Chapter 15: Medical Overview - Emergency Care and Transportation of the Sick and Injured (12th Edition)
Introduction
- Objective: Understand proper assessment techniques for patients with medical emergencies.
Types of Emergencies
- Trauma Emergencies: Injuries from physical forces.
- Medical Emergencies: Illnesses caused by diseases.
- Patients can have both medical and trauma conditions.
Types of Medical Emergencies
- Respiratory: Breathing troubles or inadequate oxygen supply.
- Cardiovascular: Affecting the circulatory system.
- Neurological: Brain-related issues.
- Gastrointestinal: Includes appendicitis, pancreatitis, etc.
- Urologic: Kidney stones, etc.
- Endocrine: Mainly complications from diabetes.
- Hematologic: Sickle cell disease, blood clotting disorders.
- Immunologic: Body’s response to foreign substances.
- Toxicological: Poisoning, substance abuse.
- Gynecological: Female reproductive organs.
Patient Assessment
- Focus: Nature of illness, symptoms, chief complaint.
- Avoid Tunnel Vision: Don’t get locked into preconceived ideas.
- Professional Attitude: Stay calm, non-judgmental, avoid bias.
Scene Size-Up
- Ensure safety and use standard precautions.
- Determine number of patients and need for additional help.
- Establish the nature of illness and initiate spinal immobilization if needed.
Primary Assessment
- Develop a general impression and perform rapid patient exam.
- Use the AVPU scale for consciousness.
- ABCs: Airway, Breathing, Circulation.
- Check airways, breathing adequacy, and apply oxygen if needed.
- Check circulation via pulse and skin assessment.
- Transport Decision: Rapid transport for serious conditions (unconscious, altered mental status, airway/breathing problems, shock).
History Taking
- Determine and investigate the chief complaint.
- Use SAMPLE: Signs/Symptoms, Allergies, Medications, Past Medical History, Last Oral Intake, Events leading up to.
- Use OPQRST for pain: Onset, Provocation, Quality, Radiation, Severity, Time.
Secondary Assessment
- Perform physical exams based on consciousness and complaint.
- Full-body assessment for unconscious patients.
Vital Signs
- Check pulse rate, rhythm, and quality.
- Assess respirations and blood pressure.
- Consider blood glucose and pulse oximetry.
Reassessment
- Continue reassessment throughout transport.
- Reassess chief complaint and obtain vital signs every 5-15 minutes based on stability.
Transport and Destination
- Emergency Treatment: Often beyond pre-hospital scope. Requires medical control.
- Scene Time: Longer for medical cases to gather information.
- Transport Types: Ground or air, based on patient condition.
Infectious Disease Assessment
- Perform scene size-up and take precautions.
- Gather history with emphasis on recent travel and contacts.
- Management: Focus on life-threatening conditions, comfort, and warmth.
Epidemic and Pandemic Considerations
- Definitions: Epidemic (local excess cases), Pandemic (global outbreak).
- Communicable Diseases: Influenza, Herpes Simplex, HIV, Hepatitis, Meningitis, Tuberculosis, Whooping Cough, MRSA, COVID-19, MERS-CoV, Ebola.
- Use protective equipment and follow guidelines for exposure prevention.
Conclusion
- Medical assessments are complex due to non-obvious conditions compared to trauma.
- Use calm and thorough assessment and transport safely.
Review Questions Highlights:
- Seizure = Neurologic emergency.
- Avoid tunnel vision; don't assume based on frequent flyer history.
- Scene stay: Gather comprehensive info.
- Respiratory difficulty requires emergency transport.
- Infectious disease: Start with standard precautions.
- Hepatitis C = Likely with liver cirrhosis symptoms.
- Meningitis = Stiff neck, red blotches.
- Tuberculosis exposure warrants a TB test.
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