1 / 59

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. Possible overdose. Perspective Pathophysiology

herman-collier
Download Presentation

DOT National Standard EMT-Intermediate/85 Refresher

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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. Possible overdose Perspective Pathophysiology Epidemiology Physical Exam Findings Diagnostic Findings Signs and Symptoms Differential considerations Scenario Treatment MEDICAL EMERGENCIES

  4. Overdose/Poisoning • Perspective • Most poisoned pts- adult • Acute oral OD • Other common clinical scenarios in children • Drug abuse • Smoking, snorting, IV • Other • Environmental, industrial, agricultural • Medication reaction or interaction • envenomation

  5. OD/Poisoning • General treatments • Specific antidotes or treatments

  6. General Support ABCs Poison control (1-800-222-1222) Empty the stomach Gastric lavage Syrup of ipecac Activated Charcoal (adsorbent) Specific Toxidromes (common toxic syndromes) Anticholinergic Sympathomimetic Opioid/sedative/ ethanol Cholinergic OD/Poisoning

  7. Acetaminophen Anticholinergics Arsenic, lead & mercury Benzodiazepines Black widow spider bite Beta-blockers Calcium channel blockers Cyanide Digitalis Ethylene glycol Tricyclic antidepressants Hydrofluric acid Iron Lead Methanol Methemoglobin-forming agents Opioids Organophosphates & carbamates Rattlesnake bite Serotonin syndrome Sulfonureas Valproic acid OD/Poisoning- Specific Antidotes

  8. Poisoning/OD • The leading cause of poisoning in the US is prescription drug OD • Intentional and accidental • 2006 sedatives, hypnotics, & antipsychotics cause of the most deaths (382) • Analgesics most deaths 2006 (307 opioids, 214 acetaminophen containing meds, 138 acetaminophen alone, 61 ASA only, 1 ASA containing med)

  9. Poisoning/OD • 80% of poisoning fatality intentional ingestion (although not all were suicidal) • 2006 - 50% of fatalities suicide attempts

  10. OD/Poisoning • Toxins/poisons can poison the EMS provider as well as the pt. • Decontamination is paramount because the environment may be hazardous, the pt may be hazardous, or their behavior unpredictable. • Discuss organophosphate call

  11. Poisoning/OD • Nerve Agent/Organophosphate Exposure • Beta-blocker toxicity • Narcotic opioid OD • Ethanol OD

  12. Epidemiology • Pesticides = insecticides herbicides, & rodenticides • During 2008 >93,000 pesticide exposures reported - Toxic Exposure Surveillance System of the American Association of Poison Control Centers • >43,000 exposures to children <6yrs • 13 deaths 2008

  13. epidemiology • Pesticide intoxication • Intentional • Accidental • Occupational

  14. organophosphates • Common • Diazinon, acephate, malathion, parathion, chlorpyrifos • In addition to insecticides- chemical warfare agent since WWII • Sarin - terrorist attack Tokyo subway 1995

  15. epidemiology • Poisoning primarily from accidental home exposure • Recently sprayed or fogged area • Other - agriculture, industry & transport of these products • Exposure to flea-dip products in pet groomers & children • Food contamination • Homicide & suicide

  16. epidemiology • Systemic absorption • Inhalation • Mucus membrane • Transdermal • Transconjunctival • GI

  17. pathophysiology • The primary action is inhibition of carboxyl ester hydrolases, particularly acetylcholinesterase (AChE) • AChE -enzyme that degrades the neurotransmitter acetylcholine (ACh). • ACh is found in the central & peripheral nervous system, neuromuscular junction, & RBCs

  18. pathophysiology • Once AChE has been inactivated, ACh accumulates throughout the nervous system, resulting in overstimulation of muscarinic & nicotinic receptors • Clinical effects are manifested via activation of the autonomic & central nervous systems & at nicotinic receptors on skeletal muscles

  19. pathophysiology • In plain English = • The messengers for the parasympathetic system are usually controlled • The messenger deactivators have been disabled • Therefore the messengers of the parasympathetic system are unregulated & are overstimulating the parasympathetic system

  20. pathophysiology

  21. Organophosphate poisoning: Physical Exam Findings, Diagnostic Findings, S/S • Pt’s are on a continuum • Mild, moderate, severe • Analogy - movie • Progression • Analogy drain • Stable • Fast • Slow

  22. Organophosphate Poisoning: Physical Exam Findings, Diagnostic Findings, S/S • AB-SLUDGEM • ALOC • Bronchorrhea(watery sputum), Breathingdifficulty or wheezing, Bradycardia • Salivation, Sweating, Seizures • Lacrimation • Urination, Defecationor Diarrhea • GI upset • Emesis • Miosis, Muscle activity.

  23. Organophosphate poisoning: Physical Exam Findings, Diagnostic Findings, S/S • AB-SLEDGEM is an over-simplification • Clinical presentations depend on the specific agent involved, quantity absorbed, & route of exposure • Organophosphate poisoning is not a single entity • substantial variability in clinical course, response to oximes, outcomes

  24. Organophosphate Poisoning: Physical Exam Findings, Diagnostic Findings, S/S • Acetylcholine is the presynaptic neurotransmitter at nicotinic receptors in the sympathetic ganglia & adrenal medulla • Pallor, mydriasis (pupil dilatation), tachycardia, HTN

  25. Organophosphate poisoning: Physical Exam Findings, Diagnostic Findings, S/S • Parasympathetic overstimulation usu. predominates, but mixed autonomic effects are common. • Nicotinic overstimulation at the neuromuscular junctions results in • Muscle fasciculations, cramps, & muscle weakness • Can progress to paralysis, areflexia

  26. Organophosphate poisoning: Physical Exam Findings, Diagnostic Findings, S/S • The cholinergic toxidrome may vary depending on the predominance of muscarinic, nicotinic, and central neurologic manifestations and the severity of the intoxication

  27. Organophosphate poisoning: Physical Exam Findings, Diagnostic Findings, S/S • Other mneumonics for the muscarinic effects of cholinesterase inhibition • SLUDGE DUMBELS Killer Bees • Salivation, Lacrimation, Urinary incontinence, Defecation, GI pain, Emesis • Defecation, Urination, Muscle weakness, miosis, bradycardia, bronchorrhea, bronchospasm, Emesis, Lacrimation, Salivation • Bradycardia, bronchorrhea, bronchospasm

  28. Differential Diagnosis Considerations • Direct acting cholinergic agents: bethanechol or pilocrapine • Digitalis, clonidine, calcium or Beta-receptor agonist poisoning • Miosis, bradycardia, lethargy & respiratory - opiod overdose • Nicotine poisoning

  29. Scenario • Dispatch info: • You are dispatched to Village Store in Yosemite Valley for a 44 y/o male who is threatening suicide. The time of call is 17:00 and your response time to the scene is approximately 5 minutes.

  30. Scenario • You arrive at the scene at 17:05 where you find the pt sitting in the aisle of the store. He is sobbing uncontrollably.

  31. Scenario • As you perform an initial assessment the pt tells you that he is depressed because his wife is divorcing him. • His respirations are labored, however, he has adequate tidal volume and is able to speak to you in full sentences

  32. Scenario

  33. Question? • What initial management is indicated for this patient?

  34. Go to “Call Matrix- General”

  35. Question? • What initial management is indicated for this pt? • After the scene size upand the initial assessment • Diagnostics, Monitoring & Mtg • VerbalSurvey that includes pertinent positives/negatives & hx, meds, allergies • SpecificProtocol Treatments

  36. Scenario • Is the pt stable or unstable? • What is your rationale?

  37. Scenario • After placing the pt on supplemental oxygen, an IV line of NS is established & set at KVO • You conduct a hx & PE

  38. Scenario • What size IV catheter would you use? • Rationale?

  39. Scenario • What size IV catheter would you use? • Rationale? • Large bore = 14 or 16ga

  40. Scenario

  41. Scenario • Further assessment of the pt reveals that he has defecated in his pants. He is salivating all over his shirt & he tells you he “just doesn’t feel so good.”

  42. Scenario

  43. Scenario • What is your field impression of this pt? • Give your rationale

  44. Scenario • This pt is suffering from organophosphate poisoning. • The following assessment findings support a field impression of organophosphate poisoning: • Bradycardia • Low BP • Defecation • Salivation • Insecticide

  45. Scenario • What treatment will you provide to this patient?

  46. Scenario • General • Position, VS, SPO2, Oxygen & airway, IV • Specific • Atropine 2mg IV/IM q 5 minutes PRN • (discuss IM)

  47. Scenario • You administer the atropine indicated for the pt’s condition, after which you note that the pt’s condition seems to remained the same. • You continue oxygen therapy & load the pt into the ambulance for transport to the ED

  48. Scenario • En route to the ED, the pt’s condition does not improve. • You perform an ongoing assessment & then call your radio report to the receiving facility

  49. Scenario

More Related