Medical and Obstetrics/​Gynecology Study Guide for the EMT Test

Gastrointestinal and Urologic Emergencies

Gastrointestinal and urologic emergencies may involve the stomach, intestines, bladder, gallbladder, and more. Since a wide variety of emergencies may occur, narrowing down the problem as soon as possible is critical for appropriate treatment.

Pathophysiology of the Gastrointestinal System

Several conditions can affect the gastrointestinal system, including peritonitis. Peritonitis occurs when any material such as blood or pus irritates the peritoneum. An acute abdomen may also be something an EMT frequently encounters. An acute abdomen is a sudden onset of abdominal pain, and it can occur due to many conditions, including appendicitis, gastroenteritis, and diverticulitis.

Patient Assessment

After sizing up the scene for safety, complete a primary assessment. Be aware that some gastrointestinal emergencies can lead to internal bleeding and cause life-threatening symptoms, including low blood pressure. Continue with a review of medical history and a secondary assessment. It is helpful to determine when symptoms started and if symptoms such as vomiting and diarrhea are present. A secondary assessment should include palpation of the abdomen to determine if tenderness is present. Continue with reassessment because patients with gastrointestinal emergencies can quickly develop other serious conditions, including shock.

Emergency Care

Emergency care involves assessing and treating the patient for shock. Vomiting can lead to airway compromise, so patients should be positioned to maintain airway patency. In situations where a patient is vomiting, it’s important to protect yourself from contamination.

Dialysis Emergencies

Patients with end stage renal disease may need dialysis. Dialysis does the work of the kidneys when they are not functioning as they should. In some cases, a patient may experience side effects from dialysis. EMTs may treat patients who are experiencing side effects and dialysis emergencies. Emergencies may include bleeding at the access site, vomiting, and infection. Emergency care involves assessing and managing airway, circulation, and breathing.

Endocrine and Hematologic Emergencies

Endocrine and hematologic emergencies can include treating patients with diabetes and blood disorders, including sickle cell anemia.

Endocrine Anatomy and Physiology

The endocrine system controls several functions. The endocrine system includes various glands, including the pancreas, thyroid, and adrenal glands that secrete hormones affecting the cells of organs in the body. The endocrine glands may produce too much of a hormone or too little. One of the functions of the endocrine system is to produce adequate amounts of insulin so glucose can enter the cells and provide energy.

Endocrine Pathophysiology

One of the main conditions associated with the endocrine system is diabetes. Diabetes involves impaired glucose metabolism. Glucose production may be impaired or insulin cannot bind to the receptor cells, which prevents glucose from getting into the cell. Diabetes can cause life-threatening symptoms and coma. It can also lead to severe complications, including blindness and kidney disease.

Patient Assessment of Diabetes

Start by making sure the scene is safe. Be aware of needles used for insulin injection, which may be on scene. Breathing can be impaired due to diabetic emergencies and should be assessed immediately during a primary assessment.The patient’s level of consciousness should also be assessed. Taking an accurate history is essential with diabetic patients, including when they last ate and took insulin. A secondary assessment should include a quick check of vital signs and other symptoms. It is important to frequently reassess a patient with diabetes during transport to determine if there is a change in status, such as an ALOC.

Diabetic Emergency Care

Diabetic emergency care often involves administering oral glucose. Oral glucose comes in different forms, including a liquid, a chewable tablet, and a gel. The gel is most commonly used because it dissolves most quickly. The only contraindication for administering oral glucose is if the patient is unable to swallow. In a patient who has an ALOC, you will have to place the gel on a tongue depressor and place it in the patient’s mouth between the gums and cheek. Care may also include treating shock and airway management in patients who are experiencing a diabetic emergency.

Hypoglycemia

Hypoglycemia is low blood glucose. Recognizing hypoglycemia as soon as possible allows for rapid treatment and can be lifesaving. Signs of hypoglycemia include shakiness, blurred vision, confusion, rapid heart rate, and sweating. Seizures, ALOC, and lack of consciousness are additional symptoms when blood glucose levels get extremely low; however, it is important to understand that seizures and an ALOC can have many causes besides hypoglycemia. Getting a history and checking blood sugar levels is a critical part of hypoglycemic care.

Hematologic Emergencies

Hematological emergencies involve treating people with various blood disorders, including sickle cell anemia, hemophilia, and thrombophilia. Patients with sickle cell anemia can develop hypoxia, organ damage, and pain crisis. Patients with hemophilia have problems with blood clotting and can develop life-threatening internal or external bleeding, even from minor injuries. People who have thrombophilia develop blood clots easily, which can block blood flow to vital organs.

Patient Assessment of Hematologic Disorders

When treating a hematological emergency and assessing scene safety, be sure to check for the presence of blood at the scene and use standard contact precautions in addition to eye protection. During the primary assessment, determine the patient’s level of consciousness and if his/her airway is compromised. A history can provide vital information such as hematological conditions of the patient. Patients with a sickle cell crisis may have a rapid and weak pulse, so measuring vital signs during a secondary assessment is critical. Frequently reassess the patient to determine if there is a change in alertness or oxygen level.

Terms/Concepts to Know: acidosis, hematology, hemophilia, thrombophilia, sickle cell anemia

Immunologic Emergencies

An immunological emergency involves an allergic reaction. Allergic reactions can range from very mild to severe. Since the airway can become blocked, quickly recognizing potential airway compromise is critical.

Anatomy and Physiology

The immune system consists of the lymph nodes, lymph vessels, spleen, and bone marrow. Together, the tissue, cells, and organs of the immune system help the body fight infection. The spleen helps kill bacteria and the bone marrow produces red and white blood cells, which fight disease. The lymph nodes and vessels trap bacteria in the fluid, which can then be removed by lymphocytes.

Pathophysiology

The immunological emergency that an EMT will treat is an allergic reaction. An allergic reaction occurs when the body responds to a normally harmless substance as if it were dangerous. The immune system overreacts and releases chemicals, including histamine. Histamine causes allergy symptoms such as sneezing, watery eyes, and hives. The most serious complication of an allergic reaction is anaphylaxis, which involves multiple organs including the respiratory system.

Allergens

The most common allergens fall into these categories: food, medications, plants, chemicals, and insects. Common food allergens include peanuts, milk, and shellfish. Penicillin is a common drug allergen. Molds, pollen, ragweed, and oak are common plant allergens. Latex is one of the most common chemical allergens. Bees and wasp bites can also cause serious allergic reactions.

Patient Assessment in Immunologic Emergencies

The airway can become blocked in an immunological emergency. A primary assessment should immediately evaluate airway patency and respiratory status. Getting a history to determine if the patient has noted allergies is critical. The secondary survey should include a quick assessment of vital signs and breath sounds, along with oxygen level. Respiratory status can change quickly during an immunological emergency, so reassessment should focus on airway patency, respiratory rate, and level of consciousness.

Immunologic Emergency Care

Emergency care for immunological emergencies typically focuses on airway support and quick transport. In severe allergic reaction, when anaphylaxis is present, administration of epinephrine is usually indicated. Epinephrine can decrease airway swelling, reduce lung bronchospasm, improve blood flow, and quickly treat anaphylaxis. Epinephrine for an allergic reaction is usually administered via an auto-injector with a premeasured dose.

Terms/Concepts to Know: histamine, allergen, anaphylaxis, urticaria, leukotrienes, angioedema