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Altered Mental Status AMS malfunction can be: ◦ Global – affecting all parts of the central nervous system equally. ◦ Localized or focal – affecting a portion of the body. BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Causes of AMS: AEIOU-TIPS or… I ATE, I SOUP!!! I - Insulin A - Alcohol, Acidosis T - Trauma, Tumors E - Epilepsy, Environment, Electrolytes I - Infection S - Seizure, Stroke, Syncope O - Oxygen, Overdose U - Uremia P - Poisoning, Psychiatric Conditions BRADY continued National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ And now it’s time for… BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Conditions Associated With AMS – chronic condition causing recurrent seizures. Epilepsy ◦ Factors associated with epilepsy – head injury, brain trauma, brain tumors, genetic conditions, and chemical imbalance. ◦ Chronic epileptics treated with anticonvulsant medications. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Seizures Seizures: electrical disturbance in the brain, causes altered awareness, attentiveness, responsiveness, behavior, or body movement Partial v. Generalized Three Phases Status epilepticus continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Conditions Associated With AMS – inability to regulate blood sugar level; glucose level to high Diabetes ◦ Chronic disease. ◦ Pancreas cannot produce enough insulin, or cells do not respond to insulin, or both. ◦ Glucose does not enter the cells and builds up in blood stream. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Diabetes – inability to regulate blood sugar level; glucose level to high Diabetes ◦ Symptoms – polyuria, polydipsia, increased appetite, change in weight, fatigue, dry mouth, cellular damage 4 ◦ ◦ ◦ ◦ BRADY Types: Type 1 Type 2 Gestational Other continued National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Type 1 Diabetes • Caused by autoimmune disease in the young. • Destroys pancreatic cells that produce insulin. • Controlled by injectable insulin or insulin pump. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Type 2 Diabetes • Unknown cause; increased incidence in the obese; also may be genetically predisposed. • Cells are resistant to action of insulin. • Controlled by weight loss, exercise, and oral hypoglycemic medication. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Gestational and Other Diabetes ◦ Gestational diabetes mellitus • Develops only during pregnancy. ◦ Other • Genetic defects in insulin production continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Hypoglycemia ◦ Low Blood sugar ◦ Early signs and symptoms – anxiety, dizziness, tachycardia, diaphoresis, tremor, headache, mild confusion, conscious ,and able to swallow. ◦ Severe signs and symptoms – marked confusion, disorientation, lethargy, slurred speech, seizures, unilateral extremity weakness or continued unresponsiveness; irrational or combative behavior is common BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Hyperglycemia ◦ High Blood sugar ◦ Early signs and symptoms – polyuria, polydipsia, dry mouth, and fatigue. ◦ Late signs and symptoms – nausea, vomiting, abdominal pain, AMS, coma, brain injury, death. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Strokes Stroke: neurological impairment due to low or no blood flow to areas of the brain. Three types of stroke – ◦ Ischemic ◦ Hemorrhagic ◦ Transient ischemic attack (TIA): BRADY continued National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Violent Behavior and AMS Be BRADY cool. National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Substance Abuse and Poisoning BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Four Ways Drugs Enter and Move Through Body 1. Absorption: the way the substance or poison enters the body. • 4 routes of absorption: ingestion, inhalation, transdermal, injection 2. Distribution: transport of substance to site where it will exert its effects. 3. Metabolism: body breaks down the substance. 4. Elimination: body purges itself of continued substance. BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Affected body systems ◦ ◦ ◦ ◦ Nervous system Myocardial Ocular Hematological continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Commonly Abused Substances and Poison-Related Emergencies - How likely is ingestion of poison? - Why is this important for us to know about? ◦ Acids & Bases ◦ Anti anxiety drugs and sedatives ◦ Antidepressants ◦ Antipsychotics ◦ Depressants ◦ Designer Drugs (“Club Drugs”) ◦ Hallucinogens BRADY ◦ ◦ ◦ ◦ ◦ ◦ ◦ Inhalants Nerve Agents Opiates Organophosphates Stimulants Prescription drugs Over the counter continued medications National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Common Substances Encountered ◦ ◦ ◦ ◦ ◦ ◦ ◦ BRADY Acetaminophen (Tylenol) Alcohol Aspirin (acetylsalicylic acid) Carbon monoxide (CO) Cocaine (coke, crack, snow, rock, nose candy) Ethylene glycol Iron supplements. LSD (lysergicdiethylamide, acid) ◦ Marijuana (pot, weed, cannabis, THC, hashish) ◦ Methamphetamine (Speed, Meth) Methane ◦ PCP (phencyclidine, angel dust) ◦ Toxic plants continued National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Management (What to do) BRADY topical poisons: ◦ brush off dry particles and rinse away any remaining with water. liquid poisons: ◦ thoroughly rinse with water. Ocular exposure ◦ immediately irrigate with sterile water or irrigation solutions. inhaled poisons: ◦ immediately remove patient from source ofcontinued poisoning. Maintain airway, high-flow O2, consider ALS transport. National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Good things to know Personal BRADY safety is always first. Alcohol is the most abused drug. Carbon monoxide is a silent killer. Antidotes exist for many types of drugs Three most deadly for children – aspirin, acetaminophen and iron. Always try to identify the poison. continued National Poison Control: 1-800-2221222 National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Allergies and Anaphylaxis BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Why do people have allergic reactions? Anatomy and Physiology Antibody-antigen reaction: ◦ Mast cells attack the offending antigen, which causes a reaction that destroys it without harming normal cells. Allergic reaction: ◦ An acquired, abnormal over-reaction by the immune system to an otherwise harmless substance that results in a continued hypersensitivity. BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Common Causes of Allergies and Anaphylaxis Foods BRADY , especially peanuts and shellfish Environmental irritants Pollen Molds Animal dander Medications Chemicals Other such as blood transfusion continued National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ 3 types of allergic reactions Mild Moderate Severe BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Mild Allergic Reaction BRADY Signs and Symptoms Itching (pruritis) Flushed skin Rash or hives (urticaria) Watery, reddened eyes Nasal congestion Increased heart rate Tingling in/around mouth Fatigue Typically results in local dermatologic changes, especially on the face and/or neck. Nasal mucosa and/or congestion are also common. continued National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Moderate Allergic Reaction Effects BRADY include those in a mild reaction, but more pronounced. The respiratory and gastrointestinal system are usually involved. Symptoms may take minutes, hours, or even days to develop. Effects might disappear over time, or increase in severity, depending continued on individual chemistry and response. National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Moderate Allergic Reaction BRADY Signs and neck, chest, arms Symptoms Persistent itching Anxiety and Angioedema confusion Abdominal pain or Tightness in the cramping throat Nausea and/or Difficulty swallowing vomiting and/or breathing Elevated vital signs Wheezing continued Rash, hives, swelling in face, National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Moderate Allergic Reaction continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Severe Allergic Reaction Causes a massive inflammatory response in the respiratory, integumentary, circulatory, and gastrointestinal systems due to massive histamine release. Effects are almost immediate- within seconds or minutes. If not treated quickly, it can lead to continued anaphylactic shock and/or death. BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Severe Allergic Reaction Signs and Symptoms Severe anxiety, impending doom Decreased level of responsiveness Severe respiratory distress; Severe BRADY angioedema, hives Abnormal lung sounds Inability to swallow Tachycardia, weak peripheral pulses Hypotension, pallor, continued cyanosis National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Preventing Allergic Reaction Triple A Approach: ◦ Awareness • of one’s allergies and the triggers ◦ Avoidance • of contact with known allergens ◦ Action • know what to do if an allergic reaction occurs (emergency and self-care) BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Assessment Moving patient may be necessary before assessment. Severity of allergic reaction determines timing, esp. if anaphylaxis is present. Observe closely skin, face, neck, and eyes for rash, swelling, breathing. Extend questioning during known allergies part of SAMPLE (EpiPen) BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Management Initial management is similar- ABCDs. Try to identify the allergen. Remove the patient from the allergen if possible. Monitor and check vitals frequently. If signs of anaphylaxis appear, treat ABCDs and seek transport and ALS. Insect bite? Remove stinger if possible. BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Epinephrine BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Chapter Summary An allergy is the body’s overreaction to a foreign substance. Allergies are caused by antigens called allergens. Many people do not know they have an allergy until they suffer an allergic reaction. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Case Presentation A woman is 34 weeks pregnant and is complaining of severe abdominal pain. She is lying supine on the snow with both knees flexed. She is awake and oriented. A ski school instructor is present and witnessed the patient fall onto her left side, striking her abdomen. Her abdominal pain as “sharp” and “all over”, unlike the labor contractions she had with her first delivery. She does not feel any leakage of fluid and denies feeling lightheaded. This is her second pregnancy and she states it has been uncomplicated to date. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Anatomy and Physiology Of a snuggie Copyright Scott Smith BRADY continued National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Anatomy and Physiology BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Common Obstetrical and Gynecological Emergencies • Abdominal pain • Dysmenorrhea • Cystitis • Ovarian cysts • Pelvic inflammatory disease • Ectopic pregnancy continued Copyright Craig Brown BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Pregnancy Complications of pregnancy ◦ Hemorrhage ◦ Pregnancy-Induced Hypertension (PIH) ◦ Miscarriage Supine Hypotensive Syndrome Situations for evacuation continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Pregnancy continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Pregnancy continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Pregnancy continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ How to Deliver a Baby in 7 Easy Steps: A Ski Hill Guide BRADY 1. Use a disposable sterile OB delivery kit 2. Assist the mother, if necessary, in removing her clothing and place in semi-fowler’s position. 3. Time the contractions 4. Once the baby is crowning, allow the mother to push 5. Deliver head and shoulders 6. Should transportation be delayed more than 20 minutes, you will need to cut the umbilical cord continued 7. Delivery of the placenta ***Always transport mother and baby to the hospital or other ALS point National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Care of the newborn (APGAR) ◦ ◦ ◦ ◦ ◦ Appearance Pulse Grimace or irritability Activity or muscle tone Respirations continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Trauma with pregnancy ◦ Ruptured uterus ◦ Abruptio placenta and premature labor ◦ Rupture of membranes continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Abruptio Placenta continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Amniotic Sac Rupture BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Management Initial ◦ ◦ ◦ ◦ ◦ ◦ management Scene safe ABCDs SAMPLE OPQRST DCAP-BTLS ALS if needed Management BRADY following trauma National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ