Evaluation of Life Threatening Conditions Peter Dajime
Jun 28, 2015
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