MEDICAL CONDITIONS

1. LESSON 12 MEDICAL CONDITIONS

2. Introduction • A medical emergency occurs because of illness or a medical problem • Some medical emergencies develop slowly, some very quickly • Medical emergencies may be life threatening • Know the signs and symptoms of common medical problems and the appropriate emergency medical care

3. General Medical Complaints • Patient or family member may call for help for signs and symptoms • You may suspect or know the cause of the problem • Neither you nor the patient may know the problem • The general approach is the same for all medical emergencies • You do not have to know the specific illness • Always begin with the standard assessment and manage life-threatening problems

4. Perform the Standard Assessment • Size up the scene • Complete the primary assessment and care for life-threatening conditions • Take the history • Perform the secondary assessment and physical examination as appropriate • Complete reassessments

5. General Signs and Symptoms • Person feels ill, dizzy, confused or weak • Skin color changes – flushed or pale • Sweating • Breathing changes • Nausea, vomiting

6. Perform Standard Patient Care • Ensure EMS has been activated • Take body substance isolation precautions • Maintain the patient’s airway and provide artificial ventilation if needed • Comfort, calm and reassure the patient

7. Additional Care for Medical Emergencies • Follow local protocol re: oxygen administration • Help patient rest and avoid chilling or overheating • Do not give food or drink • Be prepared to give BLS

8. Heart Attack

9. Heart Attack • Caused by sudden reduced blood flow to heart muscle • Medical emergency that often leads to cardiac arrest • Can occur at any age • Usually results from atherosclerosis

10. Facts about Heart Attack • 132,000people in United States die every year • More likely in those with family history • 20% of patients do not have chest pain • Patients often have other symptoms

11. Assessing Heart Attack • Assess the character and location of chest discomfort or pain: • Quality: what does it feel like? • Location: where is it occurring? • Severity: consider on a pain scale • Ask whether the pain or discomfort radiates elsewhere: • Arms • Back • Neck • Jaw • Stomach

12. Assessing Heart Attack(continued) • Monitor vital signs (blood pressure, pulse and respiratory rates) • In pediatric patients: • Heart problems are often related to congenital heart conditions • Cardiac arrest is often caused by primary respiratory problem • Geriatric patients may not experience chest discomfort with a heart attack

13. Signs and Symptoms of Heart Attack • Persistent discomfort, pressure, tightness, ache or pain in chest • Pain spreading to neck, shoulders or arms • Shortness of breath • Dizziness, lightheadedness, a feeling of impending doom • Pale, moist, cool skin or heavy sweating • Indigestion • Nausea or vomiting

14. Signs and Symptoms of Heart Attack(continued) • Signs and symptoms vary considerably • Patient may have no signs and symptoms before collapsing • Milder symptoms may come and go for 2 or 3 days • Some symptoms are more common in women, e.g., shortness of breath, jaw or back pain, and nausea and vomiting • Consider a wide range of symptoms rather than expecting a clearly defined situation • Patients occasionally deny they are having a heart attack

15. Emergency Care for Heart Attack • Act quickly • Perform standard patient care • Help patient rest comfortably (often sitting) • Loosen tight clothing • Ask if patient takes heart medication • Follow local protocol to help with medication

16. Emergency Care for Heart Attack (continued) • Follow local protocol to administer oxygen • Follow local protocol to allow patient to chew one uncoated adult aspirin or two low-dose baby aspirin • Stay with patient, reassure and calm • Be prepared to give BLS • Do not let the patient eat or drink anything

17. Nitroglycerin • Increases blood flow by dilating arteries • Often prescribed for angina – type of chest pain caused by narrowed coronary arteries • Comes in tablets, sprays and patches

18. Nitroglycerin (continued) • To administer: • Follow local protocol and instructions on the medication • Patient should be seated • Do not give to unresponsive patient

19. Angina • Chest pain caused by heart disease and temporary blood flow interruption • Usually after activity or exertion • Pain usually lasts only few minutes • People usually know they have angina and carrymedication

20. Care for Angina • Ask if the patient has been diagnosed with angina, and if the pain is like angina pain in the past • If so, help person with angina take medication and rest • If pain persists >10 minutes or stops and returns or person has other symptoms of heart attack, give first aid as for heart attack

21. Respiratory Distress Emergencies

22. Respiratory Distress • Difficulty breathing • May occur suddenly in those with chronic respiratory problems • If cause not obvious • Look for other signs and symptoms that may reveal the problem • Give general emergency care • If cause is determined • Care for that problem

23. Signs and Symptoms of Respiratory Distress • Patient gasping or unable to catch breath • Breathing that is faster or slower, deeper or shallower than normal • Breathing with wheezing or gurgling sounds • Patient feels restless, dizzy or lightheaded • Increased pulse

24. Signs and Symptoms of Respiratory Distress (continued) • Signs of altered mental status • Pale or ashen, cool and moist skin • Bluish lips and nail beds • Patient sitting in tripod position • Flaring nostrils and chest muscle movement in infant or child

25. Respiratory Distress in an Infant or Child • Act quickly because respiratory distress may rapidly progress to arrest • Upper airway obstruction may be caused by respiratory infection • Lower airway disease may be caused by birth problems or infections

26. Emergency Care for Respiratory Distress • Perform standard patient care • Help patient into easiest breathing position • Ask about prescribed medicine  help patient take it if needed

27. Emergency Care for Respiratory Distress (continued) • Be prepared to give BLS • Follow local protocol for supplemental oxygen • Use suction as needed to maintain the airway • Provide emotional support

28. Asthma • Affects one in 20 adults • Affects one in 10 school-agechildren • Many patients carry medication for known condition • Untreated, severe attack can be fatal

29. Assessing Asthma • Perform the standard assessment • If a young child away from caretakers has trouble breathing, always ask if he or she has medication

30. Signs and Symptoms of an Asthma Attack • Wheezing and difficulty breathing and speaking • Dry, persistent cough • Fear, anxiety • Gray-blue skin • Changing levels of responsiveness

31. Emergency Care for an Asthma Attack • Perform standard patient care • Ensure EMS has been activated (first attack) • Follow local protocol to assist with medication when: • Patient confirms asthma attack occurring • Patient identifies inhaler as his or her medication • Patient cannot self-administer the medication

32. Emergency Care for an Asthma Attack (continued) • Help patient into easiest breathing position • Patient may use inhaler again if needed as prescribed or directed by the medical provider • If breathing difficulty after using inhaler, activate EMS • Follow local protocol for supplemental oxygen • Never unnecessarily separate child from parent or loved one

33. Helping With an Inhaler Help patient use inhaler if: • Patient confirms asthma attack occurring • Patient identifies inhaler as his or her medication • Patient cannot self-administer the medication

34. Chronic ObstructivePulmonary Disease • Chronic Obstructive Pulmonary Disease (COPD) includes emphysema and chronic bronchitis • More than 12 million people in United States have COPD • Number 4 cause of death in United States • May cause respiratory distress and breathing emergencies

35. Emergency Care for COPD • Emergency care same as for respiratory distress • Ask patient if he or she has COPD • Help patient with prescribed medication

36. Hyperventilation • Fast, deep breathing • Usually caused by anxiety or stress • Sometimes caused by injury or illness • Imbalance in the body’s oxygen and carbon dioxide • Usually does not last long

37. Signs and Symptoms of Hyperventilation • Fast, deep breathing • Anxiety • Confusion or dizziness • Numbness or tingling in fingers, toes, lips • Muscle twitching or cramping

38. Care for Hyperventilation • Perform standard patient care • Help patient calm down andbreathe slowly • Do not have person breathe into a bag • Rapid breathing may be caused by injury or sudden illness  do not assume the patient is simply hyperventilating

39. Care for Hyperventilation (continued) • Look for signs of injury or illness • Ask the patient what happened • Activate EMS • If other signs and symptoms suggest injury or illness • If patient’s breathing doesn’t return to normal in a few minutes

40. Altered Mental Status

41. Altered Mental Status • Change from person’s normal responsiveness and awareness • Patient may be confused, disoriented, combative, drowsy or partially or wholly unresponsive • May be brief or prolonged • May result from different injuries and illnesses • Often a sign of deteriorating condition

42. Common Causes • Seizures • Stroke • Head injury • Poisoning, drug use or overdose • High fever, infection • Diabetic emergencies • Psychiatric conditions • Any condition causing lowered blood oxygen

43. Emergency Care forAltered Mental Status • Perform standard patient care • Determine nature of problem • Gather a SAMPLE history • Place unresponsive patient in recovery position • Have suction available • Consider the use of an airway adjunct

44. Altered Mental Status and Behavioral Emergencies • Drug or alcohol use may become a behavioral emergency • Never assume person is intoxicated or using drugs • Intoxicated person may need care for injury or illness

45. Fainting • Caused by temporary reduced blood flow to brain, hot weather, fright, emotional shock, lack of food, suddenly standing • Usually not sign of serious problem unless it occurs often or person does not recover quickly • Could be serious in someone with heart disease, pregnant or older than 65

46. Signs and SymptomsBefore Fainting • Dizziness • Sweating • Nausea • Blurring or dimming of vision • Generalized weakness • Pale, cool skin; sweating

47. Emergency Care for Fainting • Check patient; provide BLS if needed • Lay patient down and raise legs 6-12 inches • Loosen tight clothing • Check for possible injuries from falling • Reassure patient when recovering

48. Emergency Care for Fainting (continued) • If unresponsive, place in recovery position • Do not splash water on patient’s face • Do not use ammonia inhalants • Activate EMS if patient is not soon responsive or repeatedly faints • Always call EMS for older adults, heart disease patients, pregnant women

49. Stroke

50. Stroke • Cerebrovascular accident (CVA) or brain attack • May be caused by atherosclerosis • Blood clot may obstruct artery in brain • Artery in brain may rupture • Over 795,000people have strokes each year in United States • More common in older adults • Act quickly to decrease chance of permanent damage