1. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Altered Mental Status AMS malfunction can be: ◦ Global – affecting all parts of the central nervous system equally. ◦ Localized or focal – affecting a portion of the body.

2. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Causes of AMS: AEIOU-TIPS or… I ATE, I SOUP!!! I - Insulin A - Alcohol, Acidosis T - Trauma, Tumors E - Epilepsy, Environment, Electrolytes I - Infection S - Seizure, Stroke, Syncope O - Oxygen, Overdose U - Uremia P - Poisoning, Psychiatric Conditions continued

3. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY And now it’s time for…

4. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Conditions Associated With AMS Epilepsy – chronic condition causing recurrent seizures. ◦ Factors associated with epilepsy – head injury, brain trauma, brain tumors, genetic conditions, and chemical imbalance. ◦ Chronic epileptics treated with anti- convulsant medications. continued

5. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Seizures Seizures: electrical disturbance in the brain, causes altered awareness, attentiveness, responsiveness, behavior, or body movement Partial v. Generalized Three Phases Status epilepticus continued

6. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Conditions Associated With AMS Diabetes – inability to regulate blood sugar level; glucose level to high ◦ Chronic disease. ◦ Pancreas cannot produce enough insulin, or cells do not respond to insulin, or both. ◦ Glucose does not enter the cells and builds up in blood stream. continued

7. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Diabetes Diabetes – inability to regulate blood sugar level; glucose level to high ◦ Symptoms – polyuria, polydipsia, increased appetite, change in weight, fatigue, dry mouth, cellular damage 4 Types: ◦ Type 1 ◦ Type 2 ◦ Gestational ◦ Other continued

8. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Type 1 Diabetes Caused by autoimmune disease in the young. Destroys pancreatic cells that produce insulin. Controlled by injectable insulin or insulin pump. continued

9. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Type 2 Diabetes Unknown cause; increased incidence in the obese; also may be genetically predisposed. Cells are resistant to action of insulin. Controlled by weight loss, exercise, and oral hypoglycemic medication. continued

10. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Gestational and Other Diabetes ◦ Gestational diabetes mellitus Develops only during pregnancy. ◦ Other Genetic defects in insulin production continued

11. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Hypoglycemia ◦ Low Blood sugar ◦ Early signs and symptoms – anxiety, dizziness, tachycardia, diaphoresis, tremor, headache, mild confusion, conscious,and able to swallow. ◦ Severe signs and symptoms – marked confusion, disorientation, lethargy, slurred speech, seizures, unilateral extremity weakness or unresponsiveness; irrational or combative behavior is common continued

12. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Hyperglycemia ◦ High Blood sugar ◦ Early signs and symptoms – polyuria, polydipsia, dry mouth, and fatigue. ◦ Late signs and symptoms – nausea, vomiting, abdominal pain, AMS, coma, brain injury, death. continued

13. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Strokes Stroke: neurological impairment due to low or no blood flow to areas of the brain. Three types of stroke – ◦ Ischemic ◦ Hemorrhagic ◦ Transient ischemic attack (TIA): continued

14. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Violent Behavior and AMS Be cool.

15. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Substance Abuse and Poisoning

16. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Four Ways Drugs Enter and Move Through Body 1. Absorption: the way the substance or poison enters the body. 4 routes of absorption: ingestion, inhalation, transdermal, injection 2. Distribution: transport of substance to site where it will exert its effects. 3. Metabolism: body breaks down the substance. 4. Elimination: body purges itself of substance. continued

17. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Affected body systems ◦ Nervous system ◦ Myocardial ◦ Ocular ◦ Hematological continued

18. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies ◦ Acids & Bases ◦ Anti anxiety drugs and sedatives ◦ Antidepressants ◦ Antipsychotics ◦ Depressants ◦ Designer Drugs (“Club Drugs”) ◦ Hallucinogens ◦ Inhalants ◦ Nerve Agents ◦ Opiates ◦ Organophosphates ◦ Stimulants ◦ Prescription drugs ◦ Over the counter medications continued - How likely is ingestion of poison? - Why is this important for us to know about?

19. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Substances Encountered Acetaminophen (Tylenol) ◦ Alcohol ◦ Aspirin (acetylsalicylic acid) ◦ Carbon monoxide (CO) ◦ Cocaine (coke, crack, snow, rock, nose candy) ◦ Ethylene glycol ◦ Iron supplements. ◦ LSD (lysergic- diethylamide, acid) ◦ Marijuana (pot, weed, cannabis, THC, hashish) ◦ Methamphetamine (Speed, Meth) Methane ◦ PCP (phencyclidine, angel dust) ◦ Toxic plants continued

20. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management (What to do) topical poisons: ◦ brush off dry particles and rinse away any remaining with water. liquid poisons: ◦ thoroughly rinse with water. Ocular exposure ◦ immediately irrigate with sterile water or irrigation solutions. inhaled poisons: ◦ immediately remove patient from source of poisoning. Maintain airway, high-flow O 2, consider ALS transport. continued

21. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Good things to know Personal safety is always first. Alcohol is the most abused drug. Carbon monoxide is a silent killer. Antidotes exist for many types of drugs Three most deadly for children – aspirin, acetaminophen and iron. Always try to identify the poison. National Poison Control: 1-800-222- 1222 continued

22. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Allergies and Anaphylaxis

23. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Why do people have allergic reactions? Anatomy and Physiology Antibody-antigen reaction: ◦ Mast cells attack the offending antigen, which causes a reaction that destroys it without harming normal cells. Allergic reaction: ◦ An acquired, abnormal over-reaction by the immune system to an otherwise harmless substance that results in a hypersensitivity. continued

24. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Causes of Allergies and Anaphylaxis Foods, especially peanuts and shellfish Environmental irritants Pollen Molds Animal dander Medications Chemicals Other such as blood transfusion continued

25. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY 3 types of allergic reactions Mild Moderate Severe

26. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Mild Allergic Reaction Signs and Symptoms Itching (pruritis) Flushed skin Rash or hives (urticaria) Watery, reddened eyes Nasal congestion Increased heart rate Tingling in/around mouth Fatigue Typically results in local dermatologic changes, especially on the face and/or neck. Nasal mucosa and/or congestion are also common. continued

27. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Moderate Allergic Reaction Effects include those in a mild reaction, but more pronounced. The respiratory and gastrointestinal system are usually involved. Symptoms may take minutes, hours, or even days to develop. Effects might disappear over time, or increase in severity, depending on individual chemistry and response. continued

28. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Moderate Allergic Reaction Signs and Symptoms Anxiety and confusion Tightness in the throat Difficulty swallowing and/or breathing Wheezing Rash, hives, swelling in face, neck, chest, arms Persistent itching Angioedema Abdominal pain or cramping Nausea and/or vomiting Elevated vital signs continued

29. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Moderate Allergic Reaction continued

30. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Severe Allergic Reaction Causes a massive inflammatory response in the respiratory, integumentary, circulatory, and gastrointestinal systems due to massive histamine release. Effects are almost immediate- within seconds or minutes. If not treated quickly, it can lead to anaphylactic shock and/or death. continued

31. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Severe Allergic Reaction Signs and Symptoms Severe anxiety, impending doom Decreased level of responsiveness Severe respiratory distress; Severe angioedema, hives Abnormal lung sounds Inability to swallow Tachycardia, weak peripheral pulses Hypotension, pallor, cyanosis continued

32. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Preventing Allergic Reaction Triple A Approach: ◦ Awareness of one’s allergies and the triggers ◦ Avoidance of contact with known allergens ◦ Action know what to do if an allergic reaction occurs (emergency and self-care)

33. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Moving patient may be necessary before assessment. Severity of allergic reaction determines timing, esp. if anaphylaxis is present. Observe closely skin, face, neck, and eyes for rash, swelling, breathing. Extend questioning during known allergies part of SAMPLE (EpiPen)

34. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Initial management is similar- ABCDs. Try to identify the allergen. Remove the patient from the allergen if possible. Monitor and check vitals frequently. If signs of anaphylaxis appear, treat ABCDs and seek transport and ALS. Insect bite? Remove stinger if possible.

35. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Epinephrine

36. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary An allergy is the body’s overreaction to a foreign substance. Allergies are caused by antigens called allergens. Many people do not know they have an allergy until they suffer an allergic reaction. continued

37. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY

38. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation A woman is 34 weeks pregnant and is complaining of severe abdominal pain. She is lying supine on the snow with both knees flexed. She is awake and oriented. A ski school instructor is present and witnessed the patient fall onto her left side, striking her abdomen. Her abdominal pain as “sharp” and “all over”, unlike the labor contractions she had with her first delivery. She does not feel any leakage of fluid and denies feeling lightheaded. This is her second pregnancy and she states it has been uncomplicated to date. continued

39. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology continued Copyright Scott Smith Of a snuggie

40. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology

41. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Obstetrical and Gynecological Emergencies continued Copyright Craig Brown Abdominal pain Dysmenorrhea Cystitis Ovarian cysts Pelvic inflammatory disease Ectopic pregnancy

42. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Pregnancy Complications of pregnancy ◦ Hemorrhage ◦ Pregnancy-Induced Hypertension (PIH) ◦ Miscarriage Supine Hypotensive Syndrome Situations for evacuation continued

43. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Pregnancy continued

44. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Pregnancy continued

45. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Pregnancy continued

46. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY How to Deliver a Baby in 7 Easy Steps: A Ski Hill Guide 1. Use a disposable sterile OB delivery kit 2. Assist the mother, if necessary, in removing her clothing and place in semi-fowler’s position. 3. Time the contractions 4. Once the baby is crowning, allow the mother to push 5. Deliver head and shoulders 6. Should transportation be delayed more than 20 minutes, you will need to cut the umbilical cord 7. Delivery of the placenta ***Always transport mother and baby to the hospital or other ALS point continued

47. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Care of the newborn (APGAR) ◦ Appearance ◦ Pulse ◦ Grimace or irritability ◦ Activity or muscle tone ◦ Respirations continued

48. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Trauma with pregnancy ◦ Ruptured uterus ◦ Abruptio placenta and premature labor ◦ Rupture of membranes continued

49. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Abruptio Placenta continued

50. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Amniotic Sac Rupture

51. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Initial management ◦ Scene safe ◦ ABCDs ◦ SAMPLE ◦ OPQRST ◦ DCAP-BTLS ◦ ALS if needed Management following trauma