Evaluation of life threatening conditions

Evaluation of Life Threatening Conditions

Peter Dajime

Importance of Emergency Medicine

Is there a need for emergency medicine at this point in our history?

How did emergency medicine start?

The Rise of Lifestyle Diseases

5 Leading Causes of Mortality

Cause Rate per 100,000

1.Heart Diseases 69.8

2.Vascular Diseases 54.1

3.Pneumonias 43.1

4.Accidents 39.9

5.Cancer 37.5

Emergency Medicine

• Started in US around 1970• Under the Dept. of Transportation• Several levels of service providers

1. First Responder2. Dispatcher3. EMT

Role and Responsibilities

• Scene Management• Assessment• Management

Scene Safety

• Oncoming traffic• Unstable surfaces• Leaking gasoline• Downed electrical

lines• Potential for violence• Fire or smoke

• Hazardous materials

• Other dangers at crash or rescue scenes

• Crime scenes

Patient Assessment

• Scene size-up• Initial assessment• Focused history and physical exam

–Vital signs–History

• Detailed physical exam• Ongoing assessment

Develop a General Impression

• Occurs as you approach the scene and the patient

–Assessment of the environment

–Patient’s chief complaint

–Presenting signs and symptoms of patient

Obtaining Consent

• Introduce self.• Ask patient’s name.• Obtain consent.

Expressed? Or

Implied?

Good Samaritan Law

Provides immunity from liability to a first responder who stops and helps at the scene of the emergency provided they do all they can, within their knowledge, to sustain life and prevent further injury.

Trauma

Damage caused by an external energy force that dissipated at a faster rate than the body’s ability to withstand

Blunt?Penetrating?

Chief Complaint• Most serious problem voiced by the

patient• May not be the most significant

problem present

Signs?Or

Symptoms?

Signs and Symptoms

Manifestations in the gross anatomy of a patient due to physiologic and structural changes in the tissues and organs

Signs and Symptoms

Pain?Tenderness?Breathing?Pulse?Behaviour?Temperature?Appearance?

Assessing Mental Status

• Responsiveness–Response to external stimuli

• Orientation–Mental status and thinking ability

Testing Responsiveness

• A Alert• V Responsive to Verbal stimulus• P Responsive to Pain• U Unresponsive

Check Airway

• Labored breathing• Accessory muscles• Noisy breathing• Cyanosis• Rate and depth• Air movement• Choking

Types of Obstruction

Anatomical Mechanical

Partial Complete Partial Complete

Partial Complete

• weak cough

• wheezing

• strained breathing

• slight cyanosis

• inability to speak

• absence of breath sounds

• flared nostrils

• restlessness

• unresponsive

First Aid

• Back blows

• Heimlich Maneuver

• Chest Thrusts

Cardiovascular Emergencies

A rapid decline in heart function due to poor blood flow or electrical activity.

LIFE THREATENING!!

Examples are cardiac arrest, heart attack, and arrhythmia

THREE CONDITIONS OF CARDIAC ARREST1. Cardio Vascular Collapse

The heart is still beating but its action is so weak that is not being circulated through the vascular system to the brain body tissues.

2. Ventricular FibrillationOccurs when the individual fascicles of the heart beat independently rather than the coordinated, synchronized manner that produce rhythmic heart beat.

3. Cardiac standstillIt means that the heart has stopped beating.

Cardiovascular Emergencies

Heart attack is the death of the heart muscle due to deficient blood supply. Usually mistaken for angina pectoris.

What causes heart attack?

Cardiovascular Emergencies

Arrhythmia is a broad classification of heart disorders that pertain to irregularity in the sinus rhythm

1. Bradycardia – too slow

2. Tachycardia – too fast

Neurological Emergencies

Stroke or Cerebrovascular Accident

• Lack of blood flow to the brain due to a clot or a blood vessel rupture

• Risk factors include gender, age, smoking, hypertension, obesity, and diabetes

• Symptoms include dizziness, confusion, slurred speech, sudden numbness, severe headache, and trouble seeing

Neurological Emergencies

Cerebral Aneurysm

• Rupture of one of the arteries supplying the brain

• Leads to stroke or internal bleeding

Neurological EmergenciesSubdural Hematoma Epidural Hematoma

Neurological Emergencies

Intercranial Hematoma

• Symptoms include headache, dizziness, and vomiting

• Signs include HR decrease, BP increase, raccoon eyes, battle’s sign, and CSF leak

Neurological EmergenciesConcussion

• Temporary disturbance in brain function brought about by a blow or jolt to the head

• Symptoms include headache, balance problem, confusion, and dizzy

• Signs include unconsciousness, amnesia, and clumsy

Neurological Emergencies

Skull Fracture

• Trauma to the bony structure that protects the brain

• Could be linear, comminuted, depressed, or basilar

• Watch out for complications!!

• Signs and symptoms include cushing’s triad, nausea, and CSF leak