Common Medical Emergencies

Common Medical Emergencies
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. Identify the patient taking diabetic medications with altered mental status and the implications of a history of diabetes.

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.

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.

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.

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

Physiology of the Abdomen (1 of 2)
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

Physiology of the Abdomen (2 of 2)
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 Peritonitis Irritation of the peritoneum caused by illness or injury

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

The Acute Abdomen Signs and Symptoms of Acute Abdomen (2 of 3) Loss of bowel sounds Tense, often distended abdomen Sudden constipation or bloody diarrhea Tachycardia Hypotension Fever

The Acute Abdomen Signs and Symptoms of Acute Abdomen (3 of 3) Rebound tenderness Indigestion/heartburn Colic (severe painful spasms) Difficulty swallowing Jaundice

Examining the Abdomen Explain what you are about to do.
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.

Causes of Acute Abdomen
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

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

Other Organ Systems Aneurysm Weakness in aorta Pneumonia
The Acute Abdomen Other Organ Systems Aneurysm Weakness in aorta Pneumonia May cause ileus and abdominal pain Hernia Protrusion through a hole in the body wall

Emergency Medical Care (1 of 2)
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.

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.

Defining Diabetes (1 of 2)
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

Defining Diabetes (2 of 2)
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

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

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

Role of Glucose and Insulin
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.

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). Without glucose, body uses fat for fuel. Ketones are formed. Ketones can produce diabetic ketoacidosis.

Signs and Symptoms of Diabetic Ketoacidosis
Diabetic Emergencies Signs and Symptoms of Diabetic Ketoacidosis Vomiting Abdominal pain Kussmaul respirations Unconsciousness

Blood Glucose Monitors
Diabetic Emergencies Blood Glucose Monitors Test strips Normal range mg/dL Glucometer

Diabetic Coma (Hyperglycemia)
Diabetic Emergencies Diabetic Coma (Hyperglycemia)

Signs of Diabetic Coma Kussmaul respirations Dehydration
Diabetic Emergencies Signs of Diabetic Coma Kussmaul respirations Dehydration “Fruity” breath odor Rapid, weak pulse Normal or slightly low blood pressure Varying degrees of unresponsiveness

Insulin Shock (Hypoglycemia)
Diabetic Emergencies Insulin Shock (Hypoglycemia)

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

Diabetes and Alcohol Abuse
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.

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?

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.

Administering Oral Glucose (1 of 2)
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.

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

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

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

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.

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

Anaphylaxis Extreme allergic reaction Involves multiple organs
Allergic Reactions and Envenomations Anaphylaxis Extreme allergic reaction Involves multiple organs Can rapidly result in death Most common signs: Wheezing Urticaria (hives)

Allergic Reactions and Envenomations
Urticaria

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

Insect Bites and Stings
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.

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

Removing Stingers

Anaphylactic Reactions to Stings
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.

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

Patient Assessment 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 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.

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.

Using an Auto-Injector
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.

Administering an Auto-Injector
Allergic Reactions and Envenomations Administering an Auto-Injector Remove the safety cap. Place tip of the injector against the lateral side of the patient’s thigh. Push the injector firmly and hold until all of the medication is injected. Remove the injector. Record the time and dose. Reassess and record vital signs every 2 minutes.

Auto-Injector

Epinephrine Side Effects
Allergic Reactions and Envenomations Epinephrine Side Effects Tachycardia Pallor Dizziness Chest pain Headache Nausea Vomiting

Black Widow Found in all states except Alaska
Allergic Reactions and Envenomations Black Widow Found in all states except Alaska Venom poisonous to nerve tissue Requires patient transport as soon as possible

Brown Recluse Mostly in Southern and Central US
Allergic Reactions and Envenomations Brown Recluse Mostly in Southern and Central US Venom causes local tissue damage Requires patient transport as soon as possible

Snake Bites 40,000 to 50,000 reported snake bites in the US annually.
Allergic Reactions and Envenomations Snake Bites 40,000 to 50,000 reported snake bites in the US annually. 7,000 bites in the US come from poisonous snakes. Death from snake bites is rare. About 15 deaths occur each year in the US.

Four Types of Poisonous Snakes in the US
Allergic Reactions and Envenomations Four Types of Poisonous Snakes in the US Rattlesnake Cottonmouth Copperhead Coral snake

Pit Vipers Rattlesnakes, copperheads, and cotton mouths
Allergic Reactions and Envenomations Pit Vipers Rattlesnakes, copperheads, and cotton mouths Store poison in pits behind nostrils Inject poison to victim through fangs

Signs and Symptoms of a Pit Viper Bite
Allergic Reactions and Envenomations Signs and Symptoms of a Pit Viper Bite Severe burning at the bite site Swelling and bluish discoloration Bleeding at various distant sites Other signs may or may not include: Weakness – Fainting Sweating – Shock

Caring for Pit Viper Bites (1 of 2)
Allergic Reactions and Envenomations Caring for Pit Viper Bites (1 of 2) Calm the patient. Locate bite and cleanse the area. Do not apply ice. Splint area to minimize movement. Watch out for vomiting caused by anxiety. Do not give anything by mouth.

Caring for Pit Viper Bites (2 of 2)
Allergic Reactions and Envenomations Caring for Pit Viper Bites (2 of 2) If the patient is bitten on the trunk, lay the patient supine and arrange for prompt transport. Monitor patient’s vital signs. Mark the swollen area with a pen. Care for shock if signs and symptoms develop. Arrange for snake to be brought to the hospital if it has been killed.

Coral Snakes Small snake with red, yellow, and black bands
Allergic Reactions and Envenomations Coral Snakes Small snake with red, yellow, and black bands “Red on yellow will kill a fellow, red on black, venom will lack.” Injects venom with teeth, using a chewing motion that leaves puncture wounds Causes paralysis of the nervous system

Caring for Coral Snake Bites (1 of 2)
Allergic Reactions and Envenomations Caring for Coral Snake Bites (1 of 2) Quiet and reassure the patient. Flush the area with 1 to 2 quarts of warm, soapy water. Do not apply ice. Splint the extremity. Check and monitor baseline vital signs.

Caring for Coral Snake Bites (2 of 2)
Allergic Reactions and Envenomations Caring for Coral Snake Bites (2 of 2) Keep the patient warm and elevate the lower extremities to help prevent shock. Give supplemental oxygen if needed. Arrange for prompt transport. Give advance notice to EMTs of coral snake bite. Give the patient nothing by mouth.

Scorpion Stings Venom gland and stinger found in the tail end.
Allergic Reactions and Envenomations Scorpion Stings Venom gland and stinger found in the tail end. Mostly found in southwestern US With one exception, the Centruroides sculpturatus, most stings are only painful. Provide emergency care and arrange for transport.

Tick Bites (1 of 3) Ticks attach themselves to the skin.
Allergic Reactions and Envenomations Tick Bites (1 of 3) Ticks attach themselves to the skin. Bite is not painful, but potential exposure to infecting organisms is dangerous. Ticks commonly carry Rocky Mountain spotted fever or Lyme disease.

Tick Bites (2 of 3) Rocky Mountain spotted fever develops 7 to 10 days after bite. Symptoms include: Nausea, vomiting Headache Weakness Paralysis Possible cardiorespiratory collapse

Tick Bites (3 of 3) Lyme disease is the second fastest growing infectious disease next to AIDS in US Lyme disease symptoms may begin 3 days after the bite. Symptoms include: Rash Painful swelling of the joints

Caring for a Tick Bite Do not attempt to suffocate or burn tick.
Allergic Reactions and Envenomations Caring for a Tick Bite Do not attempt to suffocate or burn tick. Use fine tweezers to grasp tick by the body and pull it straight out. Cover the area with disinfectant and save the tick for identification. Provide any necessary supportive emergency care and arrange for transport.

Dog Bites and Rabies (1 of 2)
Allergic Reactions and Envenomations Dog Bites and Rabies (1 of 2) All dog bites should be considered infected until proven otherwise. Place a dry, sterile dressing over the wound and arrange for prompt transport. Rabies, an acute viral infection to the central nervous system, is a major concern.

Dog Bites and Rabies (2 of 2)
Allergic Reactions and Envenomations Dog Bites and Rabies (2 of 2) Rabies can be treated with a series of vaccine injections. A bitten patient can avoid shots only if the dog can be identified and tested for rabies. Remember scene safety; the dog may still be loose when you arrive on the scene.

Caring for Human Bites Remember, human bites that penetrate the skin can be serious injuries. Promptly immobilize the area. Apply a dry, sterile dressing. Arrange for transport.

Coelenterates Responsible for more envenomations than any other marine life animal Has stinging cells called nematocysts Results in very painful, reddish lesions Symptoms include headache, dizziness, muscle cramps, and fainting.

Caring for Stings Limit further discharge by minimizing patient movement. Inactivate nematocysts by applying alcohol. Remove the remaining tentacles by scraping them off. Arrange for transport.

Poison vs. Substance Abuse
Substance Abuse and Poisoning Poison vs. Substance Abuse Poison Any substance whose chemical action can damage body structures or impair body functions. Substance Abuse The knowing misuse of any substance to produce a desired effect.

Identifying the Patient and the Poison
Substance Abuse and Poisoning Identifying the Patient and the Poison If you suspect poisoning, ask the patient the following questions: What substance did you take? When did you take it or (become exposed to it)? How much did you ingest? What actions have been taken? How much do you weigh?

Determining the Nature of the Poison
Substance Abuse and Poisoning Determining the Nature of the Poison Give suspicious materials, containers, vomitus to EMS. Provide key information on: Name and concentration of the drug Specific ingredients Number of pills originally in bottle Name of manufacturer Dose that was prescribed

Poison Control Centers
Substance Abuse and Poisoning Poison Control Centers Information on most substances Information on emergency treatments and antidotes.

Ingested Poison Poison enters the body by mouth.
Substance Abuse and Poisoning Ingested Poison Poison enters the body by mouth. Accounts for 80% of poisonings May be accidental or deliberate Activated charcoal will bind to poison in stomach and carry it out of the body. Assess ABCs.

Substance Abuse and Poisoning
Activated Charcoal

Inhaled Poisons Wide range of effects
Substance Abuse and Poisoning Inhaled Poisons Wide range of effects Some inhaled agents cause progressive lung damage. Move to fresh air immediately, they may require supplemental O2. All patients require immediate transport.

Injected Poisons Usually result of drug overdose
Substance Abuse and Poisoning Injected Poisons Usually result of drug overdose Impossible to remove or dilute poison once injected Arrange for prompt transport

Absorbed Poisons Many substances will damage the skin, mucous membranes, or eyes. Substance should be removed from patient as rapidly as possible. If substance is in the eyes, they should be irrigated. Do not irrigate with water if substance is reactive, i.e. sodium or phosphorus.

Emergency Medical Care
Substance Abuse and Poisoning Emergency Medical Care External decontamination is important. Care focuses on support: assessing and maintaining ABCs. You may be permitted to give activated charcoal for ingested poisons per your local protocol.

Specific Poisons Tolerance
Substance Abuse and Poisoning Specific Poisons Tolerance Need for increased amount of drug to have same desired effect Addiction Overwhelming desire or need to continue using an agent

Alcohol (1 of 3) Most commonly abused drug in the US
Substance Abuse and Poisoning Alcohol (1 of 3) Most commonly abused drug in the US Kills more than 200,000 people a year Alcohol is a powerful CNS depressant. Acts as a sedative and hypnotic A person who appears intoxicated may have a medical problem.

Alcohol (2 of 3) Intoxicated patients should be transported and seen by a physician. If patient shows signs of serious CNS depression, provide respiratory support. A patient with alcohol withdrawal may experience delirium tremens (DTs).

Alcohol (3 of 3) Patients with DTs may experience:
Substance Abuse and Poisoning Alcohol (3 of 3) Patients with DTs may experience: Agitation and restlessness Fever Sweating Confusion and/or disorientation Delusions and/or hallucinations Seizures

Opioids (1 of 2) Drugs containing opium
Substance Abuse and Poisoning Opioids (1 of 2) Drugs containing opium Most of these, such as codeine, Darvon, Oxycontin, and Percocet, have medicinal purposes. The exception is heroin, which is illegal. Opioids are CNS depressants causing severe respiratory distress.

Opioids (2 of 2) Care includes supporting airway and breathing.
Substance Abuse and Poisoning Opioids (2 of 2) Care includes supporting airway and breathing. You may try to wake patients by talking loudly or shaking them gently. Always give supplemental oxygen and prepare for vomiting.

Sedative-Hypnotic Drugs
Substance Abuse and Poisoning Sedative-Hypnotic Drugs These drugs are CNS depressants and alter level of consciousness. Patients may have severe respiratory depression and even coma. The main concern is respiratory depression and airway clearance, ventilatory support, and transport.

Abused Inhalants (1 of 2) Common household products inhaled by teenagers for a “high” Effects range from mild drowsiness to coma May often cause seizures

Abused Inhalants (2 of 2) Patient is at high risk for sudden cardiac arrest. Try to keep patient from struggling or exerting self. Give oxygen and use a stretcher to move patient. Prompt transport is essential.

Sympathomimetics CNS stimulants cause hypertension, tachycardia, and dilated pupils. Amphetamines and methamphetamines are commonly taken by mouth. Cocaine can be taken in many different ways. Can lead to seizures and cardiac disorders Be aware of personal safety.

Marijuana Smoked by 20 million people daily in the US
Substance Abuse and Poisoning Marijuana Smoked by 20 million people daily in the US Produces euphoria, relaxation, and drowsiness Impairs short-term memory and ability to work Transport to hospital is rarely needed. Marijuana can be used as vehicle for other drugs, ie, can be coated with PCP or crack.

Hallucinogens (1 of 2) Alter an individual’s sense of perception
Substance Abuse and Poisoning Hallucinogens (1 of 2) Alter an individual’s sense of perception LSD and PCP are potent hallucinogens. Sometimes, people experience a “bad trip.” Patients typically are hypertensive, tachycardic, anxious, and paranoid.

Hallucinogens (2 of 2) Use a calm, professional manner and provide emotional support. Only restrain if danger of injury exists. Watch the patient carefully during evacuation and while awaiting EMS.

Anticholinergics “Hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter” Block the parasympathetic nerves Patient may go from “normal” to seizure to death within 30 minutes. Arrange for ALS transport.

Cholinergic Agents Commonly used as nerve agents for warfare
Substance Abuse and Poisoning Cholinergic Agents Commonly used as nerve agents for warfare Overstimulate body functions controlled by the parasympathetic nervous system Organophosphate insecticide or wild mushrooms are also cholinergic agents.

Signs and Symptoms of Cholinergic Poisoning
Substance Abuse and Poisoning Signs and Symptoms of Cholinergic Poisoning D Defecation U Urination M Miosis B Bronchorrhea E Emesis L Lacrimation S Salivation S Salivation L Lacrimation U Urination D Defecation G GI irritation E Eye constriction

Care for Cholinergic Poisoning
Substance Abuse and Poisoning Care for Cholinergic Poisoning Main concern is to avoid exposure May require field decontamination Priority after decontamination is to decrease the secretions in the mouth and trachea. Provide airway support. May be treated as a HazMat incident

Aspirin Overdose Signs and symptoms Nausea/vomiting Hyperventilation
Substance Abuse and Poisoning Aspirin Overdose Signs and symptoms Nausea/vomiting Hyperventilation Ringing in ears Confusion Seizures Arrange for prompt transport to the hospital.

Acetaminophen Overdose
Substance Abuse and Poisoning Acetaminophen Overdose Overdosing is common. Generally not very toxic Symptoms may not appear until it is too late. Liver failure may not be apparent for a full week. Gathering information at the scene is very important.

Other Alcohols Methyl alcohol and ethylene glycol are more toxic than ethyl alcohol. May be taken by people with chronic alcoholism who cannot obtain drinking alcohol More often taken by someone attempting suicide Immediate transport is essential.

Food Poisoning Salmonella bacterium causes severe GI symptoms within 72 hours. Staphylococcus is a common bacteria that grows in foods kept too long. Botulism often results from improperly canned foods.

Caring for Food Poisoning
Substance Abuse and Poisoning Caring for Food Poisoning Try to obtain as much history as possible. Arrange for prompt transport. If two or more persons have the same illness, give some of the suspected food to EMS, if possible.

Plant Poisoning Several thousand cases of plant poisonings occur each year. If you suspect plant poisoning: Assess the patient’s airway and vital signs. Notify poison control center. Give the plant to EMS to take to the hospital. Arrange for prompt transport.

Common Medical Emergencies

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