Name That Condition
A 68-year-old suddenly has slurred speech, a facial droop, and weakness on one side of the body.
STROKE
You arrive for a 62-year-old male with chest pain. He is awake, talking, and sitting in a chair.
What's your first action?
Begin the primary assessment (general impression/ABCs) before jumping to treatments.
A PT with suspected stroke has a BGL of 46 the crew immediately loads the PT and transport without addressing the BGL
Hypoglycemia can mimic a stroke
however also note someone can still be a fully functional human with a low BGL however treat it and see if it fixes the problem.
A patient's skin is pale, cool, and diaphoretic. What does this suggest about their perfusion?
Poor peripheral perfusion.
M406: Hyper/Hypoglycemia
(AT WHAT BGL DO WE BEGIN TREATING HYPOGLYCEMIA)
60MG/DL
A 24-year-old female presents with sudden shortness of breath, chest tightness, tingling around the mouth and fingers, and carpopedal spasms after an argument. Lungs are clear, SpO₂ is 99%, HR 118, RR 34.
Hyperventilation syndrome / anxiety-induced respiratory alkalosis.
(PANIC ATTACK)
WHAT IS A DIFFERENTIAL DIAGNOSIS?
A 6-year-old is actively seizing when you arrive. The parents are trying to hold him down.
WHATS YOUR NEXT MOVE?
Protect the patient from injury, maintain the airway as able, and do not restrain them.
a PT involved in a MVC has significant abdominal tenderness, HR 118,BP 108/72 & Cool skin. the crew decides the patient isn't in shock because the BP is good
the crew is relying on blood pressure to identify if the patient is in shock, currently this patient is showing signs of compensated shock
A patient's pulse pressure becomes progressively narrower during reassessment. What should this make you concerned about?
Worsening/decompensating shock.
Positive Airway Pressure Procedure Protocol
( WHAT THE CONTRINDICATIONS)
B. Contraindications
1. Respiratory arrest.
2. Suspected pneumothorax.
3. Patient has a tracheostomy.
4. Patient is at risk for aspiration i.e.: vomiting, foreign body airway occlusion.
5. The patient is intubated. (The PAP device is not configured for use with ETT).
A 71-year-old diabetic is confused and weak. Family reports several days of increased thirst and urination. Skin is warm and dry, respirations are deep and rapid,
HYPERGLYCEMIA
POSSIBLY DKA
You respond to a diabetic who is awake but confused. He keeps pushing your hand away when you attempt to assess him.
WHATS YOUR NEXT MOVE?
Assess decision-making capacity and determine if the patient can refuse; continue verbal de-escalation and assessment rather than forcing treatment.
A 58-year-old complains of weakness and dizziness. BP 92/60, HR 104, RR 20. He says he's had black, loose stools for the last two days. The crew documents "general illness" and transports
The crew failed to recognize a possible GI bleed with developing hypovolemic shock.
A head-injury patient's pupils were equal on your initial assessment. Ten minutes later, one pupil is noticeably larger and sluggish. What should you suspect?
Increasing intracranial pressure/neurological deterioration.
M419: Sepsis
(GIVE ME THREE OF THE CRITERIAS NEEDED TO CALL A SEPSIS ALERT)
Hospital Pre-Notification
A. If the following criteria are met, pre-notify the receiving hospital with a “Sepsis Alert”:
1. ETCO2 ≤ 25 and
2. At least two (2) of the following: a. T ≥ 100.4 F (38 C) OR ≤ 96.0 F (~36 C) b. Hypotension 1. Adults: SBP ≤ 90 mmHg
2. Pediatric:
a. Neonates (0-28 days): SBP < 60 mmHg
b. Infants (1 mo – 12 months): SBP < 70 mmHg
c. Children (1 yr – 10 years): SBP < 70 + (2 x age in years) mmHg
d. Children (>10 years): SBP ≤ 90 mmHg
c. HR ≥ 90 bpm for adults; sustained tachycardia for age in pediatric patients (see chart above)
d. RR ≥ 20 bpm for adults; tachypnea for age in pediatric patients e. Altered mental status / confusion
A 76-year-old female has fever, weakness, altered mental status, RR 30, HR 124, BP 86/48, and warm flushed skin.
SEPSIS SECONDARY TO UTI
You are transporting a trauma patient with a femur fracture. Five minutes into transport, the bleeding that was previously controlled has soaked through the dressing and blood is now pooling on the floor.
WHATS YOUR NEXT MOVE?
Control the hemorrhage immediately with direct pressure (and a tourniquet if direct pressure is ineffective or appropriate based on the injury).
and warm them up if als provide fluids reassess patient including vitals determine if there's a underlying injury causing the problem.
A 34-year-old involved in an MVC complains only of left shoulder pain. There is no obvious injury to the shoulder, but he has increasing abdominal tenderness, HR 116, and pale skin.
The crew shouldn't assume an isolated shoulder injury. Referred left shoulder pain (Kehr's sign) can indicate intra-abdominal bleeding/splenic injury.
A respiratory patient's rate decreases from 32 to 18, but they're becoming more lethargic and their tidal volume is decreasing. Improvement or deterioration?
Deterioration — respiratory fatigue/failure.
M409: Allergic Reaction - Anaphylaxis
J. If epinephrine auto-injector is not available, then:
1. Administer epinephrine 0.3 mL (1 mg/mL) intramuscularly (IM) if patient is in anaphylaxis. (See notes).
May repeat dose every 5 - 15 minutes as needed.
A 58-year-old male develops sudden tearing chest pain that radiates between the shoulder blades. He is pale and diaphoretic. BP is 196/110 in the right arm and 164/92 in the left.
AORTIC DISECTION
You're treating an asthma patient. They were wheezing loudly when you arrived. Five minutes later, they have almost no wheezing, are exhausted, and can only nod yes or no.
WHATS YOUR NEXT MOVE?
EPI ALS BACK UP
a Pt with severe respiratory distress has SpO2 of 96% they're becoming exhausted, respirations are increasingly shallow, mental status is deteriorating, the crew decides they are providing adequate treatment based on the SpO2 reading
this crew is treating the number not the PT this is well on their way to respiratory failure and death. remember SpO2 can be delayed as well as become contaminated with Co2 binding and giving a false reading.
WHAT IS A MUCH BETTER TOOL FOR THIS?
WHAT WOULD YOU EXPECT SEE ON THAT TOOL?
A trauma patient's heart rate was 122. It's now 96, but their BP has fallen, mental status is worsening, and peripheral pulses are becoming difficult to palpate. Is the falling heart rate reassuring?
No. The overall presentation indicates worsening perfusion/decompensation; don't interpret a single improving vital sign in isolation.
Acute Coronary Syndrome
( GIVE 3 INCLUCSION CRITERIAS)
Inclusion Criteria
A. Patient’s age is 25 years or older.
B. Patient complains of discomfort suggestive of cardiac origin (heaviness, pressure, tightness, or dull sensations with or without radiation to other body areas) and may be accompanied by other associated signs and symptoms such as: dyspnea, diaphoresis, nausea, vomiting, or general weakness.
C. If any doubt about pain/discomfort or related symptoms, treat as cardiac.
D. Patient may have a history of cardiac disease.
E. Patient may have risk factors associated with cardiac disease.
F. Atypical signs and symptoms that may be seen in women, the elderly, chronic hypertensives, and diabetics.