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Medical Emergencies

Medical Emergencies. Diabetes. Diabetes. The bodies inability to use sugar properly Hypoglycemia Too much insulin or not enough sugar Hyperglycemia Too much sugar or not enough insulin. Hypoglycemia (Insulin Shock). Signs and Symptoms Progresses quickly Increased heart rate

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Medical Emergencies

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  1. Medical Emergencies

  2. Diabetes

  3. Diabetes • The bodies inability to use sugar properly • Hypoglycemia • Too much insulin or not enough sugar • Hyperglycemia • Too much sugar or not enough insulin

  4. Hypoglycemia (Insulin Shock) Signs and Symptoms • Progresses quickly • Increased heart rate • Pale, cool and clammy skin • Dilated pupils • Lethargic • Slurred speech, confusion • Seizures, agitated • Combative, may appear intoxicated

  5. Hyperglycemia (Diabetic Coma) Signs and Symptoms • Progresses slowly • Excessive thirst, hunger • Frequent urination • Vomiting, ABD Pain • Musty odor (acetone) on breath • Fast, deep respirations (Kussmal’s) • Altered LOC • Dehydration

  6. Allergies and Anaphylaxis

  7. Anaphylaxis • An immediate, systemic, life-threatening allergic reaction associated with major changes in the cardiovascular, respiratory, and cutaneous systems • Prompt recognition and appropriate drug therapy are important to patient survival

  8. Antigens • A substance that induces the formation of antibodies • Antigens can enter the body by injection, ingestion, inhalation, or absorption • Examples: • Drugs (penicillin, aspirin) • Envenomation (wasp stings) • Foods (seafood, nuts) • Pollens

  9. Antibodies • Protective protein substances developed by the body in response to antigens • Bind to the antigen that produced them • Facilitate antigen neutralization and removal from the body • This normal antigen-antibody reaction protects the body from disease by activating the immune response

  10. Immune Response • Immune responses are normally protective • They can become oversensitive or be directed toward harmless antigens to which we are often exposed • This response is termed “allergic” • The antigen or substance causing the allergic response is called an “allergen” • Common allergens include drugs, insects, foods, and animals

  11. Immune Response • The healthy body responds by a defense system known as immunity that may be: • Natural • present at birth • Acquired • resulting from exposure to a specific antigenic agent or pathogen • Artificially induced • inoculation

  12. Allergic Reaction • Marked by an increased physiological response to an antigen after a previous exposure (sensitization) to the same antigen • Initiated when a circulating antibody (IgG or IgM) combines with a specific foreign antigen, resulting in hypersensitivity reactions • Or to antibodies bound to mast cells or basophils (IgE)

  13. Hypersensitivity Reactions • Agents that may cause hypersensitivity reactions (including anaphylaxis) • Drugs and biological agents • Insect bites and stings • Foods

  14. Localized Allergic Reaction • Localized allergic reactions (type IV) do not manifest multi-system involvement • Common signs and symptoms of localized allergic reaction include: • Conjunctivitis • Rhinitis • Angioedema • Urticaria • Contact dermatitis

  15. Anaphylaxis • comes from Greek and means “against or opposite of protection” It is the most extreme form of an allergic reaction • Rapid recognition and aggressive therapy are essential

  16. Anaphylaxis • Almost any substance can cause anaphylaxis • Most common: • Penicillin (by ingestion or injection) • Envenomation by stinging insects Risk increases with the frequency of exposure

  17. Histamines • Promote vascular permeability • Cause dilation of capillaries and venules • Cause contraction of nonvascular smooth muscle, especially in the GI tract and bronchial tree • Increased capillary permeability allows plasma to leak into the interstitial space • The profound vasodilation that results further decreases cardiac preload, compromising stroke volume and cardiac output

  18. Histamines • These physiological effects lead to: • Cutaneous flushing • Urticaria • Angioedema • Hypotension • Onset of action is very rapid • Effects are short lived because they are quickly broken down by plasma enzymes

  19. Other Chemical Mediators • The remaining chemical mediators (heparin…) exert varying effects that may include: • Fever, Chills, Bronchospasm • Pulmonary vasoconstriction • These chemical processes can rapidly lead to: • Upper airway obstruction and bronchospasm • Dysrhythmias and cardiac ischemia • Circulatory collapse and shock

  20. Assessment Findings • Respiratory effects • Cardiovascular effects • Gastrointestinal effects • Nervous system effects • Cutaneous effects

  21. Assessment Findings • Palpitations • Parasthesia • Pruritis (itching) • Erythema or urticaria • Throbbing in the ears • Coughing , wheezing and difficulty breathing • Difficulty swallowing because of swelling of the tongue and throat • In a severe reaction, patient may go into shock, become incontinent, convulse, become unconscious and die

  22. Airway and breathing Airway assessment is critical Evaluate the conscious patient for voice changes, stridor, or a barking cough Complaints of tightness in the neck and dyspnea suggest impending airway obstruction The airway of unconscious patient should be evaluated and secured Initial Assessment

  23. If airflow is impeded, endotracheal intubation should be performed If there is severe laryngeal and epiglottic edema, surgical or needle cricothyrotomy may be indicated to provide airway access Monitor the patient closely for signs of respiratory distress Circulation Assess pulse quality, rate, and location frequently Initial Assessment

  24. History • May be difficult to obtain but is critical to rule out other medical emergencies that may mimic anaphylaxis • Question the patient regarding the chief complaint and the rapidity of onset of symptoms • Signs and symptoms of anaphylaxis usually appear within 1 to 30 minutes of introduction of the antigen

  25. Significant Past Medical History • Previous exposure and response to the suspected antigen • Not always reliable • Method of introduction of the antigen • Chronic or current illness and medication use • Preexisting cardiac disease or bronchial asthma • Prescribed Epi-Pen

  26. Physical Examination • Assess and frequently reassess vital signs • Inspect the patient's face and neck for angioedema, hives, tearing, and rhinorrhea, and note the presence of erythema or urticaria on other body regions • Assess lung sounds frequently to evaluate the clinical progress of the patient and to monitor the effectiveness of interventions • Monitor ECG

  27. Drug Therapy • Ventilatory support • Epinephrine • are the most specific interventions in the management of anaphylaxis • Fluid resuscitation • in the presence of hypovolemia • Additional pharmacological therapy: • Benadryl, Ventolin, Corticosteroids • Antidysrhythmics • Vasopressors to manage protracted hypotension

  28. Pathophysiology of anaphylactic shock.

  29. Urticaria as a result of an allergic reaction.

  30. Urticaria

  31. Toxicology

  32. Poisonings • Poison • Any substance that produces harmful physiological or psychological effects

  33. Routes of Absorption • Poisons may enter the body through: • Ingestion • Inhalation • Injection • Absorption

  34. Types of Toxicological Emergencies • Accidental poisoning • Dosage errors • Idiosyncratic reactions • Childhood poisoning • Environmental exposure • Occupational exposure • Drug/alcohol abuse • Intentional poisoning/overdose • Chemical warfare • Assault/homicide • Suicide attempts

  35. Types of Toxicological Emergencies • Statistics from the grand ole USA • 80% of suicidal gestures are from OD • 28,000 suicidal deaths/yr from OD • Peak age for accidental OD is 2 years old • Chance of reoccurrence post poisoning is 25% in within one year

  36. General Guidelines • Most poisoned patients require only supportive therapy to recover • Airway: monitor and clear if req’d • Breathing: support as req’d • Circulation: support as req’d • Oxygen (100%), IV, Monitor and Blood glucose • Consider other causes in the Unconscious or seizing patient • Obtain a thorough history and perform a focused physical examination

  37. General Guidelines • If overdose is suspected, obtain an overdose history from the patient, family, or friends • Consult with OLMC/poison control center for specific treatment to prevent further absorption of the toxin (or antidote therapy) • Frequently reassess the patient; monitor vital signs and ECG • Safely obtain any substance or substance container of a suspected poison and transport it with the patient • Transport the patient for physician evaluation

  38. Assessment • Consider ICP • Watch for seizures • Watch for changes in condition (ABC’s) • Expose the patient • History………………………….

  39. General Management Principles • Vitals • Evaluate skin for perfusion status • Monitor • Head to Toe (rule out old trauma) • Neuro • Pupils • LOC (GCS, AVPU) • Symmetry of motion, ataxia

  40. Poisoning by Ingestion • About 80% of all accidental ingestions of poisons occur in children 1 to 3 years of age • Most result from household products • Poisoning in adults is usually intentional, although accidental poisoning from exposure to chemical in the workplace also occurs. • Toxic effects of ingested poisons may be immediate or delayed, depending on the substance ingested

  41. Poisoning by Ingestion • Early management focuses on: • Removing the toxin from the stomach or • Binding the toxin to prevent absorption before the poison enters the intestines

  42. Assessment and Management • The primary goal of physical assessment of poisoned patients is to identify the poison’s effects on the three vital organ systems most likely to produce immediate morbidity and mortality: • Respiratory system • Cardiovascular system • Central nervous system

  43. Assessment and Management • Five signs of major toxicity • Coma • Cardiac dysrhythmias • GI disturbances • Respiratory depression • Hypotension or hypertension

  44. History • What was ingested? • When was the substance ingested? • How much of the substance was ingested? • Was an attempt made to induce vomiting? • Has an antidote or activated charcoal been administered? • Does the patient have a psychiatric history pertinent to suicide attempts or recent episodes of depression?

  45. Poisoning by Inhalation • Accidental or intentional inhalation of poisons can lead to a life—threatening emergency • The type and location of injury caused by toxic inhalation depend on the specific actions and behaviors of the chemical involved • Toxic gases can be classified in three categories: simple asphyxiants, chemical asphyxiants, and irritants/corrosives

  46. General Management—Inhaled Poisons • Scene safety • Personal protective measures • Rapidly remove the patient from the poison environment • Surface decontamination • Adequate airway, ventilatory, and circulatory support • Initial assessment and physical examination • Irrigation of the eyes (as needed) • IV line with a saline solution • Regular monitoring of vital signs and ECG • Rapid transport to an appropriate medical facility

  47. Carbon Monoxide Poisoning • A colorless, odorless, tasteless gas produced by incomplete combustion of carbon-containing fuels • Does not physically harm lung tissue • Its affinity for hemoglobin is 250 times that for oxygen • Small concentrations of carbon monoxide can result in severe physiological impairments • Physical effects of carbon monoxide poisoning are related to the level of COHb in the blood • Treatment

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