Signs and Symptoms

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Author:
anysen
ID:
252887
Filename:
Signs and Symptoms
Updated:
2013-12-13 21:09:25
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EMT Signs Symptoms
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Description:
Basic/general descriptions and signs/symptoms of EMT related emergencies.
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  1. Medical/Trauma Assessment
    • PPE
    • Scene Size Up (ENAMES)
    • Primary Survey
    •    General Impression (Big/Little Sick)  // LOC (AVPU)  //  Chief Complaint
    •    Airway - open & clear (suction, OPA/NPA?)
    •    Breathing - rythm, rate, quality (BVM? o2?)
    •    Circulation - strength, regularity, skin signs, bleeding, shock
    •    Transport Decision - (Stay & Play? Load & Go?)

    • History Taking
    •    Signs/Symptoms (OPQRST / PASTE)
    •    Medical History (AMPLE)

    Secondary Assessment - (Head to Toe - Detailed to CC)

    Vital Signs (BP, Pulse, Resp, Skin, Eyes)

    Re-Assess

    Transport?
  2. SECONDARY ASSESSMENT
    "Head to Toe Assessment” - detailed physical examination

    • Check a minimum of the following: 
    • Skin perfusion (again)
    • Pupil and eye condition (using the acronym PERRL “Pupils Equal, Round, and Reactive to Light)
    • Jugular Venous Distention (JVD), condition of the Trachea/neck (is it Midline? Is it mobile? Tugging to one side? Trauma?),
    • Chest Rise and Fall/condition (Equal bilaterally? Normal?)
    • Lung sounds 
    • Abdomen (Pain? Tenderness? Soft, Firm, or Rigid? What quadrant? Any Pulsatile Mass? Any Rebound Tenderness?)
    • Extremities (distal pulse/perfusion, deformity, Motor/Sensory/neurological function, Pitting Edema?.

    Check for any hidden injuries and for anything that doesn’t appear normal.

    DCAPBTLS
  3. PRIMARY ASSESSMENT
    • The quickest assessment and the first impression made.
    • Rapidly identify life-threatening conditions and facilitate immediate stabilizing treatment.
    • Check for Airway Patency (openness)
    • Breathing (Rate, quality, presence)
    • Circulation (Pulse, blood pressure
    • Skin perfusion – Color, temperature, and moisture).

    Gross deformity, major trauma and/or blood loss, or anything else that may cause the patient to crash.

    If found, you should act immediately to provide stabilizing treatment.

    Determine the chief complaint, the need for spinal immobilization, and form your general impression of the overall patient condition.
  4. Introduction
    Hi, I’m _____ and I’m a/an _____with _____. This is my partner  _____. What is your name Sir/Madame?

    My partner is going to take some vitals and I'd like to ask you a few questions.
  5. Heart Attack (AMI)
    Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.

    • Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
    • Shortness of breath with or without chest discomfort

    • Cool & diaphoretic
    • Nausea or lightheadedness.
  6. Hypovolemic Shock
    • This type of shock is caused by a loss of blood or body fluids. It should be suspected first whenever a patient presents with signs and symptoms of shock. Blood loss may be external or internal secondary to a traumatic injury. Body fluids can be lost due to burns, excessive vomiting, or diarrhea.
    • 1. Management of a patient with hypovolemic shock focuses on preventing further blood or fluid loss.
    • 2. Manage threats to the ABCs.
    • 3. Control external bleeding with direct pressure, pressure dressings, and tourniquets.
    • 4. Internal bleeding is difficult to manage. Splinting injured extremities may slow blood loss.
    • 5. Place the patient on a long backboard. The Trendelenburg's or the shock position may used to assist with perfusion.
    • 6. High-flow oxygen should be administered all hypovolemic patients.
    • 7. Prompt transport to a trauma center is required. Do not delay transport.
  7. Psychogenic Shock
    • A sudden reaction of the nervous system causes a temporary vasodilation, resulting in syncope (fainting). It is important to investigate other possible causes of the syncopal episode. Once supine, the patient regains consciousness.
    • 1. Perform a thorough primary assessment to identify any possible life-threatening causes of the syncope.
    • 2. Administer oxygen, elevate the legs, and prevent heat loss.
    • 3. Perform a secondary assessment to identify any injuries that may have occurred when the patient collapsed.
    • 4. Patient should be transported for evaluation.
  8. Anaphylactic Shock
    • Severe allergic reactions can rapidly
    • progress to anaphylactic shock. The body's response to the allergen causes widespread vasodilation.
    • 1. Request ALS.
    • 2. Be prepared to assist the patient with their prescribed epinephrine auto-injector.
    • 3. Oxygenate and ventilate the patient as necessary.
    • 4. Prompt transport to the closest emergency department is essential.
  9. Neurogenic Shock
    This type of shock involves an injury to the central nervous system, causing the patient's blood vessels to dilate (container gets bigger). Even though the blood pressure drops, there is no blood loss.

    • 1. Suspect neurogenic shock if the MOI is suspicious.
    • 2. Maintain cervical spine stablization and airway control with a modified jaw-thrust.
    • 3. Provide oxygen and assist breathing as necessary.
    • 4. Provide spinal immobilization.
    • 5. Elevate the foot end of the backboard slightly to help move blood into the vital organs.
    • 6. Prevent body heat loss.
    • 7. Transport promptly to a trauma center.
  10. Septic Shock
    • A systemic infection causes the blood vessels to become leaky and dilate, causing the container to enlarge. Patient requires complex management in the hospital.
    • 1. Assess and manage life threats to the ABCs.
    • 2. Administer high-fl ow oxygen.
    • 3. Prevent heat loss.
    • 4. Transport as promptly as possible.
  11. Obstructive Shock
    • This type of shock is usually caused by cardiac tamponade or tension pneumothorax. Patient requires management by ALS providers or more complex management at the hospital.
    • 1. Request ALS.
    • 2. In treating cardiac tamponade, weigh the need for positive-pressure ventilations against the possibility of hypoventilation. In treating tension pneumothorax, high-flow oxygen should be applied early to prevent hypoxia.
    • 3. Prompt transport to the closest emergency department is essential.
  12. Cardiogenic Shock
    • This type of shock is a failure of the pump (heart) and is often the result of a myocardial infarction. Since the heart is no longer an effective pump, fluid backs up in the body and the lungs.
    • 1. Assess ABCs. Patient will often have rales (fluid in the lungs). 
    • 2. Patient is often complaining of chest pain.
    • 3. Administer high-fl ow oxygen via a nonrebreathing mask.
    • 4. Place the patient in a sitting or semi-sitting position to assist breathing.
    • 5. Do not administer nitroglycerin if blood pressure is low; contact medical control.
    • 6. Keep the patient calm, request ALS if available, and transport promptly.
    • 7. Keep alert for the need to assist ventilation, perform cardiopulmonary resuscitation, or defibrillate
  13. Irreversible Shock
    • Blood pressure drops so much that even the carotid pulse barely palpable
    • Breathing is ineffective (rapid, shallow)
    • Skin mottles
    • Bleeding may occur from every orifice
    • Patient is unresponsive
  14. Decompensated Shock
    • Blood pressure drops
    • Tachycardia + very weak pulse
    • Skin becomes pale, cool and clammy
    • Thirst
    • Anxiety and eventually altered mental status.
  15. Compensatory Shock
    • Increased pulse and respiratory rate
    • Normal blood pressure but has a high diastolic blood pressure (vasoconstriction)
    • Pale and cool skin
    • Anxiety
  16. Stroke
    • Confusion
    • Sudden weakness or numbness
    • Trouble seeing or talking

    • Test: speech, facial, droop arm drift
    • Immediate Transport
    • *discover last time seen normal*
  17. Hyperglycemia
    • Slow onset of symptoms
    • Extreme thirst
    • Frequent urination
    • Warm, red skin
    • Hunger
    • Blurred vision
    • Drowsiness
    • Nausea
    • Fruity odor on breath
    • Blood glucose in excess of 140 mg/dL
    • Hypertension
    • Tachypnea
    • Dehydration
    • Altered mental status
    • Shock

    • *Potential for diabetic ketoacidosis
    • * Transport!
  18. Hypoglycemia
    • Blood glucose below 60 mg/dL
    • Rapid onset of symptoms
    • May appear drunk
    • Shaking
    • Tachycardia
    • Diaphoresis
    • Anxiety
    • Dizziness
    • Hunger
    • Impaired vision
    • Weakness/fatigue
    • Headache
    • Altered mental status
    • Seizures
    • Unconsciousness
    • Pale/sweaty skin

    If conscious and able to swallow: Oral glucose or Sugary drink/candy
  19. Pulmonary Edema
    • Increasing discomfort over a period of days
    • Sudden weight gain / swelling
    • Anxiety
    • Pale/sweaty skin
    • Tachycardia
    • Hypertension
    • Rapid and labored respirations
    • Low SpO2
    • Gurgling respirations
    • Crackles/wheezes in lungs on auscultation
    • Cough (with bloody sputum)

    Contributing factors: Previous cardiac history (MI/CHF) Recent visits to high altitudes

    Administer high-concentration oxygen. Consider assisting ventilations. Keep patients legs hanging down, if possible CPAP application
  20. Pulmonary Embolism
    • Sudden onset of sharp, pleuritic chest pain
    • Shortness of breath
    • Anxiety
    • Cough (possibly with bloody sputum)
    • Sweaty skin (pale/cyanotic)
    • Tachycardia
    • Tachypnea

    • Alternative:
    • Lightheadedness
    • Dizziness
    • Pain and swelling in one or both legs

    Administer oxygen & treat as other causes of shortness of breath
  21. Tuberculosis
    • Fever
    • Coughing
    • Fatigue
    • Night sweats
    • Weight loss

    If the lung infection becomes more severe, the patient will experience shortness of breath, coughing, productive sputum, bloody sputum, and chest pain.
  22. Pertussis (whooping cough)
    Coughing spells that can last for more than a minute, in which the child may turn red or purple

    • Whooping sound
    • Fever

    Mostly seen in pediatric patients.
  23. Pulmonary embolus
    • Sharp, pinpoint pain
    • Dyspnea
    • Sudden onset
    • After childbirth or surgery
  24. Pneumonia
    • Dyspnea
    • Chills
    • Fever
    • Cough
    • Dark sputum
  25. Emphysema
    • Barrel chest
    • Pursed lip breathing
    • Dyspnea on exertion
  26. Croup
    • Fever
    • Barking cough

    Mostly seen in pediatric patients
  27. Congestive Heart Failure
    • Dependent edema
    • Rales
    • Paroxysmal nocturnal dyspnea

    *Patient may sleep propped up (or seated)
  28. Bronchitis
    • Chronic cough
    • Wheezing
    • Cyanosis
    • Productive cough
  29. Anaphylaxis
    • Flushed skin or hives
    • Generalized edema
    • Decreased blood pressure
    • Laryngeal edema with dyspnea
  30. Asthma
    • Wheezing on inspiration/expiration
    • Bronchospasm
  31. Kidney and Ureters damage
    Pain that is following the angle from the lateral hip to the midline of the groin can be a result of damage to the kidneys or the ureters.
  32. Liver and Spleen Injuries
    Pain is referred to the shoulder (This finding is called the kehr sign when it involves injury to the spleen and pain in the tip of the left shoulder)

    Shoulder pain can be misleading and injury to the liver or spleen could possibly be overlooked if the shoulder is also injured or if the MOI suggest that an impact or injury may have occured in the shoulder girdle.
  33. Closed Abdominal Injuries
    In the abdomen, pain can often be deceiving because it is often diffuse in nature and may be referred from the site of injury to another location in the body.
  34. Traumatic Asphyxia
    • Distended neck veins
    • Cyanosis in the face and neck
    • Hemorrhage into the sclera of the eye, signaling the bursting of small blood vessels.

    These findings suggest an underlying injury to the heart and possibly a pulmonary contusion.
  35. Flail Chest
    Paradoxical motion is the main sign

    • Bruises
    • Grazes, and/or discoloration in the chest area 
    • Chest pain
    • Difficulty inspiration breathing
  36. Chest Injuries
    • Pain localized at the site of injury that is aggravated by or increased with breathing.
    • Bruising to the chest wall
    • Crepitus with palpation of the chest
    • Any penetration injury to the chest.
    • Dyspnea
    • Hemoptysis
    • Failure of one or both sides of the chest to expand normally with inspiration
    • Rapid, weak pulse
    • Low blood pressure.
    • Cyanosis around the lips or fingernails
  37. Pneumothorax
    Sudden chest pain with dyspnea

    If the lung is colapsed past 30% to 40% you may hear diminished breath sounds on that side of the chest.
  38. Spontaneous Pneumothorax
    • Sudden sharp chest pain
    • Increasing difficulty breathing

    A portion of the affected lung collapses, losing its ability to ventilate normally.
  39. Simple Pneumothorax
    • Dyspnea/Tachypnea (accessory muscle use)
    • Decreasing oxygen saturation on the pulse oximeter.

    • Late findings:
    • Decreased breath sounds on the injured side 
    • Lethargy
    • Cyanosis.
  40. Adult - Vital Signs
    • P: Adolescents: 60-105 bpm     
    •     Children (5-12 years): 60-120 bpm     
    •     Children (1-5 years): 80-150 bpm
    • R: 15-30 per minute
    • BP: : 90 (lower limit of normal) / 2/3 of systolic pressure
    •         90 + (2 x age in years) (upper limit of normal) / 2/3 of systolic pressure
    •         70 + (2 x age in years) (lower limit of normal) / 2/3 of systolic pressure
    • Cap Refill: 2 seconds
    • Eyes: PERL at 3-4 mm
    • Skin: Pink, warm and dry
    • SPO2: 97-100%
  41. Child - Vital Signs
    • P: Adolescents: 60-105 bpm     
    •     Children (5-12 years): 60-120 bpm     
    •     Children (1-5 years): 80-150 bpm
    • R: 15-30 per minute
    • BP: : 90 (lower limit of normal) / 2/3 of systolic pressure
    •         90 + (2 x age in years) (upper limit of normal) / 2/3 of systolic pressure
    •         70 + (2 x age in years) (lower limit of normal) / 2/3 of systolic pressure
    • Cap Refill: 2 seconds
    • Eyes: PERL at 3-4 mm
    • Skin: Pink, warm and dry
    • SPO2: 97-100%
  42. Infant - Vital Signs
    • P: 120-150 bpm
    • R: 25-50 per minute
    • BP: 70 (lower limit of normal) / 2/3 of systolic pressure
    • Cap Refill: 2 (male) / 3 (female) seconds
    • Eyes: PERL at 3-4 mm
    • Skin: Pink, warm and dry
    • SPO2: 97-100%
  43. Elderly - Vital Signs
    • P: 90 bpm
    • R: 12-20 per minute
    • BP: (Male): 100 + age in years to age 40 / 60-90 mmHg
    •       (Female): 90 + age in years to age 40 / 60-90 mmHg
    • Cap Refill: 4 seconds
    • Eyes: PERL at 3-4 mm
    • Skin: Pink, warm and dry
    • SPO2: 97-100%
  44. Tension Pneumothorax
    • Increasing respiratory distress
    • Altered level of consciousness,
    • Distended neck veins
    • Deviation of the trachea to the side of the chest opposite the tension pneumothorax,

    • Tachycardia,
    • Low blood pressure
    • Cyanosis
    • Decreased breath sounds on the side of the pneumothorax

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