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CASE
ASSESSMENT
PATHOPHYSIOLOGY
STATUS ASTHMATICUS
Onset
Provocation
Quality
Radiation
Severity
SAMPLE Hx
PULMONARY EDEMA
CHRONIC
OBSTRUCTIVE
PULMONARY DISEASE
(COPD)
Chronic
Bronchitis
Provocation:
1. Resp Infection
2. Emotional Stress
3. Allergic Reaction
Excess FLUID BUILD UP in the
lungs often caused by MI or
related heart disease and
occasionally by inhalation of
smoke and or toxic fumes.
Alveoli collapse due to
adhesive property of H2O.
Repeated infections
thicken and destroy the
lining of the bronchi and
bronchioles causing
narrowing and
becoming obstructive
by too much MUCUS
and EXCESSIVE
CONTRACTIONS of the
muscle in their walls.
Pulmonary
Emphysema
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Anxiety
Patient breathes through pursed
lips
Wheezing
Chest overinflated
Tachycardia
Tripod post
MANAGEMENT
VENTILATION
OXYGEN
POSITION
1.
2.
1.
High Flow O2
Consider
PEEP/CPAP
Ventilate with
100% O2.
TRANSPORT
CONSIDERATION
IMMEDIATE while
monitoring vital
signs.
IMMEDIATE
Same as Status
Asthmaticus
Hyperventilation
Syndrome
Deep Venous
Thrombosis and
PULMONARY EMBOLISM
DANGER SIGNS!!!
1. Loss of Wheezing
2. Change in Sensorium (Confusion,
Irritability, Lethargy)
3. Hypoxia
Onset
Provocation
Quality
Radiation
Severity
SAMPLE Hx
Abnormal increase in
respiration rate and
tidal volume.
Anxiety of an
emergency often
leads to
hyperventilation.
Stasis
Hypercoagulation
Blood vessel
endothelial damage
3% chance Pulmonary
Embolism will kill your
patient.
Blood clot in deep veins goes
to the lungs and interrupt
blood flow to the lungs.
Affected extremity:
Painful
Swollen
Red
Warm
Prevent Lethal
Hypoxia
Depending on the
level of hypoxia.
Reassurance and
instruct the patient
to slow down
breathing.
Depending on the
severity.
IMMEDIATE
Pulmonary Embolism
1. LOC restless, anxiety
C
1. Rapid heart rate
2. Cold clammy skin
3. Falling blood pressure
4. Distended Neck Veins
5. Cyanosis
A&B
1.
2.
3.
Respiratory Infections
Croup
Onset
Provocation
Viral
Upper Airway
VENTILATE with
100% O2
Epiglotitis
Pneumonia
Bacterial
Quality
Radiation
Severity
1.
SAMPLE Hx
CASE
ASSESSMENT
PATHOPHYSIOLOGY
Angina Pectoris
OPQRSTA
CARDIOVASCULAR EMERGENCIES
SIGNS AND SYMPTOMS
1.
2.
3.
4.
5.
Indigestion
Chest pain that comes after
exertion
Chest pain that lasts only for a
few minutes
Relieved after admin of
nitroglycerins
SOB, Nausea, increased pulse
rate
MANAGEMENT
1.
2.
3.
4.
ACUTE MYOCARDIAL
INFARCTION
(Silent MI patient
doesnt feel any pain)
Heart Attack
Portion of the myocardium
dies due to deprived
coronary blood flow.
1.
2.
3.
High flow O2
asap.
Assist in
nitroglycerin
admin if systo
BP is greater
than 90 (know
if
administered
already and
know how
many times)
Place in restful
and
comfortable
position.
Reassure.
Conscious:
1. High conc. O2
2. Keep patient
calm and still.
3. Take the Hx and
VS.
4. Help patient
with prescribed
medications
5. Transport
immediately in
TRANSPORT
CONSIDERATION
LIGHTS ONLY
Transport
immediately in
semi sitting
position. Quiet
transport (little
or no use of siren)
4.
Signs of shock
6.
semi sitting
position. Quiet
transport (little
or no use of
siren)
Monitor VS
throughout care
and transport
Unconscious:
1. Establish and
maintain Airway.
2. Provide
CPR/Defib if
needed. PPV if
needed through
BVM.
3. High conc. O2.
4. Transport
immediately in
semi sitting
position. Quiet
transport (little
or no use of
siren)
5. Monitor VS
throughout care
and transpo.
Aortic Aneurysm
OPQRSTA
Dilatation or
outpouching of a blood
vessel particularly the
aorta.
1.
2.
3.
1.
2.
3.
Calm and
reassure the
patient.
Administer
100% O2 by
NRM
Place in a
Transport without
delay
4.
HYPERTENSIVE
EMERGENCIES
Hypertension
Cardiac Tamponade
Pericarditis
Major contributing
cause in many cases of
MI, CHF, and CVA.
Present when BP at rest
is consistently greater
than 140/90 mmHg
Common complication
is renal damage, heart
failure and brain attack.
Accumulation of blood
in the pericardial sac
Most common result in
penetrating injury.
1.
2.
3.
4.
5.
6.
7.
Severe headache
Nausea and vomiting
Altered Mental Status
Aphasia, sudden blindness
Muscle twitching
Seizures
Hemiparesis
1.
1.
2.
3.
4.
5.
1.
2.
3.
Inflammation of the
pericardium (inner wall of
the heart )
Idiopathic infection
Metabolic factors
Trauma
1.
2.
1.
2.
3.
3.
4.
5.
6.
7.
8.
Dyspnea
Chest Pain that aggravates while
2.1. Breathing
2.2. Lying on left side
2.3. Turning on Bed
Fever, Chills, Fatigue (sign of
infection)
Anxiety or Confusion
Engorged, pulsating neck vein
(LATE SIGN)
Cyanosis
Normal/ Elevated BP
Tachycardia
Pedal Edema
Dyspnea
Pulmonary Edema with rales,
sometimes coughing of Frothy
white or pink sputum
2.
3.
4.
5.
1.
2.
3.
1.
2.
3.
comfortable
position.
Transport
without delay.
Secure airway ,
administer O2.
Transport
without delay
Seizure
precaution
Transport without
delay
Semi-fowlers
O2
Immediate
transport
Monitor
Surgeons will
immediately do
a
pericardiocent
esis
IMMEDIATE
Priority of care
CAB, Administer
O2.
Immediate
transport in
sitting position
Monitor
Place patient in
a comfortable
position (Semi
fowler or sitting)
Give high
concentration
O2 through NRM
Monitor
Immediate
transport in sitting
position
Lights only?
9.
BLEEDING (Heart,
Blood Vessels,
Blood)
External Bleeding
Severity:
1.
2.
Safety BSI
Control bleeding
2.1. Direct
pressure
2.2. Elevation
above level
of heart (if
swollen or
deformed DO
NOT)
2.3. Pressure
points
2.4. Splints
2.5. Pressure
splints
2.6. Torniquet
(last resort)
2.6.1. Torniquet
must be at
least 4
inches
2.6.2. Put the
tourniquet
around
twice
2.6.3. Knot and
put a stick
2.6.4. Twist and
secure the
stick or
rod until
bleeding
stops
2.6.5. Document
2.6.6. NEVER use
a wire
2.6.7. NEVER
remove
once
Depends on the
amount of
bleeding.
Internal Bleeding
Injured or damaged
internal organs
Fractured extremities
esp. Femur and Pelvis
1.
2.
3.
4.
5.
LATE SIGNS:
1. Altered LOC, Anxiety,
restlessness, combativeness.
2. Weakness, faintness, dizziness
3. THIRST
4. Signs of shock
SHOCK
Scene Size
up
Monitor for
s/sx of
shock
through
focused Hx
and PE
Establish
VS
Mental
Status
Peripheral
perfusion
Mental Status:
1. Restlessness
2. Anxiety
3. Altered LOC
Peripheral Perfusion and skin
perfusion
1. Pale, cool, clammy skin
2. Weak, thread, or absent
peripheral pulses
3. Delayed capillary refill in ambient
air temp.
VS
1. Increased Pulse rate
2. Increased RR deep, shallow,
labored, irregular
3. Decreased BP(LATE)
secured
2.6.8. Leave in
OPEN
VIEW
2.6.9. NEVER
APPLY TO
JOINT
Goals:
Recognize
presence of
internal
bleeding
Maintain body
perfusion
Provide rapid
transport
1. Safety BSI
2. Open airway
and provide O2
and ventilation
per SpO2 and
ETCO2
3. Transport
Immediately
4. Shock
treatment
1. Safety BSI
2. Maintain open
airway
3. Control any
external
bleeding
4. Elevate lower
extremities
approx. 8 to 12
inches
5. Splint suspected
injuries
6. Use blanket to
warm patient
7. IMMEDIATE
TRANSPORT
ADVANCED CARE
1. Fluid
IMMEDIATE
IMMEDIATE
Class I
(Compensated)
15% 750 ml
Compensates
Constricts
blood vessels
in effort to
maintain BP
and deliver
oxygen to ALL
organs
MI
TheACUTE
Four Stages
of Shock
Class II
Class III
(Decompensate (Decompensated)
Other:
d)
1.30%
Dilated
1,500pupils
ml (sluggish)
40% 2000 ml
2. Marked
thirst
Body
Response
3. Nausea and vomiting
Continued
Compensatory
4. Pallor and cyanosis to the lips
vasoconstrictio
mechanism
n
to
maintain
become
R heart failure Pulmonary
edema
but Pedal edema
overtaxed.
L perfusion
heart failure
with some
Vasoconstrictio
difficulty
n cannot
N LOC
N VS
750 ml
enough to
occupy a limb
or a body
cavity which
could cause
little
discomfort,
pain,
swelling.
pressure rise
and fall. May
stay the same
on healthy
patients
Decreased
pulse
pressure
Class IV
(Irreversible)
replacement
LR/NSS
warmml
>40%
>2000
1.1. Large bore IV
G16, G14
min.
Compensatory
ideal
vasoconstrictio
1.2. Use blood
n become a
tubings
complicating
1.3. Apply
factor further
pressure
to
impairing
bag
to speed
tissue
Blood is
up
infusion
maintain BP
perfusion
BT is and
shunted to
begins to fall. 2. Unless
cell
available,
titrate
vital organs
Decreased CO
oxygenation.
fluid
infusion to
Decreased flow
and perfusion
the BP using
to intestines,
Patient can still
radial pulse as
kidneys, and
recover with
guide. 250
skin.
prompt
initial until
treatment.
radial pulse is
Effect on Patient
present then
Restlessness
Confused,
TKOLethargy,
3. Head
injury
and confusion
restless,
drowsy,
min
systolic
anxious
stuporous90
Pale, cool, dry
mmHg
Classic signs
Sign of shock
skin due to
shunting
of shock
become more
appears
pronounced
Diastolic
Cool clammy
Pulse Pressure
continues to
narrow
Symphatetic
response also
causes rapid
HR
Stages of Shock
Increased RR
Delayed
capillary refill.
ANGINA
Pain after exertion or stress
Relieved by Rest
Usually relieved by nitro (post
3 doses in 15 min assume MI)
BP not affected
Short term
extremities
Continued BP
fall
Organ failure
and death due
to insufficient
blood flow.
Cardiogenic Shock
Hypovolemic Shock
Obstructive Shock
Distributive Shock
CLASSIFICATION OF SHOCK
Heart in origin
Severe Blood loss
Hemorrhagic Shock
Problem in the vascular system
Cardiac tamponade
Tension Pneumo
Pulmonary embolism
Fluid or blood in the wrong place
Septic Shock
Anaphylactic Shock
NEUROLOGICAL EMERGENCIES
CASE
Transient Ischemic
Attack (TIA)
ASSESSMENT
PATHOPHYSIOLOGY
RECURRENT
neurological deficits
of any type that
correspond to the
disorientation of a
particular cerebral
artery and vertebrabasilar artery and
last anywhere from a
FEW SECOND to 12
HOURS.
MANAGEMENT
TRANSPORT
CONSIDERATION
SEIZURE DISORDERS
Tonic Clonic (Grand
Mal)
Neurologic
examination
between attacks
maybe ENTIRELY
NORMAL
Some patients
onset of attack is
clearly related to
standing up after
lying or sitting or it
occurs on relation to
exertion, emotional
stress or bout of
coughing.
Types of Seizures:
1. Simple partial seizure (focal
motor, focal sensory or
Jacksonian) tingling, stiffening
or jerking in just one part of the
body. Aura may present (bright
lights, crust of colors, or a rising
sensation in the stomach)
2. Complex partial seizure
(psychomotor) abnormal
behavior that varies. May
involve confusion, glassy stare,
lip smacking or chewing, aimless
moving about or fidgeting with
clothing.
1.
2.
3.
4.
5.
Protect the
patient from
injury
Guard airway but
NPO
DO NOT restrain
patient. Remove
objects and gently
guide away from
danger.
Loosen
obstructive
clothing.
Take vital signs
and monitor
respirations
closely.
Causes of seizure:
1. Febrile
2. Idiopathic
3. Brain tumor
4. Congenital brain
deficits
5. Metabolic
6. Infection
7. Toxic
Stroke
(Cerebrovascular
Accident/ CVA)
Ischemic Stroke
Hemorrhagic Stroke
Blockage in arteries
supplying oxygenated
blood will result in
damage to affected parts
of the brain.
An aneurysm or other
weakened are of an artery
ruptures.
Often associated with
arteriosclerosis and
hypertension
Two effects:
1. An area of the brain
is deprived of
oxygenated blood
2. Pooling blood push
8. Trauma
Same as grand mal
Classification:
1. Transient Ischemic Attack
2. Reversible Ischemic Neurologic
Deficit
3. Stroke in Evolution/Completed
Stroke
3 Types of Cerebral
Edema
1. Cytotoxic
2. Vasogenic
3. Interstitial
If Brain Edema
suspected:
1. Modest Fluid
restriction
2. Elevation of head
of bed (20 30
degree)
3. O2 and Ventilation
support
4. Control of
agitation and
pain.
Conscious:
1. Ensure an open
airway
2. Keep patient calm
3. Maintain eye
contact and speak
SLOW and
CLEARLY.
4. High O2
5. Monitor VS
6. Semi reclined post
7. NPO
8. Keep warm
9. Sit in front of
patient.
Unconscious:
LOAD AND GO
Window period 3
hours but the
faster the
better.
Causes:
A Alcohol and other
drugs
E pilepsy,
Endocrine/Exocrine
I insulin, hypo/hyper
O oxygen, overdose and
opiates
U Uremia
T trauma and temp
I infection (Sepsis or
Meningitis)
P poisons and
psychiatric
S shock, stroke or space
occupying lesion.
4.
S/Sx:
1. Confusion
2. Hemiparesis
3. Hemiplegia
4. Impaired speech
5. Facial flaccidness and loss
expression
6. Headache
7. Unequal pupil size
8. Impaired vision
9. Cushings Triad
9.1. Hypertension
9.2. Irregular RR
9.3. Slow pulse
10. Convulsions
11. Coma
12. Incontinence
13. Inappropriate behavior
14. Stiffed neck
15. Staggering gate
1.
2.
3.
4.
5.
6.
1.
2.
3.
4.
5.
6.
Maintain open
airway
High O2
Ventilation if
needed
Monitor VS
Lateral recumbent
post.
Protective
padding
Visual
Memory
Comprehensi
on
Proprioceptio
n
Verbal
Memory
Carelessness
and
Impulsivenes
s
Emotion and
Affect
OK: Appropriate
7 Ds of Stroke Management:
1.
2.
3.
4.
5.
6.
7.
ASSESSMENT
Hyperglycemia
Hypoglycemia
Have you
taken your
meals?
Have you
taken your
insulin?
Have you
vomited
your
meals?
Have you
done
strenuous
activities?
CAUSES
1.
2.
3.
4.
1.
2.
3.
4.
MANAGEMENT
1.
2.
O2 via NRM
Transport to
medical
facility
3. Arrange for
ALS intercept.
However, all
management to
DM
emeregencies
towards
hypoglycemia.
1.
Granular
Sugar under
tongue.
1.1. Conscious:
any sweet
solid or
liquid
1.2. Unconsciou
s:
1.2.1. Avoid
giving
liquid
1.2.2. Turn head
to side or
place in
lateral
recumbent
.
CAUSE OF
DEATH
1. Dehydration
and poor
nutrition
2. Hypokalemia
3. Hypoinsuline
mia
4. DKA (Diabetic
Ketoacidosis)
ketones in
urine >
acidosis
>compensate
s by
Kaussmals
breathing to
decrease
acidosis >
Diabetic
COMA
Hyperinsulinemia
- Insulin Shock.
2.
3.
4.
Provide High
O2
Transport to
medical
facility
Arrange ALS
intercept.
ASSESSMENT
Supine
Knee chest
flexed
Examine
last most
painful
part
N abd.
Assess:
No pain,
soft, non
rigid,
warm to
touch, not
distended
PATHOPHYSIOLOGY
Pain/ tenderness
Anxiety / fear
Guarded position
Rapid shallow breathing
Rapid pulse
Nausea vomiting or diarrhea
Rigid or tense abdomen
Internal bleeding
MANAGEMENT
1.
2.
3.
4.
5.
6.
7.
8.
Safety and
BSI
CAB
Keep airway
patient be
alert for
vomiting
Place pt. to
position of
comfort
NPO
Calm and
reassure pt.
Be alert for
shock
Transport
efficiently
TRANSPORT
CONSIDERATION
Efficient Transport
Urinary Colic
Nephrolitiasis formation
of stone in the kidney (or
anywhere in the urinary tract
but calculi begin to form in
kidney). Stone size may vary
in size.
Renal calculi classification
Calcium Phosphate
65%
Calcium Oxalate
Magnesium
Ammonium
Phosphate (stravite)
15%
Supersaturation of
Urine stone formation
due to crystalloid
Presence of Nidus a
must. Nidus or nuclei
which layer can be
deposited
Stasis further
promotion of stone
formation
pH or solution
1.
2.
3.
4.
If alert, advise
to increase
fluid intake to
over 4000
ml/24 hour.
Administer
analgesic/anti
spasmodic
according to
local protocol
Keep on bed
rest (with
Entonox)
Transport to
hosp for
further
management.
Transport
efficiently
Rupture of Ovarian
Cyst
Pelvic Inflammatory
Disease (PID)
ASSESSMENT
PATHOPHYSIOLOGY
Development of a fetus
outside the womb
Causes:
Past ectopic
pregnancy
Past salpingitis
Surgery of the
fallopian tube
Formation of mass in the
ovary with idiopathic cause.
Sexually transmitted
disease
1.
2.
3.
4.
5.
6.
Ammenorhea
Pain in the L/R iliac region
Abnormal vaginal bleeding
Low back pain
Breast tenderness
Nausea
1.
2.
3.
4.
5.
6.
1.
2.
3.
4.
5.
MANAGEMENT
1.
2.
3.
4.
5.
6.
Ensure open
airway
O2 as
required
NPO
Vomiting
precaution
(positioning)
Monitor VS
Shock
precaution
TRANSPORT
CONSIDERATION
Dysfunctional Uterine
Bleeding (DUB)
Estrogen imbalance
Menopause syndrome
Female of advanced
age
6.
1.
2.
3.
4.
5.
6.
7.
8.
Other : Rape
OBSTETRICS
o
o
o
o
o
3 weeks
zygote/ fertilized
ovum
3-8 weeks
embryo
9-38 weeks
fetus
Birth to 28 days
neonate
29 days to 1 yo
infant
Maximum
tact and
sensitivity
Female
EMT
should be
present
EMT must
take care
of urgent
med.
Problems
Preserve
evidence
Protect
patients
privacy
Document
Important
elements of
Assessment:
1. Age of
patient
2. LMP
3. AOG
4. Gravida
5. Parity
Criterias:
1. Due date
2. Contraction
1.
2.
3.
4.
5.
6.
Mech. Of Delivery:
Engagement > Descent >
Flexion > Internal Rotation >
Extension > Expulsion
Equipments:
1. Gloves
2. Drawsheet
3. Suction Bulb
4. Towels
5. Gauze
6. Scalpel
7. Umbilical clamp
Sx of
1.
2.
3.
imminent delivery:
Urgeto push
Presence of crowning
Increase pressure in the vagina
Ensure open
airway
O2 as
required
NPO
Vomiting
precaution
(positioning)
Monitor VS
Shock
precaution
Imminent delivery:
1. Do not allow
to use toilet
2. Consult MD
concerning
decision to
deliver baby
at the scene.
3. Do not
clamp/cut
cord if the
baby is not
breathing on
General Steps in
NSD
1. Prepare
mother for
delivery
2. Assist
3. Initial care of
the newborn
o
o
1 yo to 12 yo
child
UTZ most
reliable dx tool
3.
4.
5.
6.
COMPLICATION
ONFIRST TRIMESTER
Abortion
? Frequency
and
Duration?
Increase
Spressure
in vagina?
Urge to
push?
Crowning?
Broken bag
of water?
8.
Termination of pregnancy
before 28 weeks
1.
2.
Threatened
Closed cervix
a. Mild pain (back pain,
lower abd.)
b. Mild vaginal spotting
3. Inevitable cannot
preserve pregnancy
a. With placental/fetal
fragments came out
b. Severe back pain
c. Moderate, obvious
bleeding
d. Shock
4. Incomplete
placental/fetal
fragments expelled
5. Complete
abortus/fetus expelled
5.
its own.
If within 5
minutes woman
will deliver the
baby, do not load
and go. If inside
the ambu,stop
and deliver the
baby.
Pre Eclampsia
Eclampsia
Supine Hypotension
H-mole
Eclampsia
Abrutio Placenta
Cerebral retinal
damage
Pulmonary edema
1.
2.
3.
4.
5.
6.
Neurological
Compression of the Vena
Cava due to pregnancy.
No fetus but with signs of
pregnancy
1.
2.
3.
Excessive vomiting during
pregnancy
1.
2.
3.
4.
3RD TRI/ANTENATAL
COMPLICATIONS
Abruptio Placenta
Placenta Previa
LIGHTS ONLY
Left Lateral
Position
Incompetent Cervix
Hyperemesis Gravidum
Transport
FHT
monitoring
CAB
Prevent
stimulus
O2 per SpO2
Therapeutic
Environment
1.
Complete bed
rest
Constant OB
supervision
Cervical
Cerclage
Crackers on
bed side
Small
frequent
feeding
Ensure
nutrition
Maintain
hydration
Transport for
Emergency CS
1.
2.
Transport
immediately
Shock
precaution
IMMEDIATE
Uterine Rupture
Common to G3 above
Due to Blunt Trauma.
Repeated stretching of
the uterine wall
Old CS
Prolonged labor against
o
Obstruction
o
Weakened uterine
wall
COMPLICATIONS OF
LABOR and
DELIVERY
Prolapsed Cord
For emergency CS
Cord compressed
between the neonates
head and birth canal
1.
2.
3.
4.
3.
1.
2.
Do not IE
CAB
Transport
1.
Position
mother to
knee chest
position
Push the
neonates
head to
relieve
compression
to cord
Wrap cord
with moist
sterile gauze
to prevent
damage
Upon delivery
of head look
for the cord if
looped around
the neck
Gently slip if
possible
If not, clamp
the cord and
cut (protocol)
2.
3.
1.
2.
3.
Meconium Staining
IMMEDIATE
greenish discoloration
of the amniotic fluid
Complication:
o
Neonatal Sepsis
meconium
aspiration
o
Neonatal
respiratory distress
neonate may not
be able to clear
lungs.
Difficulty of fetus to
come out
Infection
Trauma
Complication to mother
o
Leak to pelvis
>Amniotic fluid
enter circulation >
Pulmonary Embolism
NEONATAL CARE
Cardio respiratory
changes that occur in
birth:
o
To get rid of the
fluid filling the
lungs so that it
can expand
o
Closing of the
foramen ovale
and ductus
arteriosus
Routine care:
1. Warming
2. Airway
3. Position
4. Cord
cutting
5. Prevention
of
meconium
aspiration
HR
< 60 CPR
APGAR
8 10 mild distress
4 7 moderate
1 3 severe
Medical
Dilated pupil
GCS <10
Pediatric trauma score <8
Persistent Fever
Increase effort in breathing
Trauma
Struck by a car.
NEONATAL SEIZURES
Stage
1st
2nd
3rd
Causes:
1. Hypoxic Ischemic
Encephalopathy
2. Metabolic Disturbance
3. Meningitis or
Encephalitis
4. Developmental
abnormalities
5. Drug withdrawal
6. Maternal anesthesia
7. Stroke
Hallmark Signs
True labor to full cervical dilation
Full cervical dilatation to birth of neonate
Birth of neonate to placental delivery
Contractions
PainSIGN
radiation
Appearance
Bluish
Pain alleviation
Frequency,
Duration,
Intensity
Cervical Dilatation
False Labor
True Labor
Irregular
Regular
Abdomen
Lower back then
0
1
2
or pale
Pink trunk, blueabdomen
Pink
Alleviated by
Not alleviated
extremity
ambulation
No increase
Increasing
No dilatation
Types:
1. Subtle Head part ocular, facial,
oral or ligual movements and
respiratory manifestation such as
apnea or stutortorous breathing
2. Tonic pre-term infant: seizure
appear decerebrate or decorticate
posturing
3. Multifocal clonic term infants:
noted in one limb and migrate to
another part of the body.
4. Focal clonic term infants:
localize and are accompanied by
short activity of EEG.
5. Myoclonic premature and term
infants: single multiple jerk and
flexion of the upper and lower
extremities
With dilatation
APGAR SCORING
Pulse
Grimace
Absent
No Response
Activity
Limp
Respiration
Absent
<100 bpm
Some motion,
grimace
Some flexion,
extremeties
Slow and
irregular
>100 bpm
Cry, cough,
sneeze
Active, good
motion
Normal, crying
BURN EMERGENCIES
CASE
Type
1.
2.
3.
4.
5.
6.
7.
of burns
Chemical
Radiation
Electrical
Thermal
Scald
Contact
Flash
ASSESSMENT
PATHOPHYSIOLOGY
MANAGEMENT
Factors to consider in
evaluating burns
1. Agent of burn
2. Depth
3. Severity (BSA)
a. Rule of nines
b. Palm rule
4. Age under 5 and
over 55 (adults
reaction to burn
injury increases after
age 35)
a. Infants and children
are at higher risk
due to more body
surface area
i. Hypovolemic
shock
ii. Airway problem
iii. Hypothermia
5. Other illnesses and
injuries
Thermal Burn:
1. Emergent Phase
response to pain >
catecholamine release.
2. Fluid shift massive
shift from intracellular to
extracellular fluid
3. Hypermetabolic phase
increase demands for
nutrients
4. Resolution phase
scar tissue and
remodeling of tissue
Special Considerations:
Pedia:
1. Thin skin
2. Large surface volume
2.1. Rapid fluid loss
2.2. Increased heat loss
3. Dehydration vs. Overhydration
4. Immature Immunological response
Treatment of burn
wound
1. Low priority
after CAB and
IV
2. Do not
rupture
blisters.
3. Dry Sterile
Dressings
4. Cover with burn
sheet
Complications:
1. Hypovolemia leading to
shock - Leading
2. Infection
3. Renal/hepatic failure
4. Formation of eschar
5. Complication of
circumferential burn
(tourniquet effect)
6. Increase catecholamine
release,
vasoconstriction
7. Inability to maintain
body temperature
Eschar formation:
Geria:
1. Decreased Myocardial reserve
2. Fluid resuscitation difficult
3. Peripheral vascular disease
4. COPD
5. Decreased immune response
6. % mortality = age + % of BSA
affected
4 Phases of burn
management
1. Emergent
Phase time of
injury to
structural
2. Resuscitation
Phase admin
of IV fluids,
return of
capillary
membrane to N
level
2.1. Parkland
formula:
4 mL/kg *
total BSA
TRANSPORT
CONSIDERATION
1.
2.
3.
4.
Skin denaturing
Skin constricts over
wound
Respiratory compromise
Circulatory compromise
Rapid PE
1. Check for other
injuries
2. Rapid estimate
burned wound
3. Remove restricting
band
Hx:
1.
2.
3.
4.
5.
6.
7.
Remove patient
from the scene
2. Stop burning
process
3. Ensure open
airway, assess
breathing
4. Look for signs
of airway injury,
soot deposits,
burnt nasal
hair, facial
burns
5. Complete the
intial
assessment.
6. Treat for shock.
High O2 (per
SpO2). Treat
serious injuries.
7. Evaluate burns
by depth,
extent and
severity.
8. Do not clear
debris
9. Wrap with dry
sterile dressing.
10. Burns of hands
or feet
remove rings
and jewelry that
may constrict
with swelling.
Separate
IMMEDIATELY
fingers or
toes with
gauze pads.
11. Burns to eyes
do not open
eyelids if
burned.
11.1. Be certain
burn is
thermal, not
chemical.
11.2. Apply sterile
gauze pads
to both eyes
to
immobilize.
11.3. If burn is
chemical,
flush eyes
for a
minimum of
20 minutes.
12. Shock
precaution (if
theres other
injuries)
Others:
1. Analgesic
Morphine
Sulfate
1.1. 2-3 mg q
10 min
titrated to
adequate
ventilation
and BP
1.2. 0.1 mg/kg for
pedia
1.3. May require
large but
tolerable
doses.
2. Avoid topical
agent except
per protocol
(Silvadine)
3. Fluid Therapy
3.1. Objective:
3.2. HR < 110
bpm
3.3. Urine output:
30 50 cc per
hour or
0.5-1 cc/kg/h
r for pedia
Insert chemical
burn handout
Chemical
Inhalation
Electrical
Problems:
1. Hypoxia
2. CO toxicity
2.1. SpO2 could be
meaningless
3. Upper airway injury
3.1. May result to edema
of pharynx and larynx
4. Lower airway injury
4.1. Rare, involves lung
parenchyma,
Transport
Generally get
chemical
contaminated object
off the body and
flush with LR/NS
except if chemical
reacts with water.
Airway, O2,
Ventilation:
1. Bronchodilators
needed?
2. Diuretics are
not appropriate
Circulation:
1. Treat for Shock
(rare)
2. IV access
2.1. LR/NS large
bore multiple
IVs
2.2. Titrate fluids
to maintain
systolic BP
AC current:
Others:
Treat burns and
injuries
1. TRANSPORT
1.
Severity depends on
1. Tissue
2. With or extent of current
3. AC/DC
4. Duration of current
contact
2.
3.
4.
5.
6.
Radiation
Skin
Surface
s
Sensati
on
Healing
<15%
Mottled red, moist
<2%
and except
shiny for
face, genitalia,
hands and feet
Dry (-)
blisters
Painful
Painful
3-6 days
2 4 weeks
depending on
depth
CASE
ASSESSMENT
Odor
2.
3.
4.
Make sure
current is off
CAB
Rhabdomyolysi
s breakdown
of muscle fiber
that leads to
release of
myoglobin to
bloodstream
which is
harmful to the
kidneys.
Alpha large
Beta small
Gamma most
dangerous
Partial Thickness
Skin
Red
Full Thickness
Color
flame, hot
metals
15 30%
Pearly
white
2 10%
and
or
charred
translucent
and
parchmentlik
e
Dry with
thrombosed
blood vessels
Anesthetic
Critical
All complicated by
injury of soft tissue
and bones
>30%
>10% Partial full
thickness on hands,
genitalia,
circumferential burn.
Requires skin
grafting
POISONING EMERGENCIES
PATHOPHYSIOLOGY
Poison (toxin )
MANAGEMENT
General approach:
TRANSPORT
CONSIDERATION
Ingested
Inhaled
Absorbed
Injected
Level of
Consciousness
Vital Signs
Hx
What?
When?
How much?
What else was
taken, if
anything?
Antidote?
Vomited, if so
how long after
the ingestion?
Why?
Odor
Level of
Consciousness
Vital Signs
Hx
What?
When?
How much?
What else was
taken, if
anything?
Antidote?
Vomited, if so
how long after
the ingestion?
Why?
substance which, if
taken into the body in
sufficient quantity can
cause temporary or
permanent damage
Self poisoning and
parasuicide
deliberate ingestion of
more than the
therapeutic dose of a
drug or substance not
intended for
consumption usually
by an adult in a
moment of distress
Accidental poisoning
non intentional
3 Leading causes of
Poisoning:
1. Alcoholic intoxication
2. Methamphetamine
3. Isoniazid toxicity
Organophosphate agent
most commonly associated
with mortality.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
mouth
Unusual breath/body/
clothing/scene odor
AbN breathing
AbN pulse rate
Profuse sweating,
headache, dizziness
Excessive salivation or
foaming at the mouth
Pain in the mouth or throat
Abdominal pain
Abdominal tenderness
sometimes with distention
Nausea, vomiting
Seizures
Altered mental status
Signs of shock
Circulation
Airway
Breathing
Drug induced CNS
depression
Electrolytes and
metabolic
abnormalities
Oxygen
precautions
o
Watusi
o
Paraquat
o
Zinc phosphate
Activated Charcoal
Absorbs many
poisonous
compounds to its
surface, thereby
reducing their
absorption by the
body
Effective among:
o
Aspirin
o
Amphetamines
o
Strychnine
o
Dilantin
o
Theophylline
o
Phenobarbitals
Ineffective:
o
Methanol
o
Caustic acids
o
Alkalis
o
Iron tables and
lithium
1g/kg
Syrup of IPECAC
Induces vomiting
Contraindications
o
Stupor/Coma
o
Absent gag reflex
o
Seizures
o
Pregnancy
Acute MI
Children < 6 mo
Ingestion of
corrosives
o
Volatile
hydrocarbons
o
Strycnines or
iodides
Dosage
o
Children 3-5 tsp
followed by a
glass of water
o
Adults 1-2 tsp
followed by
water
1. Maintain open
airway
2. Transport
Immediately
3. Follow protocol
of your EMS
system
4. Keep patient on
NPO
5. Position the
conscious
patient in semi
recumbent
position
6. Monitor
vomiting
7. Save all vomits
and endorse to
the hospital
o
o
o
Ingested
Inhaled
1.
2.
3.
Remove patient
from inhaled
poison. Avoid
touching
contaminated
clothing.
Maintain open
airway
Provide needed
BLS measures
and administer
O2 (if not
contrainidicated
) NRM
Injected
1.
2.
3.
4.
5.
Absorbed
1.
2.
3.
Follow local
protocol
Monitor patient
and maintain
open airway
Remove jewelry
from affected
limbs
Keep the limb
immobilized
Transport
immediately
Move the patient
from the source
of the poison
while avoiding
contact with the
substance
Use water to
immediately
flood all the
areas of the
patients body
that has been
exposed to the
poison
Monitor patient
and transport
immediately
COLD EMERGENCIES
CASE
ASSESSMENT
Temp Conversion:
C = (F-32)*5/9
F = C*5/9 +32
Keeping warm:
Thermogenesis
o
Conversion of food
to energy in body
cells
o
Muscle activity,
voluntary or
involuntary
Heat absorption
PATHOPHYSIOLOGY
Core Temp
Internal temp of
normothermic humans
Does not vary >1-2 from
normal temp
Esophageal and tymphanic
temp almost the same
with pulmonary artery
May cause permanent
disability or death
Hypothalamus temp
regulator center
Mechanism of Heat Loss
1. Convection heat loss
to surrounding air
2. Conduction heat loss
to nearby objects
through physical
contact
3. Radiation Body heat
is lost to nearby
objects without direct
contact
4. Evaporation Body
heat loss through
perspiration
5. Respiration
MANAGEMENT
TRANSPORT
CONSIDERATION
2nd degree
(Superficial Frost)
General S/Sx
1. Shivering
2. Numbness
3. Stiff, rigid posture
4. Drowsiness or inability
to do even simplest
activity
5. Rapid breathing and
rapid pulse in early
stages, Late stage:
Slow pulse and
breathing.
6. Decrease LOC
7. Cool skin temp
8. Loss of motor
coordination
9. Joint, muscle stiffness
and rigidity.
1.
2.
3.
1.
2.
3.
4.
5.
6.
1.
2.
3.
4.
Remove patient
from site
Remove all of the
patients clothing
that is wet
During transport,
rewarm the patient
Shock treatment
Give warm fluid for
conscious and
alert patient
Keep patient at
rest.
If still frozen,
leave it frozen
Pad the injured
extremity to
protect from
further trauma
Do not massage
Notify the
receiving facility
so that they can
start preparing
Hypothermia
Prolonged exposure to
cold outdoor especially
in wet and windy
conditions
Death from cold water
immersion may be
caused by hypothermia
rather than drowning
and re-warming
both.
5. If the extremity is
partially thawed,
rewarm the
injured area at 38
42 C
6. Once rewarming
is comlete
6.1. Dry extremity
very gently and
apply it gently to
thawed part
6.2. Take care not to
rupture blisters.
6.3. Use soft sterile
gauze or cotton
to separate
frostbiten
fingers and toes
7. Transport the
patient in supine
position and
elevate the
injured extremity
on soft pillow, well
covered and
protect from cold.
1. Remove patient
from cold
environment
2. Remove any wet
clothing and
cover the patient
with blanket
3. Handle the
patient with
extreme care.
Avoid rough
handling at all
cost
4. Admin high flow
O2 (warmed and
humidified)
5.
6.
7.
Too hot
Too cold
Blood
Vasodilation
Vasoconstriction
vessels
Perspiratio
Increase
Decrease
n
Cardiac
Increase
Decrease
output
Respiratory Increase
Decrease
Rate
Heat
Decrease
Decrease
production
Stages of Hypothermia (ILCOR 2005)
Progression of Hypothermia
C
F
Body Temperature
Symptoms
Mild
36 34 C
96.8 93.2 F
37 35.5 C
Shivering
Moderat
34 30 C
86 F
35.5 32.7 C
1. Decreased shivering replaced
e
by strong muscular rigidity
Severe
< 30 C
<86 F
CASE
ASSESSMENT
Heat Cramps
29.4 27.7 C
2. Less
clear thinking
HEAT
EMERGENCIES
PATHOPHYSIOLOGY
SIGNS ANDisSYMPTOMS
3. General comprehension
dull
Severe muscle cramps
Exhaustion
4. Possible total1.
amnesia
2. Dizziness
(usually in the legs and
1. Irrational 3. Periods of faintess
abdomen)
2. Loses contact with envi and
drifts into stuporous state
3.
4.
26.6 20.5 C
MANAGEMENT
1.
2.
3.
Possible cardiac
dysrhythmias
Unconscious without reflexes
4.
Move patient to a
nearby cool place
Give the conscious
patient fluids and
electrolytes
Massage the cramped
muscle to help ease the
patients discomfort.
Massaging with
pressure will be more
effective than light
rubbing
Apply moist towels to
TRANSPORT
CONSIDERATION
5.
Heat Exhaustion
1.
2.
3.
4.
5.
6.
7.
Rapid, shallow RR
Weak pulse
Cold, clammy skin
Heavy perspiration
Total body weakness
Dizziness
Possible
unconsciousness
1.
2.
3.
4.
5.
6.
7.
8.
9.
Heat Stroke
1.
2.
3.
4.
5.
6.
1.
2.
3.
Condition
Heat Cramps
Heat
Exhaustion
Heat Stroke
Muscle
Cramps
Weakne
ss
Breathing
Pulse
Skin
Perspirati
on
Varies
Varies
Heavy
Rapid shallow
Weak
Heavy
Sometimes
Deep, then
shallow
Full Rapid
Moistwarm
Cold
clammy
Dry-hot
Loss of
Consciousn
ess
Seldom
Little or
none
Often
CASE
ASSESSMENT
Typical sources of
infected poisons or
toxins (insect, spider
& scorpion)
PATHOPHYSIOLOGY
Gather
information
from the
patient,
bystanders,
at the
scene.
2.
3.
4.
5.
6.
7.
Find out
whatever
you can
about the
insect or
other
possible
source of
the
poisoning
8.
9.
10.
11.
12.
13.
14.
15.
Snake bites
1.
2.
3.
4.
5.
6.
7.
8.
MANAGEMENT
1.
1.
2.
3.
4.
5.
2.
3.
4.
5.
Pit Viper
Has pit in
maxillary bone
Eliptical pupil
Tissue Necrosis
Minimal
None
Swelling
Pain
1.
2.
3.
TRANSPORT
CONSIDERATION
IMMEDIATE
Triangular head
4.
Immobilize injured
limb and maintain
it.
1.
2.
3.
Calm Victim
O2
Proximal
constricting band
(+/-)
Clean bandage
wound
Immobilize bitten
area
Watch constricting
bands
Moderate
Progressive swelling
Coral Snake
Red on yellow
kill a fellow; Red
on black venom
lack
Thin
Small rounded
4.
5.
6.
Dog bites
Head
Neck
Upper Extremities
Percentage
Face 11%
Trunk 7%
Upper extremity 28%
Lower extremity 31%
7.
1.
2.
3.
4.
5.
Immediately and
thoroughly wash
the wound with
soap and water
Flush the wound
with water and
apply dressing
Transport the
patient to the
hospital for
medical care
especially if the
wound needs
stitching or
occurred in the
face or neck
Do not kill the dog
unless it is
absolutely
necessary to
prevent a full
scale crippling
attack.
If you kill the dog,
call for an animal
Spiders
Black Widow
(Larodectus
mactans)
Brown recluse
(Loxosceles reclusa)
Fiddle-back
spiders
6 eyes
Violin markings
officer and
request that the
corpse be
examined for
rabies.
6. Immobilize injured
part
7. Patient is usually
frightened calm
him/her down.
1. Remove stinger by
scraping with a
plastic card or
blunt edge of a
knife
2. Manage airway
3. O2 / Ventilation
4. Shock position
5. Epinephrine
5.1. Dilate airway
5.2. Constrict Blood
vessels
5.3. Ask for
medical
direction
5.4. Dosage
5.4.1. Adult 0.3 mg
yellow
5.4.2. Child 0.15
mg
Local reaction
Bronchospasm
Hypotension
Anaphylaxis
Neurotoxic
1.
1.
2.
1.
2.
3.
4.
Necrosis
Hemoglobinuria
Hypotension
Possibility of death
Supportive care
2.
3.
Local cold
application
Symptomatic care
Immediate
transport
IMMEDIATE
Scorpion
( Centuroides
sculpturatus)
1.
Airway
management
2. Look out for
cardiac
dysrrhytmias
1. CAB
2. Flush with water
3. Immerse in warm
water
Vinegar and hot
water
1. Safety BSI
2. LOC
3. CAB
4. O2/ ventilation
5. Immerse wound
30-40 min as hot
as can be
tolerated, repeat
as necessary to
control pain
without scalding
6. Transport
Sting ray
Jellyfish
Scorpion/Lion/Stone
fish
Sea Urchins
Hypotension
Stonefish being the most
poisonous of them
WATER EMERGENCIES
CASE
ASSESSMENT
Drowning
Active
drowning:
Conscious
Thrashing
Vertical in
H2O
Unable to
call for
help
Body
maybe low
in H2O
Causes:
Rip Currents
PATHOPHYSIOLOGY
Step 1
Victim goes under,
water enters the
airway.
Coughing and
gasping victim
swallows water
Step 2
A small amount
enters the larynx
and causes
laryngospasm
Breathing ceases
and metabolic
acidosis occurs.
Dry drowning (10
MANAGEMENT
Stages of
management of
drowning
1. Do not enter
unless trained
in water
rescue
2. Ensure open
airway and
attempt
rescue
breathing
3. Continue
rescue
breathing and
remove from
TRANSPORT
CONSIDERATION
Diving Emergencies
Boyles law
o
As pressure
increase, volume
decreases
o
As pressure
decreases, volume
increases
Daltons law
o
P1= P(O2) + P(N2)
+ P(X)
o
Total pressure of gas
15% of gases)
Step 3
Laryngeal muscles
became severely
hypoxic and relax
allowing air and
water to enter the
lungs. (Wet
drowning)
Triggers peripheral
airway resistance
and constriction of
the pulmonary
vessels > Stiff
Lung lung ceases
to be compliant.
Step 4
Victems
hypercarbic/hypoxi
c drive further
stimulate inhalation
of water which
mixes with air and
chemical resident
in the lungs to form
a froth.
Brain damage and
death follows
4.
5.
6.
the water
Check pulse, if
no pulse, start
chest
compression
Transport
If given the
opportunity
positive
pressure
ventilation
using PEEP to
dry the lungs.
Henrys law
o
Pressure of a gas in
liquid is proportional
to its pressure in
the atmosphere
o
1 atm 34 ft water
Barotrauma
compression or expansion
of gas actually in adjacent
to body air spaces
Descent
Ear Squeeze
External
Middle
Sinus Squeeze
Lung Squeeze
Ascent
POPS (Pulmonary
Overpressure Syndrome)
Burst lung
Pneumothorax/Tension
Pneumothorax
Pneumomediastinum
Subcutaneous
emphysema
Dyspnea
Chest pain
Cough
Hemoptysis
Pulmonary edema
Pneumomediastinum/
Subcutaneous emphysema
o
Fullness of his throat
o
Dysphagia
o
Dyspnea
o
Substernal chest pain
o
Subcutaneous air palpable
above clavicles
o
Crunching noise synch with
heart beat
Lung Squeeze
1. No PPV or
PEEP
2. 100% O2 NRM
3. IV
4. Keep patient
sitting up
5. TRANSPORT to
hosp
Pneumomediastinu
m/
Subcutaneous
emphysema
o
Bed rest and
oxygen
therapy
POPS
o
100% O2
NRM
o
Dont give
PEEP to
POPS
o
keep patient
quiet
o
transport him
to hospital.
Decompression
Sickness
Narcosis (Narcs/Rapture of
the deep)
Not dangerous but can
impair the divers
judgment.
Type I DS
DS of the skin
DS of the joints
(musculoskeletal)
Accumulation of nitrogen in
the tissues > increase
pressure > increase amount
of dissolved nitrogen in the
tissues > anesthetic effect >
martini effect
Most common but least
reported
If in doubt of
AIR
EMBOLISM >
go to
hyperbaric
chamber
facility
Ascend slowly to
alleviate martini
effect.
1.
2.
3.
1.
2.
3.
4.
Pruritis
SQ emphysema
Mottled rashes
Deep, dull aches in muscle/joints
Movement worsen pain
Fatige
Inflating cuff will relieve pain
1.
2.
3.
4.
5.
6.
Ensure
Adequate
Airway
Give 100%
oxygen
Start an IV
with LR and
give as
directed
Give steroids,
preferably
Methylpredni
silone 125
mg IV
Do not use
nitrous oxide
for analgesia
Advise hospital
that you will
require a use
of a hyperbaric
chamber
TYPE II DS
DS of the CNS
4-10 min rule
Brain involvement
CHOKES
1.
2.
3.
4.
1.
2.
3.
4.
Paresthesia
Seizure
Spinal cord involvement
Paralysis
Chest pain
Dry cough
Dyspnea
Pulmonary edema
1.
2.
3.
4.
5.
6.
Treatment of Suspected Air Embolism
1.
2.
3.
Admin. 100% O2
4.
5.
6.
7.
1.
2.
3.
4.
5.
6.
Ensure
Adequate
Airway
Give 100%
oxygen
Start an IV
with LR and
give as
directed
Give steroids,
preferably
Methylpredni
silone 125
mg IV
Do not use
nitrous oxide
for analgesia
Advise hospital
that you will
require a use
of a hyperbaric
chamber
WATER EMERGENCIES
CASE
Drowning
ASSESSMENT
PATHOPHYSIOLOGY
MANAGEMENT
TRANSPORT
CONSIDERATION