medical SOCs

acute coronary syndrome s/s

• chest discomfort

• SOB

• nausea

• pale/cool/diaphoretic

• anxiety, feeling of impending doom

• high/low BP

acs assessment

• visualize chest

• auscultate BBS

• palpate chest wall for reproducible pain

• assess JVD

• assess pedal edema

acs treatment

• aspirin 324 mg PO

• nitroglycerin if chest discomfort

• NTG caution if HR more than 100 and less than 50

• als intercept for ECG and medication

AMS forms

physical and mental causes

AMS s/s

• confusion

• decreased responsiveness

• hallucinations

• memory loss

• delusions

• mood swings

• disorganized speech

AMS assessment

• mentation: orientation and decisional capacity

• physical vs mental cause: history, CVA, trauma, seizure, pupils, blood glucose

AMS treatment

• establish rapport with support

• address physical causes

• supportive care: O2 and vital signs

• transport if lacking decisional capacity and suicidal ideation

anaphylaxis s/s

• dyspnea

• wheezing

• tongue swollen

• skin warm/flushed

• hypotension

• lightheadedness

• weak radial pulse

• tachypnea/tachycardia

• angioedema

anaphylaxis assessment

• mentation

• airway: tongue, ability to swallow

• auscultate BBS

• visualize/palpate chest wall for accessory muscle use

• skin urticaria/edema

• blood pressure

anaphylaxis treatment

• support ABCs

• epi pen

• ALS intercept for fluid and medication

• rapid transport

asthma s/s

• wheezing

• sudden dyspnea

• non productive cough

• tachynpea/tachycardia

• anxiety

• chest tightness

• SpO2 < 94% without O2

• tripod position

• history and MDI

asthma treatment

• O2 via NRB or BVM or CPAP

• assist with MDI

• albuterol SVN

• medication intubation

• rapid transport

cardiac arrest s/s

• unresponsive

• apneic

• pulseless

• pediatric with HR < 60 and poor perfusion

cardiac arrest assessment

• AVPU

• breathing

• carotid pulse

• signs incompatible with rescusitation

cardiac arrest treatment

• CPR with EtCO2

• AED

• ALS intecept with ECG, IV, and medications

• if return of spontaneous circulation then rapid transport

• consult advise family

CHF defintiion

inadequate heart pumping leads to fluid buildup

CHF s/s

• chest pain/discomfort

• JVD

• SOB and fatigue

• paroxysmal nocturnal dyspnea

• orthopnea

• pulmonary edema: rales/crackles

• cough: pink, frothy sputum

• pedal edema

• tachynpea/tachycardia

• skin pale/cool/clammy

CHF asessment

• visualize chest

• auscultate BBS

• palpate chest wall for reproducible pain

• assess JVD

• assess pedal edema

• assess EtCO2

CHF treatment

• O2 CPAP or BVM

• NTG if chest pain

• ALS for ECG and medication

• rapid transport

COPD forms

-chronic bronchitis

emphysema

COPD chronic bronchitis s/s

• dyspnea with productive cough

• BBS coarse rhonchi with wheezing/rales

• tachynpea/tachycardia

• overweight

• cyanotic chronic

• recurring infections

• clubbed nails/fingers

COPD emphysema s/s

• dyspnea with non productive cough

• BBS diminished with wheezing/rhonchi

• tachypnea/tachycardia

• pursed lip breathing

• thin, barrel chest

• skin chronically pink

• tripod position

• home O2

COPD assessment

• visualize chest

• auscultate BBS

• palpate chest wall for equal, bilateral chest rise

COPD treatment

• O2 via NRB or BVM or CPAP preferred

• SpO2 88-92%

• ALS intercept with medication and intubation

• rapid transport

headache s/s

• migraine: throbbing

• cluster: pain starts and stops

• tension: aching, squeezing, pressure

• pain localized to one area or generalized

• photosensitivity

• nausea

• sweating

• tear production on side of pain

• suspect underlying problem if: AMS, deficit, behavior change, seizure, fever, stiff neck

headache assessment

• assess mentation for orientation, cognition, memory, perception

• assess pupils

• palpate head

• palpate neck and shoulder muscles: tenderness, pain relief

• assess blood pressure

headache treatment

• support ABCs

• prepare for vomiting with emesis bag and suction

• position of comfort

• prepare for seizures

• dim lights

• gentle transport

hyperglycemia s/s

• slow onset

• tachycardia

• positive orthostatic tilt test

• skin warm/dry/flushed

• the 4 P’s

• DKA if: BGL > 350, fast and deep respirations, sweet and fruity breath

• HHS if: BGL between 700-1200, severe dehydration, no change in respirations or breath odor

hyperglycemia assessment

• assess mentation

• get history

• physical exam for signs of dehydration

• vital signs: d stick

hyperglycemia treatment

• O2 via NRB

• no fluid by mouth

• ALS intercept: IV fluid

• transport

hypoglycemia s/s

• acute onset

• LOC/AMS

• skin pale/cool/clammy

• diaphoresis

• tachynpea/tachycardia

• tremors

• hunger

• unusual/violent behavior

• stroke-like signs

hypoglycemia assessment

• mentation for orientation and cognition

• get history for diabetes mellitus

• trauma physical exam

• vital signs d stick

hypoglycemia treatment

• support ABCs: suction and O2 via NC

• oral glucose

• glucagon if can’t swallow

• unresponsive patient requires ALS for IV

• transport PRN

peritonitis s/s

• abdominal pain/tenderness

• nausea

• diarrhea

• fever

• chills

• lack of appetite

peritonitis assessment

• rebound tenderness

• markle test: heel drop and heel jar

peritonitis treatment

• supportive care: ABCs

• ALS intercept: fluid, medication

• transport

pneumothorax s/s

• sudden dyspnea/SOB

• sharp, stabbing, localized chest pain

• decreased BS on one side

• subcutaneous emphysema

• tachynpea

• SpO2 < 94%

• cyanosis late

• penetrating chest trauma

tension pneumothorax s/s

• declining blood pressure or narrowing pulse pressure

• lightheadedness, declining mentation

• increased dyspnea

• JVD

• tracheal deviation

pneumothorax assessment

• visualize chest for trauma and deformity

• auscultate BBS

• palpate chest wall for reproducible pain and equal chest rise

pneumothorax treatment

• O2 via NRB, beware BVM

• cover penetrating chest wound

• ALS intercept for tension pneumothorax: needle thoracotomy

• rapid transport

generalized tonic-clonic seizure s/s

• aura

• LOC

• muscle contraction followed by convulsions

• incontinence

• tongue trauma

• excessive saliva

• postictal period

simple partial seizure s/s

localized twitching with no AMS

complex partial seizure s/s

• AMS

• accompanied by dazed or blank stare

• chewing/smacking lips

• repetitive hand wringing or finger rolling

febrile seizure s/s

pediatric patient with fever

seizure assessment

• assess mentation

• get history from witnesess

• obtain BGL and temperature

• head to toe exam for trauma/tongue lacerations/incontinence

seizure treatment

• remove obstacles and guard the patient

• support ABCs: O2 via NRB and suction PRN

• recovery position following convulsions

• ALS intercept if prolonged or status epilepticus

• rapid transport

compensation shock signs

• anxiety

• SOB

• pale/cool/clammy

• distributive shock is flushed and warm

• tachynpea/tachycardia

• neurogenic is bradycardia

• narrowing pulse pressure with hypovolemia

decompensation shock s/s

• lightheaded

• decreased responsiveness

• declining mentation

• hypotension

shock assessment

• history

• physical exam pertinent to patient presentation

• vital signs

shock treatment

• treat underlying cause

• O2 via NRB or BVM

• warm patient if hypovolemia: blanket and heater

• supine position if hypovolemia

• ALS intercept for fluid, medication, ECG

• rapid transport

stroke s/s

• sudden headache

• facial droop

• slurred speech

• AMS

• unilateral motor/sensory deficit

• pronator drift

• unequal pupils

• vision changes

• nausea

• incontinence

stroke assessment

• assess mentation

• get history and time of symptom onset

• neuro assessment

• BGL

• cincinnati prehospital stroke scale

stroke treatment

• support ABCs: O2, suction, emesis bag

• position patient: left lateral recumbent, supine, semi-fowler’s

• protect paralyzed extremities

• call hospital stroke alert

• ALS intercept: ECG

• rapid transport to stroke center