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Chapter 13

Chapter 13. Common Medical Emergencies. Objectives (1 of 5). Identify the signs and symptoms of the acute abdomen and the necessity for immediate transport of patients with these symptoms.

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Chapter 13

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  1. Chapter 13 Common Medical Emergencies

  2. Objectives (1 of 5) • Identify the signs and symptoms of the acute abdomen and the necessity for immediate transport of patients with these symptoms. • Identify the patient taking diabetic medications with altered mental status and the implications of a history of diabetes.

  3. Objectives (2 of 5) • State the steps in the emergency care of the patient taking diabetic medicine with an altered mental status and a history of diabetes. • Recognize the patient experiencing an allergic reaction.

  4. Objectives (3 of 5) • Describe the emergency care of the patient with an allergic reaction. • Describe the mechanisms of allergic response and the implications for airway management. • List the signs and symptoms associated with poisoning.

  5. Objectives (4 of 5) • Describe the steps in the emergency care for the patient with suspected poisoning. • Perform a rapid gentle assessment of the abdomen. • Demonstrate the steps in the emergency care for the patient taking diabetic medicine with an altered mental status and a history of diabetes.

  6. Objectives (5 of 5) • Demonstrate the emergency care of the patient experiencing an allergic reaction. • Demonstrate the steps in the emergency care for the patient with suspected poisoning

  7. The Acute Abdomen Physiology of the Abdomen (1 of 2) • Acute abdomen • Sudden onset of abdominal pain • Peritoneum • Thin membrane lining the entire abdomen • Colic • Severe, intermittent cramping pain

  8. The Acute Abdomen Physiology of the Abdomen (2 of 2) • Referred pain • Perceived pain at a distant point of the body caused by irritation of the visceral peritoneum(e.g. Gallbladder and R. Shoulder – page 353) • Peritonitis • Irritation of the peritoneum caused by illness or injury (e.g. Appendicitis)

  9. Abdominal pain and/or tenderness Quiet patient guarding the abdomen (shock) (appendicitis) Rapid andshallow breathing Referred (distant) pain Anorexia, nausea, vomiting The Acute Abdomen Signs and Symptoms of Acute Abdomen (1 of 3)

  10. Loss of bowel sounds (Not practical) Tense, often distended abdomen (What would this indicate????) Sudden constipation or bloody diarrhea (Or both… Is this possible) Tachycardia (Why) Hypotension (Why) Fever (Why) The Acute Abdomen Signs and Symptoms of Acute Abdomen (2 of 3)

  11. Rebound tenderness Indigestion/heartburn Colic (severe painful spasms) Difficulty swallowing Jaundice (what organ affected?) The Acute Abdomen Signs and Symptoms of Acute Abdomen (3 of 3)

  12. The Acute Abdomen Examining the Abdomen • Explain what you are about to do. • Position the patient supine with legs drawn up and knees flexed. • Observe the patient. • Gently palpate the abdomen. • Determine if the patient can relax the abdominal wall on command. • Determine if abdomen is tender when palpated.

  13. The Acute Abdomen Causes of Acute Abdomen • Substances lying in or adjacent to the abdominal cavity • Other common causes: • Appendicitis • Perforated gastric ulcer • Cholecystitis • Diverticulitis (where’s the diverticuli???)

  14. The Acute Abdomen Uterus and Ovaries • Always consider a gynecological problem with women having abdominal pain. • Causes of pain • Menstrual cycle • Pelvic inflammatory disease • Ectopic pregnancy (Any women in her childbearing years c/o ABD pain is believed to have an ectopic pregnancy until proven otherwise!!!!)

  15. The Acute Abdomen Other Organ Systems • Aneurysm • Weakness in aorta (pulsatile mass w/ upper back discomfort) • Pneumonia • May cause ileus and abdominal pain • Hernia • Protrusion through a hole in the body wall

  16. The Acute Abdomen Emergency Medical Care (1 of 2) • Do not delay transport. • Do not attempt to diagnose. • Clear and maintain the airway. • Anticipate vomiting. • Administer high-flow oxygen. • Give nothing by mouth.

  17. The Acute Abdomen Emergency Medical Care (2 of 2) • Document all pertinent information. • Anticipate the development of hypovolemic shock. • Make the patient comfortable. • Monitor vital signs.

  18. Diabetic Emergencies Defining Diabetes (1 of 2) • Diabetes mellitus • Metabolic disorder in which the body cannot metabolize glucose • Usually due to a lack of insulin • Glucose • One of the basic sugars in the body • Along with oxygen, it is a primary fuel for cellular metabolism

  19. Diabetic Emergencies Defining Diabetes (2 of 2) • Insulin • Hormone produced by the pancreas • Enables glucose to enter the cells • Without insulin, cells starve • Hormone • Chemical substance produced by a gland • Has special regulatory effects on other body organs and tissues

  20. Diabetic Emergencies Type I Diabetes • Insulin-dependent diabetes • Patient does not produce any insulin • Insulin injected daily • Onset usually in childhood

  21. Diabetic Emergencies Type II Diabetes • Noninsulin-dependent diabetes • Patient produces inadequate amounts of insulin • Disease may be controlled by diet or oral hypoglycemics

  22. Diabetic Emergencies Role of Glucose and Insulin • Glucose is the major source of energy for the body. • Constant supply of glucose needed for the brain. • Insulin acts as the key for glucose to enter cells.

  23. Diabetic Emergencies Hyperglycemia • Lack of insulin causes glucose to build up in blood in extremely high levels. • Kidneys excrete glucose. • This requires a large amount of water (3 P’s: Polyuria, Polydipsia, Polyphagia). • Without glucose, body uses fat for fuel. • Ketones are formed. • Ketones can produce diabetic ketoacidosis.

  24. Diabetic Emergencies Signs and Symptoms of Diabetic Ketoacidosis • Vomiting • Abdominal pain • Kussmaul respirations (a form of hyperventilation) • Unconsciousness

  25. Diabetic Emergencies Blood Glucose Monitors • Test strips • Normal range 80-120 mg/dL • Glucometer

  26. Diabetic Emergencies Diabetic Coma (Hyperglycemia)

  27. Diabetic Emergencies Signs of Diabetic Coma • Kussmaul respirations • Dehydration • “Fruity” breath odor (might smell like ETOH) • Rapid, weak pulse • Normal or slightly low blood pressure • Varying degrees of unresponsiveness

  28. Diabetic Emergencies Insulin Shock (Hypoglycemia)

  29. Normal or rapid respirations Pale, moist skin Sweating Dizziness, headache Rapid pulse Normal to low blood pressure Altered mental status Aggressive or confused behavior Hunger Fainting, seizure, or coma Weakness on one side of the body Diabetic Emergencies Signs of Insulin Shock

  30. Diabetic Emergencies Diabetes and Alcohol Abuse • Patients may appear intoxicated. • Suspect hypoglycemia with any altered mental status. • Be alert to the similarity in symptoms of acute alcohol intoxication and diabetic emergencies.

  31. Diabetic Emergencies Emergency Medical Care (1 of 2) • Ask a patient with known diabetes: • Do you take insulin or any pills to lower blood sugar? • Have you taken your usual dose of insulin (or pills) today? • Have you eaten normally today? • Have you had any illness, unusual amount of activity, or stress today?

  32. Diabetic Emergencies Emergency Medical Care (2 of 2) • Perform initial assessment. • Obtain baseline vital signs and SAMPLE history. • Check for emergency medical identification symbol. • Always do a full, careful assessment. • Ask patient or family about last meal or insulin dose. • DO NOT administer anything to an unconscious patient.

  33. Diabetic Emergencies Administering Oral Glucose(1 of 2) • Names: • Glutose • Insta-Glucose • Dose equals one tube • Glucose should be given to a patient with diabetes and a decreased level of consciousness. • DO NOT give glucose to a patient with the inability to swallow or who is unconscious.

  34. Diabetic Emergencies Administering Oral Glucose (2 of 2)

  35. Diabetic Emergencies Complications of Diabetes • Heart disease • Visual disturbances • Renal failure • Stroke • Ulcers • Infections of the feet and toes • Seizures • Altered mental status

  36. Diabetic Emergencies Seizures • Consider hypoglycemia as the cause. • Use appropriate BLS measures for airway management. • Arrange for prompt transport.

  37. Diabetic Emergencies Altered Mental Status • Altered mental status is often caused by complications of diabetes. • Ensure that airway is clear. • Be prepared to ventilate and suction. • Arrange for prompt transport.

  38. Allergic Reactions and Envenomations Allergic Reactions • Allergic reaction • Exaggerated immune response to any substance • Histamines and leukotrienes • Chemicals released by the immune system

  39. Allergic Reactions and Envenomations Anaphylaxis • Extreme allergic reaction • Involves multiple organs • Can rapidly result in death (What would cause death) • Most common signs: • Wheezing • Urticaria (hives) • What else?

  40. Allergic Reactions and Envenomations Urticaria

  41. Allergic Reactions and Envenomations Five General Allergen Categories • Insect bites and stings • Medications • Plants • Food • Chemicals

  42. Allergic Reactions and Envenomations Insect Bites and Stings • Death from insect stings outnumber those from snake bites. • Venom is injected through stinging organ. • Some insects and ants can sting repeatedly.

  43. Allergic Reactions and Envenomations Signs and Symptoms • Sudden pain, swelling, and redness at site • Itching and sometimes a wheal • Sometimes dramatic swelling

  44. Allergic Reactions and Envenomations Removing Stingers

  45. Allergic Reactions and Envenomations Anaphylactic Reactions to Stings • 5% of all people are allergic to bee, hornet, yellow jacket, and wasp stings. • Anaphylaxis accounts for approximately 200 deaths a year. • Most deaths occur within half an hour of being stung.

  46. Itching and burning Widespread urticaria Wheals Swelling of the lips and tongue Bronchospasm and wheezing Chest tightness and coughing Dyspnea Anxiety Abdominal cramps Hypotension Allergic Reactions and Envenomations Signs and Symptoms of Allergic Reaction

  47. Allergic symptoms are almost as varied as allergens themselves. Assessment should include evaluations of: Respiratory system Circulatory system Mental status Skin Allergic Reactions and Envenomations Patient Assessment

  48. Allergic Reactions and Envenomations Emergency Medical Care (1 of 2) • Give oxygen. • Perform a focused history and physical examination. • Find out if the patient has a history of allergies. • Obtain baseline vital signs and a SAMPLE history.

  49. Allergic Reactions and Envenomations Emergency Medical Care (2 of 2) • Inform medical control. • Find out if the patient has a prescribed auto-injector. • Be prepared to use standard airway procedures. • Assist the patient with the auto-injector if permitted.

  50. Allergic Reactions and Envenomations Using an Auto-Injector • Receive order from medical direction. • Follow BSI precautions. • Make sure the prescription is for the patient. • Make sure the medication is not discolored or expired.

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