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Emergency Care Overview and Patient Assessment

May 20, 2025

Chapter 15: Medical Overview - Emergency Care and Transportation of the Sick and Injured (12th Ed.)

Overview

  • Importance of proper assessment techniques for medical emergencies.
  • Types of emergencies: medical, trauma, or both.

Types of Medical Emergencies

  • Respiratory Emergencies: Trouble breathing or inadequate oxygen supply.
  • Cardiovascular Emergencies: Affecting the circulatory system.
  • Neurological Emergencies: Involving the brain.
  • Gastrointestinal Conditions: Include appendicitis, diverticulitis, pancreatitis.
  • Urologic Emergencies: Such as kidney stones.
  • Endocrine Emergencies: Mainly diabetes complications.
  • Hematologic Emergencies: Sickle cell disease, clotting disorders.
  • Immunologic Emergencies: Body's response to foreign substances.
  • Toxicological Emergencies: Poisoning and substance abuse.
  • Gynecological Conditions: Female reproductive organs.

Patient Assessment

  • Focus on nature of illness, symptoms, and chief complaint.
  • Establish accurate medical history without tunnel vision.
  • Maintain professional demeanor; avoid biases.

Scene Size-Up

  • Ensure safety, standard precautions, determine number of patients.
  • Identify nature of illness and need for spinal immobilization.

Primary Assessment

  • Develop general impression and identify life threats.
  • Use AVPU scale to determine consciousness.
  • ABCs: Airway, Breathing, Circulation.
    • Airway & Breathing: Ensure open airway, adequate breathing, apply oxygen if needed.
    • Circulation: Check pulse and skin color.
    • Transport Decision: Rapid transport for unconscious, altered mental status, airway/breathing problems.

History Taking

  • Gather thorough history using SAMPLE and OPQRST mnemonics.
    • SAMPLE: Allergies, Medications, Past Medical History, Last Oral Intake, Events Leading Up.
    • OPQRST: Onset, Provocation, Quality, Radiation, Severity, Time.

Secondary Assessment

  • Conduct limited or detailed physical exams based on chief complaint.
  • Full body assessment for unconscious patients.

Vital Signs

  • Measure pulse, respirations, blood pressure.
  • Consider additional testing like blood glucose and pulse oximetry.

Reassessment

  • Repeat assessments and adjust treatments as needed.
  • Monitor vitals every 5 minutes if unstable, every 15 if stable.

Transport and Destination

  • Choose appropriate transport mode: ground or air.
  • Rapid transport for life-threatening conditions.
  • Closest hospital usually selected unless specialized care is needed.

Infectious Diseases

  • General Management: Scene size-up, standard precautions, patient history.
  • Specific Diseases:
    • Influenza: PPE includes gloves, eye protection, mask.
    • Herpes Simplex: Close contact transmission, standard precautions.
    • HIV: Risk from blood and fluids; use gloves and proper disposal of sharps.
    • Hepatitis: Types A, B, C; A transmitted orally, B more contagious than HIV.
    • Meningitis: Particularly menolococcal, highly contagious.
    • Tuberculosis: Airborne transmission, requires N95 or HEPA masks.
    • Whooping Cough: Bacterial, vaccinate with DPT/TDAP.
    • MRSA: Transmitted via unwashed hands, leads to soft tissue infections.
    • COVID-19: Respiratory symptoms, PPE is crucial.
    • MERS-CoV, Ebola: Newer viruses requiring updated precautions.

Travel Medicine

  • Be aware of travel-acquired infections, gather thorough travel history.
  • Use appropriate PPE and notify facilities for communicable diseases.

Conclusion

  • Assessments and treatment in medical emergencies can be complex.
  • Accurate, calm, and systematic approaches are crucial for effective care.

Practice Questions

  • Neurologic Emergency: Seizure patient.
  • Tunnel Vision: Focus on one injury while missing others.
  • Frequent Flyer Consideration: Avoid assumptions based on past calls.
  • Scene Time for Non-Critical Patients: Gather comprehensive information.
  • Transport for Non-Responsive Patient: Use lights and sirens.
  • Infectious Disease Precautions: Standard precautions.
  • Hepatitis Indicators: Signs of cirrhosis likely indicate Hepatitis C.
  • Meningitis Symptoms: Stiff neck, blotches indicate meningitis.
  • TB Exposure: Require TB test and follow-up.
  • MRSA Risk Factors: Exclude contact with wild birds.

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