clinical quiz in emergancy medicine

بناء عل رغبة أمير ها نبدأ سلسلة من الفوازير الطبي ها نناقش فيها كل مر حالة و ها يبقى فية أسئلة و نرجو المشاركة:و ها حاول أركز معاكوا فى الحاجات المهمة اللى ممكن نقابلها فى الشارع أو فى الحياة العامة و خاصة الطوارئ لأنة للأسف البيب المصرى يفتقر لمهارة التعامل مع الطوارئ و للأسف نجد هذا حتى فى الكثير من الأخصائيين و الأستشاريين
و طب الطوارئ يمتاز عن الطب العادى فى أنة إذا فعلت التصرف الصحيح مهما بلغت تفاهتة فسوف تنقذ حياة المريض...
while u was in alex. u was walking & u see crowded people around one person & they tell that it was a case of drowning so u tried to examin the patient u found the following:
fully conscious
air way: clear & clean
breathing: spontaneous
pulse: full & regular

then u talk to him he told u that he vomited sea water & coughed a moderate amount of frothy profuse sputum as he was aspirated water during drowning.

1) what will be ur dicision about such case? (go home or to the hospital)? why?
2) would u like to do certein investigation?
3) what is the most common complications that may occure in such case?
4) do u want to give such patient any conservative medications?

شكرا يا د. روما على سرعة استجابتك ..

انا اعتقد انه يروح بيته .. و طالما تنفسه سليم يبقى ماحصلهوش aspiration
ممكن اديله antifungal & Flagyl علشان ميه البحر اكيد فيها بلاوى ..
الcomplications ممكن تبقى pneumonia & otitis media & fungal infections & sinusitis
ال investigation ممكن تبقى x ray & ear examination ..
ارجو الافادة .............
وشكرا ليك ..

THANKS FOR REPLAY
1) IT IS BETTER TO STAY IN HOSPITAL FOR 48 HOURS POST DROWNING...but why???
as it is highly expected to develope adult respiratory distress syndrom (ARDS )which is simply some sort of diffuse bronchopneumonia which may require urgent mechanical ventilation.

2) first of all chest x ray is mandatory in such situation and as ERA mentioned previosly ENT exam. may be valuable

3) as i mentioned before the most serious complication is ARDS then sinusitis & upper airway inflamatory conditions

4) now what about conservative managment?

a- anti biotics : eg. anti gm +ve ( eg. unasyn) + anti gm -ve ( eg. garamycin or amikin)

b- corticosteroid: eg apidon .syroup as a prophylaxis of ARDS
c- bronchodilators as aminophyllin may play a role.

Thanks for ur Help
It is important to gain clinical Knowledge
so I wait for mooooooooooooooore cases
pleeeeeeeeeeeeeeeease
Thanks again

Hi dr.roma
thanks aloooooooot 4 this case
really it's so important

please go on

we r waiting mooooore

ياريت يكون المانع اللى مأخرك عنا يكون خير ..
واحنا مستنيين حالات تانية فى الجزء ده من المنتدى ..
ومواضيع تانية فى بقية الأقسام ..