Management Of Life Threatening Conditions....
From the foregoing remarks, it is clear that the aim of treatment must be to maintain a good supply of well-oxygenated blood to the tissues. To remember that tissue oxygenation depends on gasexchange in the lungs, on transport to the cells, and on efficient chemistry within the cells makes it easy to adopt a logical approach to these problems.
Is the airway clear? This point is particularly relevant to the unconscious patient. The most common cause of airway obstruction is the patient's own tongue, which may flop backwards when the unconscious patient is lying on his back and obstruct the entrance to the larynx. Other common obstructing agents are inhaled false teeth and vomitus. Treatment is to inspect the mouth and pharynx, remove any foreign body or hook forward thc tongue with a finger, and then if possible turn the patient into the semi- prone position so that the jaw and tongue fall forwards rather than back-wards. If the patient must for other reasons be nursed on his back, then the lower jaw (to which the tongue is attached) must be held well forwards by finger-tips behind the angles of the jaws.
Is the patient breathing? If there are no definite spontaneous movements of respiration visible, artificial respiration must he undertaken. If there is an embarrassment to respiratory movements, every effort must be made to put it right. Possible embarrassments are open pneumothorax, tension pneumothorax, and flail chest . The management of disorders of diffusion and distribution are beyond the province of the nurse.,
Is the patient's heart beating? This question must be settled rapidly by reference to the pulse at the wrist or in the neck, or by listening for heart beats through the anterior chest wall with a stethoscope. Remember that :
I. When the heart stops, only four minutes are available for resuscitation before the brain suffers irreversible damage 2. Respiratory movements also stop.
Therefore, management includes the rapid institution of both artificial
respiration and external cardiac massage so that some reasonably well oxygenated air inflates the pulmonary alveoli and some circulation of blood is maintained. Since these measures andjurther treatment aimed at re-starting the heart are too complicated to be undertaken singlehanded, the nurse must call for help as soon as possible.
Is the patient bleeding externally? Of the many causes of a diminution in the cardiac output mentioned previously, the only one which the nurse can tackle directly is obvious blood loss, external haemorrhage, from an accessible site on the surface of the patient. The bleeding must be stopped so that the cardiac output is not further reduced. The most effective method in nearly every case is direct pressure on the bleeding point with the cleanest agent available in the emergency--preferably, a sterile d ressing. Haemorrhage is further considered.
Are the kidneys functioning? After a period of circulatory arrest, the doctor usually requires a urethral catheter to be inserted in order to obtain early warning of renal failure : cessation of urine flow, anuria, or a reduction of flow rate to less than 350 ml in 24 hours in an adult, oliguria.
From the foregoing remarks, it is clear that the aim of treatment must be to maintain a good supply of well-oxygenated blood to the tissues. To remember that tissue oxygenation depends on gasexchange in the lungs, on transport to the cells, and on efficient chemistry within the cells makes it easy to adopt a logical approach to these problems.
Is the airway clear? This point is particularly relevant to the unconscious patient. The most common cause of airway obstruction is the patient's own tongue, which may flop backwards when the unconscious patient is lying on his back and obstruct the entrance to the larynx. Other common obstructing agents are inhaled false teeth and vomitus. Treatment is to inspect the mouth and pharynx, remove any foreign body or hook forward thc tongue with a finger, and then if possible turn the patient into the semi- prone position so that the jaw and tongue fall forwards rather than back-wards. If the patient must for other reasons be nursed on his back, then the lower jaw (to which the tongue is attached) must be held well forwards by finger-tips behind the angles of the jaws.
Is the patient breathing? If there are no definite spontaneous movements of respiration visible, artificial respiration must he undertaken. If there is an embarrassment to respiratory movements, every effort must be made to put it right. Possible embarrassments are open pneumothorax, tension pneumothorax, and flail chest . The management of disorders of diffusion and distribution are beyond the province of the nurse.,
Is the patient's heart beating? This question must be settled rapidly by reference to the pulse at the wrist or in the neck, or by listening for heart beats through the anterior chest wall with a stethoscope. Remember that :
I. When the heart stops, only four minutes are available for resuscitation before the brain suffers irreversible damage 2. Respiratory movements also stop.
Therefore, management includes the rapid institution of both artificial
respiration and external cardiac massage so that some reasonably well oxygenated air inflates the pulmonary alveoli and some circulation of blood is maintained. Since these measures andjurther treatment aimed at re-starting the heart are too complicated to be undertaken singlehanded, the nurse must call for help as soon as possible.
Is the patient bleeding externally? Of the many causes of a diminution in the cardiac output mentioned previously, the only one which the nurse can tackle directly is obvious blood loss, external haemorrhage, from an accessible site on the surface of the patient. The bleeding must be stopped so that the cardiac output is not further reduced. The most effective method in nearly every case is direct pressure on the bleeding point with the cleanest agent available in the emergency--preferably, a sterile d ressing. Haemorrhage is further considered.
Are the kidneys functioning? After a period of circulatory arrest, the doctor usually requires a urethral catheter to be inserted in order to obtain early warning of renal failure : cessation of urine flow, anuria, or a reduction of flow rate to less than 350 ml in 24 hours in an adult, oliguria.
No comments:
Post a Comment