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1 Medical Emergencies Review, Part 1

2 Neurological Emergencies

3 Headache (1 of 6)

One of the most common complaintsCan be a symptom of another condition or a ____________________________________

condition on its ownMost headaches are ____________________________________ and do not require

emergency medical care.

4 Headache (2 of 6)

Sudden, severe headache requires assessment and ____________________________________ .– If more than one patient reports headache, consider carbon monoxide poisoning.

Tension headaches, migraines, and sinus headaches are the most common.– ____________________________________ medical emergencies

5 Headache (3 of 6)

____________________________________ headaches are the most common:Caused by muscle contractions in the head and neckAttributed to ____________________________________ Pain is usually described as squeezing, dull, or as an ache.

6 Headache (4 of 6)

____________________________________ headaches are the second most common:Thought to be caused by changes in the blood vessel size in the base of the brain Pain is usually described as pounding, throbbing, and pulsating.Often associated with visual changesCan last for several ____________________________________

7 Headache (5 of 6)

Sinus headaches:Caused by ____________________________________ that is the result of fluid

accumulation in the sinus cavities Patients may also have ____________________________________ like symptoms of

nasal congestion, cough, and fever. Prehospital emergency care is not required.

8 Headache (6 of 6)

Serious conditions that include headache as a symptom are hemorrhagic ____________________________________ , brain tumors, and meningitis.

You should be concerned if the patient complains of a ____________________________________ -onset, severe headache or a sudden headache that has associated symptoms.

9 Emergency Medical Care: Headache

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Most headaches are ____________________________________ and do not require emergency medical care.

You should be concerned if the patient complains of:– A sudden-onset, severe headache– A sudden headache with fever, ____________________________________ , AMS, or

following trauma

10 Emergency Medical Care: MigraineAlways ____________________________________ the patient for other signs and

symptoms that might indicate a more serious condition.Apply high-flow oxygen, if tolerated. Provide a darkened, ____________________________________ environment.Do not use lights and sirens during transport.

11 Cerebrovascular Accident and StrokeCerebrovasuclar ____________________________________ (CVA)

– Interruption of blood flow to the brain that results in the loss of brain function ____________________________________

– The loss of brain function that results from a CVA

12 3 Causes of a CVA ____________________________________ : Blockage of a vessel by a thrombus (blood

clot) which forms at a narrow area. ____________________________________ : Rupture of a blood vessel. ____________________________________ : Blood clot or plaque travels through a

blood vessel until it lodges in the brain, blocking blood flow.

13 Thrombosis Caused CVA

14 Embolism Caused CVA

15 Hemorrhage Caused CVA

16 Hemorrhagic Stroke (1 of 2)

Accounts for 10% to 20% of strokes People at high risk include those experiencing stress or

____________________________________ . People at highest risk are those who have very high blood pressure.Results from ____________________________________ in the brain

– Arterial rupture

17 Hemorrhagic Stroke (2 of 2)

Cerebral hemorrhages are often ____________________________________ .An aneurysm is a swelling or enlargement of an artery due to weakening of the arterial

wall. Some people are born with ____________________________________

18 Ischemic Stroke (1 of 2)

Most ____________________________________ , accounting for more than 80% of

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strokesResults from an embolism or thrombosisResults when blood flow to a particular part of the brain is cut off by a blockage inside a

blood vessel ____________________________________

– Clotting of the cerebral arteriesCerebral ____________________________________

– Blockage by a clot formed elsewhere in the body

19 Ischemic Stroke (2 of 2)

Symptoms may range from nothing at all to complete ____________________________________ .

Atherosclerosis in the blood vessels is often the cause. ____________________________________ forms inside the walls of the blood vessels

and may obstruct blood flow.Eventually, it causes complete occlusion of an artery.

20 Signs and Symptoms of StrokeLeft Hemisphere

– ____________________________________ : Inability to speak or understand speech– Receptive aphasia: Ability to speak, but unable to understand speech– Expressive aphasia: Inability to speak correctly, but able to understand speech

Right Hemisphere– ____________________________________ : Able to understand, but hard to be

understood

21 Other S/S of CVA1 Alterations in consciousness

ParalysisLoss of speech or ____________________________________ speechUnilateral blindness ____________________________________

2 SeizuresHeadacheUnequal ____________________________________ ____________________________________ blood pressureDizzinessOther S/S of increased intracranial pressure

22 Stroke Mimics: ____________________________________ Postictal state Subdural or epidural bleeding ____________________________________

23 Assessing the Stroke Patient Primary assessment

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– Check and care for ____________________________________ . – Obtain history if possible.– Administer oxygen and manage airway.

Focused history and physical exam– Perform neurologic exam.– Check all 4 extremities for movement and

____________________________________ – Utilize the Cincinnati Stroke Scale

24 Cincinnati Stroke Scale (1 of 2)

Facial ____________________________________ – Ask patient to show teeth or smile– Abnormal if asymmetrical

____________________________________ drift– Ask pt to close eyes and hold both arms out with palms up– Abnormal if arms do not move equally

25 Cincinnati Stroke Scale (2 of 2)

____________________________________– Ask patient to say “the sky is blue in Cincinnati” or something similar– ____________________________________ if words are slurred or confused

26 Emergency Medical Care for Stroke (1 of 2)

Patient needs to be evaluated by computed topography (____________).Recognizing the signs and symptoms of stroke can shorten the delay to CT.Treatment needs to start within ____________ hours of onset.

– Use of “clot buster” medications– Document times carefully

Careful what you ____________________________________

27 Emergency Medical Care for Stroke (2 of 2)

Rule out other causes Check for ____________________________________ Check blood sugarEstablish IV at TKO rate Provide supportive care

– ____________________________________– ____________________________________ if drooling

28 Baseline Vital SignsExcessive bleeding in the brain may ____________________________________ pulse

and cause erratic respirations. Signs of increased ICP just like head injury may developBlood pressure is usually ____________________________________ .Excessive bleeding in the brain may cause changes in pupil size and reactivity.

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29 Transport Considerations Place the patient in a comfortable position.

– Usually on one side– Paralyzed side ____________________________________ and well protected

Elevate patient’s ____________________________________ about 6".Continue giving oxygen and monitor vitals.

30 Transient Ischemic Attack (TIA)A TIA is a “mini-stroke.” Stroke symptoms go away within ____________ hours.Every TIA is an emergency.TIA may be a warning sign of a larger ____________________________________ . Patients with possible TIA should be evaluated by a physician.

31 Seizures Seizures: episodes of uncoordinated electrical activity in the brain.A seizure, or ____________________________________ , is a temporary alteration in

consciousness.Account for up to 30% of EMS calls In the United States, it is estimated that

4 million people have epilepsy. ____________________________________ : Tendency to have repeated episodes of

seizure activity.

32 Types of Seizures ____________________________________(Grand Mal) seizure ____________________________________(Petit Mal) seizure ____________________________________ seizure

33 Generalized SeizureAKA: Major Motor or Grand Mal SeizureAffects all parts of body ____________________________________ : sensation before convulsionConvulsion

– loss of consciousness– ____________________________________ phase (rigidity)– ____________________________________ phase (rhythmic jerking)

incontinence ineffective breathing

____________________________________ phase-exhaustion, drowsiness

34 Partial Seizure (1 of 2)

Simple partial seizure:No ____________________________________ in the patient’s level of consciousnessMay have numbness, weakness, dizziness, visual changes, or unusual smells/tastesMay have some ____________________________________ or brief paralysis

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35 Partial Seizure (2 of 2)

____________________________________ partial seizure:Altered mental statusResults from abnormal discharges from the ____________________________________

lobe of the brainLip smacking, eye blinking, isolated jerkingUncontrollable ____________________________________

36 Absence (Petit Mal) SeizureLoss of consciousness without loss of ____________________________________ tone.Brief lapse of attention manifested by staring and no apparent response to anyoneMost common in ____________________________________ Last for ____________________________________ Patient fully recovers with a brief lapse of memory

37 Characteristic of SeizuresMay occur on one side or spread throughout the whole body (generalized)Usually last 3 to 5 minutes, followed by period of unconsciousness known as

____________________________________ state Patient may experience an ____________________________________ . Seizures recurring every few minutes are known as status

____________________________________ .

38 Causes of SeizuresCongenital (epilepsy)High ____________________________________ Structural problems in the ____________________________________ Metabolic disordersChemical disorders (poison, drugs) Sudden high fever ____________________________________(Low blood sugar)

39 Recognizing SeizuresCyanosisAbnormal or absence of ____________________________________ Possible head injuryLoss of bowel and bladder control Severe muscle ____________________________________ Post seizure state of unresponsiveness with deep and labored respirations

40 Postictal State Patient may have labored breathing.May have ____________________________________ : weakness on one side of the

body. Patient may be lethargic, confused or combative.Consider underlying conditions.

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– ____________________________________– Infection

41 Management of Seizures (1 of 2)

Remove from harm. ____________________________________ from injury.Don’t forcibly restrain the patient.Roll patient on side.After seizure:

– Assess ABC’s– Clear airway– ____________________________________– Assist ____________________________________ as needed

Lower body temperature if febrile seizure

42 Management of Seizures (2 of 2)

Never insert anything in patient’s mouth!Obtain History about seizures and medications

– Phenobarbital, Depakote, ____________________________________ , Topamax and Dilantin most common

Establishing an IV is a ____________________________________ Obtain blood glucose level Physical exam for injuries caused by seizureRequest ____________________________________ backup if seizure continuesMonitor N/V and vital signs

43 When to Encourage Treatment and Transport If patient’s ____________________________________ seizure. If patient has not taken meds recently. If seizures are ____________________________________ or different from usual. If patient had repeated seizures.Any signs of trauma, ____________________________________ , aspiration, or other

serious condition

44 Status EpilepticusDefined as ____________ or more seizures without intervening periods of consciousness. Immediate life threat.Assist ____________________________________ .Rapid Transport.Attempt IV and request Paramedic backup for administration of

____________________________________ .

45 ComaComa-state of unconsciousness from which patient cannot be arousedComa=Immediate Life ThreatManagement

– ____________________________________ before investigating

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– Control c-spine if trauma known or suspected– Establish IV access– Look for ____________________________________

46 Investigating Cause of ComaAfter ABC’s, investigate cause using DERMD= ____________________________________ of comaE=EyesR=Respiratory PatternM= ____________________________________ function

47 Investigating Cause of Coma1 Vital Signs

– Shock?– Increased ____________________________________ ?– Arrhythmias?

Blood glucose?– ____________________________________

Possible narcotics OD?– ____________________________________

2 Head to Toe Exam– Injuries?– Snake bites? Insect stings?– Drug “tracks

Examine ____________________________________ for clues

48 Altered Mental Status (AMS)1 ____________________________________

Hypoxemia IntoxicationDrug overdoseUnrecognized head injury

2 ____________________________________ infectionBody temperature abnormalitiesBrain tumorsGlandular abnormalities ____________________________________

49 Assessing a Patient With AMS (1 of 2)

Same assessment process Patient cannot tell you reliably what is wrong.Establish vascular accessObtain blood ____________________________________ Be vigilant in ____________________________________ .Monitor for changes or deterioration.

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50 Assessing a Patient With AMS (2 of 2)

Use ____________________________________ scale to classify severity.Consider underlying conditions.Monitor for depressed respirations.Ensure that basic airway maneuvers are followed.Evaluate need for advanced airwayConsider ____________________________________ Provide prompt transport to hospital while monitoring the patient.

51 Cardiovascular Emergencies

52 Cardiovascular EmergenciesCardiovascular disease has been ____________________________________ killer of

Americans since 1900.Accounts for 1 of every 2.8 deathsCardiovascular disease (CVD) claimed 931,108 lives in the US during 2001.

– 2,551 per day– Almost ____________________________________ people per minute!

53 The HeartHas it’s own ____________________________________ supplyHas it’s own electrical systemThe heart is divided into 2 types of circulation: 1. ____________________________________ Circulation 2. ____________________________________ Circulation

54 Pulmonary CirculationCirculation to and from ____________________________________ ____________________________________ side of heartBlood is pumped through pulmonary arteries to lungsReceives ____________________________________ from alveoli and leaves waste

products and carbon dioxide

55 Systemic CirculationCirculation to and from ____________________________________ ____________________________________ side of heart Pumped to aorta and the bodyDelivers oxygen to cells and removes ____________________________________

56 Cardiac CompromiseChest pain results from ____________________________________ Ischemic heart disease involves decreased blood flow to the heart. If blood flow is not restored, the tissue ____________________________________ .

57 Coronary Artery Disease (CAD)AtherosclerosisArteriosclerosis

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58 AtherosclerosisMaterials build up inside blood vessels.This decreases or ____________________________________ blood flow. ____________________________________ factors place a person at risk.

59 ArteriosclerosisCoronary artery wall becomes hard and stiff due to calcium deposits “Hardening of the Arteries”Causes coronary arteries to loose their ____________________________________

natureDecreases blood flowCauses ____________________________________

60 Major Risk Factors of Coronary Artery Disease1 Uncontrollable

____________________________________ Sex ____________________________________Heredity

2 Controllable ____________________________________High Blood PressureHigh ____________________________________ Diabetes

61 Minor Risk Factors of Coronary Artery Disease ____________________________________ Inactivity ____________________________________ Personality

62 Coronary Artery Disease

63 Coronary Artery Disease

64 Angina Pectoris ____________________________________ in chest that occurs when the heart does not

receive enough oxygenTypically crushing or squeezing painRarely lasts longer than 10-15 minutesCan be difficult to differentiate from heart attackNo ____________________________________ damage to the heart

65 Angina PectorisSigns/Symptoms Squeezing/crushing chest ____________________________________ Pain may ____________________________________ to shoulders, arms, neck, jaw,

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upper back, or upper abdomen Pain may be in area of radiation only Possible shortness of ____________________________________ (SOB)

66 Angina Pectoris Pain associated with the “3 E’s”

- ____________________________________ - ____________________________________ - ____________________________________

Pain seldom lasts for more than 10-15 minutes Pain normally relieved by:

-rest-nitroglycerin

67 Angina PectorisTwo Forms of Angina1. ____________________________________ Angina

-Pain predictable in duration and frequency-Pain relieved by predictable amounts of rest and nitroglycerin

2. ____________________________________ Angina-Change occurs in usual patterns-30% go on to infarct within 3 months

68 Treatment of Angina Pectoris ____________________________________ all first time angina and unstable angina as a

myocardial infarction. When in doubt, manage ____________________________________ chest pain as a

myocardial infarction

69 Acute Myocardial InfarctionAcute Myocardial Infarction (AMI)--Heart Attack ____________________________________ of the myocardium due to inability of

diseased coronary arteries to allow adequate perfusionOnce myocardium tissue dies, it will not ____________________________________

70 Acute Myocardial Infarction (AMI) Pain signals ____________________________________ of cells.Opening the coronary artery within the first ____________________________________

can prevent damage. Immediate transport is essential.

71 Pain of AMIChest Pain is “cardinal sign” of an AMIOccurs in _____________% of AMIsMay or may not be caused by ____________________________________Does not resolve in a few minutesCan last from 30 minutes to several hoursMay not be relieved by ____________________________________ or nitroglycerin

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72 Pain of AMIMay be ____________________________________ , squeezing, tight, heavyMay radiate to neck, jaw, shoulders, arm, upper back, or even abdomenMay occur in areas of ____________________________________ onlyMay vary in intensity, unaffected by swallowing, coughing, deep breathing, or movement 15% have “____________________________________ AMI”

73 Signs/Symptoms of AMIChest pain Shortness of breath (SOB)Weakness, dizziness, fainting ____________________________________, vomiting Pallor, diaphoresis (sweating) Feeling of impending ____________________________________ Pulmonary ____________________________________

74 Signs/Symptoms of AMIChanges is pulse, BP, or respirations are ____________________________________

diagnostic of an AMIEarly recognition is critical 50% of deaths occur in first ___________ hours. But the average person waits

____________ hours before seeking help

75 Atypical Presentation of MI Pain that is sharp or intermittent Pain to ____________________________________ (toothache with no inflammation) Pain to neck, shoulder, arm or abdomenMostly includes females, ____________________________________ and the elderly Suspect cardiac event with these S/S

76 Anginal EquivalentsDyspnea ____________________________________ Syncope or ____________________________________ syncopeGeneralized weakness with no hx of GI bleed or fever ____________________________________Often, the only S/S presented but may be cardiac in nature

77 Risk Factors for Anginal Equivalents ____________________________________Hypertension ____________________________________ Family history of CADObesity ____________________________________ Sedentary life style

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78 Treatment of Cardiac Chest Pain (1 of 3)

Reassure Pt, High concentration of ____________________________________ Give ____________________________________ (325mg) PO (unless contraindicated)Reassure/calm patientObtain brief history and perform physical examEstablish IV at appropriate rate (normally ____________________________________ )Give nitroglycerin (0.4mg) SL

79 Treatment of Cardiac Chest Pain (2 of 3)

If patient has history of angina with changes in pattern, transport immediately.Transport in semi- ____________________________________ position if BP is normal,

supine if BP is low.Do NOT allow patient to ____________________________________ to ambulance.Don’t use lights and sirens if patient is awake, alert, and breathing without distress.

80 Treatment of Cardiac Chest Pain (3 of 3)

Monitor vital signs every 10 minutesRequest ____________________________________ Backup

-90% of deaths occur from arrhythmias.-Arrhythmias can often be treated with early drug therapy.

ALWAYS examine for pedal edema and listen to ____________________________________ sounds

81 Cardiogenic ShockHeart lacks power to force blood through the circulatory system.Onset may be immediate or not apparent for 24 hours after AMI. Failure of the ____________________________________ and circulatory system ____________________________________ BPCauses arrhythmiasTreated with ____________________________________ of fluids if lung sounds are

clearNeeds drug therapy if fluids are ineffective or if pulmonary edema is present

82 Congestive Heart FailureCongestive Heart Failure (CHF)--Inability of the heart to

____________________________________ blood out as fast as it enters.Can be left-sided or right-sidedUsually begins with ____________________________________ -sided failure.

83 Congestive Heart FailureCauses of CHFCoronary Artery Disease (CAD)Chronic ____________________________________ ____________________________________Valvular heart disease

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84 Pathophysiology of CHF (1 of 2)

____________________________________ ventricle failsBlood backs up into lungs Pressure increases in capillary beds Fluids forced out of capillary beds into the alveoli causing

____________________________________ edema; fluid in the lungs

85 Pathophysiology of CHF (2 of 2)

Blood backs up into ____________________________________ circulation-distended neck veins-fluid in abdominal cavity- ____________________________________ edema-fluid in feet and ankles

86 S/S of CHFDyspnea on ____________________________________ Paroxysmal nocturnal dyspneaOrthopnea-dyspnea lying downTachycardia-rapid pulse rate (>100 bpm) ____________________________________ -rapid breathingNoisy, labored breathingRales, wheezing Pedal edema Pink, frothy ____________________________________

87 Management of CHF Sit patient up with feet ____________________________________ Hi concentration of oxygenAssist ventilations as needed IV at ____________________________________ rate

– Limit ____________________________________ administrationMonitor vital signs every 5 to 10 minutesRequest Paramedic backup if pulmonary and/or pedal edema is severe

88 Physical Findings of Cardiac Compromise Pulse rate increases and may be ____________________________________ .Blood pressure may be normal or falling.Respirations are usually normal.General appearance

– ____________________________________– Nausea, vomiting, cold sweat

89 Approach to the Patient with Chest Pain (1 of 2)

Reassure the patient and perform initial assessment.Administer oxygen.Measure and record vital signs.

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Place the patient in a position of ____________________________________ .Administer ____________________________________ unless contraindicatedEstablish IV (CHECK LUNG SOUNDS)

90 Approach to the Patient with Chest Pain (2 of 2)

Obtain history and physical exam.Ask about the chest pain (description, ____________________________________ score)Consider nitroglycerin.Transport promptly with head elevated about ___________ degreesReport to medical control en route.

91 Internal Cardiac PacemakersMaintains a ____________________________________ heart rhythm and rateDo not place ____________________________________ patches over pacemaker.

92 Automatic Implantable Cardiac DefibrillatorsMonitor heart rhythm and deliver ____________________________________ as needed.Low ____________________________________ will not affect rescuers.

93 Sickle Cell Disease

94 Sickle Cell Disease Inherited disorder of ____________________________________ blood cell production,

so named because the RBCs become sickle shaped when oxygen levels are low Patients with sickle cell disease has chronic anemiaAverage life span of a RBC is 10-20 days as compared to 120 days for normal RBC Primarily affects ____________________________________ -Americans

95 Sickle Cell Disease

96 Sickle Cell Crises● ____________________________________ Crises: causes musculoskeletal pain,

abdominal pain, priapisms, pulmonary problems, renal infarctions, and CNS problems●Hematological Crises: fall in the hemoglobin level and problems with bone marrow

function● ____________________________________ Crises: vulnerable to infections●Management

– Supportive measures– Fluid replacement as indicated – Consider analgesics.

97 Complications of Sickle Cell Disease1 Cerebral vascular attack

____________________________________ JaundiceAvascular necrosis Splenic infectionsOpiate tolerance

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2 Leg ulcersRetinopathyChronic ____________________________________ Pulmonary hypertensionChronic ____________________________________ failure

98 Endocrine Emergencies

99 Endocrine SystemA complex message and control system.Glands secrete ____________________________________ .Hormones are chemical messengers. System maintains ____________________________________

100 Diabetes (1 of 2)

Diabetes affects the body’s ability to use ____________________________________ (sugar) for fuel.

Occurs in about 7% of the populationComplications include blindness, cardiovascular disease, and

____________________________________ failure.

101 Diabetes (2 of 2)

As an EMS provider, you need to know signs and symptoms of blood glucose that is:– High (____________________________________ )– Low (____________________________________ )

Central problem in diabetes is lack, or ineffective action, of insulin.

102 Defining Diabetes (1 of 2)

Diabetes mellitus– Metabolic disorder in which the body cannot metabolize glucose– Usually due to a lack of ____________________________________ .

Glucose– One of the basic sugars in the body– Along with oxygen, it is a primary fuel for cellular

____________________________________

103 Defining Diabetes (2 of 2)

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

____________________________________– Chemical substance produced by a gland– Has special regulatory effects on other body organs and tissues

104 Type I Diabetes ____________________________________ -dependent diabetes (IDDM)

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Patient does not produce any insulin Insulin injected dailyOnset usually in ____________________________________

105 Type II DiabetesNon- ____________________________________ -dependent diabetes (NIDDM) Patient produces inadequate amounts of insulinUsually appears ____________________________________ in lifeDisease may be controlled by diet or oral hypoglycemics

106 Role of Glucose and InsulinGlucose is the major source of ____________________________________ for the body.Constant supply of glucose needed for the brain. Insulin acts as the key for glucose to enter cells.Normal glucose (blood sugar) is ____________ to ____________mg/dL.

107 Insulin

108 Classic Symptoms of Uncontrolled Diabetes (3 Ps) ____________________________________ : frequent, plentiful urination ____________________________________ : frequent drinking to satisfy continuous

thirst ____________________________________ : excessive eating

109 Energy SourcesThe body uses glucose as a principal energy sourceWhen glucose is not available, the body turns to other sources

– ____________________________________ is most abundant.– Using fat for energy results in buildup of ____________________________________

and fatty acids in blood and tissue.

110 HyperglycemiaLack of insulin causes glucose to build-up in blood in extremely high levels. ____________________________________ excrete glucose. This requires a large amount of ____________________________________ .Without glucose, body uses fat for fuel.Ketones are formed.Ketones can produce diabetic ____________________________________ .

111 HypoglycemiaBlood glucose is ____________________________________ normal.Untreated, results in unresponsiveness and ____________________________________

crisis Signs and symptoms of hyperglycemia and hypoglycemia are similar

112 Hyperglycemic Emergencies

113 Diabetic Ketoacidosis (DKA) (1 of 2)

____________________________________ in insulin levels.

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Most common in type 1 diabetesGlucose cannot enter cells.Glucose accumulates in the ____________________________________ .Body PH ____________________________________ Polyuria Polydypsia

114 Diabetic Ketoacidosis (DKA) (2 of 2)

Osmotic ____________________________________ ____________________________________ Shock Cells metabolize fat, produce ketones as wasteRetention of ____________________________________ by kidneys which leads to

cardiac arrhythmias

115 Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC) More often caused by type ____________ diabetes ____________________________________, more gradual onset than DKANo sweet-smelling ____________________________________ Other S/S same as DKAExcessive urination results in dehydration.

116 Hyperglycemic Crisis (Diabetic Coma) (1 of 3)

A state of unconsciousness resulting from:Ketoacidosis or ____________________________________ HyperglycemiaDehydrationExcess blood ____________________________________

117 Hyperglycemic Crisis (Diabetic Coma) (2 of 3)

Can occur in diabetic patients:Not under medical treatmentWho have taken insufficient insulinWho have markedly ____________________________________ Under ____________________________________ due to infection, illness, overexertion,

fatigue, or alcohol

118 Hyperglycemic Crisis (Diabetic Coma) (3 of 3)

If untreated, can result in ____________________________________Treatment may take hours in a well-controlled

____________________________________ setting. Suspect for all unconscious patients of unknown etiology

119 Diabetic Coma

120 S/S of DKAAir hunger (____________________________________ Respirations)

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Dehydration Sweet, fruity breath odorRapid, weak pulseNormal or slightly low blood pressureVarying degrees of unresponsiveness ____________________________________ onset--over several hours or days Skin is ____________________________________

121 Management of DKAHigh Con OxygenObtain ____________________________________ glucose level Establish IV at appropriate rate

– May need fluid ____________________________________ if dehydratedTransport

122 Hypoglycemic Emergencies

123 Insulin Shock (Hypoglycemic Crisis)

124 Insulin Shock (Hypoglycemic Crisis)Three causes of Insulin Shock

– insulin ____________________________________ – taking insulin but not ____________________________________ adequately– over ____________________________________

Decreased blood sugar Brain is deprived of sugar

125 S/S of Insulin Shock1 Normal or rapid breathing

Pale, ____________________________________ skin SweatingDizziness, headache ____________________________________ pulseNormal or slightly elevated B/P

2 Aggressive or confused ____________________________________ Hunger Fainting, seizure, or comaWeakness on one side of the body ____________________________________ Speech

126 Care for Insulin ShockOxygenObtain sugar levelEstablish IV and give ____________________________________ If IV is unobtainable, give ____________________________________

127 D50WD50 is a 50% dextrose (sugar solution)

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ALWAYS the drug of choice for insulin shock ____________________________________ SolutionWorks very rapidlyMust have a patent IV lineWill cause ____________________________________ of the skin if IV infiltratesUse as ____________________________________ an IV catheter as possibleWatch for infiltration as drug is being administered slowly

128 Dosages of D50WAdult Dosage:

– ____________ grams slow IV push Pediatric Dosage:

– ____________ cc/kg of D25W to a max of 100cc (25gm)– D25W can be achieved by diluting D50W 1 to 1 with normal saline– ____________ cc/kg of D12.5W for infants < 1yoa– D12.5 can be achieved by diluting D50W 2 to 1 with NS

129 Glucagon Polypeptide hormone identical to human glucagonActs only on liver ____________________________________ , converting it to glucoseDosage: ____________ - ____________ mg IV, IM, or SCRepeat X 1 if patient does not regain consciousness however repeat doses are not

normally needed since oral glucose can then be given and the repeat dosage may not work if liver glycogen is depleted

130 Diabetic Conditions

131 Diabetes and Alcohol Abuse Patients may appear ____________________________________ . Suspect ____________________________________ with any altered mental status.Be alert to the similarity in symptoms of acute alcohol intoxication and diabetic

emergencies. ____________________________________ may drink alcohol and become intoxicated

132 Ask All Diabetics:Do you take insulin or any ____________________________________ to lower blood

sugar?Have you taken your usual dose of insulin (or pills) today?Have you ____________________________________ normally today?Have you had any ____________________________________ , unusual amount of

activity, or stress today?

133 DKA vs. Insulin Shock Pt eaten but has not taken insulin?

- ____________________________________ Pt taken insulin and has exercised profusely?

- ____________________________________ Pt accidentally took two doses of insulin?

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- ____________________________________ Pt has been sick and vomiting lately and has been taking insulin?

- ____________________________________

134 DKA vs. Insulin Shock Pt has taken insulin and has been eating normally?

- ____________________________________ Pt has not been eating and has not taken insulin?

- ____________________________________ When in doubt, GIVE SUGAR!!

135 Allergic Reactions

136 Immune System ____________________________________ system protects the body from foreign

substances and organisms.When a foreign substance invades the body:

– Body goes on alert.– Body initiates a series of ____________________________________ to inactivate the

invader.

137 Allergic ReactionsAllergic reaction

– Exaggerated immune response to any substance ____________________________________ and leukotrienes

– Chemicals released by the immune system ____________________________________

– Substance triggering body’s immune system

138 AnaphylaxisExtreme ____________________________________ reaction Involves multiple organsCan rapidly result in deathMost common signs:

– ____________________________________– ____________________________________(hives)

139 Severe Allergic Reaction

140 Five General Allergen Categories ____________________________________ bites and stingsMedications Plants ____________________________________Chemicals

141 Insect Stings (1 of 2)

Death from insect stings outnumber those from snakebites.

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Venom is injected through stinging organ. Some insects and ants can sting ____________________________________ .May cause local or systemic reaction ____________________________________ cannot withdraw their stinger.

– Fly away and dieWasps, hornets, and ____________________________________ ants can sting multiple

times.

142 Insect Stings (2 of 2)

Some ants, especially the fire ant, also strike ____________________________________ .– Often inject a particularly irritating ____________________________________ at the

bite sites

143 Signs and Symptoms of Insect Stings Sudden pain, swelling, and ____________________________________ at site Itching and sometimes a wheal Sometimes dramatic swellingLocalized ____________________________________ Redness in light-skinned individuals

144 Wheal

145 Management of Insect Stings (1 of 3)

There is no specific treatment for these injuries.Applying ____________________________________ sometimes helps. Swelling may be dramatic and frightening. ____________________________________ manifestations are not serious.Establish IV at appropriate rate if needed

146 Management of Insect Stings (2 of 3)

____________________________________ of the honeybee can continue to inject venom for up to 20 minutes.

Attempt to remove the stinger by ____________________________________ the skin with the edge of a sharp, stiff object such as a credit card.

147 Management of Insect Stings (3 of 3)

Do not use ____________________________________ or forceps.Wash the area with soap and water.Remove any ____________________________________ from the area.Be alert for ____________________________________ or signs of shock.Give oxygen if needed.Monitor the patient’s vital signs.Establish an IV if needed

148 Anaphylactic Reactions to Stings 5% of all people are allergic to bee, hornet, yellow jacket, and wasp stings.

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Anaphylaxis accounts for approximately ____________________________________ deaths a year.

Most deaths occur within ____________________________________ an hour of being stung.

149 Signs and Symptoms of Allergic Reaction1 Itching and burning

Widespread ____________________________________ ____________________________________ Swelling of the lips and tongueBronchospasm and ____________________________________

2 Chest tightness and coughingDyspneaAnxietyAbdominal cramps ____________________________________Loss of Consciousness

150 Patient Assessment Allergic symptoms are almost as ____________________________________ as

allergens themselves.Assessment should include evaluations of:

– ____________________________________ system– ____________________________________ system– Mental status– Skin

151 Emergency Medical Care (1 of 2)

Give oxygen. Perform a focused history and physical examination.

– Find out if the patient has a history of ____________________________________ .Obtain baseline vital signs and a SAMPLE history.Establish IV at appropriate ____________________________________ .

152 Emergency Medical Care (2 of 2)

Find out if the patient has a prescribed auto-injector.Be prepared to use standard airway procedures and

____________________________________ . If bee sting, carefully scrape stinger and venom sac away if present.Apply ____________________________________ Consider ____________________________________ and/or Benadryl

153 EpinephrineMimics the ____________________________________ (fight-or-flight) responseRapidly reverses the effects of ____________________________________ Discussed in Chapter 7 Part 1

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154 Epinephrine Auto-InjectorNormal adult dosage is ____________ mg via auto-injector (0.3 to 0.5mg SC) Pediatric dosage is normally ____________ mg via auto-injector (0.01mg/kg SC) In this area, EMS carries and utilizes either intramuscular Epi or auto-injectors

155 Key Points on EpinephrineEpinephrine is a powerful drug and is not intended or indicated for

____________________________________ allergic reactions; only anaphylactic reactions– SPEMS protocols require a SBP < 80mmHg prior to administration without orders

Follow local ____________________________________ for Epinephrine usage

156 BenadrylMany EMS organizations are allowing EMT-I’s to administer Benadryl ____________________________________Blocks the production of histamine release during an allergic reactionNo contraindications except for allergyAdult Dosage: ____________ mg IV or IM Pediatric Dosage: ____________ mg/kg up to 50mg