MEDICAL EMERGENCIES

Heart attack

A general term used to indicate a failure of circulation to the heart muscle that damages or kills a portion of the heart

Signs & symptoms Early symptoms are often mistaken for indigestion As an attack worsens, pain originates behind the

sternum & radiates to either of the upper extremities (usually left) with pain radiating to the shoulder, arm & elbow. In some cases, the pain may extend down the limb to the little finger

Shortness of breath Nausea Pain last throughout the attack Patient usually remains still Pain may diminish when physical or emotional stress

ends or when nitroglycerin is taken

Additional signs may include

Sweating, increase pulse rate, and on rare occasions, shock-level blood pressure.

Patients who have taken repeated dosages of nitroglycerin may have low blood pressure as a result of blood vessel dilation

Emergency care Provide emotional support-keep the patient

calm and reassured Keep the patient at rest-do not allow the

patient to move himself Place the patient in a restful, comfortable

position Ensure open airway Cover to conserve body heat, but do not allow

overheating Find out if patient takes nitroglycerin and

when was the last dose was taken and how much was taken over what period of time

Emergency care Contact medical facility and let them

know: You had patient with chest pain Patient’s history When last medicated

Assist the patient with prescribed dose of medication (nitroglycerin)

Do not leave the patient unattended Monitor vital signs

STROKE (Cerebrovascular Accident – CVA)

The blocking or bursting of a vessel that supplies blood to the brain. A portion of the brain is damaged or killed by this event

Cerebral Thrombosis

Blockage in arteries supplying oxygenated blood will result in damage to the affected parts of the brain

Cerebral Hemorrhage

An aneurysm or other weakened part of an artery ruptures . This has two effects: An area of the brain is deprived of

oxygenated blood Pooling of blood puts increased pressure on

the brain, displacing tissue ands interfering with function. It is often associated with arteriosclerosis and hypertension

Signs and Symptoms - CVA

Headache Confusion and / or dizziness Loss of function or paralysis of extremities (usually on one side

of the body) Numbness (usually limited on one side of the body) Collapse Facial droop Impaired or slurred speech Unequal pupil size Impaired vision Rapid pulse Difficulty respiration, snoring Nausea Convulsion Coma Loss of bladder and bowel control

Emergency care Ensure open airway Keep the patient calm Monitor vital signs Give nothing by mouth Treat for shock Properly position the patient

DIABETIC EMERGENCIESDIABETIC EMERGENCIES

IntroductionIntroduction

Sugar is required in the body for Sugar is required in the body for nourishment. Insulin is a hormone that nourishment. Insulin is a hormone that helps the body use the sugar. When the helps the body use the sugar. When the body does not produce enough Insulin, body does not produce enough Insulin, body cells do not get the needed body cells do not get the needed nourishment and diabetes results. nourishment and diabetes results.

People with this condition take Insulin to People with this condition take Insulin to keep their diabetes under control. keep their diabetes under control.

Diabetes Diabetes

Usually refers to diabetes mellitus. This Usually refers to diabetes mellitus. This is the condition in which there is a is the condition in which there is a decrease or absence of insulin produced decrease or absence of insulin produced by the pancreas. The glucose level of by the pancreas. The glucose level of the blood will increase movement of the blood will increase movement of this sugar into the cells will decrease as this sugar into the cells will decrease as the insulin level failsthe insulin level fails

Diabetics are subject to two Diabetics are subject to two very different types of very different types of emergencies: emergencies:

Insulin ShockInsulin Shock Severe hypoglycemia. A form of shock Severe hypoglycemia. A form of shock

usually caused by too high level of usually caused by too high level of insulin in the blood, producing a sudden insulin in the blood, producing a sudden drop of blood sugar. The causes are too drop of blood sugar. The causes are too much insulin injected by diabetic or too much insulin injected by diabetic or too little food taken in for the amount of little food taken in for the amount of insulin injected or produced by insulin injected or produced by medication medication

SIGNS & SYMPTOMS:SIGNS & SYMPTOMS:

Rapid onset of signs and symptoms, over a Rapid onset of signs and symptoms, over a period of minutesperiod of minutes

Dizziness and headacheDizziness and headache Abnormal, hostile or aggressive behavior, Abnormal, hostile or aggressive behavior,

which may be diagnosed as cute alcoholic which may be diagnosed as cute alcoholic intoxicationintoxication

Fainting, convulsions, and occasionally comaFainting, convulsions, and occasionally coma Full rapid pulseFull rapid pulse Patient intensely hungryPatient intensely hungry Skin pale, cold clammy; perspiration may be Skin pale, cold clammy; perspiration may be

profuseprofuse

Diabetic ComaDiabetic Coma Severe hyperglycemia. The sugar Severe hyperglycemia. The sugar

(glucose) level increases in the blood (glucose) level increases in the blood and decreases in the tissue cells. The and decreases in the tissue cells. The problem can be serious enough to problem can be serious enough to produce comaproduce coma

SIGNS AND SYMPTOMS:SIGNS AND SYMPTOMS:

Gradual onset of signs & symptoms more Gradual onset of signs & symptoms more slowly than Insulin shock, sometimes over a slowly than Insulin shock, sometimes over a period of days. period of days.

Patient complains of dry mouth & intense thirstPatient complains of dry mouth & intense thirst Abdominal pain and vomiting commonAbdominal pain and vomiting common Gradually increasing restlessness & confusionGradually increasing restlessness & confusion Coma, with this signsComa, with this signs

Signs of air hungerSigns of air hunger Weak, rapid pulseWeak, rapid pulse Dry, red, warm skinDry, red, warm skin Eyes that appear sunkenEyes that appear sunken Breath smells of acetoneBreath smells of acetone

Emergency care for Emergency care for Insulin shock and Diabetic Insulin shock and Diabetic ComaComa Looking for the signs and symptoms listed above will Looking for the signs and symptoms listed above will

help to distinguish the two diabetic emergencies. In help to distinguish the two diabetic emergencies. In addition, if the patient is conscious, you can ask two addition, if the patient is conscious, you can ask two very important questions which will help determine very important questions which will help determine the nature of the problem: the nature of the problem:

ASK ASK "HAVE YOU EATEN TODAY?""HAVE YOU EATEN TODAY?" Someone who has Someone who has eaten, but has not taken prescribed medication may eaten, but has not taken prescribed medication may be in a diabetic coma. ASK be in a diabetic coma. ASK "HAVE YOU TAKEN YOUR "HAVE YOU TAKEN YOUR MEDICATION TODAY?"MEDICATION TODAY?" Someone who has not eaten, Someone who has not eaten, but did take their medication, may be having an but did take their medication, may be having an Insulin shock. DISTINGUISHING BETWEEN THE TWO Insulin shock. DISTINGUISHING BETWEEN THE TWO TYPES OF DIABETIC EMERGENCIES CAN BE TYPES OF DIABETIC EMERGENCIES CAN BE DIFFICULT. DIFFICULT.

(Always look for an identifying bracelet which may (Always look for an identifying bracelet which may reveal a person's condition) reveal a person's condition)

Emergency care for Emergency care for Insulin shock and Diabetic Insulin shock and Diabetic ComaComa

OF THE TWO CONDITIONS, INSULIN SHOCK IS A OF THE TWO CONDITIONS, INSULIN SHOCK IS A TRUE EMERGENCY WHICH REQUIRES PROMPT TRUE EMERGENCY WHICH REQUIRES PROMPT ACTION!ACTION!

A PERSON IN INSULIN SHOCK NEEDS SUGAR, A PERSON IN INSULIN SHOCK NEEDS SUGAR, QUICKLY! IF THE PERSON IS CONSCIOUS, GIVE QUICKLY! IF THE PERSON IS CONSCIOUS, GIVE SUGAR IN ANY FORM: CANDY, FRUIT JUICE OR A SUGAR IN ANY FORM: CANDY, FRUIT JUICE OR A SOFT DRINK!SOFT DRINK!

SUGAR GIVEN TO A PERSON IN INSULIN SHOCK CAN SUGAR GIVEN TO A PERSON IN INSULIN SHOCK CAN BE LIFE-SAVING! IF THE PERSON IS SUFFERING BE LIFE-SAVING! IF THE PERSON IS SUFFERING FROM DIABETIC COMA, THE SUGAR IS NOT FROM DIABETIC COMA, THE SUGAR IS NOT REQUIRED BUT WILL NOT CAUSE THEM FURTHER REQUIRED BUT WILL NOT CAUSE THEM FURTHER HARM.HARM.

TRANSPORT TO A MEDICAL FACILITY IMMEDIATELYTRANSPORT TO A MEDICAL FACILITY IMMEDIATELY

Hyperglycemia Hypoglycemia

Onset Slow RapidSkin Warm, Dry, Red Cool, Pale, moistBreath Acetone NormalRespirations “Kussmaul’s” Rapid, Shallow

Distinguishing Factors:

Hyperglycemia and Hypoglycemia

Poisoning and Poisoning and Substance Substance AbuseAbuse

Poison Any substance whose chemical action can

damage body structures or impair body functions

Substance Abuse The knowing misuse of any substance to

produce a desired effect

How poison gets into the How poison gets into the bodybody

DigestedDigested InhaledInhaled InjectedInjected Contact or AbsorbedContact or Absorbed

Identifying the Patient and the Poison

If you suspect poisoning, ask the patient the following questions:

What substance did you take? When did you take it or (become

exposed to it)? How much did you ingest? What actions have been taken? How much do you weigh?

Determining the Natureof the Poison Take suspicious materials,

containers, vomitus to the hospital. Provides key information on:

Name and concentration of the drug Specific ingredients Number of pills originally in bottle Name of manufacturer Dose that was prescribed

Can you identify the Can you identify the poison?poison?

Ingested Poison Poison enters the body by mouth. Accounts for 80% of poisonings May be accidental or deliberate Activated charcoal will bind to

poison in stomach and carry it out of the body.

Assess ABCs.

For poisoning by For poisoning by swallowing:swallowing:

Signs and symptomsSigns and symptoms Burns and stains around the patient’s mouthBurns and stains around the patient’s mouth Unusual breath and body odors at the patients Unusual breath and body odors at the patients

clothingclothing Abnormal breathing and pulse rate & characterAbnormal breathing and pulse rate & character Sweating, nausea, vomiting and diarrhea Sweating, nausea, vomiting and diarrhea Excessive saliva formation or foaming on the Excessive saliva formation or foaming on the

mouthmouth Stomach or abdominal painStomach or abdominal pain Altered mental statusAltered mental status

For poisoning by For poisoning by swallowing:swallowing:

Check and monitor the victim's airway, Check and monitor the victim's airway, breathing and circulationbreathing and circulation.. If necessary, begin If necessary, begin rescue breathing and rescue breathing and CPR.

Try to make sure that the victim has indeed Try to make sure that the victim has indeed been poisonedbeen poisoned.. It is not always obvious. It is not always obvious. Some signs include chemical-smelling Some signs include chemical-smelling breath, breath, burns around the mouth, difficulty breathing, vomiting, or unusual odors on the victim. If possible, identify the poison.

Only induce vomiting if the poison control Only induce vomiting if the poison control center tells you to do so. center tells you to do so.

For poisoning by For poisoning by swallowing:swallowing: If the victim vomits, protect the airway.If the victim vomits, protect the airway. If you If you

must clear the victim's airway, wrap a cloth must clear the victim's airway, wrap a cloth around your fingers before cleaning out his or her around your fingers before cleaning out his or her mouth and throat. If the victim has vomited a mouth and throat. If the victim has vomited a plant part, save the vomitus as it may allow plant part, save the vomitus as it may allow identification by an expert who can then identification by an expert who can then determine an antidote. determine an antidote.

Reassure the victim and keep him or her Reassure the victim and keep him or her

comfortable.comfortable. Position the victim on their left side Position the victim on their left side while getting or awaiting medical help. Stomach while getting or awaiting medical help. Stomach is located at the upper left quadrant. If the poison is located at the upper left quadrant. If the poison has spilled on the victim's clothes, remove the has spilled on the victim's clothes, remove the clothing and flush the skin with water. clothing and flush the skin with water.

Inhaled Poisons Wide range of effects

Some inhaled agents cause progressive lung damage.

Move to fresh air immediately. All patients require immediate

transport.

For inhalation For inhalation poisoning:poisoning:

Shortness of breathShortness of breath CoughingCoughing Pulse rate too fast or too slowPulse rate too fast or too slow DizzinessDizziness

For inhalation For inhalation poisoning:poisoning: Call for emergency helpCall for emergency help.. Never attempt Never attempt

to rescue a victim without notifying to rescue a victim without notifying others first. others first.

If it is safe to do so, rescue the victim If it is safe to do so, rescue the victim from the danger of the gas, fumes, or from the danger of the gas, fumes, or smokesmoke.. Hold a wet cloth over your nose Hold a wet cloth over your nose and mouth. Open windows and doors to and mouth. Open windows and doors to remove the fumes. remove the fumes.

Take several deep breaths of fresh air, Take several deep breaths of fresh air, then hold your breath as you go in. then hold your breath as you go in.

For inhalation For inhalation poisoning:poisoning: Avoid lighting a match as some gases may Avoid lighting a match as some gases may

ignite. ignite. After rescuing the victim from danger, After rescuing the victim from danger,

check his or her airway, breathing, and check his or her airway, breathing, and circulation. If necessary, perform rescue circulation. If necessary, perform rescue breathing and breathing and CPR.

If the victim vomits, protect his or her If the victim vomits, protect his or her airway. airway.

Even if the victim seems perfectly fine, get Even if the victim seems perfectly fine, get medical help. medical help.

Absorbed Poisons Many substances will damage the

skin, mucous membranes, or eyes. Substance should be removed from

patient as rapidly as possible. If substance is in the eyes, they

should be irrigated. Do not irrigate with water if

substance is reactive.

For absorbed poisoningFor absorbed poisoning

Signs and symptomsSigns and symptoms Skin reactionsSkin reactions ItchingItching Eye irritationEye irritation HeadacheHeadache Increased skin temperatureIncreased skin temperature Allergy shockAllergy shock

For absorbed poisoningFor absorbed poisoning

Emergency care for absorbed Emergency care for absorbed poisoning includes moving the patient poisoning includes moving the patient from the source of the poison when from the source of the poison when safe to do so and immediately safe to do so and immediately flooding with water all the areas of the flooding with water all the areas of the patient’s body that have been patient’s body that have been exposed to the poison. Remove exposed to the poison. Remove contaminated clothingcontaminated clothing

Injected Poisons

Usually result of drug overdose Impossible to remove or dilute

poison once injected Prompt transport

For injected poisoningFor injected poisoning

Signs and symptomsSigns and symptoms Noticeable stings or bites to the skinNoticeable stings or bites to the skin Puncture marks to the skinPuncture marks to the skin Pain around the wound sitePain around the wound site ItchingItching Weakness and dizziness or collapseWeakness and dizziness or collapse Difficult breathing and unusual pulse rateDifficult breathing and unusual pulse rate Headache and nauseaHeadache and nausea Allergy shockAllergy shock

For injected poisoningFor injected poisoning

Provide care for shockProvide care for shock Scraping away bee and wasp stingers and Scraping away bee and wasp stingers and

venom sacs- do not pull stingers, always venom sacs- do not pull stingers, always scrape them from the skinscrape them from the skin

Place an ice bag or cold pack over the Place an ice bag or cold pack over the bitten area or stung areabitten area or stung area

Specific Poisons Tolerance

Need for increased amount of drug to have same desired effect

Addiction Overwhelming desire or need to

continue using an agent

Alcohol (1 of 3)

Most commonly abused drug in the US

Kills more than 200,000 people a year

Alcohol is a powerful CNS depressant.

Acts as a sedative and hypnotic

A person that appears intoxicated may have a medical problem.

Alcohol (2 of 3)

Intoxicated patients should be transported and seen by a physician.

If patient shows signs of serious CNS depression, provide respiratory support.

A patient with alcohol withdrawal may experience delirium tremors (DTs).

Alcohol (3 of 3)

Patients with DTs may experience: Agitation and restlessness Fever Sweating Confusion and/or disorientation Delusions and/or hallucinations Seizures

Opioids (1 of 2)

Drugs containing opium Most of these, such as codeine,

Darvon, and Percocet, have medicinal purposes.

The exception is heroin, which is illegal.

Opioids are CNS depressants causing severe respiratory distress.

Opioids (2 of 2)

Care includes supporting airway and breathing.

You may try to wake patients by talking loudly or shaking them gently.

Always give supplemental oxygen and prepare for vomiting.

Sedative-Hypnotic Drugs These drugs are CNS depressants

and alter level of consciousness.

Patients may have severe respiratory depression and even coma.

The main concern is respiratory depression and airway clearance, ventilatory support, and transport.

Abused Inhalants (1 of 2)

Common household products inhaled by teenagers for a “high”

Effects range from mild drowsiness to coma

May often cause seizures

Abused Inhalants (2 of 2)

Patient is at high risk for sudden cardiac arrest.

Try to keep the patients from struggling or exerting themselves.

Give oxygen and use a stretcher to move patient.

Prompt transport is essential.

Sympathomimetics CNS stimulants cause hypertension,

tachycardia, and dilated pupils. Amphetamine and

methamphetamine are commonly taken by mouth.

Cocaine can be taken in may different ways. Can lead to seizures and cardiac

disorders Be aware of personal safety.

Marijuana Smoked by 20 million people daily in

the US Produces euphoria, relaxation, and

drowsiness Impairs short-term memory and

ability to work Transport to hospital is rarely

needed. Marijuana can be used as vehicle for

other drugs, ie, it can be covered with PCP or crack.

Hallucinogens (1 of 2)

Alter an individual’s sense of perception

LSD and PCP are potent hallucinogens.

Sometimes, people experience a “bad trip.”

Patient typically are hypertensive, tachycardic, anxious, and paranoid.

Hallucinogens (2 of 2)

Use a calm, professional manner and provide emotional support.

Only restrain if danger of injury exists.

Watch the patient carefully during transport.

Aspirin Signs and symptoms

Nausea/vomiting Hyperventilation Ringing in ears Confusion Seizures

Patients should be transported quickly to the hospital.

Food Poisoning Salmonella bacterium causes severe

GI symptoms within 72 hours.

Staphylococcus is a common bacteria that grows in foods kept too long.

Botulism often results from improperly canned foods.

Care for Food Poisoning Try to obtain as much history as

possible.

Transport patient to hospital promptly.

If two or more persons have the same illness, bring some of the suspected food to the hospital, if possible.

Plant Poisoning Several thousand cases of plant

poisonings occur each year. If you suspect plant poisoning:

Assess the patient’s airway and vital signs.

Notify poison control center. Take the plant to the emergency

department. Provide prompt transport.

Poisoning don'ts Poisoning don'ts

DO NOT give an DO NOT give an unconscious victim anything by mouth.

DO NOT induce DO NOT induce vomiting unless you are told to do so by the Poison Control Center or a doctor. A strong poison that burns on the way down the throat will also do damage on the way back up.

DO NOT try to neutralize the poison with lemon DO NOT try to neutralize the poison with lemon juice or vinegar, or any other substance, unless you juice or vinegar, or any other substance, unless you are told to do so by the Poison Control Center or a are told to do so by the Poison Control Center or a doctor. doctor.

DO NOT use any "cure-all" type antidote. DO NOT use any "cure-all" type antidote. DO NOT wait for symptoms to develop if you DO NOT wait for symptoms to develop if you

suspect that someone has been poisoned. suspect that someone has been poisoned.

Respiratory DisordersRespiratory Disorders

Respiratory distress- any Respiratory distress- any difficulty in breathingdifficulty in breathing

Chronic obstructive Chronic obstructive pulmonary disease (COPD)- a pulmonary disease (COPD)- a variety of lung problems variety of lung problems related to disease of air related to disease of air passageways or exchanging passageways or exchanging levels. Patient will suffer levels. Patient will suffer difficulty in breathing difficulty in breathing

Respiratory DistressRespiratory Distress

Signs & symptomsSigns & symptoms Difficulty breathing & shortness of breathingDifficulty breathing & shortness of breathing Rapid & deep noisy breathingRapid & deep noisy breathing Faintness of unconsciousnessFaintness of unconsciousness Stabbing chest painsStabbing chest pains Restlessness & dizzinessRestlessness & dizziness Strained muscles on face, neck, chest, & Strained muscles on face, neck, chest, &

abdomenabdomen Blue discoloration (cyanosis)Blue discoloration (cyanosis)

Emergency care for respiratory Emergency care for respiratory distressdistress

Ensure an open airway. Check for Ensure an open airway. Check for airway obstructionairway obstruction

Check if the patient is allergic to Check if the patient is allergic to anything to the scene ( remove anything to the scene ( remove substance or move the patient)substance or move the patient)

Keep patient at rest. Conscious patient Keep patient at rest. Conscious patient may desire to sit uprightmay desire to sit upright

Monitor patient and provide emotional Monitor patient and provide emotional supportsupport

Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD)(COPD)

Signs & symptomsSigns & symptoms History of respiratory problems or allergiesHistory of respiratory problems or allergies Shortness of breathingShortness of breathing CoughCough Swelling of lower extremities (advanced cases)Swelling of lower extremities (advanced cases) DizzinessDizziness Rapid pulseRapid pulse Blue discoloration (cyanosis)Blue discoloration (cyanosis) Desire to sit upright at all times. May use hands or Desire to sit upright at all times. May use hands or

elbows to push up on chair armselbows to push up on chair arms

Emergency care for COPDEmergency care for COPD

Ensure an open airway. Check for Ensure an open airway. Check for airway obstructionairway obstruction

Check if the patient is allergic to Check if the patient is allergic to anything to the scene ( remove anything to the scene ( remove substance or move the patient)substance or move the patient)

Keep patient at rest. Conscious patient Keep patient at rest. Conscious patient may desire to sit uprightmay desire to sit upright

Monitor patient and provide emotional Monitor patient and provide emotional supportsupport

HyperventilationHyperventilation

UncontrolledUncontrolled rapid, deep breathing that rapid, deep breathing that is usually self-correcting. This may occur is usually self-correcting. This may occur by itself or a sign of a more serious by itself or a sign of a more serious problemproblem

Emergency careEmergency care Have the hyperventilating patient Have the hyperventilating patient

breathe into a paper bag (not plastic). breathe into a paper bag (not plastic). The bag should be positioned over the The bag should be positioned over the patient’s mouth and nose so that the patient’s mouth and nose so that the patient rebreathes exhaled airpatient rebreathes exhaled air

Seizures Seizures

In general, any event in the brain that In general, any event in the brain that causes uncontrolled muscles causes uncontrolled muscles contractions (convulsions)contractions (convulsions)

Most common kind is epilepsyMost common kind is epilepsy Two kinds of seizureTwo kinds of seizure

Grand mal- produce visible convulsionsGrand mal- produce visible convulsions Petit mal- do not produce convulsions or no Petit mal- do not produce convulsions or no

reactionsreactions

SeizuresSeizures

Signs & symptomsSigns & symptoms Sudden loss of consciousness with the patient falling Sudden loss of consciousness with the patient falling

in the groundin the ground Patient may report a bright light, colors or sensation Patient may report a bright light, colors or sensation

of strong odor prior to losing consciousnessof strong odor prior to losing consciousness UrinaryUrinary incontinenceincontinence Convulsions jerking all parts of the bodyConvulsions jerking all parts of the body After convulsions, the patient’s body completely After convulsions, the patient’s body completely

relaxesrelaxes Patient becomes conscious, but very tired & Patient becomes conscious, but very tired &

confused & may complain of headacheconfused & may complain of headache

Emergency careEmergency care

Remove any objects that might cause injuries to the patient or remove the patient from the dangerous situation

Turn the patient onto his side after the fit has finished. Loosen tight clothing Do not force the patient’s mouth to open w/ any hard

objects as this may cause more damage than tongue biting.

Do not put anything in the mouth. Seizures that lasts longer than five minutes requires

medical assistance Protect the patient from embarrassment by asking

onlookers to give the patient some privacy