West Coast EMT Signs & Symptoms (Block 3)

Migraine

Pathophysiology: A type of headache caused by abnormal brain activity affecting nerve signals, blood vessels, and chemical messengers in the brain. During a migraine, certain brain areas become overactive, leading to changes in blood vessel size and the release of inflammatory chemicals, which cause pain and other symptoms.

S/Sx: Moderate to severe throbbing or pulsing headache, often on one side; sensitivity to light/sound; nausea/vomiting; possible aura before onset. Can last hours to days.

Risk Factors: Family history, hormonal changes (especially in women), certain foods/drinks (caffeine, alcohol), stress, lack of sleep.

T/Tx: Rule out other life threats (e.g., stroke), provide quiet, dimly lit environment, oxygen if hypoxic, monitor vitals, transport if severe, atypical, or patient has new neuro deficits.

Ischemic stroke

Pathophysiology: Blockage of a brain artery by a clot (thrombus) or traveling clot/debris (embolus), cutting off blood and oxygen. Brain cells begin to die within minutes due to ischemia (lack of blood supply).

S/Sx: Sudden weakness/numbness (often one-sided), facial droop, speech difficulty, vision problems, dizziness, loss of coordination, altered mental status.

Risk Factors: Hypertension, atherosclerosis, atrial fibrillation, diabetes, smoking, high cholesterol.

T/Tx: Airway/oxygen if hypoxic, check blood glucose, determine time last known well, rapid transport to stroke center, minimize patient exertion and movement.

Hemorrhagic stroke

Pathophysiology: A blood vessel in the brain bursts (aneurysm), leaking blood into surrounding tissue or the subarachnoid space. This raises intracranial pressure (ICP) and damages brain cells.

S/Sx: Sudden severe headache ("worst headache of my life"), nausea/vomiting, sudden neuro deficits, decreased level of consciousness, seizures.

Risk Factors: Chronic hypertension, aneurysms, AVMs (abnormal blood vessel tangles), anticoagulant use.

T/Tx: Maintain airway, oxygen if hypoxic, elevate head ~30° if tolerated, monitor neuro status, rapid transport.

Transient ischemic attack

Pathophysiology: Temporary blockage of blood flow to the brain, causing stroke-like symptoms that resolve completely, usually in <1 hour (by definition, always <24 hrs).

S/Sx: Same as stroke but resolves quickly — weakness, facial droop, speech changes, vision loss.

Risk Factors: Hypertension, atherosclerosis, atrial fibrillation, diabetes, smoking, high cholesterol.

T/Tx: Treat as a stroke until proven otherwise, monitor ABCs, oxygen if needed, glucose check, rapid transport.

Status epilepticus

Pathophysiology: Seizure lasting >5 minutes, or two or more seizures without recovery in between. Can cause brain injury from prolonged electrical activity and hypoxia.

S/Sx: Continuous convulsions, unresponsiveness, cyanosis (bluish skin), possible injury from uncontrolled movement.

Risk Factors: Epilepsy, head trauma, brain tumor, infection, hypoglycemia, drug withdrawal.

T/Tx: Protect airway and patient from injury, O2 as needed, suction secretions after convulsions are done, left lateral recovery position if postictal and breathing adequately, rapid transport.

Meningitis

Pathophysiology: Inflammation of the meninges — the protective membranes covering the brain and spinal cord — usually from bacterial or viral infection. In bacterial meningitis, swelling and pus can increase intracranial pressure and impair brain function.

S/Sx: Fever, severe headache, stiff neck, nausea/vomiting, photophobia, altered mental status, sometimes rash (especially in meningococcal meningitis).

Risk Factors: Close living quarters (dorms, military), very young or elderly, immunocompromised, lack of vaccination.

T/Tx: Droplet PPE for suspected bacterial cases, airway and oxygen support, rapid transport, early hospital notification.

Appendicitis

Pathophysiology: Blockage of the appendix (small pouch at start of large intestine) → bacterial growth → inflammation and possible rupture → peritonitis.

S/Sx: Early: generalized abdominal pain → localizes to RLQ, nausea, vomiting, low-grade fever, loss of appetite. Pain often worsens with coughing or movement.

Risk Factors: Adolescents/young adults, history of GI blockage.

T/Tx: NPO (nothing by mouth), monitor for shock (especially if rupture suspected), transport promptly.

Cholecystitis

Pathophysiology: Inflammation of gallbladder, usually from gallstones blocking the cystic duct.

S/Sx: RUQ pain, worse after fatty meal; fever, nausea, vomiting, possible referred pain to right shoulder.

Risk Factors: "Four F's" — Female, Fat, Forty, Fertile. High-fat diet.

T/Tx: NPO, pain control within local protocols, transport.

Peptic ulcer disease

Pathophysiology: Erosion of the stomach or duodenal lining from excess acid or decreased mucosal protection. Common causes: Helicobacter pylori infection, long-term NSAID use.

S/Sx: Burning epigastric pain (may improve or worsen with eating), bloating, possible GI bleed.

Risk Factors: Smoking, alcohol, stress, NSAID use, H. pylori infection.

T/Tx: Monitor for GI bleed/shock, oxygen if hypoxic, transport.

Diverticulitis

Pathophysiology: Inflammation/infection of diverticula — small pouches in colon wall.

S/Sx: LLQ pain, fever, nausea, altered bowel habits.

Risk Factors: Low-fiber diet, age >50.

T/Tx: NPO, transport for imaging and treatment.

Cystitis (UTI)

Pathophysiology: Bladder infection, usually bacterial.

S/Sx: Frequent painful urination (dysuria), urgency, suprapubic pain, cloudy/bloody urine.

Risk Factors: Female, sexual activity, urinary catheter use.

T/Tx: Comfort care, transport.

Pancreatitis

Pathophysiology: Inflammation of pancreas, often from gallstones or chronic alcohol use. Digestive enzymes damage pancreas tissue.

S/Sx: Severe upper abdominal pain radiating to back, worse after eating; N/V, fever.

Risk Factors: Alcohol use, gallstones, high triglycerides.

T/Tx: NPO, monitor for shock, transport.

Peritonitis

Pathophysiology: Inflammation of peritoneum (lining of abdominal cavity), usually from infection or rupture of abdominal organ.

S/Sx: Severe abdominal pain, rigid abdomen, fever, shock.

Risk Factors: GI perforation, trauma, ruptured appendix.

T/Tx: Treat for shock if needed, oxygen, NPO, rapid transport.

Gastrointestinal bleeds

Pathophysiology: Bleeding anywhere from esophagus to rectum; can be upper (stomach/esophagus) or lower (intestine/colon).

S/Sx: Hematemesis (vomiting blood), melena, hematochezia (bright red blood in stool), shock signs.

Risk Factors: Ulcers, varices, cancer, anticoagulants.

T/Tx: Airway support if vomiting blood, treat for shock, transport rapidly.

Diabetes (type 1)

Pathophysiology: Autoimmune destruction of pancreas beta cells → no insulin production. Insulin is needed for glucose to enter cells.

S/Sx: Polyuria, polydipsia, polyphagia, weight loss.

Risk Factors: Genetic predisposition, autoimmune disorders.

T/Tx: Monitor glucose, treat hypo/hyperglycemia per protocol.

Diabetes (type 2)

Pathophysiology: Cells become resistant to insulin; pancreas may not make enough insulin over time.

S/Sx: Gradual onset, similar to type 1 in severe cases.

Risk Factors: Obesity, sedentary lifestyle, age >45, family history.

T/Tx: Monitor glucose, treat hypo/hyperglycemia per protocol.

Symptomatic hypoglycemia

Pathophysiology: Low blood glucose → brain and body starved for energy.

S/Sx: AMS, sweating, tremors, tachycardia, seizures.

Risk Factors: Too much insulin/oral meds, missed meals, excess exercise.

T/Tx: Oral glucose, glucagon IM if available and trained, rapid transport if no improvement.

Symptomatic hyperglycemia

Pathophysiology: High glucose → dehydration from osmotic diuresis.

S/Sx: Thirst, frequent urination, AMS, dry skin.

Risk Factors: Poor diabetes control, infection.

T/Tx: Supportive care, transport.

Diabetic ketoacidosis

Pathophysiology: No insulin → fat metabolism → ketones → metabolic acidosis.

S/Sx: Fruity breath, Kussmaul respirations (deep/rapid), AMS, dehydration.

Risk Factors: Type 1 diabetes, illness, missed insulin.

T/Tx: Airway/oxygen, fluids per protocol, rapid transport.

HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome)

Pathophysiology: Severe hyperglycemia without significant ketone production; causes extreme dehydration and high blood osmolarity.

S/Sx: AMS, severe dehydration, possible seizures.

Risk Factors: Type 2 diabetes, elderly, infection.

T/Tx: Airway/oxygen, rapid transport.

Delirium tremens

Pathophysiology: A severe, life-threatening form of alcohol withdrawal. After long-term heavy drinking, the brain adapts to alcohol's depressant effects by increasing excitatory neurotransmitters. When alcohol is suddenly stopped, the brain becomes hyperexcitable → dangerous overactivity of the nervous system.

S/Sx: Confusion, agitation, hallucinations, tremors, sweating, fever, tachycardia, seizures. Usually starts 2-4 days after last drink.

Risk Factors: Chronic heavy alcohol use, history of withdrawal seizures.

T/Tx: ABCs, O₂ as needed, protect from injury during seizures, keep environment calm and quiet, rapid transport.

Narcotic overdose

Pathophysiology: Opioids (heroin, fentanyl, oxycodone, etc.) bind to receptors in the brain and spinal cord, reducing pain but also depressing the respiratory drive and level of consciousness.

S/Sx: Decreased LOC, slow or absent breathing, pinpoint pupils, cyanosis.

Risk Factors: Opioid use disorder, high dose, mixing with alcohol or sedatives.

T/Tx: Open airway, ventilate if needed. O2, naloxone (per protocol) intranasal or IM, transport even if improved (risk of re-sedation).

Pelvic inflammatory disease

Pathophysiology: Infection of the female reproductive organs, usually from sexually transmitted bacteria ascending from the vagina/cervix.

S/Sx: Lower abdominal pain, fever, abnormal vaginal discharge, painful intercourse.

Risk Factors: Multiple sexual partners, untreated STIs, no condom use.

T/Tx: Supportive care, transport.

Preeclampsia

Pathophysiology: Pregnancy complication after 20 weeks — blood vessels react abnormally, causing high BP and often protein leakage into urine.

S/Sx: Hypertension, swelling in hands/face, headaches, vision changes.

Risk Factors: First pregnancy, multiple gestation, history of hypertension.

T/Tx: Monitor BP and fetal movement if possible, minimize stimulation (light, noise), transport for OB care.

Eclampsia

Pathophysiology: Preeclampsia + seizures, caused by severe high BP and brain irritation.

S/Sx: Seizure in pregnant patient with signs of preeclampsia.

Risk Factors: Untreated/poorly managed preeclampsia.

T/Tx: Seizure precautions, airway/Ot, left lateral position to reduce vena cava compression, rapid transport.

Supine hypotensive syndrome

Pathophysiology: In later pregnancy, lying flat compresses the inferior vena cava, reducing blood return to the heart → hypotension.

S/Sx: Dizziness, pallor, hypotension when supine, improves when turned.

Risk Factors: Pregnancy >20 weeks.

T/Tx: Position patient on left side or tilt with pillow under right hip.

Ectopic pregnancy

Pathophysiology: Fertilized egg implants outside uterus (most commonly in fallopian tube) → rupture risk and internal bleeding.

S/Sx: Lower abdominal pain (often one side), vaginal bleeding, possible signs of shock.

Risk Factors: History of PID (pelvic inflammation disease), tubal surgery, previous ectopic pregnancy.

T/Tx: ABCs, O2, treat for shock if needed, rapid transport.

Abruptio placentae

Pathophysiology: Placenta detaches from uterine wall before delivery → bleeding and loss of oxygen to fetus.

S/Sx: Painful vaginal bleeding, abdominal tenderness, signs of shock.

Risk Factors: Hypertension, trauma, smoking, cocaine use.

T/Tx: High-flow O₂, treat for shock, rapid transport, preferably to OB-capable facility

Placenta previa

Pathophysiology: Placenta covers cervical opening → painless bleeding.

S/Sx: Painless, bright red vaginal bleeding, usually in late pregnancy.

Risk Factors: Multiparity (more than one baby), prior C-section, multiple gestation.

T/Tx: Do NOT perform vaginal exam, high-flow O2, monitor for shock, transport.

Croup

Pathophysiology: Viral infection causing swelling of larynx/trachea, narrowing airway.

S/Sx: Barking cough, inspiratory stridor, low-grade fever, worse at night.

Risk Factors: Young children (6 months-3 years), fall/winter season.

T/Tx: Calm environment, humidified O2 if available, keep child comfortable, transport if moderate/severe.

Epiglottitis

Pathophysiology: Bacterial infection (often Haemophilus influenzae type b) causes inflammation of epiglottis → potential airway obstruction.

S/Sx: Severe sore throat, drooling, tripod position, stridor, fever, sudden onset.

Risk Factors: Unvaccinated, young children.

T/Tx: Do NOT put anything in mouth or agitate child, provide O2 if tolerated, rapid transport.

Bronchiolitis

Pathophysiology: Viral infection (often RSV) causes swelling/mucus in small airways of lungs.

S/Sx: Wheezing, cough, nasal congestion, low-grade fever, respiratory distress in infants.

Risk Factors: Infants <2 years, winter season, exposure to RSV.

T/Tx: O2 as needed, suction nasal secretions, monitor for worsening distress.

Pertussis

Pathophysiology: Bacterial infection (Bordetella pertussis) damages airway lining → severe, prolonged coughing fits.

S/Sx: Runny nose, mild cough → progresses to fits of rapid coughing followed by high-pitched "whoop" sound, vomiting after coughing.

Risk Factors: Unvaccinated, infants, close contact exposure.

T/Tx: Droplet PPE, O2 as needed, transport, especially for infants.