1. 1 Medical Emergencies Pakistan ICITAP

2. Learning Objectives Know what the medic should complete when providing care for medical emergencies Know what altered mental status is and some reasons that cause it Know how to identify and treat diabetic, seizure, behavioral, breathing, and cardiac emergencies Know how to gather good patient history 2

3. Medical Complaints Victim may request medical services for a variety of medical complaints Medic should assess each victim to determine victim’s c/c as well as s/s present Medical care is based on victim’s s/s 3

4. Medical Emergencies The medic should:  Complete a scene assessment before initiating victim care  Complete an initial assessment on all victims  Complete an focused/detailed physical exam as needed  Complete an on-going assessment 4

5. Medical Emergencies Altered Mental Status:  Sudden or gradual decrease in the victim’s level of responsiveness and understanding  Support the victim - do not worry about determining the cause of ALOC  Length of altered mental status may be brief or prolonged 5

6. Medical Emergencies Victim’s with ALOC often can not protect their airway  Consider the use of airway adjuncts  Have suction ready  If no spinal trauma place victim in recovery position 6

7. Medical Emergencies There are many reasons for a victim to have ALOC: Fever Infections Poisoning Low blood sugar Insulin reactions Head injury Decreased level of oxygen in the brain Psychiatric conditions 7

8. Diabetic Emergency Hypoglycemia (low blood sugar) is the most common  Rapid onset of ALOC  Especially after missing a meal, vomiting or increased exercise  Victim may appear intoxicated, stagger, slur speech  Victim may have increased heart rate 8

9. Diabetic Emergency Hypoglycemia (continued):  Cool clammy skin  Unusual behavior or combativeness  Hunger 9

10. Diabetic Emergency Hyperglycemia (high blood sugar):  Slow onset hours to days  Warm dry skin  Deep rapid breathing  Intense thirst 10

11. Diabetic Emergency Hyperglycemia (continued):  ABD pain  Nausea, vomiting  New onset diabetes will often think they have severe flu and miss several days of work before seeking help  Sweet fruity breath odor (acetone breath) 11

12. Diabetic Emergency  Treatment  If unsure if victim hyper or hypoglycemia, it is safer to treat victim for hypoglycemia  Hypoglycemia Treatment  If conscious and can protect own airway, administer oral glucose in accordance with local protocol  If unconscious secure airway, start IV, transport to nearest medical facility 12

13. Diabetic Emergency Hyperglycemia Treatment  Secure airway  Start IV at TKO rate  Transport to nearest medical facility Document all treatment given  Document changes in victim’s mental status 13

14. Medical Emergencies Seizures  A sudden attack related to nervous system function  Many causes and types of seizures  Support the victim, do not worry about determining the cause of the seizure 14

15. Medical Emergencies Some causes of seizures may include:  Chronic medical conditions  Fever  Infections  Poisoning  Low blood sugar  Head injury  Decreased levels of oxygen  Brain tumors  Complications of pregnancy  Unknown causes 15

16. Medical Emergencies The length of the seizure will vary from < 5 min or may be prolonged Seizures are rarely life threatening  If a victim is in status seizures (victim has not regained conscious before starting another seizure this is considered a true emergency) Some seizures produce violent muscle contractions called convulsions 16

17. Medical Emergencies  Seizure victim often have significant oral secretions  Suction secretions as needed  Victims who are actively seizing often turn bluish and breath inadequately  Assist victim with ventilations if possible especially if the seizure lasts > a few minutes  When convulsions have ended place victim in the recovery position 17

18. Medical Emergencies Most victims are unconscious during a seizure Many become incontinent and rarely may vomit during convulsion Victims are usually tired and sleep following a seizure 18

19. Medical Emergencies Behavior:  Manner in which a person acts or performs any or all activities of a person including physical and mental activity 19

20. Medical Emergencies Behavioral emergency:  Situation where the victim exhibits abnormal behavior that is unacceptable or intolerable to the victim, family community  Behavior can be due to extremes of emotion leading to violence or other inappropriate behavior or due to a psychological or physical condition 20

21. Medical Emergencies Common causes for behavior alteration:  Situational stresses  Illness/injury  Low blood sugar  Lack of oxygen  Inadequate blood flow to the brain  Head trauma  Excessive heat/cold  Mind altering substances  Psychiatric problems/crises 21

22. Medical Emergencies Some principles for assessing a behavioral victim:  Identify yourself as there to help  ALWAYS remain with victim  Speak in a calm reassuring non-judgmental voice  Maintain comfortable distance from victim for caregiver safety and victim comfort 22

23. Medical Emergencies Some principles for assessing a behavioral victim:  Assess victim without unnecessary physical contact  Tell the truth  Do not “play along” with victim’s visual or auditory disturbances 23

24. Medical Emergencies Behavioral assessment (continued):  Tell victim what you are doing  Acknowledge victim’s feelings  Assess victim’s mental status  Appearance  Activity  Speech  Orientation to time, person, place 24

25. Medical Emergencies Assessment for potential violence:  Check with family, bystanders, friends to see if victim has a known history of violence  Observe victim physical posture  Clinched fists, lethal objects in hands, yelling or verbally threatening to harm self or others  Moves towards others in a threatening manner 25

26. Medical Emergencies Restraining violent victim: Restraints should be avoided unless victim is a danger to self or others Use only the force necessary to prevent victim from harming self or others  Reasonable force is determined by victim’s size & strength  Type of abnormal behavior  Sex of patient  Mental state of victim  Method of restraint 26

27. Medical Emergencies Sometimes after a period of combativeness and aggression some “calm” victims may cause sudden and unexpected injury to self or others 27

28. Medical Emergencies Breathing difficulty:  Often described by the victim as difficult, labored or unable to “get a good breath”  Victim often prefer to remain in a seated position  Victim experiencing respiratory distress can progress to cardiac arrest (full arrest)  A victim complaining of difficulty breathing should receive oxygen if available  If shortness persists long enough victim will become tired and need to be assisted with a BVM 28

29. Ventilation Rate Provide one breath every 5 seconds:  This equates to 12 breath \ minute 29

30. Medical Emergencies Signs and symptoms:  Shortness of breath  Restlessness  Increased or decreased respiratory rate  Respiratory rate will decrease when victim is becoming tired 30

31. Medical Emergencies Signs and symptoms:  Increased pulse rate  Skin color changes  Cyanotic  Pale  Flushed 31

32. Medical Emergencies Signs and symptoms (continued):  Victim may be unable to speak in full sentences  Victim may be able to speak only a few  words or too SOB to speak  Accessory muscle use  Abdominal breathing 32

33. Medical Emergencies Signs and symptoms (continued):  Irregular breathing pattern  Victim may have noisy breathing  Snoring  Crowing  Stridor  Gurgling  Audible wheezing 33

34. Medical Emergencies Treatment guideline for SOB:  Apply oxygen  Position victim for ease of breathing  If victim is too tired to continue breathing on their own, assist with BVM  Obtain complete set of V.S. 34

35. Medical Emergencies Treatment guideline for SOB:  Perform focused physical exam  Obtain victim history  Ask victim about interventions  Medications (type, times used, dosage)  Have they improved the SOB  Has the SOB remained the same or increased 35

36. Medical Emergencies Use of O, P, Q, R, S, T is helpful in gathering information for victim history: O = Onset P = Provoke/Provocation Q = Quality R = Radiation S = Severity T = Time 36

37. Medical Emergencies Cardiac Emergencies: Chest pain with physical symptoms should be taken seriously Victims having an Myocardial Infarction may go into cardiac arrest (full arrest) at any time 37

38. Medical Emergencies Signs and symptoms:  Pain, pressure, discomfort in the chest, epigastric area, left arm, left lower jaw  SOB  Sudden onset of sweating with N/V  Feeling of impending doom 38

39. Medical Emergencies Signs and symptoms:  Palpitations  Abnormal pulse rate  Usually bradycardia (<60 bpm)  Tachycardia (>100 bpm) 39

40. Medical Emergencies Signs and symptoms:  Abnormal B/P  Hypotensive (systolic pressure <90)  Hypertensive (systolic pressure >150)  Pulmonary edema (fluid in the lungs due to cardiac damage)  SOB  Rales  Blood tinged sputum  Pedal edema  Swelling of lower legs and ankles 40

41. Medical Emergencies Treatment guideline for chest pain:  Have victim stop all physical activity  Place victim in position of comfort  Sitting, semi-fowlers, lying down  Apply high concentration of oxygen (mask at 10 lpm)  Start IV at TKO rate 41

42. Medical Emergencies In accordance with local protocol if victim can maintain their own airway:  Give 300 mg chewable aspirin  If victim has current prescription for nitroglycerin and systolic B/P is > 100 assist victim with taking meds  Recheck B/P Q 2-5 min and if systolic falls below 100, no more nitro  Do not give more than 3 doses of nitro  Document all interventions  Document changes in victim’s condition 42

43. Summary Know what the medic should complete when providing care for medical emergencies Know what altered mental status is and some reasons that cause it Know how to identify and treat diabetic, seizure, behavioral, breathing, and cardiac emergencies Know what to ask to gather good patient history 43

44. 44 Questions?

45. 45 Class Practical Exercise Practice some of the skills shared in this presentation