329 terms

EMT

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Assault
unlawfully placing a patient in fear of bodily harm
battery
touching a patient or providing emergency care without consent
kidnapping
the seizing, confining, abducting, or carrying away of a person by force, including transporting a competent adult for medical treatment without his or her consent
defamation
the communication of false information about a person that is damaging to that persons reputation or standing in the community
gross negligence
conduct that constitutes a willful or reckless disregard for a duty or standard of care
ethics
the philosophy of right and wrong, of moral duties, and of ideal professional behavior
factors and strategies for communication
age, body language, clothing, culture, educational background, environment, eye contact, facial expression, gender, posture, voice tempo, volume
Ten golden rules
1. Make and keep eye contact with your patient at all times
2. Provide your name and use the patients proper name
3. Tell the patient the truth
4. Use language that the patient can understand
5. Be careful what you say about the patient to others
6. Be aware of your body language
7. Always speak slowly, clearly, and distinctly
8. If hearing impaired, face the patient so they can read your lips
9. Allow time for the patient to answer or respond to your questions
10. Act and speak in a calm, confident manner while caring for the patient
Include in Oral Report
1. Opening info; name, chief complaint, NOI or MOI
2. Detailed information; not provided in radio report
3. Any important history; not already provided
4. Patients response to treatment
5. Vital signs; during transport and after radio report
6. Other information
Patient care report
legal document used to record all aspects of the care your patient received
Information collected on PCR
Patients name, gender, date of birth, and address
Dispatched as? (time and what was said)
Chief complaint
Location of patient (what did you see when you arrived)
Rescue and treatment before your arrival
Signs and symptoms during patient assessment
Care and treatment given by you at site and during transport
Vital signs (any changes in vitals and condition)
SAMPLE history
Date, time, location of call
Time of dispatch, arrival at scene, leaving of scene and arrival at hospital
Patient's insurance info
Names and/or certification #'s of responding EMT's
Name of base hospital
Emergency or routine run
standing orders
written documents, signed by the EMS system's medical director, that outline specific directions, permissions, and sometimes prohibitions regarding patient care; also called protocols
six functions of PCR
1. continuity of care
2. legal documentation
3. education
4. administrative information
5. essential research record
6. evaluation and continuous quality improvement
thorax
enclosed the heart, lungs, and great vessels
arm
humerus- upper arm
radius- lateral, thumb side
ulna- medial
Function of Skeletal System
Shape, protection of organs, movement, storage of calcium, helps create bloodcellls
Function of Musculoskeletal System
form, upright posture, movement (byproduct is heat)
Types of Muscle
Cardiac muscle- found in heart
Smooth muscle- found in intestines
Skeletal muscles- actual muscles for movement
Function of Respiratory System
Provide body with oxygen, remove carbon dioxide
alveoli
functional unit of lungs, oxygen and CO2 exchange takes place
ventilation
movement of air between the lungs and the environment; regulated by pH of CSF
respiration
process of gas exchange
Characteristics of normal breathing
-normal rate and depth
- regular rhythm or pattern
- good audible breath sounds on both sides
- regular rise and fall movement on both sides
- movement of the abdomen
labored breathing
the use of muscles of the chest, back, and abdomen to assist in expanding the chest; occurs when air movement is impacted
Indication of NOT normal breathing
-muscle retractions above the clavicles, between the ribs and below rib cage
-pale or cyanotic (blue) skin
-cool, damp (clammy) skin
- tripod position (leaning forward onto two arms)
agonal gasps
respiratory center in the brain continues to send signals to the breathing muscles even though the heart has stopped
Normal respiratory rate ranges
Adults: 12 to 20 breaths/min
Children: 15 to 30 breaths/min
Infants: 25 to 50 breaths/min
Components of Blood
Plasma (liquid), platelets (clotting), RBC (O2 transport), WBC (immune system)
Systole
left ventricle contracting
Diastole
left ventricle relaxes
perfusion
the circulation of oxygenated blood within an organ or tissue in adequate amounts to meet the cells' current needs
Spleen
filters blood, located in Left upper quadrant
3 parts of brain
cerebrum (main part), cerebellum (coordination), brain stem (life vital functions)
central nervous system
brain and spinal cord
peripheral nervous system
cables of nerve fibers, divided into somatic and autonomic systems
Somatic nervous system
voluntary movement
Autonomic nervous system
involuntary movement; split into sympathetic and parasympathetic nervous systems
sympathetic nervous system
"fight or flight" increases HR, respiratory rate, pupil dilation, and increased use of glucose
parasympathetic
"rest and digest" slows down the body
Skin layers
Epidermis, Dermis, Subcutaneous
Function of Skin
protection, regulation of temperature, transmits info from the environment to the brain
Organs of the RUQ
liver, gallbladder, portion of colon
organs of the LUQ
stomach, spleen, portion of colon
Organs of RLQ
two portions of colon, appendix
Organs of LLQ
descending and sigmoid colon
Retroperitoneal organs
kidneys and pancreas
endocrine system
complex message and control system that integrates many body functions
pharmacology
...
dose
...
"Six rights" of medication administration
Right patient
Right medication
Right dose
Right route
Right time
Right documentation
Per rectum (PR)
commonly used in children, rapid rate of absorption, used if patient is unconscious or cannot swallow, enteral
Oral (PO)
by mouth, slow rate of absorption, unpredictable absorption rate, enteral
Intravenous injection (IV)
into the vein, immediate rate of absorption, parenteral
Intraosseous Injection (IO)
into the bone, used for absolute emergency, immediate rate of absorption, parenteral
Subcutaneous Injection (SC)
beneath the skin, slowly absorbed, effects last longer,
Intramuscular Injection (IM)
into the muscle, usually butt or deltoid, auto-injector, parenteral
Inhalation
inhalers, inhaled into the lungs, fast absorption, parenteral
Sublingual (SL)
under the tongue, fast absorption, parenteral
Transcutaneous (transdermal)
through the skin, patches, gels, lotions, parenteral, longer lasting effects, slow absorption
Intranasal (IN)
pushed through a specialized atomizer device (MAD), fast absorption
peer-assisted medication
when the EMT administers medication to him or herself or to a partner
patient-assisted medication
when the EMT assists the patient with the administration of his or her own medication
EMT-administered medication
when the EMT directly administers the medication to the patient
symptom
subjective condition that the patient feels and tells you about
sign
an objective condition that you can observe about the patient
How to: Patient Assessment
Scene Size-up
Primary Assessment
History Taking
Secondary Assessment: Medical or Trauma
Reassessment
Scene Size Up
(begins with basic info from dispatcher)
1. Ensure scene safety
2. Determine Mechanism of Injury/Nature of Illness
3. Take standard precautions: gloves, gown, goggles, mask...
4. Determine number of patients
5. Consider additional/specialized resources: ALS, law enforcement
Mechanism of Injury
the way in which traumatic injuries occur
Nature of Illness
the general type of illness a patient is experiencing
Primary Assesment
1. Form a general impression
2. Assess level of Consciousness
3. Assess the airway: identify and treat life threats; administer oxygen
4. Assess breathing: identify and treat life threats
5. Assess circulation: identify and treat life threats
6. Perform rapid scan
7. Determine priority of patient care and transport
Form a general impression
greet patient, visual assessment, determine if stable or unstable
Asses LOC
AVPU scale, orientation, can use Glascow coma scale, check PEARRL,
Level of Consciousness
Conscious with an unaltered LOC
Conscious with an altered LOC
Unconscious
AVPU Scale
Alert
responsive to Verbal stimuli
responsive to Pain
Unresponsive
Orientation
test to evaluate a patients ability to remember four things: person, place, time, event
PEARRL
Pupils, Equal, And, Round, Regular in size, react to Light
stridor
a brassy crowing sound prominent on inspiration, suggest a mildly occluded airway caused by swelling
Signs of airway obstruction
obvious trauma, blood or other obstruction
noisy breathing
extremely shallow or absent breathing
Assessing Breathing
obtain: Respiratory rate, Rhythm (regular or irregular), Quality/character of breathing, Depth of breathing
Assess Circulation
Assess pulse, skin, external bleeding,
Normal Pulse Rates
Adult: 60-100
Children: 80-120
Infants: 100-160
Rapid Scan
60-90 sec; determine priority of injuries
High-Priority Patients: Transport Immediately
Difficulty Breathing
Poor general impression
Unresponsive with no gag or cough reflex
Severe chest pain
Pale skin or other signs of poor perfusion
Complicated child birth
Uncontrolled breathing
Responsive but unable to follow commands
Severe pain in any part of the body
Inability to move any part of the body
History Taking
Investigate Chief complaint
Obtain SAMPLE history
SAMPLE
Signs and symptoms
Allergies
Medications
Pertinent past medical history
Last oral intake
Events leading up to injury/illness
OPQRST
(follow up of SAMPLE)- about pain
Onset
Provocation or palliation
Quality
Region/radiation
Severity
Timing
Secondary Assessment
Assess vital signs
Systematically assess the patient: full body scan and/or focused assessment
DCAP-BTLS
Deformities
Contusions
Abrasions
Punctures/penetrations
Burns
Tenderness
Lacerations
Swelling
Normal BP
Adults: 90-140 (systolic)
Children: 80-110 (systolic)
Infants: 50-95 (systolic)
Reassesment
Repeat Primary Assessment
Reassess vital signs
Reassess the chief complaint
Recheck interventions
Identify and treat changes in the patients condition
Reassess patient time
Unstable: every 5 min
Stable: every 15 min
function of upper airway
warm, filter and humidify air
function of lower airway
exchange oxygen and carbon dioxide
mediastinum
space between the lungs; contains the heart, great vessels, esophagus, trachea, major bronchi and many nerves
oxygenation
process of loading oxygen molecules onto hemoglobin molecules in the bloodstream
Recognizing adequate breathing
-normal rate (12-20 breaths/min)
-regular pattern of inhalation and exhalation
- clear and equal lung sounds on both sides of the chest
-regular and equal chest rise and fall
-adequate depth
ataxic breathing
ineffective respirations that may or may not have an identifiable pattern
oropharyngeal airway
keeps tongue from blocking airway, makes easier to suction oropharynx
indications for oropharyngeal airway
unresponsive patients without a gag reflex,
contraindications for oropharyngeal airway
conscious patients, or who has a gag reflex
Indications for nasopharyngeal airway
semiconscious or unconscious patients with a gag reflex, or who would not tolerate an oropharyngeal airway
Contraindications for nasopharyngeal airway
severe head injury with blood draining from the nose, history of fractured nasal bone
Suctioning times
no more than; 15 sec- adults
10 sec- children
5 sec- infants
Non rebreathing Mask
preferred way of giving oxygen in the prehospital setting to patients who are breathing adequately but are suspected of having or showing signs of hypoxia; 10-15 L/min; up to 90% oxygen
Nasal cannula
delivers oxygen through two small tube like prongs that fit into the patient's nostrils; can provide 24% to 44% inspired oxygen; 1-6L/min flow rate
Tracheostomy masks
cover tracheostomy hole and have a strap that goes around the neck
best way to deliver tidal volume
mouth to mask
pneumothorax
partial or complete accumulation of AIR in the pleural space
Shock
a state of collapse and failure of the cardiovascular system; hypoperfusion, can occur because of anything
Three parts of cardiovascular system
Heart- pump
Blood vessels- container
Blood- content
Causes of Shock
A. Pump failure
B. Low fluid volume
C. Poor vessel function
Types of Shock
A. Pump Failure
- Cardiogenic Shock
- Obstructive Shock
B. Low fluid volume
- Hypovolemic Shock
- Hemorrhagic shock
- Nonhemorrhagic shock
C. Poor vessel function
- Distributive shock
- septic shock
- neurogenic shock
- anaphylactic shock
- psychogenic shock
Cardiogenic shock
inadequate function of the heart or pump failure; major effect is backup of blood into the lungs (pulmonary edema)
Edema
presence of abnormally large amounts of fluid between cells in body tissues causing swelling to the affected area; pulmonary edema caused by cardiogenic shock
Obstructive shock
results when conditions that cause mechanical obstruction of the cardiac muscle also impact pump function; cardiac tamponade and tension pneumothorax
cardiac tamponade
occurs when blood leaks into the tough fibrous membrane known as the pericardium, causing an accumulation between the heart and the sac; heart cannot refill
tension pneumothorax
caused by damage to the lung tissue; air normally held in the lung escapes into the chest cavity; begins to apply pressure to the structures in the mediastinum
Distributive shock
widespread dilation of the small arterioles, small venues or both; circulating blood volume pools in the expanded vascular beds and tissue perfusion decreases; septic, neurogenic, anaphylactic and psychogenic shock
septic shock
result of severe infections in which toxins are generated by the bacteria or by infected body tissues; toxins damage vessel walls causing increased cellular permeability
Neurogenic Shock
circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries
Anaphylactic Shock
severe shock caused by an allergic reaction
Psychogenic Shock
shock caused by a sudden, temporary reduction in blood supply to the brain that causes fainting
Hypovolemic Shock
inadequate amount of fluid or volume in the system; hemmorhagic and non-hemmorhagic shock
Hemorrhagic shock
loss of fluid volume caused by injuries
Nonhemorrhagic shock
loss of fluid volume caused by vomiting and diarrhea
3 Stages of Shock
Compensating: body trying to fix it
Decompensated: BP falls
Irreversible: terminal
Signs of compensating shock
agitation, anxiety, restlessness, feeling of impending doom, altered mental status, clammy skin, nausea or vomiting, marked thirst
Signs of decompensated shock
drop in BP, labored or irregular breathing, dull eyes, dilated pupils, poor urinary output
The type of pain where the patient experiences tenderness when direct pressure is applied but severe pain when that pressure is released is called:
rebound tenderness
In which condition does the junction between the esophagus and the stomach tear, causing severe bleeding and potentially death?
Mallory-Weiss Syndrome
Another common name for envenomation is:
Sting
*Signs of Adequate Breathing
...
*Cheyne-stokes respiration
occurs with stroke and head injury
Basic Life Support (BLS)
noninvasive emergency lifesaving care that is used to treat medical conditions including airway obstruction, respiratory arrest, and cardiac arrest
ABC's
Airway (obstruction), breathing (respiratory arrest), and circulation (cardiac arrest)
Cardiopulmonary resuscitation (CPR)
used to establish artificial ventilation and circulation in a patient who is not breathing and has no pulse
Steps for CPR
Chest compressions- restore circulation
30 compressions- 2" deep
2 breaths- chest rise
Chain of Survival
-Early access
-Early CPR
-Early defibrillation
-Early advanced care
-Integrated post-arrest
gastric distention
stomach becomes filled with air
When to not start CPR
rigor mortis, dependent lividity, putrefaction, evidence of non survivable injury
When to stop CPR
S- patient starts breathing and has a pulse
T- patient transferred to another person trained in BLS
O- out of strength to continue
P- a physician is present or providing online direction and assumes responsibility of the patient, gives direction to stop
Types of respiratory emergencies
asthma, emphysema, chronic bronchitis
types of cardiovascular emergencies
heart attack, congestive heart failure
types of neurological emergencies
seizure, stroke, syncope
types of gastrointestinal emergencies
appendicitis, diverticulitis, pancreatitis
types of urologic emergencies
kidney stones
types of endocrine emergencies
diabetes mellitus
types of hematologic emergencies
sickle cell disease, hemophilia
types of immunologic emergencies
anaphylactic reaction, food allergy
types of toxicology emergencies
substance abuse, food or plant poisonings
types of psychiatric emergencies
alzheimer disease, schizophrenia, depression
types of gynecologic emergencies
vaginal bleeding, sexually transmitted disease, pelvic inflammatory disease
index of suspicion
awareness and concern for potentially serious underlying and unseen injuries or illness
Common/serious infectious communicable diseases
Herpes simplex
HIV
Syphilis
Hepatitis
Meningitis
Tuberculosis
Whooping Cough
Methicillin-resistant staphylococcus aureus (MRSA)
Hantavirus
West Nile
SARS
Avian flu
H1N1
HIV
Causes acquired immune deficiency
Can occur via sexual contact or exposure to blood or body fluids
Syphillis
Bloodborne disease, can be treated with penicillin
Hepatitis
Inflammation of the liver
Early signs of hepatitis
Loss of appetite, vomiting, fever, fatigue, sore throat, cough, muscle and joint pain: later jaundice and right upper quadrant pain
Virulence
Strength or ability of a pathogen to produce disease
Meningitis
Inflammation of the meningeal coverings of the brain and spinal cord
Signs and symptoms of meningitis
fever, HA, stiff neck, altered mental status
tuberculosis
chronic mycobacterial disease that usually strikes the lungs
pertussis
whooping cough, airborne disease caused by bacteria; mostly affects children under 6
methicillin-resistant staphylococcus aureus
MRSA, resistant to most antibiotics
dyspnea
difficulty breathing
Signs and symptoms of difficulty breathing
altered mental status, anxious or restless, resp rate to fast or slow, irregular breathing, skin is pale cool or clammy, cyanosis, wheezing, coughing, decreased or noisy breath sounds , unequal chest rise,
signs of asthma
wheezing on inspiration/expiration, bronchospasm
signs of anaphylaxis
flushed skin or hives, generalized edema, decreased bp, laryngeal edema with dyspnea
signs of bronchitis
chronic cough, wheezing, cyanosis, productive cough
signs of congestive heart failure
dependent edema, rales, paroxysmal nocturnal dyspnea
signs of croup
fever, barking cough, mostly in pediatric patients
signs of emphysema
barrel chest, pursed lip breathing, dyspnea on exertion
signs of pneumonia
dyspnea, chills, fever, cough, dark sputum
signs of pneumothorax
sudden chest pain with dyspnea, decreased lung sounds/affected side
signs of pulmonary embolism
sharp pinpoint pain, dyspnea, sudden onset, after childbirth or surgery
signs of tension pneumothorax
progressive shortness of breath, increasing alerted level of consciousness, neck vein distention, tracheal deviation
signs of pertussis
coughing spells, "whooping" sound, fever, pediatric patients
causes of dyspnea
upper or lower airway infection
acute pulmonary edema
chronic obstructive pulmonary disease (COPD)
asthma
hay fever
anaphylaxis
spontaneous pneumothorax
pleural effusion
prolonged seizures
obstruction of airway
pulmonary embolism
hyperventilation syndrome
environmental exposure
carbon monoxide poisoning
infectious diseases
acute pulmonary edema
fluid builds up within the alveoli and in the lung tissue between the alveoli and the pulmonary capillaries; result of congestive heart failure
chronic obstructive pulmonary disease (COPD)
slow process of dilation and disruption of the airways and alveoli caused by chronic bronchial obstruction
emphysema
loss of the elastic material around the air spaces as a result of chronic stretching of the alveoli when inflamed airways obstruct easy expulsion of gases
chronic bronchitis
ongoing irritation of the trachea and bronchi
wet lungs
pulmonary edema, congestive heart failure
dry lungs
COPD
Asthma
acute spasm of the smaller air passages associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages
Hay fever
causes cold like symptoms, caused by allergic response
anaphylactic reactions
severe allergic reaction characterized by the airway swelling and dilation of blood vessels all over the body which may significantly lower BP.
spontaneous pneumothorax
pneumothorax caused by medical conditions
pleuritic chest pain
sharp stabbing pain on one side that is worse during inspiration and expiration or with certain movement of the chest wall
pleural effusion
collection of FLUID outside the lung on one or both sides of the chest
embolism
anything in the circulatory system that moves from its point of origin to a distant site and lodges there, obstructing subsequent blood flow in that area
pulmonary embolism
passage of a blood clot formed in a vein, usually in the legs or pelvis, that breaks off and circulates through the venous system, becomes lodged in pulmonary artery blocking blood flow
signs and symptoms of pulmonary embolism
dyspnea, acute chest pain, hemoptysis, cyanosis, tachypnea, varying degrees of hypoxia
hemoptysis
coughing up blood
hyperventilation
over breathing to the point that the level of arterial carbon dioxide falls below normal; can indicate underlying illness
acidosis
buildup of excess acid in the blood or body tissues that results from the primary illness
rales
crackles, sounds of air trying to pass through fluid in the alveoli
Identifying life threats- transport immediately
problems with ABC's
poor initial general impression
unresponsiveness
potential hypo perfusion or shock
chest pain associated with a low blood pressure
severe pain anywhere
excessive bleeding
treatment of respiratory illnesses
oxygen, suction if necessary, ventilate if needed, transport
automaticity
allows cardiac muscle cells to contract spontaneously without a stimulus from a nerve source; starts at SA node
If: O2 demands increase for heart
coronary arteries dialate
common pulse points
carotid, femoral, brachial, radial, posterior tibial, dorsalis pedis
ischemia
decreased blood flow
atherosclerosis
disorder in which calcium and cholesterol build up and form a plaque inside the walls of blood vessels, obstructing blood flow and interfering with their ability to dilate or contract
thromboembolism
blood clot that is floating though blood vessels until it reaches an area too narrow for it to pass, blocks the blood flow from that point
acute myocardial infarction
blockage that occurs in coronary artery, heart attack
infarction
death of tissue
cardiac arrest
stopping of heart pumping completely
angina pectoris
pain from heart tissue not getting enough oxygen, hasn't started to die yet
unstable angina
pain in the chest that occurs in response to progressively less exercise or fewer stimuli than ordinarily required to produce angina
stable angina
pain in the chest of coronary origin that is received by the things that normally relieve it in a given patient
Signs and symptoms of AMI
sudden onset of weakness, nausea and sweating without obvious cause
chest pain, discomfort, or pressure
pain, discomfort or pressure in lower jaw, arms, back, abdomen or neck
irregular heart beat and syncope
shortness of breath
pink, frothy sputum
sudden death
syncope
fainting
AMI pain vs. Angina pain
not always due to exertion
AMI lasts 30 min to several hours
not always relieved by rest or nitro
Consequences of Acute myocardial infarction
Sudden death
Cardiogenic shock
Congestive heart failure
congestive heart failure
ventricular heart muscles is so damages it can no longer keep up with the return flow of blood from the atria; can occur anytime after a myocardial infarction
hypertensive emergency
occurs only with a systolic pressure greater than 160 mmHg or a rapid rise in the systolic pressure
aortic aneurysm
weakness in the wall of the aorta; aorta dilates at weakened area and is susceptible to rupture
dissecting aortic aneurysm
inner layer of the aorta become separated, allowing blood to flow between these layers
cerebrovascular accident (CVA)
stroke
stroke
interruption of blood flow to the brain that results in the loss of brain function
two types of strokes
ischemic and hemmorhagic
thrombosis
clot forms at the site of blockage
embolus
clot forms in a remote area and then travels to the site of blockage
ischemic stroke
most common, 80%, result of blockage of vessel
general rule for neurologic emergencies
problem in brain... only that part will be affected
problem in heart and lungs.... entire brain will be affected
hemorrhagic stroke
10-20%, occurs as a result of bleeding inside the brain
aneurysm
swelling or enlargement of part of an artery resulting from weakening of the arterial wall
transient ischemic attack (TIA)
stroke symptoms go away on their own in less than 24 hours, most patients that experience this will have another larger stroke soon after
signs and symptoms of a stroke
facial dropping, sudden weakness or numbness, loss of movement and sensation on one side of the body, lack of muscle coordination, sudden vision loss in one eye, difficulty swallowing, decreased or increased level of responsiveness, speech disorders, difficulty expressing thought, inability to speak, slurred speech, sudden/severe headache, confusion, dizziness, weakness, combativeness, restlessness, tongue deviation, coma
FAST
Facial drooping Arm weakness Speech difficulty Time to call 9-1-1
dysphasia
speech disorders
aphasia
inability to produce or understand speech
conditions that may mimic a stroke
hypoglycemia, postictal state, subdural or epidural bleeding
postictal state
period following a seizure, lasts between 5 and 30 minutes
seizure
convulsion, temporary alteration in consciousness
hemiparesis
weakness on one side of the body
status epilepticus
seizure that lasts longer than 30 minutes
Causes of altered mental status
hypoglycemia
head injury
alcohol
psychological problems
medications
infections
AMS
altered mental status
TIPS AEIOU
Trauma
Infection
Psychogenic causes
Seizure, syncope

Alcohol
Electrolytes
Insulin
Opiates
Uremia
When to use TIPS AEIOU
when reviewing the possible causes of altered mental status
How to assess a stroke
cincinatti stroke scale
glasgow coma scale
FAST
When treating neurologic emergencies
check vitals, oxygen, transport
peritonitis
any foreign material such as blood, pus, bile, pancreatic juice, or amniotic fluid can cause irritation of the peritoneum
acute abdomen
sudden onset of abdominal pain
ileus
paralysis of the muscular contractions that normally propel material through the intestine
emesis
vomiting
causes of acute abdomen
ulcers, gallstones, pancreatitis, appendicitis, gastrointestinal hemorrhage, esophagitis, esophageal varies, mallory-weiss Syndrome, gastroenteritis, diverticulitis, hemorrhoids,
ulcers
upper midabdomen or upper part of back pain
gallstones
can lead to inflammation of gallbladder, pain in RUQ, refered to the right shoulder
pancreatitis
caused by an obstructing gallstone, alcohol abuse, and others. Pain in upper quadrants
appendicitis
inflammation or infection in the appendix; RLQ
gastrointestinal hemorrhage
bleeding within the digestive tract, symptom of another disease
esophagitis
lining of the esophagus becomes inflames by infection or from the acids in the stomach
mallory-weiss syndrome
junction between the esophagus and the stomach tears, causing severe bleeding and potentially death;
Cystitis
bladder inflammation, UTI,
hernia
protrusion of an organ or tissue through hole or opening into a body cavity where it does not belong
Causes of hernias
congenital defect
surgical wound that failed to heal properly
natural weakness in an area such as the groin
signs and symptoms of serious hernia
formerly reducible mass is no longer reducible
pain at the hernia site
tenderness when the hernia is palpated
red or blue skin discoloration over the hernia
diabetes mellitus
presence of sugar in the urine, body cannot metabolize glucose
type 1 diabetes
patients do not produce insulin, need daily injections,
type 2 diabetes
usually appears later in life, patients produce inadequate amounts of insulin or insulin does not function normally
Classis symptoms of uncontrolled diabetes
the 3 P's:
Polyuria: frequent and plentiful urination
Polydipsia: frequent drinking of liquid to satisfy continuous thirst
Polyphagia: excessive eating
Kussmaul respirations
deep, rapid breathing
Normal blood glucose level
80-120 mg/dL
hyperglycemia
state in which the blood glucose level is above 120 mg/dL
hypoglycemia
state in which the blood glucose level is below 80 mg/dL
hyperglycemic crisis
"diabetic coma", state of unconsciousness resulting from several problems including ketoacidosis, hyperglycemia, and dehydration
hypoglycemic crisis
"insulin shock", insufficient levels of glucose in the blood, insulin levels remain high causing low glucose levels
Hypoglycemic crisis occurs when:
taken too much insulin
taken regular dose of insulin but not enough food
had an unusual amount of activity or vigorous exercise and used up all available glucose
Signs and symptoms of hypoglycemic crisis
normal to shallow or rapid respirations
pale, moist skin
diaphoresis (sweating)
dizziness, headache
rapid pulse
normal to low BP
AMS
anxious or combative behavior
hunger
seizure, fainting or coma
weakness on one side of the body
rapid changes in mental status
Signs and symptoms of hyperglycemic crisis
kussmaul respirations
dehydration, dry, warm "tenting" skin and sunken eyes
sweet or fruity odor on the breath
rapid, weak pulse
normal or slightly low BP
weakness, nausea, and vomiting
3P's
four types of sickle cell crisis's
vaso-occlusive crisis
aplastic crisis
hemolytic crisis
splenic sequestation crisis
vaso-occlusive crisis
blood flow to an organ becomes restricted, causing pain, ischemia and often organ damage
aplastic crisis
worsening of the patients baseline anemia which causes tachycardia, pallor and fatigue
hemolytic crisis
acute accelerated drop in the patients hemoglobin level
splenic sequestration crisis
painful acute enlargement of the spleen, causing the abdomen to become very hard and bloated
complications of sickle cell
cerebral vascular attack
gallstones
jaundice
avascular necrosis
splenic infections
osteomyelitis
opiate tolerance
leg ulcers
retinopathy
chronic pain
pulmonary hypertension
chronic renal failure
thrombophilia
tendency to develop blood clots
risk factors for increased clotting
recent surgery
impaired mobility
congestive heart failure
cancer
respiratory failure
infectious diseases
age, older than 40
being overweight/obesity
smoking
oral contraceptive use
hemophilia
body is not able to control bleeding by developing spontaneous clots as normal, resulting in an increased bleeding time
Emergency medical care for hematologic disorders
supportive and symptomatic; high flow oxygen at 12 to 15 L/min via non rebreather
immunology
study of the body's immune system
immune system
protects the human body from substances and organisms that are foreign to the body
allergic reaction
an exaggerated immune response to any substance
most common allergies
insect bites and stings
medications
plants
food
chemicals
wheal
raised, swollen, well-defined area on the skin
removing the stinger
gently remove by scraping the skin with the edge of a sharp, stiff object such as a credit card
toxicology
study of toxic or poisonous substances
poison
any substance whose chemical action can damage body structures or impair body function
signs and symptoms of opioid overdose
hypoventilation or respiratory arrest
pinpoint pupils
sedation or coma
hypotension
signs and symptoms of sympathomimetics overdose
hypertension
tachycardia
dilated pupils
agitation or seizures
hyperthermia
signs and symptoms of sedative-hypnotics overdose
slurred speech
sedation or coma
hypoventilation
hypotension
signs and symptoms of anticholinergics overdose
tachycardia
hyperthermia
hypertension
dilated pupils
dry skin and mucous membranes
sedation, agitation, seizures, coma or delirium
decreased bowel sounds
signs and symptoms of cholinergic overdose
excess defecation or urination
muscle fasciculations
pinpoint pupils
excess lacrimation (tearing) or salivation
nausea or vomiting

DUMBELS
questions to ask for overdose
what substance did you take?
when did you take it?
how much did you ingest?
what actions have been taken?
how much do you weigh?
4 ways poisons get into the body
inhalation
absorption
ingestion
injection
signs and symptoms of inhaled poisons
burning eyes, sore throat, cough, chest pain, hoarseness, wheezing, respiratory distress, dizziness, confusion, headache, or stridor
signs and symptoms of absorbed poisons
history of exposure, liquid or powder on a patients skin burns, itching, irritation, redness of the skin, or typical odors
signs and symptoms of ingested poisons
depend on type of ingested poison, age of patient
signs and symptoms of injected poisons
weakness, dizziness, fever, chills, and unresponsiveness
emergency medical care for overdose
assess and maintain patients ABC's
monitor patients breathing
provide oxygen
prompt transport

-charcoal for ingested if given direction to give it
sedative
substance that decreases activity and excitement
delirium tremens (DTs)
syndrome characterized by restlessness, fever, sweating, disorientation, agitation, and even seizures; withdrawal from alcohol causing frightening hallucinations
DUMBELS
Defecation
Urination
Mitosis (constriction of pupils)
Brochorrhea (discharge of mucus from the lungs)
Emesis
Lacrimation (tearing)
Salivation
behavioral crisis
any reaction to events that interferes with the activities of daily living or has become unacceptable to the patient, family, or community
psychiatric emergency
patient may show agitation or violence or become a threat to himself, herself, or others
psychiatric disorder
an illness with psychological or behavioral symptoms that may result in impaired functioning
Organic brain syndrome
temporary or permanent dysfunction of the brain caused by a disturbance in the physical or physiologic functioning of the brain tissue
causes of organic brain syndrome
sudden illness
recent trauma to the head
seizure disorders
drug and alcohol intoxication, overdose or withdrawal
diseases of the brain (azheimers or meningitis)
altered mental status
change in the way a person thinks or behave; can be indicator of psychiatric disease such as bipolar disorder
functional disorder
one in which the abnormal operation of an organ cannot be traced to an obvious change in the actual structure or physiology of the organ or organ system
examples of functional disorders
schizophrenia, anxiety conditions, and depression
psychosis
state of delusion in which the person is out of touch with reality
How to assess level of danger
History
Posture
The scene
Vocal activity
Physical activity
Pelvic inflammatory disease (PID)
infection of the female upper organs of reproduction specifically the uterus, ovaries, and fallopian tubes
Signs and symptoms of PID
generalized lower abdominal pain
abnormal, foul smelling vaginal discharge
increased pain with intercourse
fever
general malaise
nausea and vomiting
Trauma emergencies
occur as a result of physical forces applied to the body
Medical emergencies
occur when the patient has an illness or condition that is not caused by an outside force
ecchymosis
bruise
hematemesis
vomiting blood
melena
bloody stool
rule of nines
% of body in burn cases
hematuria
blood in the urine
crepitus
grating or grinding sensation when fractured bone ends rub together
Apgar Score
standard scoring to assess the status of a newborn
Appearance, Pulse, Grimace or irritability, Activity or muscle tone, Respirations
PAT (pediatric assessment triangle)
assessing appearance, work of breathing, and circulation to the skin
GEMS diamond
Geriatric Patients
Environmental Assessment
Medical Assessment
Social Assessment