Flashcards in Chapter 19, 20, and 32 Deck (195):
What is the reticular activating system?
series of neurologic circuits in the brain that control the functions of staying awake, paying attention and sleeping. oxygen, water, and glucose control normal consciousness
What is altered mental status?
usually the most common causes hypoxia. can lead to combativeness
What is the pancreas?
midline of upper abdomen producing insulin
What is glucose?
a form of sugar, the body’s basic source of energy
What is insulin?
a hormone produced by the pancreas or taken as a medication by many diabetics
What is diabetes mellitus?
also called “sugar diabetes” or just “diabeteres,” the condition brought about by decreased insulin production or the inability of the body cells to use insulin properly. the person with this condition is a diabetic
What is type 1 diabetes?
insulin- dependent diabetes when pancreatic cells fial to function properly and insulin is not secreted normally not having enough insulin in system to transfer circulating glucose into cells
What is type 2 diabetes?
non-insulin dependent diabetes when body cells fail to use insulin properly pancreas may be secreting enough but body is unable to use or move glucose out of blood and into cells.
What is hypoglycemia?
low blood sugar. rapid onset occurs when take too much insulin, reduces sugar intake by not eating, over exercising exerting and using up sugar faster than normal, vomits a meal, increases metabolic rate by sickness lead to sympathetic response: pale, sweaty skin, tachycardia, and rapid breathing can lead to unconsciousness, seizures, and permanent brain damage less than 60 mg/dL, 50 mg/dL unresponsive. regular to rapid/shallow respirations; skin pale, cool and clammy; AMS, combative, lethargic; weak, rapid pulse; normal to low BP; behavior may mimic stroke or intoxication; seizure, fainting or coma; blood glucose levels
What is hyperglycemia?
high blood sugar, decrease in insulin leaving sugar in bloodstream instead of cells occurs over months or weeks chronic thirst and hunger, warm red skin, breathe deep and rapid, abdominal pain, vomiting and increased urination with nausea causing dehydration and diabetic ketoacidosis. 140 mg/dL greater than 300 mg/dL dehydration and other medical symptoms. so give glucose. skin warm, pink and dry; AMS more progressive, drowsiness and lethargy; severe dehydration causing thirst and dark urine “polydipsia and urea; visual or sensory deficits; muscle weakness or pain, seizures; as blood glucose levels increase kussmaul respirations may develop; blood glucose levels > 300 mg/dL. need fluids before insulin, glucometer history must be able to speak and swallow can give oral glucose not going to be more detrimental to a hyperglycemia but will save life of hypoglycemia.
What is diabetic ketoacidosis?
a condition that occurs as the result of high blood sugar (hyperglycemia), characterized by dehydration, altered mental status, and shock fruity acetone odor on breath.
What are the diabetic medicines?
humulin, glucotrol, glucophage, and micronase
What are oral glucose?
patient has history of diabetes, altered mental status, away enough to swallow ingest whole tube or based on size. can give via intranasal via atomizer
What is altered mental status?
can be caused by hypoxia, sepsis, drug and alcohol use, brain injuries traumatic and medical, metabolic abnormalities, brain tumor, and infectious diseases meningitis.
What is sepsis?
infection usually UTI pneumonia and skin/wound infections, especially a severe, system wide response to infection causing systemic inflammation causing drop in pressure in cardiovascular system, hypovolemic shock leading to hypoperfusion of body tissues. microbes then release toxins harming cardiac output furthering shock state.
What is seizure?
sudden change in sensation, behavior, or movement. the most severe form of seizure produces violent muscle contractions called convulsions
What is partial seizure?
a seizure that affects only one part or one side of the brain may or may not lose consciousness. tingling, stiffening, or jerking in just one part of body; may be aura such as smell, bright lights, burst of colors, rising sensation in stomach may spread and develop into tonic-clonic seizure. complex partial seizure (psychomotor or temporal lobe- abnormal behavior varies from person to person involve confusion, glassy stare, aimless moving about, lip smacking or chewing, or fidgeting with clothing appearing drunk or on drugs not violent but may struggle or fight if restrained rarely screaming, running, disrobing, or showing great fear.
What is a generalized seizure?
a seizure that affects both sides of the brain and affects consciousness. absence seizure- brief usually less than 10 second no dramatic motor activity and person doesn’t slump or fall with temporary loss of concentration or awareness and may go unnoticed to everyone except person and knowledgeable members of family can have several hundred throughout the day
What is a tonic-clonic seizure?
a generalized seizure in which the patient loses consciousness and ahs jerking movements of paired muscle groups. tonic- body becomes rigid, stiffening for no more than 30 seconds breathing may stop and patient may bite his tongue (rare), and bowel and bladder control may be lost. clonic- body jerks about violently, no more than 1-2 minutes (can last 5) with patient possibly foaming at mouth and drool face and lips often becoming cyanotic
What is postical phase?
the period of time immediately following a tonic-clonic seizure in which the patient goes from full loss of consciousness to full mental status. when convulsions stop patient may regain consciousness immediately entering state of drowsiness and confusion may remain unconscious for several hours with headache. vary in length, and may become combative
What is an aura?
a sensation experienced by a seizure patient right before the seizure, which might be a smell, sound or general feeling
What is a seizure?
caused by pediatric (fever), hypoxia, stroke, traumatic brain injury, toxins, hypoglycemia, brain tumor, congenital brain defects, infection, metabolic, and idiopathic, and can be seen with epilepsy, measles, mumps and other childhood diseases, eclampsia, and heart stroke
What do you do when seizing?
place patient on floor and side if no spine injury, loosen restrictive clothing, remove objects that can harm, protect from injury but don’t hold them
What do you do after seizures are over?
protect airways, if blue ensure open airway providing artificial ventilations with supplemental oxygen, treat any injuries or rule out trauma may have to immobilize patient. if patient refuses make sure someone stays with them and doesn't drive
What is epilepsy?
a medical condition that causes seizures. multiple seizures from unknown cause, what was the person doing what did person do during and after seizure
What is status epilepticus?
a prolonged seizure or situation when a person suffers two or more convulsive seizures without regaining full consciousness or single seizure lasting more than 10 minutes when have give oxygen and call ALS
What is a stroke?
a condition of altered function caused when an artery in the brain is blocked or ruptured, disrupting the supply of oxygenated blood or causing bleeding into the brain. formerly called cerebrovascular accident (CVA). death or injury of brain tissue deprived of oxygen.
don't know that there is something wrong, transient ischemic same as stroke with all normal stroke type symptoms but usually resolve themselves within 24 hours and patients with pre-existing heart conditions. ischemic- thrombotic (originating at that point) ischemia block in cerebral arteries and enough pressure pushes it through, embolic (works its way from somewhere else) or hemorrhagic- bleed comes on suddenly and worst headache of their life
What is an ischemic stroke?
clot or embolism occludes an artery. hemorrhagic stroke- caused by bleeding into brain, from long-standing high blood pressure (hypertensions) occurring when weak area of artery (aneurysm) bulges out and eventually ruptures, forcing brain into smaller than usual space within skull. one-sided weakness (hemiparesis), patient may be unable to form words and be speaking incomprehensibly, patient trouble forming words using inappropriate phrasing or jumbled pattern of speech- expressive or receptive aphasia. less commonly headache- subarachnoid hemorrhage
What is a transient ischemic attack?
confused, weak on one side, and having difficulty speaking but appear fine or mini-stroke looks like stroke but unlike has complete resolution of symptoms without treatment within 24 hours. small clots temporarily blocking circulation to part of brain when breaks up patient resolves has a significant risk of having full-blown stroke
What is Cincinnati prehospital stroke scale?
assess for facial droop have patient to grimace or smile showing teeth, test control of facial muscles should be able to use both sides of face abnormal response is unequal movement or no movement at all, speech difficulties like slurred speech using wrong words or unable to speak, assess for arm drift asking them to close eyes and extend arms palms up for 10 seconds (usually are able to) stroke patient will have arm drift or palm rotation and affected side will drift downward or turn over. facial droop (patient shows teeth or smiles)- bystander said it's not normal looking. normal- both sides of face move equally. abnormal- one side of face does not move as well as other. bells palsy- neuromuscular affecting certain muscular junctions from viruses trauma or tumor and is self resolving
arm drift )patient closes eyes and extend both arms straight out for 10 seconds) normal- there is no drift at all or both arms drift the same. abnormal- one arm drifts/moves down compared to the other arm or one arm noticeably weaker than the other.
speech (score first attempts: patient repeats “sky is blue in boston” speech at all, order of words different, not saying right words. normal: patient says correct words with no slurring of words o first attempt. abnormal: patient slurs words, says wrong words or is unable to speak on first attempt
one of more sudden acute stroke symptoms: sudden numbness, weakness or paralysis of face, arm or leg on one side of body; sudden confusion, trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble walking, loss of balance or coordination; sudden severe headache with no known cause.
What are the signs of symptoms of stroke?
confusion, dizziness, numbness weakness or paralysis, loss of bowel and/or bladder control, impaired vision, high blood pressure, difficult respiration or snoring, nausea or vomiting, unequal pupils, headache, loss of vision in one eye, unconsciousness (uncommon) or can mimic signs of stroke or hypoglycemia analyzing blood glucose level
What are things that mimic strokes?
tumor or infection in brain, head injury, seizures, hypoglycemia, and bacterial or viral infections causing weakness or paralysis of facial nerves
What are the treatment of strokes?
transport to hospital that has CT scan, find out exact time of onset
What is syncope?
fainting with brief loss of consciousness with spontaneous recovery from a few second to a few minutes. will feel light-headed, dizzy, nausea, weakness, vision changes, sudden pallor (loss of normal skin color), or sweating, incontinence of bladder and/or bowel occurs during. can be caused by life threatening things ex. chest (palpitations, sensation of racing heart (tachycardia), slow heart rate (bradycardia, or headache)
What is dizziness?
means different things to different people, weakness such as sensation or loss of strength, vertigo, light-headedness. causes of dizziness such as hypoxia, hypoglycemia, and hypovolemia interfering with normal brain functions
What are cardiovascular causes causes of dizziness?
immediate consideration sign of acute myocardial infarction caused by alteration in heart’s ability to pump caused by electrical changes in heart resulting in abnormal heart rates; cardiac dysrhythmia where heart beats extremely fast with tachycardia leading to dizziness or syncope. when heart beats fast, ventricles don’t have time to fill before pump blood out. or bradycardia can also result in dizziness can be bad or from overactive carotid sinus fom
What are hypovolemic causes causes of dizziness?
low fluid volume, not enough blood for brain from dehydration, internal bleeding, and trauma such as bleeding. if women lower abdominal pain could be ectopic pregnancy and internal bleeding or aneurysm or gastrointestinal bleeding in older
What is metabolic causes of dizziness?
something wrong with brain structures around or near, middle ear inflammation from drugs, with stroke or seizure but if longer than a few minutes its not a syncope
What is the environmental/toxicological causes of dizziness?
alcohol or drugs central nervous depressants or panic attacks and anxiety changing breathing
What do you do to treat dizziness?
when did it start, how long did it last, what position were you in, similar episodes, on meds, signs or symptoms, nausea, vomiting (blood), black stools (digested blood), see or feel something. lay patient flat and untighten clothing around neck
What is poison?
any substance that can harm the body by altering cell structure or functions. can be corrosive or irritant, destroying skin or other tissues or entire system overstimulate nervous system causing vomiting and diarrhea preventing cells from carrying oxygen or interfere with biochemical processes
What are toxins?
a poisonous substance secreted by bacteria, plants, or animals. plants: mistletoe, holly berries, rubber plant
What is ingested poison?
poisons that are swallowed such as common household and industrial chemicals, medications, improperly prepared or stored foods, plant materials, petroleum products, and agricultural products made to control animals weeds, insects, and crops
What is an acetaminophen overdose?
loss of appetite, nausea, and vomiting causes irreparable liver damage with delayed and not very specific signs
What is inhaled poisons?
poisons that are breathed in. gases, vapors or sprays can be similar common household items acting as suffocating agent, such as carbon monoxide (car exhaust, wood-burning stoves, and furnaces), carbon dioxide (industrial sources) ammonia (household cleaners), chlorine (pool chemicals), insect sprays and gases from industrial solvents that are volatile. may have to use SCBA (self-contained breathing apparatus when chlorine gas, ammonia or moke), oxygen is very important
What is carbon monoxide poisoning?
most common inhaled poison, motor-vehicle exhaust and fire suppression from wood-burning stoves and charcoal for heating and indoor cooking in areas without adequate ventilation. malfunctioning oil, gas and coal-burning furnaces and stoves can be sources. symptoms: headache band around head, dizziness, breathing difficulty, nausea, cyanosis, and altered mental status with unconsciousness vague flu-like symptoms in enclosed area. give oxygen
What is smoke inhalation?
serious problem on fire scenes. indicate smoke inhalation: red watering eyes, injury to airway, difficulty breathing, coughing, breath with smoky smell, black residue in mouth or nose, black sputum when coughed, nose hairs singed. give oxygen no matter pulse oximetry reading.
smoke from burning materials can contain poisonous and toxic substances, including CO, amonia, chlorine, and cyanide. substances can irritate skina nd eyes, damage lungs, and progress to respiratory or cardiac arrest. signs and symptoms: difficulty breathing, coughing, “smoky” or checmical smell on breath, black (carbon) residue in mouth nose or sputum, signed nasal or facial hair
What are detergent suicides?
mixing easily obtained, release toxic hydrogen sulfide, pesticide and cleaner preventing oxygen from binding to iron by binding to them. mild exposure: coughing, eye irritation, sore throat, with more sever: dizziness, nausea, shortness of breath, headache, and vomiting. severe cases: fluid collect in lungs, resulting in death. beware of small, enclosed spaces with tape sealing windows and doors. method of suicide in japan and Us.two easily obtained chemcials release toxic hydorgen sulfide gas inside enclosed space. can be absorbed through skin damaging it, may need to decontaminate before treatment. remove powder, irrigate with clean water for at least 20 minutes during transport
What are absorbed poisons?
poisons that are taken into the body through unbroken skin can damage skin, corrosive or irritants injuring it and slowly absorbing into body tissues and bloodstream causing widespread damage or others don't injure skin but are absorbed such as insecticide and agricultural chemicals. irritate or damage skin but same can be absorbed with little or no damage to skin. remove poison by: brushing powder off patient, with liquid poisons irrigate with clean water for 20 minutes, and when in eyes: irrigate with water for 20 minutes
What are injected poisons?
poisons that are inserted through the skin, for example, by needle, snake fangs, or insect stinger. Illicit drugs,
What is activated charcoal?
a substance that absorbs many poisons and prevents them from being absorbed by the body. give in covered cup and if vomit save all vomit
When is activated charcoal contraindicated?
cannot swallow, altered mental status whereby might choke or aspirate, ingested acids or alkalis (oven cleaners, drain cleaners, toilet bowl cleaners, and lye) because of possible damage to digestive tract, gasoline, and food poisoning. if refuse when overmedicating contact medical control
How do you treat absorbed poisons?
need to know what substance bringing container, when did it occur, how much using maximum, over how long ingestion occurred, interventions, effects from ingestion with nausea and vomiting most common. may find altered mental status, abdominal pain, diarrhea, chemical burns, and unusual breath odors. call poison centers 1-800-221-1222 when local protocol says so but may not have authority for decisions
What is the syrup of ipecac?
orally administered causes vomiting removal of ⅓ of stomach contents hardly used because slow
What is dilution?
thinning down or weakening by mixing with something else. ingested poisons are sometimes diluted by drinking water or milk
What is an antidote?
a substance that will neutralize the poison or its effects such as naloxone
What is naloxone?
antidote reversing narcotics’ depressant effects on level of consciousness and respiratory drive with no effect on someone without drugs, via intranasally
What is alcohol abuse?
person could have low blood sugar levels, poor nutrient, gastrointestinal bleeding, heart attack, hypoglycemic and taken with other meds- depressed vital signs . other conditions: diabetes, epilepsy, head injuries, high fevers, hypoxia, can appear to be alcohol related. signs and symptoms of alcohol abuse: alcohol odor on breath or clothing and not acetone breath (diabetic), swaying and unsteadiness of movement, slurred speech, rambling thought patterns, incoherent words or phrases, flushed appearance to face with patient sweating and complaining of being warm, nausea or vomiting, poor coordination, slowed reaction time, blurred vision, confusion, hallucinations visual or auditory, lack of memory (blackout), altered mental status. be alert for violent tendencies and make sure to keep them alert and always transport as under implied consent. potent drug affect CNS, can be addictive, emergencies resulting from recent consumption or years of abuse, treat patients as others, can lead to or worsen other medical conditions, often consumed with other drugs, impaaired can be uncooperative or combativ
What is withdrawal?
referring to alcohol or drug withdrawal in which the patient’s body reacts severely when deprived of the abused substance. symptoms of withdrawal: confusion and restlessness, unusual behavior, to point of “insane behavior”, hallucinations, gross tremor (obvious shaking) of hands, profuse sweating, seizures (common and not serious), hypertension, and tachycardia. drug withdrawal symptoms: shaking, anxiety, nausea, confusion and irritability, hallucinations visual or auditory, profuse sweating, increased pulse and breathing rate
What is delirium tremens?
a severe reaction that can be part of alcohol withdrawal, characterized by sweating, trembling, anxiety, and hallucinations. severe alcohol withdrawal with the DTs can lead to death if untreated
What is substance abuse?
chemical substance taken for other than therapeutic (medical) reasons. increased risk from things they abuse as well as effects from impaired judgements and have illness. designer drugs have worse effect than traditional. including upers, downers, narcotics, hallucinogens, and volatile chemicals.
What are uppers?
stimulants such as amphetamines that affect the central nervous system to excite the user relieving fatigue or create feelings of well-being ex. bath salts (hallucinogenic) caffeine, amphetamines- pill, and cocaine- snorted, smoked or injected. symptoms include: excitement, increased pulse and breathing rates, rapid speech, dry mouth, dilated pupils, sweating, and complaint of not sleeping. with repeated doses having “speed run,” resulting in restless, hyperactive, and apprehensive and uncooperative
What are downers?
depressants, such as barbiturates, that depress the central nervous system, which are often used to bring on a more relaxed state of mind, sleeping pill, or tranquilizer. ex. barbiturates- pill, rohypnol (roofies) date rape, GHB goop sense of euphoria and hallucinations- need assisted ventilations. signs and symptoms: sluggish, sleepy patient lacking typical coordination of body and speech with low pulse and breathing rate to emergency
What are narcotics?
a class of drugs that affect the nervous system and change many normal body activities. their legal use is for the relief of pain. illicit use is to produce an intensive state of relaxation such as stupor or sleep. ex. codeine, oxycodone (chronic pain), heroin (injected), overdoses have three signs: coma (depressed level of consciousness), pinpoint pupils, and respiratory depression (slow, shallow respiration) opiate triad. symptoms: reduced rate of pulse and rate and depth of breathing, seen with lowering of skin temperature, pupils constricted and pinpoint, muscles relaxed, sweating is profuse, sleepy and doesn't want to do anything. overdoses: coma, respiratory arrest or cardiac arrest rapidly
What are hallucinogens?
mind-affecting or mind-altering drugs that act on the central nervous system to produce excitement and distortion of perceptions. ex. LSD, PCP, and mushroom eaten and dissolved in mouth and mucous membranes or ecstasy also an upper. symptoms: fast pulse rate, dilated pupils, flushed face seeing or hearing things no concept of real time and not aware of environment making no sense and may be aggressive or timid
What are volatile chemicals?
vaporizing compounds, such as cleaning fluid, model cement, and correction fluids that are breathed in (by “huffing” breathing fumes directly or from substance impregnated facbir and bagging from substance sprayed in bag” by the abuser to produce a “high.” give an initial rush then act as depressive. Symptoms: appear dazed or temporary loss of contact with reality, develop a coma, linings of nose and mouth with swollen membranes, funny numb feeling or tingling inside head with changes of heart rhythm leading to death
What is the labia?
soft tissues that protect the entrance of the vagina. urethral opening, and nerve-rich center of sexual stimulation clitoris found in anterior aspects of labia with high vascular tissues prone to significant bleeding with trauma
What is the perineum?
the surface area between the vagina and anus and is prone to tearing during childbirth
What is mons pubis?
soft tissue that covers the pubic symphysis area where hair grows when a woman reaches puberty
What is the vagina?
birth canal, smooth muscle connecting uterus to outside world and stretch to accommodate passage of fetus during delivery and passageway for menstrual waste products leaving uterus at conclusion of menstrual cycle
What is the ovary?
female reproductive organ that produces ova in lower abdominal quadrants producing hormones
What are the fallopian tubes?
narrow tube that connects ovary to uterus called oviduct where fertilization occurs
What is an ectopic pregnancy?
ovum implants in fallopian tubes and is dangerous because they cannot expand as fetus develops and can lead to rupture and severe bleeding
What is a uterus?
muscular abdominal organ found on the midline where the fetus develops and can stretch and grow as fetus gets larger; the womb. top, or fundus found as high as the xiphoid process in a late-term pregnant women with the lower aspect connected to the vagina. becomes less protected by abdominal cavity as it is thinner walled and gets larger during prengnancy
What is the cervix?
neck of uterus at the entrance to the birth canal but closed off in nonpregnant female but during labor cervix thins and dilates allowing muscular walls of uterus to contract and push fetus out through vagina and into outside world
What is ovulation?
phase of female reproductive cycle in which ovum is released from ovary and when walls of uterus thicken in preparation for implantation and egg is moved by peristalsis through the fallopian tubes and if fertilization does not occur, hormone levels change and slough off
What is an embryo?
baby from fertilization to 8 weeks of development implanting in lining of uterus and developing basic connections between itself and the mother
What is a fetus?
baby from 8 weeks of development to birth develop for 32 more weeks. 1st trimester fetus is being formed remaining quite small with little uterine growth, second trimester uterus grows rapidly reaching navel by fifth month and epigastrum (upper abdomen) by sevent month
What is a placenta?
organ of pregnancy where exchange of oxygen, nutrients and wastes occurs between a mother and fetus. made of maternal and fetal tissue attached to wall of uterus and is site for diffusion. expelled at birth
What is an umbilical cord?
fetal structure containing blood vessels that carry blood to and from placenta expelled at birth, 1 inch wide 22 inches long
What is the amniotic sac?
enclosed and protected within this membranous bag of water that surrounds developing fetus with 1 quart of amniotic fluid allowing fetus to float, cushion between fetus and minor injury helping maintain constant fetal body temperature. amniotic sac breaks during labor and fluid gushes from birth canal providing natural lubrication to ease infants progress through the birth canal.
What are the physical changes to a women's body during pregnancy?
cardiovascular system increases blood volume (pink coloration to skin), cardiac output, increased O2 demand/decreased lung capacity (shortness of breath), fetus growing/uterus enlarging (belly enlarging), ligaments stretched carrying extra weight of fetus with swayback posture and back pain affecting balance, growing uterus displaces GI tract with nausea vomiting and heartburn can lead to dehydration and hypovolemia, and increases heart rate (faster pulse) with number of red blood cells staying the same causing it to be anemic with slightly decreased blood pressure or high and massive increase in vascularity (blood and blood vessels) in uterus and related structures with diseases like asthma and diabetes made worse during pregnancy
What is supine hypotensive syndrome?
dizziness and a drop in blood pressure caused when the mother is in a supine position and the weight of the uterus, infant, placenta, and amniotic fluid 20-25 pounds compress the inferior vena cava, reducing return of blood to the heart and cardiac output contracting uterine arteries and redirecting blood to major organs severely affecting the fetus. all third trimester patients should be transported on left side with pillow or rolled blanket placed behind them to maintain proper positioning
What is labor?
the three stages of the delivery of a baby that begin with the contractions of the uterus and end with the expulsion of the placenta. first stage- regular contractions and thinning and gradual dilation of cervix ending when cervix is fully dilated, second stage- time from when baby enters birth canal until born, third stage- after baby is born and lasts until afterbirth.
What is after birth?
the placenta, membranes of the amniotic sac, part of the umbilical cord, and some tissues form the lining of the uterus that are delivered after the birth of the baby
What are brixton-hicks contractions?
irregular prelabor contractions of the uterus no sustained
What is lightening?
the sensation of the fetus moving from high in the abdomen to low in the birth canal occurring a little while or right before labor
what is meconium stained?
amniotic fluid that is greenish or brownish-yellow rather than clear as a result of fetal defecation; an indication of possible maternal or fetal distress during labor
What occurs in the first stage of birth?
dilation period where long neck of cervix shortened and thinned- effacement, and the opening dilates for a couple weeks before with braxton-hicks contractions. uterus contract regularly signaling labor with cycle starting farther apart and becoming shorter ranging from every 30 minutes to 3 minutes apart or less near end producing labor pains or ache in lower back and lower abdomen increasing intensity with pain at regular intervals of 30 seconds-1 minute and 2 occurring at 2-3 minute intervals beginning when uterus contracts and going away when muscles relax, and cervix begin to dilate as head moves down and cervix fully open to birth canal is the end of the first stage. Pay attention to contraction time or duration from beginning of contraction to relaxation, contraction interval or frequency start of one contraction to beginning of next. first time mothers lasts for on average 16 hours, or 4 hours. water breaking preceding labor, or well before onset and is serious problem and it is normally clear with watery blood discharge of mucus from mucus plug helping keep cervix closed during pregnancy
What occurs in the second stage of birth?
after full dilation of cervix, contractions are increasingly frequent and labor pains are more severe with cramping and abdominal pains typically still present, and as delivery approaches most women feel urge to push or move bowels, placing pressure on rectum
What occurs in the third stage of birth?
immediately after baby is born, placenta detaches from wall of uterus and is expelled with contractions resuming and continuing until placenta is delivered and may be as painful and severe as in second and lasts ten to twenty minutes ending as placenta delivered
What are some questions to ask a pregnant patient?
ask name, age, and expected due date, number of previous pregnancies? first pregnancy-16-17 hours long with subsequent births shorter acting like a well toned muscle or less effective and take longer, seen doctor regarding pregnancy to identify known complications with pregnancy medical issues and multiple gestations, when labor pains started and how often having pains water broken or bleeding?, feels urge to push or feels like needs to move bowels if yes baby is in birth canal and pressing vaginal wall against rectum don’t allow to go to bathroom and don’t hold legs together to delay delivery, crowning? bulging at vaginal opening or presenting part of baby visible with each contraction, feel for contractions only when she is having labor pains palm of gloved hand on abdomen above navel feeling contraction keeping track of duration and frequency with tissues and uterus feel more rigid, and take vitals
What is crowning?
when part of the baby is visible through the vaginal opening. if occurs during transport stop vehicle and prepare for delivery call medical assistant if longer than 10 minutes ask to tranpsort
What is cephalic presentation?
when the baby appears headfirst during birth. this is the normal presentation
What is breech?
when the butt and legs appear first
When is neonatal resuscitation likely?
no prior prenatal care and no idea regarding her health or health of baby, premature delivery, labor induced by trauma or medical conditions affecting mother, multiple births twins triplets or more increases likelihood of resuscitation, history of problems with pregnancy placenta previa and breech presentation, labor induced by drugs, meconium staining
What do you do to prepare the mother for delivery?
control scene so mother has privacy (birthing coach) if not in private room and can’t transport asking bystanders to leave, get surgical gloves, gowns, caps, face masks, and eye protection. place mother on bed, floor or ambulance stretcher (faster if complications arise), elevate buttocks with blanket or pillow lying with knees up and spread apart allowing (2 feet), remove clothing or underclothing obstructing view of vaginal opening (sterile sheet or towels covering mother with clean sheets clothes towels if no obstetric kit within reach). position assistant, father or whoever mother agrees at mother’s head, stay alert to help turn mother in case she vomit providing emotional support, making environment warm heat on high cold is fatal
What is in the obstetric kit?
several pairs of sterile surgical gloves to protect from infection, towels or sheets for draping mother, 1 dozen 2x2 (or 4x4 gauze pads (sponges) for wiping and drying baby), 1 rubber bulb syringe (3 oz) to suction baby’s mouth and nostrils, cord clamps or hemostats to clmap umbillical cord (extra in case multiple), umbilical cord tape to tie cord, 1 pair of surgical scissor to cut cord, 1 baby blanket to wrap baby and keep warm, several individual wrapped sanitary napkins to absorb blood and other fluids, plastic bag, head covering for baby and neonatal bag valve mask
What do you need off-duty?
clean sheets and towels to drape around mother and newborn, heavy flat twine or new shoelaces to tie cord (no thread, wire, or light string as it may cut through), towel or plastic bag to wrap placenta, clean-unused rubber gloves and eyewear
What do you do when delivering a baby?
constant view of vaginal opening, talk to mother encourage to relax between contractions, time contractions from beginning of one to next, encourage not to strain unless feels the need to, bowel movements is just pressure by baby, breath deeply through mouth, don’t breath rapidly. if explosive put one hand with slight pressure on head avoiding direct pressure to soft spots on skull. monitor vital signs between contractions, alert for vomiting, position gloved hands at vaginal opening when baby’s head starts appearing place a hand on head as it comes out to prevent sudden uncontrolled expulsion don’t touch area around vagina except assisting delivery have partner present at all time. place one hand below baby’s head as delivers, spreading fingers evenly as infant has soft spots, support baby’s head avoiding pressure at top and sides of skull, other hand hod sterile towel supporting tissue between mother vagine and anus preventing tearing of tissue during delivery. DON’T PULL BABY. if amniotic sac hasn’t broken baby’s head by time baby’s head is delivered using your finger to puncture membrane and pull membranes away from baby’s mouth and nose and make sure fluid is clear if meconium-stained (dark green-black or mustard yellow) suction immediately. help deliver shoulders with upper shoulders coming next (with delay), followed quickly by lower shoulder support baby throughout guiding baby’s head downward to assist mother in delivering baby’s upper should is lower shoulder slow to deliver after upper shoulder delivered assist mother by guiding head upward. support baby throughout entire process, rmemebr that newborns are very slippery as lower extremities are born grasp them eo ensure hold on baby, never pick up babies by feet as they are slpper once feet delivered lay baby on side with head slightly lower than body done to allow blood fluid and mucus to drain from mouth and hose keep baby at same level as mother’s vagina until umbilical cords stops pulsating dry infant and wrap in warm, dry blanket. assess airway most active babies wont require suctioining, and will be important if positive pressure ventilations are necessary or if secretions threaten airway or obstruct normal breathing. if baby is not moving or not breathing or if airway is obstructed, use rubber bulb syrnge to suction bab’y mouth then nose, compressing syringe before placing it in baby’s mouth. suction mouth first then nostrils, isnert tip of syringe about 1-1.5 inches into baby’s mouth and release bulb to allow fluids to be drawn into syringe controlling and releasing with fingers withdraw tip and discrage syringe’s contents onto towel and tip of syrginge should not be inserted more than ½ inch into baby’s notrsil. note exact itme of birth write mother’s last name and time of delivery on piece of tape fold so adhesive doesnt touch baby’s skin and place around baby’s wrist
What do you check for in umbilical cord?
once head delivered check to see if umbilical cord is wrapped around baby’s neck tell her not to push while you check if pant, take short quick breaths may help relieve urge to push. loosen cord if necessary rough handlings may cause it to tear if cord wrapped around neck place two fingers under cord at back of baby’s neck bring cord forward over upper shoulder and head. if can’t loosen or slip cord over head baby cannot be delivered so clamp cord in two places don’t injure baby with extreme care cut cord between two clamps and unwrap ends of cord from around bab’y neck and proceed with delivery
What is a neonate?
a newly born infant or an infant less than one month old
What is the breech position?
when the baby’s buttocks or both legs appear first during birth
What is APGAR?
assess baby for breathing easily, heart rate, vigorous crying is good, movement (more active the better), and skin color normal pulse should be above 100 beats/minute, blue coloration at hands and feet only (5 minutes later these signs apparent with breathing becoming more relaxed and blue coloring disappearing
After brith what is the most important thing?
keeping baby warm as they rapidly lose heat, if baby is wet dry discarding wet blankets and wrapping in dry ones, use infant swaddler (space blankets), cover baby’s head moving baby to mother’s chest and encourage breat feeding
How do you cut the umbilical cord?
if cord wrapped around baby’s neck and cannot be slipped over head, if delivery is impeded or cord tightens around neck it must be cut, if attachment of cord impedes resuscitation effort, if attachment interferes with urgent need for transport of mother and/or baby, some systems will have protocols requiring cord to be cut. cord should be cut no earlier than one minute after birth palpate cord with finger making sure it is no longer pulsating as it does shortly after delivery. Do not tie, clmap or cut cord of baby that is not breathing on own unless have to remove cord from baby’s neck during birth or performing CPR dont cut or clamp cord still pulsating. leave protective coating, vernix, on baby do not wash, use sterile clamps or umbilical tape when cutting forming knot slowly to avoid tearing cord using a square knot, aplly clamp 10 inches from baby and second clamp 7 inches from baby with of four fingers apart cutting cord between clamps or knots using sterile scissors protecting eye and never untie or unclamp cord once cut. placental end of cord place on drape over mother’s legs to avoid contact with expelled blood feces and fluid examining fetal end for bleeding applying another tie or clamp if needed. when moving baby be careful that no trauma happens to clamped cord as baby may bleed ot death from cord. if dont have good resources dont cut the cord if urgency can find items. if tie cord, and have some time before able to trasnport and transfer neonate and dont have sterile scissors, soak scissors in alcohol for several minutes then use them to cut and if still attached to placenta when delivered wrap placenta in towel and transport infant and placenta as unit placing at same level as abby or slightly high.
What do you do if a neonate isn't breathing?
administer blow-by-blow oxygen if torso is blue, ifdoes not breath on own after drying and warming for 30 second begin resuscitation. if secretions obstruct airway or positive pressure ventilation necessary use bulb syringe to suction mouth firs tthen nostrils, squeezing bulb before inserting syringe into baby’s mouth, relelase blb to create suction using sterile gauze apd to clear mucus and blood from around baby’s nose and mouth. establish baby’s breathing looking at repsirations, heart rate, and muscle tone is it crying or breathing active and moving should be breathing within 30 seconds. use gentle but vigorous rub of baby’s back promoting spontaneous respiration, if fails snap index fingers against sole of baby’s foot hadns and feet will appearslgihly blue. if breathing shallow, slow, gasping or absent provide positive pressure at 40-60 per minute to get chest rise using room air. assess hear rate if heart rate less than 100 ventilate. if heart rate less than 60 beats per minute initiate chest compressions too at rat eof 120 compressions per minute over lower third of sternum with two thumbs and fingers supporting back ⅓ of body. 3:1 ratio of compression to breaths
What do you do when the mother is giving birth to the placenta?
stage 3 birthing at risk for serious bleeding, infection, and emboli helping her deliver placenta, controlling vaginal bleeding and making comfortable. leave before placenta comes and can stop if placenta does come. after birth- the cord has lengthened indicating a separation from the wall of uterus within a few minutes after baby is born taking 30 minutes or longer don’t put pressure on abdomen over uterus to hasten delivery if both doing fine can wait, save all afterbirth tissues, catching afterbirth in container or plastic bag or towel if don’t give birth in 20 transport right away
What is vaginal bleeding?
usually no more than 500 cc but may be profuse leading to shock, place sanitary napkin over mother’s vaginal opening, don’t place anything inside, have mother lower legs keeping them together, doesn’t have to squeeze legs together, massing uterus to help contract controlling bleeding feeling until notice grapefruit sized object rubbing lightly with circular motion contracting and becoming firm diminishing bleeding and is painful for mother so tell her. encourae mother to begin nursing as it will stimulate uterus to contract and decrease bleeding. tearing of tissue in perineum at vaginal opening during birth feeling discomfort let know normal and will be careful treating as wound with sanitary napkin and pressure. take vital signs, wiping face and hands with damp washcloth and drying with towel, replace blood soaked sheets and blankets making sure both are warm. cleaning up whatever disorder but not delay trasnport and may have you return to house hafter ot help cleanup getting ird of in biohazard. control bleeding as other hemorrhage with bulky dressing or sanitary pad, do not remove undergarments unless necessary or pack vagina, respect privacy and consider assault with law enforcement and social service referrals
what do you do if there is breech presentation?
when the baby’s buttocks or both legs appear first during birth with high risk of birth trauma and proplased cord and meconium staining dont deliver by pulling on legs, palce mother in head-down position with pelvis elevated if body delivers support it and prevent explosive delivery of head inserting vloved index and middle fingers into vagina to form V on either side of baby’s nose to lift away from wall in case it begins to creath. . if in breech provide high-concentration oxygen and rapidly trasnport to hospital
What do you do if there is limb presentation?
when an infant’s limb protrudes from the vagina before the appearance of any other body part commonly a foot when in breech and cannot be delivered in preshospital so trasnport immeditadely when checking for crowning may see arm, single leg or together if one or more limbs present prolapsed umbilical cord as well. and place mother in head-down positon giving high concentration oxygen.
What happens when an infant has a prolapsed umbilical cord?
when the umbilical cord presents first and is squeezed between the vaginal wall and the baby’s head. position mother with head down pelvis raised with blanket or pillow using gravity to lessen pressure on birth canal elevating hips providing oxygen, check cord for pulses and wrpa exposed cord using sterile towel keeping it warm. inserts several fingers into mother’s vagina to gently push up on baby’s head or butt to keep pressure off cord pushing up through cervix continuing to push on baby until physician relieves you and may feel cord pulsating when pressure is released transport immediately and get vital signs.
What do you do when there are multiple births?
when more than one baby is born during a single delivery. prematurity and other complicaitons are common with multiple births twins delivered ins ame manner as single delivery one birth following other identifing infant as to order of birth if appearing abrnoamlly large before dleivery or remains large after delivery with contractions contuing and delivering shortly after first making sure yoou have enough resources and posisble multiple simulatneous resuscitation clamp or tie cord of first baby before second is born, second baby born before or after placenta,.
What do you do in the case of a premature birth?
any newborn weighing less than 5.5 pounds born pounds or born before the 37th week of pregnancy. determine whether baby is full term or premature based on due date and baby’s appearance, and if unsure of due date estimate by last menstrual period and adding forty weeks. keeping baby warm is priority as they are at great risk of hypothermia wrapped snugly in warm blanket with extra protectoin from outer wrap of plastic bubble wrap away form infant’s face or small reflective blanket. allowing to see cord for bleeding with stockinette cap placed on baby head, keep airway clear, provide ventialtions and/or chest compressions may not be possible if too premature, watch umbilically cord for bleeding adding another clamp in case, avoid contamination keeping away from other peopel and not breathing in face, trasnport in warm ambulance between 90-100oF using heater to warm patient compartment prior to tranpsort calling ahead
What do you do if there is meconium?
result of fetus defecating (putting out waste as a sign of fetal or maternal distress) staining it green or brownish yellow at increased risk for respiratory problems don’t stimulate infant before suctioning, then suction maintaining open airway providing artificial ventilations and/or chest compressions based on effort of breathing and heart rate
Wha do you ask the patient if you believe there is an emergency occurring?
around 20 weeks baby begins moving, ask about vaginal discharge
What is placenta previa?
a condition in which placenta is formed in an abnormal location (low in the uterus and close to or over the cervical opening) that will now allow for a normal delivery of the fetus; a cause of excessive pre birth bleeding. give high-flow oxygen and rapidly transport placing sanitary napkin over vaginal opening saving all pads and tissue that is passed
What ectopic pregnancy?
when implantation of fertilized egg is not in body of uterus, occurring instead in the fallopian tube (oviduct), cervix, or abdominopelvic cavity. with symptoms of acute abdominal pain beginning on one side or other, vaginal bleeding (with pain), rapid and weak pulse (late sign), low blood pressure (very late sign), and absent menstrual period. give immediate transport, position patient for shock, giving oxygen and give them nothing by mouth
What is eclampsia?
a severe complication of pregnancy that produces seizures and coma. preeclampsia or pregnancy-induced hypertension, elevated blood pressure increasing risk of abruptio placentae, excessive weight gain, extreme swelling of face, hands, ankles, and feet with altered mental status headache or other neurological findings. transport on left side give oxygen, handle patient gently, keep warm, suction and delivery kit
What is preeclampsia?
a complication of pregnancy in which the woman retain large amount of fluid and has hypertension. she may also experience seizures and/or coma during birth, which is very dangerous to the infant symptoms: altered mental status, swollen hands, feet or face and high blood pressure
What is an abortion?
spontaneous (miscarriage) or induced termination of pregnancy. signs and symptoms: cramping abdominal pains not unlike those associated with first stage of labor, bleeding ranging from moderate to severe, noticeable discharge of tissue and blood from vagina if longer than 24 weeks be ready with obstetric kit. It is best to obtain vital signs if shock present give oxygen, help absorb caginal bleeding, trasnport soon, replace and save all blood soaked pads saving all tissues don’t replace or pull out any tissues that are expelled. providing emotional support for mother use miscarriage
What is a spontaneous abortion?
when the fetus and placenta deliver before the 28th week of pregnancy; called miscarriage
What is an induced abortion?
expulsion of fetus as a result of deliberate actions taken to stop pregnancy
What is stillborn?
born dead be thoughtful and honest and allow them to see keeping records of time of sitllbirth and care rendered with presence of blisters, foul odor, skin or tissue deterioration and iscoloration and a softened head or in arrest and can be resuscitated. withholding resuscitative measures who are obviosuly dead but provide full resuscitation born in pulmonary and cardiac arrest. q
What is trauma like in pregnancy?
automobile can cause blunt trauma to abdomen during later months of pregnancy causing uterine rupture or premature separation of placenta, or ruptured spleen or liver and possiblerupture of diaphgragm can cause massive bleeding and shoc
What are the special considerations about pregnant women?
0-15 beats per minute faster, blood volumr that is up to 48 percent higher than nonpregnant with hemorrhage 30-35 percent blood loss occur before exhitbiting signs of symptoms iwth oxygen requirements 10-20 percent greater than normal greater risk of vomiting and aspirating trasnport as soon as posisble in left recumbent posiiton supported with pilllows or blankets unless psinal injury is suspected securingmother to spine board then tip board as unit to left
What do you do in cardiac emergencies?
if more than 20 weeks pregnant uterus displaced manually during CPR don’t by placing two hands on side of pregnant abdomen and pulling it toward the patient’s left side and use in same transport position to prevent supin hypotensive syndrome lfiting at lateral angle of 27-30 degrees, repositioning hands 1-2 inches higher on sternum making up for shifting of heart by uterus. immediately transporting pregnancy patient as the exception especially if less than 5 minutes,
What do you do in the case of sexual assaults?
be nonjudgemental and maintain professional but compassionate attitude, with medical and psychological consdierations unless delay care have EMT of same sex. stage unit near scene until rendered safe by police, conscious of personal space explainiang examinations and treatments beforehand and be aware of patient’s fears and embarassment. avoid cutting clothes, do not move items on scene and limit number of provider who access, discourage paitent from bathing, voiding or cleansing wounds, as may result in loss of important evidence. fulfilling reporting requirements providing social service suggestoins.
What is pathophysiology?
normal consciousness is regulated by a series of neurologic circuits in brain that comprise reticular activating system (RAS), which is responsible for functions of staying awake, paying attention, and sleeping keeping a person alert and oriented
What are some instance that can cause altered mental status?
in cases of oxygen, glucose, or water deficiencies in the brain tissue. Due to trauma, infection, checmical toxins harming brain tissue; primary brain problem (stroke), problem within another system (hypoxia) due to asthma.
What is type 1 diabetes?
pancreatic cells do not function properly, insulin not secreted normally, not enough insulin to transfer circualting glucose into cells, synthetic insulin typically presribed to supplement inadequate natural insulin
What is type 2 diabetes?
body’s cells fail to utilize insulin properly, pancreas is secreting enough insulin but body is unable to use it to move glucose into cells, condition often controlled through diet and/oral antidaibetic medications
What is hypoglycemia?
tiabetic takes too much insulin, diabetic does not eat, diabetic overexercises or overexerts, diabetic vomits, diabetic increases metabolic rate (fever or shivering). less than 60mg/dL
What are the signs and symptoms of hypoglycemia?
very rapid onset, may presnet with abnormal behavior mimicking drunken stupor; pale, sweaty skin, tachycardia, rapid breathing, and seizure
What is hyperglycemia?
high blood sugar caused by a decrease in inslun, may be due to body’s inability to produce insulin, and may exist because insulin injections not given in sufficient quantity, stress, and increasing dietary intake. greater than 140- hyperglycemia with 300mg/dl leading to more deleterious symtpoms
What are the signsand symptoms of hyperglycemia?
develops over days or weeks, chronic thirst and hunger, increased urination, warm red dry skin, and nausea resulting in profoudn dehydration, excessive waste products and diabetic ketoacidosis (shock acetone breath)
What is sepsis?
collection of problems associated with response to infection moving from local site to become systemic problem and can release toxins to harm cardiac output.
What are the signs and symptoms of sepsis?
altered mental status, increased heart rate, increased respiratory rate, low blood pressure, high blood glucose, and decreased capilalry refill time and seizure if affects brain activity (sudden change in sensation, behavior or movement)
What is aura?
sensation patient has just before it is about to happen noting smell, sound or just a general feeling right before seizure
What is a seizure?
caused by hypoxia, stroke, traumatic brain injury, toxins, hypoglycemia, brain tumor, congenital brain defects, infection, metabolic, idiopathic, epilepsy; measles, mumps and other childhood diseases; eclampsia, heat stroke
What do you do if seizure occurs?
place patient on floor or ground, loosen restrictive clothing, remove objects that may harm patient;protect patient from injury, but do not try to hold patient still during convulsion. after ended protect airway, no possibility of spiny injury palcing patient on slide, if cyanotic ensure open airway and provide artifical ventilations with supplemental oxygen
What is status epilepticus?
two or more convuslive seizures in a row without regaining full consciousness or a single seizure lasting more than 10 minutes, high-priority emergency requiring immediate trasnport to hospital and possible ALS intercept
What is an absence seizure?
brief, without dramatic motor activity; temporary loss of concentraiton or awareness, may go unnnoticed by everyone except the patient and knowledgeable memebrs of their family
What are the signs of seizure?
one-sided weakness (hemiparesis) very common, difficulty speaing or complete inability to speak, headache caused by bleeding from ruptured vessel-less comon, but improtant. confusion, dizziness; numbeness, weakness or paralysis usually on one side of the body, loss of bowel and/or bladder control, impaired vision, high blood pressure, difficult respiraiton or snoring, nausea or vomiting, sezirues, unequal pupils, headache, loss of vision in one eye, and unconsciouness (uncommon)
What is a transient ischemic attack?
small clots temporarily block circulation to part of the brain, stroke-like symptoms, symptoms resolve when clots break up, complete resolution of symptoms without treatment within 24 hours
What is dizziness?
vertigo (sensation of surroundings spinning around you), light-headedness (sensation you are about to pass out presyncope).
What is syncope?
brief loss of consciousness with spontaneous recovery, typically very short (few second to few minutes), some warning about to occur
What are the causes of dizziness and syncope?
bradycardia and tachycardia can cuase decreased cardiac output and syncope, vasovagal syncope thought to be result of stimulation of vagus nerve signaling heart rate as slowing down with decreased cardiac output causing syncope. hypovolemic with low fluid/blood volume causes dizziness or syncope, especially when patient attempts to sit up or stand with the source of bleeding not necessarily obvious. metabolic and structural causes such as alterations in brain chemistry or structure leading to diminished level of consciousness, inner and middle ear problems. environmental/toxicological causes- alcohol and drugs can cause fluctuations in consciousness.
What do you ask people experiencing dizziness?
have you had similar episodes in the past, what do you mean by dizziness, did u have any warning, when did it start, how long did it last, how were you positioned, on meds for it?, any other signs or symptoms- nausea? did you witness any unpleasant sight or experience a strong emotion, did you hurt yourself, did anyone witness involuntary movements of the extremities like seizures?
What is a poison?
any substance that can harm the body
What are common poisonings?
medications, petroleum products, cosmetics, pesticides, plants and food
What are the effects of a poison?
harm to body based on nature of poison, concentration, route of entry, patient’s age, weight, and health. resuling in damamge to skin and tissues from contact, suffocation, and localized or systemic damage to body systems.
What are some questions to ask patient you think has been poisoned?
find out what substance was involved looking for container, checking labels, and transporting with patient look for possibilities to know if quick acting, how much, how long, interventions?, rate of onset (based on weight) in order to test in ER. effects- nausea, vomiting, altered mental status, abdominal pain, diarrhea, chemical burns around mouth, and unusal breath odors
what is food poisoning?
improperly handled or prepared food symptoms such as nausea, vomiting, abdominal cramps, diarrhea and fever within hours of ingestion to a day or two later
What does syrup of ipecac do?
induces vomiting in one dose has potential to aspirate and only removes ⅓ of stomach content
What are the treatments of poison?
call medical direction, adult patient should drink one to two glasses of water or milk, children should drink ½ to one glass of water or milk. water slows absorption but milk soothes upset stomach if dont need transportation.
What is naloxone?
antidote reverses effects of narcotic depressant on level of consciousness and respiratory drive
What are the signs and symptoms of inhaled poisons?
difficulty breathing, chest pain, coughing, horaseness, dizziness; headache, confusion, or altered mental status; and seizure
What is alcohol withdrawaL and what are the signs and symptoms?
abrupt cessation of drinking may caus esome alcoholic to suffer from delirium tremens (DTs). can be serious resulting in tremors, hallucinations, an seizures.
signs and symptoms of alcohol withdrawl: confusino and restlessness, unusual behavior, hallucinations, gross tremors of hands, profuse sweating, seizures, hypertension, and tachycardia
When do you give oxygen in the cases of poisoning?
if poison was inhaled or injected
what kind of information about a patient’s altered mental status might you obtain from the scene?
injuries, diabetes markers
could a seizure or syncopal event be a symptom of a larger problem? what might the larger problem be?
hypoxia, head trauma, hypoglycemia, tumors, . syncope- ½ unexplained, dehydration, heat stroke, locked knees, cardiac patient, dementia patients mistaking medications, new or changed medications
using AEIOUTIPS as a possible acronym for Altered Mental Status what could each letter stand for?-
intervene with oxygen or glucose
A- alcohol, anaphylaxis
O- oxygen, opiates, overdose
U- urinary tract infection, underdose
T- trauma, temperature, tachycardia, toxicology, transient ischemic attack (TIA)
I- insulin, injection
S- stroke, shock, sepsis
What are routes of poisoning?
classified by route- ingested, absorbed, injected and insect remembered as 4 I’s and an A.
What do you see with snakes?
signs and symptoms one or more fang marks, pain bite at site, edema, weakness, diaphoresis, nausea, vomiting, paresthesia, subcutaneous ecchymosis. non-venomous have horseshoe, and fang marks is venomous. red bordered by yellow kill a fellow; red bordered by black venom lack. treat with oxygen, consider splinting, elevation or extremity don't use cold packs
What do you see with anticholinergic?
antihistamines or antidepressants have normal appearance hot as a hare, dry as a bone, red as a beet, and mad as a hatter.
What is opiate toxidrome?
opioid triangle CNS depression, pinpoint pupils respiratory depression, and hypotension
What is cholinergic toxidrome?
SLUDGE salivation, lacrimation-crying, urination, defecation, GI distress, emesis. in farm accident or doing surgery
What is a sedative?
hypnotic slows everything down
What is a sympathomimetic toxidrome?
everything fast such as amphetamines, epinephrine, cocaine, ritalin, and dopamine. restlessness, dystonic reaction, insomnia, excessive speech, tachycardia, excessive motor activity, hallucinations, and tremor
What is withdrawn toxidrome?
alcohol, cocaine, barbiturates, methaqualone, benzodiazepines, and opioids- diarrhea, tachycardia, large pupils, pinpoint pupils, muscle cramps, hypertension, and hallucinations
What do you see with spiders?
very elderly and young potentially lethal
What do you do with drugs?
call poison control first before anything.
What is activated charcoal?
activated charcoal- generic. trade- superchar, insta char, actidose (most commonly found), and charcodote. it is an absorptant and chemically binds to substance in there does not bind to alcohol and prevents body from absorbing into digestive tract. massachusetts can give activated and other places need medical control only. 1-2g/Kg en route gie 25-50g two 25 or two 50 grams. pediatric- 1-2g/Kg (en-route 12.5-25 given). if vomiters repeat dose once. contraindications if can't speak and swallow and protect own airway should not be given. nausea and vomiting, constipation, diarrhea or black tarry stools initiating gag reflex. does not bind to activated charcoal CHARCOAL- corrosives, hydrocarbons, arsenic/alcohol, radioactive elements, caustics (acids), organophosphorus (pesticide), antidotes, lead/lithium/mercury
What is albuterol sulfate?
albuterol sulfate-generic. trade- proventil, ventolin, volmax, proair, bronkosol, vospire, accuneb- used in bronchospasm bronchodilator binds and stimulates beta receptors resulting in relaxation of bronchial smooth muscles which dilates bronchioles thus reducing airway resistance. anyone with severe bronchospasms such as emphysema, chronic bronchitis, asthma, developing pneumonia if have metered dose inhaler help them with using their dose.
albuterol updraft. 6mos-2 y 1.25mg/3mL nebulizer. age 2+2.5-3 mg/3mL can put on mask or pipe. contraindications: hypersensitivity, can’t use themselves.
side untoward effects: restlessness, tremors, dizziness, increased heart rate, increased BP, nausea, vomiting, tachycardia, dysrhythmias, paradoxical bronchospasm. confirm no recent heart problems and if diagnoses but don't have a prescription.
What is aspire?
acetylsalicylic acid- generic. brand name: bayer, ecotrin. antiplatelet decreasing platelet aggregation, essentially making platelets slippery reducing clotting action. given as chewable tablet when chest pain (2-4/81 mg tablets) or can chew 325 mg. if allergic ask the symptoms if stomach ache fine is anaphylaxis fine. contraindications: hypersensitivity, active GI bleed, recent hemorrhagic stroke, be careful with asthma don't give to pediatric patients. side effects: nausea, vomiting, stomach irritations, heartburn, prolonged bleeding time/GI bleeding, wheezing in the asthma patient tinnitus (ringing in ears) with high doses 200-500
What is nitroglycerin?
generic. nitrostat and nitrolingual- nitrate vasodilator smooth muscle relaxant that decreases preload, afterload and oxygen demand chest pain cardiac in origin. adult- .3-.4 mg tab/spray 3-5 mins and a max of 3 doses. systolic blood pressure must be 120 mmHg. contraindications SBP less than 120, erectile dysfunction sildenafil (viagra) tadalafil or vardenafil levitra and cialis within 24-48 hours; intracranial bleed and stroke or head trauma, anemia severe bradycardia or tachycardia. side effects: nausea, vomiting, headache, burning underneath tongue if working, lightheadedness, flushing/hypotension, syncope, reflex tachycardia sitting down. standing order above 120 and no contraindications and prescription.
What is epinephrine?
epinephrine-generic; aviQ, adrenaline, epipen, twinject, auvi-q. class- sympathomimetic, bronchodilator and antihistamine. epinephrine naturally occurring catecholamine act directly on alpha and beta bronchial dilation blocking histamine release. severe allergic reaction adult- auto-injector .3mg with 2nd dose given 5 minutes after. epi-junior 1.5 mg have to be over than 6 months and if less than 25 kg give pediatric and if over 25 give adult auto injector. med control need approval for second in kids and in adults over 60 need approval for both. no contraindications in emergency situation. side effects- increased heart rate, respiratory rate, nausea, headache, chest pain.
mild-itching, urticaria, nausea, no respiratory compromise
severe- stridor, bronchospasm, severe abdominal pain, respiratory distress, shock. systemic urticaria, edema of lips tongue and face
What is naloxone?
naloxone- generic. trade- narcan, evzio- inject. class: opioid antagonist, narcotic antagonist, antidote. Action competes for the opioid/opiate receptor sites, binds to the unoccupied sites and bumps opiates off the already occupied sites blocking the narcotic effects in both examples. this reverses the respiratory depressive effects of both naturally occurring and synthetic opioids competitive antagonist. patients with opioid overdose, self-administered accidental, unintentional patient overdose. Adult/pediatric 2 mg via nasal atomizer vomiting or .4 mg via auto-injector repeated in 3-5 minutes if no response if suspected or confirmed hypoglycemia. don’t wake all the way up and just have breathing.
What is oral glucose
oral glucose- gluctose, instatose. hyperglycemic class provides quickly abosrbed glucose to rapidly increase circulaitng blood glucose levels making sugar redily avialable. patient with known diabetes 70mg/dl altered mental status. 1 dose=1 tube put in cheak. repeated in ten minutes if symptomatic. contraindications; unconsciousness unable to speak and swallow not taken insulin for days. side effects: nausea, vomiting, aspiration in patient without gag reflex, rebound hypoglycemia (so give more doses).
What is oxygen
oxygen- confirmed or expected hypoxia less than 94%, anemia sickle cell disease, major trauma, shock, ischemic chest pain, pulmonary edmea, pneumonia, respiratory distress, pulmonary emboli, MI, smoke inhalation, carbon monoxide or cyanide posiosning
nasal cannula- 106 24/44%- mostly used for patient anxiety
nrm 10-15Lpm 80-95%
contradinidcations- hyperventilation, explosive environment known paraquat highly toxic weed killer to destroy marijuana plants. side effects0 irritation and drying of mucus membranes/rare respiratory distress, development of free radicals secondary to hyperoxemia
What do you do on the way to a birth call?
know what hospital does what equipped for preterm babies. Triage of who gets to do what who takes care of what, multiple births and call somebody else getting somebody coming, review stes for delivery find OB kit or what do we need to have. infant BVM too big for neonate.
What are some possible complications?
Possible complications experiencing: preterm labor 40-41 is term earlier than 37 weeks preterm anything before 32 weeks out of hospital not likely to survive (heat on in ambulance, towels and blankets on heater to heat them up heat packs on towels) need to be hot and sweaty, post-term pregnancy- first time deliveries older moms over 40 or 45 (shoulder dysplasia, prolapsed cord, hypoglycemic), multiple gestations (if good prenatal care should know- breech, prolapsed cord 80% of time problem with second baby first is easy), placenta previa (if good prenatal care should know- adheres to uterine wall completely or partly covering cervical wall causing tearing, separation and bleeding wont always come externally, painless), known breech presentation (anything not head first, limb presentation, butt), shoulder dystocia (top shoulder hung up on pubic symphysis), prolapsed cord (cord first sometimes can deliver normally putting moist pressure and make sure pulsating if not push baby). 4% of pregnancies are breech. notifying hospital of pre-term.
What do you ask the parents?
is this your first delivery? if not, how long was the labor of the first delivery?
do you feel the urge to push or go to the bathroom? if yes, delivery is usually within 30 minutes
do anatomic conditions allow for successful prehospital delivery? do you know you have placenta previa? is the baby really big and c-section scheduled. transverse breech knowing position of baby if not, prepare for immediate transport.
assess for immediate threats to life for mom
perform brief physical assessment? is the baby’s head crowning. how often/long are contractions? if less than two minutes stay on scene. if new mom 3 minutes can make it. how long are contractions lasting longer than 30 second imminent delivery. is the head or scalp visible at perineum during contractions? if yes, delivery is imminent.
What do you tell the hospital?
tell hospital- having twins?- second amulance when are you due to deliver? what color was the amniotic fluid? have you been receiving prenatal care? meconium staining- baby in kind of fetal distress defecate and it will be on amniotic fluid. viscous sticky, need to suction baby.
What are some benefits to deliver on scene?
benefits to delivering on scene: second provider to assist, assistane from patient’s family/bystanders; no vehicle movmeent, noise, or hazards; more room to assess patient and deliver baby. best deliveries on bed
What are the risks to delivery on scene?
risks to delivering on scene: no progress toward definitive care if complicaitons develop, bystanders may interfere with patient care, the scene may pose safety hazards, scene may have less room or more obstacles
How do you position mother for delivery?
position mother for vaginal delivery- prepare an area for baby and keep room warm, supine position or sims position- easier for mom full access to baby facing posterior to back.
What are the stages of brith?
first stage beginning contractions to pull cervical dilation, expulsion dilation to expulsion of fetus, placental stage after deliver of baby to delivery of placenta. place hand around neck posteriorly to control delivery have hand gently resting on head with numbers of birth. as needed, pull anterior shoulder downward to clear mother’s symphysis ubis gently glide baby up then down and lots of wet gown and gown lap of towels
What do you do once delivered?
once delivered- keep baby at level of uterus because of a transfer of blood having hypovolemic and hematocrit. dry baby and wrap them rubbing and stimulating dont clamp and cut cord till stops pulsating and by time wrapped in something got them going a little bit 30 second to minute. thumb to finger 4-6 inches away from baby and another 2-3 inches for second cutting in-between two. in regular delivery tablespoon of blood loss from neonate can cause shock. cut and clamp cord have extra clamp. take carseat with you and somehow make barrier bed device on back of stretcher. have to cut corm
What do you do with the baby?
baby: dry and warm, clear airway by suctioning if necessary (no spontaneous breathing, mouth mouth mouth then nares, and begin resuscitation of bay as needed delivery of placenta is nonemergent. package baby up and leave transporting knees up semi-fowler contractions large gush of blood and deliver placenta put pads on women and drive off.
What do you do during birth?
allow mother to push head out, reduce nuchal cord 50-60% of deliveries move cord around baby's head and dont pull on cord preventing progression clamp and cut in between which is bad if u cut the cord of the second child killing it, guide baby out dont pull let mother do the work
What is postpartum hemorrhage?
baby: dry and warm, clear airway by suctioning if necessary (no spontaneous breathing, mouth mouth mouth then nares, and begin resuscitation of bay as needed delivery of placenta is nonemergent. package baby up and leave transporting knees up semi-fowler contractions large gush of blood and deliver placenta put pads on women and drive off.
⅓ babies born have arms and legs that are blue
What do you do if the baby is born limp and lifeless?
baby born limp and lifeless- no respiratory effort is noted and blue. dry warm and stimulatte suction clearing airway 30 seconds. make sure airway clear fi no respriatory effort ventilate (dont push too hard on face as it can push them down, assess heart rate anything leess than 100 1 breath every 3 seconds, and if heart rate less than 60 do CPR 3 compressions to ventilation (heart rate on chest and umbilical cords count for 6 second multiple by 10. do not give supplemental oxygen, dont give newborns narcon as it causes severe withdrawal and complications. reassess in 30 seconds.