Lecture#11

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Author:
jessjohnson0617
ID:
213872
Filename:
Lecture#11
Updated:
2013-04-16 23:05:24
Tags:
Behavioral Emergencies Anaphylactic Reactions Toxicological
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Thurston County EMT
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  1. Define Immunity
    the ability of the body to resist certain types of organisms or toxins
  2. Define Acquired Immunity
    occurs after the body has been exposed to a substance (an antigen) that triggers the immunity
  3. Define Antibodies
    a protein that protects against antigens by direct attack on the antigen, and activation of other systems that also attack the antigen
  4. Define Allergic Reaction
    an exaggerated response to the presence of antigens
  5. Define Anaphylaxis
    a severe allergic reaction to the presence of antigens that affects 2 or more systems; histamine and heparin are released into the bloodstream
  6. Define Anaphylactic Shock
    a severe allergic reaction to the presence of antigens that affects 2 or more systems that causes hypoperfusion
  7. What is happening in the body in a state of anaphylaxis
    • spasms of smooth muscles of bronchioles causing SOB
    • histamine is released and causes the capillaries to become permeable and leak fluid causing urticaria (hives)
    • angioedema: swelling of the mouth/oropharynx, possibly leading to the tongue and lips
    • nausea, vomiting, abdominal cramps and diarrhea are common
  8. What are the systems involved in anaphylaxis?
    • cardiovascular
    • respiratory
    • skin
    • GI tract
  9. What is the treatment for anaphylaxis?
    • ensure ABCs
    • administer epinephrine
  10. What does epinephrine do to the body?
    vasoconstricts (increasing BP) and bronchodilates (opening the airway)
  11. Define Flushing
    an increase in blood flow to the area of exposure from heparin and histamine ( which causes an increase of the plasma leakage out of capillaries and causing urticaria, swelling, tachycardia, and hypotension)
  12. Define Angioedema
    the rapid swelling of the dermis, subcutaneous tissue, mucosa and submucosal tissues (mouth, lips, tongue, oropharynx)
  13. What are the respiratory affects of anaphylaxis?
    • bronchospasm (wheezing)
    • excessive mucus production/plugging (wheezing)
    • airway swelling (pharynx, tongue, epiglittis)
    • facial edema
  14. What is the dosage for Epinephrine?
    • Adult = 0.3 mg (for someone over 30kg/66lbs)
    • Child = 0.15 mg (for someone under 30kg/66lbs)
  15. What are the ALS upgrades for an allergic reaction?
    • Pt is presenting w/ signs and/or symptoms of an anaphylactic reaction within 1 hour of exposure to an allergen AND has a history of anaphylactic reaction to this allergen
    • difficulty swallowing or swelling in throat, lips or tongue
    • severe adbominal cramps, nausea, vomiting or diarrhea with urticaria or flushing
    • any use of epinephrine requires an ALS upgrade
  16. If the patient is asthmatic, and has a BP of at least ____ and is still SOB after the administration of epinephrine, assist with patient's albuterol.
    90 systolic
  17. What class of drug is epinephrine?
    adrenergic
  18. What are the indications for the administration of epinephrine?
    patient is displaying s/s of anaphylaxis OR shock OR difficulty swallowing (throat edema) and consents to treatment
  19. What are the adverse reactions/precautions for the use of epinephrine?
    • hypotension
    • tachycardia
    • may cause cardiac ischemia in the elderly or in pts with known coronary artery disease
  20. What are the pertinent subjective findings in a patient with an allergic reaction? (protocol)
    • known allergies
    • previous allergic reaction and severity
    • recent exposure to possible allergens
    • prescription for epi-pen
    • abdominal cramps
    • itching
    • dizziness
    • dyspnea
    • chest discomfort
    • nausea
  21. What are the pertinent objective findings in a patient with an allergic reaction? (protocol)
    • urticaria
    • flushing
    • cyanosis or pallor
    • swelling of face, pharynx, or tongue
    • medic alert tag
    • weak, rapid pulse
    • hypotension
    • anxiety
    • vomiting
  22. What are the steps for the administration of an Epi-pen?
    • Place auto injector on pt's lateral thigh and push firmly against the site. hold for 10 seconds minimum
    • massage site
    • dispose of injector in sharps container
    • record time of injection
    • reassess in 2 minutes
    • contact ALS for additional doses of epinephrine
    • treat for shock as necessary
    • turn in MIR to Medic One and pick up Epi-pen replacement
  23. What are the three things you should check on the epi-pen itself before administering?
    • expiration date
    • that it is not cloudy
    • always use our epi-pens, not the patients
  24. What are the 4 ways that poison can enter the body?
    • ingestion
    • inhalation
    • absorbed
    • injected
  25. What is the number for poison control?
    1-800-709-0911
  26. What are the ALS upgrades for overdose/poisoning (toxic exposure)?
    • Polypharmacy (use of multiple meds)
    • Overdose of Tylenol, ASA or iron
    • Intentional overdose with prescription meds
    • Seizure without history
    • On recommendation of WA poison center
    • Patient with impaired gag reflex
  27. What does SLUDGE stand for?
    • Salivation
    • Lacrimation (watery eyes)
    • Urination
    • Defication
    • Gastrointestinal
    • Emesis (vomiting)
  28. What are the pertinent subjective findings in an overdose/poisoning (toxic exposure)?
    • substance exposed to
    • time, route, duration, concentration/dose of exposure
    • number of ppl exposed (consider WMD)
    • nausea/vomiting
    • alcohol
    • street drugs
    • suicidal ideation/note
    • history of mental illness
    • are weapons present or accessible?
  29. What are pertinent objective findings in an overdose/toxic poisoning (toxic poison)?
    • respiratory distress
    • ¬†altered/decreased LOC
    • difficulty swallowing
    • empty containers/pill bottles
    • seizures
    • s/s of ACS
    • drug paraphernalia
    • unusual odors
    • gag reflex (present/absent)
    • SLUDGE symptoms
  30. What class of drug is activated charcoal?
    antidtote
  31. What is another name for activated charcoal?
    actidose
  32. What are the indications for the use of activated charcoal?
    treatment of patient who has ingested poisons by mouth, when recommended by the Washington Poison Control
  33. What are the contraindications of the use of activated charcoal?
    relative (without GI tube): absent gag, unconscious patient, potential sedation from suspected overdose
  34. What are the precautions/adverse reactions to activated charcoal?
    does not absorb iron, lithium, inorganic ions, ethanol, methanol, or cyanide
  35. What is the suggested dosage for activated charcoal?
    • adult: 50g PO/NG¬† (by mouth/nasogastric intubation)
    • pediatric: less than 12 y/o - 1g/kg
  36. EMTs are required to contact ____________ at __________ prior to administration.
    • Washington Poison Center
    • 1-800-0911
  37. Consider providing charcoal using _______ and _______.
    • covered cup
    • straw
  38. What should the EMT do to treat a dry chemical exposure?
    brush off then rinse with copious amounts of water
  39. What should the EMT do to treat wet chemical exposures?
    rinse with copious amounts of water
  40. What are the three levels of alcohol abuse?
    • Withdrawl
    • Possible seizures
    • delirium tremens
  41. What does carbon monoxide poisoning do to the body?
    takes over O2 on the hemoglobin, causing death due to hypoxia

    O2 is the antidote, but it takes times
  42. What are the effects of a narcotic?
    • decreased LOC
    • bradycardia
    • near apneic
    • hypotension
    • contracted pupils
  43. What are the effects of stimulants?
    • dilated pupils
    • tachycardia
    • tachypnea
    • hypertension
    • anxiousness/fidgity
  44. Define behavior
    the manner in which a person acts or performs, involving all activities including physical and mental. varies from person to person
  45. Define behavioral emergency
    behavior in a given situation that is unacceptable or intolerable to the patient, family, or community
  46. When a patient is hypoglycemic, how does their behavior change?
    may cause rapid onset of erratic or hostile behavior and diaphoresis
  47. When a patient is hypoxic, how does their behavior change?
    can cause restlessness, confusion, cyanosis, and altered LOC
  48. When a patient has inadequate perfusion of the central nervous system, how does their behavior change?
    may cause confusion, dizziness, slurred or broken speech
  49. When a patient has a head trauma, how does their behavior change?
    • may cause altered LOC/vitals
    • behavior from rational to aggressive
    • amnesia or confusion are possible
  50. Define schizophrenia
    an altered perception of reality; a mental disorder characterized by a breakdown of thought processes and by a deficit of typical emotional responses
  51. What are the main methods of suicide?
    • OD
    • hanging
    • ingesting poison
    • wrist cutting
    • self mutilation
    • stabbing
    • shooting
    • jumping from high places
    • inhaling gases
  52. What are the risk factors associated with suicide?
    • depression
    • stress
    • emotional trauma
    • age 15-25 and over 40
    • alcohol or other substance abuse
    • threats of suicide (verbal or written)
    • suicide plan
    • previous attempts/plans
    • sudden improvement
  53. AEIOUTIPPS?
    • Alcohol/Acidosis
    • Endocrine, Epilepsy, Electrolyte
    • Insulin
    • Overdose
    • Underdose/Uremia
    • Trauma
    • Infection
    • Pump/Poison
    • Phsycosis
    • Stroke/Shock
  54. Define reasonable force.
    the force necessary to keep a patient from injuring self/others
  55. What are the guidelines for restraints?
    • 5 ppl minimum - one person per limb and one for the head
    • plan, estimate and act quickly
    • position patient on their back and secure all four limbs
    • anticipate if they become more voilent
    • wear appropriate PPE (pt will spit/bite, surgical mask on pt?)
    • use multiple straps for torso
    • reassess distal circulation after restraint
    • document why patient and technique used
  56. What are the things an EMT should document when restraints have been used?
    • why the patient needed restraints (your observations and actions of pt) and technique used
    • your suspicion of drug/alcohol use
    • names of family/witnesses/LE

    use quotations to denote significant vebal moments

    be objective and professional, avoid opinion or slang
  57. What are the indications for restraining a violent/combative patient?
    • All of the following must exist:
    • a potential or recognized medical emergency exists
    • patient is exhibiting violent or combative behavior
    • less restrictive means of gaining patient cooperation have failed
    • in the judgement of the provider, the patient is incapable of making appropriate health care decisions for him/herself (e.g. intoxication, head injury, developmental delay, psychosis)
    • must call law enforcement and ALS
  58. In order to refuse care, a patient must...
    • have fluency in english
    • be over the age of 18
    • be oriented to person, place, time and not show any obvious cognitive deficit
    • be free of the influence of alcohol, drugs, or any mind altering substances
    • hot have any injury or medical condition affecting their judgement
    • not have threatened or attempted suicide during this episode
    • demonstrate the ability to explain the decision they are making and the possible negative outcomes including death and devastating disability

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