PEARLS #4

A pt presents with joint and abdominal pain, fatigue, paresthesia, and CNS disturbances. You know this pt has just gotten back from a deep sea dive. What is this pt suffering from?

A pt presents with joint and abdominal pain, fatigue, paresthesia, and CNS disturbances. You know this pt has just gotten back from a deep sea dive. What is this pt suffering from?

Decompression sickness (DCS)

Define paresthesia

An abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves.

What are 3 other names for decompression sickness?

1. Barotrauma

2. “The Bends”

3. Caisson’s disease

Define decompression sickness (DCS)

Injuries caused by a rapid decrease in the pressure that surrounds you, of either air or water. It occurs most commonly in scuba or deep-sea divers, although it also can occur during high-altitude or unpressurized air travel.

In severe cases of decompression sickness (DCS, barotrauma, caisson’s disease, “the bends”) what can pt’s present with?

• pneumothorax

• embolism

• stroke

What is the treatment for decompression sickness (DCS, barotrauma, caisson’s disease, “the bends”)?

Hyperbaric chamber

What is a hyperbaric chamber?

AN enclosed chamber that is fed 100% oxygen. The air pressure inside is raised to a level that is higher than normal air pressure. The increased air pressure in the chamber helps the lungs collect more oxygen.

What is another name for Diabetic Ketoacidosis?

Diabetic Coma

A pt presents with diuresis, dry warm skin, excessive hunger and thirst, malaise, tachycardia, feelings of physical weakness, kussmaul respirations, fruity or acetone smelling breath, hyperglycemia, acidic pH, hypokalemia, decrease mental function, and in extreme cases a coma. All of these symptoms has a slow onset. What is the pt suffering from?

Diabetic Ketoacidosis (Diabetic Coma)

What happens when a pt goes into diabetic ketoacidosis?

Their body begins to burn fat instead of sugar, but it is an incomplete burning of these fats in the liver which produces the acids. This will result in:

• High BG

• Rapid respirations that are deep (kussmauls)

• Warm and dry skin

• Fruity acetone breath

• Hypokalemia

• Potassium problems

What is the main cause of DKA?

A pt has diabetes mellitus type I, and no insulin isa produced

What are 3 classic signs that someone has diabetes mellitus type I?

1. Polyuria

2. Polydipsia

3. Polyphagia

Define Polyuria

Excessive urination (in diabetic pt’s this is due excessive sugar in the blood)

Define Polydipsia

Excessive thirst

Define Polyphagia

Excessive hunger

What are the two most common signs of heat exhaustion?

1. Diarrhea

2. Nausea

What is the Tx for a pt suffering from heat exhaustion?

1. Removal from the hot environment

2. Cooling of the pt (air conditioning, cold/wet towels/sheets)

3. Fluids and electrolytes

What body temp must be present to determine that a pt is suffering from a heat stroke?

105+ degrees

A pt presents with the cessation of sweating, hot skin that is dry or moist, very high core temp, deep respirations that become shallow, rapid respirations that may later become slow, rapid full pulse that may slow later, hypotension with low or absent diastolic reading, confusion or disorientation or unconsciousness, and possible seizures. What is this pt suffering from?

Heatstroke

If a pt is suffering from a heatstroke, why might their skin still be wet despite their cessation of sweating?

The pt may still be wet as a result of the heat exhaustion they experiences leading up to the heatstroke

What is a key sign of heatstroke?

The pt’s pulse becoming bounding/full, then slows and becomes weak as he/she goes into cardiovascular collapse

A pt presents with blunt or penetrating chest trauma, S&S of shock, dyspnea, dull percussion sounds over the site of collecting blood. What is this pt suffering from?

Hemothorax

Define dyspnea

Difficult or labored breathing.

What is the Tx of a hemothorax?

• Administer O2

• Initiate 2 large bore IV’s

• Keep a close eye on lung sounds

Why do you want to keep a close eye on the lung sounds of a pt suffering from a hemothorax?

Commonly, there can be a transition from a hemothorax to a tension pneumothorax

Define tension pneumothorax

A severe condition that results when air is trapped in the pleural space under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function.

If a pt is suffering from a hemothorax, what do they commonly die from before the hemothorax transitions into a tension pneumothorax?

Shock

What’s a hemothorax?

A collection of blood in the space between the visceral and parietal pleura (pleural space)

What is this?

• Pneumothorax

• Hemothorax

• Hemopneumothorax

What is the difference between hyperresonant lungs and hypo resonant lung sounds

• Hyperresonant lung sounds: fill your cheeks with air and tap on them (lung area is full of air)

• Hyporesonant lung sounds: blow out all the air in your cheeks and tap on them (lung area filled with blood or fluids)

What symptom will pt’s present will before they present with signs of respiratory destress from a hemothorax?

Hypovolemic shock

How much blood is a “unit” of blood?

Roughly a pint (525mL, or 0.525L)

With a pt suffering from a hemothorax, how much blood will have to be lost into the lung area before S&S of hypovolemic shock will arise?

Approx. 2 units (2L)

How many units (liters) of blood does the average person have?

Approx. 10 units (1.2-1.5 gallons, 4.5-5.7L)

What is a highly common sign that a pt is suffering from a hemothorax?

Flat jugular veins

What is there most common cause of a hemothorax?

Chest trauma

What are the 3 kinds of pneumothorax?

1. Closed

2. Open

3. Tension

Definitions in picture

What causes a pneumothorax?

An injury to the lung. Injuries can include a gunshot or knife wound to the chest, rib fracture, or certain medical procedures.

If a pt’s body temp is 105+ degrees, what should you immediately suspect and treat for?

Heatstroke

What is the difference between Type I and Type II diabetes mellitus?

• Type I - your pancreas doesn't make any insulin

• Type II - your pancreas doesn't make enough insulin, and the insulin it is making doesn't always work as it should

What is another name for hyperadrenalism?

Cushing syndrome

Whats another name for Cushing syndrome?

Hyperadrenalism

What do these symptoms represent?

Cushing syndrom (hyperadrenalism)

What hormone is affected the most with a pt suffering from hyperadrenalism (Cushing syndrome)?

Cortisol (too much of it)

What is cortisol?

The primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain's use of glucose and increases the availability of substances that repair tissues. Cortisol also curbs functions that would be nonessential or harmful in a fight-or-flight situation.

A pt presents with recent weight gain (usually a lot of weight), a moon face appearance, buffalo hump (fat pad around C7), thinning or almost transparent skin (bruises easily), mood swings, and impaired memory or concentration. What is this pt suffering from?

Hyperadrenalism (Cushing syndrome)

A pt presents with diaphoresis, increased skin temp, flushing, erythema (superficial reddening of the skin, usually in patches), altered level of consciousness. What is this pt suffering from?

Hyperthermia

What is another name for hypoglycemia?

Insulin shock (type I)

What does IDDM stand for?

Insulin dependent diabetes mellitus (type I)

A pt presents with altered mental status, early signs (restless, impatient, complaint of hunger), bizarre behavior, diaphoresis, tachycardia, hypoglycemic seizure (possible comatose), and has a quick onset. What is this pt suffering from?

Hypoglycemia

What is insulin shock?

A type of hypoglycemia (refers specifically to a person with diabetes type 1 who takes too much insulin and it drives the sugar out of the bloodstream or they take the normal amount of insulin then throw up or something to put them in an insulin dominant position > sweaty, irrational, altered mental status, cool skin

What is the body temp range from a pt in MILD hypothermia?

90-95 degrees

What is the body temp range from a pt in SEVERE hypothermia?

Below 90 degrees (<90)

S/S of hypothyroidism

Fatigue, decreased mental function, lethargy, cold intolerance, constipation, decreased appetite with increased weight gain, an intolerance of cold very tolerant of heat

Another name for hypothyroidism

Myxedema

What disease state causes a decrease in core temperature (classism registry question)?

Hypothyroidism

A pt presents with altered mental status, one to two word dyspnea, cyanosis, hemoptysis (coughing up blood), hypoxia, cough, dyspnea, hoarseness, vague chest pain, fever and chills, pleuritic chest pain, crackles, wheezes, diminished breath sounds heard in affected lung > severe signs > cachexia, profound weight loss, what is this pt suffering from?

Lung Cancer

Define pleuritic chest pain/inflammation

The pleura — two large, thin layers of tissue that separate your lungs from your chest wall — becomes inflamed. Also called pleuritis, pleurisy causes sharp chest pain (pleuritic pain) that worsens during breathing.

Define cachexia

Weakness and wasting of the body due to severe chronic illness.

What are the two main causes of lung cancer?

Smoking and genetics

How do people with lung cancer generally die?

A wasting (cachexia) away of the muscles

What are some complications that pt’s with lung cancer have?

These people have many pulmonary embolisms and bleeding out due to cancer infringing on a large vessel in the lungs

A pt presents with intense local pain/swelling, weakness, nausea and vomiting, dyspnea, tachycardia, hypotension or shock (severe). What is this pt suffering from?

Marine animal injection (Jelly fish)

What is a Tx for a pt who have been stung/injected by a marine animal (jelly fish)?

Establish/maintain airway, apply a constricting band between the wound and heart no tighter than a watchband to occlude lymphatic flow only, apply heat or hot water, inactivate or remove any stingers

Why would you pour hot water or put a hot pack on a marine animal (jelly fish) wound/injection?

Venom designed to interact with other marine animals > oceans arecold so the venom is designed to operate at the cooler temperature > heat the area to disable the venom (hot pack)

A pt presents with full body rash, hacking cough, runny nose, high fever, watery red eyes, koplik’s spots (small red spots with blue white centers that appear inside the mouth). What is this pt suffering from?

Koplik’s Spots

What is this?

Measles

A pt presents with high fever, headache, stiff neck, nausea and vomiting, discomfort looking into bright lights, confusion, sleepiness, seizures (late), rash on the thorax (meningococcal rash). What is this pt suffering from?

Meningitis

If a 6 year old kid has a high temp for 2 days, what should you first suspect?

Meningitis

How is meningitis spread?

Airborne

A pt presents with these three S/S, what should you suspect?

Menengitis

A pt presents with chest pain, elevated blood pressure during episodes, chest pain lasts more than 30 minutes, pain can radiate to arms, neck and posterior to the back, acute onset of nausea and vomiting, nitroglycerin and rest offer no/ little relief, frightened, “feeling of impending doom”, what should you suspect?

Myocardial Infarction

What is the difference between and MI and angina?

With an MI, there is tissue death of the myocardium, with angina, there is no tissue death

What is the classic sign of MI?

Crushing substernal chest pain

Does nitro help with pain in a pt having an MI?

No

What unusual locations can pain radiate to with an MI?

Jaw and teeth

Where does the pain from an MI generally radiate to in women?

Stomach (will feel like a bad stomach ache), women generally don’t feel substernal chest pain during an MI

Women generally don’t feel chest pain during an MI, what other groups usually don’t feel chest pain during an MI?

• Old

• Diabetics

What assessment should you always do with a pt suspected of having an MI?

Always listen to the lungs for pulmonary edema (#1 cause is left side failure) most heart attacks occur in the left ventricle

What is the #1 cause of an MI?

Left side heart failure

A pt presents with fever, headache, loss of appetite, swelling and pain in the parotid glands. What is this pt suffering from?

Mumps

What is this?

Mumps

A trauma pt presents with penetrating chest trauma (3mm or bigger), sucking chest wound, frothy blood at wound site, dyspnea, hypovolemia. What is this pt suffering from?

Open Pneumothorax

What is the Tx for a pt suffering from an open pneumo?

High flow O2, cover opening with sterile occlusive dressing taped on 3 sides

What is the Tx for a sucking chest wound?

Place a gloved hand over the injury then an occlusive dressing and monitor for signs of a tension pneumo

Study

Open pneumothorax

Study

Tension pneumothorax

A pt presents with tremors, rigidity, bradykinesia (defined=slow movement/halts), postural instability, frozen facial features, shuffled gait. What is this pt suffering from?

Parkinson’s disease

Define bradykinesia

Slowness of movement and speed (or progressive hesitations/halts) as movements are continued

What stage of life does Parkinson’s disease usually occur?

The 5/6 decade of life (geriatrics)

What causes Parkinson’s disease?

Lack of dopamine in brain (neurotransmitter)

What is the Tx for Parkinson’s disease?

Give dopamine as a supplement

A pt presents with dyspnea, possible cyanosis, JVD → muffled heart tones → decreasing blood pressure (Beck’s Triad), shock, narrowing pulse pressure, weak thread pulse. What is this pt suffering from?

Pericardial Tamponade

How do you differentiate between a pt suffering from pericardial tamponade and a pt suffering from a tension pneumo?

Breath sounds - tension pneumo would be diminished on one side → tamponade would be equal

What causes a Pericardial Tamponade?

A bleed or medical problem such as right side failure (venous system leak into pericardium) or pericarditis which would cause some fluid to enter this space

What abnormality on an ECG would indicate the pt is suffering from pericardial tamponade?

Nonsensical ST changes across the board

What does this ECG indicate?

Beck’s Triad

What 3 characteristics make up Beck’s Triad?

1. JVD

2. Hypotension

3. Muffled heart sounds

What is the #1 cause of bleeding in third trimester?

Placenta previa

What is placenta previa and what is the key sign to look for when assessing?

Definition: a condition in which the placenta partially or wholly blocks the neck of the uterus, thus interfering with normal delivery of a baby

Key sign: painless bright red vaginal bleeding