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Welcome!. DOT National Standard EMT-Intermediate/85 Refresher. MEDICAL EMERGENCIES. Allergic reaction Possible overdose Near-drowning ALOC Diabetes Seizures Heat & cold emergencies Behavioral emergencies Suspected communicable disease. ALOC. Perspective Pathophysiology Epidemiology

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Dot national standard emt intermediate 85 refresher

Welcome!

DOT National Standard

EMT-Intermediate/85 Refresher


Medical emergencies
MEDICAL EMERGENCIES

  • Allergic reaction

  • Possible overdose

  • Near-drowning

  • ALOC

  • Diabetes

  • Seizures

  • Heat & cold emergencies

  • Behavioral emergencies

  • Suspected communicable disease


Medical emergencies1

ALOC

Perspective

Pathophysiology

Epidemiology

Physical Exam Findings

Diagnostic Findings

Signs and Symptoms

Differential considerations

Treatment

MEDICAL EMERGENCIES


Probably the most difficult call to run

In most cases - the parkmedic will NOT be able to ascertain the cause of the ALOC

Therefore, the dx is usually ALOC of Unknown Etiology

ALOC


Pathophysiology
pathophysiology

  • Consciousness is the sum of the activities & interactions of the reticular activating system (RAS) & cerebral cortex

  • Coma results from the dysfunction of either the

    • RAS

    • the bilateral cerebral cortices


S s physical exam assessment diagnotics monitoring management pertinent positives
s/s, physical exam & assessment, diagnotics, monitoring, management, pertinent positives

  • ALOC - spectrum

    • Drowsy or lethargic = slight decrease in wakefulness & interaction w/ the environment

      • Verbal or light touch arouses pt

    • Deeply comatose = complete failure of arousal system

      • No spontaneous eye opening & unable to awaken w/ vigorous sensory stimulation

    • Obtundation & stupor = intermediate stage

      • Awakened only by energetic stimulation


S s physical exam assessment diagnotics monitoring management pertinent positives1
s/s, physical exam & assessment, diagnotics, monitoring, management, pertinent positives

  • ALOC - spectrum

    • Drowsy or lethargic = slight decrease in wakefulness & interaction w/ the environment

      • Verbal or light touch arouses pt

    • Deeply comatose = complete failure of arousal system

      • No spontaneous eye opening & unable to awaken w/ vigorous sensory stimulation

    • Obtundation & stupor = intermediate stage

      • Awakened only by energetic stimulation


Epidemiology
epidemiology management, pertinent positives

  • Metabolic

  • Infectious

  • Vascular

  • Neurologic Structural

  • Seizures

  • Trauma

  • Toxicologic

  • Environmental


Epidemiology1

Electrolyte disorders management, pertinent positives

Hypernatremia

Hyponatremia

Hypercalcemia

Hypoglycemia

Hypermagnesemia

Diabetic ketoacidosis

Hyperglycemia hyperosmolar states

Hypothyroidism

Thyrotoxicosis

Adrenal insufficiency

Hepatic encephalopathy

Uremia

Thiamine deficiency

Meningitis

Encephalitis

Intracranial abscess

Sepsis

Hypertension

Hypotension

Vasculitis

Cerebrovascular accident

Subarachnoid hemorrhage

Tumor

Hydrocephalus

Intracerebral hemorrhage

epidemiology


Epidemiology2
epidemiology management, pertinent positives

  • Status epilepticus

  • Subdural hematoma

  • Epidural hematoma

  • Cerebral contusion

  • Diffuse cerebral edema

  • Carbon monoxide

  • Ethanol, methanol, isopropyl alcohol, ethylene glycol

  • Drug use/overdose

  • Heatstroke hypothermia

  • HACE

  • Near drowning

  • dysbarism


Assessment
assessment management, pertinent positives

  • In the field:

  • Alcohol

  • Epilepsy

  • Insulin

  • Overdose

  • Uremia

  • Trauma

  • Infection

  • Psychosis

  • Stroke


Review protocol
Review Protocol management, pertinent positives

  • Go to ALOC-Adult

  • Go to Call Matrix -General


  • Perspective management, pertinent positives

  • Pathophysiology

  • Epidemiology

  • Physical Exam Findings

  • Diagnostic Findings

  • Signs and Symptoms

  • Differential considerations

  • Treatment


Questions
Questions? management, pertinent positives

  • References

    • Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010.

    • Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011.

    • Wolfson, Allan B. ed. , Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.


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