NREMTP Review-Jennifer 🚒🚑 "Mixed Topics"
Order of operations for priority questions
Determine the Differential Diagnosis (What are the different things happening)
SAFETY!!!! (Traffic, Violence, Weapons, Infectious disease)
Treat immediate life threats=Stop external bleeding
Airway
Breathing
Circulation
Disability (Neuro status)
Pain
Do NOT go off local protocols or current/past experience
NO Assumptions
Do NOT add to the question
We can only go off what the question says
Type 1 Diabetes
Juvenile onset
Born with it
The pancreas does NOT produce ANY Insulin!!!!!!
On insulin for life!!!!
Type 2 Diabetes
Adult Onset
occurs from poor diet, obesity, lack of exercise
pancreas produces too little insulin
They can be insulin resistant
Insulin (Hormone)
Lowers BGL
Lock & Key-Opens up the cells, and allows them to use glucose for energy
DKA (Occurs in Type 1 Diabetics)
Blood glucose levels increase to 250-550 mg/dl (Not compliant w/ insulin)
The cells begin to starve!!!! (No insulin)
The cells now start using FATS for energy
The biproduct of FAT breakdown=Ketones!!!
Ketones are ACIDS!!!!
Metabolic Acidosis
Massive Dehydration/electrolyte imbalances
HHNK/HHS/HHNS (Occurs in Type 2 Diabetics)
Glucose levels massively rise-600-1200 mg/dl
NO ketones
NO Kussmaul
NO fruity breath
NO acidosis
Massive Dehydration/Electrolyte imbalances
Glucose and Sodium are dehydrating agents!!!!!!
3 Ps of Diabetes
Polydipsia-excessive thirst
Polyurea-excessive urination
Polyphagia-Excessive hunger
Appendicitis
The pain ALWAYS starts in the umbilicus (Belly Button)
The pain radiates to the RLQ
McBurney's Sign
N/V
Fever
Rovsing's Sign-pain felt in the RLQ, when palpating the LLQ
Rebound Tenderness-pain felt when your hand is released from palpation
Anorexia-Loss of appetite
COPD
Chronic Bronchitis
Emphysema
Chronic Bronchitis (Blue Bloaters)
Chronic inflammation of the bronchioles, causing an accumulation of thick mucus
Heavy
A problem getting air in!!!!!!
Hypoxia
Cyanotic
Productive cough (producing thick secretions)
Low spo2
Rhonchi & Wheezing
Emphysema (Pink puffers)
Destruction of the alveoli, causing loss of elasticity, leading to air trapping
Thin
A problem getting air out!!!
Dyspnea
Quiet chest or very diminished
Dysphasia "Think S for speech"
Difficulty speaking
Dysphagia "Think G for glottis"
Difficulty swallowing
Epiglottitis
Ages 3-7 yrs
Bacterial Infection
High grade fever
Fast Onset
Muffled voice
Unable to clear or swallow secretions
Unable to lie flat
Stridor
Do NOT attempt to visualize the airway
Do NOT attempt an IV
Do NOT separate from the parents
Do NOT administer nebs or racemic Epi
prepare or be ready for intubation in a well-lit and controlled environment
If we need to intubate, we get 1 chance
use an ET Tube 1-2 sizes smaller