Caring for Common Medical Emergencies

1. 15 Caring for Common Medical Emergencies

2. Objectives • Define the following terms: • Altered mental status • Behavioral emergency • Convulsions • Diabetes • Epilepsy • Febrile • Generalized seizure • Hemodialysis • Hyperglycemia • Hypoglycemia (continued)

3. Objectives • Define the following terms : • Overdose • Partial seizure • Postictal • Sepsis • Stroke (brain attack) (continued)

4. Objectives • Explain the common causes of altered mental status. • Describe the signs and symptoms of a patient with an altered mental status. • Explain the appropriate assessment and care for a patient with an altered mental status. • Describe the signs and symptoms of a patient experiencing a generalized seizure. (continued)

5. Objectives • Explain the appropriate assessment and care for a patient experiencing a generalized seizure. • Describe the signs and symptoms of a patient experiencing a stroke (brain attack). • Explain the appropriate assessment and care for a patient experiencing a stroke (brain attack). • Describe the signs and symptoms of a patient experiencing a diabetic emergency. (continued)

6. Objectives • Differentiate between the signs and symptoms of hyperglycemia and hypoglycemia. • Explain the appropriate assessment and care for a patient experiencing a diabetic emergency. • Describe the signs and symptoms of a patient experiencing an overdose or poisoning. • Describe the signs and symptoms of a patient experiencing carbon monoxide poisoning. (continued)

7. Objectives • Explain the appropriate assessment and care for a patient experiencing an overdose or poisoning. • State when it is most appropriate to contact the poison control center. • Describe the signs and symptoms of a patient experiencing an emergency related to renal failure. • Explain the special considerations when caring for a hemodialysis patient. (continued)

8. Objectives • Describe the signs and symptoms of a patient experiencing a generalized infection (sepsis). • Explain the appropriate assessment and care for a patient experiencing a generalized infection (sepsis). • Describe the signs and symptoms of an allergic reaction. • Explain the appropriate assessment and care for a patient experiencing a severe allergic reaction. (continued)

9. Objectives • Describe the signs and symptoms of a patient experiencing a suspected behavioral emergency. • Explain the appropriate assessment and care for a patient experiencing a suspected behavioral emergency. • Demonstrate the ability to appropriately assess and care for a patient experiencing an altered mental status. (continued)

10. Objectives • Value the significance of an altered mental status as a sign of an unstable patient.

11. Media Slide 27 Introduction to Seizures Video Slide 29 Complex Partial Seizures Video Slide 30 Tonic-Clonic Seizures Video Slide 44 Diabetes Animation Slide 61 Poisoning Video

12. Topics • Medical Emergencies • Evaluating Mental Status • Overdose and Poisoning • Behavioral Emergencies

13. MEDICAL EMERGENCIES

14. Medical Emergencies • Caused by infections, poisons, or failure of one or more of body's organ systems. • Signs and Symptoms: • Altered mental status • Abnormal pulse rate and rhythm • Abnormal breathing rate and character • Abnormal skin signs • Abnormal pupil size or response (continued)

15. Medical Emergencies • Signs and Symptoms: • Unusual breath odors • Tenderness or rigidity in abdomen • Abnormal muscular activity (spasms or paralysis) • Bleeding or discharges from body • Pain • Shortness of breath (continued)

16. Medical Emergencies • Signs and Symptoms: • Fever or chills • Upset stomach and/or vomiting • Dizziness or feeling faint • Chest or abdominal pain • Unusual bowel or bladder activity • Thirst, hunger, odd tastes in mouth

17. Medical Emergencies • Assessment • Take appropriate BSI precautions; complete a scene size-up. • Perform primary assessment. • Perform secondary assessment. • Complete reassessments. • Comfort and reassure patient while awaiting additional EMS resources.

18. Think About It You respond to a single-vehicle MVC with minor MOI. Your patient is unresponsive. What conditions could have preceded the collision? How might the EMR proceed with assessment and treatment in this case?

19. EVALUATING MENTAL STATUS

20. Evaluating Mental Status • Normal mental status: complete and accurate awareness of one's surroundings. • Altered mental status (AMS): decrease in patient's alertness and responsiveness to surroundings.

21. Evaluating Mental Status • Common causes: • Trauma to head • Seizures • Stroke (brain attack) • Diabetic emergencies • Poisonings and overdose • Hypoxia (continued)

22. Evaluating Mental Status • Common causes: • Shock • Infection • Trauma • Psychiatric condition • Liver failure

23. Evaluating Mental Status • Signs and Symptoms: • Confusion • Seizures • Inappropriate behavior • Lack of awareness of surroundings • Combativeness • Syncope (collapse or fainting) • Unresponsiveness

24. Evaluating Mental Status • Assessing the Patient • Focus on observation. • Obtain complete medical history. • Use AVPU scale: • Alert • Verbal • Painful • Unresponsive

25. Evaluating Mental Status • Specific Conditions: Seizures • Irregular electrical activity in brain that can cause sudden change in mental status and behavior. • Can have many causes.

26. Evaluating Mental Status • Causes of Seizures: • Epilepsy (disorder of brain) • Ingestion of drugs, alcohol, poisons • Alcohol withdrawal • Brain tumors • Infections, high fever (febrile) • Diabetic problems; stroke • Heat stroke; head injury

27. Click here to view a video on the topic of seizures. BACK TO DIRECTORY

28. Evaluating Mental Status • Seizures • Types: • Generalized: loss of consciousness and full body convulsions (uncontrolled muscular contractions). • Partial: temporary loss of awareness with no dramatic body movements.

29. Click here to view a video on the topic of complex partial seizures. BACK TO DIRECTORY

30. Click here to view a video on the topic of tonic-clonic seizures. BACK TO DIRECTORY

31. Evaluating Mental Status • Generalized Seizure: • Sudden loss of responsiveness • Report of bright light, bright colors, sensation of strong odor prior to losing responsiveness • Convulsions • Loss of bladder and/or bowel control (continued)

32. Evaluating Mental Status • Generalized Seizure: • Labored breathing (frothing at mouth) • Complaint of headache prior to or following seizure • Following seizure, patient's body completely relaxes • Postictal: the phase of seizure following convulsions

33. Protect the patient from injury by removing objects that he may strike and by placing something soft beneath his head.

34. Evaluating Mental Status • Seizure Care • Move objects away; place something soft under head. • Do not attempt to restrain patient or force anything into mouth. • Loosen restrictive clothing. • After convulsions have stopped, place patient in recovery position.

35. Evaluating Mental Status • Specific Conditions: Stroke • Cerebrovascular accident (CVA) or brain attack. • Blood flow to brain disrupted. • Causes: obstruction or rupture of blood vessel. • Portion of brain does not receive adequate supply of oxygenated blood.

36. Evaluating Mental Status • Stroke Signs and Symptoms • Headache • Syncope (fainting) • Altered mental status • Numbness or paralysis (extremities or face) • Difficulty with speech or vision • Confusion, dizziness

37. Evaluating Mental Status • Cincinnati Prehospital Stroke Scale (CPSS) • Facial droop • Arm drift • Abnormal speech

38. Altered Mental Status—Stroke: Cerebrovascular Accident

39. Altered Mental Status—Stroke: Cerebrovascular Accident

40. A patient suffering a stroke may have facial droop on one side or the other.

41. An inability to hold both arms up may be a sign of possible stroke.

42. Evaluating Mental Status • Stroke Care • Maintain open airway; be prepared to provide ventilations or CPR. • Keep patient at rest; protect all paralyzed parts. • Provide emotional support. • Place patient in recovery position. • Do not administer anything by mouth.

43. Evaluating Mental Status • Specific Conditions: Diabetic Emergencies • Diabetes: disease that prevents individuals from producing enough insulin or from using insulin effectively. • Insulin: hormone released by pancreas; allows glucose (blood sugar) to enter cells so glucose can be used.

44. Click here to view an animation on the topic of diabetes. BACK TO DIRECTORY

45. Evaluating Mental Status • Hypoglycemia (low blood sugar): • Diabetic who has taken too much insulin, eaten too little sugar, overexerted himself/herself, or experienced excessive emotional stress may develop low blood sugar. • Alert patient: provide oral glucose or suitable substitute, if allowed by protocol. • Non-alert patient: do not provide anything orally if the patient is unable to swallow.

46. Evaluating Mental Status • Hypoglycemia: Signs and Symptoms • Altered mental status • Pale, cool skin; often moist • Rapid, strong pulse • Dizziness • Headache • Normal or shallow breathing • Very hungry • Some patients develop seizures

47. Evaluating Mental Status • Hyperglycemia: Signs and Symptoms • Extreme thirst • Abdominal pain • Dry, warm skin • Rapid, weak pulse • Sweet or fruity odor (ketone) breath • Dry mouth • Restlessness • Altered mental status, including coma

48. Evaluating Mental Status • Care for Hyperglycemia • If patient is alert and you are not certain if problem is too much sugar or too little sugar, give patient sugar, candy, orange juice, or soft drink.

49. Hyperglycemia

50. Hypoglycemia