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258 Cards in this Set
- Front
- Back
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Acute Abdomen
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sudden onset of abdominal pain
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Peritoneum
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thin membrane lining the entire abdomen
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Peritonitis
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irritation of the peritoneum caused by illness or injury
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Referred pain (2)
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- perceived pain at a distant point of the body caused by irritation of the visceral peritoneum
- ruptured spleen may refer to L shoulder |
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Radiating pain (2)
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- pain that travels away from the point of origin
- appendicitis may start at the umbilicus and radiate to the lower right quadrant |
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Colic (2)
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- severe, intermittent cramping pain
- patient attempting to pass kidney or gall stones |
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Gi
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Gastrointestinal
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Gastrointestinal (1)
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path food follows from ingestion to excretion
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GU
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Genitourinary
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Genitourinary (1)
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- all organs involved with reproduction and urine formation and excretion
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Anorexia
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lack of desire to eat
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Emesis
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vomitus
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Cecum
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valve near the appendix, separates the small and large intestine
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Hematemesis (2)
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- blood in vomit
- usually has coffee ground like appearance |
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Hematuria (1)
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blood in urine
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Rebound tenderness
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pain that is felt most when pressure is removed or released after palpation
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Melena (2)
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- black tarry stool
- usually caused by blood that has run all or most of the course of the GI tract |
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Hematochezia (1)
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red runny stool
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9 GI Conditions (9)
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- aneurysm
- appendicitis - evisceration - hepatitis - intestinal obstruction - ruptured spleen - peptic ulcer - cholecystitis - diverticulitis |
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3 GU Conditions (3)
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- ectopic pregnancy
- gynaecological disorders (PID, Menstrual) - urinary tract infection |
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AAA
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Abdominal Aortic Aneurysm
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Abdominal Aortic Aneurysm: pathophysiology (2)
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- the descending aorta ruptures due to a weakening in the aortic wall, usually due to atherosclerosis or congenital precondition
- blood leaking from the aorta pools around the peritoneum |
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Abdominal Aortic Aneurysm: signs / symptoms (7)
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- hypotension
- quiet patient guarding the abdomen - rapid and shallow breathing - tense, often distended abdomen - tachycardia - possible history of high blood pressure - possible symptoms mimicking an MI |
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MI
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myocardium infarction
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Abdominal Aortic Aneurysm: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Appendicitis: pathophysiology (3)
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- the opening between the lumen of the appendix and cecum becomes obstructed by fecal material causing the inflammation and the swelling of the vermiform appendix
- a viral or bacteria infection causing inflammation and swelling of the vermiform appendix - if this persists long enough, the organ becomes gangrenous and ruptures in the abdominal cavity |
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Appendicitis: signs / symptoms (7)
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- initially: diffuse periumbilical pain
- later: intense RLQ with rebound tenderness - abdominal pain / cramping - N/V - chills - low grade fever - anorexia |
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Appendicitis: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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What happens to pain when the appendix burst inside the abdominal cavity, and what comes into focus then? (2)
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pain will greatly decrease, pain from the peritonitis comes into focus
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Hepatitis: pathophysiology (1)
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- inflammation or swelling of the liver due to: alcohol or drug use, toxic bacterial/fungal/parasitic/viral infections, autoimmune disorders
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Hepatitis: signs / symptoms (7)
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- intermitten RUQ pain
- jaundice - sudden onset malaise - weakness - anorexia - N/V - dark coloured urine |
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Hepatitis: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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When dealing with patients suspect of having hepatitis, ensure… (1)
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proper PPE (personal protective equipment)
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Intestinal Obstruction: pathophysiology (1)
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- an occlusive of the intestinal lumen resulting in blockage of the normal flow of intestinal continents
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Possible causes of intestinal obstruction (5)
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- adhesions (organs sticking together or to peritoneum)
- hernias (protrusions of a bowel through the peritoneum) - fecal impaction (still that cannot be passed) - polyps (small tissue growths, possibly cancerous) - tumors (large tissue growths, possibly cancerous) |
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Intestinal obstruction: signs / symptoms (5)
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- N/V
- abdominal pain - constipation - abdominal distention - speed of onset varies with location (small vs. large bowel) |
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Intestinal obstruction: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Peptic Ulcer: pathophysiology (2)
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- the interaction of acidic gastric juices, enzymes and the mucosal barrier of the stomach cause an ulcer (small hole) to develop in the stomach lining or duodenum
- left untreated perforation and hemorrhage may occur |
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Peptic Ulcer: signs / symptoms (7)
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- patient self medicates with antacids
- burning in epigastric or LUQ region - pain develops before meals or during stressful periods - sudden onset pain - pain relieved by food intake, antacids or vomiting - hematemesis - melena stool |
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Peptic Ulcer: treatment (5)
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- high O2
- AMPLE - PQRSTA - vital signs - transport |
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Patients with ulcers are often aware or unaware of them? (1)
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aware
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Cholecystitis: pathophysiology (2)
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- the inflammation or swelling of the gallbladder, usually associated with the presence of gallstones
- the gallstones occasionally completely obstruct the cystic duct (leading to the duodenum) causing a rapid pressure increase within the gallbladder, and pain |
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Cholecystitis: signs / symptoms (7)
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- RUQ pain radiating to R shoulder and / or scapula
- low grade fever - N/V - RUQ tenderness to palpation - shaking chills - jaundice - family history |
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Cholecystitis: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Diverticulitis: pathophysiology (2)
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- a diverticulum is a sac or pouch that develops (usually with age) in the wall of the colon
- diverticulitis is when one of these pouches becomes obstructed with fecal matter |
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Diverticulitis: signs / symptoms (5)
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- LLQ/ RLQ pain
- alternating bowel habits (diarrhea / constipation) - fever - bright red rectal bleeding - no pain |
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Diverticulitis: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Ectopic Pregnancy: pathophysiology (2)
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- a fertilized egg comes to lie in an area outside of the uterus, usually a fallopian tube
- at 6 to 8 weeks of development, the tube is too small to hold the fetus, the tube ruptures producing massive internal hemorrhaging and pain |
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Ectopic Pregnancy: signs / symptoms (5)
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- unilateral RLQ or LLQ pain
- possibility of being pregnant - hypovolemia - N/V/ - possible vaginal bleeding |
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Ectopic Pregnancy: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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PID
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Pelvic Inflammatory Disease
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Pelvic Inflammatory Disease: pathophysiology (1)
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an infection of the fallopian tubes surrounding the pelvis
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Pelvic Inflammatory Disease: signs / symptoms (2)
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- lower abdominal pain with a high fever
- peritonitis |
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Pelvic Inflammatory Disease: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Menstrual Cramps: pathophysiology (2)
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- mittelschmerz: intense pain caused by the release of an egg from the ovary, characteristically in the middle of the menstrual cycle
- menstrual cramps: painful cramps at the time of their menstrual period |
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Menstrual Cramps: signs / symptoms (2)
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- abdominal pain / tenderness
- mild to severe menstrual flow |
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Menstrual Cramps: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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UTI
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Urinary Tract Infection
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Urinary Tract Infection: pathophysiology (1)
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- an infection of the upper or lower urinary tract
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Urinary Tract Infection: signs / symptoms (6)
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- burning on urination
- urinary frequency - hematuria - abdominal pain - fever / chills - malaise |
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Urinary Tract Infection: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Males complaining of burning while urinating most commonly result from …………, rather than a true UTI
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venereal disease
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Generalized GI/GU Assessment & Treatment (6)
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- initiate high flow oxygen appropriately (after determining rate of respirations)
- position the patient supine with legs drawn up and knees flexed - perform a GI/GU special assessment - give nothing by mouth - anticipate the development of hypovolemic shock - consider saving any emesis, especially in the case of food poisoning or drug overdose |
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Diabetes Mellitus (2)
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- metabolic disorder in which the body cannot metabolize glucose
- usually due to a lack of appropriate insulin production |
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Glucose (2)
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- one of the basic sugars in the body
- along with oxygen, it is primary fuel for cellular metabolism |
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Insulin (3)
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- hormone produced by the pancreas (beta cells)
- enables glucose to enter the cells - without insulin, cells starve even if there is plenty of serum glucose available |
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Hormone (2)
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- chemical substance produced by a gland
- has special regulatory effects on other body organs and tissues |
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Type l Diabetes (5)
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- insulin dependent diabetes (IDDM)
- patient does not produce any appreciable insulin - insulin injected daily or multiple times a day - onset usually in childhood - often referred to as "juvenile diabetes" or "easily onset diabetes" |
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IDDM
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insulin dependent diabetes
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Type ll Diabetes (5)
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- Non insulin dependent diabetes
- patient produces inadequate amounts of insulin relative to sugar intake - disease may be controlled by diet or oral hypoglycemics - also referred to as "adult diabetes" or "late onset diabetes" - make up a greater percentage of the diabetic population than IDDMs |
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NIDDM
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Non Insulin Dependent Diabetes
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Role of Glucose and Insulin (3)
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- glucose is the major source of energy for the body
- constant supply of glucose needed for the brain - insulin acts as the key for glucose to enter cells |
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What are the two diabetic emergencies? (2)
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- hypoglycemia
- hyperglycemia |
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What are 8 complications of Diabetes (8)
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- heart disease
- visual disturbances - renal failure - CVAs - Ulcers - infections of the feet and toes due to peripheral vascular disease - seizures - altered mental status |
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3 Diabetic Conditions are… (3)
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- hypoglycemia (BGL less than 3.8 mmol)
- hyperglycemia (BGL more than 7mmol) - gestational diabetes |
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Hyperglycemia: pathophysiology (5)
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- lack of insulin causes glucose to build-up in blood in extreme high levels
- kidneys excrete glucose via urine, this leads to a large amount of water being excreted - without glucose, body uses fat for fuel, causing inefficient metabolism - ketones are formed, producing diabetic ketoacidosis, a life threatening emergency - onset takes days to weeks, not an immediate onset |
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Hyperglycemia: signs / symptoms (14)
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- increased thirst
- increased frequency of urination - flushed - warm - dry skin - N/V - abdominal pain - kussmaul respirations (deep, rapid breathing) - unconsciousness or altered LOC - dehydration - "fruity" breath door - rapid, weak pulse - normal or slightly low blood pressure - varying degrees of unresponsiveness |
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Hyperglycemia: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Hyperglycemia is common in who…. ? (2)
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- elderly people
- those who did not know they were diabetic |
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Hypoglycemia: pathophysiology (1)
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- the body's level of glucose available in the bloodstream are too low to adequately supply all demand
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Hypoglycemia: signs / symptoms (14)
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- sudden mentation changes
- appearance and attitude of being drunk - violence or aggression - normal or rapid - pale, moist skin - sweating - dizziness, headache - rapid pulse - normal to low blood pressure - may mimic a CVA - altered mental status - hunger - fainting, seizure or coma - weakness on one side of the body |
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Hypoglycemia: treatment (6)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport - consider administering oral glucose |
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Never give oral glucose to…. (1)
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an unconscious patient
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Gestational Diabetes: pathophysiology (1)
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- some women have encountered a temporary change in their own body chemistry which has led to a difficulty in maintaining a balance in blood sugar
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Generalized Diabetic Assessment & Treatment (3)
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- initiate high flow oxygen appropriately (after determining rate of respirations)
- consider administration of oral glucose - consider the following during your AMPLE Hx: (do you take insulin or pills to manage blood sugar? have you taking you dosage toady? have you changed insulin type? have you eaten normally today, what, when? have you had any illness, more activity than normal, stress today?) |
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Blood Glucose Monitors (3)
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- test strips "normal range" is 3.8 - 7mmol/l
- certain patients will have BGL readings outside of the "normal" range without any clinical manifestations - known as a glucometer |
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What equipment is required with a BGL Monitor? (4)
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- alcohol swab to clean site
- 2x2 gauze to wipe alcohol away & to help stop bleeding - bandage to dress site after (band aid) - lancet to pierce the skin |
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Steps to using a blood glucose monitor? (7)
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- massage finger to bring blood to surface
- clean site with alcohol swabs by moving in a circular motion from inside out - hold finger firmly & gently pierce the finger with the lancet - wipe away the first drop of blood & massage finger for more blood - place a full drop of blood over the reagent area & await the reading (up to 30 seconds, depending on monitor) - cover site with gauze to stop bleeding, then dress with bandage - document reading obtained, including time taken |
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Oral Glucose names are… (2)
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- glutose
- insta Glucose |
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One tube of Oral Glucose is …… , actual dose given is …...
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31g , 25g
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What symptoms suggest poorly controlled or uncontrolled diabetes (3)
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- non healing
- blindness - renal failure |
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Allergic Reaction (1)
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exaggerated immune response to any substance
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Histamine and leukotrienes (1)
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chemicals released by the immune system causing inflammation and swelling
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Allergen (1)
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the substance that causes the allergic reaction
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What are the 5 generic classifications of allergens (5)
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- insect bites, stings and animals
- medications - plants - food - chemicals |
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Subsequent exposure to an allergen does what usually? (2)
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- increases strength of reaction
- speed of reaction |
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What is an allergic reaction caused by? (1)
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the body's own immune system over-responding to an allergen (includes release leukotrienes and histamines, ranges from minor to severe)
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9 immune / bite / stings conditions (9)
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- allergic reactions
- anaphylactic reaction - insect stings - spider bites - snake bites - scorpion stings - tick bites - dog / bat bites - coelenterates |
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Mild Allergic Reaction: pathophysiology (1)
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an allergen is introduce to the body causing the release if histamines
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Mild Allergic Reaction: signs / symptoms (2)
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- localized urticaria (hives)
- wheals (raised swollen area) - pustules (raised bumps) - patient tells you they were bitten/stung - exposure to the allergen, directly or indirectly |
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Mild Allergic Reaction: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Anaphylaxis: pathophysiology (2)
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- an extreme allergic/immune react to an allergen that involves multiple body systems that is life threatening
- 5 % of all people are allergic to bee, hornet, yellow jacket, and wasp stings |
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Anaphylaxis: signs / symptoms * hallmark (3)
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- swollen tongue/lips
- wheezing - systemic urticaria |
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Anaphylaxis signs and symptoms (skin 5, respiratory 4, cardiovascular 3, GI 3, nervous 3)
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skin
- flushing - itching - hives - swelling - cyanosis Respiratory - SOB - wheezing, stridor - laryngeal edema / spasm - bronchospasm Cardiovascular - vasodilation - increased HR - decreased BP GI - N/V - abdominal cramping - diarrhea Nervous - dizziness - headache - convulsions |
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Anaphylaxis: treatment (6)
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- high O2
- AMPLE - OPQRSTA - vital signs - transportation - consider an Epi-pen administration |
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How long does and Epi-pen last after an injection? (1)
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20 minutes (anaphylactic reactions may last longer)
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Histamine released in a reaction causes… (3)
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- bronchoconstriction
- vasodilation - increase membrane permeability |
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Epinephrine causes … (3)
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- bronchodilation (B2 stimulation)
- vasoconstriction (a stimulation) - decrease membrane permeability (inhibiting histamine release) |
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Insect Stings: pathophysiology (1)
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- bee, wasp, yellow jacket or hornet becomes upset at the patient and proceeds to sting them, possibly repeatedly
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Insect Stings: signs / symptoms (5)
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- bee: stinger still in place
- multiple bite/sting sites - dramatic swelling - itchiness - pain - possible anaphylactic reaction |
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Insect Stings: treatment (5)
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- remove stinger (with something with an edge - credit card)
- ice to numb pain/itchiness - remove jewellery - clean area - high O2 - AMPLE - OPQRSTA - vital signs - transport |
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How long can a stinger inject venom into a body once it's separated from it's body? (1)
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20 minutes
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What are two spider bites to be worried about? (2)
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- black widow
- brown recluse |
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Black Widow (4)
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- found in all states except Alaska
- venom poisonous to nerve tissue - requires patient transport as soon as possible - produces a neurotoxin (inhibits / depresses respiration) |
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Brown Recluse (4)
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- mostly in Southern and Central US
- venom causes local tissue damage - requires patient transport as soon as possible - produces a cytotoxin (results in necrotizing fascitis) |
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Spider Bites: pathophysiology (1)
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patient has bothered a black widow or a brown recluse spider and was bitten
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Spider Bites: signs / symptoms (7)
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- localized pain
- N/V Black Widow: - agonizing muscle cramps - tightness in chest - difficulty breathing Brown Recluse: - swollen and tender bite area - ulceration of bitten area over time |
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Spider Bites: treatments Black widow & Brown Recluse (6 each)
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Black Widow:
- high O2 - AMPLE - OPQRSTA - vital signs - transport - venom runs its course within 48 hours Brown Recluse: - high O2 - AMPLE - OPQRSTA - vital signs - transport - bite site requires medical attention |
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Snake Bites: Pit Viper (4)
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- rattlesnakes, copperheads, and cotton mouths
- stores poison in pits behind nostrils - inject poison to victim through fangs - produce a digestive enzyme (not a paralytic or neurotoxin) |
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Snake Bites: pathophysiology (1)
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patient has bothered a snake and been bitten
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Snake Bites: signs / symptoms (6)
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- characteristic puncture marks about 1/2 an inch apart
- N/V - weakness / fainting / shock - psychosomatic complaints - sweating - pain |
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Snake Bites: treatment (7)
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- clean the area with soap and water (if available)
- remove jewellery - DO NOT apply ice - splint the extremity - circle and timestamp the swollen area - high O2 - AMPLE - OPQRSTA - vital signs - transport - if the snake has been killed bring it to the hospital |
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Tick Bites (3)
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- ticks attached themselves to the skin
- bite is not painful, but potential exposure to infecting organisms is dangerous - ticks commonly carry Rocky Mountain spotted fever or Lyme disease |
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Tick Bites: pathophysiology (2)
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- tick bites themselves are harmless
- ticks may be carriers of diseases, transmission takes at least 12 hours |
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Tick Bites: signs / symptoms (2)
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- tick on skin
- bulls eye pattern where bitten |
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Tick Bites: treatment (4)
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- remove tick using tweezers, grasp head (or as close to) and pull straight out
- save tick for hospital analysis - clean area (with soap and water if available) - High O2 - AMPLE - OPQRSTA - vital signs |
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Coelenterates are also known as… (1)
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jelly fish!
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Coelenterate: pathophysiology (1)
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- introduction of stinging cells from the coelenterate to the patient via direct contact
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Coelenterate: signs / symptoms (5)
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- painful, reddis lesions
- headache - dizziness - muscle cramps - fainting |
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Coelenterate: treatment (3)
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- inactive stinging cell using alcohol
- scrape off remaining cells (with something with an edge) - high O2 - AMPLE - OPQRSTA - vital signs - transport |
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Using an Auto - Injector (4)
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- receive order from medical direction
- follow BSI precautions - make sure the prescription is for the patient - make sure the medication is not discoloured or expired |
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Administering an Auto Injector (7)
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- remove the safety cap
- place tip of the injector against the lateral side of the patients thigh - push the injector firmly and hold until all of the medication is injected (10seconds) - remove the injector, place in sharps box - record the time and dose - reassess and record vitals every 5 minutes - expect side-effects, tachycardia, anxiety... |
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Poison (1)
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- any substance whose chemical action can damage body structures or impair body functions
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Substance Abuse (1)
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the knowing misuse of any substance to produce a desired effect
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Tolerance (1)
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the psychological or physical need to increase concentration of a substance to reach similar levels of effect (tolerance can be built up)
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Addiction (1)
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overwhelming desire or need to continue using an agent
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5 methods of administering poisons (5)
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- ingest
- inject - inhale - absorb - radiate |
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Ingested Poison: pathophysiology (1)
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poison is introduced into the system via the GI tract (mouth)
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Ingested Poison: signs / symptoms (2)
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- burns to lips and mouth (assuming a corrosive poison)
- varies depending upon type of poison/chemical ingested |
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Ingested Poison: treatment (6)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport - be alert for vomiting and airway compromise if LOC deteriorates |
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Inhaled Poison: pathophysiology (1)
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poison is introduced into the system via the respiratory system (lungs)
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Inhaled Poison: signs / symptoms (3)
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- varies depending on the type of poison/ chemical inhaled
- coughing / wheezing - wheezing or stridor on auscultation |
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Inhaled Poison: treatment (7)
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- move to fresh air immediately (ensure personally safety)
- high flow O2 - AMPLE - OPQRSTA - vital signs - transport - ensure fresh air flow in pt compartment of the ambulance |
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Injected Poison: pathophysiology (3)
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- insect sting
- drug overdose - administration |
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Injected Poison: signs / symptoms (3)
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- puncture or track marks
- altered LOC - depressed respirations (if it is a narcotic, be prepared to support their respirations) |
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Inject Poison: treatment (6)
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- high flow O2
- AMPLE - OPQRSTA - vital signs - transport - attempt to identify poison |
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Once a poison has been injected it is possible to remove or dilute. T/F
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False
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What are 5 examples of injected poison. (5)
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- bee sting
- wasp sting - snake bite - ant bite - drug injection |
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Absorbed Poison: pathophysiology (1)
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- poison is introduced into the system via absorption through the: eyes, mucous membranes, skin
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Absorbed Poison: signs / symptoms (3)
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- varies depending on poison/ chemical exposure
- burning / itching - development of a rash |
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Absorbed Poison: treatment (5)
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- high flow O2
- AMPLE - OPQRSTA - vital signs - transport |
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If a substance (poison) is in a patients eyes, they should be …. (1)
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irrigated for at least 20 minutes
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Two examples of absorbed poison (2)
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- poison oak
- poison ivy |
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Poison Centers information (5)
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- staff have information on most substances
- center has information on emergency treatments and antidotes - all hospital and prehospital care staff follow Poison Center's orders as long as the directions are in their scope - the Poison centre may request a call back for follow up on the patient's condition and treatment efficacy - you can contact the Poinson Center via 9-1-1 |
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If you suspect a patient is poisoned, what are 8 questions you should ask them? (8)
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- what substance did you take?
- what did you take with the substance? - when did you take it or (become exposed to it)? - how much did you ingest? - what actions have been taken (ingest anything or vomit)? - how much do you weigh? - have you done this before? - contact the poison center |
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Why must you take suspicious materials, containers and/or vomitus to the hospital (5)
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- name and concentration of the drug
- specific ingredients - number of pills originally in bottle - name of manufacturer - dose that was prescribed |
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MSDS
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Material Safety Data Sheet
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What do MSDS's provide? (2)
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- properties of materials
- emergency measures to be taken in the event of exposure to the product |
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Sedativ Hypnotic: pathophysiology (1)
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- cause central nervous system (CNS) depression (may cause respiratory depression and/or arrest
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Sedativ Hypnotic: signs / symptoms (4)
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- decreased / depressed LOC
- possible cardiac arrest - N/V - memory loss |
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Sedativ Hypnotic: treatment (3)
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- ensure patent airway (anticipate vomiting)
- ventilatory assistance - high flow O2 - AMPLE - OPQRSTA - vital signs - transport |
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What is the most commonly abused drug in the USA, and most likely Canada? (1)
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alcohol
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Patient's coming down off of alcohol may experience…. (1)
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Delirium Tremens (DT's)
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Delirium Tremens: pathophysiology (1)
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- the body begins an adjustment period when the patient discontinues their regimen of alcohol intoxication after a prolonged period or excessive drinking
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Delirium Tremens: signs / symptoms (7)
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- agitation and restlessness
- fever - sweating - confusion and/or disorientation - delusions and/or hallucinations - seizures - N/V |
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Delirium Tremens: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Symptoms of Delirium tremens may2 develop between …. to …. days after the patient stops drinking. (2)
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1 to 7
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Barbiturates (3)
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- produce a wide spectrum of central nervous system depression, from mild sedation to coma, and have been used as sedatives, hypnotics, anesthetics, and anticonvulsants
- one cam rapidly develop tolerances, physical dependance, and psychological dependance. - with tolerances, the margin between effective dose and the lethal dose becomes very narrow |
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Benxodiazepines (2)
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- are class CNS depressant drugs with hypnotic, anticonvulsant, amnesia and muscle relaxant properties
- they have replaced barbiturates because they have a lower abuse potential and relatively lower adverse reactions |
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Opioids / Narcotics: pathophysiology (1)
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- the abused ingredient in an opioid blocks the pain receptors in the brain and causes severe depression of the respiratory system and alteration of LOC
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Opioids / Narcotics: signs / symptoms (6)
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- pinpoint pupils
- decreased respirations - decreased ventilatory volume - depressed to absent respirations - altered LOC - cyanotic |
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Opioids / Narcotics: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Definitive treatment for opioids / narcotics comes with …. , who will administer ……… via IV will reverse / delay the opioid high. (2)
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ALS
nalaxone (Narcan) |
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Opioids / narcotic examples (13) and which of those must EMR's know?
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- Butorphanol (Stadol)
- Codeine - Fentanyl ("china white") - Heroin - Hydrocodone (Hycodan) - Hydromorphone (Dilaudid) - Meperidine (Demerol) - Methadone (Dolophine) - Morphine - MS Contin * - Oxycodone * (Percodan) - Pentazocine (Talwin) - Propoxyphene (Darvon) |
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Abused Inhalants: pathophysiology (2)
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- similar to sedative hypnotics
- hydrocarbons in these inhalants cause the patient's heart to be hypersensitive to adrenaline, causing instant death or arrhythmias |
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Abused Inhalants: signs / symptoms (3)
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- atlered LOC
- seizures - cardiac arrest / arrhythmias |
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Abused Inhalants: treatment (6)
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- move patient gently, never let them walk
- high flow O2 - AMPLE - OPQRSTA - vital signs - transport |
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Abused Inhalants list (10)
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- acetone
- toluene - xylene - hexane - glues - cleaning compounds - paint thinners - gasoline freon |
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Sympathomimetics: pathophysiology (1)
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- stimulation of the central nervous system (CNS)
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Sympathomimetics: signs / symptoms (10)
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- dilated pupils
- unusually high energy or attentiveness levels - hypertension - tachycardia - fear / paranoia - delusions - seizures - cardiac arrhythmias / arrest - N/V |
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Sympathomimetics: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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What drug is more addicting than heroine or nicotine? (1)
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cocaine
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Sympathomimetics examples are (4)
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- caffeine
- ecstasy / Eve - cocaine (crack, meth, ice) - ephedrine |
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Hallucinogens: pathophysiology (2)
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- these alter the patient's sensory perceptions
- some have sympathomimetic properties |
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Hallucinogens: signs / symptoms (4)
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- visual hallucinations
- hypertensive - tachycardia - anxious / paranoid |
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Hallucinogens: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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When dealing with a patient on hallucinogens, never…. (1)
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leave them alone, they are very unpredictable
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8 examples of hallucinogens (8)
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- lysergic Acid Diethylamide (LSD)
- Phencyclidine (PCP) "angel dust" - bufotenine - dimethyltryptamine (DMT) - marijuana - mescaline - nutmeg - psilocybin "magic shrooms" |
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LSD
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lysergic Acid diethyl amide
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PCP
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phencyclidine
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DMT
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dimethyl tryptamine
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Marijuana: pathophysiology (1)
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affects the central nervous system, produces euphoria, relaxation and drowsiness
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Marijuana: signs / symptoms (5)
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- impaired motivation
- hunger "munchies" - tachycardia - paranoia - hallucinations |
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Marijuana: treatment (1)
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transport is rarely needed
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Marijuana can be use as a ….. (1)
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vehicle for other drugs (covered with PCP or crack)
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Anticholinergics: pathophysiology (2)
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- these drugs block the effects of the parasympathetic nervous system
- very similar to a sympathomimetic reaction, however different |
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Anticholinergics: signs / symptoms (5)
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- tachycardia
- hypertension - cardiac arrhythmias - seizures - "hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter" |
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Anticholinergics: treatment (5)
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- high flow O2
- AMPLE - OPQRSTA - vital signs - transport |
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Patients who are on anticholinergics have the capacity to go from normal to dead in a matter of …… minutes (1)
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30
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Anticholinergics examples (9)
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- diphenhydramine (Benadryl)
- jimson weed - Gravol - Haldol - fluoxetine (prozac) - sertraline (zoloft) - amitriptyline (elavil) - imipramine (tofranil) |
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Cholinergic Agents: pathophysiology (1)
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these drugs stimulate the parasympathetic nervous system
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Cholinergic Agents: signs / symptoms (6)
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- salvation
- lacrimation - urination - defecation - GI irritation - eye constriction/ emesis |
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SLUDGE
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S - salivation
L - lacrimation U - urination D - defecation G - GI irritation E - eye constriction / emesis |
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Lacrimation
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the secretion of tears especially when abnormal or excessive
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Emesis
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vomiting
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Cholinergic Agents: treatment (8)
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- avoid exposure: PPE
- treat as a HazMat incident - ensure patent airway - high O2 - AMPLE - OPQRSTA - vital signs - transport |
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This type of overdose is common in what, and give an example (1)
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- warfare
- nerve gases or lawn care chemicals |
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Cholinergic Agents 7 examples (10)
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- organophosphates & carbamates (4)
insecticides some wild mushrooms lawn care chemicals flea collars - chemical warfare agents (1) sarin and soman - others (5) aspirin acetaminophen other alcohols food poisoning - plant poisoning |
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Aspirin: signs / symptoms (5)
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- N/V
- hyperventilation - ringing in ears - confusion - seizures |
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What is the toxic dose of Aspirin? (1)
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150mg/kg (36 capsules for an 80kg pt)
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Aspirin: treatment (1)
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should be transported quickly to the hospital
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Acetaminophen notes (4)
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- overdosing is common
- generally not very toxic - symptoms may not appear until it is too late - liver failure may not be apparent for a full week and is the primary cause of death |
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What is the toxic dose for Acetaminophen? (1)
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150mg/kg (36 capsules for an 80kg pt)
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What is more toxic than ethyl alcohol? (The kind of alcohol made by fermentation of the sugar in grains; the fermentation is brought about by the enzymes in yeast.) (2)
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- methyl alcohol (methanol, wood spirit, wood alcohol)
- ethylene glycol ( A colorless syrupy alcohol used as an antifreeze in cooling and heating systems) |
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Caring for Food Poisoning (3)
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- try to obtain as much history as possible
- if two or more people have the same illness, bring some of the suspected food to the hospital - expect vomiting, explosive diarrhea: better to be driving than attending during these calls |
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Plant Poisoning: suspecting plant poisoning (4)
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- assess the patient's airway and vital signs
- notify poison control center - take the plant to the emergency department - provide prompt transport |
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What must you consider when dealing with elderly patient's who have overdosed on medications? (2)
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- patients may have been confused about medications and accidentally over medicated
- patient intentionally over medicated, suicide attempt |
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Behaviour (1)
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what can you see of a person's response to the environment and his or her actions
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Behavioural crisis (2)
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- any reaction to events that interferes with activities of daily living or that becomes unacceptable to the patient, family, or others
- a pattern, not an isolated incident |
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What are 11 behavioural conditions? (11)
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- aggression
- alzheimer's disease - anxiety - delirium - dementia - depression - suicidal emergencies - sexual assault -critical incident stress |
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Aggression: pathophysiology (1)
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numerous causes
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Aggression: signs / symptoms (5)
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- anxiety
- pacing - hostile verbal activity - hostile physical activity vs inanimate objects - hostile physical activity vs people |
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Aggression: treatment (3)
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- ensure personal safety (its okay to leave the scene if your safety is or becomes jeopardized)
- call for law enforcement - wait until it is safe to proceed |
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Dealing with aggression info (2)
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- dispatch may already have this houses location from previous history
- you may use your equipment as a shield (not a weapon) |
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ETOH
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Ingestion of ethyl alcohol
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Alcohol Intoxication: pathophysiology (2)
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- ingesting of ethyl alcohol
- quantity required varies according to individual tolerance / experience |
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Alcohol Intoxication: signs / symptoms (5)
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- possible door of ETOH on their breath
- slurred speech - staggered gait - decreased LOC - possible aggression / infatuation |
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Alcohol Intoxication: treatment (3)
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- high O2
- transport - ensure patent airway |
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Anxiety: pathophysiology (3)
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- panic attacks
- phobias - post traumatic stress syndrome |
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Anxiety: signs / symptoms (8)
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- fear / paranoia / envy
- tachycardia / arrhythmias - diaphoresis - trembling / shaking - dyspnea - hyperventilating - chest pain - dizziness or light headed |
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Anxiety: treatment (2)
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- high O2
- consider transport - search for underlining reason (trauma, stress, medical condition) |
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Delirium (2)
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- a rapid, temporary change in cognitive status due to an outside factor (i.e. alcohol)
- impaired ability to organize or sequence |
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Dementia (2)
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- a progressive change in mental status over a period of years
- results in impaired ability to organize or sequence |
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Delirium / Dementia: signs / symptoms (3)
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- forgetfulness (not oriented to person, place, time and/or event)
- medical alert - environment (long term care facility, hospital…) |
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Delirium / Dementia: treatment (3)
|
- reassure the patient
- treat other conditions first - DO NOT encourage their delusions |
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Patients who have dementia or delirium may have impaired ability to… (3)
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- communicate
- carry out motor activities, despite intact motor/sensory functions - recognize objects of stimuli |
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Depression: pathophysiology (4)
|
- chemical imbalance
- extended anxiety - financial hardship - loss of a loved one |
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Depression: signs / symptoms (11)
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- air of tearfulness
- profound sadness / melancholy - diminished interest in all/most activities - significant weight loss or gain (+ / - 5%) - insomnia / hypersomnia - feelings of worthlessness - excess of inappropriate guilt - diminished ability to think or concentrate - indecisiveness - recurrent thought of death - self mutilation / scarification |
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Depression: treatment (4)
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- high O2
- transport - maintain a calm, protective environment - avoid confusing the patient |
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Suicidal Ideation: pathophysiology (1)
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numerous causes, most common is depression
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Suicidal Ideation: main signs / symptoms (2)
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- patient specific plans related to death
- suicide attempt has been made or is in progress |
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Suicidal Ideation: warning signs (5)
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- does the patient have an air of tearfulness, sadness, deep despair, or hopelessness?
- does the patient avoid eye contact, speak slowly, or project a sense of vacancy? - does the patient seem unable to talk about the future? - is there any suggestion of suicide? - does the patient have a previous Hx |
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Suicidal Ideation: treatment (2)
|
- high O2
- transport |
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Who are more likely to use violent means to commit suicide? i.e. guns, hanging (1)
|
men
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Who are more likely to use passive means? i.e. pills, carbon monoxide (1)
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women
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Is law enforcement required at all attempted suicides? (1)
|
yes
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Critical Incident Stress: pathophysiology (2)
|
- exposure to an abnormal event
- this is your body's normal reaction to an abnormal situation i.e. kid call, unusual or gruesome death or injury |
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Critical Incident Stress: signs / symptoms (11)
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- sleep disturbances
- memory problems / poor concentration - flashback phenomena - depression - feeling numb - change in interpersonal interactions - increased smoking / caffeine / other drug intake - being overly vigilant of the environment - excessive humour or silence - unusual behaviour for the individual - crying spells |
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Critical Incident Stress: treatment (2)
|
- critical incident stress management
- professional mental help |
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Generalized Behavioural Emergency Assessment & Treatment (4)
|
- listen to your patient, do not talk or make them talk
- do not talk downy to or make fun of your patient - this is not the time for personal anecdotes - be compassionate and supporting |
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Generalized Behavioural Emergency Assessment & Treatment - Safety Guidelines (14)
|
- call back up early, you can always send them home
- be prepared to spend extra time - have a plan of action - identify yourself - be calm - be direct - assess the scene - stay with patient - encourage purposeful movement (to the ambulance) - express interest - do not get too close - avoid fighting - be honest and reassuring - do not judge |
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What are three major ares to consider when dealing with a patient with a behavioural issue? (3)
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- is the patient's central nervous system functioning properly
- are hallucinogens, other drugs, or alcohol a factor? - Are psychogenic circumstances, symptoms, or an illness involved? |
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Geriatric needs concerning behavioural emergencies (4)
|
- depression is a common mental status problem
- dementia is a progressive change in mental status over years - underlying conditions may cause altered behaviour - a smile and a touch can go a long way in alleviating fear, especially with the elderly |
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What can go a long way in alleviating fear? (2)
|
- smile and a touch
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Medicolegal Considerations (5)
|
- mental incapacity may take many forms
- once a patient has been determined to have impaired mental capacity, you must decide if care is needed - do not leave patient alone - obtain help from law enforcement as necessary - EMS may call law enforcement if a patient proves to be a danger to themselves or others (for transportation against their will) |
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Medicolegal Considerations: Consent (3)
|
- when a patient is not mentally competent, the law assumes that there is implied consent
- the matter is not always clear - cut with psychiatric emergencies - if you are not sure about the situation, request law enforcement assistance and consider medical control |
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Medicolegal Consideration: Limited Legal Authority (4)
|
- we have limited legal authority to require or force a patient to undergo care
- police may put a patient in protective custody to allow you to provide care - know your local laws and protocols - remember the Mental Health Act: form 10 |
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Medicolegal Consideration: Restraints (3)
|
- you cannot restrain a patient unless it is an emergency (danger to themselves or others)
- transport a disturbed patient without restraints if possible (sitting in jump seat or bench) - if you must restrain the patient, use only the minimum force required (law enforcement personnel should be involved) |
