9- main medical emergencies

What basic vs advanced emergency equipment is included in an emergency kit?

Medical emergencies are…why do they occur?

Infrequent and unexpected

Patients take meds for underlying conditions + clinics can be a stressful environment

What 8 emergency drugs are part of the emergency kit?

Oxygen

Aromatic ammonia

Aspirin

Albuterol (bronchodilator)

Glucose

Nitroglycerine

Epinephrine

Diphenyhydramine

ASA classification of patients

ABCDE assessment in emergencies

AIRWAY- Identify any foreign body obstruction and stridor

BREATHING- Check respiratory rate, use of accessory muscles, presence wheeze or cyanosis

CIRCULATION- Assess skin colour, temperatures estimate capillary refill time, assess pulse rate

DISABILITY- check blood glucose, assess consciousness (AVPU- alert, voice, painful stimulus, unresponsive)

EXPOSURE- respect dignity

What is syncope and its causes?

Sudden transient loss of consciousness caused by inadequate cerebral perfusion and oxygenation (hypoxia)

• Low BP by vagal overactivity

• Abrupt changes in posture

• Anxiety/fear at sight of needle/injection

• Extreme pain

• Pregnancy

Prevention of syncope (4)

Talk to patient

Watch their face

Monitor level of anxiety

Encourage them to take time, slowly upright them

How to treat syncope?(11)

Immediately stop treatment

Remove everything from the patient’s mouth

Complete initial assessment- breathing, BP, pulse

Use ammonia inhalants to stimulate breathing and movement if unresponsive

Place the patient in the Trendelemburg position

Administer O2 by nasal cannula (3-5L/min) or by mask (10L/min)

Loosen tight clothing

If the patient is unconscious for >1min, call 112

Start CPR if needed

Reassess the patient’s airway every 30sec

Refer to hospital

What is hypoglycemia and how do you treat it?

Low glucose levels- variable level at which it’s symptomatic- usually around 50mg/dl

More frequently in type 1 diabetics

Confirm diagnosis- measure blood glucose

If in early stages (cooperative, conscious, intact gag reflex)- give oral glucose like surgir, orange juice glucose tablets or gel or milk with sugar- repeat on 10-15min if needed

If severe- give o2, buccal glucose gel, IM glucagon

If worsens- IV 10% dextrose, call 112

What is Hyperglycaemia, etiology and treatment?

High glucose level- common in type 2 diabetics, develops slowly over days

Wrong med dose, excessive glucose intake

Insulin IV, saline solution, hospital

What is asthma and it’s triggering factors?

Inflammatory respiratory disease- attacks of spasms in bronchi in lungs causing difficulty breathing

Connected to allergic reaction or drugs

Anxiety, intense emotions, fear, infection

High risk asthmatics include those indivuals… (4)

Take oral meds in addition to inhaled β2 agonists and corticosteroids

Who regularly use a nebulizer at home

Needed oral steroids for their asthma within last yr

Been admitted to hospital with asthma within last yr

What is the treatment of acute vs severe asthma attack? Bronchospasm?

Stop all treatment immediately

Seat them upright

Use own inhaler first (salbutamol 100mg)

Admin of O2

Severe asthma if doesn’t respond, develops tachycardia, distressed/cyanosed, can’t complete sentence in 1 breath

10 activations of salbutamol inhaler- repeat every 10 min

Corticoids IV (hydrocortisone 100mg)

Bronchospasm- IM adrenaline

What are allergic reactions? Where do the lesions start?

Sensitivities to allergens- contact skin, nose, eyes, respiratory tract, GI tract

Drug allergies start on chest, spread to trunk and back- more significant on face

How do you treat MINOR allergic reactions?

Stop procedure

Position patient comfortably

Monitor vital signs- ABCDE

Use cool compresses

Follow algorithm for management of a mild allergic reaction

How do you mange mild allergic reaction?

What is anaphylaxis? Causes what? Avoid?

Life threatening, generalised or systemic type 1 hypersensitivity reaction

Rapidly developing problems- threaten ABC, skin/mucosal changes

Detail known allergies and severity, avoid allergens

What 7 causal agents may induce anaphylaxis?

Penicillins and other antimicrobials

Latex

Muscle relaxants

NSAIDs

Opioids

Benzodiazepines

Radiographic contrast media

STRICTLY AVOID

What is the treatment of anaphylaxis

More rapid onset= more serious

ABCDE

Tredelemburg position

Admin epinephrine 1:1000– repeat after 5 min if no improvement

If unresponsive to epinephrine- admin glucagon 1-2mg every 5 min (IM/IV)

Admin hydrocortisone 200mg

What is angina pectoris?caused by?

Severe chest pain caused by ischemic to heart

Caused by physical activity/stress/fear/pain— adrenal catecholamine release— causes tachycardia, VC, raised BP

How does angina pectoris present?

Central chest pain or pressure

Pain may radiate to neck, left arm or jaw

Relieved by rest or medication (glyceryl trinitrate (GTN))

Pain lasts 3-5 mins— up to 30 mins

How to treat angina pectoris?

Give o2

Sedatives and anxiolytics

Admin nitrates sublingually (GTN)

If pain doesn’t abate- consider myocardial infarction- give single dose of aspirin (300mg) and continue O2

What is myocardial infarction?

Myocardial cell death due to prolonged ischemia

Similar to angina but more severe and prolonged- partial or no repone to GTN

How does myocardial infarction present?

Severe persistent crushing pain substernal across chest

Radiate to shoulders left arm, neck, jaw and back

No relieve by rest or medication

Pain persists beyond 30 min

How to treat myocardial infarction?

Sublingual GTN spray

Breathlessness in sitting, if faint- lie flat

Give 300mg aspirin

Admin high flow o2

What is cardiac arrest- risk factors and causes?

Heart suddenly stops beating

History of ischemic heart disease, diabetics, older

Hypoxia, drug overdose, anaphylaxis, severe infection or hypotension

Clinical presentation and treatment of cardiac arrest

What is choking and its treatment?

Respiratory obstruction of upper airway by foreign body

Remove objects

If aspiration- cough if conscious

If unable to cough- sharp back blows

Heimlich if isn’t dislodged

What are epileptic seizures

Paroxismo, disturbance on consciousness, behaviour, motor activity

Associated with electrical abnormalities of brian

Epilepsy- chronic neurological condition that causes recurrent seizures

Seizures during fever, infection, toxic, metabolic are REACTIVE seizures

Clinical presentations of epileptic seizures?

Brief warning of aura

Sudden loss of consciousness

Tonic phase- rigid, cries out, cyanoses

Clonic phase- limbs jerk, tongue or lip bitten

Frothing + urinary incontinence

Treatment of epileptic seizure

Ensure not at risk to injury

Don’t put anything in mouth of insert oropharyngeal airway whilst they’re fitting

Put in supine position

Don’t restrain them

How do you provide supportive care for epileptic seizures?

Position on right side to limit aspiration

Remove prosthetics

Observed airway obstruction

Obtain viral signs

Admin o2

Concierge use of drug therapy if over 3 mins- 10mg diazepam, 2mg lorazepam, 2mg Midazolam

What is a stroke and its risk factors?

Cerebro vascular accident- blood supply to part of brain cut off

Over 55, family history, hypertensive individuals

Weakness/numbness/paralysis on 1 side

Slurred or loss of speech, vision disturbed, loss of coordination/consciousness

How to diagnose a stroke?

Ask them to smile, raise both arms, speak simple sentence

How to treat stroke patient?

Check the patient’s pulse:

If CPR is necessary, place the patient in a supine position.

Check patient’s BP and monitor vital signs- if high- lift patient’s head slightly

If the patient becomes unconscious, place him/her in a supine position.

Maintain the patient’s airway and support respiration.

Administer O2, record the vital signs.

Continue CPR or other supportive care until EMS arrive