Tuesday, November 28, 2023

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/


Sunday, November 26, 2023

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

Friday, November 24, 2023

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.


Wednesday, November 22, 2023

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


Monday, November 20, 2023

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

Saturday, November 18, 2023

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

Thursday, November 16, 2023

EMS Anatomy & Physiology - The Brain



EMS Providers should have a basic understanding of the functions of the cerebrum, cerebellum, and brainstem, as these are the three primary regions of the brain, each with distinct roles.

Here's what EMS providers need to know about the functions of these brain regions:

1. Cerebrum: the largest and most prominent part of the brain, occupying the uppermost portion of the cranial cavity.

Functions:

- Higher Cognitive Functions: The cerebrum is responsible for complex cognitive processes, including thinking, reasoning, problem-solving, and decision-making.

- Sensory Perception: It processes sensory information received from the body's sensory organs, allowing us to perceive the external environment. This includes functions like vision, hearing, taste, and touch.

- Voluntary Motor Control: The cerebrum controls conscious and voluntary movements of the body, allowing us to perform tasks such as walking, talking, and reaching for objects.

- Memory and Emotions: It plays a crucial role in forming and storing memories and regulating emotional responses.

- Language Processing: Language comprehension and production, as well as communication, are governed by various regions of the cerebrum.

- Assessment Considerations: EMS providers should assess the patient's level of consciousness, cognitive function, and signs of abnormal behavior, which could be indicative of cerebrum dysfunction.

2. Cerebellum: located at the base of the brain, posterior to the brainstem.

Functions:

- Coordination and Balance: The cerebellum is primarily responsible for coordinating voluntary muscle movements and maintaining balance and posture.

- Fine Motor Control: It fine-tunes and refines motor movements, enabling precise activities such as handwriting, playing musical instruments, and detailed tasks.

- Proprioception: The cerebellum receives sensory information about the body's position and movements and adjusts muscle contractions accordingly.

- Assessment Considerations: EMS providers should assess for signs of ataxia (a lack of coordination), balance problems, and abnormal movements, as these may suggest cerebellar dysfunction.

3. Brainstem: the lower part of the brain that connects to the spinal cord.

Functions:

- Vital Functions: The brainstem is responsible for essential life functions, including controlling breathing, heart rate, blood pressure, and maintaining arousal and consciousness.

- Reflexes: It controls reflex actions, such as coughing, sneezing, and swallowing.

- Regulation of Sleep and Wake Cycles: The brainstem is involved in regulating the sleep-wake cycle.

- Assessment Considerations: EMS providers should monitor vital signs, assess for signs of altered consciousness, and be alert to any abnormalities in breathing, heart rate, and blood pressure, as dysfunction in the brainstem can have life-threatening consequences.

Understanding the functions of these brain regions is important for EMS providers to assess and manage patients with neurological symptoms and to recognize potential issues that may require prompt medical attention.

Sunday, November 12, 2023

EMS Peculiar Patient Presentations - Angioedema


Angioedema is a condition characterized by localized swelling, typically involving the face, lips, tongue, throat, or extremities. It occurs due to the rapid swelling of the deeper layers of the skin and underlying tissues. In some cases, it can be accompanied by hives or itching.

In the prehospital setting, EMS Providers should be aware of the following key points regarding angioedema:

1. Airway Management: Angioedema can cause swelling of the airway, potentially leading to respiratory distress or obstruction. EMS providers should closely monitor the patient's airway and be prepared to intervene with advanced airway management techniques if necessary.

2. Assessment: A thorough assessment should be conducted to determine the severity of angioedema and any associated symptoms. This includes evaluating the patient's breathing, vital signs, and level of distress.

3. Allergies and Medical History: It is important to gather information about the patient's medical history, including any known allergies or previous episodes of angioedema. This information can help in identifying potential triggers and guiding treatment decisions.

4. Treatment: The primary goal of treatment is to maintain a patent airway and alleviate symptoms. Depending on the severity and underlying cause, interventions may include administering oxygen, providing nebulized bronchodilators, administering epinephrine, or initiating intravenous access for medications such as antihistamines or corticosteroids.

5. Transport: Patients with angioedema should be transported to a medical facility for further evaluation and management. Ongoing monitoring of the patient's airway and vital signs during transport is crucial.

Remember, angioedema can have various causes, including allergic reactions, medications, hereditary factors, or other underlying medical conditions. Prompt recognition and appropriate management by EMS providers can help ensure the best possible outcome for the patient.

#Angioedema #AirwayManagement #Assessment #Allergies #MedicalHistory, #Treatment #PreHospitalCare #Transport #EMS

Friday, November 10, 2023

EMS Trauma Emergencies - Thoracic Injuries


The "Deadly Dozen" is a term used in emergency medicine and prehospital care to refer to a list of twelve potentially life-threatening chest injuries. 

EMS Providers need to be familiar with these injuries because prompt recognition and appropriate management are crucial for the survival and well-being of the patient. 

Here are the Deadly Dozen Chest Injuries and why they are important for EMS providers to know about:

1. Lung Contusion: A lung contusion is a bruising of lung tissue caused by chest trauma, leading to impaired gas exchange and respiratory distress. Monitoring for signs of respiratory compromise is crucial.

2. Tracheobronchial Injury: Trauma to the trachea or bronchi can lead to airway compromise and respiratory distress. EMS providers should maintain a high index of suspicion for this injury in patients with chest trauma.

3. Diaphragmatic Injury: A diaphragmatic injury can lead to herniation of abdominal contents into the chest, causing respiratory compromise and other complications. EMS providers should be aware of the potential signs and manage accordingly.

4. Esophageal Injury: Trauma to the chest can cause damage to the esophagus, leading to leakage of gastric contents into the chest cavity. EMS providers should be vigilant for signs of mediastinitis and infection.

5. Open Pneumothorax (Sucking Chest Wound): An open wound in the chest allows air to enter the pleural space, leading to a pneumothorax. It can impair ventilation and lead to respiratory distress. EMS providers must apply airtight seals to manage it.

6. Tension Pneumothorax: This occurs when air accumulates in the pleural space and compresses the lung, causing pressure on the heart and other vital structures. It can lead to cardiovascular collapse and requires immediate intervention, such as needle decompression.

7. Massive Hemothorax: This injury involves the accumulation of blood in the pleural space, which can impair lung function and cause hypovolemic shock. It may result from chest trauma, and EMS providers need to identify and manage it.

8. Flail Chest: A flail chest occurs when a segment of the ribcage becomes detached due to multiple rib fractures. It can impair ventilation and lead to respiratory failure. Stabilization and pain management are essential.

9. Cardiac Tamponade: This is a condition where blood or fluid accumulates in the pericardial sac, compressing the heart and impairing its function. It can cause hemodynamic instability and requires immediate intervention.

10. Aortic Disruption: Trauma can cause a tear or rupture in the aorta, which can lead to massive internal bleeding and shock. Early recognition and rapid transport are essential.

11. Myocardial Contusion: Blunt chest trauma can lead to a bruising or injury to the heart muscle, causing arrhythmias, myocardial infarction, or heart failure. EMS providers need to monitor for signs of cardiac injury.

12. Pulmonary Contusion: Similar to lung contusion, pulmonary contusion involves bruising of lung tissue, which can lead to impaired gas exchange and respiratory distress. EMS providers should monitor for signs of respiratory compromise.

EMS providers need to be aware of these chest injuries and their potential consequences because early recognition and appropriate management can be life-saving. 

Proper assessment, stabilization, and rapid transport to a medical facility for definitive care are critical in the prehospital setting for patients with these injuries.

Wednesday, November 08, 2023

EMS Anatomy & Physiology - Mammalian Gag Reflex

The gag reflex is a protective mechanism that helps prevent choking. It involves the contraction of the muscles at the back of the throat in response to stimulation, such as when objects touch the back of the tongue or throat.

In the prehospital setting, EMS Providers need to be aware of the gag reflex for several reasons:

1. Airway Management: The gag reflex can impact airway management. If a patient has an intact gag reflex, inserting certain airway devices or suctioning the airway may trigger a strong gag reflex response, potentially causing complications.

2. Assessment: The presence or absence of the gag reflex can provide valuable information about the patient's neurological status. Its absence may indicate a potential neurological problem or a compromised airway.

3. Interventions: EMS providers should take precautions to minimize stimulation of the gag reflex during procedures, such as intubation or suctioning, to prevent complications and ensure patient comfort.

4. Patient Safety: Being aware of the gag reflex helps EMS providers identify patients who may be at a higher risk of aspiration or choking, ensuring appropriate precautions are taken to protect their airway during transport.

Overall, understanding the gag reflex and its implications is crucial for EMS Providers to effectively manage airways and provide safe care in the prehospital setting.

#AirwayManagement #firstresponders #Assessment #GagReflex #PatientSafety

Sunday, November 05, 2023

EMS Peculiar Patient Presentations - Compartment Syndrome

Compartment syndrome is a serious medical condition that occurs when there is increased pressure within a muscle compartment in the body. A muscle compartment is a group of muscles, nerves, and blood vessels surrounded by a tough membrane called fascia. 

When the pressure within a compartment becomes too high, it can lead to inadequate blood flow to the muscles and other tissues within the compartment, causing damage and potentially leading to serious complications. Compartment syndrome most commonly occurs in the arms and legs.

Key points that EMS Providers need to know about compartment syndrome in the prehospital setting include:

Causes: Compartment syndrome can be caused by various factors, such as trauma (e.g., fractures or crush injuries), prolonged pressure on a limb, or conditions like bleeding disorders. It can also occur after surgical procedures.

Signs and Symptoms: EMS providers should be aware of the signs and symptoms of compartment syndrome, which may include severe pain that is out of proportion to the injury, swelling, tightness, numbness, tingling, weakness, and decreased range of motion in the affected limb. Pain that worsens with passive stretching of the muscles is a classic sign.

Rapid Assessment: In the prehospital setting, quick assessment is crucial. EMS providers should evaluate the patient's limb for signs of compartment syndrome and consider the mechanism of injury. A high index of suspicion is important, especially in cases of trauma.

Immediate Immobilization: Immobilization of the affected limb is important to prevent further injury and minimize the risk of worsening compartment syndrome.

Avoidance of Circulatory Compromise: Providers should avoid placing constricting devices (like tourniquets) on the limb, as these can exacerbate the condition. Instead, focus on ensuring that the limb is adequately supported and not subject to excessive pressure.

Prompt Transport: Compartment syndrome is a medical emergency. If you suspect compartment syndrome, the patient should be transported to a medical facility as quickly as possible.

Communicate With Hospital: It's crucial to communicate your suspicion of compartment syndrome to the receiving hospital. This can help them prepare for the patient's arrival and expedite the necessary diagnostic tests and treatment.

Treatment: Definitive treatment for compartment syndrome typically involves a surgical procedure called a fasciotomy, where the fascia surrounding the affected compartment is cut open to relieve the pressure and restore blood flow. EMS providers do not perform this procedure but should facilitate the patient's access to definitive medical care.

Complications of untreated compartment syndrome can be severe and include muscle and nerve damage, permanent disability, tissue death (necrosis), and in severe cases, amputation. Early recognition and prompt intervention are critical to minimize these complications. 

EMS providers play a crucial role in the initial assessment, stabilization, and transportation of patients with suspected compartment syndrome to ensure they receive timely and appropriate medical care.

#CompartmentSyndrome #PatientAssessment #PeculiarPatientPresentations #SignsAndSymptoms #EMR #EMT #AEMT #Paramedic

Friday, November 03, 2023

EMS Mnemonics - RICES

EMS Providers should be familiar with the RICES mnemonic as it relates to the initial care and management of soft tissue injuries. RICES stands for:

Rest: The injured area should be rested to prevent further damage and allow the body to initiate the healing process. Limiting movement and weight-bearing on the injured limb or area is essential to avoid exacerbating the injury.

Ice: Applying ice to the injured area helps reduce swelling and inflammation. Use a cold pack or ice wrapped in a cloth and apply it to the injured site for 15-20 minutes every 1-2 hours during the initial 24-48 hours after the injury. Ensure that you place a barrier (such as a cloth) between the ice and the skin to prevent frostbite.

Compression: Use an elastic bandage or compression wrap to gently compress the injured area. This helps reduce swelling and provides support. Be careful not to wrap it too tightly, which could impede blood flow. You should be able to slide a finger beneath the bandage.

Elevation: Elevating the injured limb or area helps minimize swelling by allowing excess fluid to drain away from the site. For example, if the injury is in the leg, elevate it above heart level when possible.

Stabilization: Immobilize or stabilize the injured area, especially if there is a risk of further injury due to movement. This can be achieved with splints or slings when necessary to prevent further harm.

EMS providers should keep in mind that the RICES protocol is most effective for acute soft tissue injuries, such as sprains, strains, and contusions. It can provide initial relief and help with pain and swelling reduction. 

However, for more serious injuries or fractures, further medical evaluation and interventions may be required. It's also essential to consider any contraindications, such as not applying ice directly to open wounds or areas with impaired circulation.

Additionally, the mnemonic PRICE is a similar concept but includes "Protection" as the first step. In some cases, protecting the injured area from further harm may be necessary before starting RICES, especially in emergency situations.

Overall, EMS providers should be knowledgeable about the appropriate first aid and initial care for soft tissue injuries to help improve patient comfort and outcomes.

#EMS #Mnemonics #SoftTissueInjury #Rest #Ice #Compression #Elevation #Stabilization

Wednesday, November 01, 2023

EMS Patient Assessment - Abdominal Pain


Visceral and parietal pain are two types of pain that originate from distinct structures in the body and are perceived differently by a patient.

Visceral Pain: Visceral pain arises from the internal organs, such as the heart, lungs, liver, intestines, and bladder. It is often described as a deep, dull, aching, or cramping sensation.

Visceral pain results from the stimulation of pain receptors within the internal organs themselves. These pain receptors are not as sensitive as those found in the skin and muscles, so visceral pain tends to be less localized and can be challenging to pinpoint. It is often described as a vague, diffuse discomfort and may be difficult to locate precisely.

Visceral pain is typically caused by conditions like inflammation, stretching, or ischemia (lack of blood flow) in the internal organs.

Parietal Pain: Parietal pain, on the other hand, originates from the parietal peritoneum, which is the membrane that lines the abdominal cavity and covers the abdominal wall. It is a thin, sensitive membrane with a high density of pain receptors.

Parietal pain is usually sharp, well-localized, and easier to pinpoint compared to visceral pain. It occurs when the parietal peritoneum is irritated, inflamed, or damaged due to conditions like peritonitis (inflammation of the peritoneum), trauma, or surgery. The pain is often described as more intense and precise than visceral pain.

The key differences between visceral and parietal pain are their origins and the way they are perceived:

• Visceral pain originates from internal organs and is often described as a diffuse, deep, and aching sensation.

• Parietal pain originates from the parietal peritoneum and is typically sharp, well-localized, and easier to identify.

Understanding the distinction between these two types of pain is important for medical professionals when diagnosing and treating various medical conditions, as the quality and location of pain can provide important clues to the underlying issue.

#PreHospitalCare #PatientAssessment #Visceral #Parietal #PainManagement 

#EMS #EMR #EMT #AEMT #Paramedics 

Tuesday, October 31, 2023

EMS Medical Emergencies - Asthma Attacks

 


EMS providers should be familiar with key aspects of asthma and associated respiratory emergencies. Here are some important points to consider:

Asthma Overview: Understand that asthma is a chronic inflammatory condition of the airways, characterized by recurrent episodes of wheezing, coughing, chest tightness, and shortness of breath. It can range from mild to severe, and triggers may include allergens, exercise, respiratory infections, or environmental factors.

Signs and Symptoms: Recognize the signs and symptoms of an asthma attack, such as audible wheezing, increased respiratory rate, use of accessory muscles, coughing, cyanosis (bluish discoloration), and difficulty speaking in full sentences.

Assessment: Perform a thorough respiratory assessment, including checking the patient's oxygen saturation levels, lung sounds, and respiratory effort. Assess the severity of the asthma attack using a validated scoring system, such as the Asthma Severity Score.

Treatment: Administer high-flow supplemental oxygen to maintain adequate oxygenation. Consider providing bronchodilator medications, such as albuterol, through a nebulizer or metered-dose inhaler with a spacer. Corticosteroids may also be administered to reduce airway inflammation.

Monitoring: Continuously monitor the patient's vital signs, oxygen saturation, and respiratory status. Reassess the patient's response to treatment periodically and adjust interventions accordingly.

Complications: Be aware of potential complications, including respiratory failure, pneumothorax (collapsed lung), and status asthmaticus (severe, prolonged asthma attack refractory to treatment). Promptly recognize and manage these complications as needed.

Communication: Communicate effectively with the patient and their caregivers, providing reassurance and explaining the actions being taken. Obtain a thorough medical history, including any known asthma triggers or previous exacerbations.

Transport and Referral: Determine the appropriate level of care and transport the patient to the nearest appropriate healthcare facility. Ensure a smooth handoff to the receiving medical team, providing them with a detailed report of the patient's condition, interventions performed, and response to treatment.

Remember, asthma management should be individualized based on the patient's condition and medical history. 

Regular training, updated protocols, and close coordination with medical direction are crucial for providing optimal care to patients experiencing asthma and associated respiratory emergencies.

#Asthma #ChronicInflammatoryDisorder #RespiratoryDistress #RespiratoryFailure 

#Cyanosis #Bronchospasm #StatusAsthmaticus

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 

Monday, October 30, 2023

EMS Medical Emergencies - Excited Delirium

 


Excited delirium is a controversial and complex medical condition that has been associated with certain behaviors and symptoms, often observed in individuals who are agitated, combative, and potentially at risk of harm to themselves and others.

EMS Providers should be aware of the concept of excited delirium and the controversies surrounding its diagnosis in a prehospital setting.

Here are some key points for EMS Providers to consider:

Definition and Presentation: Excited delirium is not officially recognized as a medical diagnosis by all medical authorities. It is typically described as a state of extreme agitation, delirium, and often violent behavior in individuals, which may be associated with drug intoxication, psychiatric conditions, or other underlying medical issues.

The classic presentation may include severe agitation, hyperthermia, combativeness, incoherent speech, hallucinations, increased strength, and a lack of responsiveness to pain.

Controversies: Controversy exists regarding whether excited delirium is a distinct medical entity or if it is a syndrome resulting from other underlying conditions, such as drug intoxication, psychiatric disorders, or medical illness.

Some medical professionals and organizations argue that excited delirium is not a valid diagnosis and is more of a descriptive term for a cluster of symptoms.

Potential Causes: Common causes or contributing factors to the presentation of excited delirium may include substance abuse (especially stimulants like cocaine or methamphetamine), mental health disorders, traumatic brain injury, and medical conditions such as hyperthyroidism.

Management by EMS Providers: EMS providers should prioritize the safety of both the patient and themselves when dealing with individuals who exhibit signs of excited delirium.

The primary goal is to protect the patient from self-harm or harm to others.

Patients may require physical restraint and sedation. However, the use of physical restraints and sedation is a subject of controversy and should be used with caution and in accordance with local protocols and laws.

Immediate Medical Care: Immediate medical attention is essential, and EMS providers should initiate transport to the hospital. These individuals are at risk of severe medical complications, including hyperthermia, cardiac arrhythmias, and rhabdomyolysis.

Documenting Care: Accurate and thorough documentation of the patient's presentation, behavior, interventions performed, and any discussions with law enforcement or other involved parties is crucial for legal and medical reasons.

Legal Considerations: EMS providers should be aware of the legal and ethical issues associated with the management of excited delirium, particularly regarding the use of force, restraint, and sedation.

Ongoing Education: EMS providers should receive ongoing training and education on recognizing and managing agitated and potentially dangerous patients. Additionally, it is important to stay updated on local and regional protocols and guidelines.

EMS providers should prioritize patient safety, provide appropriate care, and be aware of the legal and ethical issues associated with its management.

with law enforcement, mental health professionals, and medical staff is often necessary in these cases.

Sunday, October 29, 2023

EMS Trauma Emergencies - Epidural & Subdural Hematomas

EMS providers should have a good understanding of epidural and subdural hematomas, as prompt recognition and management are crucial.

An epidural hematoma occurs when blood accumulates between the skull and the outer layer of the brain (dura mater). It is typically caused by a traumatic head injury, such as a skull fracture that damages the middle meningeal artery.

Examples of causes include motor vehicle accidents, falls, or assaults.

A subdural hematoma, on the other hand, is the accumulation of blood between the dura mater and the brain. It can result from a direct blow to the head or rotational forces causing tearing of the bridging veins.

Causes can include falls, sports injuries, shaken baby syndrome, or head trauma in older adults due to minor falls.

In both cases, the accumulation of blood can lead to increased pressure on the brain, potentially causing neurological deficits.

EMS Providers should be aware of the signs and symptoms, such as severe headache, altered mental status, focal neurological deficits, or changes in consciousness.

Prompt transportation to a trauma center is essential for definitive diagnosis and surgical intervention, if necessary.

Remember, this information is not a substitute for medical advice. If you suspect a head injury, it's important to consult with a healthcare professional for proper evaluation and management.

#PreHospitalCare #TraumaEmergencies #EpiduralHematoma #SubduralHematoma #NeurologicalDeficits

Saturday, October 28, 2023

EMS Celebration - National First Responder Day


Thank you for all that you do. Stay safe out there

National First Responder Day is dedicated to honoring and recognizing the selfless contributions of first responders in the United States.

The origins of National First Responder Day can be traced back to the tragic events of September 11, 2001, when countless firefighters, police officers, paramedics, and other emergency personnel risked their lives to save others during the terrorist attacks.

The bravery and heroism displayed by these first responders inspired a nationwide recognition of their sacrifices.

The goal of National First Responder Day is to dedicate a day of gratitude and appreciation for the people who serve as first responders, including firefighters, police officers, paramedics, emergency medical technicians, emergency medical responders, and other professionals who play critical roles in emergency situations.

#EMR #EMT #PARAMEDIC #NREMT

#NAEMT #FirstRespondersDay

Friday, October 27, 2023

EMS Mnemonics - DCAP BTLS

 

EMTs shoul be aware of the mnemomic DCAP-BTLS and how it is used as part of the patient assessment process to identify potential injuries.

Here's what it stands for:

D - Deformities: Look for any visible abnormalities or misalignments of bones or joints.

C - Contusions: Observe for bruises or areas of localized bleeding under the skin.

A - Abrasions: Check for superficial scrapes or scratches on the skin's surface.

P - Punctures/Penetrations: Assess for any wounds caused by objects piercing the skin.

B - Burns: Identify any burns or evidence of thermal injuries.

T - Tenderness: Note areas of pain or tenderness when touched.

L - Lacerations: Look for cuts or tears in the skin.

S - Swelling: Observe for any abnormal swelling or edema.

By systematically evaluating each element of DCAP-BTLS, EMTs can identify potential injuries and prioritize appropriate care for trauma patients. 

Remember, this information is not a substitute for formal medical training.

Thursday, October 26, 2023

EMS Trauma Emergencies - Le Fort Fractures


Emergency Medical Services (EMS) providers need to be well-prepared to assess and manage facial injuries including Le Fort Fractures. These injuries can result from various mechanisms, such as motor vehicle accidents, falls, or assaults. 

Recognizing and managing them appropriately is crucial to ensure the best possible outcome for the patient. Here's what EMS providers need to know:

Assessment:

Start by assessing the patient's airway, breathing, and circulation (ABCs).

Be vigilant for signs of life-threatening injuries, such as airway compromise, respiratory distress, or severe bleeding.

Examine the face for deformities, swelling, and visible fractures.

La Forte Fractures:

La Forte fractures are complex facial fractures that involve the upper jaw (maxilla). They are classified into three types: Le Fort I, Le Fort II, and Le Fort III. These fractures may not always be obvious from the outside.

Le Fort I Fracture (Horizontal Fracture):

This fracture separates the maxilla from the rest of the face. The midface may be mobile, and the upper teeth may be mobile or displaced.

The patient may have pain in the upper jaw, and there may be bruising or swelling around the cheek and upper lip.

Le Fort II Fracture (Pyramidal Fracture):

This fracture involves the central part of the maxilla and extends up to the nasal bones.

The patient may have a floating midface, with mobility and deformity of the nose and upper jaw.

There may be a change in the appearance of the eyes, such as raccoon eyes (bruising around the eyes) or epistaxis (nosebleeds).

Le Fort III Fracture (Transverse Fracture):

This is the most severe and involves the entire midface, including the orbits (eye sockets).

The patient may have widely separated eyes, called telecanthus.

Check for visual disturbances or signs of injury to the eyes.

Management:

Focus on maintaining the airway and ensuring adequate ventilation. Patients with severe facial injuries can experience airway compromise due to swelling and bleeding.

Stabilize any obvious fractures with gentle manual pressure, if necessary.

Control any bleeding by applying direct pressure with sterile dressings.

Provide pain management as needed.

Transport the patient to the nearest appropriate medical facility, preferably one with a trauma center and maxillofacial surgery capabilities.

Continuous monitoring of vital signs is essential during transport.

Precautions:

Handle facial fractures with care to avoid worsening the injuries or causing further damage.

Avoid pressure on the eyes or the nose.

Immobilize the head and neck, especially if there is concern about cervical spine injuries.

Remember that prompt and appropriate care is crucial in managing facial injuries, as they can impact the patient's ability to breathe, see, eat, and speak. 

Always follow local protocols and guidelines, and communicate effectively with the receiving hospital to ensure the best possible outcome for the patient.

#TraumaEmergencies #LeFortFractures #PreHospitalCare #EMS

Wednesday, October 25, 2023

EMS Trauma Emergencies - Stop The Bleed

 


The "Stop the Bleed" campaign, initiated by the American College of Surgeons, is a national program aimed at training individuals in basic bleeding control techniques to save lives in emergencies. These guidelines focus on empowering bystanders to take immediate action in case of severe bleeding. 

The following are the key steps recommended by the American College of Surgeons for "Stop the Bleed":

Ensure Personal Safety:

Always prioritize your own safety. Ensure that the scene is safe for you to approach and provide assistance.

Call 911:

In any severe bleeding emergency, it is essential to call 911 or emergency services to ensure that professional medical assistance is on the way.

Identify the Source of Bleeding:

Quickly identify the source of bleeding. Look for wounds or areas where blood is actively flowing or pooling.

Apply Direct Pressure:

Use your hands or a cloth to apply firm, direct pressure to the wound. If possible, use a clean cloth, bandage, or gauze to prevent direct contact with the blood.

Use Dressings and Bandages:

If direct pressure alone doesn't stop the bleeding, use dressings or bandages to cover the wound and apply additional pressure. Maintain consistent pressure until the bleeding is under control.

Apply Tourniquet:

If the bleeding is severe and not responding to direct pressure or dressings, consider using a tourniquet as a last resort. Place the tourniquet above the bleeding site, if possible. Ensure it is tight enough to stop the blood flow but not so tight that it causes other problems. Document the time the tourniquet was applied.

Continue to Monitor:

Continue to monitor the injured person's condition, especially if a tourniquet has been applied. Make sure the tourniquet remains effective, and do not remove it.

Provide Emotional Support:

Stay with the injured person and provide reassurance and emotional support. Severe bleeding can be traumatic, and your presence can help keep the individual calm.

The "Stop the Bleed" program emphasizes the importance of early intervention by bystanders, as controlling severe bleeding within the first few minutes after an injury can significantly improve a person's chances of survival. The program also offers hands-on training and resources to help individuals become more confident in their ability to assist in emergency situations involving severe bleeding.

#EMS #StopTheBleed #PersonalSafety #Call911 #Tourniquets