hello and welcome to chapter 15 medical overview of the emergency care and transportation of the sick and injured 12th edition after you complete this chapter and the related coursework you will understand the need for proper assessment techniques when called to patients with the chief complaint of a medical nature okay so let's get started patients who need ems assistance generally have experienced a medical emergency a trauma trauma emergency or both trauma emergencies involve injuries resulting from physical forces being applied to the body and medical emergencies involve illness and conditions that caused by disease it's important to remember that patients may have a combination of medical and trauma conditions okay so let's talk about some types of medical emergencies you can have respiratory emergencies and they occur when patients have trouble breathing or when the amount of oxygen supplied to the tissues is inadequate you can have cardiovascular emergencies and they are caused by conditions affecting the circulatory system neurological emergencies involve the brain and gastrointestinal conditions involve appendicitis diverticulitis pancreatitis and many others a urologic emergency may involve kidney stones and the most common endocrine emergencies are caused by complications of diabetes hematologic emergencies may be the result of sickle cell disease or various types of blood clotting disorders such as hemophilia immunologic emergencies involve the body's response to foreign substances and toxological emergencies involve poisoning and substance abuse results in other types of medical emergencies so some medical emergencies are caused by physiological or behavioral problems and may be especially difficult to deal with because patients often do not present with typical signs and symptoms gynological conditions are a special category of emergencies that involve female reproductive organs this table shows types of common medical emergencies all right so let's talk about the patient assessment so an assessment of a medical patient is similar to an assessment of a trauma patient but with one different focus medical patient assessments they focus on the nature of illness the symptoms and the chief complaint okay so you want to establish an accurate medical history you use dispatch information to guide your initial response but do not get locked into preconceived idea of a patient's condition so injuries may distract you from underlying conditions tunnel vision occurs when you become focused on one aspect of the patient's condition and exclude all the others which may cause you to miss an important injury or illness okay assessment may be difficult with an uncooperative or hostile patient so maintain a professional calm non-judgmental demeanor at all times refrain from labeling patients and displaying their uh your personal biases okay a frequent caller may have a frequent a different complaint this time so let's start with the scene size up you have to ensure your safety for you your crew and your patient use standard precautions and determine the number of patients and whether you need additional help next is going to be to determine the nature of illness so the index of suspicion is your awareness and concern for potentially serious underlying and unseen injuries or illnesses and initiate spinal immobilization if needed when you get to your primary assessment develop your general impression depression perform a rapid exam of the patient to identify life threats and quickly determine the patient's level of consciousness using avu scale then we're going to go into the airway breathing circulation and decisions so airway and breathing in conscious patients ensure the airways open and they are breathing adequately check the respiratory rate depth and quality and consider applying oxygen if breathing has been affected for unconscious patients of course we need to make sure we open the airway using the proper technique and take several seconds to evaluate their breathing we're going to apply some oxygen so always when we have a patient in shock or with difficulty breathing or when low oxygen saturations are measured with spo2 less than 94 percent unconscious patients may need airway adjuncts and ventilatory assistance with a bag valve mask all right now our c part of our abcs so in a conscious patient we are going to check the radial pulse and observe for the patient's skin color type of condition for unconscious patients we are checking the circulation at the carotid artery and now it's our d so our transport decision the following patient should be considered in a in serious condition and in need of rapid transport so anybody who is unconscious or who has an altered mental status patients with airway or breathing problems or patients with obvious circulation problems such as bleeding or signs of shock if the patient did not meet the criteria for rapid transport continue your assessment on scene and prepare for transport when you have completed the assessment and treatment next remember we're going to go into history taking so determine what the problem is or what may be causing the problem we need to gather a thorough history investigate the nature of illness by inquiring about the chief complaint for an unconscious patient survey the scene for medication containers and medical devices we're going to obtain the history of the patient by asking sample so sample stands for allergies medications past pertinent medical history last oral intake and events leading up to this okay and then we're going to get the history of the patient's chief complaint by using that opqrst pneumonic and that's onset provocation quality radiation severity and tender and time and record all allergies medications and medicines and some patients take numerous meds so take the medicines with you to the hospital and list them in your report okay so the secondary assessment the secondary assessment may occur on scene or in route to the emergency department in some cases you may not have time to con conduct that secondary so physical exam so all conscious patients should undergo a limited or detailed physical exam that's based on their chief complaint for an unconscious patient you should always perform a secondary assessment of the entire body or head to toe exam to obtain clues to assess the problem a full body assessment should help you obtain clues and should be performed quickly so it does not delay transport if the patient's condition warrants the secondary assessment examine the head scalp face the neck then the chest and abdomen palpate the legs and arms and examine the patient's back treatment will depend on the conditions found and your local protocols now we're going to take the vital signs so what do we mean by vital signs we're going to check for the pulse and we're going to check the rate rhythm and quality of the pulse at the appropriate site okay so identify the rate quality and regularity of the respirations as well and any difficulties that may be apparent next we're going to obtain an initial blood pressure so we're going to measure both systolic and diastolic pressures and we're going to consider using the automatic blood pressure cuff for future assessments at regular intervals consider obtaining blood glucose levels and pulse oximetry as well now our reassessment so once the assessment and treatment have been completed reassessment should begin and continue throughout transport repeat the primary assessment and reassess the chief complaint consider the need for advanced life support backup repeat your physical examination to identify the tr and treat in changes in the patient's condition now obtain vital signs every five minutes if your patient is unstable and every 15 minutes if the patient is stable so review all treatments that you have performed and document any changes that have been that has been developed as a result of treatments and if needed adjust any of the treatments accordingly so let's talk about transport and destination so most emergencies require a level of treatment beyond that available in the pre-hospital setting may require advanced testing available in the hospital so it may be beyond the scope of the emt to administer medicines to a patient any administration of a medicine by an emt requires direct permission from medical control emts can use an aed on a patient who is pulseless and ethnic so let's talk about scene time scene time may be longer for medical patients than for trauma because we want to gather as much information as possible to transmit to the emergency department critical patients always need rapid transport and like we said these include altered mental status airway or breathing difficulties um any signs of circulatory compromise and and some who are very old or very young okay in the type of transport if a life-threatening conditions exist the transport should include lights and sirens if the patient's not critical we're going to consider non-emergency transport and modes of transport ultimately come in one of two categories so you have ground transport or air transport now ground transport ems units are generally staffed by an emt and paramedics air transport ems units are generally staffed by critical care transport professionals and paramedics so let's talk about the destination selection generally the closest hospital should be your destination however sometimes the patient will benefit from going to another hospital that is capable of handling his her own particular condition infectious diseases so general assessment so when we're going to approach the patient with an infectious disease like any other medical patient we want to perform scene size up take standard precautions and complete primary assessments we want to gather patient history using opqst to elaborate on the patient's chief complaint we want to obtain that sample history and set a baseline vital signs we're going to pay particular attention to medicines and the events leading up to today's problem ask whether the patient has recently traveled or has come in contact with someone who has traveled and then general management principles for infectious diseases so we want to focus on any life-threatening conditions identified in that primary assessment we're going to be empathetic we want to place the position income the patient in the position of comfort on the stretcher and keep them warm and then we're going to use standard precautions so always follow your agency's exposure control plan in cleaning equipment and properly discard any disposable supplies and wash linens epidemic and pandemic considerations just understand that an epidemic is when new cases of disease in a human population substantially exceed what is expected a pandemic is a disease outbreak that occurs on a global scale common or serious communicable diseases include we're going to start off with influenza so those with chronic medical conditions comprise immune systems and the very young and the very old are susceptible to complications of influenza transmitted by direct contact with nasal secretions and air slice droplets from coughing and sneezing by affected people for diseases that can be passed by the respiratory route we need to always wear ppe and this includes gloves eye protection and a hipaa h-e-a-h-e-p-a respirator or an n95 mask at a minimum we have to wash hands frequently place a surgical mask on the patient with suspected or confirmed respiratory disease wear a hepa respirator or an n95 during air slice generating procedures such as suctioning of airway secretions performing cpr or assisting with an endotracheal tube innervation any annual influenza immunization is important for ems personnel to protect providers and patients next type of communicable disease we're going to talk about is herpes simplex so this is a common virus strain carried by humans it is um symptomatic infections cause eruptions of tiny fluid blisters placed blisters cause vesicles that appear on the lips and genitals so it can cause more serious illness like pneumonia and meningitis in the very young very old or immunocompromised the primary mode of infection is through close personal contact so you use standard precautions and are generally sufficient to prevent form or spread to healthcare workers okay the next we're going to talk about is hiv infection emts face a risk of exposure to the virus that causes aids on a regular basis aids can still be fatal however with treatment patients can expect a near normal lifespan so hiv infection is potentially hazard only when deposited on mucous membranes or directly into the bloodstream if it is not easily transmitted in a work setting it's not easy your risk of infection is limited to exposure to an infected patient's blood and bodily fluids many patients with human immunodeficiency virus show no symptoms always wear wear the proper type of gloves and take great care and handling and properly disposing of nasals and other sharp objects cover any wounds that you have whenever you are on the job so if you think that a patient's blood or secretions may have entered your system seek medical advice as soon as possible and notify your infectious disease officer okay so hepatitis is the next disease we're going to talk about and that is inflammation of the liver and it can be caused by a number of different viruses and toxins there is no sure way to tell which hepatitis patients are contagious so hepatitis a can be transmitted only from a patient who has an actual acute infection whereas b and c can be transmitted from long-term carriers who have no signs of illness okay so a carrier is a person or animal in whom an infectious organism has taken a permanent residence and may or may not cause an active disease so hepatitis a is transmitted orally or through oral or fecal contamination hepatitis b is far more contagious than hiv and vaccination with hepatitis b is highly recommended for emts the table shows the characteristics of different types of hepatitis and then you have meningitis so this is an inflammation of the meningeal covering of the brain and spinal cord most forms of meningitis are not contagious one form though menolococcal meningitis is highly contagious so take standard precautions gloves in a mask will go a long way to prevent the patient's secretions from getting into your nose and mouth and vaccines are rarely used so meningitis can be treated at the emergency department with antibiotics and after treating a patient with meningitis contact your employer's health representative so the next infectious disease we're going to talk about is tuberculosis and most infected patients are well most of the time a chronic myocobacterial disease that strikes the lungs so disease this disease that occurs shortly after infection is called the primary tuberculosis and this is a reactive tuberculosis is common and can be much more difficult to treat okay so patients who pose a high risk almost always have a cough so consider respiratory tuberculosis to be the only contagious form because it is the only one that can spread by airborne transmission okay so in droplet nuclei that's the remnants of the droplets produced by coughing after the excess water has evaporated so n95 and hepa mass are required to stop that droplet type nuclei okay so absolute protection from infection with tuberculosis does not exist according to the centers for disease control and prevention one-third of the world's population is infected with tuberculosis the mechanism of transmission is not very efficient so have tuberculin skin tests regularly and if the infection is found before you become ill preventative therapy is almost 100 effective whooping cough that's what we're going to talk about next and this is also called pertussis whooping cough is an airborne disease caused by bacteria that mostly affects children younger than six years old so symptoms incur include a fever and a whoop sound that occurs when inhaling after a coughing attack the best way to prevent exposure to is to be vaccinated with the dpt or tdap and you can also place a mask on the patient and yourself next is mrsa so mrsa is a bacterium that causes infections and is resistant to many antibiotics in health care settings mrsa is transmitted from patient to patient by the unwashed hands of healthcare providers factors that increase the risk of developing mrsa include antibiotic therapy prolonged hospital stays a stay in intensive care or burn unit exposure to an infected patient the incubation period for mrsa appears to be between 5 to 45 days immersive results in soft tissue infections skin signs and symptoms include localized skin abscesses and sepsis in older patients okay next we're going to talk about covid19 so the 2019 novel coronavirus it originated in wu hand spread quickly infecting millions and killing hundreds of thousands controlling the virus included social distancing symptoms include fever cough shortness of breath that appear between two to 14 days after exposure to the infected person for current updates on coven 19 use the cdc website now we're going to talk about mers covid so it's a middle eastern respiratory syndrome so first human case of mers kovi it was discovered in 2012 in saudi arabia most human infections found in the middle east cases of that mers kovi have been found in europe in the u.s and if you suspect mr kovi place a surgical mask on the patient and notify the receiving facility next we're going to talk about ebola and in 2014 an outbreak of ebola virus in west africa spread when infected people traveled to other countries it caused international concern incubation period is from 6 to 12 days after the exposure symptoms may not appear for as long as 21 days after infection fatality rate can be as high as 70 percent if treated in an icu is not initiated promptly if you suspect ebola place a surgical mask on the patient follow ppe precautions as outlined by local protocols and the cdc and notify the receiving facility next we're going to talk a little bit about travel medicine so you must be aware of travel acquired infections when assisting a patient who has recently been outside the united states patients can present with a variety of symptoms including fever cough vomiting bloody diarrhea body aches and rashes so when you encounter an ill patient with a recent travel history please place a mask on the patient and gather as much information as possible important questions to ask are where did you recently travel did you receive any vaccinations before your trip were you exposed to any infectious diseases is there anyone else in your travel party who is sick and what types of food did you eat what was your source of drinking water and if you suspect the patient has a communicable disease follow your appropriate ppe precautions and notify the receiving facility so in conclusion the assessment and treatment of medical patients can be challenging and interesting because of the nature of medical conditions the condition of the medical patient may not be as apparent as in the trauma and treatment may not be as straightforward delays in an attempt to diagnose a condition can be harmful to your patient so keep calm use your patient assessment skills treat the patient's symptoms report to medical control and transport the patient safely to the emergency department be prepared to handle any combination of conditions including conditions of medical patients who have also been involved in trauma so this concludes a chapter 15 lecture next we're going to start the review questions see what we learned okay so a seizure patient is having what type of emergency and we didn't specifically go over this however it's going to be a neurologic emergency okay so neurologic emergencies involve the brain and may be caused by a seizure stroke or fainting if an injury distracts an emt from assessing a more serious underlying illness the emt has suffered from and i'm going to say it's tunnel vision yes so you should use the dispatch information to guide your response but do not get locked into preconceived ideas of the patient's condition a frequent flyer calls 9-1-1 because of a suspected head injury you should never assume you know what the problem is so c every case is different and you don't want to miss a potential serious problem if your medical patient is not critical how long should you stay on scene i'm going to say however long it takes to gather as much information as possible and that's correct your patient is having respiratory difficulty and is not responding to your treatment what is the best method of transport i'm going to say with lights and sirens to the closest hospital yes exactly so with lights and sirens when assessing a patient with an infectious disease what is the first action you should perform i think it would be standard precautions of course okay so it looks like they have the slides a little mixed up but your patient believes that he has hepatitis and he's now accepting signs of cirrhosis of the liver he mostly has and we're going to say it's hep c yep hep c okay your patience completing a fever headache stiffness of the neck and red blotches he's most likely okay so anytime you get that stiffness of the neck with those red blotches that's going to be meningitis stiffness of the neck neck complaints all right and you what should you do if you are exposed to a patient who is found to have pulmonary tuberculosis okay so if you suspect that you need to get a tb test okay and all the following are factors that increase the risk of developing mrsa except close contact with wild birds that would be close contact with wild birds okay so this concludes the chapter 15 medical overview so if you like this lecture go ahead and subscribe because we're going to be getting the whole book chapters of the of the whole book and you don't want to miss them thanks