Medical Emergencies, Pt 1 (Respiratory, Cardiac, Diabetic, Altered Mental Status, Anaphylactic Emergencies) Flashcards
Tidal Volume
The volume of air moved in one cycle of breathing
Respiratory
distress
Increased respiratory effort caused by impaired respiratory function
Hypoxemia
Decreased oxygen levels in the blood
Ventilation
The process of air moving in and out of the lungs
Minute volume
Tidal volume * RR
Amount of air moved in and out of lungs in one minute
Dead air space
Air that occupies the space between the mouth and alveoli but does not reach the area of gas exchange
Plasma oncotic presure
Pull exerted by large proteins that draw water from body into the bloodstream
Hydrostatic pressure
Pressure within blood vessels that pushes water out of the bloodstream
Major structures in Respiratory system (Top to Bottom)
- Nasal cavity (cleanses, warms & humidifies air)
- Pharynx & larynx (carries air to trachea, produces sound)
- Trachea (transports air to & from lungs)
- Bronchial tubes (airway passages inside lungs)
- Lungs (site of gas exchange between air & blood)
Inspiration
Inhalation
- Active process
- Intercostal muscles contract & move ribcage up & out
- Diaphragm contracts & moves down and out
- Abdominal muscles contract
Expiration
Exhalation
- Passive process
- Intercostal muscles relax & move ribcage down and in
- Diaphragm relaxes and moves up and in
- Abdominal muscles relax
Boyle’s Law
The concept that the volume of a gas is inversely proportionate to the pressure
Conditions for adequate perfusion
- An oxygen-rich environment of at least 21% oxygen.
- A patent (open) airway with adequate inhalation and expiration for oxygen to reach the alveoli for gas exchange.
- An adequate circulation of blood to transport oxygen and nutrients and to get rid of waste products.
Respiratory
distress
Increased respiratory effort caused by impaired respiratory
function.
Respiratory failure
When respiratory compensatory mechanisms begin to fail and
respiration becomes inadequate.
Respiratory arrest
Complete stoppage of breathing; also called apnea.
Dyspnea
Shortness of breath or perceived difficulty in breathing.
Tripod position
When patients sit or stand and lean forward, and place their
hands on a hard surface or their knees; sign of respiratory
distress.
Hypoxia
The absence of sufficient oxygen in the body cells. (Severe respiratory distress)
Bronchoconstriction
Constriction of the smooth muscle of the bronchi and
bronchioles that causes a narrowing of the air passage.
Bronchodilator
A drug that relaxes the smooth muscle of the bronchi and
bronchioles, and reverses bronchoconstriction.
Metered Dose Inhaler
A device that consists of a plastic container and a canister of
medication used to form an aerosolize that a patient can inhale.
Early & Late S&S of Hypoxia
EARLY:
- Pale, cool, clammy skin
- Tachycardia
- Elevated blood pressure
- Agitation/Altered mental status
- Headache
- Tachypnea and dyspnea as possible initial signs, but can be delayed until hypoxia is severe
LATE:
- Cyanosis
- Bradycardia
- Confusion
- Coordination problems
- Sleepiness
- Altered mental status with decreased cognitive and psychomotor function (the inability of the patient to think or perform simple tasks)
Where cyanosis is visible
- Conjuctiva (inner eye)
- Mucosa (Inner mouth)
- Fingernail beds
- Circumoral area (around lips)
S&S of Breathing difficulty
- Altered mental status
- Barrel chest (prominent thorax, retracted abdomen)
- Tripod position
- Retractions, use of accessory muscles
- Flared nostrils
- Pursed lips
- “Two word” dyspnea
- Pale, cyanotic, flushed skin
- Pedal edema
- Sacral edema
- Noisy breathing (wheezing, stridor, coughing, gurgling, snoring, crowing)
- Abnormal lung sounds
- Shallow, gasping breaths
- Changes in breathing rhythm
- Hyper- or hypotension
- Extremely fast or slow pulse
- Extremely fast or slow RR
- SpO2 <95%
Asthma (Path)
- Chronic reactive airway disease that causes airway obstruction resulting from bronchospasms, increased mucous secretions, and mucosal edema
- Patient may be prescribed a bronchodilator (inhaler)
Characterisitcs:
- There is often a trigger (exercise, allergens, air pollutants, infection, stress)
- Wheezing, especially on expiration
Emphysema
- Form of COPD
- Permanent destruction of the alveolar walls that results in a decreased surface area
- Recurrent inflammation damages and eventually destroys the alveolar walls, creating a large air space distal to the bronchioles
- Results in poor elasticity and makes the lungs less compliant & bronchiolar collapse on expiration
- This traps air in the lungs and leads to over distention, which results in a “barrel-chest” appearance.
Characteristics:
Expiratory wheezing
Bronchitis
- A form of COPD
- Caused by irritants which trigger inflammation of the bronchi.
- Chronic bronchitis initiates resistance in the small airways, resulting in a V/Q imbalance that decreases oxygenation
- Causes thick mucus production that does not allow oxygen to reach the alveoli–> decreases oxygenation.
Characteristics:
A chronic, productive cough.
Pneumonia
- Acute infection of the lung that can be viral or bacterial, and can involve one lobe of the lung, part of a lobe, all of one side of the lung, or both sides of the lungs
Pneumonia can be caused by:
1) pathogens that colonize and form a bacterial infection, which cause alveolar inflammation and edema
2) a viral infection, which destroys the epithelial bronchiolar cells, causing capillaries to fill with blood and fluid.
3) In aspiration pneumonia, the surfactant is destroyed within the alveoli, which causes them to collapse (also called atelectasis).
Aspiration pneumonia commonly arises after resuscitation, when an airway was not secured properly or timely enough so that gastric distention and vomiting occurs.
S&S:
- Coughing (w/ green, yellow, bloody mucus), chest pain (worse in inhalation), fever, chills, headache, pale skin, fatigue
Atelectasis
Collapse of part or (much less commonly) all of a lung
Pulmonary embolism
- Obstruction of the pulmonary arteries, which blocks the blood flow to the area distal to the obstruction and results in hypoxia.
- The alveoli distal to the blockage are unable to produce enough surfactant, which results in atelectasis. With the alveoli collapsed, exchange of oxygen and carbon dioxide is impaired.
- Pulmonary embolism is generally the result of a thrombi (clot) developing in the large veins of the lower extremities (Deep Vein Thrombosis)
- Prolonged immobilization, irregular heart rhythms such as atrial fibrillation, pregnancy, heart failure, and recent surgery are some of the many causes of a thrombus.
S&S: - Sharp, pleuritic chest pain - Shortness of breath - Anxiety - Cough (w/ bloody sputum) - Pale skin - Tachycardia/tachypnea - Patient may enter cardiac arrest Often patients present as: - Lightheaded - Pain or swelling in leg(s)
Spontaneous Pneumothorax
- A spontaneous pneumothorax results when a subpleural bleb (a small cystic space) develops at the surface of the lung
- The result is an air leak into the pleural space
- The lung collapses, which causes a decrease in lung capacity (tidal volume) and compliance
- Often results from COPD
- In some cases, very thin, tall individuals who strain or have severe coughing spells will develop a spontaneous pneumothorax
S&S:
- Sharp chest pain
- Shortness of breath
- Fatigue
- Tachycardic
- Tachypneic
- Low SpO2
- Signs of hypoxia or displays cyanosis
- Diminished or absent lung sounds on one side
Hyperventilation Syndrome
- Pt. is breathing more oxygen than what the body needs, typically from tachypnea.
- Could be a sign of infection, heart attack, bleeding, or psychological disorder. It is commonly associated with patients who are emotionally disturbed or who have panic attacks.
- When a patient hyperventilates, excess air can enter the gastrointestinal tract and cause symptoms such as bloating or pressure in the abdominal area.
- Hyperventilating releases too much carbon dioxide, which decreases blood flow to the brain
- Nervous system disorders from hyperventilating result from calcium-level changes that cause numbness and tingling sensations in the lips and extremities, spasms of the muscles.
- For a patient with coronary artery disease, this spasm could cause the patient to have a heart attack.
S&S:
- weakness
- agitation
- dizziness
- anxiety
- shortness of breath (SOB)
- Can cause some patients to experience chest pain and to exhibit wheezing
- numbness and tingling sensations in the lips and extremities
- spasms in the hands and feet, and twitching of the muscles.
- spasms of the heart may occur.
Epiglottitis
- Acute infection of the epiglottis more commonly associated with infants and children.
- The infection and inflammation (usually beginning at the base of the tongue and above the epiglottis) may spread not only to the epiglottis, but also to other upper airway structures.
- With continued inflammation and swelling of the epiglottis, complete blockage of the airway may occur, leading to death.
S&S:
- Patients will commonly be found sitting upright and leaning forward
- Head and neck thrust forward while drooling.
- Patients normally have a high temperature (100°F or higher)
- May present with inspiratory stridor.
Pertussis
Pertussis (also called whooping cough) is an infectious bacterial illness that affects the upper respiratory passages by causing damage to the cilia
S&S:
- Spasms of coughing that creates a “whoop” sound when the patients inhale.
- Patient has violent episodes of coughing in an attempt to remove thick mucus from the respiratory passages.
Cystic firbrosis
Cystic fibrosis is an inherited disease involving glands within the body, including the glands that make mucus and sweat. This disease also affects the pancreas, liver, and intestines.
S&S:
- Coughing,large amounts of mucus
- Fatigue
- Frequent occurrences of pneumonia
- Abdominal pain & distention
- Coughing up blood
- Nausea
- Weight loss
Viral respiratory infections
- Viral respiratory infections are infections of the upper airway, including the common cold and the flu.
S&S:
- Runny nose
- nasal congestion
- sneezing
- sore throat
- cough
- headache
- In severe cases, such as the flu, upper respiratory infections can enter the lungs, which cause inflammation and an increase in mucous production.
Pulmonary edema
Pulmonary edema is the result of fluid accumulating in the extravascular spaces (spaces between the alveoli and capillaries) in the lung. There are two types of pulmonary edema: cardiogenic and noncardiogenic.
S&S:
- Anxiety
- Pale, sweaty skin
- Tachycardia
- Hypertension
- Dyspnea (Labored breathing)
- Coughing up frothy sputum
- Gurgling/crackles/wheeses auscultated
- Cannot lay supine
- Weight gain
CPAP may be useful
Cardiogenic edema
Cardiogenic pulmonary edema is caused by arteriosclerotic disease, hypertension, or problems with the valves of the heart.
Arteriosclerosis
Hardening of the arteries, also called atherosclerosis, is a common disorder. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques
NOT to be confused with arterioLOsclerosis
Noncardiogenic edema (causes?)
Noncardiogenic pulmonary edema is often referred to as ARDS (acute respiratory distress syndrome), in which the destruction of capillary beds causes fluid to leak from them, forming fluid inside the alveoli.
Causes of noncardiogenic pulmonary edema include pneumonia, aspiration of foreign substances, exposure to a toxic gas, high altitudes and trauma (pulmonary contusion).
Commonly inhaled poisons ( and S&S)
- Carbon monoxide
- Solvents
- Hydrogen sulfide
- Glue
- Nitrous oxide
- Natural gas
- Chlorine gas
Common S&S:
dysphoria, altered level of consciousness, hallucinations, fluid buildup in the lungs, and cardiac arrest.
Pulses paradoxus
- A decrease in pulse strength during inhalation; a drop in blood pressure of more than 10 mmHg during inhalation
- Resulting from increased pressure within the chest that suppresses the filling of the ventricles of the heart with blood.
Snoring
Tongue partially blocking the upper airway at the pharynx
Can hear w/out stethoscope
Gurgling
Fluid in upper airway
Can hear w/out stethoscope
Stridor
A harsh, high-pitched sound heard on inspiration that indicates swelling of the larynx or obstruction of the upper airway.
Can hear w/out stethoscope
Wheezing
Constriction & inflammation resulting in decreased diameter of bronchioles
Can hear w/ stethoscope
Rales
Fluid surrounding and filling alveoli
Can hear w/ stethoscope
Rhonchi
Mucus blocking larger bronchioles
Can hear w/ stethoscope
Crowing
A sound similar to that of a cawing crow that indicates that the muscles around the larynx are in spasm and beginning to narrow the opening into the trachea.
Can hear w/out stethoscope
Beta 2 agonist side effects
- Tachycardia
- Nervousness
- Tremors
- Dry mouth
- Nausea
Metered dose inhaler
A device consisting of a plastic container and a canister of
medication that is used to form an aerosol that a patient can
inhale.
Small volume nebulizer
A device that uses compressed air or oxygen to nebulize a liquid
medication into a mist that a patient can inhale.
Spacer
A chamber that is connected to an MDI to collect the medication
until it is inhaled.
Circulatory
system
System composed of the heart and blood vessels that bring
oxygen and nutrients to and takes wastes away from body cells;
also called the cardiovascular system.
Cardiac conduction system
The specialized contractile and conductive tissues of the heart
that generate electrical impulses and cause the heart to beat;
also called the coronary conduction system.
Automaticity
The ability of cells within the cardiac conduction system to
generate a cardiac impulse on their own.
Arteries
Blood vessels that carry blood away from the heart.
Veins
Veins that carry deoxygenated blood from the lungs to the left
atrium of the heart.
Capillaries
Tiny blood vessels that connects an arteriole to a venule.
Arteriole
The smallest branch of an artery, which at its distal end leads
into a capillary.
Venule
The smallest branch of a vein.
Effects of Stimulation of Sympathetic Nervous System
Increase in heart rate and contractility
Effects of Stimulation of Parasympathetic Nervous System
Stimulation of this nervous system decreases heart rate and increases blood flow to other areas of the body, including the stomach and genitals
Sinoatrial node
The “pacemaker” of the heart generates electrical impulses that trigger cardiac contraction
Erythrocytes
Part of the blood that gives it its color, carries oxygen to body cells, and carries carbon dioxide away from body cells; also referred to as RED BLOOD CELLS
Leukocytes
Part of the blood that helps the body’s immune system defend against infection (WBCs)
Plasma
The liquid part of the blood.
Platelets
Blood components that are essential to the formation of blood clots.
How electrical impulses travel in heart
Superior-to-inferior fashion (up do down)
- They then travel through the sinoatrial node (SA node), atrioventricular node (AV node), and the Purkinje fibers
- Center, then out
Parts of Electrocardiogram
- Atria contracting (depolarization, or P wave)
- Ventricles contracting (depolarization, or QRS –>big one in center)
- Ventricles relaxing (repolarization, or T wave).
Rhythms that signify Cardiac Arrest
Ventricular fibrilation, Ventricular tachycardia, and asystole
Fibrinolytic medications
- Help dissolve clots by blocking the coronary artery
- The earlier the fibrinolytics are administered, the better the outcome and/or the success of restoring blood flow through the clogged artery.
- These medications can also dissolve clots elsewhere in the body, so EMTs and other health care providers must ensure a complete history has been taken to screen patients for events such as recent stroke and major trauma (anything that could cause life-threatening hemorrhage).
Effects of nitroglycerin
Dilates the arteries, including the coronary arteries, increasing blood flow to the myocardium.
Effects of aspirin
Decreases bloods ability to clot, prevents and treats clot formations that could damage the heart
Cardiac Emergencies & Diabetes (Considerations)
- As a result of nerve damage from diabetes, diabetic patients will often present unusual symptoms
- Look out for uncommon complaints (like the “big toe pain”), which may turn out to be cardiac in nature.
- Be thorough when assessing diabetic patients who complain of pain, especially any type of pain above the belt line.
Acute Coronary Sydrome
A group of signs and symptoms resulting from any of a variety of
conditions that can affect the heart in which the coronary arteries
are narrowed or occluded by fat deposits, clots, or spasm.
Cardiac Compromise
Reduced heart function caused by any of a variety of conditions,
diseases, or injuries affecting the heart.
Coronary Artery Disease
- Causes loss of oxygen and nutrients to the myocardial tissue because of poor blood flow (chest pain)
- Prone to forming thrombus
- If the patient already has significant heart disease, the likelihood of cardiac arrest is greater
Thrombus
Clot formed of blood and plaque attached to inner wall of artery or vein
Occlusion
Blockage, as of an artery by fatty deposits
Embolism
Blockage of a vessel by a clot or foreign material brought to site by blood flow
Aneurysm
Dilation, or ballooning, of a weakened section of the arterial wall
Angina Pectoris
“Pain in the chest”
S&S:
- Pain is substernal/ across chest
- Radiates to neck, jaw, back, arms, shoulders
- Dull or heavy discomfort, pressure or squeezing sensation
- Lasts 2-15 minutes, or until trigger stops
- Triggered by physical exertion, emotional stress, weather, meals
- Nitroglycerin provides relief
Myocardial infarction
A condition in which a portion of the myocardium dies due to lack of oxygen; brought on by occlusion of coronary artery
- Over one million cases per year
- Pain is substernal/ across chest (may be intense)
- Radiates to neck, jaw, back, arms, shoulders
- Dull or heavy discomfort, pressure or squeezing sensation, may be intense
- Lasts more than 10 minutes
- Perspiration
- Pale, gray skin
- Nausea
- Weakness
- Dizziness
- Lightheadedness
- Nitroglycerin may provide little to no relief
Congestive Heart Failure
Failure of the heart to pump efficiently, resulting in blood/fluid buildup in the lungs, body, or both. Often due to AMI damage
S&S:
- Mild to severe confusion
- Cyanosis
- Tachypnea
- May cough up pink sputum
- Low, normal, or high BP
- Rapid heart rate
- Desire to sit upright
- Anxiety
- Crackles (Pulmonary edema)
- SOB (Dyspnea)
- Pale, cool, clammy skin/diaphoresis
- Abdominal distention
- Pedal & lower edema
- JVD (late)
S&S of Cardiogenic shock
Often due to AMI
- Hypotension
- Altered level of consciousness
- Diaphoresis
- Dyspnea
When Hypertension is concerning
Typically BP >160 systolic
Dangerous when accompanied by:
- Severe headache
- Nausea and vomiting
- Chest pain
- Dyspnea
- Signs of stroke
- Signs of pulmonary edema
- Epistaxis (nosebleed)
Altered mental status
A variation from normal function of the mind as judged by a person’s behavior, appearance, speech, memory, judgment, or responsiveness to stimuli; may range from disorientation to total
unresponsiveness or unconsciousness.
Coma
An unconscious state in which a person does not respond to any
stimulus, including pain.
Neurological Deficit
Any deficiency in the nervous system’s functioning typically
exhibited as a motor, sensory, or cognitive deficit.
Nontraumatic Brain Injury
A medical injury to the brain that is not caused by external
trauma; for example, stroke.
Stroke (S&S)
A type of ischemic stroke caused by plaque or other material that lodges in and blocks a cerebral artery.
S&S:
- Decrease consciousness
- Change in personality/mental status
- Severe headache
- Drooping eyelid/mouth on one side of face
- Paralysis or weakness on one or both sides of body
- Arm drift
- Loss of bowel or bladder movement
- Loss of vision, dimness, diplopia
- Difficulty speaking, or slurred speech
- Inablility to speak
- Nausea or vomiting
- Sudden weakness/paralysis of face, arm, leg
- Possible seizures
- Pupils unequal in side
To administer medicine at hospital, patient must be delivered within three hours of the onset of stroke
Ischemic stroke
A stroke caused by a clot that obstructs a blood vessel in the
brain, resulting in an inadequate amount of blood being
delivered to a portion of the brain distal to the blocked vessel.
Hemorrhagic stroke
A stroke caused by rupture of a blood vessel in the brain that
allows blood to leak and collect in or around the brain tissue.
Embolic stroke
A type of ischemic stroke caused by plaque or other material
that lodges in and blocks a cerebral artery.
Transient Ischemic Attack
Often referred to as a “mini stroke” or warning stroke; occurs when a blood clot temporarily clogs an artery, and part of the brain doesn’t get the blood it needs; TIAs mimic a stroke, and have the same signs and symptoms, but the signs andsymptoms go away quickly and there is no permanent damage to the brain.
Causes: atherosclerosis, hypertension, atrial fibrillation, lack of exercise, smoking, and high triglyceride levels.
Thrombotic stroke
A type of ischemic stroke caused by a stationary clot that forms
in and blocks a cerebral artery.
Elements of Cincinnati Prehospital Stroke Scale
- Facial droop
- Arm drift
- Abnormal speech
Receptive aphasia
Patient doesn’t understand what you are saying, but can speak–> will say things that do not make sense in situation
Expressive aphasia
Patient may be able to understand you, knows what he wants to say, but cannot use the words
Causes of Headaches
- Tumor
- Subarachnoid hemorrhage
- Bleeding within brain
- Bleeding around brain
- Meningitis
- Hypertension
- Hypoglycemia
- Toxic inhalation
- Fever
- Hypoxemia
- Stroke
- Depression
- Cyanide poisoning
Vascular Headaches
- Result of vasodilation (vasodilation is when the blood vessels expand or dilate) in the brain.
- These headaches are typically described as “throbbing” and may be felt on one or both sides of the head.
- Migraines are the most commonly recognized type of vascular headache. Migraines are characterized by severe pain on one or both sides of the head, blurred or double vision, sensitivity to light (photophobia), tingling in the face or hands, “cloudy” mental state, and so on.
- Migraines usually come on quickly, can be debilitating, and can last for days at a time. Some patients may have an aura or warning (shimmering lights, weakness on one side of the body, seeing spots) before the migraine begins.
- Patients with long histories of migraine headaches may be taking medications known as “beta blockers” for preventive treatments.
Cluster headaches
- Cluster headaches are far less common than vascular headaches and are characterized by pain on one side of the head.
- This pain is typically found localized behind one eye and may radiate to the forehead or side of the face. Sometimes patients will have facial flushing, a drooping eyelid, excessive sweating, and a congested nostril on the affected side.
- Unlike vascular/migraine headaches, there is usually no gastrointestinal distress (nausea/vomiting) with cluster headaches.
Tension headache
- Tension-type headache pain is often described as a constant pressure, as if the head were being squeezed in a vice.
- The pain is frequently bilateral which means it is present on both sides of the head at once.
- Most common type of primary headache
- Pain can radiate from head to lower back of the head, the neck, eyes, or other muscle groups in the body.
Emergency Care for Headaches
Maintaining a patent airway (suction), administering oxygen to maintain an oxygen saturation level greater than 95%, placing the patient in a comfortable position, and transporting the patient to the appropriate facility.
Also remember to ask patients if they have a history of headache or migraine.
Seizure
Abnormal electrical discharge in the brain.
Generalized
tonic–clonic
seizure
A common type of seizure that produces unresponsiveness and
a convulsion that exhibits generalized jerky muscle activity; also
known as a grand mal seizure.
- Both cerebral hemispheres are affected, with the RAS being affected contributing to the postictal state
- often, the patient falls to the ground, with the body stiffening (tonic) followed by muscle spasms and relaxation (clonic).
- During this phase it is important to protect patients from further harm by placing a soft object beneath their head. Do not try to hold patients’ extremities or stick anything in their mouth
- The patient may experience incontinence (urine and feces), laceration to the tongue, and cyanosis.
Aura
An unusual sensory sensation that may precede a seizure
episode by hours or only a few seconds.
Convulsion
Unresponsiveness accompanied by a generalized jerky muscle
movement (muscles contract and relax rapidly and repeatedly)
that affects the entire body.
Epilepsy
A medical disorder characterized by recurrent seizures.
Postictal state
The recovery period that follows the clonic phase of a
generalized seizure; in this state the patient commonly appears
weak, exhausted, confused, and disoriented, and progressively
improves.
Status epilepticus
A seizure lasting longer than 5 minutes or seizures that occur
consecutively without a period of responsiveness between them;
this is a serious medical emergency that may be life threatening.
Reticular Activating System
A network of specialized nerve cells within the brainstem that
controls states of arousal and consciousness, including
wakefulness, attentiveness, and sleep.
Common causes of seizures
- High fever
- Infection
- Poisoning
- Hypoglycemia
- Hyperglycema
- Head injury
- Shock
- Hypoxia
- Stroke
- Drug or alcohol withdrawal
- Dysrhythmias
- Hypertension
- Pregnancy complications (eclampsia)
- Blood electrolyte imbalance
- Hyperthermia
- Most are Idiopathic
Complex partial seizure
A complex partial seizure involves only one hemisphere. Patients may display purposeless behavior, exhibit a glassy stare, pick at their clothing, smack their lips, and wander around.
Simple partial seizure
Comes from a localized area of the brain (involves one hemisphere). There are subtypes of partial seizures known as a focal seizure or a Jacksonian seizure. A Jacksonian seizure begins as a localized seizure that involves only an extremity, but may progress to a grand mal seizure. Although patients cannot control their seizure activity, they are awake during it.
Absence seizure
An absence seizure occurs most commonly in children and usually begins with a brief mental status change that is usually signaled by rolling of the eyes or blinking. The patient may also exhibit a blank stare and mouth movements
Febrile seizure
- A febrile seizure is a seizure in infants and small children brought on by a fever
- It occurs most commonly in children between six months and six years of age with a temperature greater than 103 °F (the seizure is a result of the “sudden spike” in temperature).
- This type of seizure usually lasts only a minute or two.
- The child loses consciousness and displays tonic–clonic like activity.
- Make sure to ask the parents about any recent trauma sustained by the child.
- When getting a history, ask the parents about any irritability or lethargy prior to the seizure, which may indicate a central nervous system infection.
High priority seizures
- A seizure in a patient who has never had a seizure before; this can be a sign of a much more serious problem, such as a brain tumor, new onset of epilepsy, chemical imbalance, or other cerebral event.
- Any time there is a problem with one of the ABCs (airway, breathing, circulation).
- Any time the patient does not readily regain consciousness following the event.
- A grand mal seizure lasting more than five minutes.
- Seizures in a patient who is pregnant; this is a sign of a more serious problem with the pregnancy called preclampsia.
- Any time there is evidence of a head injury before the seizure occurred, which could be a sign of increased intracranial pressure in the skull from head injury.
- Any time the seizure is a result of drug or alcohol withdrawal, because this is a sign of a severe withdrawal problem called delirium tremens.
Questions to ask regarding seizure (Patent History)
- How long did the seizure last?
- Does the patient have a history of seizures?
- How many seizures has the patient had today? If more than one, how far apart were the seizures and did the patient wake up—to a normal state—between the seizures?
- Is there a history of a recent fall or accident that could have caused an injury to the patient’s head?
- Is the patient pregnant? (Ask this question of female patients.)
- Has the patient recently stopped using drugs or alcohol?
- Did the patient remain awake during the seizure?
- Can you describe the seizure for me? Was it full body, one sided, or single limb?
- Are there any injuries resulting from the seizure such as a bitten tongue, head injury, lacerations, fractures, and so forth?
Syncope ( & Severe Causes)
Brief period of unresponsiveness caused by a lack of blood flow
to the brain; fainting.
Causes:
- Over exaggerated parasympathetic nervous system
- Myocardial infarction
- Dysrrhytmias
- Stroke/TIA
- Hypovolemia
- Drug use/poisoning
- Pulmonary embolism
- Cardiac tampanade
Syncope v. Seizures (S&S)
Syncope:
- Begins in standing position
- Patient may complain of dizziness/lightheadedness/weakness prior to
- Sudden loss of consciousness that immediately returns when patient is supine or prone
- May have some muscle twitching
- Cool, moist, pale skin
Seizures:
- May begin in any position
- May be preceded by aura
- Sudden LOC, Gradual return to consciousness
- Convulsive muscle activity or repetative movements during unconsciousness
- Skin may be warm, sweaty
Diabetes Mellitus
A disease in which the normal relationship between glucose and insulin is altered.
Features:
- Long-term problems with the eyes, blood vessels, nerves, kidneys and heart
- It can mimic serious events such as stroke and can make you think the patient is drunk or on drugs.
- Over time, diabetes causes blood vessels to become thicker and less elastic, which makes it harder for blood to be squeezed through them.
- The decreased circulation in the legs, which causes poor perfusion, makes them more susceptible to develop infections resulting from the decreased blood flow.
- Develop what is called neuropathy, causing them to be unable to feel their lower legs and especially their feet.
- Poor perfusion cause these areas to be starved of blood
- Any injuries and wounds to these areas may go “unnoticed.” When you add to neuropathy the increased chance of heart attack and stroke, you have a patient with multiple problems, and usually not just one of them at a time.
Glucagon
A hormone secreted by the pancreas that raises the blood
glucose level by stimulating the liver to convert stored glycogen
and other substances into glucose
Glucose
A form of sugar that is the body’s basic source of energy.
Insulin
A hormone secreted by the pancreas that lowers the blood
glucose level by promoting the movement of glucose from the
blood into the cells
Oral glucose
A form of sugar often given as a gel, by mouth, to raise a
patient’s blood glucose level.
Type 1 Diabetes
A form of diabetes in which the patient's pancreas typically does not produce or secrete any insulin; also called insulin-dependent diabetes mellitus (IDDM).
Type 2 Diabetes
A form of diabetes in which the pancreas continues to produce
and secrete insulin; however, the insulin is not completely
effective in controlling the blood glucose level; does not usually
require the patient to take insulin and can, instead, be regulated
by diet, exercise, and drugs other than insulin; also called
noninsulin-dependent diabetes mellitus (NIDDM).
Diabetic Ketoacidosis
A condition typically found in patients with type 1 diabetes in which the blood glucose level is excessively elevated and the
insulin level is extremely low to absent, which causes glucose to be excreted in the urine, dehydrating the patient, which causes
the body to metabolize fat for energy, producing ketones and creating an acidic environment.
S&S: Dehydration, altered mental status, shock
Hyperglycemia (S&S)
High blood sugar; a blood glucose level greater than 120 mg/dL.
- Weakness, Confusion, unconsciousness
- Red, dry skin
- Elevated heart rate
- Uncharacteristic behavior
- Hunger
- Anxiety
- Combativeness
- Fruity-smelling breath
- Nausea and vomiting
- Shortness of breath
- Dry mouth/thirst
- Abdominal pain
- Seizures
Hyperglycemic
hyperosmolar
nonketotic
syndrome (HHNS)
A condition typically found in patients with type 2 diabetes in
which the blood glucose level increases excessively, causing the
loss of large amounts of fluid from glucose spilling into the urine,
leading to severe dehydration.
Allergen
A substance (antigen) that enters the body by ingestion,
injection, inhalation, or absorption and triggers an allergic
reaction; see antigen.
Hypoglycemia (S&S)
Low blood sugar; a blood glucose level of 60 mg/dL with signs or
symptoms of hypoglycemia, or a blood glucose level of less than
50 mg/dL with or without signs or symptoms of hypoglycemia.
S&S:
- Intoxicated appearance, unconsciousness
- Cold, clammy skin
- Elevated heart rate
- Hunger
- Uncharacteristic behavior
- Anxiety
- Combativeness
- Seizures
Allergic reaction
A misdirected and excessive response by the immune system to
a foreign substance or an allergen.
Anaphylactic reaction
A reactive release of chemical mediators that produce bronchoconstriction, vasodilation, capillary permeability, and increased mucus production leading to airway and respiratory
compromise and hypoperfusion.
Anaphylactic shock
A shock (hypoperfusion) state that results from dilated and leaking blood vessels related to severe allergic reaction; also called anaphylaxis or anaphylactic reaction.
Antibodies
Special proteins produced by the immune system that search
out antigens and combine with and help to destroy them.
Anaphylactoid reaction
A reaction to a foreign substance that resembles an anaphylactic reaction that may occur on first exposure to the substance without immune system sensitization.
Antigen
A foreign substance that enters the body and triggers an
immune response; see allergen
Auto-injector
A device with a concealed, spring-loaded needle used for
injecting a single dose of medication; an epinephrine autoinjector is often prescribed to patients with a history of
anaphylactic reaction.
Endotracheal intubation
Placement of a tube down the trachea to facilitate airflow into the
trachea and lungs.
Epinephrine
A natural hormone that, when used as a medication, constricts
blood vessels to improve blood pressure, reduces leakage from
blood vessels, relaxes smooth muscle in the bronchioles
(causes bronchodilation), and increases the heart rate and force
of ventricular contractions.
Histamine
The primary chemical mediator released from the mast cells
during an anaphylactic reaction.
Hives
Raised, red blotches associated with allergic and anaphylactic
reactions.
Hypersensitivity
A state of altered reactivity to an antigen, or foreign substance,
that causes allergic reactions to that substance; see
sensitization.
Immune response
Production of antibodies by the immune system to fight off
invasion by foreign substances.
Immune system
The body’s defense mechanism against invasion by foreign
substances.
Malaise
A general feeling of weakness or discomfort.
Sensitization
Exposure to an allergen that results in hypersensitivity to that
allergen; see hypersensitivity.
Signs & Symptoms of Allergic Reaction v. Anaphylaxis
Allergic Reaction:
- Sneezing cough, mild dyspnea
- Wheezing
- Local hives
- Possible pallor
- Local swelling
- Close to normal vital signs
- Mild, moderate, or severe anxiety
Anaphylaxis:
- Moderate to severe dyspnea, tightness in chest
- Wheezing, muffled voice, stridor
- Generalized hives
- Generalized pallor, flushed skin
- Swelling of face, lips, eyes, tongue, injection site
- Tachycardia, tachypnea, hypotension, low SpO2
- Feeling of impending doom
Amount of Oxygen in Cylinders (D, E, M, G, H)
D: 350 L
E: 625 L
Often in ambulance:
M: 3,000 L
G: 5,300 L
H: 6,900 L
Pressure when oxygen cylinder is full
2,000 to 2,200 psi (pounds per square inch)
Formula to determine duration of flow of O2
Constant * [Gauge pressure in psi- safe residual pressure (200 psi)]/flow rate in LPM = duration of flow in minutes
Constants: D= 0.16 E= 0.28 M= 1.56 G= 2.41 H= 3.14
Before cylinder reaches 200 psi, you must change it
Common hazards with medical oxygen
- If tank is punctured, can explode
- Oxygen supports combustion, and can saturate towels, sheets, and clothing
- Oxygen is reactive with petroleum based products, including adhesive tape
Oxygen delivery devices, flow rate, O2 concentration
- Nonrebreather mask, 12-15 LPM, 80-90% oxygen
- Partial rebreather mask, 9-10 LPM, 40-60% O2
- Nasal cannula, 1-6 LPM, 24-44% O2
- Venturi (mixes O2 & inhaled air), varies- up to 15 LPM, 24-60% O2
- Tracheostomy mask, 8-10 LPM, varies
Signs of upper airway obstruction
Agitation, cyanosis, decreased LOC, choking, wheezing, difficulty breathing, confusion
Types of lung sounds
Bronchial: heard over tracheobronchial tree
Vesicular: heard over lung tissue
CPR compression depth
1.5 to 2 inches
Sutures
Zigzagged joints that hold the cranium together
