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   Signs & Symptoms

"He brought me to the banqueting house, and his banner over me was love." --- (SofS 2:4)
Travis Case, Pastor/Teacher          Northgate Baptist Church          F.E.A.S.T Ministries


The following are some of my notes taken while training to become Certified as an EMT in 1992. This training was taken at Collin County Comunity College while serving as Chaplain for the Plano Police/Fire Departments. I hope they will be of some help to those of you who are Chaplains and are interested in EMT trainging

Shock --- Generalized

Signs And Symptoms:

Nervousness progressing to anxiety, possibly anger progressing to combativeness.

Drowsiness progressing to unconsciousness. (Changes in the LOC)

Cool and clammy skin.

Small beads of sweat progressing to diaphoresis.

Skin color becomes progressively pale.

Eyes become glazed.

History.

Weak and rapid pulse.

Nausea and vomiting.

Late signs are: decreasing blood pressure, cyanosis and unconsciousness.

Treatment:

High O2, monitor, and transport.

Prevent body heat loss.

Elevate the feet.

Find and record the reason for the shock and treat if appropriate.

Assist ventilation if necessary.

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Most All the Diseases And Tgrauma Conditions That We Are Studying Can Cause Shock To Aoccur In The body. Therefore, The Signs And Symptoms Listed Above Are Subject To Occur With Almost Any Malady.

To Combat This Problem We Will List Some Common "Key" Signs And Syjmptoms That Must Be Recognized If You Are To Be Able To Identify The Different Situations Alone With These "Key" Signs And Symptoms Will Be Listed The Statement That "All Shock Signs" Also Will Occur..

Of Course, The Treatment For "Generalized Shock" Listed Above Is Appropriate, alone with Additional Specified Treatment For Other Particular Shocks.

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Shock --- Hypovolemic

Key Signs And Symptoms:

History.

Physical evidence.

All shock signs.

Treatment:

Control bleeding if possible.

General shock treatments as listed above.

Shock --- Neurogenic

Key Signs And Symptoms:

There should be physical evidence and/or history to tip you off, neurogenic may present as an unconscious patient with a bump on his head.

Treatment:

As with general shock treatment.

Hyperventilate with high O2.

Shock --- Anaphylactic

Key Signs And Symptoms:

Hives or a rash usually generalized over the body.

Dyspnea.

History.

Physical evidence.

All shock signs.

Treatment:

Assist with medications if appropriate.

Assist ventilation if needed.

All shock treatments.

Shock --- Psychogenic

Key Signs And Symptoms:

Fainting with no sign of serious injury or illness.

Patient should recover fairly rapidly.

Should show only the early signs of shock except for unconsciousness.

Treatment:

ABC's; tilt head, etc., if still unconscious.

Look for injuries that may have occurred during fall.

Patient should recover fairly rapidly and may not want to go to the hospital, you should encourage them to do so for your own protection.

If you are completely sure that you are dealing with a simple fainting, your treatment does not have to be as aggressive as with other forms of shock.

Shock --- Cariogenic

Key Signs And Symptoms:

Chest pain.

Patient posturing --- usually seated and still.

Dyspnea.

Nausea and vomiting.

All shock signs.

All MI signs.

Treatment:

High O2, monitor, transport.

Allow the patient to transport in their most comfortable position.

Don't allow the patient to walk.

Don't do anything that may cause the patient's heart to increase it's work load.

Assist ventilation if necessary.

Fractures

Key Signs And Symptoms:

There should be some physical evidence.

Deformity.

Possibly an open or closed wound associated with the site.

Swelling and ecchymosis.

Point tenderness.

Angulation.

Redness.

Possibly a reduced or absent distal pulse.

Guarding.

Crepitus.

False motion.

History --- including mechanism of injury.

Treatment:

Non-pressure dressing, if there is an associated wound.

Splint. (Know splinting principles)

Straighten to obtain a pulse if necessary. (Never straighten a joint)

High O2, monitor and transport.

Dislocations of Joints

Key Signs And Symptoms:

All of the fracture signs except that a joint will be involved.

Loss of normal joint movement. (Locked joint)

Treatment:

Never straighten a joint.

High O2, monitor and transport.

Splint --- In position found.

Wounds

Key Signs And Symptoms:

Physical signs, (You should be able to see it)

History --- including the mechanism of injury.

Pain.

Bleeding.

All of the shock signs.

Treatment:

Bandage. (Know bandage principles)

High O2, monitor and transport.

Head Injuries --- Non-Skull Fracture, Soft Tissue Only

Key Signs And Symptoms:

Physical signs. (Should be fairly obvious,bump on head, etc.)

History.

Lack of skull fracture signs.

Should be stable and alert unless underlying injuries i.e. skull fracture, concussion, etc.

Treatment:

Pressure bandage is ok.

High O2, monitor and transport.

C-spine immobilization.

Head Injury --- Skull Fracture

Key Signs And Symptoms:

Raccoons eyes.

Battle signs.

Cerebrospinal fluid from noise, ear or an open scalp wound.

Changes in the LOC.

Unequal pupils.

Physical signs.

Nausea and/or vomiting.

Changes in blood pressure.

Treatment:

Non-pressure dressing.

High O2, monitor, and transport.

Hyperventilate.

C-spine immobilization.

Spinal Injuries

Key Signs And Symptoms:

Pain.

Deformity.

Point tenderness.

Laceration or contusion.

Paralysis or anesthesia.

Numbness, tingling, or weakness.

These signs should appear at about the level of the injury.

Changes in the LOC.

Decreased respirations.

All shock signs.

Treatment:

Full spinal immobilization.

High O2, monitor, and transport.

Assist ventilation if necessary.

Treat for shock.

Rib Fracture

Key Signs And Symptoms:

Pain on inspiration or movement.

Point tenderness.

History.

Physical signs.

Dyspnea.

Treatment:

Sling and swathe the arm to the affected side.

High O2, monitor, and transport.

Keep patient fairly immobile.

Flail Chest

Key Signs And Symptoms:

Paradoxical movement of the flail segment.

Physical signs.

Dyspnea that can progress to apnea.

Cyanosis.

All shock signs.

Treatment:

High O2, monitor, and transport.

Apply firm support to the flail segment, as with a pillow.

Position patient on affected side.

Assist ventilation.

Pneumothorax --- Spontaneous

Key Signs And Symptoms:

Deviated trachea toward the affected side.

History. (Should be sudden onset, usually occurs in young, thin, athletic males.)

Dyspnea.

Decreased breath sounds on the affected side.

Cyanosis.

All shock signs.

Treatment:

High O2, monitor and transport.

Assist ventilation if necessary.

Position patient on affected side if comfortable.

Pneumothorax --- Tension

Key Signs And Symptoms:

Deviated trachea toward the unaffected side.

Decreased breath sounds on the affected side.

Dyspnea.

Cyanosis.

Bulging intercostal spaces.

Distended neck veins.

Hollow percussion sounds on the affected side.

Falling blood pressure.

Rapidly progressing signs.

All shock signs.

Treatment:

If a bandage has caused the tension, then remove it.

High O2, monitor, and transport.

Assist ventilation.

Position patient on affected side.

Patient needs a needle decompression.

Hemothorax

Key Signs And Symptoms:

All of the tension pneumothorax signs except that the percussion sounds will be solid on the affected side.

There may be some physical signs or something in the history to tip you off that this is a hemothorax instead of a pneuma. Most of the time you won't know for sure which it is.

Treatment:

Same as with tension pneumothorax.

Sucking Chest Wound

Key Signs And Symptoms:

There should be plenty of physical evidence.

History --- includes mechanism of injury.

All of the pneumothorax signs.

Treatment:

Occlusive dressing.

All of the treatment for a tension pneumothorax.

Pericardial Tamponade

Key Signs And Symptoms:

Very soft, faint and distant heart tones.

Weak pulse.

Narrowing blood pressures.

Distended neck veins.

Almost always a result of penetrating chest trauma.

All of the shock signs.

Treatment:

High O2, monitor, and transport.

Assist ventilation.

Intercranial Pressure

Key Signs And Symptoms:

Treatment:

Acute Myocardial Infarction

Key Signs And Symptoms:

Substernal, crushing or squeezing type chest pain.

The pain can radiate up into the neck and down the left arm.

The pain isn't positional and does not get worse with movement or on inspiration.

The pain generally last longer than 30 minutes and is not relieved with rest or nitroglycerin.

The attack can come on at rest or during a work or stress situation.

Patient will probably be sweating. (Diaphoresis)

Cyanosis may be present.

Cool and clammy skin.

Posturing by the patient will usually be seated and still leaning forward slightly.

Dyspnea will normally be present.

Changing blood pressure may be present.

Irregular pulse may be present.

All shock signs can be present.

Treatment:

High O2, monitor, and transport.

Keep the patient still and quite as possible. Do not allow him to walk or do anything that can increase the heart's work load.

Allow the patient to be transported in their most comfortable position.

Assist ventilation if necessary.

Angina --- Stable

Key Signs And Symptoms:

The pain is much the same as an MI except not as hard.

The pain usually has a reason to start --- the 3 E's: Emotion, Exercise, and Eating.

The pain of angina is usually relieved by rest or nitroglycerin.

Treatment:

Much the same as for an MI, except you may assist the patient in taking another nitro if he has only had one or two.

Sometimes the patient will have gotten a noticeable amount of relief from his medication or rest by the time you get there. In these cases the patient may not want to be transported. However, you should never advise him not to go. Even though it is appropriate to feel more relaxed when you see that the patient has experienced the relief you still can not be sure that it was not a small MI.

Angina --- Unstable

Key Signs And Symptoms:

Unstable angina is like stable angina in the most important way, that there is no permanent damage done to the heart muscle. However, unstable angina is more serious than stable angina. When a person starts getting unstable angina attacks he or she must realize that a true MI is on the way.

Therefore, the signs you see with unstable angina are about what you would expect --- somewhere between those of an MI and stable angina. The pain may or may not be relieved by medication or rest, and should be more severe than stable angina pain.

Treatment:

The treatment for unstable angina is the same as for an MI. It is important to know that there is no real way of knowing for sure, in the field, if it is unstable angina or an MI.

Stroke or CVA --- Cerebrovascular Accident

Key Signs And Symptoms:

Complete or partial paralysis of one or both extremities on one side of the body. Rarely are both sides of the body affected but it can happen.

Decreasing level of consciousness.

Difficulty with speech, vision or memory.

Seizures.

Loss of facial tone or facial motion.

Unequal pupils.

Diaphoresis.

Headache. (Sometimes this will be the only clue especially early on.)

Treatment:

High O2, monitor, and transport.

Maintain some stability to the head.

Hyperventilate if patient becomes unconscious.

Transport the patient with the affected side down.

Diabetes

Diabetics can become unbalanced in either of two different ways:

LOW blood sugar = insulin shock = Hypoglycemia.

HIGH blood sugar = diabetic coma = Hyperglycemia.

Key Signs And Symptoms: (Insulin Shock)

Normal or rapid respirations.

Pale moist skin. (clammy)

Diaphoresis.

Full, rapid pulse.

Normal blood pressure.

Decreasing level of consciousness. (Fainting, seizure, or coma)

Aggressive or unusual behavior.

Hunger.

Treatment:

Give sugar if conscious (for faster relief).

If patient in early stages encourage him to eat a good meal.

If unconscious: High O2, monitor, and transport.

Key Signs And Symptoms: (Diabetic Coma)

Polyuria.

Polydipsia.

Polyphasea.

Dehydration.

Weak rapid pulse.

Kussmaul respirations --- a fairly late sign.

Fruity smell to their breath --- a fairly late sign.

Unconsciousness --- a late sign.

Treatment:

Give a small amount of sugar --- it won't hurt the patient and it covers you in the event of a wrong diagnosis.

High O2, monitor, and transport.

Congestive Heart Failure --- CHF

Your text book generally describes CHF as a chronic condition which affects both sides of the heart and will present in the patient with a mixture of left and right sided heart failure signs and symptoms. While it is true that the chronic condition will present with both sets of signs, it is also true that you will see patients who have not reached the chronic stage. These people will show signs and symptoms of either left or right heart failure only. It is unusual to see right side failure by itself but it does happen. It is not uncommon to see left sided failure by itself, especially in connection with AMI's. Since you will be dealing with people in acute situations, it is important that you recognize the signs of left heart failure in order to better diagnose the current state of your patient.

For this reason we will explain and deal with CHF under separate conditions for right and left sided failure. However, you should be aware that the chronic condition does exist and these patients will present to you with a combination of signs and symptoms.

Left Side Heart Failure

Key Signs And Symptoms:

Dyspnea. (rales)

Pink frothy sputum.

1, 2, or 3 pillow orthopnea or PND (paraoxsimal nocturnal dyspnea) this will usually be discovered in the history.

Cyanosis. (In the late stages)

Posturing to the seated position.

Severe sweating. (Diaphoresis)

Treatment:

High O2. (90% or higher)

All of the MI treatments.

It is not uncommon for these people to progress to a CPR situation if you catch them in the late stages and therefore it is important to monitor respirations closely and be ready to assist ventilation if theirs become inadequate.

Right Side Heart Failure

Key Signs And Symptoms:

Pitting edema in the extremities.

History.

Distended neck veins.

Usually accompanied by left sided heart failure signs.

Treatment:

Same as with an MI.

Chronic Obstructive Pulmonary Disease --- COPD

Emphysema

Key Signs And Symptoms:

Usually a thin, emaciated individual with a barrel chest that spends most of his life in

the assist ventilation position. (Leaning forward slightly)

Use of accessary to breathe normally.

Becomes short of breath unusually fast.

In acute attacks may show a tendency to hyperventilation.

Cyanosis in serious situations.

Treatment:

Low flow O2 unless cyanotic, then high flow O2 is preferred.

Allow the patient to be transported in the position of comfort; will probably be sitting up.

Chronic Bronchitis

Key Signs And Symptoms:

Usually a heavy set, ruddy complected individual.

Same signs as in 2 through 5 of emphysema.

Treatment:

Same as for CHF.

Croup And Epiglottitis

Key Signs And Symptoms:

History of fever or illness.

Characteristic seal bark.

Hoarseness.

Progressive and excessive muscular effort with breathing.

Typical signs of dyspnea.

Treatment:

High O2, monitor, and transport.

Do not use oropharyngeal airways or put anything in their mouth. Your text book advocated the use of oral airways but the paramedic textbook states that you should never do this for fear of causing spasms in the larynx.





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