HOT SUMMER NIGHT

HOT SUMMER NIGHT

1. Ismail got into an accident when driving at night

   • Epidemiology of driving
     • residents of UAE are 7 times more likely to die in car accident compared to those in UK.
     • Road accidents are the second major cause of deaths in UAE
     • road accidents are primary cause of deaths of children in UAE
     • The trend of road traffic fatalities is increasing among UAE nationals as well as expatriates. RTIs were found to be more frequent on roads with high speed limits and with the presence of trucks. Further research is needed to identify associated risk factors.
   • First aid
     • Ensure personal safety
     • Look at the patient in general to see if the patient appears unwell
     • Check the patient's responses
     • Check airway, breathing, and circulation
     • If the patient is unconscious, unresponsive, and is not breathing normally (occasional gasps are not normal) start CPR according to the resuscitation guidelines
     • Monitor the vital signs early. Attach a pulse oximeter, ECG monitor and a non-invasive blood pressure monitor to all critically ill patients, as soon as possible
     • Insert an intravenous cannula as soon as possible. Take bloods for investigation when inserting the intravenous cannula
   • After assessment he was found to have
     • Ruptured spleen
     • Impaired kidney function
       • Acute Renal Failure
         • Definition
           • When the kidneys lose their filtering ability, dangerous levels of wastes may accumulate, and the blood's chemical makeup may get out of balance
         • Causes
           • Pre-renal
           • Renal
             • Glomerular disease
             • Tubular injury
             • Interstitial nephritis
             • Vascular disease
           • Post-renal
         • Investigations
           • Urinanalysis
           • Renal panel
           • Kidney function tests
           • Ultrasound
         • Management
           • Initiative management
             • Fluid balance
               • Lack of fluid >> intravenous (IV) fluids Swelling >>> diuretics particularly (furosemide )
             • Hyperkalemia
               • Decreasing the intake of potassium in diet
               • Exchanging potassium across the gut lumen using potassium-binding resins
               • Promoting intracellular shifts in potassium with insulin, and dextrose solutions
             • Hypocalcemia
               • infusion of calcium
             • Hypophosphatemia
               • Restriction of dietary phosphate
               • Aluminum hydroxide , calcium carbonate
             • Anemia
               • Blood transfusion
             • Your patient doesn’t seem to improve on the management you are giving him You will go for renal replacement therapy
               • Dialysis
               • Kidney transplant
       • Normal kidney tubular functions

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