Medical

Sickle cell crisis care

ABCs, good history, PAIN MEDICATION. Oxygen! sickle shaped RBCs don't effectively carry oxygen. Beware of chest pain and cardiac ischemia. Blood clots are also common as their RBCs are oddly shaped and may occlude vessels

Cocaine O.D treatment

ABCs, no reversal agent. CARDIAC MONITORING, IV.

Care of GI bleed

ABCs, oxygenation, fluids, rapid transport, good history/ questioning. Treat for shock if necessary. Melena, dark stools, indication of lower GI bleed. Upper GI bleed can include vomiting up blood and the blood may look like coffee grounds

Primary cause of AMS

AEIOUTIPS Alcohol/acidosis Epilepsy Insulin Overdose Uremia Trauma Infection Psychosis Stroke

A 39 year old female complains of chronic left-sided flank pain that radiates to her hip. She called EMS because the pain is "unbearable." Vital signs are BP 133/86, P 104, R 16. What should you do?

Administer 4 mg morphine sulfate.

A 24 year old male with a history of sickle cell anemia complains of leg and lower abdominal pain. He is lying in the fetal position. Vital signs are BP 140/92, P 114, R 18, SpO2 98% with 15 lpm. What should you do?

Administer morphine sulfate intravenously

A 20 year old female is postictal after having a 10 minute seizure. Her family states that the she had a traumatic brain injury 8 months ago. Vital signs are BP 144/82, P 92, R 16, SpO2 90%, blood glucose analysis 66 mg/dL. What should you do?

Apply supplemental oxygen.

While spraying pesticide on his crops, a 51 year old male started to feel lightheaded and had trouble breathing with excessive saliva production. What should you administer?

Atropine

An 80 year old male complains of a headache and nausea. He is confused with hot, dry skin. His house is hot and humid. Vital signs are BP 90/55, P 96, R 18, SpO2 88%, blood glucose analysis 88 mg/dL. What should you do?

Begin active cooling measures

Care for hyperglycemia

Dehydrated: fluids

A 43 year old male tells you that he is a chronic alcoholic but that he quit drinking 3 days ago. He now complains of sweating, trembling, anxiety, and hallucinations. What is the most likely cause?

Delirium tremens

Inquire about his suicidal ideations because

Depression is the number one reason for suicide in the teenage population. The patient is displaying the depressed affect state. His response “I’m not sure if I can take this anymore†should be a warning sign that he or she might be thinking of suicide. The patient needs some professional help from a psychologist.

A 24 year old female is sitting in a chair slumped to one side. She has slurred speech and her skin is clammy. Vital signs are BP 118/70, P 80, R 20, blood glucose analysis 40 mg/dL. What should you administer?

Dextrose 50%

A 25 year old male complains of watery eyes and localized edema to his eyelids. He has a peanut allergy and his friends had been eating peanuts. Vitals signs are BP 130/80, P 90, R 18. What should you administer?

Diphenhydramine

While transferring a 34 year old male receiving a blood transfusion, he begins to complain of difficulty breathing. His skin is red and warm with urticaria. Vital signs are BP 70/40, P120, R 24. What should you do?

Discontinue the blood transfusion.

A 28 year old female complains of a sudden onset of dyspnea while eating in a restaurant. Her tongue is swelling and she has urticaria on her neck. Vital signs are BP 86/44, P 116, R 18 with wheezing. What should you administer?

Epinephrine

A 46 year old female is vomiting blood. She is holding a bucket of approximately 1500 mL dark, purple blood by her bed. She has a history of peptic ulcer disease, reflux, and alcoholism. Her upper right quadrant is tender on palpation. Vital signs are BP 90/50, P 130, R 18, skin pale, cool, and moist. What should you suspect?

Esophageal varices

Why do patients with hyperglycemia have Kussmaul respirations?

Excessive ketones

Signs and symptoms of kidney stone

Flank and groin pain unable to void bladder

Gout

Gout is a common and complex form of arthritis that can affect anyone. It's characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe.

Which condition would make a patient more prone to thyroid storm?

Graves' disease

A 68 year old female is confused, and her husband states that she has had a general malaise and loose stools. She has a history of diabetes for which she takes metformin. Vital signs are BP 82/54, P 98, R 18, blood glucose analysis 720 mg/dL. What should you suspect?

HHNS

Graves disease-

HYPERthyroidism, thyroid grows as activity increases, can be fatal. Thyroid is in charge of regulating metabolism. May see hypertension, tachycardia, bulging eyes,

Delirium tremens because

He is displaying classic signs and symptoms of delirium tremens. The cause is usually due to alcohol withdrawal. The patient usually quits drinking alcohol and in 48-72 hours starts showing the signs and symptoms listed in the question. These can be life threatening to the patient. Current treatment for this patient would include oxygen, IV crystalloid solution, glucose monitoring, Thiamine and possibly Valium if the patient starts experiencing seizures.

Atropine because

He is exhibiting signs and symptoms of organophosphate poisoning. This is considered a cholinergic response with the signs of SLUDGE. The appropriate treatment of this poisoning is the use of anticholinergic drugs like atropine or pralidoxime to block the effects of the accumulating acetylcholine.

Begin active cooling measures because

He is exhibiting signs of heat stroke. He needs immediate cooling measures done to bring down his internal temperature. Remove clothing and place ice packs in his groin and axillary (arm pits). Start an IV of crystalloids to begin fluid replacement as well due to possible dehydration.

Remove his clothing and cover him with blankets because

He is most likely suffering frost nip or frostbite. Due to the extreme colds the patient will develop blisters because the areas are exposed to the cold developing what looks like burns. The patient needs to have the rewarming process started. This can be accomplished by removing the patient’s wet clothing and wrapping them in warm blankets, placing hot packs in the axillary, groin, and around the neck

What is a potential risk for patients who are delinquent for renal dialysis?

Hyperkalemia

HHNC

Hyperosmolar hyperglycemia nonketotic coma, also known as HONK, is usually seen in patients with type 2 DM. Like type 1 DM patients, hyperglycemia causes sugar to spill into the urine to prevent a toxic bodily overload, but they lack the ketone production and therefore no fruity smell can be noted. Infection of some sort may precipitate this. THe body in people with type 2 DM usually still is able to synthesize some glucose into the cells which is why ketones are not produced

A mother of a 17 year old male called EMS because her son has a depressed affect. While assessing him, he states, "I'm not sure if I can take this anymore." What should you do?

Inquire about his suicidal ideations

A 46 year old female complains of shortness of breath. She has a history of alcohol abuse and presents with severe ascites. Her vital signs are BP 142/84, P 102, R 24 with crackles. What should you suspect?

Liver failure

Graves' disease because

More than 95 percent of thyrotoxicosis is due to Graves’ disease. Graves’ disease is autoimmune in origin. Autoantibodies are generated that stimulate the thyroid tissue to produce excessive amounts of thyroid hormones. Signs and symptoms of a thyroid storm are high fever, irritability, delirium or coma, tachycardia, hypotension, vomiting, and diarrhea. Care for patients suffering from a thyroid storm is mainly supportive.

A 27 year old female complains of general weakness. She tells you that she feels "unstable" when she walks so she lay down in bed. She is supine in bed and was incontinent. She is out of her prescribed methylprednisolone. What should you suspect?

Multiple sclerosis

Tuberculosis because

One of the worries of tuberculosis is that it can present with different manifestations of other clinical conditions. The common signs and symptoms that are presented with this disease are night sweats, hemoptysis, chills fever, fatigue, productive or nonproductive cough, and weight loss. If you suspect tuberculosis (TB), you should immediately don a N95 respirator and place a mask over the patient as well for further protection.

risk factors of hhnc

Patient who does not manage their diabetes, usually type 2 (no ketones). People who have a concurrent illness, commonly pneumonia or a UTI, are more prone to getting and experiencing HHNC

varicella pain

Primary infection with VZV causes varicella. (chicken pox) Once the illness resolves, the virus remains latent in the dorsal root ganglia. VZV can reactive later in a person's life and cause a painful, maculopapular rash called herpes zoster.

A confused 39 year old male was found after being lost in the woods for 24 hours. His clothing is damp and he is shivering. He has blisters on his feet and hands. What should you do?

Remove his clothing and cover him with blankets.

Kidney stones/renal colic

Renal colic is a type of pain you get when urinary stones block part of your urinary tract. Your urinary tract includes your kidneys, ureters, bladder, and urethra. You can get stones anywhere in your urinary tract. Treat with pain med and fluids. Coach pt on breathing exercises

A 56 year old male is unconscious and jaundiced. He has peripheral edema and a shunt in his left upper arm. What should you suspect?

Renal failure

Valium OD

Romazicon/flumazenil Benzodiazepine OD: may cause drowsiness, AMS, lethargy, and possibly loss of consciousness/ apnea. Manage ABCs, intubation may be necessary in cases of apnea/ respiratory arrest. IV access, fluids if necessary

A febrile 54 year old female complains of nausea and vomiting with pain around her umbilicus. Her abdominal tenderness increases on palpation. Vital signs are BP 80/40 and P 130. What should you suspect?

Ruptured appendix

Heat stroke/exhaustion

STROKE: HOT, DRY SKIN, POSSIBLY AMS. EXHAUSTION: SWEATING, THIRSTY

Thyrotoxic crisis because

She is exhibiting signs and symptoms of a thyroid storm or thyrotoxic crisis. The mechanisms underlying thyrotoxic crisis are not well understood. The thought is that a shift of thyroid hormone in the blood from the protein-bound to the free state. This is thought to be from the biologically inactive to the biologically active state. Treatment in the field is to be mainly supportive in nature.

Apply supplemental oxygen. because

She is presenting in a postictal state after experiencing her seizure. She needs oxygen therapy due to the Sp02 readings that are being presented. ABC’ is the treatment priority for this patient. An IV line of a crystalloid solution would be indicated, however, benzodiazepines are only indicated when a patient is suffering a seizure. Glucose monitoring is appropriate but with her current readings she is within the normal parameters. She is not showing signs that she can’t protect her airway so paralysis and intubation would not be indicated for this particular patient.

Administer 4 mg morphine sulfate because

She is presenting with signs and symptoms of a kidney stone. Due to the nature of the pain and her vital signs she would be a good candidate to receive analgesics for the pain. The dose of 4mg of morphine is a good starting point to help relieve the pain she is experiencing. Also, IV fluid of a crystalloid solution will help with the production of urine that would help expel the kidney stone. She may require additional doses of morphine for pain control enroute to the hospital. Follow your local protocols to determine the amount that can be administered to her.

Administer morphine sulfate intravenously because

Sickle cell anemia and sickle cell disease is from the malformation of red blood cells hemoglobin making this a C shape or sickle shape. This leads to hypoxia and the anemia is from these cells destroying abnormal red blood cells which lead to the anemia. Their blood becomes very viscous (sludge) and then blocks blood flow to the capillaries and small blood vessels. This process is very painful for the patient due to decrease blood flow. The patients do require fluid administration with a crystalloid solution and analgesics to help control their pain

A 31 year old female complains of diplopia and nausea with vomiting. She has a well-developed goiter and is sweating profusely. Vital signs are BP 132/92, P 104, R 18. What should you suspect?

Thyrotoxic crisis

A 41 year old male returned from a scuba diving trip 12 hours ago. He complains of a gradual onset of stiff joints and a headache. His skin is mottled and his vital signs are BP 110/74, P 112, R 22, SpO2 82% on high-flow oxygen. What should you do?

Transport him to a hyperbaric facility.

A 26 year old male complains of chest pain and hemoptysis. He has a productive cough with purulent discharge and a low-grade fever. What should you suspect?

Tuberculosis

Excessive ketones because

Type 1 diabetics who are in a hyperglycemic state (DKA) build up ketones in their blood stream and these ketones are an acid that is produced. Due to the cells being unable to utilize glucose to burn they turn to fat. The byproduct of the fat that they are using for energy turns into ketones. So during the acidotic state the body tries to eliminate the acid by increasing respirations and making them deep to blow off the acid.

Diphenhydramine because

You should administer 25 - 50mg IV or IM to help block the histamine release that is happening from the mast cells degranulating. Diphenhydramine is the medication of choice for an allergic reaction. You would not need to administer epinephrine because the signs and symptoms are localized and not systemic wide.

Discontinue the blood transfusion. because

You should suspect a blood transfusion reaction. His blood and the donors blood is not compatible. This can lead to the reaction and shock. The blood becomes hemolysis and blood clots can form causing damage to organ systems. The step is to stop all blood being transfused, replace the blood tubing. Initiate fluid therapy with a crystalloid solution and if the patient remains hypotensive after fluid bolus start a dopamine drip at 2-5mcg/kg/min. You also may administer Lasix to promote diuresis. Benadryl will help with the allergic reaction and block the histamine release. The paramedic may also need to administer epinephrine if the allergic reaction turns into anaphylaxis.

Ruptured appendix because

You should suspect appendicitis from the rebound tenderness and she is febrile. She is in hypovolemic shock from the ruptured appendix and possibly peritonitis

Transport him to a hyperbaric facility. because

You should suspect decompression illness. The patient was diving deeper than 33 feet and for a duration to let the body saturate with nitrogen. As the diver ascends rapidly the nitrogen in the body starts to form nitrogen bubbles causing increased pressure in joints, tendons, the spinal cord, skin, brain, and inner ear. The patient needs to be recompressed in a hyperbaric chamber. The patient is subjected to oxygen under greater than atmospheric pressure to force the nitrogen in the body to redissolve, and then the body is able to allow the nitrogen to escape without forming the nitrogen bubbles.

liver failure because

You should suspect liver failure. She is suffering from alcohol abuse she also most likely has developed hepatitis. Failure of the liver can cause ascites in the patient. Ascites is fluid buildup in the peritoneal space from the liver releasing fluid causing the edema that is present. The shortness of breath develops from the edema in the abdomen pushing on the diaphragm hindering the use of that muscle in ventilation thus causing the patient to be short of breath.

Multiple sclerosis because

a disease that causes demyelization of the nerve cells and nerve fibers from the brain and spinal cord. This results in weakness of one or more limbs, sensory loss, parethesias, and changes in vision. This autoimmune disease can also cause swelling of the nerve fibers which would lead to the treatment of steroids

Organophosphate O.D

alivation, lacrimation, urination, diaphoresis, gastrointestinal upset, emesis and progressing to bronchospasm, bronchorrhea, blurred vision, bradycardia or tachycardia, hypotension, confusion, and shock. Nicotinic effects, remove from environment, cardiac monitoring, intubate, irrigate eyes

Captopril used for

an ACE inhibitor and works by relaxing blood vessels so that blood can flow more easily. Used to treat hypertension

rheumatoid arthritis

autoimmune disease where the body attack the muscles

Romazicon (flumazenil)

benzo od treatment

tick bite

bullseye rash, Lyme disease, fever, chills, muscle and joint pain

thyrotoxicosis

condition caused by excessive thyroid hormones, graves disease, bulging eyes, agitation and diarrhea

TB signs

dyspnea, labored breathing, productive bloody cough, night-sweats, unexplained weight loss, fever. Possibly contagious, also may show on skin test and chest x-ray

Bells palsy signs

facial droop slurred speech. facial signs of stroke without extremity weakness. also known as acute peripheral facial palsy of unknown cause, can occur at any age. The exact cause is unknown. It's believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of your face. Or it might be a reaction that occurs after a viral infection.

allergic reaction

failed immune system response/ hypersensitivity to an allergen similar to anaphylaxis, but is less severe than anaphylaxis. This involves inflammation and swelling due to histamine response in a localized area

delusions

false beliefs, often of persecution or grandeur, that may accompany psychotic disorders

hallucinations

false sensory experiences, such as seeing something in the absence of an external visual stimulus

complications of acute renal failure

fluid build up, pulmonary edema, chest pain and cardiac issues, muscle weakness, permanent kidney damage, electrolyte imbalances ultimately death. Caused due to a sudden decrease of filtration of blood entering the kidneys.

iv pyrogenic reactions

foreign proteins capable of producing fever, characterized by abrupt temperature elevation with general illness symptoms. Carefully inspect IV bag before use to ensure no leaks/ issues.

MRSA best protection

gloves and washing hands. Sanitize equipment and patient care areas.

Tonic- Clonic

grand mal seizure, tonic-muscles tense up, clonic-jerking motion of muscles in seizure, usually accompanied by loss of consciousness. ABCs, let patient seize without hazard, administer benzos, and monitor cardiac rhythm and spo2%.

black widow

has venom called neurotoxin, trigger release of neurotransmitters, causes pain and swelling as well as muscle spasms and paralysis, Nausea, vomiting, lethargy, and respiratory depression may occur. wash the area with soap and water, apply cold compress over area, take over the counter pain relief

Epididymitis

inflammation of back of testicle, pain meds/ comfort transport required. Antibiotics required

cholecystitis

inflammation of the gallbladder, gallbladder holds a digestive fluid that's released into your small intestine

peritonitis pain

inflammation of the peritoneum — a silk-like membrane that lines your inner abdominal wall and covers the organs within your abdomen — that is usually due to a bacterial or fungal infection.

inhaled ammonia poisoning care

intubate, abcs possible angioedema

Trigeminal neuralgia care and signs

is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain.

Esophageal varices because

is due to the increase portal pressures. The blood flows from the abdominal organs to the liver through the portal vein. If there is damage to the liver blood flow can be impeded causing blood to back up into the left gastric vein into the esophageal vein. Due to the increase in pressure can cause those veins to engorge. Pain to the right upper quadrant is due to cirrhosis of the liver. This is commonly associated with alcoholism

Petit mal seizure

milder form of seizure lasting only a few seconds and does not include convulsive movements; also known as absence seizures

DKA

occurs in patients with type 1 DM where the BGL rises as does the acid levels to the point where the body can't neutralize the acid, lowering overall pH. When this happens, the calls turn to fat for fuel instead of glucose since they don't have any, and ketones are produced (fruity smelling breath or urine).

signs of physical abuse

old bruising, shy patient, caregiver speaks for them, confusing stories, lack of eye contact

brown recluse spider

painless bite, fluid filled vesicle will develop at location of bite, causes gangrene and necrosis, apply soap and water as well as a cold compress and otc pain relievers

Absence seizure

patient remains conscious and does not have tonic/ clonic movements, but zones out and may stop speaking

nuchal rigidity

rigidity of neck, sign of meningitis

anaphylaxis

sensitized to an allergen and when introduced, the mast cells release large amounts of histamine, which is a chemical the body uses to signal a problem and begins the inflammatory response. The histamines are overproduced all over the body, causing the capillaries to dilate and become leaky causing edema. This causes wide-spread edema of the skin, face, lips, tongue and also causes constriction of smooth muscles. Histamine also has a negative inotropic effect on the heart, so hypotension will occur, epinephrine 1:1,000 IM, large bore IV access, antihistamine meds (benadryl), fluids, albuterol and a steroid such as solu-medrol or decadron.

Esophageal varices

severe bleeding from esophagus caused by erosion and untreated acid reflux. Common in alcoholics and bulimia and Hep C. Hepatic portal hypertension may also be cause, causes veins to rupture. May be rapid, or slower with possible melena. ABCs, IV access and maintain MAP.

brudzinski sign

sign of meningitis, pain in spine with bending of legs towards core

suspect anaphylactic shock

signs of angioedema and wheezing make her a critical patient. The use of epinephrine .3 to .5 mg IM with a 1:1,000 solution is the most appropriate treatment pathway. This will help with vasoconstriction and bronchodilator to decrease angioedema and help dilate the airways to decrease wheezing. You may have to give a beta 2 agonist if the wheezes persist and Benadryl would be appropriate after the administration of epinephrine

care of postictal patient

stop seizure with Benzo, maintain airway, oxygenation and glucose

Care of migraines

stroke assessment, be cautious with lighting near patient, pain management, IV access.

Peptic ulcer pain- (PUD)

super painful, LUQ pain and bleeding. Happens due to the ability of bacteria to live and survive in the acidic stomach, and overcome the mucus protective barrier. Once this mucus barrier is gone, the acid can erode the stomach lining itself, causing bleeding. Excessive use of NSAIDs or erosive gastritis can also cause this. ABCs, treat for shock/ bleeding, and monitor patient

ascending aortic aneurysm

wall becomes weakened and enlarges, causes atherosclerosis, hypertension and connective tissue disorders, difficulty speaking, sob, chest pain, varying blood pressures, pulsating abd, abcs, iv access

Diseases caused by blood and bodily fluids exposur

​Bloodborne pathogens are microorganisms such as viruses or bacteria that are carried in blood and can cause disease in people. There are many different bloodborne pathogens, including malaria, syphilis, and brucellosis, and most notably Hepatitis B (HBV), Hepatitis C (HCV) and the Human Immunodeficiency Virus (HIV). Many of these diseases like MRSA can be prevented by wearing gloves and washing hands. Being careful with needles and other sharps or equipment that may have come in contact with blood is also important, as is disposing of these items properly. Using an N95 and placing a facemask on a patient with the flu or other possibly-contagious respiratory aliment can also stop the spread of germs/ infection

Renal failure because

The shunt in his left arm should lead you to a differential diagnosis of renal failure. The patient probably has not received dialysis recently and the toxins in his body is starting to build up making this patient at risk for hyperkalemia and accumulating acids as well.

HHNS because

The signs and symptoms associated with this is polyuria, polydipsia, polyphagia, warm dry skin (dehydration), dry mucous membranes, orthostatic hypotension, tachycardia, decreased level of consciousness and coma. The cause of this is poor control of their diabetes with oral medications or insulin injections. The causes for this are physiologic stress (infections or strokes), which produces hyperglycemia and noncompensated diuresis. The sustained hyperglycemia allows glucose to spill in the urine producing the dehydration from osmotic diuresis. Due to insulin activity in the body there are no ketones present.

Hyperkalemia

The body is retaining potassium to do the kidney failure of the patient. Signs and symptoms that are associated with hyperkalemia include paralysis, irregular heart rate, numbness and tingling, difficulty breathing and associated nausea and vomiting. The patient can appear with no symptoms to having cardiac compromise

Angioedema

the rapid edema, or swelling, of the area beneath the skin or mucosa. It is normally an allergic reaction, but it can also be hereditary. The swelling happens because fluid accumulates. It tends to affect areas with loose areas of tissue, especially the face and throat, as well as the limbs and genitals

DVT signs

throbbing or cramping pain in 1 leg (rarely both legs), usually in the calf or thigh, swelling in 1 leg (rarely both legs), warm skin around the painful area, red or darkened skin around the painful area, swollen veins that are hard or sore when you touch them.

Grand mal seizure

tonic clonic convulsions, loss of consciousness and muscle jerking

UTI

urinary tract infection. Dark, foul smelling urine, pain upon urination. Can easily lead to sepsis. Can cause mental status changes. Treated with antibiotics. Common in elederly females and pts with urinary catheters