RESPIRATORY EMERGENCIES

CASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT

CONSIDERATION

STATUS ASTHMATICUS Onset Acute asthmatic attack involves 1. Anxiety VENTILATION IMMEDIATE while
airway obstruction due to : 2. Patient breathes through pursed lips monitoring vital signs.
Provocation 3. Wheezing OXYGEN
1. Bronchospasm 4. Chest overinflated
Quality 2. Swelling of mucous 5. Tachycardia POSITION
membranes 6. Tripod post
Radiation 3. Mucus secretions

Severity

Provocation:

SAMPLE Hx 1. Resp Infection

2. Emotional Stress
3. Allergic Reaction

PULMONARY EDEMA Excess FLUID BUILD UP in the 1. RAPID HEART RATE 1. High Flow O2 IMMEDIATE
lungs often caused by MI or related 2. Cyanosis 2. Consider
heart disease and occasionally by 3. Distended Neck Veins PEEP/CPAP
inhalation of smoke and or toxic 4. Wheezing
fumes. Alveoli collapse due to 5. Frothy or flecked sputum
adhesive property of H2O. 6. Water filled spongy lung
7. Dyspnea
8. Frothy fluid in bronchi
9. Cool, Clammy skin
10. Edema

CHRONIC OBSTRUCTIVE 1. Ventilate with

● Repeated infections thicken
PULMONARY DISEASE 100% O2.
(COPD) and destroy the lining of the
bronchi and bronchioles
causing narrowing and
● Chronic becoming obstructive by too
Bronchitis much MUCUS and
EXCESSIVE
CONTRACTIONS of the
 muscle in their walls.

● Pulmonary ● Alveoli of the lungs become

Emphysema inflated or over distended with
trapped air (may burst and
merge to make fewer but
larger alveoli causing
reduction in the lung’s surface
area) Less oxygen through
walls of the alveoli and into
the bloodstream.

Asthma Onset Same as Status Asthmaticus DANGER SIGNS!!! Prevent Lethal Hypoxia Depending on the level
of hypoxia.
Provocation 1. Loss of Wheezing
2. Change in Sensorium (Confusion,
Quality Irritability, Lethargy)
3. Hypoxia
Radiation
Hyperventilation Syndrome Reassurance and Depending on the
● Abnormal increase in
Severity instruct the patient to severity.
respiration rate and tidal slow down breathing.
volume.
● Anxiety of an emergency
SAMPLE Hx
often leads to
hyperventilation.
● Could cause acidosis.

Deep Venous Thrombosis Formation of blood clot in a deep Affected extremity: IMMEDIATE
and PULMONARY vein due to VIRCHOW’S TRIAD:
EMBOLISM ● Painful
● Stasis
● Swollen
● Hypercoagulation
● Red
● Blood vessel endothelial
● Warm
damage
● Superficial Veins Engorged
3% chance Pulmonary Embolism
will kill your patient.
 Blood clot in deep veins goes to the Pulmonary Embolism
lungs and interrupt blood flow to the
lungs. 1. LOC restless, anxiety

1. Rapid heart rate

2. Cold clammy skin
3. Falling blood pressure
4. Distended Neck Veins
5. Cyanosis

A&B

1. Sharp and stabbing chest pain

2. Sudden unexplained dyspnea
3. Cough +/- blood

Respiratory Infections

Croup Onset Viral Agitated and Barking VENTILATE with

100% O2
Provocation Upper Airway

Quality

Epiglotitis Radiation Bacterial 1. Swelling cause airway obstruction

2. DROOLING SALIVA
Severity

Pneumonia Virus, Bacteria, Fungi Dyspnea

SAMPLE Hx Develops in days

Young children and elderly are at

high risk
 Alveoli infected decrease in O2 that
leads to dyspnea.

CARDIOVASCULAR EMERGENCIES
CASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATION

Angina Pectoris OPQRSTA Sudden pain when portion of the 1. “Indigestion” 1. High flow O2 LIGHTS ONLY
myocardium is not receiving enough 2. Chest pain that comes after exertion asap.
oxygenated blood 3. Chest pain that lasts only for a few 2. Assist in
minutes nitroglycerin
4. Relieved after admin of nitroglycerins admin if systo BP
5. SOB, Nausea, increased pulse rate is greater than 90
(know if
administered
already and know
how many times)
3. Place in restful
and comfortable
position.
4. Reassure.

ACUTE MYOCARDIAL Heart Attack 1. Chest Pain rel to stress and exertion or Conscious: Transport
INFARCTION even at rest. Originates from sternum immediately in semi
Portion of the myocardium dies due but radiate to arm, neck, and jaw and 1. High conc. O2 sitting position. Quiet
to deprived coronary blood flow. described as sharp, squeezing or 2. Keep patient calm transport (little or no
throbbing pain and still. use of siren)
(Silent MI – patient doesn’t 2. Pain lasts 30 minutes to several hours. 3. Take the Hx and VS.
feel any pain) 3. Accompanied dyspnea, nausea, 4. Help patient with
diaphoresis, dizziness, and FEELING prescribed
OF IMPENDING DOOM. medications
4. Signs of shock 5. Transport
immediately in semi
sitting position.
Quiet transport (little
or no use of siren)
6. Monitor VS
throughout care and
 transport

Unconscious:

1. Establish and
maintain Airway.
2. Provide CPR/Defib
if needed. PPV if
needed through
BVM.
3. High conc. O2.
4. Transport
immediately in semi
sitting position.
Quiet transport (little
or no use of siren)
5. Monitor VS
throughout care and
transpo.

Aortic Aneurysm OPQRSTA Dilatation or outpouching of a 1. Sudden chest pain (ripping, tearing, and 1. Calm and reassure Transport without
blood vessel particularly the sharp that starts between the shoulder the patient. delay
aorta. blades) 2. Administer 100%
2. BP discrepancy between arm or O2 by NRM
decrease in femoral or carotid pulse. 3. Place in a
 3. Signs of Shock. comfortable
position.
4. Transport without
delay.

HYPERTENSIVE
EMERGENCIES

Hypertension 1. Severe headache 1. Secure airway , Transport without

● Major contributing cause in
2. Nausea and vomiting administer O2. delay
many cases of MI, CHF, and 3. Altered Mental Status 2. Transport without
CVA. 4. Aphasia, sudden blindness delay
● Present when BP at rest is 5. Muscle twitching 3. Seizure precaution
consistently greater than 6. Seizures
140/90 mmHg 7. Hemiparesis

● Common complication is renal

damage, heart failure and
brain attack.

Cardiac Tamponade 1. Muffled heart sounds 1. Semi-fowler’s IMMEDIATE

● Accumulation of blood in the
2. Falling blood pressure 2. O2
pericardial sac 3. Distended neck veins 3. Immediate transport
● Most common result in 4. Tachycardia 4. Monitor
penetrating injury. 5. Pale, cool, sweaty skin. 5. Surgeons will
immediately do a
pericardiocentesis

Pericarditis Inflammation of the pericardium 1. Dyspnea 1. Priority of care

(inner wall of the heart ) 2. Chest Pain that aggravates while CAB, Administer
2.1. Breathing O2. Immediate transport in
● Idiopathic infection 2.2. Lying on left side 2. Immediate transport sitting position
2.3. Turning on Bed in sitting position
● Metabolic factors 3. Fever, Chills, Fatigue (sign of infection) 3. Monitor

● Trauma

CHF (Congestive Heart Excessive fluid build up in the lungs 1. Anxiety or Confusion 1. Place patient in a Lights only?
Failure) and or other organs and in the body 2. Engorged, pulsating neck vein (LATE comfortable position
because of inadequate pumping (Semi fowler or
 SIGN) sitting)
3. Cyanosis 2. Give high
4. Normal/ Elevated BP concentration O2
5. Tachycardia through NRM
6. Pedal Edema 3. Monitor
7. Dyspnea
8. Pulmonary Edema with rales, sometimes
coughing of Frothy white or pink sputum
9. Enlarged liver, spleen with abdominal
distention (LATE)

BLEEDING (Heart, Blood

Vessels, Blood)

External Bleeding Severity: 1. Safety BSI Depends on the

● Arterial – bright red, spurting
2. Control bleeding amount of bleeding.
● 1000 cc for adults ● Venous – dark red, steady flow 2.1. Direct pressure
2.2. Elevation above
● 500 cc for child ● Capillary – dark red, slowly oozing, level of heart (if
often clots spontaneously swollen or
● 100 – 200 cc for infant deformed DO
NOT)
2.3. Pressure points
2.4. Splints
2.5. Pressure splints
2.6. Torniquet (last
resort)
2.6.1. Torniquet
must be at
least 4 inches
2.6.2. Put the
tourniquet
around twice
2.6.3. Knot and put
a stick
2.6.4. Twist and
secure the
stick or rod
until bleeding
stops
2.6.5. Document
2.6.6. NEVER use a
 wire
2.6.7. NEVER
remove once
secured
2.6.8. Leave in
OPEN VIEW
2.6.9. NEVER
APPLY TO
JOINT

Internal Bleeding Most common cause : 1. Pain, tenderness, swelling, discoloration Goals: IMMEDIATE
of site
● Injured or damaged internal 2. Bleeding from mouth, rectum, vagina, ● Recognize
other orifice
organs 3. Vomiting bright red blood or blood presence of
(coffee ground) internal bleeding
● Fractured extremities esp.
Femur and Pelvis 4. Dark, tarry stools with bright red color. ● Maintain body
5. Tender, rigid, distended abdomen. perfusion
● Provide rapid
transport
LATE SIGNS: 1. Safety BSI
2. Open airway and
1. Altered LOC, Anxiety, restlessness, provide O2 and
combativeness. ventilation per
2. Weakness, faintness, dizziness SpO2 and ETCO2
3. THIRST 3. Transport
4. Signs of shock Immediately
4. Shock treatment

SHOCK Mental Status: 1. Safety BSI IMMEDIATE

● Scene Size –
2. Maintain open
up 1. Restlessness airway
● Monitor for 2. Anxiety 3. Control any external
3. Altered LOC bleeding
s/sx of shock
through 4. Elevate lower
focused Hx extremities approx.
and PE 8 to 12 inches
Peripheral Perfusion and skin perfusion 5. Splint suspected
● Establish VS injuries
1. Pale, cool, clammy skin 6. Use blanket to warm
● Mental Status 2. Weak, thread, or absent peripheral pulses patient
3. Delayed capillary refill in ambient air 7. IMMEDIATE
● Peripheral
temp. TRANSPORT
perfusion

VS ADVANCED CARE

1. Increased Pulse rate 1. Fluid replacement

2. Increased RR deep, shallow, labored, LR/NSS warm
irregular 1.1. Large bore IV
3. Decreased BP(LATE) min. G16, G14
ideal
1.2. Use blood tubings
1.3. Apply pressure to
Other: bag to speed up
infusion
1. Dilated pupils (sluggish) 2. Unless BT is
2. Marked thirst available, titrate
3. Nausea and vomiting fluid infusion to the
4. Pallor and cyanosis to the lips BP using radial
pulse as guide. 250
initial until radial
pulse is present then
R heart failure – Pulmonary edema TKO
3. Head injury – min
L heart failure – Pedal edema systolic 90 mmHg

The Four Stages of Shock

Class I (Compensated) Class II Class III Class IV (Irreversible)
(Decompensated) (Decompensated)

15% 750 ml 30% 1,500 ml 40% 2000 ml >40% >2000 ml

Body Response

● Compensates for ● Continued ● Compensatory ● Compensatory

Blood loss vasoconstriction to mechanism become vasoconstriction
maintain perfusion overtaxed. become a
● Constricts blood
but with some complicating
vessels in effort to ● Vasoconstriction
difficulty factor further
maintain BP and cannot maintain BP impairing tissue
deliver oxygen to ● Blood is shunted begins to fall. perfusion and cell
ALL organs to vital organs oxygenation.
● Decreased CO and
● Decreased flow to perfusion
intestines, kidneys,
● Patient can still
and skin.
recover with
prompt treatment.

Effect on Patient

● N LOC ● Restlessness and ● Confused, ● Lethargy, drowsy,

confusion restless, anxious stuporous
● N VS
● Pale, cool, dry skin ● Classic signs of ● Sign of shock
● 750 ml enough to due to shunting shock appears become more
occupy a limb or a pronounced
● Diastolic pressure ● Cool clammy
body cavity which
rise and fall. May extremities ● Continued BP fall
could cause little
discomfort, pain, stay the same on
● Organ failure and
swelling. healthy patients
death due to
● Decreased pulse ● Pulse Pressure insufficient blood
pressure continues to narrow flow.
● Symphatetic
response also
causes rapid HR
● Increased RR
 ● Delayed capillary
refill.

ANGINA ACUTE MI

Pain after exertion or Pain often related to stress or exertion

stress

Relieved by Rest Not relieved

Usually relieved by nitro Nitro may relieve pain

(post 3 doses in 15 min
assume MI)

BP not affected Reduced BP. Diaphoresis

Short term Pain may last 30 min to hour

Stages of Shock

● Compensatory Shock – maintain perfusion

● Progressive Stage – normal compensatory will work only for so long

● Irreversible Stage – cannot be reversed.

7 Stages of Cell Death

1. Normal Cell

2. Hypoxia > Ischemia > Anaerobic metabolism >lactic acid build up > met. Acidosis >sodium pump fails

3. Ion Shift – sodium rushes into the cell bringing water with it.

4. Cellular edema

5. Mitochondrial edema – cessation of ATP production.

6. Intracellular disruption – releases lysosomes (cell digesting enzymes) > cell membrane breakdowns.

7. Cell destruction lead to cell death.

 CLASSIFICATION OF SHOCK

Cardiogenic Shock Heart in origin

Hypovolemic Shock Severe Blood loss

● Hemorrhagic Shock

Obstructive Shock Problem in the vascular system

● Cardiac tamponade

● Tension Pneumo

● Pulmonary embolism

Distributive Shock Fluid or blood in the wrong place

● Spinal/ Vasogenic shock

● Septic Shock

● Anaphylactic Shock
 NEUROLOGICAL EMERGENCIES
CASE ASSESSMENT PATHOPHYSIOLOGY
Transient Ischemic Attack
● RECURRENT
(TIA)
neurological deficits of
any type that correspond
to the disorientation of a
particular cerebral artery
and vertebra-basilar artery
and last anywhere from a
FEW SECOND to 12
HOURS.
● Neurologic examination
between attacks maybe
ENTIRELY NORMAL
● Some patients – onset of
attack is clearly related to
standing up after lying or
SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATION
1. Carotid System Blockage
1.1. Hemiparesis / Hemiplegia
1.2. Unilateral Numbness
1.3. Aphasia
1.4. Confusion, coma
1.5. Convulsion
1.6. Incontinence, sometimes
1.7. Numbness of face
1.8. Slurred speech
1.9. Dysphagia
1.10. Posterior headache
1.11. Dizziness or Vertigo
 sitting or it occurs on
relation to exertion,
emotional stress or bout of
coughing.

SEIZURE DISORDERS

Tonic Clonic (Grand Mal) Types of Seizures: 1. Protect the patient

● Tonic phase– the body
from injury
becomes rigid stiffening for 1. Simple partial seizure – (focal motor, 2. Guard airway but NPO
no more than 30 sec. focal sensory or Jacksonian) – tingling, 3. DO NOT restrain
Breathing may stop. Patient stiffening or jerking in just one part of patient. Remove
may bite his tongue. the body. Aura may present (bright objects and gently
Incontinence may result. lights, crust of colors, or a rising guide away from
● Clonic phase – body jerks sensation in the stomach) danger.
2. Complex partial seizure (psychomotor) – 4. Loosen obstructive
about violently, usually for
abnormal behavior that varies. May clothing.
more than 1 – 2 minutes.
involve confusion, glassy stare, lip 5. Take vital signs and
Patient may foam at the
smacking or chewing, aimless moving monitor respirations
mouth and drools. Face and
about or fidgeting with clothing.ok closely.
lips may become cyanotic
● Postictal phase – regains
consciousness immediately
and enter a stage of
drowsiness and confusion or
he may remain unconscious. Causes of seizure:

1. Febrile
2. Idiopathic
3. Brain tumor
4. Congenital brain
deficits
5. Metabolic
6. Infection
7. Toxic
8. Trauma

Absence (Petit mal) Seizure is brief usualy only 1 – Same as grand mal
10 sec. There is no dramatic
motor activity. Person does not
slump on face. Goes unnoticed
by everyone except by the
person and knowledgeable
 members of the family.

Stroke (Cerebrovascular Sudden onset of focal Classification: 3 Types of Cerebral Edema

Accident/ CVA) neurological deficit caused by a
non-traumatic brain injury 1. Transient Ischemic Attack 1. Cytotoxic
resulting in occlusion or rupture 2. Reversible Ischemic Neurologic Deficit 2. Vasogenic
of the cerebral blood vessel. 3. Stroke in Evolution/Completed Stroke 3. Interstitial

If Brain Edema suspected:

1. Modest Fluid
restriction
2. Elevation of head of
bed (20 – 30 degree)
3. O2 and Ventilation
support
4. Control of agitation
and pain.

Ischemic Stroke Blockage in arteries supplying Pathological Process (applicable on ischemic Conscious: LOAD AND GO
oxygenated blood will result in and hemorrhagic):
damage to affected parts of the 1. Ensure an open airway Window period 3
brain. 1. Intrinsic blood vessel pathology 2. Keep patient calm hours but the faster
(atherosclerosis, lipohyalinosis, 3. Maintain eye contact the better.
Hemorrhagic Stroke An aneurysm or other weakened inflammation, amyloid deposition, and speak SLOW and
are of an artery ruptures. arterial dissection, developmental CLEARLY.
malformation, aneurismal dilation and 4. High O2
Often associated with /or venous thrombosis.) 5. Monitor VS
arteriosclerosis and hypertension 2. Lodging of embolus in intracranial vessel 6. Semi reclined post
from a remote part such as heart or 7. NPO
Two effects: extracranial circulation 8. Keep warm
3. Decreased perfusion pressure or 9. Sit in front of patient.
1. An area of the brain is increased blood viscosity with
deprived of oxygenated inadequate cerebral blood flow.
blood 4. Vessel rupture in subarachnoid space or
2. Pooling blood push intracerebral tissue. Unconscious:
increased ICP on the brain,
displacing tissue and 1. Maintain open airway
interfering with function. 2. High O2
S/Sx: 3. Ventilation if needed
4. Monitor VS
1. Confusion 5. Lateral recumbent
 2. Hemiparesis post.
3. Hemiplegia 6. Protective padding
4. Impaired speech
5. Facial flaccidness and loss expression
6. Headache
7. Unequal pupil size
8. Impaired vision
9. Cushing’s Triad
9.1. Hypertension
9.2. Irregular RR
9.3. Slow pulse
10. Convulsions
11. Coma
12. Incontinence
13. Inappropriate behavior
14. Stiffed neck
15. Staggering gate

Altered Mental Status Causes: 1. Secure airway and

control respiration
A – Alcohol and other drugs 1.1. O2 – guided by
SpO2
E – pilepsy, Endocrine/Exocrine 1.2. Ventilation –
guided by
I – insulin, hypo/hyper ETCO2
2. Protective reflexes
O – oxygen, overdose and (+/-)
opiates 3. Immobilize spine
unless absolutely
U – Uremia certain injury not
suspected
4. Monitor Neuro VS q
5min
T – trauma and temp 5. Protect patient eyes on
long transpo
I – infection (Sepsis or
6. Treat and reassure
Meningitis)
accordingly

P – poisons and psychiatric

S – shock, stroke or space

occupying lesion.
 Right Hemisphere Lesion Left Hemisphere Lesion

Impaired Visuomotor perception Unable to communicate properly

Visual Memory X: Loss of visual memory OK: Positive visuomotor retention

and memory

Lack of insight and judgment BUT Positive visuomotor retention and

NOT OBVIOUS because of intact memory
verbal fluency

Comprehension OK: No deficit understand and X: Aphasia

express

Proprioception X: Inability to assess position in OK: Unimpaired

space and safely interact with the
environment

Verbal Memory OK: Intact. Perceptual memory X: Impaired ability to retain verbal
impaired information; remote memory
impaired

Carelessness and YES: Careless. Obvious mistakes. NO?: Usually impaired.

Impulsiveness Impulsive with decreased ability to
anticipate consequence of behavior.

Emotion and X: Inappropriate emotion and affect OK: Appropriate

Affect

7 D’s of Stroke Management:

1. Detection – recognition of the s/sx of stroke or TIA and activate EMS.

2. Dispatch – EMS dispatcher must prioritize the call same as an AMI.
3. Delivery – transport to stroke center.
4. Door – hospital that can provide fibrinolytic therapy within 1 hour after arrival.
5. Data – hospital obtaining CT scan.
6. Decision – identifying eligible patient for fybrinolytic therapy.
7. Drug – treating with fibrinolytic therapy.
 DIABETIC EMERGENCIES normal glucose 60 to 120 mg/dL
CASE ASSESSMENT CAUSES SIGNS AND SYMPTOMS MANAGEMENT CAUSE OF DEATH

Hyperglycemia 1. Gradual onset in days 1. O2 via NRM 1. Dehydration and

● Have you ● Condition has not been
2. Dry mouth, intense thirst 2. Transport to poor nutrition
taken your diagnosed or treated 3. Abd. Pain and vomiting common medical facility 2. Hypokalemia
meals? 4. Gradually increasing restlessness, 3. Arrange for ALS 3. Hypoinsulinemia
● Has not taken insulin
● Have you confusion followed by stupor and coma intercept. 4. DKA (Diabetic
● Over eaten – flooding the 5. Weak, rapid pulse Ketoacidosis) –
 body with excess carbs 6. Air hunger – deep sighing respirations However, all ketones in urine
(Kaussmal’s breathing) management to DM > acidosis
● Diabetic suffers an infection
7. Acetone breath (child) emeregencies towards >compensates by
that disrupts his 8. Warm, red, dry skin hypoglycemia. Kaussmal’s
glucose/insulin balance 9. Normal or slightly elevated BP breathing to
10. Sunken eyes decrease acidosis
11. No hostile or aggressive behavior > Diabetic
COMA
taken your
Hypoglycemia insulin? 1. Rapid onset in minutes. 1. Granular Sugar Hyperinsulinemia -
● Taken too much insulin
● Have you 2. Copious saliva, drooling under tongue. Insulin Shock.
● Not eaten enough to provide N 3. Patient intensely hungry. 1.1. Conscious: any
vomited your
4. Dizziness and headache, sudden fainting, sweet solid or
meals? sugar intake
seizures and occasionally coma liquid
● Have you ● Over exercised/ exerted 5. Full rapid pulse 1.2. Unconscious:
done 6. Normal respiration , no odor 1.2.1. Avoid giving
● Vomited 7. Cold, clammy, pale skin. liquid
strenuous
activities? 8. N BP 1.2.2. Turn head to
9. N eyes side or place
10. Hostile/aggressive behavior. in lateral
recumbent.
2. Provide High O2
3. Transport to
medical facility
4. Arrange ALS
intercept.

ACUTE ABDOMINAL EMERGENCIES

CASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATION

1. Pain/ tenderness 1. Safety and BSI Efficient Transport

❖ All adults with ● Supine
2. Anxiety / fear 2. CAB
abdominal pain 3. Guarded position 3. Keep airway
● Knee chest
always consider MI. 4. Rapid shallow breathing patient – be alert
o Heart problem flexed
5. Rapid pulse for vomiting
irritates the vagus ● Examine last 6. Nausea vomiting or diarrhea 4. Place pt. to
nerve> affects 7. Rigid or tense abdomen position of
most painful
gastric mucosa >
 producing excess part 8. Internal bleeding comfort
HCl and 5. NPO
● N abd.
abdominal pain. 6. Calm and
Assess: reassure pt.
❖ Causes:
● No pain, soft, 7. Be alert for shock
o Ulcer 8. Transport
non rigid,
o Intestinal efficiently
warm to
Obstruction
touch, not
o Cholecystitis
distended
o Hernia (emergency
due to possibility of
circulation
obstruction)
o Abdominal Aortic
Aneurysm
o Pancreatitis
o Appendicitis

Urinary Colic Nephrolitiasis – formation of stone 1. If alert, advise to Transport efficiently

● Pain – intensity depends upon the size of
in the kidney (or anywhere in the increase fluid
urinary tract but calculi begin to the calculi. intake to over
form in kidney). Stone size may vary ● Renal colic – a group of symptoms 4000 ml/24 hour.
in size. associated with movement of a calculus 2. Administer
through the narrow anatomical points in analgesic/antispas
the ureter causing obstruction of urine. modic according
o Severe costovertebral angle pain to local protocol
Renal calculi classification 3. Keep on bed rest
radiates throughout the flank area and
(with Entonox)
groin due to the muscle spasm
● Calcium Phosphate – 65% 4. Transport to hosp
injured by the stretching and
for further
obstruction of the ureter by the
● Calcium Oxalate management.
calculus
● Magnesium Ammonium

● Phosphate (stravite) – 15%

● Uric Acid – 10%

● Cystine Stone – 10%

Factors promoting to Stone
Formation:

● Supersaturation of Urine –
stone formation due to
crystalloid
● Presence of Nidus – a must.
Nidus or nuclei which layer
can be deposited
● Stasis – further promotion of
stone formation
● pH or solution
 OBSTETRICS - GYNECOLOGICAL EMERGENCIES
CASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATION

Common Gynecological
Emergencies

Ectopic Pregnancy Development of a fetus outside the 1. Ammenorhea 1. Ensure open ALL LOAD AND
womb 2. Pain in the L/R iliac region airway GO
3. Abnormal vaginal bleeding 2. O2 as required
Causes: 4. Low back pain 3. NPO
5. Breast tenderness 4. Vomiting
● Past ectopic pregnancy 6. Nausea precaution
(positioning)
● Past salpingitis 5. Monitor VS
6. Shock precaution
● Surgery of the fallopian
tube

Rupture of Ovarian Cyst Formation of mass in the ovary with 1. Sharp, piercing pain in the lower
idiopathic cause. abdominal quadrant.
2. Fever
3. Nausea
4. Vomiting
5. Weakness, dizziness or fainting
6. Signs of internal bleeding

Pelvic Inflammatory Disease Infection from the vagina making the 1. Fever
(PID) pelvis inflamed. 2. Profuse discharge from the vagina
3. Malaise
Causes: 4. Lower abd pain
5. Difficulty passing urine
● Sexually – transmitted 6. Irregular vaginal bleeding

disease

Dysfunctional Uterine Bleeding from the uterus that is not 1. Increase PR >20 bpm when pt. sits
Bleeding (DUB) due to menstrual period from supine position. > blood loss of
more than 1 unit.
2. Abnormal vaginal bleeding
 Cause: 3. Abnormal spotting
4. Metrorrhagia – bleeding in b/t period
● Estrogen imbalance 5. Menorrhagia – excessive bleeding
6. Bleeding after menopause
● Menopause syndrome 7. Bleeding unrelated to periods
8. Bleeding in young girls
● Female of advanced age

Other : Rape 1. Ensure open

● Maximum
airway
tact and 2. O2 as required
sensitivity 3. NPO
● Female EMT 4. Vomiting
should be precaution
present (positioning)
5. Monitor VS
● EMT must 6. Shock precaution
take care of
urgent med.
Problems
● Preserve
evidence
● Protect
patient’s
privacy
● Document

OBSTETRICS Important elements Mech. Of Delivery: Sx of imminent delivery: Imminent delivery: General Steps in NSD
of Assessment:
Engagement > Descent > Flexion > 1. Urgeto push 1. Do not allow to 1. Prepare mother
1. Age of Internal Rotation > Extension > 2. Presence of crowning use toilet for delivery
o 3 weeks – zygote/ patient Expulsion 3. Increase pressure in the vagina 2. Consult MD 2. Assist
fertilized ovum 2. LMP concerning 3. Initial care of
o 3-8 weeks – embryo 3. AOG decision to the newborn
o 9-38 weeks – fetus 4. Gravida deliver baby at
o Birth to 28 days – 5. Parity Equipments: Labor and Delivery the scene.
neonate 3. Do not clamp/cut
1. Gloves 1. Safety BSI cord if the baby is
o 29 days to 1 yo –
2. Drawsheet 2. Lie knee flexed drawn up wide separated, not breathing on
infant
Criterias: 3. Suction Bulb semi-fowlers its own.
o 1 yo to 12 yo – child
4. Towels 3. Create sterile field around vag. Opening
1. Due date 5. Gauze with sterile towels
 o UTZ – most reliable 2. Contraction? 6. Scalpel 4. Crowning – place gentle pressure on If within 5 minutes
dx tool Frequency and 7. Umbilical clamp perineum woman will deliver the
Duration? 8. Cotton with alcohol 5. Once delivered, support the head as it baby, do not load and
3. Increase rotates and wipe neonate’s mouth and nose go. If inside the
Spressure in > suction mouth and nose ambu,stop and deliver
vagina? 6. Guide head down to deliver 1st shoulder, the baby.
4. Urge to push? Premature (<38 weeks/ <2500 kg) – then up to deliver the 2nd shoulder >
5. Crowning? TRANSPORT to ER for incubator support the baby
6. Broken bag of 7. Grasp the feet firmly with one hand
water? 8. Clean out the baby’s mouth with gauze.
Suction. The baby should start to cry. If
500 ml – normal bleeding during not, ABC of resuscitation.
delivery
✔ Intervention for non breathing baby
Cord Cutting – 10 incles away from 1. Rub the back
umbilicus 2. Snap fingers at soles of the feet
3. ABC
4. If with spontaneous breathing, let
neonate breath room air
5. If APGAR is low (4-7) give O2 via
blowby

COMPLICATION
ONFIRST TRIMESTER

Abortion Termination of pregnancy before 28

weeks

1. Threatened
2. Closed cervix
a. Mild pain (back pain,
lower abd.)
b. Mild vaginal spotting
3. Inevitable – cannot preserve
pregnancy
a. With placental/fetal
fragments came out
b. Severe back pain
c. Moderate, obvious
bleeding
d. Shock
4. Incomplete – placental/fetal
 fragments expelled
5. Complete – abortus/fetus
expelled out with bleeding
6. Criminal
7. Therapeutic

Pre – Eclampsia Hypertension. BP of more than 1. Transport LIGHTS ONLY

130/80. 2. FHT monitoring
3. CAB
Comlications: 4. Prevent stimulus
5. O2 per SpO2
● Eclampsia 6. Therapeutic
Environment
● Abrutio Placenta

● Cerebral retinal damage

● Pulmonary edema

Eclampsia Neurological

Supine Hypotension Compression of the Vena Cava due Left Lateral Position
to pregnancy.

H-mole No fetus but with signs of pregnancy

Incompetent Cervix 1. Complete bed rest

2. Constant OB
supervision
3. Cervical Cerclage

Hyperemesis Gravidum Excessive vomiting during 1. Crackers on bed

pregnancy side
2. Small frequent
feeding
3. Ensure nutrition
4. Maintain
hydration
3RD TRI/ANTENATAL
COMPLICATIONS

Abruptio Placenta Premature separation of the placenta 1. Mild to moderate vaginal bleeding Transport for
before labor and delivery 2. Sx of shock Emergency CS
3. Continous knife like pain in the
abdomen
4. Rigid tender uterus

Placenta Previa Implantation of the placenta over the Painless bright red vaginal bleeding. 1. Transport
cervical opening immediately
2. Shock precaution
3. Do not IE

Uterine Rupture 1. Tearing abdominal pain 1. CAB

● Common to G3 above
2. Severe hypovolemic shock 2. Transport IMMEDIATE
● Due to Blunt Trauma. 3. Firm rigid abd.
4. Vaginal bleeding
● Repeated stretching of the
uterine wall
● Old CS

● Prolonged labor against

o Obstruction
o Weakened uterine wall

COMPLICATIONS OF
LABOR and DELIVERY

Prolapsed Cord No pulsation of the umbilical cord 1. Position mother IMMEDIATE

● For emergency CS
to knee chest
● Cord compressed between the position
2. Push the
neonate’s head and birth canal
neonate’s head to
relieve
compression to
cord
3. Wrap cord with
moist sterile
gauze to prevent
 damage

Cord coil/ Cord loop 1. Upon delivery of

head look for the
cord if looped
around the neck
2. Gently slip if
possible
3. If not, clamp the
cord and cut
(protocol)

Meconium Staining Sign of fetal distress

● Common in pre term and
post term 1. No FHR
● Lack of O2 > Spasm of the 2. FHR < 120
3. Mother do not feel baby moving
large intestines > meconium
staining > greenish
discoloration of the amniotic
fluid
● Complication:
o Neonatal Sepsis –
meconium aspiration
o Neonatal respiratory
distress – neonate may
not be able to clear
lungs.

Amniotic Fluid Leak

● Difficulty of fetus to come out

● Infection

● Trauma

● Complication to mother
o Leak to pelvis >Amniotic
fluid enter circulation >
Pulmonary Embolism

NEONATAL CARE
Cardio respiratory changes Routine care: Risk factor for shock and N neonatal vital signs
that occur in birth: hypotension
1. Warming RR 30 – 50 cpm
o To get rid of the 2. Airway 1. Low birth weight
fluid filling the lungs 3. Position 2. Maternal sepsis PR 120 – 160 bpm
so that it can expand 4. Cord cutting 3. Prolapsed cord
o Closing of the 5. Prevention of 4. Acute onset of maternal BP >60 mmHg
foramen ovale and meconium vaginal bleeding
ductus arteriosus aspiration

HR

● < 60 – CPR

● >100 – breath on room air

● 60 – 100 ventilate (full 5 Lpm; premature

3 Lpm)

APGAR

8 – 10 mild distress

4 – 7 moderate

1 – 3 severe

Medical

● Unconscious or decreasing level of

consciousness
● Dilated pupil
 ● GCS <10

● Pediatric trauma score <8

● Persistent Fever

● Increase effort in breathing

Trauma

● Fall from a height of 20 ft

● Involved in an accident with fatalities

● Ejected in a car accident

● Struck by a car.

NEONATAL SEIZURES Causes: Types:

1. Hypoxic – Ischemic 1. Subtle – Head part – ocular, facial, oral or

Encephalopathy ligual movements and respiratory
2. Metabolic Disturbance manifestation such as apnea or stutortorous
3. Meningitis or Encephalitis breathing
4. Developmental abnormalities 2. Tonic – pre-term infant: seizure appear
5. Drug withdrawal decerebrate or decorticate posturing
6. Maternal anesthesia 3. Multifocal clonic – term infants: noted in
7. Stroke one limb and migrate to another part of the
body.
4. Focal clonic – term infants: localize and
are accompanied by short activity of EEG.
5. Myoclonic –premature and term infants:
single multiple jerk and flexion of the
upper and lower extremities

Stage Hallmark Signs Duration for Primi Duration for Multi

1st True labor to full cervical dilation 12 to 16 hours 30 min

 2nd Full cervical dilatation to birth of neonate 30 min Matter of minutes

3rd Birth of neonate to placental delivery Within 20 min Within 20 min

False Labor True Labor

Contractions Irregular Regular

Pain radiation Abdomen Lower back then

abdomen

Pain alleviation Alleviated by ambulation Not alleviated

Frequency, Duration, No increase Increasing

Intensity

Cervical Dilatation No dilatation With dilatation

APGAR SCORING

SIGN 0 1 2

Appearance Bluish or pale Pink trunk, blue Pink

extremity

Pulse Absent <100 bpm >100 bpm

Grimace No Response Some motion, Cry, cough, sneeze

grimace

Activity Limp Some flexion, Active, good motion

extremeties

Respiration Absent Slow and irregular Normal, crying

Insert Neonatal Circulation and Neonatal Resuscitation

 BURN EMERGENCIES
CASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATION

Type of burns Factors to consider in Thermal Burn: Special Considerations: Treatment of burn
evaluating burns wound
1. Chemical 1. Emergent Phase – response to Pedia:
2. Radiation 1. Agent of burn pain > catecholamine release. 1. Low priority after
3. Electrical 2. Depth 2. Fluid shift – massive shift 1. Thin skin CAB and IV
4. Thermal 3. Severity (BSA) from intracellular to 2. Large surface volume 2. Do not rupture
5. Scald a. Rule of nines extracellular fluid 2.1. Rapid fluid loss blisters.
6. Contact b. Palm rule 3. Hypermetabolic phase – 2.2. Increased heat loss 3. Dry Sterile
7. Flash 4. Age – under 5 and over 55 increase demands for nutrients 3. Dehydration vs. Overhydration Dressings
(adult’s reaction to burn 4. Resolution phase – scar tissue 4. Immature Immunological response 4. Cover with burn
injury increases after age and remodeling of tissue sheet
35)
a. Infants and children are at
higher risk due to more Geria: 4 Phases of burn
body surface area Complications: management
i. Hypovolemic shock 1. Decreased Myocardial reserve
ii. Airway problem 1. Hypovolemia leading to shock 2. Fluid resuscitation difficult 1. Emergent Phase –
iii. Hypothermia - Leading 3. Peripheral vascular disease time of injury to
5. Other illnesses and injuries 2. Infection 4. COPD structural
3. Renal/hepatic failure 5. Decreased immune response 2. Resuscitation
4. Formation of eschar 6. % mortality = age + % of BSA affected Phase – admin of
5. Complication of IV fluids, return of
circumferential burn capillary membrane
(tourniquet effect) to N level
6. Increase catecholamine 2.1. Parkland
release, vasoconstriction formula: 4 mL/kg
7. Inability to maintain body * total BSA
temperature 2.2. 1st half in first 8
hrs
2.3. 2nd half in next 16
hrs.
Eschar formation: 3. Acute Phase –
hemodynamically
1. Skin denaturing stable
2. Skin constricts over wound 4. Rehabilitation
3. Respiratory compromise Phase
4. Circulatory compromise
 Jackson’s Burn Theory

1. Zone of Coagulation
2. Zone of Stasis
3. Zone of Hyperemia

Thermal Rapid PE 1. Remove patient IMMEDIATELY

from the scene
1. Check for other injuries 2. Stop burning
2. Rapid estimate burned process
wound 3. Ensure open airway,
3. Remove restricting band assess breathing
4. Look for signs of
airway injury, soot
deposits, burnt
Hx: nasal hair, facial
burns
1. How long ago? 5. Complete the intial
2. What has been done? assessment.
3. What cause? 6. Treat for shock.
4. Close space? High O2 (per
5. LOC? SpO2). Treat
6. Allergies/meds? serious injuries.
7. Past med Hx? 7. Evaluate burns by
depth, extent and
severity.
8. Do not clear debris
9. Wrap with dry
sterile dressing.
10. Burns of hands or
feet – remove rings
and jewelry that
may constrict with
swelling. Separate
fingers or toes with
gauze pads.
11. Burns to eyes – do
not open eyelids if
burned.
11.1. Be certain burn
is thermal, not
chemical.
 11.2. Apply sterile
gauze pads to
both eyes to
immobilize.
11.3. If burn is
chemical, flush
eyes for a
minimum of 20
minutes.
12. Shock precaution (if
there’s other
injuries)

Others:

1. Analgesic –
Morphine Sulfate
1.1. 2-3 mg q 10 min
titrated to
adequate
ventilation and
BP
1.2. 0.1 mg/kg for
pedia
1.3. May require large
but tolerable
doses.
2. Avoid topical agent
except per protocol
(Silvadine)
3. Fluid Therapy
3.1. Objective:
3.2. HR < 110 bpm
3.3. Urine output: 30
– 50 cc per hour
or 0.5-1 cc/kg/hr
for pedia

Chemical Insert chemical burn

handout
 Generally get chemical
contaminated object off
the body and flush with
LR/NS except if chemical
reacts with water.

Inhalation Problems: Anticipate respiratory problems Airway, O2,

Ventilation:
1. Hypoxia 1. Head, Face, Neck or Chest burns
2. CO toxicity 2. Nasal/ eyebrow hairs signed 1. Bronchodilators
2.1. SpO2 could be 3. Hoarsness, tachypnea needed?
meaningless 4. Coughing - Black sputum 2. Diuretics are not
3. Upper airway injury appropriate
3.1. May result to edema of
pharynx and larynx
4. Lower airway injury
4.1. Rare, involves lung Circulation:
parenchyma, Transport
1. Treat for Shock
(rare)
2. IV access
2.1. LR/NS large bore
multiple IV’s
2.2. Titrate fluids to
maintain systolic
BP

Others:

Treat burns and injuries

Electrical Ohm’s law – 1 = V/R AC current: 1. TRANSPORT

2. Make sure current is
Low voltage – 500 – 1000V 1. Tetanic Muscle Contraction off
1.1. Muscle injury 3. CAB
High voltage 1000V up (Lightning) 1.2. Tendon rupture 4. Rhabdomyolysis –
1.3. Joint distraction breakdown of
1.4. Fractures muscle fiber that
2. Cardiac arrhythmias leads to release of
3. Apnea myoglobin to
 Severity depends on 4. Seizure bloodstream which
5. Contact burn/Flash burn is harmful to the
1. Tissue 6. Flame burn kidneys.
2. With or extent of current
3. AC/DC
4. Duration of current contact

Radiation
● Alpha – large

● Beta – small

● Gamma – most dangerous

Burn Depth Characteristics

1st Degree 2nd Degree 3rd Degree

Cause Sun or minor flash Hot liquids, flashes or flame Chemicals, electricity, flame, hot metals

Skin Color Red Mottled red, moist and shiny Pearly white and or charred translucent and parchmentlike

Skin Surfaces Dry (-) blisters (+) blisters with weeping Dry with thrombosed blood vessels

Sensation Painful Painful Anesthetic

Healing 3-6 days 2 – 4 weeks depending on depth Requires skin grafting

Burn severity

Depth Minor Moderate Critical

Superficial < 50% >15% All complicated by injury

of soft tissue and bones

Partial Thickness <15% 15 – 30% >30%

Full Thickness <2% except for face, 2 – 10% >10% Partial full
genitalia, hands and feet thickness on hands,
genitalia, circumferential
burn.
 Insert Rule of Nines for Adult, Child and Pedia

POISONING EMERGENCIES
CASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATION

Poisons could be: Odor 1. Burns and strains around mouth General approach:
● Poison (toxin ) substance
2. Unusual breath/body/
Ingested Level of which, if taken into the body clothing/scene odor
in sufficient quantity can ● Circulation
Consciousness 3. AbN breathing
Inhaled cause temporary or 4. AbN pulse rate ● Airway
Vital Signs permanent damage 5. Profuse sweating, headache,
Absorbed ● Self poisoning and dizziness ● Breathing
parasuicide – deliberate 6. Excessive salivation or foaming at
Injected the mouth ● Drug induced CNS
ingestion of more than the
Hx 7. Pain in the mouth or throat depression
therapeutic dose of a drug or
substance not intended for 8. Abdominal pain
What? ● Electrolytes and
consumption usually by an 9. Abdominal tenderness sometimes
with distention metabolic
When? adult in a moment of distress abnormalities
10. Nausea, vomiting
● Accidental poisoning – non 11. Seizures ● Oxygen precautions
How much? 12. Altered mental status
intentional
o Watusi
13. Signs of shock
What else was o Paraquat
taken, if anything? o Zinc phosphate
Antidote? 3 Leading causes of Poisoning:

Vomited, if so how 1. Alcoholic intoxication

long after the 2. Methamphetamine Activated Charcoal
ingestion? 3. Isoniazid toxicity
● Absorbs many
Why?
poisonous compounds
Odor to its surface, thereby
Organophosphate – agent most
reducing their
Level of commonly associated with mortality. absorption by the body
Consciousness
● Effective among:

Vital Signs o Aspirin

o Amphetamines
o Strychnine
o Dilantin
Hx o Theophylline
o Phenobarbitals
What?
● Ineffective:
When? o Methanol
o Caustic acids
How much?
o Alkalis
o Iron tables and
What else was
taken, if anything? lithium
Antidote? ● 1g/kg

Vomited, if so how
long after the
ingestion?
Syrup of IPECAC

Why?
● Induces vomiting

● Contraindications
o Stupor/Coma
o Absent gag reflex
o Seizures
o Pregnancy
o Acute MI
o Children < 6 mo
o Ingestion of
corrosives
o Volatile
hydrocarbons
o Strycnines or iodides
● Dosage
o Children 3-5 tsp
followed by a glass of
water
 o Adults 1-2 tsp
followed by water

Ingested 1. Maintain open

airway
2. Transport
Immediately
3. Follow protocol of
your EMS system
4. Keep patient on
NPO
5. Position the
conscious patient in
semi recumbent
position
6. Monitor vomiting
7. Save all vomits and
endorse to the
hospital

Inhaled 1. Remove patient

from inhaled poison.
Avoid touching
contaminated
clothing.
2. Maintain open
airway
3. Provide needed BLS
measures and
administer O2 (if
not contrainidicated)
NRM

Injected 1. Follow local

protocol
2. Monitor patient and
maintain open
airway
 3. Remove jewelry
from affected limbs
4. Keep the limb
immobilized
5. Transport
immediately

Absorbed 1. Move the patient

from the source of the
poison while
avoiding contact with
the substance
2. Use water to
immediately flood all
the areas of the
patient’s body that
has been exposed to
the poison
3. Monitor patient and
transport immediately

Insert Table of S/Sx of common poisons.

COLD EMERGENCIES
CASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATION

Temp Conversion: Core Temp

C = (F-32)*5/9
● Internal temp of normothermic

F = C*5/9 +32 humans

● Does not vary >1-2 º from normal
temp
Keeping warm: ● Esophageal and tymphanic temp
almost the same with pulmonary
● Thermogenesis artery

o Conversion of food to ● May cause permanent disability

energy in body cells or death
o Muscle activity,
voluntary or involuntary Hypothalamus – temp regulator
center
● Heat absorption

● During cold conditions

o Constricting blood Mechanism of Heat Loss
vessels at body surface to
keep warm blood at the 1.
core
o Reducing sweating 2.
o Erecting body hairs to
“trap: the warm air at the
skin 3.
4.
Losing body heat
5.
● Heat maybe lost to
o Cool surrounding air
o Cool objects in contact
with skin
● In hot conditions, the body
Convection – heat loss to
surrounding air
Conduction – heat loss to
nearby objects through
physical contact
Radiation – Body heat is lost
to nearby objects without
direct contact
Evaporation – Body heat loss
through perspiration
Respiration
 reacts to lose heat
o Blood vessels in or near
the skin dilate tin order
to lose blood heat
o Sweat glands become
active. Sweat evaporates
in cooler air. Hairs are
flat
o The rate and depth of
breathing will increase

Local Cold Injury

1st degree frostbite General S/Sx Victim unaware unless he Redness and tingling sensation 1. Remove patient from
(Frostnip) sees himself in the mirror and site
1. Shivering notices unusual pallor and the 2. Remove all of the
2. Numbness return of the warmth to patient’s clothing that
3. Stiff, rigid posture frotnipped area is wet
4. Drowsiness or inability to do 3. During transport,
2nd degree (Superficial even simplest activity Skin is stiff but underlying 1. Waxy and white rewarm the patient
Frost) 5. Rapid breathing and rapid tissue is soft 2. Numbness 4. Shock treatment
pulse in early stages, Late 3. As thawing occurs 5. Give warm fluid for
stage: Slow pulse and 3.1. Area turned mottled conscious and alert
breathing. blue patient
6. Decrease LOC 3.2. Stinging sensation 6. Keep patient at rest.
7. Cool skin temp 3.3. Edema and blister
8. Loss of motor coordination within a few hours
9. Joint, muscle stiffness and
3rd Degree to 4th Degree rigidity. 1. White , mottled blue or white 1. If still frozen, leave it
(Deep Frostbite) hard cold frozen
2. Tissue feels like block of 2. Pad the injured
wood extremity to protect
3. When thawed from further trauma
3.1. Soothing pain 3. Do not massage
3.2. Burning 4. Notify the receiving
3.3. Throbbing facility so that they can
3.4. Aching start preparing and re-
3.5. Possible joint pains warming both.
3.6. Gangrene within a few 5. If the extremity is
days requiring amputation partially thawed,
 of injured part rewarm the injured
area at 38 – 42 ºC
6. Once rewarming is
comlete
6.1. Dry extremity very
gently and apply it
gently to thawed part
6.2. Take care not to
rupture blisters.
6.3. Use soft sterile gauze
or cotton to separate
frostbiten fingers and
toes
7. Transport the patient
in supine position and
elevate the injured
extremity on soft
pillow, well covered
and protect from cold.

Hypothermia 1. Remove patient from

● Prolonged exposure to cold
cold environment
outdoor especially in wet and 2. Remove any wet
windy conditions clothing and cover the
● Death from cold water patient with blanket
immersion may be caused by 3. Handle the patient
hypothermia rather than with extreme care.
drowning Avoid rough handling
at all cost
4. Admin high flow O2
(warmed and
humidified)
5. Do not allow the
patient to eat or drink
stimulants
6. Do not massage
extremities
7. Check for a pulse for
an extended period of
30 to 45 sec before
initiating BLS
 Too hot Too cold

Blood vessels Vasodilation Vasoconstriction

Perspiration Increase Decrease

Cardiac output Increase Decrease

Respiratory Increase Decrease

Rate

Heat Decrease Decrease

production

Progression of Hypothermia

Body Symptoms
Temperature

37 – 35.5 ºC Shivering

35.5 – 32.7 ºC 1. Decreased shivering replaced by

strong muscular rigidity
2. Less clear thinking
3. General comprehension is dull
4. Possible total amnesia

29.4 – 27.7 ºC 1. Irrational

2. Loses contact with envi and drifts
into stuporous state
3. Slow pulse and respiration
4. Possible cardiac dysrhythmias

26.6 – 20.5 ºC Unconscious without reflexes

 Stages of Hypothermia (ILCOR 2005)

ºC ºF

Mild 36 – 34 ºC 96.8 – 93.2 ºF

Moderate 34 – 30 ºC 86 ºF

Severe < 30 ºC <86 ºF

HEAT EMERGENCIES
CASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATION

Heat Cramps Severe muscle cramps (usually in the 1. Exhaustion 1. Move patient to a nearby cool
legs and abdomen) 2. Dizziness place
3. Periods of faintess 2. Give the conscious patient
fluids and electrolytes
3. Massage the cramped muscle
to help ease the patient’s
discomfort. Massaging with
pressure will be more
effective than light rubbing
4. Apply moist towels to the
patient’s forehead and over
cramped muscles
5. If cramps persists, or if more
serious symptoms and signs
develop, ready the patient and
transport

Heat Exhaustion Volume and electrolytes lost through 1. Rapid, shallow RR 1. Move to cool place
perspiration and is not replaced > 2. Weak pulse 2. Keep @ rest
dehydration > hypovolemia > 3. Cold, clammy skin 3. Remove enough clothing to
decrease brain perfusion 4. Heavy perspiration cool the patient without
5. Total body weakness chilling him (watch for
 6. Dizziness shivering)
7. Possible unconsciousness 4. Fan the patient’s skin
5. Give the conscious patient
fluids with electrolytes.
6. Do not try to administer fluids
to an unconscious patient
7. Treat for shock but do not
cover to the point of
overheating patient
8. Provide high conc. O2
9. If unconscious, fails to
recover rapidly, has other
injuries, or has a hx of
medical problems, transport
as soon as possible

Heat Stroke 1. Deep breaths and shallow 1. Cool the patient – in any
breathing manner – rapidly. Remove
2. Rapid, strong pulse, then from heat source.
rapid weak pulse. 2. Remove patient’s clothing
3. Dry hot skin and wrap him in wet towels
4. Dilated pupils and sheets. Pour cool water
5. Loss of consciousness over these wrappings. Body
(possible coma) heat must be lowered rapidly
6. Seizures or muscular or brain cells will die.
twitching may be seen 3. Treat for shock and
administer high conc. O2.
4. If cold packs or ice bags are
available,wrap and place one
under each
4.1. Armpit
4.2. Knee
4.3. Groin
4.4. Wrist and ankle
4.5. Each side on patient’s
neck
5. Immediate transport
6. Delayed transport: Find a tub
or container. Immerse patient
up to the face in cooled water.
Constantly monitor to prevent
drowning
7. Monitor vital signs
 throughout process

Condition Muscle Weakness Breathing Pulse Skin Perspiration Loss of

Cramps Consciousness

Heat Cramps   Varies Varies Moist-warm Heavy Seldom

Heat Exhaustion Rapid shallow Weak Cold Heavy Sometimes

  clammy

Heat Stroke Deep, then Full Rapid Dry-hot Little or none Often
  shallow

INSECT BITES & STINGS EMERGENCIES

CASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATION

Typical sources of ● Gather

1. Noticeable bites and stings on the skin 1. CAB – treat for shock
infected poisons or toxins 2. Blotchy skin 2. Follow insect bites and
information 3. Localized pain or itching sting protocol in your
(insect, spider & from the 4. Numbness local EMS
scorpion) patient, 5. Muscle cramps, chest tightening & 3. Remove jewelry from
bystanders, at joing pains affected limb
the scene. 6. Burning sensation 4. Immobilized the
7. Difficulty of brerathing and abnormal affected part, if allowed
pulse rate by your protocol, apply
8. Excessive saliva formation, profuse cold compress
● Find out sweating
 whatever you 9. Weakness/ collapse 5. Transport in semi-
can about the 10. Headaches/Dizziness sitting position for
insect or other 11. Chills and fever conscious patient and
possible source 12. Nausea and vomiting recovery position for
of the 13. Redness unconscious patient
poisoning 14. Swelling or blistering
15. Anaphylaxis

Snake bites 1. Bite on the skin 1. Locate the fang marks

2. Discoloration, pain, swelling, at area. and clean the site with
Slow to develop from 30 min to hours soap and water
3. Rapid pulse and labored breathing 2. Remove any jewelry
4. Progressive general weakness from the bitten
5. Blurring of vision extremity
6. Nausea and vomiting 3. Keep the bitten
7. Seizures extremity immobilized
8. Drowsiness of unconsciousness 4. Apply light contracting
band above the bitten
part if allowed by local
protocol
5. Transport and monitor
the patient

Pit Viper Tissue Necrosis Minimal 1. Safety BSI IMMEDIATE

2. Supine
● Has pit in maxillary ● None 3. Open and maintain
airway
bone 4. Immobilize injured limb
● Swelling
● Eliptical pupil and maintain it.
● Pain
● Triangular head

Moderate

● Progressive swelling

Coral Snake 1. Calm Victim

2. O2
3. Proximal constricting
 band (+/-)
● “Red on yellow kill
4. Clean bandage wound
a fellow; Red on 5. Immobilize bitten area
black venom lack” 6. Watch constricting
● Thin bands

● Small rounded

7.

Dog bites Very common street emergency 1. Immediately and

especially in rural areas thoroughly wash the
wound with soap and
water
2. Flush the wound with
Areas of the body most commonly water and apply
bitten: dressing
3. Transport the patient to
● Head the hospital for
medical care especially
● Neck if the wound needs
stitching or occurred in
● Upper Extremities the face or neck
4. Do not kill the dog
Percentage unless it is absolutely
necessary to prevent a
Face – 11% full scale crippling
attack.
Trunk – 7% 5. If you kill the dog, call
for an animal officer
Upper extremity – 28% and request that the
corpse be examined for
Lower extremity – 31% rabies.
6. Immobilize injured
part
7. Patient is usually
● Children <12 yo are usually frightened – calm
him/her down.
bitten on the face.
● Most dog bites occur in hot
weather when a person
 provokes a dog

Bee Sting (insert bee Local reaction 1. Remove stinger by

scientific name) scraping with a plastic
Bronchospasm card or blunt edge of a
knife
Hypotension 2. Manage airway
3. O2 / Ventilation
Anaphylaxis 4. Shock position
5. Epinephrine
5.1. Dilate airway
5.2. Constrict Blood
vessels
5.3. Ask for medical
direction
5.4. Dosage
5.4.1. Adult 0.3 mg
yellow
5.4.2. Child 0.15 mg

Spiders

Black Widow (Larodectus Neurotoxic 1. Muscle Spasms within 15 min to 2 hours 1. Local cold application IMMEDIATE
mactans) 2. Bite of 1mm apart fang mark 2. Symptomatic care
3. Immediate transport

Brown recluse (Loxosceles Hemolytic Anemia > Necrosis 1. Necrosis Supportive care
reclusa) 2. Hemoglobinuria
3. Hypotension
● Fiddle-back spiders 4. Possibility of death

● 6 eyes

● Violin markings

Scorpion ( Centuroides 1. Airway management

sculpturatus) 2. Look out for cardiac
 dysrrhytmias

Sting ray 1. CAB

2. Flush with water
3. Immerse in warm water

Jellyfish Hypotension Vinegar and hot water

Scorpion/Lion/Stonefish Stonefish being the most poisonous 1. Safety BSI

of them 2. LOC
3. CAB
Sea Urchins 4. O2/ ventilation
5. Immerse wound 30-40
min as hot as can be
tolerated, repeat as
necessary to control
pain without scalding
6. Transport

WATER EMERGENCIES
CASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATION

Drowning Active drowning: Stages of water rescue: Stages of management

● Step 1
of drowning
o Victim goes under, water 1. Yell
● Conscious
enters the airway. 2. Reach and pull 1. Do not enter
Causes: ● Thrashing o Coughing and gasping – 3. Throw unless trained in
victim swallows water 4. Tow water rescue
Rip Currents ● Vertical in 5. Go 2. Ensure open
● Step 2
H2O airway and
o A small amount enters attempt rescue
● Unable to call the larynx and causes breathing
for help laryngospasm Fresh water drowning – not much problem 3. Continue rescue
o Breathing ceases and breathing and
● Body maybe
metabolic acidosis Salt wather drowning – water has high remove from the
low in H2O occurs. Dry drowning osmolarity which attracts fluids which results to water
(10 – 15% of gases) pulmonary edema 4. Check pulse, if no
● Step 3 pulse, start chest
compression
o Laryngeal muscles
 became severely hypoxic 5. Transport
and relax allowing air 6. If given the
and water to enter the opportunity –
lungs. (Wet drowning) positive pressure
o Triggers peripheral ventilation using
airway resistance and PEEP to dry the
constriction of the lungs.
pulmonary vessels >
Stiff Lung – lung ceases
to be compliant.
● Step 4
o Victem’s
hypercarbic/hypoxic
drive further stimulate
inhalation of water
which mixes with air and
chemical resident in the
lungs to form a froth.
o Brain damage and death
follows

Diving Emergencies

What to find out about a diving emergency

● Boyle’s law
o As pressure increase, 1. Type of diving and the Type of Equipment
volume decreases 2. Diving activity (photographing, fishing)
o As pressure decreases, 3. Number of dives made the past 72 hours
volume increases with each has
4. Depth
5. Bottom time
6. Surface Interval
● Dalton’s law 7. Details of in-water decompression
8. In-water recompression? (a no-no!)
o P1= P(O2) + P(N2) + 9. Dive complications, if any.
P(X) 10. Pre-dive and post-dive activity
o Total pressure of gas mix
 is sum of partial pressure 11. Onset of symptoms (when and what came
of it’s components first)

● Henry’s law
o Pressure of a gas in liquid
is proportional to it’s
pressure in the
atmosphere
o 1 atm – 34 ft water

Barotrauma – compression or
expansion of gas actually in
adjacent to body air spaces

Descent Body air spaces attempts to Lung squeeze is typically rare. For lung squeeze Lung Squeeze
equilibrate on the outside to occur, a breath-hold diver must descend to a
atmospheric pressure > blockage> depth which total lung volume is significantly 1. No PPV or PEEP
● Ear Squeeze
barotrauma compressed (100 feet) 2. 100% O2 NRM
▪ External 3. IV
4. Keep patient
▪ Middle sitting up
Lung Squeeze Lung Squeeze 5. TRANSPORT to
● Sinus Squeeze hosp
Breath hold > 100 fsw >
● Lung Squeeze ● Dyspnea
compression of volume > negative
pressure of lungs > pulling of ● Chest pain
interstitial fluid and blood in
shrunken air spaces ● Cough

● Hemoptysis

● Pulmonary edema

Ascent Could cause:

● Pneumomediastinum/ Subcutaneous ● Pneumomediastinu

POPS (Pulmonary Overpressure emphysema m/ Subcutaneous

● Pneumothorax/Tension o Fullness of his throat emphysema
Syndrome)
Pneumothorax o Dysphagia o Bed rest and
● Pneumomediastinum o Dyspnea oxygen therapy
“Burst lung” o Substernal chest pain
● Subcutaneous emphysema ● POPS
o Subcutaneous air palpable above
clavicles o 100% O2 NRM
● Arterial Air Embolism
o Crunching noise synch with heart beat o Don’t give
PEEP to POPS
o keep patient
quiet
o transport him to
● Dysbaric Air Embolism - Symptoms
hospital.
occurs within seconds or minutes after o If in doubt of
surfacing. Air bubbles coalesce into larger AIR
and larger bubbles as they travel through EMBOLISM >
the veins > go to hyperbaric
o Cornoray arteries > MI chamber facility
o or
o Cerebral artery > just like Stroke
● Pneumothorax/Tension Pneumothorax
o Tracheal deviation
o Unequal breath sounds
o Hyper – resonance on the affected
side

Decompression Sickness

Narcosis (Narcs/Rapture of the Accumulation of nitrogen in the Ascend slowly to

deep) tissues > increase pressure > alleviate “martini”
increase amount of dissolved effect.
Not dangerous but can impair the nitrogen in the tissues > anesthetic
diver’s judgment. effect > martini effect

Type I DS

DS of the skin Most common but least reported 1. Pruritis 1. Ensure Adequate
2. SQ emphysema Airway
3. Mottled rashes 2. Give 100%
oxygen
DS of the joints (musculoskeletal) 1. Deep, dull aches in muscle/joints 3. Start an IV with
2. Movement worsen pain LR and give as
3. Fatige directed
4. Inflating cuff will relieve pain 4. Give steroids,
preferably
Methylprednisilo
ne 125 mg IV
 5. Do not use
nitrous oxide for
analgesia
6. Advise hospital
that you will
require a use of a
hyperbaric
chamber

TYPE II DS

DS of the CNS Brain involvement 1. Paresthesia 1. Ensure Adequate

2. Seizure Airway
4-10 min rule 3. Spinal cord involvement 2. Give 100%
4. Paralysis oxygen
3. Start an IV with
CHOKES 1. Chest pain LR and give as
2. Dry cough directed
3. Dyspnea 4. Give steroids,
4. Pulmonary edema preferably
Methylprednisilo
ne 125 mg IV
5. Do not use
nitrous oxide for
analgesia
6. Advise hospital
that you will
require a use of a
hyperbaric
chamber
 Treatment of Suspected Air Embolism

1. Ensure adequate airway, especially in the unconscious patient – if

licensed to do so, INTUBATE
2. Admin. 100% O2
3. Transport in L Lateral recumbent with 10 degree head down tilt
4. If licensed – establish an IV lifeline with LR
5. Monitor cardiac rhytm and be prepared to treat dysrhythmias
6. Have the following drugs ready for use Under Medical Direction:
6.1. Diazepam, 5mg for Seizures
6.2. Dopamine infusion 10mg/kg/min for treatment of Hypotension
7. Notify medical command/ hospital to make arrange for reception at a
hyperbaric chamber facility

Treatment of Decompression Sickness

1. Ensure Adequate Airway

2. Give 100% oxygen
3. Start an IV with LR and give as directed
4. Give steroids, preferably Methylprednisilone 125 mg IV
5. Do not use nitrous oxide for analgesia
6. Advise hospital that you will require a use of a hyperbaric chamber
 WATER EMERGENCIES
CASE ASSESSMENT PATHOPHYSIOLOGY SIGNS AND SYMPTOMS MANAGEMENT TRANSPORT
CONSIDERATION

Drowning