Care for Common Medical Emergencies

Pearson chapter 16

clonic muscle activity

convulsions - jerking movements of arms and legs

febrile seizure

seizures that occurs in young children with a fever

generalized vs partial seizure

Causes ENTIRE body to convulse are generalized.

Partial are localized convulsion area + patient is responsive

postictal

Postictal refers to the period of time that occurs after a seizure ends, during which the brain and body recover

tonic muscle activity

stiffening of the entire body (form of convulsions)

common causes of altered mental status

• Seizure

• Stroke

• Diabetic emergency

• Poisoning and overdose

• Hypoxia

• Shock

• Infection

• Head injury

• Psychiatric condition

• Kidney failure

Glasgow coma scale - eye opening (assesses responsiveness)

4 - Spontaneous

3 - To verbal command

2 To pain

1 None

Glasgow coma scale - verbal response

5 - Oriented

4 - Confused

3 - Inappropriate words (saying actual words, but doesnt make sense)

2 - incomprehensible sounds (not saying actual words)

1 - No response

Glasgow coma scale - motor response

Obeys verbal commands - 6

Localizes pain (like moving to be in less pain) - 5

Withdraws from pain (flexion) - 4

Abnormal flexion in response to pain (decorticate rigidity) - 3

Extension in response to pain (decerebrate rigidity) - 2

No response - 1

recognizing altered mental status

• Confusion

• Incoherent speech

• Drowsiness

• Abnormal behavior

• Lack of awareness of surroundings

• Combativeness

• Repetitive questions

• Syncope (collapse or fainting)

• Unresponsiveness

altered mental status care

• Take BSI precautions and perform a primary assessment.

• Monitor the patient’s airway and breathing.

• Administer oxygen per local protocols.

• Monitor vital signs.

• Provide emotional support.

• Position the patient properly for comfort and protection of the airway.

• Do not administer anything by mouth.

  • Continue to monitor the patient while awaiting EMS arrival

common seizure causes

• Epilepsy

• Ingestion of drugs, alcohol, or poisons

• Alcohol withdrawal

• Brain tumors

• High fever

• Complications of diabetes

• Stroke

• Heat stroke

• Head trauma

• Hypoxia

care for generalized seizure

• Take BSI precautions and perform a primary assessment.

• During the seizure, protect the patient from further injury. Move objects away from the patient and place something soft under their head if necessary.

• Do not attempt to restrain the patient or force anything into their mouth.

• Loosen restrictive clothing.

• After convulsions have stopped, place the patient in the recovery position.

• Perform a primary assessment.

• Administer oxygen per local protocols.

• Provide care for any injuries that may have occurred as a result of the seizure

remember: during postictal stage they likely will be weak and tired

status epilepticus

life-threatening condition that occurs when an individual has very long seizures or seizures that occur in quick succession.

recognizing stroke (AKA cerebrovascular accident/CVA, or brain attack)

• Facial droop (on one side)

• Hemiparesis (weakness on one side of the body)

• Difficulty with speech or vision

• Altered mental status

• Severe headache

• Confusion

• fainting or seizures

• Altered breathing patterns

• Unequal pupils

• Loss of bowel and/or bladder control

• Hypertension (high blood pressure)

care for strokes

• Take BSI precautions and perform a primary assessment.

• Reassure the patient while performing a secondary assessment.

  • thorough history related to onset of signs and symptoms

• Obtain baseline vital signs.

• Administer oxygen per local protocols.

• Position the patient for comfort and airway protection.

• Perform frequent reassessments.

recognizing hyperglycemia

Gradual onset
◦ Drowsiness
◦ Extreme thirst
◦ Frequent urination
◦ Warm and dry skin
◦ Vomiting
◦ Fruity, sweet breath odor (ketone breath)
◦ Rapid breathing
◦ Unresponsiveness

recognizing hypoglycemia

• Sudden onset
  ◦ Staggering
  ◦ Anger
  ◦ Pale color
  ◦ Confusion
  ◦ Sudden hunger
  ◦ Excessive sweating
  ◦ Trembling, seizures, unresponsiveness

care for hyperglycemia

• Take BSI precautions and perform a primary assessment.

• Reassure the patient while performing a secondary assessment.

• Obtain baseline vital signs.

• Administer oxygen per local protocols.

• Position the patient for comfort and airway protection.

• Perform frequent reassessments.

care for hypoglycemia

• Take BSI precautions and perform a primary assessment.

• Perform a secondary assessment. Obtain a medical history, and determine if the patient has diabetes. Find out if the patient has taken insulin and/or has eaten recently.

• Obtain baseline vital signs.

• Administer oxygen per local protocols.

• Make certain that the patient can swallow without difficulty before giving anything by mouth. If the patient can swallow without choking and you are not certain if the problem is too much sugar (hyperglycemia) or too little sugar (hypoglycemia), administer oral glucose per local protocol.

recognizing ingested poisons

• Burns or stains around the mouth

• Unusual breath odors or odors on the clothing

• Abnormal vital signs

• Sweating

• Dilated or constricted pupils

• Excessive saliva or foaming at the mouth

• Burning in the mouth or throat or painful swallowing

• Abdominal pain

• Nausea, vomiting, diarrhea

• Convulsions

• Altered mental status, or unresponsiveness

care for ingested poisons

1. BSI, primary assessment'

2. ensure open airway + adequate breathing

3. secondary assessment - call poison control, figure out what patient took

4. dont give anything by mouth unless POISON CONTROL or MED DIRECT says to

5. give oxygen or ventilations, if needed

6. if directed to, give activated charcoal

   • adult: 25-50 grams

   • child: 12.5-25 grams

7. if vomiting, put in recovery position

8. if possible, save vomit to give to hospital

recognizing carbon monoxide poisoning

• irritated eyes

• shortness of breath

• coughing

• dizzy, confused

• headache

• seizure

care for smoke inhalation

• Move the patient to a safe, smoke-free area.

• primary assessment and assist with breathing as necessary.

• Administer oxygen, if allowed to do so.

• position of comfort, if responsive

• Obtain baseline vital signs.

• Closely monitor the airway and breathing status.

Recognizing absorbed poisoning

• Skin reactions, ranging from mild irritations to severe burns

• Hives

• Itching

• Eye irritation

• Headache

care for absorbed poisoning

1. remove patient from environment

2. primary assessment

3. secondary assessment

4. brush powder off

5. flush area with water

6. remove contaminated clothing (including shoes, jewelry)

recognizing injected poisoning

• Noticeable sting, bite, or puncture mark on the skin

• Pain at or around the wound site

• Itching

• Altered mental status

• Difficulty breathing and abnormal pulse rate

• Headache

• Nausea

• Anaphylactic shock

caring for injected poisoning

1. primary assessment

2. secondary assessment

3. oxygen, if needed

4. assist with EpiPen if needed

5. scrape off stingers or venom sacs

6. flush site with clean water

7. apply pressure bandage, if snack bite on extremity

8. place cold pack over site

9. monitor CSM’s

recognizing alcohol intoxication

• Odor of alcohol on the patient’s breath or clothing

• Unsteady, uncoordinated movements

• Slurred speech and the inability to carry on a conversation

• Flushed appearance, often with sweating and complaining of being warm

• Nausea and vomiting

care for alcohol intoxication

• Take appropriate BSI precautions, and perform a primary assessment.

• Ensure a clear airway and adequate breathing.

• Perform a thorough secondary assessment to detect any signs of illness or injury. Remember that alcohol may mask pain. Look carefully for mechanisms of injury and signs of illness.

• Monitor vital signs, staying alert for respiratory problems.

• Help the patient when they are vomiting, so the vomit will not be aspirated (inhaled).

• Protect the patient from further injury.

Delirium tremens

severe alcohol withdrawal

caring for overdose

• Take BSI precautions and perform a primary assessment.

• Maintain an open airway and ensure adequate breathing.

• Perform a secondary assessment.

• Obtain baseline vital signs.

• Administer oxygen per local protocols.

• Be alert for vomiting and the need to manage the airway and breathing.

• Continue to reassure the patient throughout all phases of care.

recognizing sepsis (extreme reaction to infection)

• Fever

• Chills

• Rapid breathing

• Rapid heart rate

• Low blood pressure

• Altered mental status

care for sepsis

• BSI

• primary assessment

• Perform a secondary assessment.

• Obtain baseline vital signs.

• Administer oxygen per local protocols.

• Perform reassessments as necessary.

care for anaphylaxis

• Take appropriate BSI precautions, and perform a primary assessment.

• Ensure a clear airway and adequate breathing.

• Perform a secondary assessment.

• Administer oxygen per local protocols.

• Assist the patient with their prescribed epinephrine autoinjector as indicated by local protocols.

• Perform reassessments as necessary and closely monitor vital signs and ABCs until EMS arrives.

recognizing renal failure

AKA kidney failure.

• Weakness

• Altered mental status

• Edema (swelling) in the lower extremities, abdomen, face, or other areas of the body

• Increased heart rate

• Increased blood pressure

• Decreased urine output

care for renal failure

• Take appropriate BSI precautions, and perform a primary assessment.

• Perform a secondary assessment (ask if they’ve missed hemodialysis)

• Control any bleeding from the access point with direct pressure.

• Administer oxygen per local protocols.

• Perform reassessments as necessary.

recognizing behavioral emergencies

abnormal behavior - acting VERY differently than how they normally

assessment for behavioral emergencies

1. Scene safety - don’t approach if you think patient is violent

2. identify yourself. Say you’re there to help

3. inform patient of what you’re doing at ALL times

4. ask questions in calm voice

5. allow patient to say what happened (JUDGEMENT FREE ZONE)

6. rephrase everything they say (to know you’re listening, and so you TRULY understand)

7. be non-threatening (body language)

8. assess mental status, appearance, activity, speech, and orientation

9. consider need for law enforcement

care for behavioral emergencies

1. assessment from before, consider law enforcement

2. primary assessment from SAFE DISTANCE

3. acknowledge the patient is upset and restate youre there to help

4. use calm voice

5. encourage them to say what’s bothering them

6. don’t argue, threaten, or challenge. Be honest

7. involve family/friends, if needed

8. dont move quickly

9. don’t ‘play along’ with hallucinations

10. don’t let patient be between you and exit