Medical Triads and Symptoms

Overview

This lecture covers key signs and symptoms commonly tested on the NREMT exam, focusing on three major medical triads and a sample question review.

Cardiac Tamponade - Beck's Triad

• Cardiac tamponade is pressure on the heart from fluid in the sac surrounding it.
• Heart fails as a pump, causing blood to back up in the veins.
• Beck’s triad includes: Jugular Venous Distension (JVD), hypotension (low blood pressure), and muffled heart sounds.

Increased Intracranial Pressure - Cushing's Triad

• Increased intracranial pressure (ICP) can result from head trauma or brain bleed.
• Cushing’s triad includes: hypertension (high systolic blood pressure and wide pulse pressure), bradycardia (slow heart rate), and irregular, slow respirations.
• Cushing’s triad is the opposite of shock signs (shock: tachycardia, hypotension, rapid breathing).

Wheezing - Asthma, Anaphylaxis, COPD

• Wheezing is commonly found in Asthma, Anaphylaxis, and COPD patients.
• Asthma attacks cause acute wheezing and are a common EMS call.
• Anaphylaxis involves two or more body systems and may include wheezing, stridor, nausea/vomiting, and hives.
• COPD patients (chronic bronchitis or emphysema) often require long-term steroids and may be on home oxygen.

Example NREMT Question Review

• 42-year-old female, altered mental status, tachycardia, and bulging eyes at a bar.
• Cocaine OD presents with dilated pupils and tachycardia, not bulging eyes.
• Opiate OD shows bradycardia, hypotension, and respiratory depression.
• Bulging eyes with AMS and tachycardia is classic for Graves’ disease.
• Graves’ disease is the correct answer due to bulging eyes and vital signs.

Key Terms & Definitions

• Cardiac Tamponade — Compression of the heart by fluid, causing pump failure.
• Beck’s Triad — Combination of JVD, hypotension, and muffled heart sounds in cardiac tamponade.
• Increased Intracranial Pressure (ICP) — Raised pressure in the skull, often from trauma or bleeding.
• Cushing’s Triad — Hypertension, bradycardia, and irregular respirations seen with increased ICP.
• Wheezing — High-pitched lung sound from narrowed airways, seen in asthma, anaphylaxis, and COPD.
• Graves’ Disease — Autoimmune disorder causing hyperthyroidism, often presenting with bulging eyes.

Action Items / Next Steps

• Review and memorize Beck's and Cushing’s triads.
• Study common causes of wheezing and their distinguishing features.
• Practice identifying signs and symptoms in sample NREMT scenarios.