EHS Exam 4

Croup

Croup

infection of the upper airway that causes swelling between the glottis and progressively narrows the airway

S&S of croup

• hoarse

• coughs with harsh “seal bark”

• stridor with inhalation

Medical care for croup

• administer oxygen to maintain SpO2 of 94%+

• position of comfort

• be aware that cool night air can reduce the swelling in the airway = relief

Epiglottis

bacterial infection = swelling of the epiglottis

S&S of epiglottis

• pain on swallowing

• high fever

• drooling

• mouth breathing

• changes in voice quality and pain upon speaking

• tripod position

• 3 D’s

  • drooling

  • dysphagia

  • distress

Medical care for epiglottis

• do not place anything in the mouth

• position of comfort

• 15 lpm NRB

• ALS backup and transport

Whooping cough/pertussis

contagious disease characterized by uncontrollable coughing followed by a “whooping” sound

S&S of whooping cough

• history of upper respiratory infection

• sneezing, runny nose, low-grade fever

• malaise

• inspiratory “whoop” at the end of coughing burst

Medical care for whooping cough

• oxygenation NC

• preventing airway obstruction

Activated charcoal dosage

1/2 g/kg PO

Indications of activated charcoal

most oral poisoning

Contraindications of activated charcoal

altered LOC (cannot swallow)

Albuterol dosage

2.5 mg/3 mL via nebulizer PO

1-2 inhalations (0.09-0.18 mg) MDI PO

Indications of albuterol

• suspected bronchospasms

• wheezing

• diminished lung sounds

• asthma

• COPD

Contraindications of albuterol

hypersensitivity

Aspirin dosage

324 mg (baby asprin: 81 mg = 4 tablets) PO

Indications of aspirin

• atraumatic chest pain/discomfort

• mild pain/headache

Contraindications of aspirin

• hypersensitivity

• clear association between chest pain and trauma

Epinephrine dosage

0.3 mg IM: adult

0.15 mg IM: 1-8 y/o

Indications of epinephrine

anaphylactic reaction

Contraindications of epinephrine

• hypersensitivity

• hypertension

Naloxone/Narcan dosage

2-4 mg per nostril IN

0.4 mg IM

Indications of naloxone

• opioid poisoning

• respiratory depression

• pinpoint pupils

Contraindications of naloxone

hypersensitivity

Nitroglycerin dosage

0.3-0.4 mg SL

0.4 mg spray

Indications of nitroglycerin

• atraumatic chest pain

• CHF

Contraindications of nitroglycerin

• hypotension (systolic < 90 mmHg)

• use of meds for sexual dysfunction within 24 hrs

• 150 < pulse <50

Oral glucose dosage

15 g PO

Indications of oral glucose

hypoglycemia

Contraindications of oral glucose

• unable to maintain airway

• trouble swallowing

Oxygen dosage

• 1-6 lpm NC

• 6-8 lpm NEB

• 12-15 lpm NRB

• 15 lpm BVM

Indications of oxygen

• acute hypoxia

• dyspnea/respiratory distress

• signs of shock/hypoperfusion

Contraindications of oxygen

N/A in prehospital setting

Alpha

vasoconstriction

Beta 1

• increases HR

• increases force of heart contraction

• increases speed of electrical impulses in heart

Beta 2

dilation of bronchiole smooth muscle

What does stridor represent?

severe obstruction in the upper airway

e.g. swelling to the larynx

Pathophysiology of asthma

smaller bronchioles collapse when the lungs recoil = difficult/prolonged exhalation = air is trapped in alveoli = wheezing upon exhalation

Main processes of asthma

• bronchospasm: constriction fo the smooth muscle in the bronchi and bronchioles

• edema (swelling) of the inner lining of the airways

• increased secretion of mucus that plugs the airways

Pneumonia

acute infectious disease caused by bacteria/virus that affects the lower respiratory tract

Pathophysiology of pneumonia

infection = lung inflammation and fluid-filled alveoli = poor gas exchange, hypoxemia, cellular hypoxia

CPAP indications

• awake, alert, and oriented enough to obey commands (GCS >10)

• able to maintain their own airway

• able to breathe on their own and has a RR > 25 breaths

• S&S of moderate to severe respiratory distress/early respiratory failure

Examples of causes for CPAP

• CHF

• pulmonary edema

• COPD

• asthma

• pneumonia

Allergic reactions

hypersensitivity reaction caused by exposure to an allergen = localized reaction

Pathophysiology of allergic reactions

immune system detects antigen → IgE (antibody) is created to destroy antigen → IgE releases histamine = S&S

Anaphylaxis

allergic reaction that causes a systemic, multi-system, life-threatening reaction with respiratory failure, circulatory failure, and shock

Indicators of anaphylaxis

acute onset w/involvement of skin and mucosal tissue AND signs of respiratory distress AND/OR S&S of poor perfusion/hypotension

Treatment of anaphylaxis

• airway

• epi (0.3 mg for adults, 0.15 for peds)

• breathing

• circulation

Anaphylactoid reaction

histamine is released the first time the antigen is introdued = sensitization is not required/patient wouldnt have had a prior exposure

Treatment of anaphylactoid reaction

• airway

• epi (0.3 mg for adults, 0.15 for peds)

• breathing

• circulation

Stroke symptoms

FAST, VAN

FAST

facial droop

arm drift

speech

timing

VAN

difference in S&S between SVO and LVO

visual, aphasia, neglect

Visual in VAN

• gaze

• peripheral vision

• pupils + blurry vision

Aphasia in VAN

• understand language

• produce language

Neglect in VAN

• force gaze

• close eyes and ask waht side you are touching

• Do all body parts exist?

Treatment for stroke

• maintain airway

• suction secretions and vomitus

• be prepared to assist ventilation

• maintain adequate oxygenation

• position the patient

  • pt cannot protect their own airway = recovery position

  • pt is responsive = supine position

• check blood glucose level

  • < 70 mg/dL = hypoglycemia

• protect any paralyzed extremities

• rapid transport

• reassessment every 5 min

Routes of toxins

• ingestion

• inhalation

• injection

• absorption

Ingestion

swallowed and absorbed into the GI tract

Inhalation

breathing a substance into the lungs where rapid absorption takes place

Injection

can cause immediate local reaction and more delayed systemic reaction

Absorption

poison can enter the body when it comes in contact with skin/mucous membranes

Commonly ingested toxins

• toxic plants

• food poisoning

• acids/alkalis

• hydrocarbons

• alcohols (methanol, isopropanol)

S&S of ingested acids/alkalis

• Burns/pain to the mouth, lips, face

• Dysphagia (difficulty swallowing, drooling)

• Abdominal pain

• Hoarseness/dysphagia

• Stridor

• Dyspnea

• Shock from perforation of the stomach/esophagus

S&S of ingested hydrocarbons

• coughing, choking, crying

• burns to mouth/contact area

• stridor

• dyspnea

• wheezing

• tachypnea

• cyanosis

• abdominal pain

• N/V

• fever

• seizures

• AMS/coma

• slurred speech

S&S of ingested alcohols

• AMS

• seizures

• N/V

• abdominal pain

• blurred vision

• dilated and sluggish pupils

• seeing spots/blindness

• dyspnea

• tachypnea

Commonly inhaled toxins

• carbon monoxide

• cyanide

• anesthetic gasses

• fumes

• suicide bags

S&S of inhaled carbon monoxide

• AMS

• tachypnea

• headache

• dizziness

• N/V

• high pulse ox reading

Early S&S of inhaled cyanide

• headache

• confusion

• agitation/combative behavior

• burning in mouth/throat

• dyspnea

• hypertension

• bradycardia/tachycardia

• smell of bitter almonds

Late S&S of inhaled cyanide

• seizures

• coma

• hypotension

• pulmonary edema

• cardiac dysrhythmias

• cardiac arrest

• acidosis

S&S of inhaled anesthetic gasses

• nausea

• dizziness

• headaches

• fatigue

• irritability

S&S of inhaled fumes

• tearing eyes

• burning eyes, nose, throat, chest, skin

• headache

• sweating

• blurred vision

• stomach ache

Commonly injected toxins

• snakebites

• stings

• drugs

Commonly absorbed toxins

• poisonous plants

• organophosphates (plant pesticides)

What is SLUDGE/DUMBLES used for?

remember S&S of absorbed organophosphates

SLUDGE

Salivation

Lacrimation

Urinary incontinecne

Defecation

GI pain

Emesis

DUMBLES

Defcation

Urination

Muscle weakeness/myosis

Bradycarida, bronchorrhea, bronchospasm

Lacrimation

Emesis

Salivation

Common drugs and alcohol

• opioids

• stimulants

• cannabis

• hallucinogins

• alcohol

S&S of opioids

• LOC

• slow respirations

• pupil constriction

• nausea

• slow pulse

• decreased BP

S&S of stimulants

• alertness

• mood elevation

• excitement

• pupil dilation

• rapid respirations

• increased pulse

• increased BP

• mania

S&S of cannabis

• euphoria

• relaxation

• disoriented behavior

• tremors

• paranoia

S&S of hallucinogins

• motor disturbances

• anxiety

• paranoia

• delusions

• hallucinations

• poor perception of time and distance

• psychosis

• exacerbation of preexisting issues

S&S of alcohol

• odor of alcohol

• swaying/unsteadiness

• slurred speech

• N/V

• flushed face

• drowsiness

• violence

• self injury

P wave

atria contraction

QRS complex

ventricle contraction

T wave

resting in preparation for next round of atria contraction

AEIOU-TIPPSS (common causes of AMS)

• Alcohol intoxication

• Epilepsy

• Insulin

• Oxygen

• Uremia

• Trauma

• Infection

• Psychiatric

• Poisoning

• Shock

• Stroke

Types of stroke

ischemic stroke: caused by a blockage

hemorrhagic stroke: caused by rupture and bleeding

Types of headaches

• vascular: dilation of vessels = inflammation

• cluster: repeated headaches in clusters

• tension: caused by contraction of muscles in neck and scalp

• organic: symptoms of another condition

Treatment of LVO

thrombectomy (wire in brain pulls clot out)

Difference between SVO and LVO

positive VAN test = LVO

negative VAN test = SVO

Pediatric upper airway distress

croup, epiglottitis, mechanical obstruction

Pediatric lower airway distress

asthma, bronchiolitis