1
Q
What GI disease affects over one quarter million Americans ?
A
Renal failure
2
Q
What are the leading causes of renal failure?
A
Diabetes and hypertension
3
Q
How many Americans suffer from kidney stones annually?
A
Over 1/2 million
4
Q
What part of the digestive track is allows for
-the physical destruction of food
-mastication
- introducing saliva (adds moisture + break down starches
A
Mouth (oral cavity)
5
Q
The muscular tube of the digestive track
- moves food bolus through peristalsis
-inferior end is cardiac sphincter (constant construction, prevents reflux)
A
Esophagus
6
Q
Digestive track muscular sack
-tumbles and churns food
- introduces pepsin and hydrochloric acid
-physical breakdown of food creating chyme
- little absorbtion
- exits at pyloric sphincter
A
Stomach
7
Q
First part of small intestine
-bile and pancreatic secretions added
- sphincter of oddi
- breaks down fats and proteins
A
Duodenum
8
Q
Absorption in the digestive track
-chyme moves through peristalsis
-nutrients are absorbed
-jejunum 2/3
- ileum 1/3
A
Small bowel
9
Q
Reabsorbs fluids in the digestive track
- five sections (cecum, ascending, transverse, descending, sigmoid)
A
Large Bowel (colon)
10
Q
What organ filters and secretes bile ?
A
Liver
11
Q
What organ stores and concentrates bile?
A
Gall bladder
12
Q
What organ secretes secretes enzymes that help digest fats, carbohydrates, and proteins?
A
Pancreas
13
Q
What parts of the body are involved in the urinary system ?
A
Kidneys, ureters, urinary bladder, urethra
14
Q
What filters BLOOD and removes the waste products in blood.
A
Kidney
15
Q
Provides glomeruler filtration and tubular reabsorbtion
A
Nephron
16
Q
What controls arterial blood pressure?
A
Renin
17
Q
Regulating erythrocyte development
A
Erythropoietin
18
Q
Pathophysiology of abdominal pain
A
Bacterial contamination - perforated appendix, PID
Chemical irritation- perforated ulcer, pancreatitis
19
Q
Type of abdominal pain that originates in the walls of the abdominal cavity.
-sharp and localized
- seen in bacterial and chemical irritation
A
Somatic pain
20
Q
Type of abdominal pain that originates in the walls if hollow organs
- dull, poorly localized
- usually bacterial infections
(Obstruction of hollow viscera)
A
Visceral pain
21
Q
Type of abdominal pain that originates in an area other than where felt
- caused by an embryonic organ of nerves
- diaphragmatic injury (neck and shoulders pain)
- appendicitis (periumbilical pain)
- AAA ( between shoulder blade pain)
A
Referred pain
22
Q
Cullen’s sign
A
Ecchymosis in periumbilical regional
23
Q
Grey-Turner’s sign
A
Ecchymosis in the flank and periumbilical region, often associated with pancreatic injury.
24
Q
GI illness that is bleeding from esophagus, stomach, and duodenum.
-caused by peptic ulcer disease
- gastritis
- varix rupture
- Mallory-Weiss tear
-esophagitis
- duodenitis
A
Upper gastrointestinal bleeding
25
Portal hypertension from chronic alcohol abuse and liver cirrhosis
-ingestion of caustic substances
-hematemesis, dysphagia
- painless bleeding
- hemodynamic instability
- classic signs of shock
Esophageal varices
26
Damage to the musosa GI surfaces
- pathologic inflammation causes hemorrhage and erosion of the mucosal and submucosal layers of the GI tract
- risk factors
- ETOH and tobacco
- chemical ingestion( NSAIDs, chemotherapeutics)
- systemic infections
Acute gastroenteritis
27
Long term mucosal changes or permanent damage
- primarily due to microbial infection
- more frequent in developing countries
Chronic gastroenteritis
28
Caused by erosions caused by gastric acid
- terminology based on the portion of tract affected
- causes
- NSAID use
- ETOH tobacco
- helibacter pylori
- zollinger-Ellion syndrome
Peptic ulcer
29
Bleeding distal to the ligament of Treitz
-diverticulosis
- colon lesions
- rectal lesions
-inflammatory bowel disorder
Lower GI bleed
30
Disease of unknown pathophysiology
S/S
-abd cramps
- NVD
- fever
-weight loss
ulcerative colitis
31
Unknown pathophysiology
- can affect entire GI tract
- pathologic inflammation
- damages mucosa
- hypertrophy and fibrosis of underlying muscle
- fissures and fistulas ( tear and polyps)
Crohn’s disease
32
Inflammation of small out-pockets in the mucosal lining of the intestinal tract
-common in elderly
-abd pain/ tenderness
- LLQ pain, sharp and rapid onset
-may be more diffuse and occur over hours-days
- fever, nausea, vomiting
Diverticulitis
33
Mass of swollen veins in anus or return
Hemorrhoids
34
Blockage of the hollow space of the small or large intestines
-multiple causes
Bowel obstruction
35
Inflammation of the vermiform appendix
-frequently affects older children and young adults
- lack of treatment can cause rupture and subsequent peritonitis
-Nausea, vomiting, low-grade fever
- McBurney’s point
Appendicitis
36
Inflammation of gall bladder
- fat, forty, fertile, fair skinned, flatulent, female
- Murphy’s sign
- nausea, vomiting
-pain after meal high in fats
- pain radiates to the right shoulder
Cholecystitis
37
Murphy’s sign
Pain on palpation under the right costal margin
38
Inflammation of the pancreas
Caused by:
-ETOH
- gallstones
- elevated serum lipids, or drugs
S/S
Mild:- epigastric pain, abdominal distention, nausea, vomiting, elevate amylase and lipase levels
Severe:- refractory hypotension shock and blood loss, respiratory failure
Pancreatitis
39
Injury to the liver (typically due to inflammation or infection)
- ABCD
-alcoholic
- traumatic
S/S:
-URQ abdominal tenderness
- loss of appetite, weight loss, malaise
- clay-colored stool, jaundice, scleral icterus
-photophobia, nausea/ vomiting
Hepatitis
40
Dysfunction BEFORE the level of kidneys
-most common and most easily reversible
Caused by:
-hypovolemia
-cardiac failure
- cardiovascular collapse
- renal vascular anomalies
Pre-renal acute renal failure
41
Dysfunction with the kidneys themselves
Causes:
-Small vessel/ glomerular damage
- tubular cell damage (ischemic or toxic)
- interstitial damage (acute pyelonephritis, allergic reactions)
Renal Acute Renal Failure
42
Dysfunction distal to the kidneys
Causes:
-abrupt obstruction of both ureters
- abrupt obstruction of the bladder neck (prostate)
-abrupt obstruction of the urethra
Post-renal acute renal failure
43
Treatment for hyperkalemia and acidosis
Sodium bicarbonate, mEq/kg
Calcium chloride, 1g
44
Permanent loss of nephrons
End stage renal failure
Caused by:
-Mircoangiopathy, glomerular injury
- tubular cell injury
- interstitial injury
-polycystic diseases
- renal hypoplasia
Chronic renal failure
45
“Too much insoluble stuff” accumulates in the kidneys
- more common in men
- risk factors: heredity, immobility, opiates/ psychotropic drugs, dehydration
Renal calculi, kidney stones
46
Twisting of spermatic cord
-disrupts blood supply to the testicle
- results in severe pain
- a significant emergency because the testicle will die after a few hours
Testicular torsion
47
Type of toxic route exposure where absorption occurs in the stomach and small intestine
Common agents:
-household products
- petroleum-based agents
- cleansing agents
-cosmetics
-drugs, plants, or foods
Ingestion
48
Route of toxicology where absorption occurs via the capillary-alveolar membrane in the lungs
Common agents:
-Toxic gases,vapors, fumes, aerosols
- carbon monoxide, ammonia, chlorine
- tear gas, Freon, nitrous oxide, methyl chloride
- carbon tetrachloride
Inhalation
49
Toxicology route where absorption occurs through capillaries in the skin
Common agents:
- Poison ivy, oak, sumac
- organophosphates
- nerve agents
Surface absorption
50
Toxicology route where substance enters directly into the body through a break in the skin
Injection
51
Antidote for acetaminophen
N-acetylcysteine, 140mg/kg
52
Antidote for atropine
Physostigmine, 0.5-2mg IV
53
Benzodiazepines
Flumazenil, 0.2mg q 1 min to total of 1-3mg
54
Antidote for cyanide
Amyl nitrite, inhaled 20-30 seconds each minute
Hydroxocobalamine
55
Antidote for ethylene glycol, methyl alcohol
Ethyl alcohol, 1mL/ kg of 80-100 proof
56
Antidote for nitrates
Methylene blue, 0.2 mL/kg of 1% solution over 5 min
57
Antidote for opiates
Naloxone, 0.4 to 2.0mg IV
58
Antidote for organophosphates/ nerve agent exposure
Atropine, 2-5mg until SLUDGE is gone
Pralidoxime, 1G
59
During gastric absorption what role does the liver play?
Portal circulation, and first pass metabolism
60
Anticholinergic S/S
Red as a boat
Dry as a bone
Blind as a bat
Mad as a hatter
Hot as a hare
61
Treatment for anticholinergic OD
Supportive
-benzodiazepines for seizures
- physostigme
Belladonna alkaloids:
-atropine
-scopolamine
62
Phenathiazines
-psych medication
-antiemetics
-antihistamine
What is the S/S?
– Parkinsonian
appearance
– Dystonia
– Dysphagia
– Eye muscle spasm
– Rigidity / Tremors
– Neck spasms
– Shrieking
– Jaw spasm
– Laryngospasm
63
Phenathiazines
-psych medication
-antiemetics
-antihistamine
What is the management?
Diphenhydramine 25-50mg IV bolus.
64
Sympathomimetic S/S and treatment
– CNS excitation
• Excited delirium
– Seizures
– Extreme hypertension
– Hypotension with
caffeine
– Tachycardia
– Hyperthermia
• Management
– Maintain airway and
ventilation
– Begin IV access
– Administer diazepam for
excited states
– Consider use of
chemical restraint (PAI /
RSI)
– If hyperthermic, begin
external cooling
65
Minimum time for rinsing external contact with acids with copious amounts of water?
5 minutes
66
Minimum time to rinse external contacts with alkali with copious amounts of water ?
15 minutes
67
Tricyclic antidepressants TCA overdose management
Sodium bicarbonate may be indicated for seizures
Monitor and treat cardiac dysrhythmias (WIDE QRS )
Avoid use of flumazenil, which may precipitate seizures
68
-infrequently prescribed antidepressant
- can cause toxic effects when eating foods containing tyrosine
S/S of headache, agitation, restlessness, tremor, nausea, severe HTN, hyperthermia
-palpitations and tachycardia progressing into bradycardia, hypotension, coma, and death
MAO inhibitors
69
newer antidepressants
S/S drowsiness, tremor, nausea, vomiting, tachycardia
-triggered by increasing the dose or by adding selected drugs
- separate condition that can be marked by agitation, anxiety, confusion, insomnia, headache, coma, salivation, diarrhea, abdominal cramps, cutaneous piloerection, flushed skin, hyperthermia, rigidity, shivering, incoordination, myoclonic jerks
SSRIs, trazodone, bupropion
70
Prescribed to treat bipolar disorder
S/S
Thirst, dry mouth, tremors, muscle twitching, increased reflexes, confusion, stupor, seizures, coma, nausea, vomiting, diarrhea, bradycardia, dsyrhythmias
Activated charcoal is not effective
Lithium
71
Common overdose drug
-includes aspirin, oil wintergreen
S/S tachypea, hyperthermia, confusion, lethargy, coma, cardiac failure, and dysrhythmias, abdominal pain, vomiting, pulmonary edema, ARDS
Activated charcoal is indicated
Salicylates
72
Common OTC antipyretic and analgesic
S/S
Stage 1- 24hrs NVD, weakness, fatigue
Stage 2- 24-72hrs abdominal pain, decreased urine, elevated liver enzymes
Stage 3- 72-96hrs liver function disruption
Stage 4- up to 14 days gradual recovery or progressive failure
Acetaminophen
73
Includes ibuprofen, ketoralac, naproxen sodium
S/S headache, tinnitus, nausea, vomiting, abdominal pain, drowsiness, dyspnea, wheezing, pulmonary edema, swelling of extremities, rash, itching
NSAIDs
74
Inhaled toxin that has s/s of headache, nausea, vomiting, dizziness, dyspnea, seizures, coma, death, cutaneous blisters, gastroenteritis, epidemic occurrences with carbon monoxide, cyanosis, chocolate blood, with non-functional hemoglobin
Carbon monoxide
Methemoglobin
75
Inhaled toxin found in nature, seeds/ pits, combustion of plastics, buildup from patients taking sodium nitroprusside.
Exposure:
Fast-acting toxin
Usually ingested, inhaled, or absorbed
Cyanide
76
Cyanide poisoning with s/s
-odor of almonds
- burning sensation in the mouth and throat
-headache, confusion, combativeness
-hypertension, tachycardia
- seizures and coma
- pulmonary edema
Amyl nitrate 20-30 seconds per minute inhaled
Sodium nitrate
Sodium thiosulfate
Hyroxocobalamine (CYANOKIT)
-vitamin B12
-converts cyanide to be excreted in urine
- 5G over 15 minutes repeat x1 prn
77
Management for carbon monoxide poisoning
- remove the pt from area
- initiate supportive measures (HF o2, monitor sp02)
- hyperbaric therapy
78
Surface absorbed toxin with SLUDGE
-salivation
-lacrimation
- urination
- diarrhea
-gastritis
-emesis
Bradycardia or tachycardia
Hypo or hypertension
Muscle cramps + weakness
CNS alterations
Respiratory and cardiovascular depression
Organophosphates
-parathion
-malathion
-diazanon
-trithion
Nerve Agents
-100 to 500 times more potent then insecticides
-terrorist agents
- sarin (GB), Soman (GD), Tabun( GA), GF, VX
79
Treatment for contact dermatitis
- poison oak
-poison ivy
-poison sumac
Topical cortisone cream
80
Treatment for insect bites and stings
-wasps, bees, fire ants
-venom causes pain, edema, and local irritation
– Wash the area
– Remove stingers, if present
• Use care not to disturb the venom sac
– Apply cool compresses to the injection site
– Observe for and treat allergic reactions and/or
anaphylaxis
81
What type of toxin is a black widow
Neurotoxin
82
Treatment for arachnid bites
– Follow general treatment guidelines
– Provide supportive care
– Consider using muscle relaxants to
relieve severe muscle spasms
• Diazepam 2.5–10mg IV
• 0.1–0.2 mg/kg of a 10% calcium
gluconate solution IV
83
What toxin is a brown recluse spider
Necrotoxin
84
Type of venom in pit viper bites
Hemolytic venom
85
Type of venom in coral snake bites
Neurotoxic venom
86
Types of pit vipers
Rattlesnake
Copperhead
Cottonmouthed water moccasin
87
Venomous snake
Arrow head
Elliptical pupils
Red and yellow, kill a fellow
88
Non-venomous snakes
Round head
Round pupil
Red and black, venom lack
89
Western diamond back rattle snake venom
Venom
– Hemolytic
– Proteolytic
90
Timber rattle snake venom
Venom
– Neurotoxic
– Protoelytic
– Myotoxic
– Hemolytic
91
Mottled rock rattlesnake
Venom
– Hemolytic
– Neurotoxic
92
Banded rock rattlesnake venom
Hemolytic
93
Black tail rattlesnake venom
Hemolytic
94
Mohave rattlesnake venom
Neurotoxic
Hemolytic
95
Prairie rattlesnake
Hemolytic
Neurotoxic
96
Massasauga sistrurus catenatus venom
Hemolytic
97
Pygmy rattle snake
Hemolytic
98
Cottonmouthed water moccasin venom
Hemolytic
99
Copperhead venom
Hemolytic
100
Coral snakes venom
Neurotoxic
101
Snakebite treatment
Keep the patient supine and calm
• Wash site
• Immobilize limb, neutral or below level of heart
• Apply high-flow oxygen
• Establish IV access
• Controversial
– Constricting bands or tourniquets
– Ice, cold packs
• DO NOT apply electrical
stimulation
102
Gila monster venom and treatment
Neurotoxic and treat as snakebite
103
What is the treatment for animals that puncture such as stingrays, lionfish, stone fish, and sea urchin?
-Supportive care, assure ventilation and circulation
- place injured area in hot water, 105-115 degrees (avoid pain medications initially)
-if patient has severe spasms
Administered calcium gluconate, 10mL of 10% solution, IV push
104
What is the treatment for animals bites that cause envenomation?
Most cause respiratory paralysis and can be deadly in less than five minutes.
Includes blue-ringed octopus, sea snakes, cone shells.
-supportive
-assure ventilations and circulation
-pressure immobilization technique still recommended
105
What is scombroid poisoning ?
Caused by poorly refrigerated tuna like fish
106
What is ciguatera? And the S/S
Buildup of toxins in fish flesh from eating toxic phytoplankton (known for causing red tide)
- no way to test presence
-seen in Mahi-mahi, grouper, barracuda, snapper
S/S
-CNS changes
- paralysis
-reversal of hot and cold sensation
107
S/S of marijuana use
-euphoria
-dry mouth
- green/ brown residue on back of tongue
-dilated pupils
-body tremors
-altered sensation
108
S/s of ETOH use
– CNS depression
– Slurred speech
– Disordered thought
– Impaired judgment
– Nystagmus
– Diuresis
– Stumbling gait
– Stupor
– Coma
109
Management for ETOH intox?
-ABCs
-respiratory support
-oxygen
-IV access
-thiamine 100mg IV
-D50W 25g, if low blood sugar
110
S/S and management of barbiturates
S/S
-Altered mentation and coronation
-nystagmus
-hypotension
- respiratory depression
Management
-support respirations
-Oxygen
-IV access
111
S/S and management for sedatives
Signs and Symptoms
– Altered mental status
– Hypotension
– Slurred speech
– Respiratory depression
– Bradycardia
– Seizures
• Management
– Protect the airway
– Support respirations
– Oxygen
– IV access
– Benzodiazepines as
needed for seizure
activity
112
S/S and management of benzodiazepines
Signs and Symptoms
– Respiratory insufficiency
– Altered mental status
– Slurred speech
– Dysrhythmias
– Decrease/loss of
reflexes
– Decrease in body temp.
– Nystagmus
• Management
– Require large
overdosage before
serious toxicity occurs.
– Support respirations
– Consider Flumazenil
(Romazicon®)
• 1 to 10 mg
• Should be used cautiously
• May cause seizures
• Not usually recommended
113
S/S and management of gammahydroxybutarate
• Signs & Symptoms
– Severe Respiratory
Depression
– Aphasia
– Loss of muscle
tone/paralysis
– Hypothermia
– Seizures
– Death
• Management
– Aggressive airway
intervention
• Intubate
– 100% oxygen
• Support ventilations
– IV access
– Transport
114
S/S and management of narcotics
Signs and Symptoms
– CNS depression
– Pupil constriction
– Respiratory depression
– Hypotension
– Bradycardia
– Hypothermia
• Management
– Support respirations
• Do not intubate until
naloxone has been given
– Establish IV access
– Consider naloxone
• 0.4 to 2.0 mg (up to 10 mg
for darvon)
• Titrated to respirations
NOT consciousness
115
S/S and management of cocaine
Signs and Symptoms
– Euphoria
– Hyperactivity
– Dilated pupils
– Psychosis
– Hypertension
– Tachycardia
– Chest pain
– Hyperthermia
– Vasoconstriction
• Management
– ABC’s
– Support respirations
– Oxygen
– IV access
– Violent patients can
have heart attacks
during struggle
– Cardiac arrest likely
• Monitor ECG Carefull
116
S/S and management for methamphetamine
Signs and Symptoms
– Exhilaration
– Hyperactivity
– Dilated pupils (dark
glasses)
– Hyperthermia
– Hypertension
– Tachycardia
– Psychosis
– Seizures
Management
– Supportive
– Patient may “Crash”
– Treat threats to life
– Consider
benzodiazepines for
excited delirium and
hyperthermia
117
S/S and management of hallucinogens?
Signs and Symptoms
– Psychosis
– Nausea
– Dilated pupils
– Rambling speech
– Headache, dizziness
– Hallucinations
– Distorted senses
Management
– Safety first
• Patients can be violent
– Reassure the patient
– Provide dark and quiet
transport
118
S/S and management of methylinedioxymethamphetamine?
Signs & Symptoms
– Dilated Pupils
– Bruxism
– Cracked teeth
– Hyperthermia
– Hypertension
– Tachycardia
– Psychosis
– Dysrhythmia
– Death
Management
– Remove external stimuli
– Initiate controlled cooling (consider benzodiazepines)
– Oxygen via NRB
• 12-15 liters
– Initiate IV access
– Transport
119
S/S and management of inhaled volatile solvents
Signs & Symptoms
– Dizziness
– Coughing, sneezing
– Tinnitus
– Hallucinations/delusions
– Ataxia
– Confusion
– Aggression
– Seizures
• Management
– DON’T agitate
– Remove from offensive
environment
– Initiate aggressive
oxygen
• 15 liters by non-rebreather
• Intubate if indicated
– Initiate IV access
– Transport
120
S/S and management for inhaled aerosols ?
Signs & Symptoms
– Confusion
– Dizziness
– Nausea/vomiting
– Open sores around
mouth and/or nose
– Ataxia
– Irritable
– Aggressive
• Management
– DON’T agitate
– Remove from offensive
environment
– Initiate aggressive
Oxygen
• 15 lpm
• Intubate if indicated
– Initiate IV access
– Transport
121
S/S and management of anesthetics
Signs & Symptoms
– Flushed face
– Cool Skin
– Hypotension
– Tachycardia
– Nausea/vomiting
– Dizziness
– Relaxation of vessel
tone
– Slowed perception of
time
• Management
– Oxygen
• 15 liter by non-rebreather
– IV access
– Transport
122
S/S and management of bath salts
Signs and Symptoms
– Increased heart rate and
blood pressure
– Euphoria
– Increased sociability and
sex drive
– Paranoia, agitation,
hallucinations
– Violent behavior
– Sweating
– Nausea / vomiting
– Insomnia; irritability;
dizziness; depression;
panic attacks; reduced
motor control; cloudy
thinking.
• Management
– Supportive
123
S/S and management of KHAT
Signs and Symptoms
– Euphoria
– Increased alertness and
arousal
– Hypertension
– Tachycardia
– Depression
– Paranoia
– Headaches
– Loss of appetite
– Insomnia
– Fine tremors
– Loss of short-term
memory
– Gastrointestinal
disorders
– Increased risk of MI
• Management
– Supportive
124
Management of subdued pts
Management
– Support ventilations
– Maintain patient in supine or recovery position
– Begin fluid administration
• Normal saline, Keep open
– Administer benzodiazepines
– Consider sodium bicarbonate
• Evaluate all patients before releasing to police
– Not all need medical attention, all need assessment
– Police policies and procedures should seek assessment
• DRASTICALLY reduces liability and prisoner death
125
Physiological effects of alcohol effects
-CNS depressant
-susceptible to methanol or ethylene glycol ingestion
-peripheral vasodilation, diuresis
126
Delirium Tremens (DTs) S/S
Signs & Symptoms
– Coarse tremor of hands, tongue, eyelids
– Nausea, vomiting, general weakness, anxiety
– Tachycardia, sweating, hypertension, hallucinations,
irritability or depressed mood, poor sleep
– Increased sympathetic tone, orthostatic hypotension
127
Antibuse (Disulfiram) S/S
Used to discourage drinking in alcoholics
– Creates:
• Blurred vision
• Chest pain
• Confusion
• Dizziness or fainting
• Fast or pounding
heartbeat
• Flushing or redness of
face
• Increased sweating
• Nausea and vomiting
• Throbbing headache
• Troubled breathing
• Weakness
128
What do you not want to give to stimulant users such as with cocaine?
Beta-blockers
Reason: cocaine stimulates alpha and beta receptors and if you block beta, alpha will run rampant and increase BP while HR is decreased.
Paramedic Class Ashift
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