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DOT National Standard EMT-Intermediate/85 Refresher

Welcome!. DOT National Standard EMT-Intermediate/85 Refresher. MEDICAL EMERGENCIES. Allergic reaction Possible overdose Near-drowning ALOC Diabetes Seizures Heat & cold emergencies Behavioral emergencies Suspected communicable disease. ALOC. Perspective Pathophysiology Epidemiology

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DOT National Standard EMT-Intermediate/85 Refresher

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  1. Welcome! DOT National Standard EMT-Intermediate/85 Refresher

  2. MEDICAL EMERGENCIES • Allergic reaction • Possible overdose • Near-drowning • ALOC • Diabetes • Seizures • Heat & cold emergencies • Behavioral emergencies • Suspected communicable disease

  3. ALOC Perspective Pathophysiology Epidemiology Physical Exam Findings Diagnostic Findings Signs and Symptoms Differential considerations Treatment MEDICAL EMERGENCIES

  4. Probably the most difficult call to run In most cases - the parkmedic will NOT be able to ascertain the cause of the ALOC Therefore, the dx is usually ALOC of Unknown Etiology ALOC

  5. pathophysiology • Consciousness is the sum of the activities & interactions of the reticular activating system (RAS) & cerebral cortex • Coma results from the dysfunction of either the • RAS • the bilateral cerebral cortices

  6. s/s, physical exam & assessment, diagnotics, monitoring, management, pertinent positives • ALOC - spectrum • Drowsy or lethargic = slight decrease in wakefulness & interaction w/ the environment • Verbal or light touch arouses pt • Deeply comatose = complete failure of arousal system • No spontaneous eye opening & unable to awaken w/ vigorous sensory stimulation • Obtundation & stupor = intermediate stage • Awakened only by energetic stimulation

  7. s/s, physical exam & assessment, diagnotics, monitoring, management, pertinent positives • ALOC - spectrum • Drowsy or lethargic = slight decrease in wakefulness & interaction w/ the environment • Verbal or light touch arouses pt • Deeply comatose = complete failure of arousal system • No spontaneous eye opening & unable to awaken w/ vigorous sensory stimulation • Obtundation & stupor = intermediate stage • Awakened only by energetic stimulation

  8. epidemiology • Metabolic • Infectious • Vascular • Neurologic Structural • Seizures • Trauma • Toxicologic • Environmental

  9. Electrolyte disorders Hypernatremia Hyponatremia Hypercalcemia Hypoglycemia Hypermagnesemia Diabetic ketoacidosis Hyperglycemia hyperosmolar states Hypothyroidism Thyrotoxicosis Adrenal insufficiency Hepatic encephalopathy Uremia Thiamine deficiency Meningitis Encephalitis Intracranial abscess Sepsis Hypertension Hypotension Vasculitis Cerebrovascular accident Subarachnoid hemorrhage Tumor Hydrocephalus Intracerebral hemorrhage epidemiology

  10. epidemiology • Status epilepticus • Subdural hematoma • Epidural hematoma • Cerebral contusion • Diffuse cerebral edema • Carbon monoxide • Ethanol, methanol, isopropyl alcohol, ethylene glycol • Drug use/overdose • Heatstroke hypothermia • HACE • Near drowning • dysbarism

  11. assessment • In the field: • Alcohol • Epilepsy • Insulin • Overdose • Uremia • Trauma • Infection • Psychosis • Stroke

  12. Review Protocol • Go to ALOC-Adult • Go to Call Matrix -General

  13. Perspective • Pathophysiology • Epidemiology • Physical Exam Findings • Diagnostic Findings • Signs and Symptoms • Differential considerations • Treatment

  14. Questions? • References • Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010. • Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011. • Wolfson, Allan B. ed. , Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.

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