WEEK 8 - The Complex Patient

Question 1

In anaphylaxis signs and symptoms may develop within minutes of exposure and include:

Answer 1

facial and airway swelling/oedema
hives and welts on the skin
itchy skin/rash
abdominal pain/vomiting
broncoconstriction/respiratory distress
tachycardia/tachypnoea
severe hypotension
altered conscious state

Question 2

Management of anaphylaxis

Answer 2

• Removal of allergen (if environmetal and not already ingested/absorbed)
• Oxygen
• IV fluids (to replace relative hypovolaemia and hypotension)
• Adrenaline (this stabilises mast cell membranes and causes vasoconstriction). Adrenaline should be given in 500mcg boluses IM, and repeated every 5-10 minutes PRN.
• consider clinical support
• nebulised adrenaline for any upper airway angioedema
• nebulised salbutamol and ipatropium for bronchospasm
• prednisone for persistent wheeze
• prompt transport with notification

Question 3

Signs and symptoms of meningococcaemia include:

Answer 3

fever and rigors
altered conscious state/confusion
pain in muscles/joints, chest or abdomen
tachypnoea
diarrhoea
pale, grey or blotchy skin
non-blanching purpuric rash (purple)

Question 4

Prehospital management of meningococcal

Answer 4

In the prehospital setting paramedics must move quickly to assess a patient and come up with a provisional diagnosis of meningococcal septicaemia. Treatment revolves around prompt administration of antibiotics (benzylpenicillin or ceftriaxone) and IV fluid, and may include supporting ABCs if a patient deteriorates. Paramedics must also ensure they wear appropriate PPE when in contact with these patients.

Question 5

Things to consider when presented with a drug/medication overdose:

Answer 5

what was taken? what route was it taken?
how much and at what time?
is the packaging accessible/handy?
has the dosage changed or the patient taken the drug before?
has the patient vomited since?
is there any alcohol involved?
how long after the drug did the patient develop signs and symptoms?
what are the exact signs and symptoms?

Question 6

Prehospital management of drug overdose (polypharmacy)

Answer 6

In the prehospital setting all patients who have taken an overdose of drugs/medication should be taken to hospital for further tests and monitoring. Often you haven’t even heard of a certain party drug or know specifically how it can affect the body (or what it is mixed with), so these patients should not be left at home! The paramedic should also consider the assistance of the police when dealing with people with altered behaviour or who are non-compliant. Emphasis should be made on symptom management and safe transportation of these patients.