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The patient with acute neurological problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Having established that the patient is not in cardiac arrest (i.e. they are breathing), place the patient in the recovery position to optimise the airway. Reduced consciousness is potentially life-threatening and may result in postural airway obstruction and loss of airway reflexes such as cough, gag and swallow reflexes. Without these reflexes, the patient is at risk of aspirating secretions or vomit. A nasopharyngeal airway may be required if positioning alone does not maintain the airway.
Emergencies
Published in Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson, Pocket Prescriber Psychiatry, 2019
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson
Standard ABC assessment and management, considering the following: Airway: Lie patient on floor and assess. Support airway if necessary, preferentially with a jaw thrust, to avoid destabilising the C-spine.Breathing and circulation: If not breathing, or pulseless, initiate Basic Life Support (BLS). The patient may be apnoeic but have a pulse, in which case rescue breaths are indicated. Continue to administer BLS until help arrives. If breathing and circulation are intact, place the patient in the recovery position. This is best achieved by two people, with one attempting to maintain the C-spine in an anatomically neutral position, neither flexed, nor extended. This position may be supported manually, until help arrives. Ensure that breathing and circulation are maintained.Petechiae in the face and conjunctivae are common.
Common clinical problems
Published in Jackie Hole, Moira Davies, The Newly Qualified Nurse’s Survival Guide, 2018
This procedure should be followed if the patient collapses with signs of seizure. Protect the airway. Place the patient in the recovery position if possible.Reassure the patient and stay with them. Do not try to restrain them.Most seizures last less than 5 minutes, but if they are prolonged, administer 100% oxygen to prevent hypoxia.Check the blood glucose level.Inform the doctor of the above.
High-flow versus conventional nasal cannula oxygen supplementation therapy and risk of hypoxia in gastrointestinal endoscopies: a systematic review and meta-analysis
Published in Expert Review of Respiratory Medicine, 2022
Michael Doulberis, Fotios Sampsonas, Apostolis Papaefthymiou, Vasileios Karamouzos, Maria Lagadinou, Theodoros Karampitsakos, Grigorios Stratakos, Thomas Kuntzen, Argyrios Tzouvelekis
All included studies were elaborated during the last 3 years, thus reflecting the emerging need for safe and clear conclusions about the role of HFNC application in GIE. The main sedation agent was propofol, occasionally accompanied with adjuvant medications (mostly midazolam, fentanyl or lidocaine). All but one study, evaluated routine endoscopic procedures, gastroscopy or colonoscopy, with patients in left side-recovery position, without time-consuming or advanced manipulations. In this regard, data considering interventional techniques, such as endoscopic mucosal resection or submucosal dissection, peroral endoscopic myotomy, endoscopic ultrasound guided procedures, were not collected by enrolled studies. Nevertheless, Kim et al. evaluated the role of HFNC in ERCP, which is a demanding endoscopic intervention in the pancreato-biliary region, performed with patients in prone position.
Characteristics and circumstances of death related to gamma hydroxybutyrate (GHB)
Published in Clinical Toxicology, 2020
Shane Darke, Amy Peacock, Johan Duflou, Michael Farrell, Julia Lappin
The current study has clinical and public health implications. Responses at GHB overdose were poor, a finding previously reported elsewhere [20]. Bystander response to a GHB-induced coma is crucial, and calling an ambulance a priority. The maintenance of adequate respiration and a free airway are crucial, respiratory and cardiovascular support being the primary management of acute toxicity [5]. Vomiting is common in such circumstances, and aspiration was common in our series. Many of the deaths involving aspiration could possibly have been avoided by placing the person in the recovery position. It should be noted that training in overdose responses has been implemented successfully with heroin users [32,33]. This illustrates the fact that a drug that may cause profound respiratory depression and coma should never be used alone. While the presence of another does not preclude possible death, no intervention can occur if the person is alone. The titration of doses amongst these cases appeared to be poor, with unknown amounts of liquid being drunk from bottles or poured into drinks. This raises the issue of polydrug use. The use of GHB with other substances such as alcohol or psychostimulants increases the risk for an adverse event, whether through respiratory depression and/or cardiovascular stress. Finally, the risk of motor vehicle accident after using GHB needs to be made clear to users of the drug.
Bystander Assistance for Trauma Victims in Low- and Middle-Income Countries: A Systematic Review of Prevalence and Training Interventions
Published in Prehospital Emergency Care, 2019
Kamna S. Balhara, Nirma D. Bustamante, Anand Selvam, W. Tyler Winders, Amin Coker, Indi Trehan, Torben K. Becker, Adam C. Levine
Seven studies reported the prevalence of application of learned skills after intervention completion (Table 3). While participants in some studies had used their skills at least once following the intervention, other studies demonstrated an increase in the use of specific skills as compared to before the intervention. Two studies examined not only the prevalence of first aid provision, but the provision of correct or appropriate aid after the training intervention (Table 4). Li et al reported that over 70% of participants were subsequently providing correct aid (93). Vakili et al, on the other hand, demonstrated statistically significant increases in appropriate victim transfer, fracture management, and placement in recovery position by participants after the training intervention (104).