Medical Emergencies

NATIONAL EMS EDUCATION

STANDARD COMPETENCIES (1

OF 6)

Medicine
Recognizes and manages life threats based on assessment
findings of a patient with a medical emergency while
awaiting additional emergency response.

NATIONAL EMS EDUCATION

STANDARD COMPETENCIES (2

OF 6)

Medical Overview
Assessment and management of a
Medical complaint
Neurology
Anatomy, presentations, management of
Decreased level of responsiveness
Seizure
Stroke

NATIONAL EMS EDUCATION

STANDARD COMPETENCIES (3

OF 6)

Abdominal and Gastrointestinal Disorders

Anatomy, presentations, and management of shock
associated with abdominal emergencies
Gastrointestinal bleeding
Endocrine Disorders
Awareness that
Diabetic emergencies cause AMS

NATIONAL EMS EDUCATION

STANDARD COMPETENCIES (4

OF 6)

Cardiovascular
Anatomy, signs, symptoms, and management
Chest pain
Cardiac arrest

NATIONAL EMS EDUCATION

STANDARD COMPETENCIES (5

OF 6)

Respiratory
Anatomy, signs, symptoms, and management of respiratory
emergencies including those that affect the
Upper airway
Lower airway

NATIONAL EMS EDUCATION

STANDARD COMPETENCIES (6

OF 6)

Genitourinary/Renal
Blood pressure assessment in hemodialysis patients

INTRODUCTION

(1 OF 2)

Common medical conditions include:

Angina pectoris
Heart attack
Dyspnea
Asthma
Stroke
Insulin shock and diabetic coma
Abdominal pain

INTRODUCTION

(2 OF 2)

EMRs can prepare to treat medical patients by studying the

signs, symptoms, and treatments of each condition.

PATIENT ASSESSMENT IN
MEDICAL EMERGENCIES (1 OF

3)

PATIENT ASSESSMENT IN
MEDICAL EMERGENCIES (2

OF 3)

Review the dispatch information.

Carefully assess the scene to identify safety issues.
As you perform the primary assessment:
Try to form an impression of the problem first.
Then, determine the patients responsiveness, introduce yourself,
check the ABCs, and acknowledge the chief complaint.

PATIENT ASSESSMENT IN
MEDICAL EMERGENCIES (3

OF 3)

Usually, it is best to obtain a medical history on a medical

patient before you perform the secondary assessment.
Use the SAMPLE history format.
Obtain the patients vital signs.

Monitor the patient through ongoing reassessment.

Remember to reassure the patient.

GENERAL MEDICAL
CONDITIONS

General medical conditions may have different causes, yet

result in similar signs and symptoms.
Initial treatment can stabilize the patient until other EMS
and hospital personnel can take over.

ALTERED MENTAL STATUS

(1 OF 5)

Sudden or gradual decrease in the patients level of

responsiveness
Use the AVPU scale to assess mental status:
Alert
Verbal
Pain
Unresponsive

ALTERED MENTAL STATUS

(2 OF 5)

When assessing the patients mental status, consider two

factors:
The patients initial level of consciousness
Any change in that level of consciousness

ALTERED MENTAL STATUS

(3 OF 5)

Conditions causing an altered level of consciousness

Head injury
Shock
Decreased level of oxygen to the brain
Stroke
Slow heart rate
High fever

ALTERED MENTAL STATUS

(4 OF 5)

Conditions causing an altered level of consciousness (contd)

Infection
Poisoning
Low level of blood glucose
Insulin reaction
Psychiatric condition

ALTERED MENTAL STATUS

(5 OF 5)

Initial treatment
Maintain the patients ABCs and normal body temperature.
Keep the patient from additional harm.
If the patient is unconscious and has not sustained trauma, place
the patient in the recovery position or use an airway adjunct.
Be prepared to suction.

SEIZURES

(1 OF 6)

Caused by sudden episodes of uncontrolled electrical

impulses in the brain
Generalized seizures
Produce shaking movements
Involve the entire body
Last 1 to 2 minutes
Usually leave patients unconscious

SEIZURES

(2 OF 6)

Generalized seizures caused by a sudden high fever

Called febrile seizures
Occur in infants and young children

Absence seizures
Result in only a brief lapse of consciousness
Patients may blink, stare vacantly, or jerk one part of their body

SEIZURES

(3 OF 6)

Monitor the patients ABCs and arrange for transport.

Seizures can be caused by:
Epilepsy
Trauma
Head injury
Stroke
Shock

SEIZURES

(4 OF 6)

Seizures can be caused by: (contd)

Decreased level of oxygen to the brain
High fever
Infection
Poisoning
Brain tumor or infection
Diabetic emergencies
Complication of pregnancy

SEIZURES

(5 OF 6)

Treatment
Usually, the seizure will be over by the time you arrive at the scene.
If it has not ended, focus on protecting the patient from injury.
Once the seizure stops, ensure an open airway and place the
patient in the recovery position.

SEIZURES

(6 OF 6)

Treatment (contd)
If the patient does not resume breathing, begin mouth-to-mask or
mouth-to-mouth breathing.
After the seizure, move the patient to a more comfortable, private
place.

SPECIFIC MEDICAL
CONDITIONS

You will find it helpful to be knowledgeable about some of

the more specific medical conditions you may encounter as
an EMR.
This information will help you assess, treat, and
communicate more effectively with patients.

HEART CONDITIONS

The heart must receive a constant supply of oxygen or it will

die.
The heart receives its oxygen through a complex system of
coronary arteries.
These arteries may narrow as a result of atherosclerosis.
Progressive atherosclerosis can cause angina pectoris, heart
attack, and cardiac arrest.

ANGINA PECTORIS

2)

(1 OF

Chest pain caused by an inadequate flow of blood and

oxygen to the heart muscle
Often described as pressure or heavy discomfort
The patient is often short of breath and sweating, is
extremely frightened, and has a sense of doom.

ANGINA PECTORIS

2)

(2 OF

Ask if the patient is already being treated for a heart

condition and has nitroglycerin.
Assist the patient in taking one pill or administering the aerosol
spray.
If the pain has not lessened 5 minutes after the first dose, help the
patient take another.
If the pain has not lessened 5 minutes after the second dose,
assume the patient is having a heart attack and transport promptly.

HEART ATTACK

(1 OF 4)

Results when one or more

of the coronary arteries is
completely blocked
Two causes of coronary
artery blockage:
Severe atherosclerosis
Blood clot

HEART ATTACK

(2 OF 4)

Signs of heart attack include:

The patient suffers immediate and severe pain.
The pain may radiate from the chest to the left arm or to the jaw.
The patient is usually short of breath, weak, sweating, and
nauseated, and may vomit.
If the blocked area is critical or large, the heart may stop
completely.

HEART ATTACK

(3 OF 4)

Complete cessation of heartbeat is called cardiac arrest.

CPR is your first emergency treatment.

Take the following actions:

Summon additional help.
Talk to the patient to relieve his or her anxiety.
Touch the patient to establish a bond.
Reassure the patient.

HEART ATTACK

(4 OF 4)

Take the following actions: (contd)

Move the patient as little as possible.
Place the patient in the most comfortable position.
Administer oxygen if it is available.
Be prepared to administer CPR.
If an AED is available, have it brought to the patient and make sure
it is ready for use.

CONGESTIVE HEART
FAILURE (1 OF 3)

Caused by failure of the

heart to pump adequately

The failure is in the heart

muscle, but the congestion
is in the blood vessels.

CONGESTIVE HEART
FAILURE (2 OF 3)

Signs and symptoms

Breathing difficulty (major symptom)
Rapid, shallow breathing
Moist or gurgling respirations
Profuse sweating
Enlarged neck veins
Swollen ankles
Anxiety

CONGESTIVE HEART
FAILURE (3 OF 3)

Take these actions:

Place the patient in a sitting position with the legs down to drain
some of the fluid back into the lower parts of the body.
Administer oxygen in large quantities and at a high flow rate.
Summon additional help.
Arrange for prompt transport.

DYSPNEA

(1 OF 4)

Shortness of breath or difficulty breathing

Usually associated with serious heart or lung disease
Heart-related causes: angina pectoris, heart attack, and CHF
Other causes: pulmonary disease such as COPD, emphysema,
chronic bronchitis, pneumonia, and asthma

DYSPNEA

(2 OF 4)

General treatment
Check the patients airway to be sure it is not obstructed.
Check the rate and depth of breathing.
Place the patient in a comfortable position.
Provide reassurance.
Loosen any tight clothing.
Administer oxygen if it is available.

DYSPNEA

(3 OF 4)

Asthma
Acute spasm of the air passage associated with excess mucus
production and swelling of the lining of the respiratory passage
Can be caused by:

An allergic reaction
Severe emotional stress
Exercise
Respiratory infections

DYSPNEA

(4 OF 4)

Asthma (contd)
Asthma attacks kill 4,000 to 5,000 people each year.
Patients will have great difficulty exhaling and a wheezing sound
will be heard.
Follow the treatment steps for dyspnea and instruct the patient to
perform pursed-lip breathing.
If ALS is not available, transport promptly.

STROKE

(1 OF 6)

Leading cause of brain injury and disability in adults

Most strokes are caused by a blood clot that blocks blood
supply to a part of the brain.
Signs and symptoms
Dizziness
Confusion

STROKE

(2 OF 6)

Signs and symptoms (contd)

Drooling
Numbness/paralysis on one side of the body
Difficulty seeing
Unequal pupil size
Patient may be alert, confused, unresponsive, or unable to speak
Seizures

STROKE

(3 OF 6)

Signs and symptoms (contd)

Unconsciousness
Incontinence
Respiratory arrest

Cincinnati Prehospital Stroke Scale

Used to determine whether a patient may have experienced a
stroke
Requires no special equipment

STROKE

(4 OF 6)

STROKE

(5 OF 6)

Treatment
The first priority is to maintain an open airway.
Administer oxygen using a nonrebreathing face mask.
If the patient is having a seizure, try to prevent further injury.
Be prepared to administer rescue breathing.

STROKE

(6 OF 6)

Treatment (contd)
Place an unresponsive patient in the recovery position.
Provide psychological support by talking to and touching the
patient.
Some patients can be treated with drugs to dissolve the blood clot
in their brain.
Arrange for prompt transport.

DIABETES

(1 OF 8)

Caused by the bodys inability to process and use glucose

The body produces insulin, which enables glucose to move
into individual cells.
If the body does not produce enough insulin, the cells become
starved for sugar and diabetes results.

DIABETES

(2 OF 8)

Insulin shock
Occurs if the body has enough insulin but not enough blood glucose
Signs and symptoms

Pale, moist, cool skin

Rapid, weak pulse
Dizziness or headache
Confusion or unconsciousness
Sweating

DIABETES

(3 OF 8)

Insulin shock (contd)

Signs and symptoms (contd)

Hunger
Rapid onset of symptoms (within minutes)
A person experiencing insulin shock may appear to be drunk.
If the patient is able to swallow, have him or her eat or drink
something sweet.

DIABETES

(4 OF 8)

Insulin shock (contd)

If the patient is
unconscious, open the
airway and assist
breathing and circulation.
Do not administer fluids
by mouth.
Some EMRs carry a tube
of oral glucose gel or
tablets that can be placed
inside the cheek.

DIABETES

(5 OF 8)

Diabetic coma
Occurs when the body has too much blood glucose and not enough
insulin
Signs and symptoms

History of diabetes
Warm, dry skin
Rapid pulse
Deep, rapid breathing
Fruity odor on the patients breath

DIABETES

(6 OF 8)

Diabetic coma (contd)

Signs and symptoms (contd)

Weakness, nausea, and vomiting

Increased hunger, thirst, and urination
Slow onset of symptoms (days)
Misdiagnosis is commonit is not always easy to distinguish
between insulin shock and diabetic coma.

DIABETES

(7 OF 8)

DIABETES

(8 OF 8)

Diabetic coma (contd)

In general, give conscious diabetic patients sugar by mouth and
arrange for prompt transport.
If the diabetic patient is unconscious, arrange for prompt
transport.

ABDOMINAL PAIN

5)

(1 OF

The contents of the abdomen are divided into hollow and

solid structures.
Hollow structures are really tubes through which contents pass.
Solids structures produce substances.

Abdominal pain is a common complaint.

ABDOMINAL PAIN

5)

(2 OF

Acute abdomen
Caused by irritation of the abdominal wall
May result from infection or the presence of blood in the abdominal
cavity
Pain can be referred to other parts of the body.
The abdomen may feel as hard as a board.
Patients may have nausea and vomiting, fever, and diarrhea as well
as pain.

ABDOMINAL PAIN

5)

(3 OF

Some patients will vomit blood because they are bleeding

from the esophagus or stomach.
If a patient has abdominal pain:
Monitor vital signs.
Treat symptoms of shock.
Keep the patient comfortable.
Arrange for transport.

ABDOMINAL PAIN

5)

(4 OF

Abdominal aortic aneurysm (AAA)

One cause of acute abdomen
Occurs when one or more layers of the aorta become weakened
and separate from other layers of the aorta
Risk factors: diabetes, high blood pressure, atherosclerosis, and
heavy smoking

ABDOMINAL PAIN

5)

(5 OF

Treatment for AAA

Place the patient in a comfortable position.
Treat the patient for shock.
Handle these patients gently.
Arrange for prompt transport.

KIDNEY DIALYSIS PATIENTS

(1 OF 3)

People with certain types of kidney disease are unable to

filter waste products from their bloodstream.
Many patients with chronic renal failure must undergo
hemodialysis.
The patients blood passes through a machine that filters out the
waste products and returns the cleansed blood to the patient.

KIDNEY DIALYSIS PATIENTS

(2 OF 3)

Hemodialysis (contd)
Most hemodialysis patients have a shunt implanted in their arm or
leg.
A shunt is a surgically created connection between an artery and a
vein.
If the patient has a shunt, take the patients blood pressure in the
arm without the shunt.

KIDNEY DIALYSIS PATIENTS

(3 OF 3)

Patients may experience emergencies related to their

dialysis treatment.
Low blood pressure due to the changes in their body
Shock due to decreased blood pressure
Internal bleeding
Abnormal levels of electrolytes, which can cause cardiac
arhythmias

SUMMARY

(1 OF 3)

General medical conditions may have different causes, yet

result in similar signs and symptoms.
Usually, it is best to collect a medical history on the patient
experiencing a medical problem before you perform a
physical examination.

SUMMARY

(2 OF 3)

Altered mental status is a sudden or gradual decrease in the

patients level of responsiveness. When assessing altered
mental status in a patient, use the AVPU scale.
Seizures are caused by sudden episodes of uncontrolled
electrical impulses in the brain.

SUMMARY

(3 OF 3)

Specific medical conditions include angina pectoris, heart

attack, congestive heart failure, dyspnea, stroke, insulin
shock, diabetic coma, and abdominal pain.

REVIEW

1. Signs and symptoms of stroke include all of the following

EXCEPT:
A. numbness or paralysis.
B. high fever.
C. drooling.
D. unequal pupil size.

REVIEW

Answer:
B. high fever.

REVIEW

2. Which of the following actions would NOT be

appropriate when managing a patient who is suffering a
heart attack?
A. Place the patient in the most comfortable position.
B. Administer oxygen if it is available.
C. Be prepared to administer CPR.
D. Move the patient as quickly as possible to the ambulance
for transport.

REVIEW

Answer:
D. Move the patient as quickly as possible to the
ambulance for transport.

REVIEW

3. Insulin shock occurs when a patient:

A. consumes too many high-fat foods.
B. has enough insulin but not enough blood glucose.
C. suffers severe dehydration.
D. has too much blood glucose and not enough insulin.

REVIEW

Answer:
B. has enough insulin but not enough blood glucose.

CREDITS

Background slide image (ambulance):

Comstock Images/Alamy Images
Background slide images (non-ambulance): Jones &
Bartlett Learning. Courtesy of MIEMSS.