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					  Chapter 13
Common Medical
 Emergencies
Chapter 13: Common Medical Emergencies



                Objectives (1 of 5)
     • Identify the signs and symptoms of the acute
       abdomen and the necessity for immediate
       transport of patients with these symptoms.

     • Identify the patient taking diabetic medications
       with altered mental status and the implications
       of a history of diabetes.




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Chapter 13: Common Medical Emergencies


                Objectives (2 of 5)
     • State the steps in the emergency care of the
       patient taking diabetic medicine with an
       altered mental status and a history of
       diabetes.

     • Recognize the patient experiencing an allergic
       reaction.



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Chapter 13: Common Medical Emergencies



                Objectives (3 of 5)
    • Describe the emergency care of the patient
      with an allergic reaction.

    • Describe the mechanisms of allergic response
      and the implications for airway management.

    • List the signs and symptoms associated with
      poisoning.


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Chapter 13: Common Medical Emergencies



                Objectives (4 of 5)
    • Describe the steps in the emergency care for
      the patient with suspected poisoning.

    • Perform a rapid gentle assessment of the
      abdomen.

    • Demonstrate the steps in the emergency care
      for the patient taking diabetic medicine with
      an altered mental status and a history of
      diabetes.
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Chapter 13: Common Medical Emergencies



                Objectives (5 of 5)
     • Demonstrate the emergency care of the
       patient experiencing an allergic
       reaction.

     • Demonstrate the steps in the
       emergency care for the patient with
       suspected poisoning


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Chapter 13: Common Medical Emergencies
The Acute Abdomen


        Physiology of the Abdomen
                          (1 of 2)

       • Acute abdomen
         – Sudden onset of abdominal pain
       • Peritoneum
         – Thin membrane lining the entire
           abdomen
       • Colic
         – Severe, intermittent cramping pain

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Chapter 13: Common Medical Emergencies
The Acute Abdomen


       Physiology of the Abdomen
                         (2 of 2)

     • Referred pain
       – Perceived pain at a distant point of the
         body caused by irritation of the visceral
         peritoneum
     • Peritonitis
       – Irritation of the peritoneum caused by
         illness or injury
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Chapter 13: Common Medical Emergencies
The Acute Abdomen


            Signs and Symptoms of
             Acute Abdomen (1 of 3)
        • Abdominal pain and/or tenderness
        • Quiet patient guarding the abdomen
          (shock)
        • Rapid and shallow breathing
        • Referred (distant) pain
        • Anorexia, nausea, vomiting

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Chapter 13: Common Medical Emergencies
The Acute Abdomen


              Signs and Symptoms of
               Acute Abdomen (2 of 3)
          •   Loss of bowel sounds
          •   Tense, often distended abdomen
          •   Sudden constipation or bloody diarrhea
          •   Tachycardia
          •   Hypotension
          •   Fever
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Chapter 13: Common Medical Emergencies
The Acute Abdomen


              Signs and Symptoms of
               Acute Abdomen (3 of 3)
          •   Rebound tenderness
          •   Indigestion/heartburn
          •   Colic (severe painful spasms)
          •   Difficulty swallowing
          •   Jaundice


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Chapter 13: Common Medical Emergencies
The Acute Abdomen


          Examining the Abdomen
     • Explain what you are about to do.
     • Position the patient supine with legs drawn up
       and knees flexed.
     • Observe the patient.
     • Gently palpate the abdomen.
     • Determine if the patient can relax the
       abdominal wall on command.
     • Determine if abdomen is tender when
       palpated.
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Chapter 13: Common Medical Emergencies
The Acute Abdomen


        Causes of Acute Abdomen
       • Substances lying in or adjacent to the
         abdominal cavity
       • Other common causes:
          – Appendicitis
          – Perforated gastric ulcer
          – Cholecystitis
          – Diverticulitis
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Chapter 13: Common Medical Emergencies
The Acute Abdomen



               Uterus and Ovaries
           • Always consider a gynecological
             problem with women having
             abdominal pain.
           • Causes of pain
              – Menstrual cycle
              – Pelvic inflammatory disease
              – Ectopic pregnancy

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Chapter 13: Common Medical Emergencies
The Acute Abdomen


             Other Organ Systems
         • Aneurysm
           – Weakness in aorta
         • Pneumonia
           – May cause ileus and abdominal pain
         • Hernia
           – Protrusion through a hole in the
             body wall

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Chapter 13: Common Medical Emergencies
The Acute Abdomen


     Emergency Medical Care (1 of 2)
           •   Do not delay transport.
           •   Do not attempt to diagnose.
           •   Clear and maintain the airway.
           •   Anticipate vomiting.
           •   Administer high-flow oxygen.
           • Give nothing by mouth.

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Chapter 13: Common Medical Emergencies
The Acute Abdomen


     Emergency Medical Care (2 of 2)

         • Document all pertinent information.
         • Anticipate the development of
           hypovolemic shock.
         • Make the patient comfortable.
         • Monitor vital signs.

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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


              Defining Diabetes (1 of 2)
      • Diabetes mellitus
         – Metabolic disorder in which the body
           cannot metabolize glucose
         – Usually due to a lack of insulin
      • Glucose
         – One of the basic sugars in the body
         – Along with oxygen, it is a primary fuel for
           cellular metabolism
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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


             Defining Diabetes (2 of 2)
         • Insulin
            – Hormone produced by the pancreas
            – Enables glucose to enter the cells
            – Without insulin, cells starve
         • Hormone
            – Chemical substance produced by a
              gland
            – Has special regulatory effects on
              other body organs and tissues
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Chapter 13: Common Medical Emergencies
Diabetic Emergencies



                       Type I Diabetes

       • Insulin-dependent diabetes
       • Patient does not produce any insulin
       • Insulin injected daily
       • Onset usually in childhood


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Chapter 13: Common Medical Emergencies
Diabetic Emergencies



                   Type II Diabetes
     • Noninsulin-dependent diabetes
     • Patient produces inadequate amounts of
       insulin
     • Disease may be controlled by diet or oral
       hypoglycemics


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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


        Role of Glucose and Insulin
      • Glucose is the major source of energy for
        the body.
      • Constant supply of glucose needed for the
        brain.
      • Insulin acts as the key for glucose to enter
        cells.


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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


                       Hyperglycemia
      • Lack of insulin causes glucose to build up in
        blood in extremely high levels.
      • Kidneys excrete glucose.
      • This requires a large amount of water (3 P’s).
      • Without glucose, body uses fat for fuel.
      • Ketones are formed.
      • Ketones can produce diabetic ketoacidosis.


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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


            Signs and Symptoms of
             Diabetic Ketoacidosis
                  •    Vomiting
                  •    Abdominal pain
                  •    Kussmaul respirations
                  •    Unconsciousness



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Chapter 13: Common Medical Emergencies
Diabetic Emergencies



            Blood Glucose Monitors

           • Test strips
           • Normal range
             80-120 mg/dL
           • Glucometer



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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


                    Diabetic Coma
                   (Hyperglycemia)




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Chapter 13: Common Medical Emergencies
Diabetic Emergencies



            Signs of Diabetic Coma
        •   Kussmaul respirations
        •   Dehydration
        •   “Fruity” breath odor
        •   Rapid, weak pulse
        •   Normal or slightly low blood pressure
        •   Varying degrees of unresponsiveness

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Chapter 13: Common Medical Emergencies
Diabetic Emergencies



      Insulin Shock (Hypoglycemia)




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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


             Signs of Insulin Shock
   • Normal or rapid          • Altered mental status
     respirations
                              • Aggressive or confused
   • Pale, moist skin           behavior
   • Sweating                 • Hunger
   • Dizziness, headache      • Fainting, seizure, or
   • Rapid pulse                coma

   • Normal to low blood      • Weakness on one side
     pressure                   of the body
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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


       Diabetes and Alcohol Abuse
          • Patients may appear intoxicated.
          • Suspect hypoglycemia with any
            altered mental status.
          • Be alert to the similarity in symptoms
            of acute alcohol intoxication and
            diabetic emergencies.


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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


      Emergency Medical Care (1 of 2)
     • Ask a patient with known diabetes:
         – Do you take insulin or any pills to lower
           blood sugar?
         – Have you taken your usual dose of insulin
           (or pills) today?
         – Have you eaten normally today?
         – Have you had any illness, unusual amount
           of activity, or stress today?
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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


      Emergency Medical Care (2 of 2)
     • Perform initial assessment.
     • Obtain baseline vital signs and SAMPLE
       history.
     • Check for emergency medical identification
       symbol.
     • Always do a full, careful assessment.
     • Ask patient or family about last meal or insulin
       dose.
     • DO NOT administer anything to an
       unconscious patient.
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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


        Administering Oral Glucose
                           (1 of 2)
         • Names:
            – Glutose
            – Insta-Glucose
         • Dose equals one tube
         • Glucose should be given to a patient with
           diabetes and a decreased level of
           consciousness.
         • DO NOT give glucose to a patient with the
           inability to swallow or who is unconscious.
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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


    Administering Oral Glucose (2 of 2)




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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


         Complications of Diabetes
           •   Heart disease
           •   Visual disturbances
           •   Renal failure
           •   Stroke
           •   Ulcers
           •   Infections of the feet and toes
           •   Seizures
           •   Altered mental status

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Chapter 13: Common Medical Emergencies
Diabetic Emergencies


                       Seizures
          • Consider hypoglycemia as the
            cause.
          • Use appropriate BLS measures
            for airway management.
          • Arrange for prompt transport.




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Chapter 13: Common Medical Emergencies
Diabetic Emergencies



              Altered Mental Status
             • Altered mental status is often
               caused by complications of
               diabetes.
             • Ensure that airway is clear.
             • Be prepared to ventilate and
               suction.
             • Arrange for prompt transport.

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations



                  Allergic Reactions
             • Allergic reaction
               – Exaggerated immune
                  response to any substance
             • Histamines and leukotrienes
               – Chemicals released by the
                  immune system


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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                        Anaphylaxis
                 •   Extreme allergic reaction
                 •   Involves multiple organs
                 •   Can rapidly result in death
                 •   Most common signs:
                      – Wheezing
                     – Urticaria (hives)


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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations



                            Urticaria




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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


              Five General Allergen
                   Categories
                    •   Insect bites and stings
                    •   Medications
                    •   Plants
                    •   Food
                    •   Chemicals


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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


              Insect Bites and Stings
         • Death from insect stings outnumber
           those from snake bites.
         • Venom is injected through stinging
           organ.
         • Some insects and ants can sting
           repeatedly.


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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


               Signs and Symptoms
                  • Sudden pain, swelling,
                    and redness at site
                  • Itching and sometimes
                    a wheal
                  • Sometimes dramatic
                    swelling


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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                 Removing Stingers




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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


          Anaphylactic Reactions to
                  Stings
           • 5% of all people are allergic to bee,
             hornet, yellow jacket, and wasp stings.
           • Anaphylaxis accounts for
             approximately 200 deaths a year.
           • Most deaths occur within half an hour
             of being stung.

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


            Signs and Symptoms of
               Allergic Reaction
     • Itching and burning             • Chest tightness and
     • Widespread urticaria              coughing
     • Wheals                          • Dyspnea
     • Swelling of the lips            • Anxiety
       and tongue                      • Abdominal cramps
     • Bronchospasm and
                                       • Hypotension
       wheezing

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                Patient Assessment
           • Allergic symptoms are almost as
             varied as allergens themselves.
           • Assessment should include
             evaluations of:
              – Respiratory system
              – Circulatory system
              – Mental status
              – Skin
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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


      Emergency Medical Care (1 of 2)
             • Give oxygen.
             • Perform a focused history and
               physical examination.
               – Find out if the patient has a
                 history of allergies.
             • Obtain baseline vital signs and a
               SAMPLE history.

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations



      Emergency Medical Care (2 of 2)
          • Inform medical control.
          • Find out if the patient has a
            prescribed auto-injector.
          • Be prepared to use standard airway
            procedures.
          • Assist the patient with the auto-
            injector if permitted.

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


              Using an Auto-Injector
   • Receive order from
     medical direction.
   • Follow BSI precautions.
   • Make sure the
     prescription is for the
     patient.
   • Make sure the
     medication is not
     discolored or expired.

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


      Administering an Auto-Injector
        • Remove the safety cap.
        • Place tip of the injector against the lateral
          side of the patient’s thigh.
        • Push the injector firmly and hold until all of
          the medication is injected.
        • Remove the injector.
        • Record the time and dose.
        • Reassess and record vital signs every 2
          minutes.
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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                       Auto-Injector




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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


           Epinephrine Side Effects
                       • Tachycardia
                       • Pallor
                       • Dizziness
                       • Chest pain
                       • Headache
                       • Nausea
                       • Vomiting
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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                       Black Widow
     • Found in all states except
       Alaska
     • Venom poisonous to
       nerve tissue
     • Requires patient transport
       as soon as possible


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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                     Brown Recluse
       • Mostly in Southern and
         Central US
       • Venom causes local
         tissue damage
       • Requires patient
         transport as soon as
         possible

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                        Snake Bites
        • 40,000 to 50,000 reported snake
          bites in the US annually.
        • 7,000 bites in the US come from
          poisonous snakes.
           – Death from snake bites is rare.
           – About 15 deaths occur each year
             in the US.

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations

            Four Types of Poisonous
               Snakes in the US

   Rattlesnake                         Cottonmouth




 Copperhead                            Coral snake



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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                          Pit Vipers
     • Rattlesnakes,
       copperheads, and
       cotton mouths
     • Store poison in
       pits behind nostrils
     • Inject poison to
       victim through
       fangs
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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


            Signs and Symptoms of a
                  Pit Viper Bite
        •   Severe burning at the bite site
        •   Swelling and bluish discoloration
        •   Bleeding at various distant sites
        •   Other signs may or may not include:
            – Weakness          – Fainting
            – Sweating          – Shock
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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


       Caring for Pit Viper Bites (1 of 2)
       • Calm the patient.
       • Locate bite and cleanse the area.
       • Do not apply ice.
       • Splint area to minimize movement.
       • Watch out for vomiting caused by anxiety.
       • Do not give anything by mouth.

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


       Caring for Pit Viper Bites (2 of 2)
        • If the patient is bitten on the trunk, lay the
          patient supine and arrange for prompt
          transport.
        • Monitor patient’s vital signs.
        • Mark the swollen area with a pen.
        • Care for shock if signs and symptoms
          develop.
        • Arrange for snake to be brought to the
          hospital if it has been killed.
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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                       Coral Snakes
       • Small snake with red, yellow, and black
         bands
       • “Red on yellow will kill a fellow, red on
         black, venom will lack.”
       • Injects venom with teeth, using a chewing
         motion that leaves puncture wounds
       • Causes paralysis of the nervous system


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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


   Caring for Coral Snake Bites (1 of 2)
             • Quiet and reassure the patient.
             • Flush the area with 1 to 2
               quarts of warm, soapy water.
             • Do not apply ice.
             • Splint the extremity.
             • Check and monitor baseline
               vital signs.

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


   Caring for Coral Snake Bites (2 of 2)
        • Keep the patient warm and elevate the
          lower extremities to help prevent shock.
        • Give supplemental oxygen if needed.
        • Arrange for prompt transport. Give
          advance notice to EMTs of coral snake
          bite.
        • Give the patient nothing by mouth.

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                    Scorpion Stings
    • Venom gland and stinger
      found in the tail end.
    • Mostly found in
      southwestern US
    • With one exception, the
      Centruroides sculpturatus,
      most stings are only painful.
       – Provide emergency care
         and arrange for transport.

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                      Tick Bites (1 of 3)
     • Ticks attach themselves
       to the skin.
     • Bite is not painful, but
       potential exposure to
       infecting organisms is
       dangerous.
     • Ticks commonly carry
       Rocky Mountain spotted
       fever or Lyme disease.
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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations



                     Tick Bites (2 of 3)
         • Rocky Mountain spotted fever develops
           7 to 10 days after bite.
         • Symptoms include:
            – Nausea, vomiting
            – Headache
            – Weakness
            – Paralysis
            – Possible cardiorespiratory collapse

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                     Tick Bites (3 of 3)
             • Lyme disease is the second fastest
               growing infectious disease next to
               AIDS in US
             • Lyme disease symptoms may
               begin 3 days after the bite.
             • Symptoms include:
                – Rash
                – Painful swelling of the joints

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


               Caring for a Tick Bite
      • Do not attempt to suffocate or burn tick.
      • Use fine tweezers to grasp tick by the
        body and pull it straight out.
      • Cover the area with disinfectant and
        save the tick for identification.
      • Provide any necessary supportive
        emergency care and arrange for
        transport.
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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


          Dog Bites and Rabies (1 of 2)
        • All dog bites should be considered
          infected until proven otherwise.
        • Place a dry, sterile dressing over the
          wound and arrange for prompt
          transport.
        • Rabies, an acute viral infection to the
          central nervous system, is a major
          concern.

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Allergic Reactions and Envenomations


          Dog Bites and Rabies (2 of 2)
       • Rabies can be treated with a series of
         vaccine injections.
       • A bitten patient can avoid shots only if
         the dog can be identified and tested
         for rabies.
       • Remember scene safety; the dog
         may still be loose when you arrive on
         the scene.

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


             Caring for Human Bites
           • Remember, human bites that
             penetrate the skin can be serious
             injuries.
           • Promptly immobilize the area.
           • Apply a dry, sterile dressing.
           • Arrange for transport.


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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                      Coelenterates
         • Responsible for more envenomations
           than any other marine life animal
         • Has stinging cells called nematocysts
         • Results in very painful, reddish lesions
         • Symptoms include headache,
           dizziness, muscle cramps, and
           fainting.

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Chapter 13: Common Medical Emergencies
Allergic Reactions and Envenomations


                   Caring for Stings
             • Limit further discharge by
               minimizing patient movement.
             • Inactivate nematocysts by
               applying alcohol.
             • Remove the remaining tentacles
               by scraping them off.
             • Arrange for transport.

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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


       Poison vs. Substance Abuse
      • 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.

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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


             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?
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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


            Determining the Nature
                of the Poison
       • Give suspicious materials, containers,
         vomitus to EMS.
       • Provide key information on:
          – Name and concentration of the drug
          – Specific ingredients
          – Number of pills originally in bottle
          – Name of manufacturer
          – Dose that was prescribed
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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


            Poison Control Centers

            • Information on most substances
            • Information on emergency
              treatments and antidotes.




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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


                   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.


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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


                Activated Charcoal




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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


                   Inhaled Poisons
            • Wide range of effects
               – Some inhaled agents cause
                 progressive lung damage.
            • Move to fresh air immediately, they
              may require supplemental O2.
            • All patients require immediate
              transport.

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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


                   Injected Poisons

           • Usually result of drug overdose
           • Impossible to remove or dilute
             poison once injected
           • Arrange for prompt transport




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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


                 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, i.e. sodium or phosphorus.
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Substance Abuse and Poisoning


          Emergency Medical Care
        • External decontamination is important.
        • Care focuses on support: assessing and
          maintaining ABCs.
        • You may be permitted to give activated
          charcoal for ingested poisons per your
          local protocol.


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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


                   Specific Poisons
     • Tolerance
       – Need for increased amount of drug to
         have same desired effect
     • Addiction
       – Overwhelming desire or need to
         continue using an agent


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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


                       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 who appears intoxicated may
       have a medical problem.

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Substance Abuse and Poisoning


                       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 tremens (DTs).


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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


                       Alcohol (3 of 3)
       • Patients with DTs may experience:
         – Agitation and restlessness
         – Fever
         – Sweating
         – Confusion and/or disorientation
         – Delusions and/or hallucinations
         – Seizures

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Chapter 13: Common Medical Emergencies
Substance Abuse and Poisoning


                        Opioids (1 of 2)
      • Drugs containing opium
      • Most of these, such as codeine,
        Darvon, Oxycontin, and Percocet, have
        medicinal purposes.
      • The exception is heroin, which is illegal.
      • Opioids are CNS depressants causing
        severe respiratory distress.

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                        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.

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          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.
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             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
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             Abused Inhalants (2 of 2)
      • Patient is at high risk for sudden cardiac
        arrest.
      • Try to keep patient from struggling or
        exerting self.
      • Give oxygen and use a stretcher to move
        patient.
      • Prompt transport is essential.

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                Sympathomimetics
       • CNS stimulants cause hypertension,
         tachycardia, and dilated pupils.
       • Amphetamines and methamphetamines
         are commonly taken by mouth.
       • Cocaine can be taken in many different
         ways.
          – Can lead to seizures and cardiac
            disorders
       • Be aware of personal safety.
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                         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, can be coated with PCP or crack.

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                 Hallucinogens (1 of 2)
      • Alter an individual’s sense of perception
      • LSD and PCP are potent hallucinogens.
      • Sometimes, people experience a “bad
        trip.”
      • Patients typically are hypertensive,
        tachycardic, anxious, and paranoid.

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                 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
         evacuation and while awaiting EMS.



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                   Anticholinergics
     • “Hot as a hare, blind as a bat, dry as a
       bone, red as a beet, and mad as a hatter”
     • Block the parasympathetic nerves
     • Patient may go from “normal” to seizure to
       death within 30 minutes.
     • Arrange for ALS transport.


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                Cholinergic Agents
      • Commonly used as nerve agents for
        warfare
      • Overstimulate body functions controlled
        by the parasympathetic nervous system
      • Organophosphate insecticide or wild
        mushrooms are also cholinergic agents.


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             Signs and Symptoms of
              Cholinergic Poisoning
     •   D   Defecation         •   S   Salivation
     •   U   Urination          •   L   Lacrimation
     •   M   Miosis             •   U   Urination
     •   B   Bronchorrhea       •   D   Defecation
     •   E   Emesis             •   G    GI irritation
     •   L   Lacrimation        •   E   Eye constriction
     •   S   Salivation

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     Care for Cholinergic Poisoning
         • Main concern is to avoid exposure
         • May require field decontamination
         • Priority after decontamination is to
           decrease the secretions in the mouth
           and trachea.
         • Provide airway support.
         • May be treated as a HazMat incident

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                  Aspirin Overdose
    • Signs and symptoms
       – Nausea/vomiting
       – Hyperventilation
       – Ringing in ears
       – Confusion
       – Seizures
    • Arrange for prompt transport to
      the hospital.
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         Acetaminophen Overdose
               • Overdosing is common.
               • Generally not very toxic
               • Symptoms may not appear
                 until it is too late.
               • Liver failure may not be
                 apparent for a full week.
               • Gathering information at the
                 scene is very important.

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                    Other Alcohols
          • Methyl alcohol and ethylene glycol
            are more toxic than ethyl alcohol.
          • May be taken by people with
            chronic alcoholism who cannot
            obtain drinking alcohol
          • More often taken by someone
            attempting suicide
          • Immediate transport is essential.
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                    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.


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          Caring for Food Poisoning
     • Try to obtain as much history as possible.
     • Arrange for prompt transport.
     • If two or more persons have the same
       illness, give some of the suspected food to
       EMS, if possible.



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                   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.
        – Give the plant to EMS to take to the
          hospital.
        – Arrange for prompt transport.

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