Alexander ch28 lecture

Copyright © 2017, 2012 Pearson Education, Inc. All Rights Reserved.
Advanced EMT
A Clinical-Reasoning Approach, 2nd Edition
Chapter 28
Infectious Illnesses

• Applies fundamental knowledge to provide basic
and selected advanced emergency care and
transportation based on assessment findings for
an acutely ill patient.
Advanced EMT
Education Standard

Objectives (1 of 3)
1. Define key terms introduced in this chapter.
2. Describe the body’s defenses against infectious
illnesses.
3. Explain the actions that health care providers must
take to prevent the spread of communicable illnesses
to themselves and others.
4. Describe the routes of transmission of infectious
illnesses.
5. Discuss what constitutes a significant exposure to a
communicable illness.

Objectives (2 of 3)
6. Describe the general stages of infectious illnesses.
7. Identify the general signs and symptoms of infectious
illnesses.
8. Describe the nature of the agents of infectious illnesses,
including bacteria, viruses, fungi, helminths, protozoa,
and external parasites.
9. Discuss the causative agents, pathophysiology, routes of
transmission, methods of prevention, and management
of specific infectious diseases discussed in the chapter.

10.Discuss the significance and prevention of nosocomial
infections and antibiotic-resistant infections.
11.Given various scenarios involving known or suspected
infectious disease, obtain relevant history and
assessment information, formulate and implement an
appropriate treatment plan, and take precautions to
prevent disease transmission.
12.Access definitive sources of up-to-date information on
infectious diseases.
Objectives (3 of 3)

• Infectious illnesses are caused by living
organisms that invade the body.
• Including
– Bacteria
– Viruses
– Fungi
– Parasites
Introduction (1 of 2)

• Pathogens
– Disease-producing organisms
• Mild illness can be life threatening in patients who
are immunocompromised.
• Many hospital-acquired infections are antibiotic-
resistant and thus difficult to treat.
• Recognize signs and symptoms of infection and
specific infectious diseases.
Introduction (2 of 2)

Think About It
• What are possible causes of a rash that fits this
description?
• What significance is there in all four children
having the same rash?
• What Standard Precautions would be appropriate
in this situation?
• What other signs and symptoms should James
and Marti look for?

Anatomy and Physiology Review (1 of 2)
• Skin and mucous membranes
– Barrier between external and internal environment
of body
• Body fluids
– Contain antimicrobial substances
• White blood cells
– Recognize foreign material; defend body against it
• Inflammation and fever
– Responses that fight infectious disease

Anatomy and Physiology Review (2 of 2)
• Passive immunity
– Natural passive
– Acquired passive
• Active immunity
– Natural active
– Induced active

Infection and Disease Transmission
(1 of 7)
• Pathogens introduced to body through
– Injured skin
– Mucous membranes
– Respiratory, digestive, urinary, reproductive tracts

(2 of 7)
• Body exposed to pathogens from
– Food
– Water
– Soil
– Surfaces
– Insects
– Animals
– Other people

(3 of 7)
• Communicable disease
– Infectious illness transmitted from one person to
another, either directly or indirectly
• Direct transmission
– Infected person in contact with, or close proximity to,
another person
• Indirect transmission
– Infected person contaminates fomite that another
person comes in contact
– When there is vector contact

(4 of 7)
• Infectious illnesses classified by routes of entry
and exit from body
• Routes of transmission
– Direct contact
– Airborne
– Sexually transmitted
– Bloodborne
– Gastrointestinal system

(5 of 7)
• Once pathogen gains access to body, it must
multiply, or colonize.
• Course of infection can take different routes.
– Asymptomatic:
 No signs or symptoms
– May never become apparent
– May proceed to symptomatic illness

(6 of 7)
• Incubation period
• Latent
• Window phase
• Disease period
• Bacteria
• Virus
• Fungi
• Protozoa

(7 of 7)
• Infection control
– Standard precautions
– Hand washing
– Cleaning and disinfecting equipment and
work environment
– Immunizations
– Maintaining general good health
– If exposed to infectious illness, follow your
employer’s policy.
– You have an obligation to protect patients from
exposure to infectious diseases.

General Assessment and Management
(1 of 8)
• Scene size-up
– Certain environments associated with increased risk for
infectious disease
– Chief complaints:
 Fever, cough, nausea, vomiting, diarrhea, muscle aches,
fatigue, malaise, runny nose, rash, headache, pain, swelling,
stiff neck

Table 28-1 (1 of 3)
Signs and Symptoms of Infectious Illness
General Signs and Symptoms
• Fatigue
• Malaise
• Headache
• Muscle or joint pain
• Fever
• Chills
• Swollen lymph nodes
• Nausea
• Vomiting
• Rash

Table 28-1 (2 of 3)
Signs and Symptoms of Respiratory Illness
• Nasal congestion
• Burning eyes, eye irritation
• Nasal discharge (rhinorrhea)
• Earache
• Sore throat
• Cough, productive or nonproductive
• Wheezing, rhonchi, crackles (rales)
• Respiratory distress
• Stridor
• Drooling
• Difficult or painful swallowing
• Hoarseness
• Signs of hypoxia, decreased SpO2
• Tachypnea
• Altered mental status

Table 28-1 (3 of 3)
Signs and Symptoms of Hepatitis
• Upper right quadrant tenderness
• Jaundice
• Dark urine
• Clay-colored stools
• Anorexia
Signs and Symptoms of Meningitis
• Stiff neck
• Photophobia
• Possible altered mental status
• Possible purpura

(2 of 8)
• Primary assessment
– Assess pulse.
 Begin CPR and apply AED if pulseless.
– If infectious illness suspected
 Use appropriate respiratory protection for airway and
ventilation procedures.
– Listen for stridor, observe for tripod positioning, note
any drooling.

(3 of 8)
• Primary assessment (continued)
– Use manual maneuvers and basic adjuncts, if
necessary, to establish and maintain airway.
– If unresponsive, consider advanced airway.
– Respiratory distress can occur in childhood respiratory
illnesses, pneumonia, bronchitis.

(4 of 8)
• Primary assessment (continued)
– Observe for
 Fatigue, tachypnea, accessory muscle use, wheezing,
coughing, diaphoresis, cyanosis
– Apply oxygen and assist ventilations as needed.
– Tachycardia is an indication of fever, dehydration, and
shock.
– If signs of shock, consider fluid replacement.

(5 of 8)
• Secondary assessment
– Rapid medical assessment for critical patients
– Focused secondary assessment for noncritical patients
– Obtain SAMPLE history.
– Obtain SpO2 and baseline vital signs.
– Check blood glucose level in diabetics and patients
with altered mental status.

(6 of 8)
• Clinical-reasoning process
– Adapt assessment and history to patient’s complaint,
presentation, emerging information from assessment
and history.
– Test hypotheses; determine whether infectious disease
will be among differential diagnoses.
– Recognize if infectious disease is possibility and what
body systems affected.

(7 of 8)
• Treatment
– Depends on patient’s complaints and problems rather
than specific diagnosis
– Consider need for bronchodilators, intravenous fluids,
temperature regulation.
– For high fever, follow protocols for medication
administration.
– Patients with sepsis may be hypothermic.

(8 of 8)
• Reassessment
– Critical patients: every 5 minutes or sooner
– Noncritical patients: every 15 minutes or more often
as needed
– Patient’s vital signs, SpO2, complaints, relevant
aspects of assessment, effects of interventions

Bloodborne Infections (1 of 4)
• Spread through contact between blood or body
fluids and nonintact skin or mucous membranes
– Always take Standard Precautions.
– Carefully handle sharps.
– Hand washing and disinfecting contaminated surfaces
minimize risk of bloodborne infections.

• HIV/AIDS
– Human immunodeficiency virus (HIV) infects T
lymphocytes.
– Virus uses cell to replicate itself.
– Results in immune suppression: acquired
immunodeficiency syndrome (AIDS).
– HIV mutates frequently so immune system cannot
recognize and destroy it.

Figure 28-1
Kaposi’s sarcoma. (© Science Source)

• HIV/AIDS
– Prone to numerous infections and cancers and CNS
eventually affected
– Signs and symptoms:
 Fever, night sweats, lymphadenopathy, unexplained
weight loss
– Any infection in patient with HIV/AIDS is more serious
because of immune compromise.
 Pneumonias, tuberculosis, and Kaposi’s sarcoma are seen in
patients with HIV/AIDS.

• Hepatitis
– Types A and E spread through fecal–oral route,
including contaminated food.
– Types B, C, D, G spread through blood; body fluids;
and shared drug, acupuncture, and tattoo needles.
 Flu-like symptoms, headache, fever, joint pain, malaise,
nausea, vomiting, loss of appetite

Respiratory Infections (1 of 7)
• Mild to lethal, depending on infectious agent and
patient’s underlying health
• Types of infections
– Pneumonia
– Influenza
– Respiratory syncytial virus (RSV)
– Bronchitis

• Types of infections (continued)
– Croup
– Tuberculosis
– Sudden acute respiratory syndrome (SARS)
– Upper respiratory infections

• Tuberculosis (TB)
– Spread through respiratory droplets
– Manifests as respiratory disease; can affect many
different parts of body.
– Higher rate among patients with HIV/AIDS
 Fever, chills, night sweats, fatigue, chronic cough,and
hemoptysis

• Pneumonia
– Many different infectious agents cause pneumonia
(viruses, fungi, strains of bacteria).
– Risk is increased in smokers, elderly, chronic illnesses,
immunocompromised patients.
– Sudden onset of high fever with chills, difficulty
breathing, pleuritic chest pain, cough
– Often localized to one lobe of lung

• Influenza, colds, pharyngitis, bronchitis
– Cold
 Caused by rhinoviruses and coronaviruses
– Pharyngitis
 Inflammation of pharynx (sore throat)
– Acute bronchitis
 Inflammation of bronchi

• Influenza, colds, pharyngitis, bronchitis (continued)
– Influenza (flu): infection with one of several influenza
viruses through airborne route
 Highly contagious; significant mortality rate from complications
 Sudden onset of fever (chills), sore throat, muscle aches,
headaches, cough, weakness, fatigue
 Complications: dehydration, pneumonia, encephalitis

• SARS
– Coronavirus infection that causes acute pneumonia-
like illness
• Pertussis (whooping cough)
– Serious, sometimes fatal disease that causes coughing
fits and characteristic “whooping” sound

Infections of Regional Concern
• Bubonic plague and hantavirus (carried by
rodents) occasionally occur in U.S. Southwest.
• Domestic arboviruses (transmitted to humans by
insects) cause of infectious encephalitis.

Childhood Illnesses (1 of 3)
• Croup: viral illness causes inflammation of airways
(laryngotracheobronchitis)
– Characteristic “seal bark” cough
– Can lead to respiratory distress and airway obstruction
in severe cases
– Humidified oxygen prevents drying, irritation, and
further swelling of airway.

• Epiglottitis
– Rare bacterial infection causes swelling of epiglottis
– Vaccine available
– Request ALS for patients with suspected epiglottitis;
transport without delay to appropriate emergency
department.

Figure 28-3
Chickenpox lesions. (Dr. P. Marazzi/Science Source)

• Mumps, measles, rubella, chickenpox
– Vaccines available
– Mumps
 Viral infection that affects glandular tissue
– Measles and rubella
 Viral illnesses that cause fever and rash
– Chickenpox (varicella)
 Viral disease in herpes family; general malaise and itchy,
fluid-filled blisters on skin that later crust and scab

Meningitis and Encephalitis (1 of 2)
• Meningitis
– Inflammation and swelling of meninges that surround
the central nervous system
• Viral or bacterial
– Bacterial transmitted through contact with nasal and
oral secretions
 Fever, headache, photophobia, and stiff neck

Meningitis and Encephalitis (2 of 2)
• Encephalitis is the inflammation of brain tissue.
– Signs and symptoms are similar to those of meningitis.
– Common causes
 West Nile virus
 St. Louis encephalitis
 Eastern equine encephalitis
 Herpesvirus
 Toxoplasmosis

Other Vectorborne Illnesses (1 of 3)
• Lyme disease, tularemia, and Rocky Mountain
spotted fever are tickborne illnesses.
– Rocky Mountain spotted fever is the most severe.

• Rabies is very rare, but fatal, in humans.
– Contracted through contact with saliva of infected
animals
– Animal rabies is common in bats, raccoons, skunks,
coyotes, and foxes.
– Viral disease that attacks CNS

• Tularemia is identified as a potential weapon of
bioterrorism—highly infectious and significant
morbidity.
• Infection is fatal if not treated.

Think About It
• General signs and symptoms of infectious illness.
May develop skin ulcers, sore throat, mouth sores,
eye inflammation, a dry cough, weakness, and
pneumonia with bloody sputum and respiratory
failure.

• Gastrointestinal infections
– Caused by foodborne or waterborne pathogens or
through oral–fecal route of transmission
– Causes: salmonella, E. coli, norovirus, staphylococcal
bacteria
– Signs and symptoms: abdominal cramping, nausea,
vomiting, diarrhea, sometimes fever
Gastrointestinal Infections
and Botulism

• Botulism
– Bacterium that produces neurotoxin
– Found in low-acidity canned foods that are improperly
processed
– Causes paralysis by blocking release of acetylcholine
in motor neurons
– Not common
Gastrointestinal Infections
and Botulism

Mononucleosis and Herpes (1 of 2)
• Mononucleosis
– Viral infection causes fever and fatigue
– Affects upper respiratory system (sore throat, swollen
tonsils, enlarged painful lymph nodes)

Mononucleosis and Herpes (2 of 2)
• Herpes simplex viruses
– Affect mucous membranes and skin
– Infection results in blisters that ulcerate
– Virus remains dormant between outbreaks; does not
go away.

• Scabies, lice, ringworm present with intense
itching and skin lesions
• Both scabies and lice external parasites
• Scabies caused by mite that burrows under skin
and lays eggs
– Causes rash with intense itching
– Transmitted through direct skin-to-skin contact with
infected person
External Parasites and Skin Infections
(1 of 4)

• Lice: tiny insects that infest body, using hair shafts
to deposit eggs (nits)
– Infestation with lice: pediculosis
– Head, pubic, body lice
– Spread by close contact with infected persons
(2 of 4)

(3 of 4)
• Ringworm (tinea corporis): not worm at all but
fungus that results in itching, circular lesions
on skin
– Spread through direct contact with infected person,
contaminated soil, infected pet
• Impetigo: caused by streptococcal or
staphylococcal bacteria

(4 of 4)
• Boils
– Painful abscesses result from infection of hair follicles
or oil glands
– Cluster of boils: carbuncle
– Cause: Staphylococcus
• MRSA (methicillin-resistant Staphylococcus
aureus)
– Resistant to antibiotics used to treat staphylococcal
infections
– Affects skin

• Signs and symptoms
– Affect genitals
– Can infect other structures
– Have systemic effects.
• Avoid contact with skin lesions and discharge.
• Wash hands after contact.
Sexually Transmitted Infections (1 of 4)

• Gonorrhea
– Bacterial infection that causes painful urination and
purulent urethral discharge in men; asymptomatic in
women
• Syphilis
– Bacterial infection transmitted sexually; can be
transmitted through contact with lesions
– Untreated infected women can pass infection to fetus:
congenital syphilis.

Table 28-2
Stages of Syphilis
Stage Description
Primary syphilis Approximately three to six weeks after exposure, a painless lesion called a
chancre occurs at the site of exposure. The regional lymph nodes may be
enlarged.
Secondary syphilis Five to six weeks after the chancre heals, the patient may develop a rash
on the palms of the hands or soles of the feet; a rash in warm, moist areas;
and loss of hair in affected areas. The eyes, kidneys, or central nervous
system can be affected.
Latent syphilis Signs and symptoms disappear for a period of time that can last for months
to years. During this time, secondary-stage
symptoms can reappear. One third of cases develop tertiary syphilis.
Tertiary syphilis Patient can develop painful lesions of the skin and bones. Cardiovascular
infection can lead to aortic aneurysm. Appearance of neurologic signs and
symptoms indicates neurosyphilis, which can include progressive
dementia.

• Genital warts
– Fleshy growths caused by HPV; certain types
associated with cervical cancer in women
– Vaccine available

• Chlamydia
– Caused by organism that has characteristics of
bacteria but lives within cells
– Can affect eyes and respiratory system
– Spread through secretions and sexual contact

Chapter Summary (1 of 4)
• Recognizing signs and symptoms of infectious
illnesses guides history taking, assessment, and
decisions about protecting yourself and others
from exposure to infectious disease.
• General signs and symptoms of infection: malaise,
fever, chills, muscle or joint pain, swollen lymph
nodes.

• Recognizing signs and symptoms of specific
infectious illnesses allows you to anticipate
complications and risks of those diseases.
• Cough, stridor, drooling, sore throat, nasal
congestion, adventitious lung sounds are
indications of respiratory infection.
• Assess for hypoxia; ensure adequate airway,
breathing, ventilation.

• Rashes common in many illnesses; some have
characteristic rashes that can assist in differential
diagnosis.
• Nausea, vomiting, diarrhea common with
gastrointestinal illnesses.
– Prone to dehydration; consider IV fluids.

• Vaccination and good health reduce risks of
contracting infectious illness through work.
• Using Standard Precautions and communicating
with other health care providers reduce risk of
contracting infectious illness, risk to other health
care providers, risk to patients for nosocomial
infection.

Alexander ch28 lecture

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