Special needs, metabolic, and final review

Head injuries

The severity of head injuries can vary greatly. The history of the injury (i.e., details about what it is and how it happened) is crucial for determining appropriate management. With a head injury, the patient may appear normal; may experience dizziness, severe headache, mental confusion, or memory loss; or may even be unconscious. Loss of consciousness may be brief or prolonged; it may appear immediately or may be delayed. The victim may experience vomiting; loss of bladder and bowel control; and bleeding from the nose, mouth, or ears. The pupils of the eyes may be unequal and unreactive to light.

All head injuries must be considered serious. Notify the provider or contact EMS immediately. If evidence of a neck injury is seen, stabilize the neck and do not attempt to move the victim. Do not administer anything by mouth. Keep the patient warm and quiet. Watch the pupils of the eyes and record any changes. Measure vital signs and record the extent and duration of any unconsciousness. If the patient is at home or is sent home after the provider’s assessment, he or she should be watched closely for 24 hours after the injury for any change in mental status.

Foreign bodies in the eye

The eye is a delicate organ with a unique structure that demands special handling. This kind of emergency is uncomfortable, and it often is extremely difficult to keep the patient from rubbing the eye. Tell the patient not to touch the eye in any way. The provider may order ophthalmic topical anesthetic drops to relieve pain. The patient should be placed in a darkened room to wait for the provider because photophobia is common with eye irritations. If a contusion and swelling are present, cold, wet compresses can help. Ask the patient to close both eyes and cover them with eye pads until the provider arrives. The provider may order an eye irrigation to remove the object. The medical assistant should not attempt to search for or remove an object in the eyes.

Heat and cold injuries

Exposure to extremes in temperature can cause minor to severe injuries. Heat injuries occur most often on hot, humid days and result in cramps, heat exhaustion, or heatstroke. Heat-related muscle cramps may be the first sign of heat exhaustion, which is a serious heat-related condition. Patients with heat exhaustion appear flushed and report headaches, nausea, vertigo, and weakness. Heatstroke, the most dangerous form of heat-related injury, results in a shutdown of body systems. Patients with heatstroke have red, hot, dry skin; altered levels of consciousness; tachycardia; and rapid, shallow breathing. This is a true medical emergency. If heat-related problems are recognized in the early stages and are adequately treated, the patient does not usually develop heatstroke. Management of heat-related conditions includes getting the person out of the heat; loosening clothing or removing perspiration-soaked clothing; and giving the person cool electrolyte drinks if he or she is alert. An effective way to lower the victim’s temperature is to apply cool, wet cloths and then fan the moist skin so that heat is released from the body by evaporation.

The two types of cold-related injuries are frostbite and hypothermia. Frostbite, which is the actual freezing of tissue, occurs when the skin temperature falls to a range of 14° to 25° F (−10° to −3.9° C). Prolonged exposure of the skin to cold causes damage similar to a burn. The tissue may appear gray or white, may be swollen, and may have clear blisters; in full-thickness frostbite, the skin may show signs of tissue necrosis, including blackened areas and severe deformity. The more advanced the frostbite, the more serious the tissue damage and the more likely the body part will be lost. Frozen tissue has no feeling, but as thawing occurs, the patient reports itching, tingling, and burning pain. Mild frostbite can be managed by applying constant warmth to the affected areas; this can be done by immersing the area in warm water (no warmer than 105° F [40.6° C]) or by wrapping it in warm, dry clothing. Friction should never be used because this could increase tissue damage. If blisters have formed or if evidence of full-thickness frostbite is seen, the patient should be transported to the nearest ED.

Hypothermia is a medical emergency that may result in death unless the patient receives immediate assistance. Systemic hypothermia occurs when the core body temperature drops below 95° F (35° C). Signs and symptoms of hypothermia include shivering, numbness, apathy, and loss of consciousness. If hypothermia is suspected, activate EMS and provide care for any life-threatening conditions until help arrives. Remove the victim’s wet clothing and wrap the victim in blankets while moving him or her to a warm place. If the victim is alert, give warm liquids and apply heating pads (using a barrier to prevent burns) or chemical hot packs to help slowly raise the core body temperature.

Dehydration

A person dehydrates when more water is excreted than is taken in. Dehydration can be a very serious health emergency, leading to convulsions, coma, and even death. Infants, young children, and older adult patients are at greatest risk of developing serious complications from dehydration. Severe dehydration may be caused by excessive heat loss, vomiting, diarrhea, or lack of fluid intake. Symptoms include vertigo; dark yellow urine or no urine output for 8 to 10 hours; extreme thirst; lethargy or confusion; and abdominal or muscle cramps. If the patient shows any of these symptoms and is unable to retain fluids, schedule an urgent appointment or recommend that the patient be taken to the ED. Replacement of lost fluids is vital, so the patient should be encouraged to drink water, tea, sports drinks, fruit juice, or Pedialyte.