Chapter 15: Medical Overview of Emergency Care
Introduction
- Focus on assessment techniques for patients with medical complaints.
- Patients may experience medical emergencies, trauma emergencies, or both.
- Trauma Emergencies: Result from physical forces.
- Medical Emergencies: Result from illnesses or conditions caused by disease.
Types of Medical Emergencies
- Respiratory Emergencies: Breathing difficulties or inadequate oxygen supply to tissues.
- Cardiovascular Emergencies: Conditions affecting the circulatory system.
- Neurological Emergencies: Involves the brain.
- Gastrointestinal Conditions: Appendicitis, diverticulitis, pancreatitis.
- Urologic Emergencies: Kidney stones.
- Endocrine Emergencies: Complications of diabetes.
- Hematologic Emergencies: Sickle cell disease, blood clotting disorders.
- Immunologic Emergencies: Body’s response to foreign substances.
- Toxicological Emergencies: Poisoning and substance abuse.
- Gynaecological Conditions: Female reproductive organs.
Patient Assessment
- Similar to trauma assessment but focuses on nature of illness, symptoms, and chief complaint.
- Establish an accurate medical history and avoid tunnel vision.
- Maintain professional demeanor, avoid assumptions.
Scene Size-Up
- Ensure safety for crew and patient.
- Use standard precautions.
- Determine number of patients and need for additional help.
Primary Assessment
- Develop general impression.
- Rapid exam to identify life threats.
- Determine consciousness level using AVPU scale.
- Focus on Airway, Breathing, Circulation, and Decision:
- Airway & Breathing: Ensure airways are open, check respiratory rate, depth, and quality.
- Circulation: Check pulse and skin condition.
- Transport Decision: Rapid transport for serious conditions.
History Taking
- Gather thorough history using SAMPLE (Signs & Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading up) and OPQRST (Onset, Provocation, Quality, Radiation, Severity, Time).
Secondary Assessment
- May occur on scene or en route.
- Conduct full-body assessment for unconscious patients.
- Examine head, neck, chest, abdomen, legs, arms, and back.
Vital Signs
- Check pulse, respirations, blood pressure.
- Consider blood glucose levels and pulse oximetry.
Reassessment
- Continuously reassess primary assessment and vital signs.
- Document changes and treatments.
Transport and Destination
- Treatment often beyond pre-hospital care.
- Requires rapid transport if life-threatening.
- Types of transport: Ground (EMT and paramedics) and Air (Critical care professionals).
- Destination usually closest capable hospital.
Infectious Diseases
General Assessment
- Scene size-up and standard precautions.
- Gather history using OPQRST and SAMPLE.
General Management
- Focus on life-threatening conditions.
- Use standard precautions.
- Understand epidemic vs pandemic.
Specific Diseases
- Influenza: Transmitted via nasal secretions and droplets.
- Herpes Simplex: Causes blisters; transmitted through close contact.
- HIV: Potentially hazardous, but not easily transmitted.
- Hepatitis: Inflammation of liver; different types have different transmission modes.
- Meningitis: Inflammation of brain and spinal cord coverings.
- Tuberculosis: Chronic bacterial lung disease.
- Whooping Cough (Pertussis): Airborne bacterial infection.
- MRSA: Antibiotic-resistant bacteria.
- COVID-19: Virus causing respiratory issues.
- MERS-CoV: Middle Eastern virus.
- Ebola: High fatality virus with global impact.
Travel Medicine
- Consider recent travel in diagnosis.
- Ask about vaccinations, exposure, and food/water sources.
Conclusion
- Assessment and treatment of medical patients can be challenging due to non-apparent symptoms.
- Remain calm, use assessment skills, and transport safely.
Review Questions
- Types of emergencies (e.g., seizure as neurological).
- Importance of avoiding tunnel vision.
- Scene time considerations.
- Transport decisions based on severity.
Note: Refer to emergency medical protocols and guidelines for specific procedures and PPE requirements.