2d • Paramedic Talk
More NREMTP Must knows
HEPATIC ENCEPHALOPATHY vs WERNICKE’S ENCEPHALOPATHY
Hepatic Encephalopathy - Cause: Liver failure leading to buildup of ammonia and toxins in the blood.
Signs and symptoms:
- Altered mental status
- Confusion
- Jaundice
- Ascites
Pathophysiology: The liver cannot detoxify ammonia, allowing it to affect brain function.
Treatment priorities:
- Support airway
- Oxygen
- Monitor glucose
- Transport
Wernicke’s Encephalopathy - Cause: Thiamine (vitamin B1) deficiency, most common in chronic alcohol abuse.
Classic triad:
- Confusion
- Ataxia
- Ophthalmoplegia (eye movement abnormalities)
Important exam point: Give thiamine before glucose when treating suspected alcoholic patients.
IMMUNOGLOBULINS / ANTIBODIES
Antibodies are proteins produced by B-cells that help identify and neutralize pathogens.
Major types include:
IgG
- Most abundant antibody
- Provides long-term immunity
IgM
- First antibody produced in infection
- Indicates recent infection
IgA
- Found in mucous membranes and secretions
IgE
- Responsible for allergic reactions and anaphylaxis
IgD
- Involved in B-cell activation
PUPIL SIZE
Normal pupil size: approximately 2–3 mm
Dilated pupils (greater than 4 mm) may indicate:
- Sympathetic stimulation
- Drug intoxication (stimulants, anticholinergics)
- Brain injury
- Hypoxia
Constricted pupils (less than 1 mm) may indicate:
- Opioid overdose
- Organophosphate poisoning
- Pontine stroke
ACIDOSIS vs ALKALOSIS
Acidosis occurs when blood pH is below 7.35.
Common causes:
- Diabetic ketoacidosis
- Renal failure
- Lactic acidosis
- Respiratory failure
Signs include:
- Kussmaul respirations
- Confusion
- Hypotension
Alkalosis occurs when blood pH is above 7.45.
Common causes:
- Hyperventilation
- Vomiting
- Diuretic use
Signs include:
- Muscle twitching
- Tingling
- Tachycardia
INCOMPLETE SPINAL CORD INJURY
Incomplete spinal cord injury means partial damage to the spinal cord.
Patients may retain:
- Some motor function
- Some sensory function
- Movement below the injury
Common patterns include:
- Central cord syndrome
- Brown-Sequard syndrome
- Anterior cord syndrome
TOXIDROMES
Serotonin Syndrome - Caused by excessive serotonin.
Signs:
- Hyperthermia
- Agitation
- Tremor
- Clonus
- Diaphoresis
Common causes include SSRI medications.
Extrapyramidal Symptoms (EPS) Often caused by antipsychotic medications.
Signs:
- Muscle rigidity
- Tremors
- Dystonia
- Akathisia
Cholinergic Toxicity - Common cause: organophosphate exposure.
Symptoms (SLUDGE):
- Salivation
- Lacrimation
- Urination
- Diarrhea
- GI upset
- Emesis
Also causes bronchospasm and bradycardia.
Anticholinergic Toxicity - Common cause: antihistamines or certain psychiatric drugs.
Symptoms include:
- Dry skin
- Dilated pupils
- Tachycardia
- Delirium
- Urinary retention
Digoxin ToxicitySigns include:
- Nausea and vomiting
- Bradycardia
- Visual disturbances (yellow or green vision)
- Dysrhythmias
ENDOCRINE EMERGENCIES
Addison’s Disease - Adrenal insufficiency leading to low cortisol.
Signs:
- Hypotension
- Weakness
- Hyperkalemia
- Hyponatremia
Cushing’s SyndromeExcess cortisol.
Signs:
- Moon face
- Buffalo hump
- Hypertension
- Hyperglycemia
Thyroid Disorders
Hyperthyroidism (Graves disease):
- Tachycardia
- Weight loss
- Heat intolerance
- Anxiety
Hypothyroidism (Hashimoto disease):
- Bradycardia
- Weight gain
- Cold intolerance
- Fatigue
DIAPHRAGMATIC RUPTURE
Often caused by blunt trauma.
Signs include:
- Respiratory distress
- Decreased breath sounds
- Bowel sounds in the chest
- Abdominal organs moving into thoracic cavity
BOERHAAVE SYNDROME
Spontaneous rupture of the esophagus.
Common cause: Severe vomiting or retching.
Signs:
- Severe chest pain
- Subcutaneous emphysema
- Difficulty swallowing
- Shock
HYPERKALEMIA
Elevated potassium levels in the blood.
Common causes:
- Renal failure
- Crush injuries
- Severe burns
- Metabolic acidosis
EKG findings:
- Peaked T waves
- Widened QRS
- Ventricular dysrhythmias
TYPES OF ANEMIA
Iron Deficiency Anemia - Most common anemia.
Causes:
- Blood loss
- Poor nutrition
Signs:
- Fatigue
- Pale skin
- Weakness
Aplastic Anemia - Bone marrow failure leading to reduced blood cell production.
Causes:
- Radiation
- Chemotherapy
- Autoimmune disease
Sickle Cell Anemia - Genetic disorder causing abnormal red blood cells.
Complications:
- Pain crises
- Stroke
- Organ damage
WHITE BLOOD CELL TYPES
Neutrophils
- Fight bacterial infections
- Most abundant WBC
Lymphocytes
- Key role in immune response
- Includes B-cells and T-cells
Monocytes
- Become macrophages
- Remove pathogens and debris
Eosinophils
- Fight parasites
- Involved in allergic reactions
Basophils
- Release histamine
- Involved in inflammation
CONGENITAL DIAPHRAGMATIC HERNIA
Birth defect where abdominal organs move into the chest cavity due to a hole in the diaphragm.
Signs in newborns:
- Severe respiratory distress
- Cyanosis
- Scaphoid abdomen
- Decreased breath sounds
SICKLE CELL CRISIS
Occurs when sickled red blood cells block blood flow.
Triggers include:
- Infection
- Dehydration
- Hypoxia
- Stress
Signs:
- Severe pain
- Fever
- Shortness of breath
- Fatigue
Treatment priorities:
- Oxygen
- IV fluids
- Pain control
- Transport
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