Lecture#11

the ability of the body to resist certain types of organisms or toxins

occurs after the body has been exposed to a substance (an antigen) that triggers the immunity

a protein that protects against antigens by direct attack on the antigen, and activation of other systems that also attack the antigen

an exaggerated response to the presence of antigens

a severe allergic reaction to the presence of antigens that affects 2 or more systems; histamine and heparin are released into the bloodstream

a severe allergic reaction to the presence of antigens that affects 2 or more systems that causes hypoperfusion

• 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

• cardiovascular
• respiratory
• skin
• GI tract

• ensure ABCs
• administer epinephrine

vasoconstricts (increasing BP) and bronchodilates (opening the airway)

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)

the rapid swelling of the dermis, subcutaneous tissue, mucosa and submucosal tissues (mouth, lips, tongue, oropharynx)

• bronchospasm (wheezing)
• excessive mucus production/plugging (wheezing)
• airway swelling (pharynx, tongue, epiglittis)
• facial edema

• Adult = 0.3 mg (for someone over 30kg/66lbs)
• Child = 0.15 mg (for someone under 30kg/66lbs)

• 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

90 systolic

adrenergic

patient is displaying s/s of anaphylaxis OR shock OR difficulty swallowing (throat edema) and consents to treatment

• hypotension
• tachycardia
• may cause cardiac ischemia in the elderly or in pts with known coronary artery disease

• known allergies
• previous allergic reaction and severity
• recent exposure to possible allergens
• prescription for epi-pen
• abdominal cramps
• itching
• dizziness
• dyspnea
• chest discomfort
• nausea

• urticaria
• flushing
• cyanosis or pallor
• swelling of face, pharynx, or tongue
• medic alert tag
• weak, rapid pulse
• hypotension
• anxiety
• vomiting

• 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

• expiration date
• that it is not cloudy
• always use our epi-pens, not the patients

• ingestion
• inhalation
• absorbed
• injected

1-800-709-0911

• 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

• Salivation
• Lacrimation (watery eyes)
• Urination
• Defication
• Gastrointestinal
• Emesis (vomiting)

• 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?

• 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

antidtote

actidose

treatment of patient who has ingested poisons by mouth, when recommended by the Washington Poison Control

relative (without GI tube): absent gag, unconscious patient, potential sedation from suspected overdose

does not absorb iron, lithium, inorganic ions, ethanol, methanol, or cyanide

• adult: 50g PO/NG  (by mouth/nasogastric intubation)
• pediatric: less than 12 y/o - 1g/kg

• Washington Poison Center
• 1-800-0911

• covered cup
• straw

brush off then rinse with copious amounts of water

rinse with copious amounts of water

• Withdrawl
• Possible seizures
• delirium tremens

takes over O2 on the hemoglobin, causing death due to hypoxia

O2 is the antidote, but it takes times

• decreased LOC
• bradycardia
• near apneic
• hypotension
• contracted pupils

• dilated pupils
• tachycardia
• tachypnea
• hypertension
• anxiousness/fidgity

the manner in which a person acts or performs, involving all activities including physical and mental. varies from person to person

behavior in a given situation that is unacceptable or intolerable to the patient, family, or community

may cause rapid onset of erratic or hostile behavior and diaphoresis

can cause restlessness, confusion, cyanosis, and altered LOC

may cause confusion, dizziness, slurred or broken speech

• may cause altered LOC/vitals
• behavior from rational to aggressive
• amnesia or confusion are possible

an altered perception of reality; a mental disorder characterized by a breakdown of thought processes and by a deficit of typical emotional responses

• OD
• hanging
• ingesting poison
• wrist cutting
• self mutilation
• stabbing
• shooting
• jumping from high places
• inhaling gases

• 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

• Alcohol/Acidosis
• Endocrine, Epilepsy, Electrolyte
• Insulin
• Overdose
• Underdose/Uremia
• Trauma
• Infection
• Pump/Poison
• Phsycosis
• Stroke/Shock

the force necessary to keep a patient from injuring self/others

• 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

• 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

• 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

• 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