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Lesson Medical and Behavioral Emergencies

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									Medical and Behavioral
    Emergencies
               Medical Emergencies
   Medical emergencies are sometimes like solving
    a medical mystery!

   Responders need to think about:
       What is the possible problem?
       What are the possible causes?
       When did the condition begin to develop?
            Acute – Diabetes, heart attack
            Chronic – Diabetes, COPD (respiratory distress),
             hypothermia?
     Links in the Chain of Survival
Citizen Response

    Rapid activation of EMS

                    EMR

                    Advanced out-of Hospital care


                                 Hospital care


                                           Rehabilitation
          Responding to Emergencies
1.        Survey the scene               5.   Provide intervention
     1.      BSI                              1.   Keep the victim comfortable
     2.      Nature of illness                2.   Treat for shock
     3.      # of victims                     3.   Supplemental oxygen
     4.      Need for additional
             resources                        4.   Other care as necessary
     5.      Scene safety                6.   On going assessment
2.        Conduct an initial                  1.   5 minutes vs. 15 minutes
          assessment
     1.      Form a general impression
            1.   Sick or Not Sick
            2.   Ill or injured
            3.   Gender and age
     2.      Assess the LOC (AVPU)
     3.      ABC
3.        SAMPLE and Physical Exam
4.        Summon advanced care
     General Signs and Symptoms of
          Medical Emergencies

   Change in level of
    consciousness (AMS)
   Headache/light-
    headed, dizzy/weak
   Nausea/vomiting
   Change in
    breathing/pulse/skin
    temperature, color,
    moisture
   Video
       Medical Emergencies
      General Care for a Victim of an
          Altered Mental Status
   Do initial assessment, physical
    exam, and SAMPLE history as
    needed.
   Elevate legs
   Do ongoing assessment
   Check airway; put unconscious
    victims in recovery position.
   Loosen any restrictive clothing.
   Do not give victim anything to
    eat.
   Have suction equipment
    available.
   Summon more advanced
    medical personnel.
   Reassure victim.
         Specific Medical Conditions
   AMS occurs due to:
       Fever
       Infection
       Poisoning, including substance
        abuse or misuse.
       High or low blood sugar or
        insulin reactions
       Head injury
       Any condition that results in
        decreased blood flow to the
        brain
       Conditions resulting from
        mental, emotional, or behavioral
        disorders
       AMS Video
               Altered Mental Status
                                     Fainting

   Syncope
       A sudden and brief LOC not associated with a head injury

   Simple fainting is a common and usually a benign sign of
    hypoperfusion (shock) that can have either a physical or
    emotional cause
       Pooling of blood in the lower extremity when the blood vessels
        dilate 3-4x the normal size
            Therefore, fainting happens when the brains blood flow decreases
             because the nervous system caused a dilation of the blood vessels
             Altered Mental Status
                                 Fainting

   May be caused by unpleasant sight usually, usually when
    in the upright position

   May occur because of low blood sugar, dehydration, heat
    exhaustion (causes a pooling of blood from standing in the
    sun)

   Summons more advanced help when:
       Repeated attacks of unconsciousness occur
       DOES NOT regain consciousness quickly
       Faints for no reason or losses consciousness while sitting
             Altered Mental Status
                      Fainting

   Dizziness             1.   Check and monitor ABC;
   Weakness              2.   Loosen tight clothing; Elevate
   Seeing spots               legs
                          3.   Check for signs of injury
   Visual blurring
                          4.   Put victim in recovery position;
   Nausea
                          5.   After recovery, have victim sit
   Pale skin                  in a comfortable position
   Sweating              6.   Move slowly to an upright
                               position
                          7.   Consider referral to MD for
                               more serious problem
            Altered Mental Status
                            Seizures


   The brain controls all activities with the body through a
    complex interaction of messages from specialized cells

   When the brain becomes irritated, it creates confusing
    messages, resulting in confusion, LOC, or repeated
    involuntary muscle contractions known as a seizure

   A seizure is NOT a disease, but rather a sign of some
    underlying defect, injury, or disease
             Altered Mental Status
                       Types of Seizures


   Think of the brain as a “circuit board” with
    electrical pathways
   If a bucket of water is poured over the circuit
    board, the circuit board stops working
   When the brain’s “electrical circuit” malfunctions,
    owing to a short in the brain, the patient
    experiences a seizure
       Isolated malfunctions = partial seizures
       Systemic malfunctions = generalized seizure
                Altered Mental Status
                                    Seizures


   Types of seizures
       Tonic-clonic (grand Mal, generalized motor
        seizures)
            Characterized by an aura, LOC, muscle contractions (tonic phase
             lasting 2-5 minutes), LOBF (clonic phase), & mental confusion,
             followed by deep sleep, headache, and muscle soreness (postictal)
       Absence (petit mal)
            Characterized by blank stare, lasting only a few seconds (1-10 s),
             no dramatic activity, individuals may stare into space, may go
             unnoticed by individuals
       Partial (focal motor)
            Tingling, stiffening, or jerking in just one part of the body, NO
             LOC
           Altered Mental Status
                  Caring for A Tonic-Clonic

Active Seizure                  Post seizure
1.  DO NOT restrain;            5.   Protect the airway,
2.   Remove objects that             place in the recovery
     are harmful to the              position if possible;
     patient;                   6.   If the patient is
3.   Loosen restrictive              cyanotic, open the
     clothing;                       airway & ventilate;
4.   Turn the victims head      7.   Treat any injuries that
     to the side if possible;        may have occurred,
5.   DO NOT force anything           immobilize the C-spine if
     into the mouth;                 you suspect injury;
6.   Protect the patient, but   8.   Monitor vitals and
                                     summons more
     DO NOT try to hold
                                     advanced help
             Altered Mental Status
                             Seizures


   When to summons more advanced help:
       Victim DOES NOT have a seizure history;
       Seizure lasts for more than 5 minutes;
       There is a second seizure, patient is slow to recover,
        or they have difficulty breathing afterward;
       Pregnant, diabetic;
       Seizure occurs in the water;
       Seizure occurs to a child;
       Signs of injury or illness
         Altered Mental Status
                  Diabetes Mellitus

   The brain uses glucose and oxygen to
    create energy

   Without an abundance of both, the brain
    malfunctions, and the individual presents
    with confusion, combativeness, lethargy,
    and eventually a coma
          Altered Mental Status
                     Diabetes Mellitus

   Sugar is obtained in
    the food we eat
   However, sugar does
    not enter the body
    cells without help
   Glucose enters the
    bloodstream and is
    carried into the cells
    via insulin
Altered Mental Status
      Diabetes Mellitus




                          Figure 18.3.2
              Altered Mental Status
        Juvenile-onset or insulin dependent (type I)


   Requires external insulin to allow sugar to pass
    from blood to the cells

   Without the insulin there is an increased level of
    circulating glucose, and the brain is starved for fuel

   Supplemental insulin is produced via pig and cow
    pancreas, however, we can now use synthetic
    human insulin
       Slow-acting
       Fast-acting
            Altered Mental Status
     Adult-onset / non-insulin dependent (type II)


   Pancreas produces insulin but not enough
    or the insulin is used ineffectively

   Considered the milder form of diabetes

   Increased incidence in younger adults,
    usually occurs after the age of 35-40
            Altered Mental Status
                       Gestational


   During pregnancy there is an increased need for
    insulin due the increased need for glucose

   If the pancreas is unable to supply the insulin, a
    high blood glucose level will occur

   Normally when the pregnancy is over the insulin
    demand drops back to former levels (occurs in 2
    – 5% of all pregnancies
           Altered Mental Status
                    Diabetes Mellitus

   When the body stop creating sufficient insulin,
    excess blood sugar begins to develop

   Kidneys attempt to rid the body of excess circulating
    glucose

   This increased urination increases fluid loss leading
    to dehydration, thus the body now craves water and
    the patient drink excessively

   Because the brain has gone without energy the
    body attempts to eat to increase glucose stores
           Altered Mental Status
               Acute Diabetic Problems


   Even in the best situations an individual
    may need help to manage their glucose
    levels when they get into extreme ranges
            Diabetic Emergency
                      Hyperglycemia


   Often seen in untreated or undertreated
    diabetes, taking from 12 hours to days to
    develop

   When glucose cannot be used for fuel, other
    sources need to be found

   Fat is this source, however, it is much less
    efficient and produces toxic by products
               Diabetic Emergency
                          Hyperglycemia

   When sugar is used, its by products are water and carbon
    dioxide, which can be eliminated via the kidneys and lungs
   When fats are used, an organic acid (keto-acid) is created,
    creating a condition known as DKA
   These ketones are exhaled on our breath usually like a sweat
    smelling smell (juicy fruit)
   As the ketones build up, acid levels in the blood increase,
    increasing the rate and depth of respirations
   This is occurring at the same time that the level of circulating
    glucose is increasing frequency of urination
                 Diabetic Emergency
               Signs of Hyperglycemia - Diabetic Coma


                                           Gradual onset;
                                           Frequent urination;
                                           Extreme thirst;
                                           Fruity breath odor
                                            (ketones);
                                           Heavy breathing;
                                           Vomiting;
                                           Drowsiness;
                                           Flushed, dry, warm skin;
                                           Eventual LOC

An unconscious diabetic who is hyperglycemic is said to be in a diabetic coma
           Diabetic Emergency
                    Hypoglycemia


   Is the opposite of hyperglycemia, in that
    hypoglycemia is too much insulin and not
    enough circulating glucose

   If left untreated it can quickly lead to
    brain damage and even death
            Diabetic Emergency
                      Hypoglycemia


   When the circulating glucose level falls the body
    reacts by allowing the adrenal glands to release
    adrenaline into the blood

   This stimulates the release of stored sugar,
    however, it also stimulates the heart, makes a
    person sweaty, shaky and agitated

   These are also signs of shock, therefore, the
    term insulin shock is used
               Diabetic Emergency
                       Signs of Hypoglycemia

   Usually a sudden onset;
   AMS (lack of glucose);
       Poor coordination,
        confusion,
        combativeness, anxiety
   Intoxicated appearance,
    staggering;
   Cold, clammy;
   Sudden hunger;
   Excessive sweating;
   Trembling;
   Seizure (low blood
    sugar);
   Eventual LOC            (“Insulin Reaction” or “Low-Blood Sugar”)
              Diabetic Emergency
                   Caring for Hypoglycemia

   Follow the Rule of 15’s if:
       Victim is a known diabetic, mental status is
        altered and victim is Conscious enough to
        swallow
   Provide
       15 grams of carbohydrate (sugar)
       Wait 15 minutes
       If NO improvement, give 15 more grams
       If NO improvement, seek medical attention
             Altered Mental Status
        Cerebral Vascular Accident (CVA or Stroke)

   CVA refers to “…the death or injury of brain tissue that is
    deprived of oxygen”

   Third leading cause of death for all ages and are caused
    by:
       Thrombus (clot in the brain)
       Embolus (clot from the heart to the brain)
       Hemorrhage (rupture of blood vessel)
       Tumor
       Spasm
       Aneurysm
            Altered Mental Status
          Cerebral Vascular Accident (CVA or Stroke)

   Sign and Symptoms
       Weakness, numbness, or paralysis of face, arm, and
        leg on one side of body (hemiparesis)
       Headache caused by bleeding from a ruptured vessel
       Blurred or decreased vision
       Problems speaking and understanding (may say the
        wrong word)
       Dizziness or loss of balance
       Sudden, severe, unexplained headache
       Unusual pupils (look for PEARL), deviations indicate
        the brain is being affected by a lack of O2
 Altered Mental Status
Cerebral Vascular Accident (CVA or Stroke)

                         Cincinnati Stroke Scale
                             Facial Droop
                                  Have the person smile or
                                   show teeth
                             Arm Drift
                                  Close eyes and hold arms
                                   out straight
                             Speech
                                  You can’t teach an old dog
                                   new tricks
                         Time
           Altered Mental Status
          Cerebral Vascular Accident (CVA or Stroke)

   Caring for a stroke victim
       RECOGNIZE that an event has occurred;
       Call EMS;
       Check and monitor ABC’s;
       Place the victim in the recovery position if
        unconscious and lay down with the shoulders
        and head slightly elevated if conscious
   Time is of the essence!
               Assignment

   Read Chapter 15 in the textbook
   Complete workbook Unit 15

								
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