Patient Care

Created by WT2002 

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Inadequate breathing

provide artificial ventilation and supplemental oxygen to the patient.

Symptoms of Acute Coronary Syndrome

pain, pressure, or discomfort in the chest or upper abdomen. Difficulty breathing. Palpitations. Sudden onset of sweating and nausea or vomiting. Anxiety. Unusual generalized weakness. Abnormal pulse. Abnormal blood pressure.

Acute Coronary Syndrome

place in position of comfort. apply high oxygen with nonrebreather. Transport immediately. Can give nitro if patient has chest pain, history of cardiac problems, been prescribed nitro, blood pressure is within range, no ED meds taken recently, Medical direction authorizes the administration.
Can give aspirin if has chest pain, not allergic to aspirin, no history of asthma, not taking meds to prevent clotting, no contraindications for aspirin, can swallow, and Medical direction authorizes.

Symptoms of Congestive Heart Failure

Tachycardia, Dyspnea, Normal or elevated blood pressure, cyanosis, diaphoresis (profuse sweating) or cool and clammy skin, pulmonary edema, anxiety or confusion due to hypoxia caused by poor oxygen/carbon dioxide exchange, pedal edema, engorged pulsating neck veins (late sign), enlarged liver and spleen with abdominal distention (late sign)

Symptoms of Diabetic Emergencies

rapid onset of altered mental status, after missing a meal on a day that patient took prescribed insulin, after vomiting a meal on the day the patient took prescribed insulin, after an unusual amount of physical exercise or work, may occur with no identifiable predisposing factor; intoxicated appearance, staggering, slurred speech, to unconsciousness; cold, clammy skin; elevated heart rate; hunger; uncharacteristic behavior; anxiety; combativeness; seizures.

range of normal blood sugar

60-80mg/dL with systomatic diabetic mental status for a hypoglycemia. 140mg/dL and above indicates hyperglycemia.

diabetic emergencies

minor hypoglycemia can be treated by giving patient something to eat. If severely hypoglycemic, if they meet the qualifications for oral glucose, give the patient oral glucose. if they are not awake enough to swallow, treat like any other patient with altered mental status. Secure airway, provide artificial ventilation if necessary. Lay in recovery position. Transport.

seizure disorders

place patient on the floor or ground. if no possibility of spinal injury, place on side. loosen restrictive clothing. remove objects that may harm the patient. protect patient from injury, but do not restrict.
after convulsions: protect airway, provide artificial ventilation if needed, treat injuries if sustained during convulsions, transport.

symptoms of stoke

confusion; dizziness; numbness, weakness, or paralysis (usually one side of the body); loss of bowel or bladder control; impaired vision; high blood pressure; difficult respiration or snoring; nausea or vomiting; seizures; unequal pupils; headache; loss of vision in one eye; unconsciousness (uncommon)

stroke

cor conscious patients who can maintain their airway, administer oxygen, transport in semi-sitting position. for unconscious, maintain airway, provide oxygen, transport patient lying on affected side.

dizziness and syncope

administer oxygen, call ALS if signs of instability and if available, loosen tight clothing around neck, lay patient flat, treat any associated injuries the patient may have incurred from the fall.

allergic reactions or anaphylaxis

apply oxygen, may be able to administer epi if the patient is prescribed it. If not, consider ALS and transport.

ingested poison

treat life threatening problems, remove any pills, tablets, or fragments from mouth. Keep any material found. consult medical direction, administer charcoal if indicated. transport the patient.

inhaled poison

administer oxygen, transport right away. transport with all containers, bottles, and labels from the substance.

symptoms of carbon monoxide

headache, dizziness, breathing difficulty, nausea, cyanosis, altered mental status (in severe cases, unconsciousness may result)

absorbed poision

treat life threatening injuries, remove the poisons, transport the patient with all containers, bottles, MSDS sheets, and labels from the substance.

signs of alcohol abuse

odor of alcohol, swaying and unsteadiness of movement, slurred speech, rambling thought patterns, incoherent words or phrases, a flushed appearance to the face (may be sweating or complaining of being warm), nausea or vomiting, poor coordination, slowed reaction time, blurred vision, confusion, hallucinations (visual and auditory), lack of memory, altered mental status.

withdrawal of alcohol abuse

confusion and restlessness; unusual behavior, to the point of demonstrating "insane" behavior; hallucinations; gross tremor (obvious shaking) of the hand; profuse sweating; seizures (common and often very serious); hypertension; tachycardia

alcohol abuse

stay alert for airway and respiratory problems. assess any trauma that may have occurred. talk to the patient and try to keep them as alert as possible. monitor vital signs, treat for shock, protect the patient from self injury (use restraint as authorized by your ems system, request law enforcement as needed). be alert for seizures, transport.

signs of drug withdrawal

shaking, anxiety, nausea, confusion, and irritability, hallucinations, profuse sweating, increased pulse and breathing rates.

substance abuse

treat for shock, talk to patient to maintain level of conciousness, assess for injuries. protect from self harm and injury of others(use restraint as authorized by your ems system, request law enforcement as needed). check for track marks. stay alert for siezures, transport.

abdominal distress

perform primary and secondary assessments. apply oxygen, be prepared to suction, transport in a position of comfort.

behavioral or psychiatric emergency

treat any life threats, be alert for medical or traumatic conditions that may mimic behavior emergencies. encourage patient to talk about what is bothering them. Never play along with hallucinations, do not lie to the patient.

signs and symptoms of behavioral or psychiatric emergencies

panic or anxiety; unusual appearance, disordered clothing, or poor hygiene; agitated or unusual activity, such as repetitive motions, threatening movements, or withdrawn stance; unusual speech patterns, such as too rapid or pressured-sounding speech, or an inability to carry on a coherent conversation; bizarre behavior or thought patterns; suicidal or self-destructive behavior; violent or aggressive behavior with threats or intent to harm others

potential or attempted suicide

ensure scene safe, treat any life threats. transport

sickle cell anemia

administer oxygen, monitor for breathing. may need to treat for shock. transport

ESRD Patient who has missed dialysis

administer oxygen, place in position of comport. monitor vitals. be alert for a fistula. transport. if they are having complications, may need to treat for shock.

external bleeding

assess ABCs, control bleeding with direct pressure, elevation, hemostatic agent, tourniquet. can use splint, cold application, or a pneumatic antishock garment. administer oxygen. transport.

signs of internal bleeding

injuries to surface of the body, which could indicate underlying injuries. Bruising, swelling, or pain over vital organs. painful, swollen, or deformed extremities. bleeding from the mouth, rectum, vagina, or other body orifice. tender, rigid, or distended abdomen. vomiting a coffee-ground-like substance or bright red vomitus. dark, tarry stools or bright red blood in the stool. signs and symptoms of shock.

internal bleeding

maintain ABCs. Administer oxygen. Control any external bleeding. if you suspect internal bleeding to an injured extremity, apply splint. provide prompt transport.

signs of shock

altered mental status. pale, cool, and clammy skin. nausea and vomiting. vital sign changes, increase pulse and respiration, blood pressure drop. late signs can include thirst, dilated pupils, and sometimes cyanosis around lips and nail beds.

shock

maintain ABC, control external bleeding. give oxygen. apply PASG if approved and orderd by medical direction. splint bone injuries. cover patient with a blanket. transport.

open wounds

expose wound. clean the wound surface, leaving embedded particles and debris, remove large pieces. Control bleeding, direct pressure and elevation. If necessary, apply tourniquet. for serious wounds, care for shock. prevent futher contamination with sterile dressing. bandage the dressing in place after controlling the bleeding. keep patient calm and laying still, transport.

impaled objects

expose wound area. control bleeding with direct pressure if possible. stabilize the object. secure dressing. care for shock. keep patient at rest, and transport. If it is impaled in the cheek and can see both ends of the object, pull it out in the direction that it entered the cheek if can be done easily.

avulsions

clean the wound, fold the skin back to its normal position gently, control bleeding and dress wound using bulky pressure dressings. transport

amputations

apply pressure dressing over the stump. use pressure points to control bleeding, should not use tourniquet unless other methods used to control bleeding have failed. wrap amputated part in sterile dressing, keep cool by cold packs.

flail chest

oxygen, stabilize the flail chest with a bulky dressing. transport.

open chest wound symptoms

wound to the chest, may or not be a characteristic sucking sound associated with an open chest wound. patient may be gasping for air.

open chest wound

seal the open chest wound as soon as possible with occlusive dressing. administer oxygen. care for shock. transport as soon as possible.

symptoms of chest cavity injuries

signs of pneumothorax: respiratory difficultly. uneven chest wall movement. reduction of breath sounds on the affected side of the chest.
signs of tension pneumothorax: increasing respiratory difficulty. indications of developing shock, due to decreased cardiac output. distended neck veins. tracheal deviation to hte uninjured side. deduced or absent breath sounds on the affected side.
signs of hemothorax: coughing up frothy red blood.
signs of traumatic asphyxia: head, neck, and shoulders appearing dark blue or purple. bloodshot or bulging eyes. swollen and blue tongue and lips, chest deformity.
signs of cardiac tamponade: distended neck veins. very weak pulse. low blood pressure. decreasing pule pressure.
signs of aortic injury or dissection: tearing chest pain. differences in pulse and blood pressure between left and right. Palpable pulsating mass. cardiac arrest

chest cavity injuries

oxygen. care for shock, transport.

symptoms of abdominal injury

pain, often starting as mild pain then becoming intolerable. cramps, nausea, weakness, thirst. obvious lacerations and puncture wounds to the abdomen, pelvis, middle and lower back or chest near diaphragm. indications of blunt trauma. developing shock. coughing up or vomiting blood. rigid or tender abdomen. distended abdomen.

abdominal injury

lay on back, with knees up to reduce pain by relaxing abdominal muscles. oxygen, care for shock. apply pasg. transport.

musculoskeletal injuries

splint suspected extremity fractures. cover wounds with sterile dressings, elevate, and apply cold pack.

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