HEAT STROKE

HEMORRHAGE

HEAT STROKE

DEFINITION

Heat stroke is an acute medical emergency caused by failure of the heat-regulating mechanisms of the body. People at risk are elderly and very young people, those unable to care for themselves and those with chronic and debilitating diseases and those taking medications.

OBJECTIVE

1.To reduce high temperature as quickly as possible.

2.To monitor fluid losses and weight loss.

POLICY

1.Heat stroke causes thermal injury at the cellular level, resulting in damage to the heart, liver, kidney and blood coagulation.

2.1 Exposure to elevated temperature2.1 Exercise during extreme heat2.3 Profound CNS dysfunction (manifested by confusion, delirium, bizarre behavior, coma)2.4 Hot, dry skin2.5 Tachypnea, hypotension and tachycardia

3.The patient is monitored carefully for vital signs and ECG and level of responsiveness.

4.Oxygen is administered and patient may require endotracheal intubation and mechanical ventilation.

5.Intravenous infusion is initiated as prescribed and administered carefully because of dangers of myocardial injury from high body temperature and poor renal function.

6.Urine output is measured frequently because tubular necrosis is a complication of heat stroke.

7.Blood specimens are obtained for investigations.

8.Dialysis maybe done for renal failure.

MATERIALS & EQUIPMENT

1.Cool sheets and towels2.Ice and cool water3.Cooling blankets4.Iced saline lavage of stomach or colon5.Thermometer 6.Oxygen7.I.V. fluids as prescribed

PROCEDURERATIONALE 1. Assess the patient for:

1.1Elevated temperature1.2Confusion, delirium, bizarre behavior1.3Hot, dry skin.

1.4Tachypnea, hypotension, tachycardia.1. To properly assess and provide measures for emergency treatment.

2. After removing patient's clothes, start2. To reduce temperature cooling measuresas rapidly as possible.Cool sheets and towelsApply ice packs to neck, groin, axillaIced saline lavage of stomach or colon.Immerse patient in cold water.

HEMORRHAGE

DEFINITION

It is a loss of more than 500ml. of blood, or 30% of estimated total volume of blood - which maybe internal or external.

OBJECTIVE

1.To control bleeding.

2.To maintain an adequately circulating blood volume for tissue oxygenation.

3.To prevent shock.

POLICY

1.Blood transfusion must be initiated immediately.

2.Intravenous fluid replacement is started as ordered.

3.Vital signs are taken and monitored frequently.

4.The patient is maintained in a supine position and monitored closely until hemodynamic circulatory parameters are stable.

CBC, blood chemistry, PT, PTT.Blood grouping, cross- matching.Blood gas determination.

7.Most bleeding can be stopped by applying direct pressure or a firm pressure dressing.

8.A tourniquet is applied as a last resort when external hemorrhage cannot be controlled.

MATERIALS & EQUIPMENT

1.Oxygen 2.Pressure dressing 3.Suction machine 4.Blood and blood products 5.Intravenous fluids

6.Blood containers for blood samples 7.Medications are ordered 8.Sphygmomanometer and stethoscope9.Tourniquet 10.Large-bore intravenous cannula

PROCEDURE & RATIONALE1.Assess the patient for the following symptoms.1.Patients with hemorrhage are at risk for cardiac arrest caused by hypovolemia with secondary anoxia.

1.1Cool, moist skin (resulting from poor peripheral perfusion).

1.2Falling blood pressure.

1.3Increased heart rate.

1.4Delayed capillary refill.

1.5Decreasing urine volume.2.Initiate fluid replacement as ordered.2.A loss of circulating blood leads to a fluid volume deficit and decreased cardiac output.

3.Obtain blood samples for analysis, blood grouping and cross-matching.3.For blood replacement due to massive blood loss.4.Perform rapid assessment of hemorrhage:.

DISCUSSION