Medical Exam Study Guide

Describe the signs and symptoms of a patient suffering from hyperglycemia.

- Frequent urination - thirst - dehydration - dry, warm skin - air hunger and kussmaul respirations - sweet, fruity odor - slow progression to unresponsiveness - ketoacidosis (DKA)

hypoglycemia symptoms

- weakness - diaphoresis - tachycardia - low BP - altered LOC

Describe the signs and symptoms of a patient suffering from hypothermia and describe the treatment conditions. p 1144, 1149

Signs and symptoms: Mild (>93.2): Shivering, foot stamping Moderate (93.2-86): Loss of coordination, muscle stiffness, coma Severe (<86): apparent death Treatment: move pt from cold environment, don't allow pt to walk, remove wet clothing and place dry blanket over and under pt, give pt warm humidified O2, handle pt gently, do not massage extremities or allow pt to drink any stimulants (vasoconstrictors, which impair circulation) If pt has mild hypothermia(alert, shivering, core temp between 90-95): place pt in warm environment, remove wet clothing, apply heat packs or hot water to groin, axillary and cervical regions(not directly on skin), turn heater on in ambulance If pt has moderate to severe hypothermia: remove pt from cold environment, place pt in ambulance, remove wet clothes, cover pt with blankets, transport

Describe the treatment of a patient exposed to a dry chemical. p 934

+ Always brush off dry chemicals from the skin and clothing before flushing with water + Remove pt's clothing bc there ay be more chemical on clothing (shoes, jewelry, stockings, gloves) + pt should be decontaminated by properly trained professionals

Describe the treatment for a bee sting.

+ remove the stinger + scrape the stinger off because you can inject more venom into the pt if you pinch or squeeze the stinger + maintain the airway, O2, BVM + rapid transport, early admin of EpiPen

Rocky mountain spotted fever

7-10 days after bitten nausea, vomiting, headache, paralysis, cardiopulmonary failure

anaphylaxis

BP PLUMMETS - because of vasodilation bronchoconstriction

Describe the signs and symptoms of a patient suffering from syncope including why the signs and symptoms occur. p 685

Definition: loss of consciousness caused by interruption of blood flow to the brain, transient cerebral hypoxia lasts less than 30 seconds should be immediately alert and oriented pt may be hypoglycemic, causing syncopal episode pt might have a lack of oxygen, causing syncope pt may be having a TIA

Describe the signs and symptoms of a patient suffering from a migraine.

Pain usually on one side of your head, but often on both sides. Pain that throbs or pulses. Sensitivity to light, sound, and sometimes smell and touch. Nausea and vomiting.

List the organs by the abdominal quadrant in which they are found.

Right Upper Quadrant: Liver, stomach, gallbladder, duodenum, right kidney, pancreas, and the right adrenal gland. Left Upper Quadrant: Liver, stomach, pancreas, left kidney, spleen, and the left adrenal gland. Right Lower Quadrant: appendix, reproductive organs, right ureter. RUQ: liver(solid) lies almost entirely under the protection of the 8th to 12th ribs, gallbladder (hollow), portion of the colon(hollow), portion of the pancreas (solid) LUQ: stomach (hollow), spleen (solid) in front of the 9th to 11th ribs, portion of the colon, portion of the pancreas (solid) RLQ: cecum (hollow), ascending colon(hollow), appendix (hollow), portion of urinary bladder (hollow) LLQ: descending colon (hollow), sigmoid (hollow), portion of urinary bladder (hollow)

Describe the signs and symptoms of a patient suffering from schizophrenia including treatment considerations.

Schizophrenia is characterized by thoughts or experiences that seem out of touch with reality, disorganized speech or behavior, and decreased participation in daily activities. Difficulty with concentration and memory may also be present. People may experience: Behavioral: social isolation, disorganized behavior, aggression, agitation, compulsive behavior, excitability, hostility, repetitive movements, self-harm, or lack of restraint Cognitive: thought disorder, delusion, amnesia, belief that an ordinary event has special and personal meaning, belief that thoughts aren't one's own, disorientation, mental confusion, slowness in activity, or false belief of superiority Mood: anger, anxiety, apathy, feeling detached from self, general discontent, loss of interest or pleasure in activities, elevated mood, or inappropriate emotional response Psychological: hallucination, paranoia, hearing voices, depression, fear, persecutory delusion, or religious delusion Speech: circumstantial speech, incoherent speech, rapid and frenzied speaking, or speech disorder Also common: fatigue, impaired motor coordination, lack of emotional response, or memory loss A disorder that affects a person's ability to think, feel, and behave clearly. The exact cause of schizophrenia isn't known, but a combination of genetics, environment, and altered brain chemistry and structure may play a role. Schizophrenia is characterized by thoughts or experiences that seem out of touch with reality, disorganized speech or behavior, and decreased participation in daily activities. Difficulty with concentration and memory may also be present. Treatment is usually lifelong and often involves a combination of medications, psychotherapy, and coordinated specialty care services. Treatment: clearly identify yourself; be calm, direct, and straightforward; maintain an emotional distance, don't touch the pt, do not patronize the pt, do not argue, explain what you would like to do ("let's walk downstairs to the ambulance"), involve people the pt trusts such as family members or friends to gain the pt's cooperation

Describe the signs and symptoms of a patient suffering from agitated delirium including treatment considerations.

Signs and symptoms of delirium usually begin over a few hours or a few days. They often fluctuate throughout the day, and there may be periods of no symptoms. Symptoms tend to be worse during the night when it's dark and things look less familiar. Primary signs and symptoms include those below. Reduced awareness of the environment This may result in: An inability to stay focused on a topic or to switch topics Getting stuck on an idea rather than responding to questions or conversation Being easily distracted by unimportant things Being withdrawn, with little or no activity or little response to the environment Poor thinking skills (cognitive impairment) This may appear as: Poor memory, particularly of recent events Disorientation — for example, not knowing where you are or who you are Difficulty speaking or recalling words Rambling or nonsense speech Trouble understanding speech Difficulty reading or writing Behavior changes These may include: Seeing things that don't exist (hallucinations) Restlessness, agitation or combative behavior Calling out, moaning or making other sounds Being quiet and withdrawn — especially in older adults Slowed movement or lethargy Disturbed sleep habits Reversal of night-day sleep-wake cycle Emotional disturbances These may appear as: Anxiety, fear or paranoia Depression Irritability or anger A sense of feeling elated (euphoria) Apathy Rapid and unpredictable mood shifts Personality changes Treatment: determine cause (MOI or NOI), provide manual spinal immobilization as indicated, airway and ventilation support, transport to appropriate facility

Describe the signs and symptoms of a patient suffering from meningitis and the treatment considerations.

Symptoms include headache, fever, and stiff neck. People may experience: Pain areas: in the back, muscles, or neck Whole body: fever, chills, fatigue, lethargy, loss of appetite, malaise, or shivering Gastrointestinal: nausea or vomiting Skin: blotchy rashes or red rashes Also common: irritability, mental confusion, sensitivity to light, stiff neck, bulging fontanelle, fast breathing, fast heart rate, fear of loud sounds, headache, lack of interest in feeding in infants, sleepiness, sluggishness, or stiff back Treatment: Depending on the cause, meningitis may get better on its own, or it can be life-threatening, requiring urgent antibiotic treatment. Transport so antibiotics could be given at ED

Describe the signs and symptoms of a patient suffering from anemia including why the signs and symptoms occur.

Symptoms may include fatigue, skin pallor, shortness of breath, lightheadedness, dizziness, or a fast heartbeat. People may experience: Whole body: dizziness, fatigue, lightheadedness, or malaise Heart: fast heart rate or palpitations Also common: brittle nails, headache, pallor, shortness of breath, or weakness A condition in which the blood doesn't have enough healthy red blood cells. Anemia results from a lack of red blood cells or dysfunctional red blood cells in the body. This leads to reduced oxygen flow to the body's organs. Symptoms may include fatigue, skin pallor, shortness of breath, lightheadedness, dizziness, or a fast heartbeat. Treatment depends on the underlying diagnosis. Iron supplements may be used for iron deficiency. Vitamin B supplements maybe used for low vitamin levels. Blood transfusions may be used for blood loss. Medications to induce blood formation may be used if the body's blood production is reduced.

gastrointestinal bleeding

Upper GI Bleeding: Vomiting bright red blood Dark, tarry stools (melena) Lower GI Bleeding: Frank blood in the stool Can lead to shock and major blood loss

Contrast the signs and symptoms of a gastrointestinal bleed which occurs high in the GI tract and low in the GI tract. p 710

Upper: occurs from esophagus to the upper small intestine; black stool Lower: occurs between the upper part of the small intestine and the anus; bright red blood in stool

how do EMT's treat abdominal problems

address airway, breathing, circulation issues, treat for shock

what epipens do

bronchodilate vasoconstrict

heroin

depressant

Contrast the signs and symptoms of a patient suffering from high and low blood sugar.

hypo: Fatigue Pale skin Shakiness Anxiety Sweating Hunger Irritability hyper: Increased thirst Headaches Trouble concentrating Blurred vision Frequent peeing Fatigue (weak, tired feeling) Weight loss Blood sugar more than 180 mg/dL

typical candidates for charcoal

ibuprofen, acetaminophen, aspirin

black widow _____ pain brown recluse ______ pain

immediate, delayed

insulin shock

low blood sugar levels symptoms: - cool, clammy, diaphoretic skin - rapid, shallow respirations - rapid, weak pulse

opioid

pain - reliever

diabetic coma

pass out from high or low blood sugar symptoms include warm, dry skin & slow onset, occurring over a period of days

narcotic overdose

pinpoint pupils + bradycardia

narcotic

produces sleep/altered mental consciousness

cocaine

sympathomemioc

Describe the signs and symptoms of a patient suffering from a cerebral vascular accident (stroke). p 678

Definition: An interruption of blood flow to the brain that results in the loss of brain function; also called a stroke Signs and symptoms: · Sudden weakness or numbness in the face, arm, leg or one side of the body · Decreased or absent movement and sensation on one side of the body · Lack of muscle coordination (ataxia) or loss of balance · Sudden vision loss in one eye; blurred or double vision · Difficulty swallowing (a primary reason for good airway management in a pt with a stroke) · Facial drooping · Decreased level of responsiveness · Speech disorders · Aphasia; difficulty expressing thoughts or inability to use the right words (expressive aphasia) or difficulty understanding spoken words (receptive aphasia) · Slurred speech (dysarthria) · Sudden and severe headache · Confusion · Dizziness · Weakness · Combativeness · Restlessness · Tongue deviation · Coma

List the steps in the primary assessment including the pertinent findings. page 563

Develop general impression of pt condition, rapid exam. to identify life threats (unconsciousness, obvious severe bleeding, extreme difficulty breathing), AVPU, ensure airway is open/patent, resp rate (depth and quality), O2 if breathing has been affected, if unconscious open airway, if in shock give O2, if difficulty breathing give O2, if SpO2 < 94% give O2, unconscious pt may need airway adjuncts and BVM, check circulation for conscious (radial pulse, skin color, temp, condition), if unconscious check carotid artery, check identify life threats (severe bleeding/injury to chest affecting breathing) and address them, make decision to transport (transport: unconscious pt's, pt's w/ altered mental status, pt's w/ airway or breathing problems, pt's with obvious circulation problems such as severe bleeding or signs of shock), if pt doesn't meet criteria for rapid transport continue assessment on scene and prepare for transport after completing assessment and treatment, if pt's condition deteriorates during primary assessment prepare pt for immediate transport and complete assessment en route to the emergency department (ED)

Describe the signs and symptoms of a patient suffering from frostbite including the treatment conditions. p 1150

Frostbite: damage to tissues as a result of exposure to cold; frozen or partially frozen body parts. Treatment: cover the frostbitten part with soft, padded, sterile cotton dressings. If blisters have formed, do not break them.

List the different types of seizures and describe the signs and symptoms associated with each.

Generalized (tonic-clonic) seizure: A seizure characterized by severe twitching of all of the body's muscles that may last several minutes or more; formerly known as a grand mal seizure Absent seizure: brief lapse of consciousness in which the pt seems to stare and not to respond to anyone; doesn't involve any changes in motor activity Partial (focal) seizure: A seizure affecting a limited portion of the brain. · May be simple or complex · Simple partial seizure: no change in pt's level of consciousness may report numbness, weakness, dizziness, visual changes, unusual smells or tastes, twitching of muscles and the extremities that spreads from one part of the body to another (not a dramatic severe twitching), brief paralysis · Complex partial seizure(results from abnormal discharges from the temporal lobe of the brain): altered mental status, doesn't interact normally with their environment, lip smacking, eye blinking, isolated convulsions or jerking of the body or one part of the body such as an arm, experience unpleasant smells and hallucinations, exhibit uncontrollable fear, exhibit repetitive behavior such as constant sitting and standing. Status epilepticus: A condition in which seizures recur every few minutes or last longer than 30 minutes

Describe the signs and symptoms of a patient suffering from hypoglycemia including why the signs and symptoms occur.

Glucose and oxygen are needed for proper brain function + Altered or decreased level of consciousness + may have hemiparesis(weakness on one side of the body) + may experience seizures (mental status may not improve after seizure is over) - dizziness, headache - agressive or confused behavior - rapid progression of altered level of consciousness - hunger - fainting, seizure, or coma - pale, moist skin - sweating

List the steps in the medical assessment including pertinent findings for each body region. page 565-566

Head/scalp/face: look for evidence of possible trauma, monitor pt for signs of pain w/palpation throughout assessment, examine head and face for symmetry, check pupils for equality and reactivity to light, look at conjunctiva of eyes for moisture and the ears and nose for drainage, look for nasal flaring, examine mouth for foreign bodies(including loose teeth or dentures) and pink, moist mucosa Neck: evidence of accessory muscle use w/ respirations, jugular vein distention, tracheal deviation (indicating respiratory or cardiac problems), move any clothing to check for tracheostomy or stoma Chest/abdomen: check breath sounds and ensure the pt is breathing adequately w/ equal chest rise and fall on each side, inspect and palpate the chest and abdomen to identify any areas of tenderness or swelling, look for medication patches on chest or abdomen and any implanted medical devices (usually can be palpated under the skin), check for rigidity and distention in the abdomen and look for scars on the chest or abdomen that might indicate previous surgeries Pelvis/ genital area: check area and ask about pain, look for signs of incontinence or bleeding Legs/arms: palpate legs and arms for swelling and other abnormalities, check for distal motion, check for sensation, check for circulation, note any scars or track marks along veins (indicating intravenous drug use), look for medical alert jewelry at the wrist Back: note irregularities, pain , or scars +at this point, full assessment is complete and treatment of non-life-threatening conditions should be instituted

Contrast the signs and symptoms of a patient suffering from heat exhaustion and heat stroke and describe the treatment considerations for each. p. 1152; 1156

Heat exhaustion: a heat emergency in which a significant amount of fluid and electrolyte loss occurs because of heavy sweating; also called heat prostration or heat collapse. (most common) Causes of heat exhaustion: heat exposure, stress, fatigue Signs and symptoms: + Dizziness, weakness, or syncope signifying a change in level of consciousness with accompanying nausea, vomiting, or headache. Muscle cramping may also be present, including abdominal cramping. + Onset while working vigorously or exercising in a hot, humid, or poorly ventilated environment and sweating heavily + Onset, even at rest, in the older and infant age groups in hot, humid environments. People who are not acclimatized to the environment may also experience onset at rest. + Cold, clammy skin with ashen pallor. + Dry tongue and thirst. + Normal vital signs, although the pulse is often rapid and weak (an indication for use of pulse oximetry) and the diastolic blood pressure may be low. + Normal or slightly elevated body temperature; on rare occasions, as high as 104 degrees Fahrenheit (40 degrees Celsius) Treatment: Move the pt to a cooler environment. remove extra clothing. Give oxygen if indicated. Check pt's blood glucose level if indicated. Perform cold water immersion or other cooling measures as available. Place the pt in a supine position and fan the pt. if pt is fully alert, give water by mouth. If nausea develops, secure and transport the pt on his or her left side. Heat stroke: a life-threatening condition of severe hyperthermia caused by exposure to excessive natural or artificial heat, marked by warm, dry skin; severely altered mental status; and often irreversible coma. (least common but most serious) Causes: ma develop during vigorous physical activity (maybe in a poorly ventilated), children left unattended in a locked vehicle on a hot day, heat waves among people (particularly geriatric pt's) who live in buildings with no AC or w/ poor ventilation Signs and Symptoms: + Hot, dry flushed skin (b/c their sweating mechanism has been overwhelmed + the skin may be moist or wet due to exertion by the pt (pt can have a heat stroke even if he or she is still sweating)--> often seen in endurance athletes, military personnel, or emergency providers who wear PPE such as firefighters, SWAT team members, or HazMat workers +decrease level of consciousness/unconsciousness (caused by rise in core temperature: ) + Change in behavior (seizures may occur) + pulse is rapid and strong at first, but pulse becomes weaker and BP falls as the pt becomes increasingly unresponsive + Respiratory rate increases as body attempts to compensate + telltale sign: pt no longer perspires (body has lost its thermoregulatory mechanisms) if you are perspiring in the environment, you r pt should too. Treatment: Move the pt out of the hot environment and into the ambulance. Set the air conditioning to maximum cooling. Remove the pt's clothing. Administer high-flow oxygen if indicated, if this was not already done as part of the primary assessment. If needed, assist the pt's ventilations with a BVM and appropriate airway adjuncts as per your protocol. If the pt is unresponsive and unable to to protect his or her airway, consider rapid transport and cooling en route. Consult medical control if available. Provide cold-water immersion in an ice bath, if possible. Cooling should begin immediately and continue en route and cold water immersion is available at the scene, continue cold-water immersion is available at the scene until the core body temperature is between 101 degrees Fahrenheit and 102 degrees Fahrenheit. Cover the pt with wet towels or sheets, or spray the pt with cool water and fan him or her to quickly evaporate the moisture on the skin. Aggressively and repeatedly fan the pt with or without dampening the skin. Exclude other causes of altered mental status and check blood glucose level if possible. Provide rapid transport to the hospital. Notify the hospital as soon as possible so that the staff can prepare to treat the pt immediately on arrival. Do not overcool the pt. Call for ALS assistance if the patient begins to shiver.

Contrast the pathophysiology of a hemorrhagic stroke and an ischemic stroke. p 678, 679

Hemorrhagic stroke: Definition: A type of stroke that occurs as a result of bleeding inside the brain Pathophysiology: A blood vessel ruptures and the accumulated blood forms a blood clot, compressing the brain tissue next to it. The compression prevents oxygenated blood from getting into the area, and the brain cells begin to die. Ischemic stroke: Definition: A type of stoke that occurs when blood flow to a particular part of the brain is cut off by a blockage (e.g. a blood clot) inside a blood vessel Pathophysiology: Blood flow to a particular part of the brain is stopped by a blockage (blood clot) inside a blood vessel. Blockage may be due to thrombosis (a blood clot, either in the arterial or venous system. When the clot occurs in a cerebral artery, it may result in the interruption of cerebral blood flow and subsequent stroke; where a clot forms at the site of blockage) or an embolus (a blood clot or other substance in the circulatory system that travels to a blood vessel where it causes a blockage; where the blood clot forms in a remote area and then travels to the site of the blockage)

Describe the signs and symptoms of a patient suffering from pneumonia and why the signs and symptoms occur.

INFECTION OF ALVEOLI THAT CAUSES THEM TO FILL WITH PUS: Symptoms include cough with phlegm or pus, fever, chills, and difficulty breathing. People may experience: Pain types: can be sharp in the chest Whole body: fever, chills, dehydration, fatigue, loss of appetite, malaise, clammy skin, or sweating Respiratory: fast breathing, shallow breathing, shortness of breath, or wheezing Also common: coughing or fast heart rate Infection that inflames air sacs in one or both lungs, which may fill with fluid. With pneumonia, the air sacs may fill with fluid or pus. The infection can be life-threatening to anyone, but particularly to infants, children, and people over 65. Symptoms include cough with phlegm or pus, fever, chills, and difficulty breathing. Antibiotics can treat many forms of pneumonia. Some forms of pneumonia can be prevented by vaccines.

Describe the signs and symptoms of a patient suffering from kidney stones including why the signs and symptoms occur. p 713

If stone passes into the ureter, it will cause a blockage. Pressure will build up behind the kidney and cause swelling (pt will report discomfort in flank, radiating to groin), pt will be agitated trying to find a comfortable position to relieve pain, may report nausea/vomiting, hematuria (blood in the urine) may be present because of irritation of the ureter [the pain from kidney stones is often caused when the stone moves within the ureter]

Describe the signs and symptoms of a patient suffering from appendicitis including why the signs and symptoms occur. p 710

Inflammation can eventually cause the tissues to die and/or rupture, causing an abscess, peritonitis, or shock. Appendicitis can cause referred pain, report nausea, vomiting, fever, chills, rebound tenderness (a result of peritoneal irritation)

Describe the signs and symptoms of a patient suffering from bipolar disorder including treatment considerations.

Manic episodes may include symptoms such as high energy, reduced need for sleep, and loss of touch with reality. Depressive episodes may include symptoms such as low energy, low motivation, and loss of interest in daily activities. Mood episodes last days to months at a time and may also be associated with suicidal thoughts. People may experience: Mood: mood swings, sadness, elevated mood, anger, anxiety, apathy, apprehension, euphoria, general discontent, guilt, hopelessness, loss of interest, or loss of interest or pleasure in activities Behavioral: irritability, risk taking behaviors, disorganized behavior, aggression, agitation, crying, excess desire for sex, hyperactivity, impulsivity, restlessness, or self-harm Cognitive: unwanted thoughts, delusion, lack of concentration, racing thoughts, slowness in activity, or false belief of superiority Psychological: depression, manic episode, agitated depression, or paranoia Weight: weight gain or weight loss Sleep: difficulty falling asleep or excess sleepiness Also common: fatigue or rapid and frenzied speaking Treatment: stay with the pt, do not get too close to a potentially volatile pt, express interest in the pt's story, avoid fighting with the pt, be honest and reassuring, do not judge, transport

Describe the signs and symptoms of a patient suffering from influenza including the treatment considerations. p569, mayoclinic

Pain areas: in the muscles Cough: can be dry or with phlegm Whole body: chills, dehydration, fatigue, fever, flushing, loss of appetite, body ache, or sweating Nasal: congestion, runny nose, or sneezing Also common: chest pressure, head congestion, headache, nausea, shortness of breath, sore throat, or swollen lymph nodes Treatment: Treatment consists of fluids and activity modifications The flu is treated primarily with rest and fluid to let the body fight the infection on its own. Over-the-counter anti-inflammatory pain relievers may help with symptoms. An annual vaccine can help prevent the flu and limit its complications.

Describe the signs and symptoms of a patient suffering from anaphylaxis including why the signs and symptoms occur.

Symptoms include a skin rash, nausea, vomiting, difficulty breathing, and shock. People may experience: Whole body: fainting, lightheadedness, low blood pressure, dizziness, or flushing Respiratory: difficulty breathing, rapid breathing, shortness of breath, or wheezing Skin: hives, swelling under the skin, blue skin from poor circulation, or rashes Gastrointestinal: nausea or vomiting Also common: fast heart rate, feeling of impending doom, itching, tongue swelling, difficulty swallowing, facial swelling, mental confusion, nasal congestion, or impaired voice A severe, potentially life-threatening allergic reaction. The reaction can occur within seconds or minutes of exposure to an allergen. Symptoms include a skin rash, nausea, vomiting, difficulty breathing, and shock. If not treated right away, usually with epinephrine, it can result in unconsciousness or death.

Describe the signs and symptoms of a patient suffering from a narcotic overdose including treatment considerations.

Symptoms may include shallow breathing, confusion, lessened alertness, and loss of consciousness. People may experience: Common symptoms: respiratory failure, slow breathing, small pupils, unresponsiveness, or blue skin from poor circulation Treatment: narcan, BVM ventilations, rapid transport

how hepatitis is transmitted

The virus is found in blood and certain body fluids. It is spread when a person who is not immune comes in contact with blood or body fluids from an infected person

Contrast the signs and symptoms of a patient suffering from a stroke and a transient ischemic attack. p 680

Transient ischemic attack (TIA): A disorder of the brain in which brain cells temporarily stop functioning because of insufficient oxygen, causing stoke-like symptoms that resolve completely within 24 hours of onset.

early/late symptoms of hepatitis

early: - loss of appetite - vomiting - fever - fatigue - muscle/joint pain late: - jaundice - right upper abdominal pain

Describe the signs and symptoms of a patient suffering from gastrointestinal bleeding including why the signs and symptoms occur. p 710

forceful vomiting, black stool, frank red blood in stool, abdominal pain, hypovolemic shock Bleeding within the gastrointestinal tract is a symptom of another disease, not a disease itself.

symptoms of hyperglycemia

polyuria, polydipsia, polyphagia Fruity-smelling breath. Dry mouth. Abdominal pain. Nausea and vomiting. Shortness of breath. Confusion. Loss of consciousness. rapid pulse rapid deep breaths (ketoacidosis)

rules to rescue a patient in water

reach throw row then go

gastrointestinal bleeding can cause

shock