Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Medical...

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Medical Emergencies

Medical Emergencies

Chapter 9Chapter 9


OutlineOutline

• General Medical Complaints

• Specific Medical Complaints– Difficulty Breathing

– Chest Pain

– Altered Mental Status

– Seizures

– Stroke

• General Medical Complaints

• Specific Medical Complaints– Difficulty Breathing

– Chest Pain

– Altered Mental Status

– Seizures

– Stroke

– Acute Abdomen

– Exposure to Cold

– Exposure to Heat

– Poisoning

– Allergic Reactions

– Behavioral Emergencies

– Acute Abdomen

– Exposure to Cold

– Exposure to Heat

– Poisoning

– Allergic Reactions

– Behavioral Emergencies


General Medical

Complaints

General Medical

Complaints


General Medical ComplaintsGeneral Medical Complaints

• Scene size-up

• Initial assessment

• Physical exam (as needed)

• Vital signs/SAMPLE history

• Ongoing assessment

• Scene size-up


• Physical exam (as needed)




Specific Medical

Complaints

Specific Medical

Complaints


Difficulty BreathingDifficulty Breathing


Difficulty BreathingDifficulty Breathing

• Common complaint

• Variety of causes


• Variety of causes


Causes include:Causes include:

• FBAO

• Chronic lung disease

– COPD

• Infections

– Pneumonia

– Influenza

• FBAO

• Chronic lung disease

– COPD

• Infections

– Pneumonia

– Influenza

• CHF with pulmonary edema

• Hyperventilation syndrome

• CHF with pulmonary edema

• Hyperventilation syndrome


Does a First Responder have to determine the cause of difficulty

breathing?

Does a First Responder have to determine the cause of difficulty

breathing?


The most important considerations for the

First Responder are to

recognize signs and symptoms of inadequate breathing

and…

The most important considerations for the First Responder are to

recognize signs and symptoms of inadequate breathing

and…


provide

airway management

and ventilation

as needed

provide

airway management

and ventilation

as needed



OPQRSTOPQRST

O = Onset

P = Provocation

Q = Quality

R = Radiation

S = Severity

T = Time

O = Onset

P = Provocation

Q = Quality

R = Radiation

S = Severity

T = Time


Chest PainChest Pain


Chest PainChest Pain• Common

complaint

• May be life threatening

• Be prepared to assist with a/w, breathing and circulation


• May be life threatening

• Be prepared to assist with a/w, breathing and circulation



Chest Pain

Chest Pain

• Heart related

• Lung related

• Musculoskeletal related

• Always assume it life threatening

• Heart related

• Lung related

• Musculoskeletal related

• Always assume it life threatening



Chest Pain - HeartChest Pain - Heart

Acute Coronary Syndrome (ACS)

– Myocardial infarction

– Angina

– Abnormal heart rhythms

What are some signs and symptoms of ACS?

Acute Coronary Syndrome (ACS)

– Myocardial infarction

– Angina

– Abnormal heart rhythms

What are some signs and symptoms of ACS?


ACS - Signs and SymptomsACS - Signs and Symptoms

• Pale, cool, clammy skin

• Cyanotic lips and nail beds

• Altered mental status

• Indigestion

• Pale, cool, clammy skin

• Cyanotic lips and nail beds


• Indigestion

• Vomiting/Nausea

• Chest pain

• Sense of impending doom

• Irregular pulse rate

• Vomiting/Nausea

• Chest pain

• Sense of impending doom

• Irregular pulse rate


Chest Pain - LungsChest Pain - Lungs

• Pulmonary embolism

• Congestive heart failure

• Pulmonary embolism

• Congestive heart failure


Does a First Responder have to determine the cause of chest

pain?

Does a First Responder have to determine the cause of chest

pain?


A First Responder should

recognize

that a complaint of chest pain is potentially life threatening, and…

A First Responder should

recognize

that a complaint of chest pain is potentially life threatening, and…


Chest PainChest Pain

• Continually re-evaluate the patient for signs of deterioration

• Continually re-evaluate the patient for signs of deterioration



Altered Mental Status

Altered Mental Status


What is altered mental status?What is altered mental status?


Altered Mental StatusAltered Mental Status

A gradual or sudden change in the patient’s level of awareness and responsiveness to his or her surroundings.

A gradual or sudden change in the patient’s level of awareness and responsiveness to his or her surroundings.




• Can range from disorientation to complete unresponsiveness

• Important to determine the patient’s usual mental status

• Can range from disorientation to complete unresponsiveness

• Important to determine the patient’s usual mental status


Causes of AMSCauses of AMS

• Fever

• Infection

• Poisoning

• Drugs/Alcohol

• Fever

• Infection

• Poisoning

• Drugs/Alcohol

• Low blood sugar

• Head injury

• Decreased O2 to brain

• Psychiatric disorders

• Low blood sugar

• Head injury


• Psychiatric disorders



• Status may change

• Look for clues during scene size-up

Is it necessary to know the cause of the AMS?

• Status may change

• Look for clues during scene size-up

Is it necessary to know the cause of the AMS?


Goals of TreatmentGoals of Treatment

• Maintain scene and personal safety

• Support airway, breathing, circulation

Don’t need to determine the specific cause.

• Maintain scene and personal safety

• Support airway, breathing, circulation

Don’t need to determine the specific cause.


AMS - TreatmentAMS - Treatment

• Scene size-up



• Physical examination (as needed)

• Place in recovery position/position of comfort

• Reassure patient and family

• Scene size-up



• Physical examination (as needed)

• Place in recovery position/position of comfort

• Reassure patient and family


Remember!Remember!

Maintain the airway

• Place in recovery position

• Have suction available


Maintain the airway

• Place in recovery position

• Have suction available



DiabetesDiabetes


Hyperglycemia or

Hypoglycemia?

Hyperglycemia or

Hypoglycemia?

DiabetesDiabetes


That is the question…That is the question…


DiabetesDiabetes• Rx same as that for AMS

• Ask questions:– Do you take insulin?

– When did you last eat?

– What did you eat?

– Have you exercised recently?

• Rx same as that for AMS

• Ask questions:– Do you take insulin?

– When did you last eat?

– What did you eat?

– Have you exercised recently?


SeizuresSeizures


?

What is a seizure?What is a seizure?


SeizuresSeizures

A sudden attack due to a change in the electrical activity of the brain.A sudden attack due to a change in the electrical activity of the brain.


Causes of SeizuresCauses of Seizures

• Epilepsy

• Chronic medical condition

• Fever

• Infections

• Poisoning

• Low blood sugar

• Epilepsy

• Chronic medical condition

• Fever

• Infections

• Poisoning

• Low blood sugar

• Head injury


• Brain tumor

• Pregnancy complications

• Unknown cause

• Head injury


• Brain tumor

• Pregnancy complications

• Unknown cause


Regardless of the cause of the seizure, the First Responder’s role is to maintain the patient’s airway and breathing.

Regardless of the cause of the seizure, the First Responder’s role is to maintain the patient’s airway and breathing.


Seizures (with convulsions)Seizures (with convulsions)

Patients

• Are almost always unresponsive

• Have excessive salivation

• May lose control of the bladder

Patients

• Are almost always unresponsive

• Have excessive salivation

• May lose control of the bladder


Post-seizurePost-seizure

Patients may be:

• Very sleepy

• Confused

• Unable to answer questions

• Combative

Patients may be:

• Very sleepy

• Confused

• Unable to answer questions

• Combative


SeizuresSeizures

• Most are brief (< 5 min)

• If prolonged, may need advanced care

• Most are non life threatening

• Most are brief (< 5 min)

• If prolonged, may need advanced care

• Most are non life threatening


TreatmentTreatment

• Scene size-up



• Physical exam


Sound familiar?

• Scene size-up



• Physical exam


Sound familiar?


Special ConsiderationsSpecial Considerations

• Protect patient

– Move objects

– Protect privacy

– Place in recovery position after seizure

• Protect patient

– Move objects

– Protect privacy

– Place in recovery position after seizure


Special ConsiderationsSpecial Considerations

• Never restrain patient

• Never place anything in patient’s mouth

• Have suction ready

• Be prepared to manage airway and provide ventilation

• Never restrain patient

• Never place anything in patient’s mouth

• Have suction ready

• Be prepared to manage airway and provide ventilation


Hand-Off ReportHand-Off Report

Your observations can be helpful

• Did the seizure start in one extremity and then spread?

• Was only one side of body involved?

• How long did the seizure last?

Your observations can be helpful

• Did the seizure start in one extremity and then spread?

• Was only one side of body involved?

• How long did the seizure last?


StrokeStroke


StrokeStroke

• Leading cause of death and disability

• Commonly encountered

What causes a stroke?

• Leading cause of death and disability

• Commonly encountered

What causes a stroke?


StrokeStroke• Occurs when artery

in brain is occluded or ruptures, interrupts blood flow to brain

• Cerebral Vascular Accident (CVA) or “Brain Attack”

• Signs and symptoms depend on location and area involved

• Occurs when artery in brain is occluded or ruptures, interrupts blood flow to brain

• Cerebral Vascular Accident (CVA) or “Brain Attack”

• Signs and symptoms depend on location and area involved


Signs & SymptomsSigns & Symptoms

• Facial drooping

• One-sided paralysis

• Slurred speech

• Dilated pupil(s)

• Facial drooping

• One-sided paralysis

• Slurred speech

• Dilated pupil(s)

• Weakness

• Nausea/vomiting

• Dizziness

• Blurred vision

• Weakness

• Nausea/vomiting

• Dizziness

• Blurred vision


Cincinnati Prehospital Stroke ScaleCincinnati Prehospital Stroke Scale

Assess

• Facial droop

• Arm drift

• Abnormal speech

Assess

• Facial droop

• Arm drift

• Abnormal speech


Time is Critical!Time is Critical!

Stroke patients can be treated with drugs that dissolve blood clots if they reach an appropriate hospital in a short amount of time.

Stroke patients can be treated with drugs that dissolve blood clots if they reach an appropriate hospital in a short amount of time.


TreatmentTreatment

• Support airway, breathing, and circulation

• Reassure patient

• Ensure rapid transport by EMS



• Ensure rapid transport by EMS


Acute Abdomen

Acute Abdomen


Acute AbdomenAcute Abdomen

Term used to describe sudden onset of abdominal pain.

Term used to describe sudden onset of abdominal pain.


Signs and SymptomsSigns and Symptoms

• Abdominal pain

• Nausea/vomiting

• Abdominal guarding

• Distended/rigid abdomen

• Shock

• Abdominal pain

• Nausea/vomiting

• Abdominal guarding

• Distended/rigid abdomen

• Shock


Common CausesCommon Causes

• Gall bladder disease

• Gastric ulcers

• Aortic aneurysm

• Gastrointestinal illness

• Appendicitis

• Gall bladder disease

• Gastric ulcers

• Aortic aneurysm

• Gastrointestinal illness

• Appendicitis

• Diverticulitis

• Bowel obstruction

• Female reproductive system

• Diverticulitis

• Bowel obstruction

• Female reproductive system


Acute AbdomenAcute Abdomen

• Observe for signs and symptoms of shock

• Allow patient to remain in position of comfort

• Be prepared to clear airway

• Observe for signs and symptoms of shock

• Allow patient to remain in position of comfort

• Be prepared to clear airway


Exposure to Cold

Exposure to Cold


BRRRRRR…BRRRRRR…



Exposure to ColdExposure to Cold

• Localized cold emergency = frostbite

• Generalized cold emergency = hypothermia

• Patient can have either one or both

• Localized cold emergency = frostbite

• Generalized cold emergency = hypothermia

• Patient can have either one or both


Contributing FactorsContributing Factors

• Cold environment

• Age

• Underlying medical conditions

• Alcohol, drugs, poisons

• Wind

• Wet conditions

• Cold environment

• Age

• Underlying medical conditions

• Alcohol, drugs, poisons

• Wind

• Wet conditions


Frostbite

Frostbite• Freezing or near-freezing of body

part– Nose

– Ears

– Fingers

– Toes

– Face

• Freezing or near-freezing of body part– Nose

– Ears

– Fingers

– Toes

– Face



Early Signs – FrostbiteEarly Signs – Frostbite

• Blanched skin (white)

• Loss of sensation to area

• Skin soft to touch

• Tingling/burning sensation with rewarming

• Blanched skin (white)

• Loss of sensation to area

• Skin soft to touch

• Tingling/burning sensation with rewarming


Late Signs - FrostbiteLate Signs - Frostbite

• Firm, pale, waxy skin

• Area feels frozen

• Swelling

• Blisters

• Skin may appear mottled with thawing or partial thawing

• Firm, pale, waxy skin

• Area feels frozen

• Swelling

• Blisters

• Skin may appear mottled with thawing or partial thawing


6 Weeks later6 Weeks later



TreatmentTreatment

• Remove patient from cold

• Protect part from further harm

• Remove wet or restrictive clothing/jewelry


• Protect part from further harm

• Remove wet or restrictive clothing/jewelry

• Stabilize extremity and cover loosely (if early injury)

• Do not rub or massage area

• Do not re-expose to cold

• Stabilize extremity and cover loosely (if early injury)

• Do not rub or massage area

• Do not re-expose to cold


Late or Deep InjuryLate or Deep Injury

• Cover area with loose, dry dressing

• Do not break blisters

• Do not apply heat

• Do not allow patient to use affected extremity

• Cover area with loose, dry dressing

• Do not break blisters

• Do not apply heat

• Do not allow patient to use affected extremity


HypothermiaHypothermia

• Occurs when body temp < 95° F

• Can occur in normal temperature

• Occurs when body temp < 95° F

• Can occur in normal temperature


TreatmentTreatment

• Assess pulses for 30–45 sec before starting CPR


• Remove wet clothing/prevent further heat loss

• Handle patient gently

• Assess pulses for 30–45 sec before starting CPR


• Remove wet clothing/prevent further heat loss

• Handle patient gently


TreatmentTreatment

• Do not allow patient to eat or drink

– Avoid caffeine, nicotine, alcohol

• Do not massage extremities

• Do not attempt to rewarm patient

• Do not allow patient to eat or drink

– Avoid caffeine, nicotine, alcohol

• Do not massage extremities

• Do not attempt to rewarm patient


Exposure to Heat

Exposure to Heat


Contributing FactorsContributing Factors

• Hot, humid climate

• Exercise/activity

• Age

• Pre-existing illness

• Drugs and medications

• Hot, humid climate

• Exercise/activity

• Age

• Pre-existing illness

• Drugs and medications


Heat-Related IllnessHeat-Related Illness

• Heat cramps

• Heat exhaustion

• Heat stroke

• FR needs to recognize heat emergencies but not distinguish between them

• Heat cramps

• Heat exhaustion

• Heat stroke

• FR needs to recognize heat emergencies but not distinguish between them


ManagementManagement

• Remove patient from heat into cool environment

• Place patient in recovery position if AMS

• Maintain patient comfort


• Remove patient from heat into cool environment

• Place patient in recovery position if AMS

• Maintain patient comfort



PoisoningsPoisonings


PoisonPoison

• Any substance that can potentially harm the body

• Can enter body in four ways– Ingestion

– Inhalation

– Absorption

– Injection

• Any substance that can potentially harm the body

• Can enter body in four ways– Ingestion

– Inhalation

– Absorption

– Injection


PoisoningPoisoning

• May be accidental or intentional

• Amount required may vary

• May be accidental or intentional

• Amount required may vary


Common PoisonsCommon Poisons

• Drugs/medicine

• Plants

• Snake/spider venom

• Alcohol

• Spoiled food

• Drugs/medicine

• Plants

• Snake/spider venom

• Alcohol

• Spoiled food

• Household chemicals

• Carbon monoxide

• Insecticides

• Nerve agents

• Household chemicals

• Carbon monoxide

• Insecticides

• Nerve agents


Be Careful!Be Careful!

Do your scene size-up.

Make sure that you won’t be exposed to the poison!

Do your scene size-up.

Make sure that you won’t be exposed to the poison!


Carbon monoxide poisoning is a serious possibility with fire victims.



DecontaminationDecontamination

• The patient may need to be decontaminated

• Done by specially trained HAZMAT personnel

• The patient may need to be decontaminated

• Done by specially trained HAZMAT personnel


Effects of PoisonsEffects of Poisons

• Respiratory failure

• Shock

• Abdominal pain

• Nausea/vomiting

• Diarrhea


• Respiratory failure

• Shock

• Abdominal pain

• Nausea/vomiting

• Diarrhea




• Call Poison Control Center

– Specific poisons may have specific treatment

• Support airway and breathing

• Provide CPR if necessary

• Call Poison Control Center

– Specific poisons may have specific treatment

• Support airway and breathing

• Provide CPR if necessary


Allergic ReactionsAllergic

Reactions


Allergic ReactionsAllergic Reactions

• Occur when a person is sensitized to a foreign substance and comes in contact with it

• Occur when a person is sensitized to a foreign substance and comes in contact with it


Signs and SymptomsSigns and Symptoms• Localized rash

• Swelling

• Watery eyes

• Sneezing

• Asthma-like reaction

• Localized rash

• Swelling

• Watery eyes

• Sneezing

• Asthma-like reaction


Allergic ReactionsAllergic Reactions

Commonly caused by:

• Shellfish

• Peanuts

• Strawberries

• Sesame seeds

Commonly caused by:

• Shellfish

• Peanuts

• Strawberries

• Sesame seeds


AnaphylaxisAnaphylaxis

• Severe, life-threatening allergic reaction

• Body overwhelmed with substance

• Patient goes into shock

• Severe, life-threatening allergic reaction

• Body overwhelmed with substance

• Patient goes into shock


Signs and SymptomsSigns and Symptoms

• Generalized swelling

• Hives

• Wheezing

• Abdominal pain

• Low blood pressure

• Generalized swelling

• Hives

• Wheezing

• Abdominal pain

• Low blood pressure




• Anaphylaxis is a life-threatening emergency

• Swelling → Airway Obstruction → Respiratory Arrest

• Watch patient for signs of deterioration


• Anaphylaxis is a life-threatening emergency

• Swelling → Airway Obstruction → Respiratory Arrest

• Watch patient for signs of deterioration



Behavioral EmergenciesBehavioral

Emergencies


• Behavior refers to all of the physical

and mental activities of a person

• A behavioral emergency occurs when a person exhibits abnormal behavior that is unacceptable to the patient, family or community

• Behavior refers to all of the physical and mental activities of a person

• A behavioral emergency occurs when a person exhibits abnormal behavior that is unacceptable to the patient, family or community


Behavioral ChangesBehavioral Changes

May result from:

• Extremes of emotions

• Mental illnesspsychological stress

• Physical illness

May result from:

• Extremes of emotions

• Mental illnesspsychological stress

• Physical illness



Common CausesCommon Causes

• Situational stress

• Low blood sugar

• Decreased oxygen to brain

• Head injury

• Heat or cold injury

• Drugs/alcohol

• Situational stress

• Low blood sugar

• Decreased oxygen to brain

• Head injury

• Heat or cold injury

• Drugs/alcohol

• Psychiatric illness

• Psychological crisis

• Psychiatric illness

• Psychological crisis


Does anything look wrong here?Does anything look wrong here?



Always keep your escape routes open!Always keep your escape routes open!



• Do a thorough scene size-up

– Potential for violence

– Unpredictable behavior

• Do a thorough scene size-up

– Potential for violence

– Unpredictable behavior



Role of the FRRole of the FR

• Attempt to calm patient

• Do not leave patient alone

– Unless patient threatens your safety

• Consider need for law enforcement or backup

• Collect containers if an OD or poisoning

• Attempt to calm patient

• Do not leave patient alone

– Unless patient threatens your safety

• Consider need for law enforcement or backup

• Collect containers if an OD or poisoning


AssessmentAssessment

• Identify yourself and that you are there to help

• Inform patient of your actions

• Identify yourself and that you are there to help

• Inform patient of your actions




• Use calm, reassuring voice

• Don’t be judgmental

• Show you are listening

• Use calm, reassuring voice

• Don’t be judgmental

• Show you are listening




• Acknowledge the patient’s feelings

• Assess patient’s mental status as you talk

• Note patient’s rate and content of speech

• Acknowledge the patient’s feelings

• Assess patient’s mental status as you talk

• Note patient’s rate and content of speech




• Note patient’s general appearance

• Note patient’s level of physical activity

• Note patient’s general appearance

• Note patient’s level of physical activity



Violent SituationsViolent Situations

• The safety of everyone is critical

• Watch for signs of impending violence

• The safety of everyone is critical

• Watch for signs of impending violence



Violent SituationsViolent Situations

• Is there a weapon? Anything that can be used as a weapon?

• Does patient have a history of violence?

• Is there a weapon? Anything that can be used as a weapon?

• Does patient have a history of violence?



Impending ViolenceImpending Violence

• Tense, threatening posture

• Clenched fist

• Loudness, profanity, threats

• Quick erratic movements

• Tense, threatening posture

• Clenched fist

• Loudness, profanity, threats

• Quick erratic movements


Agitated PatientsAgitated Patients

• Do not put yourself in harms way

• Acknowledge that the person is upset

• State that you are there to help

• Keep the patient informed

• Use a calm voice

• Do not put yourself in harms way

• Acknowledge that the person is upset

• State that you are there to help

• Keep the patient informed

• Use a calm voice



• Maintain a comfortable distance

• Encourage patient to talk

• Don’t make sudden moves

• Be honest

• Do not threaten, challenge, or argue

• Maintain a comfortable distance

• Encourage patient to talk

• Don’t make sudden moves

• Be honest

• Do not threaten, challenge, or argue



• Do not “play along” with hallucinations/voices

• Involve trusted friends/family

• Be prepared to spend lots of time

• Use eye contact if appropriate

• Avoid unnecessary physical contact

• Do not “play along” with hallucinations/voices

• Involve trusted friends/family

• Be prepared to spend lots of time

• Use eye contact if appropriate

• Avoid unnecessary physical contact


RestraintsRestraints

• Responsibility of law enforcement

• Special considerations

– Monitor airway and breathing

– Monitor circulation distal to restraint

• Responsibility of law enforcement

• Special considerations

– Monitor airway and breathing

– Monitor circulation distal to restraint


Legal ConsiderationsLegal Considerations

• Document patient’s behaviors accurately

• Have witnesses

• Use same-sex attendant

• Obtain consent

• Document patient’s behaviors accurately

• Have witnesses

• Use same-sex attendant

• Obtain consent


SummarySummary

• Medical complaints make up a large number of calls. Although there are a variety of medical problems, the principle of treatment is to maintain the patient’s airway, breathing and circulation until the transporting unit arrives.

• Medical complaints make up a large number of calls. Although there are a variety of medical problems, the principle of treatment is to maintain the patient’s airway, breathing and circulation until the transporting unit arrives.


SummarySummary

• Some medical emergencies, such as cold and heat emergencies, require special measures such as protecting the patient from the environment.

• Behavioral emergencies present special challenges to First Responders because there are only guidelines for dealing with them, rather than specific hands-on skills with which to help the patient.

• Some medical emergencies, such as cold and heat emergencies, require special measures such as protecting the patient from the environment.

• Behavioral emergencies present special challenges to First Responders because there are only guidelines for dealing with them, rather than specific hands-on skills with which to help the patient.


Is this man intoxicated? diabetic? fallen? sleeping?

Suspect the worst and treat accordingly.

Is this man intoxicated? diabetic? fallen? sleeping?

Suspect the worst and treat accordingly.


Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Medical...

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Transcript of Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Medical...