Chapter 14: Medical Overview

6. Define infectious disease and communicable disease. (p 569)

An infectious disease is a medical condition caused by the growth and spread of small harmful organisms within the body. A communicable disease is a disease that can be spread from one person or species to another. -With most patients who have a potentially infectious disease in the prehospital setting, the next step after scene size-up and primary assessment is to gather patient history, using OPQRST to elaborate on the patient's chief complaint. -obtain SAMPLE history

Which of the following is a physiologic effect of epinephrine when used to treat anaphylactic shock? A) As a vasodilator, it increases the blood pressure. B) As a vasoconstrictor, it lowers the blood pressure. C) As a bronchodilator, it improves the patient's breathing. D) As an antihistamine, it blocks chemicals that cause the reaction.

Epinephrine possesses dual effects. As a bronchodilator, it relaxes the smooth muscle of the bronchioles and improves the patient's breathing. As a vasoconstrictor, it constricts the blood vessels and increases the patient's blood pressure. Diphenhydramine (Benadryl) is an antihistamine; it blocks H1 histamine receptor sites, which blocks the release of the chemicals (histamines) that are causing the allergic reaction

define TACOS

Tabacco Alcohol Caffeine Over the counter meds/herbal supplements Sexual and street drugs

5. Explain the importance of transport time and destination selection for a medical patient. (p 567)

after primary assessment, determine if rapid transport is needed. Includes factors such as: -Patients who are unconscious or who have an altered mental status -Patients with airway or breathing problems -Patients with obvious circulation problems such as severe bleeding or signs of shock -If you find that your patient's condition deteriorates during the primary assessment, prepare the patient for immediate transport and complete the assessment en route to the emergency department (ED). -Critical patients always need rapid transport. The time on scene should be limited to 10 minutes or less for these patients. -It is generally appropriate to select the closest ED as your destination. -If a patient needs specialized care, the closest hospital is not necessarily the most appropriate choice.

Your transport decision should be based on the: A. secondary assessment B. past medical history C. physical examination D. primary assessment

primary assessment

After you assess the ABCs, what should be done for this patient? A. Transport B. Secondary assessment C. Vital signs D. Reassessment

vital signs

List 7 infectious diseases of concern for EMA personnel

Influenza, tuberculosis, herpes, HIV, Hepatitis, meningitis, whooping cough, MRSA

**** GOOD DIABETES QUESTION A 56-year-old diabetic man is found unresponsive by his wife. She tells you that he ate breakfast this morning, but is unsure if he took his insulin. His respirations are rapid and shallow, his skin is cool and profusely diaphoretic, and his pulse is rapid and weak. Which of the following statements regarding this patient is correct? A) The fact that he ate breakfast makes hypoglycemia highly unlikely. B) He probably did not take his insulin and has a high blood glucose level. C) You should request an ALS unit so they can give the patient his insulin. D) He needs glucose as soon as possible because he is likely hypoglycemic.

D) He needs glucose as soon as possible because he is likely hypoglycemic. Based on the patient's presentation, you should suspect that he is in insulin shock (hypoglycemic crisis) and requires glucose as soon as possible. Cool, clammy (diaphoretic) skin; rapid, shallow respirations; and a rapid, weak pulse are classic signs of insulin shock. Diabetic coma (hyperglycemic ketoacidosis) typically presents with deep, rapid respirations (Kussmaul respirations); warm, dry skin; and tachycardia. If a diabetic patient has an altered mental status or is unresponsive, you should assume that he or she is hypoglycemic unless there is a specific information to the contrary (ie, failure to take prescribed insulin, hypoglycemia ruled out by glucometer). Even if the patient is in diabetic coma and needs insulin, it is rarely given in the field by ALS personnel. The EMT can quickly rule hypoglycemia in or out by assessing the patient's blood glucose level with a glucometer.

What standard precautions should be taken with this patient? A. Gloves only B. Gloves and mask C. Gloves, mask, and eye protection D. Mask only

gloves only

If this patient has recently traveled out of the country, what questions should you ask him?

-Where did you recently travel? -did you receive any vaccinations before your trip? -were you exposed to any infectious diseases -is there anyone else in your travel party who is sick? -What types of food did you eat? -What was your source of drinking water

4. Discuss the assessment of a patient with a medical emergency. (pp 562-566)

-develop a general impression of the patient's condition -life threats include: apparent unconsciousness, obvious severe bleeding, extreme difficulty breathing -determine LOC using AVPU scale -in conscious patients, ensure airway is open and they are breathing adequately -in unconscious patients, open airway -apply O2 to patients in shock, with difficulty breathing, and when SpO2 is less than 94% -Assess the circulation in a conscious patient by checking the radial pulse and observing the patient's skin color, temperature, and condition.

Activated charcoal is contraindicated for a patient who is: A) emotionally upset and has ingested two bottles of aspirin. B) awake and alert and has swallowed a commercial drain cleaner. C) agitated and claims to have ingested a bottle of Tylenol. D) conscious and alert and has ingested a large amount of Motrin.

B) awake and alert and has swallowed a commercial drain cleaner. Activated charcoal adsorbs (binds to) many ingested substances, preventing them from being absorbed into the body by the stomach or intestines. In some cases, you may give activated charcoal to patients who have ingested certain substances, if approved by medical control or local protocol. Activated charcoal is contraindicated for patients who have ingested an acid or alkali (ie, drain cleaner) or a petroleum product (ie, gasoline), who have a decreased level of consciousness and cannot protect their own airway, or who are unable to swallow.

Immediately following a generalized tonic-clonic seizure, most patients are: A) apneic. B) confused. C) hyperactive. D) awake and alert.

B) confused. After a generalized motor (tonic-clonic) seizure, the patient typically will be confused, sleepy, or, in some cases, combative. This is referred to as the postictal phase. The patient's level of consciousness typically improves within 30 minutes. In many cases, the patient's respirations will be fast (tachypnea) following a seizure; this is the body's attempt to eliminate excess carbon dioxide that accumulated in the blood during the seizure. Tachycardia is also common immediately following a generalized tonic-clonic seizure.

Which of the following best describes a communicable disease? A. The growth and spread of small harmful organisms within the body B. A disease that can be spread from one person or species to another C. A disease that cannot be transmitted from one person to another D. Presence of infectious organisms on or in objects

B. A disease that can be spread from one person or species to another

A 16-year-old, 125-pound male ingested a bottle of aspirin approximately 20 minutes ago. Medical control orders you to administer activated charcoal in a dose of 1 g/kg. How much activated charcoal should you administer? A) 51 g B) 54 g C) 57 g D) 60 g

C) 57 g First, you must determine the patient's weight in kilograms (kg). Either of the following formulae can be used to convert pounds to kilograms: Formula 1: weight (in pounds) / 2.2 = weight in kg. Formula 2: weight (in pounds) / 2 - 10% = weight in kg. On the basis of the above formulae, a 125-pound patient weighs 57 kg. Using formula 1, the equation is as follows: 125 (weight in pounds) / 2.2 = 56.81 (57 [rounded to the nearest tenth]). Using formula 2, the equation is as follows: 125 (weight in pounds) / 2 = 62.5 (63 [rounded to the nearest tenth] - 6.3 (10% of 63) = 56.7 (57 [rounded to the nearest tenth]). Since the drug order is for 1 g/kg, you should administer 57 g of activated charcoal to your 125-pound patient.

***types of seizures A 31-year-old man presents with uncontrolled twitching of his left arm that began shortly after he experienced an odd taste in his mouth. He denies loss of consciousness and states that this has happened to him before. What should you suspect? A) Absence seizure B) Generalized seizure C) Simple partial seizure D) Complex partial seizure

C) Simple partial seizure Seizures are classified as being generalized or partial. Generalized seizures are further classified as being tonic-clonic (formerly called grand mal) or absence (formerly called petit mal) seizures. Generalized tonic-clonic seizures result from abnormal electrical discharges from large areas of the brain, usually involving both hemispheres. They are characterized by unconsciousness and generalized severe twitching of the body's muscles; they last several minutes or longer. Absence seizures are characterized by a brief lapse of consciousness in which the patient seems to stare and does not respond to anyone. Absence seizures do not involve any changes in motor activity. Partial (focal) seizures begin in one part of the brain and are classified as simple and complex. In a simple partial seizure, no change occurs in the patient's level of consciousness. Patients may report numbness, weakness, or dizziness. The senses may also be involved; the patient may report visual changes and unusual smells or tastes. A simple partial seizure may also cause twitching of the extremity muscles that spreads slowly from one part of the body to another. In a complex partial seizure, the patient has an altered mental status and does not interact normally with his or her environment. This type of seizure results from abnormal discharges from the temporal lobe of the brain. Other signs may include lip smacking, eye blinking, and isolated convulsions or jerking of the body or one part of the body, such as the arm. The patient may experience unpleasant smells and visual hallucinations, exhibit uncontrollable fear, or exhibit repetitive physical behavior such as constant sitting or standing.

Functions of the liver include: A) production of insulin. B) production of red blood cells. C) production of clotting factors. D) concentration and storage of bile.

C) production of clotting factors. The liver is a solid, very vascular organ that performs many functions. Among these functions are detoxification of harmful substances; the production of glycogen, a complex sugar; the production of bile (bile is concentrated and stored in the gallbladder); and production of many of the body's blood-clotting factors. Insulin is produced by the pancreatic beta cells. Red blood cells are produced by red bone marrow.

Review Q's 70 y/o man with difficulty breathing. Appears to be in Resp. distress. Can't speak. Cough and shortness of breath. History of COPD, High BP, and diabetes 1. What is the first step in the assessment process? A. Manage the airway B. Obtain vital signs C. Determine scene safety D. Perform a secondary assessment

C. determine scene safety

Which of the following conditions would place the patient at greatest risk for complications after receiving epinephrine? A) Asthma B) Bradycardia C) Hypovolemia D) Heart disease

D) Heart disease While there are no contraindications for epinephrine in a life-threatening situation such as anaphylaxis, the EMT should be aware that epinephrine could cause complications in patients with heart disease or acute coronary syndrome. Epinephrine increases the heart rate, which increases cardiac oxygen demand and consumption. This could exacerbate underlying cardiac disease. The EMT should therefore consult with medical control when administering epinephrine to such patients. In addition to increasing the heart rate and causing vasoconstriction, epinephrine also dilates the bronchioles; this would be a desirable effect in patients with asthma. Hypovolemia should be treated initially with IV fluids; however, epinephrine (or other similar drugs) may be required if IV fluids alone do not improve perfusion.

In the patient with diabetes, insulin shock typically presents with: A) dry skin and a slow onset. B) dry skin and a rapid onset. C) clammy skin and a slow onset. D) clammy skin and a rapid onset.

D) clammy skin and a rapid onset. In the patient with diabetes, insulin shock (hypoglycemic crisis) presents with cool, clammy skin and a rapid onset. The brain is critically dependent on glucose and responds quickly when the body is in short supply. Diabetic coma (hyperglycemic crisis) typically presents with warm, dry skin and a slow onset, sometimes occurring over a period of days.

What is the general impression of this patient? A. The patient is experiencing mild dyspnea B. The patient appears stable C. The patient appears well D. The patient needs immediate intervention

D. The patient needs immediate intervention

What mnemonic is used to gather a patient's health information?

SAMPLE

***diabetic ketoacidosis question A woman with type I diabetes presents with deep, rapid breathing; tachycardia, dehydration; and an altered mental status. Which of the following would MOST likely explain her clinical presentation? A) Her blood sugar level is less than 60 mg/dL B) She has not taken her insulin in several days C) She took her insulin but has not eaten today D) She has an infection that led to dehydration

The patient's clinical presentation is consistent with hyperglycemic ketoacidosis. Of the options listed, the only logical explanation is that she has not taken her insulin in several days. Without insulin, glucose cannot enter the cell to make energy, so it pools in the blood to excessive levels (hyperglycemia). Excess blood glucose levels cause the body to eliminate large amounts of water via the kidneys, resulting in dehydration. In the absence of glucose, the cell will metabolize fat, which produces ketoacids. The respiratory system will attempt to eliminate these ketoacids from the body by increasing the rate and depth of breathing (Kussmaul respirations). Had she taken her insulin, but did not eat, you would her blood glucose level to be lower than normal. Although an underlying infection cannot be ruled out, the primary cause of her problem is failure to take her prescribed insulin.

3. Describe the evaluation of the nature of illness (NOI). (p 562)

Trauma assessments focus on MOI, whereas medical assessments focus on NOI. Medical patient assessment focuses on: -The nature of illness (NOI) -Symptoms -The patient's chief complaint

1. Differentiate between medical emergencies and trauma emergencies, remembering that some patients may have both. (p 561)

Trauma emergencies involve injuries resulting from physical forces applied to the body. Medical emergencies involve illnesses or conditions caused by disease. -some traumatic injuries may be the result of a medical condition. -The index of suspicion is your awareness and concern for potentially serious underlying and unseen injuries or illnesses.