Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Chapter 16 Medical Emergencies Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 1.Define key terminology introduced in this chapter Describe the EMR’s responsibility in caring for patients with a medical emergency while awaiting EMS response Given a scenario in which a patient has a general medical complaint, demonstrate assessment and management of the patient List special considerations in the assessment of patients with a hemodialysis access site (shunt or fistula). 3333

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 5.Describe the basic pathophysiology and presentation of patients with: 11-17, 22-26, a.Anaphylaxis and allergic reactions b.Abdominal complaints and emergencies c.Emergency complications of hemodialysis 6.Anticipate the effects on the patient of administration of an epinephrine auto-injector If allowed by local protocol, demonstrate the administration of epinephrine by auto-injector

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer TOPICS General Medical Complaints Anaphylaxis Abdominal Emergencies Renal Emergencies

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer INTRODUCTION Emergency not caused by trauma Specific versus nonspecific complaints Common medical complaints Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Call Environment –Fall day with sunny skies –Mild temperature with a breeze Dispatch –Private residence –Male patient not feeling well –Not responding appropriately Scene –Safe to proceed –Standard Precautions donned –Patient sitting on living room couch

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer General Medical Complaints Back to Topics

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment: General Medical Complaints Specific complaints Nonspecific complaints

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: General Medical Complaints Monitor ABCs Position patient Administer oxygen Monitor vital signs and mental status Provide emotional support Notify EMS of changes Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Anaphylaxis Back to Topics

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Anaphylaxis Allergen Antibodies Allergic reaction Anaphylaxis

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Anaphylaxis Common causes of an allergic reaction –Medications –Food –Insects –Plants –Others

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment: Anaphylaxis Signs and symptoms –Respiratory Severe respiratory distress Wheezing –Skin Pale, red, cyanotic Itching and hives Swelling of eyes, mouth, and tongue –Nervous Altered mental status –Cardiovascular Rapid pulse Low blood pressure –GI Nausea Vomiting

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Monitor ABCs Position patient Administer oxygen Remove allergen Epinephrine auto-injector Monitor vital signs and mental status Provide emotional support Notify EMS of changes EMR Emergency Care: Anaphylaxis Photo: © Charles Stewart, MD and associates Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Anaphylaxis Epinephrine auto-injectors Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Anaphylaxis

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Anaphylaxis

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Anaphylaxis Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Anaphylaxis Epinephrine auto-injector side effects –Increased heart rate –Pale skin –Dizziness –Chest pain –Headache –Nausea and vomiting –Excitability/anxiousness Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Abdominal Emergencies Back to Topics

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment: Abdominal Emergencies Acute abdomen Complaints can be from variety of sources Patient positioning –Fetal position Abdomen –Distended –Rigid –Tender

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment: Abdominal Emergencies Signs and symptoms –Pain –Tenderness –Rigid, tense, or distended abdomen –Anxiety –Fetal position –Loss of appetite –Shock –Nausea, vomiting, diarrhea –Blood in vomit or stool –Fever

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Abdominal Emergencies Monitor ABCs Position patient Administer oxygen Monitor vital signs and mental status Provide emotional support Notify EMS of changes Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Response Patient is very pale Looks sick Answers questions slowly Vital signs –Respirations: 28 and nonlabored –Pulse: 146 and weak –Blood pressure: 88/40 States he feels “very weak” and “doesn’t feel well” CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Response Continued Sitting upright No allergies Medications for high blood pressure Ate toast an hour ago Not much of an appetite lately Feeling sick for a couple of weeks Placed on oxygen at 15 lpm via nonrebreather mask CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Response Continued Generalized tenderness to abdomen Has had several black stools over past weeks Repeat vital signs –Respirations: 26 and nonlabored –Pulse: 132 and weak –Blood pressure: 90/42

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Renal Emergencies Back to Topics

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Renal Emergencies Hemodialysis –Filters patient’s blood

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment: Dialysis Patients Do not take blood pressure in extremity with fistula or shunt Life-threatening emergencies associated with dialysis –Low blood pressure –Nausea and vomiting –Irregular pulse –Cardiac arrest –Bleeding from access site –Difficulty breathing Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Dialysis Patients Monitor ABCs Stop bleeding Position patient Monitor vital signs and mental status Reassure patient Notify EMS of changes Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Transition EMTs arrive and assume care You give verbal report After helping load the patient in the ambulance, you restock your unit and document the call

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Define the following terms –Allergen –Allergic reaction –Anaphylaxis –Anaphylactic shock –Acute abdomen –Fetal position –Distended –Hemodialysis

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER Which of the following is an example of a general medical complaint? a)“My chest hurts.” b)“I feel weak.” c)“I’m having a hard time breathing.” d)“I think I broke my ankle.” CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER Which of the following patients may be in anaphylactic shock? a)Patient with a runny nose b)Patient with localized redness and itching c)Patient with hives and trouble breathing d)Patient with itching and hives CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER When palpating the abdomen, palpate the quadrant with the pain a)first. b)second. c)third. d)fourth.

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Discussion 1.Differentiate between the signs and symptoms of a mild allergic reaction and anaphylaxis. 2.Describe the appropriate way to administer an epinephrine auto-injector. 3.List the various organs that could be the cause of an acute abdomen.

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Please visit and click on the mykit links to access content for this text. REINFORCE AND REVIEW