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Public Health
On-the-spot emergency medical diagnosis and treatment
What problems, complaints, incidents, and issues need on-the-spot diagnosis and treatment?
What should be your focus of assessment in an emergency medical situation?
What should you know about basic life support?
How does one diagnose and treat an unconscious patient?
How many types of human health care assessment are there?
When should you start on-the-spot cardiopulmonary resuscitation?
When should you start an on-the-spot intravenous line?
How should you evaluate and treat an unconscious patient?
What is cardiopulmonary resuscitation?
What is unconsciousness?
In what situations is a directive like "Do not Resuscitate" justified?
What are the causes of unconsciousness?
What is the difference between being asleep and being unconscious?
Is there a difference between unconsciousness and cardiopulmonary arrest?
What is the difference between unconsciousness and cardio pulmonary arrest?

What problems, complaints, incidents, and issues need on-the-spot diagnosis and treatment?
  1. Unconsciousness at a public location.
  2. Sudden unconsciousness at home.
  3. Trauma

  4. Burns

  5. Drowning

  6. Seizures

  7. Survival Needs
Glasgow Coma scale analysis.

Glasgow Coma scale analysis.
First, analyze Glasgow Coma scale, then analyze vital signs including consciousness.

When was the patient normal?
Can the patient open both eyes spontaneously?
Can the patient talk or make noise relevant to age?
Can the patient walk or move extremities relevant to age?

If yes, Glasgow Coma scale is 15.
Glasgow Coma scale of 15 means the patient is not in a coma.
The patient can have less serious medical issues.
Go ahead with vital signs, including consciousness.

When should you do on-the-spot endotracheal intubation?
If Glasgow coma scale is 9 or less with airway obstruction, even with gag reflex, you should intubate the patient. Do you know how to calculate Glasgow coma scale?
How do you intubate a patient in coma with Glasgow coma scale less than 9 with gag reflex in respiratory distress?

When should you start an on-the-spot intravenous line?
If there is blood loss with hypotension.
In case of cardiopulmonary arrest.

Cardiopulmonary resuscitation if required.

The nearest hospital with critical care is 20 minutes by vehicle.
In case of head injury with coma, prolonging diagnosis and treatment for 20 minutes may cause patient to die.

That is what happened in this case.
Patient died even though seen by a neurosurgeon and an anesthetist.

Medical emergency diagnosis and treatment of trauma with coma with respiratory distress, or imbalance in circulation, should happen within 4-6 minutes of occurrence or report of a medical emergency.

Is that clear?
Do you have any questions for me?

Ability to perform calculations: Can the patient perform simple addition, multiplication, subtraction, and division? Are the responses appropriate for the patientís level of education?
Are there any problems in calculations?

Consciousness

Level of alertness: Is the patient conscious?
If not, can the patient be awakened?
Can the patient remain focused on your questions and conversation?
What is attention span of the patient?

In case of altered sensorium, get answers to these questions.

How would you rate Glasgow Coma Scale of this patient in the range of 3ó15, with a score of 3 indicating brain death (the lowest defined level of consciousness), and 15 indicating full consciousness?

Language

How are English language understanding, reading, writing, and speaking abilities of the individual?
The individual can understand, read, write, and speak the English language.
The individual is unable to understand, read, write, and speak the English language.

Assessment by medical emergency specialist in emergency medical situation.

What should be your focus of assessment in an emergency medical situation?
Vital signs, including consciousness.
No pain, wounds, or abnormal findings that needs emergency treatment.
Glasgow coma scale.
Mobility assessment (Is individual able to walk or make limb movements relevant to age?)
Survival needs assessment.
Emotion: Anger, sadness, fear or emotions not relevant to situation need further evaluation

Criteria for discharge from medical emergency room

1. Vital signs including consciousness: Normal
2. Glasgow coma scale: 15.
3. Mobility assessment: Normal.
4. Survival needs assessment: Yes.
5. Emotions: Normal relevant to situation.
6. Psychiatric evaluation if required: Normal

Emergency diagnosis and treatment and disability assessment are two different assessments.
For example, a person can be 100% mentally fit and 95% physically fit.

This is relevant to the individualís age.
1. Vital signs including consciousness: Normal

Are vital signs including consciousness normal?
Yes.

No pain, wounds, or abnormal findings that needs emergency treatment.

2. Glasgow coma scale: 15.

Is Glasgow coma scale 15?
Yes.

3. Mobility assessment

Is individual able to walk or make limb movements relevant to age?
Normal

4. Survival needs assessment.

Does the individual have survival needs form the state?
Yes.

Is it safe for the individual at the residence?

5. Emotions: Anger, sadness, fear, or emotions not relevant to situation needs further evaluation. Normal.

Are emotions expression normal relevant to situation?

6. Psychiatric evaluation if required.

Is this individual mentally fit relevant to age?

Advice on discharge from medical emergency room.
This depends on original complaint and diagnosis with relevant treatment.
Treatment depends on the underlying cause.

What best describes the individualís emotions at this point?

Basic life support

What should you know about basic life support?
Basic life support is meant for an unconscious patient.
All unconscious patients need basic life support.
Not all unconscious patients need cardiopulmonary resuscitation (breathing support, chest compressions). Only unconscious patients with cardiac arrest or respiratory arrest need cardiopulmonary resuscitation including breathing support and chest compressions).

Does the unconscious patient need basic life support with CPR or without CPR?

If the unconscious patient needs basic life support with cardiopulmonary resuscitation with chest compressions here are further guidelines.
Cardiopulmonary resuscitation guidelines.

Unconscious patient.

What type of patient needs basic life support?
An unconscious patient.

Do all unconscious patients need cardiopulmonary resuscitation?
No.

How should you evaluate and treat an unconscious patient?
Assessment is very important.
Not all unconscious patients need cardiopulmonary resuscitation.
For adults, assess the victim, activate EMS and get AED, check pulse, start CPR.

When do you start cardiopulmonary resuscitation in adults?
CPR is required someone's breathing or heartbeat has stopped, as in cases of electric shock, drowning, or heart attack. CPR is a lifesaving procedure in this situation.

What is cardiopulmonary resuscitation?
Cardiopulmonary resuscitation is a combination of rescue breathing and chest compressions.
Rescue breathing provides oxygen to a person's lungs.
Chest compressions keep the person's blood circulating.
Permanent brain damage or death can occur within minutes if a person's blood flow stops. Therefore, you must continue these procedures until the person's heartbeat and breathing return, or trained medical help arrives.

In what situations is a directive like "Do not Resuscitate" justified?
Old age more than 95 years with known complications.

What is unconsciousness?
Unconsciousness means being unable to see, hear, and talk.
Often, this is called a coma or being in a comatose condition.
An unconsciousness person will be unresponsive to activity, touch, sound, or other stimulation.
He or she will not be able to communicate and wonít respond to stimulation.

Conscious means able to see, hear, and talk.
In pediatric patients younger than six months of age, the ability to make any verbal noise or cry is equivalent to talking.

A person may be unconscious for a few seconds (as is the case with fainting) or for longer periods of time.

What are the causes of unconsciousness?
Alcohol use.
Drowning.
Electric shock
Substance abuse
Severe blood loss
8 H's and 6 T's: mnemonic for mechanisms
Hypoxia
Hypovolemia
Hyperkalemia
Hypokalemia
Hypoglycemia
Hypothermia
Hyperthermia (heat stroke)
Hydrogen ions (acidosis)
Thrombosis (MI/heart attack)
Tension pneumothorax
Tamponade
Toxins/therapeutics
Thromboembolism
Trauma

What is the difference between being asleep and being unconscious?
Being asleep is not the same thing as being unconscious.
A sleeping person will respond to loud noises or gentle shaking; an unconscious person will not.

An unconscious person cannot cough or clear his or her throat. This can lead to death if the airway becomes blocked.

Is there a difference between unconsciousness and cardiopulmonary arrest?
Yes.

What is the difference between unconsciousness and cardio pulmonary arrest?
Unconsciousness is usually without cardiac arrest.
If unconsciousness is associated with cardiac arrest or respiratory arrest, cardiopulmonary resuscitation is required.

http://www.qureshiuniversity.com/comadiagnosis.html

How does one diagnose and treat an unconscious patient?

Eye Opening

Can the patient do spontaneous eye opening?
Is the patient capable of opening eyes to speech, to stimulus, to pain not applied to face, breast, genitals or not opening his/her eyes?

Spontaneous eye opening ? 4 points
Opens to verbal command, speech, or shout ? 3 points
Opens to pain, not applied to face ? 2 points
None ? 1 point

Verbal Response

Oriented ? 5 points

Is patient confused?
Confused conversation, but able to answer questions ? 4 points

Is patient making inappropriate responses?
Inappropriate responses, words discernible ? 3 points

Can patient make any incomprehensible spoken sounds or no spoken sounds?
Incomprehensible speech ? 2 points
None ? 1 point

Motor Response

Can patient move all extremities when instructed?
Obeys commands for movement ? 6 points

Can patient do purposeful movement to painful stimulus?
Purposeful movement to painful stimulus ? 5 points

Can patient withdraw from painful stimulus?
Withdraws from pain ? 4 points

Is there any spasticity or rigidity?
Abnormal (spastic) flexion, decorticate posture ? 3 points
Extensor (rigid) response, decerebrate posture ? 2 points
Is there any movement of extremities?
None ? 1 point

Did the coma start abruptly or gradually?
Were there problems with vision, dizziness, or numbness beforehand?
What is the Glasgow Coma Scale?
How is the Glasgow Coma Scale helpful?
Can a patient's diagnosis and treatment be done without the Glasgow Coma Scale?
How do you define coma?
What is the mathematical value of coma?
Is evaluation of coma in adults different than in children?
Here are further guidelines.
Critical Care
Medical emergencies.

What is on-the-spot diagnosis and treatment?

This example will make you understand.
On November 30, 2012, Aswell Salmon, 46 years old, was shot at 9:27 p.m. near the 5000 block of North Winthrop Avenue, Chicago, Illinois.
He died more than 30 minutes later.
This needed on-the-spot diagnosis and treatment within five minutes of the incident.
Transfer to a hospital was required after on-the-spot diagnosis and treatment.

Was this death preventable?
Yes.

What is the cause of death in this scenario?
Criminal conspiracy.
Criminal Violence.
Delayed Diagnosis.
Wrong Diagnosis.
Wrong Treatment.
Trauma due to shooting.
Gunshot wounds at three sites of the body (leg, buttocks, and chest).
Witnesses report that patient was alive 30 minutes after the shooting.

What is the original spot of the medical emergency?

The location where the incident occurs is the original spot of the medical emergency. Certain problems, complaints, incidents, and issues need on-the-spot diagnosis and treatment.

All medical emergencies on the spot, including trauma, must be attended by a medical doctor.

Experience has shown that police and military officers are the first to get updates about trauma, and then health care professionals, including medical doctors, are updated.

Because police or military officers are the first to be updated about trauma, if they have medical doctorsí skills and knowledge of on-the-spot diagnosis and treatment, this is going to prevent various premature or unexpected deaths.

Recovery from a medical condition
What is recovery from a medical condition?

The process of returning to normal activity after an illness or injury.

What can be the location of recovery from a medical condition?

ER, ICU, ward, rehabilitation facility, or at home, depending on the severity of the medical condition.

When can a patient recover from medical condition at home?

If consciousness, pulse, blood pressure, temperature, respiratory rate, behavior, and mobility relevant to age are normal without any acute external or internal injury, and proper survival and civilized conditions exist at home, the patient can recover from the medical condition at home.

Internet health care/home/home office or OPD

How many medical conditions can get health care via Internet health care/home/home office or OPD?

More than 6,000 medical conditions.

Here are further guidelines.