Medical Emergencies: Asthma

Medical Emergencies Outcomes

• Take appropriate steps in recognizing and providing initial care for medical emergencies.
• Key medical emergencies include respiratory, cardiovascular, diabetic, neurological, and systemic shock.

Respiratory Emergencies: Asthma

• Asthma involves increased reactivity of the trachea, bronchi, and bronchioles.
• Allergic reactions to inhaled irritants, respiratory infections, or emotional stress can trigger asthma.
• Pathological processes include bronchospasm, swelling of mucous membranes in bronchial walls, and plugging of bronchi by thick mucous secretions.

Physical Examination for Asthma

• Expected findings include an elevated pulse rate and respiratory rate.
• Retraction of the neck muscles may occur on inhalation.
• Restlessness, faintness, and agitation are potential symptoms.
• A silent chest may be observed.
• Wheezing may be audible without a stethoscope.
• Patients may adopt a sitting position, leaning forward to aid breathing, called Tripodding.
• Coughing may be spasmodic and unproductive.

Asthma Treatment

• Aims to relieve bronchospasm, improve ventilation, and clear mucous plugs.
• Eliminate asthma triggers such as smoke, hair, and pollen.
• Maintain a calm attitude and help loosen tight clothing.
• Ensuring an open airway is vital.
• Administer quick relief medication (inhaler), such as Albuterol or Ventolin, if available.
• Only assist patients with their own prescribed medication.

Cardiovascular Emergencies: Myocardial Infarction

• The heart muscle is deprived of oxygen long enough for the muscle to die.
• The heart cannot effectively pump if too much tissue dies.
• Heart's electrical system can be interfered with.
• Cardiogenic shock and/or cardiac arrest can occur.

Signs of Myocardial Infarction

• Anxiety, paleness, ashen grey skin, wet and cold, sweating, confusion, and restlessness can indicate a myocardial infarction.

Symptoms of Myocardial Infarction

Chest Pain

• Mild discomfort to unbearable pain can be present.
• A Heavy, squeezing, crushing, or tight sensation in the chest can indicate myocardial infarction.
• Pain may radiate to the left arm, shoulder, neck, jaw, upper back, or epigastrium.
• Symptoms may not be relieved by resting, changing position, or taking oral medication.
• Additional symptoms include diaphoresis (sweating), dyspnoea (shortness of breath), anorexia (loss of appetite), nausea, vomiting, or belching.
• Dizziness can be a symptom with low blood pressure.
• Palpitations are another symptom.
• Patients can experience a feeling of impending death.

Management of Acute Myocardial Infarction

• Call EMS immediately
• Get an AED
• Assist the person to a comfortable position, usually sitting, to aid breathing.
• Have the patient chew Aspirin (160 to 325 mg).
• Administer Nitro-glycerine sublingually or as an aerosol dose every 3-5 minutes, to a maximum of 3 doses.
• Be prepared to start CPR (with AED).
• Conduct a "Secondary Survey" using PQRST-A for pain assessment.

Medical Emergencies: Diabetic Emergencies

• Diabetes is a systemic disease where the pancreas cannot produce insulin.
• Insulin helps glucose be used by the body's cells.
• The absence of insulin causes glucose to accumulate in the blood.
• Uncontrolled blood glucose levels can lead to diabetic emergencies.

Types of Diabetic Emergency

• Hyperglycaemia (high glucose)
• Hypoglycaemia (low glucose)

Treating Diabetic Emergencies

• Difficult to determine if a comatose diabetic is hyper or hypoglycaemic.
• When in doubt, assume the diabetic is hypoglycaemic and give glucose.
• Memory aid:
  • "Hot and Dry – INSULIN I cry!"
  • "Cold and Wet – SUGAR I get!"

Characteristics of Severe Hypoglycaemia

• It can be caused by excessive insulin administration, too little food, or excessive exercise.
• Hypoglycaemia can lead to brain starvation because the brain depends solely on glucose for energy.
• Hypoglycaemic coma can stem from alcoholism, drug overdose, cancer, liver disease, or kidney disease.

Signs and Symptoms of Severe Hypoglycaemia

• Slurred speech
• Mental confusion
• Memory loss
• Incoordination
• Seizures or coma in severe cases
• Cold, clammy skin

Managing Severe Hypoglycaemia

• If the patient is alert and can swallow, administer sugar by mouth (candy bar, juice, soda drink) while avoiding diet drinks.
• Eat a healthy snack to stabilize blood glucose when feeling better.
• If the patient is not fully conscious, do not give anything by mouth.
• Maintain the comatose victim’s airway.
• Activate EMS immediately for intravenous treatment with dextrose.

Medical Emergencies: Neurological Emergencies

• Epilepsy is a neurological illness with recurrent episodes of sensory disturbance, loss of consciousness.

Convulsions

• Convulsions are a symptom of another underlying problem like head injuries, fevers, and also epilepsy.
• Involve a massive discharge of a group of neurons in the brain.
• Range from mild blackouts to uncontrolled muscular contractions for several minutes.
• They usually resolves if the primary problem e.g. fever etc. is rectified if epilepsy is not the primary problem.

Possible causes of convulsions

• Missing anti-epileptic medication
• Stroke
• Head trauma
• Brain tumors
• Hypoxemia
• Hypoglycaemia
• Toxins
• Drug use or withdrawal
• Alcohol withdrawal
• Meningitis
• Preeclampsia in pregnancy (high blood pressure)
• Fever in infants and young children

Signs and symptoms of convulsions

• Loss of consciousness
• Tonic phase with continuous motor tension
• Hypertonic phase followed by clonic phase, rigid hyperextended muscles with alternating rigidity and relaxation.
• Apnoea (not breathing)
• Hyperventilation, salivation and tachycardia
• Confusion, headache, and extreme fatigue after the episode

Management of Convulsion/Seizures

• Call for help
• Maintain an open airway and protect from injuries
• After the seizure, place the person in the recovery position.
• Never put anything in the mouth.
• Remove harmful objects in order to prevent injuries.
• Do not try to restrain the victim.
• Pad the patient's head with a soft object like a pillow or towel.

Neurological Emergencies: Stroke / Cerebrovascular Accident (CVA)

• It when blood and oxygen supply to part of the brain is compromised.
• Either by a blood clot (thrombus or embolism) or haemorrhage in the brain.

Recognition of stroke "FAST"

• Face drooping
• Arm weakness
• Speech difficulty
• Time to call emergency services

Stroke other signs and symptoms

• Confusion
• Stiff neck or severe headache
• Incoordination
• Seizures or coma
• Unequal sized pupils
• High blood pressure

Stroke management:

• CALL EMS immediately!
• Main airway
• Record time of onset of S&S (signs and symptoms)
• Recovery position
• Provide comfort and honest reassurance
• Do not give the victim anything to eat or drink
• Observe vital signs frequently and start CPR if indicated!

Medical Emergencies: Systemic Shock

• Shock is a life-threatening medical condition of poor perfusion.
• The body doesn't have enough oxygen-carrying blood to vital organs.
• This can cause organ function to become affected, and can rapidly lead to death.

Hypovolemia

• The main cause of Hypovolemic shock is due to low levels of fluids
• Caused by excessive bleeding, loss of fluids due to diarrhea or vomiting, extensive burns, excess urination or poor fluid intake.

More causes of Systemic Shock

• Septic shock from severe infection
• Neurogenic shock from spinal cord injury
• Anaphylactic shock due to severe allergic reactions

Key notes on Systemic Shock

• Septic, Neurogenic and Anaphylactic shock, are caused by severe low blood pressure due to abnormal relaxation, and are enlargement (dilation) of blood vessels.
• Cardiogenic shock is caused by a heart attack which then causes a failure of the heart muscle to pump effectively.

Signs and Symptoms:

• The body compensates by decreasing blood flow to the skin and increases the blood flow to the vital organs like the brain, heart and kidneys.
• Pale, cool and clammy skin
• Cool and pale extremities
• Prolonged (>2 seconds) capillary refill
• Increasing the heart and respiratory rate to provide more oxygen-rich blood to the cells
• Tachycardia
• Shortness of breath
• Weak peripheral pulses as compared to central pulses
• At first, normal blood pressure and then later decreased blood pressure of untreated
• Insubstantial blood supply will cause the victim to feel weak, dizzy, and they may faint
• They may also feel sick and vomit, along with becoming thirsty

Treatment of Shock:

• Call emergency medical services
• Stop any bleeding
• Reassure and comfort the patient
• Elevate the legs of the patient at 30-60 degrees
• The leg should not be elevated if there is a suspected pelvis and or femur fracture
• Body temperature should be maintained by covering the patient appropriately
• Loosen any tight clothing
• Do not administer anything to eat or drink
• Check pulse, respiration, and the level of consciousness every 2 minutes or whenever there is a change in the patient's condition
• If they are vomiting or loss of consciousness occurs, place the victim in the recovery position if there is no head and or spine injury, along with the use of log roll
• Commence CPR if necessary(pulseless/unresponsive, not breathing victim)

Anaphylactic Shock:

• This is caused by an anaphylactic reaction which forces fluid to come out of the blood vessels.
• Is generally encountered in patients with severe allergic reactions from insect stings, food and certain drugs.
• The symptoms may become life-threatening with 2 or more symptoms.

Anaphylactic Shock Symptoms:

• Acute respiratory difficulty, with a progressive swelling of the throat, face and even the tissue, while stridor wheeze will be heard and there will be dyspnoea and distress as well.
• Shock is apparent with a decrease in blood pressure and capillary refill.
• Generalized hives become pale, dizzy and with severe swelling for skin or mucosal tissue.

Gastro-intestinal symptoms:

• Crampy abdominal pain
• Nausea
• Vomiting
• Diarrhoea

Treatment:

• Treatment for anaphylactic shock includes giving a dose of adrenaline (Epinephrine)
• Adrenaline reverses the effects of anaphylaxis by reducing throat swelling, opening the airways, and maintaining heart function and blood pressure.
• It is essential for all people that have a known allergic reaction to carry an epipen with them at all times.
• There is no need to remove any clothing before the injection, it will go right through denim