LESSON 12 MEDICAL CONDITIONS

Introduction A medical emergency occurs because of illness or a medical problem Some medical emergencies develop slowly, some very quickly Medical emergencies may be life threatening Know the signs and symptoms of common medical problems and the appropriate emergency medical care

General Medical Complaints Patient or family member may call for help for signs and symptoms You may suspect or know the cause of the problem Neither you nor the patient may know the problem The general approach is the same for all medical emergencies You do not have to know the specific illness Always begin with the standard assessment and manage life-threatening problems

Perform the Standard Assessment Size up the scene Complete the primary assessment and care for life-threatening conditions Take the history Perform the secondary assessment and physical examination as appropriate Complete reassessments

General Signs and Symptoms Person feels ill, dizzy, confused or weak Skin color changes – flushed or pale Sweating Breathing changes Nausea, vomiting

Perform Standard Patient Care Ensure EMS has been activated Take body substance isolation precautions Maintain the patient’s airway and provide artificial ventilation if needed Comfort, calm and reassure the patient

Additional Care for Medical Emergencies Follow local protocol re: oxygen administration Help patient rest and avoid chilling or overheating Do not give food or drink Be prepared to give BLS

Heart Attack

Heart Attack Caused by sudden reduced blood flow to heart muscle Medical emergency that often leads to cardiac arrest Can occur at any age Usually results from atherosclerosis

Facts about Heart Attack 132,000 people in United States die every year More likely in those with family history 20% of patients do not have chest pain Patients often have other symptoms

Assessing Heart Attack Assess the character and location of chest discomfort or pain: Quality: what does it feel like? Location: where is it occurring? Severity: consider on a pain scale Ask whether the pain or discomfort radiates elsewhere: Arms Back Neck Jaw Stomach

Assessing Heart Attack (continued) Monitor vital signs (blood pressure, pulse and respiratory rates) In pediatric patients: Heart problems are often related to congenital heart conditions Cardiac arrest is often caused by primary respiratory problem Geriatric patients may not experience chest discomfort with a heart attack

Signs and Symptoms of Heart Attack Persistent discomfort, pressure, tightness, ache or pain in chest Pain spreading to neck, shoulders or arms Shortness of breath Dizziness, lightheadedness, a feeling of impending doom Pale, moist, cool skin or heavy sweating Indigestion Nausea or vomiting

Signs and Symptoms of Heart Attack (continued) Signs and symptoms vary considerably Patient may have no signs and symptoms before collapsing Milder symptoms may come and go for 2 or 3 days Some symptoms are more common in women, e.g., shortness of breath, jaw or back pain, and nausea and vomiting Consider a wide range of symptoms rather than expecting a clearly defined situation Patients occasionally deny they are having a heart attack

Emergency Care for Heart Attack Act quickly Perform standard patient care Help patient rest comfortably (often sitting) Loosen tight clothing Ask if patient takes heart medication Follow local protocol to help with medication

Emergency Care for Heart Attack (continued) Follow local protocol to administer oxygen Follow local protocol to allow patient to chew one uncoated adult aspirin or two low-dose baby aspirin Stay with patient, reassure and calm Be prepared to give BLS Do not let the patient eat or drink anything

Nitroglycerin Increases blood flow by dilating arteries Often prescribed for angina – type of chest pain caused by narrowed coronary arteries Comes in tablets, sprays and patches

Nitroglycerin (continued) To administer: Follow local protocol and instructions on the medication Patient should be seated Do not give to unresponsive patient

Angina Chest pain caused by heart disease and temporary blood flow interruption Usually after activity or exertion Pain usually lasts only few minutes People usually know they have angina and carry medication

Care for Angina Ask if the patient has been diagnosed with angina, and if the pain is like angina pain in the past If so, help person with angina take medication and rest If pain persists >10 minutes or stops and returns or person has other symptoms of heart attack, give first aid as for heart attack

Respiratory Distress Emergencies

Respiratory Distress Difficulty breathing May occur suddenly in those with chronic respiratory problems If cause not obvious Look for other signs and symptoms that may reveal the problem Give general emergency care If cause is determined Care for that problem

Signs and Symptoms of Respiratory Distress Patient gasping or unable to catch breath Breathing that is faster or slower, deeper or shallower than normal Breathing with wheezing or gurgling sounds Patient feels restless, dizzy or lightheaded Increased pulse

Signs and Symptoms of Respiratory Distress (continued) Signs of altered mental status Pale or ashen, cool and moist skin Bluish lips and nail beds Patient sitting in tripod position Flaring nostrils and chest muscle movement in infant or child

Respiratory Distress in an Infant or Child Act quickly because respiratory distress may rapidly progress to arrest Upper airway obstruction may be caused by respiratory infection Lower airway disease may be caused by birth problems or infections

Emergency Care for Respiratory Distress Perform standard patient care Help patient into easiest breathing position Ask about prescribed medicine  help patient take it if needed

Emergency Care for Respiratory Distress (continued) Be prepared to give BLS Follow local protocol for supplemental oxygen Use suction as needed to maintain the airway Provide emotional support

Asthma Affects one in 20 adults Affects one in 10 school-age children Many patients carry medication for known condition Untreated, severe attack can be fatal

Assessing Asthma Perform the standard assessment If a young child away from caretakers has trouble breathing, always ask if he or she has medication

Signs and Symptoms of an Asthma Attack Wheezing and difficulty breathing and speaking Dry, persistent cough Fear, anxiety Gray-blue skin Changing levels of responsiveness

Emergency Care for an Asthma Attack Perform standard patient care Ensure EMS has been activated (first attack) Follow local protocol to assist with medication when: Patient confirms asthma attack occurring Patient identifies inhaler as his or her medication Patient cannot self-administer the medication

Emergency Care for an Asthma Attack (continued) Help patient into easiest breathing position Patient may use inhaler again if needed as prescribed or directed by the medical provider If breathing difficulty after using inhaler, activate EMS Follow local protocol for supplemental oxygen Never unnecessarily separate child from parent or loved one

Helping With an Inhaler Help patient use inhaler if: Patient confirms asthma attack occurring Patient identifies inhaler as his or her medication Patient cannot self-administer the medication

Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease (COPD) includes emphysema and chronic bronchitis More than 12 million people in United States have COPD Number 4 cause of death in United States May cause respiratory distress and breathing emergencies

Emergency Care for COPD Emergency care same as for respiratory distress Ask patient if he or she has COPD Help patient with prescribed medication

Hyperventilation Fast, deep breathing Usually caused by anxiety or stress Sometimes caused by injury or illness Imbalance in the body’s oxygen and carbon dioxide Usually does not last long

Signs and Symptoms of Hyperventilation Fast, deep breathing Anxiety Confusion or dizziness Numbness or tingling in fingers, toes, lips Muscle twitching or cramping

Care for Hyperventilation Perform standard patient care Help patient calm down and breathe slowly Do not have person breathe into a bag Rapid breathing may be caused by injury or sudden illness  do not assume the patient is simply hyperventilating

Care for Hyperventilation (continued) Look for signs of injury or illness Ask the patient what happened Activate EMS If other signs and symptoms suggest injury or illness If patient’s breathing doesn’t return to normal in a few minutes

Altered Mental Status

Altered Mental Status Change from person’s normal responsiveness and awareness Patient may be confused, disoriented, combative, drowsy or partially or wholly unresponsive May be brief or prolonged May result from different injuries and illnesses Often a sign of deteriorating condition

Common Causes Seizures Stroke Head injury Poisoning, drug use or overdose High fever, infection Diabetic emergencies Psychiatric conditions Any condition causing lowered blood oxygen

Emergency Care for Altered Mental Status Perform standard patient care Determine nature of problem Gather a SAMPLE history Place unresponsive patient in recovery position Have suction available Consider the use of an airway adjunct

Altered Mental Status and Behavioral Emergencies Drug or alcohol use may become a behavioral emergency Never assume person is intoxicated or using drugs Intoxicated person may need care for injury or illness

Fainting Caused by temporary reduced blood flow to brain, hot weather, fright, emotional shock, lack of food, suddenly standing Usually not sign of serious problem unless it occurs often or person does not recover quickly Could be serious in someone with heart disease, pregnant or older than 65

Signs and Symptoms Before Fainting Dizziness Sweating Nausea Blurring or dimming of vision Generalized weakness Pale, cool skin; sweating

Emergency Care for Fainting Check patient; provide BLS if needed Lay patient down and raise legs 6-12 inches Loosen tight clothing Check for possible injuries from falling Reassure patient when recovering

Emergency Care for Fainting (continued) If unresponsive, place in recovery position Do not splash water on patient’s face Do not use ammonia inhalants Activate EMS if patient is not soon responsive or repeatedly faints Always call EMS for older adults, heart disease patients, pregnant women

Stroke

Stroke Cerebrovascular accident (CVA) or brain attack May be caused by atherosclerosis Blood clot may obstruct artery in brain Artery in brain may rupture Over 795,000 people have strokes each year in United States More common in older adults Act quickly to decrease chance of permanent damage

Assessing Stroke Perform standard assessment Find out when signs and symptoms first occurred – time may affect medical treatment

Assessing Stroke (continued) Signs and symptoms vary depending on site of blocked artery Do not attribute signs and symptoms to other condition

Signs and Symptoms of Stroke Complaints of sudden headache Complaints of sudden weakness or decreased or absent sensation in one side of the face, arm or leg; gait problems Decreased or absent movement of one or more extremities Facial droop, drooling, inability or difficulty swallowing, tongue deviation Dizziness, confusion Slurred speech, difficulty speaking and understanding speech 53

Signs and Symptoms of Stroke (continued) Becoming combative, uncooperative or restless Double vision or blurred vision Unequal pupils Vomiting Changing levels of responsiveness or unresponsiveness, possible coma Bladder or bowel incontinence 54

Cincinnati Prehospital Stroke Scale Ask patient to smile – one side droops Ask patient to close eyes and raise both arms in front of body – one arm drifts lower than other

Cincinnati Prehospital Stroke Scale (continued) Ask patient to say “You can’t teach an old dog new tricks” Slurs words Uses wrong words Cannot speak

Emergency Care for Stroke Perform standard patient care Relay your assessment to EMS crew Monitor patient; give BLS if needed Follow local protocol for oxygen Have patient lie on back with head and shoulders slightly raised

Emergency Care for Stroke (continued) Turn patient’s head to side to drain mouth of drool or vomit  use suction if needed Do not give food or drink Keep patient warm and quiet Put unresponsive patient who is breathing normally in recovery position with affected side down

Seizures

Seizures Caused by many different conditions Brain’s electrical activity out of balance Results in altered mental status/uncontrolled muscular contractions Rarely life-threatening, but a serious emergency

Seizure Causes Epilepsy Head injuries Low blood glucose Any condition causing low oxygen Poisoning, including drugs and alcohol Electric shock High fever (infants and young children) Brain tumors Complications of pregnancy

Facts about Epilepsy Affects 3 million people in United States Approximately 200,000 new cases each year 10% of United States population will have seizure in their lifetime

Common Types of Seizures Complex partial seizure Person seems dazed Person may mumble or wander Absence seizure Person seems to stare blankly into space Person doesn’t respond to others

Common Types of Seizures (continued) Generalized tonic clonic seizure Convulsions or grand mal seizure Person loses consciousness, falls, is stiff, then experiences jerking of muscles (clonic)

Common Types of Seizures (continued) Febrile seizures Caused by rapid spike in fever in infants/young children Convulsions similar to tonic clonic

Signs and Symptoms of Seizures Minor seizures: Staring blankly ahead Slight twitching lips, head, arms or legs Other movements

Signs and Symptoms of Seizures (continued) Major seizures: Crying out then becoming unresponsive Body becomes rigid then shakes Jaw may clench

Signs and Symptoms of Seizures (continued) Fever convulsion: Hot, flushed skin Violent muscle twitching Arched back Clenched fists

Signs and Symptoms of Seizures (continued) Generally occur suddenly without warning Sometimes aura in advance of seizure Possible unresponsiveness and vomiting during convulsion Possible bowel or bladder incontinence Seizure length may be brief or prolonged Patients typically tired or sleepy after attack

Emergency Care for Seizures Perform standard patient care Provide artificial ventilation if needed Prevent injury especially to head Loosen tight clothing around neck Don’t restrain patient Don’t put anything in patient's mouth

Emergency Care for Seizures (continued) Have suction available Look for medical identification jewelry Turn patient onto side if vomiting occurs Ask bystanders to leave area For fever convulsions, sponge body with lukewarm water Keep track of how long seizure lasts

Emergency Care for Seizures (continued) Place unresponsive patient in recovery position Be reassuring after seizure If recovering patient is agitated or angry, stay back, but prevent any dangers Follow local protocol for oxygen Report your assessment to arriving EMS

Seizure in the Water or Confined Space Do not try to remove person from water Support person with head tilted to keep water out of mouth For person in airplane, motor vehicle or other confined area Lie person on side across seats Cushion head

Diabetic Emergencies

Diabetic Emergencies Blood glucose levels not regulated by body Insulin needed for cells to use glucose When insulin level too low, glucose level too high Over 18 million people in United States have diabetes 5 million not diagnosed

Diabetic Emergencies (continued) Hypoglycemia Person may take too much insulin Person doesn’t eat enough or right foods Uses blood sugar too fast Exercise Emotional stress Hyperglycemia Person may take too little insulin Person eats too much or wrong foods Does not use blood sugar with activity

Assessing Diabetic Emergencies Perform standard assessment During SAMPLE history ask about diabetes Look for medical alert identification

Signs and Symptoms of Hypoglycemia Rapidly occurring changes in mental status Sudden dizziness, shaking, tremors, bizarre behavior or mood change (even combativeness) Headache, confusion, difficulty paying attention May appear to be intoxicated (slurred words, staggering gait, confusion, etc.) Generalized feeling of sickness Rapid, full pulse

Signs and Symptoms of Hypoglycemia (continued) Rapid, shallow respirations Pale or ashen skin, sweating Hunger Clumsy, jerky movements Possible seizure or coma may develop late

Signs and Symptoms of Hyperglycemia Gradually occurring changes in mental status Weak, rapid pulse Increased urination, appetite, thirst Drowsiness, weakness Dehydration, dry mouth, thirst Shortness of breath, deep rapid breathing

Signs and Symptoms of Hyperglycemia (continued) Breath that smells fruity Skin is pale, warm and dry Nausea, vomiting Eventual unresponsiveness

Emergency Care for Diabetic Emergencies Perform standard patient care Talk to patient and confirm he or she has diabetes Look for medical alert identification Provide care for hypoglycemia or hyperglycemia

Emergency Care for Hypoglycemia Ensure patient can maintain open airway Follow local protocol to give patient sugar Give more sugar after 15 minutes if patient still feels ill Call for help if patient becomes unresponsive or continues to have significant signs and symptoms

Emergency Care for Hyperglycemia In the early stage, difficult to tell if high or low blood sugar: Give sugar as for hypoglycemia If patient does not improve within 15 minutes, or patient’s signs and symptoms become worse, call for help In the later stage, high blood sugar is a medical emergency: Call for help immediately Put an unresponsive patient in recovery position and monitor breathing and vital signs

Glucose Paste for Hypoglycemia If trained to use oral glucose paste or gel: Squeeze small amount onto tongue depressor Spread between cheek and gums Administer small doses until all used

Severe Allergic Reactions

Severe Allergic Reactions Anaphylaxis is a severe allergic reaction Airway may swell, making breathing difficult or impossible Signs and symptoms may begin within seconds The more quickly it occurs, the more serious

Causes of Anaphylaxis Common allergens: Certain drugs Certain foods Insect stings and bites

Signs and Symptoms of Anaphylaxis Early signs and symptoms: Skin flushing, itching or burning, rash Swelling around eyes, mouth, tongue Sneezing, watery eyes and nose Coughing or a feeling of a tickle or lump in the throat that persists Nausea, vomiting

Signs and Symptoms of Anaphylaxis (continued) Developing signs and symptoms: Anxiety, agitation Feel throat is closing, chest is tight Rapid, weak pulse Low blood pressure Difficulty breathing Severe respiratory distress Coughing, wheezing or hoarseness

Signs and Symptoms of Anaphylaxis (continued) Developing signs and symptoms: Altered mental status Severe headache Weakness or dizziness Pale or ashen skin or cyanosis

Emergency Care for Anaphylaxis Remove allergen if possible Perform standard patient care Follow local protocol for oxygen Help into easiest breathing position Monitor patient’s vital signs Put breathing, unresponsive patient in recovery position

Emergency Epinephrine Auto-Injector May be carried by people with severe allergies Medication temporarily controls anaphylactic reaction Ask patient if he/she has an auto-injector Help patient open and use kit Follow local protocol to administer yourself

Using an EpiPen Remove from its case and remove cap Firmly push tip firmly against outer thigh Hold tip in place 10 seconds Properly dispose of injector Effects last 15-20 minutes

Abdominal and Gastrointestinal Disorders

Severe Abdominal Pain or Gastrointestinal Bleeding May result from medical condition Not necessary to determine cause

Assessing Severe Abdominal Pain or Gastrointestinal Bleeding Normal assessment finding is soft and non-tender abdomen Abnormal findings include: Nausea, vomiting, diarrhea Blood in vomit (color is red or looks like coffee grounds) Blood in stool (color is red or black) Pain Signs of shock Fever

When Emergency Care Is Needed for Severe Abdominal Pain in Adults Sudden, severe, intolerable pain or pain that causes awakening from sleep Pain that begins in central abdomen and later moves to lower right Pain accompanied by fever, sweating, black or bloody stool, or blood in urine Pain in pregnancy or accompanying abnormal vaginal bleeding Pain accompanied by dry mouth, dizziness on standing or decreased urination Pain accompanied by difficulty breathing Pain accompanied by vomiting blood or a greenish-brown fluid

When Emergency Care Is Needed for Severe Abdominal Pain in Children Pain that occurs suddenly, stops and then returns without warning Pain accompanied by red or purple, jelly-like stool; or with blood or mucus in the stool Pain accompanied by greenish-brown vomit Pain with a swollen abdomen that feels hard Pain with a hard lump in the lower abdomen or groin area

Emergency Care for Severe Abdominal Pain or GI Bleeding Perform standard patient care Follow local protocol for oxygen Put patient in position of comfort Be prepared for vomiting Don’t give food or drink

Developmental Considerations In pediatric patients vomiting or diarrhea more easily causes shock In geriatric patients abdominal pain may be symptom of heart attack

Dialysis Patients Hemodialysis eliminates water and wastes from body when kidneys fail Dialysis machine is connected to patient Take care not to disturb equipment or connection with patient Do not use an arm with a dialysis fistula or shunt to obtain blood pressure

Emergencies More Common in Hemodialysis Patients Low blood pressure Nausea and vomiting Irregular pulse Bleeding from access site Difficulty breathing Cardiac arrest

Care for a Dialysis Emergency Perform standard patient care Follow local protocol for oxygen administration Control bleeding from shunt if present Position patient: Flat if there are signs of shock Upright in a position of comfort if patient has difficulty breathing