Module 7- Medical Emergencies II Flashcards
Describe the pathophysiology and the signs and symptoms associated with appendicitis
Describe the pathophysiology and the signs and symptoms associated with gastrointestinal bleeding
Describe the pathophysiology and the signs and symptoms associated with esophageal varices
Describe the pathophysiology and the signs and symptoms associated with abdominal aortic aneurysm.
Explain the technique of restraining a combative patient.
Describe the pathophysiology, the signs and symptoms, treatment, and evidence preservation associated with sexual assault.
Describe the pathophysiology, signs and symptoms, and treatment associated with esophageal varices
Recognize indications for physical restraint of a patient and follow principles of safe physical restraint of patients
Describe emergency medical care for a heat emergency patient with moist, pale, normal-to-cool skin
Define poisoning:
is any substance—liquid, solid, or gas—that impairs health or causes death by its chemical action when it enters the body or contacts the skin.
Describe special considerations in assessing and managing patients with Carbon Monoxide Poisoning:
Describe the important steps in managing a poisoning patient, regardless of the specific poison or route of exposure:
Describe each of the 4 routes by which poison can enter the body
- Ingestion
- Inhalation
- Injection
- Absorption
Describe the basic anatomy and physiology of the female reproductive system
Describe the pathophysiology of drowning, important assessment questions, and management of drowning patients
Describe the signs and symptoms and the emergency medical care for anaphylactic shock resulting from a bite or sting
Recognize the signs and symptoms associated with all types of hyperthermia:
Describe the anatomy and physiology of the retroperitoneal structures:
Explain actions you should take to protect your own safety when responding to a water emergency:
Describe the pathophysiology and the signs and symptoms associated with pelvic inflammatory disease:
Understand the difference between visceral, parietal, and referred pain
Describe the emergency care for a heat emergency patient with hot skin that is moist or dry
- Ingestion
- Inhalation
- Injection
- Absorption
Recognize behavioral characteristics of paranoia, schizophrenia
Describe the association between shallow water diving and spinal injuries
Understand the meaning of tolerance, withdrawal, dependence, adverse reactions, and delirium tremens, and overdose
Describe the pathophysiology and the signs and symptoms associated with endometriosis:
Explain the pathophysiology of lightning strike injuries and the associated emergency medical care
Describe the signs and symptoms associated with hypothermia
Explain the pathophysiology of decompression sickness
Describe special considerations in assessing and managing patients experiencing emergencies associated with huffing
Describe the signs and symptoms and the emergency medical care for a bite or sting
Understand the purpose of performing a Markle test on a patient complaining of abdominal pain and how the properly perform this test
Describe the pathophysiology and the signs and symptoms associated with kidney stones, urinary tract infection, and kidney failure
Explain the importance of recognizing and responding to patients suffering from behavioral emergencies
Describe the indications, contraindications mechanism of action, side effects, dosage, and administration of activated charcoal
Describe the emergency care for patients with generalized hypothermia and localized cold injury
Recognize factors that contribute to a patient’s risk for urban hypothermia
Given a scenario involving a patient who has absorbed a poison, describe the steps of assessment-based management
Describe the pathophysiology and the signs and symptoms associated with peritonitis
Discuss basic principles related to the assessment and management of patients with behavioral emergencies
Sensitization is the process by which the body:
produces antibodies to combine with antigens and destroy them.
What organs are in the LUQ?
stomach, spleen, left kidney, part of the pancreas; in the right lower quadrant
What organs are in the RUQ?
liver, gallbladder, right kidney, part of the pancreas, and duodenum; in the left upper quadrant
What organs are in the LLQ?
descending colon, sigmoid colon, left ovary (in females)
What organs are in the RLQ?
cecum, appendix, part of the small intestine, right ovary (in females); and in the left lower quadrant
Somatic pain is:
pain that originates in the body’s soft tissues, such as the skin, muscles, tendons, joints, and bone
Parietal pain is:
a type of abdominal pain that occurs when the parietal peritoneum, the lining of the abdominal cavity, is irritated
What are the four quadrants?
RUQ (Right upper quadrant), RLQ (Right lower quadrant), LUQ (Left upper quadrant), LLQ (left lower quadrant)
What are the 9 abdominal regions?
- Right Hypochondriac
- Epigastric Region
- Left Hypochondriac
- Right Lumbar
- Umbilical cord
- Left Lumbar
- Right Illiac
- Hypogastric Region
- Left Illiac
tachypneic, tachycardic, Bradycardia,
Tachypnea: Rapid breathing
Tachycardia: A fast heart rate
Bradycardia: A slow heart rate
Define Antigen:
Foreign substances
Define Allergen:
Specific type of antigen
What are the 4 ways antigens can enter your body?
- Injection
- Ingestion
- Inhalation
- Contact (absorption)
When the body detects antigens it releases ________.
Antibodies
What is the treatment for a mild allergic reaction?
Benadryl (diphenhydramine) or topical anti-inflammatory (Hydrocortisone)
What is the treatment for anaphylactic reaction or anaphylaxis?
If cardiovascular collapse and hypotension are present during a severe allergic reaction, this life-threatening response can be referred to as:
anaphylactic shock
The type of antibody that is produced specific to anaphylaxis is called
Immunoglobulin E (IgE)
What is hypersensatization?
State of the body that reacts to the antigen, that causes a allergic reaction reactions to that substance
What is sensitization?
exposure that results in hypersensitization to a specific antigen
What is the treatment for anaphylactic reaction?
First line treatment: Epinephrine
Swelling in upper airway:
- Inset airway adjunct
Swelling at the larynx:
- PPV with high air flow
Unresponsive, inadequate breathing, etc.
- PPV with high flow oxygen
- endotracheal Intubation
What are the early signs of anaphylaxis?
- Rhinitis (stuffy, runny, itchy nose)
- Tachycardia
- Pruritus (itching)
- Faintness or light headness
- Warm, flushed skin
- Agitation or anxiousness
- Urticaria (Hives)
- Edema (swelling of the skin)
- abdominal cramping
Most anaphylactic reactions are apparent within _______ minutes after exposure to the antigen
20 minutes
Signs of anaphylactic reaction by body system :
Skin:
- Warm, tingling feeling in the face, mouth, chest, feet, and hands (early symptom)
- Intense itching (pruritus), especially of hands and feet (hallmark symptom)
- Hives (urticaria) (hallmark sign)
- Flushed or red skin
- Swelling to the face, lips, neck, hands, feet, and tongue
- Cyanosis (severe cases
Respiratory System:
- Patient complaints of a “lump in the throat”
- Tightness in the chest
- High-pitched cough
- Tachypnea (increased breathing rate)
- Labored breathing
- Noisy breathing (wheezing, stridor, or crowing)
- Impaired ability to talk or hoarseness
- Excessive amounts of coughed-up mucus
- Partially or completely occluded airway
- Difficulty in breathing
- Cardiovascular System
- Tachycardia (increased heart rate)
- Hypotension (decreased blood pressure)
- Irregular pulse
- Absent radial pulse (severe shock)
Central Nervous System:
- Increased anxiety
- Light-headedness
- Unresponsiveness
- Disorientation
- Restlessness
- Seizures
- Headache
Gastrointestinal System:
- Nausea/vomiting
- Abdominal cramping
- Diarrhea
- Difficulty in swallowing
- Loss of bowel control
Genitourinary System:
- Urgent need to urinate
- Cramping of the uterus
- Generalized Signs and Symptoms
- Itchy, watery eyes
- Runny or stuffy nose
- Sense of impending doom
- Complaints of “not feeling well”
- General weakness or discomfort
three key categories of signs and symptoms that specifically indicate a severe anaphylactic reaction:
Airway and respiratory compromise:
Airway occlusion; respiratory distress or respiratory failure with possible wheezing or stridor
Shock (hypoperfusion):
Absent or weak pulses; tachycardia; decreased blood pressure (<90mmHg systolic BP); deteriorating mental status.
Gastrointestinal (GI) signs and symptoms:
Vomiting, diarrhea, abdominal cramping, and abdominal pain are common GI signs and symptoms seen in anaphylaxis
What steps are needed in a severe systemic anaphylactic
- Maintain patent airway
- Suction any secretions
- Maintain adequate oxygenation
- Be prepared to assist ventilation
- Administer epinephrine
- consider ALS
- Initiate rapid transport
When is considered anaphylactic shock instead of anaphylactic reaction?
If cardiovascular collapse and hypotension are present
Epinephrine:
Indications
Contraindications
Medication Form
Dosage
Administration
Actions
Side Effects
Indications:
Anaphylactic reaction or shock
Contraindications:
N/A
Medication form:
Liquid drug
Dosage:
- Adult: 0.3 mg
- Child/infant: 0.15 mg
Administration:
- IM for 3 seconds and rub for 10 seconds
Actions:
- Mimics the response of the sympathetic nervous sys.
- Alpha properties constrict blood vessels
- Beta 2 prosperities relax the smooth muscles in the bronchioles to improve breathing & alleviate wheezing dyspnea
- Beta 1 increases heart rate and contractibility
- takes effects within seconds and last for 10-20 minutes
Side Effects:
- Increased heart rate
- pale skin
- Dizziness
- Chest pain
- headache
- nausea and vomiting
- excitability and anxiousness
What is a anaphylactic reaction ?
severe allergic reaction that is an exaggerated immune response to a foreign substance known as an antigen
What are the signs and symptoms of poisons?
- History of ingestion
- Swelling of mucosal membranes
- Nausea
- Diarrhea
- Altered mental status
- Abdominal pain, tenderness distention, and/or cramps
- Burns or stains around mouth, pain in mouth/throat and pain during swallowing
- Unusual breath/body odors
- Respiratory distress
- Altered heart rate
- Altered blood pressure
- Dilated or constricted pupils
- Warm/dry/cool/moist skin
- Seizures
Activated Charcoal:
Indications
Contraindications
Medication Form
Dosage
Administration
Actions
Side Effects
Indications:
May be used for PT who has ingested poison by mouth, upon medical direction
Contraindication:
- PT has altered mental status
- swallowed acids or alkalis
- unable to swallow
- overdose on cyanide
Medication form:
- Premixed in water
- Powder
Administration:
- consult medical direction
- Shake in container well
- no icecream, sherbet or milk
Actions:
- AC absorbs poisons in stomach, prevents absorption, and helps elimination from body
- not used for alcohol, kerosene, gasoline, caustics, metals, acids, alkalis
Side Effects:
- blackening of stools
- nausea/vomitting
Primary assessment: What do you closely assess for breathing for a suspected PT with inhaled poison?
Adequate rate and depth of respirations
Define bradypnea, hypopnea:
- Bradypnea: slow breathing
- Hypopnea: shallow breathing
If PT has respiratory distress due to Alcohol, CNS , or depressants what treatment are provided?
- inadequate breathing, PPV with supplemental O2 (10-12 / minute )
- if adequate breathing, administer supplemental O2
What are the 6 signs and symptoms of a high priority PT of alcohol and drug emergencies?
- unresponsiveness
- respiratory difficulties
- fever
- tachycardia , bradycardia, irregular pulse
- voting with altered mental status
- seizures
CNS stimulants do what?
Excite the nervous system
CNS stimulant signs and symptoms:
Excitability, elevated mood, agitation, uncooperativeness, tachycardia, tachypnea, dilated pupils, dry mouth, sweating, increased BP, loss of appetite, lack of sleep
CNS depressants do what?
Depress the nervous system
CNS signs and symptoms:
Euphoria, drowsiness, sleepiness, decreased breathing rate and depth, bradycardia, hypotension, dilated pupils that are sluggish to respond to light
Narcotics are:
CNS depressants are derived from opium (opiates) or synesthetic opium (opioids)
Narcotic signs and symptoms :
Bradycardia, hypotension, inadequate breathing rate and depth, cool clammy skin, lethargy, constricted pupils, nauseappssible respiratory distress and arrest can
Hallucinogens signs and symptoms :
Motor disturbances, paranoia, anxiety, visual or auditory hallucinations, tachycardia, hallucinations, tachycardia, dilated pupils, flushed face, poor perception of time and distance,
What are the 4 stages of alcohol withdrawal ?
Stage 1. This occurs within approximately and is characterized by nausea, insomnia, sweating, and tremors.
Stage 2. This occurs within to and is characterized by a worsening of stage plus hallucinations.
Stage 3. This can occur as early as following the last alcoholic beverage and is characterized by major seizures.
Stage 4. This is characterized by delirium tremens which can occur to days after the last drink
what is an opiod?
is any natural, synthetic, or semisynthetic agent that mimics the effects of morphine
what is Fentanyl?
is a synthetic opioid pain reliever that is 50 to 100 times more powerful than morphine.
What are the signs from opioid ?
-CNS depression
- Respiratory depression (decreased respiratory rate and tidal volume)
- Miosis (constricted pupils)
also
- seizures
- psychomotor delay
- Dysarthria (speech delay from paralysis of face)
- Ataxia
- Tremors
- Crackles
- Hearing loss
- Crackles from acute pulmonary edema
- nausea and vomiting
- Hypotension
- Bradycardia
- urinary retention
- Pruititus
- Hypoglycemia
- Hypothermia
Activated Naloxone:
Indications
Contraindications
Medication Form
Dosage
Administration
Actions
Side Effects
Indications:
for suspected or known opioid intoxication
Contraindications:
Hypersensitivity to Naloxone
Medication Form:
intravenous, subcutaneous, intramuscular, intranasal, or endotracheal route
Dosage:
typical dose is total 2 mg with in 1 mg each nostril.
Administration:
1. obtain medical direction offline/online
2. confirm medication
3. make sure each nostril is clear
4. consider restraining PT prior to treatment
5. Draw up 1 mg for needle
6. assemble nose spray device
7. spray in each nostril
Actions:
-Naloxone is a pure opioid antagonist with a rapid onset of action.
-It competitively binds opioid receptors and can block opioid from attaching to receptor sites
Side Effects:
- Acute opioid withdrawal
- Increased blood pressure
- Headache
- Musculoskeletal pain
- Nasal dryness, edema, congestion or inflammation
What are the symptoms of
Long-term cannabis use over years, daily to weekly use of marijuana
- Severe nausea and vomiting, often in the morning
- vomiting that occurs in a cyclic pattern over months
- Colicky (crampy) abdominal pain
- Periumbilical or epigastric abdominal pain
- Relief of symptoms with a hot shower or bath
- Elimination of symptoms after stopping the use of cannabis
What are the symptoms of HEP B & C?
Fatigue
Nausea and loss of appetite
Abdominal pain
Headache
Fever
Yellowish color of skin and whites of eyes (jaundice)
Dark urine
What are the signs and symptoms of Tuberculosis?
Fever
Cough (often coughing up blood)
Night sweats
Weight loss
What are the 3 categories of COVID-19 and what characterizes them?
Stage 1: Asymptomatic the first 1-2 days
Stage 2: over next few days virus replicates and 80% of those infected will have upper & airways
Stage 3: Remaining 20% will develop more serious symptoms as virus makes it way down to the alveoli
What is a hollow organ ?
contain some type of substance that might leak into the abdominal cavity if the organ is perforated or injured
List the 9 examples of hollow organs?
appendix
bladder
common bile duct
fallopian tubes
gallbladder
intestines
stomach
uterus
ureters
What is solid organs?
are vascular (contain many vessels and a large amount of blood)
What are 5 examples of solid organs?
kidneys
liver
ovaries
pancreas
spleen
abdominal pain results from 3 of following mechanisms?
- Mechanical forces (stretching)
- Inflammation
- Ischemia (organ and tissue hypoxia, or oxygen deficiency)
Signs and symptoms of appendicitis:
- Pain in RLQ
- nausea and vomiting
- low grade fever and chills
- lack of appetite
- abdominal guarding
- Positive markle
What is the “Markle Test” and how do you peform it?
a simple bedside test to check for appendicitis and other inflammation in the abdomen
- Stand with their knees straight, with or without shoes
- The clinician stands on their toes for a few seconds, then suddenly relaxes and comes down with their full weight onto their heels
- The patient then does the same
What are the Common Signs and Symptoms of Gastrointestinal Bleeding?
- Hematemesis
- Hematochezia
- melena
- altered mental status
- Tachycardia
- pale, cool , clammy skin
- abdominal pain or tenderness
Common Signs and Symptoms of AAA (abdominal aortic aneurysm)
- Gradual onset of lower lumbar, groin, and abdominal pain
- Rupture associated with sudden onset of severe, constant abdominal pain. Can radiate to the lower back, flank, or pelvis.
- Testicular pain in the male patient
- Possible nausea and vomiting
- Mottled or spotty abdominal skin
- Pale, cool, clammy, and possibly cyanotic skin in legs from decreased blood and perfusion
- Absent or decreased femoral or pedal pulses
- If the abdomen is soft and thin, a pulsating abdominal mass may be felt. If the aneurysm has burst, the abdomen will be rigid and tender.
- If the aortic aneurysm is starting to rupture, the skin below the waistline can become cyanotic, cold, and mottled
S/S of GI bleeding:
- Hematemesis (vomiting blood)
- Hematochezia (red undigested blood in bowel movement)
- Melena (dark tarry bowel movement, indicative of digested blood)
- Dyspepsia (indigestion)
- Hepatomegaly (enlarged liver)
- Jaundice (yellowing of sclera and skin, indicative of liver problems)
- Constipation or diarrhea
- Agitation
- Dizziness
- Inability to find a comfortable po
What is treatment for GI bleeding in Elderly look like?
- Establish and maintain adequate airway
- Be prepared to treat for shock
If SpO2 is less than 94%, start with Nasal cannula O2 with 2 lpm and titrate up to achieve 94%
If 6 lpm is not enough, switch to NBM with 10-15 lpm O2
When assessing PT for Abdominal pain, what is a sign of internal bleeding?
Difference between Systolic and diastolic BP :
If it is narrow—along with tachycardia, and pale, cool, clammy skin—it can be a sign of internal bleeding.
Pale oral mucosa- can mean longer internal bleeding
What is the emergency care for Abdominal pain?
- Keep airway patent
- place PT in position of comfort
- if breathing is inadequate, began PPV
- if breathing is adequate, maintain oxygenation and consider using supp. O2
- never give anything by mouth
- calm and reassure PT
- if signs of hypoperfusion are present treat for shock
- Initiate quick transport
S/S of Sickle cell crisis :
Bone pain
Joint pain
Fever
Chest pain
Shortness of breath
Fatigue
Pale skin
Tachycardia
Jaundice (yellowed sclera and skin)
Ulcers on the lower legs
Excessive thirst
Priapism
Frequent urination
Sudden blindness in one eye
What is treatment for “sick cell crisis”?
Ensure an adequate airway, ventilation, oxygenation, and circulation.
What is pulmonary embolism?
a blockage in a lung artery caused by a blood clot that travels from a vein in the body to the lungs
What are the female organs and their function?
vagina, uterus, ovaries, and fallopian tubes
Vagina:
Birth canal for baby, canal for penis during intercourse, passageway for menstrual cycle
Uterus:
organ that provides an appropriate site for egg implantation and fetal development during pregnancy
Ovaries:
excrete hormones and develop and release eggs that are needed for reproduction
Fallopian Tubes:
Where fertilization of egg occurs
Common Signs and Symptoms of a Spontaneous Abortion:
Lower abdominal or pelvic pain
Abdominal tenderness
Vaginal bleeding
Rapid pulse
Signs and symptoms of shock (rare)
dysmenorrhea:
severe pain or cramps during mensuration
mittelschmerz :
abdominopelvic pain during middle of menstrual cycle that is associated with ovulation
Common Signs and Symptoms of an Ovarian Cyst:
- Unilateral abdominopelvic pain that can radiate to the back
- Abdominal tenderness
- Vaginal bleeding that can be irregular or abnormal
- Pain during sexual intercourse or bowel movements
Emergency Medical Care for abdominopelvic pain or vaginal bleeding:
- establish spine restriction if necessary
- keep airway patent
- if breathing is inadequate start PPV
- if breathing is adequate, maintain oxygenation and consider using supp. O2
- Control any major vaginal bleeding if present
- place PT in position of comfort
- calm patient
- reassure PT
What are 3 Common Genitourinary/Renal Conditions:
Urinary tract infections
Kidney stones
Kidney failure
Common Signs and Symptoms of Urinary Tract Infections:
Abdominopelvic pain or tenderness
Blood in the urine (hematuria)
Urine with cloudiness or a foul or strong odor
Pain or burning with urination or sexual intercourse
Frequent or urgent need to urinate
Genital or flank pain
Fever or chills
Nausea or vomiting
Altered mental status
Common Signs and Symptoms of Kidney Stones:
Abdominopelvic pain or tenderness
Flank or back pain that is colicky and severe
Groin pain
Abnormal urine color
Pain with urination
Frequent or urgent need to urinate
Fever or chills
Nausea or vomiting
Common Signs and Symptoms of Kidney Failure:
Blood in the urine or stools
Altered mental status
Edema of the feet, ankles, and legs
Decreased urine output or cessation of urination
Hypertension
Swelling or easy bruising
Anorexia
Tachycardia
What are some adverse effects and life-threatening complications from Dialysis?
Hypotension
Muscle cramps
Peritonitis (especially in peritoneal dialysis)
Nausea and vomiting
Hemorrhage (especially from the access site)
Infection at the access site
Irregular pulse or cardiac arrest
Sepsis
Difficulty breathing
Treatment for dialysis emergency:
Maintain the airway, breathing, and circulation.
Support ventilation as needed.
Provide high-concentration oxygen.
Stop any bleeding from the shunt or access site as needed.
Position the patient. If the patient has signs of shock, place him in a supine position. If the patient has pulmonary edema, place him upright.
Transport.
signs and symptoms associated with a genitourinary or renal emergency
Urine with an abnormal color, consistency, or odor
Abdominopelvic pain or tenderness
Nausea and vomiting
Fever or chills
Syncope or altered mental status
Pain or burning during sexual intercourse, urination, or a bowel movement
Flank, groin, or back pain
Frequent or urgent need to urinate or decreased urine output
Blood in the urine (hematuria)
Edema of the feet, ankles, and legs
Hypertension
Anorexia
Tachycardia
Signs of shock
What is the “Heel Jar test”?
What are two types of test that can check for appenditicis?
- Markle test
- Heel jar test
