MEDICAL CONDITIONS

© 2011 National Safety Council 12-1

MEDICAL CONDITIONSLESSON 12


Introduction

• A medical emergency occurs because of illness or a medical problem

• Some medical emergencies develop slowly, some very quickly

• Medical emergencies may be life threatening

• Know the signs and symptoms of common medical problems and the appropriate emergency medical care


General Medical Complaints

• Patient or family member may call for help for signs and symptoms

• You may suspect or know the cause of the problem

• Neither you nor the patient may know the problem

• The general approach is the same for all medical emergencies

• You do not have to know the specific illness

• Always begin with the standard assessment and manage life-threatening problems


Perform the Standard Assessment

• Size up the scene

• Complete the primary assessment and care for life-threatening conditions

• Take the history

• Perform the secondary assessment and physical examination as appropriate

• Complete reassessments


General Signs and Symptoms

• Person feels ill, dizzy, confused or weak

• Skin color changes – flushed or pale

• Sweating

• Breathing changes

• Nausea, vomiting


Perform Standard Patient Care

• Ensure EMS has been activated

• Take body substance isolation precautions

• Maintain the patient’s airway and provide artificial ventilation if needed

• Comfort, calm and reassure the patient


Additional Care for Medical Emergencies

• Follow local protocol re: oxygen administration

• Help patient rest and avoid chilling or overheating

• Do not give food or drink

• Be prepared to give BLS


Heart Attack


Heart Attack

• Caused by sudden reduced blood flow to heart muscle

• Medical emergency that often leads to cardiac arrest

• Can occur at any age

• Usually results from atherosclerosis


Facts about Heart Attack

• 132,000 people in United States die every year

• More likely in those with family history

• 20% of patients do not have chest pain

• Patients often have other symptoms


Assessing Heart Attack

• Assess the character and location of chest discomfort or pain:

- Quality: what does it feel like?

- Location: where is it occurring?

- Severity: consider on a pain scale

• Ask whether the pain or discomfort radiates elsewhere:

- Arms

- Back

- Neck

- Jaw

- Stomach


Assessing Heart Attack(continued)

• Monitor vital signs (blood pressure, pulse and respiratory rates)

• In pediatric patients:

- Heart problems are often related to congenital heart conditions

- Cardiac arrest is often caused by primary respiratory problem

• Geriatric patients may not experience chest discomfort with a heart attack


Signs and Symptoms of Heart Attack

• Persistent discomfort, pressure, tightness, ache or pain in chest

• Pain spreading to neck, shoulders or arms

• Shortness of breath

• Dizziness, lightheadedness, a feeling of impending doom

• Pale, moist, cool skin or heavy sweating

• Indigestion

• Nausea or vomiting


Signs and Symptoms of Heart Attack (continued)

• Signs and symptoms vary considerably

• Patient may have no signs and symptoms before collapsing

• Milder symptoms may come and go for 2 or 3 days

• Some symptoms are more common in women, e.g., shortness of breath, jaw or back pain, and nausea and vomiting

• Consider a wide range of symptoms rather than expecting a clearly defined situation

• Patients occasionally deny they are having a heart attack


Emergency Care for Heart Attack

• Act quickly

• Perform standard patient care

• Help patient rest comfortably (often sitting)

• Loosen tight clothing

• Ask if patient takes heart medication

• Follow local protocol to help with medication


Emergency Care for Heart Attack (continued)

• Follow local protocol to administer oxygen

• Follow local protocol to allow patient to chew one uncoated adult aspirin or two low-dose baby aspirin

• Stay with patient, reassure and calm


• Do not let the patient eat or drink anything


Nitroglycerin

• Increases blood flow by dilating arteries

• Often prescribed for angina – type of chest pain caused by narrowed coronary arteries

• Comes in tablets, sprays and patches


Nitroglycerin (continued)

• To administer:

- Follow local protocol and instructions on the medication

- Patient should be seated

• Do not give to unresponsive patient


Angina

• Chest pain caused by heart disease and temporary blood flow interruption

• Usually after activity or exertion

• Pain usually lasts only few minutes

• People usually know they have angina and carry medication


Care for Angina

• Ask if the patient has been diagnosed with angina, and if the pain is like angina pain in the past

• If so, help person with angina take medication and rest

• If pain persists >10 minutes or stops and returns or person has other symptoms of heart attack, give first aid as for heart attack


Respiratory Distress Emergencies


Respiratory Distress

• Difficulty breathing

• May occur suddenly in those with chronic respiratory problems

• If cause not obvious

- Look for other signs and symptoms that may reveal the problem

- Give general emergency care

• If cause is determined

- Care for that problem


Signs and Symptoms of Respiratory Distress

• Patient gasping or unable to catch breath

• Breathing that is faster or slower, deeper or shallower than normal

• Breathing with wheezing or gurgling sounds

• Patient feels restless, dizzy or lightheaded

• Increased pulse


Signs and Symptoms of Respiratory Distress (continued)

• Signs of altered mental status

• Pale or ashen, cool and moist skin

• Bluish lips and nail beds

• Patient sitting in tripod position

• Flaring nostrils and chest muscle movement in infant or child


Respiratory Distress in an Infant or Child

• Act quickly because respiratory distress may rapidly progress to arrest

• Upper airway obstruction may be caused by respiratory infection

• Lower airway disease may be caused by birth problems or infections


Emergency Care for Respiratory Distress


• Help patient into easiest breathing position

• Ask about prescribed medicine help patient take it if needed


Emergency Care for Respiratory Distress (continued)


• Follow local protocol for supplemental oxygen

• Use suction as needed to maintain the airway

• Provide emotional support


Asthma

• Affects one in 20 adults

• Affects one in 10 school-age children

• Many patients carry medication for known condition

• Untreated, severe attack can be fatal


Assessing Asthma

• Perform the standard assessment

• If a young child away from caretakers has trouble breathing, always ask if he or she has medication


Signs and Symptoms of an Asthma Attack

• Wheezing and difficulty breathing and speaking

• Dry, persistent cough

• Fear, anxiety

• Gray-blue skin

• Changing levels of responsiveness


Emergency Care for an Asthma Attack


• Ensure EMS has been activated (first attack)

• Follow local protocol to assist with medication when:

- Patient confirms asthma attack occurring

- Patient identifies inhaler as his or her medication

- Patient cannot self-administer the medication


Emergency Care for an Asthma Attack (continued)

• Help patient into easiest breathing position

• Patient may use inhaler again if needed as prescribed or directed by the medical provider

• If breathing difficulty after using inhaler, activate EMS

• Follow local protocol for supplemental oxygen

• Never unnecessarily separate child from parent or loved one


Helping With an Inhaler

Help patient use inhaler if:

• Patient confirms asthma attack occurring

• Patient identifies inhaler as his or her medication

• Patient cannot self-administer the medication


Chronic ObstructivePulmonary Disease

• Chronic Obstructive Pulmonary Disease (COPD) includes emphysema and chronic bronchitis

• More than 12 million people in United States have COPD

• Number 4 cause of death in United States

• May cause respiratory distress and breathing emergencies


Emergency Care for COPD

• Emergency care same as for respiratory distress

• Ask patient if he or she has COPD

• Help patient with prescribed medication


Hyperventilation

• Fast, deep breathing

• Usually caused by anxiety or stress

• Sometimes caused by injury or illness

• Imbalance in the body’s oxygen and carbon dioxide

• Usually does not last long


Signs and Symptoms of Hyperventilation

• Fast, deep breathing

• Anxiety

• Confusion or dizziness

• Numbness or tingling in fingers, toes, lips

• Muscle twitching or cramping


Care for Hyperventilation


• Help patient calm down and breathe slowly

• Do not have person breathe into a bag

• Rapid breathing may be caused by injury or sudden illness do not assume the patient is simply hyperventilating


Care for Hyperventilation (continued)

• Look for signs of injury or illness

• Ask the patient what happened

• Activate EMS

- If other signs and symptoms suggest injury or illness

- If patient’s breathing doesn’t return to normal in a few minutes


Altered Mental Status


Altered Mental Status

• Change from person’s normal responsiveness and awareness

• Patient may be confused, disoriented, combative, drowsy or partially or wholly unresponsive

• May be brief or prolonged

• May result from different injuries and illnesses

• Often a sign of deteriorating condition


Common Causes

• Seizures

• Stroke

• Head injury

• Poisoning, drug use or overdose

• High fever, infection

• Diabetic emergencies

• Psychiatric conditions

• Any condition causing lowered blood oxygen


Emergency Care forAltered Mental Status


• Determine nature of problem

• Gather a SAMPLE history

• Place unresponsive patient in recovery position

• Have suction available

• Consider the use of an airway adjunct


Altered Mental Status and Behavioral Emergencies

• Drug or alcohol use may become a behavioral emergency

• Never assume person is intoxicated or using drugs

• Intoxicated person may need care for injury or illness


Fainting

• Caused by temporary reduced blood flow to brain, hot weather, fright, emotional shock, lack of food, suddenly standing

• Usually not sign of serious problem unless it occurs often or person does not recover quickly

• Could be serious in someone with heart disease, pregnant or older than 65


Signs and SymptomsBefore Fainting

• Dizziness

• Sweating

• Nausea

• Blurring or dimming of vision

• Generalized weakness

• Pale, cool skin; sweating


Emergency Care for Fainting

• Check patient; provide BLS if needed

• Lay patient down and raise legs 6-12 inches

• Loosen tight clothing

• Check for possible injuries from falling

• Reassure patient when recovering


Emergency Care for Fainting (continued)

• If unresponsive, place in recovery position

• Do not splash water on patient’s face

• Do not use ammonia inhalants

• Activate EMS if patient is not soon responsive or repeatedly faints

• Always call EMS for older adults, heart disease patients, pregnant women


Stroke


Stroke

• Cerebrovascular accident (CVA) or brain attack

• May be caused by atherosclerosis

• Blood clot may obstruct artery in brain

• Artery in brain may rupture

• Over 795,000 people have strokes each year in United States

• More common in older adults

• Act quickly to decrease chance of permanent damage


Assessing Stroke

• Perform standard assessment

• Find out when signs and symptoms first occurred – time may affect medical treatment


Assessing Stroke (continued)

• Signs and symptoms vary depending on site of blocked artery

• Do not attribute signs and symptoms to other condition


Signs and Symptoms of Stroke

• Complaints of sudden headache

• Complaints of sudden weakness or decreased or absent sensation in one side of the face, arm or leg; gait problems

• Decreased or absent movement of one or more extremities

• Facial droop, drooling, inability or difficulty swallowing, tongue deviation

• Dizziness, confusion

• Slurred speech, difficulty speaking and understanding speech


Signs and Symptoms of Stroke (continued)

• Becoming combative, uncooperative or restless

• Double vision or blurred vision

• Unequal pupils

• Vomiting

• Changing levels of responsiveness or unresponsiveness, possible coma

• Bladder or bowel incontinence


Cincinnati PrehospitalStroke Scale

• Ask patient to smile – one side droops

• Ask patient to close eyes and raise both arms in front of body – one arm drifts lower than other


Cincinnati PrehospitalStroke Scale (continued)

• Ask patient to say “You can’t teach an old dog new tricks”

- Slurs words

- Uses wrong words

- Cannot speak


Emergency Care for Stroke


• Relay your assessment to EMS crew

• Monitor patient; give BLS if needed

• Follow local protocol for oxygen

• Have patient lie on back with head and shoulders slightly raised


Emergency Care for Stroke (continued)

• Turn patient’s head to side to drain mouth of drool or vomit use suction if needed

• Do not give food or drink

• Keep patient warm and quiet

• Put unresponsive patient who is breathing normally in recovery position with affected side down


Seizures


Seizures

• Caused by many different conditions

• Brain’s electrical activity out of balance

• Results in altered mental status/uncontrolled muscular contractions

• Rarely life-threatening, but a serious emergency


Seizure Causes

• Epilepsy

• Head injuries

• Low blood glucose

• Any condition causing low oxygen

• Poisoning, including drugs and alcohol

• Electric shock

• High fever (infants and young children)

• Brain tumors

• Complications of pregnancy


Facts about Epilepsy

• Affects 3 million people in United States

• Approximately 200,000 new cases each year

• 10% of United States population will have seizure in their lifetime


Common Types of Seizures

• Complex partial seizure

- Person seems dazed

- Person may mumble or wander

• Absence seizure

- Person seems to stare blankly into space

- Person doesn’t respond to others


Common Types of Seizures (continued)

• Generalized tonic clonic seizure

- Convulsions or grand mal seizure

- Person loses consciousness, falls, is stiff, then experiences jerking of muscles (clonic)


• Febrile seizures

- Caused by rapid spike in fever in infants/young children

- Convulsions similar to tonic clonic

Common Types of Seizures (continued)


Signs and Symptomsof Seizures

• Minor seizures:

- Staring blankly ahead

- Slight twitching lips, head, arms or legs

- Other movements


Signs and Symptomsof Seizures (continued)

• Major seizures:

- Crying out then becoming unresponsive

- Body becomes rigid then shakes

- Jaw may clench


• Fever convulsion:

- Hot, flushed skin

- Violent muscle twitching

- Arched back

- Clenched fists




• Generally occur suddenly without warning

• Sometimes aura in advance of seizure

• Possible unresponsiveness and vomiting during convulsion

• Possible bowel or bladder incontinence

• Seizure length may be brief or prolonged

• Patients typically tired or sleepy after attack


Emergency Care for Seizures


• Provide artificial ventilation if needed

• Prevent injury especially to head

• Loosen tight clothing around neck

• Don’t restrain patient

• Don’t put anything in patient's mouth


Emergency Care for Seizures (continued)

• Have suction available

• Look for medical identification jewelry

• Turn patient onto side if vomiting occurs

• Ask bystanders to leave area

• For fever convulsions, sponge body with lukewarm water

• Keep track of how long seizure lasts


Emergency Care for Seizures(continued)

• Place unresponsive patient in recovery position

• Be reassuring after seizure

• If recovering patient is agitated or angry, stay back, but prevent any dangers


• Report your assessment to arriving EMS


Seizure in the Water or Confined Space

• Do not try to remove person from water

- Support person with head tilted to keep water out of mouth

• For person in airplane, motor vehicle or other confined area

- Lie person on side across seats

- Cushion head


Diabetic Emergencies


Diabetic Emergencies

• Blood glucose levels not regulated by body

• Insulin needed for cells to use glucose

• When insulin level too low, glucose level too high

• Over 18 million people in United States have diabetes

• 5 million not diagnosed


Diabetic Emergencies (continued)

Hypoglycemia

• Person may take too much insulin

• Person doesn’t eat enough or right foods

• Uses blood sugar too fast

- Exercise

- Emotional stress

Hyperglycemia

• Person may take too little insulin

• Person eats too much or wrong foods

• Does not use blood sugar with activity


Assessing Diabetic Emergencies

• Perform standard assessment

• During SAMPLE history ask about diabetes

• Look for medical alert identification


Signs and Symptomsof Hypoglycemia

• Rapidly occurring changes in mental status

• Sudden dizziness, shaking, tremors, bizarre behavior or mood change (even combativeness)

• Headache, confusion, difficulty paying attention

• May appear to be intoxicated (slurred words, staggering gait, confusion, etc.)

• Generalized feeling of sickness

• Rapid, full pulse


Signs and Symptomsof Hypoglycemia (continued)

• Rapid, shallow respirations

• Pale or ashen skin, sweating

• Hunger

• Clumsy, jerky movements

• Possible seizure or coma may develop late


Signs and Symptomsof Hyperglycemia

• Gradually occurring changes in mental status

• Weak, rapid pulse

• Increased urination, appetite, thirst

• Drowsiness, weakness

• Dehydration, dry mouth, thirst

• Shortness of breath, deep rapid breathing


Signs and Symptomsof Hyperglycemia (continued)

• Breath that smells fruity

• Skin is pale, warm and dry

• Nausea, vomiting

• Eventual unresponsiveness


Emergency Care for Diabetic Emergencies


• Talk to patient and confirm he or she has diabetes

• Look for medical alert identification

• Provide care for hypoglycemia or hyperglycemia


Emergency Carefor Hypoglycemia

• Ensure patient can maintain open airway

• Follow local protocol to give patient sugar

• Give more sugar after 15 minutes if patient still feels ill

• Call for help if patient becomes unresponsive or continues to have significant signs and symptoms


Emergency Care for Hyperglycemia

• In the early stage, difficult to tell if high or low blood sugar:

- Give sugar as for hypoglycemia

- If patient does not improve within 15 minutes, or patient’s signs and symptoms become worse, call for help

• In the later stage, high blood sugar is a medical emergency:

- Call for help immediately

- Put an unresponsive patient in recovery position and monitor breathing and vital signs


Glucose Paste for Hypoglycemia

If trained to use oral glucose paste or gel:

• Squeeze small amount onto tongue depressor

• Spread between cheek and gums

• Administer small doses until all used


Severe Allergic Reactions


Severe Allergic Reactions

• Anaphylaxis is a severe allergic reaction

• Airway may swell, making breathing difficult or impossible

• Signs and symptoms may begin within seconds

• The more quickly it occurs, the more serious


Causes of Anaphylaxis

Common allergens:

• Certain drugs

• Certain foods

• Insect stings and bites


Signs and Symptomsof Anaphylaxis

• Early signs and symptoms:

- Skin flushing, itching or burning, rash

- Swelling around eyes, mouth, tongue

- Sneezing, watery eyes and nose

- Coughing or a feeling of a tickle or lump in the throat that persists

- Nausea, vomiting


Signs and Symptoms of Anaphylaxis (continued)

• Developing signs and symptoms:

- Anxiety, agitation

- Feel throat is closing, chest is tight

- Rapid, weak pulse

- Low blood pressure

- Difficulty breathing

- Severe respiratory distress

- Coughing, wheezing or hoarseness


Signs and Symptomsof Anaphylaxis (continued)

• Developing signs and symptoms:

- Altered mental status

- Severe headache

- Weakness or dizziness

- Pale or ashen skin or cyanosis


Emergency Care for Anaphylaxis

• Remove allergen if possible



• Help into easiest breathing position

• Monitor patient’s vital signs

• Put breathing, unresponsive patient in recovery position


Emergency EpinephrineAuto-Injector

• May be carried by people with severe allergies

• Medication temporarily controls anaphylactic reaction

• Ask patient if he/she has an auto-injector

• Help patient open and use kit

• Follow local protocol to administer yourself


Using an EpiPen

•Remove from its case and remove cap

• Firmly push tip firmly against outer thigh

•Hold tip in place 10 seconds

• Properly dispose of injector

• Effects last 15-20 minutes


Abdominal and Gastrointestinal Disorders


Severe Abdominal Pain or Gastrointestinal Bleeding

• May result from medical condition

• Not necessary to determine cause


Assessing Severe Abdominal Pain or Gastrointestinal Bleeding

• Normal assessment finding is soft and non-tender abdomen

• Abnormal findings include:

- Nausea, vomiting, diarrhea

- Blood in vomit (color is red or looks like coffee grounds)

- Blood in stool (color is red or black)

- Pain

- Signs of shock

- Fever


When Emergency Care Is Needed for Severe Abdominal Pain in Adults

• Sudden, severe, intolerable pain or pain that causes awakening from sleep

• Pain that begins in central abdomen and later moves to lower right

• Pain accompanied by fever, sweating, black or bloody stool, or blood in urine

• Pain in pregnancy or accompanying abnormal vaginal bleeding

• Pain accompanied by dry mouth, dizziness on standing or decreased urination

• Pain accompanied by difficulty breathing

• Pain accompanied by vomiting blood or a greenish-brown fluid


When Emergency Care Is Needed for Severe Abdominal Pain in Children

• Pain that occurs suddenly, stops and then returns without warning

• Pain accompanied by red or purple, jelly-like stool; or with blood or mucus in the stool

• Pain accompanied by greenish-brown vomit

• Pain with a swollen abdomen that feels hard

• Pain with a hard lump in the lower abdomen or groin area


Emergency Care for Severe Abdominal Pain or GI Bleeding



• Put patient in position of comfort

• Be prepared for vomiting

• Don’t give food or drink


Developmental Considerations

• In pediatric patients vomiting or diarrhea more easily causes shock

• In geriatric patients abdominal pain may be symptom of heart attack


Dialysis Patients

• Hemodialysis eliminates water and wastes from body when kidneys fail

• Dialysis machine is connected to patient

• Take care not to disturb equipment or connection with patient

• Do not use an arm with a dialysis fistula or shunt to obtain blood pressure


Emergencies More Commonin Hemodialysis Patients

• Low blood pressure

• Nausea and vomiting

• Irregular pulse

• Bleeding from access site

• Difficulty breathing

• Cardiac arrest


Care for a Dialysis Emergency


• Follow local protocol for oxygen administration

• Control bleeding from shunt if present

• Position patient:

- Flat if there are signs of shock

- Upright in a position of comfort if patient has difficulty breathing

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MEDICAL CONDITIONS