Emergency Care and Transportation of the Sick and Injured ...



Chapter 10

Medical Emergencies

Unit Summary

After students complete this chapter and the related coursework, they will know the signs and symptoms of medical emergencies they are likely to encounter in the field, including altered mental status (AMS), seizures, heat and cold emergencies, cardiac emergencies, respiratory emergencies, stroke, diabetic emergencies, and acute abdomen. Students will also know the appropriate treatments for patients suffering from these conditions.

National EMS Education Standard Competencies

Medicine

Recognizes and manages life threats based on assessment findings of a patient with a medical emergency while awaiting additional emergency response.

Medical Overview

Assessment and management of a

• Medical complaint (pp 203-204)

Neurology

Anatomy, presentations, and management of

• Decreased level of responsiveness (p 204)

• Seizure (pp 204-206)

• Stroke (pp 210-211)

Abdominal and Gastrointestinal Disorders

Anatomy, presentations, and management of shock associated with abdominal emergencies

• Gastrointestinal bleeding (pp 214-215)

Endocrine Disorders

Awareness that

• Diabetic emergencies cause altered mental status (AMS) (pp 213-214)

Cardiovascular

Anatomy, signs, symptoms, and management of

• Chest pain (p 207)

• Cardiac arrest (pp 207-209)

Respiratory

Anatomy, signs, symptoms, and management of respiratory emergencies including those that affect the

• Upper airway (Chapter 7, Airway Management)

• Lower airway (pp 209-210)

Genitourinary/Renal

• Blood pressure assessment in hemodialysis patients (p 215)

Knowledge Objectives

1. Describe the general approach to a medical patient. (p 203)

2. Explain the causes, signs, symptoms, and treatment of a patient with AMS. (p 204)

3. Explain the causes, signs, symptoms, and treatment of a patient with seizures. (pp 204-206)

4. Describe how to place an unconscious patient in the recovery position. (p 205)

5. Explain the causes of angina pectoris. (p 207)

6. Describe the signs, symptoms, and initial treatment of a patient with angina pectoris. (p 207)

7. Describe how to assist a patient with administering his or her nitroglycerin pills or spray. (p 207)

8. Explain the major causes of a heart attack. (p 207)

9. Describe the signs, symptoms, and initial treatment of a patient with a heart attack. (pp 207-209)

10. Explain the cause of congestive heart failure. (p 209)

11. Describe the signs, symptoms, and initial treatment of a patient with congestive heart failure. (pp 209-210)

12. Explain the causes of dyspnea. (p 210)

13. Describe the signs, symptoms, and initial treatment of a patient with dyspnea. (p 210)

14. Explain the causes of asthma. (p 210)

15. Describe the signs, symptoms, and initial treatment of a patient experiencing an asthma attack. (p 210)

16. Explain the major cause of a stroke. (p 211)

17. Describe the signs, symptoms, and initial treatment of a patient with a stroke. (p 211)

18. Explain the use of the Cincinnati Prehospital Stroke Scale as a stroke assessment tool. (p 211)

19. Explain the causes of diabetes. (p 213)

20. Describe the signs and symptoms of hypoglycemia. (p 213)

21. Describe the initial treatment of a patient with hypoglycemia. (p 213)

22. Describe the signs and symptoms of a patient in a diabetic coma. (p 214)

23. Describe the initial treatment of a patient in a diabetic coma. (p 214)

24. Describe the causes, signs, and symptoms of an abdominal condition. (pp 214-215)

25. Describe the initial treatment of a patient with abdominal pain. (p 215)

26. Explain how to measure blood pressure in a dialysis patient. (p 215)

27. Discuss potential complications for dialysis patients. (p 215)

Skills Objectives

1. Demonstrate a patient assessment on a medical patient. (pp 203-204)

2. Demonstrate placing an unconscious patient in the recovery position. (p 205)

3. Demonstrate how to protect a patient who is seizing from sustaining further harm. (p 206)

4. Demonstrate how to assist a patient with administering his or her nitroglycerin pills or spray. (p 207)

5. Demonstrate how to support a patient experiencing a heart attack. (p 208)

6. Demonstrate care of a patient with congestive heart failure. (pp 209-210)

7. Demonstrate the steps to treat a patient with dyspnea. (p 210)

8. Demonstrate the use of the Cincinnati Prehospital Stroke Scale as a stroke assessment tool. (p 211)

9. Demonstrate treatment of a patient with hypoglycemia. (p 213)

10. Demonstrate treatment of a patient in a diabetic coma. (p 214)

11. Demonstrate treatment of a patient with abdominal pain. (p 215)

12. Demonstrate how to measure blood pressure in a dialysis patient. (p 215)

Readings and Preparation

Review all instructional materials, including Emergency Medical Responder, Sixth Edition, Chapter 10, and all related presentation support materials.

• Review any local protocols on treatment of medical emergencies.

Support Materials

• Lecture PowerPoint presentation

• Samples of oral glucose containers and nitroglycerin tablets and spray for examination and practice

Enhancements

• Direct students to visit Navigate 2.

• Give students information on local protocols for assisting with medications in diabetic and cardiac emergencies.

Teaching Tips

• This section assists students in refining their assessment skills by obtaining the SAMPLE history and interviewing the patient. These emergencies account for a large percentage of the patients encountered by emergency medical services (EMS) personnel.

• Remind students that patients often stop taking their medications because of the unpleasant side effects, and they will occasionally have to deal with combative and uncooperative patients. The emergency medical responder (EMR)’s safety is always the first priority!

Unit Activities

Writing assignments: Assign students to research diabetes, stroke, and/or dyspnea in more detail. Ask students to write three to four paragraphs on what they find during research.

Student presentations: Set up scenarios in which students present with some of the medical emergencies covered in this chapter, including the appropriate vital signs and SAMPLE history, and ask other students to interview and treat the patient correctly. Their role will be similar to that of a detective trying to solve a mystery!

Group activities: Form groups and assign each group a type of medical emergency (eg, respiratory, cardiovascular, neurologic). Ask each group to provide examples of conditions that fall under their type of medical emergency. For example, if the type of medical emergency is “respiratory,” conditions may include asthma and chronic bronchitis.

Medical terminology review: Ask students to define a medical emergency and describe how it differs from a trauma emergency.

Pre-Lecture

You are the Provider

“You are the Provider” is a progressive case study that encourages critical thinking skills.

Instructor Directions

1. Direct students to read the “You are the Provider” scenario found throughout Chapter 10.

2. You may wish to assign students to a partner or a group. Direct them to review the discussion questions at the end of the scenario and prepare a response to each question. Facilitate a class dialogue centered on the discussion questions.

3. You may also use this exercise as an individual activity and ask students to turn in their comments on a separate piece of paper.

Lecture

I. Introduction

A. General medical complaints may result from a wide variety of medical conditions.

B. Common medical conditions include

1. Angina pectoris

2. Heart attack

3. Dyspnea

4. Asthma

5. Stroke

6. Hypoglycemia

7. Diabetic coma

8. Abdominal pain

C. Treating patients with medical conditions can be very challenging, but EMRs can prepare to treat medical patients by studying the signs, symptoms, and treatments of each condition.

D. Patient assessment in medical emergencies

1. Review the dispatch information to help you decide which problems are likely.

2. Carefully assess the scene to identify pertinent safety issues for you and your patient.

3. As you perform the primary assessment

a. First try to form an impression of the patient’s problem.

b. Then determine the patient’s responsiveness, introduce yourself, check the patient’s ABCs, and acknowledge the patient’s chief complaint.

4. Usually, it is best to obtain a medical history on a patient experiencing a medical problem before you perform the secondary patient assessment.

5. The SAMPLE history format helps secure the needed information:

a. Signs/symptoms

b. Allergies

c. Medications

d. Pertinent past medical history

e. Last oral intake

f. Events associated with or leading to the illness or injury

6. Obtain the patient’s vital signs and perform ongoing reassessment (patient monitoring) if the arrival of additional emergency medical services (EMS) personnel is delayed.

7. Remember to reassure the patient.

II. General Medical Conditions

A. General medical conditions may have different causes, yet result in similar signs and symptoms.

B. Learn to recognize signs and symptoms as well as general treatment guidelines so you can provide immediate care.

C. Initial treatment can stabilize the patient until other EMS and hospital personnel can take over.

D. Altered mental status

1. A sudden or gradual decrease in the patient’s level of responsiveness

2. To assess this condition, use the AVPU scale:

a. Awake and alert: An alert patient will answer simple questions accurately and appropriately.

b. Responsive to Verbal stimuli: A patient who is responsive to verbal stimuli will react to loud noises.

c. Responsive to Pain: A patient who is responsive to a painful stimulus will react to the pain by moving or crying out.

d. Unresponsive: An unresponsive patient will not respond to either verbal or painful stimuli.

3. When assessing the patient’s mental status, consider two factors:

a. The patient’s initial level of consciousness

b. Any change in that level of consciousness

4. Many different conditions may cause an altered level of consciousness, including

a. Head injury

b. Shock

c. Decreased level of oxygen to the brain

d. Stroke

e. Slow heart rate

f. High fever

g. Infection

h. Poisoning, including drugs and alcohol

i. Low level of blood glucose (diabetic emergencies)

j. Insulin reaction

k. Psychiatric condition

5. Even if you cannot determine what is causing the patient’s altered level of consciousness, you can help by treating the symptoms of the problem.

6. Initial treatment

a. Maintain the patient’s ABCs and normal body temperature.

b. Keep the patient from additional harm.

c. If the patient is unconscious and has not sustained trauma, place the patient in the recovery position or use an airway adjunct to help maintain an open airway.

d. Be prepared to suction if there is a chance that the patient may vomit or not be able to handle secretions accumulating in the airway.

E. Seizures

1. Seizures are caused by sudden episodes of uncontrolled electrical impulses in the brain.

2. Generalized seizures produce shaking movements and involve the entire body.

a. These seizures usually last 1 to 2 minutes, although prolonged seizures may continue for more than 2 minutes.

b. Patients are usually unconscious during generalized seizures and do not remember them afterwards.

3. Although seizures are rarely life threatening, they are a serious medical emergency and may be the sign of a life-threatening condition.

4. One cause of generalized seizures is a sudden high fever.

a. These seizures are called febrile seizures.

b. They occur most commonly in infants and young children.

5. Some seizures result in only a brief lapse of consciousness.

a. These seizures are called absence seizures.

b. Patients may blink their eyes, stare vacantly, or jerk one part of their body.

6. You must monitor the patient’s ABCs and arrange for transport to an appropriate medical facility.

7. Seizures can be caused by many factors, including

a. Epilepsy

b. Trauma

c. Head injury

d. Stroke

e. Shock

f. Decreased level of oxygen to the brain

g. High fever

h. Infection

i. Poisoning

j. Overdose of drugs or alcohol

k. Brain tumor or infection

l. Diabetic emergencies (low blood glucose)

m. Complication of pregnancy

n. Unknown causes

8. Usually, the seizure will be over by the time you arrive at the scene.

9. If it has not ended, your treatment should focus on protecting the patient from injury.

a. The patient should be moved only if he or she is in a dangerous location.

10. You cannot do anything about the patient’s airway during the seizure.

a. Once the seizure has stopped, it is essential that you ensure an open airway.

b. This is usually best accomplished using the head tilt–chin lift maneuver.

11. After you have opened the airway, place the patient in the recovery position.

12. If the patient does not resume breathing after a seizure or if the seizure is prolonged, begin mouth-to-mask or mouth-to-mouth breathing.

a. Administer supplemental oxygen as soon as it is available.

13. After the seizure, move the patient to a more comfortable, private place if other EMS personnel are delayed.

III. Specific Medical Conditions

A. You will find it helpful to be knowledgeable about some of the more specific medical conditions you may encounter as an EMR.

B. This information will help you assess, treat, and communicate more effectively with patients who have medical conditions.

C. Heart conditions

1. The heart must receive a constant supply of oxygen or it will die.

2. The heart receives its oxygen through a complex system of coronary (heart) arteries.

3. The coronary arteries may narrow as a result of atherosclerosis.

a. This disease process causes layers of fat to coat the inner walls of the arteries.

b. Progressive atherosclerosis can cause angina pectoris, heart attack, and even cardiac arrest.

4. Angina pectoris

a. This chest pain is caused by an inadequate flow of blood and oxygen to the heart muscle.

b. Angina is often described as pressure or heavy discomfort.

c. Angina attacks are usually brought on by exertion, emotion, or eating.

d. Crushing pain may be felt in the chest and may radiate to either or both arms, the neck, jaw, or any combination of these sites.

e. The patient is often short of breath and sweating, is extremely frightened, and has a sense of doom.

f. Ask whether the patient is already being treated for a diagnosed heart condition and has nitroglycerin.

i. Nitroglycerin usually relieves angina pain.

ii. If the patient has been prescribed nitroglycerin, assist the patient in taking one pill or administering the aerosol spray.

iii. If the pain has not lessened 5 minutes after the first dose, help the patient take another.

iv. If the pain has still not lessened 5 minutes after the second dose, assume the patient is having a heart attack and transport immediately.

v. Always follow local protocols regarding the administration of nitroglycerin.

5. Heart attack

a. A heart attack (myocardial infarction) results when one or more of the coronary arteries is completely blocked.

b. The two primary causes of coronary artery blockage are severe atherosclerosis and a blood clot from somewhere else in the circulatory system that breaks free and becomes lodged in the artery.

c. Signs of heart attack include

i. The patient suffers immediate and severe pain.

ii. The pain may radiate from the chest to the left arm or to the jaw or to the back.

iii. The patient is usually short of breath, weak, sweating, and nauseated and may vomit.

iv. If the blocked area is critical or large, the heart may stop completely.

v. Complete cessation of heartbeat is called cardiac arrest.

d. Cardiopulmonary resuscitation (CPR) is the first emergency treatment for cardiac arrest.

e. Take the following actions:

i. Summon additional help.

ii. Talk to the patient to relieve his or her anxiety.

iii. Touch the patient to establish a bond.

iv. Reassure the patient that you are there to help.

v. Move the patient as little as possible and do not allow the person to move.

vi. Place the patient in the most comfortable position (usually a semireclining or sitting position).

vii. Help the patient take one adult aspirin (325 mg) or 2-4 low-dose aspirins (81 mg each).

viii. Administer oxygen if it is available and protocols permit.

ix. Be prepared to administer cardiopulmonary resuscitation, if necessary.

x. If an automated external defibrillator (AED) is available, have it brought to the patient and make sure it is ready for use if needed.

f. Your primary role is to provide emotional support and arrange for prompt transport to an appropriate medical facility.

6. Congestive heart failure

a. Congestive heart failure (CHF) is caused by failure of the heart to pump adequately.

b. If one side of the heart becomes weak and cannot pump as well as the other side, the circulatory system becomes unbalanced, resulting in circulatory congestion.

c. In CHF, the failure is in the heart muscle, but the congestion is in the blood vessels.

d. Signs and symptoms of CHF:

i. Breathing difficulty (major symptom)

ii. Rapid, shallow breathing

iii. Moist or gurgling respirations

iv. Profuse sweating

v. Enlarged neck veins

vi. Swollen ankles

vii. Anxiety

e. As soon as you determine that the patient is experiencing CHF, take these actions:

i. Place the patient in a sitting position with the legs down to drain some of the fluid back into the lower parts of the body.

ii. Administer oxygen in large quantities and at a high flow rate if protocols permit and you are trained to use it.

iii. Summon additional help.

iv. Arrange for prompt transport to an appropriate medical facility.

D. Dyspnea

1. Dyspnea means shortness of breath or difficulty breathing.

2. It is usually associated with serious heart or lung disease.

a. Heart-related causes include angina pectoris, heart attack, and CHF.

b. Pulmonary diseases such as chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, pneumonia, and asthma can cause dyspnea.

i. COPD and emphysema are caused by damage to the small air sacs (alveoli) in the lungs.

ii. Chronic bronchitis is caused by an inflammation of the airways in the lungs.

iii. Pneumonia is caused by an infection in the lungs.

iv. Asthma is caused by a clamping down or spasm of the smaller air passages.

3. Dot not spend too much time trying to determine the specific cause of dyspnea, but rather focus on treating the symptoms.

4. General treatment

a. Check the patient’s airway to confirm it is not obstructed.

b. Check the rate and depth of the patient’s breathing.

i. Be prepared to assist with mouth-to-mask or mouth-to-barrier device rescue breathing.

c. Place the patient in a comfortable position.

d. Provide reassurance.

e. Loosen any tight clothing.

f. Administer oxygen if it is available and you are trained to do so.

5. Asthma

a. Asthma is an acute spasm of the smaller air passages associated with excess mucus production and swelling of the lining of the respiratory passages.

b. Asthma can be caused by

i. An allergic reaction

ii. Severe emotional stress

iii. Exercise

iv. Respiratory infections

c. Asthma is a serious disease that killed 3,630 people in the United States in 2013

d. Patients experiencing an asthma attack will have great difficulty exhaling through partially obstructed air passages.

i. A wheezing sound will be heard on exhalation.

ii. Many patients will have taken medications before your arrival.

e. Patients can die during asthma attacks.

i. Follow the treatment steps for dyspnea and instruct the patient to perform pursed-lip breathing.

ii. Pursed-lip breathing relieves some of the internal lung pressures that cause the asthma attack.

iii. If advanced life support is not available, arrange for prompt transport to an appropriate medical facility.

E. Stroke

1. Strokes are a leading cause of brain injury and disability in adults.

2. Most strokes occur when a blood clot blocks blood supply to a part of the brain.

3. Signs and symptoms vary depending on which portion of the brain is affected.

a. Headache

b. Numbness or paralysis on one side of the body

c. Dizziness

d. Confusion

e. Drooling

f. Inability to speak

g. Difficulty seeing

h. Unequal pupil size

i. Unconsciousness

j. Seizures

k. Respiratory arrest

l. Incontinence

m. Unresponsiveness

4. The Cincinnati Prehospital Stroke Scale is an easy-to-administer and accurate tool that you can use to determine whether a patient may have experienced a stroke.

a. Requires no special equipment

b. Consists of three assessments:

i. Assessment of the facial muscles by having the patient smile

ii. Assessment of arm drift by having the patient hold his or her arms in front of the body

iii. Speech assessment by having the patient repeat a simple phrase.

c. If the patient cannot complete one or more of these tasks, suspect a stroke.

5. Treatment

a. Your first priority is to maintain an open airway.

b. Administer oxygen using a nonrebreathing face mask if it is available and you are trained to use it.

c. If the patient is having a seizure, try to prevent further injury from occurring.

d. Be prepared to administer rescue breathing if the patient stops breathing.

e. Place an unresponsive patient in the recovery position to help maintain an open airway.

f. Give emotional support by talking to and touching the patient.

g. Some stroke patients can be treated with special drugs to dissolve the blood clot in the brain.

h. Arrange for prompt transport to a medical facility that is equipped to treat stroke patients.

F. Diabetes

1. Diabetes is caused by the body’s inability to process and use glucose (sugar), which is carried by the bloodstream to the body’s cells.

a. The body’s cells need both oxygen and glucose to survive.

2. The body produces a hormone called insulin that enables the glucose carried by the blood to move into individual cells, where it is used as fuel.

a. If the body does not produce enough insulin, the cells become “starved” for glucose and diabetes results.

b. Many diabetics must take supplemental insulin injections.

3. Diabetes is a serious medical condition. Two specific medical conditions that can occur in conjunction with it

a. Hypoglycemia

b. Diabetic coma

4. Hypoglycemia

a. Hypoglycemia occurs if the body has enough insulin but not enough blood glucose.

i. An older term for hypoglycemia is insulin shock.

b. Signs and symptoms include

i. Pale, moist, cool skin

ii. Rapid, weak pulse

iii. Dizziness or headache

iv. Confusion or unconsciousness

v. Sweating

vi. Hunger

vii. Rapid onset of symptoms (within minutes)

c. Suspect low blood sugar if the patient has a history of diabetes or is wearing medical emergency information.

d. If hypoglycemia is not diagnosed and corrected by the rapid administration of glucose in some form, the patient may die.

e. A person experiencing hypoglycemia may appear to be drunk. Try to get answers to the following questions:

i. Are you a diabetic?

ii. Did you take your insulin today?

iii. Have you eaten today?

f. If the patient is able to swallow, attempt to get him or her to eat or drink something sweet.

g. If the patient is unconscious, open the patient’s airway and assist breathing and circulation.

i. Do not administer fluids by mouth because the patient may choke and aspirate the fluid into the lungs.

ii. The patient must have glucose administered intravenously as soon as possible.

h. Some EMRs carry a tube of oral glucose gel or tablets that can be placed inside the patient’s cheek.

5. Diabetic coma

a. Diabetic coma occurs when the body has too much blood glucose and not enough insulin.

b. Signs and symptoms include

i. History of diabetes

ii. Warm, dry skin

iii. Rapid pulse

iv. Deep, rapid breathing

v. Fruity odor on the patient’s breath

vi. Weakness, nausea, and vomiting

vii. Increased hunger, thirst, and urination

viii. Slow onset of symptoms (days)

c. Misdiagnosis is common—it is not always easy to distinguish between hypoglycemia and diabetic coma.

d. Administer a liquid substance that contains sugar.

i. In a patient who is experiencing insulin shock, the sugar may improve the patient’s condition.

ii. If the patient is experiencing a diabetic coma, the sugar will not raise blood glucose levels enough to do any further harm.

e. In general, give conscious diabetic patients sugar by mouth and arrange for prompt transport to an appropriate medical facility.

f. If the diabetic patient is unconscious, arrange for prompt transport to an appropriate medical facility.

G. Abdominal pain

1. The contents of the abdomen are divided into hollow and solid structures.

a. Hollow structures are really tubes through which contents pass.

b. Solid structures produce substances.

2. The abdomen occupies a large part of the body, and abdominal pain is a common complaint.

3. As an EMR, you need to recognize that a patient has an abdominal problem, but are not expected to determine the cause of the abdominal pain.

4. Acute abdomen

a. Acute abdomen is caused by irritation of the abdominal wall.

b. This irritation may be the result of infection or may be caused by the presence of blood in the abdominal cavity.

c. Pain can be referred to other parts of the body.

d. The abdomen may feel as hard as a board.

e. These patients may have nausea and vomiting, fever, and diarrhea as well as pain.

5. Some patients with abdominal pain will vomit blood because they are bleeding from the esophagus or the stomach.

a. Bleeding from the lower part of the gastrointestinal tract may produce bloody stools that contain bright red blood, or the stools may be black and tarry.

b. These patients must be treated for shock.

6. If a patient has abdominal pain:

a. Monitor vital signs.

b. Treat symptoms of shock.

c. Keep the patient comfortable.

d. Arrange for transport to an appropriate medical facility.

7. One cause of an acute abdomen is an abdominal aortic aneurysm (AAA).

a. AAA occurs when one or more layers of the aorta become weakened and separate from other layers of the aorta.

b. Patients who have diabetes, high blood pressure, or atherosclerosis, as well as heavy smokers are at high risk for developing AAA.

c. Patients may complain of pain (a tearing sensation) in the abdomen and may have pain referred to the shoulder.

d. If an AAA ruptures, the patient will experience severe pain and profound shock.

e. Treatment

i. Place the patient in a comfortable position and treat for shock.

ii. Handle these patients gently.

iii. Arrange for prompt transport to an appropriate medical facility.

H. Kidney dialysis patients

1. People with certain types of kidney disease are unable to filter waste products from their bloodstream.

2. Many patients with chronic renal (kidney) failure undergo hemodialysis two or three times a week.

a. The patient’s blood passes through a machine that filters out the waste products and returns the cleansed blood to the patient.

b. Most hemodialysis patients have a shunt implanted in their arm or leg.

i. A shunt is a surgically created connection between an artery and a vein.

c. If the patient has a shunt, take his or her blood pressure in the arm without the shunt to avoid damaging this device.

3. Patients who are being treated by dialysis may experience medical emergencies related to their dialysis treatment.

a. Patients may experience a drop in blood pressure because of the changes in their body from the treatment.

b. This decrease in blood pressure can produce shock.

c. Dialysis patients are also at risk for internal bleeding.

d. Hemodialysis patients may experience abnormal levels of electrolytes in their blood; these imbalances can cause cardiac arrhythmias that sometimes result in cardiac arrest.

4. Treat the symptoms presented by the patient.

IV. Summary

A. General medical conditions may have different causes, yet result in similar signs and symptoms. EMRs who are skilled at recognizing the signs and symptoms of various general medical conditions and knowledgeable about general treatment guidelines will be able to provide immediate care for patients even if they cannot determine the exact cause of the problems.

B. With a patient who has a general medical complaint, follow the systematic patient assessment sequence. Usually, it is best to collect a medical history—using the SAMPLE format—on the patient experiencing a medical problem before you perform a physical examination.

C. AMS is a sudden or gradual decrease in level of responsiveness. When assessing AMS in a patient, use the AVPU scale. You should complete the patient assessment sequence to ensure scene safety and proper assessment. Initial treatment seeks to maintain the patient’s ABCs and normal body temperature and to keep the patient from incurring any additional harm. If the patient is unconscious and has not sustained trauma, place the patient in the recovery position or use an airway adjunct to help maintain an open airway.

D. Seizures are caused by sudden episodes of uncontrolled electrical impulses in the brain. Usually, the seizure will be over by the time you arrive at the scene. If it has not ended, focus on protecting the patient from injury. Do not restrain the patient’s movements. Once the seizure has stopped, ensure that the patient has an open airway. You can then place the patient in the recovery position and arrange for transport to an appropriate medical facility.

E. Some specific medical conditions typically encountered by the EMR include angina pectoris, heart attack, congestive heart failure, dyspnea, stroke, hypoglycemia, diabetic coma, and abdominal pain. By learning the causes and knowing the signs and symptoms of these conditions, you may be able to provide more specific care for the patient. Although these conditions must be diagnosed and treated by a physician, you can greatly improve the patient’s chances of survival by taking some simple actions until more highly trained EMS personnel arrive on the scene to assist you.

Post-Lecture

This section contains various student-centered end-of-chapter activities designed as enhancements to the instructor’s presentation. As time permits, these activities may be presented in class. They are also designed to be used as homework activities.

Assessment in Action

This activity allows the student an opportunity to analyze an emergency care scenario and develop responses to critical-thinking questions. The scenario is designed to help students simulate the steps taken on a medical call. Help students to understand that a patient who appears to be a “medical patient” could also be suffering from trauma.

Instructor Directions

1. Direct students to read the “Assessment in Action” scenario located in the Prep Kit at the end of Chapter 10.

2. Direct students to read and individually answer the quiz questions at the end of the scenario. Facilitate a class review and discussion of the answers, allowing students to correct their responses as needed. Use the quiz question answers noted here to assist in building this review.

3. You may wish to ask students to complete the activity on their own and turn in their answers on a separate piece of paper.

Answers to Assessment in Action Questions

1. Answer: D Pertinent past medical history

2. Answer: D Name of the illness

3. Answer: C Ask the patient’s son, who is standing nearby.

4. Answer: D Cardiac arrest.

5. Answer: D Respiratory distress.

6. Answer: Initially, you are trying to form a preliminary impression of the man’s condition. Is he breathing normally? How is his color?

7. Answer: If the heart muscle is without oxygen for more than a few minutes, the heart muscle will die. If enough heart muscle dies, the heart will not be able to pump an adequate amount of blood to supply the needs of the body.

8. Answer: C Measuring the patient's blood pressure

9. Answer: B Diet coke

10. Answer: C Increased rate of respirations

Lesson Review

A. True or false: Part of the primary assessment is to form a general impression of the patient. (Lecture I-D)

B. List the steps in taking a SAMPLE history. (Lecture I-D)

C. List the possible causes of an altered mental status (AMS). (Lecture II-D)

D. What should you do if a seizing patient stops breathing and does not start breathing again after the seizure ends? (Lecture II-E)

G. A person who is experiencing chest pain brought on by exertion, emotion, or eating is most likely having which problem? (Lecture III-C)

H. Describe how you can tell the difference between angina pectoris, a heart attack, and congestive heart failure. (Lecture III-C)

I. What should you check when a patient has dyspnea? (Lecture III-D)

Assignments

A. Complete all the Student Workbook activities for Chapter 10.

B. Review all materials from this lesson and be prepared for a lesson quiz to be administered (date to be determined by the instructor).

C. Read Chapter 11: Poisoning and Substance Abuse for the next class session.

Unit Assessment Keyed for Instructors

1. Name five different conditions that may cause an altered level of consciousness.

Answer: Any five of the following: head injury, shock, decreased level of oxygen to the brain, stroke, slow heart rate, high fever, infection, poisoning (including drugs and alcohol), low level of blood glucose (diabetic emergencies), insulin reaction, psychiatric condition

p 204

2. Seizures that produce shaking movements and involve the entire body are called

A. absence seizures.

B. generalized seizures.

C. petit mal seizures.

D. tonic-clonic seizures.

Answer: B

p 204

3. Which of the following is not a treatment for a patient exhibiting seizures?

A. Clear the area of harmful objects.

B. Place the patient in the recovery position after the seizure is stopped.

C. Restrain the patient.

D. Start rescue breathing after the seizure ends if the patient does not start breathing.

Answer: C

p 205

4. Some seizures may be caused by stroke or diabetic emergencies.

A. True

B. False

Answer: A

p 205

5. The EMR should suspect a heart condition if the patient complains of which of the following?

A. pain or discomfort in the chest, neck, jaw, arm, or back

B. difficulty in breathing

C. nausea and vomiting

D. all of the above

Answer: D

P 207

6. Indications that a patient may be suffering from a heart attack include

A. chest pain or pressure

B. dyspnea

C. nausea

D. all of the above

Answer: D

p 207

7. Why is it important to place a patient with congestive heart failure in a sitting position?

Answer: Having the legs hang down over the edge of a bed or chair helps drain some of the fluid back into the lower parts of the body and may improve breathing. This position helps relieve CHF symptoms until more highly trained EMS personnel arrive on scene.

p 209

8. The proper treatment for the patient with breathing difficulties includes

A. ensuring an open airway and administering supplemental oxygen.

B. placing the patient in a position of comfort, usually sitting up.

C. loosening any tight clothing.

D. all of the above.

Answer: D

p 210

9. Signs and symptoms of a stroke include all of the following except

A. confusion and dizziness.

B. numbness or paralysis on one side of the body.

C. slow pulse.

D. unequal pupils.

Answer: C

p 211

10. If you are unsure whether a conscious diabetic patient is suffering from hypoglycemia or diabetic coma, you should

A. continue questioning the patient until you get an answer.

B. administer a sugary substance.

C. withhold glucose until you are certain that this is a diabetic problem.

D. provide only water.

Answer: B

p 214

Unit Assessment

1. Name five different conditions that may cause an altered level of consciousness.

2. Seizures that produce shaking movements and involve the entire body are called

A. absence seizures.

B. generalized seizures.

C. petit mal seizures.

D. tonic-clonic seizures.

3. Which of the following is not a treatment for a patient exhibiting seizures?

A. Clear the area of harmful objects.

B. Place the patient in the recovery position after the seizure is stopped.

C. Restrain the patient.

D. Start rescue breathing after the seizure ends if the patient does not start breathing.

4. Some seizures may be caused by stroke or diabetic emergencies.

A. True

B. False

5. The EMR should suspect a heart condition if the patient complains of which of the following?

A. pain or discomfort in the chest, neck, jaw, arm, or back

B. difficulty in breathing

C. nausea and vomiting

D. all of the above

6. Indications that a patient may be suffering from a heart attack include

A. chest pain or pressure

B. dyspnea

C. nausea

D. all of the above

7. Why is it important to place a patient with congestive heart failure in a sitting position?

8. The proper treatment for the patient with breathing difficulties includes

A. ensuring an open airway and administering supplemental oxygen.

B. placing the patient in a position of comfort, usually sitting up.

C. loosening any tight clothing.

D. all of the above.

9. Signs and symptoms of a stroke include all of the following except

A. confusion and dizziness.

B. numbness or paralysis on one side of the body.

C. slow pulse.

D. unequal pupils.

10. If you are unsure whether a conscious diabetic patient is suffering from hypoglycemia or diabetic coma, you should

A. continue questioning the patient until you get an answer.

B. administer a sugary substance.

C. withhold glucose until you are certain that this is a diabetic problem.

D. provide only water.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download