EMS Equipment - Shock Pants

EMS providers should be aware of the following key points regarding Military Anti-Shock Trousers (MAST) and Pneumatic Anti-Shock Garment (PASG):

1. Purpose: MAST and PASG are devices used to manage hemorrhagic shock and hypovolemia. They help stabilize patients by applying external pressure to the lower extremities, which helps redirect blood to vital organs and increase blood pressure.

2. Mechanism of Action: MAST and PASG apply circumferential pressure to the legs and lower abdomen. This pressure compresses the blood vessels, reducing blood pooling in the lower extremities and promoting blood flow back to the heart and brain.

3. Application: MAST consists of a pair of inflatable trousers, while PASG is a single-piece garment that wraps around the patient's lower body. They are typically applied to patients with suspected or confirmed hemorrhagic shock or hypovolemia. The garments are inflated using a manual or automatic pump until a specific pressure is achieved.

4. Considerations: EMS providers should be cautious when applying MAST or PASG, as these devices may have contraindications and potential complications. It is essential to follow proper application techniques and adjust the pressure according to the patient's condition and vital signs. Regular reassessment of the patient is crucial to ensure adequate perfusion.

5. Limitations: MAST and PASG are considered adjuncts to other resuscitative measures and should not replace definitive interventions or delay transportation to a medical facility. They are not suitable for patients with certain injuries or conditions, such as fractures, burns, or abdominal trauma.

6. Training and Familiarity: EMS providers should receive appropriate training on the correct application, monitoring, and potential complications associated with MAST and PASG. Familiarity with local protocols and guidelines is crucial for safe and effective use.

Remember, the use of MAST or PASG should be based on specific protocols, medical direction, and individual patient assessment. Always consult local guidelines and medical control when considering the use of these devices.

Additional Reading:

https://www.ncbi.nlm.nih.gov/books/NBK534783/

https://www.hmpgloballearningnetwork.com/site/emsworld/article/10325078/ems-myth-1-medical-anti-shock-trousers-mast-autotransfuse-significant-amount-blood-and-save-lives

EMS Pharmacology - Aspirin (Acetylsalicylic Acid)

EMS Providers should have knowledge of aspirin administration including, amongst other things, its mechanism of action, the effect, and contraindications 

Here are key points to know:

Indications: Aspirin is commonly used in emergency situations to treat suspected heart attacks (myocardial infarctions). It helps prevent blood clot formation and reduces the risk of further cardiac damage.

Mechanism of Action (MOA): Acetylsalicylic acid is an antiplatelet agent. It works by inhibiting the activity of an enzyme called cyclooxygenase (COX). COX is involved in the production of prostaglandins, which play a role in platelet aggregation (clumping) and vasoconstriction.

Effect: By inhibiting COX, aspirin reduces the formation of thromboxane A2, a substance that promotes platelet aggregation and vasoconstriction. As a result, aspirin makes platelets less sticky and less likely to form blood clots. It primarily affects platelet function and is often used to prevent arterial thrombosis, such as in cases of myocardial infarction (heart attack) or stroke.

Dosage: The recommended dosage of acetylsalicylic acid for suspected heart attacks is typically 4 x 81 mg ‘baby aspirin’. EMTs should follow local protocols and medical direction regarding the specific dosage and formulation used.

Route: Aspirin is usually administered orally, which means EMTs may give the patient chewable or crushed aspirin tablets to be swallowed. It is important to ensure the patient can safely swallow the medication and has no contraindications.

Contraindications: EMTs should be aware of contraindications for aspirin administration, such as a known allergy to aspirin, active bleeding, or a history of gastrointestinal bleeding or ulcers. 

If the patient has any contraindications, aspirin should not be administered, and medical direction should be sought.

Documentation: EMS Providers should document the administration of aspirin, including the dosage, time, and the patient's response. Accurate documentation helps ensure continuity of care and provides important information to healthcare providers, including whether the patient has already taken aspirin.

Communication: EMTs should inform receiving healthcare providers about the administration of aspirin, including the dosage and timing. This helps ensure appropriate follow-up care and treatment continuation.

Remember, EMS Providers should always adhere to their local protocols and receive proper training on aspirin administration. They should work under medical direction and consult with a physician or follow local guidelines when administering aspirin to patients.

EMS Neurological Emergencies - Different Strokes

EMS providers play a crucial role in recognizing and assessing stroke patients. Here's what they need to know about ischemic and hemorrhagic strokes, as well as transient ischemic attacks (TIAs):

1. Ischemic Stroke: It occurs when a blood clot blocks a blood vessel in the brain, leading to reduced blood flow and oxygen supply. EMS providers should be aware of common symptoms like sudden weakness or numbness on one side of the body, difficulty speaking or understanding, and facial drooping.

2. Hemorrhagic Stroke: This type of stroke happens when a blood vessel bursts, causing bleeding into the brain. EMS providers should look for signs such as a severe headache, vomiting, altered consciousness, and neck stiffness. Rapid recognition and transport to a specialized stroke center are critical.

3. Transient Ischemic Attack (TIA): Often referred to as a "mini-stroke," a TIA is caused by a temporary disruption of blood flow to the brain. Symptoms are similar to an ischemic stroke but usually resolve within 24 hours. EMS providers should consider TIAs as warning signs of a future stroke and ensure prompt medical evaluation.

To recognize the difference between these conditions, EMS providers should assess the patient's symptoms, their medical history, and conduct a thorough neurological examination. They should also obtain a detailed timeline of symptom onset and duration. It's important to remember that differentiating stroke types accurately is challenging in the prehospital setting, and prompt transport to a stroke center is crucial regardless of the stroke type suspected.

EMS providers should follow established stroke protocols, initiate appropriate interventions, provide supportive care, and communicate with the receiving hospital to facilitate optimal stroke management. Regular training and staying updated on the latest guidelines will enhance their ability to recognize and assess stroke patients effectively. 

EMS Mnemonics - BE FAST

EMS providers should be familiar with the BE FAST mnemonic as it relates to stroke recognition and assessment. BE FAST helps us identify common stroke symptoms and prompt appropriate action.

Here's what EMS providers need to know:

B - Balance: Check if the person has a sudden loss of balance or coordination. Watch for stumbling, difficulty walking, or a sudden onset of dizziness.

E - Eyes: Look for sudden vision changes, such as blurred or double vision, or vision loss in one or both eyes. Ask the person if they are experiencing any visual disturbances.

F - Face: Ask the person to smile and check for facial drooping or asymmetry. A lopsided smile or drooping on one side of the face is a potential sign of a stroke.

A - Arms: Have the person raise both arms and observe if one arm drifts downward or cannot be held up. Weakness or numbness in one arm or hand is indicative of a stroke.

S - Speech: Listen for slurred or garbled speech. Ask the person to repeat a simple phrase and watch for difficulty speaking or understanding. Incoherent or abnormal speech may suggest a stroke.

T - Time: Time is critical in stroke cases. If any of the above symptoms are present, please note when they started. The sooner the person receives medical attention, the better their chances of receiving appropriate treatment.

By using the BE FAST mnemonic, EMS providers can quickly assess stroke symptoms and initiate appropriate care. It's important to remember that this is a screening tool and not a definitive diagnosis. Timely transportation to a stroke center is crucial for further evaluation and treatment.

EMS Discussion - Speaking of Death

Thanatology is the study of death, dying, and bereavement. While it may not be a primary focus for EMS providers, having a basic understanding of thanatology can be valuable in their line of work. Here are a few key points for EMS providers to know:

1. Cultural Sensitivity: Different cultures have diverse beliefs and practices surrounding death and dying. Being sensitive to these cultural differences can help EMS providers provide appropriate care and support to patients and their families.

2. Grief & Bereavement: Understanding the grieving process can enable EMS providers to provide compassionate care to individuals who have experienced a loss. Recognizing common grief reactions and offering empathy can make a significant difference during difficult times.

3. Communication: Effective communication is crucial when dealing with end-of-life situations. Developing good communication skills can help EMS providers navigate sensitive conversations with patients, families, and other healthcare professionals involved in end-of-life care.

4. Palliative & Hospice Care: Familiarity with the principles of palliative and hospice care can enhance an EMS provider's ability to provide comfort and pain management to patients with life-limiting illnesses. Collaborating with palliative care teams and understanding the goals of care can improve the overall patient experience.

5. Ethical Considerations: EMS providers may encounter situations where difficult decisions need to be made, such as withholding or withdrawing life-sustaining treatments. Understanding the ethical principles involved and having knowledge of advance directives and legal frameworks can guide decision-making processes.

While thanatology may not be a primary focus in EMS training, having a basic understanding of these aspects can contribute to providing more holistic and compassionate care to patients and their families during end-of-life situations.

Additional Reading:

https://limmereducation.com/article/death-and-dying-ems/

EMS Operations - Landing Zones

EMS providers play a crucial role in facilitating helicopter operations and setting up landing zones for patient transport.

Here are key points they need to know:

Landing Zone Criteria:

- The landing zone should be a minimum of 100’x100', suitable for both day and night operations.

- Ensure the site is free of obstacles, hazards, and debris.

- Opt for a firm surface and avoid slopes greater than five degrees whenever possible.

- Soft sand or dirt landing sites should be avoided, but can be wet down as a last resort.

Obstruction Assessment:

- Conduct a thorough survey of the landing site to identify overhead power lines, telephone wires, antennas, buildings, or tall trees.

- Attempt to remove or limit any obstructions from the landing location.

- If obstructions cannot be removed, inform the flight crew, and be prepared to find an alternative location if necessary.

Marking the Landing Zone:

- Mark the landing zone using weighted cones or position emergency vehicles at the corners, with headlights facing inward to form an X.

- Clearly visible markings help pilots identify the designated landing area, especially during low-light conditions.

Weather Considerations:

- Inform the flight crew of wind direction and speed, particularly if strong winds exist.

- Weather conditions can impact helicopter operations, and pilots need this information to make informed decisions.

Safety Buffer:

- Ensure all nonessential personnel, bystanders, and vehicles are at least 200 feet away from the landing zone.

- This safety buffer protects individuals from potential hazards associated with helicopter operations.

Personal Protective Equipment (PPE):

- Responders operating near the landing zone should wear appropriate PPE, including helmets with chin straps, ear protection, and face shields or other eye protection.

- Be prepared for high wind and noise associated with helicopter take-offs and landings.

Communication:

- Maintain effective communication with the flight crew before, during, and after the landing.

- Be prepared to provide updated information about the landing zone, weather conditions, and any changes in the situation.

- By adhering to these guidelines, EMS providers can contribute to the safe and efficient operation of helicopter transports, ensuring the well-being of both the patient and the emergency response team.

https://www.lifeflight.cc/site_pages/landing_zone.html

EMS Trauma Tuesdays - Amputations

EMS providers should have a basic understanding of amputations and how to treat them.

Here are some key points to consider:

1. Scene Safety: Ensure the scene is safe for both the patient and responders before approaching an amputation.

2. Control Bleeding: Apply direct pressure to the wound using a sterile dressing or clean cloth. If bleeding is severe, use a tourniquet proximal to the injury site.

3. Preserve the Amputated Part: If the amputated part is available, handle it with care. Wrap it in a sterile, moist gauze or plastic bag, place it in a sealed container, and keep it cool without freezing.

4. Airway and Breathing: Assess the patient's airway, breathing, and circulation. Provide appropriate support as needed.

5. Stabilize the Patient: Immobilize the patient and the injured limb to prevent further injury during transportation. Use splints or bandages to secure the amputated part separately, if available.

6. Pain Management: Administer appropriate pain relief measures, such as analgesics, according to your protocols and the patient's condition.

7. Transport: Arrange for immediate transportation to a facility equipped to manage amputations and traumatic injuries.

Remember, these are general guidelines, and the specific protocols and procedures may vary based on your local EMS system and medical direction.

It is crucial to consult your organization's guidelines and receive proper training on amputation management.

EMS Mnemonics - SAMPLE

The SAMPLE mnemonic is a useful tool for EMS Providers to gather important information during the initial assessment of a patient.

It helps ensure a systematic and thorough evaluation of the patient's condition.

Here's what EMS Providers need to know about the SAMPLE mnemonic:

Signs and Symptoms: This refers to the physical signs and symptoms the patient is experiencing. EMS providers should assess the patient's complaints, such as pain, shortness of breath, or dizziness. It's essential to listen carefully to the patient's description of their symptoms and note any obvious signs of distress.

Allergies: Determine if the patient has any known allergies, especially to medications or substances. Allergies are crucial to know because administering a medication or treatment that a patient is allergic to can have serious consequences.

Medications: Find out what medications the patient is currently taking. This includes prescription medications, over-the-counter drugs, and any herbal or dietary supplements. Knowing the patient's medications can help avoid potential drug interactions and guide treatment decisions.

Past Medical History: Ask about the patient's past medical history, including chronic conditions, surgeries, and significant illnesses. Understanding the patient's medical history can provide insights into their current condition and help in decision-making.

Last Oral Intake: Determine when the patient last ate or drank anything. This information is crucial if the patient requires surgery or sedation because it helps prevent complications related to anesthesia. It's also relevant for patients with certain medical conditions.

Events Leading Up to the Present Illness or Injury: Ask the patient or any available witnesses about the events leading up to the current illness or injury. This can help in understanding the mechanism of injury and identifying any potential contributing factors.

By following the SAMPLE mnemonic, EMS providers can collect vital information that assists in the assessment and management of the patient.

This information is essential for making informed decisions regarding treatment, transport, and communication with medical facilities. Additionally, it contributes to better patient care and safety.

#PatientAssessment #SignsAndSymptoms #Allergies #Medications #PastMedicalHistory #PertinentMedicalHistory #LastOralIntake #EventsLeadingUpTo

EMS Anatomy & Physiology - Curvature of the Spine

 

EMS Providers should have a basic understanding of skeletal issues like kyphosis, lordosis, and scoliosis, as well as related problems, to provide appropriate care for patients.

Here are a few key points:

Identification: EMS providers should be able to identify these skeletal issues through visual observation and patient history.

1. Kyphosis: Kyphosis refers to an excessive forward curvature of the upper spine, leading to a rounded or hunched posture. It can be caused by several factors, including poor posture, osteoporosis, spinal fractures, or certain medical conditions. EMS providers should be aware of the potential for compromised breathing and mobility in patients with severe kyphosis.

2. Lordosis: Lordosis is an excessive inward curvature of the lower spine, commonly known as swayback. It can be caused by various factors such as obesity, pregnancy, muscle imbalances, or certain medical conditions. EMS providers should be cautious of potential back pain and difficulty maintaining a supine position in patients with pronounced lordosis.

3. Scoliosis: Scoliosis is a medical condition characterized by an abnormal sideways curvature of the spine. This condition can manifest in various degrees of severity and is often idiopathic, meaning the cause is unknown. However, it can also result from congenital factors, neuromuscular conditions, or trauma.

Symptoms: Be aware of common symptoms associated with these conditions, such as pain, limited range of motion, and respiratory difficulties, which can occur due to the abnormal spinal curvature.

Assessment: Conduct a thorough physical assessment to evaluate the severity of the condition, including the degree of curvature, associated deformities, and neurological symptoms.

Stabilization: When immobilizing the patient, EMS providers should consider the unique spinal curvature and use appropriate spinal immobilization techniques to ensure patient comfort and safety. This may involve padding and positioning devices to accommodate the curvature.

Transport: Ensure safe and appropriate transport of patients with these conditions. They may require specialized equipment, such as scoop stretchers or vacuum mattresses, to maintain proper spinal alignment.

Communication: Effective communication with the patient is crucial. Ensure the patient is comfortable and aware of the care being provided. Also, obtain a medical history to determine if there are underlying causes or exacerbating factors related to the skeletal issue.

Related Problems: Understand that these skeletal issues can lead to other medical problems. For example, kyphosis and lordosis can cause respiratory issues by reducing lung capacity, so monitor the patient's respiratory status carefully. They might also be at a higher risk of spinal fractures or other spinal cord injuries. Additionally, scoliosis can sometimes be associated with cardiac and pulmonary complications, which should be considered during patient assessment.

Medication and Pain Management: Be aware of any medications the patient is taking, as well as their potential side effects and interactions. Patients with these conditions may require pain management during transport, so be prepared to administer appropriate pain relief under medical direction.

Special Considerations: Individuals with skeletal issues may require special handling, including assistance with transfers, lifting, or moving the patient. Consider the patient's comfort and any potential complications that may arise from moving them.

Collaboration: Work closely with other healthcare providers, including receiving facilities and specialists, to ensure a seamless transition of care and to address any specific needs related to the patient's condition.

Remember that each patient's needs may vary, so adapt your care accordingly. Additionally, staying updated on current guidelines and protocols for spinal immobilization and care of patients with skeletal issues is essential to providing appropriate care in the field.

It is always important to work collaboratively with other healthcare professionals to ensure optimal care for patients with these conditions.

#Kyphosis #Lordosis #Scoliosis #PreHospitalCare #CurvatureOfTheSpine #AnatomyAndPhysiology

EMS Eponymous Condition - Cushing's Triad

Cushing's Triad is named after Dr. Harvey Cushing, an American neurosurgeon who made significant contributions to the field of neurosurgery.

Dr. Cushing described a set of clinical signs and symptoms associated with increased intracranial pressure in his work "Intracranial Tumours: Notes upon a Series of Two Thousand Verified Cases with Surgical Mortality Percentages Pertaining Thereto."

This work was published in 1901, and it was one of the earliest descriptions of the physiological changes associated with intracranial pressure.

Recognizing Cushing's Triad is crucial for EMS Providers, as it is suggestive of a potentially life-threatening situation due to various adverse conditions, including head injuries and brain pathologies. As such, the need for urgent medical intervention is paramount.

Cushing's Triad consists of the following three key signs:

Hypertension (High Blood Pressure):

A significant increase in systolic blood pressure is a common feature of Cushing's Triad. This is a response to the body's attempt to maintain cerebral perfusion (blood flow to the brain) in the face of elevated intracranial pressure.

Bradycardia (Slow Heart Rate):

Cushing's Triad often includes a slow heart rate (bradycardia), particularly as a result of increased ICP. This is a compensatory mechanism intended to decrease the heart's pumping strength, reducing blood flow to the brain and thereby minimizing the risk of further brain damage.

Irregular or Abnormal Respiratory Patterns:

The third component of Cushing's Triad is abnormal breathing patterns, typically characterized by irregular or irregularly deep respirations. This is often referred to as "agonal" or "Cheyne-Stokes" breathing.

These respiratory changes are a response to the brain's attempt to restore oxygen levels and eliminate excess carbon dioxide, which can occur due to impaired blood flow or brainstem compression.

Recognizing Cushing's Triad in a patient is a critical finding for EMS providers, as it may indicate an impending brain herniation, which is a life-threatening condition.

Patients displaying Cushing's Triad should be managed promptly and transported to a specialized facility for further evaluation and potential surgical intervention.

Here are some key points for EMS Providers:

Perform a detailed neurological assessment, including monitoring vital signs, level of consciousness, and pupillary response.

Administer supplemental oxygen to ensure adequate oxygenation.

Maintain cervical spine immobilization to prevent further spinal cord injury, if applicable.

Communicate with the receiving medical facility to ensure they are prepared for the patient's arrival and can provide neurosurgical expertise if necessary.

Avoid hyperventilation, as it may worsen cerebral ischemia.

Cushing's Triad is a critical clinical finding that requires immediate attention and transport to a higher level of care.

EMS providers should follow their local protocols and seek medical direction when managing patients with Cushing's Triad.

#EponymousCondition #CushingsTriad #Hypertension #Bradycardia #IrregularRespirations