911 TACTICAL MEDICINE - 911 Tactical Medicine



SHOCK Review Notes:Types of shock with signs and symptoms –Neurogenic (vasodilation )Warm, dry, pink skinHypotensionBradycardia and bradypneaMay have normal cap refillSeptic ( vasodilation )HypotensionAltered mental statusHyper or hypothermicAnaphylaxis ( vasodilation )HypotensionTachycardiaAnxietyUrticaria, angioedemaWheezingHypovolemic ( loss of plasma or blood )Cool, pale, clammy skinHypotension – late signAltered mental statusDelayed cap refillCardiogenic shock ( loss of pump function )Cool, clammy, pale skin. May also be cyanoticIncreased or decreased heart rate or dysrhythmiaHypotensionAltered mental statusDecreased cap refillMay have pulmonary edema - cracklesObstructive shock ( tamponade, tension pneumo, pulmonary embolus)JVDTracheal deviation in pneumothoraxMuffled heart tones in tamponadePulsus pardoxusCompensated shock – the renin-angiotension-aldosterone system is activated when the blood pressure drops. This causes an increase in preload through reabsorption of water and sodium. Increased preload will also increase afterload.RESPIRATORY DISORDERS Lecture Notes:COPD patients with an acute onset of SOB may have a pulmonary embolism.Clinical findings of a pulmonary embolism:Clear breath soundsSudden sharp, localized chest painTachypneaHypotension (poor outcome)12 lead changesNarcotic overdose causes respiratory acidosis Acute Respiratory Distress Syndrome (ARDS) caused a breakdown of the alveolar-capillary membrane.Indications for CPAP (continuous positive airway pressure) (use only in patients who can follow commands and clear their own airway secretions)COPDAsthma – if not responding to beta agonistsCHFRespiratory Alkalosis may result from:Infections, feveranxietyRespiratory Acidosis may result from:Narcotic overdoseBenzodiazepinesPneumoniaForeign bodyAs we age we have a decreased lung compliance.Left heart failure causes fluid back up in the lungs causing dyspnea at night or paroxysmal nocturnal dyspneaAsthma patients usually present with respiratory distress, no fever, increased expiratory phase of breathing, wheezingCOPD patients may present with pursed lip breathing, increased respiratory effort upon exertion, rhonchi, no JVD, wheezing.CHEST DISCOMFORT Lecture Notes:Pericarditis presents with ST elevation in all leads – global ST elevationSigns and symptoms of Cardiac Tamponade:Low amplitude EKG Muffled heart tonesPulsus ParadoxusHypotensionIn a patient with CP, recent stent placement is concerningAny patient presenting with CP or any possible cardiovascular complaint should have a 12 lead obtained.ENDOCRINE, METABOLIC, ENVIRONMENTAL Lecture Notes:Signs of hyperglycemiaPolydipsiaPolyphagiaPolyuriaAMSTachycardiaRapid, deep breathing ( Kussmauls )Signs of hypoglycemiaCold, clammy skinDiaphoresisAMSSeizuresMetabolic acidosisDecreased pHNormal or abnormal CO2Decreased bicarbonate and carbonic acidHHNS – hyperglycemic hyperosmolar non ketotic syndromeCommon with Type II diabeticsBecome severely dehydratedRequire aggressive fluid resuscitationAllergic reactionsMild – IV, O2, monitorGraves disease ( overactive thyroid )If having tachycardia, tremors, anxiety treat with Beta BlockersHypothermiaMild – shivering, increased HR and decreased tempALTERED MENTAL STATUS Lecture Notes:Anaphylaxis causes a relative hypovolemia by vasodilation.HHNS is hyperosmolar hyperglycemic nonketonic syndrome and is a very high blood glucose level. This is more common with Type II diabetics. The body is still producing a small amount of insulin but not enough for the amount of sugar intake. The body does not produce ketones so there is no fruity odor to the breath and no Kussmauls respirations. Patient may have been feeling bad with a low grade fever for several days and be lethargic.Management of HHNS is initially a fluid bolus due to significant volume depletion. Other management includes supporting airway, breathing and circulation.Initial bolus is 1-2 liters rapid infusion (peds 20ml/kg)Frequent glucose checksEKG to monitor for hyperkalemia, wide QRS and bradycardiaCrucial findings in a stroke patient are the time of onset of neurological deficits or onset of symptomsSubarachnoid hemorrhage presents with sudden, severe headache ( described as like a thunderclap ), possible AMS, elevated blood pressure, blurred vision, seizures, nausea and photophobiaMeningitis often presents with:Nuchal rigidityFever & chillsPhotophobiaAMSPositive Brudzinski sign (legs flex when neck flexed )INFECTIOUS DISEASES Lecture Notes:Clostridium difficile results from long term antibiotic therapySigns and symptoms:Diarrhea with very foul odorAbdominal painSigns and symptoms of tuberculosis:Night sweatsWeight lossHeadachePersistent cough (2-3 weeks)Chest painWhen dealing with an infectious disease in geriatrics you may have a hard time getting a history a history, they have multiple medical conditions, living conditions may be bad, they may have malnutrition and cannot regulate temperatures (may not present with a fever).Anaphylaxis is a heightened immune response.MRSA is methicillin resistant staph aureus – presents with rash, then may progress to fever and signs of systemic infection.Meningitis – flat red rash, fever, HA, feels bad, nausea and vomiting, neck stiffnessABDOMINAL Lecture Notes:Melena is black, tarry stools and are a sign of an blood that is partially digested from an upper GI bleed.Diffuse abdominal pain (peri-umbilical) nausea, vomiting that progresses to a precise pinpoint pain when rt. Leg is extended from hip is most likely to be associated with appendicitis (called positive psoas sign).Cullen’s sign is discoloration or bruising around the umbilicus and is associated with an intra-abdominal bleed.All patients over 50 with vague complaints - indigestion, aching between the shoulders and weakness should have a 12 lead EKG performed.In a patient with lower abdominal pain on the left side should include considering the following as a possible differentials diagnosis:DiverticulitisEctopic pregnancyAortic aneurysmOvarian cystPIDEndometriosisRenal calculi (kidney stones)Psoas abscess (appendicitis) UTIWhen assessing abdominal pain remember that patients do not benefit from staying on scene. Look for life threats and relevant information and transport.Pancreatitis presents with nausea, vomiting, fever and constant mid-epigastric pain and may have a history of gall stones and heavy alcohol use.Gastroenteritis usually presents with diffuse abdominal cramping, vomiting and diarrhea.TOXINS, HAZ MAT, WMD Lecture Notes:Beta Blockers overdose causes:BradycardiaHypotensionHypoglycemiaHeart BlocksAMSOrganophosphate ( or nerve agent ) poisoning side effects:bradycardiaIncontinenceNausea/vomitingDyspneaIncreased oral secretionsSeizures ( treat w/ midazolam )Acetaminophen overdose side effects:Abdominal pain, nausea and vomitingPallor and diaphoresisHypotensionLate signs - jaundiceCyanide PoisoningHyperventilation (early)Restlessness, anxietyHeadache, confusionBradycardia then tachycardiaBitter almond smellConfusionTricyclic antidepressant overdoseMay have no symptoms early in ingestionDysrhythmiasHypotensionAltered mental statusWhen seizures develop as a result of a suspected nerve agent exposure treat with valium, midazolam, or versed.AMLS Assessment SequenceInitial ImpressionScene Size-Up/General ImpressionInitial AssessmentMS, ABC, D/PerfusionStatus After Initial AssessmentPossible Field DiagnosesInitial Management PrioritiesFocused History (SAMPLE)OPQRSTVSFocused Physical ExamField DiagnosisManagementDetailed Physical ExamOngoing Assessment ................
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