Signs and Symptoms Notebook Block 3 PDF

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Sarah Kwok Saturday-Hybrid Signs and Symptoms Notebook Block 3 Migraine Headache ● Definition: Migraines occur when blood vessels change in size near the base of the brain. Patients of any age can experience migraines, whether they are young or old. ● Risk Factors: ○ Acute condition- lifestyle origin ○ Structural ■ Females ○ Metabolic ■ History of migraines ● Signs & Symptoms ○ Pain in the head ■ Pounding ■ Throbbing ■ Pulsating ○ Nausea ○ Vomiting ○ Flashing lights ○ Partial vision loss ○ Symptoms can last from a few hours, to multiple days ● Field Treatment ○ Be sure to reassess patient for serious underlying conditions ○ High flow oxygen via nonrebreather mask ○ Dark, quiet environment ■ Do NOT use lights and sirens when transporting patient ■ Patients are sensitive to sound and light ○ Immediate transport via position of comfort

Transient Ischemic Attack (TIA) ● Definition: A Transient Ischemic Attack (TIA) is a temporary blood clot that gets lodged in the brain,

which decreases blood supply to brain tissue. Usually these symptoms will disappear within 24 hours, but as an EMT, you may not be able to judge between a TIA and a stroke. Transient Ischemic Attacks (TIA) are often called mini strokes, because they present the symptoms of a stroke, however they go away after the clot dissolves or gets dislodged. Since these symptoms are temporary, the patient’s brain tissue is not damaged. Though a TIA is not necessarily a dangerous condition, a TIA is usually a warning sign for a future stroke. ● Risk Factors: ○ Acute Condition- lifestyle origin ○ Structural ■ Geriatric patients ○ Metabolic ■ Atherosclerosis ● Signs & Symptoms ○ Facial drooping ○ Sudden weakness on one side of the body ○ Lack of muscle coordination ○ Loss of balance ○ Loss of sensation and movement on one side of the body ○ Vision loss; blurred or double vision ○ Difficulty swallowing ○ Decreased level of responsiveness ○ Speech disorders ○ Aphasia (speech difficulty) ○ Acute severe headache ○ Confusion, dizziness, combativeness, restlessness ○ Tongue deviation ○ coma ○ Symptoms that last for 24 hours or less ● Field Treatment ○ Strict airway maintenance ○ High flow oxygen via nonrebreather mask ONLY if patient is experiencing hypoxia or respiratory distress ○ Aspirin ○ Restraint (protection from injury) if patient has paralysis of extremities ○ Verbal comfort ○ Immediate transport

Concussion ● Definition: Concussions occur after mild traumatic brain injury, such as some sort of blow to the head. In a concussion, there shouldn’t be any visible trauma to the head, rather a temporary loss or altered function of the brain. Concussions range from mild to serious, depending on the mechanism of injury.

● Risk Factors ○ Acute Condition- Traumatic Origin ○ Structural ■ Athletes ○ Metabolic ● Signs & Symptoms ○ Loss of consciousness (10% of patients) ○ Inability to breathe for a short time ○ Amnesia ■ Retrograde amnesia (remembers event) ■ Anterograde (posttraumatic) amnesia (does not remember event) ○ Dizziness ○ Weakness ○ Visual changes ○ Nausea or vomiting ○ Ringing in ears ○ Slurred speech ○ Inability to focus vision ○ Lack of coordination ○ Delay of motor functions ○ Inappropriate emotional responses ○ Temporary headache, disorentation ○ “Seeing stars” ● Field Treatment ○ Use jaw-thrust maneuver to open up airway ■ If you cannot maintain an open and clear airway, you can use head tilt chin lift technique only as a last resort ○ OPA or NPA as needed ○ High flow oxygen via nonrebreather mask ○ Emotional support ○ In-line stabilization ○ Immediate transport via supine position in a long backboard

Generalized Seizure ● Definition: Also known as a convulsion is a temporary alteration in consciousness. Characterized by unconsciousness and a generalized severe twitching of all of the body’s muscles that lasts several minutes or longer. This type of seizure results from abnormal discharges from large areas of the brain, usually involving both hemispheres. ● Risk Factors

○ Epileptic- Congenital Origin ○ Structural - Tumor (benign or cancerous) ■ Infection (brain abscess) ■ Scar tissue from injury ■ Head trauma ■ Stroke ○ Metabolic ■ Hypoxia ■ Abnormal blood chemical values ■ Hypoglycemia ■ Poisoning ■ Drug overdose ■ Sudden withdrawal from alcohol, medications ● Signs & Symptoms ○ Cyanosis ○ Hypoxia ○ Drop of blood glucose level ○ Incontinence ○ Unconsciousness ○ Convulsions ○ Muscle rigidity ● Field Treatment ○ Possible C- Spine ○ Strict maintenance of the airway ○ High flow oxygen or BVM ○ Rapid transport

Heat Stroke ● Definition: Heat stroke is a fatal condition stimulated by the environment in which the body shuts down after being exposed to too much heat. This condition is dangerous because the heat can cause tissue damage, which if untreated, can lead to death. Heat stroke can develop in people of all ages and backgrounds, however people who perform strenuous exercise or live in hot, unventilated spaces are more at risk. Heat stroke causes the patient’s sweating mechanism to be overwhelmed and shut down, because the body cannot handle the excessive amount of heat. When the body temperature increases, the patient’s level of consciousness will decrease. If untreated, heat stroke can also lead to stress on the

heart, and heart attack. ● Risk Factors: ○ Acute condition- environmental origin ○ Structural ■ Athletes ■ Children left in hot cars ■ People who live in unventilated hot buildings ■ Emergency providers who wear protective gear ■ Military personnel, Firefighters, Swat team, HazMat team ○ Metabolic ● Signs & Symptoms ○ Pale, moist and cool skin (excessive fluid and salt loss) ○ Hot, dry/moist skin (inability to regulate temperature) ○ Nausea ○ Vomiting ○ Heat cramps ○ Exhaustion ● Field Treatment ○ Consider ALS for further treatment ○ If patient is in ice bath, wait until temperature has decreased to normal body temperature (101℉102℉ ) to transport. In addition, don’t wait too long, because if the patient’s temperature drops below that, the patient will generate more heat, reversing the effects of the icebath. ○ Look for mechanism of injury ○ Evaluate mental status via AVPU ○ Open airway correctly (keep spine in mind) ○ High flow oxygen via nonrebreather mask if there are signs of hypoxia or respiratory distress ○ Insert OPA/NPA if patient becomes unresponsive and use BVM ○ DCAPBTLS ○ Remove patient from hot environment immediately ○ Remove clothing ○ Spray patient with water ○ Give the patient water or a diluted sports drink ○ Encourage patient to lay down ○ Monitor vitals every 5 minutes ○ Immediate transport Stroke (CVA-cerebrovascular accident) ● Definition: A stroke is defined as a condition in which blood loss in the brain leads to impaired brain function. Starvation of oxygen in brain cells can cause cell death if not treated in time. Two types of stroke are possible: hemorrhagic and ischemic. Ischemic stroke is more common (80%) and occurs when a blood vessel in the brain is blocked by a blood clot. There can be a number of causes for this condition: thrombosis or embolus could be reasons for the blockage. Hemorrhagic strokes are more rare (13%) and are more serious. Hemorrhage strokes occur when a blood vessel bursts within the brain, increasing pain and pressure in the brain. ● Risk Factors: ○ Acute condition: developed origin

○ Structural ■ Atherosclerosis ■ Cerebral embolism ■ Geriatric patients ■ Patient with weak vessel walls ○ Metabolic ■ Stress ● Signs & Symptoms ○ Partial or fully paralysis ○ Facial drooping ○ Sudden weakness/loss of movement or muscle coordination (ataxia) on one side of the body ○ Loss of vision in one eye/ blurred or double vision ○ Difficulty of swallowing ○ Decreased level of responsiveness/consciousness ○ Speech disorder/aphasia (expressive and receptive)/ dysarthria (slurred speech) ○ Sudden/severe headache ○ Dizziness, combativeness, restlessness, coma ○ Tongue deviation ● Left Hemisphere ○ Aphasia (can’t produce or understand speech) ○ Right side paralysis of the body ● Right Hemisphere ○ Patient can understand language but speech is slurred and incomprehensible ○ Will neglect the left side of their body ○ Sit on the patient’s good side so patient can see you ● Field Treatment ○ Aspirin ○ Strict maintenance of the airway ○ Maintain SpO2 of at least 94% ○ High flow oxygen if they are experiencing respiratory distress or show signs of hypoxia ○ Restrain patient if extremities are paralyzed to protect them ○ Verbal, emotional support ○ Immediate transport Increased Intracranial Pressure (ICP) or (Cushing’s Reflex) ● Definition: Because the cranium has few openings to protect the brain, fluid or blood buildup (intracranial hemorrhage) within the cranium will lead to immense pressure and pain. Increased intracranial pressure occurs due to fluid and blood building up within the brain for whatever the reason, and squeezes the brain. ● Risk Factors ○ Blah ○ Structural ○ Metabolic ● Cushing reflex (triad that shows worsening of ICP) ○ Increased systolic blood pressure ○ Decreased pulse rate

○ Irregular respirations ● Signs & Symptoms ○ Cheyne-Stokes respirations (fast then slow breathing, with apnea intervening) ○ Ataxic (Biot) respirations (irregular rate, pattern, and depth of breathing with periods of apnea) ○ Decreased pulse rate (bradycardia) ○ Headache ○ Nausea ○ Vomiting ○ Decreased alertness ○ Sluggish, unresponsive pupils ○ Decerebrate posture (supine with hands twisted backwards) ○ Increased blood pressure ○ Severity increases ● Field Treatment ○ Have suction machine ready in case patient feels nauseous or vomits ○ Provide high flow oxygen ○ Strictly maintain airway ○ Elevate head at about 30 degrees to avoid worsening of symptoms ○ Use lights and sirens to your discretion ○ Provide comfort ○ Immediate transport

Intracranial Bleed (Subdural and Epilepticus) ● Definition: An intracranial bleed is described as a severe bleed within the brain, which can cause immense pressure on the cranium. The blood also presses against the soft tissue in the brain which can cause permanent brain damage if not fixed by surgery ○ Epidural Hematoma: An epidural hematoma occurs when blood accumulates between the skull and dura mater. Usually, this is caused by trauma to the head, producing a linear fracture of the thin temporal bone. Fracturing the temporal bone is very dangerous, because the middle meningeal artery runs along the groove, and may rupture when the temporal bone is fractured. ICP develops very suddenly. ○ Subdural Hematoma: A subdural hematoma occurs when blood accumulates between the dura mater and the outside of the brain. Usually, this is caused by falls. This type of hematoma is more common, and does not always involve a skull fracture. ICP develops more gradually than in an epidural hematoma. ● Risk Factors:

○ Acute condition- traumatic origin ○ Structural ■ Geriatric patients ○ Metabolic ■ Taking a blood thinner like aspirin ● Signs & Symptoms ○ Epidural hematoma ■ Immediate loss of consciousness (LOC) ■ Lucid interval of consciousness ■ Sudden increase of ICP ○ Subdural hematoma ■ Gradual increase of ICP ■ Fluctuating consciousness and slurred speech ● Field Treatment ○ Provide appropriate oxygen ○ Strictly maintain the airway (insert OPA or NPA if no facial/head trauma, and unconscious) ○ Suction if needed ○ In-line stabilization ○ C-collar ○ Secure patient to backboard or KED depending on the conditions ○ Immediate transport

Status Epilepticus ● Definition: Status epilepticus is a secondary condition in which a seizure lasting longer than 5 minutes turns into repeated seizures lasting 30 minutes or longer, without regaining consciousness. ● Risk Factors ○ Epileptic- Congenital condition ○ Structural ■ Tumor (benign or cancerous) ■ Infection (brain abscess) ■ Scar tissue from injury ■ Head trauma ■ Stroke ○ Metabolic ■ Hypoxia ■ Abnormal blood chemical values ■ Hypoglycemia ■ Poisoning

■ Drug overdose ■ Sudden withdrawal from alcohol, medications ● Signs & Symptoms ○ Seizure that last longer than 30 minutes ○ Patient does not regain consciousness ○ See signs and symptoms for general seizure ● Field Treatment ○ Call for ALS backup ○ Protect patient from self harm (restraint) ○ Strict airway management

Heat Exhaustion (heat prostration or heat collapse) ● Definition: Heat exhaustion occurs when the body has been exposed to excessive amounts of heat, and the body can’t effectively cool itself down. Usually this is due to a loss of fluids or electrolytes, leading to hypovolemia. This is the most common type of heat related emergency. ● Risk Factors ○ Acute condition- developed origin ○ Structural ■ Heat exposure ■ High humidity ■ Athletes ■ Sports fans ■ Parade watchers ■ People wearing heavy clothing under extreme heat conditions ■ Geriatric or infant patients ■ People in hot, poorly ventilated conditions ○ Metabolic ■ Stress ■ Fatigue

● Signs & Symptoms ○ Dizziness ○ Weakness ○ Change of level of consciousness ○ Nausea, vomiting, headache ○ Muscle or abdominal cramping ○ Cool, clammy skin with ashen pallor ○ Dry tongue, thirsty ○ Normal vital signs with rapid and weak pulse and low diastolic blood pressure ○ Normal or slightly raised body temperature (104℉) ● Field Treatment ○ Remove patient from hot environment ○ Move patient to cool environment ○ Remove any excess clothing to cool patient ○ Administer appropriate oxygen ○ Check blood glucose level if there is an altered mental status ○ Mist patient or submerge patient in ice bath ○ Encourage patient to lie down and loosen clothing ○ Consider ALS backup ○ Stay and play

Obstructive Shock ● Definition: Obstructive shock occurs when a physical obstruction prevents blood from adequately filling up the chambers of the heart. ● Risk Factors: ○ Acute condition- developed origin ○ Structural ■ Pericardial effusion ■ Cardiac tamponade ■ Tension pneumothorax ■ Pulmonary embolism ○ Metabolic ■ Hypercoagulation ● Signs & Symptoms ○ Dyspnea ○ Rapid and weak pulse ○ Rapid and shallow breaths ○ Decreased rise and fall of the chest ○ Unilateral, decreased and absent breath sounds ○ Decreased blood pressure ○ Jugular vein distention

○ Subcutaneous emphysema ○ Cyanosis ○ Tracheal deviation towards unaffected side ○ Beck triad (cardiac tamponade- narrowing pulse pressure and muffled heart tones) ● Field Treatment ○ Consider ALS backup or rapid transport ○ High flow oxygen via nonrebreather mask

Cardiogenic Shock ● Definition: Cardiogenic shock is defined as the heart’s failure to pump blood adequately to the rest of the body. This can be caused by many different conditions, but essentially if this occurs, the heart muscle is damaged, the electrical system is broken, or there is some type of disease or injury to the heart. The problem with cardiogenic shock is that heart cells can’t regenerate once they are dead. When the myocardial muscle can’t keep up and supply blood to the rest of the body, the heart cells wear out and eventually die off. ● Risk Factors ○ Acute condition- developed origin ○ Structural ■ Pulmonary edema ■ Inflammation of heart muscle ■ Pulmonary embolism ■ Disease or injury to heart’s electrical system ○ Metabolic ■ Low cardiac output after high afterload ■ Low preload ■ Poor contractility ● Signs & Symptoms ○ Chest pain ○ Irregular pulse ○ Weak pulse

○ Low blood pressure ○ Cyanosis in lips and under nails ○ Cool, clammy skin ○ Anxiety ○ Crackles (rales) ○ Pulmonary edema ● Field Treatment ○ High flow oxygen via nonrebreather mask ○ BVM if needed ○ Have suction ready in case the patient vomits ○ Consider ALS backup ○ Immediate transport via position of comfort

Hyperglycemic Crisis (Symptomatic Hyperglycemia) ● Definition: A hyperglycemia crisis occurs when a patient’s glucose levels are extremely high. When the glucose levels are too high in the body, the body will release more glucose into the urine (hyperosmolarity), causing the patient to be excessively thirsty, or dehydrated. The urine will appear dark and concentrated because of the excessive glucose. ● Risk Factors ○ Acute condition- developed origin ○ Structural ■ Chronic high glucose levels in the blood ○ Metabolic ■ Type 1 diabetes patients (ketoacidosis + dehydration + frequent urination) ■ Type 2 diabetes patients (nonketotic hyperosmolar state of dehydration) ■ Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) from diabetes mellitus type 2 ● Signs & Symptoms ● Hyperglycemia ● Altered mental status, drowsiness, lethargy ● Severe dehydration, thirst, dark urine ● Visual or sensory deficit ● Partial paralysis or weak muscle ● Seizures, loss of consciousness (LOC) ● Kidneys become overwhelmed and blood thickens ● Signs & Symptoms ○ Numbness in the hands and feet

○ Blindness ○ Renal failure ○ Gastric motility problems ○ Warm and dry skin ○ Altered mental status ○ Deep and rapid respirations ○ Rapid, weak, and thready pulse ○ Low blood pressure ○ ● Field Treatment ○ Apply high flow oxygen via nonrebreather mask if patient is experiencing respiratory distress ○ BVM if unconscious ○ Apply OPA or NPA if patient is not breathing on their own ○ Strict airway maintenance and monitoring ○ ALS backup

Diabetes Mellitus Type 1 ● Definition: Diabetes Mellitus Type 1 is an autoimmune condition in which a patient’s body produces antibodies to attack the pancreas beta cells, preventing the pancreas from producing insulin. Insulin is an essential hormone because it helps cells absorb glucose, providing cells with energy. This causes diabetes type 1 patients to feel chronic fatigue. Most patients diagnosed with diabetes type 1 inject themselves with insulin every day, whether they do it manually or with an insulin pump. Additionally, they may check their glucose levels with a glucometer or a lancet. ● Risk Factors ○ Autoimmune condition- congenital origin ○ Structural ■ Younger patients ■ Patients with a history of type 1 diabetes ○ Metabolic ■ Hyperglycemia ● Signs & Symptoms ○ Polyuria (frequent urination) ○ Polydipsia (frequent thirstiness) ○ Polyphagia (chronic hunger and increased food intake) ○ Weight loss ○ Fatigue ○ Dark, concentrated urine ○ Rapid and deep respirations ○ Normal to low blood pressure ○ Rapid, weak, and thready pulse ○ Gradually increasing symptoms ○ Kussmaul respirations

○ Diabetic Ketoacidosis (DKA) ■ Abdominal pain ■ Body aches ■ Nausea ■ Vomiting ■ Altered mental status ■ Loss of consciousness ● Field Treatment ○ Apply glucose gel to patient’s gum line ○ Consider ALS backup ○ Transport decision is determined by judgement ○ Apply oxygen if needed

Cholecystitis ● Definition: Cholecystitis is defined as the inflammation of the gallbladder. ● Risk Factors ○ Acute condition- developed origin ○ Structural ■ Gallstones ■ Women ■ Geriatric patients ■ Obese patients ■ People of Scandinavian, Native American, and Hispanic descent. ○ Metabolic ● Signs & Symptoms ○ Pain in the right shoulder ○ Pain in the lower mid abdomen (retropubic) ○ Symptoms appear 30 mins after eating a fatty meal ○ Nausea ○ Vomiting ○ Indigestion ○ Bloating ○ Gas ○ Belching ○ Chronic pain ● Field Treatment ○ Be sure to consider wearing extra BSI/PPE to protect yourself from vomit and feces ○ Stabilize airway ○ Administer oxygen as needed ○ Immediate transport via position of comfort

Pancreatitis ● Definition: Pancreatitis is defined as the inflammation of the pancreas. ● Risk Factors ○ Blah ○ Structural ■ Obstructing gallstone ○ Metabolic ■ Alcohol abuse ● Signs & Symptoms ○ Severe pain in upper abdominal quadrants ○ Pain radiating in the back ○ Nausea ○ Vomiting ○ Abdominal distention ○ Tenderness ○ Fever ○ Tachycardia ○ Sepsis ○ Hemorrhage ○ Guarding ● Field Treatment ○ Be sure to consider wearing extra BSI/PPE to protect yourself from vomit and feces ○ Stabilize airway ○ Administer oxygen as needed ○ Immediate transport via position of comfort

Diverticulitis ● Definition: Diverticulitis is defined as the inflammation of small balloon like pockets in the intestine. Diverticulitis is developed when the patient decreases their fiber intake. This causes the patient’s stool to become increasingly dense, putting pressure on the intestine. ...