MEDICAL OVERVIEW

Power point presented by

Dr. Samah Mohammed

EMS 232 LECTURE (1)

2015 - 2016

Out lines

1. Introduction

2. Identify Types of emergency

3. Discuss patient assessment.

4. Explain management – transport.

5. Discuss some disease as (infectious control –

hepatitis – whooping cough).

Introduction• Patients who need EMS assistance generally

have experienced either a medical emergency, a trauma emergency, or both.

A. Trauma emergencies involve injuries resulting from physical forces applied to the body.

B. Medical emergencies involve illnesses or conditions caused by disease.

Types of Medical Emergencies

Types of Medical Emergencies

1. Respiratory emergencies occur when patients have trouble breathing or when the amount of oxygen supplied to the tissues is inadequate.

2. Cardiovascular emergencies are caused by conditions affecting the circulatory system.

3. Neurologic emergencies involve the brain & CNS.

4. Gastrointestinal tract(GIT) emergencies condition is appendicitis.

5. A urologic emergency can involve kidney stones.

6. Endocrine emergencies are caused by complications of diabetes mellitus.

Types of Medical Emergencies

7. Hematologic emergencies may be the result of sickle cell disease or various types of blood clotting disorders.

8. Immunologic emergencies involve the body’s response to foreign substances.

9. Toxicologic emergencies include poisoning and substance abuse.

10. Behavioral emergencies may be especially difficult to deal with because patients do not present with typical signs and symptoms.

11. Gynecologic emergencies involve female reproductive organs.

Patient Assessment• Similar to the assessment of the trauma patient, but with

a different focus

• Focus is on:

Nature of illness (NOI)

Symptoms

Chief complaint

• Establish an accurate medical history.

• Use dispatch information to guide initial response.

– Injuries may distract from the underlying condition.

Patient Assessment• Assessment may be difficult with uncooperative

or hostile patients.

–Maintain a professional, calm, nonjudgmental behavior.

• Patient assessment steps:

1. Scene size-up.

2. Primary assessment.

3. History taking.

4. Secondary assessment.

5. Reassessment.

Scene Size-up• Scene safety

Make certain the scene is safe.

Use standard precautions.

• Nature of illness (NOI)

Determine the NOI.

The index of suspicion is your awareness of potentially

serious underlying, unseen injuries or illness.

Primary Assessment• Form a general impression.

1. Perform a rapid scan of the patient.

2. Visual clues include unconsciousness, severe bleeding, and extreme difficulty breathing.

3. Determine the patient’s LOC.

• Airway and breathing1. In conscious patients, ensure the airway is open and they are

breathing adequately.

2. Check respiratory rate, depth, and quality.

3. When in doubt, apply oxygen.

4. For unconscious patients, make sure to open the airway using the proper technique

Primary Assessment• Circulation– Assess in a conscious patient by checking the radial pulse

and observing the patient’s skin color, temperature, and condition.

– For unconscious patients, assess at the carotid artery.

• Transport decision– Patients in need of rapid transport:• Patients who are unconscious or who have an altered

mental status• Patients with airway or breathing problems• Patients with obvious circulation problems such as

severe bleeding or signs of shock

History TakingI. Investigate the chief complaint.

II. Gather a thorough history from:

a) The patient

b) Any family, friends, or bystanders

III. For an unconscious patient, survey the scene for medication.

IV. Obtain a SAMPLE history and use the OPQRST mnemonic.

1. Onset of problem

2. Provocation or palliation

3. Quality

4. Region/radiation

5. Severity

6. Timing of pain

Secondary Assessment

A. Physical examination1. All conscious patients should be focused assessment.

2. For unconscious patients, always perform a full-body scan from head-to-toe examination.

3. Examine the head, scalp, and face.

4. Examine the neck closely.

5. Assess the chest and abdomen.

6. Palpate the legs and arms.

7. Examine the patient’s back.

Secondary Assessment

B. Vital signs

1. Assess the pulse for rate, quality, and rhythm at the most

appropriate site.

2. Identify the rate, quality, and regularity of the

respirations.

3. Obtain an initial blood pressure.

4. Consider obtaining a blood glucose level and a pulse

oximetry reading.

Reassessment

1. Performed once the assessment and treatment have

been completed.

2. Begins and continues throughout transport

3. Reassess interventions.

4. Document any developed changes.

Management: Transport

• Most medical emergencies require a level of treatment that available in the prehospital setting.A. May require advanced testing available in a hospital.

B. scope of the EMT to administer medications to a patient.

• Scene timeA. May be longer for medical patients than for trauma

patients.

B. Gather as much information as possible to transmit to the emergency department.

C. Critical patients always need rapid transport

Management: Transport

• Type of transport

a) Life-threatening condition: lights and serious.

b) Non–life-threatening condition: consider nonemergency transport.

i. Modes of transport come in one of two categories: ground or air.

ii. Ground transport EMS units are generally staffed by EMTs and paramedics.

iii. Air transport EMS units are generally staffed by critical care nurses and paramedics.

Management: Transport

Infectious Diseases• General assessment principles:

1. Approach like any other medical patient.

2. Size up the scene and take standard precautions.

3. Perform the primary assessment and history taking.

4. Typical chief complaints include fever, nausea, rash, chest pain, and difficulty breathing.

5. Focus on any life-threatening conditions identified in the primary assessment.

6. Be empathetic.

7. Place the patient in the position of comfort on the stretcher to keep warm.

8. Follow standard precautions.

Herpes Simplex

1. Common virus strain carried by humans

2. Of individuals carrying the virus, 80% are

asymptomatic.

3. Symptomatic infections can be serious and are on

the rise.

4. Primary mode of infection is through close personal

contact.

HIV Infection1. No vaccine yet exists.

2. Despite treatment progress, AIDS is still fatal.

3. Not easily transmitted in the EMS work setting.

4. The EMT’s risk of infection is limited to exposure to an infected patient’s blood or body fluids.

5. Many patients with HIV show no symptoms.

a. Always wear the proper type of gloves.

b. Take great care in handling needles.

c. Cover any open wounds.

Syphilis

1. Sexually transmitted, but also blood borne

2. Small risk for transmission through:

I. Needles tick injury

II. Direct blood-to-blood contact

3. If treated with penicillin, the individual is

considered no communicable within 24 to 48 hours.

Hepatitis

1. Inflammation or infection of the liver.

2. Early signs:

Loss of appetite, Vomiting, Fever, Fatigue, Sore throat

3. Toxin-induced hepatitis is not contagious.

4. There is no sure way to tell which hepatitis patients are contagious.

5. Vaccination with hepatitis B vaccine is highly recommended for EMTs.

Meningitis1. Inflammation of the meningeal coverings of the brain

and spinal cord

• Signs and symptoms include:

– Fever, Headache, Stiff neck, Altered mental status

2. Most forms of meningitis are not contagious.

– However, one form, meningococcal meningitis, is highly contagious.

3. Take standard precautions.

4. Meningitis can be treated at the emergency department with antibiotics.

Whooping Cough1. Also called pertussis

2. Mostly affects children younger than 6 years

Symptoms include:

fever and a “whoop” sound that occurs when inhaling after a coughing attack.

3. Prevent exposure by placing a mask on the patient and yourself.

Tuberculosis1. Chronic mycobacterium disease that usually strikes the lungs.

2. Many infected patients are well most of the time.

3. Patients who pose the highest risk almost always have a cough.

– Consider respiratory tuberculosis to be the only contagious form.

• protection from the tubercle bacillus does not exist.

A. Everyone who breathes is at risk.

B. One third of the world’s population is infected with tuberculosis.

C. The vaccine is rarely used in the United States.

D. Mechanism of transmission is not efficient.

• Have tuberculin skin tests regularly.

– If the infection is found before you become ill, preventive therapy is almost 100% effective.