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Presentation on theme: "LESSON 12 MEDICAL CONDITIONS."— Presentation transcript:


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
132,000 people 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 carry medication

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-age children
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 Obstructive Pulmonary 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 and breathe 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 for Altered 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 Symptoms Before 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 795,000 people have strokes each year in United States More common in older adults Act quickly to decrease chance of permanent damage

51 Assessing Stroke Perform standard assessment
Find out when signs and symptoms first occurred – time may affect medical treatment

52 Assessing Stroke (continued)
Signs and symptoms vary depending on site of blocked artery Do not attribute signs and symptoms to other condition

53 Signs and Symptoms of Stroke
Complaints of sudden headache Complaints of sudden weakness or decreased or absent sensation in one side of the face, arm or leg; gait problems Decreased or absent movement of one or more extremities Facial droop, drooling, inability or difficulty swallowing, tongue deviation Dizziness, confusion Slurred speech, difficulty speaking and understanding speech 53

54 Signs and Symptoms of Stroke (continued)
Becoming combative, uncooperative or restless Double vision or blurred vision Unequal pupils Vomiting Changing levels of responsiveness or unresponsiveness, possible coma Bladder or bowel incontinence 54

55 Cincinnati Prehospital Stroke Scale
Ask patient to smile – one side droops Ask patient to close eyes and raise both arms in front of body – one arm drifts lower than other

56 Cincinnati Prehospital Stroke Scale (continued)
Ask patient to say “You can’t teach an old dog new tricks” Slurs words Uses wrong words Cannot speak

57 Emergency Care for Stroke
Perform standard patient care Relay your assessment to EMS crew Monitor patient; give BLS if needed Follow local protocol for oxygen Have patient lie on back with head and shoulders slightly raised

58 Emergency Care for Stroke (continued)
Turn patient’s head to side to drain mouth of drool or vomit  use suction if needed Do not give food or drink Keep patient warm and quiet Put unresponsive patient who is breathing normally in recovery position with affected side down

59 Seizures

60 Seizures Caused by many different conditions
Brain’s electrical activity out of balance Results in altered mental status/uncontrolled muscular contractions Rarely life-threatening, but a serious emergency

61 Seizure Causes Epilepsy Head injuries Low blood glucose
Any condition causing low oxygen Poisoning, including drugs and alcohol Electric shock High fever (infants and young children) Brain tumors Complications of pregnancy

62 Facts about Epilepsy Affects 3 million people in United States
Approximately 200,000 new cases each year 10% of United States population will have seizure in their lifetime

63 Common Types of Seizures
Complex partial seizure Person seems dazed Person may mumble or wander Absence seizure Person seems to stare blankly into space Person doesn’t respond to others

64 Common Types of Seizures (continued)
Generalized tonic clonic seizure Convulsions or grand mal seizure Person loses consciousness, falls, is stiff, then experiences jerking of muscles (clonic)

65 Common Types of Seizures (continued)
Febrile seizures Caused by rapid spike in fever in infants/young children Convulsions similar to tonic clonic

66 Signs and Symptoms of Seizures
Minor seizures: Staring blankly ahead Slight twitching lips, head, arms or legs Other movements

67 Signs and Symptoms of Seizures (continued)
Major seizures: Crying out then becoming unresponsive Body becomes rigid then shakes Jaw may clench

68 Signs and Symptoms of Seizures (continued)
Fever convulsion: Hot, flushed skin Violent muscle twitching Arched back Clenched fists

69 Signs and Symptoms of Seizures (continued)
Generally occur suddenly without warning Sometimes aura in advance of seizure Possible unresponsiveness and vomiting during convulsion Possible bowel or bladder incontinence Seizure length may be brief or prolonged Patients typically tired or sleepy after attack

70 Emergency Care for Seizures
Perform standard patient care Provide artificial ventilation if needed Prevent injury especially to head Loosen tight clothing around neck Don’t restrain patient Don’t put anything in patient's mouth

71 Emergency Care for Seizures (continued)
Have suction available Look for medical identification jewelry Turn patient onto side if vomiting occurs Ask bystanders to leave area For fever convulsions, sponge body with lukewarm water Keep track of how long seizure lasts

72 Emergency Care for Seizures (continued)
Place unresponsive patient in recovery position Be reassuring after seizure If recovering patient is agitated or angry, stay back, but prevent any dangers Follow local protocol for oxygen Report your assessment to arriving EMS

73 Seizure in the Water or Confined Space
Do not try to remove person from water Support person with head tilted to keep water out of mouth For person in airplane, motor vehicle or other confined area Lie person on side across seats Cushion head

74 Diabetic Emergencies

75 Diabetic Emergencies Blood glucose levels not regulated by body
Insulin needed for cells to use glucose When insulin level too low, glucose level too high Over 18 million people in United States have diabetes 5 million not diagnosed

76 Diabetic Emergencies (continued)
Hypoglycemia Person may take too much insulin Person doesn’t eat enough or right foods Uses blood sugar too fast Exercise Emotional stress Hyperglycemia Person may take too little insulin Person eats too much or wrong foods Does not use blood sugar with activity

77 Assessing Diabetic Emergencies
Perform standard assessment During SAMPLE history ask about diabetes Look for medical alert identification

78 Signs and Symptoms of Hypoglycemia
Rapidly occurring changes in mental status Sudden dizziness, shaking, tremors, bizarre behavior or mood change (even combativeness) Headache, confusion, difficulty paying attention May appear to be intoxicated (slurred words, staggering gait, confusion, etc.) Generalized feeling of sickness Rapid, full pulse

79 Signs and Symptoms of Hypoglycemia (continued)
Rapid, shallow respirations Pale or ashen skin, sweating Hunger Clumsy, jerky movements Possible seizure or coma may develop late

80 Signs and Symptoms of Hyperglycemia
Gradually occurring changes in mental status Weak, rapid pulse Increased urination, appetite, thirst Drowsiness, weakness Dehydration, dry mouth, thirst Shortness of breath, deep rapid breathing

81 Signs and Symptoms of Hyperglycemia (continued)
Breath that smells fruity Skin is pale, warm and dry Nausea, vomiting Eventual unresponsiveness

82 Emergency Care for Diabetic Emergencies
Perform standard patient care Talk to patient and confirm he or she has diabetes Look for medical alert identification Provide care for hypoglycemia or hyperglycemia

83 Emergency Care for Hypoglycemia
Ensure patient can maintain open airway Follow local protocol to give patient sugar Give more sugar after 15 minutes if patient still feels ill Call for help if patient becomes unresponsive or continues to have significant signs and symptoms

84 Emergency Care for Hyperglycemia
In the early stage, difficult to tell if high or low blood sugar: Give sugar as for hypoglycemia If patient does not improve within 15 minutes, or patient’s signs and symptoms become worse, call for help In the later stage, high blood sugar is a medical emergency: Call for help immediately Put an unresponsive patient in recovery position and monitor breathing and vital signs

85 Glucose Paste for Hypoglycemia
If trained to use oral glucose paste or gel: Squeeze small amount onto tongue depressor Spread between cheek and gums Administer small doses until all used

86 Severe Allergic Reactions

87 Severe Allergic Reactions
Anaphylaxis is a severe allergic reaction Airway may swell, making breathing difficult or impossible Signs and symptoms may begin within seconds The more quickly it occurs, the more serious

88 Causes of Anaphylaxis Common allergens: Certain drugs Certain foods
Insect stings and bites

89 Signs and Symptoms of Anaphylaxis
Early signs and symptoms: Skin flushing, itching or burning, rash Swelling around eyes, mouth, tongue Sneezing, watery eyes and nose Coughing or a feeling of a tickle or lump in the throat that persists Nausea, vomiting

90 Signs and Symptoms of Anaphylaxis (continued)
Developing signs and symptoms: Anxiety, agitation Feel throat is closing, chest is tight Rapid, weak pulse Low blood pressure Difficulty breathing Severe respiratory distress Coughing, wheezing or hoarseness

91 Signs and Symptoms of Anaphylaxis (continued)
Developing signs and symptoms: Altered mental status Severe headache Weakness or dizziness Pale or ashen skin or cyanosis

92 Emergency Care for Anaphylaxis
Remove allergen if possible Perform standard patient care Follow local protocol for oxygen Help into easiest breathing position Monitor patient’s vital signs Put breathing, unresponsive patient in recovery position

93 Emergency Epinephrine Auto-Injector
May be carried by people with severe allergies Medication temporarily controls anaphylactic reaction Ask patient if he/she has an auto-injector Help patient open and use kit Follow local protocol to administer yourself

94 Using an EpiPen Remove from its case and remove cap
Firmly push tip firmly against outer thigh Hold tip in place 10 seconds Properly dispose of injector Effects last minutes

95 Abdominal and Gastrointestinal Disorders

96 Severe Abdominal Pain or Gastrointestinal Bleeding
May result from medical condition Not necessary to determine cause

97 Assessing Severe Abdominal Pain or Gastrointestinal Bleeding
Normal assessment finding is soft and non-tender abdomen Abnormal findings include: Nausea, vomiting, diarrhea Blood in vomit (color is red or looks like coffee grounds) Blood in stool (color is red or black) Pain Signs of shock Fever

98 When Emergency Care Is Needed for Severe Abdominal Pain in Adults
Sudden, severe, intolerable pain or pain that causes awakening from sleep Pain that begins in central abdomen and later moves to lower right Pain accompanied by fever, sweating, black or bloody stool, or blood in urine Pain in pregnancy or accompanying abnormal vaginal bleeding Pain accompanied by dry mouth, dizziness on standing or decreased urination Pain accompanied by difficulty breathing Pain accompanied by vomiting blood or a greenish-brown fluid

99 When Emergency Care Is Needed for Severe Abdominal Pain in Children
Pain that occurs suddenly, stops and then returns without warning Pain accompanied by red or purple, jelly-like stool; or with blood or mucus in the stool Pain accompanied by greenish-brown vomit Pain with a swollen abdomen that feels hard Pain with a hard lump in the lower abdomen or groin area

100 Emergency Care for Severe Abdominal Pain or GI Bleeding
Perform standard patient care Follow local protocol for oxygen Put patient in position of comfort Be prepared for vomiting Don’t give food or drink

101 Developmental Considerations
In pediatric patients vomiting or diarrhea more easily causes shock In geriatric patients abdominal pain may be symptom of heart attack

102 Dialysis Patients Hemodialysis eliminates water and wastes from body when kidneys fail Dialysis machine is connected to patient Take care not to disturb equipment or connection with patient Do not use an arm with a dialysis fistula or shunt to obtain blood pressure

103 Emergencies More Common in Hemodialysis Patients
Low blood pressure Nausea and vomiting Irregular pulse Bleeding from access site Difficulty breathing Cardiac arrest

104 Care for a Dialysis Emergency
Perform standard patient care Follow local protocol for oxygen administration Control bleeding from shunt if present Position patient: Flat if there are signs of shock Upright in a position of comfort if patient has difficulty breathing


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