular tachycardia with pulse
Indications
  • Pulseless ventricular tachycardia
  • Ventricular fibrillation
50–200 J (biphasic)
  • 200 J (biphasic)
  • 360 J (monophasic)
 
Monophasic versus Biphasic Defibrillators
  • Defibrillators are machines that deliver electrical energy to the heart by monophasic or biphasic waveform technology through paddles applied on the chest wall.
  • Monophasic defibrillators deliver the charge in only one direction, from one electrode to the other. They use higher energy, typically 360 J and have many disadvantages. They are no longer used in most EDs.
  • Biphasic defibrillators use lesser energy, are more efficient and cause lesser damage to the heart. They deliver a charge in one direction in 14the first half and the direction is reversed in the second half; hence a biphasic waveform.
  • Currently, almost all the AEDs, manual and implantable defibrillators use the biphasic waveform technology.
 
Using an Automatic External Defibrillator
  • Read the instructions on the AED
  • Stick the pads on the chest wall.
Place the right pad (white) below the right clavicle and the left pad (red) on the left inferior-lateral chest, lateral to the apex.
  • If the patient has an open thorax injury, respective pads may be placed on the left and right axilla.
  • Turn on the AED and follow the voice prompts.
  • The AED will analyze the cardiac rhythm and will deliver defibrillation if a shockable rhythm is present.
 
Using a Manual Defibrillator
  • Turn on the defibrillator to the biphasic mode.
  • Select the desired dose of energy (200 J in adults, 2 J/kg in children).
  • Remove paddles, apply gel on the paddles.
  • Charge paddles using the charge button on the paddles or on the device.
  • Place paddles over the chest wall. (Sternal paddle below the right clavicle and apex paddle on left lateral chest wall.
  • Resuscitation team should stay clear of contact, oxygen circuit should be disconnected.
  • Deliver shock by using the discharge button on the paddles or on the device.
  • Resume CPR immediately; do not pause to check pulse/electrical rhythm soon after the shock.
 
Cardioversion Using a Manual Defibrillator
  • Turn on the defibrillator to the biphasic mode.
  • Select the desired dose of energy (50–200 J).
  • Remove paddles, apply gel on the paddles. Pads may also be used, if available.
  • Place paddles/pads over the chest wall. (Sternal paddle below the right clavicle and apex paddle on left lateral chest wall).
  • Turn on the synchronized mode.
  • Resuscitation team should stay clear of contact and oxygen circuit should be disconnected.
  • Keep paddles on contact while holding discharge till shock is delivered.
  • Check pulse and electrical activity immediately after the shock.
  • If arrhythmia persists, repeat the cardioversion with higher doses.