Spofr Emt Ch. 19

Front 1

Series of neurologic circuits in the brain that control the functions of staying awake, paying attention, and sleeping

Back 1

Reticular activating system (RAS)

Front 2

3 substances required for brain tissue to function properly. Function of each substance.

Back 2

1) Oxygen--perfuse tissue

2) Glucose--nourish tissue

3) Water--hydrate tissue

Front 3

Broad spectrum of abnormal responsiveness, clarity of thought, or mood that ranges from unconsciousness to slight anxiety

Back 3

Altered mental status

Front 4

3 primary causes of altered mental status

Back 4

1) Structural damage to brain. ex) TBI

2) Chemical changes to brain ex) caused by exposure to toxin

3) Metabolic changes to brain ex) caused by lack of oxygen or glucose

Front 5

A form of sugar, the body's basic source of energy

Back 5

Glucose

Front 6

This is needed in order for the body to allow the large glucose molecules to pass into cells

Back 6

Insulin

Front 7

3 potential irregularities regarding insulin in diabetic patients

Back 7

1) Don't produce insulin

2) Don't produce enough insulin

3) Body has become resistant to the insulin produced

Front 8

A hormone produced by the pancreas or taken as a medication by many diabetics

Back 8

Insulin

Front 9

Specialized clusters of cells within the pancreas that secrete insulin

Back 9

Islets of Langerhans

Front 10

One of the few types of cells in the body that do not require insulin to move glucose from the bloodstream

Back 10

Brain cells

Front 11

Condition brought about by decreased insulin production or the inability of the body cells to use insulin properly

Back 11

Diabetes mellitus (also known as "sugar diabetes" and "diabetes")

Front 12

2 types of diabetes and definition of each

Back 12

1) TYPE 1: body does not produce enough insulin. If untreated, glucose will build up in blood and not enter cells. Patient is usually prescribed insulin.

2) TYPE 2: body doesn't use insulin properly. Body is unable to use existing insulin to move glucose out of the blood and into cells. Patient can often control condition with diet/oral antidiabetic meds

Front 13

Low blood sugar

Back 13

Hypoglycemia

Front 14

High blood sugar

Back 14

Hyperglycemia

Front 15

Most common medical emergency for a diabetic

Back 15

Hypoglycemia

Front 16

5 common causes of hypoglycemia

Back 16

1) Taking too much insulin which transfers glucose into cells too quickly

2) Reducing sugar intake by not eating

3) Overexercising or overexerting which uses sugars up faster than normal

4) Vomiting a meal which empties the stomach of sugar as well as other food

5) Increased metabolic rate (ex-fever/shivering)

Front 17

HYPOGLYCEMIA

1) Definition

2) Causes

3) Signs/Symptoms

4) Treatments

Back 17

1) Low blood sugar (less than 60 mg/dL

2) Excess insulin intake, not eating, overexercise/overexertion, vomiting a meal, increased metabolic rate

3) Rapid onset

Fight or flight response (pale/diaphoretic skin, tachycardia, tachypnea);

altered mental status (confusion, anxiety, combativeness, stupor, unconsciousness, seizures)

4) If patient is only mildly hypoglycemic and has mild level of mental alteration, give patient a glass of milk/sandwich/toast.

Oral glucose if patient has Hx of diabetes, has altered mental status, and is able to swallow.

If patient is not alert enough to swallow: artificial ventilations if needed, prep for CPR, transport in recovery position if ventilations aren't needed

Front 18

HYPERGLYCEMIA

1) Definition

2) Causes

3) Signs/Symptoms

4) Treatments

Back 18

1) High blood sugar (above 140 mg/dL)

2) Decrease in insulin due to: inability to produce insulin, forgotten/insufficient insulin injections, infection, stress, increasing dietary intake

3) Onset takes days to weeks;

Chronic intense thirst/hunger;

Increased urination (in attempt to purge sugar);

Nausea;

Dry mouth;

Abdominal pain;

Vomiting

In readings of 300+ (DKA)=profoundly altered mental status;

Severe shock due to dehydration (tachycardia, tachypnea, hypotension);

Fruity, acetone odor to breath

4) Oral glucose in any altered diabetic patient who is able to swallow and protect their own airway since hypo/hyper is often hard to distinguish in the field

Front 19

Condition that occurs as the result of high blood sugar and is characterized by dehydration, altered mental status, and shock

Back 19

Diabetic ketoacidosis (DKA)

Front 20

5 steps in patient assessment on a diabetic patient

Back 20

1) Ensure scene safety

2) Primary assessment--ID altered mental status

3) Secondary assessment

a) History of present episode (how it occurred, time of onset, duration, associated symptoms, MOI or other evidence of trauma, if there have been seizures/fever)

b) During SAMPLE, determine if Hx of diabetes exists.

Look for medical ID bracelet/wallet card/blood glucose meter, insulin, insulin pump.

Ask about last meal, last med dose, illnes

c) Check blood glucose reading

4) Determine if patient is alert enough to swallow

5) Baseline vitals and check for signs/symptoms of diabetic emergency

Front 21

These types of diabetics are at a higher risk for medical emergencies

Back 21

Children

(more active so they exhaust blood glucose levels quicker. Also less likely to be disciplined about eating correctly and on time)

Front 22

3 diabetes related health complications

Back 22

1) Heart disease

2) Blindness

3) Kidney failure

Front 23

Blood glucose meter values and meanings:

1) <50 mg/dL

2) <60 mg/dL

3) >140 mg/dL

4) >300 mg/dL

5) HIGH/HI

6) LOW

Back 23

1) Significant alterations in metal status that may include complete unresponsiveness

2) Hypoglycemia in a symptomatic diabetic

3) Hyperglycemia

4) Diabetic Ketoacidosis (DKA)

5) Extreme hyperglycemia (500+ mg/dL)

6) Extreme hypoglycemia (<15 mg/dL)

Front 24

New alternative to oral glucose that can be administered to diabetic patients who are unable to swallow

Back 24

Intranasal glucagon (EMT draws dose into syringe, attaches to atomizer, and sprays in nostril)

Front 25

3 indications for oral glucose

Back 25

1) History of diabetes

2) Altered mental status

3) Able to swallow

Front 26

3 contraindications for oral glucose

Back 26

1) Unconsciousness

2) Hasn't taken insulin for days

3) Unable to swallow

Front 27

Standard dose of oral glucose

Back 27

One tube

Front 28

7 examples of causes of altered mental status other than diabetic emergencies

Back 28

Hypoxia;

Sepsis;

Drug/alcohol use;

Brain injuries (traumatic and medical);

Metabolic abnormalities;

Brain tumors;

Infectious diseases such as meningitis

Front 29

3 typical differences between presentations of hypo- and hyper- glycemia

1) Onset

2) Skin

3) Breath

Back 29

1) Hyper = slow

Hypo = fast

2) Hyper = warm, red, dry

Hypo = cold, pale, diaphoretic

3) Hyper = acetone, fruity odor; deep/rapid resp.

Hypo = no unique odor

Front 30

Infection, especially a severe, systemwide response to infection

Back 30

Sepsis

Front 31

One of the most dangerous causes of altered mental status

Back 31

Sepsis

Front 32

SEPSIS

1) Definition

2) Causes

3) Signs/Symptoms

4) Treatment

Back 32

1) Severe systemwide response to infection

2) Localized reaction to infection spreading throughout the entire body rather than remaining confined to one location. Occurs more frequently in patients who have recently had surgery, who are immunocompromised,

3) Initial signs/symptoms are those of a localized infection.

Once the infection becomes systemic and severe:

altered mental status;

tachycardia;

Tachypnea;

Hypotension;

Hyperglycemia;

Decreased capillary refill time

4) Treat for shock;

Oxygen if hypoxic

Transport

Front 33

Sometimes the only finding an EMT will see indicating that a simple infection has progressed to severe sepsis

Back 33

Change in mental status

Front 34

Always suspect sepsis in patients who meet these 2 criteria

Back 34

1) Altered mental status

2) Signs of recent infection

Front 35

Most important step in the treatment of sepsis

Back 35

Recognition

Front 36

Sudden change in sensation, behavior, or movement

Back 36

Seizure

Front 37

A seizure is NOT a disease in itself, but rather a ___________________

Back 37

Sign of some underlying defect, injury, or disease

Front 38

2 types of seizures + definitions of each

Back 38

1) Partial: affects only 1 part or 1 side of brain (patient may or may not lose consciousness)

2) Generalized: affects both sides of brain (affects consciousness of patient)

Front 39

Generalized seizure in which the patient loses consciousness and has jerking movements of paired muscle groups.

Back 39

Tonic-clonic seizure

Front 40

Type of seizure that EMS is most likely to be called for

Back 40

Tonic-clonic

Front 41

3 phases of tonic-clonic seizures

Back 41

1) Tonic

2) Clonic

3) Postictal

Front 42

Postictal phase

Back 42

Period of time immediately following a tonic-clonic seizure in which the patient goes from full loss of consciousness to full mental status

Front 43

Characteristics of tonic phase of seizure

Back 43

Body becomes rigid, stiffening for no more than 30 seconds

Breathing may stop

Patient may bite tongue (rare)

Bowel and bladder control could be lost

Cyanosis

Front 44

Characteristics of clonic phase of seizure

Back 44

Body jerks about violently with paired muscle movements (usually for no more than 1-2 minutes--some can last 5 minutes)

Patient may foam at mouth and drool

Face and lips often become cyanotic

Front 45

Characteristics of postictal phase of seizure

Back 45

Begins when convulsions stop.

Patient may regain consciousness immediately and enter a state of drowsiness and confusion or may remain unconscious for several hours.

Headache is common.

Patient may become combative/violent

Confusion and repetitive questions are common

Front 46

Sensation experienced by a seizure patient right before the seizure, which might be a smell, sound, or general feeling

Back 46

Aura

Front 47

Most common cause of seizures in adults

Back 47

Failure to take prescribed antiseizure meds

Front 48

Most common cause of seizures in infants and children 6 months-3 years old

Back 48

High fever (febrile seizures)

Front 49

10 additional causes of seizures

Back 49

1) Stroke

2) Traumatic brain injury (TBI)

3) Toxins

4) Hypoglycemia

5) Brain tumor

6) Congenital brain defects

7) Infection

8) Metabolic

9) Idiopathic

Front 50

Occurring spontaneously with an unknown cause

Back 50

Idiopathic

Front 51

4 conditions which seizures may be seen with

Back 51

1) Epilepsy

2) Measles, mumps, other childhood diseases

3) Eclampsia

4) Heat stroke

Front 52

Medical condition which causes seizures.

Umbrella term used when person has multiple seizures from an unknown cause.

Can be born with the condition or develop it due to head injury or surgery

Back 52

Epilepsy

Front 53

4 important patient history questions to ask relating to seizures EMT does not witness

Back 53

1) What was patient doing before seizure started? Aura?

2) What did patient do during seizure? Was there loss of bladder/bowel control?

3) How long did seizure last?

4) What did the patient do after seizure? Asleep?--how long? Awake? Able to answer questions?

Front 54

SEIZURES

1) Definition

2) Causes

3) Signs/symptoms

4) Treatments

Back 54

1) Sudden change in sensation, behavior, or movement

2) Many potential causes. Most common in adults is failure to take prescribed anti seizure meds. Most common in 6 mo - 3 yr is high fever

3) Simple partial (focal motor, focal sensory, Jacksonian): tingling, stiffening, jerking in just one part of the body. May be an aura. No loss of consciousness.

Complex partial (psychomotor or temporal lobe): Often preceded by aura. Abnormal behavior which varies widely from person to person (confusion, glassy stare, aimless moving about, lip smacking or chewing, fiddling with clothing. May appear drunk or on drugs.). May struggle or fight if restrained. No loss of consciousness, but may be confusion or amnesia of episode.

it mal): usually lasts less than 10 seconds. No dramatic motor activity. Temporary loss of concentration or awareness. More common in children and usually stop before adulthood.

Absence (petit mal): usually lasts less than 10 seconds. No dramatic motor activity. Temporary loss of concentration or awareness. More common in children and usually stop before adulthood.Tonic-clonic: 3 phases which may be preceded by an aura 1) tonic --stiff muscles, apnea, loss of bladder/bowel control, blood in mouth and airway if bitten tongue, cyanosis. 2) clonic --violent jerking of paired muscle groups, breathing resumes (lasts a few minutes). 3) postictal --return to full consciousness). 4)

petit mal): usually lasts less than 10 seconds. No dramatic motor activity. Temporary loss of concentration or awareness. More common in children and usually stop before adulthood.Tonic-clonic: 3 phases which may be preceded by an aura 1) tonic --stiff muscles, apnea, loss of bladder/bowel control, blood in mouth and airway if bitten tongue, cyanosis. 2) clonic --violent jerking of paired muscle groups, breathing resumes (lasts a few minutes). 3) postictal --return to full consciousness). 4)

Tonic-clonic: 3 phases which may be preceded by an aura 1) tonic --stiff muscles, apnea, loss of bladder/bowel control, blood in mouth and airway if bitten tongue, cyanosis. 2) clonic --violent jerking of paired muscle groups, breathing resumes (lasts a few minutes). 3) postictal --return to full consciousness).

4)

Front 55

SEIZURES

1) Definition

2) Causes

3) Signs/symptoms

4) Treatments

Back 55

1) Sudden change in sensation, behavior, or movement

2) Many potential causes. Most common in adults is failure to take prescribed anti seizure meds. Most common in 6 mo - 3 yr is high fever

3) Simple partial (focal motor, focal sensory, Jacksonian): tingling, stiffening, jerking in just one part of the body. May be an aura. No loss of consciousness.

Complex partial (psychomotor or temporal lobe): Often preceded by aura. Abnormal behavior which varies widely from person to person (confusion, glassy stare, aimless moving about, lip smacking or chewing, fiddling with clothing. May appear drunk or on drugs.). May struggle or fight if restrained. No loss of consciousness, but may be confusion or amnesia of episode.

Absence (petit mal): usually lasts less than 10 seconds. No dramatic motor activity. Temporary loss of concentration or awareness. More common in children and usually stop before adulthood.

Tonic-clonic: 3 phases which may be preceded by an aura 1) tonic --stiff muscles, apnea, loss of bladder/bowel control, blood in mouth and airway if bitten tongue, cyanosis. 2) clonic --violent jerking of paired muscle groups, breathing resumes (lasts a few minutes). 3) postictal --return to full consciousness).

4) Do not restrain patient during seizure. Remove objects that could harm patient. Be prepared to suction and provide oxygen after clonic phase ends. Assess for trauma.

Front 56

Seizures usually last no more than ______ minutes.

Back 56

3

Front 57

A prolonged seizure (lasting more than 10 minutes) or situation when a person suffers two or more convulsive seizures without regaining full consciousness

Back 57

Status epilepticus

Front 58

Condition of altered function caused when artery in brain is blocked or ruptured, disrupting supply of oxygenated blood or causing bleeding into brain.

Back 58

Stroke

(Used to be called a cerebrovascular accident or CVA)

Front 59

2 types of stroke + definitions

Back 59

1) Ischemic --caused by a blockage (I.e.-clot or embolism)

2) Hemorrhagic --caused by bleeding into the brain (frequently as a result of long-standing hypertension or when a weak area of an artery bulges out and ruptures)

Front 60

Most strokes are this type

Back 60

Ischemic

Front 61

Most strokes are this type

Back 61

Ischemic

Front 62

Most common sign of a stroke

Back 62

Hemiparesis (one-sided weakness)

Front 63

STROKE

1) Definition

2) Causes

3) Signs/symptoms

4) Treatment

Back 63

1) Death or injury of brain tissue that is deprived of oxygen

2) Blockage of an artery in the brain (ischemic), bleeding from a ruptured blood vessel in the brain. Long-term hypertension increases risk factor.

3) Hemiparesis (one-sided weakness) on the side of the body opposite the location of the stroke,

Facial droop (does not indicate side of stroke),

Difficulty speaking or complete inability to speak

Forming words but using inappropriate phrasing or jumbled speech pattern;

Headache;

Dizziness;

Loss of bowel/bladder control;

Impaired vision;

Hypertension;

Difficult respiration or snoring;

Nausea or vomiting;

Seizures;

Unequal pupils;

Loss of vision in one eye

*Use Cincinnati Prehospital Stroke Scale assessment

4) Oxygen if hypoxic;

Airway if patient can't maintain on their own;

prompt transport to stroke center;

Place in position of comfort (usually place affected side down);

Front 64

Patient who demonstrates any 1 of 3 findings of Cincinnati Pre hospital Stroke Scale has a _______% chance of having an acute stroke

Back 64

70

Front 65

Condition which can imitate the signs of a stroke

Back 65

Hypoglycemia

Front 66

Fainting

Back 66

syncope

Front 67

Most important treatment step in caring for a stroke patient

Back 67

Recognition

Front 68

3 components of the Cincinnati prehospital stroke scale

Back 68

1) Assess for facial droop

2) Assess for speech difficulties (slurred speech, wrong words, unable to speak at all)

3) Assess for arm drift by asking patient to close eyes and extend arms palms up for 10 seconds

Front 69

Most important treatment priority for a stroke patient

Back 69

Rapid transport to an appropriate destination

Front 70

New treatment for ischemic strokes

Back 70

Thrombolytic drugs

Front 71

3 criteria which must be met for a stroke patient to receive thrombolytic therapy

Back 71

1) Definite onset of stroke symptoms less than 3 hours prior to admin of thrombolytic drugs

2) Emergency CT scan confirming no evidence of hemorrhagic stroke

3) BP that is not excessively hypertensive at the time the drug is administered

Front 72

Most important thing an EMT can do to optimize care of stroke patients who are potential candidates for thrombolytics

Back 72

Exact time of onset of symptoms

Front 73

Length of tome a syncopal episode usually lasts

Back 73

A few seconds to a few minutes

Front 74

Symptoms a patient may experience just before a syncopal event

Back 74

Light-headedness;

Dizziness;

Nausea;

Weakness;

Vision changes;

Sudden pallor;

Sweating;

Palpitations;

Tachycardia;

Bradycardia;

Headache

Front 75

Factors that cause dizziness and syncope are generally related to the ______.

Back 75

Brain

Front 76

3 conditions which interfere with normal brain function

Back 76

1) Hypoxia

2) Hypoglycemia

3) Hypovolemia

Front 77

4 categories of causes of dizziness and syncope

Back 77

1) Cardiovascular causes

2) Hypovolemic causes

3) Metabolic and structural causes

4) Environmental/Toxicological causes

Front 78

Cardio causes of syncope

Back 78

Acute MI;

Tachycardia;

Bradycardia;

Stimulation of carotid sinus (in carotid artery under mandible)-->bradycardia;

Vasovagal-stimulation of vague nerve-->bradycardia

Front 79

One of most common types of syncope

Back 79

Vasovagal syncope

Front 80

Hypovolemic causes of syncope

Back 80

Dehydration--sweating and not rehydrating, vomiting, diarrhea;

Internal bleeding--ruptured ectopic pregnancy, leaking AAA, GI bleeding;

Trauma

Front 81

Most serious cause of hypovolemia

Back 81

Bleeding

Front 82

Most serious cause of hypovolemia

Back 82

Bleeding

Front 83

Metabolic and structural causes of syncope

Back 83

Metabolic causes are due to the brain or structures near it;

Inner and middle ear inflammation;

Hypoglycemia (if unconsciousness lasts less than a few minutes);

Stroke;

Seizure

Front 84

Environmental/toxicological causes of syncope

Back 84

Alcohol and other central nervous system depressants;

Panic attacks/anxiety attacks lead to hyperventilation which alters brain chemistry and constricts blood vessels in brain

Front 85

In ____ the cases of dizziness and syncopy, no cause is ever found

Back 85

Half

Front 86

Assessment questions to ask patients with dizziness/syncope

Back 86

1) Describe what you mean by "dizziness."

2) Did you have any warning? If so, what was it like?

3) When did it start?

4) How long did it last?

5) What position were you in when the episode occurred?

6) Have you had any similar episodes in the past? If so, what cause was found?

7) Are you on medication for this kind of problem?

8) Did you have any other signs or symptoms? Nausea? Vomiting? Black, tarry stools?

9) Did you witness any unpleasant sight or experience a strong emotion?

10) Did you hurt yourself?

11) Did anyone witness involuntary movements of the extremities?

Front 87

Rationale for calling ALS to evaluate syncope patients

Back 87

Cardiac monitoring for potential dysrhythmias