Presentation is loading. Please wait.

Presentation is loading. Please wait.

Condell Medical Center EMS System August 2006 Site Code # E1206

Similar presentations


Presentation on theme: "Condell Medical Center EMS System August 2006 Site Code # E1206"— Presentation transcript:

1 Condell Medical Center EMS System August 2006 Site Code #10-7200-E1206
Curriculum Update: The Hematopoietic System, Patients with Special Challenges, Interventions For The Patient With Chronic Care Needs Condell Medical Center EMS System August 2006 Site Code # E1206 Program revised by: Sharon Hopkins, RN, BSN EMS Educator

2 Objectives Upon successful completion of this CE module, the EMS provider should be able to: discuss insults to the hematopoietic system discuss the uniqueness when caring for patients with special challenges review acute interventions necessary for the chronic care patient discuss medications used in Region X participate in case scenario review successfully complete the post quiz with a score of 80% or better

3 Hematology Definition - the study of blood and blood-forming organs collectively known as the hematopoetic system. Prehospital care for most patients with hematological disorders is mainly supportive. Understanding some of the hematological disorders enhances EMS assessment skills

4 Blood Cells Produced mainly in bone marrow - the spongy material in the center of bone Assistance to regulation of production, destruction and differentiation (development of a specific function) of cells carried out in the: lymph nodes spleen liver

5 Components of Blood Plasma Platelets White blood cells Red blood cells
thrombocytes White blood cells leukocytes Red blood cells erythrocytes

6 Components by Volume -WBC’s & platelets together form <5%
of formed elements - RBC’s 95% of volume of formed elements

7 Components of Blood 78% water
22% solids (plasma, RBC’s, WBC’s, platelets) Plasma Clear fluid part of blood; about 92% water Plasma contains various cellular materials in solution and suspension: proteins (albumin, globulins, fibrinogen) salts metals inorganic compounds

8 Red Blood Cells (RBC’s) - Erythrocytes
Mainly comprised of water and hemoglobin Hemoglobin (a protein) - oxygen carrying component of the RBC; gives blood its red color; carries oxygen Primary function of RBC: transport oxygen from the lungs to various body tissue transport carbon dioxide from various tissues to the lungs Average life expectancy RBC days

9 Pulse Oximetry Estimates the amount of oxygen carried in the bloodstream using infrared technology across the skin

10 White Blood Cells (WBC’s) - Leukocytes
Helps fight infection and aids in the immune process Helps heal wounds by ingesting matter (dead cells, tissue debris, old RBC’s) Protects the body from foreign material (antigens) Involved in the protection from mutated cells (ie: cancer) Includes: lymphocytes, monocytes, eosinophils, basophils, neutrophils

11 Platelets - Thrombocytes
Small, sticky cells Helps in blood clotting Groups together to form clumps to plug holes and leaks to stop the bleeding WBC’s, RBC’s, and platelets make up about 45% of the blood volume Plasma takes up about 55% of the blood volume

12 More Blood Components Fat globules Chemical substances Gases including
carbohydrates proteins hormones Gases including oxygen carbon dioxide nitrogen

13 Complete Blood Count - CBC
A particular and common blood test Measures the size, number, and maturity of different blood cells in a specific volume of blood Can be used to determine abnormalities in production of blood cells in destruction of blood cells

14 Blood Groups Surfaces of RBC’s contain glycoproteins and glycolipids
Based on the presence or absence of isoantigens (an antigen substance that can stimulate antibody production), we can classify blood into groups Most common blood grouping is ABO and Rh A, B, AB, and O blood types Person can be Rh+ or Rh-

15 Blood Types Type AB blood- universal recipient
Can receive any of the 4 types of blood Carries both A & B antigens but does not have antibodies to A or B blood Type O blood - universal donor Can be given to patients regardless of blood type Has both anti-A & anti-B antibodies but no antigens Type A blood has A antigens & anti-B antibodies Can receive type A or O blood only Type B blood has B antigens & anti-A antibodies Can receive type B or O blood only

16 Blood groups Rh blood groups
Discovered in the blood of the rhesus monkey in 1940’s If the blood has Rh antigen they are Rh+ If the blood lacks the antigen they are Rh- Rh+ & Rh- blood is incompatible; the immune system makes antibodies if mixed When a subsequent infusion of Rh+ blood is received the immune response causes a severe reaction (hemolysis - breakdown of RBC’s and release of hemoglobin)

17 Acquired Factor Deficiencies
Rh Hemolytic disease of the newborn Arises during pregnancy Maternal and fetal blood may be incompatible if Rh factor discrepancy is present Usually the first born is unaffected Future problems in pregnancy prevented by Rhogam injections given after birth to Rh- mother delivering an Rh+ baby Rhogam given to Rh- mother binds to any Rh+ antigens left by the fetus and prevent any production of antibodies by the mother that would affect future pregnancies of Rh+ baby

18 Blood Transfusions Blood is the most easily shared human tissue
Many lives are saved each year Most often used to alleviate anemia An antibody-antigen reaction can occur causing the transfused blood to hemolyze or burst The liberated hemoglobin causes kidney damage from sludging

19 Hemostasis The sequence of clot formation that stops bleeding
Quick, localized and carefully controlled Three mechanisms reduce blood loss: Vascular spasm - local vasoconstriction Platelet plug formation Blood clotting (coagulation) Failure of these mechanisms could result in hypoperfusion and shock

20 Mechanisms of Hemostasis
Vascular spasm Contraction of the smooth muscle around the injured vessel Plug formation Platelets stick to the walls (platelet adhesion) Platelets physically change to have projections that hold onto one another Enzymes released that make other platelets more sticky in the same area

21 Mechanisms of Hemostasis
Blood clotting A ruptured blood vessel exposes collagen and other structural proteins to the blood Proteins activate an enzyme reaction & certain blood proteins are changed into long fibrin strands A gelatinous mass is formed that further occludes vessel opening Clot reabsorbed by body when no longer needed

22 General Patient Assessment
Most patients with hematological problems are dealing with a chronic condition Most patients need help due to a change in their baseline condition Most care administered by EMS providers will be supportive in nature - treat the symptoms When possible, honor patient requests for hospital destination improved continuity of care have release signed if necessary (not closest)

23 Patient Assessment Scene size-up, BSI precautions, general impression
Initial assessment Assess airway, breathing, circulation, mental status (AVPU) Check for life threats common issues could include life-threatening bleeds and massive infections with septic shock

24 Patient Assessment cont’d
Focused history and physical exam Patient categorized as: responsive or unresponsive medical patient trauma patient with significant or non-significant mechanism of injury Categorization determines which format is used to complete history and physical

25 Patient Assessment cont’d
SAMPLE history anemia - increased heart rate & respirations poor tissue oxygenation - fatigue, malaise, apprehension, confusion, change in skin color clotting problem - excessive bruising, skin discoloration infection - lymph node enlargement (swollen glands), sore throat, pain on swallowing bleeding abnormalities - nausea, anorexia, bloody vomiting or diarrhea, bleeding gums Vital signs, pulse oximetry, pain scale, EKG

26 Patient Assessment cont’d
Physical exam eye problems especially with autoimmune disorders (immune system can’t determine which tissues are self and which are not) and sickle cell anemia skin condition liver disease or hemolysis of RBC’s - jaundice polycythemia - reddish tone anemia - pale bleeding under the skin - petechia (tiny red dots), purpura (large purple blotches), bruising pruritis (itching) - excess of bilirubin prolonged bleeding of relatively minor injuries

27 Patient Assessment cont’d
GI system Low platelet counts & blood clot abnormalities epistaxis (nosebleed) is common may swallow excessive blood causing nausea and loose, dark bowel movements bleeding of the gums abdominal pain especially associated with problems of the spleen and/or liver Musculoskeletal system Pain & swelling in joints autoimmune diseases (rheumatoid arthritis), hemophilia (bleeding into joint)

28 Patient Assessment cont’d
Cardiorespiratory system Anemia dyspnea, tachycardia, chest pain Genitourinary system Hematuria - blood in the urine Heavy menstrual bleeding Frank vaginal bleeding

29 General Treatment Airway & breathing Circulation Comfort measures
Supplemental oxygen usually with non-rebreather Watch for dyspnea and fatigue Circulation Fluid volume replacement with crystalloid solution (ie: NS or LR) does not carry oxygen Watch for & treat dysrhythmias Comfort measures Morphine, oxygen, positioning Psychological support for patient & family

30 Diseases of Red Blood Cells
Anemias The most common disease of RBC’s Defined as a hematocrit less than 37% in women; 40% in men Sickle cell anemia = sickle cell disease Disorder in production of red cells (sickle shape when oxygen levels become low) Polycythemia Excess production in red blood cells

31 Anemia A sign and not a disease process
Bone marrow must be able to keep up with the destruction of older RBC’s to maintain adequate percentages Anemia is a significant drop in the percentage of red blood cells (RBC’s) (low hematocrit) Oxygen carrying capacity of the blood is reduced due to decrease in hemoglobin Females may temporarily decrease RBC levels during menstruation

32 Anemia Signs and symptoms
Fatigue, intolerance of cold, pale skin, dizziness, irritability, tachycardia, shortness of breath, chest pain Many actual types of anemia: Iron deficiency - inadequate iron intake Pernicious - poor absorption vitamin B12 Hemolytic - RBC’s destroyed faster than produced Aplastic - bone marrow fails to produce blood cells

33 Sickle Cell Anemia/Disease
Inherited disorder of red blood cell production RBC’s have sickle shape when oxygen levels are low; red blood cells become rigid Average sickled RBC life span days (normal is 120 days) Generation of new RBC’s can’t keep up with the hemolysis (destruction) Blood viscosity increased sludging of blood obstruction of capillaries & small blood vessels blood flow to tissues & organs disrupted tissues & organs eventually damaged adults often have multiple organ problems cardiopulmonary, renal, neurological diseases

34 Sickle Cell Crisis Disease not limited to 1 ethnicity but can affect many including Caucasian 3 presentations of crisis common: Vasoocclusive crisis musculoskeletal pain abdominal pain priapisms pulmonary problems renal crisis (renal infarction) central nervous system crisis (cerebral infarctions)

35 Sickle Cell Crisis cont’d
Hematological Crisis fall in hemoglobin level stagnation of red blood cells in spleen problems with bone marrow function Infectious crisis patient functionally immunosuppressed vulnerable to infection & sepsis loss of splenic function makes patient susceptible to massive bacterial infection

36 Sickle Cell Complications
Sepsis - due to immunosuppression Acute chest syndrome infection or sickled red cells trapped in lungs dyspnea, coughing, chest pain Hand-and-foot syndrome painful swelling due to severe vascular occlusion Splenic sequestration crisis accumulation of sickled cells in spleen pale, enlarged spleen, abdominal pain, shock

37 Sickle Cell Complications cont’d
Aplastic crisis severe anemia when bone marrow temporarily stops producing red blood cells pale, tired, less active than normal Stroke cerebral vascular occlusion due to sickled cells can affect any age extremity weakness, change in level of consciousness Painful episode acute and severe pain anywhere but most often hands, arms, chest, legs, feet

38 Prehospital Care Sickle Cell Anemia/Disease
Care is primarily supportive Oxygen via nonrebreather mask to increase the saturation of the circulating RBC’s - evaluate pulse oximetry IV of normal saline to hydrate patient Pain relief with analgesics larger than normal amounts of morphine are often required for pain control involve medical control for higher dosing

39 Polycythemia Abnormally high percentage of RBC’s (high hematocrit)
Rare disorder; typically in people over 50 No cure but can be treated Can be caused by: Unregulated increase in RBC production Tissue hypoxia Dehydration Blood doping - athlete training at high altitudes to increase RBC production Makes it harder to pump blood through the body because it’s thicker Increases risk of thrombosis

40 Polycythemia Signs and symptoms Treatment
Bleeding abnormalities epistaxis, spontaneous bruising, GI bleeding Headache, dizziness, blurred vision Itching Severe cases with congestive heart failure Treatment Supportive IV - O2 - monitor Hospital treatment - phlebotomy (“blood letting”) to remove excess red blood cells

41 Diseases of White Blood Cells (WBC’s)
White blood cells are body’s principal defense system against infection Problems could include: Leukopenia/neutropenia decrease in number of WBC’s Leukocytosis increase in number of circulating WBC’s could indicate: bacterial infection, rheumatoid arthritis, DKA, leukemia, pain, excercise Leukemia Lymphomas

42 Leukemia Malignant disease (cancer) of blood forming tissue
Classifications Acute lymphocytic leukemia (ALL) primarily of children and young adults Acute myelogenous leukemia (AML) primarily of older people in their 60’s and 70’s Chronic lymphocytic leukemia (CLL) Chronic myelogenous leukemia (CML) occurs in children and adults

43 Leukemia Common presentations: Common complication - infection
moderate to severe anemia abnormal decrease in platelets patient appears acutely ill; febrile, weak, & fatigued; lymph node enlargement; history of weight loss & anorexia; enlarged liver & spleen with abdominal tenderness; tender sternum Common complication - infection primarily due to low number of circulating neutrophils (main blood component protecting against bacterial or fungal infection)

44 Leukemia & EMS Care Patient at risk for infection
Isolation techniques (gloves and masks) to prevent spread of your germs to the patient Care primarily supportive Position of comfort Oxygen via nonrebreather mask if needed IV (fluid bolus if patient is dehydrated) Analgesics (ie: morphine) for pain

45 Lymphomas Cancer of the lymphatic system
Most prominent in the lymph nodes Malignant lyphoma classification: Hodgkin’s lymphoma 7,500 diagnosed annually in USA long-term survival better treatable with radiation, chemotherapy, or both can be curable Non-Hodgkin’s lymphoma 40,000 diagnosed annually in USA cure rate depends on type of lymphoma identified

46 Lymphoma Presenting signs & symptoms Field treatment
may report fever, night sweats, anorexia, weight loss, fatigue, itching many with Hodgkin’s have no symptoms non-Hodgkin’s most commonly have swollen lymph nodes Field treatment supportive consider IV, O2, pain control if necessary isolation techniques gloves & mask

47 Diseases of Platelets & Blood Clotting Abnormalities
Thrombocytosis - increased platelets patients usually asymptomatic Thrombocytopenia - decrease in platelets easy bruising & bleeding Hemophilia absence of protein necessary for blood clotting von Willebrand’s disease inherited disease affecting both sexes excessive bleeding after injury or surgery aspirin contraindicated

48 Hemophilia Inherited clotting deficiency Females are carriers
1 in 10,000 males have the disease Bleeding may occur spontaneously or after minor trauma Can be caused by deficiency of different clotting factors - factor VIII or factor IX Bleeding takes longer to stop because body cannot form stable fibrin clots

49 Hemophilia Signs and symptoms numerous bruises deep muscle bruising
joint bleeding - hemarthrosis Characterized by blood in the urine, bloody noses and painful, swollen joints Permanent joint damage with repeated bleeding Transfusion of specific clotting factor near time of injury may lessen the bleeding but will never make the disease go away

50 Field Treatment Hemophilia
The platelet plug is not stable but the mechanisms of vasoconstriction and platelet aggregation will still occur Patients may have prolonged bleeding and possible rebleeding IV - O2 via nonrebreather- monitor Ice application Superficial injuries - patience & pressure If joint injury, splinting will reduce pain Transport to ED necessary for replacement of deficient factor

51 Other Hematopoietic Disorders
Disseminated intravascular coagulation - DIC Disorder of coagulation High mortality rate Most commonly results from: sepsis, hypotension, obstetric complications, severe tissue injury, brain injury, cancer, major hemolytic blood transfusion reactions Fibrin clots formed throughout circulation instead of just at the affected area of need Simultaneous clotting and bleeding Patient experiences widespread thrombosis and end-organ ischemia

52 DIC Signs & symptoms Oozing blood at venipuncture and wound sites
Purpuric rash often over chest and abdomen Minute hemorrhages just under skin Prehospital care Supportive and focused on symptoms IV - O2- monitor Patient often hemodynamically unstable Hospital treatment Fresh frozen plasma & platelets at hospital

53 Additional Hematopoietic Disorders
Multiple myeloma Cancer disorder of plasma cells (cells that produce antibodies) Rarely found in persons under 40 Approximately 14,000 new cases every year Cancer plasma cells overcrowd healthy cells with a reduction in blood cell production Patient becomes anemic and is prone to infection

54 Multiple Myeloma Signs & symptoms Pain in back or ribs
Diseased marrow weakens bones and pathological fractures occur (fractures with minimal or no trauma) Fatigue Risk for bleeding due to decrease in platelets Renal failure from elevated calcium levels Increased risk for infection due to a lack of certain antibody secretion

55 Multiple Myeloma Treatment
Prehospital care Supportive IV if signs of dehydration Pain control - disease can be painful and pain in presence of pathological fractures Hospital care Chemotherapy Radiation Bone marrow transplants

56 What Is Bone Marrow? Tissue in the center of large bones where new blood cells are produced 2 types of stem cells produced hematopoietic stem cells - forms blood cells: WBC’s - leukocytes RBC’s - erythrocytes platelets - thrombocytes stromal stem cells - mix of cells to generate: fat cartilage bone can differentiate into many kinds of tissue (ie: nervous)

57 Bone Marrow

58 Bone Marrow Transplant
Pioneered in 1970 Transplant of hematopoietic stem cells Most often done for life-threatening diseases of blood or bone marrow acute lymphocytic leukemia acute myelogenous leukemia aplastic anemia chronic myelogenous leukemia Hodgkin’s and non-Hodgkin’s diseases multiple myeloma radiation poisoning

59 Types of Bone Marrow Transplant
Autologous bone marrow transplant stem cells obtained months in advance of use stem cells isolated from patient; stored in freezer; patient treated to destroy remaining stem cells; harvested stem cells reinfused Allogenic bone marrow transplant involves donor & recipient; must match tissue type recipient requires immunosuppressant drugs donor bone marrow harvested under general anesthesia (>100 needle sticks in large bone)

60 Bone Marrow Transplant Cont’d
Peripheral blood stem cell process - apheresis donor blood withdrawn via needle; blood passes thru machine to remove WBC’s; RBC’s returned to donor; WBC stem cells can be stored frozen recipient gets injection to boost stem cell yield Cord blood donation of umbilical cord & placenta after infant delivered cord blood yields higher concentration of stem cells but limited volume (50 ml - 2 T) usually transplanted into children, not adults cord blood can be stored frozen for years

61 Bone Marrow Infusion Stem cells (bone marrow transplant) given IVPB
stem cells circulate in the blood stream stem cells migrate into bone marrow spaces stem cells grow & start to produce new blood cells takes several weeks to grow enough new cells Bone marrow transplant mortality rate is high - 10% reserved for life-threatening conditions

62 Case Scenario #1 Your 22 year-old patient with hemophilia presents after falling off his motorcycle at low speed. There are some minor abrasions over the extremities and the patient complains of pain and swelling to the left elbow. Vital signs: B/P 132/70; P - 96; R - 18 What is the order of the assessment steps to take? What interventions are necessary?

63 Case Scenario #1 Assessment steps
Scene size-up, BSI, general impression Initial assessment ABC’s, AVPU, check for life threats Focused history & physical exam trauma without significant mechanism of injury perform a head-to-toe SAMPLE, vital signs, pulse ox, pain scale

64 Case Scenario #1 Interventions Manual c-spine control
Follow SOP “Spinal clearance, In-field” evaluate mechanism of injury, signs & symptoms, patient reliability IV-O2-monitor as applicable Application of ice Splinting of injured/swollen extremities will help with pain control Direct pressure for bleeding wounds

65 Case Scenario #2 Your 65 year old patient undergoing treatment for leukemia calls for transport. What is a common complication for this group of patients? What method of infectious control needs to be exercised by the EMS responders?

66 Case Scenario #2 A common complication for patients with leukemia is infection primarily due to the low number of circulating neutrophils (WBC component responsible for protecting against bacterial and fungal infection) BSI’s necessary for providers to wear include gloves mask


Download ppt "Condell Medical Center EMS System August 2006 Site Code # E1206"

Similar presentations


Ads by Google