Transcript Health Science Core Chapter 1, 2, 3, and 4

Emergency Medical Technician
Basic
Health Science Core
Chapter 18
Medical Incidents
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Seizures
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Seizures
• A temporary alteration in behavior
or consciousness and typically
characterized by twitching muscle
• Different types of Seizures:
– Focal or Partial Seizure –
happen in just one part of the
brain
– Generalized or Grand Mal
Seizure – abnormal activity on
both sides of the brain
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Seizure Causes
• Epileptic – congenital in origin
• Structural – tumor, stroke, head
trauma, infection
• Metabolic – Hypoxia, hypoglycemia,
poisoning, drug overdose, sudden
withdraw from alcohol or medications
• Febrile – Sudden high fever
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Seizure
Signs and Symptoms
• Aura – a warning event that something is going
to happen
• Sudden loss of consciousness
• Chaotic muscle movement and tone
• Bladder or bowl incontinence
• Tongue biting
• Postictal state – patient gradually regains
consciousness
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Seizure
Assessment
• Scene size-up
– Consider the need for spinal precautions
• Initial Assessment
– Patient still seizing – move objects out of the
way and do not restrain
– Do not put anything into the patient’s mouth
– Determine patient level of consciousness
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Seizure
Assessment
• Focused History and physical
assessment
– Perform SAMPLE and look for
medications typical to chronic
seizure patients
• Dilantin
• Phenobarbital
• Tegretol
– Vital signs
• Blood sugar check
– Physical assessment look for
medical alert identifications
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Seizure
Treatment
• Treat any trauma
• Provide oxygen
• Actively seizing:
– move objects out of the way that they can
strike
– Contact ALS transport to provide medication
• Febrile seizures – lower fever
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Chest Pain
McFatter Technical Center, Broward County Public Schools
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Chest Pain
• Decrease in blood flow through
the coronary arteries which
cause vessel to spasm and
results in pain
• Necrosis – death of tissue
• Myocardial infarction – death of
cardiac tissue
• Ischemia – insufficient oxygen
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Chest Pain
Causes
• Atherosclerosis –
disorder in which calcium
and fatty material form
plaque on the walls of the
blood vessels.
• Rupturing plaques form
blood clots (thrombus)
that may block the blood
flow through an artery or
break off and travel to
another part of the body
(embolus).
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Chest Pain
Causes
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Chest Pain
Signs and Symptoms
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Begin resting or during exercise
Tight / squeezing pain
Sharp / stabbing pain
Indigestion
Chest pressure
Located middle of chest
Radiating to one extremity or both,
in the jaw, the neck, or the back
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Chest Pain
Signs and Symptoms
• Skin color may be
pale, gray, cool,
and/or diaphoretic
• Anxious and uneasy
• Nausea and/or
vomiting
• Short of breath
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Chest Pain
Assessment
• Initial Assessment
– Assess circulation – regular or irregular, fast
or slow, skin color, skin temperature, and
capillary refill time.
• Focused history and physical assessment
– History of chest pain
– History of heart problems
– Cardiac medication – Nitroglycerin
• Vital Signs
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Chest Pain
Assessment
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O – onset of the discomfort
P – provocation of the pain or makes it worse.
Q – quality of the pain. Feel like.
R – radiation of the pain. Where it travels.
S – severity of the pain. 1 to 10 pain scale.
T – time. How long the pain lasts
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Chest Pain
Treatment
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Place patient in position of comfort
Try not to allow the patient to exert himself/herself by
walking
Some protocols baby aspirin 324mg – which prevents clots
from getting bigger
Assist with patient’s nitroglycerin x3 – which dilates the
cardiac arteries
– Take body substance isolation precautions.
– Verify patient has blood pressure greater than 100
mmHg systolic.
– Check for right medication.
– Check for right patient.
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Chest Pain
Treatment
– Check expiration date.
– Verify number of doses previously taken by the
patient.
– Position patient in semi-fowler position.
– Ask patient to lift tongue.
– Place tablet or spray metered dose under the tongue.
– Recheck blood pressure after 5 minutes.
– monitor blood pressure closely and do not readminister under 100 mmHg
• Oxygen
• Transport to appropriate type of hospital
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Shortness of Breath
Asthma
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Asthma
• An acute spasm of the smaller
airway passages, associated
with excessive mucus production
and swelling of mucus lining
• Air passage opens easily during
inspiration
• Difficult to exhale
• Normally the result of allergic
reaction to inhaled, ingested, or
injected substances.
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Asthma
Signs and Symptoms
• Difficulty exhaling
• Wheezing breath sounds during
exhalation
• Blood pressure normal or elevated
• Respirations increased
• Anxiety
• Tired because of struggling to breath
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Asthma
Assessment
• Initial Assessment
– General impression of calm or anxious, tired,
stable or unstable
– Is patient breathing adequately by looking at
chest movement, rate, skin color, or labored
• Focused History and physical assessment
– Medication for history
– Environment for causes
– Patient intervention
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Asthma
Treatment
•
•
Supplemental oxygen
Self administer metered dose inhaler
– Take body substance isolation
precautions.
– Check for right medication.
– Check for right patient.
– Check expiration date.
– Verify number of doses previously
taken by the patient.
– Make sure the inhaler is at room
temperature.
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Asthma
Treatment
– Shake inhaler.
– If administering oxygen therapy with face mask, then
stop and remove from patient’s face.
– Ask patient to exhale deeply before placing lips
around opening of the inhaler.
– Have the patient inhale deeply and depress the
inhaler.
– Instruct patient to hold breath for as long as
comfortable.
– Reapply oxygen therapy.
• Position 45 or 90 degree angle of comfort
McFatter Technical Center, Broward County Public Schools
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Shortness of Breath
Emphysema
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Emphysema
• Slow process disease that results from repeated
infections or inhalation of toxic agents
• Destruction of lung tissue around smaller
airways that makes these airways unable to hold
their shape properly when you exhale.
• Loss of elastic material
• Cigarette smoking number one cause
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Emphysema
Signs and Symptoms
• Pursed lips due to difficulty to
exhale
• Cough caused by the production of
mucus
• Wheezing
• Barrel chest," because air becomes
trapped behind obstructed airways.
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Emphysema
Assessment
• Initial Assessment
– General impression of calm or anxious, tired,
stable or unstable
– Is patient breathing adequately by looking at
chest movement, rate, skin color, or labored
• Focused History and physical assessment
– Medication for history – Atrovent or Albuterol
– Environment for causes
– Patient intervention
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Emphysema
Treatment
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Supplemental oxygen
Self administer metered dose
inhaler
Semi-fowler’s position patient at 45
degree angle on the stretcher
High fowler’s position patient at 90
degree angle on the stretcher
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Acute Pulmonary Edema
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Acute Pulmonary Edema
• Swelling and/or fluid
accumulation in the lungs
• Causes impaired gas
exchange and may cause
respiratory failure.
• It is due to either failure of the
heart to remove fluid from the
lung circulation or due to a
direct injury to the lung
parenchyma
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Acute Pulmonary Edema
Signs and Symptoms
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Rapid and shallow respiration
Frothy pink sputum
Lung sounds of rales or crackles
Anxiety
Excessive sweating
Pale skin
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Acute Pulmonary Edema
Assessment
• Initial Assessment
– General impression of calm or anxious, tired,
stable or unstable
– Is patient breathing adequately by looking at
chest movement, rate, skin color, or labored
• Focused History and physical assessment
– Medication for history – Lasix
– Patient intervention
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Acute Pulmonary Edema
Treatment
• Supplemental oxygen
• Sitting upright
• C-PAP Device –
Continuous positive
airway pressure
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Poisoning
McFatter Technical Center, Broward County Public Schools
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Poisoning
• Substance whose chemical action can damage body
structures or impair body function
• Occur accidentally or intentionally
• Poison Control Center at (800) 222-1222
• Methods:
– Inhalation
– Absorption
– Ingestion
– Injection
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Poisoning
Signs and Symptoms
Based on the type of poison:
• Burns or redness around the mouth and lips, which can
result from drinking certain poisons
• Breath that smells like chemicals
• Burns, stains and odors on the person, on his or her
clothing or on the furniture, floor, rugs or other objects in
the surrounding area
• Empty medication bottles or scattered pills
• Vomiting, difficulty breathing, sleepiness, confusion or
other unexpected signs
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Poisoning
Assessment
• Scene size-up
– scene may indicate substance
– wear appropriate BSI
• Initial assessment
– Do not be fooled that AAOX3 means stable,
the patient can rapidly decompensate
– Have suction available
– Decontamination may be required
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Poisoning
Assessment
• Focused history and physical assessment
– What substance did you take?
– When did you take it or become exposed?
– How much did you ingest?
– What action have been taken?
– How much do you weigh?
– Focus assessment based on route of
exposure
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Poisoning
Treatment
• Contact Poison Control for
treatment recommendations
• Oxygen therapy based on situation
• Activated charcoal based on poison
control orders
• Syrup of ipecac no longer
recommended
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Diabetic
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Diabetic
• Body’s ability to metabolize simple
carbohydrates is impaired
• Caused by lack or ineffective action of insulin
• Insulin hormone enables glucose to enter cells
• Type I diabetes – no insulin production
• Type II diabetes – inadequate amounts of insulin
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Hyperglycemia or Diabetic coma
Signs and Symptoms
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Blood glucose is above normal
Kussmaul respirations
Dehydration
Sweet or fruity odor on breath
Rapid pulse
Normal or slightly lower blood pressure
Varying degrees of unresponsiveness
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Hypoglycemia or Insulin Shock
Signs and Symptoms
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Insufficient blood glucose
Normal or rapid respirations
Diaphoresis
Rapid pulse
Normal to low blood pressure
Altered mental status
Seizure
Weakness to one side of the body (mimic of
stroke)
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Diabetic Emergency
Assessment
• Scene size up
– Remember diabetics use syringes and be
careful to not get stuck
• Focused history and physical assessment
– History of insulin or pills
– Last meal
– Illness or unusual activity
– Check for medical alert bracelet
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Diabetic Emergency
Treatment
•
Patient is conscious and able to swallow without risk of
aspiration:
– Provide juice or milk
Or
– Oral glucose
– Take body substance isolation precautions.
– Utilize glucometer to determine blood glucose
levels.
– Determine patient can swallow and is able to protect
his/her airway.
– Check expiration date.
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Diabetic Emergency
Treatment
– Squeeze glucose gel on tongue depressor.
– Direct patient to open mouth and insert tongue
depressor between cheek and gum.
– After glucose gel is dissolved, repeat with another
dose till the tube is emptied.
– Repeat blood glucose level check after 5 minutes.
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Anaphylactic Reaction
• Extreme allergic reaction that is life threatening
• Causes:
– Insect bites and stings
– Medications
– Plants
– Food
– Chemicals
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Anaphylactic Reaction
Signs and Symptoms
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Urticaria
Redness
Swelling
Itching and burning
Wheals
Bronchospasm
Wheezing
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Anaphylactic Reaction
Assessment
• Scene Size up
– Precautions with Africanized bees
• Initial assessment
– Severe forms of allergic reaction
can cause:
• Rapid swelling of upper airway
• Shock or low blood pressure
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Anaphylactic Reaction
Assessment
• Focused History and physical
assessment
– Medications – auto-injectors,
Benadryl, bronchodilator
– When did it occur
– Evaluate rapidly spreading rash or
red hot skin which can indicate
systematic reaction
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Anaphylactic Reaction
Treatment
•
•
•
Identify severity
Less severe – oxygen
More severe – assist with
epinephrine auto-injector
– Take body substance isolation
precautions.
– Check for right medication.
– Check for right patient.
– Check expiration date.
– If possible, check cloudiness and
discoloration.
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
Anaphylactic Reaction
Treatment
– Grasp device with the tip pointing downward (hold like
a pen).
– Remove auto-injector activation cap.
– Identify the injection site on the lateral portion of thigh,
midway between waist and knee.
– Push auto-injector at a perpendicular angle to the
thigh and hold firmly against site until injector
activates.
– Hold in place until medication is fully injected for a
minimum of 10 seconds.
– Dispose of injector in biohazard container.
McFatter Technical Center, Broward County Public Schools
Revised: August 2007
References
•
•
Pollak, Andrew N. Emergency Care and
Transportation of the Sick and Injured. 9th ed.
Sudbury, Massachusetts: Jones and Bartlett,
2005.
Stevens, Kay, and Garber, Debra. Introduction
to Clinical Allied Healthcare. 2nd ed. Clifton
Park, New York: Thomson Delmar Learning,
1996.
McFatter Technical Center, Broward County Public Schools
Revised: August 2007