ABM medical

Discus the mechanism of burn injuries inhalation burns

• Heat and toxic chemicals can irritate the lungs and the airway, causing coughing, wheezing and swelling of the upper airway tissues, often evidenced by stridor. Lower airway burns are more often associated with inhalation of steam or hot particulate matter whereas supraglottic damage is more often associated with inhalation of superheated gases. 

• Smoke/superheated gas inhalation is a common cause of upper airway compromise or pulmonary injury after a fire. 

Acute psychosis path

• a state of delusion in which a person is out of touch with reality, cannot differentiate between fantasy and reality, loosening of associations, though broadcasting, though insertion 

Delirium path

• impairment in cognitive function that can present with disorientation, hallucinations, or delusions, usually older adults takes hours or days for symptoms, dementia vs excited elirium 

Suicidal ideation

• willful act to ends ones life, more common amoung men who are white and single widowed or divorced depressed, DO not leave patient alone, collect impelments, acknowledge the patients feelings, encourage transport 

Abuse and neglect

remain professional and positive and treat your patients, assess every one in environment and act accordingly

Mood disorders

• Most common psychiatric disorder, manic depressive and depression are EX, causing major disturbances in how people function,

Schizophrenia

• complex disorder that cannot be defined, or treated, hallucinations, delusions, apathy, mutism, flat affect, lack of interest in pleasure, erratic speech, extreme motor behavior 

Verbal techniques useful in managing the emotionla disturbed pt

Ectopic pregnancy

• s/s: sudden onset lower unilateral abdominal pain, 6-8 week since LMP, delayed menses with or without bleeding, hypovolemic shock possible, childbearing age female, may not know she is pregnant 

• TX: ensure adequate airway and administer supplemental oxygen, left lateral recumbent , IV fluid with 18 gauge, keep warm, cardiac monitor, transport to SURGERY facility, 

Placental abruption

• s/s: sudden onset severe abdominal or back pain, more common past 28 weeks, rigid uterus, tender to palpation, decreased fetal movement/ heart tones, may or may not have vaginal bleeding, hypovolemic shock possible, May cause DIC 

Placental previa

• S/s:painless bright red vaginal bleeding, movement may make it worse, normal fetal movement and heart tones, may cause DIC, soft non tender uterus upon palpation 

Uterine rupture

S/s: sudden decrease in intensity of regular contractions during active labor, weakness, dizziness, thirst, catastrophic hemorrhage, shock, tachycardia, very high mortality rate. Can palpate fetal parts through the abdominal wall.

Preeclampsia

• s/s: gradual onset of hypertension after 20 weeks of pregnancy BP:140/90 or greater, edema- hand ankles, proteinuria hyperreflexia, headache, dizziness, nausea, vomiting, visual disturbances, RUQ abd pain

Eclampsia

• s/s: seizures with pregnancy not epileptic, gradual onset of hypertension after 20 weeks of pregnancy BP:140/90 or greater, edema- hand ankles, proteinuria hyperreflexia, headache, dizziness, nausea, vomiting, visual disturbances, RUQ abd pain, s/s of preeclampsia , may occur up to 6 weeks postpartum,

Umbilical cord prolapse

• S/s: cord presents before fetus, immediately instruct mom to pant, goal is to prevent pushing or bearing down, fetal distress, contractions cut off O2 supply to baby, more likely to occur in premature births or excess amniotic fluid 

Uterine rupture

S/s: uterus turns inside out due to excess pressure or traction on the uterus, incomplete- no external protrusion, complete- external protrusion, very painful, severe hemorrhage, possible shock, 1 attempt to replace uterus, if unable then cover with wet sterile dressing/cloth

PID

• infection of a women’s reproductive organs, often caused by STI 

• s/s: general pain that starts with or after menstruation, diffuse pain over both Lower quadrants, achy pain, pain made worse by walking or sexual intercouse, pain in RUQ indicates spore and of infection, vaginal discharge, fever and chills, pain or burning on urination, febrile 

• tx: supportive care, transport with gentle ride 

Bartholin abcess

• s/s: vulvular pain either bilateral or unilateral, pain with intercourse with a painful bump in the vulvular area 

• Tx: supportive care gentle ride 

Vaginitis

• inflammation of the vagina caused by an infection, yeast infection, retained tampons, condoms

• s/s: itching,irritation, discharge, odor, painful intercourse, lower abd pain

• s/s: yeast infection= all of the above plus cottage cheese discharge 

• TX: transport to OB supportive care, needs antibiotics

Cystitis

• bladder infection

• s/s: Supra public pain, cloudy urine, urinary frequency, hematuria, and dysuria, can lead to pyelnephritis

• Tx: antibiotic and pain relief, transport 

Ovarian cyst

s/s:suden onset of severe lower abd pain, one sided, pain radiates to back, possible vaginal bleeding, possible hypotension and tachycardia and other shock symptoms

Endometritis

• s/s: inflammation of uterine lining, MOST common cause of infection following childbirth, occur within 36 hours after birth, fever, chills, vomiting, tachycardia, lower abdominal pain or pelvic pain, cramping, foul smelling vaginal discharge, 

• TX: antibiotics 

Endometriosis

• s/s: presence of tissue outside the uterus, pain localized in the lower back pelvic or abd region, constant and deep pain, either unilateral or bi lateral, sharp or dull, heavy or prolonged menstrual period, 

• tx: pain relief dependent on symptoms

Dysfunctional uterine bleeding

• s/s: abnormal amount or frequency of bleed, more then every 21 days, 

• tx: soak up blood as needed and transport

Traumatic vaginal bleeding

• s/s: bleeding usually after violent intercourse can be either voluntary or involuntary, 

• TX: shock, IV fluids, warm, high priority transport 

Role model behavior for dealing with gynecological pts

• Protect their modesty at all times. Limit the crowd in the room to only those required to perform the tasks. Do not pass judgment of others onto the patient. 

Hypertensive emergencies clinical features

S/S

Neurological: headache , blurred vision , sudden blindness , aphasia , unilateral numbness or weakness.

Cardiovascular: Chest pain , shortness of breath , palpitations , dysrhythmias , or signs of heart failure.

Other: N/V , ringing in the ears , nosebleeds , muscle cramping.

abnormal finding with hypertensive emergencies

• They develop rapidly and the patient appears sick. Signs and symptoms can range from headache, blurred vision and sudden blindness to confusion and unresponsiveness. Other signs may bne chest pain or tightness, shortness of breath palpitations, dysrhythmias, or signs of heart failure. 

• Symptoms generally depend on the “end organ affected”.

Non cardiac causes of cardiac arrest

Respiratory failure, hypovolemia, lightning strikes, overdoses and other toxins, hypothermia, hypoxemia and hyperkalemia/hypokalemia and tension pneumothoraces. 

Dissecting thoracic aortic aneurysm

Thoracic : Unequal BP readings in both arms.

Window of opportunity as it pertains to reprofusion

• EMS to Balloon time: starts at the first moment of patient contact by EMS providers. It ends when definitive therapy occurs.

• Door to Balloon time: The interval between patient presentation to the medical facility and definitive therapy.

• Door to Needle: Begins when the patient arrives at the ED and ends when fibrinolytic medication is administered. 

Commonly used pharmacological agents in the management of congestive heart

• Nitroglycerin to reduce preload/afterload and lessen blood pressure. 0.4mg sublingual for a total of 3 sprays/tabs. 1.2mg total dose. 

• Furosemide is no longer recommended in the prehospital setting per Pg. 1268

Patho abscesses

• Caused by an infection in the brain or spinal column, then your body tries to kill the infection when the body cannot kill the infection it will make a wall around it to keep it from spreading, 

• s/s: are dependent on where in the body they infection is located low grade or high grade fever, persistent headache, drowsiness, confusion, generalized or focal seizures, nausea, vomiting, nuchal rigidity, hemiparesis, focal motor or sensory impairments

Management/ treatment plan of hemorrhagic/ ischemic stroke

• Ischemic strokes, fibrinolytics need to be given in 3 to 4.5 hours of onset.

• Maintain ETCO2 at 30-35 and if ICP is present maintain an SBP of 110. 

• EMS providers need to recognize it early and transport to an appropriate hospital

• Maintain o2 above 94% and do not push them to 100%

• DO NOT administer aspirin. 

Assessment finding associated with nontraumatic neurological emergencies

Effects of increased serum glucose

Discuss the utilization of glycogen with hypoglycemia

• When glucose levels are low, the pancreas releases glucagon and stimulates the liver to produce and release glucose into the blood. This is done by the Alpha cells. In response to autonomic nervous system stimulation, the hormones produced by the body begin to break down fatty and amino acids from stored fat and muscle to make new glucose in a process called gluconeogenesis. 

Recognize the signs and symptoms of the patient with hyperglycemia

• Blurred vision, polyuria, polydipsia, polyphagia, orthostatic syncope, frequent infections, and skin ulcerations. Tachycardia as a result of dehydration, deep, rapid respirations, warm, dry skin and a fruity odor of ketones are all possible. 

Anaphylaxis

• The person may be warm and flushed. Itching (pruritus) is often another early sign that is due to vasodilation and capillary leaking. Swollen red eyes and swelling of the tongue. Hives/urticaria are experienced. 

Management of anaphylaxis

• Allergic reaction = Diphenhydramine 

• Anaphylaxis = Oxygen , IM Epi 1:1k (every 5-15 min as needed) , IV fluid 20mL/kg, Diphenhydramine, Albuterol, Neb Epi, Corticosteroids.

Esophageal varices

• pressure increase in the blood vessels that surround esophagus and stomach, liver gets damaged more than likely form alcoholism causing back up into portal vessels causing rupture 

Malloryweiss

• the junction between the stomach and esophagus tear causing massive bleeding, during vomiting the mucosal lining and the wall of the esophagus separate, causing severe hemorrhage, DOES NOT completely tear through the wall of the esophagus 

Boerhaave syndrome

• esophagus tears longitudinally through the entire wall of the esophagus, blood air and food enter the mediastinum, typically occurs after a large meal with alcohol 

Peptic ulcer disease

• stomach and duodenum exposed to way too much acid which erodes the protective mucosal layers, causing the stomach and digestive acids to erode the internal organs 

Gastritis

• stomach is inflamed by PUD but the mucosal lining is not yet eroded 

GERD

• the lower esophageal sphincter is loose and allows the stomach acids to move up the esophagus, causing burning pain with in the chest= heartburn, over prolonged issue of gerd can cause damage and erode the lining of the esophagus causing bleeding 

S/s upper gastrointestinal bleeding

• Esophagogastric Varices - Mallory Weiss & Boerhaave - Peptic Ulcer - Gastritis - GERD - Hiatal hernia

• Melena (dark, tarry stool) , Hematemesis 

Colitis

• Gradual onset of bloody diarrhea, discharge of mucus via the rectum, hematochezia and mild to severe abdominal pain that is usually in the lower left quadrant. May also report rectal fullness aka tenesmus. May also have joint pain and skin lesions which may tip you off to an autoimmune issue. 

Patho appendicitis

• Occurs when fecal matter or other material accumulates in the appendix. When the organ can no longer flush out this material normally, pressure builds up. This pressure decreases the flow of blood and lymph fluid, hindering the body's ability to fight infection. The combination of bacteria in the feces and diminished ability to combat local infection creates an ideal environment for the uncontrolled reproduction of bacteria. If left unchecked, overpressurization of the appendix will eventually cause it to rupture, resulting in peritonitis, sepsis, and death.

• S/S: Early: Periumbilical pain, N/V, Low grade fever, loss of appetite

Ripe: Pain in the RLQ (McBurney’s Point)

Rupture: Initial decrease in pain, generalized severe abdominal pain, rebound tenderness.

Management of Crohns

S/S: Lower right abdominal pain , rectal bleeding , weight loss , diarrhea , arthritis , skin problems , possible fever , hip / knee / ankle pain.

Tx: Managing ABC’s, provide comfort measures , fluid resuscitation (diarrhea or chronic hemorrhage) , Nausea and pain management.

S/s hepatitis

• S/s: loss of appetite, jaundice of skin and eyes, low grade fever, general malaise, gray feces

• hep B,C, and D are bloodborne (Blood Causes Disease) , A and E are through the oral fecal route ( ass eaters)

• Hepatitis D cannot occur without already being infected with Hep B.

ESRD

• TX is dialysis, s/s: weak and dehydrated, volume overload= SOB and peripheral edema, uremic frost, confusion, muscle twitching due to accumulated toxins, hyperkalemia, needs ecg monitoring especially on dialysis 

AKI

• sudden loss of function and accumulation of toxins in the blood, generalized edema, volume overload, hyperkalemia, uremia, AMS , signs of heart failure 

Prenal

• caused by hypo profusion to kidneys, hypovolemia is most common cause, 

  • s/s: dehydration, shock, pale skin, decreased urine output

Internal

• damage to one of the 3 major areas in the kidneys, often caused by immune diseases such as diabetes or  drugs , structures in kidneys are not functioning or getting flow, 

  • s/s: flank pain , 

Postrenal

• obstruction stopping flow of urine from functioning kidneys, kidney stones

  • s/s: suprapubic area pain with BLADDER DISTENSION, 

• TX: abcs, IV bolus with caution do not want to fluid overload the pt more possible pulmonary edema, IV calcium or bicarbonate depending on med control for hyperkalemia

Complication of renal dialysis

• Hypotension, TX: administer 50 mL of normal saline IV

• hemorrhage from fistula: TX: clamp off and apply direct pressure 

• potassium imbalance: 

  • hypokalemia: removing too much fluid from pts, hypotension, treat dysrhythmia 

  • hyperkalemia: peaked T waves, chest pain dizziness, weakness

• air embolism: sudden dyspnea, hypotension, cyanosis TX: place pt in left lateral recumbent, with a 10% head down tilt, transport immediately 

• Disequilibrium syndrome: dialysis can cause water to shift from blood to CSF increasing intracranial pressure, S/S: vomiting, nausea, headache, confusion,

  • occurs in people who are starting dialysis or have missed a few days and are restarting, 

  • can mimic stroke and pre hospital care iOS to treat it as a stroke and rapid transport for neurological assessment 

• hypotension and shock: 

  • hypotension is common for pts in dialysis but needs to be corrected promptly, it can lead to cardiac arrest, 

  • shock: from blown dialysis shunts due to hemorrhage 

  • TX: need to be assessed for cardiac dysrhythmia 

Management of renal calculi

ABC’s  -  Position of comfort  -  Administer analgesics  -  Nitrous oxide as alternative to the treatment of narcotics  -  IV fluids for dehydration  -  Antiemetic as needed.

Patho of most common poisoning ingestion

Toxic emergencies

• Age (old and young) 

• Change in medications

S/s related to the most common poisoning by injection

• Stimulants= tachycardia, hypertension, dilated pupils, agitated delirium, high fevers, seizures, sudden collapse(cardiac arrest), combative or violent

  • TX: treat symptoms, ABCs, benzo for seizures, aggressive cooling for high fever

• opiates= respiratory depression, hypotension, pinpoint pupils, nausea, vomiting, and constipation

  • TX: narcan to return respiratory drive not consciousness

Poison control center in the United States

• To rapidly identify unknown substances that may have been ingested or exposed to and to provide information on best treatments. 

Path toxic substance exposure

Hematological crisis

Compare contrast old vs young SI ands depression

Describe the categorizes of abuse

• Physical: Hitting/striking 

• Emotional: Causes a substantial change in the victim’s behavior, emotional response or cognitive function or it may manifest as a variety of mental illnesses. 

• Neglect: Not providing the basic necessities of life and protection for someone under their care. 

• Abandonment: Caregiver leaves a dependent person alone or unsupervised. 

Accommodations that may be needed in order to properly manage pts