Medical Conditions

Unconsciousness & FaintingA person may become unconscious or faint due to a variety of factors: - Stress / shock - Over-exertion - Stroke - Alcohol poisoning / drug use - Medical conditions (hypoglycemia, epilepsy) - Head trauma

***AIRWAY IS TOP PRIORITY***

How to Manage Fainting and Unconscious PatientIf patient is about to faint, use the standing takedown manoeuvre, loosen clothing and ensure a fresh supply of airPut patient on high concentration, humidified O2Position the patient in the recovery position if unconsciousPerform Secondary history, vitals, head-to-toe

How Can You Tell if a Patient Has a Medical Condition?

How to Determine What Condition(s) a Patient Has1) Ask the Patient What Happened and if they have any Pre-Existing Medical Conditions

2) Family, Friends or Co-Workers (By-standers)

3) Medic Alert Jewellery/Tattoos/Wallet Cards

4) Devices/Medications on Patient

5) Signs, Symptoms and Behaviour

1) What Happened? Ask the Patient if they have any Pre-Existing Medical ConditionsAlways ask the conscious patient what happened and if they have any pre-existing medical conditionsBe prepared to get 80% of your information from the Secondary Survey

2) Family, Friends or Co-Workers (By-standers)

If the patient is unconscious, family members, friends and by-standers can provide key details to first responders regarding the nature of the condition. However, there are situations where bystanders are completely useless.

3) Medic Alert Jewellery/Tattoos/Wallet Cards

If the patient owns a medic alert device, it is normally discovered during the rapid body or head to toe examination.Medic alert devices (tattoos, piercings, bracelets, necklaces, wallet cards) are the best indicators of pre-existing medical conditions. Unfortunately, not everyone has a medic alert device.

4) Devices/Medications on Patient

- If unconscious (during the Rapid Body) check for objects in pockets, on torso or on belt

5) Signs, Symptoms and Behaviour

Assess LOC, Airway, Breathing and Circulation - If conscious, perform SAMPLE - Assess the patients Level of Consciousness and Behaviour - if they are acting aggressively, approach with caution. This could be indicative of hypoglycemia or a cardiovascular emergency. - Complexion/Skin Temperature

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The HumanSkeletal System

The Skeletal SystemThe adult Human Skeletal System has 206 bonesNeonates and Infants have approx. 300 - 350 bonesBy age 9, most children have approx. 206 bonesTeeth are part of the skeletal system, but not considered bonesThe skeletal system plays vital roles in processes such as hematopoiesis, movement, protection, calcium storage and endocrine regulation It takes a minimum of 10 16 PSI to break a bone; the skull and the femur are much tougher to break

Conditions of the Skeletal SystemOsteoporosis Characterized by a decrease in skeletal Ca levels and weak bones, osteoporosis is found mostly in older people and even more in older femalesArthritis Joint disorder that includes over 100 types of inflammatory conditions. First aid is ice pack Fractures Broken bones use Rest Ice/immobilization Compression Elevation (R I C E)

Gastrointestinal Conditions Diverticulitis Inflammation of the small pockets of the colon: Increased temperature. Opposite area to that of appendicitis.

Cystitis Inflammation of the bladder: pain in lower mid-abdomen. Pain during urination.

Perforated Gastric Ulcer Pain radiates in mid-abdomen or upper back. Characterized by guarding, bloating. Sharp or burning sensation after meals.

Kidney Stones A calculus (mass of mineral salts around tissue) in the kidney: Pain in right or left flanks radiating to the genitalia. Pain during urination.

Pancreatitis Pain in both upper quadrants and back. Characterized by guarding, assuming the fetal position.

AppendicitisInflammation of the appendix, creates painKnown as AppendicitisRupturing causes faecal matter and other waste products to seep into the peripheral tissuesIdentification of Acute AppendicitisLocalized pain around navel with direct pain in lower right abdomenPt may draw up their right knee or clutch their abdomenIf RUPTURED, abscess in LR quad forms

Abdominal Assessment

McBurneys Point

How to Manage Acute Abdominal InjuriesPut patient on high concentration, humidified O2Position the breathing patient in a comfortable position, loosen clothingAuscultate the lungs, record all observationsBe prepared to deal with shockPerform Secondary history, vitals, head-to-toeUpdate EMS , continuously monitor vitals and reassure pt

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The Human Nervous SystemCentral Nervous System Peripheral Nervous System

Autonomic Nervous System: Controls automatic actions, such as heart beat, breathing, pain response, etc.,

Epilepsy & Idiopathic SeizuresEpilepsy is characterized by a chemical imbalance in the brain which induces seizure activity. All epileptics have seizures, but not all people who have seizures are epileptic. It is unknown what triggers seizures, but common signs of oncoming seizure include: sudden cry, stiffening of the body and unconsciousness, convulsions, frothy saliva, loss of bladder or bowel control, irregular breathing and confusion.

Epilepsy in a NutshellPartial Seizures: Affect only part of the brain. Patient may experience tingling or twitching on one side of the body.Generalized Seizures: The entire brain is affected patient loses consciousness and convulses.Phases of Generalized SeizuresAura A sense of impending seizure that some epileptics have just before seizing.Tonic Phase A sudden loss of consciousness. The face and neck may turn cyanotic.Clonic Phase Convulsions occur, breathing is irregular and rigid, frothy saliva may appear at mouth.Postictal State A period of confusion. For a few minutes, the patient will appear incapacitated.

How to Manage SeizuresBegin ESM What happened? Perform a scene survey: call EMS if episode is severePerform primary assessment LOC, ABCs and Rapid BodyIf the patient is convulsing, clear the area of furniture and other debrisIf there are any life threatening injuries, treat those first. Airway management is top priority.Auscultate the lungs, record all observationsPut patient on high concentration, humidified O2Find out how long the seizure lasted if more than 5 minutes or if seizures are recurring, this may be STATUS EPILEPTICUS and patient must be hospitalized.***NEVER CHECK PUPIL DILATION IN*** EPILEPTIC PATIENTSPerform Secondary LOC, history, vitals, head-to-toeUpdate EMS

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The Human Respiratory System

AsthmaNormally, individuals with asthma have no trouble breathing. But during an asthmatic attack the bronchioles constrict, inducing shortness of breath, with considerable wheezing and coughing.Asthma can be triggered by intense physical activity, stress, humidity, smoke, mold, allergens and pollutants.

Signs and Symptoms of a Severe Asthmatic AttackShortness of breath with trouble breathingCoughing or wheezingFast and shallow breathingCyanosisAnxiety and tightness in chestFast pulse, signs of shockInitially restlessness, followed by fatigue patient becomes tired due to stress and attempting to breathe

How to Manage an Asthma AttackBegin ESM perform a scene survey: call EMS if attack is severe or does not stopPerform primary assessment LOC, ABCs and Rapid BodyAuscultate the lungs, record all observationsPosition the patient in a semi-sitting positionPut patient on high concentration, humidified O2Assist with medication administration Follow the 5 rights of medication: - Right medication - Right person - Right amount - Right time - Right method/dosePerform Secondary history, vitals, head-to-toeUpdate EMS

***ONLY ASSIST WITH MEDICATION*** IF PATIENT IS CONSCIOUS OR WITH CONSENT OF FAMILY MEMBER

DOCUMENT TIMES/DOSAGES ADMINISTERED

Types of Aerosol InhalersBronchodilator: Usually blue,Green or white. Can be used Multiple times to relieve symptoms. Can not be used ifHR is above 150 bpm in adults or 180 bpm in children.

Inhaled Corticosteroid: UsuallyBurgundy or brown in colour will not help the patient during an attack. Used to reduce inflammation and strengthen the airway.

Types of Dry Powder InhalersTurbo Inhalers: Handheldinhalers that either comepre-loaded or have reloadable capsules for each dose.

DISKUS: Holds 60 doses,With built in counters (so thepatient knows how much they have left.

Chronic Obstructive Pulmonary Disease Prevalent among older populations, COPD is a term that encompasses conditions such as chronic bronchitis and emphysema. Characterized by a patients difficulty with or inability to breathe. Some signs and symptoms of COPD are:Gasping for airDistended neck veinsAudible wheezing and coughingCyanosisPursed lips

Devices Used by COPD PatientsO2 Canister, NRB/NPA

Salbutamol, Symbicort and Ventolin puffers (identical to asthma inhalers)***COPD PATIENTS ARE TYPICALLY OLDER,*** FRAIL AND CARRY O2 CANISTERS WITH THEM

COPDThe ESM and First Aid is the same for all respiratory emergencies:Begin ESM perform a scene survey: call EMS Perform primary assessment LOC, ABCs and Rapid BodyAuscultate the lungs, record all observationsPut patient on high concentration, humidified O2Position the patient semi-sitting, loosen clothing***ENCOURAGE COUGHING IF PATIENT IS DISCHARGING*** SALIVA OR SPUTUMAssist with medication administration Follow the 5 rights of medication: - Right medication - Right person - Right amount - Right time - Right method/dosePerform Secondary history, LOC, vitals, head-to-toeUpdate EMS

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The Human Endocrine System

Type 1 DiabetesType 1 Diabetes is characterized by the patients inability to produce insulin (a hormone necessary for maintenance of proper blood-glucose levels).There are two diabetic emergencies an MFR may be faced with: Hypoglycemia low blood glucoseHyperglycemia high blood-glucose

What Devices do Diabetics Use?Glucometer: Used to test blood-glucose levels

Insulin Pump: Used to administer a basal rate (long term, slow) or bolus (large, single dose) of fast-acting insulin

Insulin Pen: A portable insulin syringe

Types of InsulinHumulin R Fast actingHumlog Fast actingNova Rapid Fast acting

Humulin N Long acting

How to use a Blood Glucose Meter(Glucometer)Have patient insert strip into glucometer the brand name of the strip should appear facing the patientHave patient prick their finger with lancetHave patient squeeze pricked fingerHave patient administer blood to glucometerWithin 10 seconds, a BG level should appear on the meter1 3 mmol/dL LOW4 10 mmol/dL Normal 11 30 mmol/dL HIGH

HypoglycemiaThe most threatening conditionLow blood sugar caused by physical exertion, not eating, taking too much insulin, stress etc., Hypoglycemia is characterized by:Extreme hungerChange in mental status and behaviour aggression, lethargy, slurred speech and intoxication are all signs of low blood glucoseDilated pupilsPale, clammy skinConfusionUnresponsiveness Fatigue

How to Manage HypoglycemiaBegin ESM What happened? Perform a scene survey: call EMS Perform primary assessment LOC, ABCs and Rapid BodyPlace the conscious patient in semi-sitting positionAuscultate the lungs, record all observationsPut patient on high concentration, humidified O2Have the patient check their blood glucose (if they have a meter)Assist with GLUCOSE administration ***NEVER GIVE ANYTHING ORALLY TO*** UNRESPONSIVE PATIENTSPerform Secondary LOC, history, vitals, head-to-toeUpdate EMS

HyperglycemiaHigh blood sugar caused by eating too many carbohydrates/too much sugar, not getting enough insulin, stress etc.,Hyperglycemia is characterized by:Unquenchable thirst Frequent urinationVomitingShort breathsRapid heart rateFruity odourFlushed appearanceFatigue

How to Manage HyperglycemiaBegin ESM What happened? Perform a scene survey: call EMS Perform primary assessment LOC, ABCs and Rapid BodyPlace the conscious patient in semi-sitting positionAuscultate the lungs, record all observationsPut patient on high concentration, humidified O2Have the patient check their blood glucose (if they have a meter)Give patient WATER ***NEVER GIVE ANYTHING ORALLY TO*** UNRESPONSIVE PATIENTSPerform Secondary LOC, history, vitals, head-to-toeUpdate EMS

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The Human Immune System

AnaphylaxisSevere allergic reactions (anaphylaxis) occur when an irritant affects two or more body systems. Typically characterized by: Red, itchy or flushed skin (hives) Watery eyes, sneezing Swelling of the mouth, tongue and airway Coughing Nausea and vomiting.

As the condition progresses, MFRs may note:Pale skin or cyanosisHeadacheWheezing, chest tightnessRapid heart rateShortness of breath, severe respiratory distressDecreased LOC / respiratory rate / circulation

How to Manage AnaphylaxisBegin ESM What happened? Perform a scene survey: call EMS Perform primary assessment LOC, ABCs and vitalsAuscultate the lungs, record all observationsPut patient on high concentration, humidified O2Place the patient in semi-sitting positionAssist with medication administration Follow the 5 rights of medication: - Right medication - Right person - Right amount - Right time - Right method/dosePerform Secondary LOC, history, vitals, head-to-toeUpdate EMS

***EPIPENS MUST ONLY BE*** USED IN RESPIRATORY EMERGENCIES

Types of Epi PensAuto Injector Must be administered intramuscularly (typically, the outer thigh)

How to use the Auto InjectorGrasp the device in the middle with your dominant hand do not place your thumb over the other endPull the blue safety cap off of the aspirator (end of the injector)Press the tip gently against the mid-outer thigh and press firmly for 10 seconds (or until the auto injector activates)

Twinject Auto InjectorContains two doses of epinephrine. Similar administration to the standard auto injector.

***ALWAYS SEND MEDICATIONS TO HOSPITAL***WITH PATIENT

How to use Twinject Auto InjectorsGrasp the device in the middle with your dominant hand do not place your thumb over the other endPull both of the green safety caps offPress the red tip gently against the mid-outer thigh and press firmly for 10 seconds (or until the auto injector activates)

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Cardio-Vascular ConditionsCV conditions are characterized by disorders of the blood vessels and heart tissues.Signs and symptoms include:Indigestion, aching jaw or armClutching of the chestHeaviness in chest, shortness of breathFear, fatigue, denialNausea, vomitingPale, cool, sweaty skinUnconsciousness and cardiac arrest

American Heart AssociationInteractive Videos:

http://watchlearnlive.heart.org/CVML_Player.php?moduleSelect=angina

Devices Used by CV Patients

Nitroglycerin Tablets Taken orally

Nitroglycerin Patches Provide long-acting nitroglycerin

Nitroglycerin Spray Sprayed sub-lingually (under the tongue)

ANGINA

- Arteries harden due to plaque build up. Not enough O2 gets to the heart. - Causes pain and discomfort - Mimics a heart attack but wont last longer than 10 minutes - Usually have nitroglycerin patches or sprays and will be relieved once administered

How to Assist with NitroglycerinNitroglycerin is a vasodilator that opens the blood vessels, allowing blood to mobilize freelyAvailable in tablet, patch and spray form, Nitro starts working within 1 to 2 minutes for approximately 6 minutesAsk the patient if they use NitroglycerinAssess vitals Ask the patient to administer their Nitro nitro may be used every 5 10 minutes for a maximum of 3 doses. BP must be monitored regularly!

***TELL PATIENT NOT TO TAKE NITRO IF*** THEY ARE USING ERECTILE DYSFUNCTION DRUGS

How to Assist with AspirinAspirin (ASA - acetylsalicylic acid) is a blood thinner that helps blood pass through clogged arteries into the heartMFRs should only recommend patients take ASA and explain whyAsk patient if they have already taken ASA before your arrival if so, dont recommend itIf patient is allergic to ASA do not recommend itAfter the first dose of Nitro, reccomend 2 baby aspirins (81 mg) or one adult (325 mg). Have patient chew the tablet(s)Document all medication doses/times

How to Manage AnginaBegin ESM perform a scene survey: call EMS if episode is severe or does not stopPerform primary assessment LOC, ABCs and Rapid BodyPut patient on high concentration, humidified O2Position the patient in a semi-sitting position, loosen clothingAuscultate the lungs, record all observations***If patients BP is 100 or below, the patient should NOT*** take nitroIf patient takes nitroglycerin, and their BP is at 150, assist them with their medication Follow the 5 rights of medication: - Right medication - Right person - Right amount - Right time - Right method/doseMonitor BPPerform Secondary LOC, history, vitals, head-to-toeUpdate EMS

Cerebro-Vascular EmergenciesCerebrovascular emergencies (strokes/TIAs) are usually indicative of pre-existing conditions.Hardening of the arteries stops the flow of blood (and oxygen) to the brain.The signs and symptoms for both TIAs and strokes are similar and EMS should be called immediately. Some signs include:Paralysis of face musclesDifficulty speaking/swallowingDizziness/confusionNumbness/weakness in one side of body, loss of bladderDecreased LOCSevere headacheUnequal pupil size

TIAs and StrokesTransient ischemic attacks (TIAs) mimic the signs/symptoms of a stroke, but typically do not leave permanent brain damage. TIAs are a warning sign that a stroke is coming.Strokes are very serious and can leave permanent brain damageUse FAST as a method to determine whether a patient is having a stroke/TIAFacial Droop One side of the face is paralyzedArm Drift Have the patient hold both arms out if one arm doesnt move as well as the other, they may be having a stroke/TIASpeech Slurred speech, incorrect words, inarticulateTime Get immediate help

How to Manage a Stroke/TIABegin ESM perform a scene survey: call EMS if episode is severe or does not stopPerform primary assessment ABCs and vitalsPut patient on high concentration, humidified O2Position the patient in a semi-sitting position, loosen clothingAuscultate the lungs, record all observationsMonitor BPReassure the patient keep them comfortablePerform Secondary history, vitals, head-to-toeUpdate EMS

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