EMT Test 6

PTSD

Post traumatic stress disorder A delayed stress reaction that develops after a horrifying ordeal that involved physical harm or the threat of physical harm An estimated 7% to 8% of the general population will experience signs of PTSD at some point in their lives. 4. Military personnel who have experienced combat have a high incidence of PTSD (Up to 30%). 1. Symptoms of PTSD include feelings of: a. Helplessness b. Anxiety c. Anger d. Fear People with PTSD: a. May avoid things that remind them of the trauma, including loud noises or smells, and sometimes avoid interactions with other people b. Suffer constant nervous system arousal that is not easily suppressed i. Heart rate increases, pupils dilate, and systolic blood pressure increases. ii. Senses are sharpened and mental acuity is heightened. iii. The victim may be hypervigilant or display an exaggerated startle response to perceived danger. c. Can relive the traumatic event through intrusive thoughts, nightmares, or even flashbacks 3. Dissociative PTSD occurs when the person attempts to find an escape from constant internal distress or a particularly disturbing event. a. Other psychologic conditions, such as personality disorders and increased functional impairment, can develop in individuals with this type of PTSD.

Labia Minora

Inner fleshy "lips" devoid of pubic hair that protect the vagina

Miscellaneous Drugs

-Aspirin poisoning remains a potentially lethal condition. a. Ingesting too many may result in: i. Nausea ii. Vomiting iii. Hyperventilation iv. Ringing in the ears 5. Danger of seizures -Cardiac med overdoses are common (Side effects of over dose may include bleeding, dysrythmia, cardiac arrest, LOC) Overdosing with acetaminophen and medications that contain acetaminophen is also common. a. Among the top 25 substances with the largest number of fatalities due to poisoning b. Overdose, unintentional or intentional, must be treated promptly and aggressively. c. Accidental acetaminophen overdose is as serious as intentional overdose. i. Patient is unaware of the continuous exposure to the toxin and massive liver failure may not be apparent for a full week. d. Gathering information at the scene is very important. 4. Some alcohols, including methyl alcohol and ethylene glycol, are even more toxic than ethyl alcohol (drinking alcohol). a. Both will cause severe tachypnea, blindness, renal failure, and eventually death. Methyl Alcohol and ethylene glycol = blindness (Methyl), renal failure (ethyl) = death

Powders

-Brush off powder and irrigate with copious amount of clean water for 15-20 minutes

Most Common Allergens

-Food, meds, plants, chemicals, insect bites/stings A. The most common allergens fall into one of the following five general categories. 1. Food: Certain foods (eg, shellfish, peanuts) may be the most common trigger of anaphylaxis. i. These foods account for 30% of deaths from anaphylaxis, most commonly in adolescents and young adults. b. Symptoms: i. May take more than 30 minutes to appear ii. May not include skin signs (eg, hives) iii. The reaction can be severe and involve the respiratory and/or cardiovascular systems. 2. Medication a. Medications are the second most common source of anaphylactic reactions, particularly antibiotics (eg, penicillin) and nonsteroidal anti-inflammatory drugs (NSAIDs). b. If the medication is injected, the reaction may be immediate (within 30 minutes) and severe. c. Reactions to oral medications may take more than 30 minutes to appear, but can also be very severe. 3. Plants a. Dusts, pollens, and other plant materials can cause a rapid and severe allergic reaction. b. Common plant allergens include ragweed, ryegrass, maple, and oak. 4. Chemicals a. Certain chemicals, makeup, soap, hair dye, latex, and various other substances can cause severe allergic reactions. b. Latex is of particular concern to health care providers; patients can be sensitive to it, and as many as 12% of health care providers become sensitized to latex.- Use latex alternatives such as nitrile gloves. . Insect bites and stings b. The reaction can be localized, causing swelling and itching at the site, or it may be a severe and systemic reaction (ie, anaphylaxis).

The effects of Epi are typically observed within:

1 minute

Abnormal behavior patterns that last _ _____ or more are considered a mental health concern

1 month

Insect Stings

1. Approximately 3% of adults and 1% of children are allergic to the venom of bees, wasps, and hornets, and allergic reactions to insect stings account for at least 50 deaths in the United States per year. 2. In about half of these deaths, the victim had never experienced a reaction to prior stings. -Sting from honey bee is barbed, so it can't withdraw it (If not removed, it can continue to inject for up to 20 minutes) -Multiple, small pustules on feet and legs may be from fire ants Signs and Symptoms: Sudden pain,swelling, localized heat, widespread urticaria, redness, wheal (Applying ice may help) If a stinger is present, scrape the skin with the edge of a sharp, stiff object such as a credit card (do not use tweezers or forceps because it may squeeze the venom sack). -Wash area with soap/water or mild antiseptic -Remove jewelry before swelling -Position injection sight slightly below heart and put ice on it for at most 10 min

Vaginal Bleeding

1. Bleeding may be considered menstrual bleeding and overlooked. 2. Possible causes include: a. Abnormal menstruation b. Vaginal trauma c. Ectopic pregnancy d. Spontaneous abortion e. Cervical polyps f. Cancer Injuries to external genitalia are very painful, but injuries to internal genitalia (Polyps, cancer) are usually relatively painless

External Female Genitalia

1. Consists of the vaginal opening just posterior to the urethral opening. 2. The labia majora and labia minora are folds of tissue that surround the urethral and vaginal opening. 3. The clitoris is at the anterior end of the labia. 4. The anus is at the posterior end of the labia. -Labia are incredibly vascular, but are usually only injured in sexual assault 5. The perineum is the area of skin between the vagina and the anus.

Hydrogen Sulfide

1. Hydrogen sulfide is a highly toxic, colorless, and flammable gas with a distinctive rotten-egg odor. 2. Poisoning usually occurs by inhalation. 3. Hydrogen sulfide affects all organs, but it has the most impact on the lungs and CNS. 4. Used to commit suicide; referred to as chemical or detergent suicide a. If you approach an enclosed vehicle with an unconscious patient inside, be alert for warning signs, as well as containers, buckets, or pots. b. If you suspect the presence of a toxic gas, wait for a HazMat team to tell you the scene is safe. 5. Signs and symptoms include nausea and vomiting, confusion, dyspnea, a loss of consciousness, seizures, shock, coma, and cardiopulmonary arrest. -Industrial workers may experience low-level exposure over time leading to irritation, headache, and bronchitis 6. Once the patient has been decontaminated, management is largely supportive - no antidote a. Monitor and assist the patient's respiratory and cardiovascular functions. b. Provide rapid transport.

Primary Assessment for Hematologic Emergencies

1. Is the patient in pain and of African American or Mediterranean descent? a. If yes, may have undiagnosed sickle cell disease a. Is the patient anxious, restless, or listless? b. Is the patient apathetic or irritable? c. Determine level of consciousness. 4. Assess the patient's airway and breathing. a. For patients with inadequate breathing or altered mental status: i. Provide high-flow oxygen at 12 to 15 L/min via nonrebreathing mask. b. Patients experiencing a sickle cell crisis may have increased respirations or exhibit signs of pneumonia. c. For patients with breathing difficulty: i. Open the airway; insert airway adjunct. ii. Administer oxygen; assist ventilations. a. Sickle cell crisis patients will have increased heart rate to "force" sickled cells through smaller blood vessels. b. For suspected hemophilia patients: i. Be alert for signs of acute blood loss: (a) Pallor, Weak pulse, Hypotension ii. Note bleeding of unknown origin: (a) Nosebleeds, Bloody sputum, Blood in urine or stool iii. Be alert for signs of hypoxia, which is due to blood loss. 6. Make a transport decision. a. Transport to an ED should always be recommended to any patient who is experiencing a sickle cell crisis or hemophilia. b. Be alert for physical signs indicating sickle cell crisis: i. Swelling of the fingers and toes ii. Priapism iii. Jaundice

Seizures

1. Should be considered very serious, even in patients with a history of chronic seizures. 2. Possible causes: a. Infection b. Poisoning c. Hypoglycemia d. Trauma e. Decreased levels of oxygen f. Idiopathic (unknown cause) g. Fever (children) h. Undiagnosed epilepsy (children) Though brief seizures are not harmful, they may indicate a potentially life-threatening underlying condition. 4. Management a. Ensure that the airway is clear. b. Place the patient on his or her side if there is no possibility of cervical spine trauma. c. Do not place anything in the patient's mouth (eg, bite stick or oral airway). d. Have suctioning equipment ready in case the patient vomits. e. If the patient is cyanotic or appears to be breathing inadequately, provide oxygen or artificial ventilations. f. Transport promptly.

Secondary Assessment and Reassessment for Hematologic Emergencies

1. Systematically examine the patient. a. Focus on major joints at which cells congregate. b. Evaluate and document mental status using the AVPU scale. 2. Obtain a complete set of vital signs, including oxygen saturation level. a. Normal sickle cell crisis vital signs: i. Normal to rapid respirations ii. Weak, rapid pulse iii. Pale, clammy skin iv. Low blood pressure b. Use pulse oximeter, if available, to monitor oxygen saturation. i. Reading may be inaccurate due to patient's anemic state. 3. Administer supplemental oxygen to attempt to compensate for decreased cellular oxygenation related to the sickled cells or hemophilia. 4. Hospital care for sickle cell crises may include: a. Analgesics for pain b. Penicillin to treat infection c. IV fluid for hydration d. Blood transfusion, depending on severity of condition Hospital care for hemophilia may include: a. IV therapy to treat hypotension b. Transfusion of plasma 6. Communicate with hospital staff for continuity of care and document clearly. A. Emergency care is mainly supportive and symptomatic. B. For patients with inadequate breathing or altered mental status: 1. Administer high-flow oxygen 12 to 15 L/min via nonrebreathing mask. 2. Place in position of comfort and transport rapidly to hospital.

Internal Female Genitalia

1. The ovaries are the primary female reproductive organs. 2. Ovaries lie on each side of the lower abdomen and produce an ovum (egg). a. A fetus develops from a fertilized ovum. 3. Fallopian tubes connect each ovary with the uterus. 4. The uterus is the muscular organ where the fetus grows during pregnancy. a. The narrowest part of the uterus is the cervix, which opens into the vagina. 5. The vagina is the outermost cavity of a woman's reproductive system.

Anticholinergic Agents

1. These are medications that have properties that block the parasympathetic nerve. 2. The classic picture of a person who has taken too much of an anticholinergic medication is "hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter." - hyperthermia, dilated pupils, dry skin/mucous membranes, agitation or delirium 3. Common drugs include atropine, Benadryl, jimsonweed, and amitriptyline (Elavil). a. With the exception of jimsonweed, these medications usually are not abused drugs. 4. It is often difficult to distinguish between an anticholinergic overdose and a sympathomimetic overdose. Both groups of patients may be agitated and have tachycardia and dilated pupils. Some tricyclic antidepressants have significant anticholinergic effects. a. Death from these agents can be rapid—the patient can go from appearing "normal" to seizure and death within 30 minutes. b. The seizures and dysrhythmias are best treated in the hospital. c. Transport immediately; consider calling for ALS backup en route.

Oral Glucose

1. Three types of oral glucose preparations available commercially a. Rapidly dissolving gel (Most common) b. Large chewable tablets c. Liquid formulation One tube of glucose gel = 15g Gel acts to increase a patients BG levels Give to patients with decreased LOC and history of diabetes, but not unconscious patients 2. The only contraindications are the inability to swallow and unconsciousness. a. Aspiration can occur. 3. Wear gloves before putting anything in the patient's mouth. - Use tongue depressor

Ingested Poisons

80% of all poisons are by mouth -liquids, cleaners,s contaminated food, plants, drugs.... Usually accidental in children and on purpose with adults -Plant poisonings are common in children -Children will cry if poison is alkaline or acid because it burns their mouth Signs and Symptoms differ but may include gastrointestinal pain, vomiting, cardiac dysrhythmias, and seizures. Consider whether there is unabsorbed poison remaining in the gastrointestinal tract and whether you can safely and effectively prevent its absorption. Note that some chemicals react with water -Be prepared to ventilate because many poisons can depress CNS

Thrombosis

A blood clot, either in the arterial or venous system

Altered Mental Status

A change in the way a person thinks and behaves that may signal disease in the central nervous system or elsewhere in the body Often caused by diabetes comlications (Hypoglycemia and ketoacidosis) Altered mental status can arise from: a. Hypoglycemia b. Hypoxia c. Impaired cerebral blood flow d. Hyperthermia or hypothermia

Hormone

A chemical substance produced by a gland that regulates the activity of organs and tissues Travel through the blood to the end organs, tissues, or cells that they are intended to affect

Addiction

A state of overwhelming obsession or physical need to continue the use of a substance A person with an addiction has an overwhelming desire or need to continue using the substance, at whatever cost, with a tendency to increase the dose. Almost any substance can be abused (Laxitives, vitamins, etc.)

Schizophrenia

A complex, difficult-to-identify mental disorder whose onset typically occurs during early adulthood. Symptoms typically become more prominent over time and include delusions, hallucinations, a lack of interest in pleasure, and erratic speech Influences thought to contribute to the disorder: a. Brain damage b. Genetics c. Psychologic and social influences

Type 2 Diabetes

A condition in which insulin resistance develops in response to increased blood glucose levels Can be managed by exercise and diet modification, but is often managed by medications Caused by resistance to the effects of insulin at the cellular level (Fewer insulin receptors) a. Obesity = increased resistance to the effects of insulin. b. The pancreas produces more insulin to make up for the increased levels of blood glucose and dysfunction of cellular insulin receptors. i. This response becomes inefficient. ii. The blood glucose levels continue to rise and do not respond when the pancreas secretes insulin, a process called insulin resistance. c. Insulin resistance can sometimes be improved by exercise and dietary modification.

Hemophilia

A congenital abnormality in which the body is unable to produce clots, which results in uncontrollable bleeding Rare: only about 20,000 Americans have the disorder. Hemophilia A affects mostly males (inherited from carrier mother, females only inherit it if mom is carrier and dad has disease) Patients with hemophilia A typically have intravenous factor VIII replacement infusions, which help the blood clot, either close at hand or with them. People with hemophilia A have a decreased ability to create a clot after an injury, which can be life threatening. . Common complications of hemophilia A include: i. Long-term joint problems that may require a joint replacement ii. Bleeding in the brain (intracerebral hemorrhage) iii. Thrombosis due to treatment

Functional Disorder

A disorder in which there is no known physiologic reason for the abnormal functioning of an organ or organ system A functional disorder is a physiological disorder that impairs bodily function when the body seems to be structurally normal. Examples include schizophrenia, anxiety conditions, and depression and bipolar disorder are examples of functional disorders.

Narcotic

A drug that produces sleep or altered mental consciousness Signs and symptoms: -Pinpoint pupils -Profuse sweating -Reduced rate of pulse and rate and depth of breathing -Pinpoint pupils -Coma/ Somulance / Lethargy (being very sleepy)

Stridor

A harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway May be audible without stethoscope

Sickle Cell Disease

A hereditary/genetic disease that causes normal, round red blood cells to become oblong, or sickle shaped AKA Hemoglobin S Disease - RBC contain inadequate form of hemoglobin -Prevents individuals from getting malaria Discovered in 1910 by Dr. James Herrick 2. Found predominantly in people of African (1/12 of African Americans have the trait), Caribbean, and South American ancestry b. All newborns in the United States are tested for sickle cell disease shortly after birth. 3. Leads to dysfunction in oxygen binding and unintentional clot formation. a. Clots may result in a blockage known as vasoocclusive crisis. b. Blockages can result in hypoxia, substantial pain, and organ damage Sickled cells have a short life span (Normal RBC span is 110-120 days), resulting in more cellular waste products in the bloodstream and contributing to sludging (clumping) of the blood- Leads to anemia. a. Maintaining hydration is important, as insufficient hydration leads to increased clumping. Treatment can be IV fluid Administer supplemental oxygen , monitor for signs of inadequate respiration, hypoperfusion Complications: Destruction of spleen Sickle pain crisis Acute chest syndrome (Could lead to heart attack, stroke pulmonary embolism) Priapism Stroke Jaundice

Wheezing

A high-pitched, whistling breath sound that is most prominent on expiration, and which suggests an obstruction or narrowing of lower airways Occurs in asthma and bronchiolitis

Insulin

A hormone produced by the islets of Langerhans (Endocrine gland located throughout the pancreas) that enables glucose in the blood to enter cells Used in synthetic form to treat and control diabetes mellitus -Necessary for glucose to enter cells for metabolism

Diabetes Mellitus

A metabolic disorder in which the ability to metabolize carbohydrates (sugars) is impaired, usually because of a lack of insulin Affects 9.3% of population -Disorder of glucose metabolism (body has an impaired ability to get glucose into the cells to be used for energy) - Could also be defined as difficulty metabolizing carbs, fats, and proteins -Lack or ineffective action of insulin -Patients either have impaired insulin production or not enough functional receptors for insulin to bind to (Either way, glucose can't get into cells) -Without treatment, blood glucose levels become too high. If not managed well, it can have severe complications such as: a. Blindness b. Cardiovascular disease c. Kidney failure d. Coma/death B. There are three types of diabetes. 1. Diabetes mellitus type 1 2. Diabetes mellitus type 2 3. Pregnancy-induced gestational diabetes C. Treatments for diabetes: Medications and injectable hormones that lower blood glucose level. a. If administered correctly or incorrectly, can create a medical emergency for the patient with diabetes. b. Low blood glucose level (hypoglycemia) can be life threatening - so can hyperglycemia (Affects type 1 and type 2)

Acidosis

A pathologic condition that results from the accumulation of acids in the body

Toxin

A poison or harmful substance produced by bacteria, animals, or plants that acts by changing the normal metabolism of cells, or by destroying them -Can have acute or chronic effects

Type 1 Diabetes Symptoms

A patient with new-onset type 1 diabetes will have symptoms related to eating and drinking: a. Polyuria b. Polydipsia c. Polyphagia d. Weight loss e. Fatigue f. Malaise

Depression

A persistent mood of sadness, despair, and discouragement May be a symptom of many different mental and physical disorders, or it may be a disorder on its own

Wheal

A raised, swollen, well-defined area on the skin resulting from an insect bite or allergic reaction

Excited Delirium

A serious behavioral condition in which a person exhibits agitated behavior combined with disorientation, hallucinations, or delusions Also called agitated delirium or exhaustive mania . Delirium is a condition of impairment in cognitive function that can present with disorientation, hallucinations, or delusions. 1. Agitation is a behavior characterized by restless and irregular physical activity. 2. Although patients experiencing delirium are generally not dangerous, if they exhibit agitated behavior, they may strike out irrationally. 3. In such cases, your personal safety must be considered. -Vivid hallucinations, dilated pupils

Gonorrhea

A sexually transmitted disease caused by Neisseria Gonorrhoeae a. Grows and multiply rapidly in warm, moist areas of reproductive tract i. Cervix, uterus, fallopian tubes in women/Urethra in men and women b. Bacteria can also grow in the mouth, throat, eyes, and anus (oral sex) - painful swallowing, sore throat, fever c. Symptoms are more severe in men than women (Appears 2-10 days after exposure). d. Women may present with painful urination, burning or itching, yellowish or bloody vaginal discharge, and blood associated with sexual intercourse. -Rectal infections can occur e. Severe infections present with cramping and abdominal pain, nausea, vomiting, and bleeding between periods. i. These symptoms indicate it has progressed to PID. f. Untreated, it can enter the bloodstream and spread to other parts of the body, including the brain.

Chlamydia

A sexually transmitted disease caused by the bacterium chlamydia trachomatis a. Most common STD in the United States c. Usually mild or absent symptoms d. Some women may report lower abdominal pain, low back pain, nausea, fever, pain during sexual intercourse, or bleeding between menstrual periods. e. Infection of the cervix can spread to the rectum and can progress to PID. -In rare cases it can lead to arthritis

Hypnotic

A sleep-inducing effect or agent -Alcohol

Symptomatic Hyperglycemia

A state of unconsciousness/ altered mental status resulting from several problems, including ketoacidosis, dehydration because of excessive urination, and hyperglycemia *Acidosis, dehydration, hyperglycemia 1. Occurs when blood glucose levels are very high; the patient is in a state of altered mental status resulting from several combined problems. a. In type 1 diabetes, leads to ketoacidosis with dehydration from excessive urination b. In type 2 diabetes, leads to a nonketotic hyperosmolar state of dehydration due to the discharge of fluids from all of the body systems and eventually out through the kidneys, leading to fluid imbalance

Opiate

A subset of the opioid family, referring to natural, non-synthetic opioids

Epinephrine

A substance produced by the body (commonly called adrenaline), and a drug produced by pharmaceutical companies that increases pulse rate and BP Drug of choice for anaphylactic reaction -Sympathomimetic hormone (Mimics sympathetic nervous system) -It has various properties that cause the blood vessels to constrict, which reverses vasodilation and hypotension. 3. Other properties of epinephrine increase cardiac contractility and relieve bronchospasm in the lungs. -Can rapidly reverse the effects of anaphylaxis. -The adult EpiPen system delivers 0.3 mg of epinephrine via a spring-loaded needle and syringe system; the infant-child system delivers 0.15 mg. -If the medication has expired or is discolored, do not give the medication. -Can have an effect within 1 minute, so it is the primary way to save the life of someone with a severe anaphylactic reaction. -Dilates bronchioles and constricts blood vessels, so it may cause the patient's blood pressure to rise significantly. -Side-effects: Tachycardia, sweating, pale skin, dizziness, headache, palpitations, Increased pulse rate b. Anxiety c. Cardiac arrhythmias f. Chest pain h. Nausea/ Vomiting j. Increased myocardial oxygen demand *Patients without signs of respiratory compromise or hypotension and who do not meet the criteria for a diagnosis of anaphylaxis should not be given epinephrine* Elderly patients/patients with history of heart problems may not be able to handle epi-pen With IM epinephrine injection, the concentration must be 1:1,000 (1 mg epi per 1 mL) Hold injector in place for 10 seconds

Sedative

A substance that decreases activity and excitement -Alcohol

Antidote

A substance that is used to neutralize or counteract a poison Most poisons don't have one -Narcan

Poison

A substance whose chemical action could damage structures or impair function when introduced into the body Any substance that can harm the body Doses can turn even a remedy into a poison Acute poisoning affects 2 million people each year Chronic poisoning Often caused by long term abuse of alcohol, meds, and tobacco Rates of child poisonings have decreased since 60's, but risen for adults (drug abuse) Your primary responsibility with poisoned patients is to recognize that poisoning has occurred Never open door or approach scene until you know it's safe to enter 1. The presence of injuries at the patient's mouth strongly suggests the ingestion (swallowing) of a poison. Chronic poisoning is more common. If you are uncertain how to treat a patient who has been poisoned or exposed to a specific substance, find the container, if possible, and contact medical control and/or the poison control center before you proceed. - always make sure scene is safe first 1-800-222-1222 = poison control MOST IMPORTANT TREATMENT IS TO DILUTE OR PHYSICALLY REMOVE THE POISONOUS AGENT

Opioid

A synthetically-produced narcotic medication, drug, or agent similar to the opiate morphine, but not derived from opiuim Used to relieve pain Prescription opioids are among most commonly abused drugs in US Synthetic opioids include meperidine, hydromorphone, oxycodone, hydrocodone, and methadone Heroin deaths have tripled to 44,000

Reflective Listening

A technique in which you repeat, in question form, what the patient tells you—allows the patient to further expand on his or her thoughts; it also helps the EMT gain insight into the patient's situation. Use reflective listening to gain insight into the patient's thinking. This encourages the patient to expand on the thoughts.

Thrombophilia

A tendency toward the development of blood clots as a result of an abnormality of the system of coagulation a. A disorder in the body's ability to maintain the smooth flow of blood through the venous and arterial systems b. The concentration of particular elements in the blood creates clogging or blockage issues. Thrombophilia is a general term for many different conditions that result in the blood clotting more easily than normal. i. Inherited (genetic) disorders ii. Medications or other factors iii. Patients with cancer d. Clots can spontaneously develop in the blood of the patient.

Suicide

A. Depression is the single most significant factor that contributes to suicide. B. It is a common misconception that people who threaten suicide never commit it. 1. Suicide is a cry for help. 2. Threatening suicide is an indication that someone is in a crisis that he or she cannot handle alone. 3. Immediate intervention is necessary. Teen suicide = third leading cause of death for people 15-24 Be alert to these warning signs: 1. Does the patient have an air of tearfulness, sadness, deep despair, or hopelessness that suggests depression? 2. Does the patient avoid eye contact, speak slowly or haltingly, and project a sense of vacancy, as if he or she really is not there? 3. Does the patient seem unable to talk about the future? 4. Is there any suggestion of suicide? 5. Does the patient have any specific plans related to death? Sudden improvement from depression can be a very bad side indicating suicidal tendency A suicidal patient may be homicidal as well. 1. If you believe you are in danger, obtain police intervention. 2. The most important service you can provide for a suicidal patient is compassionate transport to a medical facility where the patient can receive proper treatment.

Definitive Treatment for Hypoglycemia in unconscious patient:

Glucose or glucagon We can't administer this

________ ______ connects each ovary to the uterus.

Fallopian Tubes

Blood Glucose Levels

Above 400 mg/dL: DKA, HHNS, or symptomatic hyperglycemia 120-400 mg/dL: Hyperglyceia 80-120 mg/dL: Normal 40-80 mg/dL: Hypoglycemia 0-40 mg/dL: Hypoglycemic crisis Less than 60 mg/dL in symptomatic diabetic Hypoglycemia Less than 50 mg/dL Significant alterations in mental status Greater than 140 mg/dL Hyperglycemia Special Glucose readings: Indicates extremely high or extremely low (Greater than 500 or lower than 15)

Activated Charcoal

Activated charcoal binds to specific toxins and prevents their absorption by the body; the toxins are then carried out of the body in the stool. 2. Activated charcoal is not indicated for patients: a. Who have ingested alkali poisons, cyanide, ethanol, iron, lithium, methanol, mineral acids, or organic solvents b. Who have a decreased level of consciousness and cannot protect their airway If local protocol permits, you will likely carry plastic bottles of premixed suspension, each containing up to 50 g of activated charcoal. a. Some common trade names are InstaChar, Actidose, and LiquiChar. b. The usual dose for an adult or child is 1 g of activated charcoal per kilogram of body weight. i. 30 to 100 g for adults ii. 15 to 30 g for children In most cases it should be given within one hour -Shake frequently -May cause constipation and black stool (May vomit) Not an antidote Works through adsorption If it's not injected, its not effective

Street Names for Sympathomimetics

Adam: 3,4-Methylenedioxymethamphetamine (MDMA) Angel Dust: Phencyclidine (PCP) Bennies: Amphetamines Coke: Cocaine Crank: Crack cocaine, heroin, amphetamine, methamphetamine, methcathinone DOM: 4-Methyl-2,5- dimethoxyamphetaine Ecstasy/Eve: MDMA Golden Eagle: 4-Methylthioamphetamine Ice: Cocaine, crack cocaine, smokable methamphetamine, methamphetamine, MDMA, phencyclidine (PCP) MDA: Methaqualone Meth: Methamphetamine Molly: MDMA Speed: Crack cocaine, amphetamine, methamphetamine Uppers: AMphetamines Phentermine Hydrochloride: Appetite suppressant Amphetamine Sulfate (Benzedrine): Taken for weight control, narcolepsy, chronic fatigue Caffiene and phenylpropanolamine (Nasal deconestant): mild sympathomimetics

Hyperglycemia

An abnormally high blood glucose level

Hypoglycemia

An abnormally low blood glucose level ACUTE- Comes on rapidly Can often mimic stroke or alcohol intoxication (Also, intoxicated patients often have abnormal glucose levels) Patients are more likely to have depressed LOC than hyperglycemia patients Hypoglycemia can develop: a. If a person takes his or her medications but fails to eat enough food. b. If a person takes too much medication, resulting in low blood glucose levels despite normal food a. Correct dose of insulin with change in routine (the patient exercised more and didn't adjust insulin, consumed a meal later than usual, or skipped the meal) d. Correct dose of insulin and the patient developed an acute illness All hypoglycemic patients require prompt treatment. a. Oral glucose paste (if alert and able to protect their airway) b. Injection of glucose (dextrose) or glucagon by an ALS provider

Hallucinogen

An agent that produce false perceptions in any one of the five senses Creates intense state of excitement and distorted perception Signs and symptoms : Rapid pulse, dilated pupils, flushed skin Make sure to ask if there is any drug stuff around the patient - is the scene safe? Never play along with a patients hallucinations a. The classic hallucinogen is lysergic acid diethylamide (LSD). b. Abuse of PCP is relatively uncommon among young adults. c. PCP is a dissociative anesthetic that is easily synthesized and highly potent. a. Cause visual hallucinations b. Intensify vision and hearing c. Generally separate the user from reality 3. Patients experiencing a "bad trip" have: a. Hypertension b. Tachycardia c. Anxiety d. Paranoia Do not use restraints unless you or the patient is in danger of injury. -Sympathomimetic properties -Examples: Jimsonweed, PCP/angel dust, psilocybin (mushrooms), morning glory, DXM, DMT, hashish, XTC,LSD

Stimulant

An agent that produces an excited state Methamphetamine and amphetamine (ice)

Sexual Assault

An attack against a person that is sexual in nature, the most common of which is rape

Type 1 Diabetes

An autoimmune disorder in which the individual's immune system produces antibodies to the pancreatic beta cells, and therefore the pancreas cannot produce insulin - Glucose can not enter cell -Body attacks cells that produce insulin Not enough insulin to handle sugar - synthetic insulin is administered Patients that need insulin = high blood sugar (neither paramedic or EMT can help administer) Onset usually happens from early childhood through the fourth decade of life. a. The immune system progressively destroys the ability of the pancreas to produce insulin. b. The patient must obtain insulin from an external source. c. Patients with type 1 diabetes cannot survive without insulin. d. Patients who inject insulin often need to check blood glucose levels up to six times or more a day. Many patients have insulin pump (can malfunction) Most common metabolic disease of childhood

Psychiatric Emergency

An emergency in which abnormal behavior threatens a person's own health and safety or the health and safety of another person, for example when a person becomes suicidal, homicidal, or has a psychotic episode.

Overdose

An excessive quantity of a drug that, when taken or administered, can have toxic or lethal consequences -Toxic dose of a drug Common complication of substance abuse

A 30-year-old male, who ingested an unknown substance, begins to vomit. You should: collect the vomitus and bring it to the hospital. apply a bag-valve mask. analyze the vomitus and try to identify the poison. suction his oropharynx for no longer than 30 seconds.

Answer: A Rationale: If the patient vomits, examine the contents for pill fragments. Ensure that you are wearing proper personal protective equipment for this activity. Note and document anything unusual that you see. You should try to collect the vomitus in a separate plastic bag so that it can be analyzed at the hospital.

Anaphylaxis

An extreme, life-threatening, systemic allergic reaction that may include shock and respiratory failure (And in rare cases death) -Involves multiple organ systems -Two of the most common signs are widespread urticaria and angiodema -Wheezing! Severe, life threatening allergic reaction Can cause rapid dilation of blood vessels (Hypotension) Airway swelling Bronchoconstriction Watch out for latex allergies Signs and symptoms: Skin: Itching, flushing/red skin, facial swelling,warm/tingling feeling in face/ mouth/ chest/ feet/ hands Rapid, labored, noisy breathing Hoarseness, muffled voice, loss of voice Stridor produced in upper airway, wheezing is lower Increased heart rate, decreased BP Patients may experience: a. Bronchospasm and wheezing b. Chest/throat tightness and coughing c. Dyspnea d. Anxiety e. Gastrointestinal complaints f. Hypotension . Occasionally, respiratory failure h. If untreated, an anaphylactic reaction can proceed rapidly to death. i. More than two-thirds of patients who die of anaphylaxis do so within the first 30 minutes, so rapid treatment and transport is essential. DONT GIVE PATIENT ANYTHING BY MOUTH (Nausea is common) -Place patient in supine position and give O2

Psychiatric Disorder

An illness with psychological or behavioral symptoms and/or impairment in functioning caused by a social, psychological, genetic, physical, chemical, or biologic distrurbance

Bacterial Vaginosis

An overgrowth of bacteria in the vagina Characterized by itching, burning, or pain, and possibly a "fishy" smelling discharge a. The most common vaginal infection to afflict women ages 15-44 years b. Normal bacteria in the vagina are replaced by an overgrowth of other bacteria. d. Untreated, it can lead to premature birth or low birth weight in case of pregnancy, make the patient more susceptible to other serious infections, and cause PID.

A diabetic patient presents with a blood glucose level of 310 mg/dL and severe dehydration. The patient's dehydration is the result of: excretion of glucose and water from the kidneys. a deficiency of insulin that causes internal fluid loss. an infection that often accompanies hyperglycemia. an inability to produce energy because of insulin depletion.

Answer: A Rationale: In severe hyperglycemia, the kidneys excrete excess glucose from the body. This process requires a large amount of water to accomplish; therefore, water is excreted with the glucose, resulting in dehydration.

Patients with diabetic ketoacidosis experience polydipsia because: they are dehydrated secondary to excessive urination. the cells of the body are starved due to a lack of glucose. fatty acids are being metabolized at the cellular level. hyperglycemia usually causes severe internal water loss.

Answer: A Rationale: Severe hyperglycemia—which leads to diabetic ketoacidosis—causes the body to excrete large amounts of glucose and water. As a result, the patient becomes severely dehydrated, which leads to excessive thirst (polydipsia).

The MOST reliable indicator of upper airway swelling during a severe allergic reaction is: stridor. anxiety. cyanosis. wheezing.

Answer: A Rationale: Stridor is a high-pitched sound that is most often heard during inhalation. It indicates swelling of the upper airway. Wheezing, a whistling sound, is caused by narrowed bronchioles; it indicates narrowing or swelling of the lower airway. Anxiety and cyanosis can occur from a variety of causes; they are not exclusive to airway swelling.

The mnemonic DUMBELS can be used to recall the signs and symptoms of a cholinergic drug poisoning. The "E" in DUMBELS stands for: emesis. erythema. ecchymosis. elevated blood pressure

Answer: A Rationale: The mnemonic "DUMBELS," which can help you recall the signs and symptoms of cholinergic drug poisoning (ie, organophosphates), stands for excessive defecation, urination, miosis (pupillary constriction), bronchorrhea, emesis, lacrimation, and salivation.

A behavioral crisis is MOST accurately defined as: a severe, acute psychiatric condition in which the patient becomes violent and presents a safety threat to self or to others. any reaction to events that interferes with activities of daily living or has become unacceptable to the patient, family, or community. a normal response of a patient to a situation that causes an overwhelming amount of stress, such as the loss of a job or marital problems. a reaction to a stressful event that the patient feels is appropriate, but is considered inappropriate by the patient's family or the community.

Answer: B Rationale: A behavioral crisis is any reaction to events that interferes with the patient's activities of daily living or has become acceptable to the patient, his or her family, or the community. Not all patients with an emotional crisis are "psychotic," nor are all violent patients experiencing a psychiatric condition; these are common misconceptions. Various medical conditions can cause a behavioral crisis (eg, hypoglycemia, hypoxemia, brain tumors).

What is the EMT's FIRST priority when dealing with a patient experiencing excessive vaginal bleeding? Determine the cause of the bleeding. Treat the patient for shock and transport. Determine if the bleeding is a result of sexual assault. Keep the patient warm and apply oxygen.

Answer: B Rationale: Determining the cause of the bleeding is less important than treating for shock and transporting the patient. EMTs can control the bleeding by using sanitary pads on the external genitalia. When treating for shock, the EMT must place the patient in the appropriate position, keep her warm, and apply oxygen.

The onset of menstruation is called: menopause. menarche. ovulation. bleeding.

Answer: B Rationale: Menarche is the onset of menstruation, typically occurring between the ages of 11 and 16 years.

A 21-year-old male was found unconscious in an alley. Your initial assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. Further assessment reveals that his pupils are bilaterally constricted. His presentation is MOST consistent with an overdose of: cocaine. an opioid. a stimulant drug. methamphetamine.

Answer: B Rationale: Opioids are central nervous system depressant drugs; when taken in excess, they cause respiratory depression, bradycardia, and hypotension. Another common sign is miosis (constricted [pinpoint]) pupils. Cocaine, stimulant drugs (uppers), and methamphetamine have the opposite effect; they stimulate the central nervous system and cause tachycardia and hypertension.

What are the two main components of blood? Erythrocytes and hemoglobin Cells and plasma Leukocytes and white blood cells Platelets and neutrophils

Answer: B Rationale: The blood is made up of two main components: cells and plasma. The cells in the blood include red blood cells (erythrocytes), white blood cells (leukocytes), and platelets. These cells are suspended in a straw-colored fluid called plasma.

Which combination of factors would MOST likely cause a hypoglycemic crisis in a diabetic patient? Eating a meal and taking insulin Skipping a meal and taking insulin Eating a meal and not taking insulin Skipping a meal and not taking insulin

Answer: B Rationale: The combination that would most likely cause a hypoglycemic crisis is skipping a meal and taking insulin. The patient will use up all available glucose in the bloodstream and become hypoglycemic. Left untreated, hypoglycemic crisis may cause permanent brain damage or even death.

How much activated charcoal should you administer to a 55-pound child who swallowed a bottle of aspirin? 12.5 g 25 g 2 g/kg 50 g

Answer: B Rationale: The usual dose of activated charcoal for adults and children is 1 g of charcoal per kg of body weight. To convert a patient's weight from pounds to kilograms, simply divide the weight in pounds by 2.2. Therefore, a 55-pound child should receive 25 g of activated charcoal (55 [pounds] ÷ 2.2 = 25 [kg]). The average pediatric dosing range for activated charcoal is 12.5 to 25 g.

Type 1 diabetes is a condition in which: too much insulin is produced. glucose utilization is impaired. too much glucose enters the cell. the body does not produce glucose

Answer: B Rationale: Type 1 diabetes is a disease in which the pancreas fails to produce enough insulin (or produces none at all). Insulin is a hormone that promotes the uptake of sugar from the bloodstream and into the cells. Without insulin, glucose utilization is impaired because it cannot enter the cell.

After taking Vicodin for 2 years for chronic pain, a 40-year-old woman finds that her usual dosage is no longer effective and goes to the doctor to request a higher dosage. This is an example of: addiction. dependence. tolerance. drug abuse.

Answer: C Rationale: A person who takes a medication for a prolonged period of time often finds that higher doses of the medication are required to achieve the same effect. This is called tolerance.

What breathing pattern would you MOST likely encounter in a patient with diabetic ketoacidosis (DKA)? Slow and shallow Shallow and irregular Rapid and deep Slow and irregular

Answer: C Rationale: Kussmaul respirations—a rapid and deep breathing pattern seen in patients with DKA—indicates that the body is attempting to eliminate ketones via the respiratory system. A fruity or acetone breath odor is usually present in patients with Kussmaul respirations.

A young male is experiencing signs and symptoms of anaphylactic shock after being stung by a scorpion. His level of consciousness is diminished, his breathing is severely labored, you can hear inspiratory stridor, and his face is cyanotic. The patient has a prescribed epinephrine auto-injector. What should you do first? Assist him in administering his epinephrine. Apply high-flow oxygen via nonrebreathing mask. Provide ventilatory assistance with a bag-valve mask. Elevate his legs and cover him with a warm blanket.

Answer: C Rationale: The patient is not breathing adequately, as noted by his decreased level of consciousness, severely labored breathing, inspiratory stridor, and cyanosis. Therefore, you should first assist his ventilations with a bag-valve mask. He clearly requires epinephrine, but not before restoring adequate breathing first. Regardless of the situation, a patient's airway must be patent and his or her breathing must remain adequate at all times.

The most common trigger of anaphylaxis is: plants. chemicals. medications. food.

Answer: D Rationale: Foods such as shellfish and peanuts are the most common triggers of anaphylaxis. These foods account for 30% of deaths from anaphylaxis, especially in adolescents and young adults.

The signs and symptoms of an allergic reaction are caused by the release of: histamine. epinephrine. leukotrienes. both histamine and leukotrienes.

Answer: D Response: The two chief chemicals released by the body that result in the signs and symptoms of an allergic reaction are histamines and leukotrienes. Epinephrine (adrenaline) is used to treat allergic reactions. Glucagon is a hormone secreted by the pancreas that helps control metabolism.

Anxiety Disorders

Anxiety disorders are among the most common mental health disorders. a. Generalized anxiety disorder b. Panic disorder c. Social and other phobias d. Posttraumatic stress disorder (PTSD) e. Obsessive-compulsive disorder

Endocrine Glands

Glands that secrete or release chemicals that are used inside the body Secretes messenger hormones

Anticholinergics

Atropine, diphenhydramine, chlorpheniramine, doxylamie, datura stramonium (jimsonweed) Signs and Symptoms: Tachycardia, hyperthermia, hypertension, dilated pupils, dry skin and mucous membranes, sedation, agitation, seizures, coma, delirium, decreased bowel sounds

Psychosis

BREAK WITH REALITY A mental disorder characterized by the loss of contact with reality Psychosis is a state of delusion in which the person is out of touch with reality. 1. Affected people live in their own reality of ideas and feelings. 2. Causes of psychotic episodes: a. Mind-altering substances b. Intense stress c. Delusional disorders d. Schizophrenia 3. Some episodes last for brief periods; others last a lifetime.

Synthetic Cathinones

Bath Salts 1. An emerging class of drugs similar to MDMA. 2. Sold as bath salts to escape the legal restrictions imposed on illicit drugs. -Includes chemical MDPV a. Brand names include Ivory Wave and Cloud Nine. 3. Cathinones produce euphoria, increased mental clarity, and sexual arousal. a. Most users of this drug snort or insufflate the powder nasally. b. Effects reportedly last as long as 48 hours. 4. Adverse effects include teeth grinding, appetite loss, muscle twitching, lip smacking, confusion, gastrointestinal conditions, paranoia, headache, elevated heart rate, and hallucinations. 5. Keep the patient calm and transport. 6. Consider ALS assistance; some of these patients may require chemical restraint to facilitate safe transport.

Extra Hematolgic Notes

Blood Representative of its own organ system Aggregation of platelets is body's most rapid and initial response to stop bleeding Clotting factors are a group of proteins produced in liver and released into bloodstream Once activated, clotting factors form clots through clotting cascades Coagulopathies Abnormal clotting of blood Can occur when body forms clots too readily or patient clots too slowly Certain diseases make patients prone to poor clotting Advanced liver disease Hemophilia (More likely in men) Von willebrand disease Certain medical conditions, medications in which the normal ability to form clots can worsen patients disease

Blood

Blood is made up of four components: erythrocytes, leukocytes, platelets, and plasma. 1. Each of the components of the blood serves a purpose in maintaining the body's homeostatic balance. a. Transports oxygen and carbon dioxide into and out of tissues. 2. Red blood cells (RBCs or erythrocytes) contain hemoglobin, which carries oxygen to the tissues. a. Red blood cells make up 42% to 47% of blood volume. 3. White blood cells (WBCs or leukocytes) make up 0.1% to 0.2% of a person's blood cell volume. (In times of health there are fewer) a. Collect dead cells and provide for their correct disposal b. Respond to infection 4. Platelets make up 4% to 7% of a person's blood cell volume. a. Essential for clot formation b. Respond to skin or blood vessel damage c. Assist in forming a clot to stop bleeding 5. Plasma serves as the transportation medium for blood components, proteins, and minerals.

Alcohol is a:

Blood thinner Inhibits clotting

Serious Signs and Symptoms of Alcohol Abuse

Blurred vision Confusion Hallucinations, visual, auditory Lack of memory (blackout) Altered mental status

Sympathomimetics

CNS stimulants that mimic effect of sympathetic nervous system 2. Examples include amphetamines and methamphetamines (stimulants), phentermine hydrochloride, and amphetamine sulfate (Benzedrine). -Epinephrine, albuterol, cocaine -Designer drugs, such as MDMA (ecstasy or Molly), are also frequently abused -Commonly taken by mouth; they are also injected by drug abusers -Makes user feel good, improve task performance, less appetite, no sleepiness, irritability, anxiety/fear, paranoia, lack of concentration, delusions, seizures Signs and Symptoms: Hypertension, tachycardia, dilated pupils, agitation, seizures, hyperthermia

Naloxone

Can be given by the intravenously, intramuscularly, or intranasally (IV route may be difficult due to tracks, so IN is preferred) b. In many EMS systems, EMTs administer naloxone by the intranasal route. i. Atomized through the nares into the nasal mucosa ii. Should only be used when the patient has agonal respirations or is apneic c. Place an oropharyngeal airway and ventilate the patient using a BVM prior to administering naloxone. i. Adequate ventilation decreases the risk of permanent brain damage related to hypoxia. ii. As the level of consciousness rises, the patient will react to the presence of the oropharyngeal airway and you will have to remove it to prevent aspiration. d. In some areas, lay people are permitted to administer naloxone; find out from bystanders if the patient was given naloxone. -If patient doesn't regain consciousness after narcan, wait 4 minutes and try again while continuing CPR Not any serious contraindications Goal of Narcan: To improve respiratory status Slow respirations + pinpoint pupils = ventilate and then administer narcan

Absorbed and Surface Contact Poisons

Can damage patient through: a. Skin, mucous membrane, or eye damage b. Chemical burns c. Rashes or lesions d. Systemic effects 2. It is important to distinguish between contact burns and contact absorption. -Acids, alkalis, and some petroleum products (hydrocarbon) = real bad -Common in agriculture and manufacturing Signs and symptoms of absorbed poisoning include: a. A history of exposure b. Liquid or powder on a patient's skin c. Burns d. Itching e. Irritation f. Redness of the skin g. Typical odors of the substance Treatment: avoid contaminating yourself, and remove substance from patient ASAP (Remove all contaminated clothing & Flush and wash the skin for 15-20 minutes and clean with soap+water). -If chemical is in eyes, irrigate quickly and thoroughly (Use nasal cannula)

Marijuana

Cannabis Sativa -49% of Americans have tried it - abused around the world -THC produces high c. Inhaling marijuana smoke produces euphoria, relaxation, and drowsiness. d. It impairs short-term memory and the capacity to do complex thinking and work. e. The euphoria could progress to depression and confusion. -Altered perception of time, anxiety/panic can occur . With very high doses, patients may experience hallucinations or become very anxious or paranoid. a. Reassure the patient and transport with a minimum amount of excitement. 3. Marijuana is often used as a vehicle to get other drugs into the body. Ingestion can lead to cannabinoid hyperemesis syndrome, characterized by chronic marijuana use and extreme nausea and vomiting that is relieved only by a hot shower or bath - definitive treatment = stop using weed Synthetic marijuana or "Spice" refers to a variety of herbal incense or smoking blends that resemble THC and produce a similar high. -Marketed as"safe" alternative to skunk and k2 a. Powerful and unpredictable effects may result, ranging from simple euphoria to complete loss of consciousness.

Food Poisoning (Ptomaine poisoning)

Caused by eating food contaminated by bacteria. B. There are two main types of food poisoning. 1. The organism itself may cause disease. 2. The organism may produce toxins that cause disease. -Salmonella, staphylococcus (more sudden, within 2-3 hours), botulism (most severe form) Scombrotoxin: Fish poison

Salmonellosis

Characterized by severe gastrointestinal symptoms within 72 hours of ingestion, including nausea, vomiting, abdominal pain, and diarrhea. 2. Proper cooking kills bacteria, and proper cleanliness in the kitchen prevents the contamination of uncooked foods.

Histamines

Chemical substances released by the immune system in allergic reactions that are responsible for many of the symptoms of anaphylaxis, such as vasodilation. Oral or IM antihistamines block the effect of histamine - works slowly (1 min to 1 hour)

Leukotrienes

Chemical substances that contribute to anaphylaxis Released by the immune system in allergic reactions

If fertilization has not occurred within about ___ days following ovulation, the lining of the uterus begins to separate and menstruation occurs. 8 10 12 14

D. 14

DVT

Deep vein thrombosis - A blood clot a. A common medical problem in sedentary patients and in patients who have had recent injury or surgery b. You may encounter several methods to prevent blood clot formation, including: i. Blood-thinning medications ii. Compression stockings iii. Mechanical devices Risk factors include i. Recent history of joint replacement and complaints of leg swelling ii. Travelers, truck and long-distance bus drivers iii. Bedridden nursing home patients . Treatment i. Anticoagulation therapy (a) In-hospital IV medications transitioned to oral medications before discharge (b) Self-administered subcutaneous injectable or oral medications ii. Oral medications are typically administered for at least 3 months after diagnosis of a DVT. e. Patients prescribed medications to treat DVT are at increased risk of bleeding complications (ie, gastrointestinal bleeding), and minor trauma is more likely to produce severe internal or external hemorrhage. f. A clot from the DVT can travel from the patient's heart, brain or lower extremity to the lung (causing a pulmonary embolus) i. Pulmonary emboli can cause chest pain, difficulty breathing, or sudden cardiac arrest.

Kussmaul Respirations

Deep, rapid breathing; usually the result of an accumulation of certain acids when insulin is not available in the body When glucose is unavailable to cells, the body turns to burning fat. a. When the body burns fat rather than glucose, it produces acid waste (ketones). i. As ketone levels go up in the blood, they spill into the urine. ii. Kidneys become saturated with glucose and ketones, and cannot maintain acid-base balance in the body. iii. The patient breathes faster and deeper, as the body attempts to reduce the acid level by releasing more carbon dioxide through the lungs.

DTs

Delirium Tremens A severe withdrawl syndrome seen in alcoholics who are deprived of ethyl alcohol Can be fatal if untreated The syndrome is characterized by: i. Agitation and restlessness ii. Fever iii. Sweating iv. Tremors v. Confusion and/or disorientation vi. Delusions and/or hallucinations vii. Seizures b. May develop after a person stops drinking or alcohol consumption levels are decreased suddenly. c. Provide prompt transport. d. Reassure the patient and provide necessary care and emotional support. Alcohol Withdrawal: 1-7 days after person stops drinking Abrupt cessation of drinking may cause alcoholics to suffer from delirium tremens (DTs) Unconscious patients will have dilate pupils

DKA

Diabetic Ketoacidosis A form of hyperglycemia in controlled diabetes in which certain acids accumulate when insulin is not available DKA may present as generalized illness along with: (a) Abdominal pain (b) Body aches (c) Nausea (d) Vomiting (e) Altered mental status or unconsciousness (if severe) If not rapidly recognized and treated, DKA can result in death. vii. When a patient with DKA has altered mental status, ask family or friends about the patient's history and presentation. viii. Obtain a glucose level with a fingerstick using a lancet and a glucometer. (a) Generally higher than 400 mg/dL DKA may also present when there is a relative lack of insulin (May occur with acute illness or untreated infection) that leaves patient in weakened condition

Sedative-Hypnotics

Diazepam, secobarbital, flunitrazepam, midazolam -Barbiturates and benzodiazepines: Easy to get and cheap Signs and Symptoms: CNS depressants and alter the level of consciousness, with effects similar to those of alcohol. -The patient may appear drowsy, peaceful, or intoxicated. -Slurred speech, sedation or coma, hypoventilation, hypotension -Does not eliminate pain or get person high on it's own -Usually taken by mouth. a. Users often take alcohol or an opioid at the same time to boost their effects. b. Occasionally, the capsules are suspended or dissolved in water and injected. c. IV sedative-hypnotic drugs quickly induce tolerance, so the person requires increasingly larger doses. 3. These drugs may be given to people as a "knock-out" drink, or "Mickey Finn," to incapacitate them without their knowledge (chloral hydrate) 4. Generally, your treatment is to ensure airway is patent, assist ventilations, and provide prompt transport. -May cause vomiting, cardiac arrest, respiratory depression, airway problems -Date rape drugs: -Flunitrazepam (Rohypnol) -Ketamine (Ketalar / Special K) More examples on pg 786

Dysphasia

Difficulty speaking

Polyphagia

Excessive eating In diabetes, the inability to use glucose properly can cause a sense of hunger

Polydipsia

Excessive thirst that persists for long periods, despite reasonable fluid intake Often the result of excessive urination

Injected Poisons

Exposure by injection includes intravenous drug abuse and envenomation (Act of injecting venom) by insects, arachnids, and reptiles. a. Injected poisons are usually absorbed quickly into the body or cause intense local tissue destruction. b. They cannot be diluted or removed from the body in the field. Signs and Symptoms: Weakness, dizziness, fever, chills, unresponsiveness, or easily excited patient Monitor the airway, provide high-flow oxygen (Spo2 level less than 94%), and be alert for nausea and vomiting. 4. Remove rings, watches, and bracelets from areas around the injection site if swelling occurs. - Take stuff to hospital

Hemophilia A VS B

Hem A is a deficiency in the blood clotting protein factor VII. Hem B is a deficiency in blood clotting factor IX

HHNS

Hyperosmolar Hyperglycemic Nonketotic Syndrome A life-threatening condition resulting from high blood glucose that typically occurs in older adults, and which causes altered mental status, dehydration, and organ damage Caused by uncontrolled blood glucose levels in type 2 diabetes (Similar to DKA in Type 1) -Often associated with infection/illness Key signs and symptoms of HHNS include: i. Hyperglycemia ii. Altered mental status, drowsiness, lethargy iii. Severe dehydration, thirst, dark urine iv. Visual or sensory deficits v. Partial paralysis or muscle weakness vi. Seizures Higher glucose levels in the blood cause the excretion of glucose in the urine. a. Patients respond by increasing their fluid intake (polydipsia), which causes polyuria. b. In HHNS, the patient cannot drink enough fluid to keep up with the exceedingly high glucose levels in the blood. c. The urine becomes dark and concentrated. d. The patient may become unconscious or have seizure activity due to severe dehydration.

Behavior

How a person functions or acts in response to his or her environment

Hyperglycemia vs Hypoglycemia

Hyper is gradual (hours to days), while hypo can occur within minutes Hyper skin is warm and dry while hypo skin is pale, cool , and moist Infection is common with hyper but not with hypo Hyper is associated with intense thirst and hunger, while hypo is associated with absence of both Hyper commonly sees vomiting and abdominal pain, while hypo doesn't Hyper: with diabetic ketoacidosis (DKA) there are rapid, deep (Kussmaul) respirations Hypo: breathing is mostly normal, but may be shallow and depressed if severe enough Hyper may experience sweet, fruity smelling breath with DKA Both will see normal to low BP and a rapid and weak pulse (Hyper pulse may be thready) Hyper will be restless, may progress to coma, abnormal/slurred speech, unsteady gait Hypo: irritability,confusion, seizure or coma, unsteady gait Treatment: Hyper will be gradual (6-12 hours), hypo will show immediate improvement

Dyspepsia

Indigestion

Four Routes for Poison

Ingested (Activated charcoal or dilute with water) Absorbed and Surface Contact (Water) Inhaled (Dilute with O2) Injected

Definitive treatment for hyperglycemia

Insulin We can't administer it

Chlorine Gas

Irritating to tissue Causes airway obstruction and pulmonary edema Burning eyes, sore throat, cough, chest pain, hoarseness, wheezing, respiratory distress, dizziness, confusion, headache, stridor, seizures, altered mental status

Vasoocclusive Crisis

Ischemia and pain caused by sickle-shaped red blood cells that obstruct blood flow to a portion of the body.

Anemia

Lack of normal amount of red blood cells Acute anemia: Sudden blood loss Chronic anemia: Excessive menstrual periods Slow gastrointestinal bleeding Diseases affecting bone marrow

Angioedema

Localized areas of swelling beneath the skin, often around the eyes and lips, but it can also involve other body areas as well -Lips, tongue, or larynx can cause airway obstruction

Alcohol

Many calls for service have a connection to alcohol use. a. 1 in 10 deaths among working-age adults in the United States can be attributed to excessive alcohol use. -Alcohol can damage liver, whether through chronic use or binge drinking (Binge can be more dangerous than chronic) Binge used has increased 17% - Causes altered mental status, slowed reflexes, and impaired reaction time -Alcohol is a powerful CNS depressant (Sedative and hypnotic) b. In general, alcohol dulls the sense of awareness, slows reflexes, and reduces reaction time. c. It may also cause aggressive and inappropriate behavior and lack of coordination. d. A person who appears intoxicated may have other medical problems as well. i. Look for signs of head trauma, mental illness, toxic reactions, or uncontrolled diabetes. ii. Severe acute alcohol ingestion may cause hypoglycemia. e. Assume that all intoxicated patients are experiencing a drug overdose and require a thorough examination by a physician - they can't refuse treatment 3. Alcohol increases the effects of many other drugs and is commonly taken with other substances (OTC drugs including antihistamines and diet meds) . If a patient exhibits signs of serious CNS depression, provide respiratory support. a. Depression of the respiratory system can also cause emesis, or vomiting. b. The vomiting may be very forceful or even bloody (hematemesis) because large amounts of alcohol irritate the stomach. c. Internal bleeding should also be considered if the patient appears to be in shock.

MSDS

Material Safety Data Sheet A form, provided by manufactureres and compounders (blenders) of chemicals, containing information about chemical composition, physical and chemical properties, health and safety hazards, emergency response, and waste disposal of a specific material -Helps identify and quickly make available specifiv interventions and potential antidotes AKA safety data sheet (SDS)

Veterans

May veterans develop a host of adverse physical conditions—some from injuries from combat, and sometimes from unfocused pain that is not associated with any specific body part. a. Combat veterans in particular may be prone to: i. Early heart disease ii. Higher incidence of type 2 diabetes iii. Loss of brain gray matter 5. Another consideration for the combat veteran is the higher incidence of traumatic brain injury (TBI) sustained from trauma secondary to the explosion of an improvised explosive device (IED). a. Symptoms may go undiagnosed for several reasons: i. Similarity to the symptoms of PTSD ii. The patient may downplay the symptoms. b. Health care providers should eliminate excess noise, refrain from touching or doing anything to the veteran without an explanation, and keep their diesel equipment far away. -Keep away diesel fuel, it often triggers flashbacks Physical restraint will not be effective with this population and may simply escalate the problem. a. If it is necessary to calm the patient, especially if there are safety concerns, chemical restraints administered by ALS should be considered.

Romazicon

Med given to reverse the effects of medicines similar to valium but is not on the list of meds an EMT can administer

Labia Majora

Outer fleshy "lips" covered with pubic hair that protect the vagina

Glucose Metabolism

Non-diabetic The pancreas stores and secretes insulin and glucagon in response to the level of glucose in the blood. - when you eat, glucose levels rise, causing pancreas to secrete insulin - glucose is allowed to enter body cells to be used for energy and also allows glucose to be stored as glycogen in the liver and skeletal muscles Person is hungry but doesn't eat - message is sent to pancreas to secrete glucagon, glucagon stimulates liver and skeletal muscles to release glycogen, converts glycogen back to glucose for use as cellular fuel

Glucose

One of the basic sugars Primary fuel, in conjunction with oxygen, for cellular metabolism

Opiates and Opioids

Opiates (Morphine, codeine) Opiods (Heroin, methadone, oxycodone) Signs and Symptoms: -Hypoventilation or respiratory arrest -Pinpoint pupils -Sedation or coma -Hypotension

Cholinergicss

Organophosphates, pilocarpine, nerve gas Signs and Symptoms: Airway compromise SLUDGEM: Salivation, sweating, lacrimation (excessive tearing of eye), urination, defecation, drooling, diarrhea, gastric upset and cramps, emesis (vomiting), muscle twitching/miosis (Pinpoint pupils)

Cholingeric Agents

Overstimulate normal body functions that are controlled by the parasympathetic nerves. 2. Includes "nerve gases" designed for chemical warfare and organophosphate insecticides. Poisoning results in: i. Excessive salivation or drooling ii. Mucus membrane oversecretion iii. Runny nose (rhinorrhea) iv. Excessive urination v. Tearing of the eyes vi. Uncontrolled diarrhea vii. Abnormal heart rate The signs and symptoms of cholinergic drug poisoning are easy to remember with the mnemonic DUMBELS: a. Diarrhea b. Urination c. Miosis (constriction of the pupils) d. Bradycardia, bronchospasm, bronchorrhea (discharge of mucus from the lungs) e. Emesis (vomiting) f. Lacrimation (tearing) g. Seizures, salivation, sweating Alternatively, you can use the mnemonic SLUDGEM: a. Salivation, sweating b. Lacrimation c. Urination d. Defecation, drooling, diarrhea e. Gastric upset and cramps f. Emesis g. Muscle twitching/miosis The most important consideration is to avoid exposure yourself. a. Decontamination may take priority over immediate transport. i. In many jurisdictions, the HazMat team will provide decontamination and contain the exposure chemical. b. Your priorities after decontamination are to: i. Decrease the secretions in the mouth and trachea. ii. Provide airway support. Antidote kits may be available. a. Most common is the DuoDote Auto-injector. b. The kit consists of a single auto-injector containing 2 mg atropine and 600 mg pralidoxime. c. If a known exposure to nerve agents or organophosphates with manifestation of signs and symptoms has occurred, use the antidote kit on yourself.

PID

Pelvic Inflammatory Disease An infection of the fallopian tubes and the surrounding tissues of the pelvis -Infection of upper organs of reproduction (Uterus, ovaries, fallopian tubes) -Occurs almost exclusively in sexually active women i. Disease-causing organisms enter the vagina and migrate into the uterine cavity. c. Infection expands to fallopian tubes = scarring (Can result in increased risk of ectopic pregnancy or sterility) d. If infection expands to ovaries, it can lead to the development of a life-threatening abscess. 2. Most common sign = generalized lower abdominal pain. a. Other signs include abnormal or foul-smelling vaginal discharge, increased pain with intercourse, fever, chills, burning urination, general malaise, and nausea/vomiting. -PID Shuffle - unbuttoned or loose pants, bent forward, shuffling -STDs like Gonorrhea and chlamydia can lead to PID Pain usually starts during or after normal menstruation. i. Inquiring about the date of last menstrual period is important. b. The pain may be made worse by walking. Patients often present with a distinctive gait that appears as a shuffle. 2. Prehospital treatment is limited. 3. Non Emergency transport is usually recommended. a. PID itself is seldom a threat to life but it is serious enough to require transport and evaluation in the hospital.

Pancreas

Produces and stores two hormones that play a major role in glucose metabolism: Glucagon and insulin Small portion of pancreas is filled with the isles of langerhans Within these islets are alpha and beta cells Alpha cells produce glucagon and beta cells produce insulin

Endocrine System

Regulates metabolism and maintains homeostasis Communication system that controls functions inside the body

Study Guide Notes

Renal failure is a serious result of untreated hyperglycemia Homeostasis is a stable environment within the body Sometimes your best action is to simply manage airway and transport In an unresponsive patient we must open airway and then determine if breathing is adequate A person who has made a suicide plan is more likely to commit it Excess glucose can be stored in body- child cannot store glucose as effectively Bleeding from any area of genitalia is always a serious finding EMT's focus in treating sexual assault should be addressing life threats and preserving evidence if possible Always treat chest pain as cardiac related

Positional Asphyxia

Restriction of chest wall movements and/or airway obstruction Can rapidly lead to sudden death

Six Rights of Patients

Right patient Right meds Right dose Right time Right route Right documentation

History Taking and Secondary Assessment for Gynecologic Emergences

SAMPLE history a. Make a note of any allergies or medications she may be taking. i. Birth control pills and devices b. Ask patient about medical conditions and last menstrual period. i. This will help determine possible pregnancy. ii. Also ask about the possibility of STDs. 2. Pertinent secondary assessment findings should include: a. Vital signs: blood pressure, pulse, skin color, orthostatic vital signs b. Abdomen: distention and tenderness c. Genitourinary: visible bleeding d. Neurological: mental status Focus assessment on NOI and patient chief complaint For vaginal bleeding: visualize the bleeding and ask about quality and quantity. i. Use external pads to control vaginal bleeding. ii. Keep the possibility of hypoperfusion or shock in mind. iii. Always ask if there is pain associated with the bleeding. iv. Never insert anything into the vagina to control bleeding, even a tampon. d. Observe for vaginal discharge. i. Make observations about the discharge. e. Fever, nausea, and vomiting are considered significant in gynecologic emergencies. f. Syncope is considered significant; treat as being in shock until proven otherwise.

Symptomatic Hypoglycemia

Severe hypoglycemia resulting in rapid changes in mental status 1. An acute emergency in which a patient's blood glucose level drops and must be corrected swiftly a. Can occur in patients who inject insulin or use oral medications that stimulate the pancreas to produce more insulin i. When insulin levels remain high, glucose is rapidly taken out of the blood. ii. If glucose levels fall, there may be an insufficient amount to supply the brain. (Patient may become more aggressive or display weird behavior) If BG remains low, unconsciousness and permanent brain damage can quickly follow.

Rape

Sexual intercourse forcibly inflicted on another person, against that person's will.

Leukotriene

Substance made by body and released in anaphylaxis

Allergen

Substance that causes an allergic reaction

Signs and Symptoms of Hypoglycemia

Signs and symptoms of hypoglycemia: a. Normal to shallow or slightly rapid respirations b. Pale, moist (clammy), sweaty skin c. Diaphoresis (sweating) d. Dizziness, headache e. Weak and Rapid pulse f. Normal to low blood pressure g. Altered mental status (aggressive, confused, lethargic, or unusual behavior) h. Anxious or combative behavior i. SEIZURES, fainting, or coma j. Weakness on one side of the body (may mimic stroke) k. Rapid changes in mental status l. Tachycardia Hypoglycemia is quickly reversed by giving the patient glucose. a. Without the glucose, however, the patient can sustain permanent brain damage. b. Minutes count. Results: Starvation of brain cells, altered mental status, unconsciousness, permanent brain damage

Urticaria

Small areas of generalized itching and/or burning that appear as multiple raised areas on the skin AKA Hives Sign of impending allergic reaction

Inhaled Poisons

Smoke inhalation Burning materials can contain poisonous and toxic substances Provide high-concentration oxygen Soot around nose/mouth - injury in airway and lungs -Ammonia+bleach = chlorine gas :( -Natural gas, sewer gas, some pesticides, carbon monoxide (especially in winter), chlorine Patients should be moved to fresh air immediately (May need supplemental oxygen) -Dilate with O2 -Some patients commit suicide via chemical/detergent suicide (homemade hydrogen sulfide gas in sealed area - call HazMat) -Can for HazMat if you suspect toxic gas - Never approach contaminated patient unless you have HazMat training -You may need to use self-contained breathing apparatus -Patient may need to be decontaminated before you treat them -Most patients just need to be removed from environments with inhaled poisons and given oxygen, but if lung damage occurs it can take 2-3 days in intensive care - All patients need prompt transport to ER Pulse ox may be inaccurate with inhaled poisons

Abused Inhalants

Some of the more common agents include acetone, toluene, xylene, and hexane. b. Found in glues, cleaning compounds, paint thinners, and lacquers (Inexpensive) 2. Gasoline and various halogenated hydrocarbons such as Freon, used as propellants in aerosol sprays, are also abused as inhalants. a. These are commonly abused by teenagers. b. The effective dose and the lethal dose are very close, making these extremely dangerous drugs - Can lead to permanent brain damage -Causes a rush of euphoria -Similar CNS effects as sedative-hypnotics, but these are likely to cause seizures -Method of abuse = huffing 3. Take special care in dealing with a patient who may have used inhalants. a. Halogenated hydrocarbon solvents can make the heart hypersensitive to the patient's own adrenaline. b. Even the action of walking may cause a fatal ventricular dysrhythmia. c. Try to keep such patients from struggling with you or exerting themselves. 4. Use a stretcher to move the patient, give oxygen, and transport the patient to the hospital.

Opioids and Opiates

Some patients may use IV drugs so they are at an increased risk for Hep C and HIV These agents are CNS depressants and can cause severe respiratory depression and then cardiac arrest if not treated promptly. a. Tolerance develops quickly, so some users may require massive doses to experience the same high. b. These drugs often cause nausea and vomiting and may lead to the development of hypotension. c. Although seizures are uncommon, they can occur. d. Patients typically appear sedated or unconscious and cyanotic with pinpoint pupils. i. PINPOINT PUPILS are the most commonly accepted sign of opiate abuse. Naloxone (Narcan) is an antidote that reverses the effects of opiate or opioid overdose.

Carbon Monoxide

Squeezing headache pain Colorless, odorless, severe hypoxia, no damage to lungs "A band around chest and head" Administer 100% oxygen - high flow Takes time to "wash out" CM from bloodstream

Ingestion

Swallowing/ Taking a substance by mouth

Cocaine

Sympathomimetic/Stimulant POTENT STIMULANT -May be taken in a number of different ways. a. It can be absorbed through all mucous membranes and even across the skin. b. Immediate effects include excitement and euphoria and last less than an hour. c. Smoked crack produces the most rapid means of absorption and, therefore, the most potent effect. AKA crystal, snow, freebase, rock, gold dust, blow, and lady One of the most addictive substances known IV form = skin-popping Crack is pure cocaine Acute overdose is a genuine emergency. -HIGH BP a. Patients have a high risk of seizures, cardiac dysrhythmias, and stroke. b. Patients may be experiencing hallucinations or paranoia, placing you at risk. c. Law enforcement officers should restrain the patient if necessary. d. Do not leave the patient unattended during transport. 5. Patients need prompt transport to the ED. Give supplemental oxygen and be ready to provide suctioning

Symptoms of Delirium

Symptoms: a. Hyperactive irrational behavior b. Vivid hallucinations c. Hypertension d. Tachycardia e. Diaphoresis f. Dilated pupils

Organic Brain Syndrome

Temporary or permanent dysfunction of the brain, caused by a disturbance in the physical or physiologic functioning of brain tissue . Causes: i. Sudden illness ii. Traumatic brain injury iii. Seizure disorders iv. Drug and alcohol abuse, overdose, or withdrawal v. Diseases of the brain, such as Alzheimer disease and meningitis

Envenomation

The act of injecting venom

Perineum

The area of skin between the vagina and the anus

Activities of Daily Living

The basic activities a person usually accomplishes during a normal day, such as eating, dressing, and bathing

Immune System

The body system that includes all of the structures and processes designed to mount a defense against foreign substances and disease-causing agents

Allergic Reaction

The body's exaggerated immune response to an internal or surface agent 1. It is not caused directly by an outside stimulus, such as a bite or sting. 2. Rather, it is caused by the body's immune system, which releases chemicals to combat the stimulus. a. These chemicals include histamines and leukotrienes, both of which contribute to an allergic reaction. b. Given the right person and the right circumstances, almost any substance can become an allergen. i. First, the person becomes sensitized (exposed for the first time) to the substance. ii. Then, his or her immune system learns to recognize the substance. iii. When the patient is exposed to the substance again, an allergic reaction occurs. Reaction may be mild and local (characterized by itching, redness, and tenderness), or severe and systemic (a condition known as anaphylaxis)

Immune Response

The body's response to a substance perceived by the body as foreign

Gynecologic Notes

The female reproductive system includes internal and external structures. -STDs can lead to more serious conditions, such as PID. You will only be able to gain primary impression of problem in the field Involve police with sexual assault (Female EMT provider) Treat for hypoperfusion or shock (Very few interventions with gynecologic emergency) -For abdominal pain, ask about onset, duration, quality, and radiation; provoking or relieving factors; and associated symptoms such as syncope, lightheadedness, nausea, vomiting, and fever (could be caused by ucers or appendicitis) -Syphyllis, HIV, and Hep are STDs that can be transmitted by blood

Cervix

The lower third, or neck, of the uterus

Substance Abuse

The misuse of any substance to produce a desired effect -heroin intoxication

Botulism

The most severe form of toxin ingestion is botulism. Can result from eating improperly canned food. a. The spores of Clostridium bacteria grow and produce a toxin. 2. The symptoms are neurologic. a. Blurring of vision b. Weakness c. Difficulty in speaking and breathing 3. Often fatal, symptoms may develop within the first 24 hours after ingestion or as long as 4 days later.

Uterus

The muscular organ where the fetus grows, also called the womb Responsible for contractions during labor

Tolerance

The need for increasing amounts of a drug to obtain the same effect Over time, a person who routinely misuses a substance may need increasing amounts of it to achieve the same result.

Menarche

The onset of menstruation When a female reaches puberty, she begins to ovulate and experience menstruation. a. It usually occurs between age 11 and 16 years. b. Any female who reaches menarche is capable of becoming pregnant. -Women continue the cycle of ovulation and menstruation until they reach menopause. -Menopause marks the end of menstrual activity and usually occurs around age 50.

Vagina

The outermost cavity of a woman's reproductive tract Lower part of the birth canal Cervix opens into vagina

Polyuria

The passage of an unusually large volume of urine in a given period In diabetes, this can result from the wasting of glucose in the urine

Behavioral Crisis

The point at which a person's reactions to events interfere with activities of daily living This becomes a psychiatric emergency when it causes a major life interruption, such as attempted suicide A behavioral crisis or psychiatric emergency includes patients of all ages who exhibit agitated, violent, or uncooperative behavior or who are a danger to themselves or others. 1. EMS is called when the behavior has become unacceptable to the patient, family, or community.

Ovaries

The primary female reproductive organs that produce an ovum, or egg, that, if fertilized, will develop into a fetus

Ovulation

The process in which an ovum is released from a follicle Each ovary produces an ovum in alternating months. Each month one ovum is released into the fallopian tube Some women experience minor cramping pain during this release period.

Hematology

The study and prevention of blood related disorders 1. Three disorders that can create a prehospital emergency: a. Sickle cell disease (AKA Hemoglobin S disease) b. Hemophilia A (AKA classic hemophilia or factor VIII deficiency) c. Thrombophilia

Immunology

The study of the body's immune system

Toxicology

The study of toxic or poisonous substances

Fallopian Tubes

The tubes that connect each ovary with the uterus and are the primary location for fertilization of ovum

Plant Poisoning

There are tens of thousands of cases of plant poisoning annually. 1. Many household plants are poisonous if ingested. 2. Some cause local skin irritation. 3. Some can affect the circulatory system, the gastrointestinal tract, or the CNS. It is impossible to memorize every plant and poison, let alone their effects. 1. You can and should do the following: a. Assess the patient's airway and vital signs. b. Notify the regional poison center for assistance in identifying the plant. c. Take the plant to the emergency department. d. Provide prompt transport. Irritation of the skin and/or mucous membranes is a problem with the common houseplant called dieffenbachia (Resembles elephant ears) AKA Dumb Cane. 1. When chewed, a single leaf may irritate the lining of the upper airway enough to cause difficulty swallowing, breathing, and speaking. 2. Emergency medical treatment includes: a. Maintaining an open airway b. Giving oxygen c. Transporting the patient promptly to the hospital for respiratory support

Dysphagia

Trouble swallowing

Treatment Notes for Gynecologic Bleeding

Uterine massage/fundal massage 2. Most women will use sanitary pads to control bleeding before you arrive. 3. Use sanitary pads on the external genitalia to absorb the blood. 4. Document the number of sanitary pads that were saturated with blood. 5. If the woman has a tampon in place, it is not necessary for it to be removed. C. The external genitals have a rich nerve supply. 1. This makes injuries to the area very painful. 2. Treat external lacerations, abrasions, or tears with sterile compresses. a. Use local pressure to control bleeding. b. Use a diaper-type bandage to hold dressings in place. c. Under no circumstances should you pack or place dressings in the vagina.

The process of fertilization begins in the:

Vagina 1. Sperm are deposited into the vagina from the male penis. a. Sperm pass through the cervix into the uterus and eventually up the fallopian tubes. b. When an ovum is FERTILIZED IN FALLOPIAN TUBES the developing embryo travels into the uterus. c. The embryo attaches to the uterine wall and continues to grow. If ovum is not fertilized in fallopian tubes, it travels to uterus If fertilization does not occur within about 14 days of ovulation, the lining of the uterus begins to separate, and menstruation occurs. 1. The menstrual flow consists of blood from the separated lining of the uterus and lasts about 1 week. 2. Female hormones, produced primarily in the ovaries, control the process of ovulation and menstruation

Emesis

Vomiting

Hematemesis

Vomiting blood

Type 1 Diabetes and Kidneys

When a patient's blood glucose level is above normal, the kidney's filtration system becomes overwhelmed and glucose spills into the urine. More glucose in urine = more water pulled from bloodstream to urine = more urination = more thirst a. Polyuria: frequent urination b. Polydipsia: increase in fluid consumption c. Polyphagia: severe hunger and increased food intake (If not caught, appetite will eventually decrease

Complications associated with Sickle-Cell Disease

a. Anemia b. Gallstones c. Jaundice d. Splenic dysfunction e. Vascular occlusion with ischemia: i. Acute chest syndrome (hypoxia, dyspnea, chest discomfort, and fever) ii. Stroke iii. Joint necrosis (specifically the head of the femur and the humerus) iv. Pain crises v. Acute and chronic organ dysfunction/failure vi. Retinal hemorrhages vii. Increased risk of infection/ more susceptible to infection

Sexual Assault and Rape

a. One in five women has reported being raped. b. One in four women will be sexually molested, often before the age of 12 years. a. Issues range from obvious medical ones to serious psychologic and legal issues. . When performing your assessment, be aware of drugs used during sexual assault or rape to incapacitate a person. a. Inability to remember the event should create suspicion (Roofies, GHB, Ketalar) b. If these drugs are still in the patient's system, you may see hypotension, bradycardia, abdominal complaints, difficulty breathing, seizures, coma, and even death. c. Preserve evidence i. Do not cut through any clothing. ii. Do not throw away anything from the scene. iii. Place bloodstained clothing and anything else that could be evidence in separate paper bags. 9. It may be necessary to persuade the patient not to clean herself. a. Doing so can destroy evidence. b. Patient should also be discouraged from urinating, changing clothes, moving her bowels, or rinsing out her mouth. c. She will be photographed and examined by nurses trained in sexual assault examination and management. -Patients CAN refuse treatment 10. Offer to call the local rape crisis center for the patient. a. Getting a professional advocate to the scene may help the patient deal with the trauma. 11. Take the patient's history and limit any physical examination to a brief survey for life-threatening injuries. 12. The patient report is a legal document and may be subpoenaed. a. Keep the report concise, and record only what the patient stated in her own words. i. Do not insert your own opinion. ii. Use quotation marks when reporting the patient's version of events. iii. Focus on the facts. b. Bear in mind that rape is a legal diagnosis, not a medical diagnosis. -Sexual Assault Nurse Examiners - SANE

SAMPLE History for Poisoned Patients

a. What substance did you take? b. When did you take it (or become exposed to it)? c. How much did you ingest? d. Did you have anything to eat or drink before or after you took it? e. Has anyone given you an antidote or any substance orally since you ingested it? f. How much do you weigh?

Restraints

i. Soft restraints include sheets, wide wristlets, and chest harnesses. ii. Hard restraints include plastic ties, handcuffs, or leather restraints. . The process of restraining a patient 1. Once the decision has been made to restrain a patient, you should carry it out quickly. a. Make sure you have adequate help to safely restrain the patient. b. Ideally, five people should be present to carry out the restraint—one responsible for each extremity and one responsible for the head. c. There should be a team leader who directs the process and a plan of action before you begin. d. Use the minimum force necessary Four-point restraints (both arms and both legs) are preferred for uncooperative patients. a. Do not place anything over the patient's face, head, or neck. Spitting = a surgical mask may be placed loosely over the patient's mouth. Biting = a hard cervical collar may be placed on the patient's neck Restrain in lateral decubitus position 2 point restraint technique - one arm up one down

If an individual has hyperglycemia for a protracted length of time, consequences of diabetes may present:

i. Wounds that do not heal ii. Numbness in the hands and feet iii. Blindness iv. Renal failure v. Gastric motility problems