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EMT NOTES

Medical Patients Skills Lab, Specific conditions



Diabetes

  • Diabetes is a common call for many EMT's, so it is important to be familiar with proper procedure and protocol.
  • Administering glucose:
    • given to hypoglycemic (low blood sugar) patients
    • administration can change level of consciousness/mental status dramaticallly within a short period of time (several minutes)
    • can give multiple doses
    • glucose gel carried on ambulance
      • put gel on tongue depressor and put in mouth at inside of cheek, allowing gel to dissolve on its own
    • can also use orange juice, chocolate bar, or other food to raise blood sugar.  This is often easier and more convenient (and more palatable!) than using glucose gel.  

  • Contraindication for glucose administration
    • unconscious
    • breathing problems
    • unable to swallow (indicated by lack of saliva)

    • hypoglycemia less serious than hyperglycemia
      • hyperglycemia may lead to convulsions, coma, etc.

    • giving glucose does not significantly harm patient with hyperglycemia (their glucose is already high)
      • when in doubt (if patient is hyperglycemic or hypoglycemic), give glucose.

    • protocol requires paramedics to be dispatched for diabetes call

    • diabetic patient = priority patient; get them into ambulance ASAP

    Abdominal Pain/GI Bleeding

    • "C-diff"
      • bacterial infection that causes severe ("explosive") diarrhea
      • infectious and easily spread

    • Ectopic pregnancy
      • fertilized egg is implanted outside of uterus
      • tubes become blocked and may rupture, causing severe internal bleeding and subsequent shock

    • Not able to administer much treatment in this situation, besides:
      1.  putting patient in a position of comfort
      2. giving high flow O2 to assure adequate respiration
      3. get good SAMPLE history
      4. transporting to hospital

    • Indicators of shock:
      • fast pulse (tachycardia)
      • high resp. rate
      • these indicators make sense.  The body senses the lower blood volume due to bleeding and attempts to make up for it and keep blood flowing throughout the body by increasing heart rate and resp. rate.

    • If female patient is between 12-60, ask about potential pregnancy
      • if patient is young, do not ask in front of parents (wait till parents leave, take child to the side, be creative!)

    • Once a girl is pregnant she is considered an emancipated minor (no longer under control/care of parents), not matter the age.  

    • Skin color, temperature, and condition is important to monitor in GI/Abdominal complaints

    Grey-Turner Syndrome:

    -internal bleeding visible on exterior (flanks)

    -looks like assault/external injury

    -do not palpate!


    Cullen's Sign:

    -indicative of severe acute pancreatitis or ruptured ectopic pregnancy

    Dehydration

    • common in Senior homes/centers
    • do not give patients who are dehydrated anything to drink
      • this is in case a surgery is needed when they arrive at hospital, drinking/eating prior to surgery may interfere with procedure.
      • can wet patients lips with water

    Allergic Reaction/Anaphylactic Shock

    • Allergic reaction types:
      • mild 
      • local
      • systemic
    • hives first appear on chest and back

    • Epinephrine
      • used to treat anaphylactic shock
      • vasoconstrictor
      • increases pulse rate
      • dosage
        • .3mg for adults
        • .15mg for children (<70lb or prior to puberty)

    • Epipen usage
      • conditions for use: 
        1. hypotension
        2. respiratory distress
        3. known allergen
                       these conditions MUST be in place in order to use Epipen.
      • In the course, always take vitals/BP before giving meds.  In real life, situations may dictate for you to do otherwise. 
      • stick patient for 10 seconds in meaty part of thigh
      • do not put thumb on any side of pen
      • afterwards, put epipen in sharps container or bring to hospital
      • reassess patient every 5 min after administration, even if no symptoms persist
      • take patient to closest hospital

    • Always try to get patient to go to hospital after administering Epipen
      • if they refuse, try to convince them
      • once epinephrine wears off, allergic reaction may continue and they may be in danger again

    • For severe anaphylaxis, may need "diesel therapy"-flooring the gas pedal to get to hospital faster ;)

    Psychological Emergencies

    • refrain from judgement
    • EDP=Emotionally Disturbed Patient
    • if unable to obtain vitals, document the reason for this
    • not all hospitals accept psych. patients (may ask police/dispatch for nearest hospital with psych. department).
    • patients may need to be "medically cleared" at a regular hospital before being admitted into a psych. facility

    • Document what the patient says directly (quote)
      • do not paraphrase

    • Restraining:
      • Patient must be violent to EMT or to self in order to justify restraining
      • need a minimum of 4 people (one per extremity) to restrain patient
      • document every 5 min
      • monitor respiration
      • check PMS (Pulse, Motor, Sensory) in extremities