MEDICAL EXAM REVIEW

Type II Diabetes

-Age of Onset: adult -Cause: insulin resistance, obesity -Prevalence: 95% -Symptoms: less severe, obesity. -Progression: gradual -Consequences: kidney, eyes, cardio. -Treatment: weight loss

Type I Diabetes

-Age of Onset: juvenile -Cause: no insulin -Prevalence: 5% -Symptoms: severe -Progression: abrupt -Consequences: kidney, eyes, cardio. -Treatment: insulin

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

-Also known as excited delirium. -Can present with hallucination, disorientation, delusion. -May exhibit agitated behavior so be aware of personal safety. -Hyperactive irrational behavior, tachycardia, hypertension, dilated pupils and diaphoresis. -Approach the patient calmly, empathetically, and supportively. -Indirectly determine patient's orientation. -If agitation worsens, call ALS and consider chemical restraint. -If overdose, take medications to psychiatric facility with patient. -Agitation can lead to sudden death via cardiac arrest, metabolic acidosis, and or positional asphyxia.

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

-Altered Mental Status -Pale, cool, and moist -Thirst absent -Hunger absent

Describe the signs and symptoms of a patient suffering from hyperglycemia

-Altered mental status. -Warm and dry skin. -Intense thirst. -Vomiting\abdominal pain common. -Restlessness, possibly progressing to coma; abnormal or slurred speech; unsteady gait.

Pathophysiology of a hemorrhagic stroke

-Bleeding inside the brain. -Blood vessel ruptures and accumulated blood then forms a blood clot, which compresses the brain tissues next to it: compression prevents oxygenated blood from getting into the area and cells die. -People experiencing stress or exertion.

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

-Can be either lower or upper GI bleed. -Upper: occurs between the esophagus and the upper small intestine blood is either bright red or has the appearance of coffee grounds. -Lower: occurs between the upper part of the small intestine and the anus. bleeding manifests itself as melena or dark tarry stools as a result of partial digestion of the blood

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

-Dizziness -Nausea -Vomit -Anorexia -Fever -Chills -Rebound tenderness -Pain in Right lower quadrant. -Occurs when appendix is blocked and infection occurs as a result.

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

-Easy fatigue and energy loss. -Unusual rapid heart rate. -Dizziness -Pale skin -Insomnia -Caused by body not making enough red blood cells, bleeding causes loss of more red blood cells than can be replaced or your body destroys red blood cells.

Describe the signs and symptoms of a patient suffering from cerebral vascular accident (stroke). (pg# 680)

-Facial drooping -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 patient with a stroke). -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

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

-First vague discomfort in flank but may become intense and radiate to groin. -Nausea and vomiting. -Agitated and restless. -Slight blood in urine. -Why? chemicals may crystallize in the urine and form kidney stones. If stone passes into the ureter, it can cause blockage. Pressure will build up behind stone and cause swelling in the kidney. -Pain is often caused when the stone moves within the ureter.

List the different types of a seizure and describe the signs and symptoms associated with each

-Generalized seizure: severe twitching of the bodies muscles and there may sometimes be instances when they stare into space and not respond to anyone instead. -Partial Seizure: brief paralysis, numbness, weakness, dizziness, twitching of muscles that spreads from one part to another slowly. -Status Epilepticus: caused by a seizure that lasts more than 5 minutes and continues to come back every few minutes without patient gaining consciousness or lasts longer than 20 minutes.

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

-Hard waxy feel of the affected tissues -Feels firm to frozen -Feels leathery or thick -Blisters swelling -Thawedness or partial thaw -May appear red or white or it may be mottled and cyanotic -Superficial frostbite: only skin is frozen -Deep frostbite: deeper tissues are frozen

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

-May possess altered sensorium or exhibit abnormal behavior. -Use caution when delivering treatment, although most won't pose a threat to your safety. -Noncompliance with medications can exacerbate symptoms. -Underlying causes include social stresses. -Treatment is dependent on psychiatric medication (outpatient is usually ok). -Psychiatric disorders can cause altered mental status in the absence of other physiological causes (i.e. hypoglycemia etc.).

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

-Pounding, throbbing, pulsating pain. Associated with nausea and vomiting, and can be preceded by visual signs such as flashing lights or partial vision loss. -Caused by changes in blood vessel size in the base of the brain -Patient will often have a history of migraines

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

-Syncope - fainting, where the patient soon reawakens -Caused by sudden, generalized vascular dilation, decreasing the brain's blood supply. -Often results from psychogenic shock.

List the steps in the primary assessment including the pertinent findings

A-airway (open and patent) B-breathing (rate, rhythm, & quality. Auscultate lung sounds based on chief complaint). C-circulation (pulse: rate, rhythm, & quality. Skin parameters: color, temperature, & moisture).

Describe the signs and symptoms of a patient suffering from hypothermia and describe the treatment conditions

Become more severe as core temp increases... 93° to 95°F (33.9°C to 35°C): SIGNS & SYMPTOMS: shivering, foot stamping. CARDIORESPIRATORY RESPONSE: constricted blood vessels, rapid breathing. LEVEL OF CONSCIOUSNESS: withdrawn. 89° to 92°F (31.7°C to 33.3°C): SIGNS & SYMPTOMS: loss of coordination, muscle stiffness. CARDIORESPIRATORY RESPONSE: slowing respiration, slow pulse. LEVEL OF CONSCIOUSNESS: confused, lethargic, sleepy. 80° to 88°F (26.7° to 31.1°C): SIGNS & SYMPTOMS: coma. CARDIORESPIRATORY RESPONSE: weak pulse, dysrhythmias, very slow respirations. LEVEL OF CONSCIOUSNESS: unresponsive. <80°F (<26.7°): SIGNS & SYMPTOMS: apparent death. CARDIORESPIRATORY RESPONSE: cardiac arrest. LEVEL OF CONSCIOUSNESS: unresponsive.

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

Bleeding in the GI tract is a symptom of another disease, not the disease itself, and can be both acute (shorter term and more severe) or chronic (longer duration and less severe). All complaints of GI bleeding are serious. Upper GI tract bleeding occurs from the esophagus to the upper small intestine. -Problems in the esophagus might include esophagitis, esophageal varices secondary to liver failure, or a Mallory-Weiss tear, which results from excessive retching or vomiting. -Hematemesis is frequently seen in patients with upper GI bleeding. -Blood is either bright red or has the appearance of coffee grounds depending on where in the GI tract it originated and how briskly it is occurring. Lower GI tract bleeding occurs between the upper part of the small intestine and the anus -Bowel inflammation, diverticulosis, diverticulitis, cancer, and hemorrhoids are common causes of lower GI bleeding. -In lower GI bleeding, the bleeding often manifests as melena, or dark tarry stools, as a result of partial digestion of the blood.

Describe the treatment of a patient exposed to dry chemicals

Dry Chemical Exposure Treatment: -Brush off any dry chemical from the patient → Remove clothing → flush the burned area with large amounts of water for 10-15 mins (after the patient says that the burning pain has stopped). -Avoid contaminating injured areas. -Conduct a proper decontamination prior to loading any patient into the ambulance and again before entering the hospital.

Heat Exhaustion. Pg #1151-1152

HEAT EXHAUSTION: also called prostration or collapse. CAUSES: -Heat exposure -Stress -Fatigue -Hypovolemia as a result of loss of H2O and electrolytes from heavy sweating. Why? For sweating to be an effective cooling method, the sweat needs to be able to evaporate. When people are exposed to heat wearing multiple layers of clothing (sports fans, construction workers), the sweat is unable to evaporate producing the body to lose more H2O. -Environmental causes: poorly ventilated areas as people are unable to release heat through convection. SIGNS & SYMPTOMS (associated with hypovolemia): -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, and poorly ventilated environments or extended time in hot, humid environments. People who aren't acclimated to the environment may experience onset at rest. -Cold, clammy skin with ashen pallor -Dry tongue and thirst -Normal vital signs. Pulse is often rapid and weak (an indication for use of pulse oximetry) and the diastolic BP may be low. -Normal or slightly elevated body temp. On rare occasions as high as 104 °F (40 °C). TREATMENT:

Heat Stroke

HEAT STROKE: CAUSES: SIGNS & SYMPTOMS: TREATMENT:

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

HIGH: -Onset: gradual -Skin: warm, dry -Thirst: intense -Hunger: present, increasing. -Breathing: rapid, deep (kussmaul). -Breath: sweet (maybe) -BP: normal to low -Pulse: rapid, thready, weak. LOW: -Onset: rapid -Skin: pale, cool, moist -Thirst: absent -Hunger: absent -Breathing: normal to shallow. -Breath: normal -BP: normal to low -Pulse: rapid, weak.

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

Occur do to a severe allergic reaction characterized by airway swelling and dilation of blood vessels all over the body. (pg. 598) Signs and symptoms: -Airway swelling -Significantly lowered blood pressure. -Widespread hives (urticaria). -Itching -Signs of shock -Similar symptoms to asthma.

REVIEW List the organs by the abdominal quadrant in which they are found pg# 1058

RUQ- Liver, gallbladder, duodenum of the intestines, and a small portion of the pancreas. LUQ- Stomach and spleen LLQ- Large and small intestines. Descending colon and the left half of the transverse colon. RLQ - Large and small intestines, Appendix

List the steps in the medical assessment including pertinent findings for each body region

S-signs & symptoms A-allergies & what happened M-medications & compliance P-past medical history L-last oral intake E-events leading up P-pulse R-respiration rate B-blood pressure E-eyes L-lung sounds L-level of consciousness S-oxygen saturation S-blood sugar S-skin parameters G-Glasgow Coma Scale O-onset P-provocation & palpitation Q-quality R-radiation S-severity T-time Chief complaint based questions

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

SIGNS & SYMPTOMS: -Fever, headache, stiff neck, altered mental status. -Treatment: Immediate transport. Treated in hospital with antibiotics. Wear gloves and mask

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

SIGNS & SYMPTOMS: Children: present with unusually rapid or labored breathing or breathing characterized by grunting or wheezing sounds. Severe cases where oxygen exchange at the alveoli is markedly impaired, the lips and finger-nails may be blue or gray. -Bacterial Pneumonia: results in severe symptoms more quickly including high fevers, which put the child at risk for febrile seizures. Viral pneumonias present more gradually than severe cases. -Other signs and symptoms: dry skin, decreased turgor, exertional dyspnea, a productive cough, chest discomfort and pain that vary with inspiration and expiration, headache, nausea and vomiting, musculoskeletal pain, weight loss, and confusion. Patients may be febrile, tachycardic, or diminished breath sounds with sounds of wheezing, crackles, or rhonchi. -Treatment - airway support, providing supplemental oxygen (oxygen with appropriate adjuncts and provide supportive measures if needed), evaluate patient treatment through reassessment and prepare for possible deterioration in the patient's condition.

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

SIGNS & SYMPTOMS: -Fever, cough, sore throat, muscle aches, headaches, and fatigue. May lead to pneumonia or dehydration. -Treatment: place a surgical mask on patients with suspected or confirmed respiratory disease. -Prevention: an annual influenza immunization is important, especially for EMS personnel to protect providers and patients. Vaccination effectively decreases transmission rates and limits the disease incidence.

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

SIGNS: -Altered LOC, Respiratory Depression/Arrest (possible cyanosis), Constricted Pupils, Bradycardia-Hypotension, full arrest, N/V. SYMPTOMS: -Lethargy TREATMENT: Support airway/breathing: -Supplemental Oxygen -Naloxone: 2 mg/mL total (1mg/mL per nostril).

Describe the treatment for a bee sting

Scrape off the sting, if you pull it out, you might squeeze more liquid into body and allergy reaction will worsen

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

Transient ischemic attack: when stroke like symptoms resolve on their own in less than 24 hrs

Pathophysiology of an ischemic stroke

When blood flow to a particular part of the brain is stopped by blockage (blood clot) inside a blood vessel. Blockage due to: -Thrombosis: where a clot forms at the site of blockage. -Embolus: blood clot forms in a remote area and then travels to the site of the blockage. -Atherosclerosis: disorder in which calcium and cholesterol build up, forming plaque inside the walls of the blood vessels. This plaque may obstruct blood flow and interfere with the vessels' ability to dilate.