Keywords
a. Male aged 50 years
b. Shortness of breath about 3 days ago.
c. Physical examination:
- BP: 120/70 mmHg
- Pulse 110x /minute
- Breathing 30x/minute
- Temperature 37,2°C
d. The patient appears pale with decreased consciousness
e. History of asthma and heavy smoking
Question
1. What is the first action scenario for the patient with respiratory failure?
2. What are the follow-up actions if the initial action fails based on the scenario?
3. What are the causes of respiratory failure?
4. What is the relationship between the history of asthma and smoking with the patient's
symptoms?
5. What complications can occur under the scenario?
6. Mention the transportation conditions and references!
7. Explain the Islamic perspective according to the scenario !
ANSWER
1.Primary survey is a rapid examination of vital functions in patients with serious injuries with priority on
ABCDE, where in trauma cases the priority is accompanied by other appropriate measures.
Airway with cervical spine precautions /or protection
This assessment is of the patency of the patient’s airway. It is assessed by asking a question. If the patient
can speak coherently, the patient is responsive, and the airway is open.
Perform either a chin lift or jaw thrust if airway obstruction is identified; although, jaw thrust is preferred
if cervical spine injury is suspected.
Chin lift by placing the thumb underneath the chin and lifting forward.
Jaw thrust by placing the long fingers behind the angle of the mandible and pushing anteriorly and
superiorly.
Foreign bodies, secretions, facial fractures, or airway lacerations are also sought out. If there is a foreign
body, it should be removed. If there are other causes of obstruction, a definitive airway should be
established whether through intubation or creation of a surgical airway such as cricothyroidotomy. During
these evaluations and possible interventions, caution should be used to ensure that the cervical spine is
immobilized and maintained in-line. The cervical spine should be stabilized by manually maintaining the
neck in a neutral position, in alignment with the body. In this procedure, a two-person spinal stabilization
technique is recommended. This means one provider maintains the in-line immobilization, and the other
manages the airway. Once the patient is stabilized in this scenario there neck should be secured with a
cervical collar.
Airway protection is required in many trauma patients. Patients with airway obstruction demand
immediate intervention.
Breathing
This assessment is performed first by inspection. The practitioner should look for tracheal deviation, an
open pneumothorax or significant chest wounds, flail chest, paradoxical chest movement, or asymmetric
chest wall excursion. Then, auscultation of both lungs should be conducted to identify decreased or
asymmetric lung sounds. Decreased lung sounds can be a sign of pneumothorax or hemothorax. This,
combined with either tracheal deviation or hemodynamic compromise, can be a sign of a tension
pneumothorax that should be treated with needle decompression followed by a thoracotomy tube
placement. Open chest wounds should be covered immediately with a bandage taped on three sides to
prevent the entry of atmospheric air into the chest. If the bandage is taped on all four sides it may create a
tension pneumothorax. If a flail chest is present and results in respiratory compromise, positive pressure
ventilation should be provided. A flail chest may indicate an underlying pulmonary contusion.
Note that in general, all trauma patients should receive supplemental oxygen.
Circulation
Adequate circulation is required for oxygenation to the brain and other vital organs. Blood loss is the
most common cause of shock in trauma patients.
Disability
Towards the end of the primary survey, a rapid evaluation of the neurological state was undertaken. What
is assessed here is the level of consciousness, as well as the size and reaction of the pupils. A simple way
of assessing the level of consciousness is the AVPU method.
-A: Alert /aware
-V: Verbal / Vowel. Response to vocal stimuli
-P: Pain. Response to pain stimuli
-U: Unresponsive. No response.
EXPOSURE
Take off the patient's clothes to do a thorough examination. Check things that may have been missed in
the previous examination, for example, injuries to the body covered by clothes, blood coming out of the
MUE or anus, etc. After the clothes are opened, the patient must be immediately covered to prevent
hypothermia.
2. Actions performed if the initial action fails include:
Actions performed if the initial action fails include:
A. Reevaluation
Patients should be evacuated periodically, ensuring no abnormalities are missed, or any new
abnormalities. Continuous monitoring of vital signs, oxygen saturation, and urine expenditure is essential.
For adult patients normally urine comes out 0.5 mL/kg/h and in child patients who are more than the
normal year 1 mL/kg/h.
After conducting the primary ABCD survey, the helper can proceed to a secondary ABCD survey for
eligible patients. Each step requires two actions: assessment and management, and with both measures the
helper will never lose his or her observations about the need for patient evaluation and care.
If the assessment exposes a life-threatening problem, the helper should not go further until the matter is
resolved. This approach helps in dealing with all life-threatening emergency cases.
-Airway
-breathing
-circulation
3. Respiratory failure can be caused by trauma and non-traumatic cases
a. trauma
1. Airway blockage
2.Pneumothorax
3. Hematothorax
4.Lung Embolism
b. Not trauma
1. pleural effusion
2. bronchial asthma
3. valvular disease
4. The abnormality concerns Central Ventilatory Drive,which is a respiratory control or respiratory
drive located in the medulla of the brain stem
5.Abnormalities that concern the transmission of signals to the respiration muscles.
6. Abnormalities in the respiratory muscles and chest wall
4. Cigarette smoke inhaled by asthma actively causes stimulation in the respiratory system, because
burning tobacco produces irritant substances that produce complex gases from harmful particles. The
main toxins in cigarettes are tar, nicotine, carbon monoxide, nitrogen oxide and ammoniacgas.
5. Complications of respiratory failure can be effect to the pulmonary, cardiovascular, gastrointestinal ,
infectious, renal or nutritional effects. Complications from respiratory failure may be a result of blood
gases disturbances or from the therapeutic approach itself
-Lung complications: for example, pulmonary embolism irreversible scarring of the
lungs, pneumothorax, and dependence on a ventilator.
-Cardiac complications: for example, heart failure arrhythmias and acute myocardial infarction
-Neurological complications: a prolonged period of brain hypoxia can lead to irreversible brain damage
and brain death.
-Renal: acute renal failure may occur due to hypoperfusion and/or nephrotoxic drugs.
-Gastro-intestinal: stress ulcer, ileus, and hemorrhage
-Nutritional: malnutrition, diarrhea hypoglycemia, electrolyte disturbances
6. Conditions of transportation and referral
a. Patient transport, ABC must be stable
b. Do not move the patient alone and do so with caution
I. Lifting the suffers
c. Emergency Transfer
D. Lifting and transporting the victim with the one or two assistants :
E. Doctors/medical teams participate during the transport process for monitoring vital signs.
Refer the patient
1. Explain to the patient the reasons for referral for specific management.
2. Prepare the patient mentally and financially, especially patients who are referred for surgery
3. Try to adapt the specialist's skills and expertise to the patient's condition and financial capabilities
4. Do not refer patients without good reason
5. Make / write a reference letter that is both true and appropriate.
7. Surat al-baqarah ayat 195
The meaning : Do not throw yourself into destruction and do good, for indeed Allah loves those who do
good.
