CTSCAN
INDICATIONS
IN CASE OF ADULTS IN CASE OF CHILDREN ((I6YRS)
! Immediate CT scan if ! Immediate CT scan if
risk factors risk factors
Head
injudy +
any
1 of the Head
injudy +
any
1 of the
G CS < 13 on initial assessment Loss of consciousness
lasting) Smins (witnessed)
G Cs (15 at 2 houns after
injury Amnesia
(antegnade/retrognade) lasting 5 mins
Suspected open on depressed skull fracture Abnormal drowsiness
Any sign of basal skull fracture >3 episode of
vomiting
Haemotympanum
Panda
Eyes
Clinical suspicion of non-accidental
injupy
CSF
leakage from ear and nose
Battle's
sign
Post-traumatic Seizure but no
H/oepilepsy
Post-traumatic Seizure G CS < 14 on initial assessment
Fon <1
Focal
neunological deficit
year baby , GCS (paediatric) (15
> episode of
vomiting Suspected open/depressed skull fracture/tense fontanell
amnesia for events > 30 mins before impact basal skull fracture
Any sign of
Haemotympanum
Panda
Eyes
CSF
leakage from ear and nose
Head
injudy + Loss of consciousness + amnesia Battle's
sign
1 of the risk factors Focal deficit
+
any neunological
G Cs (15 at 2 houns after
injury Bruise/swelling/laceration <Scm on head (if < Iyean)
Age 65 years Dangerous mechanism of injury
High Speed RTA as
pedestrian/cyclist/vehicle occupant
coagulopathy Fall from
height) 3 m
Bleeding clotting disonder
High speed injury from projectile object
,
on
with Warfarin
Ongoing treatment
Dangerous mechanism of injury
Pedestrian/cyclist struck by motor vehicle
Occupant ejected from moton vehicle
CT scan within 6hms of
injury if
Fall from
height > Im
Fall from 5 stains
Head
injudy Anticoagulant therapy
+ + no other
indications
CT scan within 6hms of
injury if
Head
injudy Anticoagulant therapy
+ + no other
indications
7.
fluid
Epididymal cyst >
-
clear
can be aspirated
spenmatucele fluid
->
barely clean
low Residual diet x3 days
Absolute indication of
prostatectomy :
X-Ray kVB prepequisite
laxatives
BEP [ chronic andDefractory
-
Detention
BEP [ hematuria
Frequency
-
BPH PRIMARY SIGNS
- BEP C UT I
urgency
Noctudia
BED : Obstructive
-
unopathy
Female Male Calcupia stone with rpine
>
Passage of
-
Normal
voiding time : 205 .
30S .
Choice of
investigation for Hematunia -
CT Unognam
voiding flow :
3 OmL 25 m1
Colicky pain >
-
Noncontrast
CT
Unognam
% of MCC
Normal PVR =
OmL@R(10
Abnormal PVR = > 10 % of MCC
minimum
PostT significant cystometric
Desidue
capacity NO DA/DNS is
given in Intestinal Obstruction
.
2 neutralised with 1 unit Insulin
5g glucose
Faecal Fistula MX . Methonidazole >
-
analgesic function on anal canal
S skin came and control of sepsis > acts on anaenobic
organisms
-
N nutrition >
-
full stomach
A assessment
Azithromycin- empty stomach
relation to meal
D
planning Ciprofloxacin Ceftriaxone
,
> no
-
Normal air-fluid in WIA
CXR Interpretation Sequence X-ray
A
airway 1) Fundus of stomach
B bones 2) ist part of duodenum
C Candiac shadow 3) lleocaecal junction
D
diaphragm 4) Splenic flexube
E external (soft tissue shadows) 3) Meckel's diverticulum
F field
(lungfield)
G
great vessels
H hilum
MANAGEMENT
Remove contaminated
17
clothing
Wash and with N/S NEVER use Betadine (except deep bunns) it is composive
agent
2) innigate
as a
If blisten is present >
->
aspirate (but do notbemove
covering skin)
dress with Duodenm
> > softwoll >
bandage > softholl >
Kept for X4
days
-
-
>
- after nemoval of Duoderm use :
Sofra-tulle > Burn
gauge) Softnoll>
Roll
bandage
3) I/v fluid Formulat only pantial and full thickness
according to Pankland bunn are included in this calculation
Initial fluid
Requirement (H/s) = <mLx % BSAX
weight in lig -
> adult
Y2 "2 3mL- > children
Candiac
Finst & Hours Next 16 houds 2 mL >
elderly
-
from the time of bunn
injury
inhalational electrical
6 mL
injury
#Or from time of evaluation >
-
4) Inj. Cefton
(1gm) I/VX 12
nounly
5) Inj. Pethidine (75mg) 1/MX 12
hourly
6) Inj. Seclo (40mg) F/Vx12 houply
>
- for stress
ulced/curling ulcer
7) Inj . TT + TIG
3) Catheterisation to monitor upine output and maintain >0 .
5mL/kg/hr
unh
as patient may go into shock >
-
Rhabdomyolisis
↓ Bu
I Becore
↑ S creatinine
Hypovolemics
for fluid loss
.
Candiogenics develop AKI
Septics
immunity loss
Neurogenic for pain
6) Tab . Ceevit
CANNULA GUIDELINES
Flashbacka
F
ORANGE
G
Needle
gnip
-
FROng
E
Injection
Yociny
.
Ge
Luen Valve
Connector
Catheter
i T Needle
zi XFi
y9 2
i
u
F
① Peripheral cannula should be replaced 72-06 houps .
every
② If there are
any signs
of inflammation cannula should be removed
③ cannulation should be cannied out under aseptic conditions .
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F
ORANGE
14G
E I
F
Ge T
J
F T
ITS
FX
zi I
&
&
or 9 2
·
u
E Fin
BREAKING BAD NEWS
Information that
&
adnews drastically alters the life of a patient
news can be done in 3 ways
Breaking bad
SPIKES
PROTOCOL
ABCED BROW
SPIKES PROTOCOL
Setting (setting up the interview)
Penception (assessing the patient's perception)
obtaining the patient's invitation to give information)
Y
Invitation
knowledge giving knowledge and information to the patient)
Emotions (addressing patien's emotions with empathicResponses)
Strategy (strategy)
SPIKES
Perception Invitation Knowledge Emotions
Strategy
setting
GCS Scale
Eye opening
E spontaneous eye opening 4
S
Eye opening in response to speech 3 Minor Brain
Injury 13-15
D
Eye opening in response to pain 2 Moderate Brain
Injury 8 -
12
N No Response I Sevene Brain Injury 3 -
2
Verbal Response comatose
O Oriented 5
C confused 4
A Inappropriate words 3
I In comprehensible sounds 2
N No Response I
Motop Response
8 6
Obeys commands
L Localises pain 5
D Withdrawal from pain 4
flexes up pen extremities/
F Flexion to pain Extends lowen extremities
3
Extends all extremities e
pain g
.
.
A Extension to extends elbow to nail bed pressure 2
N No Response I
GCS Scale