Paramedic Science Poisoning, Overdose & Infection PDF

Paramedic Science Health & Human Development 2 Poisoning / Overdose / Infection  Overdose Opioid Overdose The term “opioids” includes compounds that are extracted from the poppy seed as well as semisynthetic and synthetic compounds with similar properties that can intera...

Paramedic Science Health & Human Development 2 Poisoning / Overdose / Infection  Overdose Opioid Overdose The term “opioids” includes compounds that are extracted from the poppy seed as well as semisynthetic and synthetic compounds with similar properties that can interact with opioid receptors in the brain. Opioids are commonly used for the treatment of pain, and include medicines such as morphine, fentanyl and tramadol.  Overdose Opioid Overdose Signs & Symptoms Pupils will contract and appear small Reduced muscle tone Scratch a lot due to itchy skin Speech may be slurred Altered Levels of Consciousness Breathing is very slow and shallow, erratic, or has stopped Cyanosis and Pale Pallor Airway noises such as stridor's or choking Vomiting Fingernails and lips turn blue or purplish black Pulse (heartbeat) is slow, erratic, or not there at all  Overdose Opioid Overdose Treatment Follow JRCALC Overdose and Poisoning in Adults and Children Specific Substance Management.  Overdose Paracetamol Overdose Paracetamol Overdose is the most common intentional overdose call attended by pre-hospital clinicians. Overdose may occur after excessive ingestion of paracetamol or paracetamol-containing medication as an acute or staggered overdose, or therapeutic excess. Patients are often asymptomatic or have only mild gastrointestinal symptoms at initial presentation. Untreated paracetamol poisoning may cause varying degrees of liver injury over the 2 to 4 days following ingestion, including fulminant hepatic failure. Rarely, massive overdose may initially present with coma and severe metabolic acidosis.  Overdose Paracetamol Overdose Signs & Symptoms Nausea Vomiting Pain and tenderness in the right upper abdomen Confusion Jaundice (yellow tinged skin) Low blood sugar (hypoglycaemia) Unexpected bleeding (normal blood clotting is impaired) Encephalopathy (damage to the brain)  Overdose Paracetamol Overdose Treatment Follow JRCALC Overdose and Poisoning in Adults and Children Specific Substance Management.  Overdose MethyleneDioxy-MethAmphetamine (MDMA) Overdose Otherwise known as ecstasy, it comes in pill or powder form; pill has a variety of logos and colours. It is also has a variety of “street names” such as: Adam, Beans, Biscuit, Clarity, Disco Biscuit, E, Eve, Go, Hug Drug, Lover’s Speed, MDMA, Molly, Peace, STP, X, XTC.  Overdose MDMA Overdose Signs & Symptoms Increased motor activity, alertness, heart rate, blood pressure, muscle tension, tremors, teeth clenching, nausea, sweating, Euphoria, empathy, reduced inhibition, Chills, blurred vision, Confusion, anxiety, depression, paranoia, severe dehydration, sharp increase in body temperature (hyperthermia), which can lead to liver, kidney and cardiovascular failure and death.  Overdose MDMA Overdose Treatment Follow JRCALC Overdose and Poisoning in Adults and Children Specific Substance Management.  Overdose Valium Overdose 'Street Valium' is a benzodiazepine-type tablet which may be known as: blues, vallies, benzos, scoobies and diazepam. They are often white or blue in colour and depending on quality may have a fuzzy or smooth texture. Users may think they are taking diazepam however, it is more likely to be a more potent benzodiazepine such as Etizolam. Etizolam works very quickly with side effects lasting several hours. It is approximately 10 times stronger than diazepam. Using tablets daily can have serious consequences to physical and mental wellbeing. Frequent use can lead to anxiety, depression and sleep problems. Using these tablets in high quantity or mixed with alcohol increases the risk of overdose and death.  Overdose Valium Overdose Signs & Symptoms Decreased energy, heart rate and appetite Blurred vision, small pupils and involuntary eye closure Impaired co-ordination and relaxed muscles Headaches, dry mouth, nausea and vomiting Sleepiness, yawning and in prolonged use – insomnia Mental effects Mental confusion and short-term memory loss Low mood and anxiety Lowered inhibitions and sedative effect  Overdose Valium Overdose Treatment Follow JRCALC Overdose and Poisoning in Adults and Children Specific Substance Management.  Overdose Tricyclic Overdose Tricyclic antidepressants (TCAs) were introduced in the late 1950s for the treatment of depression. With the advent of selective serotonin reuptake inhibitors (SSRIs) and other new antidepressants, the use of TCAs has decreased, although they are still used to treat depression that has not responded to treatment with less toxic agents. In adults, TCAs are also used for migraine headache prophylaxis, treatment of neuralgic pain, including the pain associated with Ciguatera poisoning, and obsessive- compulsive disorder.  Overdose Tricyclic Overdose Signs & Symptoms Central nervous system: excitability, confusion, blurred vision, dry mouth, fever, pupil dilation, convulsions, decreased level of consciousness, arrhythmias, hypotension, tachycardia, respiratory depression; physical condition can rapidly change.  Overdose Tricylic Antidepressant Overdose Treatment Follow JRCALC Overdose and Poisoning in Adults and Children Specific Substance Management.  Poisoning Caustic Agent Poisoning Worldwide, 80% of caustic ingestions occur in young children; these are usually accidental ingestions of small amounts and are often not very harmful. In adults, ingestions of caustic substances are frequently intentional, involve large amounts, and are life- threatening. Common sources of caustics include solid and liquid drain and toilet bowl cleaners, battery acid, and hydrochloric acid for swimming pools. Industrial products are usually more concentrated than household products and thus tend to be more damaging. However, some common household products, including drain and toilet bowl cleaners and some dishwasher detergents, contain damaging caustic substances, such as sodium hydroxide and sulfuric acid.  Poisoning Caustic Agent Poisoning Signs & Symptoms Either strong acids or strong alkalis may cause pain, blistering, penetrating necrosis and coagulating burns. Cardiovascular collapse and metabolic acidosis may occur secondary to an extensive corrosive injury.  Overdose Caustic Agents Overdose Treatment Follow JRCALC Overdose and Poisoning in Adults and Children Specific Substance Management.  Poisoning Carbon Monoxide Poisoning Carbon monoxide poisoning occurs when carbon monoxide builds up in your bloodstream. When too much carbon monoxide is in the air, your body replaces the oxygen in your red blood cells with carbon monoxide. This can lead to serious tissue damage, or even death. Carbon monoxide is a colourless, odourless, tasteless gas produced by burning gasoline, wood, propane, charcoal or other fuel. Improperly ventilated appliances and engines, particularly in a tightly sealed or enclosed space, may allow carbon monoxide to accumulate to dangerous levels.  Poisoning Carbon Monoxide Poisoning Signs & Symptoms Disorientation, decreased consciousness, unconscious, unexplained headaches. NB The supposed cherry red skin colouration in carbon monoxide poisoning is rarely seen in practice and normally precedes mortality.  Overdose Carbon Monoxide Overdose Treatment Follow JRCALC Overdose and Poisoning in Adults and Children Specific Substance Management.  Poisoning Rat Poisoning Rat poisoning is rare in humans and usually occurs accidentally in children or in adults in a suicide attempt. Zoocoumarins are anticoagulants, which disrupts the metabolism of vitamin K in the liver. Vitamin K is involved in the synthesis of various coagulation factors (VII, IX, X, prothrombin) which prevents the blood from clotting, leading to haemorrhagic syndrome. The anticoagulants are rapidly absorbed, almost completely after ingestion.  Poisoning Rat Poisoning Signs & Symptoms Intense headache, pale mucous membranes and skin, Epistaxis, bleeding from the gums, haematuria, gastrointestinal bleeding (black tarry stools, ‘coffee ground’ vomit), tachycardia, hypotension, dizziness, severe weakness, apathy and lack of appetite Rat poisoning can be lethal!  Overdose Rat Poison Overdose Treatment Follow JRCALC Overdose and Poisoning in Adults and Children Specific Substance Management.  Poisoning Paraquat Poisoning Paraquat is a chemical herbicide (weed killer) which is highly toxic. It can cause fatal poisoning when ingested or inhaled, more than 70% of Paraquat poisoning resulted in death. It is a fast process and symptoms develop quickly following ingestion/inhalation. Symptoms may occur within hours of ingestion, however symptoms may still present days to weeks following ingestion/inhalation.  Poisoning Paraquat Poisoning Signs & Symptoms Symptoms: Swelling and pain in mouth and throat, nausea, abdominal pain, vomiting, diarrhoea (blood may be present), epistaxis, hypotension, dehydration and difficulty in breathing Severe symptoms: confusion, muscle weakness, seizures, respiratory failure, tachycardia and coma Paraquat poisoning can cause: Acute kidney failure, Liver failure, Lung scarring, Pulmonary oedema and Respiratory failure  Overdose Paraquat Poison Overdose Treatment Follow JRCALC Overdose and Poisoning in Adults and Children Specific Substance Management.  Infection News2 Scoring The National Early Warning Score (NEWS2) is a system for scoring the physiological measurements that are routinely recorded at the patient's bedside. Its purpose is to identify acutely ill patients, including those with sepsis, in hospitals in England. The NEWS2 scoring system measures 6 physiological parameters: respiration rate oxygen saturation systolic blood pressure pulse rate level of consciousness or new-onset confusion temperature.  Infection News2 Scoring A score of 0, 1, 2 or 3 is allocated to each parameter. A higher score means the parameter is further from the normal range. Appropriate clinical responses are given for threshold (trigger) levels, with a recommendation to review and agree these locally: Low risk (aggregate score 1 to 4) – prompt assessment by ward nurse to decide on change to frequency of monitoring or escalation of clinical care.  Infection News2 Scoring Low to medium risk (score of 3 in any single parameter) – urgent review by ward-based doctor to determine cause and to decide on change to frequency of monitoring or escalation of clinical care. Medium risk (aggregate score 5 to 6) – urgent review by ward- based doctor or acute team nurse to decide on escalation to critical care team. High risk (aggregate score of 7 or over) – emergency assessment by critical care team, usually leading to patient transfer to higher- dependency care area.  Infection Chest Infection A chest infection is an infection of the lungs or large airways. Some chest infections are mild and clear up on their own, but others can be severe and life-threatening. This is a generic term for a number of potential conditions. However, is generally a deterioration of a cold or flu.  Infection Chest Infection Signs & Symptoms a chesty cough – you may cough up green or yellow mucus wheezing and shortness of breath chest pain or discomfort a high temperature a headache aching muscles Tiredness These symptoms can be unpleasant, but they usually get better on their own in about 7 to 10 days. The cough and mucus can last up to 3 weeks.  Infection Chest Infection Treatment Follow JRCALC Dyspnoea Guideline. Or if patient has chest pain follow the non-traumatic chest pain guideline.  Infection Urinary Tract Infection A urinary tract infection (UTI) is an infection in any part of the urinary system. The urinary system includes the kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra. Women are at greater risk of developing a UTI than are men. If an infection is limited to the bladder, it can be painful and annoying. However, serious health problems can result if a UTI spreads to the kidneys.  Infection Urinary Tract Infection Signs & Symptoms Pain/burning sensation when urinating. Increased urinary frequency and nocturia. Offensive smelling urine. Cloudy/bloody urine with a malodour. Nausea and vomiting, Lethargy, Irritability, Poor feeding, Jaundice, fever. If the infection involves the kidneys the patient may have increased temperature >38°C, and fatigue. Rigors may be present.  Infection Urinary Tract Infection Treatment Follow JRCALC Abdominal Pain Guideline.  Infection Sepsis Sepsis (also known as blood poisoning) is the immune system’s overreaction to an infection or injury. Normally our immune system fights infection – but sometimes, for reasons we don’t yet understand, it attacks our body’s own organs and tissues. If not treated immediately, sepsis can result in organ failure and death. Yet with early diagnosis, it can be treated with antibiotics. 5 people die with sepsis every hour in the UK. Infection Infection  Infection Sepsis Treatment Follow JRCALC Sepsis Guideline.  Infection Neutropenic Sepsis Neutropenic sepsis can occur when a patient’s neutrophils are diminished. Neutrophils are white blood cells that help to fight off infection. With a lowered level of white blood cells, a person is more susceptible to infection, in many cases leading to life threatening neutropenic sepsis. Neutropenic sepsis is commonly associated with patients receiving anti-cancer treatment, especially chemotherapy for cancers which affect the bone marrow (where neutrophils are produced), namely Leukaemia, Lymphoma, Myeloma or where the cancer has spread to multiple parts of the body. It is often difficult to diagnose an acute presenting condition in a patient who has recently undergone chemotherapy due to the wide ranging and differing side effects this treatment can have on individuals.  Infection Neutropenic Sepsis Treatment Follow JRCALC Sepsis Guideline.  Infection Peritonitis Your peritoneum is a thin membrane that lines the inside of your belly (abdomen) and wraps around the organs inside. Peritonitis is the term for inflammation of the peritoneum. The tissues can become inflamed if they’re exposed to irritating or infected body fluids. This usually happens when something inside leaks or breaks. Infection is the most common cause of peritonitis, and it can be very dangerous.  Infection Peritonitis Signs & Symptoms Bacterial infections are the most common cause, especially secondary infections that spread from one of your organs. This can happen if you have a hole in your stomach or intestines that lets bacteria from your gastrointestinal tract enter your peritoneal cavity. A burst appendix from appendicitis is another common cause. Less commonly, bacterial peritonitis can start in your peritoneum itself.  Infection Peritonitis Treatment Follow JRCALC Abdominal Pain Guideline.  Infection Diverticulitis Diverticular disease and diverticulitis are related digestive conditions that affect the large intestine (colon). In diverticular disease, small bulges or pockets (diverticula) develop in the lining of the intestine. Diverticulitis is when these pockets become inflamed or infected. Diverticulitis describes infection that occurs when bacteria becomes trapped inside one of the bulges, triggering more severe symptoms. Diverticulitis can lead to complications, such as an abscess next to the intestine.  Infection Diverticulitis Signs & Symptoms more severe abdominal pain, especially on the left side high temperature (fever) of 38C (100.4F) or above diarrhoea or frequent bowel movements  Infection Diverticulitis Treatment Follow JRCALC Abdominal Pain Guideline.  Infection Crohn’s Disease Crohn's disease is a type of inflammatory bowel disease (IBD). It causes swelling of the tissues (inflammation) in your digestive tract, which can lead to abdominal pain, severe diarrhoea, fatigue, weight loss and malnutrition.  Infection Crohn’s Disease Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people, most commonly the small intestine. This inflammation often spreads into the deeper layers of the bowel. Crohn's disease can be both painful and debilitating, and sometimes may lead to life-threatening complications.  Infection Crohn’s Disease Signs & Symptoms Diarrhoea (sometimes mixed with blood, pus or mucus), Stomach aches Fatigue (typically because of the impact of the other symptoms) Loss of appetite Weight loss (caused by both/either the loss of appetite or the inflammation of the gut limiting the amount of nutrients absorbed) Feverishness Mouth ulcers Anaemia (a reduction in red blood cells can manifest from a combination of the above and lead you back into a cycle of fatigue)  Infection Diverticulitis Treatment Follow JRCALC Abdominal Pain Guideline.  Infection Irritable Bowel Syndrome Irritable bowel syndrome (IBS) is a common disorder that affects the stomach and intestines, also called the gastrointestinal tract. Symptoms include cramping, abdominal pain, bloating, gas, and diarrhoea or constipation, or both. IBS is a chronic condition that you'll need to manage long term.  Infection Irritable Bowel Syndrome Only a small number of people with IBS have severe symptoms. Some people can control their symptoms by managing diet, lifestyle and stress. More severe symptoms can be treated with medication and counseling.  Infection Irritable Bowel Syndrome Signs & Symptoms abdominal (stomach) pain and cramping, which may be relieved by the patient moving their bowels. a change in the patients bowel habits – such as diarrhoea, constipation or sometimes both. bloating and swelling of the abdomen. excessive wind (flatulence) The patient occasionally experiencing an urgent need to move their bowels.  Infection IBS Treatment Follow JRCALC Abdominal Pain Guideline.  Infection Kidney Stones A kidney stone is a hard object that is made from chemicals in the urine. There are four types of kidney stones: calcium oxalate, uric acid, struvite, and cystine. A kidney stone may be treated with shockwave lithotripsy, uteroscopy, percutaneous nephrolithomy or nephrolithotripsy. Common symptoms include severe pain in lower back, blood in your urine, nausea, vomiting, fever and chills, or urine that smells bad or looks cloudy.  Infection Kidney Stones Urine has various wastes dissolved in it. When there is too much waste in too little liquid, crystals begin to form. The crystals attract other elements and join together to form a solid that will get larger unless it is passed out of the body with the urine. Usually, these chemicals are eliminated in the urine by the body's master chemist: the kidney. In most people, having enough liquid washes them out or other chemicals in urine stop a stone from forming. The stone-forming chemicals are calcium, oxalate, urate, cystine, xanthine, and phosphate.  Infection Kidney Stones After it is formed, the stone may stay in the kidney or travel down the urinary tract into the ureter. Sometimes, tiny stones move out of the body in the urine without causing too much pain. But stones that don't move may cause a back-up of urine in the kidney, ureter, the bladder, or the urethra. This is what causes the pain.  Infection Kidney Stones Signs & Symptoms severe pain on either side of your lower back more vague pain or stomach ache that doesn't go away blood in the urine nausea or vomiting fever and chills urine that smells bad or looks cloudy The kidney stone starts to hurt when it causes  Infection Kidney Stones Treatment Follow JRCALC Abdominal Pain Guideline.  Infection Appendicitis Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen.  Infection Appendicitis Signs & Symptoms Sudden pain that begins on the right side of the lower abdomen Sudden pain that begins around your navel and often shifts to your lower right abdomen Pain that worsens if you cough, walk or make other jarring movements Nausea and vomiting Loss of appetite Low-grade fever that may worsen as the illness progresses Constipation or diarrhoea Abdominal bloating Flatulence  Infection Appendicitis Treatment Follow JRCALC Abdominal Pain Guideline.  Infection Liver Conditions Cirrhosis: Scarring of the liver caused by long-term liver damage. Symptoms: - feeling very tired or weak, nausea, loss of appetite, weight loss, muscle mass loss, spider angiomas (spider-like blood vessels on the skin), redness to palms, jaundice, haemaetemasis, itchy skin, tar-like stools, ascities. Hepatitis: Inflammation of the liver, usually as a result of a viral infection or damage to liver due to alcohol. Symptoms: muscle and joint pain, pyrexia, nausea/vomiting, abdominal pain, dark urine, pale/grey stools, itchy skin, jaundice, loss of appetite, feeling unusually tired Acute/Chronic Liver Failure: loss of liver function. Symptoms: jaundice, upper right quadrant abdominal pain, ascities, nausea/vomiting, confusion, lethargy, tremors  Infection Liver Conditions Acute/Chronic Liver Failure: loss of liver function. Symptoms: jaundice, upper right quadrant abdominal pain, ascities, nausea/vomiting, confusion, lethargy, tremors Portal Hypertension: increase in the blood pressure in the portal vein, which carries blood from the bowel and spleen to the liver. The pressure may rise due to a blockage, eg blood clot, or due to the resistance in the liver increasing due to cirrhosis. Symptoms: bleeding varices, ascities and encephalopathy.  Infection Liver Conditions Treatment Follow JRCALC Abdominal Pain Guideline.  Infection Scarlet Fever Scarlet fever is a bacterial illness that develops in some people who have strep throat. Also known as scarlatina, scarlet fever features a bright red rash that covers most of the body. Scarlet fever almost always includes a sore throat and a high fever. Scarlet fever is most common in children 5 to 15 years of age. Although scarlet fever was once considered a serious childhood illness, antibiotic treatments have made it less threatening. Still, if left untreated, scarlet fever can result in more-serious conditions that affect the heart, kidneys and other parts of the body. Scarlet fever is contagious.  Infection Scarlet Fever Signs & Symptoms The signs and symptoms that give scarlet fever its name include: Red rash. The rash looks like a sunburn and feels like sandpaper. It typically begins on the face or neck and spreads to the trunk, arms and legs. Pushing on the reddened skin makes it turn pale. Red lines. The folds of skin around the groin, armpits, elbows, knees and neck usually become a deeper red than the other areas with the rash. Flushed face. The face may appear flushed with a pale ring around the mouth. Strawberry tongue. The tongue generally looks red and bumpy, and it's often covered with a white coating early in the disease.  Infection Scarlet Fever Signs & Symptoms  Infection Scarlet Fever Signs & Symptoms Signs and symptoms of scarlet fever also include: Fever of 100.4 F (38.0 C) or higher, often with chills Very sore and red throat, sometimes with white or yellowish patches Difficulty swallowing Enlarged glands in the neck (lymph nodes) that are tender to the touch Nausea or vomiting Belly (abdominal) pain Headache and body aches  Infection Scabies Scabies is a contagious skin condition caused by tiny mites that burrow into the skin. The main symptom of scabies is intense itching that's worse at night. It also causes a skin rash on areas where the mites have burrowed.  Infection Scabies Signs & Symptoms Scabies symptoms include: Itching, often severe and usually worse at night Thin, wavy tunnels made up of tiny blisters or bumps on the skin Scabies is often found in the skin folds, but scabies can appear on many parts of the body. In adults and older children, scabies is most often found: Between the fingers and toes, In the armpits, Around the waist, Along the insides of the wrists, On the inner elbows, On the soles of the feet, On the chest, Around the nipples, Around the belly button, Around the genitals, In the groin area, On the buttocks.  Infection Scabies Treatment Scabies is not usually a serious condition, but it does need to be treated. A pharmacist will recommend a cream or lotion that the patient can apply over their whole body. Scabies is very infectious, but it can take up to 8 weeks for the rash to appear. Everyone in the home needs to be treated at the same time, even if they do not have symptoms.  Infection Chicken Pox Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab over. It usually starts on the chest, back, and face, then spreads to the rest of the body.  Infection Chicken Pox The rash and other symptoms, such as fever, tiredness, and headaches, usually last five to seven days. Complications may occasionally include pneumonia, inflammation of the brain, and bacterial skin infections. The disease is usually more severe in adults than in children.  Infection Shingles Shingles (Herpes Zoster) is a viral infection of an individual nerve and the skin surface served by that nerve (dermatone). It is caused by the reactivation of the varicella-zoster virus, which causes chickenpox virus. The risk of developing shingles increases with age. Other risk factors include: immunocompromise (eg long term corticosteroid use; HIV; chemotherapy treatment), co-morbidities (such as rheumatoid arthritis and asthma, psychological factors and the female sex.  Infection Shingles Symptoms Usually a prodromal phase occurs where abnormal skin sensations and pain occur in the affected dermatome. Headache, photophobia, malaise and fever (less common) can also be experienced in this phase. Within 2-3 days a rash will occur, starting with maculopapular lesions which develop into clusters of vesicles, with further vesicles forming over 3-5 days. These vesicles then burst and crust over within 7-10 days.  Infection Guillain-Barre Syndrome Guillain-Barre Syndrome is a very rare and serious condition that affects the nerves. It mainly affects the feet, hands and limbs, causing a variety of problems such as numbness, weakness and pain. It affects people of all ages, but is more common in adults and males. Guillan-Barre syndrome is thought to be caused by the immune system, where it mistakenly attacks and damages the nerves. The condition often occurs following an infection, most commonly following a respiratory or gastrointestinal infection.  Infection Guillan-Barre Syndrome Symptoms Symptoms often start in the feet and hands before spreading to the limbs. Common symptoms include: numbness, pins and needles, muscle weakness, pain and problems with balance or co-ordination. The symptoms tend to increase over a few days and weeks before they slowly start to improve. However, in severe cases they may have difficulty in walking, moving, breathing and/or swallowing.  Infection Guillan-Barre Syndrome Treatment Most people will require to be treated in hospital where they may receive treatments such as: intravenous immunoglobin, plasma exchange, pain relief and treatments to support body functions such as ventilation and NG tube insertion. Most patients require to be admitted to hospital for a few weeks to a few months. Recovery usually occurs within 6-12 months, however it may take several years to recover. 1 in 5 people are left with long term problems such as: weakness to arms, legs or face; numbness, pain or tingling sensations; balance and co-ordination problems and extreme tiredness.  Infection Review of Systems – Red flag symptoms Respiratory: chest pain, shortness of breath, dyspnoea, cough (productive/colour/character of sputum), haemoptysis. Gastrointestinal: nausea/vomiting, haematemesis, abdominal pain, dysphagia, recent unplanned weight loss, decrease in appetite, indigestion, jaundice, diarrhoea, constipation, blood in stools, changes to bowel habits. Genitourinary: dysuria, changes to colour/smell of urine, increased/decreased frequency of urination, incontinence, back/flank pain, changes to menstruation regularity/chance of pregnancy/abnormal period. General: rashes, fatigue, fever, night sweats, unexplained bruising, disturbed sleep, neck swelling.  Contact Information Should you have any questions you should contact the module lead in the first instance. Followed by your syndicate lead if appropriate. Module Lead: Will Hendry [email protected] Programme: Paramedic Science [email protected]