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MEDICAL EMERGENCIES

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State the appropriate interventional steps to take for a patient presenting with chest pain. ... Respiratory Causes of Chest Pain: Pulmonary Embolism. Chronic ... – PowerPoint PPT presentation

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Title: MEDICAL EMERGENCIES


1
MEDICAL EMERGENCIES
  • By Kim Boncoskey EMT-P, RN,TNS

2
Objectives
  • General medical patient assessment
  • Identify and differentiate the signs and
    symptoms of a patient presenting with chest pain
    related to angina, acute myocardial infarction
    acute upper respiratory process, and
    musculoskeletal origins.
  • State the appropriate interventional steps to
    take for a patient presenting with chest pain.

3
Objectives
  • Describe the pathophysiology of insulin shock and
    diabetic ketoacidosis.
  • Signs and symptoms of insulin shock and diabetic
    ketoacidosis
  • Describe the interventions for the patient with
    hyperglycemia and hypoglycemia
  • Participate in a discussion of refusal procedure
  • Case review discussion

4
Assessment of Medical Patient
  • Primary Survey-
  • Airway
  • Breathing
  • Circulation
  • Disability/Neurological
  • Treat all life threats as found before going on

5
Assessment of the Medical Patient
  • Secondary
  • Basic History-SAMPLE
  • Pain- OPQRST
  • Exam- Inspect, Palpate, Percuss, Auscultate

6
Causes of Chest Pain
  • Cardiovascular
  • Respiratory
  • Gastrointestinal
  • Musculoskeletal

7
Cardiovascular causes
  • Angina Pectoris
  • Myocardial Infarction
  • Abdominal Aortic Aneurysm

8
Angina Pectoris
  • Occurs when blood supply to the heart is
    transient
  • Atherosclerosis causes changes in the vessel
    walls. These changes cause decreased blood flow
    in and to the heart
  • Angina can be brought on by exercise, eating, or
    stress

9
Angina Pectoris
  • Signs Symptoms of Angina
  • Chest pain or pressure
  • Pain lasts 3-5 minutes
  • Pain that radiates to jaw, back, neck, or ear.
  • Weakness
  • Diaphoresis
  • Nausea and vomiting
  • Lightheadedness
  • Palpitations

10
Angina Pectoris
  • Treatment
  • IV
  • Monitor
  • Oxygen
  • Aspirin 324 mg by mouth
  • Nitro 0.4mg SL repeat q 5 minutes
  • Morphine Sulfate 2 mg IVP q 3 minutes as needed
    (Max 10mg )

11
Myocardial Infarction
  • An imbalance between oxygen supply and demand of
    the heart. Here the lack of oxygen causes cells
    of the heart to be damaged or die.
  • Myocardial infarction always begins with
    myocardial ischemia.

12
Myocardial Infarction
  • Causes
  • Arteriosclerosis
  • Artery spasm
  • Volume overload
  • Hypotension
  • Hypoxia

13
Myocardial Infarction
  • Complications after a Myocardial Infarction
  • Shock
  • Dysrthmia
  • CHF
  • Aneurysm
  • Death

14
Myocardial Infarction
  • Signs Symptoms
  • Chest pain
  • Radiation of the pain to jaw, arm, neck, back
  • Dyspnea
  • Nausea/Vomiting
  • Anxiety
  • Syncope
  • Diaphoresis
  • Fatigue
  • Weakness
  • Dysrhythmia

15
Myocardial Infarction
  • Treatment
  • ASA 324 mg by mouth
  • Nitroglycerine 4.0 mg SL may be repeated q 5
    minutes
  • Morphine sulfate 2mg IVP may repeat q 3min
  • (max 10 mg)
  • - Watch of cardiogenic shock. If occurs treat
    with fluids and consider dopamine drip.

16
Respiratory Causes of Chest Pain
  • Pulmonary Embolism
  • Chronic Obstructive Pulmonary Disease

17
Pulmonary Embolism
  • Is a clot that forms or sticks in the pulmonary
    artery.

18
Pulmonary Embolism
  • Those at an increased risk of PE are
  • Pregnancy
  • Prolonged immobilization
  • Surgical procedures
  • Deep vein thrombosis (DVT)

19
Pulmonary Embolism
  • Signs Symptoms
  • Sudden cardiac arrest
  • Dyspnea
  • Chest pain
  • Weakness
  • Pale
  • Diaphoretic
  • Cough
  • Hypotension
  • New onset atrial fibrillation

20
Pulmonary Embolism
  • Treatment
  • Monitor
  • IV
  • O2
  • Management is supportive in nature. Treat
    hypotension and rapid transport.

21
Chronic Obstructive Pulmonary Diseases COPD
  • It is an airflow obstruction due to chronic
    bronchitis, asthma, or emphysema.
  • In chronic bronchitis the alveoli are not as
    severely affected as in emphysema. Gas exchange
    is decreased due to mucus production and
    obstruction of alveoli. Can lead to increased CO2
    levels.
  • Asthma is a inflammatory process causing
    obstruction of the airway.
  • The air sacs of the lungs enlarge and fail to
    function.
  • The emphysema patients retain CO2.
  • Emphysema patient can be both acidotic and
    hypoxic.

22
COPD
  • Signs Symptoms
  • Cough
  • Wheezing
  • Cyanosis
  • CHF
  • Anorexia
  • Tachypnea
  • Barrel chest
  • Decreased breath sounds
  • Tripod position to breath

23
COPD
  • Treatment
  • IV
  • O2
  • Monitor
  • Albuterol 2.5 mg/3ml with 6 l/min o2
  • Consider conscious sedation and intubation for
    severe distress.

24
Abdominal Aortic Aneurysm
  • Dilation of a blood vessel
  • Dilation of vessel can rapidly lead to a vessel
    rupture
  • Caused by atherosclerotic changes in the vessel

25
Abdominal Aortic Aneurysm
  • Signs and Symptoms
  • Sudden pain to chest, flank, back
  • Hypotension
  • Urge to defecate
  • Pale
  • Diaphoretic
  • Discomfort to legs
  • Impending feeling of doom

26
Abdominal Aortic Aneurysm
  • Treatment-
  • Routine medial care
  • Vomiting Precautions
  • Fluid challenge if unstable BP
  • Rapid Transport

27
Gastrointestinal causes of Chest Pain
  • Pancreatitis
  • Gastritis and Peptic Ulcer Disease
  • Gastroesophageal Reflux Disease

28
Pancreatitis
  • Inflammatory process of the pancreas
  • Auto digestion of the gland by enzymes
  • Hyperglycemia due to organ failure
  • Pain

29
Pancreatitis
  • Signs Symptoms
  • Epigastric pain
  • Nausea and vomiting
  • Fever
  • Tachycardia
  • Hypotension
  • Hyperglycemia
  • Jaundice
  • Weakness
  • Syncope
  • Abdominal Distension

30
Pancreatitis
  • Treatment-
  • Acute abdominal pain protocol
  • Routine medical care
  • Vomiting precautions
  • Menstrual history in females
  • Consider cardiac etiology

31
Gastritis and Peptic Ulcer Disease
  • Caused by the following
  • Too much acid production in the body
  • Bacterial infection
  • Over use of medications such as ibuprofen

32
Gastritis and Peptic Ulcers
  • Signs Symptoms-
  • Abdominal pain
  • Back pain
  • Pain after eating meals
  • Fatigue
  • GI bleeding
  • Hypotension
  • Tachycardia
  • Fever

33
Gastritis and Peptic Ulcers
  • Treatment-
  • Routine medical care
  • Vomiting precautions
  • Menstrual history in females
  • Consider cardiac etiology
  • Fluid challenge in 200 ml if unstable blood
    pressure
  • Transport

34
Gastroesophageal Reflux Disease GERD
  • Caused by reflux of acid into the esophagus from
    the stomach
  • Can be due to anatomical strictures

35
GERD
  • Signs Symptoms
  • Heartburn
  • Regurgitation
  • Dysphagia- patient feels the food is stuck

36
GERD
  • Treatment
  • Routine medical care
  • Vomiting precautions
  • Position of comfort
  • Consider cardiac etiology
  • Fluid challenge if Blood pressure unstable
  • Transport

37
Musculoskeletal Causes of Chest Pain
  • Costochondritis
  • Herpes Zoster- shingles

38
Musculoskeletal Injuries and Illness
  • Due to injury to chest wall
  • Due to inflammation of chest wall
  • Due to viral or bacterial infection of chest wall

39
Musculoskeletal illness
  • Signs Symptoms
  • Pain is reproducible
  • Pain with movement
  • Fever
  • Rash
  • History of injury to chest

40
Musculoskeletal Injuries and Illness
  • Treatment
  • All treatment is supportive in nature.
  • Routine medical care
  • Continual pulse oximeter
  • Morphine Sulfate 2 mg IVP (max 10 mg.)
  • Transport
  • Consider cardiac etiology

41
Diabetes
  • Type 1- insulin dependent, young onset
  • Type 2- oral medications, may take insulin as
    disease progresses, adult onset
  • Pancreas fails to produce adequate insulin in the
    body.
  • Body without insulin can not use sugar
  • 140 Hyperglycemia

42
Diabetic Coma
  • Hyperglycemia
  • Gradual
  • Too much food
  • Too little insulin
  • Stress to body
  • Infection

43
Insulin Shock
  • Hypoglycemia
  • Sudden
  • Too little food
  • Too much insulin
  • Extra activity

44
Diabetic Emergencies
  • Routine medical care
  • History of illness/medication use
  • BS unable to establish IV. If no response repeat
    dextrose 50ml IVP.
  • BS 200 fluid challenge .9 NS 200cc

45
What if ?
  • If you are unable to determine the blood sugar of
    a known diabetic patient?
  • You can administer Dextrose or glucagon.
  • Make sure the line is good and functional.
    Dextrose is necrotic to tissue if it infiltrates.

46
Refusals
  • Patient assessment needs to be documented
  • Care needs to be explained
  • Form to be completed on backside
  • Appropriate signatures secured

47
Questions
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