Module 3 Flashcards
(70 cards)
1
Q
Causes of Altered Mental Status (AMS)
A
-Altered mental status can be a life-threating emergency. Do not delay calling EMS
-AMS can be the result of many different things
~Lack of blood flow to brain, lack of oxygen, lack of sugar, electrolyte abnormalities, brain injury, brain swelling, medications/drugs, infection (sepsis), cardiac emergencies, etc.
-The condition we’ll talk about
~Fainting
~Seizures
~Strokes
~Diabetic Emergencies
2
Q
Altered Mental Status (AMS)
A
-Caused by a number of medical conditions/use of alcohol, medications, or drugs
~Significant or unusual change in a person’s personality, behavior, or consciousness
~Indication of a change in brain function
~Warning sign of serious problem and is considered a medical emergency
3
Q
Altered Mental Status (AMS)
-In case of Altered Mental Status
A
- Activate EMS
- Position person for comfort
- Calm and reassure as best you can
- Consider recovery position to protect airway if responsiveness becomes severely diminished
- Reassess regularly until another provider or EMS personnel takes over
- Condition could deteriorate quickly and require additional care
4
Q
Fainting (Syncope, Syncopal Episode, Near-Syncope)
A
-A momentary loss of consciousness due to unexpected drop in blood pressure and blood flow to the brain, caused by
~Anxiety
~Fear
~Pain
~Stress
~Standing in place too long
~Rapid movement such as standing up quickly
~A MEDICATION OR UNDERLYING MEDICAL CONDITIONS
5
Q
Fainting
-If someone complains of suddenly feeling warm, lightheaded, or that vision is narrowing
A
-Quickly lay person flat on his or her back on the ground
-Elevate feet 6-12 inches, allowing blood from legs to move back into body
~DO NOT elevate if it causes pain or you suspect person may be injured
-Fainting is a temporary condition that should pass quickly
-Consider calling EMS
6
Q
Seizures
A
- Excessive electrical discharge from one or a group of neurons
- Frequency increase and eventually involves other neurons
- Electrical discharge travels to the brain stem and spinal cord
- Generally categorized as partial or complete
7
Q
Seizures
-Causes
A
- Epilepsy
- Fever
- Drugs/ ETOH
- Hypoxia (low oxygen)
- Poisonings: pesticides, plants and/ or chemicals
- Electrolyte abnormalities
- Heat Illness
- head Trauma
- Diabetes
- Genetics
8
Q
Seizures
-What you need to know
A
-Usually self-limiting and not life-threatening
-Hypoxia, low blood sugar
-Status Epilepticus
~True Emergency
~More than 5 minutes
~2 or more seizures without regaining consciousness
9
Q
Seizures
-Typical Seizure Progression
A
-Aura Phase ~Alterations in smell, taste, vision -Tonic/Clonic Phases ~Stiffening/jerking of the muscles -Postictal Phase ~Unconscious for several minutes, gradually regaining consciousness. Often confused and exhausted
10
Q
Seizures
-Activate EMS if the person
A
- Is injured or vomits during the seizure
- Has no history of seizures
- Has multiple seizures or continues to seize from more than 5 minutes
11
Q
Seizure
-Most seizures last a short time and stop without any special treatment
A
- Once stopped, place person in recovery position to protect airway
- If responsiveness and breathing is absent, begin CPR and use AED
- Normally, responsiveness improves slowly over time
- Reassure as person improves
- Provide privacy to minimize embarrassment
- DO NOT allow person to preform action that pose rick for additional injury
- Continue to monitor until EMS takes over or person returns to normal
12
Q
Cerebrovascular Accident (CVA)
A
-Is another name for Stroke
13
Q
Stroke Overview
A
-800,000 strokes occur in US Annually
-No. 5 cause of death in US
~133,000 deaths annually
-Leading preventable cause of disability
-11.8% of deaths worldwide
~2nd leading cause of death
14
Q
Stroke Classifaction
A
-Ischemic Stroke ~80% of strokes ~Clot from build-up plaque ~Bester outcomes -Hemorrhagic Stroke ~20% of strokes ~Weakness in the walls of the vessels *Aneurysms
15
Q
CVA
-Risk Factors
A
- Heart Disease
- Arrhythmias
- Diabetes
- High Blood Pressure
- Smoking
- Obesity
- Genetics
16
Q
CVA
-Signs and Symptoms
A
- Unilateral weakness/numbness
- Facial droop
- Slurred speech
- Altered mentation
- Dizziness
- Loss of coordination
- Headache
17
Q
Stroke Assessment
A
- Just remember FAST
- Cincinnati Stroke Scale
- 1 sign = 72% probability
- All 3 = 85% probability
18
Q
FAST
A
-Face ~Does one side of the face droop *Ask the person to smile -Arms ~Is one arm weak or numb *Ask the person to raise both arms ~Does one arm drift downward -Speech ~Is speech slurred *Ask the person to repeat a simple sentence ~Is the sentence repeated correctly -Time ~If the person shows any of these symptoms; Call 911 or get to the hospital immediately
19
Q
Transient Ischemic Attack (TIA)
A
-Sometimes called a "mini stroke" ~Same symptoms as a stroke, but the symptoms resolve ~Treat the same ~Seek immediate medical care ~Patient may still be having a stroke
20
Q
Stroke
A
-Occurs when blood supply to a portion of the brain is suddenly interrupted
-Signs vary depending on location of damage and show up suddenly
~Numbness or weakness of face, arm, or leg
~Confusion
~A change in ability to speak or be understood
~Change in sight and balance
~A sever, sudden headache
21
Q
Stroke
-If you suspect a stroke
A
- DO NOT give food or drink
- Prepare for possibility of sudden cardiac arrest and need for CPR and use of AED
- Person can become frustrated at inability to move or communicate clearly
- Person may appear confused but still be aware of what is happening
- Stay close; calm, comfort, and reassure until another provider or EMS takes over
22
Q
Diabetes
A
-How due cells get “food”
~Food is digested
~Sugar is moved from the intestines into the blood stream
~Insulin is released by the pancreas into the blood stream
~insulin is the “key” that allows glucose to move from the blood stream into the cells
23
Q
Diabetes
-Pathophysiology
A
-The body either does not produce insulin or cannot utilize it
-Cells are not supplied with glucose
-Type of emergencies
~Hypoglycemia (too little)
*Type 1
~Hyperglycemia (too much)
*Type 2
24
Q
Diabetes
-HYPOglycemia
A
-A diabetic takes either too much insulin or does not eat enough after taking it
-Low blood sugar means cells are starving
-Signs and Symptoms
~Headache, fatigue
~Altered mentation
~Cool, pale, diaphoretic skin
~Unresponsive
~Seizures
-ABCs
-Give sugar only
~Juice
~Gatorade
~GU
~Candy
-If able, give something substantial
~PB&J
-It is never appropriate to administer insulin in an emergency setting
-Calm, comfort and reassure the person
-If response to sugar, mental status will improve
-If not response to sugar in 10-15 minutes or condition worsens, activate EMS and provide additional glucose or sugar
25
Diabetes
| -HYPERglycemia
-High blood sugar from not using insulin
-Sign and Symptoms
~Altered mentation
~Dehydration
~Fruity, acetone breath
~Deep, rapid respirations
~Warm, dry skin
26
Respiratory Emergencies
-Can be a chronic or acute problem
~Heart failure, lung disease, asthma, allergic reactions
-Result in a reduced ability to oxygenate blood
-Also an accumulation or carbon dioxide
-The brain and the heart are the most sensitive to change in oxygen and carbon dioxide
-Pediatric individuals are particularly at risk
27
Breathing Difficulty, Shortness of Breath
- DO NOT wait for improvement, activate EMS
- If AED available, have someone get is
- Allow person to find comfortable position
- Loosen tight clothing
- Prepare to provide CPR and use AED if breathing stops
- Reassess regularly until another provider or EMS takes over
28
Asthma
- Reactive airway disease
- Spasm and narrowing of bronchioles
- Swelling or mucus membranes with increased mucus production
- Mucus plug formation due to the drying of the mucus
29
Asthma
| -Signs and Symptoms
- Shortness of breath
- Wheezing, coughing
- Anxious
- Fatigue
- Lethargy
- Apnea (stop breathing)
30
Asthma
| -Management
- ABCs
- Request EMS
- If the person has an inhaler, they should use it
- Works by relaxing the smooth muscle around the bronchioles
- Even if inhaler relieves the symptoms, they can get worse
- Stay with them
- Consider having them seek medical attention
31
What is an allergic reaction?
- Hypersensitivity of our immune system
- In response to an allergen
- Acquired after exposure predictable thereafter
- Inflammatory response
32
Common Allergens
```
-Hymenoptera
~Bees, Wasps, Ants
-Food
~Nuts, Fruits, Eggs, Shellfish
-Drugs
~Penicillin, Salicylates (Aspirin, Pepto), Codeine, Laytex
```
33
Allergens
| -Signs and Symptoms
```
-Skin
~Itchy
~Hives/Urticaria
~Edema (swelling)
-Gastrointestinal
~Nausea/Vomiting
~Diarrhea
~Abdominal pain
-Respiratory
~Swelling of upper/lower airway
-Cardiovascular
~Drop in blood pressure
~Can lead to shock
```
34
Allergic Reaction vs. Anaphylaxis
```
-Allergic Reaction
~May be localized or systemic
-Anaphylaxis
~RAPID progression, lethal allergic reaction
*Throat swelling
*Bronchospasm
*Low blood pressure
```
35
Assssment
```
-Scene size-up
~Additional resources? Evacuation options
-ABCs
-Secondary
~Assess the other systems
~Any medications
~How bad has it been in the past
-Reassess
```
36
Management
```
-EpiPen Autoinjector
~0.3 mg of epinephrine
~If not improvement after 5-10 minutes, 2nd dose should be administered
-Benadryl?
~Not a substitute for epi
-Evacuation
```
37
Some Statistics
| -Cardiac Emergencies
```
-More than 600,000 people die in the US from heart disease every year
~1 in 4 deaths
-735,000 heart attacks a year
-Heart disease include
~Coronary Artery Disease
~Valve Disease
~Arrhythmias
~Heart Failure
```
38
Coronary Artery Disease
-Blockage of the blood supply to the heart over time
-Risk Factors
~Age
~Lifestyle
~Genetics
~Smoking
~High Blood pressure
~Diabetes
39
Acute Coronary Syndrome (ACS)
| -Myocardial Infarction (Heart Attack)
- Complete or near complete occlusion of coronary artery
- Heart muscle DIES (infarction)
- High risk for cardiac arrest and long-term impairment
40
Acute Coronary Syndrome (ACS)
| -Angina Pectoris (Chest pain)
- Partial occlusion of the coronary arteries
- Cardiac chest pain, usually associated with exertion
- Relieves with rest, nitroglycerin
- Not a heart attack, but are at increased risk for one
41
Acute Coronary Syndrome (ACS)
-We cannot differentiate between angina and heart attack
-Signs and symptoms
~Chest Pain (may or may not be present)
~Syncope
~Cool, pale, diaphoretic
~Indigestion
~Nausea and vomiting
42
Acute Coronary Syndrome (ACS)
| -Management
- ABCs
- Be prepared for sudden cardiac arrest
- EMS
- Aspirin*
- Nitroglycerin*
* You are not legally allowed to administer these medications. If the patient has their own, you may assist with them
43
Acute Coronary Syndrome (ACS)
| -A person with previous heart problems is at rick for reoccurrence
- Ask person or any bystanders about prior problems or medications taken
- Better to have EMS transport person to the hospital
- Activate EMS immediately, even if person does not want you to
44
Acute Coronary Syndrome (ACS)
| -While waiting for EMS to arrive
-If AED available, have someone get it
-Allow person to find comfortable position
-Loosen tight clothing
-Calm, comfort, and reassure
-Encourage to chew and swallow 1 adult (325mg), 2 to 4 low-dose (81 mg) "baby" aspirin
~DO NOT encourage if any allergy, evidence of stroke, bleeding problems, pain unrelated to heart, or uncertain or uncomfortable giving aspirin
-If carrying nitroglycerin, assist in self-administration
45
Nitro: A word of Caution
-Be very careful around nitroglycerin
~Causes vasodilation
~Can cause rapid decrease in blood pressure
~Is easily absorbed through the skin
46
Ingested Poisoning
-Poisoning most often occurs by ingestion
-Children under 6 years account for over half of all poisonings
-Most poisoning deaths are accidental
-Common ingested poisons
~Prescribed medications
~Personal care products
~Household cleaning products
47
Ingested Poisoning
| -Effects of ingested poisons are wide ranging and often resemble those of common illnesses
-Symptoms include
~Abdominal pain or cramping
~Nausea
~Vomiting
~Altered mental status
-Often, ingestion is described by the person
-Open and empty containers, unusual smells, and odd staining on clothing, skin, or lips may be present
48
Ingested Poisoning
| -If you suspect a person has ingested something poisonous, act quickly
-Activate EMS if serious signs/symptoms
-Nation Poison Help line, 1-800-222-1222, can provide information regarding immediate treatment
-Help by clearly identifying substance and providing details
-Save vomit, bottles, or containers for EMS
-While waiting for help
~DO NOT give anything by mouth unless advised
~Keep person still
~Reassess regularly
49
Inhaled Poisoning
-Common inhaled poisons include carbon monoxide, natural gas, solvent fumes, and chemical vapors
-Symptoms may include
~Headache
~Nausea
~Dizziness
~Difficulty breathing
~Altered mental status
-If more than one person in an area start experiencing similar symptoms, the scene is unsafe
50
Inhaled Poisoning
| -Suspect whenever someone is working in an enclosed space and is felling ill
-If safe to help
~Move to fresh air
~Help find a comfortable position
~Activate EMS if serious sings/symptoms
~Call national Poison Help Line, 1-800-222-1222
~help identify substance and provide details about incident
~Reassess regularly until another first aid provider or EMS personnel takes over
51
Overdose Fatalities
-The US is experiencing an Opioid Epidemic
-More than 3 out of 5 overdose deaths are from opioids
-Opiates and Opioids include
~Heroin
~Morphine
~Codeine (Hydrocodone, Oxycodone)
~Synthetic Opioids
*Fentanyl
*Carfentanil
52
Opiates
```
-Natural Opioids: Heroin and Morphine
~Created from the opium poppy
~Images of opium poppies date back to 4000BC
~Central Nervous System depressant
~Binds to receptors in the brain
~Extremely addictive
```
53
Opiates
| -Codeine
```
-Oxycodone ~Percocet
~OxyContin
-Hydrocodone
~Vicodin
-Prescription painkillers
~Typically combined with
*Tylenol
*Ibuprofen
*Aspirin
*Also found in cough syrup
-The most commonly taken opiate
-Common cause of drug addition and abuse
```
54
All Opioids and Opiates have similar Effects
```
-Immediate Effects
~Decrease level of consciousness
~Decreased respirations (this typically kills people)
~Decreased cardiac activity
~Constricted pupils
~Nausea/Vomiting
-Long-term Effects
~addiction
~Tolerance
~Dependence
~Risk for infection (injected forms)
~Decreased bone density, high risk for fractures
~Depression, personality changes
```
55
Management of Overdose
-DO NOT get exposed to the drug
-Notify EMS
-Respirator depression is the biggest issue in opiate overdose
~If in cardiac arrest, must provide CPR with rescue breaths
~Narcan (Naloxone) is a medication that reverse the effects or opiates
*Most effective of heroin and morphine
*Less effective on codeine, fentanyl, carfentanil
*Nose spray, autoinjectors
56
Other Overdose and Poisoning Considerations
- Consider poison control if the person looks alright
- If they look unstable (issues breathing, mentation, etc.) call EMS first
- Polysubstance is a big issue and can be challenging to manage
- If person is unresponsive, put them on their side
- Pill identifiers can be helpful
57
Severe Abdominal Pain
-May be a warning sign or serious illness, especially if appears suddenly or is new experience
~May important organs in abdomen
~Variety of problems could occur resulting in intense pain
~Accurately determining underlying cause may be impossible without professional medical assessment
58
Abdominal Pain
-One of the most common complaints in the emergency room
-VERY difficult to diagnose
-Can be benign, can be life-threatening
~Acute Abdomen
59
Abdominal Pain
| -Causes
- Appendicitis
- Abdominal Aortic Aneurysm
- GI Bleed
- Ectopic Pregnancy
- Ulcers
- Bowel Obstruction
- Kidney Stones
- Urinary Track Infection
- Food poisoning
- Irritable Bowel Syndrome
- Constipation
- Excessive Gas
60
Appendicitis
- Appendix is a small appendage that lives between the small and large intestine
- Can become infected
- Must be removed surgically
- If it bursts, patient can go into septic shock
61
Appendicitis
| -Signs and Symptoms
- Shock
- Fever
- Lower Right Quadrant abdominal pain
- Nausea/Vomiting
- Reduced appetite
62
Appendicitis
| -Management
- ABCs
- Shock management
- Evacuate
63
Abdominal Aortic Aneurysm
```
-Abdominal ballooning and weakness of the aorta
~Aorta = largest artery in the body
-Risk Factors
~High Blood Pressure
~Smoking
~Elderly
-Aorta rupture is possible
```
64
Abdominal Aortic Aneurysm
| -Signs and Symptoms
- Abdominal pain (tearing, radiates to back)
- Large, pulsatile mass
- Sings/Symptoms of shock
- Abdominal rigidity
65
Abdominal Aortic Aneurysm
| -Management
- Rapid transport
- ABCs
- EMS
- Manage shock if it develops
66
Abdominal Pain Red Flags
- Sudden, sharp abdominal pain
- Chest, neck, shoulder pain
- Vomiting blood
- Bloody, dark, tarry stool
- Bright red rectal blood
- Rigid hard abdomen
- No bowel movements
- Fever
- Shock
67
Severe Abdominal Pain in Women
-Additional Information
~Is there any possibility that they are pregnant?
~have they had their period?
-Ectopic Pregnancy
~Causes issues in 1st trimester
~Individual may not be aware that they are pregnant
~May result in serious internal bleeding and shock
68
Sever Abdominal Pain in Pregnant Women
-Internal bleeding related to a pregnancy is one cause of abdominal pain
~Light, irregular discharge of blood or spotting is normal
~Significant bleeding, especially late in pregnancy, is a medical emergency
~Severe abdominal cramping and pain can occur
~Skin may become cool, sweaty, pale
~May be weak and lightheaded
69
Sever Abdominal Pain in Pregnant Women
| -If pregnant woman is experiencing these symptoms
- Activate EMS immediately
- Lay mother on left side to improve blood flow
- Have her place sanitary pad over vaginal opening
- Do not insert anything inside vagina
- Treat for shock, help maintain normal body temp
- Do not give anything to eat or drink
- Calm, comfort, and reassure
- Reassess regularly until EMS arrives
70
Severe Abdominal Pain
| -Early suspicion and rapid transport to hospital may help prevent development of life-threating condition
-Abdomen may be rigid or tender to touch
-Person may become nauseated and vomit
-If symptoms seem severe, or unsure
~Activate EMS without delay
~Help person maintain comfortable position
~Calm and reassure until EMS arrives
