Emergency Medical Response Quiz

Chapter 17: Dealing with Acute Situations

• Objectives: Discuss procedures for assisting patients during respiratory distress, myocardial infarction, stroke, asthma, epistaxis, angina, nausea, and syncope. List the four levels of consciousness and explain the Glasgow Coma Scale. List precautions for handling patients with possible spinal, rib, or extremity fractures. Recognize shock signs and respond appropriately. Explain syncope and vertigo differences. Contrast diabetic coma/hyperglycemia, insulin shock/hypoglycemia, and seizure disorders, including safety precautions and observations. Identify the need for CPR; recognize AED indications; and list the steps.

Key Terms (Part 1)

• Anaphylaxis
• Anoxia
• Asthma
• Cardiac arrest
• Cardiac tamponade
• Cardiopulmonary resuscitation (CPR)
• Cerebrovascular accident (CVA)
• Concussion
• Defibrillator
• Edema
• Epistaxis
• Evisceration
• Hemorrhage
• Hemothorax
• Heimlich maneuver
• Hyperglycemia
• Hypoglycemia

Key Terms (Part 2)

• Myocardial infarction (MI)
• Myocardial ischemia
• Pleural effusion
• Pneumonia
• Pneumothorax
• Pulmonary edema
• Pulmonary embolism (PE)
• Respiratory arrest
• Stridor
• Syncope
• Thoracentesis
• Thoracotomy
• Tremor
• Urticaria
• Vasovagal
• Vertigo

Respiratory Emergencies

• Airway Obstruction: Usually caused by foreign objects (choking).
  • Adults: Abdominal thrusts
  • Infants/small children: Alternate back blows and chest thrusts
• Respiratory Arrest: May result from choking.
• Reactive Airway Disease: Characterized by coughing, wheezing, or shortness of breath.

Cardiac Emergencies (Part 1)

• Acute Coronary Syndrome: Group of symptoms signifying myocardial infarction (MI) or heart attack.
• Angina Pectoris: Chest pain triggered by exertion or stress, often relieved by rest or nitroglycerin.
• Cardiac Arrest: Shake and shout to rule out syncope. Check carotid pulse and respirations. Initiate CPR if needed until medical personnel arrive.

Cardiac Emergencies (Part 2)

• Defibrillator: Delivers an electric shock to correct ineffective cardiac rhythms. Personnel should be 2 feet away during administration.

Cardiac Emergencies (Part 3)

• AED (Automatic External Defibrillator): Easier to use than standard defibrillators. Steps:
  • Turn on power
  • Attach adhesive pads to the victim's chest.
  • Attach pads to machine cables
  • Clear the area.
  • Turn on rhythm analysis (5-15 seconds).
  • Press the shock control if indicated.

Trauma: Head Injuries

• Patients with head injuries can rapidly change levels of consciousness (LOC). Alert the physician immediately if a change is noticed.

Trauma: Spinal Injuries

• Assume all trauma patients have a spinal injury until ruled out.
• Obtain a cross-table lateral c-spine X-ray with immobilization in place.
• Evaluate the X-ray with the ED physician before moving the patient.
• Log-rolling is used to move patients when necessary.

Trauma: Chest Injuries

• Hemothorax: Blood in the pleural space; treated with a thoracotomy.
• Pneumothorax: Air in the pleural space; treated with a thoracotomy.
• Flail Chest: Multiple rib fractures. Observe for shock and hemorrhage into the pericardial sac.

Trauma: Extremity Fractures

• Compound Fracture: Bone fragments protruding through the skin.
• Closed Fracture: No wound associated with the fracture.
• Two people are needed to image long-bone fractures. One person supports the limb above and below, while the other positions the image receptor.

Trauma: Wounds (Part 1)

• Postsurgical Wound Dehiscence: Sutures pulling apart, potentially leading to tissues protruding (evisceration)

Trauma: Wounds (Part 2)

• Burns: Categorized as first, second, third, or fourth degree. Respiratory complications like pleural effusion and pneumonia can occur.

Shock (Part 1)

• A general circulatory failure where blood pressure is insufficient to adequately perfuse vital tissues and remove metabolic waste products. It is a dangerous, potentially fatal condition.
• Early signs include pallor, increased heart rate, increased respirations, restlessness or confusion.

Shock (Part 2)

• Five main types: Hypovolemic, septic, neurogenic, cardiogenic, and allergic (anaphylactic).

Hypovolemic Shock

• Caused by significant blood or plasma loss from hemorrhage, burns, or dehydration. Insufficient fluid in the circulatory system.

Shock (Part 1) - Continued

• Septic Shock: Caused by a severe, often systemic infection.
• Neurogenic Shock: Failure of arterial resistance. Blood pools in peripheral vessels, common in nervous system injuries.
• Closely monitor blood pressure in patients with head or spinal trauma.

Shock (Part 2) - Continued

• Cardiogenic Shock: Results from cardiac failure or interference with heart function.
• Allergic Shock (Anaphylaxis): Occurs from exposure to foreign substances.

Shock Symptoms

• Restlessness, apprehensiveness
• Increased pulse rate
• Pallor with weakness or a change in thinking ability
• Cool, clammy skin (except in septic or neurogenic shock)
• Decreased blood pressure of 30 mm Hg below baseline systolic pressure
• Decreased urination
• Increased, shallow respirations

Radiographer Response to Shock

• Stop the procedure.
• Assist the patient into a supine position.
• Elevate the feet.
• Elevate the head if dyspnea is present.
• Check blood pressure.
• Administer supplemental oxygen.
• Be prepared to perform CPR.
• Assist the code team/physician as needed.

Syncope

• Medical term for fainting. Mild form of shock. Assist patient into a supine position with elevated feet.

Psychological Shock

• Now known as posttraumatic stress disorder. Different symptoms, signs, and treatment.

Medical Emergencies

• Contrast-media reactions
• Drug reactions
• Diabetic emergencies
• Cerebrovascular accidents (CVAs)
• Seizures
• Vertigo
• Orthostatic hypotension
• Epistaxis
• Nausea and vomiting

Contrast-Media Reactions:

• Range from mild to severe.
• No predictors.
• Begin with a small amount, monitor for signs/symptoms.
• Patients at risk are premedicated with antihistamine and/or corticosteroids.

Mild Contrast Reactions

• Warmth, flushing, metallic taste, coughing, nausea. Resolve spontaneously.

Moderate Contrast Reactions

• Erythema, urticaria, bronchospasm. Treat with antihistamines, IV medications, or bronchodilators as needed.

Vasovagal Reactions

• Symptoms: Diaphoresis, hypotension, bradycardia.
• Treatment: Position supine with feet elevated (20 degrees). Head elevated if needed. IV fluids and atropine for bradycardia.

Severe (Anaphylactic) Reactions

• Symptoms: Warmth, tingling, itching (palms/soles), dysphagia, laryngeal/bronchial edema, respiratory arrest, cardiac arrest, seizures.
• Treatment: Maintain airway, call a code, epinephrine IV, other drugs as needed.

Drug Reactions

• Wide range of symptoms and severity.
• Treatment tailored to severity and symptoms.

Diabetic Emergencies:

• Diabetes Insipidus: Caused by kidney/pituitary issues, characterized by polyuria and thirst. Symptoms include fever, vomiting, and seizures. Fluid replacement needed.
• Diabetes Mellitus:
  • Type I: Insulin-dependent, more likely to lead to diabetic coma. Symptoms include extreme thirst, polyuria, and a fruity-smelling breath.
  • Type II: Related to obesity, hyperosmolar hyperglycemic nonketotic (HHNK) syndrome is an emergent condition found in neglected cases.

Hypoglycemia (Low Blood Sugar):

• Cause: Occurs with Type I diabetes when insulin is taken and meals are skipped.
• Symptoms: Sudden weakness, sweating, tremors, hunger, and potential loss of consciousness.
• Treatment: Candy, sweet fruit juice, or glucose gel (inside the cheek).

Cerebrovascular Accident (CVA)

• Also known as a stroke. Caused by an interruption of blood flow to the brain (hemorrhage or occlusion).
• Warning Signs (FAST): Facial drooping, arm weakness (one or both sides), speech difficulty. Time to call 911.
• Other symptoms may include extreme dizziness, headaches, vision changes, and loss of consciousness.

Seizures

• May involve trembling, shaking, or violent spasms (grand mal). Absent seizures are brief losses of consciousness (petit mal).
• Treatment: Keep the patient safe (remove obstacles, protect head, no restraints/objects in mouth). Call a code immediately.

Post-Seizure Care

• Turn the patient to a lateral recumbent position to prevent aspiration.
• Provide reassurance and assistance. Patient may be irritable or confused.

Orthostatic Hypotension

• Dizziness from sitting up too quickly from a lying position.
• Avoidance involves assisting to sit up slowly.

Vertigo

• Severe dizziness, sometimes with nausea. Caused by inner-ear issues or brain/spinal-cord lesions.

Epistaxis

• Medical term for a nosebleed.
• Treat by applying pressure to the nasal septum for 10 minutes with gloved hands.
• Physician consultation if bleeding continues.

Nausea

• Instruct patient to breathe slowly (nose/mouth).

Vomiting

• Wear gloves, provide an emesis basin.
• Rinse mouth with water and tissue.
• Roll patient on their side to avoid aspiration if lying down.

Test your knowledge on emergency medical treatments and shock types with this quiz. It covers important concepts like allergic reactions, vasovagal responses, and diabetes insipidus. Ideal for students in healthcare or emergency response training.