Chapter 10: Medical Emergencies

Cognitive Objectives 5-1.1 Identify the patient who presents with a general medical complaint. 5-1.2 Explain the steps in providing emergency medical care to a patient with a general medical complaint. 5-1.3 Identify the patient who presents with a specific medical complaint of altered mental status. (1 of 3)

Cognitive Objectives 5-1.4 Explain the steps in providing emergency medical care to a patient with an altered mental status. 5-1.5 Identify the patient who presents with a specific medical complaint of seizures. 5-1.6 Explain the steps in providing emergency medical care to a patient with seizures. 5-1.7 Identify the patient who presents with a specific medical complaint of exposure to cold. (2 of 3)

Cognitive Objectives 5-1.8 Explain the steps in providing emergency medical care to a patient with an exposure to cold. 5-1.9 Identify the patient who presents with a specific medical complaint of exposure to heat. 5-1.10 Explain the steps in providing emergency medical care to a patient with an exposure to heat. (3 of 3)

Affective Objectives 5-1.15 Attend to the feelings of the patient and/or family when dealing with the patient with a general medical complaint. 5-1.16 Attend to the feelings of the patient and/or family when dealing with the patient with a specific medical complaint. 5-1.18 Demonstrate a caring attitude toward patients with a general medical complaint who request emergency medical services. (1 of 3)

Affective Objectives 5-1.19 Place the interests of the patient with a general medical complaint as the foremost consideration when making any and all patient care decisions. 5-1.20 Communicate with empathy to patients with a general medical complaint, as well as with family members and friends of the patient. (2 of 3)

Affective Objectives 5-1.21 Demonstrate a caring attitude toward patients with a specific medical complaint who request emergency medical services. 5-1.22 Place the interests of the patient with a specific medical complaint as the foremost consideration when making any and all patient care decisions. 5-1.23 Communicate with empathy to patients with a specific medical complaint, as well as with family members and friends of the patient. (3 of 3)

Psychomotor Objectives 5-1.27 Demonstrate the steps in providing emergency medical care to a patient with a general medical complaint. 5-1.28 Demonstrate the steps in providing emergency medical care to a patient with an altered mental status. 5-1.29 Demonstrate the steps in providing emergency medical care to a patient with seizures. (1 of 2)

Psychomotor Objectives 5-1.30 Demonstrate the steps in providing emergency medical care to a patient with an exposure to cold. 5-1.31 Demonstrate the steps in providing emergency medical care to a patient with an exposure to heat. (2 of 2)

Knowledge and Attitude Objectives Describe the general approach to a medical patient. Explain the causes, symptoms, and treatment of a patient with altered mental status. Explain the causes, symptoms, and treatment of a patient with seizures. Describe the treatment of a patient who shows signs and symptoms of exposure to heat. (1 of 5)

Knowledge and Attitude Objectives Describe the treatment of a patient who shows signs and symptoms of exposure to cold. Explain the causes of angina pectoris. Describe the signs, symptoms, and initial treatment of a patient with angina pectoris. Explain the major cause of a heart attack. Describe the signs, symptoms, and initial treatment of a patient with a heart attack. (2 of 5)

Knowledge and Attitude Objectives Explain the cause of congestive heart failure. Describe the signs, symptoms, and initial treatment of a patient with congestive heart failure. Describe the causes of dyspnea. Explain the signs, symptoms, and initial treatment of a patient with dyspnea. Describe the causes of asthma. (3 of 5)

Knowledge and Attitude Objectives Explain the signs, symptoms, and initial treatment of a patient suffering an asthma attack. Describe the major cause of a stroke. Explain the signs, symptoms, and initial treatment of a patient with a stroke. Describe the signs and symptoms of insulin shock. Describe the initial treatment of a patient in insulin shock. (4 of 5)

Knowledge and Attitude Objectives Describe the signs and symptoms of a patient in a diabetic coma. Describe the initial treatment of a patient in a diabetic coma. Describe the signs and symptoms of an abdominal problem. Describe the initial treatment of a patient with abdominal pain. (5 of 5)

Skill Objectives Perform a patient assessment on a medical patient. Place an unconscious patient in the recovery position. Protect a patient who is seizing from sustaining further harm. Cool a patient who has suffered exposure to heat. (1 of 2)

Skill Objectives Treat a patient who has suffered exposure to cold. Position a patient who has congestive heart failure. Administer fluids or oral glucose to a patient who is in insulin shock. (2 of 2)

Medical Emergencies Medical complaints result from a wide variety of conditions. Treating patients with medical conditions can be very challenging. Know the signs, symptoms, and treatment for common medical conditions.

General Approach to a Medical Patient Perform initial assessment. Determine responsiveness. Introduce yourself. Check ABCs. Acknowledge chief complaint. Obtain SAMPLE history. Perform physical exam as needed.

Altered Mental Status Sudden or gradual decrease in patient’s level of responsiveness. Change may range from a decrease in level of understanding to unresponsiveness. Use AVPU scale when assessing altered mental status.

Causes of Altered Mental Status Head injury Seizures Shock High fever Infection Poisoning Drug overdose Low blood sugar Insulin reaction Psychiatric conditions

Care for Altered Mental Status Maintain ABCs and normal body temperature. Keep patient from additional harm. If unresponsive and not trauma, place in recovery position. Be prepared to suction.

Seizures Sudden episodes of uncontrolled electrical impulses in the brain Shaking movements that may involve whole body Serious but rarely life threatening Caused by many factors, including epilepsy, trauma, head injury, and stroke

Care for Seizures Do not attempt to restrain patient. Clear area to protect patient from injury. Do not place anything in patient’s mouth. (1 of 2)

Care for Seizures If patient is not breathing after seizure, begin rescue breathing. Place patient in recovery position if breathing to maintain a clear airway. (2 of 2)

Exposure to Heat and Cold Heat exhaustion Heatstroke Frostbite Hypothermia

Heat Exhaustion Common in temperatures above 80°F with high humidity Very young, older people, and those with preexisting medical conditions are susceptible. Signs and symptoms: Light-headedness Weak feeling Dizziness Nausea Weak pulse Profuse sweating

Care for Heat Exhaustion Move patient to a cooler place. Remove constricting clothing. Monitor ABCs. If patient is FULLY conscious, give water to drink. Arrange transport.

Heatstroke Results when a person has been in a hot environment for long period of time Patient’s temperature rises, overwhelming the sweating mechanism Brain damage and death may occur if not treated rapidly.

Signs and Symptoms of Heatstroke Very high body temperature Flushed, dry skin Skin feels hot to the touch Semiconsciousness or unconsciousness

Care for Heatstroke Remove patient from hot environment. Immediately cool the patient. Remove patient’s clothing. Wrap patient in wet towels. Prepare patient for rapid transport.

Superficial Frostbite Part becomes numb and bright red. Part then becomes pale white. Loss of sensation/feeling

Deep Frostbite Skin will be white and waxy. Skin may be firm or frozen. Swelling and blisters may be present.

Care for Frostbite Frostbitten part must be rewarmed quickly. Do not rub frostbitten area. Remove jewelry and cover part in dry clothing/dry dressings. Apply heat to rewarm the part. Do not rewarm if there is a chance of refreezing.

Hypothermia Results when body temperature drops below 95°F People with wet clothing and preexisting illnesses are susceptible to hypothermia.

Signs and Symptoms of Hypothermia Feeling cold Shivering Decreasing/altered level of consciousness Sleepiness Slowed reactions Lack of coordination

Care for Hypothermia Move patient to warm location. Remove wet clothing. Wrap patient in warm clothing and blankets. In severe hypothermia, you may need to start CPR.

Heart Conditions The heart must receive a constant supply of oxygen. Receives oxygen through a complex system of coronary arteries Atherosclerosis may cause arteries to narrow.

Angina Pectoris Heart does not receive enough oxygen. Crushing pain occurs—brought on by exertion, emotion, or eating. Pain may radiate to neck, jaws, and both arms. Patient may have shortness of breath or sweating. (1 of 3)

Angina Pectoris Ask if patient has prescribed nitroglycerin. Help patient take one pill. If no relief after 5 minutes, help patient take another. If still no relief, assume a heart attack and transport immediately. Always follow local protocols. (2 of 3)

Angina Pectoris Nitroglycerin pills and spray used for relief of chest pain. (3 of 3)

Heart Attack Caused by complete blockage of a coronary artery Patient suffers immediate, severe pain. Pain persists—unlike angina, which goes away in 5–10 minutes. If blocked area is critical or large, heart may stop completely. (1 of 2)

Heart Attack Blocked cardiac artery results in heart attack. (2 of 2)

Care for Heart Attack Summon additional help. Reassure the patient. Place patient in comfortable position and minimize movement. Administer oxygen if available and you are trained to use it.

Congestive Heart Failure (CHF) Failure of the heart to pump adequately Results in congestion (overload) in the blood vessels

Signs and Symptoms of CHF Shortness of breath Rapid, shallow breathing Moist/gurgling respirations Profuse sweating Enlarged neck veins Swollen ankles Anxiety

Care for CHF Place patient in sitting position. Administer oxygen, if available and you are trained to use it. Summon additional help. Arrange for prompt transport.

Dyspnea Shortness of breath or difficulty breathing Usually associated with serious heart or lung disease Angina pectoris or heart attack COPD, emphysema, bronchitis Asthma Pneumonia

Care for Dyspnea Check airway for obstruction and rate and depth of breathing. Place patient in comfortable position and reassure. Administer oxygen if available and you are trained to use it. Be prepared to provide rescue breathing.

Stroke A leading cause of brain injury and disability in adults Blood clot deprives a portion of the brain from an adequate supply of oxygen. Think of a stroke as a “brain attack.” High blood pressure increases the risk of stroke.

Signs and Symptoms of Stroke Headache Dizziness Confusion Drooling Numbness/paralysis on one side of body Inability to speak Difficulty seeing Unequal pupil size Unconscious Convulsions Respiratory arrest Incontinence

Care for Stroke Maintain an open airway. Administer oxygen, if available. Provide psychological support. Place an unconscious person in recovery position. Be prepared to provide rescue breathing.

Stroke Scale The Cincinnati Prehospital Stroke Scale A tool to determine if a patient is showing signs or symptoms of stroke: Facial droop Arm drift Abnormal speech

Diabetes Caused by the body’s inability to process and use sugar If the body does not produce enough of the hormone insulin, cells “starve.” Two specific conditions: Insulin shock Diabetic coma (1 of 2)

Diabetes Insulin shock: Pale, moist, cool skin Rapid pulse Dizziness or headache Confusion Rapid onset Diabetic coma: History of diabetes Warm, dry skin Rapid, weak pulse Deep, rapid breathing Fruity odor Slow onset (2 of 2)

Care for Diabetic Emergencies Ask: Are you a diabetic? Did you take your insulin today? Have you eaten today? If you suspect insulin shock, give patient sugar by mouth if fully conscious. If unconscious, monitor airway and breathing. Arrange for prompt transport.

Care for Diabetic Emergencies Instant glucose provides a high concentration of sugar.

Acute Abdomen Caused by irritation of abdominal wall Pain can be referred to other parts of the body. If the patient is a woman of child-bearing years, consider ectopic pregnancy.

Abdominal Aortic Aneurysm Layers of the aorta become weakened and separate. Patients may complain of pain that radiates to shoulder. Place in comfortable position, treat for shock, and arrange for prompt transport.