Medical Emergencies

1
Medical Emergencies
2
Agenda

• Heart Disease
• Stroke
• Diabetes
• Hypoglycemia
• Seizure Disorders
• Substance Abuse

3
Heart Attack

• Signs and symptoms are caused by the lack of
  oxygen to the heart.

4
Heart Attack-Signs and Symptoms

• pain- described as crushing or burning in the
  stomach, chest or between shoulders
• anxiety and fear of death
• respiratory distress
• pale, cold, cyanotic skin
• profuse sweating

5
Heart Attack-Signs And Symptoms

• pulse that is normal, fast, slow, irregular,
  strong or weak
• blood pressure that is abnormal or normal
• patient prefers to sit up
• complications including
• cardiac arrest, cardiogenic shock, pulmonary edema

6
Heart Attack - Emergency Care

• With proper treatment many heart attack victims
  can have many years of useful life.

7
Heart Attack Emergency Care

• perform survey, manage airway, give CPR and
  attend other serious problems
• contact EMS
• keep patient comfortable
• give oxygen at high rate
• calm and reassure patient

8
Heart Attack-Emergency Care

• shield patient from by-standers
• watch for complications and treat as they occur
• monitor and record vital signs

9
Stroke

• A cerebrovascular accident (CVA) is caused by
  interference with the blood supply to a part of
  the brain.

10
StrokeSigns and Symptoms

• normal or high blood pressure
• confusion
• impaired responsiveness
• head and eyes turned to one side
• weakness, paralysis, numbness, and/or tingling on
  one side of the body or occasionally both sides

11
StrokeSigns and Symptoms

• drooping of one side of the face, drooling,
  difficulty in swallowing, and slurred speech
• difficulty with the airway
• visual disturbances and vertigo
• seizures, headaches, or dizziness
• aphasia

12
Stroke-Emergency Care

• provide care for unresponsive patient
• maintain the upper airway
• use suction if needed
• give oxygen at high flow rates
• monitor and record vital signs
• care for seizures

13
Stroke-Emergency Care

• provide care for unresponsiveness if needed
• maintain the patients airway
• use suction as needed
• administer high flow oxygen
• keep the patient lying down in recovery position
  (head and body slightly elevated)

14
Stroke-Emergency Care

• maintain the patients body temperature
• dont give the patient anything by mouth
• care for seizures if they occur
• transport the patient rapidly to the hospital

15
Diabetes

• characterized by an absolute or relative
  deficiency of insulin
• types
• Hypoglycemia
• Diabetic Ketoacidosis

16
Hypoglycemia-Signs and Symptoms

• personality changes, stupor, confusion
• hyperactivity, pale, moist, clammy skin, rapid
  pulse
• headache, hunger, dizziness, and anxiety
• weakness, seizures
• wearing of medical-alert ID

17
Diabetic Ketoacidosis-Signs and Symptoms

• confusion,stupor, or unresponsiveness
• rapid deep respirations
• skin is flushed, dry and warm
• fruity breath odor
• weakness and fatigue
• shock
• medical-alert ID

18
Diabetes-Emergency Care

• same care for Hypoglycemia and Diabetic
  Ketoacidosis

19
Diabetes-Emergency Care

• perform an urgent survey
• assess responsiveness, airway, breathing, pulse,
  and skin
• look for medical-alert tags
• give urgent care as needed
• obtain a diabetes-oriented SAMPLE history

20
Diabetes-Emergency Care

• give sugar (or glucagon) orally if hypoglycemia
  is likely or your not sure
• call for advanced life support
• perform a rapid body survey if the patient is
  unresponsive or critical
• provide general care for unresponsive patient
• feed a recovered hypoglycemic patient

21
Seizure Disorders

• seizures are any sudden transient alteration of
  normal brain function
• epilepsy is a condition characterized by
  recurring seizures

22
Seizures-Emergency Care

• protect the person from injury
• do not restrain the person or put object between
  their teeth
• perform survey once seizure is over
• obtain medical history
• give care for unresponsiveness if needed

23
Seizures-Emergency Care

• assess the patient for injuries
• allow the patient to rest until fully recovered
• advise the person to see a physician if there is
  no history of seizures

24
Carbon Monoxide Poisoning

• carbon monoxide is an odorless, colorless gas
  that is produced by the incomplete combustion of
  carbon-containing substances

25
Carbon Monoxide Poisoning

• carbon monoxide binds with the hemoglobin in
  blood and prevents oxygen from being transported
• it can happen where stoves are used with poor
  ventilation

26
Carbon Monoxide Poisoning-Signs and Symptoms

• dizziness, confused, headache
• partial or complete unresponsiveness
• sudden respiratory arrest
• skin may be pale, blue or pink

27
Carbon Monoxide Poisoning Emergency Care

• remove patient from the contaminated area
• pay attention to your own safety
• give oxygen at high flow rate
• support breathing and give care for
  unresponsiveness if necessary
• transport to hospital

28
Substance Abuse

• the use of mind altering chemicals without a
  legitimate medical purpose
• usually self prescribed and self administered

29
Substance Abuse

• alters the perception of the environment
• use of these chemicals can cause exhilaration,
  tranquility or disorientation

30
Substance Abuse

• can cause addiction or dependence
• the users life revolves around obtaining and
  using the drug

31
Substance Abuse

• the altered state and diminished judgement make
  the individual a risk to him/herself and others

32
Definition

• Drug- a substance that alters physical and or
  mental function when taken into the body

33
Definition

• Tolerance-increasing amounts of a drug are
  required to produce the same result in the body

34
Physical Dependence

• The drug changes body physiology so that stopping
  use causes withdrawal. The symptoms and the
  withdrawal are the opposite of the effect the
  original substance. This makes the addiction
  hard to break since the drug will be taken to
  feel normal.

35
Psychological Dependence

• behavior in which the user continues to take the
  substance despite evidence of physical, mental or
  social harm

36
Addiction

• compulsive use of a substance where the user
  spends increasing amounts of time obtaining and
  using the substance

37
Addiction

• most of the users waking hours may be spent
  obtaining and using the drug
• there may or may not be a physical dependence and
  tolerance

38
Addiction

• the dose of substance gets larger and larger
• addiction is an extreme of drug dependence
• high likelihood of resuming use after withdrawal

39
Drugs

• Designer Drug- modified from its original medical
  use so it is used for recreational purposes
• Poly Drug Abuse - use of more than one drug or
  substance
• use may be planned or accidental.
• can present conflicting signs and symptoms

40
Substance Abuse

• Substance abuse should be suspected in any person
  exhibiting inappropriate behavior or whose normal
  state of responsiveness is altered without
  obvious cause.

• The users may not admit substance abuse.
• Other serious conditions such as diabetic coma,
  head injury epilepsy, can be mistaken for
  substance abuse.

41
Specific Drugs

• Alcohol, Narcotics, Depressants, Stimulants,
  Cannabis, Hallucinogens and Nicotine

42
Alcohol

• the most abused substance in the industrial
  nations
• 10 million alcoholics in the United States

43
Alcohol

• half of the nations traffic fatalities and
  drownings are due to alcohol use
• over 200,000 deaths each year result from alcohol
  use

44
Alcohol

• costs from alcohol abuse are in the billions
  annually
• can cause immeasurable damage at home and in the
  workplace

45
Alcohol

• legal drug and its sale has few restrictions
• moderate use has society approval
• Unfortunately many cannot enjoy alcohol in
  moderation

46
Alcohol

• percentage of alcohol in beverages
• beer 6
• wine 12
• hard Liquor 50

47
Alcohol

• slows the brain and dull senses
• slows reaction times and slows control of
  muscles and nerves
• can have deadly consequences

• chronic use damages the brain, heart, liver and
  other vital organs
• poor appetite and nutrition among alcoholics can
  lead to malnutrition and vitamin deficiencies

48
Fetal Alcohol Syndrome

• alcohol use during pregnancy can have serious
  consequences

• there can be damage to the fetus that would
  include
• mental deficiency
• structural abnormalities
• growth retardation
• small head circumference

49
Alcoholics

• early Intoxication
• excitement
• talkativeness
• aggressiveness
• dilated pupils

• late Intoxication
• disorientation
• slurred speech
• inability to concentrate
• falling, stumbling
• drowsiness
• stupor
• coma

50
Alcoholics

• found at all levels of society
• may deny that they have a problem
• their problem may not always be obvious

51
Alcoholism

• warning signs of the early stage of alcoholism
  include
• morning shakes
• morning drinking
• binge drinking
• red eyes
• secret drinking
• solitary drinking
• blackouts

• hiding alcohol
• have someone else buy
• drinking in isolated places

52
Alcoholism

• warning Signs of the late stages of Alcoholism
  include
• disheveled
• memory loss
• tremors
• jaundice
• chronic indigestion
• chronic diarrhea

53
Withdrawal from Alcohol

• anxiety
• tremors
• nausea
• vomiting
• seizures
• agitation
• hallucinations

54
Narcotics

• seeds of the opium poppy
• synthetically reproduced.
• legitimate medical narcotics
• Morphine, Meperidine, Methadone and Codeine.

55
Narcotics

• the principal illegal narcotic is Heroin
• designer drugs

56
Narcotics

• central nervous and respiratory system
  depressants
• tolerance develops rapidly
• can be smoked, injected or taken orally

• symptoms of use include
• lethargy
• stupor
• slowed pulse, breathing
• low blood pressure
• pinpoint pupils
• nasal stuffiness
• chronic constipation

57
Narcotics Overdose

• may result in
• coma
• respiratory failure

• withdrawal symptoms include
• rapid pulse
• anxiety
• goose bumps
• nausea, vomiting
• shakes
• sniffling, runny nose
• abdominal cramps
• diarrhea

58
Depressants

• legitimate medical uses
• sleep aids
• tranquilizers
• anticonvulsant

59
Depressants

• some cause euphoria and have effects similar to
  alcohol
• they can be divided into two types
• barbiturates
• non- barbiturates

60
Depressants and Analgesics

• barbiturates
• Seconal
• Amytal
• Nembutal
• Phenobarbital

• non- barbiturates
• Quaalude
• Valium
• Xanax

61
Symptoms

• symptoms of overdose include
• drowsiness
• coma
• slow pulse
• slow breathing
• low blood pressure
• seizures

62
Symptoms

• symptoms of withdrawal include
• disoriented
• insomnia
• agitation
• hallucinations
• shock
• seizure

63
Stimulants

• legitimate uses include caffeine, decongestants,
  and asthma drugs
• illegal drugs include cocaine and amphetamines

64
Stimulants

• produce a high and elevate mood
• when the drug wears off the user will be
  depressed, moody and sleepy

65
Stimulants

• may also cause paranoia, disorganization,
  irritability, anxiety, hyperactivity, seizures
  and insomnia

66
Cocaine

• crack is a cheap widely available form of cocaine
  used by smoking
• other forms of cocaine are injected or inhaled

• is highly additive because of the intense high or
  euphoria that it produces
• is one of the most widely abused drugs today

67
Cocaine

• not only highly additive but use can kill

• produces an accelerated heart rate at the same
  time constricting blood vessels
• blood pressure rises and may cause stroke,
  seizures, cardiac arrest or stroke

68
Cocaine

• stuffiness and runny nose are typical of cocaine
  users
• prolonged use may cause disintegration of the
  mucous membrane

• heavy use can cause collapse of the nasal septum

69
Symptoms of Cocaine Use

• heart attack
• stroke
• shock
• gangrene of intestinal system
• cardiac problems
• altered motor activities (tremors, hyperactivity)

• anxiety
• panic
• rapid pulse and respirations
• paranoia
• confusion
• dilated pupils
• hallucinations
• seizures

70
Cocaine

• chronic Cocaine abuse can cause
• neglect of family responsibilities
• ignoring job demands.
• social isolation
• neglect of body needs and hygiene

71
Cocaine

• withdrawal can produce the following symptoms
• exhaustion
• anxiety
• depression

72
Amphetamines

• originally used as a appetite suppressant or mood
  elevator
• very few legitimate medical uses

• cause wakefulness and are sometimes used by
  students while cramming
• can be taken by injection, ingestion or inhalation

73
Amphetamines

• amphetamine examples
• Desoxyn
• Dexedrine
• MDA
• MDMA
• MDEA

• non amphetamine examples
• Ritalin
• Preludin
• Tenuate

74
Symptoms of Amphetamine Use

• altered mental state
• rapid pulse and breathing
• hyperactivity
• tremors
• increased blood pressure
• inability to concentrate
• hallucinations

• anxiety, agitation
• insomnia
• irritability
• excitement
• paranoia
• confusion
• seizures
• coma
• cardiac arrhythmias

75
Stimulants

• withdrawal symptoms are the same as those for
  Cocaine

76
Symptoms of Cannabis Use

• many people do not believe that these are harmful
  substances
• marijuana available today is 275 more potent
  than that available in the 60s

77
Cannabis

• even small amounts can impair memory function,
  decrease motor skills, and impair judgement
• the effects last for 4 to 6 hours after smoking
  of a single cigarette

• the effects are even more pronounced if combined
  with alcohol

78
Cannabis

• symptoms of use
• confusion
• increased pulse
• increased appetite
• impaired memory
• poor coordination
• inability to do complex work
• reddened eyes and dilated pupils

• apathy
• loss of ambition
• loss of effectiveness
• decline in work and school performance
• difficulty concentrating

79
Cannabis

• withdrawal may cause
• anxiety
• loss of appetite
• irritability
• nausea

80
Hallucinogens

• substances that alter perception and produce
  delusions or hallucinations
• individuals may have a distorted perception of
  their physical abilities and try such things as
  flying

81
Hallucinogens

• Common Types
• LSD
• magic mushrooms
• mescaline
• peyote
• morning glory seeds
• STP
• PCP

• Designer Types
• MDMA
• MDA
• MDEA

82
Hallucinogens

• effects include
• euphoria
• paranoia
• hyperactivity
• muscular rigidity
• altered perception
• diminished ability to sense pain
• bizarre behavior

• serious reactions include
• panic
• violent behavior
• suicide attempts
• serious mental disturbance
• psychosis

83
Hallucinogens

• there are no clearly defined effects of
  withdrawal
• there may be occasional flashbacks of the
  behavior shown when on the drug

84
Nicotine and Tobacco

• taken into the system by smoking or chewing
• harmful effects of use are due to cancer causing
  agents found in tobacco

85
Nicotine and Tobacco

• Nicotine effects
• loss of appetite
• improved memory
• reduces aggression
• stimulation

• Tobacco effects
• coronary artery disease
• stroke
• lung disease
• heart disease
• cancer
• osteoporosis
• ulcers

86
Nicotine and Tobacco

• Users of nicotine develop a tolerance and
  dependence on the drug.

• Withdrawal symptoms
• irritability
• anxiety
• restlessness
• difficulty in concentrating

87
Assessment of Patient

• First Impression- Look at the surroundings. Is
  the person sick or injured? Use universal
  precautions.

• Urgent Survey - Is patient responsive? What is
  the level of responsiveness? Open and maintain
  airway. Check pulse, assess chest, pulse,
  abdomen. Check neck and head if unresponsive.

88
Assessment of Patient

• NonUrgent Survey- This is the stage where you
  will determine if substance abuse is the cause.
  Talk to the patient or companions. Get medical
  history.

• Ask the patient what happened. Ask about drugs
  being taken. Assess vital signs.
• Look for signs of substance abuse.

89
Emergency Care-Substance Abuse

• open and maintain the airway
• provide care for unresponsiveness if needed
• monitor and record vital signs
• anticipate vomiting
• support breathing as needed

90
Emergency Care-Substance Abuse

• treat for shock if it develops
• treat for hypothermia or hypothermia
• calm an agitated patient
• treat for convulsions if possible
• stay with patient.
• preserve vomitus, bottles, pills, to send with
  the patient

91
Reference

• Outdoor Emergency Care, Comprehensive Prehospital
  Care for NonUrban Settings. Third Edition Bowman,
  W., National Ski Patrol, 1998