MEDICAL EMERGENCIES

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MEDICAL EMERGENCIES

• By Kim Boncoskey EMT-P, RN,TNS

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Objectives

• General medical patient assessment
• Identify and differentiate the signs and
  symptoms of a patient presenting with chest pain
  related to angina, acute myocardial infarction
  acute upper respiratory process, and
  musculoskeletal origins.
• State the appropriate interventional steps to
  take for a patient presenting with chest pain.

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Objectives

• Describe the pathophysiology of insulin shock and
  diabetic ketoacidosis.
• Signs and symptoms of insulin shock and diabetic
  ketoacidosis
• Describe the interventions for the patient with
  hyperglycemia and hypoglycemia
• Participate in a discussion of refusal procedure
• Case review discussion

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Assessment of Medical Patient

• Primary Survey-
• Airway
• Breathing
• Circulation
• Disability/Neurological
• Treat all life threats as found before going on

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Assessment of the Medical Patient

• Secondary
• Basic History-SAMPLE
• Pain- OPQRST
• Exam- Inspect, Palpate, Percuss, Auscultate

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Causes of Chest Pain

• Cardiovascular
• Respiratory
• Gastrointestinal
• Musculoskeletal

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Cardiovascular causes

• Angina Pectoris
• Myocardial Infarction
• Abdominal Aortic Aneurysm

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Angina Pectoris

• Occurs when blood supply to the heart is
  transient
• Atherosclerosis causes changes in the vessel
  walls. These changes cause decreased blood flow
  in and to the heart
• Angina can be brought on by exercise, eating, or
  stress

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Angina Pectoris

• Signs Symptoms of Angina
• Chest pain or pressure
• Pain lasts 3-5 minutes
• Pain that radiates to jaw, back, neck, or ear.
• Weakness
• Diaphoresis
• Nausea and vomiting
• Lightheadedness
• Palpitations

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Angina Pectoris

• Treatment
• IV
• Monitor
• Oxygen
• Aspirin 324 mg by mouth
• Nitro 0.4mg SL repeat q 5 minutes
• Morphine Sulfate 2 mg IVP q 3 minutes as needed
  (Max 10mg )

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Myocardial Infarction

• An imbalance between oxygen supply and demand of
  the heart. Here the lack of oxygen causes cells
  of the heart to be damaged or die.
• Myocardial infarction always begins with
  myocardial ischemia.

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Myocardial Infarction

• Causes
• Arteriosclerosis
• Artery spasm
• Volume overload
• Hypotension
• Hypoxia

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Myocardial Infarction

• Complications after a Myocardial Infarction
• Shock
• Dysrthmia
• CHF
• Aneurysm
• Death

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Myocardial Infarction

• Signs Symptoms
• Chest pain
• Radiation of the pain to jaw, arm, neck, back
• Dyspnea
• Nausea/Vomiting
• Anxiety
• Syncope
• Diaphoresis
• Fatigue
• Weakness
• Dysrhythmia

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Myocardial Infarction

• Treatment
• ASA 324 mg by mouth
• Nitroglycerine 4.0 mg SL may be repeated q 5
  minutes
• Morphine sulfate 2mg IVP may repeat q 3min
• (max 10 mg)
• - Watch of cardiogenic shock. If occurs treat
  with fluids and consider dopamine drip.

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Respiratory Causes of Chest Pain

• Pulmonary Embolism
• Chronic Obstructive Pulmonary Disease

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Pulmonary Embolism

• Is a clot that forms or sticks in the pulmonary
  artery.

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Pulmonary Embolism

• Those at an increased risk of PE are
• Pregnancy
• Prolonged immobilization
• Surgical procedures
• Deep vein thrombosis (DVT)

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Pulmonary Embolism

• Signs Symptoms
• Sudden cardiac arrest
• Dyspnea
• Chest pain
• Weakness
• Pale
• Diaphoretic
• Cough
• Hypotension
• New onset atrial fibrillation

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Pulmonary Embolism

• Treatment
• Monitor
• IV
• O2
• Management is supportive in nature. Treat
  hypotension and rapid transport.

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Chronic Obstructive Pulmonary Diseases COPD

• It is an airflow obstruction due to chronic
  bronchitis, asthma, or emphysema.
• In chronic bronchitis the alveoli are not as
  severely affected as in emphysema. Gas exchange
  is decreased due to mucus production and
  obstruction of alveoli. Can lead to increased CO2
  levels.
• Asthma is a inflammatory process causing
  obstruction of the airway.
• The air sacs of the lungs enlarge and fail to
  function.
• The emphysema patients retain CO2.
• Emphysema patient can be both acidotic and
  hypoxic.

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COPD

• Signs Symptoms
• Cough
• Wheezing
• Cyanosis
• CHF
• Anorexia
• Tachypnea
• Barrel chest
• Decreased breath sounds
• Tripod position to breath

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COPD

• Treatment
• IV
• O2
• Monitor
• Albuterol 2.5 mg/3ml with 6 l/min o2
• Consider conscious sedation and intubation for
  severe distress.

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Abdominal Aortic Aneurysm

• Dilation of a blood vessel
• Dilation of vessel can rapidly lead to a vessel
  rupture
• Caused by atherosclerotic changes in the vessel

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Abdominal Aortic Aneurysm

• Signs and Symptoms
• Sudden pain to chest, flank, back
• Hypotension
• Urge to defecate
• Pale
• Diaphoretic
• Discomfort to legs
• Impending feeling of doom

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Abdominal Aortic Aneurysm

• Treatment-
• Routine medial care
• Vomiting Precautions
• Fluid challenge if unstable BP
• Rapid Transport

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Gastrointestinal causes of Chest Pain

• Pancreatitis
• Gastritis and Peptic Ulcer Disease
• Gastroesophageal Reflux Disease

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Pancreatitis

• Inflammatory process of the pancreas
• Auto digestion of the gland by enzymes
• Hyperglycemia due to organ failure
• Pain

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Pancreatitis

• Signs Symptoms
• Epigastric pain
• Nausea and vomiting
• Fever
• Tachycardia
• Hypotension
• Hyperglycemia
• Jaundice
• Weakness
• Syncope
• Abdominal Distension

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Pancreatitis

• Treatment-
• Acute abdominal pain protocol
• Routine medical care
• Vomiting precautions
• Menstrual history in females
• Consider cardiac etiology

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Gastritis and Peptic Ulcer Disease

• Caused by the following
• Too much acid production in the body
• Bacterial infection
• Over use of medications such as ibuprofen

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Gastritis and Peptic Ulcers

• Signs Symptoms-
• Abdominal pain
• Back pain
• Pain after eating meals
• Fatigue
• GI bleeding
• Hypotension
• Tachycardia
• Fever

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Gastritis and Peptic Ulcers

• Treatment-
• Routine medical care
• Vomiting precautions
• Menstrual history in females
• Consider cardiac etiology
• Fluid challenge in 200 ml if unstable blood
  pressure
• Transport

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Gastroesophageal Reflux Disease GERD

• Caused by reflux of acid into the esophagus from
  the stomach
• Can be due to anatomical strictures

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GERD

• Signs Symptoms
• Heartburn
• Regurgitation
• Dysphagia- patient feels the food is stuck

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GERD

• Treatment
• Routine medical care
• Vomiting precautions
• Position of comfort
• Consider cardiac etiology
• Fluid challenge if Blood pressure unstable
• Transport

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Musculoskeletal Causes of Chest Pain

• Costochondritis
• Herpes Zoster- shingles

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Musculoskeletal Injuries and Illness

• Due to injury to chest wall
• Due to inflammation of chest wall
• Due to viral or bacterial infection of chest wall

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Musculoskeletal illness

• Signs Symptoms
• Pain is reproducible
• Pain with movement
• Fever
• Rash
• History of injury to chest

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Musculoskeletal Injuries and Illness

• Treatment
• All treatment is supportive in nature.
• Routine medical care
• Continual pulse oximeter
• Morphine Sulfate 2 mg IVP (max 10 mg.)
• Transport
• Consider cardiac etiology

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Diabetes

• Type 1- insulin dependent, young onset
• Type 2- oral medications, may take insulin as
  disease progresses, adult onset
• Pancreas fails to produce adequate insulin in the
  body.
• Body without insulin can not use sugar
• 140 Hyperglycemia

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Diabetic Coma

• Hyperglycemia
• Gradual
• Too much food
• Too little insulin
• Stress to body
• Infection

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Insulin Shock

• Hypoglycemia
• Sudden
• Too little food
• Too much insulin
• Extra activity

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Diabetic Emergencies

• Routine medical care
• History of illness/medication use
• BS unable to establish IV. If no response repeat
  dextrose 50ml IVP.
• BS 200 fluid challenge .9 NS 200cc

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What if ?

• If you are unable to determine the blood sugar of
  a known diabetic patient?
• You can administer Dextrose or glucagon.
• Make sure the line is good and functional.
  Dextrose is necrotic to tissue if it infiltrates.

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Refusals

• Patient assessment needs to be documented
• Care needs to be explained
• Form to be completed on backside
• Appropriate signatures secured

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Questions