Chapter 13 Common Medical Emergencies. Chapter 13: Common Medical Emergencies 2 Objectives (1 of 5) Identify the signs and symptoms of the acute abdomen

Chapter 13

Common Medical Emergencies

2

Chapter 13: Common Medical Emergencies

Objectives (1 of 5)

• Identify the signs and symptoms of the acute abdomen and the necessity for immediate transport of patients with these symptoms.

• Identify the patient taking diabetic medications with altered mental status and the implications of a history of diabetes.

3


Objectives (2 of 5)

• State the steps in the emergency care of the patient taking diabetic medicine with an altered mental status and a history of diabetes.

• Recognize the patient experiencing an allergic reaction.

4


Objectives (3 of 5)

• Describe the emergency care of the patient with an allergic reaction.

• Describe the mechanisms of allergic response and the implications for airway management.

• List the signs and symptoms associated with poisoning.

5


Objectives (4 of 5)

• Describe the steps in the emergency care for the patient with suspected poisoning.

• Perform a rapid gentle assessment of the abdomen.

• Demonstrate the steps in the emergency care for the patient taking diabetic medicine with an altered mental status and a history of diabetes.

6


Objectives (5 of 5)

• Demonstrate the emergency care of the patient experiencing an allergic reaction.

• Demonstrate the steps in the emergency care for the patient with suspected poisoning

7


Physiology of the Abdomen (1 of 2)

• Acute abdomen– Sudden onset of abdominal pain

• Peritoneum– Thin membrane lining the entire

abdomen• Colic

– Severe, intermittent cramping pain

The Acute Abdomen

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Physiology of the Abdomen (2 of 2)

• Referred pain

– Perceived pain at a distant point of the body caused by irritation of the visceral peritoneum

• Peritonitis

– Irritation of the peritoneum caused by illness or injury

The Acute Abdomen

9


Signs and Symptoms of Acute Abdomen (1 of 3)

• Abdominal pain and/or tenderness

• Quiet patient guarding the abdomen (shock)

• Rapid and shallow breathing

• Referred (distant) pain

• Anorexia, nausea, vomiting

The Acute Abdomen

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• Loss of bowel sounds

• Tense, often distended abdomen

• Sudden constipation or bloody diarrhea

• Tachycardia

• Hypotension

• Fever

The Acute Abdomen

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• Rebound tenderness

• Indigestion/heartburn

• Colic (severe painful spasms)

• Difficulty swallowing

• Jaundice

The Acute Abdomen

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Examining the Abdomen• Explain what you are about to do.• Position the patient supine with legs drawn up

and knees flexed.• Observe the patient.• Gently palpate the abdomen.• Determine if the patient can relax the

abdominal wall on command. • Determine if abdomen is tender when

palpated.

The Acute Abdomen

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Causes of Acute Abdomen

• Substances lying in or adjacent to the abdominal cavity

• Other common causes:

– Appendicitis

– Perforated gastric ulcer

– Cholecystitis

– Diverticulitis

The Acute Abdomen

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Uterus and Ovaries• Always consider a gynecological

problem with women having abdominal pain.

• Causes of pain– Menstrual cycle– Pelvic inflammatory disease– Ectopic pregnancy

The Acute Abdomen

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Other Organ Systems

• Aneurysm– Weakness in aorta

• Pneumonia– May cause ileus and abdominal pain

• Hernia– Protrusion through a hole in the

body wall

The Acute Abdomen

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Emergency Medical Care (1 of 2)

• Do not delay transport.

• Do not attempt to diagnose.

• Clear and maintain the airway.

• Anticipate vomiting.

• Administer high-flow oxygen.

• Give nothing by mouth.

The Acute Abdomen

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• Document all pertinent information.

• Anticipate the development of hypovolemic shock.

• Make the patient comfortable.

• Monitor vital signs.

The Acute Abdomen

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Defining Diabetes (1 of 2)

• Diabetes mellitus

– Metabolic disorder in which the body cannot metabolize glucose

– Usually due to a lack of insulin

• Glucose

– One of the basic sugars in the body

– Along with oxygen, it is a primary fuel for cellular metabolism

Diabetic Emergencies

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Defining Diabetes (2 of 2)

• Insulin– Hormone produced by the pancreas– Enables glucose to enter the cells– Without insulin, cells starve

• Hormone– Chemical substance produced by a

gland– Has special regulatory effects on

other body organs and tissues


20


Type I Diabetes

• Insulin-dependent diabetes

• Patient does not produce any insulin

• Insulin injected daily

• Onset usually in childhood


21


Type II Diabetes

• Noninsulin-dependent diabetes

• Patient produces inadequate amounts of insulin

• Disease may be controlled by diet or oral hypoglycemics


22


Role of Glucose and Insulin

• Glucose is the major source of energy for the body.

• Constant supply of glucose needed for the brain.

• Insulin acts as the key for glucose to enter cells.


23


Hyperglycemia

• Lack of insulin causes glucose to build up in blood in extremely high levels.

• Kidneys excrete glucose.

• This requires a large amount of water (3 P’s).

• Without glucose, body uses fat for fuel.

• Ketones are formed.

• Ketones can produce diabetic ketoacidosis.


24


Signs and Symptoms of Diabetic Ketoacidosis

• Vomiting

• Abdominal pain

• Kussmaul respirations

• Unconsciousness


25


Blood Glucose Monitors

• Test strips

• Normal range 80-120 mg/dL

• Glucometer


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Diabetic Coma (Hyperglycemia)


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Signs of Diabetic Coma

• Kussmaul respirations

• Dehydration

• “Fruity” breath odor

• Rapid, weak pulse

• Normal or slightly low blood pressure

• Varying degrees of unresponsiveness


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Insulin Shock (Hypoglycemia)


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Signs of Insulin Shock• Normal or rapid

respirations

• Pale, moist skin

• Sweating

• Dizziness, headache

• Rapid pulse

• Normal to low blood pressure

• Altered mental status

• Aggressive or confused behavior

• Hunger

• Fainting, seizure, or coma

• Weakness on one side of the body


30


Diabetes and Alcohol Abuse

• Patients may appear intoxicated.

• Suspect hypoglycemia with any altered mental status.

• Be alert to the similarity in symptoms of acute alcohol intoxication and diabetic emergencies.


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• Ask a patient with known diabetes:

– Do you take insulin or any pills to lower blood sugar?

– Have you taken your usual dose of insulin (or pills) today?

– Have you eaten normally today?

– Have you had any illness, unusual amount of activity, or stress today?


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• Perform initial assessment.• Obtain baseline vital signs and SAMPLE

history.• Check for emergency medical identification

symbol.• Always do a full, careful assessment. • Ask patient or family about last meal or insulin

dose.• DO NOT administer anything to an

unconscious patient.


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Administering Oral Glucose(1 of 2)

• Names:– Glutose– Insta-Glucose

• Dose equals one tube• Glucose should be given to a patient with

diabetes and a decreased level of consciousness.

• DO NOT give glucose to a patient with the inability to swallow or who is unconscious.


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Administering Oral Glucose (2 of 2)


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Complications of Diabetes• Heart disease• Visual disturbances• Renal failure• Stroke• Ulcers• Infections of the feet and toes• Seizures• Altered mental status


36


Seizures

• Consider hypoglycemia as the cause.

• Use appropriate BLS measures for airway management.

• Arrange for prompt transport.


37


Altered Mental Status


• Altered mental status is often caused by complications of diabetes.

• Ensure that airway is clear.• Be prepared to ventilate and

suction.• Arrange for prompt transport.

38


Allergic Reactions• Allergic reaction

– Exaggerated immune response to any substance

• Histamines and leukotrienes

– Chemicals released by the immune system

Allergic Reactions and Envenomations

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Anaphylaxis

• Extreme allergic reaction• Involves multiple organs• Can rapidly result in death• Most common signs:

– Wheezing

– Urticaria (hives)


40


Urticaria


41


Five General Allergen Categories

• Insect bites and stings

• Medications

• Plants

• Food

• Chemicals


42


Insect Bites and Stings

• Death from insect stings outnumber those from snake bites.

• Venom is injected through stinging organ.

• Some insects and ants can sting repeatedly.


43


Signs and Symptoms

• Sudden pain, swelling, and redness at site

• Itching and sometimes a wheal

• Sometimes dramatic swelling


44


Removing Stingers


45


Anaphylactic Reactions to Stings

• 5% of all people are allergic to bee, hornet, yellow jacket, and wasp stings.

• Anaphylaxis accounts for approximately 200 deaths a year.

• Most deaths occur within half an hour of being stung.


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Signs and Symptoms of Allergic Reaction

• Itching and burning• Widespread urticaria• Wheals• Swelling of the lips

and tongue• Bronchospasm and

wheezing

• Chest tightness and coughing

• Dyspnea• Anxiety• Abdominal cramps• Hypotension


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Patient Assessment • Allergic symptoms are almost as

varied as allergens themselves.• Assessment should include

evaluations of:– Respiratory system– Circulatory system– Mental status– Skin


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• Give oxygen.

• Perform a focused history and physical examination.

– Find out if the patient has a history of allergies.

• Obtain baseline vital signs and a SAMPLE history.


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• Inform medical control.• Find out if the patient has a

prescribed auto-injector.• Be prepared to use standard airway

procedures.• Assist the patient with the auto-

injector if permitted.


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Using an Auto-Injector• Receive order from

medical direction.• Follow BSI precautions.• Make sure the

prescription is for the patient.

• Make sure the medication is not discolored or expired.


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Administering an Auto-Injector• Remove the safety cap.• Place tip of the injector against the lateral

side of the patient’s thigh.• Push the injector firmly and hold until all of

the medication is injected.• Remove the injector.• Record the time and dose.• Reassess and record vital signs every 2

minutes.


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Auto-Injector


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Epinephrine Side Effects• Tachycardia

• Pallor

• Dizziness

• Chest pain

• Headache

• Nausea

• Vomiting


54


Black Widow

• Found in all states except Alaska

• Venom poisonous to nerve tissue

• Requires patient transport as soon as possible


55


Brown Recluse

• Mostly in Southern and Central US

• Venom causes local tissue damage

• Requires patient transport as soon as possible


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Snake Bites

• 40,000 to 50,000 reported snake bites in the US annually.

• 7,000 bites in the US come from poisonous snakes.

– Death from snake bites is rare.

– About 15 deaths occur each year in the US.


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Four Types of Poisonous Snakes in the US

Copperhead

CottonmouthRattlesnake

Coral snake


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Pit Vipers

• Rattlesnakes, copperheads, and cotton mouths

• Store poison in pits behind nostrils

• Inject poison to victim through fangs


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Signs and Symptoms of aPit Viper Bite

• Severe burning at the bite site

• Swelling and bluish discoloration

• Bleeding at various distant sites

• Other signs may or may not include:

– Weakness – Fainting

– Sweating – Shock


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Caring for Pit Viper Bites (1 of 2)

• Calm the patient.

• Locate bite and cleanse the area.

• Do not apply ice.

• Splint area to minimize movement.

• Watch out for vomiting caused by anxiety.

• Do not give anything by mouth.


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Caring for Pit Viper Bites (2 of 2)

• If the patient is bitten on the trunk, lay the patient supine and arrange for prompt transport.

• Monitor patient’s vital signs.• Mark the swollen area with a pen.• Care for shock if signs and symptoms

develop.• Arrange for snake to be brought to the

hospital if it has been killed.


62


Coral Snakes

• Small snake with red, yellow, and black bands

• “Red on yellow will kill a fellow, red on black, venom will lack.”

• Injects venom with teeth, using a chewing motion that leaves puncture wounds

• Causes paralysis of the nervous system


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Caring for Coral Snake Bites (1 of 2)

• Quiet and reassure the patient.

• Flush the area with 1 to 2 quarts of warm, soapy water.

• Do not apply ice.

• Splint the extremity.

• Check and monitor baseline vital signs.


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Caring for Coral Snake Bites (2 of 2)

• Keep the patient warm and elevate the lower extremities to help prevent shock.

• Give supplemental oxygen if needed.

• Arrange for prompt transport. Give advance notice to EMTs of coral snake bite.

• Give the patient nothing by mouth.


65


Scorpion Stings• Venom gland and stinger

found in the tail end.• Mostly found in

southwestern US• With one exception, the

Centruroides sculpturatus, most stings are only painful.– Provide emergency care

and arrange for transport.


66


Tick Bites (1 of 3)

• Ticks attach themselves to the skin.

• Bite is not painful, but potential exposure to infecting organisms is dangerous.

• Ticks commonly carry Rocky Mountain spotted fever or Lyme disease.


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Tick Bites (2 of 3)

• Rocky Mountain spotted fever develops 7 to 10 days after bite.

• Symptoms include:– Nausea, vomiting– Headache– Weakness– Paralysis– Possible cardiorespiratory collapse


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Tick Bites (3 of 3)

• Lyme disease is the second fastest growing infectious disease next to AIDS in US

• Lyme disease symptoms may begin 3 days after the bite.

• Symptoms include:– Rash– Painful swelling of the joints


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Caring for a Tick Bite

• Do not attempt to suffocate or burn tick.• Use fine tweezers to grasp tick by the

body and pull it straight out.• Cover the area with disinfectant and

save the tick for identification.• Provide any necessary supportive

emergency care and arrange for transport.


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Dog Bites and Rabies (1 of 2)

• All dog bites should be considered infected until proven otherwise.

• Place a dry, sterile dressing over the wound and arrange for prompt transport.

• Rabies, an acute viral infection to the central nervous system, is a major concern.


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Dog Bites and Rabies (2 of 2)

• Rabies can be treated with a series of vaccine injections.

• A bitten patient can avoid shots only if the dog can be identified and tested for rabies.

• Remember scene safety; the dog may still be loose when you arrive on the scene.


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Caring for Human Bites

• Remember, human bites that penetrate the skin can be serious injuries.

• Promptly immobilize the area.

• Apply a dry, sterile dressing.

• Arrange for transport.


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Coelenterates

• Responsible for more envenomations than any other marine life animal

• Has stinging cells called nematocysts

• Results in very painful, reddish lesions

• Symptoms include headache, dizziness, muscle cramps, and fainting.


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Caring for Stings

• Limit further discharge by minimizing patient movement.

• Inactivate nematocysts by applying alcohol.

• Remove the remaining tentacles by scraping them off.

• Arrange for transport.


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• Poison

– Any substance whose chemical action can damage body structures or impair body functions.

• Substance Abuse

– The knowing misuse of any substance to produce a desired effect.

Poison vs. Substance Abuse

Substance Abuse and Poisoning

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Identifying the Patient and the Poison

If you suspect poisoning, ask the patient the following questions:

– What substance did you take?– When did you take it or (become

exposed to it)?– How much did you ingest?– What actions have been taken?– How much do you weigh?


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Determining the Natureof the Poison

• Give suspicious materials, containers, vomitus to EMS.

• Provide key information on:– Name and concentration of the drug– Specific ingredients– Number of pills originally in bottle– Name of manufacturer– Dose that was prescribed


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Poison Control Centers

• Information on most substances

• Information on emergency treatments and antidotes.


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Ingested Poison

• Poison enters the body by mouth.

• Accounts for 80% of poisonings

• May be accidental or deliberate

• Activated charcoal will bind to poison in stomach and carry it out of the body.

• Assess ABCs.


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Activated Charcoal


81


Inhaled Poisons

• Wide range of effects

– Some inhaled agents cause progressive lung damage.

• Move to fresh air immediately, they may require supplemental O2.

• All patients require immediate transport.


82


Injected Poisons

• Usually result of drug overdose

• Impossible to remove or dilute poison once injected

• Arrange for prompt transport


83


Absorbed Poisons

• Many substances will damage the skin, mucous membranes, or eyes.

• Substance should be removed from patient as rapidly as possible.

• If substance is in the eyes, they should be irrigated.

• Do not irrigate with water if substance is reactive, i.e. sodium or phosphorus.


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Emergency Medical Care

• External decontamination is important.

• Care focuses on support: assessing and maintaining ABCs.

• You may be permitted to give activated charcoal for ingested poisons per your local protocol.


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Specific Poisons

• Tolerance

– Need for increased amount of drug to have same desired effect

• Addiction

– Overwhelming desire or need to continue using an agent


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Alcohol (1 of 3)

• Most commonly abused drug in the US

• Kills more than 200,000 people a year

• Alcohol is a powerful CNS depressant.

• Acts as a sedative and hypnotic

• A person who appears intoxicated may have a medical problem.


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Alcohol (2 of 3)

• Intoxicated patients should be transported and seen by a physician.

• If patient shows signs of serious CNS depression, provide respiratory support.

• A patient with alcohol withdrawal may experience delirium tremens (DTs).


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Alcohol (3 of 3)

• Patients with DTs may experience:

– Agitation and restlessness

– Fever

– Sweating

– Confusion and/or disorientation

– Delusions and/or hallucinations

– Seizures


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• Drugs containing opium

• Most of these, such as codeine, Darvon, Oxycontin, and Percocet, have medicinal purposes.

• The exception is heroin, which is illegal.

• Opioids are CNS depressants causing severe respiratory distress.


Opioids (1 of 2)

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Opioids (2 of 2)

• Care includes supporting airway and breathing.

• You may try to wake patients by talking loudly or shaking them gently.

• Always give supplemental oxygen and prepare for vomiting.


91


Sedative-Hypnotic Drugs

• These drugs are CNS depressants and alter level of consciousness.

• Patients may have severe respiratory depression and even coma.

• The main concern is respiratory depression and airway clearance, ventilatory support, and transport.


92


Abused Inhalants (1 of 2)

• Common household products inhaled by teenagers for a “high”

• Effects range from mild drowsiness to coma

• May often cause seizures


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Abused Inhalants (2 of 2)

• Patient is at high risk for sudden cardiac arrest.

• Try to keep patient from struggling or exerting self.

• Give oxygen and use a stretcher to move patient.

• Prompt transport is essential.


94


Sympathomimetics• CNS stimulants cause hypertension,

tachycardia, and dilated pupils.• Amphetamines and methamphetamines

are commonly taken by mouth.• Cocaine can be taken in many different

ways.– Can lead to seizures and cardiac

disorders• Be aware of personal safety.


95


Marijuana

• Smoked by 20 million people daily in the US• Produces euphoria, relaxation, and

drowsiness• Impairs short-term memory and ability to

work• Transport to hospital is rarely needed.• Marijuana can be used as vehicle for other

drugs, ie, can be coated with PCP or crack.


96


Hallucinogens (1 of 2)

• Alter an individual’s sense of perception

• LSD and PCP are potent hallucinogens.

• Sometimes, people experience a “bad trip.”

• Patients typically are hypertensive, tachycardic, anxious, and paranoid.


97


Hallucinogens (2 of 2)

• Use a calm, professional manner and provide emotional support.

• Only restrain if danger of injury exists.

• Watch the patient carefully during evacuation and while awaiting EMS.


98


Anticholinergics

• “Hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter”

• Block the parasympathetic nerves

• Patient may go from “normal” to seizure to death within 30 minutes.

• Arrange for ALS transport.


99


Cholinergic Agents

• Commonly used as nerve agents for warfare

• Overstimulate body functions controlled by the parasympathetic nervous system

• Organophosphate insecticide or wild mushrooms are also cholinergic agents.


100


Signs and Symptoms of Cholinergic Poisoning

• D Defecation

• U Urination

• M Miosis

• B Bronchorrhea

• E Emesis

• L Lacrimation

• S Salivation

• S Salivation

• L Lacrimation

• U Urination

• D Defecation

• G GI irritation

• E Eye constriction


101


Care for Cholinergic Poisoning

• Main concern is to avoid exposure

• May require field decontamination

• Priority after decontamination is to decrease the secretions in the mouth and trachea.

• Provide airway support.

• May be treated as a HazMat incident


102


Aspirin Overdose

• Signs and symptoms – Nausea/vomiting– Hyperventilation– Ringing in ears– Confusion– Seizures

• Arrange for prompt transport to the hospital.


103


Acetaminophen Overdose

• Overdosing is common.• Generally not very toxic• Symptoms may not appear

until it is too late.• Liver failure may not be

apparent for a full week.• Gathering information at the

scene is very important.


104


Other Alcohols

• Methyl alcohol and ethylene glycol are more toxic than ethyl alcohol.

• May be taken by people with chronic alcoholism who cannot obtain drinking alcohol

• More often taken by someone attempting suicide

• Immediate transport is essential.


105


Food Poisoning

• Salmonella bacterium causes severe GI symptoms within 72 hours.

• Staphylococcus is a common bacteria that grows in foods kept too long.

• Botulism often results from improperly canned foods.


106


Caring for Food Poisoning

• Try to obtain as much history as possible.

• Arrange for prompt transport.

• If two or more persons have the same illness, give some of the suspected food to EMS, if possible.


107


Plant Poisoning• Several thousand cases of plant poisonings

occur each year.

• If you suspect plant poisoning:

– Assess the patient’s airway and vital signs.

– Notify poison control center.

– Give the plant to EMS to take to the hospital.

– Arrange for prompt transport.


Documents

Chapter 13 Common Medical Emergencies. Chapter 13: Common Medical Emergencies 2 Objectives (1 of 5) Identify the signs and symptoms of the acute abdomen