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 

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.

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

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

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.

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

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

EMS Behavioral Emergencies - Social Anxiety In A Time Of Normality

As EMS providers, it's crucial to have a well-rounded understanding of various medical conditions and mental health issues to offer the best care possible to patients. 

Social anxiety is one such condition that can significantly impact a patient's well-being and response to treatment. Here's what you need to know about this topic:

Recognizing Social Anxiety

Feelings of anxiety can be a common response when individuals are exposed to unfamiliar situations or new people. When people experience social anxiety, they may feel apprehensive or awkward when around others and might find it uncomfortable to engage in conversations. These feelings often improve as individuals become more familiar with their surroundings and peers.

Social Phobia

Social anxiety, when it becomes debilitating and significantly affects a person's life and choices, is referred to as social phobia. It can hinder one's ability to participate in social situations or even be around other people. EMS providers should be aware of the signs and symptoms of social phobia, as patients with this condition may experience heightened distress during medical emergencies.

The Impact of Social Anxiety

People with social anxiety fear negative evaluation by others and worry about potentially embarrassing themselves. They are concerned about being judged for displaying physical signs of anxiety, such as blushing, shaking, or sweating. This fear often leads individuals to avoid social situations where they might be scrutinized. For EMS providers, this avoidance can complicate patient interactions during emergencies, as those with social anxiety may be particularly distressed by the presence of unfamiliar individuals.

EMS Providers' Role

EMS providers should approach patients with social anxiety with sensitivity and empathy. Understanding that these individuals may experience heightened anxiety in social situations is essential. It's important to create a calm and non-judgmental environment during patient care. Effective communication can make a significant difference in how patients with social anxiety respond to treatment.

Seeking Help

Encourage patients to seek professional help for their social anxiety. It's a real challenge, but there are treatments available that can significantly improve their quality of life. By offering support and information about available resources, EMS providers can contribute to their patients' overall well-being.

Recognizing social anxiety and its impact on patients is vital for EMS providers. Compassion, patience, and effective communication are key when providing care to individuals with social anxiety. By acknowledging this condition and offering support, EMS providers can make a positive difference in the lives of those they serve.

#Anxiety #LifeIsPrecious #MentalHealthMatters #YouAreStrong #SocialAnxiety

EMS Anatomy & Physiology - Hemostasis

Emergency Medical Technicians (EMTs) should have a fundamental understanding of the mechanism of hemostasis, as it is critical to their ability to manage bleeding and provide appropriate care for trauma patients.

Hemostasis is the body's natural process for stopping bleeding, and it involves a complex series of steps. Here's what EMTs should know about the mechanism of hemostasis:

1. Vasoconstriction:

   - When an injury occurs, the first response is vasoconstriction, which is the narrowing of blood vessels. This helps reduce blood flow to the injured area and minimizes the loss of blood.

   - EMTs may observe vasoconstriction as part of the body's initial response to bleeding, with the skin around the wound appearing pale or blanched.

2. Primary Hemostasis:

   - Primary hemostasis involves the formation of a platelet plug. Platelets are small cell fragments in the blood that adhere to the site of injury and to each other.

   - Platelets become sticky in response to exposed collagen at the wound site. They adhere to the injured vessel wall and to each other to form a plug, temporarily sealing the breach in the blood vessel.

3. Secondary Hemostasis:

   - Secondary hemostasis, also known as the coagulation cascade, is a series of complex reactions involving clotting factors that ultimately result in the formation of a stable blood clot.

   - The coagulation cascade involves the conversion of fibrinogen into fibrin, which forms a mesh-like structure to reinforce the platelet plug and trap red blood cells to create a stable clot.

4. Clot Retraction and Repair:

   - After the blood clot has formed, it undergoes retraction, which is the process of the clot contracting and pulling the edges of the wound together. This helps to limit bleeding.

   - As the wound heals, tissue repair and regeneration occur to ultimately restore the integrity of the injured blood vessels.

5. Fibrinolysis:

   - Once the injury is healed, the body initiates the process of fibrinolysis, which breaks down the fibrin clot. This is essential to prevent excessive clot formation and to restore normal blood flow.

In the pre-hospital setting, EMTs often intervene during primary hemostasis and secondary hemostasis to control bleeding. They can apply direct pressure, elevate the injured area, use hemostatic dressings, or apply tourniquets when necessary to help facilitate hemostasis. 

Understanding the mechanism of hemostasis allows EMTs to make informed decisions about which techniques and interventions are most appropriate for each patient's specific bleeding situation.

Additionally, EMTs should be aware that certain medical conditions, medications, and coagulation disorders can affect the body's ability to achieve hemostasis, and they should take these factors into consideration when managing bleeding in trauma patients.

EMS Medical Emergencies - Alcohol Poisoning & Withdrawal

EMS Providers play a crucial role in assessing and managing individuals who may be experiencing alcohol poisoning or withdrawal. 

Here are some key things that EMS providers need to know about these conditions:

Alcohol Poisoning:

1. Recognizing the Signs: EMS providers should be able to recognize the signs and symptoms of alcohol poisoning, which can include confusion, vomiting, seizures, slow or irregular breathing, hypothermia, and unconsciousness.

2. Assessment: Perform a thorough assessment of the patient's vital signs, including heart rate, blood pressure, and respiratory rate. Pay close attention to any signs of respiratory distress or decreased consciousness.

3. Airway Management: Ensure that the patient's airway is clear and open. If there is a risk of airway obstruction due to vomiting, position the patient on their side (recovery position) to prevent aspiration.

4. Breathing: Monitor the patient's breathing closely. Administer supplemental oxygen if necessary and be prepared to assist with artificial ventilation if the patient's breathing becomes inadequate.

5. Circulation: Assess the patient's circulation, and be prepared to administer intravenous fluids if needed to treat dehydration and maintain blood pressure.

6. Transport: Patients with alcohol poisoning should be transported to the hospital for further evaluation and treatment. This is especially important if the patient's level of consciousness is severely impaired or if they have any other concerning symptoms.

Alcohol Withdrawal:

1. Recognition: EMS providers should be able to recognize the signs and symptoms of alcohol withdrawal, which can include anxiety, agitation, tremors, hallucinations, seizures, and potentially life-threatening conditions like delirium tremens (DT).

2. Assessment: Perform a comprehensive assessment of the patient's vital signs, including heart rate, blood pressure, and respiratory rate. Pay attention to signs of dehydration and electrolyte imbalances.

3. Seizure Management: Patients experiencing alcohol withdrawal may be at risk of seizures. Be prepared to manage seizures with appropriate medications and airway management if necessary.

4. Delirium Tremens (DT): Recognize the signs of DT, which is a severe form of alcohol withdrawal characterized by hallucinations, severe confusion, and cardiovascular instability. Patients with DT require intensive medical intervention and should be transported to the hospital immediately.

5. Psychiatric Assessment: Assess the patient's mental status and level of distress. Patients experiencing severe alcohol withdrawal may require psychiatric evaluation and treatment.

6. Transport: Patients experiencing alcohol withdrawal, especially those with severe symptoms, should be transported to a medical facility for evaluation and appropriate management.

7. Prevention: In cases of known alcohol dependence, consider providing information and resources for alcohol addiction treatment and rehabilitation.

It's important for EMS providers to stay up-to-date with the latest guidelines and protocols related to alcohol poisoning and withdrawal in their region, as these may vary. 

Additionally, effective communication with the receiving medical facility is crucial to ensure a seamless transition of care for the patient.

#EMS #MedicalEmergencies #AlcoholPoisoning #AirwayManagement 

#AlcoholWithdrawal #DeliriumTremens

EMS Trauma Assessment - Index of Suspicion & Mechanism of Injury

 

EMS Providers play a crucial role in assessing and managing trauma emergencies. Two important concepts they need to understand are the Index of Suspicion and Mechanism of Injury. These concepts help EMTs make quick and informed decisions about the care of trauma patients.

Index of Suspicion (IOS):

The IOS is an essential element in the assessment of trauma patients. It refers to the level of concern or suspicion an EMS Providers should have regarding potential injuries or conditions.

EMS Providers must maintain a high index of suspicion, especially in trauma situations, because injuries are not always immediately evident. This means considering the possibility of severe injuries even when there are no obvious signs or symptoms.

A high index of suspicion should be maintained for patients involved in high-impact mechanisms of injury, such as car accidents, falls from heights, or severe blows.

EMS Providers should consider the mechanism of injury, the patient's presentation, and the nature of the incident to determine the likelihood of hidden injuries. A high index of suspicion prompts a thorough assessment and treatment.

Mechanism of Injury (MOI):

The MOI is an important aspect of the assessment process for trauma patients. It involves understanding how the injury occurred, the forces involved, and the potential for damage to specific body parts or systems.

EMTs should gather information about the MOI from the scene, bystanders, and the patient whenever possible. Common mechanisms of injury include:

Motor Vehicle Accidents: Speed, type of collision, airbag deployment, seat belt use, intrusion into the vehicle, etc.

Falls: Height of fall, landing surface, position of the body during the fall, and age of the patient.

Assaults: The type of weapon or force used, number of assailants, and locations of injuries.

Penetrating injuries: The object causing the injury, its size, and depth of penetration.

Understanding the MOI helps EMS Providers predict potential injuries. For example, if a patient was involved in a high-speed car crash with significant vehicle damage, the EMT should be highly suspicious of head, neck, and chest injuries even if the patient is alert and without immediate complaints.

Combining the MOI with the patient's presentation and a high index of suspicion guides EMTs in making critical decisions regarding patient care, such as spinal immobilization, oxygen therapy, and the need for rapid transport to a trauma center.

EMS Providers need to maintain a high index of suspicion, especially in trauma cases, and carefully assess the mechanism of injury. These concepts, when used together, allow EMTs to provide timely and appropriate care to trauma patients, even when injuries may not be readily apparent.

Bibliography

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach. 2nd Ed. Hoboken, New Jersey: Pearson Education

Limmer Education (2021) What Does Mechanism Of Injury Tell Us? https://limmereducation.com/article/trauma-assessment-mechanism-of-injury/ Accessed on October 15, 2023

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care. 11th Ed. Hoboken, New Jersey: Pearson Education  

#EMS #IndexofSuspicion #MechanismofInjury #PatientAssessment #TraumaAssessment #MotorVehicleAccidents

EMS Discussion - Ethical Principles

 

Ethics in prehospital care is a critical aspect of the EMS profession. EMS providers need to be well-versed in ethical principles to ensure they provide the best possible care while maintaining patient trust and public confidence.

Here are key points that EMS providers should know about ethics in prehospital care:

Patient Autonomy: Respect for patient autonomy is a fundamental ethical principle. EMS providers should respect a patient's right to make decisions about their own care, to the extent that they are capable of doing so. This includes obtaining informed consent for treatment and respecting a patient's refusal of care.

Beneficence: EMS providers should always aim to do what is in the best interest of the patient. This involves providing appropriate and timely care, making decisions that maximize patient benefit, and prioritizing patient well-being.

Non-Maleficence: The principle of non-maleficence, "do no harm," guides EMS providers to avoid causing harm to patients. This involves careful assessment, correct procedures, and minimizing the risk of errors.

Justice: Fairness and equity are crucial. EMS providers should distribute resources and care equitably, without discrimination or bias. This includes providing care to all patients regardless of their background, socioeconomic status, or personal characteristics.

Confidentiality: Protecting patient confidentiality is essential. EMS providers must maintain patient privacy and not disclose patient information to unauthorized individuals. Only share patient information with those directly involved in the patient's care or with legal authorities when required by law.

Honesty and Integrity: Truthfulness and transparency are integral to maintaining trust. EMS providers should provide accurate information to patients and their families, report errors and incidents, and be honest about the limitations of prehospital care.

Cultural Competence: Understanding and respecting diverse cultural values and beliefs is vital. EMS providers should be culturally sensitive and consider the impact of culture on patient care and decision-making.

Advance Directives: EMS providers should be knowledgeable about and respect advance directives, such as living wills and do-not-resuscitate (DNR) orders. Patients' documented wishes should guide care decisions.

Resource Allocation: In situations where resources are limited, such as during mass-casualty incidents or disasters, EMS providers should follow ethical guidelines for resource allocation, prioritizing care based on need and potential for survival.

End-of-Life Care: Ethical considerations surrounding end-of-life care are essential. EMS providers must be prepared to provide palliative care, comfort, and support, respecting the patient's and family's wishes.

Continuing Education: EMS providers should engage in ongoing education and training to stay updated on evolving ethical guidelines, best practices, and emerging technologies.

Patient Advocacy: EMS providers should advocate for the best interests of their patients, particularly in situations where patients may be vulnerable or unable to make decisions for themselves.

In summary, ethics in prehospital care are vital for ensuring patient-centered care, maintaining trust, and upholding the integrity of the EMS profession. EMS providers should continually strive to integrate these ethical principles into their practice to provide the best care possible.

#Justice #Ethics #EthicalPrinciples #Non-Maleficence #Beneficence #EMS #PreHospitalCare #Autonomy

EMS Infographic - When Ambulances Crash

The National Highway Traffic Safety Administration (NHTSA) used 10 years of data to understand patient and provider safety in EMS-involved collisions. The above infographic illustrates their findings.

 

EMS Anatomy & Physiology - The Woes of Alcohol

 

EMS Providers should have a good understanding of the effects of alcohol on the body as they will often encounter patients who have consumed alcohol, either too excess or through habitual prolonged consumption, that may be experiencing related medical issues or emergencies. 

Here are some key points EMS providers should know about the effects of alcohol on the body:

Blood Alcohol Concentration (BAC): Understanding how alcohol is measured in the body is crucial. BAC is a measure of the amount of alcohol in a person's bloodstream. It is typically expressed as a percentage. For example, a BAC of 0.08% means that there is 0.08 grams of alcohol per 100 milliliters of blood.

Metabolism: Alcohol is metabolized in the liver. The rate of metabolism varies from person to person, but on average, the body metabolizes about one standard drink per hour.

Blood Vessel Dilation: Alcohol can cause blood vessels to dilate (expand), which can lead to a sensation of warmth and cause the skin to flush. However, vessel dilation can also cause a drop in core body temperature, which may lead to hypothermia, especially in cold environments.

Platelet Function: Alcohol can affect platelet function, potentially making the blood less likely to clot quickly. This is one reason why excessive alcohol consumption is associated with an increased risk of bleeding and bruising.

Central Nervous System (CNS) Depressant: Alcohol is a central nervous system depressant, which means it slows down brain activity. This can result in impaired judgment, coordination, and reaction times.

Behavioral and Psychological Effects: Alcohol can lead to mood swings, impaired decision-making, and can lower inhibitions. This may result in risky behaviors, including accidents and injuries.

Respiratory Depression: In high doses, alcohol can suppress the respiratory system, potentially leading to respiratory distress or failure.

Dehydration: Alcohol is a diuretic, which means it can lead to increased urine production and dehydration. In turn, dehydration can exacerbate the effects of alcohol and lead to electrolyte imbalances. Dehydration can also make the blood more viscous, which might give the impression of "thicker" blood.

Gastric Irritation: Alcohol can irritate the stomach lining, potentially leading to gastritis or ulcers. Vomiting is common in alcohol intoxication cases.

Interaction with Other Substances: EMS providers should be aware of potential drug interactions when patients have consumed alcohol, as it can interact with various medications and other substances.

Hypoglycemia: Alcohol can cause a drop in blood sugar levels, leading to symptoms like confusion, weakness, and seizures.

Alcohol Poisoning: In severe cases of alcohol intoxication, alcohol poisoning can occur. Symptoms may include vomiting, slow or irregular breathing, seizures, and unconsciousness. Alcohol poisoning is a medical emergency that requires immediate attention.

Withdrawal: Individuals who are chronic alcohol users may experience withdrawal symptoms when they stop drinking. EMS providers should be aware of these symptoms, which can include seizures, hallucinations, and delirium tremens.

Legal Implications: Understanding local laws related to alcohol, such as legal drinking ages and open container laws, is essential for EMS providers when assessing situations involving alcohol.

Patient Assessment: EMS providers should conduct a thorough patient assessment, considering vital signs, mental status, and any injuries or medical conditions that may be exacerbated by alcohol consumption.

Safety Precautions: EMS providers should take safety precautions when dealing with intoxicated individuals, as they may be unpredictable or agitated. Ensuring the safety of both the patient and the EMS team is essential.

Understanding the effects of alcohol on the body is crucial for EMS providers to provide appropriate care, make informed decisions, and ensure the safety of both the patient and themselves in alcohol-related emergencies. 

Additionally, EMS providers should be well-versed in the protocols and guidelines for managing alcohol-related cases in their specific regions.

#EMS #PatientAssessment #AnatomyAndPhysiology #Alcohol #

#BloodAlcoholConcentration #Withdrawal #Hypoglycemia

Peculiar Patient Presentations - Monkeypox

 

EMS Providers should be aware of the following key points about Monkeypox:

Transmission and Symptoms: Monkeypox is a rare viral disease that can be transmitted to humans from animals (like rodents) and sometimes from human to human. It causes symptoms similar to smallpox, such as fever, rash, and swollen lymph nodes. EMS providers should be vigilant when encountering patients with unexplained febrile illnesses or rashes, especially if they have recently traveled to areas where Monkeypox is endemic.

Infection Control: Given that Monkeypox can spread through respiratory droplets, direct contact with infected animals, or possibly through human-to-human contact, EMS providers should adhere to strict infection control measures. This includes using appropriate personal protective equipment (PPE), including masks, gloves, and gowns, when in contact with suspected cases.

Isolation: Suspected cases of Monkeypox should be isolated from other patients and transported to healthcare facilities equipped to handle highly infectious diseases. EMS providers should communicate their suspicions to the receiving facility in advance to ensure proper precautions are taken.

Vaccination and Treatment: There is no specific antiviral treatment for Monkeypox, but supportive care can be provided. Vaccination against smallpox has shown some effectiveness in preventing Monkeypox. EMS providers should inquire about the vaccination status of patients, especially if they are at higher risk due to their occupation or travel history.

Reporting: EMS providers should be aware of local and national reporting requirements for suspected cases of Monkeypox. Timely reporting is crucial for public health authorities to monitor and contain potential outbreaks.

Education: Keeping up-to-date with information about emerging infectious diseases, like Monkeypox, is essential for EMS providers. Training and education programs should include the recognition of symptoms, appropriate PPE usage, and infection control measures.

Community Awareness: EMS providers can play a role in educating the community about Monkeypox, its transmission, and prevention strategies. This can help in early detection and containment of the disease.

It's important to note that Monkeypox is rare, but awareness and preparedness are key to effectively managing any potential cases and preventing further transmission. EMS providers should collaborate closely with local health departments and follow their guidelines when dealing with suspected cases of Monkeypox.

#PeculiarPatientPresentations #Monkeypox #EmergencyMedicalServices #EMS #InfectionControl #Vaccinations

EMS Discussion - How Outrage is Hijacking Our Lives

The podcast "Screaming into the Void: How Outrage is Hijacking Our Culture, and Our Minds," hosted by Shankar Vedantam and published on October 7, 2019, explores the impact of outrage culture on our society and mental well-being.

The main claim of the podcast is to shed light on how outrage, often amplified by social media, can lead to a cycle of anger, polarization, and division within society.

Outrage culture is a cultural phenomenon characterized by the frequent expression of intense moral indignation, anger, or offense, often in response to perceived injustices or controversial issues.

"The rush of outrage makes us feel alive. And if you do it right, outrage can make you feel like a hero."

Vedantam’s ideas are highly relevant to emergency service provision and the broader world.

In EMS, effective communication, empathy, and understanding are crucial for responding to crises and helping people in need.

Outrage culture, as discussed in the podcast, can hinder constructive dialogue and cooperation. It can also affect the mental health of both emergency responders and the people they serve.

Understanding the mechanisms behind outrage and its consequences can help emergency service providers navigate challenging situations and promote more productive interactions.

Discussion Question: How can emergency service providers balance the need to address urgent situations with the challenges posed by outrage culture today?

EMS Mnemonics - TRACEM

TRACEM is a mnemonic used to determine the type of damage possible from a hazardous material exposure: thermal, radiological, asphyxiation, chemical, etiological, mechanical

.It is used in the context of emergency response and hazardous materials management to categorize the different types of damage that can occur to hazardous materials containers or packaging.

Understanding the type of damage is crucial for first responders and hazardous materials teams when assessing the potential risks and determining appropriate mitigation measures. Here's what each letter in TRACEM represents:

T - Thermal Damage: Thermal damage refers to damage caused by heat or fire. It includes situations where the hazardous material container has been exposed to high temperatures, leading to structural damage or rupture.

R - Radiological Damage: Radiological damage involves hazardous materials that emit ionizing radiation. Damage to the container may result from radiation exposure or a breach of radioactive materials.

A - Asphyxiation Damage: Asphyxiation damage pertains to hazardous materials that can displace oxygen or release gases that are harmful or oxygen-depleting. Damage scenarios may involve leaks or ruptures leading to oxygen-deficient atmospheres.

C - Chemical Damage: Chemical damage relates to the release or spill of hazardous chemicals due to container damage. This can result in exposure to harmful or toxic substances.

E - Explosive Damage: Explosive damage involves hazardous materials that are reactive and prone to explosion. Damage to the container may lead to explosive incidents.

M - Mechanical Damage: Mechanical damage includes physical damage to the container or its packaging. This can result from impact, compression, puncture, or other forms of mechanical stress.

Understanding these types of hazardous material damage helps emergency responders assess the situation, determine the appropriate protective actions, and establish safe zones during incidents involving hazardous materials. It also guides decisions on containment, mitigation, and evacuation measures to protect public safety and the environment.

EMS Pharmacology - Oxygen

EMS Providers (e.g., EMRs, EMTs, AEMTs, EMT-Is, and Paramedics) should have a thorough understanding of oxygen administration.

Here are some key points they should know:

1. Indications: Oxygen administration is used to treat patients who are experiencing hypoxia (low oxygen levels) or respiratory distress. It is commonly used for conditions such as respiratory failure, asthma, chronic obstructive pulmonary disease (COPD), and cardiac arrest.

2. Delivery Methods: EMS providers should be familiar with various delivery methods for oxygen, including nasal cannula, face mask, non-rebreather mask, and bag-valve-mask (BVM) ventilation. Each method has its own flow rates and indications based on the patient's condition and severity.

3. Flow Rates: EMS providers need to understand the appropriate flow rates of oxygen based on the patient's needs. Flow rates are typically measured in liters per minute (LPM) and can range from 1 to 15 LPM, depending on the delivery method and the patient's condition.

4. Monitoring: EMS providers should continuously monitor the patient's oxygen saturation levels using a pulse oximeter. This helps assess the effectiveness of oxygen therapy and ensures the patient is receiving adequate oxygenation.

5. Safety Precautions: EMS providers should follow safety precautions while handling and administering oxygen. This includes avoiding open flames or sparks in the vicinity, ensuring proper ventilation in enclosed spaces, and being cautious of oxygen toxicity risks with prolonged high-flow oxygen administration.

6. Documentation: EMS providers should document the administration of oxygen, including the delivery method, flow rates, and the patient's response to therapy. Accurate documentation is important for continuity of care and future reference.

Remember, EMS providers should always adhere to their local protocols and receive proper training on oxygen administration to ensure safe and effective use in emergency situations. 

#OxygenAdministration #EMR #EMT #AEMT #Paramedic #EMS #Pharmacology #PreHospitalCare #COPD #Documentation

The Glasgow Coma Scale

The Glasgow Coma Scale (GCS) was developed by Graham Teasdale and Bryan Jennett, neurosurgeons at the University of Glasgow, Scotland, in 1974. They designed the scale as a standardized method to assess and communicate the level of consciousness in patients with traumatic brain injuries (TBIs).

Teasdale and Jennett recognized the need for a simple and reliable tool that could be used by healthcare professionals across different settings to evaluate a patient's neurological status. They aimed to create a system that could provide a common language for describing levels of consciousness and facilitate communication among healthcare providers.

The GCS was based on observations and analysis of patients admitted to the neurosurgical unit at the Southern General Hospital in Glasgow. Teasdale and Jennett identified three key components of neurological function—eye-opening response, verbal response, and motor response—and assigned scores to each category based on the observed range of responses.

Their work resulted in the development of the GCS, which quickly gained acceptance and became widely used not only in the field of neurosurgery but also in emergency medicine, intensive care, and other healthcare specialties worldwide. The GCS has undergone revisions and refinements over the years to enhance its clinical utility, but the fundamental principles and scoring system established by Teasdale and Jennett remain the foundation of the scale.

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EMS providers should have a good understanding of the Glasgow Coma Scale (GCS) as it is a vital tool for assessing a patient's level of consciousness. Here are a few key points about the GCS:

1. The GCS assesses three aspects of neurological function: eye-opening response, verbal response, and motor response. Each of these aspects is assigned a score ranging from 1 to 4 or 5, depending on the specific category.

2. The scores from each category are added together to give a total GCS score, which can range from 3 (indicating deep unconsciousness) to 15 (indicating full consciousness).

3. The GCS is commonly used to assess patients with TBIs or altered mental status. It provides a standardized and objective way to assess the severity of neurological impairment and monitor changes over time.

4. EMS providers should be familiar with the criteria for assigning scores in each category. For example, eye-opening response ranges from spontaneous (4) to no response (1), verbal response ranges from oriented conversation (5) to no verbal response (1), and motor response ranges from following commands (6) to no motor response (1).

5. The GCS score can help guide treatment decisions, determine the need for immediate intervention, and provide a baseline for assessing the patient's progress. Lower GCS scores generally indicate more severe neurological injury or impairment.

Remember, the GCS is just one tool among many that EMS providers utilize to assess and manage patients. It's important to consider other factors and clinical findings in conjunction with the GCS score to make informed decisions about patient care.

#EMS #GlasgowComaScale #PreHospitalCare #TraumaAssessment

Mental Health & EMS

Mental health issues among Emergency Medical Service (EMS) providers have become a pressing concern in recent years. These dedicated professionals face unique challenges and stressors in their line of work, which can have a significant impact on their mental well-being. Some current issues and concerns related to mental health among EMS providers include:

High Stress Levels: EMS providers often encounter high-stress situations, including traumatic accidents, life-threatening emergencies, and mass casualty incidents. Exposure to these stressors can lead to acute and chronic stress, contributing to mental health issues.

Work-Related Trauma: EMS professionals are exposed to traumatic events and suffer from compassion fatigue, which can lead to symptoms of post-traumatic stress disorder (PTSD). Witnessing distressing scenes and losing patients can have a cumulative psychological toll.

Long and Irregular Shifts: EMS providers often work long hours with irregular schedules, including night shifts and weekends. These demanding work hours can disrupt sleep patterns and contribute to fatigue, which may exacerbate mental health issues.

Lack of Mental Health Support: Many EMS agencies have been slow to recognize and address mental health issues among their staff. There may be a lack of access to mental health resources, and stigma surrounding mental health can discourage providers from seeking help.

Substance Abuse: Some EMS providers turn to substance abuse as a coping mechanism for the stress and trauma they face. Substance abuse can further compound mental health issues and lead to addiction.

Burnout: EMS providers are at risk of experiencing burnout due to the emotional and physical demands of their job. Burnout can manifest as feelings of exhaustion, depersonalization, and reduced job satisfaction.

Suicide Rates: There is growing concern about elevated suicide rates among EMS professionals. The stressors, trauma exposure, and lack of mental health support can contribute to feelings of hopelessness and despair.

Impact on Personal Life: The emotional toll of the job can extend to EMS providers' personal lives, affecting their relationships, family dynamics, and overall well-being.

Addressing mental health issues among EMS providers requires a multi-faceted approach. It involves improving access to mental health resources, reducing stigma, offering peer support programs, and implementing regular mental health check-ins. EMS agencies, healthcare organizations, and policymakers need to prioritize the mental well-being of these essential frontline workers to ensure their long-term mental health and resilience.

#EMS #MentalHealth #PreHospitalCare #WhoCaresForTheCarers #SubstanceAbuse