EMT Signs and Symptoms Block 2

Emphysema

Pathophysiology- a disease of the lungs in which there is extreme dilation and damage in the air sacs in the lungs (alveoli). Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

Sign and Symptoms-

Frequent coughing or wheezing.

A cough that produces a lot of mucus.

Shortness of breath, especially with physical activity.

A whistling or squeaky sound when you breathe.

Tightness in your chest.

Thin appearance with barrel chest

"Puffing" (pursed lip) style of breathing

Tripod position

Risk Factors

Exposure to air pollution

Breathing secondhand smoke

Working with chemicals, dust and fumes

A genetic condition called Alpha-1 deficiency

A history of childhood respiratory infection

Treatment

ADMINISTER OXYGEN, BRONCHODILATORS, CORTICOSTEROIDS AND CPAP. ASSIST VENTILATION WITH CAUTION FOR PATIENTS IN RESPIRATORY FAILURE

Simple Pneumothorax (pneumothorax means collapsed lung)

Pathophysiology- any pneumothorax that is free from significant physiologic changes and does not cause drastic changes in the vital signs of the patient

Signs and Symptoms

chest pain that usually has a sudden onset.

The pain is sharp and may lead to feelings of tightness in the chest.

Shortness of breath,

rapid heart rate,

rapid breathing,

Cough,

fatigue

Risk Factors

Smoking. The risk increases with the length of time and the number of cigarettes smoked, even without emphysema.

Genetics. Certain types of pneumothorax appear to run in families.

Lung disease

Mechanical ventilation

Treatment

Provide high concentration of oxygen

Monitor oximeter readings and breaths

Treat underlying cause of the injury

Asthma

Pathophysiology- an acute spasm of the smaller air passages, called bronchioles (or bronchi or the small tubes that are attached to the alveoli), associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages

Sign and Symptoms-

Shortness of breath.

Chest tightness or pain.

Wheezing when exhaling

Trouble sleeping caused by shortness of breath, coughing or wheezing.

Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu.

Risk Factors-

Family history.

Viral respiratory infections

Allergies

Occupational exposures

Smoking

Air Pollution

Obesity

Treatment-

Depending on protocols, EMT may be allowed to assist a patient with an inhaler or nebulizer. Listen carefully to what a patient tells you; they often know exactly what they need

Pneumonia

Pathophysiology- an infectious disease of the lung that damages lung tissue; its cause can be bacterial, viral, or fungal

Signs and Symptoms-

Fever.

Chills.

Cough, usually with phlegm (a slimy substance from deep in your lungs)

Shortness of breath.

Chest pain when you breathe or cough.

Nausea and/or vomiting.

Diarrhea

Risk Factors-

Being hospitalized. You're at greater risk if you're in a hospital intensive care unit, especially if you're on a machine that helps you breathe (a ventilator).

Chronic disease. You're more likely to get this if you have asthma, chronic obstructive pulmonary disease (COPD) or heart disease.

Smoking. Smoking damages your body's natural defenses against the bacteria and viruses that cause this disease

Weakened or suppressed immune system. People who have HIV/AIDS, who've had an organ transplant, or who receive chemotherapy or long-term steroids are at risk.

Treatment-

Airway support and supplemental oxygen

Use appropriate adjuncts

Evaluate patient treatment through reassessment and prepare for possible deterioration in the patient's condition

Pulmonary Edema

Pathophysiology- a buildup of fluid in the lungs, usually as a result of congestive heart failure

Signs and Symptoms

cough, often with a pink frothy sputum.

excessive sweating.

anxiety and restlessness.

feelings of suffocation.

pale skin.

Wheezing.

rapid or irregular heart rhythm (palpitations)

chest pain

Risk Factors-

Central nervous system injury.

Coronary heart disease.

Diabetes (chronic disease that affects your body's ability to use sugar for energy)

High altitude.

Hypertension (high blood pressure)

Infection.

Inhaled toxins.

Obesity.

Treatment-

Noninvasive ventilation

Nitroglycerin

Hypertensive Emergency

Pathophysiology- an emergency situation created by excessively high blood pressure, which can lead to serious complications such as stroke or aneurysm.

Signs and Symptoms-

Severe chest pain.

Severe headache, accompanied by confusion and blurred vision.

Nausea and vomiting.

Severe anxiety.

Shortness of breath.

Seizures.

Unresponsiveness.

Risk Factors-

Forgetting to take your blood pressure medication.

Stroke.

Heart attack.

Heart failure.

Kidney failure.

Rupture of your body's main artery (aorta)

Interaction between medications.

Convulsions during pregnancy (eclampsia)

Treatment-

Monitor blood pressure

Position the patient with the head elevated and transport rapidly to the ED.

Consider ALS assistance for the patient. Paramedics can administer medication

Obstructive Shock

Pathophysiology- shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body's tissues.

Signs and Symptoms-

Airway: may have compromised the airway if level of consciousness is decreased.

Breathing: increased work of breathing and respiratory rate; respiratory distress.

Circulation: tachycardia, cyanosis, chest pain, and hypotension

Disability: decreased level of consciousness.

Exposure: cool extremities.

Risk Factors-

tension pneumothorax

pulmonary embolism

cardiac tamponade.

There are also several congenital abnormalities. Examples include critical aortic stenosis and coarctation of the aorta.

Treatment-

ALS assist and/or rapid transport

Administer high-flow oxygen

Anaphylactic Shock

Pathophysiology- occurs when a person reacts violently to a substance to which he or she has been sensitized.

Signs and symptoms-

Can develop with seconds

Mild itching or rash

Burning skin

Vascular dilation

Generalized edema

Coma

Rapid death

Risk Factors

Extreme life threatening allergic reaction

Treatment

Manage the airway

Assist ventilations

Administer high-flow oxygen

Determine cause

Assist with administration of epinephrine

Transport promptly

Consider ALS

Septic Shock

Pathophysiology- occurs as a result of severe infections, usually bacterial, in which toxins (poisons) are generated by the bacteria or by infected body tissues.

Signs and Symptoms-

Warm skin or fever

Tachycardia

Low blood pressure

Risk Factors-

Severe bacterial infection in the blood

Treatment-

Transport promptly

Administer high-flow oxygen

Assist ventilations

Keep patient warm

Consider ALS

Neurogenic shock

Pathophysiology- is usually the result of high spinal cord injury. can lead to organ dysfunction and eventual death

Signs and Symptoms-

Bradycardia (slow pulse)

Low blood pressure

Signs of neck injury

Priapism

Risk Factor

Damaged cervical spine, causes widespread blood vessel dilation

Treatment-

Secure airway

Spinal immobilization

Assist ventilations

Administer high-flow oxygen

Preserve body heat

Transport promptly

Consider ALS

Psychogenic shock

Pathophysiology- a sudden reaction of the nervous system that produces a temporary, generalized vascular dilation (widening blood vessels causing hypotension), resulting in fainting or syncope

Signs and Symptoms-

Rapid pulse

Normal or low blood pressure

Risk Factors

Temporary, generalized vascular dilation

Anxiety

Bad news

Sight of injury or blood

Prospect of medical treatment

Severe pain

Illness

Tiredness

Treatment

Determine duration of unconsciousness

Position the patient supine

Record initial vital signs and mental status

Suspect head injury if patient is confused or slow to regain consciousness

Transport promptly

Chronic Bronchitis

Pathophysiology-

is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs (the big tubes). People who have this often cough up thickened mucus, which can be discolored. It may be either acute or chronic.

Chronic: a more serious condition, is a constant irritation or inflammation of the lining of the bronchial tubes, often due to smoking

Acute: also called a chest cold, usually improves within a week to 10 days without lasting effects, although the cough may linger for weeks.

Sign and symptoms-

Frequent coughing or a cough that produces a lot mucus. (compared to asthma)

Wheezing.

Chills

General malaise

headache

A whistling or squeaky sound when you breathe.

Shortness of breath, especially with physical activity.

Tightness in your chest.

Risk Factors-

Smoking. This the main risk factor

Long-term exposure to other lung irritants,

such as secondhand smoke, air pollution,

and chemical fumes and dusts from the environment or workplace.

Age

Genetics

Treatment-

Assist with the patient's prescribed inhaler

Prompt transport to the ED

Allow them to sit upright if this is most comfortable

Spontaneous Pneumothorax

Pathophysiology- a pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space.

Signs and Symptoms-

chest pain that usually has a sudden onset.

The pain is sharp and may lead to feelings of tightness in the chest.

Shortness of breath,

rapid heart rate,

rapid breathing,

Cough

Risk Factors-

Chronic lung infections

Young people born with weak areas of the lung

emphysema

Asthma

Tall, thin men; particularly while performing strenuous activities

Treatment

Provide supplemental oxygen

Prompt transport to ED

Monitor the patient carefully

Support ABC'S

Provide CPR if necessary

Pulmonary Embolism

Pathophysiology- a blood clot that breaks off from a large vein and travels to the blood vessels of the lung causing obstruction of blood flow. These blood clots most commonly come from the deep veins of your legs, a condition known as deep vein thrombosis (DVT)

Signs and Symptoms-

Sudden shortness of breath (most common)

Chest pain (usually worse with breathing)

A feeling of anxiety.

A feeling of dizziness, lightheadedness, or fainting.

Irregular heartbeat.

Palpitations (heart racing)

Coughing or coughing up blood.

Sweating

Risk Factors-

prolonged bed rest or inactivity, including long trip in a car or in a plane.

using oral contraceptives (birth control pills)

Surgery.

pregnancy - before, during and after delivery.

Cancer.

Stroke.

heart attack.

heart surgery.

Treatment-

Place in comfortable position

Suction coughed up blood

Supplemental oxygen

Prompt transport to ED

Tuberculosis

Pathophysiology- a chronic bacterial disease that usually affects the lungs but can also affect other organs such as the brain and kidneys; it is spread by cough and can lie dormant in a person's lungs for decades and then reactivate.

Signs and Symptoms-

Coughing that lasts three or more weeks.

Coughing up blood.

Chest pain, or pain with breathing or coughing.

Unintentional weight loss.

Fatigue.

Fever.

Night sweats.

Chills.

Risk Factors-

Contacts with people who have been recently infected

Persons with medical conditions that weaken the immune system

Treatment-

protect yourself with an N95 respirator face mask.

If you learn during your patient history that a patient is taking isoniazid (INH) and rifampin, assume they are being treated for this disease and do the same.

Rapid transport

Notify receiving ED of patients medical history

Myocardial Infarction

Pathophysiology- this usually occurs when a blood clot blocks blood flow to the heart. The interrupted blood flow can damage or destroy part of the heart muscle, losing oxygen and dies.

Signs and Symptoms-

pressure or tightness in the chest.

Pain in the heart region on the left side, radiating to left shoulder

"Squeezing or crushing pain"

pain in the chest, back, jaw, and other areas of the upper body that lasts more than a

few minutes or that goes away and comes back.

shortness of breath.

Sweating, nausea, vomiting

Pink, frothy sputum

Pale, cool, and diaphoretic skin

Risk Factors-

high blood pressure,

Smoking,

Diabetes,

lack of exercise,

Obesity,

high blood cholesterol

poor diet

excessive alcohol intake

Treatment-

Nitroglycerin per protocol

High flow oxygen per non-rebreather mask

Immediate transport via position of comfort

Aortic Dissection (AAA and Thoracic Angina Pectoris)

Pathophysiology- is a medical emergency in which the inner layer of the large blood vessel branching off the heart (aorta) tears. It's most common in men in their 60s and 70s.

Signs and Symptoms-

sudden, severe chest or upper back pain that radiates to the neck or down the back,

Pulsating mass in abdomen

Indigestion

Weakness

Sweating

Lower pulses and blood pressure

Risk Factors-

Uncontrolled high blood pressure (hypertension)

Hardening of the arteries (atherosclerosis)

Weakened and bulging artery (pre-existing aortic aneurysm)

An aortic valve defect (bicuspid aortic valve)

A narrowing of the aorta at birth (aortic coarctation)

Treatment-

Transport in position of comfort

ensuring adequate airway and ventilation,

providing oxygen via a non rebreather mask,

Difficult to diagnose outside of the hospital, but consider when patient has hypertension and back pain

Hypovolemic Shock

Pathophysiology- a condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion.

Signs and Symptoms-

Rapid, weak pulse

Low blood pressure

Change in mental status

Cyanosis

Cool, clammy skin

Increased respiratory rate

Risk Factors

Loss of blood or fluid

Treatment

Secure airway

Assist ventilations

Administer high-flow oxygen

Control external bleeding

Keep warm

Transport promptly

Consider ALS

Hemorrhagic Shock

Pathophysiology- occurs when the body begins to shut down due to large amounts of blood loss

Signs and Symptoms-

Anxiety.

blue lips and fingernails.

low or no urine output.

profuse (excessive) sweating.

shallow breathing.

Dizziness.

Confusion.

chest pain.

Risk Factors-severe burns., deep cuts, gunshot wounds, Trauma., amputations.

Cardiogenic Shock

Pathophysiology- occurs when your heart cannot pump enough blood and oxygen to the brain, kidneys, and other vital organs

Signs and Symptoms-

Chest pain

Irregular pulse

Weak pulse

Low blood pressure

Cyanosis

Cool, clammy skin

Anxiety

Crackles

Pulmonary edema

Risk Factors-

Heart attack--main risk factor

Inadequate heart function

Disease of muscle tissue

Impaired electrical system

Disease of injury

Treatment-

Position comfortably

Administer high-flow oxygen

Assist ventilation

Transport promptly

Consider ALS

CHF, congestive heart failure (Right Sided vs Left Sided)

Pathophysiology- occurs when your heart muscle doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently. organic, not trauma

Left-sided: Fluid may back up in your lungs, causing shortness of breath.

Right-sided: Fluid may back up into your abdomen, legs and feet, causing swelling.

Signs and Symptoms-

Shortness of breath (dyspnea) when you exert yourself or when you lie down.

Fatigue and weakness.

Swelling (edema) in your legs, ankles and feet.

Reduced ability to exercise.

Persistent cough or wheezing with white or pink blood-tinged phlegm.

Increased need to urinate at night.

Risk Factors-

History of coronary artery disease and /or atrial fibrillation

Treatment

Assist with any prescribed medications (diuretics and antihypertensives)

High flow oxygen (10-15 L/min) via non-rebreather mask

Administer nitroglycerin per protocol

Immediate transport in high fowler's position

Avoid supine, can cause pulmonary congestion

Angina Pectoris

Definition: chest pain caused by reduced blood flow to the heart. is often described as squeezing, pressure, heaviness, tightness or pain in your chest

Signs and Symptoms: include chest pain and discomfort, possibly described as pressure, squeezing, burning or fullness. You may also have pain in your arms, neck, jaw, shoulder or back.

Risk Factors: tobacco use, diabetes, high blood pressure, lack of exercise, obesity, stress

Treatment:

Stable- usually triggered by physical activity. Can get better after rest or

Unstable- blood vessel rupture or a blood clot forms

administering nitroglycerin, oxygen, and aspirin