1 Medical Emergencies Review, Part 1. 2 Neurological Emergencies. 3 Headache (1 of 6) 4 Headache (2 of 6) 5 Headache (3 of 6) 6 Headache (4 of 6)

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1 1 Medical Emergencies Review, Part 1 2 Neurological Emergencies 3 Headache (1 of 6) One of the most common complaints Can be a symptom of another condition or a condition on its own Most headaches are and do not require emergency medical care. 4 Headache (2 of 6) Sudden, severe headache requires assessment and. If more than one patient reports headache, consider carbon monoxide poisoning. Tension headaches, migraines, and sinus headaches are the most common. medical emergencies 5 Headache (3 of 6) headaches are the most common: Caused by muscle contractions in the head and neck Attributed to Pain is usually described as squeezing, dull, or as an ache. 6 Headache (4 of 6) headaches are the second most common: Thought to be caused by changes in the blood vessel size in the base of the brain Pain is usually described as pounding, throbbing, and pulsating. Often associated with visual changes Can last for several 7 Headache (5 of 6) Sinus headaches: Caused by that is the result of fluid accumulation in the sinus cavities Patients may also have like symptoms of nasal congestion, cough, and fever. Prehospital emergency care is not required. 8 Headache (6 of 6) Serious conditions that include headache as a symptom are hemorrhagic, brain tumors, and meningitis. You should be concerned if the patient complains of a -onset, severe headache or a sudden headache that has associated symptoms. 9 Emergency Medical Care: Headache 1

2 Most headaches are and do not require emergency medical care. You should be concerned if the patient complains of: A sudden-onset, severe headache A sudden headache with fever,, AMS, or following trauma 10 Emergency Medical Care: Migraine Always the patient for other signs and symptoms that might indicate a more serious condition. Apply high-flow oxygen, if tolerated. Provide a darkened, environment. Do not use lights and sirens during transport. 11 Cerebrovascular Accident and Stroke Cerebrovasuclar (CVA) Interruption of blood flow to the brain that results in the loss of brain function The loss of brain function that results from a CVA 12 3 Causes of a CVA : Blockage of a vessel by a thrombus (blood clot) which forms at a narrow area. : Rupture of a blood vessel. : Blood clot or plaque travels through a blood vessel until it lodges in the brain, blocking blood flow. 13 Thrombosis Caused CVA 14 Embolism Caused CVA 15 Hemorrhage Caused CVA 16 Hemorrhagic Stroke (1 of 2) Accounts for 10% to 20% of strokes People at high risk include those experiencing stress or. People at highest risk are those who have very high blood pressure. Results from in the brain Arterial rupture 17 Hemorrhagic Stroke (2 of 2) Cerebral hemorrhages are often. An aneurysm is a swelling or enlargement of an artery due to weakening of the arterial wall. Some people are born with 18 Ischemic Stroke (1 of 2) Most, accounting for more than 80% of 2

3 strokes Results from an embolism or thrombosis Results when blood flow to a particular part of the brain is cut off by a blockage inside a blood vessel Clotting of the cerebral arteries Cerebral Blockage by a clot formed elsewhere in the body 19 Ischemic Stroke (2 of 2) Symptoms may range from nothing at all to complete. Atherosclerosis in the blood vessels is often the cause. forms inside the walls of the blood vessels and may obstruct blood flow. Eventually, it causes complete occlusion of an artery. 20 Signs and Symptoms of Stroke Left Hemisphere : Inability to speak or understand speech Receptive aphasia: Ability to speak, but unable to understand speech Expressive aphasia: Inability to speak correctly, but able to understand speech Right Hemisphere : Able to understand, but hard to be understood 21 Other S/S of CVA 1 Alterations in consciousness Paralysis Loss of speech or speech Unilateral blindness 2 Seizures Headache Unequal blood pressure Dizziness Other S/S of increased intracranial pressure 22 Stroke Mimics: Postictal state Subdural or epidural bleeding 23 Assessing the Stroke Patient Primary assessment 3

4 Check and care for. Obtain history if possible. Administer oxygen and manage airway. Focused history and physical exam Perform neurologic exam. Check all 4 extremities for movement and Utilize the Cincinnati Stroke Scale 24 Cincinnati Stroke Scale (1 of 2) Facial Ask patient to show teeth or smile Abnormal if asymmetrical drift Ask pt to close eyes and hold both arms out with palms up Abnormal if arms do not move equally 25 Cincinnati Stroke Scale (2 of 2) Ask patient to say the sky is blue in Cincinnati or something similar if words are slurred or confused 26 Emergency Medical Care for Stroke (1 of 2) Patient needs to be evaluated by computed topography ( ). Recognizing the signs and symptoms of stroke can shorten the delay to CT. Treatment needs to start within hours of onset. Use of clot buster medications Document times carefully Careful what you 27 Emergency Medical Care for Stroke (2 of 2) Rule out other causes Check for Check blood sugar Establish IV at TKO rate Provide supportive care if drooling 28 Baseline Vital Signs Excessive bleeding in the brain may pulse and cause erratic respirations. Signs of increased ICP just like head injury may develop Blood pressure is usually. Excessive bleeding in the brain may cause changes in pupil size and reactivity. 4

5 29 Transport Considerations Place the patient in a comfortable position. Usually on one side Paralyzed side and well protected Elevate patient s about 6". Continue giving oxygen and monitor vitals. 30 Transient Ischemic Attack (TIA) A TIA is a mini-stroke. Stroke symptoms go away within hours. Every TIA is an emergency. TIA may be a warning sign of a larger. Patients with possible TIA should be evaluated by a physician. 31 Seizures Seizures: episodes of uncoordinated electrical activity in the brain. A seizure, or, is a temporary alteration in consciousness. Account for up to 30% of EMS calls In the United States, it is estimated that 4 million people have epilepsy. : Tendency to have repeated episodes of seizure activity. 32 Types of Seizures (Grand Mal) seizure (Petit Mal) seizure seizure 33 Generalized Seizure AKA: Major Motor or Grand Mal Seizure Affects all parts of body : sensation before convulsion Convulsion loss of consciousness phase (rigidity) phase (rhythmic jerking) incontinence ineffective breathing phase-exhaustion, drowsiness 34 Partial Seizure (1 of 2) Simple partial seizure: No in the patient s level of consciousness May have numbness, weakness, dizziness, visual changes, or unusual smells/tastes May have some or brief paralysis 5

6 35 Partial Seizure (2 of 2) partial seizure: Altered mental status Results from abnormal discharges from the lobe of the brain Lip smacking, eye blinking, isolated jerking Uncontrollable 36 Absence (Petit Mal) Seizure Loss of consciousness without loss of tone. Brief lapse of attention manifested by staring and no apparent response to anyone Most common in Last for Patient fully recovers with a brief lapse of memory 37 Characteristic of Seizures May occur on one side or spread throughout the whole body (generalized) Usually last 3 to 5 minutes, followed by period of unconsciousness known as state Patient may experience an. Seizures recurring every few minutes are known as status. 38 Causes of Seizures Congenital (epilepsy) High Structural problems in the Metabolic disorders Chemical disorders (poison, drugs) Sudden high fever (Low blood sugar) 39 Recognizing Seizures Cyanosis Abnormal or absence of Possible head injury Loss of bowel and bladder control Severe muscle Post seizure state of unresponsiveness with deep and labored respirations 40 Postictal State Patient may have labored breathing. May have : weakness on one side of the body. Patient may be lethargic, confused or combative. Consider underlying conditions. 6

7 Infection 41 Management of Seizures (1 of 2) Remove from harm. from injury. Don t forcibly restrain the patient. Roll patient on side. After seizure: Assess ABC s Clear airway Assist as needed Lower body temperature if febrile seizure 42 Management of Seizures (2 of 2) Never insert anything in patient s mouth! Obtain History about seizures and medications Phenobarbital, Depakote,, Topamax and Dilantin most common Establishing an IV is a Obtain blood glucose level Physical exam for injuries caused by seizure Request backup if seizure continues Monitor N/V and vital signs 43 When to Encourage Treatment and Transport If patient s seizure. If patient has not taken meds recently. If seizures are or different from usual. If patient had repeated seizures. Any signs of trauma,, aspiration, or other serious condition 44 Status Epilepticus Defined as or more seizures without intervening periods of consciousness. Immediate life threat. Assist. Rapid Transport. Attempt IV and request Paramedic backup for administration of. 45 Coma Coma-state of unconsciousness from which patient cannot be aroused Coma=Immediate Life Threat Management before investigating 7

8 Control c-spine if trauma known or suspected Establish IV access Look for 46 Investigating Cause of Coma After ABC s, investigate cause using DERM D= of coma E=Eyes R=Respiratory Pattern M= function 47 Investigating Cause of Coma 1 Vital Signs Shock? Increased? Arrhythmias? Blood glucose? Possible narcotics OD? 2 Head to Toe Exam Injuries? Snake bites? Insect stings? Drug tracks Examine for clues 48 Altered Mental Status (AMS) 1 Hypoxemia Intoxication Drug overdose Unrecognized head injury 2 infection Body temperature abnormalities Brain tumors Glandular abnormalities 49 Assessing a Patient With AMS (1 of 2) Same assessment process Patient cannot tell you reliably what is wrong. Establish vascular access Obtain blood Be vigilant in. Monitor for changes or deterioration. 8

9 50 Assessing a Patient With AMS (2 of 2) Use scale to classify severity. Consider underlying conditions. Monitor for depressed respirations. Ensure that basic airway maneuvers are followed. Evaluate need for advanced airway Consider Provide prompt transport to hospital while monitoring the patient. 51 Cardiovascular Emergencies 52 Cardiovascular Emergencies Cardiovascular disease has been killer of Americans since Accounts for 1 of every 2.8 deaths Cardiovascular disease (CVD) claimed 931,108 lives in the US during ,551 per day Almost people per minute! 53 The Heart Has it s own supply Has it s own electrical system The heart is divided into 2 types of circulation: 1. Circulation 2. Circulation 54 Pulmonary Circulation Circulation to and from side of heart Blood is pumped through pulmonary arteries to lungs Receives from alveoli and leaves waste products and carbon dioxide 55 Systemic Circulation Circulation to and from side of heart Pumped to aorta and the body Delivers oxygen to cells and removes 56 Cardiac Compromise Chest pain results from Ischemic heart disease involves decreased blood flow to the heart. If blood flow is not restored, the tissue. 57 Coronary Artery Disease (CAD) Atherosclerosis Arteriosclerosis 9

10 58 Atherosclerosis Materials build up inside blood vessels. This decreases or blood flow. factors place a person at risk. 59 Arteriosclerosis Coronary artery wall becomes hard and stiff due to calcium deposits Hardening of the Arteries Causes coronary arteries to loose their nature Decreases blood flow Causes 60 Major Risk Factors of Coronary Artery Disease 1 Uncontrollable Sex Heredity 2 Controllable High Blood Pressure High Diabetes 61 Minor Risk Factors of Coronary Artery Disease Inactivity Personality 62 Coronary Artery Disease 63 Coronary Artery Disease 64 Angina Pectoris in chest that occurs when the heart does not receive enough oxygen Typically crushing or squeezing pain Rarely lasts longer than minutes Can be difficult to differentiate from heart attack No damage to the heart 65 Angina Pectoris Signs/Symptoms Squeezing/crushing chest Pain may to shoulders, arms, neck, jaw, 10

11 upper back, or upper abdomen Pain may be in area of radiation only Possible shortness of (SOB) 66 Angina Pectoris Pain associated with the 3 E s Pain seldom lasts for more than minutes Pain normally relieved by: -rest -nitroglycerin 67 Angina Pectoris Two Forms of Angina 1. Angina -Pain predictable in duration and frequency -Pain relieved by predictable amounts of rest and nitroglycerin 2. Angina -Change occurs in usual patterns -30% go on to infarct within 3 months 68 Treatment of Angina Pectoris all first time angina and unstable angina as a myocardial infarction. When in doubt, manage chest pain as a myocardial infarction 69 Acute Myocardial Infarction Acute Myocardial Infarction (AMI)--Heart Attack of the myocardium due to inability of diseased coronary arteries to allow adequate perfusion Once myocardium tissue dies, it will not 70 Acute Myocardial Infarction (AMI) Pain signals of cells. Opening the coronary artery within the first can prevent damage. Immediate transport is essential. 71 Pain of AMI Chest Pain is cardinal sign of an AMI Occurs in % of AMIs May or may not be caused by Does not resolve in a few minutes Can last from 30 minutes to several hours May not be relieved by or nitroglycerin 11

12 72 Pain of AMI May be, squeezing, tight, heavy May radiate to neck, jaw, shoulders, arm, upper back, or even abdomen May occur in areas of only May vary in intensity, unaffected by swallowing, coughing, deep breathing, or movement 15% have AMI 73 Signs/Symptoms of AMI Chest pain Shortness of breath (SOB) Weakness, dizziness, fainting, vomiting Pallor, diaphoresis (sweating) Feeling of impending Pulmonary 74 Signs/Symptoms of AMI Changes is pulse, BP, or respirations are diagnostic of an AMI Early recognition is critical 50% of deaths occur in first hours. But the average person waits hours before seeking help 75 Atypical Presentation of MI Pain that is sharp or intermittent Pain to (toothache with no inflammation) Pain to neck, shoulder, arm or abdomen Mostly includes females, and the elderly Suspect cardiac event with these S/S 76 Anginal Equivalents Dyspnea Syncope or syncope Generalized weakness with no hx of GI bleed or fever Often, the only S/S presented but may be cardiac in nature 77 Risk Factors for Anginal Equivalents Hypertension Family history of CAD Obesity Sedentary life style 12

13 78 Treatment of Cardiac Chest Pain (1 of 3) Reassure Pt, High concentration of Give (325mg) PO (unless contraindicated) Reassure/calm patient Obtain brief history and perform physical exam Establish IV at appropriate rate (normally ) Give nitroglycerin (0.4mg) SL 79 Treatment of Cardiac Chest Pain (2 of 3) If patient has history of angina with changes in pattern, transport immediately. Transport in semi- position if BP is normal, supine if BP is low. Do NOT allow patient to to ambulance. Don t use lights and sirens if patient is awake, alert, and breathing without distress. 80 Treatment of Cardiac Chest Pain (3 of 3) Monitor vital signs every 10 minutes Request Backup -90% of deaths occur from arrhythmias. -Arrhythmias can often be treated with early drug therapy. ALWAYS examine for pedal edema and listen to sounds 81 Cardiogenic Shock Heart lacks power to force blood through the circulatory system. Onset may be immediate or not apparent for 24 hours after AMI. Failure of the and circulatory system BP Causes arrhythmias Treated with of fluids if lung sounds are clear Needs drug therapy if fluids are ineffective or if pulmonary edema is present 82 Congestive Heart Failure Congestive Heart Failure (CHF)--Inability of the heart to blood out as fast as it enters. Can be left-sided or right-sided Usually begins with -sided failure. 83 Congestive Heart Failure Causes of CHF Coronary Artery Disease (CAD) Chronic Valvular heart disease 13

14 84 Pathophysiology of CHF (1 of 2) ventricle fails Blood backs up into lungs Pressure increases in capillary beds Fluids forced out of capillary beds into the alveoli causing edema; fluid in the lungs 85 Pathophysiology of CHF (2 of 2) Blood backs up into circulation -distended neck veins -fluid in abdominal cavity - edema-fluid in feet and ankles 86 S/S of CHF Dyspnea on Paroxysmal nocturnal dyspnea Orthopnea-dyspnea lying down Tachycardia-rapid pulse rate (>100 bpm) -rapid breathing Noisy, labored breathing Rales, wheezing Pedal edema Pink, frothy 87 Management of CHF Sit patient up with feet Hi concentration of oxygen Assist ventilations as needed IV at rate Limit administration Monitor vital signs every 5 to 10 minutes Request Paramedic backup if pulmonary and/or pedal edema is severe 88 Physical Findings of Cardiac Compromise Pulse rate increases and may be. Blood pressure may be normal or falling. Respirations are usually normal. General appearance Nausea, vomiting, cold sweat 89 Approach to the Patient with Chest Pain (1 of 2) Reassure the patient and perform initial assessment. Administer oxygen. Measure and record vital signs. 14

15 Place the patient in a position of. Administer unless contraindicated Establish IV (CHECK LUNG SOUNDS) 90 Approach to the Patient with Chest Pain (2 of 2) Obtain history and physical exam. Ask about the chest pain (description, score) Consider nitroglycerin. Transport promptly with head elevated about degrees Report to medical control en route. 91 Internal Cardiac Pacemakers Maintains a heart rhythm and rate Do not place patches over pacemaker. 92 Automatic Implantable Cardiac Defibrillators Monitor heart rhythm and deliver as needed. Low will not affect rescuers. 93 Sickle Cell Disease 94 Sickle Cell Disease Inherited disorder of blood cell production, so named because the RBCs become sickle shaped when oxygen levels are low Patients with sickle cell disease has chronic anemia Average life span of a RBC is days as compared to 120 days for normal RBC Primarily affects -Americans 95 Sickle Cell Disease 96 Sickle Cell Crises Crises: causes musculoskeletal pain, abdominal pain, priapisms, pulmonary problems, renal infarctions, and CNS problems Hematological Crises: fall in the hemoglobin level and problems with bone marrow function Crises: vulnerable to infections Management Supportive measures Fluid replacement as indicated Consider analgesics. 97 Complications of Sickle Cell Disease 1 Cerebral vascular attack Jaundice Avascular necrosis Splenic infections Opiate tolerance 15

16 2 Leg ulcers Retinopathy Chronic Pulmonary hypertension Chronic failure 98 Endocrine Emergencies 99 Endocrine System A complex message and control system. Glands secrete. Hormones are chemical messengers. System maintains 100 Diabetes (1 of 2) Diabetes affects the body s ability to use (sugar) for fuel. Occurs in about 7% of the population Complications include blindness, cardiovascular disease, and failure. 101 Diabetes (2 of 2) As an EMS provider, you need to know signs and symptoms of blood glucose that is: High ( ) Low ( ) Central problem in diabetes is lack, or ineffective action, of insulin. 102 Defining Diabetes (1 of 2) Diabetes mellitus Metabolic disorder in which the body cannot metabolize glucose Usually due to a lack of. Glucose One of the basic sugars in the body Along with oxygen, it is a primary fuel for cellular 103 Defining Diabetes (2 of 2) Insulin Hormone produced by the Enables glucose to enter the cells Without insulin, cells starve Chemical substance produced by a gland Has special regulatory effects on other body organs and tissues 104 Type I Diabetes -dependent diabetes (IDDM) 16

17 Patient does not produce any insulin Insulin injected daily Onset usually in 105 Type II Diabetes Non- -dependent diabetes (NIDDM) Patient produces inadequate amounts of insulin Usually appears in life Disease may be controlled by diet or oral hypoglycemics 106 Role of Glucose and Insulin 107 Insulin Glucose is the major source of for the body. Constant supply of glucose needed for the brain. Insulin acts as the key for glucose to enter cells. Normal glucose (blood sugar) is to mg/dl. 108 Classic Symptoms of Uncontrolled Diabetes (3 Ps) : frequent, plentiful urination : frequent drinking to satisfy continuous thirst : excessive eating 109 Energy Sources The body uses glucose as a principal energy source When glucose is not available, the body turns to other sources is most abundant. Using fat for energy results in buildup of and fatty acids in blood and tissue. 110 Hyperglycemia Lack of insulin causes glucose to build-up in blood in extremely high levels. excrete glucose. This requires a large amount of. Without glucose, body uses fat for fuel. Ketones are formed. Ketones can produce diabetic. 111 Hypoglycemia Blood glucose is normal. Untreated, results in unresponsiveness and crisis Signs and symptoms of hyperglycemia and hypoglycemia are similar 112 Hyperglycemic Emergencies 113 Diabetic Ketoacidosis (DKA) (1 of 2) in insulin levels. 17

18 Most common in type 1 diabetes Glucose cannot enter cells. Glucose accumulates in the. Body PH Polyuria Polydypsia 114 Diabetic Ketoacidosis (DKA) (2 of 2) Osmotic Shock Cells metabolize fat, produce ketones as waste Retention of by kidneys which leads to cardiac arrhythmias 115 Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC) More often caused by type diabetes, more gradual onset than DKA No sweet-smelling Other S/S same as DKA Excessive urination results in dehydration. 116 Hyperglycemic Crisis (Diabetic Coma) (1 of 3) A state of unconsciousness resulting from: Ketoacidosis or Hyperglycemia Dehydration Excess blood 117 Hyperglycemic Crisis (Diabetic Coma) (2 of 3) Can occur in diabetic patients: Not under medical treatment Who have taken insufficient insulin Who have markedly Under due to infection, illness, overexertion, fatigue, or alcohol 118 Hyperglycemic Crisis (Diabetic Coma) (3 of 3) If untreated, can result in Treatment may take hours in a well-controlled setting. Suspect for all unconscious patients of unknown etiology 119 Diabetic Coma 120 S/S of DKA Air hunger ( Respirations) 18

19 Dehydration Sweet, fruity breath odor Rapid, weak pulse Normal or slightly low blood pressure Varying degrees of unresponsiveness onset--over several hours or days Skin is 121 Management of DKA High Con Oxygen Obtain glucose level Establish IV at appropriate rate May need fluid if dehydrated Transport 122 Hypoglycemic Emergencies 123 Insulin Shock (Hypoglycemic Crisis) 124 Insulin Shock (Hypoglycemic Crisis) Three causes of Insulin Shock insulin taking insulin but not adequately over Decreased blood sugar Brain is deprived of sugar 125 S/S of Insulin Shock 1 Normal or rapid breathing Pale, skin Sweating Dizziness, headache pulse Normal or slightly elevated B/P 2 Aggressive or confused Hunger Fainting, seizure, or coma Weakness on one side of the body Speech 126 Care for Insulin Shock Oxygen Obtain sugar level 127 D50W Establish IV and give If IV is unobtainable, give D50 is a 50% dextrose (sugar solution) 19

20 ALWAYS the drug of choice for insulin shock Solution Works very rapidly Must have a patent IV line Will cause of the skin if IV infiltrates Use as an IV catheter as possible Watch for infiltration as drug is being administered slowly 128 Dosages of D50W Adult Dosage: grams slow IV push Pediatric Dosage: cc/kg of D25W to a max of 100cc (25gm) D25W can be achieved by diluting D50W 1 to 1 with normal saline cc/kg of D12.5W for infants < 1yoa D12.5 can be achieved by diluting D50W 2 to 1 with NS 129 Glucagon Polypeptide hormone identical to human glucagon Acts only on liver, converting it to glucose Dosage: - mg IV, IM, or SC Repeat X 1 if patient does not regain consciousness however repeat doses are not normally needed since oral glucose can then be given and the repeat dosage may not work if liver glycogen is depleted 130 Diabetic Conditions 131 Diabetes and Alcohol Abuse Patients may appear. Suspect with any altered mental status. Be alert to the similarity in symptoms of acute alcohol intoxication and diabetic emergencies. may drink alcohol and become intoxicated 132 Ask All Diabetics: Do you take insulin or any to lower blood sugar? Have you taken your usual dose of insulin (or pills) today? Have you normally today? Have you had any, unusual amount of activity, or stress today? 133 DKA vs. Insulin Shock Pt eaten but has not taken insulin? - Pt taken insulin and has exercised profusely? - Pt accidentally took two doses of insulin? 20

21 - Pt has been sick and vomiting lately and has been taking insulin? DKA vs. Insulin Shock Pt has taken insulin and has been eating normally? - Pt has not been eating and has not taken insulin? - When in doubt, GIVE SUGAR!! 135 Allergic Reactions 136 Immune System system protects the body from foreign substances and organisms. When a foreign substance invades the body: Body goes on alert. Body initiates a series of to inactivate the invader. 137 Allergic Reactions Allergic reaction Exaggerated immune response to any substance and leukotrienes Chemicals released by the immune system Substance triggering body s immune system 138 Anaphylaxis Extreme reaction Involves multiple organs Can rapidly result in death Most common signs: (hives) 139 Severe Allergic Reaction 140 Five General Allergen Categories bites and stings Medications Plants Chemicals 141 Insect Stings (1 of 2) Death from insect stings outnumber those from snakebites. 21

22 Venom is injected through stinging organ. Some insects and ants can sting. May cause local or systemic reaction cannot withdraw their stinger. Fly away and die Wasps, hornets, and ants can sting multiple times. 142 Insect Stings (2 of 2) Some ants, especially the fire ant, also strike. Often inject a particularly irritating at the bite sites 143 Signs and Symptoms of Insect Stings Sudden pain, swelling, and at site Itching and sometimes a wheal Sometimes dramatic swelling Localized Redness in light-skinned individuals 144 Wheal 145 Management of Insect Stings (1 of 3) There is no specific treatment for these injuries. Applying sometimes helps. Swelling may be dramatic and frightening. manifestations are not serious. Establish IV at appropriate rate if needed 146 Management of Insect Stings (2 of 3) of the honeybee can continue to inject venom for up to 20 minutes. Attempt to remove the stinger by the skin with the edge of a sharp, stiff object such as a credit card. 147 Management of Insect Stings (3 of 3) Do not use or forceps. Wash the area with soap and water. Remove any from the area. Be alert for or signs of shock. Give oxygen if needed. Monitor the patient s vital signs. Establish an IV if needed 148 Anaphylactic Reactions to Stings 5% of all people are allergic to bee, hornet, yellow jacket, and wasp stings. 22

23 Anaphylaxis accounts for approximately deaths a year. Most deaths occur within an hour of being stung. 149 Signs and Symptoms of Allergic Reaction 1 Itching and burning Widespread Swelling of the lips and tongue Bronchospasm and 2 Chest tightness and coughing Dyspnea Anxiety Abdominal cramps Loss of Consciousness 150 Patient Assessment Allergic symptoms are almost as as allergens themselves. Assessment should include evaluations of: system system Mental status Skin 151 Emergency Medical Care (1 of 2) Give oxygen. Perform a focused history and physical examination. Find out if the patient has a history of. Obtain baseline vital signs and a SAMPLE history. Establish IV at appropriate. 152 Emergency Medical Care (2 of 2) Find out if the patient has a prescribed auto-injector. Be prepared to use standard airway procedures and. If bee sting, carefully scrape stinger and venom sac away if present. Apply Consider and/or Benadryl 153 Epinephrine Mimics the (fight-or-flight) response Rapidly reverses the effects of Discussed in Chapter 7 Part 1 23

24 154 Epinephrine Auto-Injector Normal adult dosage is mg via auto-injector (0.3 to 0.5mg SC) Pediatric dosage is normally mg via auto-injector (0.01mg/kg SC) In this area, EMS carries and utilizes either intramuscular Epi or auto-injectors 155 Key Points on Epinephrine Epinephrine is a powerful drug and is not intended or indicated for allergic reactions; only anaphylactic reactions SPEMS protocols require a SBP < 80mmHg prior to administration without orders Follow local for Epinephrine usage 156 Benadryl Many EMS organizations are allowing EMT-I s to administer Benadryl Blocks the production of histamine release during an allergic reaction No contraindications except for allergy Adult Dosage: mg IV or IM Pediatric Dosage: mg/kg up to 50mg 24