acute and chronic illness Flashcards
CAUSES OF SUDDEN ILLNESS
- Degeneration
- Obstruction of hollow organs * Infection
- Congenital defects
- Neoplasm
- Environmental
- Endocrine disturbance
- Unknown / Obscure
order of treatment for medical emergency
- Secure the scene
- Chief Complaint
- Primary Assessment
- EMS / 9-1-1 as needed
- History OPQRST, SAMPLE, FOCUSED
- Vitals baseline
- Secondary Assessment (as needed)
how often to you re asses vital baseline for stable or unstable
stable: 15min
unstable: 5
unresponsive patient order of treatment for medical emergency
EMS / 9-1-1 Unresponsive
* Primary Assessment
* Rapid Secondary (to rule out trauma)
* VITALS baseline (+ re-assess every 5 min)
* Obtain history from bystanders
* Obtain history from athlete ICE / Medical Form * Patient care on-going
Mnemic: “AEIOU TIPS”
Allergy, Acidosis (hyperglycemic coma – diabetic)
* Epilepsy, Endocrine Problem, Electrolyte abnormality,
* Insulin (hypoglycemia)
* Overdose (or poisoning)
* Underdose (and other renal problems)
* Trauma, temperature abnormalities (hyper/hypo)
* Infection
* Psychogenic
* Stroke , space occupying lesion in cranium
what is syncope
“FAINTING”
Syncope is a temporary loss of consciousness typically due to a brief lack of blood flow to the brain. Normal blood flow to the brain is about 50ml/min, syncope occurs ↓30ml/min.
s/s of syncope
Signs/Symptoms may include:
“Fainting” with/without warning.
Pale, cool skin
Moist skin, lightheaded, dizzy, weak, Nausea, vomiting.
May feel numbness/tingling in fingers/toes Ventilatory Rate / Pulse Rate
etc…
Normal blood flow to the brain is about _ml/min, syncope occurs ↓_ml/min.
50,30
The most common reasons of syncope are from a
drop in blood pressure upon standing (orthostatic hypotension), from a vasovagal response (a form of neurocardiogenic syncope), or from the heart not pumping enough blood to the brain, from an arrythmia (heart temporarily beating too fast or too low), or a weak heart muscle (such as in congestive heart failure).
Near syncope is the term for
“almost” having a syncope episode. This is where you feel like you “almost pass out”, and perhaps briefly get dizzy, lightheaded, woozy, and unsteady.
SYNCOPE
Causes: Mnemic “CONSNOC”
cardiac
orthostatic
neurcardiogenic
seizure
neuropathic: paraneoplastic. chronic diabete, post-viral, neurogenerative, POTS
other (mechanical, glucose)
cerebrovascular
Definitions: Paraneoplastic and
POTS
Paraneoplastic: affects from cancerous tumour POTS: postural orthostatic tachycardia syndrome.
This is from low blood pressure which occurs when someone stands up from a lying or sitting position. It is often seen with dehydration or blood pressure medication doses that are too high.
orthostatic syncope
orthostatic intolerance is another term for this
Structural can be outflow obstruction or low ejection fraction in CHF (congestive heart failure). Arrhythmia can be from the heart beating too fast (tachycardia) or too slow (bradycardia).
cardiac syncope
This is your classic vasovagal response where there is a sudden decrease in heart rate followed by an abrupt drop in blood pressure leading to syncope and collapse (passing out, or fainting).
neurocardiogenic
The physiologic mechanism for neurocardiogenic syncope can be triggered by several things
Vasovagal syncope classically occurs with a sudden scare (sees blood, intense pain, fright, etc.). Variants of the vasovagal response also include micturition or defecation syncope (think about the old lady who passed out after standing up from using the toilet, triggered by a large parasympathetic discharge), carotid hypersensitivity (think about the old guy shaving and becomes bradycardic by inadvertent carotid massage from pressing on the neck during shaving), and cough syncope or syncope with coughing.
t/f. syncopal episodes are almost never from a seizure.
t
his correlates to dysautonomia, also known as autonomic neuropathy. This is neuropathy involving the small nerve fibers that control heart rate, heart rhythm, blood pressure, gastrointestinal motility, sweating, and other things. The result is often a disconnect between blood pressure and heart rate where they are not working in synchronicity together, leading to symptoms such as syncope.
neuropathic syncope
diabete is part of which cause of syncope
neuropathic
what are the 2 common reason for inpatient neurology consultation
cerebrovascular syncope and seizure syncope
Think posterior circulation and vertebrobasilar ischemia.assess for associated brainstem symptoms such as double vision, hemiparesis or hemisensory loss, slurred speech, vertigo, dysphagia, et
cerebrovascular syncope
how to difference seizure from syncope
The presence of a cut tongue
*Lateral tongue bite (100% specificity for tonic clonic seizure)
*Patient has no recall of unusual behaviors before the loss of consciousness
*Muscle tone (increased tone more likely seizure
*Number of limb jerks – The 10:20 Rule: patients with witnessed >20 myoclonic jerks after sudden loss of consciousness is more likely seizure
*Head turning during event
*Unusual posturing during the event
*Absence of presyncope (eg: dizziness, lightheadness symptoms prior)
*History of epilepsy
*Post-ictal state (period between when seizure subsides and when patient returns to baseline, usually between 5 and 30 minutes, characterized by confusion, drowsiness, hypertension, headache, nausea, etc.)
*Urinary incontinence (not always reliable sign of seizure)
how to difference syncope from seizure
SYNCOPE
*Loss of consciousness with prolonged sitting or standing
*Dyspnea before loss of consciousness
*Palpitations before loss of consciousness
*Muscle tone (decreased tone more likely syncope)
*Number of limb jerks - The 10:20 Rule: patients with witnessed <10 myoclonic jerks after sudden loss of consciousness is more like syncope.
The 10:20 Rule: patients with witnessed <10 myoclonic jerks after sudden loss of consciousness is more like
he 10:20 Rule: patients with witnessed >20 myoclonic jerks after sudden loss of consciousness is more likely
syncope
seizure
Approximately 90% of people who have a syncopal episode will have .
Approximately 90% of people who have a syncopal episode will have myoclonic jerks.
Post-exertional syncope frequently occurs when
exercise is stopped suddenly and reduction of lower extremity muscle pumping results in less cardiac venous return and cardiac output. In such a circumstance, an acute increase in myocardial contractility can lead to activation of the cardiac depressor reflex inducing concomitant paradoxical bradycardia. As a result, the athlete may develop acute loss of postural tone, hypotension, and therefore transient global cerebral hypoperfusion – this is termed the Bezold-Jarisch reflex.
what is Bezold-Jarisch reflex.
e athlete may develop acute loss of postural tone, hypotension, and therefore transient global cerebral hypoperfusion
t/F. Syncope immediately post- exercise which occurs when the subject is still standing, is usually less concerning than syncope during exercise.
T
what is the most common presentation, accounting for more than 85% of cases.
Syncope unrelated to exercise
This form of syncope (frequently referred to as neurocardiogenic, or reflex or vasovagal syncope) is largely
neurally mediated with poorly understood pathophysiology.
non-exercise related syncope
vasovagal syncope, considered a benign condition, typically occurs when
going from a sitting to standing position, or experiencing fear or emotional distress with specific triggers such as sight of blood or trauma.
situational syncope, as the name implies, tends to be reproducible with
certain behaviors or activities such as coughing, bearing down to pass stool, or micturition.
Dehydration and reduced intravascular volume can induce a state of
rthostatic hypotension and induce a presyncopal event with many of the same prodromal features of reflex syncope but importantly no loss of consciousness.
Syncope which occurs during exercise raises concern for
structural heart disease and can serve as the only symptom that precedes sudden cardiac death.
The differential diagnosis for life-threatening causes of syncope in athletes includes:
Hypertrophic cardiomyopathy (HCM)
* Anomalous coronary artery,
* Arrhythmogenic right ventricular dysplasia (ARVD)
* Ion channelopathies such as Long QT Syndrome (LQTS) or the Brugada Syndrome,
* Pyocarditis,
* Previously undiagnosed congenital heart disease such as noncompaction cardiomyopathy.
* Although not necessarily associated with underlying native structural heart disease, commotio cordis is an important cause of syncope and is characterized by sudden cardiac death attributable to cardiac contusion from trauma to the precordium.
* Heat stroke or hyponatremia must also be considered in patients with exercise related syncope.
which type of diabetes is a childhood disease and need injection due to no insulin production
type 1
which type of diabetes is a adult onset with little insulin production
type 2
In Canada, a person who doesn’t have diabetes has normal blood glucose levels between
4.0 mmol/L and 7.0 mmol/L.
glycémie criteria
blood sugar between 54 (3,0) mg/dl and 70 (3,9) mg/dl
blood sugar less than 54 mg/dl (3,0 mmcl/L)
an emergency where you need help from someone else to recover (no blood sugar level has been defined)
NORMAL GLUCOSE RANGES:
Fasting blood glucose (sugar)/ blood sugar before meals (mmol/L:
Blood sugar two hours after eating (mmol/L):
4.0 to 7.0
5.0 to 10.0
alternate choice of oral glucose
6 LifeSavers
* 15-20 JellyBeans
* 20-25 Skittles
* 5-10 Mentos
* 435 ml whole milk
* 200ml of orange juice
* 15g of glucose gel
Stability snack:
* cheese and crackers
* 1/2 peanut butter sandwich
how many gram of oral glucose to take with mild hypoglycemias
15g, so around 4 tablet
