my lifw sucks

CH 17: CV EMERGENCIES

Discuss the basic anatomy/physiology of the CV system.

• Heart:  

o Atrium: upper chambers that receive blood

o Ventricles: lower chambers that pump outgoing blood

o Aorta: body’s main artery that receives blood ejected from the LV and delivers it to all other arteries to the body

o Right side of heart receives O2 poor blood, left side receives O2 rich blood

o Cardiac muscles have automaticity.  Impulses start at the SA node from the ANS (further divided into the sympathetic NS (fight or flight) and parasympathetic NS (brings you back down from fight or flight)

o Myocardium (heart muscle) pumps blood and must have continual supply of O2 and nutrients

o Coronary arteries supply blood to heart muscle, beginning at the aortic valve.

o Vena cava (superior/inferior) carries blood back from the body to the heart

o Blood pressure is the force of circulation blood against the walls of the arteries (systolic/diastolic)

o Cardiac output = heart rate x stroke volume = volume of blood that passes thru the heart in 1 minute

Discuss the pathophysiology of the CV system, esp in regard to atherosclerosis heart disease and CHF:

• Atherosclerosis is a disorder where Ca and cholesterol build up and form a plaque inside the walls of BVs, obstructing flow & interfering w/ their ability to dilate/contract

o Can cause complete occlusion (blockage) of a coronary artery

▪ Thromboembolism: blood clot that is floating thruBVs until it reaches and area too narrow to pass, causing it to stop and block the blood flow at that point.  Tissues downstream experience hypoxia and will die eventually if not treated

▪ AMI (acute myocardial infarction) is a heart attack: blockage in coronary artery.  Infarction is death of tissue.  If heart stops completely = cardiac arrest

• CHF: when ventricular myocardium is so damaged that it can no longer keep up with the return flow of blood from the atria

o Can be caused by an MI, heart valve damage, long-standing high BP or any other condition that weakens the pumping strength of the heart

o Heart tries to maintain adequate output so heart rate increase and LV enlarges to increase the amt of blood pumped in each minute

▪ Left side failure: lungs become congested w/ fluid because blood backs up in pulmonary veins.

• Severe cases have pink frothy sputum, pulmonary edema and sever dyspnea

▪ right side failure: fluid collects in the body: edema in feet/legs

▪ left side failure often leads to right side failure

Give the indications, contraindications and side effects for aspirin & nitro.

• Aspirin: prevents new clots from forming or existing clots from getting bigger, makes blood slippery

o Indications: pt experiencing chest pain/discomfort

o Contraindications: pt is under 19 yro, known hypersensitivity/allergy to ASA, bleeding disorder, 325 mb ASA takin in the past 24 hrs, suspicion of thoracis or AAA, pregnancy, ASA is expired

o Adverse effects: anaphylaxis, nausea, bleeding, angioedema, vomiting, stomach irritation

• Nitro: relieves pan of angina by relaxing the muscle of BV walls, dilates coronary arteries, increases blood flow and supply of O2 to heart to decrease workload of heart.

o Indications: pt experiencing chest pain/discomfort

o Contraindications: 3 doses of nitro w/in a 15 minuteperiod prior to or during this episode, systolic BP < 100, recent head injury, ED drugs w/in last 72 hrs, nitro is expired

o Adverse effects:  headache, CV collapse, lightheadedness, methemoglobinemia, bradycardia, flushing, hypotension

Discuss the procedures to follow for standard operation of the various types of AEDs.

• Take standard precautions, scene safety, question bystanders.  Unresponsive patient, begin 30:2 chest compression to breath ratio until AED arrives and is ready.

• Turn on AED and apply pads

• Push analyze button, stop CPR when AED instructs you to

• If shock is advised, state aloud “clear”, make sure no one is touching the pt and push shock button.  Continue CPR for 5 cycles after shock is delivered w/out stopping.  If no shock advised, continue COR immediately

• After 5 cycles, pause CPR and allow AED to analyze. Repeat above steps

Describe the components of care following AED shocks.

• Follow local protocols

• If ROSC is regained: maintain pt and transport or pass care to ALS

• No pulse, AED indicates no shock advised: continue CPR immediately

• No pulse, AED indicates shock advised, follow instructions and continue CPR thereafter

• Don’t transport (CPR less effective while moving), wait for ALS while continuing CPR

• If ALS doesn’t respond and local protocols agree, only begin transport when pt regains a pulse, 6-9 shocks delivered or AED give 3 consecutive messages (separated by 2 min of CPR) that no shock is advised on pulseless pt

Explain how a LVAD works and what you would find w/ a pt who has one.

• Used to enhance the pumping of the LVV in pts with severe heart failure or in pts who need a temporary boost due to a MI.  

• Unit has internal pump and external battery pack

• Pumps are continuous so pt may not have palpable pulse

Describe the A&P, pathophysiology, assessment & management of angina pectoris and the difference b/w this and AMI.

• Angina: for a brief time, heart tissues aren’t getting enough O2 causing pain (heart’s need for O2 exceeds supply)

o Can result from spasm of artery or is a symptom of atherosclerotic coronary artery disease.

o Can occur during periods of stress/fear or after a large meal

o Pain described as crushing/squeezing, usually mid-chest under the sternum, but can radiate to jaw or arms.

o Usually lasts 3-8 minutes

o Dyspnea, nausea, sweating

o Usually disappears w/ supplemental O2, rest or nitro

o Heart cells are not dying, but could be a warning b/celectrical system is compromised b/c O2 to heart is diminished

• AMI: pain of AMI signals the actual death of heart muscle cells where blood flow is obstructed

o May or may not be caused by exertion, but can occur at any time

o Doesn’t resolve in a few minutes, can last 30 min +

o May or may not be relieved by rest or nitro

o Sudden onset of weakness, nausea, sweating, chest pain, discomfort, crushing/squeezing pain that does not resolve, pain/pressure in lower jaw, arms, back, abdomen or neck, irregular heartbeat, syncope, dyspnea, pink frothy sputum, sudden death

Recognize that all patients in cardiac arrest require an electric shock and know what to do if you get “no shock advised”

• Follow AED instructions

• If no shock advised, perform 5 cycles (2 min) of CPR(30:2), reanalyze.  If no shock advised, advised, continue CPR, transport pt and contact medical control

Explain the reason not to touch the patient while AED is analyzing and delivering shocks.

• touching can interfere with the analysis, potentially leading to an inaccurate reading or preventing the AED from delivering a necessary shock

• Don’t touch while a shock is being delivered because you could be shocked

CH 18: NEUROLOGIC EMERGENCIES

Discuss the different types of headaches, the possible causes of each and how to distinguish a harmless headache from a potentially life-threatening condition.

• Tension headache: caused by muscle contractions in the head/neck

o Attributed to stress

o Squeezing, dull pain or ache

o Typically does not have associated symptoms and doesn’t require medical attention

• Migrane: caused by changes in BV size in the base of the brain, mostly in women

o Pounding, throbbing or pulsating, nausea/vomiting, may be preceded by visual warning signs

o Pt will frequently have a history of migraines.

o Ask pt if this episode is similar to past migranes

• Sinus headache: caused by pressure resulting from fluid accumulation in the sinus cavities

o Pt may have cold like symptoms: congestion, cough and fever if sinus infection

o Increased pain when they bend over

o Usually self-limiting and prehospital emergency care is not required

• Headache red flags:

o Sudden onset

o Described as worst headache of their life

o Explosive/thunderclap pain

o Altered mental status

o 50 yro +

o Depressed immune system

o Neurologic deficits

o Neck stiffness/pain

o Fever

o Changes in vision

o One-sided paralysis/weakness

• Explain the care, treatment and transport of patients who are experiencing headaches or stroke

o See above for individual non-life threateningheadaches

o Sudden onset headaches described as the worst of my life is a sign of a hemorrhagic stroke.  Could also present with seizures and altered mental status.  Manage XABCs and transport immediately

o Headaches associated with stiff neck, fever and sensitivity to light could be bacterial meningitis.  Use standard precautions, support XABCs and rapid transport.  Provide a quiet and dark environment, avoiding lights & sirens if possible

o Stroke care: support XABCs, place pt’s affected extremity in secure & safe position, talk to patient at all times, rapid transport to stroke center and notify hospital of your arrival

• Explain the various ways blood flow to the brain may be interrupted and cause a CVA.

o Thrombosis: clot forms at site of blockage

o Embolus: blood clot forms in remote area and travels to site of blockage

o Atherosclerosis: calcium & cholesterol build up, forming plaque inside the walls of BVs, which can eventually cause complete occlusion

• Discuss the causes, similarities and differences of an ischemic, hemorrhagic and TIA.

o Ischemic: when blood flow to a specific part of the brain is stopped by a blockage inside the BV (thrombosis, embolus, atherosclerosis)

o Hemorrhagic: results from bleeding inside the brain(extremely high BP, aneurysm or chronic high BP)

o TIA: stroke-like symptoms that resolve on their own in < 24 hrs.  Caused by obstructed blood flow to brain due to atherosclerosis or a small blood clot

o Similarities: all have many of the same symptoms, and emergency care is the same.

o Differences: causes (as noted above), hemorrhagic is quick, massive and often fatal

• List the general signs & symptoms of stroke.  Explain aphasia & dysarthria.

o Facial drooping

o Sudden weakness/numbess in face, arm, leg or one side of the body

o Decreased/absent movement & sensation on one side of the body

o Lack of muscle coordination (ataxia)/loss of balance

o Sudden vision loss in 1 eye; blurred/double vision or abnormal eye mvmts

o Difficulty swallowing

o Decreased level of responsiveness

o Speech disorders

o Aphasia: difficulty expressing thoughts or inability to use the right words (expressive aphasia) or difficulty understanding spoken workds (receptive aphasia)

o Dysarthria: slurred speech

o Sudden & severe headache

o Confusion

o Dizziness/Weakness

o Combativeness

o Restlessness

o Tongue deviation

o Coma

• List 3 conditions with symptoms that mimic stroke and the assessment techniques EMTs may use to ID them.

o Hypoglycemia: find out if pt’s medical history includes diabetes, check blood glucose level

o Postictal state: in most cases, a pt who has had a seizure will recover rapidly, w/in several minutes.  Does pt have a history of seizures?

o Subdural or epidural bleed: usually caused by trauma, inquire about recent injuries – could’ve been days ago

• Discuss the importance for EMTs to recognize when a seizure is occurring or whether one has already occurred.

o You must determine if this episode differs from previous episodes

o Upon arrival, most patients will be in postictal state, but if still experiencing a seizure, assess and treat XABCs

• Define altered mental status; include possible causes and the patient assessment considerations that apply to each.

o Patient is not thinking clearly or is incapable of being awakened

o Possible causes

▪ Hypoglycemia: this pt may also experience seizures, however a pt with seizure not caused by hypoglycemia will recover soon after postictal state and a hypoglycemic pt will not.  It can also be confused with a head injury, Look for medical jewelry or medications

▪ hypoxemia,

▪ intoxication,

▪ delirium: symptom not a disease, that is a temporary state that often has a physical or mental cause

▪ drug OD,

▪ head injury,

▪ brain infection,

▪ body temp abnormalities,

▪ brain tumors,

▪ poisoning

o Most significant difference between a patient w/ altered mental status and other emergencies is that a pt w/ altered mental status cannot reliably tell you what is wrong, and there may be more than one cause.

• Explain how to use stroke assessment tools to rapidly identify a stroke patient; include 2 commonly used tools.

o BE FAST: balance, eyes, face, arms, speech and time of onset

o Glasgow Coma Scale (page 745)

• List the psychological (I bet this should readphysiological) and metabolic causes of a seizure.

o Metabolic: hypoxia, abnormal blood chemical values, hypoglycemia, poisoning, drug OD, sudden withdrawlfrom alcohol/drugs (DTs)

o Physiological: tumor, infection, scar tissue from injury, head trauma, stroke

o Epilepsy is congenital, Febrile is from sudden high fever (in kids mostly)

CH 19: GI AND UROLOGIC EMERGENCIES

• Describe pathologic conditions of the GI, genital and urinary systems

▪ GI: Acute abdomen: sudden onset of abdominal pain. Nerves from spinal cord supply skin of abdomen and parietal peritoneum so these parts can easily identify and localize a point of irritation.  Visceral peritoneum is supplied by the ANS, so these areas are far less able to localize sensation.  Pt may not be able to describe exactly where the pain is located.

• Peritonitis: irritation of the peritoneum caused by any foreign material (blood, pus, bile, pancreatic juice, amniotic fluid).  This associated loss of body fluid decreases volume of circulatiing blood and may lead to decreased BP/shock

• Diverticulitis: inflammation in small pockets at weak areas in the muscle walls of intestines.  This is the most common cause of lower GI bleed in USA.  Symptoms are abdominal pain in left side of lower abdomen, fever, malaise, body aches, chills, nausea & vomiting.

• Ulcers: peptic ulcer disease (PUD): protective layer of mucus in stomach and duodenum is eroded allowing acid to eat into organs.  Can lead to gastric bleeding, resulting in hematemesis and melana.

• Gallstones: block the outlet of the gallbladder.  Can cause cholecystitis (inflammation of walls of the gall bladder).  Pt presents w/ constant, severe pain in upper right/midabdominal region, and may refer to the right upper back, shoulder area, flank.  Gall bladder could rupture, spreading inflammation and irritation surrounding structures such as the diaphragm and bowel.

• Pancreatitis: inflammation of the pancreas which can be caused by gallstones, alcohol abuse and other diseases.  Pt presents w/severe pain in ULQ & URQ, which may radiate to the back.  Pain may be worse after eating and may also have nausea, vomiting, abdominal distention and tenderness.  Canresult in sepsis or hemorrhage, along with fever and high BP.

• Appendicitis: inflammation/infection in the appendix which can cause tissues to die/rupture resulting in an abscess, peritonitis or shock.  Initial pain is dull and in umbilical area.  Pain later localizes in RLQ and can cause referred pain.  Other symptoms are nausea, vomiting, anorexia, fever, chills, rebound tenderness.

• GI Hemorrhage: this is a symptom of another disease, not a disease itself. Upper GI bleeds, symptoms are melana, hematemesisthat looks like coffee grounds.  Lower GI bleeds are often caused by bowel inflammation, diverticulosis/diverticulitis, cancer, hemorrhoids.  Symptoms are bright red stool

• Esophagitis: lining of esophagus becomesinflamed by infection or from stomach acid (GERD).  Pt may report pain w/ swallowing and feeling as if something is stuck in their throat, heartburn, nausea, vomiting and sores in the mouth.

• Esophageal Varices: occur when the pressure w/in the BVs surrounding the esophagus increases, frequently a result of liver failure (#1 cause is alcohol).  Initial symptoms show signs of liver disease (fatigue, with loss, jaundice anorexia, edema in abs, ab pain nausea, vomiting). Takes months to years.  Rupture of the varices is sudden discomfort in epigastric region, difficulty swallowing, vomiting bright red blood, hypotension, signs of shock.

• Mallory-Weiss Tear: a tear in the junction between the esophagus and the stomach.  Causes severe bleeding and potentially fatal.  Primary cause is alcoholism and eating disorders, but also severe coughing/vomiting

• Gastroenteritis: infection combined w/ diarrhea, nausea and vomiting.  Can be caused by bacteria or virus (infectious gastroenteritis) w/ symptoms like food poisoning.  Non-infectious gastroenteritis can be caused by adverse reactions to meds, toxins or chemotherapy.

• Hemorrhoids: created by swelling and inflammation of the BVs surround the rectum.  Can be internal (not visible, often painless and associated w/ bright red, brisk bleeding) or external (visible, painful)

▪ Genital: book only says the gynecologic problems often cause acute abdominal pain.  Always consider problems w/ ovaries, fallopian tubes or uterus when a female complains of lower quadrant ab pain.

▪ Uninary

• Cystitis: bladder inflammation, common in women.  Generally caused by bacterial infection and referred to as a UTI.  Pt may report midling lower ab pain, blood in urine, an urgency to pee, pressure & pain around bladder. Can spread to kidneys if left untreated

• Uremis: when kidneys fail, pt loses ability to excrete waste from body, urea remains in blood

• Kidney stones: chemicals crystallize in urinecausing stones.  These can pass into the ureter and cause a blockage, building up pressure and kidney can swell.  Pt may report vague discomfort in flank, but pain can become intense and radiate to the groin. Stones can move and also block urine from passing.

• Kidney (renal) failure:  

o Acute kidney injury (AKI) is a sudden decrease in function.  Can be caused by hemorrhage, dehydration, trauma, shock, sepsis, heart failure, meds, drug abuse and kidney stones.  Can often be reversed w/ prompt diagnosis and treatment

o Chronic kidney disease (CKD) is irreversible and progressive.  Often caused by diabetes or hypotension.  Kidney tissue shrinks and function diminishes.  Pt usually requires a transplant or dialysis and can present with altered LOC, lethargy, nausea, headaches, cramps, and edema in extremities and face.  Pts w/ CKD have high incidence of heart disease and tend to bleed easily.

• Describe the assessment of a pt with a GI and Urologic emergency:

o Ab pain is often severe so pt may show shallow or inadequate respirations, so assist if necessary.  Assess for major bleeding, ask about amt & frequency of blood in vomit, black tarry stools or bright red bloody stools.  Skin condition could show signs of shock.  Inspect ab for pain, tenderness, bruising.

o History taking questions: any nausea/vomiting? Change in bowel habits?  Urinations changes/pain/odor/color? Unexplained weight loss (how much, over how long)?  Belching/flatulence?  Describe pain.  Concurrent chest pain?

o Look for guarding when palpating abdomen.

o High respiratory rate w/ normal pulse and BP may indicate pt is not ventilating properly b/c deep breaths cause pain.

o High respiratory rate and pulse rate w/ signs of shock may mean septic or hypovolemic shock

• Describe the basic A&P of the GI, genital & urinary systems (see pages 757-758)

o Hollow organs: gall bladder, stomach, small intestine, large intestine and bladder.  Injuries to hollow organscan cause contents to leak and contaminate ab cavity.

o Solid organs: liver, spleen, pancreas, kidneys and ovaries.  Injuries to solid organs can cause shock and bleeding because of the amt of BVs in the organ.

• Describe the procedures to follow in managing the pt with shock associated with ab emergencies (pg 770):

o Wear PPE

o Treat for effects of shock even when obvious signs of shock aren’t apparent.  Reassure patient, maintain patent airway if pt is vomiting, loosen restrictive clothing and transport pt gently in a position of comfort.  Constantly reassess pt’s condition for signs of deterioration.

• Signs & symptoms of acute cholecystitis, appendicitis and pancreatitis.  

o See above descriptions.

• Explain the prehospital care for a pt who has missed kidney dialysis.

o Control XABCs, position pt sitting up in cases of pulmonary edema or supine if in shock, and transport promptly.  Watch for dialysis shunt or fistula while getting vitals.  Leave any catheters in place.

CH 20: ENDOCRINE AND HEMATOLOGIC EMERGENCIES

• Describe the differences & similarities between hyperglycemic and hypoglycemic diabetic emergencies.

• Distinguish between the individual types of diabetes and how their onset and presentation are different.

o Diabetes Mellitus Type 1: autoimmune disorder in which the immune system produces antibodies against the pancreatic beta cells (which produce insulin).  

▪ Onset usually occurs from early childhood through 40s.

▪ Must get insulin from an external source (insulin pump)

▪ Symptoms: polyuria, polydipsia, polyphagia, weight loss, fatigue

▪ Since the cells cannot receive glucose, body burns fat, producing acid waste in the form of ketones.  Glucose and ketones build up in kidneys, so body tries to maintain balance by breathing faster and deeper to reduce the acid level by releasing more CO2 = Kussmaul respirations.

▪ Diabetic ketoacidosis (DKA): a life threateningillness that develops if ketone production continues.  Symptoms are: abdominal pain, body aches, nausea, vomiting, altered mental status or unconsciousness, fingerstick typically > 400

o Diabetes Mellitus Type 2: caused by resistance to the effects of insulin at the cellular level (less insulin receptors on cells).  Pancreas will produce more insulin to make up for the increased levels of glucose in the blood = insulin resistance over time.

▪ Usually adult onset, more common in obese patients.  DM 2 can be improved with diet & exercise.  Meds must be injected.  Common meds:

o Symptomatic Hyperglycemia: blood glucose levels are very high.  It is a metabolic condition that usually develops over time and involves all body tissues. DRY

▪ Early signs: polyuria, polydipsia, blurred vision & fatigue, fruity odor on breath, vomiting, shortness of breath, dry mouth, weakness or altered.

▪ In type 1 DM, leads to ketoacidosis anddehydration from xs urination

▪ In type 2 DM, leads to dehydration from discharge of fluids from all body systems and hyperosmolar hyperglycemic nonketotic syndrome (HHNS),which is a more ominous situation of fluid imbalance.  High glucose in blood causes excretion of glucose in urine, so pts responds by increasing their fluid intake.  Kidneys become overwhelmed and blood becomes concentrated

• HHNS: presents as hyperglycemia, altered mental status, drowsy, lethargic, severe dehydration, thirst and dark urine, visual/sensory defects, partial paralysis/muscle weakness, seizures.

o Symptomatic Hypoglycemia: acute emergency in which a patient’s blood glucose level drops and must be corrected swiftly. Develops rapidly, but can be quickly revered w/ glucose.  SWEATY

▪ Common causes: correct dose of insulin w/ a change in routine (exercised more, ate later than usual or skipped a meal), more insulin than necessary, correct dose of insulin + acute illness developed in pt

▪ Signs & symptoms:

• Normal to shallow respirations

• Pale, moist skin

• Diaphoresis

• Dizzy/headache

• Rapid pulse

• Normal to low BP

• Altered mental status

• Anxious or combative

• Seizure, fainting, coma

• Weakness on one side of body

• Rapid changes to mental status

• Describe the interventions for providing emergency care to both a conscious and unconscious patient w/ altered mental status and a history of diabetes who is having symptomatic hypoglycemia

o If pt is conscious and able to swallow w/out the risk of aspirations, administer glucose

o If pt is unconscious, pt needs IV, IM or IN glucose.  Provide prompt transport and monitor airway, keep suction available

o If pt is altered, ensure airway is clear, be prepared for artificial ventilation and suctioning, prompt transport

• Describe the 2 types of blood clotting disorder and the risk factors, characteristics and mgmt. of each

o Hemophilia:  genetic condition in males mostly, decreased ability to create a clot after an injury.  Minor trauma can cause swelling from uncontrolled bleeding in the region of the injury.  Pts can be prescribed meds to replace the missing clotting factors, release stored clotting factors or prevent the breakdown of clots.  Complications include joint problems, intraceberal hemorrhage & thrombosis

o Thrombophilia: disorder in the body’s ability to maintain viscosity and smooth flow of blood thruvenous/arterial systems = blood clots more easily than normal.   Caused by genetics or meds, pts w/ cancer at more risk.

• Explain what insulin and glucose do for the body

o Insulin: necessary for glucose to enter the cells for metabolism

o Glucose: in conjunction with O2, brain needs it for energy

CH 21: ALLERGY & ANAPHYLAXIS

• List the 5 categories of stimuli that could cause an allergic reaction or extreme allergic reaction.

o Food, Meds, Plants, Chemicals, Insect bites/stings

• Differentiate the primary assessment for a pt w/ a systemic allergic/anaphylactic reaction and with a local reaction

o Local reaction is typically from an insect sting: scrape sting with credit card to remove stinger, gently wash with soap/water or mild antiseptic.  Try to remove jewelry from area before swelling begins, position pt w/ the injection site slightly lower than the heart and apply ice or cold to the area

o Systemic: support ABCs (be alert for signs of airway swelling, nausea, vomiting, ab cramps), epi if indicated, continue to monitor vitals and interventions, rapid transport.  

• Review the process for providing emergency medical care to a patient who is experiencing an allergic reaction.

o support ABCs (be alert for signs of airway swelling, nausea, vomiting, ab cramps), epi if indicated, continue to monitor vitals and interventions, rapid transport.  

Explain the rationale, including communication/documentation considerations when determining whether to administer epi to a pt who is having an allergic reaction.

o Pt must have signs of respiratory compromise or hypotension

o Must first receive a direct order from medical control or follow local protocol before administering or helping pt administer epi.  

o Record time and dose of the injection

• Explain why a rapid response and intervention is so critical w/ an anaphylactic reaction.

o Respiratory distress (rapid swelling of upper airway) or cardiac distress in the form of shock can lead to death w/in 30 minutes

• Explain the difference between a local and systemic response to allergens.

o Local: characterized by itching, redness/tenderness.

o Systemic: anaphylaxis is an extreme allergic reaction that is life threatening and involves multiple organ systems.  Can result in shock or death w/in 30 minutes.

CH 22: TOXICOLOGY

• Describe the assessment and treatment of the pt with a suspected OD:

o Ensure scene safety, scan drug paraphernalia.

o Don’t assume a conscious, A&O pt is in stable condition or has no apparent life threats.

o Ensure open airway and adequate ventilation and treat accordingly.  Have suction available.

o Assess circulation (pulse & CTC)

o Assess LOC

o Provide prompt transport for pts w/ obvious alterations in XABCs.

• Discuss scene safety considerations for working at a scene w/ a potentially hazardous material or violent pt.

o Hazardous material: if you suspect the presence of toxic gas, call for specialized resources.  They will decontaminate the pt.  You cannot provide emergency care until this has been completed.  PPE of course

o Violent pt: Involve police

• Id the main types of toxins and poisons and their effects

o Alcohol: CNS depressant that is a sedative & hypnotic; dulls the senses, slows reflexes and decreases reaction time.  May also cause aggressive or inappropriate behavior.

o Inhalants: briefly displace O2 in brain and cause a rush of euphoria.  Effects range from mild drowsiness to coma.  Can cause seizures, loss of brain functions and making the heart hypersensitive to the pt’s own adrenaline = sudden cardiac death from Vfib.

o Hydrogen sulfide: nausea/vomiting, confusion, dyspnea, loss of consciousness, seizures, shock, coma, cardiopulmonary arrest.  No antidote

o Synthetic cathinones (bath salts): produce euphoria, increased mental clarity and sexual arousal.  Adverse effects: teeth grinding, appetite loss, muscle twitching, lip-smacking, confusion, GI conditions, paranoia, headache elevated heart rate and hallucinations

o Marijuana: impairs short term memory, altered perception of time, anxiety, panic, hallucinations/anxiety/paranoia w/ very high doses

o Hallucinogens: alters sensory perception, causes visual hallucinations, intensify vision/hearing and separate the pt from reality.  A bad trip can cause hypertension, tachycardia, anxiety & paranoia.

o See chart below for the rest of the drugs

• Describe the assessment/treatment for the pt w/ suspected plant poisoning.

o Assess the pt’s airway and vitals

o Notify the regional poison center for assistance in identifying the plant

o Take the plant to the ED

o Provide prompt transport

• Describe the assessment/treatment of a pt w/ a suspected poisoning or toxic exposure:

o General impressions assess LOC and determine life threats

o Ensure open airway and adequate ventilation and treat accordingly.  If you suspect an inhalation injury, use high flow O2 regardless of pulse ox.  Have suction available.  If pt is unresponsive to pain, consider oral airway.  Pt may require ventilatory assistance w/ BVM

o Assess circulation: pulse & skin condition.  There may not be obvious bleeding, but alterations in LOC may have contributed to trauma/bleeding.

• Explain how activated charcoal works.

o Binds to specific toxins and prevents their absorption by the body.  The toxins are carried out in stool.  Doesn’t work for alkali poisons, cyanide, ethanol, iron, lithium, methanol, mineral acids or organic solvent.

• How do you know if you should brush off a chemical or flush it off?

o If a dry powder has been spilled, thoroughly brush off the chemical, flush the skin w/ clean water for 15-20 minutes, then wash skin w/ soap & water.

o If liquid material has been spilled on a pt, flood the affected part for 15-20 minutes.

CH 23: BEHAVIORAL HEALTH EMERGENCIES

• Who is the most important person when dealing w/ an unsafe scene?  You are

• Explain the care for a patient w/ excited delirium.

o Begin assessment from the doorway.

o ABCs, LOC and a quick rapid assessment if the pt allows.

o Allow the pt to talk w/ you, ask questions, engage family members and use reflective listening (repeating in question form what the pt tells you).  Be calm, supportive and empathetic.  Be an active listener, limit physical contact

o Symptoms include hypertension, hyperthermia, tachycardia, diaphoresis & dilated pupils.  Alsohallucinations, agitation.

o May need to contact ALS for chemical restraint or you may need to physically restrain per local protocols

• Know the main principles of care for the agitated, violent or uncooperative patient

o Same as above and see chart

• Explain how to recognize the behavior of a patient at risk of suicide, including mgmt. of such a pt.​

o Depression is the biggest cause

o Pt has an air of tearfulness, sadness, deep despair or hopelessness

o Pt avoids eye contact, speaks slowly/haltingly

o Pt seems unable to talk about the future

o Any suggestion of suicide?

o Does pt have specific plans related to death

o Are there unsafe objects in the pt’s hands or nearby

o Is the environment unsafe (open window, bridge)

o Is there evidence of self-destructive behavior (cut wrists, alcohol/drugs)?

o Is there an imminent threat to the pt

o Underlying medical problem?

o Cultural, religious or social beliefs promoting suicide?

o Has there been trauma?

• Remember that some sudden illnesses can cause behavioral health emergencies.

o Hypoglycemia, trauma, hypoxia, impaired cerebral flow, hyperthermia/hypothermia

CH 24: GHYNEOLOGIC EMERGENCIES

• Discuss the assessment/management of a pt who is experiencing a gynecologic emergency; include a discussion of specific assessment findings.  

o XABCs, if pt has weak/rapid pulse or pale, cool, or diaphoretic skin, place pt supine and cover with blanket and transport.

o Focus physical exam on chief complaint.  It should be limited and professional, protecting pt’s privacy.

o Secondary assessment should include vitals, distention/tenderness in abdomen, visible bleeding in genitourinary area, mental status

o If bleeding is suspected, look for tachycardia/hypotension which could indicatehemorrhagic shock.

▪ PID: pt will report ab pain that generally stars during/after normal menstruations, so ask about date of pt’s last menstrual period.  Symptoms may include vaginal discharge, fever, chills, and pain/burning during urination.  Pt will have a shuffling gait when they walk.

▪ Ectopic pregnancy/spontaneous abortion: can cause vaginal bleeding.  Pt may not know they are pregnant

▪ Chlamydia: lower ab/back pain, nausea, fever, pain during sex, bleeding between periods.  Left untreated, it can progress to PID.

▪ Bacterial vaginosis: most common in ages 15-44.  Symptoms include itching, burning or pain and may be accompanied by a “fishy” foul smelling discharge.  Can lead to PID.

▪ Gonorrhea: can infect reproductive tract, eyes, nose, mouth, throat, eyes and anus.  Symptoms present as painful urination along w/ burning/itching, blood associated w/ sex, cramping/ab pain, nausea, vomiting, bleeding b/w periods.  Can progress to PID

• Discuss the assessment/management of a pt who has been sexually assaulted or raped; include additional steps EMTs must take on behalf of the pt.

• Know the street names of common illegal (date rape) drugs:

o Rohypnol (flunitrazepam) aka roofies

o GHB (gamma-hydroxybutyric acid) aka liquid ecstasy

o Ketalar (ketamine) aka Special K

o Klonopin (clonazepam)

o MDMA (ecstasy)

o Xanax (alprazolam)

• Explain the signs that would lead you to believe a pt has been sexually assaulted

o Pt may be scared, withdrawn, humiliated or embarrassed

o Look for signs of date rate drugs; pt may be unable to remember what happened, be weak or confused

o Bloody/torn clothing

o Lacerations/contusions

• Why are injuries to external genitalia so serious?

o Genitals have a rich nerve supply, making injuries very painful.  They also have a rich supply of BVs, socan have a lot of bleeding

• What are the signs and symptoms of gonorrhea?

o More severe in men than women

o In women, painful urination w/ associated burning or itching

o Yellowish/bloody vaginal discharge w/ foul odor

o Blood associated with intercourse

o More severe: cramping/ab pain, nausea/vomiting, bleeding between menstrual periods (these indicate the infection has progressed to PID)

o Rectal and mouth/throat infections can occur too

o If not treated, bacterium can enter the bloodstream and spread to other parts of the body, including the brain