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Acute Myocardial Infarction Pathophysiology Portion of the heart muscle dies due to lack of adequate supply of oxygenated blood due to narrowing or blockage within the coronary artery. After 20-30 minutes without adequate perfusion the heart muscle begins to die. Signs Pulse Respirations Blood Pressure O2 sat Skins Special Questions SAMPLE OPQRST Do you have a history of any cardiac problems or past surgeries? Do you take nitro or aspirin? How long has your pain been present for? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Nitro assistance if not taken more than 3 and is not on hormones and systolic pressure is greater than 100 per SD county protocol Position of comfort Transport Symptoms Chest Pain Diaphoresis Shortness of breath Anxiety Sense of impending doom Pertinent Negatives Chest pain that lasts longer than 10 minutes Positive Levine’s sign Chest pain that is not relieved with nitroglycerin administration Pale gray skins, nausea, dizziness Unstable Angina Pathophysiology Inadequate oxygen supply to the heart muscle or myocardium generally occurs during periods of stress, physical or emotional activity. Relieved after 2-15 minutes. Signs Pulse Respirations Blood Pressure O2 sat Skins Symptoms Pressure or tightness to the center of the chest Pain radiating to shoulders, arm, neck, jaw, back, or epigastric pain Cool, clammy skins Chest pain that occurs greater than 20 minutes Special Questions Pertinent Negatives SAMPLE Chest discomfort is relieved with OPQRST the administration of nitroglycerin Have you been exercising or or rest recently been under stress? Chest pain that lasts longer than 20 Have you taken any nitroglycerin? If minutes and occurs at rest you have has it helped to relieve Chest pain that awakes them at your pain and how many have you night (nocturnal angina) taken? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Nitro assistance if not taken more than 3 and is not on hormones and systolic pressure is greater than 100 per SD county protocol Position of comfort Transport Congestive Heart Failure (Left) Pathophysiology The heart cannot pump blood out of the left ventricle effectively. Blood pressure begins to build up in the left atrium and eventually into the lungs. Signs Blood Pressure Pulse Respirations 02 sat Skins Special Questions SAMPLE OPQRST Are you taking a water pill? Have you noticed an increase in swelling to your legs, face or hands? Do you take any medications for your heart? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Place the patient in position of comfort preferably sitting up Transport Symptoms Dyspnea/ dyspnea on exertion Tachypnea Tachycardia Diaphoresis Pertinent Negatives Normal to low systolic blood pressure Inspiratory Rales Poor capillary refill Congestive Heart Failure (Right) Pathophysiology Right side failure results in fluid build up in the lower legs and eventually pitting edema occurs. Signs Blood Pressure Lung Sounds 02 sat Skins Special Questions SAMPLE OPQRST Are you taking a water pill? Have you noticed an increase in swelling to your legs, face or hands? Do you take any medications for your heart? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Place the patient in position of comfort preferably sitting up Transport Symptoms Dyspnea/ dyspnea on exertion Tachypnea Edema to the lower extremities Tachycardia Diaphoresis Pertinent Negatives Normal to high systolic blood pressure JVD Edema to the lower extremities Pulmonary Embolism Pathophysiology Blood clot becomes lodged in the pulmonary arteries or one of its branches. Embolism may be caused by blood clot, air bubble, fat particle, foreign body or amniotic fluid. Signs 02 sat Blood Pressure Pulse Respirations Lung Sounds Special Questions SAMPLE OPQRST Do you take any blood thinners? Have you had any recent surgeries? Do you have a history of any previous deep venous thrombosis? If female, do you take birth control or recently given birth? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Position of comfort Transport Symptoms Sudden onset of dyspnea Tachypnea Chest Pain/Chest wall tenderness Anxiety Pertinent Negatives Peripheral edema Dyspnea JVD (late sign) Decrease in blood pressure (late sign) Thoracic Aortic Aneurysm Pathophysiology Abnormal widening of the aorta as a result of weakness in the wall of a blood vessel. Signs Blood Pressure Pulse 02 sat Lung sounds Skins Special Questions SAMPLE OPQRST Do you have a history of any cardiac problems or past surgeries? Do you have a family history of any cardiac problems? How long have you been experiencing your discomfort? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Position of Comfort Transport Symptoms Dysphagia Swelling of the neck Chest or back pain Nausea/Vomiting Pertinent Negatives Pain to the neck, jaw or upper back Dyspnea Hoarseness AAA Pathophysiology Tearing of the aortic wall begins with a small tear of the inner vessel structure and blood leaks between the walls of the aorta. There is an increasing amount of pressure until the outer wall is damaged and blood leaks out behind the peritoneum or into the abdominal cavity. Signs Pulse Blood pressure Respirations Skins Special Questions SAMPLE OPQRST Have you taken anything to help relieve your discomfort? Symptoms Gradual onset of abdominal pain Nausea/ Vomiting Pale, cool, clammy skins BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Keep the patient warm, in a supine position Transport Pertinent Negatives Soft, pulsating abdominal mass if it has not ruptured Severe abdominal pressure/ tearing sensation that radiates to the lower back, flank or pelvis (testicles in males) If burst the abdomen will be rigid and tender When starting the rupture the skins below the waistline will be cyanotic, cold, and mottled, due to drop in blood flow Appendicitis Pathophysiology Inflammation of the appendix, and is usually caused by a blockage in the intestines and results in inflammation and irritation. Signs Pulse Respirations Blood Pressure Skins Special Questions SAMPLE OPQRST Have you had your appendix removed? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Transport Symptoms Abdominal Pain Nausea/Vomiting Low grade fever/Chills No appetite Pertinent Negatives Positive McBurney’s point Tenderness to the RLQ Abdominal guarding Pancreatitis Pathophysiology Inflammation of the pancreas. Signs Pulse Respirations Blood Pressure Skins Symptoms Abdominal pain Nausea/Vomiting Abdominal tenderness and distention Special Questions Pertinent Negatives SAMPLE Pain in the middle of the upper OPQRST quadrants that may radiate to the Do you have a history of gallstones? back Do you drink alcohol/ when was the Gallstones or past history last time you did? Do you have a History of alcohol abuse history of excessive drinking? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Transport Esophageal Varices Pathophysiology Bulging, engorgement, or weakening of the blood vessels in the lining of the lower part of the esophagus. Signs Pulse Respirations Blood Pressure Skins Special Questions SAMPLE OPQRST Do you have a history of liver disease? Do you drink alcohol regularly or have a history of consumption? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Transport Symptoms Hematemesis Dyspnea Rapid pulse Pale, cool, clammy skins Pertinent Negatives Bright red emesis No abdominal pain Signs of shock Cholecystitis Pathophysiology Inflammation of the gallbladder, commonly with the presence of gallstones. Blockage causes an increase in pressure inside the gallbladder. Signs Pulse Respirations Blood Pressure Skins Special Questions SAMPLE OPQRST Have you taken anything to help relieve your discomfort? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Transport Symptoms Abdominal Pain to the RUQ Belching or Heartburn Nausea and Vomiting Pertinent Negatives Sudden onset of pain localized to the RUQ and can be referred to the right scapula Belching or Heartburn Occurs in women more than men between the ages of 30 and 50 Seizures (Grand Mal) Pathophysiology Abnormal electric activity low in the cerebral cortex that spreads upward affecting both the cerebral hemispheres and downward affecting the reticular activity system. Signs Level of consciousness Respirations 02 sat Pulse Blood Pressure Special Questions SAMPLE Did the patient fall or hit their head when the seizure began? Does the patient take medications regularly if they have epilepsy and if they do have they taken them today? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Transport Symptoms Jerky, convulsive motor activity Altered level of consciousness Confusion Headache Fatigue Pertinent Negatives Aura, if have history of epilepsy Jerky, convulsive motor activity Altered level of consciousness Loss of bowel or bladder functions Septic Shock Pathophysiology Result of an infection that releases bacteria or toxins in the blood, causing blood vessels to dilate and become permeable. Signs Respirations Pulse Blood Pressure 02 Sat Skins Special Questions SAMPLE OPQRST Do you have a history of a recent infection? Have a recent surgery or medical procedure? Do you have a weakened immune system? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Keep the patient warm Transport Symptoms Chills Lightheadedness Shortness of breath Rapid heart rate Pertinent Negatives Low blood pressure Rapid heart rate Shortness of breath Pale, cool, clammy skins Anaphylactic Shock Pathophysiology Distributive shock that causes chemical mediators cause massive systemic vasodilatation and permeability, leaking capillaries. Whole body allergic reaction. Signs Respirations Pulse Blood Pressure 02 Sat Skins Special Questions SAMPLE OPQRST Have you been exposed to any new foods or know of an ingestion of something you know you are allergic to? Have you been stung by any insects? Do you have a self prescribed MDI or epi pen? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Assistance of self prescribed epinephrine or MDI one time Keep the patient warm Transport Symptoms Hives, itchiness Palpitations Difficulty breathing Difficulty swallowing/ Wheezing Pertinent Negatives Hives, itchiness Swelling of the mucosal membranes Exposure to new foods Bee Stings Psychogenic Shock Pathophysiology Sudden and temporary loss of consciousness, due to a lack of blood flow to the brain and the brain is deprived of oxygen for a brief period of time Signs Level of Consciousness Blood Pressure Pulse Respirations Special Questions SAMPLE Did you experience any chest pain or shortness of breath prior to the fall? Did you fall, and if so did you hit your head? How long were you unconscious for? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Place the patient in a supine position Transport Symptoms Lightheaded Dizzy Sudden loss of unexplained unconsciousness Pertinent Negatives Sudden loss of unexplained unconsciousness Cool, moist and pale skins Weakness Neurogenic Shock Pathophysiology Spinal cord injury. Spinal cord injuries may damage the sympathetic nerve fibers that control vessel tone below the level of injury. Signs Blood pressure Pulse Skins Level of Consciousness Eyes Special Questions SAMPLE Have you suffered from any recent falls or suffered any trauma to the neck? Ask any family or bystanders if there has been a change in the patient’s mental status? Are you taking any blood thinners? BLS Treatment Maintain ABC’s C-Spine High Flow 02 15lpm via nonrebreather mask Transport Symptoms Neck Pain/Injury Shortness of breath Weakness Altered Mental Status Pertinent Negatives Injury to the cervical or thoracic spine Altered Mental Status Low blood pressure Hemorrhagic Hypovolemic Shock Pathophysiology Loss of whole blood from the intravascular space, from a traumatic injury or medical illness. Signs Blood Pressure Pulse Skins Level of consciousness Special Questions SAMPLE OPQRST Do you take any blood thinners? Are you experiencing a headache or feeling lightheaded? Ask family or bystanders if there has been a change in the patient’s mental status? BLS Treatment Maintain ABC’s Stop bleeding High Flow 02 15lpm via nonrebreather mask Keep the patient warm Transport Symptoms Injury with blood loss Altered Level of Consciousness Headache Shortness of Breath Pertinent Negatives Injury with blood loss Lightheadedness/Headache Altered Level of Consciousness Nonhemorrhagic Hypovolemic Shock Pathophysiology Water, plasma proteins and electrolytes are lost from the intravascular space. Due to severe diarrhea, vomiting, excessive sweating or excessive urination. Signs Blood Pressure Pulse Skins Level of consciousness Special Questions SAMPLE OPQRST Have you suffered from any recent illness or flu? Have you been drinking a lot of fluids? BLS Treatment Maintain ABC’s Try to give the patient fluids per os High Flow 02 15lpm via nonrebreather mask Transport Symptoms Malaise Diarrhea Vomiting Excessive sweating Excessive urination Pertinent Negatives Malaise Diarrhea Vomiting Excessive sweating Excessive urination Cardiogenic Shock Pathophysiology The heart is unable to supply enough blood to the organs of the body as a result of damage to the heart. Signs Blood Pressure Pulse Respirations 02 sat Skins Level of Consciousness Special Questions SAMPLE OPQRST Have you experienced anything like this in the past? Do you take any medications for your heart? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Keep the patient warm Transport Symptoms Chest pain/pressure Shortness of breath Diaphoresis Altered mental status Pertinent Negatives Chest Pain Pale, cool and clammy skins Dyspnea Altered mental status Local & Systemic Allergic Reaction Pathophysiology Massive systemic vasodilatation and permeability, leaking capillaries. Whole body allergic reaction. Signs Respirations Pulse Blood Pressure 02 Sat Skins Special Questions SAMPLE OPQRST Have you been exposed to any new foods or know of an ingestion of something you know you are allergic to? Have you been stung by any insects? Do you have a self prescribed MDI or epi pen? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Assistance of self prescribed epinephrine or MDI one time Keep the patient warm Transport Symptoms Hives, itchiness Palpitations Difficulty breathing Difficulty swallowing/ Wheezing Pertinent Negatives Hives, itchiness Swelling of the mucosal membranes Exposure to new foods Bee Stings Diabetic Type 1 Pathophysiology Most often occurs at a young age, the pancreas does not produce enough insulin to properly control blood sugar levels. Signs Level of Consciousness Skins Blood Pressure Pulse Respirations Special Questions SAMPLE BRIM/AVPU Have you experienced anything like this before? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Adminster oral glucose of the patient’s glucomater reads <60 per SD protocol, you may give 3 oral tablets or 15Gm total, give the patient something to eat as well, patient must be awake and have gag reflex Transport Symptoms Headache Increased thirst and urination Fatigue Vision changes Pertinent Negatives History of diabetes Insulin dependent Extreme thirst Altered Mental Status Diabetic Type 2 Pathophysiology High levels of glucose, lack of insulin. Signs Level of Consciousness Skins Blood Pressure Pulse Respirations Special Questions SAMPLE BRIM/AVPU Have you experienced anything like this before? Ask family or bystanders when the patient was last seen in a normal state. BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Transport Symptoms Gradual onset Excessive urination Polydipsia Polyphagia Pertinent Negatives Weak/ Rapid Pulse Kussmaul respirations Fruity acetone breath TIA Pathophysiology Brief episode of stroke-like symptoms caused by an oxygen deficit in the brain tissue. Signs Level of Consciousness Blood Pressure Pulse Eyes Skins Symptoms Sudden onset of weakness, tingling or paralysis in the face, arm, leg especially to one side of the body Altered Mental Status Headache Special Questions SAMPLE Are you experiencing a headache, and if so on a scale from 1-10, 1 being no pain and 10 being the worst headache you’ve ever had how would you rate it? Where are you experiencing weakness, tingling or paralysis? Have you experienced anything like this in the past? Pertinent Negatives Symptoms that last 10-15 minutes or no longer than an hour and subside on their own Weakness, tingling or paralysis Altered Mental Status BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Place the patient in a supine position Immediate transport CVA Pathophysiology Blood supply from a part of the brain is disrupted, causing brain cells to die. Signs Level of Consciousness Blood Pressure Pulse Respirations Eyes Special Questions SAMPLE BRIM/AVPU Ask family or bystanders if there has been a change in the patient’s mental status? When was the patient last seen in a “normal” state? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Place the patient in a supine position Immediate Transport Symptoms Sudden numbness or weakness to the face, arm or leg preferably to one side of the body Altered Mental Status Loss of Coordination Headache Pertinent Negatives Positive Cincinnati Pre-hospital Stroke Scale Sudden onset of numbness or weakness to the face, arm or leg to one side of the body Headache Altered Mental Status Syncope Pathophysiology Sudden and temporary loss of consciousness, due to a lack of blood flow to the brain and the brain is deprived of oxygen for a brief period of time Signs Level of Consciousness Blood Pressure Pulse Respirations Special Questions SAMPLE Did you experience any chest pain or shortness of breath prior to the fall? Did you fall, and if so did you hit your head? How long were you unconscious for? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Place the patient in a supine position Transport Symptoms Lightheaded Dizzy Sudden loss of unexplained unconsciousness Pertinent Negatives Sudden loss of unexplained unconsciousness Cool, moist and pale skins Weakness Chronic Bronchitis Pathophysiology Inflammation, swelling, and thickening of the lining of the bronchi and bronchioles as well as excessive mucous production. Associated with cigarette smoking. Signs Lung Sounds 02 sat Respirations Blood Pressure Pulse Skins Special Questions SAMPLE OPQRST Do you have a history of COPD? Do you smoke cigarettes? Do you have prescribed MDI that you use? BLS Treatment Maintain ABC’s Assist patient with prescribed MDI if they have one High Flow 02 15lpm via nonrebreather mask/ no distress apply nasal cannula 2-6lpm Position of comfort Transport Symptoms Productive cough Difficulty breathing Fatigue Pertinent Negatives History of COPD History of cigarette smoking Overweight Blue complexion Productive cough Asthma Pathophysiology Sensitivity to the lower airways to irritants and allergens that cause a bronchospasm. Signs 02 sat Respirations Lung sounds Blood Pressure Pulse Special Questions SAMPLE OPQRST Do you have a prescribed MDI and if yes, have you used it? How long have you been experiencing this attack? BLS Treatment Maintain ABC’s Assist the patient with prescribed MDI one time only if they have not used it, if they have obtain a BHO High Flow 02 15lpm via nonrebreather mask Position of comfort Immediate Transport Symptoms Shortness of breath Wheezing Anxiety Chest tightness Pertinent Negatives History of Asthma Wheezing Shortness of Breath Anxiety Pneumothorax Pathophysiology Collection of air in the pleural space that eventually builds up and collapses a lung. Signs Lung Sounds Blood Pressure Pulse Respirations Special Questions SAMPLE OPQRST Have you experienced anything like this in the past? Were you doing anything that may have provoked this sudden discomfort? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Position of comfort Transport Symptoms Sudden sharp chest pain Shortness of Breath Chest tightness Pertinent Negatives Absent lung sounds to one side Severe respiratory distress Chest pain worsened with cough or deep breath Tension Pneumothorax Pathophysiology Result of a pneumothorax that continues to trap air in the thoracic cavity with no relief or escape. Signs Lung Sounds 02 sat Respirations Blood Pressure Pulse Special Questions SAMPLE OPQRST BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Immediate Transport Symptoms Severe respiratory distress Severe hypoxia Cyanotic skins Pertinent Negatives JVD Tracheal deviation Respiratory distress Absent lung sounds to one side Emphysema Pathophysiology Loss of elasticity to lung tissue, alveoli become distended and with trapped air and alveoli walls are destroyed. Permanent disease process characterized by cigarette smoking. Signs 02 sat Respirations Lung sounds Blood Pressure Pulse Skins Special Questions SAMPLE OPQRST Do you smoke cigarettes? Do you have prescribed MDI that you use? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask/no distress apply nasal cannula 2-6lpm Position of comfort Transport Symptoms Dyspnea Cough Diaphoresis Pertinent Negatives History of COPD History of cigarette smoking Thin-barrel chest appearance Pink complexion Tripod position Croup Pathophysiology Infection of the upper airway caused by a virus. Causes swelling beneath the glottis and narrows the airway. Signs 02 sat Respirations Lung sounds Blood Pressure Pulse Special Questions SAMPLE OPQRST Has the patient seen a doctor recently for this probkem? BLS Treatment Maintain ABC’s Humidified 02 via non-rebreather Position of comfort Transport Symptoms “seal bark” cough Dyspnea Restlessness Pertinent Negatives “seal bark” cough Stridor with inhalation Retractions when breathing Tachycardia Multi- System Trauma Pathophysiology A patient that is involved in a trauma that has multiple injuries or involvement of more than one body system. Signs Level of Consciousness Blood Pressure Pulse Lung Sounds Respirations 02 sat Skins Special Questions AVPU/BRIM Chief complaint of pain/discomfort Palpate the body and ask if the patient is experiencing any pain when doing so Past medical history/surgeries/medications BLS Treatment Maintain ABC’s Place the patient in C-spine High Flow 02 15lpm via nonrebreather mask Immediate transport Symptoms Multiple chief complaints of pain Pertinent Negatives Involved in a traumatic incident with obvious multiple injuries or complaints Pulmonary Contusion Pathophysiology Bruising of the tissue of the lung, which may cause fluid and swelling inside of the lung. Signs Lung Sounds Respirations Blood Pressure Pulse Special Questions SAMPLE OPQRST Have you suffered any recent trauma that may have provoked this discomfort? Where is your chest wall discomfort located? Are you experiencing any shortness of breath? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Position of comfort Transport Symptoms Chest Wall pain Dyspnea Coughing up blood or sputum Dizziness/Lightheadedness Pertinent Negatives Recent trauma, MVA, CPR or fall Bruise to the chest wall Chest wall tenderness to palpation Evisceration Pathophysiology Abdominal organs protruding through the skin. Signs Level of Consciousness Blood Pressure Pulse Respirations 02 sat Special Questions SAMPLE What happened? Is there any other injuries? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Apply moist dressing to the exposed organs Immediate transport Symptoms Trauma to the abdomen with organs protruding through the skin Abdominal pain Pertinent Negatives Presentation of abdominal organ through the skin Pain Cardiac Contusion Pathophysiology Bruise to the heart from trauma. Signs Blood Pressure Pulse Respirations 02 sat Symptoms Chest wall tenderness Shortness of Breath Palpitations Special Questions SAMPLE OPQRST Have you suffered any recent trauma that may have provoked this discomfort? Where is your chest wall discomfort located? Are you experiencing any shortness of breath? Pertinent Negatives Recent trauma, MVA, CPR or fall Bruise to the chest wall Chest wall tenderness to palpation BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Position of comfort Transport ICP Epi & Subdural Pathophysiology Increased pressure within the skull. Signs Level of consciousness Blood Pressure Pulse Respirations 02 sat Special Questions SAMPLE OPQRST Have you experienced anything like this in the past? BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Position of comfort Transport Symptoms Headache Nausea/Vomiting Altered Mental Status Pertinent Negatives Severe headache Altered Mental Status ICP Subdural Pathophysiology Signs Symptoms Special Questions Pertinent Negatives BLS Treatment Cardiac Tamponade Pathophysiology Blood or fluid build up in the space between the myocardium and the pericardium, which prevents the heart from functioning adequately. Signs Blood Pressure Pulse Respirations Level of Consciousness Special Questions SAMPLE OPQRST Have you experienced anything like this before? Symptoms Chest Pain sharp and stabbing Dyspnea Palpitations Feeling faint-like Pertinent Negatives Anxiety Altered mental Status Weak or absent pulse Levine’s sign BLS Treatment Maintain ABC’s High Flow 02 15lpm via nonrebreather mask Transport Ruptured Ectopic Pregnancy Pathophysiology The egg is implanted outside the uterus either in the fallopian tube, abdominal peritoneal covering, outside wall of the uterus, on an ovary or on the cervix. Signs Pulse Respirations Blood Pressure Skins Special Questions SAMPLE OPQRST Have you been pregnant before? And if so have you had an ectopic pregnancy? How far along are you in your pregnancy? BLS Treatment Maintain ABC’s Oxygen via non-rebreather mask 15lpm Immediate transport Abruption Symptoms Sudden sharp lower abdominal pain Vaginal bleeding that may be light, heavy or absent Shoulder pain Pertinent Negatives Pregnancy with sharp abdominal pain Tender abdomen to palpation Signs of shock Pathophysiology When small arteries located in the lining between the placenta and uterus rupture, blood accumulates, tearing and separating the placenta from the uterine wall. There are two kinds, partial and complete. Signs Pulse Blood pressure Respirations 02 sat Skins Special Questions SAMPLE OPQRST Have you been pregnant before? And if so how many times? Do you have a history of diabetes? Do you have a history of high blood pressure? BLS Treatment Maintain ABC’s Oxygen via non-rebreather mask 15lpm Immediate transport Symptoms Vaginal bleeding Constant abdominal pain Lower back pain Pertinent Negatives Abdominal pain and vaginal bleeding with known pregnancy Contractions Tender abdomen to palpation Placenta Previa Pathophysiology Abnormal implantation of the placenta over or near the opening of the cervix. There are three types: Total, Partial, and Marginal. Signs Blood Pressure Pulse Respirations Skins Special Questions SAMPLE OPQRST Have you been pregnant before? And if so how many times? BLS Treatment Maintain ABC’s Oxygen via non-rebreather mask 15lpm Rapid transport Toxemia Symptoms Vaginal Bleeding in the third trimester Possible uterine cramping Pertinent Negatives Vaginal Bleeding with known pregnancy in the third trimester History of early vaginal bleeding Signs of Hypovolemic shock Pathophysiology Also known as preeclampsia. Placental disorder that causes vessels throughout the body to spasm leading to reduction of blood flow to organs. Typically occurs in the last 10 weeks of pregnancy. Signs Blood Pressure Pulse Respirations Special Questions SAMPLE OPQRST Have you experienced any vaginal bleeding or discharge? How far along are you in the pregnancy? Have you been pregnant before? BLS Treatment Maintain ABC’s Oxygen via non-rebreather mask 15lpm Normal transport NOT rapid Symptoms Sudden weight gain Headache Abdominal Pain Decreased urinary output Pertinent Negatives Patient is in their 20’s with first pregnancy Family history of ecclampsia High blood pressure