RESPIRATORY RESPIRATORY EMERGENCIES EMERGENC IES (us in alveoli - (=E;MO=3A RESPIRATORY EMERGENCIES o 2000 people o Common chief complaint o Common in infants and children due to small respiratory reserve EMTS plays an important role in the care and transport of patient with respiratory distress GOAL O EMT! Maintain and improve the patient"s condition #perfusion$ durin% transport& To To maintain ade'uate resp! resp! • Administration of O2 • (atient comfort • Assist in inhaler medications )OLE O EMT! EMT! )eco%ni*e the si%n and symptoms of respiratory distress and intervene 2 unctions of )espiratory System +& O,y% O,y%en enat atio ion n - Supp Suppli lies es O2 O2 2& .entil entilati ation on - )emo )emove ves s CO2 CO2 /ody Tissues rely on continuous supply of O2 to maintain an ener%y producin% process called aerobic metabolism Any interruptions of supply of O2 and removal of CO2 can 'uicly lead to 1iolo%ical death& 2 Types of )espiration • E,ternal - Alveolar Capillary e,chan%e • 3nternal - Capillary Cellular e,chan%e /ronchospasm /ronchoconstriction 4 Lower ower airw airway ay are are nar narrrowed owed /ronchodilator 4 5ilat late /ronchi nchio oles ASSESS ASSESS DOB ( Difculty o Breat!i"#$ • Tripod Tripod position position #leanin% #leanin% forward6 forward6 with arms arms and and el1ows loced in front of the pt$ • (atient"s face • Speech • Cyanosis! (eripheral 7 Central P%YSICA& E'AMINATION INDINGS) 8hee*es o 8hee*in% sound upon e,piration Stridor o can 1e heard on upper airway o hi%h pitched whee*in% sound with Steth 9u%ular .ein .ein 5istention 5istention o C:6 Tension Tension (neumothora,6 (neum othora,6 Cardiac Tamponade Tamponade 3nspect for Muscle )etraction o Asymmetrical chest wall movement
;((E) A3)8A< A5.E=T3T3O;S SO;=5S! Crownin%6 %ur%lin%6 snorin%6 stridor
%YPO'IA 4 5ecre creased ased O2 in cells 4 Causes! o A1sence of inade'uate respiration #sedation6 morphine overdose$ o O1struction of air>ow occurrin% on either upper of lower portion of respiratory tract&
2 Types of (ain SOMAT3C (A3= #e&% appendicitis$ • speci?clocali*ed • (arietal pain receptors .3SCE)AL (A3= #e&%& M36 Chest (ain$ • =onspeci?c dull • .isceral pain receptors COPD (C!ro"ic Obstructi*e Pulmo"ary Disease$ )eactive airway disease Chronic cou%h or air>ow o1struction 2 3ncludes! C%RONIC BRONC%ITIS 4 E,ce E,ces ss muc mucus us in airwa rway 4 5estr 5estroy oy the linin linin% % of 1ronc 1ronchi hi and and 1ro 1ronc nchio hioles les P+&MONARY EMP%YSEMA 4 5estr 5estroy oyed ed dam dama%e a%ed d alveo alveoli li cau causin sin% % reduc reductio tion n in lun%"s surface area& 4 5ecreased O2 BRONC%IA& AST%MA 4 Most Most com commo mon n in chi child ldre ren n and and youn youn% % adul adultt 4 Overse Oversensi nsitiv tive e airw airways ays to to envir environm onment ental al stim stimuli uli and emotional states 4 Small Small airw airways ays to to envir environm onment ental al stim stimuli uli and and emoti emotiona onall states 4 /ronchospasm 4 5i@ 5i@culty ulty in e,p e,piirati ratio on 4 5yspne 5yspnea6 a6 whee whee*in *in%6 %6 dry dry cou%h cou%h66 over over e,pa e,pande nded d alveo alveoli li 5A=GE) si%ns of Asthma • Loss of whee*in% • Chan%es in sensorium #confusion6 irrita1ility$ • 3ndicatin% hypo,ia if uncorrected may lead to /)A5
ated chest6 tachycardia6 prefers to sit up and lean forward& O.E)ALL A3M! Must 1e treated rapidly to prevent lethal hypo,ia& %YPER,ENTI&ATION SYNDROME 4 A1nor A1normal mal incre increase ase in )) 7 Tida Tidall .olu .olume me 4 An,iety 4 Tin%l n%lin% hands nds an and fe feet 4 Loo Loo for for evid eviden ence ce of of nec nec 1ac 1ac inu inury ry to ro trauma traumatic tic causes 4 A1nor A1normal mal incr increa ease se in resp respir irato atory ry rate rate and and tidal tidal volu volume me 4 (h B&D4B B&D4B&D &D #norm #normal al$$ if if FB& FB&D D ph ph #acid #acidos osis$ is$ Mana%ement! +& )ela, )ela,ati ation6 on6 slow slow dow down n 1rea 1reathi thin% n% 2& Seda Sedati tion on if cons consci ciou ous s
& &
/reathin% in paper 1a% no lon%er advised #can cause acidosis$ 5o not withhold O2 support
RESPIRATORY INECTION 4 CO(5 - infant and children 4 C)O;( A=5 E(3GLOTT3S CRO+P • • • •
.iral - upper airway A%itated 1arin% cou%h months to years of a%e Airway o1struction
EPIG&OTITIS • /acterial infection • Swellin% causes airway o1struction • Sits still • 5roolin% of saliva PNE+MONIA • /acteria6 virus6 fun%i • Children adult • Alveoli and airway ?lled with pus • 5ecreased O2 P+&MONARY EDEMA • luid accumulation in the lun%s • 5ue to C: M3 • 3nhalation of smoe and to,in fumes • :i%h altitude6 narcotic overdose6 >uid overload S-S') Cyanosis6 cracles6 distended nec veins6 pinish frothy sputum6 peripheral edema - Swellin% of e,tremities Ma"a#eme"t) :i%h low O2 Consider (EE(C(A( Transport immediately P+&MONARY EMBO&ISM • Clotem1olus that 1locs a pulmonary artery • /lood cut in 5.T #deep vein throm1osis$ 1eas oH and travels to lun%s interruptin% 1lood >ow to a lun% portion • ;sually post4operative 1edridden pts& • 5yspneic and Tachycardia • Transport to hospital immediately with O2 support& PNE+MOT%ORA' - %EMOT%ORA' /loodair in the pleural cavity causin% collapse of lun% parenchyma • Associated with chest pain and tachypnea • 5ecreased 1reath sounds •
I
C:3E COM(LA3=T +& :ow lon% has it 1een present 2& 8as the onset %radual or a1rupt & 3s the dyspnea made 1etter or worse 1y any particular position & :as the patient 1een cou%hin% D& 3s the cou%h productiveI 8hat does the sputum loo lie & 3s there any associated (ain B& (ast Medical :istory J& Medications
3ndication of a patient in a reclinin%supine position • Mild respi distress • Severe respi distress - too e,hausted • (ts& ace
• •
(ts& Speech (ts& Sin and mucus mem1rane
O - nset ( - rovocation K - uality ) - adiation S - everity T - ime GE= 3M()ESS3O= 3= )ES(3)ATO)< 53ST)ESS (atient"s mental status )estless6 a%itation6 unresponsive (atient"s position #Tripod"s$ Sit upri%ht and leanin% forward
CARDIO,ASC+&AR O - nset ( - rovoE K - uality ) - adiation S - everity T - imin% A - ssociated Symptoms EMS A=5 53S(ATC: 4 Trained to reco%ni*e symptoms even if atypical 4 (rovide pre4arrival noti?cation 4 Monitor and cardiac rhythm6 1e prepare to provide C() 4 Time and onset of symptoms to sta1ili*e6 tria%e and transport pt& M3 - hours E) - They are countin% the onset of pain 20+0 )ecommendation - All 5ispatchers should 1e appropriately trained to provide telephone C() #Class 3$ To help 1ystanders reco%ni*e cardiac arrest6 dispatchers should in'uire a1out! A1sence of consciousness and Kuality of 1reathin% )ecommended C() for unresponsive who are not 1reathin% normally 4 Most are cardiac arrest 4 re'uency of serious inury from CC in the non4arrest %raoup is very low 4 3nstruct untrained Lay rescuer to provide C() for adults with SCA #Class 3$ 4 3nclude )escue 1reathin% instructions if adultchild with a hi%h lielihood of asphy,ial cause& AC+TE CORONARY SYNDROME • 8itness arrest in ventricular ?1rillation #.$ • 0 N cause of death • EMS dispatch personnel - should 1e trained to respond ANGINA PECTORIS (C%EST PAIN$ 4 (resentin% si%n of acute M36 portion of myocardium is not receivin% enou%h o,y%enated 1lood )is factors! • Sedentary lifestyle • Ci%arette smoin% • O1esity • :i%h in cholesterol • 5M • Male • A%e D0 • :T= +00 • amily :, of C:5
Oral contraceptive 0 yo pills4#viscous 1lood$ An%ina (ectoris Acute Coronary Syndrome M3
4 4
•
Si%ns and Symptoms! o Mistaen for indi%estion o Chest pain after e,ertionstress o )elieved after administration of =itro%lycerin o SO/6 =ausea6 increased () NITROG&YCERIN - .ASO53LATE - CO)O=A)< A)TE)3ES Si%n that it is improvin% P Q:eadacheR Contraindication! 4 )i%ht ventricular infarcation 4 3nitial systolic /( of 0mm:% within 2 hours 4 (5E #Tadala?l$ - D 3nhi1itor #J :ours$ Emer%ency Care! +& Chew on aspirin #+042Dm%$ ta1s 3ndication! 1leedin% and aller%y 2& ind out if the patient is! tain% =itro%lycerin6 last dose taen6 how much was taen& & EMS may administer O2 at + rate as soon as possi1le & Contact EMS! 3nform the patient"s condition D& =itro%lycerin ta1spray #4Dmm$ with permission if the diastolic /( is a1ove 0 & Emotional support B& Continue to monitor .S =3T)ATES! #=itro%lycerine$ 3SO)53L 5initrate6 fast actin%6 short duration 3=5;) Mononitrate6 Slow actin%6 for maintenance AC+TE MYOCARDIA& INARCTION o (ortion of myocardium dies #necrosis$ o 5ue to deprived coronary 1lood >ow Si%ns and symptoms! 4 Chest pain related to stress and e,ertion 4 (ain ori%inate from the sternum 4 Sharp6 s'uee*in% or thro11in% pain 4 (ain lasts 0 minutes - hours 4 +D420N are painless - Silent M3 attac 4 =ot relieved 1y =TG #=itro%lycerin$ )espiratory! 5yspnea6 cou%h with sputum production /ehavioral! 3mpendin% doom6 An,iety6 3rrita1ility6 5epression6 Mild delirium Circulatory! (allor6 5iaphoresis#e,cessive sweatin%$6 decreased /( Complications! • Cardiac Arrest 0N • C: • Shoc #2hours$ Cardio%enic • (ulmonary Edema • Cardiac 5ysrhythmias CORONARY ARTERY OCC&+SION 3schemia min after occlusion =ecrosis D4 hours :ealin% D4 5ays Scarrin% +2 days Ma,imum wees Emer%ency care M3 A& Conscious (atient 4 :i%h conc& Of O2 4 eep calm and still 4 tae : and determine ss, 4 :elp with prescri1ed medication
/&
Semi sittin% position - (rovide 'uiet transport Out of :osp& ECG - determine! ;nsta1le An%ina6 STEM36 =TEM3 ;nconscious (atient 4 Maintain Airway 4 C() 5efri1 if needed 4 O2 - via /.M 4 Kuiet transport 4 Monitor .S throu%hout care and transport A - aspirin M - orphine O - ,y%en = - itrates MI (ain rt stress =ot relieved 1y rest rest =TG may relieved pain )educed /(=ormal 5iaphoresis
A"#i"a pain follows stress (ain relieved 1y )elived 1y =TG #if not # doses in +0 mins4AM3$ =ot aHected Short term diaphoresis
AORTIC ANE+RISM 4 Outpouchin% of /. 4 A1dominal aortic Aneurysm 4 J0N mortality if hypotensive Ss,! • )ippin%6 tearin% and sharp pain that starts at the 1ac 1etween shoulder 1lades • Syncope with 1ac pain or hypotension • /( discrepancy 1et& Armdecrease in femoral carotid pulse )3S ACTO)S - A=E;)
Severe headache • =ausea and .omitin% • Altered Mental Status • Aphasia6 Sudden 1lindness • Muscle twitchin% • Sei*ures • :emiparesis EME)GE=C< CA)E! • Secure airway6 administer O2 • Transport without delay • /e prepared to deal with sei*ures •
CARDIAC TAMPONADE 4 Accumulation of 1lood in the pericardial sac 4 Sta1 wound to the heart and acute M3 with cardiac rupture may cause the myocardium to ?ll with 1lood& Si%ns and Symptoms • 5ecreased preload 1ecause of ?1rous tissues • Cannot ?ll the heartmuUed heart sounds • 5ecreased /( • 5istended nec vein • (ale6 cool6 sweaty sin • Tachycardia EME)GE=C< CA)E (lace the pt& in a semi4fowlers position& Administer O2 3mmediate transport Monitor en route to the hospital #trauma sur%eons may do immediate pericardiocentesis$ 3))E.E)S3/LE 5EAT: o )i%or o Lividity o 5ecomposition o 3nuries not compati1le to life
(E)3CA)53T3S 4 3n>ammation to pericardium 4 3diopathic infection and meta1olic factors as well as trauma and tumor Si%ns and symptoms • 5yspnea • pre4cardial pain a%%ravated while 1reathin% • fever6 chills6 fati%ue #infection$ EME)GE=C< CA)E A/C Administer O2 - =)M 3mmediate transport in sittin% position Monitor pt& enroute to the hospital CONGESTI,E %EART AI&+RE 4 E,cessive >uid 1uildup on the lun%sV inade'uate pumpin% Si%ns and symptoms! • Tachycardia6 5yspnea • (ulmonary Edema with rales • rothy whitepin sputum • =ormal increased /( • Cyanosis • (edal Edema • En%or%ed nec veins#late si%ns$ • Enlar%ed live6 spleen with a1dominal distention #late si%n$ Stroe volume P 04B0ml (reload B0 5efective +ml4intravascular space Left sided - lun%s )i%ht sided - pulmonary edema (aro,ysmal =octurnal - Mild dyspnea
Can sleep 1ut will wae up complainin% dyspnea EMERGENCY CARE 4 Semi owler"ssittin% 4 3ncrease O2 throu%h =)M 4 .S throu%hout care and transport CARDIAC PACEMA.ER 4 0 1radycardia 4 :eart1loc 4 8ill not present AM36 An%ina (ectoris and C: 4 Care - same with person"s pacemaer 4 ;sually placed 1elow the clavicle6 is visi1le and can 1e palpated Si%ns of (acemaer malfunction • Slow and irre%ular pulse • Si%ns of shoc • (t& complaints of chest pain (acemaer 1attery 4 =O 5E3/)3LATE IMP&ANTED DEIBRI&&ATOR 4 8hen patient develop .6 it identi?es the rhythm and shoc the patient& EME)GE=C< CA)E A=5 C() • (atient are the same for other cardiac patients& CARDIAC BYPASS S+RGERY 4 )estore 1lood >ow to a section of the myocardium 4 (atient should tell you he had a 1ypass sur%ery 4 O1serve for a midline sur%ical scar on chest of an unconscious patient OPEN %EART - 5irect cardiac massa%e RESTERNOTOMY 4 Should 1e done on an appropriate e'uipped 3C; operatin% suite BROGADA SYNDROME - sudden .i1
NE+RO&OGICA& DISORDERS SEI/+RE • Electrical activity of 1rain 1ecome irre%ular • =ot a disease 1ut rather a si%n of an underlyin% disease Common causes of sei*ure 4 :ypo,ia 4 :ypolycemia 4 3nfection 4 Trauma 4 (oisonin% 4 3mpaired Cere1ral O,y%enation 4 Overdose 4 Epilepsy uncontrolled meds 4 3nto,ication 4 /rain Tumor 4 3diopathic Types • (artial • Generali*ed EBRI&E SEI/+RE • Generali*ed tonic4C4( • 24DN of the dse • Self4limitin% • mos4yrs • =o medication • Middle ear pro1lem STAT+S EPI&EPTIC+S • Generali*ed T4C4(
• • •
Associated riss Life threatenin% Continuous
ASSESSMENT Scene si*e up +& /e alert to the threats 2& ocus on any possi1le indication of trauma & 5etermine the need for additional resources & 3f the pt& is still sei*in% upon arrival position the pt& and o1ects around him in a safe manner
TRANSIENT ISC%EMIC ATTAC. 4 )ecurrent neurolo%ical de?cit 4 8eaness6 paralysis6 speech distur1ances 4 ew secs - +2 hours 4 5isorientation of cere1ral artery and 1asilar artery Si%ns and Symptoms :emiparesis ;nilateral =um1ness Aphasia Slurred Speech .erti%o Convulsion 2 Main Types of Stroe • 3schemic • :emorrha%ic
+& Maintain Airway and ventilator concern 2& :i%h >ow of O2 and utili*e pulse 5, & Support 1reathin% 3nitial Assessment & Evaluate the 'uality of circulation D& 5etermine priority status ocused :istory and E,amination +& Complete rapid assessment6 .S6 rapid transport 2& SAM(LE history from relatives if unresponsive & Assess head and nec & E'uality of pupils D& Test / G L if hypo%lycemia 3s present suspected PARTIA& SEI/+RES A& Simple (artial 4 ocal motor focal sensory 4 9acsonian March 4 A;)A! Small 1ri%ht li%hts6 risin% sensation to stomach 4 (atient usually awae 4 Tin%lin%6 stiHenin% or erin% in one part of the 1ody /& Comple, (artial 4 (sychomotor 4 A1normal 1ehavior 4 Glassy stare6 lip smacin% or chewin% 4 id%etin% with clothin% 4 Temporal lo1e sei*ure 4 +42 mins GENERA&I/ED SEI/+RES A& T4C4( G)A=5MAL Tonic 4 ri%id stiHenin% V 0 secs 4 (atient mi%ht 1ite his ton%ue 4 /reathin% may stop Clonic 4 9ers violently V +42 mins 4 oamin% and drollin% 4 3ne@cient 1reathin%4cyanosis (ost 3ctal 4 )ecoveryV D40 mins 4 State of drowsiness 4 5eep sleep 4 )e%ain consciousness /& (etitmal A1sence • /lan StareV +4+0 secs • Children • =o dramatic motor activity GRANDMA& SEI/+RE Sta%es! A;)A - TO=3C - CLO=3C - (OST3CTAL EME)GE=C< CA)E +& (osition 2& Maintain patent airway & Assess /reathin% & O2 D& (revent inury & Appropriate transport O=GO3=G ASSESSME=T • /e prepared to mana%e additional SS • Monitor CA/ • )epeat and record .S • 5ocument :&O
(rotect the patient from inury and %uard his airway 1ut never put anythin% hard on his mouth 5o not restrain& )emove o1ects from his path Loosen o1structive clothin%
4 4 4 4 4
STRO.E - C,A 4 Cause 1y non4traumatic 1rain inury resultin% in occlusionrupture of cere1ral 1lood vessel& Classic Si#"s a"0 Sym1toms o Stro2e +& Confusion5istur1ed Mental Status 2& acial 5roop & Sei*ure & 3nappropriate 1ehavior pattern D& 5ysarthria6 Aphasia & 3rre%ular (ulse B& StiH =ec J& :emiparesis & :emiple%ia +0& :(= ++& Sta%%erin% %ait3ncoordination Ris2 actors 3 C,A Cannot chan%e =on Modi?a1le • A%e • )ace! African6 American6 :ispanic • Men! BD6 8omen4 More fatalities • amily :istory • (rior :istory of StroeT3A Can 1e chan%e Modi?a1le • :(= - imp factor after a%e • 5M6 :i%h Cholesterol • Clot formation • (eripheral vascular dse6 hemophilia6 syphilis • Smoin%6 (hysical Activity6 O1esity • ;se of /irth Control (ill6 1lood thinner • Alcohol • Street 5ru%s6 such as cocaine Ge"eral Si#" a"0 Sym1toms Loss of consciousness Arm drift 5roopin% face (aralysis ;ne'ual si*e of pupil Commo" 4"0i"#s 4 acial droopin% 4 A1normal arm drift 4 Speech 5istur1ance ISC%EMIC • Lifestyle causin%V J04JDN • /loca%e in arteries supplyin% O2 1lood6 and 1lood supply • =arrowin% lumenV fat deposition %EMORR%AGIC • +D420N
4 Cocaine - sei*ure and stroe ;=5E)5OSE;)EM3A 4 =oncompliance6 med& Sei*ure 4 5ia1etic coma 4 CO(56 ;remia #to,in 1uild up$ T)A;MAT;MO)STEM( 4 Trauma - direct dama%e 4 Tumor - increase 3C( 4 Temp - e,tremes - impact on consciousness 3=S;L3= 4 355M 4 :ypo%lycemia (S
• )upture and weaenin% 2 main causes 4 Associat ed with :(= 4 Aneurysm which 1alloons out6 weaenin% and thinnin% until it ruptures 4 Arteriovenous malformation A.M cluster of enlar%ed and structurally wea 1lood vessels
()E:OS(3TAL T)EATME=T O ST)OE LOA5 A=5 GO • As there is a three hour window of opportunity for the initiation of throm1olytic therapy in case of 3schemic Stroe +& /S36 safety 2& Can protect patent airway - do not interfere & =o %a% re>e, - left lateral position with head sli%htly raised & Administer O2 %ently if re'uired D& .entilate when necessary - ETCO2 & .S B& Monitor Cardiac )hythm - set J& /eep tone monitor for /radycardia7 (.C"s & (rotect paraly*ed e,tremities +0& (rovide comfort and honest reassurance
ASSESSME=T A=5 CA)E 4 ;nnown history of AMS 4 SCE=E S3WE ;( 4 ;se clues if traumamedical 4 Medication found num1er of patients
)ole of EMS in ST)OE CA)E )apid activation of EMS B 5"s of stroe mana%ement +& 5etection - reco%ni*e 2& 5ispatch - prioriti*e call & 5elivery - Transport to stroe center & 5oor - hospitalV provide throm1olytic within one hour D& 5ata - CT Scan & 5ecision -i1rinolytic TherapyV 3denti?cation B& 5ru% - Treatment
4 4 4 4
3=3T3AL ASSESSME=T Manual C4spine immo1ili*ation precaution CA/ Esta1lish (riority Guidelines Chan%e in Mental status Airway discrepancy /reathin% inade'uacy Circulatory de?cit OC;SE5 :3STO)< A=5 (&E • SAM(LE • .S • (E )apid M& e,am6 ocused M& E,am
Ty1es o CEREBRA& EDEMA • Cytoto,ic • .aso%enic • 3nterstitial Mana%ement luid )estriction Elevate the head 2040 de%rees O,y%enation and .entilation A%itation and (ain control
EMERGENCY MED5 CARE • Maintain sta1ili*ation • (atent airway • 3ncrease >ow of O2V assist on ventilation • (osition • Transport
A&TERED MENTA& STAT+S Chan%e in normal mentation A - lcohol and other dru%s E - pilepsy6 Endocrine6 E,ocrine I - nsulin #:ypo6 :yper%lycemia$ O - ,y%en6 Overdose6 Opiates + - remia;nderdose T - rauma TempTumor I - nfection P - oison and psychiatric S - hoc6 stroe or space occupyin% lesion
Classi4catio" o Stro2e +& T3A 2& )eversi1le 3schemic =eurolo%ic 5e?cit & Completed Stroe Stroe in evolution
AC35OS3S 4 5ia1etes6 shoc6 poisonin%6 idney failure ALCO:OL 4 3nhi1its 1rain6 impaired ud%ement 4 Cannot maintain airway 4 Aspiratin% salivavomitus E(3LE(S< 4 E,cessive dischar%e of electricity 4 Alcohol withdrawal 3=ECT3O= 4 3ncreased temperature6 in>ammation 4 Menin%itis6 encephalitis6 altered LOC O.E)5OSE 4 /ar1iturates and =arcotics - suppress #:eroin$ 4 =arcotic - slows down ))
Ty1es o C,A by Etiolo#y 3schemic Throm1osis Em1olism :emorrha%ic 3ntracere1ral Su1arachnoid %EMORR%AGIC 4 Sei*ure more common 4 3ncrease 3C( -:emorrha%ic 4 )is of stroe increases with a%e 4 3ncrease /( - )e1leedin% tendencies 4 5o not treat - if theres :T=:(= 4 )apid Transport Causes! /rain tumor6 Anticoa%ulant therapy6 Cocaine6 :(=
4 4 4 4
ISC%EMIC 4 Tissue plasmino%en activator 4 Calcium channel 1locers 4 (revent ischemic cascade 5elay! Sleepin% ;na1le to reco%ni*e
EMERGENCY CARE EME)GE=C< CA)E O :<(E)GL
4 4 4 4 4 4 4 4 4 4
%YPOG&YCEMIA Causes! • :as taen too much insulin • =ot eaten • Over4e,ercise • .omited a meal Si%n and Symptoms! )apid Onset #mins$ 5roolin% saliva :un%er aintin%6 occasional coma Odorless /reath Cold Clammy sinV profuse perspXiration =ormal /( Eyes normal 5ecreased LOC6 altered Mental Status :ostile 1ehavior - appear to 1e acute alcoholic into,ication EME)GE=C< CA)E Conscious6 :ypo,ic /reathin% device Semifowlers (ulse O, - if connected Lateral recum1ent position #with 1reathin%$ (rovide O2 Transport ALS 3ntercept T:3=GS TO )EMEM/E)! • 5o not %ive insulin hypo%lycemia • 5irection should 1e always hypo%lycemic • 5irect care to hypo%lycemia • Loo for medications6 info card6 insulin in refri%erator • ro hypo%lycemia - assume that it is hypo%lycemia - %ive su%ar
SAET< 4 (atient should 1e conscious 4 A1le to swallow 4 Should not 1e hypo,ic Avoid! coe *ero6 Bup
Give
O=GO3=G ASSESSME=T - C.A Continue to monitor pt"s status (rovide other treatment )epeat and record .S! every D mins #unsta1le$ every +D mins #sta1le$ %YPERG&YCEMIA AND %YPOG&YCEMIA
:omeostasis - normal /GL B04++0 m%dl or J04+20 m%dl 3ncreased /lood Glucose Level • /eta cells will release insulin • 3ncreased rate of %lucose transport into cells • 3ncreased utili*ation of %lucose and AT( • 3ncreased conversion of %lucose to %lyco%en • 3ncreased protein synthesis • 3ncreased fat synthesis )esult! /GL 5eclines 3ncreased /lood Glucose Level • 3ncreased 1readown of %lyco%en to %lucose • 3ncreased 1readown of fats to fatty acids • 3ncreased synthesis and release of %lucose )esult! /GL )ises NIDDM (TYPE II$ 4 (ancreas is still a1le to secrete insulin 1ut not enou%h IDDM (TYPE I$ 4 (ancreas secretes little or no insulin %YPERG&YCEMIA ("s (olypha%ia (olydipsia (olyuria Causes 4 =ot dia%nosedtreated 4 :as not taen his insulin 4 Overeaten6 too much Car1ohydrates 4 SuHers an infection which aHects %lucose Si%ns and Symptoms! Gradual #Taes time6 days$ 5ry mouth6 intense thirst A1d& (ain Gradual increase in restlessness followed 1y coma 8ea6 rapid pulse ussmauls respiration - deep6 hyperventilation Acetone4 sicly sweet - children =ormalSli%htly :i%h /( Sunen eyes :ostilea%%ressive 1ehavior Loss of elasticity #arrod ton%ue$ :yponatremia and hypoalemia /rain cells does not re'uire insulin Myocardial and Seletal Muscles - needs insulin Kuestion to 1e ased! • :ave you taen your hypo%lycemic medsI • :ave inected yourself with insulin! chec for needle mars • 5id you vomit when you have eaten • 5id you under%one strenuous activity aside from your routine Thin%s to (repare! +& ((E 2& Circulation Meds! • Gluco%el - Chee • Ta1le su%ar - under the ton%ue • 3nsulin - not %iven 1y EMT & Airway • O(A6 =(A6 SALT • Suctionin% device & /reathin% • (ulse O,imeter • 3f hypo,ic - do not %ive GL;COSE • =)M • Supplemental O2
3. luids - (=SS - %iven 1y paramedics
• • •
T<(E 3 4 4 4
•
:yperinsulinemia :ypo%lycemia 3nsulinsia
Type 2 #Oral hypo%lycemic6 dia1etic diet$ 4 :yper%lycemia 4 :ypoinsulinemia 4 etoacidosis5ia1etic Coma
%EAT AND CO&D EMERGENCIES TEMPERAT+RE 4 :eat produce and heat loss 4 Measured in °Celcius Temperature Control • Core - 5eep tissues of the 1ody • Essential for meta1olism • (eripheral • SurfaceV not critical • Sin6 fats • Sull6 verte1ral column6 chest a1domen6 pelvis Method of %ettin% Temp +& )ectal - accurate6 hi%h and low temp 2& Oral - less than rectalV altered 1y >uids & A,illary 4 & Tymphanic - Correct positionin% forehead Temperature )e%ulation • :ypothalamus - thirst center6 hun%er& /ody temp re%ulation6 A=S • Sin - Cold and warm receptor actors aHectin% temperature! +& Environmental condition 2& (hysical condition #emale hormones6 e,ercise6 dse$ & Alcohol6 dru%s and medications & A%e #infant6 children6 elderly$ D& =utrition :ydration! 5ehydration6 Malnutrition :ow the 1ody eeps warm 4 Constrictin% peripheral vessels 4 Limitin% perspiration 4 3ncreasin% meta1olism 4 Shiverin% 4 Erectin% hair on the sin %EAT PROD+CTION • Meta1olism • Endocrine • Shiverin% • Muscular activity • E,ternal heat sources MEC%ANISM O %EAT &OSS +& Conduction - two touchin% o1ects 2& Convection - air and electric current #e&% fan$ & )adiation - without direct contact #e&% sun$ & Evaporation - water to %as D& /reathin% and respiration CO&D EMERGENCIES %YPOT%ERMIA 4 Looses more heat than it %ains 6 Mai" ty1es Gen Cold Emer%ency #GE=E)AL3WE5 :<(OT:E)M3A$ 4 8hole 1ody 4 Life threatenin% LOCAL COL5 3=9;)< #(eripheral C&3$ 4 Speci?c area#e&% frost 1ite$ actors t!at co"tribute to !y1ot!ermia • Cold windy environment
•
5ru%salcohol intae Al*heimer"s dse (revious cold e,posure ;se of dru%salcohol Low 1lood su%ar .ery youn% - less fats Elderly - (oor dietV loss of fats6 delayed circulation I&&NESS AND IN7+RIES T%AT CONTRIB+TE TO %YPOT%ERMIA • Shoc • :ead and Spinal inuries • /urns Sepsis Low /SL 8 STAGES • Mild - 42B °C or 4&2 ° • Moderate - 04 °C or J ° • Severe - less than 0 °C MI&D %YPOT%ERMIA 4 :i%h :) and )) 4 Cool SinV Shiverin% 4 9oint Aches 4 Slurred Speech 4 5i@cult y of movin% MODERATE %YPOT%ERMIA 4 Shiver decreasin% 4 )i%id muscles 4 Low :) and )) 4 (ale6 1lue6 mottled sin 4 5ilated pupils 4 /( unappreciated SE,ERE %YPOT%ERMIA 4 ;nresponsive 4 )i%id muscles 4 /lue sin 4 Slowa1sent respiration 4 :) - slow 4 () - hard to feel 4 Cardiac Arrest :3STO)< TA3=G • SAM(LE history • 3f unresponsive! 4 Alcohol a1use 4 Thyroid disorder 4 5M 4 Stroe 4 Trauma • Also as for! 4 :ow lon% pt is e,posed 4 Source of cold 4 Activities 1efore symptoms 1e%an GENERA& PRINCIP&E EMERGENCY CARE (%YPOT%ERMIA$ +& )emove from cold envt& 2& )emove wet clothin%6 cover with 1lanet & Avoid rou%h handlin% & O2 - should 1e warmed and humidi?ed #+00 N D& .ia =)M$ & Avoid stimulants B& 5o not massa%e e,tremities J& Chec pulse 04D secs & /efore /LS6 C() is only successful when patient is rewarmed +0& 5ocument& 2 Types of )E8A)M3=G (ASS3.E 4 =o use of heat
4 4
8arm environment Applyin% 1lanet
ACT3.E 4 5irect application of heat 4 Contact med protocol ?rst Application! Mild hypo - active rewarmin% 4 8arm 1lanets6 heat pads 4 (lace dressin% 1et heat pacs and sin to avoid 1urn Moderate hypo - heat pac to torso 4 Avoid underlyin% tissues Severe :ypo - Active 4 8arm 1lanet 4 5one in the hospital &OCA& CO&D IN7+RY 4 Ears6 nose cheecs6 chin6 feet )is LC3 5M Alcohol =icotine :eart 5isease
• • • • •
• • • • •
Classi4catio") A& Super?cial Cold 3nury #rost nip$ ;pper layer Gray and 8hite May not 1e seen immediately Stin%in% sensation =um1ness /& rost /ite #Late$ 5eep Cold 3nury 8a,y appearance +4B days 1listers Gan%rene may set in /urnin% and thro11in% pain EMERGENCY CARE 3 DEEP ROST BITE +& Safety /S3 2& Give O2 & )emove ewelry 1efore swellin% & Splint the inured e,tremities D& Avoid /reain% /listers6 applyin% heat6 walin% & Su1mer%e in a warm 1ath B&J40& °C B& ;se sterile %au*e cotton to separate the frost1itten ?n%ers and toes& J& Continue until the tissue is soft & Enroute +0& Assessment ++& 5ocument EMERGENCY CARE OR E'TREME CO&D +& )emove wet clothin% 2& 5urin% transport6 rewarm the patient & (rovide care4 CA/ & 8arm >uids for conscious and alert D& eep the pt& at rest %EAT EMERGENCIES %YPERT%ERMIA 4 :i%h core 1ody temp& 4 (roduce more heat that it looses %EAT RE&ATED EMERGENCIES • :eat Cramps • :eat E,haustion • :eat Stroe
%EAT CRAMPS Strenuous activity 4 Electrolytes and :2O loss 4 (ainful spasm - shoulders6 arms6 a1domen 4 3t may appear the pt& is havin% acute a1d& (ain 4 Sodium loss EMERGENCY CARE) +& Move to a near1y cool place 2& luids4 conscious patient & Massa%e cramped muscle & Apply moist towels to pts& forehead D& )est6 transport %EAT E'%A+STION 4 Too much heat and dehydration 4 Si%n and symptoms! 4 Sweatin% Si%ns and Symptoms! • :i%h :) • =ormalSu1normal /( • aintin% • Cold clammy sin • )apid6 shallow 1reathin% • 8ea pulse EMERGENCY CARE OR %EAT E'%A+STION +& Cool Environment 2& )emove e,cess clothin% & 5rin 8ater & 3f Severe! 3. luids #ALS$ %EAT STRO.E 4 =o Sweat 4 Load and %o 4 /ody coolin% system shut down )is!
Athletes ire ?%hters Military recruit Construction worers
Si%n and symptom • Altered m&s • 5ry hot6 >ushed sin • &°C • Low :) • Shallow6 deep 1reath • Muscle twitchin% • 5ilated pupils • ;nresponsive EMERGENCY CARE OR %EAT STRO.E +& Med& 5irection 2& Call ALS transport stat & O2 - ((. Supplemental & Start coolin% D& )emove outer clothin% & Cool pac - nec6 %roin6 armpit B& Comfort J& On%oin% assessment & 5ocument
E"*iro"me"tal ( I"sect Bites To,ins - produced 1y animalsplants Arthropods )eptiles .enomous Marine Life
D0N insects 0N snaes +N spiders %yme"o1tera 4 /ees6 hornets6 wasps6 ?re ants 4 Local pain6 mild redness6 swellin%6 itchin%6 to,ic venom &ocal e9ect 4 Edema Systemic 4 ;rticarial6 >ushin%6 3tchin%6 mild ;A O1struction6 laryn%eal edema6 hypotension6 severe 1ronchospasm • (am6 swellin% • 0 mins to hour • )apid pulse and la1ored 1reathin% • /lurrin% vision • =ausea and vomitin% • 5rowsiness 7 unconsciousness • /ite on sin Mana%ement! • Calm • 02 • Locate fan% mars - clean soap 7 :20 • )emove ewelry from 1itten e,tremity • eep 1itten e,tremity immo1ili*ed • 8atch 1and for edema • Apply contractin% 1and a1ove and 1elow • Transport 5o not! • • • • •
Apply ice Tourni'uet Cut 7 suc Electric shoc Locate snae
.enomous Marine Life 9elly?sh 4 vine%aralcohol6 1urnin% pain Stin% ray - lush6 hot water6 elevate6 cover Sea urchin - immersed on hot :206 vine%ar6 lar%e spine don"t remove 5o% and Cat 1ites Most commonly 1itten +& :ead 2& =ec & ;pper E,tremities ace 4 ++ N Trun 4 BN ;pper E 4 2JN Lower E 4 + N Y ;nder +2 yrs& old - face Y do% 1ites occurs in hot weather 5o% /ite - D0psi 4 Crushin% type inuries Cat /ite - sharper teeth 4 (unctured wound Emer%ency Care Circulation! 4 Control 1leedin% 4 5irect pressure and cover 4 8ash wound 4 )emoved ewelries
Airway! 4 4 4 4
Airway +00N 02 :i%h ris for wound infection4 transport On%oin% assessment
Emer%ency Care • Airway • 02 +00N • Scrape 7 credit card • Avoid usin% twee*ers • )emove ewelries • Transport Anaphyla,is Mana%ement • )emove stin%er • Airway • 02 • Shoc position - trendelen1er% • E(3 auto inector • ALS 1ac up EPI Auto I":ector Site! vastuslateralis - fast a1sorption Action! 1ronchodilate6 rela,es airways 3ndication! ss, of anaphyla,is prescri1ed authori*ed 1y med4direction contraindication 4 life threatenin% 2 types Adult Epi 4 &m% #l1s$ 9unior Epi 4 &+Dm% #4l1s$ YCan 1e administered twice (rocedure! • E,pose • )emove safety cap • 0 de%ress lateral thi%h • 02 ?rst • Monitor .S Side eHects! =ausea 7 .omitin% :eadache 5i**iness :i%h )) An,iety SPIDER ( blac2 ;i0o;< bro;" recluse $ • =euro to,ic • Local cold application • Anti4venom • (added splint SCORPIONS 4 Lethal in children Ss,! SL;5GEM S4 Salivatism &4 Lacrimation += ;rination D4 5iarrhea G4 Gastric Cramps E= Emesis #vomitin%$ M4 Miosis #pupil constriction$ • Snae#)attle Snae6 Copper head6 Coral Snaes 45eath occur from respiratory after hours$ • )ed and
Air em1olism )upture of teeth
4
)upture of eardrums
MA7OR CA+SES O >ATER MA7OR +& 2& & & D& & B& J&
CA+SES O >ATER RE&ATED EMERGENCY Gettin% e,hausted in water Losin% control and %ettin% swept Losin% support Gettin% trapped or entan%led while in water ;sin% dru%s or alcohol 1efore %ettin% in the water SuHerin% hypothermia SuHerin% trauma :avin% a divin% incident
DRO>NING ACCIDENTS PRE,ENTION # warnin%s$ • Children should 1e under constant supervision if pool is near1y • 8ater sports and alcoholic 1evera%es should never mi, • Life preserves life acets should always 1e worn when 1oatin% STAGE 4 4 4 4
O >ATER RESC+E )each and pull Throw Tow Go
STAGES O MANAGEMENT O DRO>NING +& 5o not enter water unless trained in water rescue 2& Ensure open airway and attempt rescue 1reathin% & Chec pulse6 if no pulse6 cstart C() & Transport D& (EE( to dry lun%sZ PAT%OP%YSIO&OGY 8ater enters airway - enters the laryn,#laryn%ospasm$ hypo,ic - tri%%ers airway resistance - stiH lun% - :<(O3C 5)3.E - stimulate inhalation of water with air and chemical - )OT: formation P /rain dama%e BAROTRA+MA 4 3nury to air spaces I":uries rom Baro o Asce"t +& (O(S #(;LMO=A)< O.E)4()ESS;)3WAT3O= S<=5)OME$ 4 /urst Lun% - :yper1aric Cham1er recompression 4 ft to rupture alveoli 4 Avoid %ivin% (EE( 8hat to ?nd out a1out divin% accident • Type of divin% • 5ivin% activity • Site of divin% • =um1er of dives #B2 hours$ • 5etails of in4water recompression • 5ive complications • (re4dive and post4dive activities • Onset of symptoms
4 )oarin% tinnitus Sinus s'uee*e 4 5oes not e'uali*e in frontal and ma,illary sinus ARTERIA& AIR EMBO&ISM • /reath holdin% durin% ascent • Life threatenin% • +0 mins& Altered consciousness • .isual distur1ances • ;ne'ual pupils MANAGEMENT +& CA/ 2& +00N O2 & Left lateral recum1ent & .entilation ETCO2 D& 5ecompression cham1er & Steroid of prescri1ed B& 5ia*epam6 dopamine POPS 4
compressed air in the lun%s Lun% tissue ruptures
Result) 4 4 4 4
(neumothora, (neumomediastinum Su1cutaneous Empty Arterial Air em1olism
Si#" a"0 Sym1toms) • )espiratory distress • Su1sternal chest pain • 5iminished 1reath sounds • :emoptysis
TREATMENT) 4 )est 4 O2 4 )educe si*e of 1u11les no (EE( DECOMPRESSION SIC.NESS 4 Gas trapped deep in the 1ody tissues 4 Slow circulated tissues
POISONING EMERGENCIES
3=9;)3ES 3= 5CS A& Cutaneous 1end Sin 1end • (ruritus6 scarlatiniform6 mottled rashes • )esult from lymphatic movement • (eau d" oran%e - locali*ed swellin% /& • • •
C& • •
5& •
IN7+RIES ROM BAROTRA+MA O DESCENT Ear S'uee*e 4 )upture of tympanic Middle ear s'uee*e 4 5ivin% with ;)T3 4 5escent and ascent 3nternal ear s'uee*e 4 orced valsava maneuver
•
Musculoseletal 1ends 9oint 1ends 5eep dull ache Movement worsen pain 3n>atin% /( cuH over area relieves pain Central =ervous system 5CS /rain involvementV deadly C.A6 paresthesia6 paralysis (ulmonary Choes Chest pain6 cou%h6 dyspnea (ulmo edema #pinish frothy sputum$
5CS MA=AGEME=T! +& CA/ 2& +00N O2 - :aldane eHect #:elps wash out =itro%en in the lun%s$ 4 .entilation - ETCO2 & 3. with L)#Lactated )in%ers$ & Lateral )ecum1ent if air em1olism suspected
D& &
Transport to recompression cham1er Steroids on med& Control
NITROGEN NARCOSIS 3 T%E NATES 4 )uptures of deep 4 (ressuri*ed nitro%en to,ic eHects on C=S 4 Anesthetic eHect due to lipid solu1ility of =2#into,ication$ 4 B04+00 feet dives Si%n and Symptoms! • Euphoria • Confusion • 5isorientation • Slow motor response T)EATME=T! • Surfacin% correct pro1lems • Consider CO2 to,icity %OT COMPRESS 4 /readown en*ymes 4 5ilute the to,ins AMB+&ANCE E?+IPMENT • :i%h visi1ility vest • Am1ulance trolley cat • oldin% secondary trolley cat • /aset rescue stretcher • Stair chair • E.AC stair chair • .acuum mattress • (orta1le suction unit • :and powered suction unit • AT. • 5eep valves4 Green +0cm:% Oran%e 20cm:% • )esK - (od • Air splints • (rosplints • Sam splint • Sa%er femoral traction splint • (orta1le 5oppler • Glucometer ATA& AMB+&ANCE CRAS%ES 4 Striin% vehicle 4 Travellin% in emer%ency mode 4 Crash on intersection 4 (oor drivin% history
POISON 4 Solidli'uid%as 4 May 1e swallowed6 inhaled6 a1sor1ed6 instilled TO'INS 4 (oisonous su1s6 secreted 1y 1acteria6 plants ANTIDOTE 4 =eutrali* es poison 8 &EADING CA+SES O POISONING +& Alcoholic into,ication 2& Metamphetamine #sha1u$ & 3sonia*id #3=:$ to,icity #hepatoto,ic6 neuropathy$ C&ASSIICATION O POISONING +& 3n%ested #common route$ 2& 3nhaled #'uicly a1sor1ed$ & A1sor1ed & 3nected D& Natio"al Poiso" Ma"a#eme"t a"0 Co"trol Ce"ter 6 ty1es o 1oiso"i"#
+& 4 4 4 4 2&
Accidentalunintentional (eople mistae poison for fooddrin 1ecause it is not in its ori%inal container (eople misuse chemical product Misuse pesticides
COMMON&Y AB+SED -MIS+SED Stimulants 5epressants :allucino%ens 5esi%ner"s dru%s ACTI,ATED C%ARCOA& - 0N 4 ine6 odorless6 1lac and tasteless powder made of wood 4 Acids and alaloids 4 Aspirin6 amphetamines 4 =o authori*ation 4 ;na1le to swallow 4 Altered mental status Co"trai"0icate0) iron6 lithium6 potassium and ethanol /rand =ame ! Li'ui Char6 super char6 actidose +%m% Dosa#e Adult 2D4D0% Child +2&D42D% 3nfant #up to + year$ +042D% 3=COM(A/3L3Te, • Acute M3 • 3n%estion of corrosives #stron% acids$ • :ydrocar1ons • Sei*ure • (re%nant • Fmons • iodides E9ects 4 may cause heart pro1lems S1ecial co"si0eratio" • (t should 1e encoura%ed to 8AL after tain% the syrup • Avoid %ettin% this syrup to pt with eatin% disorder • =ot 1e %iven with AC
/e sure patient have water in the stomach • )epeat after 20 mins Dosa#e) Children +D cc #4Dtsp$ followed 1y a %lass of water Adult 0cc #+42t1sp$followed 1y a %lass of water •
STRONG ACID 4 Coa%ulative - hardenin% necrosis 4 3mmediate dama%e to G3 tract 4 +42 mins complete dama%e 4 /urn to mouth6 pharyn,6 esopha%us6 ;)T and G3T 4 Toilet 1owl cleaner6 :C36 rust remover A&.A&IS 4 Li'uefactive necrosis 4 (ain4delayed 4 Lon%er tissue contact 4 Mins4hours 4 8ashin% soda6 ammonia6 1leach MANAGEMENT Support CA/ 3. luids replacement ALS )apid Transport GENERA& APPROAC% POISONING C - ade'uate circulation A - ade'uate airway / - ade'uate 1reathin% 5 - Mana%ement of dru% induced C=S dep& E - electrolyte or meta1olic a1normalities ORGANOP%OSP%ATE - most commonly associated with mortality %istory ta2i"# i" 1oiso"i"# +& 8hat was in%ested 2& 8hsn was it in%ested & :ow much was in%ested & 8hat else was taenI :as the pt& taen antidoteI D& :as the pt& vomited6 how lon% after in%estion & :as anythin% has 1een done 1efore arrival of EMS Patie"t assessme"t) GOAL • Support CA/ • 5elay a1sorption 4 Odor 4 LOC 4 .S Cyanide - 1loc aero1ic meta1olism 4 /itter almond 4 Sodium 1icar14 heat acidosis 4 :ydro,oco1alamin 4 Anticonvulsant 4 )etiral redness6 cherry red Car1on Mono,ide 4 Colorless6 odorless 4 Gas stoves6 room heaters 4 Cherry red sin4 car1o,yhemo%lo1in 4 Clues no& of pt involved 4 +00N 02 =)M 4 :yper1aric 02 t, 3nected poison #/ee6wasp6venom$ 4 cause anaphyla,is 4 (t& airway 4 )emove ewelry 4 3mmo1ili*e lim1 4 .enous constrictin% 1and 4 5ownward position allow slow a1sorption 4 Cold pac
SE?+ENCE O ANAP%Y&A'IS 4 Anti%en introduced into the 1ody 4 Anti%en anti1ody reactio1 4 )elease of mast cell chem& Mediator 4 Chemical medications e,ert their eHect on end or%ans A& /&
Stimulants 4 Cocaine6 amphetamines 5epressant 4 =ormal functions of C=S Ethyl alcohol 4 AHects ud%ement 4 Can mimic the H! • 5ia1etes • :ead inury • Epilepsy • 5ru% reaction 5isul?ran #Anta1use$ 4 04J hours 4 Treatment for alcoholics
ALCO:OL 83T:5)A8AL S<=5)OME 4 42J hours after alcohol 4 Consumption is stopped 4 Tremors6 an,iety6 sweatin% 5EL3)3;M T)EME=S 4 Shain% fren*y from ethanol withdrawal 4 242 wees 4 :i%h /(6 )) and Temperature =A)COT3CS 4 (ain iller 4 Control diarrhea 4 Overdose V pin point pupils 4 8ithdrawal! dilatation6 nasal con%estion /A)/3T;)ATES 4 )elieve an,iety 4 (romote sleep :ALL;C3=OGE= 4 lushed faceV sudden mood chan%e 4 An%el"s dust 4 (encyclidine - reduce pain 5ES3G=E)"S 5);G 4 La1oratory made 4 Synthetic 4 Snorted6 smoed6 in%ested E=TA=
4 4
CA/ Snortin% - can destroy nasal septum
SOL.E=T 4 Glue6 paint 4 +st - sniHed 2nd - soain% cloth rd - 1a%%in% 4 Sudden Sni@n% 5eath Syndrome #Cardiac Arrhythmia$ 4 Treatment! Activated charcoal 8AT;S3 (O3SO=3=G 4 5ancin% ? recracer
• • •
(atient"s sin ! /);S: the powder Li'uid! irri%ate the sin for 20 mins #attention to sin crease and ?n%ernails$ (atient"s eyes! 20 mins >ushin% 24 inches away Cover with moist dressin%
ACETAM3=O(:E= A)SE=3C AT)O(3=E /E=WO53AW3(3=E Car1on mono,ide C
3ncu1ation Acute infection 4 24 wees 4 ever6 sore throat6 lymphadenopathy Seroconversion 4 4+2 wees 4 3mmune system is still ?%htin% Should 1e tested 4 24 wees after e,posure 4 wees - months 4 months
A/SO)/E5 (O3SO= 4 (lants6 pesticides 4 Li'uidpowder 4 /urns6 itchin%
•
Across placenta - 20th wee of %estation
(recaution in dealin% :3. positive patient +& O1serve and practice ;niversal (recaution 2& )estrict pre%nant EMT from contact & (rotect pt from ac'uirin% infection from you or your crew & Assume that every patient you treat is :3.[
:E)O3=E 4 rom morphine6 nala%esia 4 =alo,one - antidote 4 Chasin% the dra%on
•
&
A=T35OTE =4Acetylcystene /AL (hysosti%mine luma*eril o,y%en Sodium =itrate :ydorco1alamine Methylene /lue =ala,one 5imecaprol Atropine Edetate Calcium 5isodium Ethanol
+&
8hen in dou1t Assume that containers were full • Entire contents were in%ested 2& Always! • /rin% sample of material • Save for analysis if vomits • Call poison center for advice & Cause of death in in%ested poison • Antidep • (ain relievers • Sedatives • Cardio meds (AT3E=T ASSESSME=T - 3=:ALE5 (O3SO= (recaution • Thorou%h scene si*e up - :AWMAT • :ave sample of su1stance involved • ire and e,plosion precaution • 3f the scene is not safe do not enter •
INECTIO+S DISEASES A35S Mode of transmission +& Se,ual Contact - semen6 saliva6 1lood 2& (arenterally - 1lood products infected needles
After infection J yearsyears+D years - adult 2 years - children Aids )elated Comple, 4 Seroconversion sta%e 4 8ei%ht loss +0N 4 diarrhea for + month 4 fever 4 ni%ht sweats True A35S 4 life threatenin% 4 opportunistic infection! a& (nuemocystis carina 4 Most common 4 Leads to aids dia%nosis 4 Life threatenin% 1& Candida Al1icans 4 Thrush in infants 4
3ndinavir
rel?rcivir
5ia%nosis! 4 Elisa - 2 wees from e,posure - to con?rm 4 8estern /lood - con?rmatory after Elisa .I&&ING %I, A& :EAT D°C #+0420mins$ Lyophili*ed protein prep J °C after 2 hours /& 53S3=ECTA=T Glutaraldehyde and hydrochloride low conc& 3sopropylEthanol #04B0N$ 3nactivates :3. Less eHective if dried :3. 5eter%ents and hi%h and low ph solutions C& 5)<3=G )educe viral ineHectivity 5ried :3. in salt solution may still detected after a wee 5ried serum or 1lood unliely to 1e si%ni?cant infection ris EMT 3 I"0irect co"tact 4 5isinfect 4 5ryin% NAT+RA& %ISTORY • Lymphadenopathy • lu lie symptoms 2 wees • ever and Malaise 4 Asymptomatic infection #+4+0 years$ 4 D0N develop true aids within +0 years RNA ,IR+S 4 )etrovirus uses reverse transcriptase en*yme 4 Tar%et cells is T4helper#C5 positive cell$ 4 2 virus can com1ine in one cell4 diversity :E(AT3T3S - in>ammation of the liver :E(A A 7 E - oral4fecal route :E(A /C5 4 (arenteral %EPATITIS A • ecal4oral #improper food handlin%$ • Can survive to hours • 3ncu1ation 2D40 days • 5oes not cause CL5 S3G= A=5 S
5ar urine (ossi1le aundice A1d& discomfort
%EPATITIS B • (arenteral • /lood 1orne6 se,ual6 perinatal • 3ncu1ation! 24+0 days • Can survive up to B days • Cause CL5 and Liver cancer6 Chronic infection Si#" a"0 S'! 24 months non speci?c 9oint pain 5ar urine Clay colored stool 9aundice Su11orti*e care o /S3 and :8 o 3nactivated 1y 0&+N %lutaraldehyde household 1leach o 3nactivated 1y heatin% J °C for 2 mins o )esistant to deter%ent and alcohol o 8ith vaccine %EPATITIS C 3 No" A< "o" B 4 (arenteral
4 4 4 4 Si%n
/lood1orne6 se,ual6 perinatal Liver Transplant possi1le Chronic Carrier Chronic Liver 5isease and infection and Symptoms 9oint pain 5ar urine Less pro%ression to aundice Treatment support care • /S3 and :8 • =o reco%ni*ed from prophylactic 3%G %EPATITIS D • 5elta virus • )e'uires :/. • (arenteral6 1lood and 1ody >uids • Chronic infection • CL5 possi1le • Coinfection can 1e prevented 1y vaccine • =on for superinfection • .accine :/. - indirectly prevents :5. %EPATITIS E (No" A No" B$ • Oral fecal transmission • Enterically transmitted • Sources! feces • 3ncu1ation! +D40 days • (atients are usually travellers • :/. not eHective :E. Ge"eral Saety) %e1atitis • /S36 safety • O1serve and practice universal precaution • Gloves • =eedle precaution • /a% la1el 1lood sampler contaminated linens • O1tain immuni*ation • 8ash 1lood spills with 1leach solution • Assess personal 1ehavior riss • Stay in touch in the hospital to wc patient was transported for rup d, T+BERC+&OSIS • Myco1acterium tu1erculosis • Transmission! droplet V air1orne • 5irect infection trou%h non4contact sin - e,tra pulmonary T/ • O1li%ate aero1e • Grows outside the cell • Gram [ /acillus • Grow very slowly #chronic illness$ C!aracteristic) • )esistant to dryin%6 acid6 alali • Sensitive to ;.6 phenol6 =ahypochloride6 heat • )emains via1le in dar areas for months • ;ntreated T/ - develop in +42 years • 3ncu1ation! 4+2 wees • Clinical manifestation 4+2 months after infection • 4)ay con?rmatory • acid fast stainin% • cell mediated immune response walls of 1acteria #tu1ercle$ • untreated - hematemesis • severe form - hemothora, • ALS - must have e,haust ventilation T and (.!
4 4 4 4 4
/S3 8ear mas )outine T/ testin% of EMS personnel E,pose - repetition of sin test 3=: - prophyla,is6 routinely in FDyears of a%es [(3TS
+& 2& & &
ME53CAT3O=! #lon%term$ 4 3sonia*id6 ritampicin6 Etham1utol6 Strep6 (yra
Yull 3solation when transportin% /S3 Avoid contact 7 respi secretions Mas pt7 yourself 3f Close contact e,posure occurs • :8 fre'uently • Air out .ehicle • Send linens to laundry • 3mmuni*ation #no routine vacc for EMS personnel$
S<(:3L3S • • •
•
Spirocheles Treponcemapallidum Transmission - se,ual contact6 mother to fetus6 direct contact 7e,udales =eedle stic - uncommon
•
Chancre - painless ulcer6 site of entry )e%ional Lymphadenopathy
SECO=5A)< • /acteremia wees after chancre healed • 4+2 wees #fever6 rashes$ • (ea 4 hours • Lesion may reappear up to + year • ishy odor female LATE=T • • • •
• • •
4
()3MA)< •
)A/3ES
+4 yearsrest of patients life Early F 2 years Late phase 2 years ;ntreated patient develop tertiary syphilis 42D years
TE)T3A)< - not conta%ios a& Gumma - lesion of sin6 1one 4 (ainless 7 sharp 1orders 4 /one 7 deep %nawin% pain 1& Cardiovascular syphilis 4 +0 years after infection 4 Aneurysm c& =eurosyphilis 4 Menin%itis 4 Loss of re>e,es
•
• •
SS! • • •
;=G;S - Cryprococcus =eoformans .3);S - Enterovirus ST)E(TOCOCC;S (& - children Transmission! Air1orne • Coloni*es the throat - respi sections • 5irect contact 7 respi secretion • 3nfant #carriers$ months4 2 years SS 4
(. 7 T!
Sei*ure6 hi%h fever6 rapid onset6 nuchal ri%idity6 pro%ressin% ecchymosis6 delirium
Apprehension :eadache Spasm on swallowin% muscle result in hydropho1ia and salivation
(:ASES of )a1ies A&
/&
C&
T 7 (. Syphilis • Avoid contact 7 sin lesions • /S3 • :.. • Conta%ious patient are in primary6 secondary and early latent sta%e ME=3=G3T3S • Menin%ococcal Menin%itis • =eisseria Menin%itis - children • /acteria6 virus6 fun%i
Lyssavirus .iral encephalitis Transmission o 4saliva containin% virus after a 1ite scratch of infected animals =e%ri1odies activation and release in their 1rains after 1ittin% 5eath usually 24 days 7 intervention 5eath - respiratory failure
T 7 (. +& 2& & & D& &
(rodromal (hase • 24 days • ever6 headache • Copious salivation #laryn%ospasm$ • Trismus #sadness$ • A=. is aHected An%er Sta%e • )estless • 5isoriented • 24 days • Sei*ure • Application of mechanical restrain =eurolo%ic Sta%e • (aralytic Sta%e • (aralysis of throuat and face • /e%in 7 the 1ody part that was 1itten • Terri?ed of :\$ • An,ious6 hyperactive • 24 days
/S36 safety ree 1leedin% and draina%e .i%orously clean wound with soap and water Tetatus (rophyla,is :uman )a1ies 3%G :uman 5iploid cell ra1ies vacc or )a1ies vacc for hi%her ris person animal care worers6 animal shelter personnel
3ntellectual (roperty of Mr& (9/autista P$
