| |
Other
conditions requiring urgent attention
There are some conditions that require immediate treatment
as part of resuscitation:
| :: |
Sucking
chest wound |
| :: |
Tension
pneumothorax |
| :: |
Cardiac
tamponade. |
Guidance on further examination and assessment of the trauma
patient and on treatment of these conditions is given in the
Annex: Primary Trauma Care Manual.
ANAEMIA
Anaemia is common in patients scheduled for surgery and often
gives rise to disagreements between surgeon and anaesthetist.
It is not possible to give any rigid rule on the lowest permissible
value of haemoglobin below which transfusion is necessary or
surgery cannot be carried out in a particular case. There is
general agreement that a patient can tolerate a haemoglobin
concentration well below the traditional value of 10 g/dl.
A preoperative value of 7 or 8 g/dl is acceptable without the
need for transfusion or making a request for blood. The following
factors will make a patient less tolerant of anaemia than this:
| :: |
Significant
blood loss anticipated |
| :: |
Respiratory,
cardiovascular disease or obesity |
| :: |
Old
age |
| :: |
Recent
blood loss or surgery. |
On
the other hand, an emergency, actively bleeding case must
go for life saving surgery without delay, no matter what the
haemoglobin level. Blood can be crossmatched while anaesthesia
and surgery are in progress.
A critical haemoglobin concentration is 4 g/dl, below which
significant reduction in oxygen consumption starts to occur.
Blood transfusion is mandatory in all such cases.
CONVULSIONS
The convulsing patient presents a difficult acute management
problem: the violent jerky movements mean there is little you
can do unless a drip has already been put in place through
which an anticonvulsant can be given.
Patients do not usually convulse without warning or without
a predictable reason. Anticipation and prevention should therefore
be possible. Possible causes include:
| :: |
Epilepsy |
| :: |
Neglected
pre-eclampsia becoming eclampsia |
| :: |
Febrile
convulsions in children |
| :: |
Meningitis |
| :: |
Cerebral
irritation: for example, following a period of hypoxia |
| :: |
Hypoglycaemia |
| :: |
Encephalopathy
or any intracranial lesion such as an abscess or tumour |
| :: |
HIV |
| :: |
Cerebral
malaria |
| :: |
Drug
poisoning, overdose of local anaesthetic or other toxic
state |
| :: |
Alcohol
or narcotic drug withdrawal. |
Convulsions are dangerous for the sufferer as there is breath-holding,
hypoxia, collapse, biting of tongue or other physical damage.
A common problem for the epileptic is falling in a fire. The
patient may vomit and aspirate.
Convulsions are usually short lived (although continuous eclamptic
fits do occur) and may have stopped by the time an anticonvulsant
has been found and given. However, a person who has convulsed
once will probably do so again soon and you should take the
following preventive measures:
| :: |
Well
secured drip |
| :: |
Bolus
of diazepam 10 mg IV, repeated 1 or 2 hourly; diazepam
10 mg rectally is safest for children |
| :: |
Paraldehyde
10 ml IM, where no drip has been put up. |
You
must urgently look for and treat the cause of the convulsion.
Intubation and ventilation is necessary if respiration has
ceased.
After a convulsion, most people are disorientated for several
minutes or remain in coma.
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