Environmental/Behavioral/GI-GU/Anaphylaxis/Gyn

Environmental conditions affecting exposure

• air temp

• humidity

• wind

air temp and wind pertinent in winter, low humidity

Factors affecting Exposure (4)

pt *****

• length of exposyr

5 Methods of heat transfer

• conduction

• convection

• evaporation

• radiation

• respiration

conduction

movement of

convection

evaporation

radiation

respiration

body heat loss as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled

• both summer and winter

Cold Exposure considerations for EMT

• blankets!!

• you’re at risk for hypothermia, dress appropriately

• extremities may vasoconstrict (frostbite)

Heat Loss Modification

• body activity

• movement to a different location

• appropriate clothing

(increasing or decreasing dep on temp)

Hypothermia

core temp below 95F

mild - 93-95

moderate - 92-89

Mild hypothermia

violent shivering

Moderate Hypothermia

86 to 93.2 F

shivering stops

Severe Hypothermia

less than 86F

• lethargic and stops fighting

• appears stiff or rigid

essentially frozen, not necessarily dead (not dead until they’re warm)

Treatment of Moderate/Severe Hypothermia

• move to warm environment

  • don’t try to actively rewarm the pt

• goal is to prevent further heat loss

  • remove clothing

• cover the patient with a blanket, ehad and neck with blankets or towels, and transport

PASSIVE REWARMING ONLYY

Why Passive Rewarming?

pt heart is getting ischemic

excessive moving and active rewarming can cause pt to go into Vfib

Hypothermic Pt Assessment/Treatment

1 minute for carotid pulse, if no, then start CPR

if slow HR, ventilate

XABCs still priority

warm, humidified oxygen

no stimulants (coffee, tea, soda, or tobacco)

reassess every 5 minutes

Hot Pack placement

underarms, groin, sides of neck

want arteries close to the skin to be warmed up

Active rewarming

bear huggers

• forced warm air

lavage

• warm water through organs

Local Cold Injuries

• frostbite

• frostnip

• trench foot

  • common in homeless pops

Factors

duration, temp, wind

Frostnip

skin may freeze while deeper tissues are unaffected

usually affects ear, nose, and ginfers

symptoms

• not very painful

• pale, cool skin

• no capillary refill

Chilblains

prolonged

• swelling, discoloration, swelling

• cellular damage, but no true freezing

• frosnip to frostbite

Frostbite

chiblain to partial thickness freezing to necrosis

• treat like a burn, dry dressing

Treating local cold injuries

longterm

• immersion in water

Heat emergencies

systemic widespread vasodilation

• body tries to get rid of excess heat

Hyperthermic

core temp of 101 F or higher

Risk Factors

• high air temp

• high humidity

Heat cramps

• painful muscle spasms that occur after vigorous exercise

• legs, abdominal muscles

Heat cramps treatments

cold packs

if shivering - maybe turn down AC, thin sheet

Heat exhaustion

101-102F

lethargic, sweating

pale clammy skin

Heat Stroke

minutes from death, call for ALS

usually in distributive shock (tachycardia, tachypnea, and hypothermic)

Heat Exhaustion vs Heat Stroke

main determinanant betwee the two is sweating

Drowning

Behavior

what you can see of a person’s response to the environment: his or her actions.

Over time, people learn to adapt to stress.

Sometimes stress is so great that the normal ways of coping do not work.

Reactions to stress that are acute and those that develop over time can create a crisis

behavioral crisis

includes patients who exhibit agitated, violent, or uncooperative behavior or who are a danger to themselves or others.

Endocrine System

communication system that controls functions inside body to maintain homeostasis

glands secrete messenger hormones

adrenal glands

release epinephrine and norepinephrine

hypersecretion

more hormone than needed, caused by gland not functioning properly

hyposecretion

more hormone than needed, caused by gland not functioning properly

glucose

usable form of energy for cells, stays in the bloodstream until insulin allows entrance into cells

insulin

hormone secreted by the pancreas

required for glucose to enter cells

produced by beta cells

lowers blood sugar

pancreas 2 hormones

glucagon and insulin

glucagon

hormone secreted by pancreas, produced by alpha cells

signals liver to release glycogen stores

raises blood sugar

Islets of langerhands

small portion of the pancreas, contains alpha and beta cells

glycogen

converted from glucose into an intermediate that can be a short time period’s amount of energy, stored in the liver

when energy is required, pancreas is signalled to release glucagon, which signals to the liver to convert glycogen to glucose for usage

Blood Sugar Normal Range

80-100

Hyperglycemia

high blood glucose level, can result in coma or death

altered mentation, unresponsiveness

Hyperglycemia Symptoms (3)

polydipsia, polyphagia, polyuria

• thirstiness (body’s attempt at diluting)

• hungry (body’s attempt to get the signal to work)

• Urination (body’s attempt at getting rid of sugar)

Hypoglycemia

low blood glucose level

all pt require prompt treatment

clinical version and more temperory version

Hypoglycemia treatment

more temporary (non serious) - eat complex carb (more healthy) - longer term treatment

clinical treatment - will see lethargy, confusion, etc

Untreated Diabetes

blood glucose levels become too high, may cause life threatening illness, or coma, and death

vasoconstriction driven by hyperglycemia

• can cause - blindness, cardiovascular disease, kidney failure, lower extremity loss due to poor circulation

3 types of Diabetes

• Diabetes Mellitus Type 1 - beta cells don’t produce insulin, earlier onset

• Diabetes Mellitus Type 2 - decreased insulin production and insulin resistance, later onset

• Gestational Diabetes - 2nd trim

hypoglycemia symptoms

• took medications but fails to eat enough food

• pale moist skin

• sweating

• dizziness/headache

• tachycardia

• normal to low BP

• altered mental status

• seizure

more likely to be unresponsive, rapid onset

insulin pump

common with type 1

press the off button if hypoglycemic

injectible insulin

multidose pens, too much insulin administered can cause hypoglycemia (common)

ketone

acidic waste formed when cells use fat when they can’t access sugar in the blood

can cause metabolic acidosis on top of hyperglycemia

kidneys become saturated, smells fruity/acetone

diabetic ketoacidosis (DKA)

metabolis acidosis common in type 1 diabetics

treatment is INSULIN

slow onset (1-3 days, a week or so to die)

cannot occur in type 2, only type 1 because they are insulin dependendent

kaussmall respirations

very very deep breaths, in response to metabolic acidosis

can we give insulin?

NO NO NO

fine line, if they’re alert and oriented and try and convince them to take their insulin

Type 2 Diabetes

receptor issues, body becomes resistant to insulin, blood sugar rises, insulin resistance is the main problem

poor diet, sedentary lifestyle

some insulin is produced, but enough to stave off DKA

untreated - more hungry, BG rises, more hunger, BG rises → higher level of sugar (600-700) until altered mental status occurs

NEED insulin

HHNS

T2DM, higher glucose levels in the blood cuas e the extretion of glucose in the urine

cannot drink enough lfuid to keep up with the high levels of glucose in the blood

treatment of diabetic emergencies

standard precautions, supportive measures

maintain ABCs

be careful of presence of syringes

question bystanders

trauma?

Sickle Cell Anemia

Hemophilia

clotting disorder, decreased ability to create a clot after an injury that can be lifethreatening

genetic, mostly male (A)

can be prescribed meds, transfusions

thrombophilia

clots can spontaneously develop, blood thinners

anemia

low RBC count in body, unable to deliver adequate amounts of oxygen to the tissues

Solid organs

liver, kidney, spleen, pancreas

robust blood supply

liver

right upper quadrant, crosses midline a little bit into LUQ

assists with digestions, secretes bile, filters, stores glucose

largest internal organ

can regenerate

bile

helps break down fat in the small intestine

produced in the liver, stored in the gallbladder

gallbladder

right behind liver, stores excess bile

small instestine

dudonem, jejunum, ilium

• pulling nutrients from food

• peristalsis from smooth muscles helps move

Large intestine

food that is not broken down come here, water is absorbed, stool is formed

Spleen

located in abdomen, no digestive function, part of lymphatic system

filters blood, stores extra RBCs

Urinary system

kidneys, ureters, urinary bladder

controls discharge of certain waste

perietal peritoneum

outer layer ADD

visceral lining

lining on outside of organs to keep them in place, and as a signal for problems

referred pain

connected nerves so that pain in one region radiates to another because of connected nerves

acute abdomen

general term for various abdomenal conditions

• rapid onset of discomfort

• nausea and vomiting

• very painful

• distended firm abdomen

recognize as a life threat

appendicitis

peak incidence 10-12 years old

infection of the appendix

• low grade fever

• diffused pain around umbilicus

• radiate to RUQ

• rebound tenderness

pain disappears? bad….it’s ruptured

rebound tenderness

quality of appendicitis where if pressed, doesn’t hurt

when you let go of pressure, hurts

gallstones

calcification in the bile duct/gallbladder

may need to get surgically removed

• RUQ pain

• referred pain

• N&V

• intolerance of fatty foods

Cholecystitis

inflammation of the gallbladder

pacreatitis

inflammation of the pancreas

caused by an obstructive gallstone, alcohol abuse, etc

sever upper quadrant pains

Upper GI bleed

stomach up bleed (esophagus, stomach)

• melana

• throwing up blood (reddish brown)

Melana

black tarry stool, Upper GI bleed that goes through digestive system and gets mixed with f3cal matter

Lower GI bleed

bright red stool

gastroenteritis

acute abdomen

diarrhea, N&V, ADD

allergic reaction

exaggerated immune response to any substance that the individual has been sensistized

releases histamines and leuukotrines as a chemical response

• can be mild and local or severe and systemic

• ranges from hives to angioedema to anaphylaxis

Anaphylaxis

an extreme, life-threatening allergic reactiin

• involves multiple organ systems

• can rapidly result in sock and death

Biphasic

characteristic of anaphylaxis occuring in 1 and 3 people that requires two doses of epinephrine

symptoms retreat after first dose and then reappear

vessel permeability (allergies)

in anaphylaxis, blood walls weakens and dilate, forming gaps because of allergen

plasma and blood leak out

hypovolemic nature of anaphylaxis

anaphylaxis pathway

antigen is introduced to this body, antibody rxtn at surface of mast cells, release of mast cell chemical mediators, specificial antibody reacts with its corressponding antigen, chemical mediators exert their effect on end organs

3 signs of anaphylaxis

urticaria, angioedema, and wheezing

urticaria

small areas of generalized itching or burning that appear as multple, small, raised areas on the skin

angioedemia

anaphylactic reaction that involves swelling of face

airway concern

can cause stridor

wheezing

high pitched, whistling breath on expiration

irritation of the bronchioles, bronchioconstriction

stridor

upper airway swelling, audibly heard

4 for most common allergies

food, medications, plants, chemicals

Treatment for anaphylaxis

• oxygen - main

• epi - main

• albuterol

• steroid

• benadryl