Transcript Ch 11 - 34 Presentation

Altered Mental Status
 AMS
malfunction can be:
◦ Global – affecting all parts of the central
nervous system equally.
◦ Localized or focal – affecting a portion of
the body.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Causes of AMS: AEIOU-TIPS or…
I ATE, I SOUP!!!
I - Insulin
 A - Alcohol, Acidosis
 T - Trauma, Tumors
 E - Epilepsy, Environment, Electrolytes
 I - Infection
 S - Seizure, Stroke, Syncope
 O - Oxygen, Overdose
 U - Uremia
 P - Poisoning, Psychiatric Conditions

BRADY
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
And now it’s time
for…
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Conditions Associated
With AMS
– chronic condition causing
recurrent seizures.
 Epilepsy
◦ Factors associated with epilepsy – head
injury, brain trauma, brain tumors,
genetic conditions, and chemical
imbalance.
◦ Chronic epileptics treated with anticonvulsant medications.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Seizures
 Seizures:
electrical disturbance in the
brain, causes altered awareness,
attentiveness, responsiveness,
behavior, or body movement
 Partial v. Generalized
 Three Phases
 Status epilepticus
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Conditions Associated
With AMS
– inability to regulate blood
sugar level; glucose level to high
 Diabetes
◦ Chronic disease.
◦ Pancreas cannot produce enough
insulin, or cells do not respond to insulin,
or both.
◦ Glucose does not enter the cells and
builds up in blood stream.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Diabetes
– inability to regulate blood
sugar level; glucose level to high
 Diabetes
◦ Symptoms – polyuria, polydipsia,
increased appetite, change in weight,
fatigue, dry mouth, cellular damage
4
◦
◦
◦
◦
BRADY
Types:
Type 1
Type 2
Gestational
Other
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Type 1 Diabetes
• Caused by autoimmune disease in the
young.
• Destroys pancreatic cells that produce
insulin.
• Controlled by injectable insulin or insulin
pump.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Type 2 Diabetes
• Unknown cause; increased incidence in the
obese; also may be genetically predisposed.
• Cells are resistant to action of insulin.
• Controlled by weight loss, exercise, and oral
hypoglycemic medication.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Gestational and Other
Diabetes
◦ Gestational diabetes mellitus
• Develops only during pregnancy.
◦ Other
• Genetic defects in insulin production
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Hypoglycemia
◦ Low Blood sugar
◦ Early signs and symptoms – anxiety,
dizziness, tachycardia, diaphoresis,
tremor, headache, mild confusion,
conscious ,and able to swallow.
◦ Severe signs and symptoms – marked
confusion, disorientation, lethargy,
slurred speech, seizures, unilateral
extremity weakness or
continued
unresponsiveness; irrational or
combative behavior is common
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Hyperglycemia
◦ High Blood sugar
◦ Early signs and symptoms – polyuria,
polydipsia, dry mouth, and fatigue.
◦ Late signs and symptoms – nausea,
vomiting, abdominal pain, AMS, coma,
brain injury, death.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Strokes
 Stroke:
neurological
impairment due to low or no
blood flow to areas of the
brain.
 Three types of stroke –
◦ Ischemic
◦ Hemorrhagic
◦ Transient ischemic attack (TIA):
BRADY
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Violent Behavior and AMS
 Be
BRADY
cool.
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Substance Abuse
and Poisoning
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Four Ways Drugs Enter and
Move Through Body
1. Absorption: the way the substance or
poison enters the body.
• 4 routes of absorption: ingestion, inhalation,
transdermal, injection
2. Distribution: transport of substance to
site where it will exert its effects.
3. Metabolism: body breaks down the
substance.
4. Elimination: body purges itself of
continued
substance.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Affected body systems
◦
◦
◦
◦
Nervous system
Myocardial
Ocular
Hematological
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
- How likely is ingestion of poison?
- Why is this important for us to know about?
◦ Acids & Bases
◦ Anti anxiety drugs and
sedatives
◦ Antidepressants
◦ Antipsychotics
◦ Depressants
◦ Designer Drugs (“Club
Drugs”)
◦ Hallucinogens
BRADY
◦
◦
◦
◦
◦
◦
◦
Inhalants
Nerve Agents
Opiates
Organophosphates
Stimulants
Prescription drugs
Over the counter continued
medications
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Substances
Encountered
◦
◦
◦
◦
◦
◦
◦
BRADY
Acetaminophen (Tylenol)
Alcohol
Aspirin (acetylsalicylic
acid)
Carbon monoxide (CO)
Cocaine (coke, crack,
snow, rock, nose candy)
Ethylene glycol
Iron supplements.
LSD (lysergicdiethylamide, acid)
◦ Marijuana (pot, weed,
cannabis, THC, hashish)
◦ Methamphetamine
(Speed, Meth) Methane
◦ PCP (phencyclidine,
angel dust)
◦ Toxic plants
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management (What to do)




BRADY

topical poisons:
◦ brush off dry particles and rinse away any
remaining with water.
liquid poisons:
◦ thoroughly rinse with water.
Ocular exposure
◦ immediately irrigate with sterile water or
irrigation solutions.
inhaled poisons:
◦ immediately remove patient from source ofcontinued
poisoning.
Maintain airway, high-flow O2, consider ALS
transport.
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Good things to know
 Personal
BRADY
safety is always first.
 Alcohol is the most abused drug.
 Carbon monoxide is a silent killer.
 Antidotes exist for many types of
drugs
 Three most deadly for children –
aspirin, acetaminophen and iron.
 Always try to identify the poison.
continued
 National Poison Control: 1-800-2221222
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Allergies and
Anaphylaxis
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Why do people have allergic
reactions?
Anatomy and Physiology
 Antibody-antigen
reaction:
◦ Mast cells attack the offending antigen,
which causes a reaction that destroys it
without harming normal cells.
 Allergic
reaction:
◦ An acquired, abnormal over-reaction by
the immune system to an otherwise
harmless substance that results in a
continued
hypersensitivity.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Causes
of Allergies and Anaphylaxis
 Foods
BRADY
, especially peanuts and
shellfish
 Environmental irritants
 Pollen
 Molds
 Animal dander
 Medications
 Chemicals
 Other such as blood transfusion
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
3 types of allergic reactions
 Mild
 Moderate
 Severe
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Mild Allergic Reaction
BRADY
Signs and Symptoms
 Itching (pruritis)
 Flushed skin
 Rash or hives
(urticaria)
 Watery, reddened
eyes
 Nasal congestion
 Increased heart rate
 Tingling in/around
mouth

Fatigue
 Typically
results in
local dermatologic
changes, especially
on the face and/or
neck. Nasal mucosa
and/or congestion
are also common.
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Moderate Allergic Reaction
 Effects
BRADY
include those in a mild
reaction, but more pronounced.
 The respiratory and gastrointestinal
system are usually involved.
 Symptoms may take minutes, hours,
or even days to develop.
 Effects might disappear over time,
or increase in severity, depending
continued
on individual chemistry and
response.
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Moderate Allergic Reaction
BRADY
Signs and
neck, chest, arms
Symptoms
 Persistent itching
 Anxiety and
 Angioedema
confusion
 Abdominal pain or
 Tightness in the
cramping
throat
 Nausea and/or
 Difficulty swallowing
vomiting
and/or breathing
 Elevated vital signs
 Wheezing
continued
 Rash, hives,
swelling in face,
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Moderate Allergic Reaction
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Severe Allergic Reaction
 Causes
a massive inflammatory
response in the respiratory,
integumentary, circulatory, and
gastrointestinal systems due to
massive histamine release.
 Effects are almost immediate- within
seconds or minutes.
 If not treated quickly, it can lead to continued
anaphylactic shock and/or death.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Severe Allergic Reaction
Signs and
Symptoms
 Severe anxiety,
impending doom
 Decreased level of
responsiveness
 Severe respiratory
distress;
 Severe
BRADY
angioedema, hives
 Abnormal lung
sounds
 Inability to swallow
 Tachycardia, weak
peripheral pulses
 Hypotension, pallor,
continued
cyanosis
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Preventing Allergic Reaction
 Triple
A Approach:
◦ Awareness
• of one’s allergies and the triggers
◦ Avoidance
• of contact with known allergens
◦ Action
• know what to do if an allergic reaction
occurs (emergency and self-care)
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
Moving patient may be necessary before
assessment.
 Severity of allergic reaction determines
timing, esp. if anaphylaxis is present.
 Observe closely skin, face, neck, and
eyes for rash, swelling, breathing.
 Extend questioning during known
allergies part of SAMPLE (EpiPen)

BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Initial
management is similar- ABCDs.
 Try to identify the allergen.
 Remove the patient from the allergen
if possible.
 Monitor and check vitals frequently.
 If signs of anaphylaxis appear, treat
ABCDs and seek transport and ALS.
 Insect bite? Remove stinger if
possible.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Epinephrine
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 An
allergy is the body’s overreaction
to a foreign substance.
 Allergies are caused by antigens
called allergens.
 Many people do not know they have
an allergy until they suffer an allergic
reaction.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
A woman is 34 weeks pregnant and is complaining of
severe abdominal pain. She is lying supine on the
snow with both knees flexed. She is awake and
oriented. A ski school instructor is present and
witnessed the patient fall onto her left side, striking
her abdomen. Her abdominal pain as “sharp” and
“all over”, unlike the labor contractions she had with
her first delivery. She does not feel any leakage of
fluid and denies feeling lightheaded. This is her
second pregnancy and she states it has been
uncomplicated to date.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
Of a snuggie
Copyright Scott Smith
BRADY
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Obstetrical and
Gynecological Emergencies
• Abdominal pain
• Dysmenorrhea
• Cystitis
• Ovarian cysts
• Pelvic inflammatory
disease
• Ectopic pregnancy
continued
Copyright Craig Brown
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Pregnancy
 Complications
of pregnancy
◦ Hemorrhage
◦ Pregnancy-Induced Hypertension (PIH)
◦ Miscarriage
 Supine
Hypotensive Syndrome
 Situations for evacuation
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Pregnancy
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Pregnancy
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Pregnancy
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
How to Deliver a Baby in 7
Easy Steps: A Ski Hill Guide
BRADY
1. Use a disposable sterile OB delivery kit
2. Assist the mother, if necessary, in removing her
clothing and place in semi-fowler’s position.
3. Time the contractions
4. Once the baby is crowning, allow the mother to
push
5. Deliver head and shoulders
6. Should transportation be delayed more than 20
minutes, you will need to cut the umbilical cord
continued
7. Delivery of the placenta
***Always transport mother and baby to the hospital or
other ALS point
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Care of the newborn (APGAR)
◦
◦
◦
◦
◦
Appearance
Pulse
Grimace or irritability
Activity or muscle tone
Respirations
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Trauma with pregnancy
◦ Ruptured uterus
◦ Abruptio placenta and premature labor
◦ Rupture of membranes
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Abruptio Placenta
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Amniotic Sac Rupture
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Initial
◦
◦
◦
◦
◦
◦
management
Scene safe
ABCDs
SAMPLE
OPQRST
DCAP-BTLS
ALS if needed
 Management
BRADY
following trauma
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ