Signs / Symptoms: Joint and abdominal pain, fatigue, paresthesis, CNS disturbances

(clue: History may include recent SCUBA diving or work in a Caisson)

Decompression Illness

aka The Bends

aka Caisson Disease

Can produce pneumothorax, embolism, stroke.

Definitive care is Hyperbaric Chamber.

S/S: Lower left Quadrant pain, Low grade fever, colicky abdominal pain, possible nausea and vomiting.

In severe cases: cool clammy skin, tachycardia, diaphoresis and hematochizia.

No way to determine in the field, but suspicion will run toward inflammation of the diverticuli due to LLQ pain, Hematochizia.

Pt may complain of alternate bouts of diarrhea and constipation with blood in stool.

R Side Failure, body senses it is low on O2, so it produces more RBCs. Preponderance of RBCs (polycythemia) causes the pink coloration.

Generally this condition is rooted in alveolar dysfunction.

#1 cause of this condition is smoking.

This condition occurs because the alveoli are stuck open and cannot expel the air.

Kussmaul sign: JVD upon inspiration and pulsus paradoxus.

BP up / pulse normal or lower / erratic breathing (cushing's reflex)

Also presents with a stiff neck (nucal rigidity) / Increased Intracranial pressure.

Treatment of this condition includes O2 with possible breathing assistance via bag valve mask.

Intubation is contraindicated.

This condition is caused by an electrolyte imbalance. Treatment includes water and electrolyte fluids.

Can be coupled with heat exhaustion.

Commonly presents with heat cramps, however this condition involves the body temperature starting to rise vs. cramps that involve the imbalance of electrolytes.

Further, this condition commonly presents with diarrhea and nausea. Treatment includes removal to a cooler environment.

S/S: Cessation of sweating, hot dry skin (may still be moist); Very high core temperature; deep respirations that are becoming more shallow.

Respirations will be fast in earlier stage, but slow as the condition progresses.

Presentation of this condition includes sweating that has stopped (though the skin may still be wet due to transition from heat exhaustion); Body temperature above 105.

Key sign is the pulse will bound and then slow, becoming weaker as the patient moves into cardiovascular collapse.

Treatment of this condition includes O2, Two large bore IVs, Closely monitoring breath sounds.

(Breath sounds closely monitored because this can transition into a tension pneumo - but pt will likely be dead from shock by then)

Diaphoresis, Increased skin temperature, flushing, altered level of consciousness. 

Anyone with an increased body temperature.

something that causes a fever;

(foreign protein, bacteria, etc)

Insulin shock

IDDM 1 patient who takes too much insulin, driving the sugar out of the blood; or the correct dose and then vomits, which places them in an insulin dominant position.

Presents with Cool skin, diaphoresis, altered mental status, irrational behavior

 Symptomatic with blood glucose less than 90

Hypothermia (mild)

Signs and Symptoms: Lethargy, lack of coordination, cool dry skin, shivering, hypertension, tachycardia, tachypnea and vasoconstriction (resulting in elevated BP)

Core temp 90°-95°

86 degrees

A fib, V fib and classically, the Osborn J wave

Severe Hypothermia

68-82

Cold exposure patient who presents with decreased pulse and respirations (but possibly accelerated heart rates such as V Tach and A Fib) with major organ failure and who may even display signs of clinical death is in what phase of hypothermia?

What temperature range do you expect to find their core body temperature?

Handle gently (rough handling can instigate V Fib)

With resuscitation issues, use first line drugs and re-evaluate.

"They aren't dead until they are warm and dead."

(In late stage hypothermia, the body will take longer to undergo brain death)

You are presented with a patient who exhibits Intense local pain and swelling, weakness, nausea and vomiting, dyspnea, tachycardia, and hypotension. What do you consider to be the cause?

(Note: severe presentation may include shock)

(Also: recently swimming in the ocean)

What condtion do you suspect when presented with chest pain lasting longer than 30 minutes, elevated episodic BP, acute onset of nausea and vomiting, with pain radiating to the arms, neck, jaw and back?

Further: Nitro offers little or no relief, and the patient is frightened with a feeling of "doom"