These emergencies arise due to accidental or deliberate exposure to harmful substances and substances used for normal medical treatment. These could be drugs, household products, environmental contaminants or occupational exposure. To determine the nature of the poison, look around the scene for clues. There may be overturned bottles, scattered pills and chemicals, and remains of food or drinks. Signs for ingested poisons, include, vomiting and gastrointestinal pains. Charcoal activation should be given as it binds to the poison in the stomach and carries it out of the system. The dosage should be, 30-100g for an adult, and 15-30 g for a child. The patient should be protected from aspirating if he is vomiting.
Absorbed and surface contact poisons, damaged the skin, mucous membranes or eyes, causing chemical burns and telltale rashes. The signs include liquid or powders on the patient’s skin, burns, irritation and redness of the skin. In treating contact poisoning, remove all the clothes contaminated with the poison, brush off any dry chemicals on the skin and flush it with running water. If the chemical agent is in the eyes, irrigate them with water for at least 10 to 20 minutes. The only time when the water should not be used is when a patient has been contaminated with a poison that reacts violently with water such as phosphorous or chemical sodium. Instead, brush the chemical off the patient, remove contaminated clothing and apply a dry dressing to the burn area.
Environmental factors such as weather, terrain and atmospheric pressure, may complicate or cause medical conditions. Heat effects may cause heat exhaustion and heat stroke. The symptoms for heat exhaustion include, pale skin, sweatiness, thirst, headaches and elevated body temperatures. Treatment involves, moving the patient to a cool area, giving sips of cool water or cooling the patient with a moist towel, applying cold packs to the neck, groin and armpits while avoiding direct skin contact. Signs for heat stroke include, hot and dry skin, fatigue and weakness, dilated pupils and seizures. Treatment involves removing the patient’s clothing, pouring cold water over the patient, using cold packs and fanning aggressively.
Cold conditions may cause hypothermia and frostbites. Symptoms include shivering, muscular rigidity, reduced coordination and cardiac irritability. The patient should be removed from the cold and be provided with warm clothing, apply heat packs to the neck, armpits, chest and groin. Supply warm and moist oxygen, and warm fluids, for the conscious patients. Intravenous therapy of warm lactated ringer solution should be provided. Signs for frost bites include loss of sensation to the affected area, soft and cold skin. The skin may turn waxy gray or yellow. The method of treatment is similar to that used for hypothermia. In addition, the frost bite injury should be protected from movement or any form of friction.
Obstetrical and Gynecological Emergencies
Medical emergencies may arise during the normal delivery, breech birth and prolapsed cord. During the normal delivery, if crowning is present, support the infant’s head with one hand to prevent the explosive delivery. Ensure that, the umbilical cord is not around the neck, suction the infant’s oral and nasal way, and have the mother stop pushing. In case of the breech birth, position the mother buttocks at the edge of a surface and hold her legs in a flexed position. Furthermore, do not pull but support the baby. If the head cannot be delivered, insert fingers between the baby’s mouth and nose to form a V. For the prolapsed cord, position the mother in a knee-chest position with her head down, or place pillows under her buttocks. Insert into the vagina, a sterile gloved hand and gently push the presenting part away from the pulsating cord. Cover the umbilical cord with a dressing moistened with a sterile solution.
These can be acute or chronic. The symptoms may be due to asthma, bronchitis, emphysema or pneumonia. These include, wheezing and dry cough associated with asthma and emphysema. Productive yellow, green or light brown cough is associated with pneumonia and bronchitis. Other symptoms include, difficulty in breathing and 1-2 word dyspnea. Assist patient with an inhaler, and provide the high-flow oxygen on a non-rebrether.
The symptoms include irregular high pulse rate, rapid and shallow breathing. The patient should be positioned with the head and the knees slightly elevated. Administer high-flow oxygen and assist in ventilations. Check for breathing, and if there is no breathing; give about two breaths while checking for the pulse. If still there is no pulse, give about 30 compressions until the patient responds. If still there is no response, give a shock and resume Cardiopulmonary resuscitation (CPR).
Acute Abdominal Emergencies
The signs for abdominal problems include tenderness in the four quadrants, pulsating masses, vomiting (check color/blood), diarrhea (check color/blood), and difficulties in urination. Maintain the airway, allow the patient to lie in a comfortable position, and start intravenous therapy with normal saline or lactated ringer’s solution.
Diabetic and Altered Mental Status Emergencies
Diabetes may be hypoglycemia or hyperglycemia. Hypoglycemia signs include altered mental status, paleness and diaphoretic. The patient may appear intoxicated with glucose levels less than 70mg/dl. Hyperglycemia signs include warmness, a dry skin, acetone breath and glucose levels greater than 350mg/dl. Treatment includes, providing ventilation, obtaining the patients glucose level and administering glucose orally or intravenously. For altered mental status, check for the distorted blood-glucose levels and provide ventilations. If there is an indication of trauma, treat the case as a trauma patient.
Allergic reactions result from exposure to any substance, to which an individual is sensitive. It can be mild, moderate or severe. Signs of reactions include difficulty in swallowing, facial swelling, hives, wheezing, itching skin, cyanosis and abdominal pain. In this case, maintain airway, remove the allergen if present and administer an inhaler or epinephrine. In addition, treat for shocks.
These are characterized by abnormal behavior that family and social groups cannot tolerate. The causes may be biological, psychological or social. Symptoms include drugs and alcohol violent behaviors, signs of depression and withdraw symptoms. Use interview skills to determine the real problem. If the patient requires restraining, use only the necessary force. Inform the law enforcers, monitor for shocks, and maintain ventilation.