Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 15 Medical Emergencies

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Topics General Medical Complaints Altered Mental Status Abdominal Pain and Distress Poisoning

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ General Medical Complaints

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ General Medical Complaints Patient with a nonspecific complaint –Complete thorough physical exam and patient history –Treat all life-threats –Maintain ABCs, ensuring adequate oxygenation –Place patient in a position of comfort

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Patient assessment First responder care Specific conditions

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status A change in the patient’s normal mental status Onset can vary Origin can be from many complaints

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Patient assessment –Ensure scene safety –Maintain BSI precautions –Ensure open airway, adequate breathing, and circulation –Obtain a thorough patient history quickly

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status First Responder care –Closely monitor airway and breathing –Position the patient appropriately –Administer high-flow oxygen –Communicate with the patient and family

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Diabetic emergencies –Stroke –Seizures

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Diabetic emergencies Body requires sugar for energy Pancreas secretes insulin to allow the body to use sugar Alterations in blood sugar can cause altered mental status Hyperglycemia Hypoglycemia

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Diabetic emergencies Hyperglycemia Too much blood sugar Results from: Infection Prolonged stress Medication errors Excess food

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Diabetic emergencies Hyperglycemia Signs and symptoms Sweet, fruity breath Flushed, warm, dry skin Extreme hunger and thirst Altered mental status Frequent urination

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Diabetic emergencies Hyperglycemia Gradual onset Progresses from excessive thirst and urination May result in altered mental status

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Diabetic emergencies Hypoglycemia Low blood sugar Sudden onset Results from: Missed meals Medication errors Stress

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Diabetic emergencies Hypoglycemia Signs and symptoms Unsteady gait, slurred speech Cool, clammy skin Seizures Altered mental status Progresses from confusion, to agitation, to unresponsiveness

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Diabetic emergencies Comparison of hyper- and hypoglycemia

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Diabetic emergencies If the patient is able to maintain his or her own airway Administer sugar Drinks Oral glucose Place between cheeks and gums

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Stroke or cerebrovascular accident Can occur through: Thrombus Embolus Aneurysm

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status a. A stroke from cerebral hemorrhageb. Brain tissue damaged by stroke

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status c. Cause of stroke: a blood vessel in the brain ruptures (cerebral hemorrhage). d. Cause of stroke: a clot or foreign body forms in the body and travels to the brain (cerebral embolism).

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status e. Cause of stroke: a blood clot forms in the brain (cerebral thrombosis). f. Cause of stroke: a compression injury.

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Stroke Risk factors High blood pressure Diabetes Smoking

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Stroke Signs and symptoms Related to area of brain affected Range from mild to severe May be temporary Transient ischemic attacks Sign of impending, permanent stroke

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Stroke Signs and symptoms Altered mental status Inability to communicate Impairment of one side of the body Slurred speech Watch for elevated blood pressure, slow pulse, and rapid or irregular breathing

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Stroke Assessment Cincinnati Prehospital Stroke Scale Facial droop Arm drift Speech

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Stroke Be especially alert to airway and breathing changes Monitor blood pressure closely Note the extent of deficits as they progress Determine the exact time of onset

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Seizures Results from a nervous system malfunction Caused by many medical conditions Range from a twitching limb to full body contractions

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Seizures Grand mal or full body seizures Four phases Aura phase Tonic phase Clonic phase Postictal phase

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Altered Mental Status Specific related conditions –Seizures If still seizing Prevent further injury to the patient Do not restrain the patient Observe for status epilepticus

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Specific related conditions –Seizures If seizing stops Assess and monitor airway and breathing Complete your assessment Monitor vital signs Altered Mental Status

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Abdominal Pain and Distress

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Abdominal Pain and Distress May be caused by many problems or conditions Complete your patient assessment plan Gather a thorough patient assessment

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Abdominal Pain and Distress Patient assessment –Abdominal pain –Tenderness –Nausea and vomiting –Signs of shock –Blood in vomit or stool

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Abdominal Pain and Distress First Responder care –Maintain an open airway –Administer oxygen –Monitor vital signs

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Poisoning

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Poisoning Routes of exposure –Ingestion –Inhalation –Absorption –Injection

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Poisoning Patient assessment –Do not enter the scene if it is unsafe –Protect yourself –Determine the following What substance is involved? How much is involved? When did the poisoning occur? What has the patient done to relieve symptoms?

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Poisoning First responder care –Maintain the ABCs –Contact poison control if allowed –Monitor vital signs

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Poisoning Specific types of poisonings –Ingested poisons Attempt to identify the poison Look for the following: Burns around the mouth Odd breath odors Nausea, vomiting, diarrhea Abdominal pains

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Poisoning Specific types of poisonings –Ingested poisons Activated charcoal Binds with the poison in the stomach May be useful for up to 4 hours Only use with permission from medical direction

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Poisoning Specific types of poisonings –Inhaled poisons Pay special attention to the airway Look for: Difficulty breathing Chest pain Burning in throat

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Poisoning Specific types of poisonings –Inhaled poisons Carbon monoxide Throbbing headache Nausea, vomiting Altered mental status Cherry red skin color

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Poisoning Specific types of poisonings –Absorbed poisons Liquid or powder on the skin Burns Itching/irritation Redness, rash, or blisters

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Poisoning Specific types of poisonings –Absorbed poisons Remove clothing Brush off or blot off chemical Flush with copious amounts of water

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Poisoning Specific types of poisonings –Injected poisons May result from: Illegal drugs Bites and stings

Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Summary Always follow your assessment plan and patient history Make sure to maintain an adequate airway Ensure adequate oxygenation Monitor your patient’s vital signs closely