Medical Emergency Flashcards
best management is
PREVENTION
- a good history and physical is essential
- review recent issues if the patient has not been in for some time
any recent changes in medical status?
any new or recent lab studues?
a proper history will provide a baseline reference in the event of an emrgency
when emergency happens primary goal?
STABILIZE the patient until arrival of emergency medical team
follow BASIC guidelines
steps in management of medical emergencies P A B D C
positioning
airway
breathing
circulation
differential diagnosis, definitive care, drugs, defibrillation
obtain baseline vital signs
PULSE PRESSURE
SATURATION OF OXYGEN
BLOOD PRESSURE
THIS IS SO CRUCIAL TO OBTAIN BASELINE
loss of consciousness can come from
syncope
hypoglycemia
seizures
MI
CVA/ stroke
Anaphylaxis
after administer LA to patient , starts sweating and eyes are closed
dizzy and nauseated
syncope likely
hypotension
bradycardia
low saturation pressure of oxygen
syncopy
physcogenic reaction leading to parasympathetic response with sudden vasodilation producing bradycardia and cerebral ischemia
manifestations of syncope
dizziness
pallow
sweating
nausea
hypotension
loss of consciousness, possible seizure
tx for sncopy
trendelenberg positoin
CAB - circualtion, airway and breathing
oxygen
spirits of ammonia
apply a cool wet towel to forehead
it will take 24 hours for patients body to fully recover
hypoglycemia vs hyperglycemia
hypoglycemia is more common – seen with diabetics who take insulin and forget to eat or do not take their normal oral intake
manifestations of hypoglycemia
hunger headache sweating pallor confusion, irritability possible resulting in loss of consciousness
tx of hypoglycemia in conscious pt. in unconscious pt?
conscious– give sugar
unconscious – 50 ml of 50% dextrose IV or 1 mg of glucagon IM
signs of syncope but in terms of circulation the blood pressure or pulse is
blood pressure and pulse is not altered much in hypoglycemia but hypotension in syncope
but do FINGER STICK
finger stick but not low … next?
does patient have facial weakness slurring or bad speech? No – consider other medical condition if yes — consider CVA and activate EMS and provide supplemental oxygen
angina/ MI
include manifestations
due to heart’s oxygen demand being greater than supply associated with exertion, anxiety or with coronary athersclerotic dsease
manifestation
- crushing pressure on chest may radiate shoulder, neck, arm and mandible
- dizziness
treatment of angina/ MI
100 % oxygen
position
sublingual nitroglycerine
(0.3-0.4 mg) every five minutes up to three doses - check VS (vital signs) prior to administration
- if symptoms persist an MI must be assumed and EMS activated
MONA
- morphine
- oxygen
- nitroglycerine
- aspirin - full strength – ask patient to chew it up
nitroglycerine amount and what it does
vasodialtion
- 3 - 0.4 mg every five minutes up to three doses
- CHECK VITAL SIGNS PRIOR TO ADMINISTRATION
chest pain and pt. becomes unconscious
make sure you elicit that they are unconscious
then check pulse – carotid - at least 5 not more than 10 seconds
CPR - until AED is available
- AED = automated external defibullator
stroke think
FAST
- facial weakness
- arm drift
- speech alteration
- TIME
stroke looks like
syncopy and hypoglycemia too
hyperventialion looks like
often caused by severe anxiety / panic attack
manifestations - palpations chest pain tachycardia dizziness numbness and tingling on extremeties muscle pain and cramp (carpopedal tetany)
common causes of anaphylaxis
foods
insect venoms
latex
medications
common causes of anaphylaxis
foods
insect venoms
latex
medications
cross reactivity of foods ___ avoid___
bananas, avocados,
avoid latex use
decrease in BP and Pulse
yes - consider?
- no
yes - consider syncope
no - consider other causes like hypoglycemia or stroke
treatment of hypoglycemia
conscious pt?
unconscious pt?
conscious
- give sugar
unconscious
- 50 ml of 50% dextrose IV OR 1 mg glucagon IM
if patient has facial weakness or slurring of speech
consider CVA
- activate EMS
- supplemental O2
pt blood sugar is 140?
below this is normal so at this or higher is prediabetic
patient states he has chest pain/ tightness and is nauseated treat as? why does this happen
angina
- due to hearts oxygen demand being greater than supply associated with exertion, anxiety or with coronary athersclerotic disease
manifestation of angina / MI
crushing pressure on the chest and may radiate shoulder, neck, arm and mandible
dizziness
could substitute what in MONA
nitrous oxide
usually M -- morphine O- oxygen N - nitroglycerin A - aspirin
general offices may not have the access to morphine - so can use nitrous oxide
treating the pt with chest pain and he becomes unconscious, what do you do
Consider BLS (basic life support) protocol
Poisition Circulation Airway Breathing D - Diff. dx
so begin CPR and place AED as soon as possible
supplement oxygen over what %
want greater than 94%
if think stroke think FAST means
F - facial weakness
A - arm drift
S - speech alteration
T - TIME
supine position when
unconscious pt. and thinking cerebrovascular - stroke accident
managment of cerebrovascular sccident/ stroke
if conscious - put patient into a comfortable position
- if unconscious, supine position
monitor vitals administer oxygen transport to ER via EMS basic support as required - maintain airway IV acess may be useful if trained
patient is breathing deeply and rapidly
pt. states they are feeling dizzy and numb
thinking?
hyperventilation
tx for hyperventilation
stop procedure
positino pt. into comfortable position
calm patient
breathe C02 enriched air through face mask or paper bag
consider IV sedation
clinical manifestations of anaphylaxis
respiratory effects?
skin?
gastro?
cardio?
skin - flushing, pruritus, urticaria, angioedema
upper respiratory - congestion, rhinorrhea
lower respiratory = bronchospasm, throat or chest tightnedd, hoarsness, wheezing, shortness of breathe, cough
GI= oral pruritis, cramps, nausea, vomiting, diarrhea
cardio = tachycardia ,bradycardia, hypotension/ shock , arrhythmias, ischemia, chest pain
anaphylaxis prsentation with hives
only about 10-20% of cases will present with hives or other cutaneoues manifestations
80% food-induced, fatal anaphylaxis cases were not associated with cutaneous signs or symptoms
incidence of latex induced anaphylaxis
1-6% population - up to 16 million
8-17% incidence among health care workers
aawareness of cross sensitivity with what foods?
regarding latex induced anaphylaxis prevention
banana avocado chestnuts kiwi stone fruit
treatment of anaphylaxis
immediate with epinephrine
no contraindications in anaphylaxis - longer wait more fatal
antihistamine - oral or parenteral - if oral use liquid or chewable tablet
call 911
repeat epi with anaphylaxis when
10-15 minutes after first if symptoms persist or increase
repeat antihistamine + H2 blocker if symptoms persist
observe for 4 hours
additional measures fo tx of anaphylaxis
corticosteroids
supplemental O2 - airway maintenance
IV fluids, vasopressor therapy
tx of mild allergic reactions?
mode of action
diphenhdramine - Benadryl –
prevetnts histamine from binding H1 receptors on certain tissues
INHIBITS
- vasodilation
- increases capillary permeability
- itching
BEST WHEN GIVEN EARLY - PREVENT SYMPTOMS FROM PROGRESSING
- should be administered on a regular schedule to prevent allergic symptoms while the allergen is still in the bod
dose of diphenhydramine
determined by severity of the symptoms
oral = 25-50 mg upon onset of symptoms then repeated every 6 hrs for 4-6 days
IM = 25-50 mg into lateral thigh, deltoid, or buttoc
rarely IV administration
pediatric dose - 1,g/ kg
- refer to ER or PC for monitor at least 24-48 hours post
immediatley after anaphylaxis
stop procedure
call 911
administer 100% oxygen
take vitals
adminster epi SC/IM/IV at .3-.5 mg
child = 0.1mg/kg SC or IM
main effects of epinephrine
best for?
MOST IMPORTANT DRUG FOR ANAPHYLAXIS –
will cause OPPOSITE EFFECTS OF HISTAMINE
EPI CAUSES
1 . VASOCONSTRICTION – counteracts the profound hypotension that can cause circulatoy collapse and cardiac arrest
- BRONCHODILATION
- it counteracts the smooth muscle contrction of the bronchioles (bronchiospams) that can lead to hypoxia
cyanosis in lips could be sign of
Asthma attack
tx for asthma attack
comfortable position
administer oxygen and maintain airway
administer MDI / bronchiodilator – albuterol
2-4 puffs ASAP - may repeat 10 minutes as required
consider use of SQ epinephrine 0.5-1.0 mg (1:1000) if attach persists
seizure what to do
remove all dental instruments and supplies from patient mouth
position patient and PROTECT patient
position airway and DO NOT PLACE ANYTHING IN PT MOUTH IS SEIZING
If no history known of seizures - contact EMS (or if severe)
