1. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training DOT National Standard EMT-Intermediate/85 Refresher DOT National Standard EMT-Intermediate/85 Refresher Welcome!

2. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training MEDICAL EMERGENCIES Allergic reaction Possible overdose Near-drowning ALOC Diabetes Seizures Heat & cold emergencies Behavioral emergencies Suspected communicable disease Allergic reaction Possible overdose Near-drowning ALOC Diabetes Seizures Heat & cold emergencies Behavioral emergencies Suspected communicable disease

3. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training MEDICAL EMERGENCIES ALOC Perspective Pathophysiology Epidemiology Physical Exam Findings Diagnostic Findings Signs and Symptoms Differential considerations Treatment

4. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training ALOC Probably the most difficult call to run In most cases - the parkmedic will NOT be able to ascertain the cause of the ALOC Therefore, the dx is usually ALOC of Unknown Etiology

5. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training pathophysiology Consciousness is the sum of the activities & interactions of the reticular activating system (RAS) & cerebral cortex Coma results from the dysfunction of either the –RAS –the bilateral cerebral cortices

6. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training s/s, physical exam & assessment, diagnotics, monitoring, management, pertinent positives ALOC - spectrum –Drowsy or lethargic = slight decrease in wakefulness & interaction w/ the environment Verbal or light touch arouses pt –Deeply comatose = complete failure of arousal system No spontaneous eye opening & unable to awaken w/ vigorous sensory stimulation –Obtundation & stupor = intermediate stage Awakened only by energetic stimulation ALOC - spectrum –Drowsy or lethargic = slight decrease in wakefulness & interaction w/ the environment Verbal or light touch arouses pt –Deeply comatose = complete failure of arousal system No spontaneous eye opening & unable to awaken w/ vigorous sensory stimulation –Obtundation & stupor = intermediate stage Awakened only by energetic stimulation

7. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training s/s, physical exam & assessment, diagnotics, monitoring, management, pertinent positives ALOC - spectrum –Drowsy or lethargic = slight decrease in wakefulness & interaction w/ the environment Verbal or light touch arouses pt –Deeply comatose = complete failure of arousal system No spontaneous eye opening & unable to awaken w/ vigorous sensory stimulation –Obtundation & stupor = intermediate stage Awakened only by energetic stimulation ALOC - spectrum –Drowsy or lethargic = slight decrease in wakefulness & interaction w/ the environment Verbal or light touch arouses pt –Deeply comatose = complete failure of arousal system No spontaneous eye opening & unable to awaken w/ vigorous sensory stimulation –Obtundation & stupor = intermediate stage Awakened only by energetic stimulation

8. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training epidemiology Metabolic Infectious Vascular Neurologic Structural Seizures Trauma Toxicologic Environmental Metabolic Infectious Vascular Neurologic Structural Seizures Trauma Toxicologic Environmental

9. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training epidemiology Electrolyte disorders Hypernatremia Hyponatremia Hypercalcemia Hypoglycemia Hypermagnesemia Diabetic ketoacidosis Hyperglycemia hyperosmolar states Hypothyroidism Thyrotoxicosis Adrenal insufficiency Hepatic encephalopathy Uremia Thiamine deficiency Electrolyte disorders Hypernatremia Hyponatremia Hypercalcemia Hypoglycemia Hypermagnesemia Diabetic ketoacidosis Hyperglycemia hyperosmolar states Hypothyroidism Thyrotoxicosis Adrenal insufficiency Hepatic encephalopathy Uremia Thiamine deficiency Meningitis Encephalitis Intracranial abscess Sepsis Hypertension Hypotension Vasculitis Cerebrovascular accident Subarachnoid hemorrhage Tumor Hydrocephalus Intracerebral hemorrhage

10. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training epidemiology Status epilepticus Subdural hematoma Epidural hematoma Cerebral contusion Diffuse cerebral edema Carbon monoxide Ethanol, methanol, isopropyl alcohol, ethylene glycol Drug use/overdose Heatstroke hypothermia HACE Near drowning dysbarism Status epilepticus Subdural hematoma Epidural hematoma Cerebral contusion Diffuse cerebral edema Carbon monoxide Ethanol, methanol, isopropyl alcohol, ethylene glycol Drug use/overdose Heatstroke hypothermia HACE Near drowning dysbarism

11. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training assessment In the field: A lcohol E pilepsy I nsulin O verdose U remia T rauma I nfection P sychosis S troke In the field: A lcohol E pilepsy I nsulin O verdose U remia T rauma I nfection P sychosis S troke

12. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Review Protocol Go to ALOC-Adult Go to Call Matrix -General Go to ALOC-Adult Go to Call Matrix -General

13. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Perspective Pathophysiology Epidemiology Physical Exam Findings Diagnostic Findings Signs and Symptoms Differential considerations Treatment Perspective Pathophysiology Epidemiology Physical Exam Findings Diagnostic Findings Signs and Symptoms Differential considerations Treatment

14. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Questions? References –Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010. –Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011. –Wolfson, Allan B. ed., Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010. References –Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010. –Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011. –Wolfson, Allan B. ed., Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.