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the ability of the body to resist certain types of organisms or toxins
Define Acquired Immunity
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
Define Allergic Reaction
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
Define Anaphylactic Shock
a severe allergic reaction to the presence of antigens that affects 2 or more systems that causes hypoperfusion
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
What are the systems involved in anaphylaxis?
- GI tract
What is the treatment for anaphylaxis?
- ensure ABCs
- administer epinephrine
What does epinephrine do to the body?
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)
What are the respiratory affects of anaphylaxis?
- bronchospasm (wheezing)
- excessive mucus production/plugging (wheezing)
- airway swelling (pharynx, tongue, epiglittis)
- facial edema
What is the dosage for Epinephrine?
- Adult = 0.3 mg (for someone over 30kg/66lbs)
- Child = 0.15 mg (for someone under 30kg/66lbs)
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
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.
What class of drug is epinephrine?
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
What are the adverse reactions/precautions for the use of epinephrine?
- may cause cardiac ischemia in the elderly or in pts with known coronary artery disease
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
- chest discomfort
What are the pertinent objective findings in a patient with an allergic reaction? (protocol)
- cyanosis or pallor
- swelling of face, pharynx, or tongue
- medic alert tag
- weak, rapid pulse
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
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
What are the 4 ways that poison can enter the body?
What is the number for poison control?
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
What does SLUDGE stand for?
- Lacrimation (watery eyes)
- Emesis (vomiting)
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)
- street drugs
- suicidal ideation/note
- history of mental illness
- are weapons present or accessible?
What are pertinent objective findings in an overdose/toxic poisoning (toxic poison)?
- respiratory distress
- altered/decreased LOC
- difficulty swallowing
- empty containers/pill bottles
- s/s of ACS
- drug paraphernalia
- unusual odors
- gag reflex (present/absent)
- SLUDGE symptoms
What class of drug is activated charcoal?
What is another name for activated charcoal?
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
What are the contraindications of the use of activated charcoal?
relative (without GI tube): absent gag, unconscious patient, potential sedation from suspected overdose
What are the precautions/adverse reactions to activated charcoal?
does not absorb iron, lithium, inorganic ions, ethanol, methanol, or cyanide
What is the suggested dosage for activated charcoal?
- adult: 50g PO/NG (by mouth/nasogastric intubation)
- pediatric: less than 12 y/o - 1g/kg
EMTs are required to contact ____________ at __________ prior to administration.
- Washington Poison Center
Consider providing charcoal using _______ and _______.
What should the EMT do to treat a dry chemical exposure?
brush off then rinse with copious amounts of water
What should the EMT do to treat wet chemical exposures?
rinse with copious amounts of water
What are the three levels of alcohol abuse?
- Possible seizures
- delirium tremens
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
What are the effects of a narcotic?
- decreased LOC
- near apneic
- contracted pupils
What are the effects of stimulants?
- dilated pupils
the manner in which a person acts or performs, involving all activities including physical and mental. varies from person to person
Define behavioral emergency
behavior in a given situation that is unacceptable or intolerable to the patient, family, or community
When a patient is hypoglycemic, how does their behavior change?
may cause rapid onset of erratic or hostile behavior and diaphoresis
When a patient is hypoxic, how does their behavior change?
can cause restlessness, confusion, cyanosis, and altered LOC
When a patient has inadequate perfusion of the central nervous system, how does their behavior change?
may cause confusion, dizziness, slurred or broken speech
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
an altered perception of reality; a mental disorder characterized by a breakdown of thought processes and by a deficit of typical emotional responses
What are the main methods of suicide?
- ingesting poison
- wrist cutting
- self mutilation
- jumping from high places
- inhaling gases
What are the risk factors associated with suicide?
- 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
- Endocrine, Epilepsy, Electrolyte
Define reasonable force.
the force necessary to keep a patient from injuring self/others
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
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
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
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