As an Emergency Medical Responder, you should assess every patient and determine the chief complaint, as well as the signs and symptoms. Give emergency medical care based on the patient's signs and symptoms. Keep in mind that some patient complaints apply to more than one illness.
Your initial assessment of the patient begins from across the room. Form a general impression by looking at your patient's appearance, work of breathing, and skin color. Once your general impression is complete, perform a hands-on assessment and gather the patient's history. Show a caring attitude when performing your assessment and providing care.
An altered mental status is a change in a patient's level of awareness. It is also called an altered level of consciousness (ALOC). A change in the patient's mental status may occur gradually or suddenly. It may last briefly or be prolonged. A patient with an altered mental status may appear confused, agitated, combative, sleepy, difficult to awaken, or unresponsive. An altered mental status should be treated as a medical emergency. Regardless of the cause of the altered mental status, emergency care focuses on airway, breathing, and circulation.
A seizure is a temporary change in behavior or consciousness caused by abnormal electrical activity within one or more groups of brain cells. A seizure is a symptom of an underlying problem within the central nervous system. The most common cause of adult seizures is the failure to take anti-seizure medication. The most common cause of seizures in infants and young children is a high fever. Epilepsy is a condition of recurring seizures; the cause is usually irreversible.
The type of seizure that involves stiffening and jerking of the patient's body is called a tonic-clonic seizure (formerly called a grand mal seizure). This type of seizure typically has four phases:
Aura—a peculiar sensation that comes before a seizure
Tonic phase—the body's muscles stiffen, the patient's breathing may be noisy, and the patient may turn blue
Clonic phase—alternating jerking and relaxation of the body occurs
Postictal phase—the period of recovery that follows a seizure; the patient often appears limp, has shallow breathing, and has an altered mental status
Status epilepticus is a seizure that lasts longer than 30 minutes or a series of seizures occurring over a 30-minute period in which the patient remains unresponsive between seizures. Status epilepticus is a medical emergency. It can cause brain damage or death if it is not treated.
No matter what caused the seizure, your emergency care must focus on the patient's airway, breathing, and circulation. In addition, remember the following:
Protect the patient's privacy.
If the patient is actively seizing, protect the patient from harm by moving furniture and other objects away from the patient.
Do not insert anything into the patient's mouth. Remove eyeglasses. Do not try to restrain body movements during the seizure.
As soon as the seizure is over, make sure the patient's airway is open.
Some patients are light sensitive (photophobic) after a seizure. Take care to reduce the patient's exposure to bright lights and loud noises.
The skin plays a very important role in temperature regulation. Cold and warmth sensors (receptors) in the skin detect changes in temperature. These receptors relay the information to the hypothalamus. The hypothalamus (located in the brain) functions as the body's thermostat. It coordinates the body's response to temperature.
The body loses heat to the environment in five ways:
Radiation
Radiation is the transfer of heat from the surface of one object to the surface of another without contact between the two objects. When the temperature of the body is more than the temperature of the surroundings, the body will lose heat.
Convection
Convection is the transfer of heat by the movement of air current. Wind speed affects heat loss by convection (wind-chill factor).
Conduction
Conduction is the transfer of heat between objects that are in direct contact. Heat flows from warmer areas to cooler ones.
Evaporation
Evaporation is a loss of heat by the vaporization of moisture on the body surface. The body will lose heat by evaporation if the skin temperature is higher than the temperature of the surroundings.
Breathing
The body loses heat through breathing. With normal breathing, the body continuously loses a relatively small amount of heat through the evaporation of moisture.
Hypothermia is a core body temperature of less than 95°F (35°C). This condition results when the body loses more heat than it gains or produces.
A rectal temperature gives the most accurate measure of core temperature. However, obtaining a rectal temperature in the field often raises issues of patient sensitivity and welfare, such as exposure to cold by removing clothing.
Your main concern in providing care should be to remove the patient from the environment. Use trained rescuers for this purpose when necessary. Perform an initial assessment, keeping in mind that you need to move the patient to a warm location as quickly and as safely as possible. Remove any cold or wet clothing. Protect the patient from the environment. Assess the patient's mental status, airway, breathing, and circulation. Keep in mind that mental status decreases as the patient's body temperature drops.
You may need to rewarm the patient. The two main types of rewarming are passive and active.
Passive rewarming is the warming of a patient with minimal or no use of heat sources other than the patient's own heat production. Passive rewarming methods include placing the patient in a warm environment, applying warm clothing and blankets, and preventing drafts.
Active rewarming should be used only if sustained warmth can be ensured. Active rewarming involves adding heat directly to the surface of the patient's body. Warm blankets, heat packs, and/or hot water bottles may be used, depending on how severe the hypothermia is.
Local cold injury (frostbite) involves tissue damage to a specific area of the body. It occurs when a body part, such as the nose, ears, cheeks, chin, hands, or feet, is exposed to prolonged or intense cold. When the body is exposed to cold, blood is forced away from the extremities to the body's core. A local cold injury may be early (superficial frostbite) or late (deep frostbite).
When the body gains or produces more heat than it loses, hyperthermia (a high core body temperature) results. The three main types of heat emergencies are heat cramps, heat exhaustion, and heat stroke.
Heat cramps usually affect people who sweat a lot during strenuous activity in a warm environment. Water and electrolytes are lost from the body during sweating. This loss leads to dehydration and causes painful muscle spasms.
Heat exhaustion is also a result of too much heat and dehydration. A patient with heat exhaustion usually sweats heavily. His or her body temperature is usually normal or slightly elevated. Severe heat exhaustion often requires intravenous (IV) fluids. Heat exhaustion may progress to heat stroke if it is not treated.
Heat stroke is the most severe form of heat-related illness. It occurs when the body can no longer regulate its temperature. Most patients have hot, flushed skin and do not sweat. Individuals who wear heavy uniforms and perform strenuous activity for long periods in a hot environment are at risk for heat stroke.
The first step in the emergency care of a patient suffering from a heat-related illness is to remove the patient from the hot environment. Move the patient to a cool (air-conditioned) location and follow treatment guidelines based on the patient's degree of heat-related illness.
As an Emergency Medical Responder, you will likely encounter various behavioral emergencies. A behavioral emergency is a situation in which a patient displays abnormal behavior that is unacceptable to the patient, family members, or community. A behavioral emergency can be due to extremes of emotion or to psychological or physical conditions. A number of factors can result in these emergencies, including mental illness, a lack of oxygen, low blood sugar, alcohol or drugs, situational stressors, medical illnesses, and psychiatric illnesses or crises.
Anxiety is a state of worry and agitation that is usually triggered by a vague or an imagined situation.
An anxiety disorder is more intense than normal anxiety. Anxiety normally goes away after the stressful situation that caused it is over. An anxiety disorder lasts for months and can lead to phobias.
A panic attack is an intense fear that occurs for no apparent reason. Panic attacks can build gradually over several minutes or hours or can occur suddenly. The fear that accompanies a panic attack is very real to the patient. It is sometimes difficult for healthcare professionals to relate to that fear because there may be no obvious trigger.
A phobia is an irrational, constant fear of a specific activity, object, or situation. Some phobias are common and usually do not create a problem because the person simply avoids the activity, object, or situation. A phobic reaction resembles a panic attack. The signs and symptoms include panic, sweating, difficulty breathing, and an increased heart rate.
Depression is a state of mind characterized by feelings of sadness, worthlessness, and discouragement. It often occurs in response to a loss. The loss may be of a job, a loved one, or a relationship. The signs of depression vary with age.
Bipolar disorder is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. A person with bipolar disorder has alternating episodes of mood elevation (mania) and depression. When manic, the person often appears restless. He or she may be extremely energetic and enthusiastic. A person with bipolar disorder also usually experiences periods of depression, in which he or she feels worthless. The person may consider suicide. The person's mood is often normal between the periods of mania and depression.
Paranoia is a mental disorder characterized by excessive suspiciousness or delusions. Paranoid patients are suspicious, distrustful, and prone to argument. They often feel as if they are being mistreated and misjudged. These patients tend to carry grudges, recalling wrongs done to them years before. They are excitable and unpredictable, with outbursts of bizarre or aggressive behavior.
Delusions are false beliefs that the patient believes are true, despite facts to the contrary.
Hallucinations are false sensory perceptions. The patient sees, hears, or feels things that others cannot.
Schizophrenia is a group of mental disorders. Its symptoms include hallucinations, delusions, disordered thinking, rambling speech, and bizarre or disorganized behavior. Schizophrenic patients are often reserved, withdrawn, and indifferent to the feelings of others. They prefer to be alone and have few, if any, close friends. They can become combative and are at high risk for suicidal and homicidal behavior.
Suicide is any willful act designed to end one's own life. Most people who commit suicide express their intentions beforehand. You should take every suicide threat or gesture seriously and arrange for patient transport for evaluation.
When called to a scene that involves a behavioral emergency, remember that the scene may be unpredictable. Take steps to ensure your safety and that of other healthcare professionals responding to the scene. Complete a scene size-up before beginning emergency medical care. Carefully assess the scene for possible dangers. Start by visually locating the patient. Visually scan the area for possible weapons. Be prepared to spend time at the scene. Limit the number of people around the patient. Take time to calm the patient.
Avoid restraining a patient unless the patient is a danger to you, him- or herself, or others. When using restraints, have police present, if possible, and get approval from your medical director. If you must use restraints, apply them with the help of law enforcement and other EMS personnel.
When caring for a patient in restraints, document the following information:
The reason for the restraints
The number of personnel used to restrain the patient
The type of restraint used
The time the restraints were placed on the patient
The status of the patient's ABCs and distal pulses before and after the restraints were applied
The reassessment of the patient's ABCs and distal pulses
