casualty management - unconscious casualty

2.13

neurological assessment - purpose

aid diagnosis, provide baseline, monitor changes (especially after trauma) detect life threatening situations

avpu - alert, voice, pain, unresponsive

rapidly assess someone’s neurological state, primary survey

alert and orientated

measures patient brain function and confusion levels. establishes if patient’s consciousness is deteriorating (time, place, person)

glasgow coma scale

more detailed assessment of neurological function, takes more time - secondary survery

pearl - pupils equal and reactive to light

checks pupil responsiveness, can indicate use of drugs or serious brain injury

patient observation

observe general behaviour and distress

epilepsy definition

seizures from recurrent, major disturbances of brain activity - can be sudden and dramatic. sometimes patient has a warning, like strange taste or smell

epilepsy recognition

loc, arching back and rigidness, noisy or difficult breathing, cyanosis, convulsive movements begin, excess saliva, loss of bladder or bowel control, muscles relax and patient regains consciousness - may sleep or feel tired

causes of seizures (other than epilepsy)

hypoglycaemia, hypoxia, tumours, drugs, fever in children

initial management of seizures

assess - march paws. position - patient comfort and safety, protect from dangers. history - has it happened before, meds administered, symptoms leading up to seizure, medical history, alcohol intake. observe and inspect - observe types of movements

seizure - airway

opa may be used, npa can be useful backup

seizure - breathing

administer high flow oxygen until reliable saturation level reached, meds can be administered if trained

seizure - circulation

blood pressure and pulse, may need iv access

seizure - disability

assess consciousness, measure blood glucose levels

seizure - exposure

temp, observe for injuries, incontinence, rash, pregnancy

diabetes definition

body doesn’t produce enough insulin or it isn’t working effectively

hypoglycaemia

low blood glucose levels

mild hypoglycaemia

conscious and able to swallow

moderate hypoglycaemia

conscious and able to swallow, may get confused or disorientated

severe hypoglycaemia

unconscious, combative, increased risk of choking

hypoglycaemia recognition

sweat, shaking, hunger, headache, nausea, coordination, speech, drowsy, aggresive, unconscious

causes of hypoglycaemia

not eating enough, excessive exercise, excessive alcohol

hypoglycaemia - initial management

march paws, avpu

hyperglycaemia recognition

elevated blood glucose levels

hyperglycaemia recognition

dehydration, polydipsia, polyuria, tiredness, blurred vision

causes of hyperglycaemia

hyperglycaemia - initial management

cerebrovascular accident

disrupted blood supply to brain

stroke (haemorrhagic)

rapidly developing signs of focal or global disturbance of cerebral function

transient ischaemic attack

acute loss of focal cerebral or ocular function

recognise strokes

arm weakness, speech difficulties, distorted vision, confusion and dizziness, severe headache, nausea, fever, neck pain

fast

face, arms, speech, time

hypothermia definition

condition where core body temp falls below 35

hypothermia recognition

cold, shivering, reduced consciousness, unresponsive, confused or irrational, cyanosis, slow or irregular pulse

hypothermia - initial management

prevent further cooing, warm casualty

prevent further cooling

protect from environment, remove wet clothing, put on dry clothes, cover head and neck

warming casulaty

high energy food, huddle around, gentle exercise when stable, evacuate for emergency care

nfci causes

gradual, prolonged cooling of hands and feet

fci causes

sub zero temp, parts of body most prone to freezing (extremities)

hyperthermia

increase in core body temp, leading to degeneration of cells and tissues - can lead to organ failure or death

heat stress definition

thermal homeostasis begins to fail, due to excessive heat generation

heat stress recognition

cramps, swelling, mild temp elevation

heat exhaustion definition

mild heat illness, core temp is moderately elevated

heat exhaustion recognition

core temp 37-40, headache, dizziness, vomiting, tachycardia, muscle pain and weakness

heat stroke definition

core body temp above 40, cns dysfunction

heat stroke recognition

fatigue, headache, fainting, d and v

hyperthermia - initial management

cooling

head injuries definition

any trauma to head other than superficial injury to face

effects of brain injury

emotional, behavioural, mental effects, physical

causes of raised intracranial pressure

swelling, haemorrhage or haematoma, tumours

cushing’s triad

hypertension, brachycardia, irregular respirations

brain injury recognition

history of trauma, unresponsive, unequal pupil size or reaction, confusion, loss of balance, seizures, vomiting, vision problems

brain injury - initial management

neurogenic shock

caused because sudden acute pain, severe emotional experience or spinal cord damage interfere with normal nervous control, leading to hypotension

poisoning definition

substance that causes temporary or permanent damage if taken in sufficient amounts

poisoning recognition

confusion, unresponsiveness, seizures, burns to airway, pain, nausea

poisoning - initial management