reviewer table for psemt
DESCRIPTION
Reviewer Table for PSEMTTRANSCRIPT
RESPIRATORY EMERGENCIESCASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATIONSTATUS ASTHMATICUS Onset
ProvocationQualityRadiationSeverity
SAMPLE Hx
Acute asthmatic attack involves airway obstruction due to :
1. Bronchospasm2. Swelling of mucous
membranes3. Mucus secretions
Provocation:1. Resp Infection2. Emotional Stress3. Allergic Reaction
1. Anxiety2. Patient breathes through pursed
lips3. Wheezing4. Chest overinflated5. Tachycardia6. Tripod post
VENTILATIONOXYGENPOSITION
IMMEDIATE while monitoring vital signs.
PULMONARY EDEMA Excess FLUID BUILD UP in the lungs often caused by MI or related heart disease and occasionally by inhalation of smoke and or toxic fumes. Alveoli collapse due to adhesive property of H2O.
1. RAPID HEART RATE2. Cyanosis3. Distended Neck Veins4. Wheezing5. Frothy or flecked sputum6. Water filled spongy lung7. Dyspnea8. Frothy fluid in bronchi9. Cool, Clammy skin10. Edema
1. High Flow O22. Consider
PEEP/CPAP
IMMEDIATE
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
Chronic Bronchitis
Pulmonary Emphysema
Repeated infections thicken and destroy the lining of the bronchi and bronchioles causing narrowing and becoming obstructive by too much MUCUS and EXCESSIVE CONTRACTIONS of the muscle in their walls.
Alveoli of the lungs become inflated or over distended with trapped air (may burst and merge to make fewer but larger alveoli causing reduction in the lung’s surface area) Less oxygen through walls of the alveoli and
1. Ventilate with 100% O2.
into the bloodstream.
Asthma
OnsetProvocationQualityRadiationSeverity
SAMPLE Hx
Same as Status Asthmaticus
DANGER SIGNS!!!1. Loss of Wheezing
2. Change in Sensorium (Confusion, Irritability, Lethargy)
3. Hypoxia
Prevent Lethal Hypoxia
Depending on the level of hypoxia.
Hyperventilation Syndrome
Abnormal increase in respiration rate and tidal volume.
Anxiety of an emergency often leads to hyperventilation.
Could cause acidosis.
Reassurance and instruct the patient to slow down breathing.
Depending on the severity.
Deep Venous Thrombosis and PULMONARY EMBOLISM
Formation of blood clot in a deep vein due to VIRCHOW’S TRIAD:
Stasis Hypercoagulation Blood vessel
endothelial damage3% chance Pulmonary Embolism will kill your patient.
Blood clot in deep veins goes to the lungs and interrupt blood flow to the lungs.
Affected extremity: Painful Swollen Red Warm Superficial Veins Engorged
Pulmonary Embolism1. LOC restless, anxiety
C1. Rapid heart rate2. Cold clammy skin3. Falling blood pressure4. Distended Neck Veins5. Cyanosis
A & B
1. Sharp and stabbing chest pain2. Sudden unexplained dyspnea3. Cough +/- blood
IMMEDIATE
Respiratory InfectionsCroup Onset
ProvocationQualityRadiationSeverity
SAMPLE Hx
ViralUpper Airway
Agitated and Barking VENTILATE with 100% O2
Epiglotitis Bacterial 1. Swelling cause airway obstruction
2. DROOLING SALIVAPneumonia Virus, Bacteria, Fungi
Develops in daysYoung children and elderly are at high risk
Dyspnea
Alveoli infected decrease in O2 that leads to dyspnea.
CARDIOVASCULAR EMERGENCIESCASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATIONAngina Pectoris OPQRSTA Sudden pain when portion of
the myocardium is not receiving enough oxygenated blood
1. “Indigestion”2. Chest pain that comes after
exertion3. Chest pain that lasts only for a
few minutes4. Relieved after admin of
nitroglycerins5. SOB, Nausea, increased pulse
rate
1. High flow O2 asap.
2. Assist in nitroglycerin admin if systo BP is greater than 90 (know if administered already and know how many times)
3. Place in restful and comfortable position.
4. Reassure.
LIGHTS ONLY
ACUTE MYOCARDIAL INFARCTION
(Silent MI – patient doesn’t feel any pain)
Heart AttackPortion of the myocardium dies due to deprived coronary blood flow.
1. Chest Pain rel to stress and exertion or even at rest. Originates from sternum but radiate to arm, neck, and jaw and described as sharp, squeezing or throbbing pain
2. Pain lasts 30 minutes to several hours.
3. Accompanied dyspnea, nausea, diaphoresis, dizziness, and FEELING OF IMPENDING DOOM.
4. Signs of shock
Conscious:1. High conc. O22. Keep patient
calm and still.3. Take the Hx and
VS.4. Help patient
with prescribed medications
5. Transport immediately in semi sitting position. Quiet transport (little or no use of siren)
6. Monitor VS throughout care and transport
Transport immediately in semi sitting position. Quiet transport (little or no use of siren)
Unconscious:1. Establish and
maintain Airway.2. Provide
CPR/Defib if needed. PPV if needed through BVM.
3. High conc. O2.4. Transport
immediately in semi sitting position. Quiet transport (little or no use of siren)
5. Monitor VS throughout care and transpo.
Aortic Aneurysm
OPQRSTA
Dilatation or outpouching of a blood vessel particularly the aorta.
1. Sudden chest pain (ripping, tearing, and sharp that starts between the shoulder blades)
2. BP discrepancy between arm or decrease in femoral or carotid pulse.
3. Signs of Shock.
1. Calm and reassure the patient.
2. Administer 100% O2 by NRM
3. Place in a comfortable position.
4. Transport without delay.
Transport without delay
HYPERTENSIVE EMERGENCIESHypertension Major contributing
cause in many cases of MI, CHF, and CVA.
Present when BP at rest is consistently greater than 140/90 mmHg
Common complication is renal damage, heart failure and brain attack.
1. Severe headache2. Nausea and vomiting3. Altered Mental Status4. Aphasia, sudden blindness5. Muscle twitching6. Seizures7. Hemiparesis
1. Secure airway , administer O2.
2. Transport without delay
3. Seizure precaution
Transport without delay
Cardiac Tamponade Accumulation of blood in the pericardial sac
Most common result in penetrating injury.
1. Muffled heart sounds2. Falling blood pressure3. Distended neck veins4. Tachycardia
1. Semi-fowler’s2. O23. Immediate
transport
IMMEDIATE
5. Pale, cool, sweaty skin. 4. Monitor5. Surgeons will
immediately do a pericardiocentesis
Pericarditis Inflammation of the pericardium (inner wall of the heart ) Idiopathic infection Metabolic factors Trauma
1. Dyspnea2. Chest Pain that aggravates while
2.1. Breathing2.2. Lying on left side2.3. Turning on Bed
3. Fever, Chills, Fatigue (sign of infection)
1. Priority of care CAB, Administer O2.
2. Immediate transport in sitting position
3. Monitor
Immediate transport in sitting position
CHF (Congestive Heart Failure)
Excessive fluid build up in the lungs and or other organs and in the body because of inadequate pumping
1. Anxiety or Confusion2. Engorged, pulsating neck vein
(LATE SIGN)3. Cyanosis4. Normal/ Elevated BP5. Tachycardia6. Pedal Edema7. Dyspnea8. Pulmonary Edema with rales,
sometimes coughing of Frothy white or pink sputum
9. Enlarged liver, spleen with abdominal distention (LATE)
1. Place patient in a comfortable position (Semi fowler or sitting)
2. Give high concentration O2 through NRM
3. Monitor
Lights only?
BLEEDING (Heart, Blood Vessels, Blood)External Bleeding Severity:
1000 cc for adults 500 cc for child 100 – 200 cc for infant
Arterial – bright red, spurting Venous – dark red, steady flow Capillary – dark red, slowly
oozing, often clots spontaneously
1. Safety BSI2. Control bleeding
2.1. Direct pressure
2.2. Elevation above level of heart (if swollen or deformed DO NOT)
2.3. Pressure points
2.4. Splints2.5. Pressure
splints2.6. Torniquet
(last resort)2.6.1. Torniquet
Depends on the amount of bleeding.
must be at least 4 inches
2.6.2. Put the tourniquet around twice
2.6.3. Knot and put a stick
2.6.4. Twist and secure the stick or rod until bleeding stops
2.6.5. Document2.6.6. NEVER use
a wire2.6.7. NEVER
remove once secured
2.6.8. Leave in OPEN VIEW
2.6.9. NEVER APPLY TO JOINT
Internal Bleeding Most common cause : Injured or damaged
internal organs Fractured extremities
esp. Femur and Pelvis
1. Pain, tenderness, swelling, discoloration of site
2. Bleeding from mouth, rectum, vagina, other orifice
3. Vomiting bright red blood or blood (coffee ground)
4. Dark, tarry stools with bright red color.
5. Tender, rigid, distended abdomen.
LATE SIGNS:1. Altered LOC, Anxiety,
restlessness, combativeness.2. Weakness, faintness, dizziness3. THIRST4. Signs of shock
Goals: Recognize
presence of internal bleeding
Maintain body perfusion
Provide rapid transport
1. Safety BSI2. Open airway
and provide O2 and ventilation per SpO2 and ETCO2
3. Transport Immediately
4. Shock treatment
IMMEDIATE
SHOCK Scene Size – up
Monitor for
Mental Status:1. Restlessness2. Anxiety
1. Safety BSI2. Maintain open
airway
IMMEDIATE
s/sx of shock through focused Hx and PE
Establish VS
Mental Status
Peripheral perfusion
3. Altered LOC
Peripheral Perfusion and skin perfusion1. Pale, cool, clammy skin2. Weak, thread, or absent
peripheral pulses3. Delayed capillary refill in ambient
air temp.
VS1. Increased Pulse rate2. Increased RR deep, shallow,
labored, irregular3. Decreased BP(LATE)
Other:1. Dilated pupils (sluggish)2. Marked thirst3. Nausea and vomiting4. Pallor and cyanosis to the lips
R heart failure – Pulmonary edemaL heart failure – Pedal edema
3. Control any external bleeding
4. Elevate lower extremities approx. 8 to 12 inches
5. Splint suspected injuries
6. Use blanket to warm patient
7. IMMEDIATE TRANSPORT
ADVANCED CARE1. Fluid
replacement LR/NSS warm
1.1. Large bore IV min. G16, G14 ideal
1.2. Use blood tubings
1.3. Apply pressure to bag to speed up infusion
2. Unless BT is available, titrate fluid infusion to the BP using radial pulse as guide. 250 initial until radial pulse is present then TKO
3. Head injury – min systolic 90 mmHg
Stages of Shock
Compensatory Shock – maintain perfusion Progressive Stage – normal compensatory will work
only for so long Irreversible Stage – cannot be reversed.
7 Stages of Cell Death
1. Normal Cell
2. Hypoxia > Ischemia > Anaerobic metabolism >lactic acid build up > met. Acidosis >sodium pump fails
3. Ion Shift – sodium rushes into the cell bringing water with it.
4. Cellular edema
5. Mitochondrial edema – cessation of ATP production.
6. Intracellular disruption – releases lysosomes (cell digesting enzymes) > cell membrane breakdowns.
7. Cell destruction lead to cell death.
The Four Stages of ShockClass I (Compensated)
Class II (Decompensated)
Class III (Decompensated)
Class IV (Irreversible)
15% 750 ml 30% 1,500 ml 40% 2000 ml >40% >2000 mlBody Response
Compensates for Blood loss
Constricts blood vessels in effort to maintain BP and deliver oxygen to ALL organs
Continued vasoconstriction to maintain perfusion but with some difficulty
Blood is shunted to vital organs
Decreased flow to intestines, kidneys, and skin.
Compensatory mechanism become overtaxed.
Vasoconstriction cannot maintain BP begins to fall.
Decreased CO and perfusion
Patient can still recover with prompt treatment.
Compensatory vasoconstriction become a complicating factor further impairing tissue perfusion and cell oxygenation.
Effect on Patient N LOC N VS 750 ml
enough to occupy a limb or a body cavity which could cause little discomfort, pain, swelling.
Decreased pulse pressure
Restlessness and confusion
Pale, cool, dry skin due to shunting
Diastolic pressure rise and fall. May stay the same on healthy patients
Pulse Pressure continues to narrow
Symphatetic response also causes rapid HR
Increased RR Delayed
capillary refill.
Confused, restless, anxious
Classic signs of shock appears
Cool clammy extremities
Lethargy, drowsy, stuporous
Sign of shock become more pronounced
Continued BP fall
Organ failure and death due to insufficient blood flow.
ANGINA ACUTE MIPain after exertion or stress Pain often related to stress or
exertionRelieved by Rest Not relievedUsually relieved by nitro (post 3 doses in 15 min assume MI)
Nitro may relieve pain
BP not affected Reduced BP. DiaphoresisShort term Pain may last 30 min to hour
CLASSIFICATION OF SHOCKCardiogenic Shock Heart in originHypovolemic Shock Severe Blood loss
Hemorrhagic ShockObstructive Shock Problem in the vascular system
Cardiac tamponade Tension Pneumo Pulmonary embolism
Distributive Shock Fluid or blood in the wrong place Spinal/ Vasogenic shock Septic Shock Anaphylactic Shock
NEUROLOGICAL EMERGENCIESCASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATIONTransient Ischemic Attack (TIA)
RECURRENT neurological deficits of any type that correspond to the disorientation of a particular cerebral artery and vertebra-basilar artery and last anywhere from a FEW SECOND to 12 HOURS.
Neurologic examination between attacks maybe ENTIRELY NORMAL
Some patients – onset of attack is clearly related to standing up after lying or sitting or it occurs on relation to exertion, emotional stress or bout of coughing.
1. Carotid System Blockage1.1. Hemiparesis / Hemiplegia1.2. Unilateral Numbness1.3. Aphasia1.4. Confusion, coma1.5. Convulsion1.6. Incontinence, sometimes1.7. Numbness of face1.8. Slurred speech1.9. Dysphagia1.10.Posterior headache1.11.Dizziness or Vertigo
SEIZURE DISORDERSTonic Clonic (Grand Mal)
Tonic phase– the body becomes rigid stiffening for no more than 30 sec. Breathing may stop. Patient may bite his tongue. Incontinence may result.
Clonic phase – body jerks about violently, usually for more than 1 – 2 minutes. Patient may foam at the mouth
Types of Seizures:1. Simple partial seizure – (focal
motor, focal sensory or Jacksonian) – tingling, stiffening or jerking in just one part of the body. Aura may present (bright lights, crust of colors, or a rising sensation in the stomach)
2. Complex partial seizure (psychomotor) –abnormal behavior that varies. May involve confusion, glassy stare, lip smacking or chewing, aimless
1. Protect the patient from injury
2. Guard airway but NPO
3. DO NOT restrain patient. Remove objects and gently guide away from danger.
4. Loosen obstructive clothing.
and drools. Face and lips may become cyanotic
Postictal phase – regains consciousness immediately and enter a stage of drowsiness and confusion or he may remain unconscious.
moving about or fidgeting with clothing.
5. Take vital signs and monitor respirations closely.
Causes of seizure:1. Febrile2. Idiopathic3. Brain tumor4. Congenital brain
deficits5. Metabolic6. Infection7. Toxic8. Trauma
Absence (Petit mal) Seizure is brief usualy only 1 – 10 sec. There is no dramatic motor activity. Person does not slump on face. Goes unnoticed by everyone except by the person and knowledgeable members of the family.
Same as grand mal
Stroke (Cerebrovascular Accident/ CVA)
Sudden onset of focal neurological deficit caused by a non-traumatic brain injury resulting in occlusion or rupture of the cerebral blood vessel.
Classification:1. Transient Ischemic Attack2. Reversible Ischemic Neurologic
Deficit3. Stroke in Evolution/Completed
Stroke
3 Types of Cerebral Edema1. Cytotoxic2. Vasogenic3. Interstitial
If Brain Edema suspected:1. Modest Fluid
restriction2. Elevation of head
of bed (20 – 30 degree)
3. O2 and Ventilation support
4. Control of agitation and pain.
Ischemic Stroke Blockage in arteries supplying oxygenated blood will result in damage to affected parts
Pathological Process (applicable on ischemic and hemorrhagic):1. Intrinsic blood vessel pathology
(atherosclerosis, lipohyalinosis,
Conscious:1. Ensure an open
airway2. Keep patient calm
LOAD AND GOWindow period 3 hours but the
faster the
of the brain. inflammation, amyloid deposition, arterial dissection, developmental malformation, aneurismal dilation and /or venous thrombosis.)
2. Lodging of embolus in intracranial vessel from a remote part such as heart or extracranial circulation
3. Decreased perfusion pressure or increased blood viscosity with inadequate cerebral blood flow.
4. Vessel rupture in subarachnoid space or intracerebral tissue.
S/Sx:1. Confusion2. Hemiparesis3. Hemiplegia4. Impaired speech5. Facial flaccidness and loss
expression6. Headache7. Unequal pupil size8. Impaired vision9. Cushing’s Triad
9.1. Hypertension9.2. Irregular RR9.3. Slow pulse
10. Convulsions11. Coma12. Incontinence13. Inappropriate behavior14. Stiffed neck15. Staggering gate
3. Maintain eye contact and speak SLOW and CLEARLY.
4. High O25. Monitor VS6. Semi reclined post7. NPO8. Keep warm9. Sit in front of
patient.
Unconscious:1. Maintain open
airway2. High O23. Ventilation if
needed4. Monitor VS5. Lateral recumbent
post.6. Protective
padding
better.
Hemorrhagic Stroke An aneurysm or other weakened are of an artery ruptures.Often associated with arteriosclerosis and hypertensionTwo effects:1. An area of the brain
is deprived of oxygenated blood
2. Pooling blood push increased ICP on the brain, displacing tissue and interfering with function.
Altered Mental Status Causes:A – Alcohol and other drugsE – pilepsy, Endocrine/ExocrineI – insulin, hypo/hyperO – oxygen, overdose and opiatesU – Uremia
T – trauma and tempI – infection (Sepsis or Meningitis)P – poisons and psychiatric
1. Secure airway and control respiration1.1. O2 – guided
by SpO21.2. Ventilation –
guided by ETCO2
2. Protective reflexes (+/-)
3. Immobilize spine unless absolutely certain injury not suspected
4. Monitor Neuro VS q 5min
S – shock, stroke or space occupying lesion.
5. Protect patient eyes on long transpo
6. Treat and reassure accordingly
7 D’s of Stroke Management:
1. Detection – recognition of the s/sx of stroke or TIA and activate EMS.
2. Dispatch – EMS dispatcher must prioritize the call same as an AMI.3. Delivery – transport to stroke center.4. Door – hospital that can provide fibrinolytic therapy within 1 hour
after arrival.5. Data – hospital obtaining CT scan.6. Decision – identifying eligible patient for fybrinolytic therapy.7. Drug – treating with fibrinolytic therapy.
Right Hemisphere Lesion Left Hemisphere LesionImpaired Visuomotor perception
Unable to communicate properly
Visual Memory
X: Loss of visual memory OK: Positive visuomotor retention and memory
Lack of insight and judgment BUT NOT OBVIOUS because of intact verbal fluency
Positive visuomotor retention and memory
Comprehension
OK: No deficit understand and express
X: Aphasia
Proprioception
X: Inability to assess position in space and safely interact with the environment
OK: Unimpaired
Verbal Memory
OK: Intact. Perceptual memory impaired
X: Impaired ability to retain verbal information; remote memory impaired
Carelessness and Impulsiveness
YES: Careless. Obvious mistakes. Impulsive with decreased ability to anticipate consequence of behavior.
NO?: Usually impaired.
Emotion and Affect
X: Inappropriate emotion and affect
OK: Appropriate
DIABETIC EMERGENCIES normal glucose 60 to 120 mg/dLCASE ASSESSMENT CAUSES SIGNS AND SYMPTOMS MANAGEMENT CAUSE OF
DEATHHyperglycemia Have you
taken your meals?
Have you taken your insulin?
Have you vomited your meals?
Have you done strenuous activities?
Condition has not been diagnosed or treated
Has not taken insulin Over eaten – flooding
the body with excess carbs
Diabetic suffers an infection that disrupts his glucose/insulin balance
1. Gradual onset in days2. Dry mouth, intense thirst3. Abd. Pain and vomiting common4. Gradually increasing restlessness,
confusion followed by stupor and coma
5. Weak, rapid pulse6. Air hunger – deep sighing
respirations (Kaussmal’s breathing)
7. Acetone breath (child)8. Warm, red, dry skin9. Normal or slightly elevated BP10. Sunken eyes11. No hostile or aggressive behavior
1. O2 via NRM2. Transport to
medical facility
3. Arrange for ALS intercept.
However, all management to DM emeregencies towards hypoglycemia.
1. Dehydration and poor nutrition
2. Hypokalemia3. Hypoinsuline
mia4. DKA (Diabetic
Ketoacidosis) – ketones in urine > acidosis >compensates by Kaussmal’s breathing to decrease acidosis > Diabetic COMA
Hypoglycemia Taken too much insulin Not eaten enough to
provide N sugar intake Over exercised/ exerted Vomited
1. Rapid onset in minutes.2. Copious saliva, drooling3. Patient intensely hungry.4. Dizziness and headache, sudden
fainting, seizures and occasionally coma
5. Full rapid pulse6. Normal respiration , no odor7. Cold, clammy, pale skin.8. N BP9. N eyes10. Hostile/aggressive behavior.
1. Granular Sugar under tongue.
1.1. Conscious: any sweet solid or liquid
1.2. Unconscious:
1.2.1. Avoid giving liquid
Hyperinsulinemia - Insulin Shock.
1.2.2. Turn head to side or place in lateral recumbent.
2. Provide High O2
3. Transport to medical facility
4. Arrange ALS intercept.
ACUTE ABDOMINAL EMERGENCIESCASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATION All adults with
abdominal pain always consider MI.o Heart problem
irritates the vagus nerve> affects gastric mucosa > producing excess HCl and abdominal pain.
Causes:o Ulcero Intestinal
Obstructiono Cholecystitiso Hernia
(emergency due to possibility of circulation obstruction)
o Abdominal Aortic Aneurysm
o Pancreatitis
Supine Knee chest
flexed Examine
last most painful part
N abd. Assess:
No pain, soft, non rigid, warm to touch, not distended
1. Pain/ tenderness2. Anxiety / fear3. Guarded position4. Rapid shallow breathing5. Rapid pulse6. Nausea vomiting or diarrhea7. Rigid or tense abdomen8. Internal bleeding
1. Safety and BSI
2. CAB3. Keep airway
patient – be alert for vomiting
4. Place pt. to position of comfort
5. NPO6. Calm and
reassure pt.7. Be alert for
shock8. Transport
efficiently
Efficient Transport
o AppendicitisUrinary Colic Nephrolitiasis – formation
of stone in the kidney (or anywhere in the urinary tract but calculi begin to form in kidney). Stone size may vary in size.
Renal calculi classification Calcium Phosphate –
65% Calcium Oxalate Magnesium
Ammonium Phosphate (stravite) –
15% Uric Acid – 10% Cystine Stone – 10%
Factors promoting to Stone Formation:
Supersaturation of Urine – stone formation due to crystalloid
Presence of Nidus – a must. Nidus or nuclei which layer can be deposited
Stasis – further promotion of stone formation
pH or solution
Pain – intensity depends upon the size of the calculi.
Renal colic – a group of symptoms associated with movement of a calculus through the narrow anatomical points in the ureter causing obstruction of urine.o Severe costovertebral angle
pain radiates throughout the flank area and groin due to the muscle spasm injured by the stretching and obstruction of the ureter by the calculus
1. If alert, advise to increase fluid intake to over 4000 ml/24 hour.
2. Administer analgesic/antispasmodic according to local protocol
3. Keep on bed rest (with Entonox)
4. Transport to hosp for further management.
Transport efficiently
OBSTETRICS - GYNECOLOGICAL EMERGENCIESCASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATIONCommon Gynecological EmergenciesEctopic Pregnancy Development of a fetus
outside the wombCauses:
Past ectopic pregnancy
Past salpingitis Surgery of the
fallopian tube
1. Ammenorhea2. Pain in the L/R iliac region3. Abnormal vaginal bleeding4. Low back pain5. Breast tenderness6. Nausea
1. Ensure open airway
2. O2 as required
3. NPO4. Vomiting
precaution (positioning)
5. Monitor VS6. Shock
precaution
ALL LOAD AND GO
Rupture of Ovarian Cyst
Formation of mass in the ovary with idiopathic cause.
1. Sharp, piercing pain in the lower abdominal quadrant.
2. Fever3. Nausea4. Vomiting5. Weakness, dizziness or fainting6. Signs of internal bleeding
Pelvic Inflammatory Disease (PID)
Infection from the vagina making the pelvis inflamed.Causes:
Sexually – transmitted disease
1. Fever2. Profuse discharge from the
vagina3. Malaise4. Lower abd pain5. Difficulty passing urine6. Irregular vaginal bleeding
Dysfunctional Uterine Bleeding (DUB)
Bleeding from the uterus that is not due to menstrual period
1. Increase PR >20 bpm when pt. sits from supine position. > blood loss of
Cause: Estrogen imbalance Menopause syndrome Female of advanced
age
more than 1 unit.2. Abnormal vaginal bleeding3. Abnormal spotting4. Metrorrhagia – bleeding in b/t
period5. Menorrhagia – excessive
bleeding6. Bleeding after menopause7. Bleeding unrelated to periods8. Bleeding in young girls
Other : Rape Maximum tact and sensitivity
Female EMT should be present
EMT must take care of urgent med. Problems
Preserve evidence
Protect patient’s privacy
Document
1. Ensure open airway
2. O2 as required
3. NPO4. Vomiting
precaution (positioning)
5. Monitor VS6. Shock
precaution
OBSTETRICS
o 3 weeks – zygote/ fertilized ovum
o 3-8 weeks – embryo
o 9-38 weeks – fetus
o Birth to 28 days – neonate
o 29 days to 1 yo – infant
o 1 yo to 12 yo – child
o UTZ – most reliable dx tool
Important elements of Assessment:1. Age of
patient2. LMP3. AOG4. Gravida5. Parity
Criterias:1. Due date2. Contraction
? Frequency and Duration?
3. Increase Spressure in vagina?
4. Urge to push?
5. Crowning?
Mech. Of Delivery:Engagement > Descent > Flexion > Internal Rotation > Extension > Expulsion
Equipments:1. Gloves2. Drawsheet3. Suction Bulb4. Towels5. Gauze6. Scalpel7. Umbilical clamp8. Cotton with alcohol
Premature (<38 weeks/ <2500 kg) – TRANSPORT to ER for incubator
500 ml – normal bleeding during deliveryCord Cutting – 10 incles away
Sx of imminent delivery:1. Urgeto push2. Presence of crowning3. Increase pressure in the vagina
Labor and Delivery1. Safety BSI2. Lie knee flexed drawn up wide
separated, semi-fowlers3. Create sterile field around vag.
Opening with sterile towels4. Crowning – place gentle pressure
on perineum5. Once delivered, support the head
as it rotates and wipe neonate’s mouth and nose > suction mouth and nose
6. Guide head down to deliver 1st shoulder, then up to deliver the 2nd shoulder > support the baby
7. Grasp the feet firmly with one hand
Imminent delivery:1. Do not allow
to use toilet2. Consult MD
concerning decision to deliver baby at the scene.
3. Do not clamp/cut cord if the baby is not breathing on its own.
If within 5 minutes woman will deliver the baby, do not load and go. If inside the ambu,stop and deliver the baby.
General Steps in NSD1. Prepare
mother for delivery
2. Assist3. Initial care of
the newborn
6. Broken bag of water?
from umbilicus 8. Clean out the baby’s mouth with gauze. Suction. The baby should start to cry. If not, ABC of resuscitation.
Intervention for non breathing baby
1. Rub the back2. Snap fingers at soles of the
feet3. ABC4. If with spontaneous breathing,
let neonate breath room air5. If APGAR is low (4-7) give O2
via blowbyCOMPLICATION ONFIRST TRIMESTERAbortion Termination of pregnancy
before 28 weeks
1. Threatened2. Closed cervix
a. Mild pain (back pain, lower abd.)
b. Mild vaginal spotting3. Inevitable – cannot
preserve pregnancya. With placental/fetal
fragments came outb. Severe back painc. Moderate, obvious
bleedingd. Shock
4. Incomplete – placental/fetal fragments expelled
5. Complete – abortus/fetus expelled out with bleeding
6. Criminal7. Therapeutic
Pre – Eclampsia Hypertension. BP of more than 130/80.Comlications:
Eclampsia Abrutio Placenta Cerebral retinal
damage Pulmonary edema
1. Transport2. FHT
monitoring3. CAB4. Prevent
stimulus5. O2 per SpO26. Therapeutic
Environment
LIGHTS ONLY
Eclampsia Neurological
Supine Hypotension Compression of the Vena Cava due to pregnancy.
Left Lateral Position
H-mole No fetus but with signs of pregnancy
Incompetent Cervix 1. Complete bed rest
2. Constant OB supervision
3. Cervical Cerclage
Hyperemesis Gravidum Excessive vomiting during pregnancy
1. Crackers on bed side
2. Small frequent feeding
3. Ensure nutrition
4. Maintain hydration
3RD TRI/ANTENATAL COMPLICATIONSAbruptio Placenta Premature separation of the
placenta before labor and delivery
1. Mild to moderate vaginal bleeding
2. Sx of shock3. Continous knife like pain in the
abdomen4. Rigid tender uterus
Transport for Emergency CS
IMMEDIATE
Placenta Previa Implantation of the placenta over the cervical opening
Painless bright red vaginal bleeding. 1. Transport immediately
2. Shock precaution
3. Do not IEUterine Rupture Common to G3 above
Due to Blunt Trauma. Repeated stretching of
the uterine wall Old CS Prolonged labor against
o Obstructiono Weakened uterine
wall
1. Tearing abdominal pain2. Severe hypovolemic shock3. Firm rigid abd.4. Vaginal bleeding
1. CAB2. Transport
COMPLICATIONS OF LABOR and DELIVERYProlapsed Cord For emergency CS
Cord compressed No pulsation of the umbilical cord 1. Position
mother to IMMEDIATE
between the neonate’s head and birth canal
knee chest position
2. Push the neonate’s head to relieve compression to cord
3. Wrap cord with moist sterile gauze to prevent damage
Cord coil/ Cord loop 1. Upon delivery of head look for the cord if looped around the neck
2. Gently slip if possible
3. If not, clamp the cord and cut (protocol)
Meconium Staining Common in pre term and post term
Lack of O2 > Spasm of the large intestines > meconium staining > greenish discoloration of the amniotic fluid
Complication:o Neonatal Sepsis –
meconium aspiration
o Neonatal respiratory distress – neonate may not be able to clear lungs.
Sign of fetal distress1. No FHR2. FHR < 1203. Mother do not feel baby
moving
Amniotic Fluid Leak Difficulty of fetus to come out
Infection Trauma Complication to mother
o Leak to pelvis >Amniotic fluid enter circulation > Pulmonary Embolism
NEONATAL CARE
Cardio respiratory changes that occur in birth:o To get rid of the
fluid filling the lungs so that it can expand
o Closing of the foramen ovale and ductus arteriosus
Routine care:1. Warming2. Airway3. Position4. Cord
cutting5. Prevention
of meconium aspiration
Risk factor for shock and hypotension
1. Low birth weight2. Maternal sepsis3. Prolapsed cord4. Acute onset of
maternal vaginal bleeding
N neonatal vital signsRR 30 – 50 cpmPR 120 – 160 bpmBP >60 mmHg
HR < 60 – CPR >100 – breath on room air 60 – 100 ventilate (full 5 Lpm;
premature 3 Lpm)
APGAR8 – 10 mild distress4 – 7 moderate1 – 3 severe
Medical Unconscious or decreasing level of
consciousness Dilated pupil GCS <10 Pediatric trauma score <8 Persistent Fever Increase effort in breathing
Trauma Fall from a height of 20 ft Involved in an accident with
fatalities Ejected in a car accident Struck by a car.
NEONATAL SEIZURES
Causes:1. Hypoxic – Ischemic
Encephalopathy2. Metabolic Disturbance3. Meningitis or
Encephalitis4. Developmental
abnormalities5. Drug withdrawal6. Maternal anesthesia7. Stroke
Types:1. Subtle – Head part – ocular, facial,
oral or ligual movements and respiratory manifestation such as apnea or stutortorous breathing
2. Tonic – pre-term infant: seizure appear decerebrate or decorticate posturing
3. Multifocal clonic – term infants: noted in one limb and migrate to another part of the body.
4. Focal clonic – term infants: localize and are accompanied by short activity of EEG.
5. Myoclonic –premature and term
infants: single multiple jerk and flexion of the upper and lower extremities
Stage Hallmark Signs Duration for Primi Duration for Multi1st True labor to full cervical dilation 12 to 16 hours 30 min2nd Full cervical dilatation to birth of neonate 30 min Matter of minutes3rd Birth of neonate to placental delivery Within 20 min Within 20 min
APGAR SCORING
SIGN 0 1 2Appearance Bluish or pale Pink trunk, blue
extremityPink
Pulse Absent <100 bpm >100 bpmGrimace No Response Some motion,
grimaceCry, cough, sneeze
Activity Limp Some flexion, extremeties
Active, good motion
Respiration Absent Slow and irregular
Normal, crying
Insert Neonatal Circulation and Neonatal Resuscitation
BURN EMERGENCIESCASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATIONType of burns
1. Chemical2. Radiation3. Electrical4. Thermal5. Scald6. Contact7. Flash
Factors to consider in evaluating burns1. Agent of burn2. Depth3. Severity (BSA)a. Rule of ninesb. Palm rule
4. Age – under 5 and over 55 (adult’s
Thermal Burn:1. Emergent Phase –
response to pain > catecholamine release.
2. Fluid shift – massive shift from intracellular to extracellular fluid
3. Hypermetabolic phase – increase demands for
Special Considerations:Pedia:1. Thin skin2. Large surface volume
2.1. Rapid fluid loss2.2. Increased heat loss
3. Dehydration vs. Overhydration4. Immature Immunological response
Treatment of burn wound1. Low priority
after CAB and IV
2. Do not rupture blisters.
3. Dry Sterile
False Labor True LaborContractions Irregular RegularPain radiation Abdomen Lower back then
abdomenPain alleviation Alleviated by
ambulationNot alleviated
Frequency, Duration, Intensity
No increase Increasing
Cervical Dilatation No dilatation With dilatation
reaction to burn injury increases after age 35)
a. Infants and children are at higher risk due to more body surface area
i. Hypovolemic shock
ii. Airway problemiii. Hypothermia
5. Other illnesses and injuries
nutrients4. Resolution phase –
scar tissue and remodeling of tissue
Complications:1. Hypovolemia leading to
shock - Leading2. Infection3. Renal/hepatic failure4. Formation of eschar5. Complication of
circumferential burn (tourniquet effect)
6. Increase catecholamine release, vasoconstriction
7. Inability to maintain body temperature
Eschar formation:1. Skin denaturing2. Skin constricts over
wound3. Respiratory compromise4. Circulatory compromise
Jackson’s Burn Theory1. Zone of Coagulation2. Zone of Stasis3. Zone of Hyperemia
Geria:1. Decreased Myocardial reserve2. Fluid resuscitation difficult3. Peripheral vascular disease4. COPD5. Decreased immune response6. % mortality = age + % of BSA
affected
Dressings4. Cover with burn
sheet
4 Phases of burn management1. Emergent
Phase – time of injury to structural
2. Resuscitation Phase – admin of IV fluids, return of capillary membrane to N level
2.1. Parkland formula: 4 mL/kg * total BSA
2.2. 1st half in first 8 hrs
2.3. 2nd half in next 16 hrs.
3. Acute Phase – hemodynamically stable
4. Rehabilitation Phase
Thermal Rapid PE1. Check for other
injuries2. Rapid estimate
burned wound3. Remove restricting
band
Hx:1. How long ago?2. What has been done?3. What cause?4. Close space?5. LOC?6. Allergies/meds?7. Past med Hx?
1. Remove patient from the scene
2. Stop burning process
3. Ensure open airway, assess breathing
4. Look for signs of airway injury, soot deposits, burnt nasal hair, facial burns
5. Complete the intial assessment.
6. Treat for shock. High O2 (per SpO2). Treat
IMMEDIATELY
serious injuries.7. Evaluate burns
by depth, extent and severity.
8. Do not clear debris
9. Wrap with dry sterile dressing.
10. Burns of hands or feet – remove rings and jewelry that may constrict with swelling. Separate fingers or toes with gauze pads.
11. Burns to eyes – do not open eyelids if burned.
11.1.Be certain burn is thermal, not chemical.
11.2.Apply sterile gauze pads to both eyes to immobilize.
11.3. If burn is chemical, flush eyes for a minimum of 20 minutes.
12. Shock precaution (if there’s other injuries)
Others:1. Analgesic –
Morphine Sulfate
1.1. 2-3 mg q 10 min titrated to
adequate ventilation and BP
1.2. 0.1 mg/kg for pedia
1.3. May require large but tolerable doses.
2. Avoid topical agent except per protocol (Silvadine)
3. Fluid Therapy3.1. Objective:3.2. HR < 110
bpm3.3. Urine output:
30 – 50 cc per hour or 0.5-1 cc/kg/hr for pedia
Chemical Insert chemical burn handout
Generally get chemical contaminated object off the body and flush with LR/NS except if chemical reacts with water.
Inhalation Problems:1. Hypoxia2. CO toxicity
2.1. SpO2 could be meaningless
3. Upper airway injury3.1. May result to edema
of pharynx and larynx4. Lower airway injury
4.1. Rare, involves lung parenchyma, Transport
Anticipate respiratory problems1. Head, Face, Neck or Chest burns2. Nasal/ eyebrow hairs signed3. Hoarsness, tachypnea4. Coughing - Black sputum
Airway, O2, Ventilation:1. Bronchodilators
needed?2. Diuretics are
not appropriate
Circulation:1. Treat for Shock
(rare)2. IV access2.1. LR/NS large
bore multiple IV’s
2.2. Titrate fluids to maintain systolic BP
Others:Treat burns and injuries
Electrical Ohm’s law – 1 = V/RLow voltage – 500 – 1000VHigh voltage 1000V up (Lightning)
Severity depends on1. Tissue2. With or extent of current3. AC/DC4. Duration of current
contact
AC current:1. Tetanic Muscle Contraction
1.1. Muscle injury1.2. Tendon rupture1.3. Joint distraction1.4. Fractures
2. Cardiac arrhythmias3. Apnea4. Seizure5. Contact burn/Flash burn6. Flame burn
1. TRANSPORT2. Make sure
current is off3. CAB4. Rhabdomyolysis
– breakdown of muscle fiber that leads to release of myoglobin to bloodstream which is harmful to the kidneys.
Radiation Alpha – large Beta – small Gamma – most
dangerous
Burn severityDepth Minor Moderate CriticalSuperficial < 50% >15% All complicated by
injury of soft tissue
Burn Depth Characteristics1st Degree 2nd Degree 3rd Degree
Cause Sun or minor flash
Hot liquids, flashes or flame
Chemicals, electricity, flame, hot metals
Skin Color
Red Mottled red, moist and shiny
Pearly white and or charred translucent and parchmentlike
Skin Surfaces
Dry (-) blisters
(+) blisters with weeping
Dry with thrombosed blood vessels
Sensation
Painful Painful Anesthetic
Healing 3-6 days 2 – 4 weeks depending on depth
Requires skin grafting
and bonesPartial Thickness <15% 15 – 30% >30%Full Thickness <2% except for
face, genitalia, hands and feet
2 – 10% >10% Partial full thickness on hands, genitalia, circumferential burn.
Insert Rule of Nines for Adult, Child and Pedia
POISONING EMERGENCIESCASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATIONPoisons could be:IngestedInhaledAbsorbedInjected
OdorLevel of ConsciousnessVital Signs
HxWhat?When?How much?What else was taken, if anything? Antidote?Vomited, if so how long after the ingestion?Why?OdorLevel of ConsciousnessVital Signs
HxWhat?When?How much?What else was taken, if anything?
Poison (toxin ) substance which, if taken into the body in sufficient quantity can cause temporary or permanent damage
Self poisoning and parasuicide – deliberate ingestion of more than the therapeutic dose of a drug or substance not intended for consumption usually by an adult in a moment of distress
Accidental poisoning – non intentional
3 Leading causes of Poisoning:
1. Alcoholic intoxication2. Methamphetamine3. Isoniazid toxicity
Organophosphate – agent most commonly associated with mortality.
1. Burns and strains around mouth
2. Unusual breath/body/ clothing/scene odor
3. AbN breathing4. AbN pulse rate5. Profuse sweating,
headache, dizziness6. Excessive salivation or
foaming at the mouth7. Pain in the mouth or throat8. Abdominal pain9. Abdominal tenderness
sometimes with distention10. Nausea, vomiting11. Seizures12. Altered mental status13. Signs of shock
General approach: Circulation Airway Breathing Drug induced CNS
depression Electrolytes and
metabolic abnormalities
Oxygen precautionso Watusio Paraquato Zinc phosphate
Activated Charcoal Absorbs many
poisonous compounds to its surface, thereby reducing their absorption by the body
Effective among:o Aspirino Amphetamineso Strychnineo Dilantin
Antidote?Vomited, if so how long after the ingestion?Why?
o Theophyllineo Phenobarbitals
Ineffective:o Methanolo Caustic acidso Alkaliso Iron tables and
lithium 1g/kg
Syrup of IPECAC Induces vomiting Contraindicationso Stupor/Comao Absent gag reflexo Seizureso Pregnancyo Acute MIo Children < 6 moo Ingestion of
corrosiveso Volatile
hydrocarbonso Strycnines or
iodides Dosageo Children 3-5 tsp
followed by a glass of water
o Adults 1-2 tsp followed by water
Ingested 1. Maintain open airway
2. Transport Immediately
3. Follow protocol of your EMS system
4. Keep patient on NPO
5. Position the conscious patient in semi recumbent position
6. Monitor vomiting
7. Save all vomits
and endorse to the hospital
Inhaled 1. Remove patient from inhaled poison. Avoid touching contaminated clothing.
2. Maintain open airway
3. Provide needed BLS measures and administer O2 (if not contrainidicated) NRM
Injected 1. Follow local protocol
2. Monitor patient and maintain open airway
3. Remove jewelry from affected limbs
4. Keep the limb immobilized
5. Transport immediately
Absorbed 1. Move the patient from the source of the poison while avoiding contact with the substance
2. Use water to immediately flood all the areas of the patient’s body that has been exposed to the poison
3. Monitor patient and transport immediately
Insert Table of S/Sx of common poisons.
COLD EMERGENCIESCASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATIONTemp Conversion:C = (F-32)*5/9F = C*5/9 +32
Keeping warm: Thermogenesis
o Conversion of food to energy in body cells
o Muscle activity, voluntary or involuntary
Heat absorption During cold conditions
o Constricting blood vessels at body surface to keep warm blood at the core
o Reducing sweatingo Erecting body hairs
to “trap: the warm air at the skin
Core Temp Internal temp of
normothermic humans Does not vary >1-2 º from
normal temp Esophageal and tymphanic
temp almost the same with pulmonary artery
May cause permanent disability or death
Hypothalamus – temp regulator center
Mechanism of Heat Loss1. Convection – heat loss
to surrounding air2. Conduction – heat loss
to nearby objects through physical contact
3. Radiation – Body heat is lost to nearby objects without direct contact
Losing body heat Heat maybe lost to
o Cool surrounding airo Cool objects in
contact with skin In hot conditions, the
body reacts to lose heato Blood vessels in or
near the skin dilate tin order to lose blood heat
o Sweat glands become active. Sweat evaporates in cooler air. Hairs are flat
o The rate and depth of breathing will increase
4. Evaporation – Body heat loss through perspiration
5. Respiration
Local Cold Injury1st degree frostbite (Frostnip)
General S/Sx1. Shivering2. Numbness3. Stiff, rigid posture4. Drowsiness or inability
to do even simplest activity
5. Rapid breathing and rapid pulse in early stages, Late stage: Slow pulse and breathing.
6. Decrease LOC7. Cool skin temp8. Loss of motor
coordination9. Joint, muscle stiffness
and rigidity.
Victim unaware unless he sees himself in the mirror and notices unusual pallor and the return of the warmth to frotnipped area
Redness and tingling sensation
1. Remove patient from site
2. Remove all of the patient’s clothing that is wet
3. During transport, rewarm the patient
4. Shock treatment5. Give warm fluid for
conscious and alert patient
6. Keep patient at rest.
2nd degree (Superficial Frost)
Skin is stiff but underlying tissue is soft
1. Waxy and white2. Numbness3. As thawing occurs
3.1. Area turned mottled blue
3.2. Stinging sensation
3.3. Edema and blister within a few hours
3rd Degree to 4th Degree (Deep Frostbite)
1. White , mottled blue or white hard cold
2. Tissue feels like block of wood
3. When thawed3.1. Soothing pain3.2. Burning3.3. Throbbing3.4. Aching3.5. Possible joint pains
1. If still frozen, leave it frozen
2. Pad the injured extremity to protect from further trauma
3. Do not massage4. Notify the
receiving facility so that they can
3.6. Gangrene within a few days requiring amputation of injured part
start preparing and re-warming both.
5. If the extremity is partially thawed, rewarm the injured area at 38 – 42 ºC
6. Once rewarming is comlete
6.1. Dry extremity very gently and apply it gently to thawed part
6.2. Take care not to rupture blisters.
6.3. Use soft sterile gauze or cotton to separate frostbiten fingers and toes
7. Transport the patient in supine position and elevate the injured extremity on soft pillow, well covered and protect from cold.
Hypothermia Prolonged exposure to cold outdoor especially in wet and windy conditions
Death from cold water immersion may be caused by hypothermia rather than drowning
1. Remove patient from cold environment
2. Remove any wet clothing and cover the patient with blanket
3. Handle the patient with extreme care. Avoid rough handling at all cost
4. Admin high flow O2 (warmed and humidified)
5. Do not allow the patient to eat or drink stimulants
6. Do not massage extremities
7. Check for a pulse for an extended period of 30 to 45 sec before initiating BLS
HEAT EMERGENCIESCASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATIONHeat Cramps Severe muscle cramps
(usually in the legs and abdomen)
1. Exhaustion2. Dizziness3. Periods of faintess
1. Move patient to a nearby cool place
2. Give the conscious patient fluids and electrolytes
3. Massage the cramped muscle to help ease the patient’s discomfort. Massaging with pressure will be more effective than light rubbing
4. Apply moist towels to the patient’s forehead and over cramped muscles
5. If cramps persists, or if more serious symptoms and signs develop, ready the patient and transport
Too hot Too coldBlood vessels
Vasodilation Vasoconstriction
Perspiration
Increase Decrease
Cardiac output
Increase Decrease
Respiratory Rate
Increase Decrease
Heat production
Decrease Decrease
Progression of HypothermiaBody Temperature Symptoms37 – 35.5 ºC Shivering35.5 – 32.7 ºC 1. Decreased shivering replaced
by strong muscular rigidity2. Less clear thinking3. General comprehension is
dull4. Possible total amnesia
29.4 – 27.7 ºC 1. Irrational2. Loses contact with envi and
drifts into stuporous state3. Slow pulse and respiration4. Possible cardiac
dysrhythmias26.6 – 20.5 ºC Unconscious without reflexes
Stages of Hypothermia (ILCOR 2005)ºC ºF
Mild 36 – 34 ºC 96.8 – 93.2 ºFModerate
34 – 30 ºC 86 ºF
Severe < 30 ºC <86 ºF
Heat Exhaustion Volume and electrolytes lost through perspiration and is not replaced > dehydration > hypovolemia > decrease brain perfusion
1. Rapid, shallow RR2. Weak pulse3. Cold, clammy skin4. Heavy perspiration5. Total body weakness6. Dizziness7. Possible
unconsciousness
1. Move to cool place2. Keep @ rest3. Remove enough
clothing to cool the patient without chilling him (watch for shivering)
4. Fan the patient’s skin5. Give the conscious
patient fluids with electrolytes.
6. Do not try to administer fluids to an unconscious patient
7. Treat for shock but do not cover to the point of overheating patient
8. Provide high conc. O29. If unconscious, fails to
recover rapidly, has other injuries, or has a hx of medical problems, transport as soon as possible
Heat Stroke 1. Deep breaths and shallow breathing
2. Rapid, strong pulse, then rapid weak pulse.
3. Dry hot skin4. Dilated pupils5. Loss of consciousness
(possible coma)6. Seizures or muscular
twitching may be seen
1. Cool the patient – in any manner – rapidly. Remove from heat source.
2. Remove patient’s clothing and wrap him in wet towels and sheets. Pour cool water over these wrappings. Body heat must be lowered rapidly or brain cells will die.
3. Treat for shock and administer high conc. O2.
4. If cold packs or ice bags are available,wrap and place one under each
4.1. Armpit4.2. Knee4.3. Groin4.4. Wrist and ankle4.5. Each side on
patient’s neck5. Immediate transport6. Delayed transport: Find
a tub or container. Immerse patient up to the face in cooled water. Constantly monitor to prevent drowning
7. Monitor vital signs throughout process
Condition Muscle Cramps
Weakness
Breathing Pulse Skin Perspiration
Loss of Consciousness
Heat Cramps Varies Varies Moist-warm
Heavy Seldom
Heat Exhaustion Rapid shallow Weak Cold
clammyHeavy Sometimes
Heat Stroke Deep, then shallow
Full Rapid Dry-hot Little or none
Often
INSECT BITES & STINGS EMERGENCIESCASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATIONTypical sources of infected poisons or toxins (insect, spider & scorpion)
Gather information from the patient, bystanders, at the scene.
Find out whatever you can about the insect or
1. Noticeable bites and stings on the skin
2. Blotchy skin3. Localized pain or itching4. Numbness5. Muscle cramps, chest
tightening & joing pains6. Burning sensation7. Difficulty of brerathing and
abnormal pulse rate8. Excessive saliva formation,
profuse sweating9. Weakness/ collapse
1. CAB – treat for shock
2. Follow insect bites and sting protocol in your local EMS
3. Remove jewelry from affected limb
4. Immobilized the affected part, if allowed by your protocol, apply cold compress
5. Transport in semi-
other possible source of the poisoning
10. Headaches/Dizziness11. Chills and fever12. Nausea and vomiting13. Redness14. Swelling or blistering15. Anaphylaxis
sitting position for conscious patient and recovery position for unconscious patient
Snake bites 1. Bite on the skin2. Discoloration, pain, swelling, at
area. Slow to develop from 30 min to hours
3. Rapid pulse and labored breathing
4. Progressive general weakness5. Blurring of vision6. Nausea and vomiting7. Seizures8. Drowsiness of unconsciousness
1. Locate the fang marks and clean the site with soap and water
2. Remove any jewelry from the bitten extremity
3. Keep the bitten extremity immobilized
4. Apply light contracting band above the bitten part if allowed by local protocol
5. Transport and monitor the patient
Pit Viper Has pit in
maxillary bone Eliptical pupil Triangular head
Tissue Necrosis Minimal None Swelling Pain
Moderate Progressive swelling
1. Safety BSI2. Supine3. Open and maintain
airway4. Immobilize injured
limb and maintain it.
IMMEDIATE
Coral Snake “Red on yellow
kill a fellow; Red on black venom lack”
Thin Small rounded
1. Calm Victim2. O23. Proximal
constricting band (+/-)
4. Clean bandage wound
5. Immobilize bitten area
6. Watch constricting bands
7.Dog bites Very common street 1. Immediately and
emergency especially in rural areas
Areas of the body most commonly bitten: Head Neck Upper Extremities
PercentageFace – 11%Trunk – 7%Upper extremity – 28%Lower extremity – 31%
Children <12 yo are usually bitten on the face.
Most dog bites occur in hot weather when a person provokes a dog
thoroughly wash the wound with soap and water
2. Flush the wound with water and apply dressing
3. Transport the patient to the hospital for medical care especially if the wound needs stitching or occurred in the face or neck
4. Do not kill the dog unless it is absolutely necessary to prevent a full scale crippling attack.
5. If you kill the dog, call for an animal officer and request that the corpse be examined for rabies.
6. Immobilize injured part
7. Patient is usually frightened – calm him/her down.
Bee Sting (insert bee scientific name)
Local reactionBronchospasmHypotensionAnaphylaxis
1. Remove stinger by scraping with a plastic card or blunt edge of a knife
2. Manage airway3. O2 / Ventilation4. Shock position5. Epinephrine
5.1. Dilate airway5.2. Constrict Blood
vessels5.3. Ask for
medical direction
5.4. Dosage
5.4.1. Adult 0.3 mg yellow
5.4.2. Child 0.15 mg
SpidersBlack Widow (Larodectus mactans)
Neurotoxic 1. Muscle Spasms within 15 min to 2 hours
2. Bite of 1mm apart fang mark
1. Local cold application
2. Symptomatic care3. Immediate
transport
IMMEDIATE
Brown recluse (Loxosceles reclusa)
Fiddle-back spiders
6 eyes Violin markings
Hemolytic Anemia > Necrosis
1. Necrosis2. Hemoglobinuria3. Hypotension4. Possibility of death
Supportive care
Scorpion ( Centuroides sculpturatus)
1. Airway management
2. Look out for cardiac dysrrhytmias
Sting ray 1. CAB2. Flush with water3. Immerse in warm
waterJellyfish Hypotension Vinegar and hot
water1. Safety BSI2. LOC3. CAB4. O2/ ventilation5. Immerse wound
30-40 min as hot as can be tolerated, repeat as necessary to control pain without scalding
6. Transport
Scorpion/Lion/Stonefish
Stonefish being the most poisonous of them
Sea Urchins
WATER EMERGENCIESCASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATIONDrowning Active Step 1 Stages of water rescue: Stages of
Causes:Rip Currents
drowning: Conscious Thrashing Vertical in
H2O Unable to
call for help
Body maybe low in H2O
o Victim goes under, water enters the airway.
o Coughing and gasping – victim swallows water
Step 2o A small amount
enters the larynx and causes laryngospasm
o Breathing ceases and metabolic acidosis occurs. Dry drowning (10 – 15% of gases)
Step 3o Laryngeal muscles
became severely hypoxic and relax allowing air and water to enter the lungs. (Wet drowning)
o Triggers peripheral airway resistance and constriction of the pulmonary vessels > Stiff Lung – lung ceases to be compliant.
Step 4o Victem’s
hypercarbic/hypoxic drive further stimulate inhalation of water which mixes with air and chemical resident in the lungs to form a froth.
o Brain damage and death follows
1. Yell2. Reach and pull3. Throw4. Tow5. Go
Fresh water drowning – not much problemSalt wather drowning – water has high osmolarity which attracts fluids which results to pulmonary edema
management of drowning1. Do not enter
unless trained in water rescue
2. Ensure open airway and attempt rescue breathing
3. Continue rescue breathing and remove from the water
4. Check pulse, if no pulse, start chest compression
5. Transport6. If given the
opportunity – positive pressure ventilation using PEEP to dry the lungs.
Diving Emergencies Boyle’s lawo As pressure
What to find out about a diving emergency
increase, volume decreases
o As pressure decreases, volume increases
Dalton’s lawo P1= P(O2) + P(N2)
+ P(X)o Total pressure of gas
mix is sum of partial pressure of it’s components
Henry’s lawo Pressure of a gas in
liquid is proportional to it’s pressure in the atmosphere
o 1 atm – 34 ft water
1. Type of diving and the Type of Equipment
2. Diving activity (photographing, fishing)
3. Number of dives made the past 72 hours with each has
4. Depth5. Bottom time6. Surface Interval7. Details of in-water decompression8. In-water recompression? (a no-no!)9. Dive complications, if any.10. Pre-dive and post-dive activity11. Onset of symptoms (when and
what came first)
Barotrauma – compression or expansion of gas actually in adjacent to body air spacesDescent
Ear Squeeze External Middle
Sinus Squeeze Lung Squeeze
Body air spaces attempts to equilibrate on the outside atmospheric pressure > blockage> barotrauma
Lung SqueezeBreath hold > 100 fsw > compression of volume > negative pressure of lungs > pulling of interstitial fluid and blood in shrunken air spaces
Lung squeeze is typically rare. For lung squeeze to occur, a breath-hold diver must descend to a depth which total lung volume is significantly compressed (100 feet)
Lung Squeeze Dyspnea Chest pain Cough Hemoptysis Pulmonary edema
Lung Squeeze1. No PPV or
PEEP2. 100% O2 NRM3. IV4. Keep patient
sitting up5. TRANSPORT to
hosp
AscentPOPS (Pulmonary Overpressure Syndrome)“Burst lung”
Could cause: Pneumothorax/Tension
Pneumothorax Pneumomediastinum Subcutaneous
emphysema Arterial Air Embolism
Pneumomediastinum/ Subcutaneous emphysemao Fullness of his throato Dysphagiao Dyspneao Substernal chest paino Subcutaneous air palpable
above clavicleso Crunching noise synch with
heart beat
Dysbaric Air Embolism -
Pneumomediastinum/ Subcutaneous emphysemao Bed rest and
oxygen therapy
POPSo 100% O2
NRMo Don’t give
PEEP to
Symptoms occurs within seconds or minutes after surfacing. Air bubbles coalesce into larger and larger bubbles as they travel through the veins >o Cornoray arteries > MIo oro Cerebral artery > just like
Stroke Pneumothorax/Tension
Pneumothoraxo Tracheal deviationo Unequal breath soundso Hyper – resonance on the
affected side
POPSo keep patient
quieto transport him
to hospital.o If in doubt of
AIR EMBOLISM > go to hyperbaric chamber facility
Decompression SicknessNarcosis (Narcs/Rapture of the deep)Not dangerous but can impair the diver’s judgment.
Accumulation of nitrogen in the tissues > increase pressure > increase amount of dissolved nitrogen in the tissues > anesthetic effect > martini effect
Ascend slowly to alleviate “martini” effect.
Type I DSDS of the skin Most common but least
reported1. Pruritis2. SQ emphysema3. Mottled rashes
1. Ensure Adequate Airway
2. Give 100% oxygen
3. Start an IV with LR and give as directed
4. Give steroids, preferably Methylprednisilone 125 mg IV
5. Do not use nitrous oxide for analgesia
6. Advise hospital that you will require a use of a hyperbaric chamber
DS of the joints (musculoskeletal)
1. Deep, dull aches in muscle/joints2. Movement worsen pain3. Fatige4. Inflating cuff will relieve pain
TYPE II DSDS of the CNS4-10 min rule
Brain involvement 1. Paresthesia2. Seizure3. Spinal cord involvement4. Paralysis
1. Ensure Adequate Airway
2. Give 100% oxygen
3. Start an IV with LR and give as directed
4. Give steroids, preferably Methylprednisilone 125 mg IV
5. Do not use nitrous oxide for analgesia
6. Advise hospital that you will require a use of a hyperbaric chamber
CHOKES 1. Chest pain2. Dry cough3. Dyspnea4. Pulmonary edema
Treatment of Suspected Air Embolism1. Ensure adequate airway, especially in the unconscious
patient – if licensed to do so, INTUBATE2. Admin. 100% O23. Transport in L Lateral recumbent with 10 degree head
down tilt4. If licensed – establish an IV lifeline with LR5. Monitor cardiac rhytm and be prepared to treat
dysrhythmias6. Have the following drugs ready for use Under Medical
Direction:6.1. Diazepam, 5mg for Seizures6.2. Dopamine infusion 10mg/kg/min for treatment of
Hypotension7. Notify medical command/ hospital to make arrange for
reception at a hyperbaric chamber facility
Treatment of Decompression Sickness
1. Ensure Adequate Airway2. Give 100% oxygen3. Start an IV with LR and give as directed4. Give steroids, preferably Methylprednisilone 125 mg
IV5. Do not use nitrous oxide for analgesia6. Advise hospital that you will require a use of a hyperbaric
chamber
WATER EMERGENCIESCASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATIONDrowning