EMS Pediatric Populations - Neonatal Emergencies

EMTs should be well-equipped to manage neonatal emergencies, including using the APGAR assessment and knowing when to initiate resuscitation.

Here's a guide for EMS providers on common neonatal emergencies:

APGAR Assessment:

The APGAR score is a quick assessment tool used to evaluate the newborn's overall condition at one and five minutes after birth.

It assesses the following five parameters, each scored from 0 to 2:

A - Appearance (skin color):

    0: Blue or pale

    1: Body pink, extremities blue

    2: Completely pink

P - Pulse (heart rate):

    0: Absent

    1: Below 100 beats per minute

    2: Above 100 beats per minute

G - Grimace response (reflexes):

    0: No response to stimulation

    1: Grimace or weak response to stimulation

    2: Vigorous response, cough, or sneeze

A - Activity (muscle tone):

    0: Limp or floppy

    1: Some flexion of limbs

    2: Active motion

R - Respiration (breathing rate and effort):

    0: Absent

    1: Slow or irregular breathing

    2: Good, strong cry

A total score of 7-10 is generally considered normal, 4-6 suggests moderate distress, and 0-3 indicates severe distress.

Common Neonatal Emergencies:

Meconium Aspiration:

• Presence of meconium in amniotic fluid.

• Suction the airway, provide respiratory support, and transport promptly.

Neonatal Sepsis:

• Signs may include poor feeding, temperature instability, and respiratory distress.

• Administer antibiotics and provide supportive care. Transport promptly.

Respiratory Distress Syndrome (RDS):

• Common in preterm infants.

• Provide respiratory support and transport to a facility with neonatal intensive care capabilities.

Neonatal Hypoglycemia:

• Low blood glucose levels can lead to seizures.

• Administer glucose gel or IV dextrose and transport for further management.

Neonatal Jaundice:

• Evaluate for jaundice and assess bilirubin levels.

• Phototherapy may be needed. Transport if severe.

When to Initiate Resuscitation:

Initiate neonatal resuscitation if the newborn exhibits severe distress, has a low APGAR score, or encounters the following conditions:

• Absent or Gasping Respirations:

• Provide positive pressure ventilation with a bag-mask device.

• Heart Rate Below 60 bpm:

• Initiate chest compressions if the heart rate remains below 60 bpm after adequate ventilation.

• Meconium Aspiration with Poor Respiratory Effort:

• Suction the airway and provide respiratory support.

• Cyanosis Persisting Despite Oxygen Administration:

• Ensure effective ventilation and consider advanced airway management.

• Profound Bradycardia or Cardiac Arrest:

• Initiate cardiopulmonary resuscitation (CPR).

EMTs must receive specific training in neonatal resuscitation and stay current with guidelines.

Communication with the receiving facility and early initiation of interventions are critical for improving outcomes in neonatal emergencies.

EMS Medical Terminology - Eponymous Conditions

EMS Providers should be aware of the origins of eponymous medical conditions and equipment names because understanding the history and context behind these terms helps them provide better patient care and communicate effectively with other medical professionals. 

Here are some key points EMS providers should know about the origins and significance of eponymous medical terms:

1. Historical Context:

Eponyms Reflect Medical Discovery: Many medical conditions and equipment are named after pioneers who either discovered the disease or developed essential medical tools. This gives EMS providers insight into the historical development of medical knowledge and practices.

Example: Beck's Triad, named after Claude Beck, describes signs of cardiac tamponade — hypotension, muffled heart sounds, and jugular vein distention — and knowing its origins can help in quick recognition of life-threatening situations.

2. Eponyms and Recognition of Disease Characteristics:

Conditions Named After Patients: Some diseases are named after the first patients or well-known individuals who had the condition, which helps in recognizing patterns of disease progression.

Example: Lou Gehrig’s Disease is a common name for amyotrophic lateral sclerosis (ALS), which became widely known when Lou Gehrig, a famous baseball player, was diagnosed with it. This eponym raises awareness of the disease’s progression and its neurodegenerative impact.

3. Impact on Communication:

Universal Understanding Across Disciplines: Eponyms serve as a universal language among healthcare providers. Even though the underlying mechanisms or treatments may evolve, using an eponym ensures that providers understand exactly what condition or tool is being referenced.

Example: APGAR Score, named after Dr. Virginia Apgar, is a quick assessment used globally to evaluate newborns immediately after birth. EMS providers can use this term to quickly communicate newborn health status to receiving hospitals.

4. Recognizing Outdated Eponyms:

Evolving Terminology: Over time, some eponyms become less frequently used, especially when new understanding or discoveries provide more precise descriptors. However, EMS providers may still encounter outdated eponyms and should recognize them.

Example: Bright’s Disease was historically used to describe a variety of kidney diseases, now recognized under more specific conditions such as nephritis or glomerulonephritis.

5. Eponyms in Medical Equipment:

Tools Named After Inventors: Certain medical tools and devices are named after their inventors, and understanding these origins can enhance the provider's appreciation for the tool’s function and use in the field.

Example: The Guedel airway, an oropharyngeal airway, was named after Dr. Arthur Guedel, an anesthesiologist, and its usage is critical in managing airway obstruction in unconscious patients.

6. Cultural Sensitivity:

Controversies Around Some Eponyms: Some eponyms are tied to individuals whose contributions to medicine are controversial due to ethical issues. Understanding these backgrounds can help EMS providers navigate discussions sensitively.

Example: The Heimlich Maneuver, named after Dr. Henry Heimlich, was widely taught for choking emergencies but later became controversial as newer techniques were developed.

7. Common Eponyms in EMS:

EMS providers frequently encounter eponyms during patient care or when communicating with other medical professionals. Familiarity with these terms aids in recognizing critical conditions and providing timely interventions.

• Kernig’s Sign: An indicator of meningitis.

• Murphy’s Sign: Associated with gallbladder disease.

• Cushing's Reflex: Indicates increased intracranial pressure.

Conclusion

EMS providers should understand the origins of eponymous medical terms and equipment to improve communication, recognize critical conditions, and appreciate the historical context behind these essential medical terms. 

This knowledge adds depth to their practice and ensures accurate patient care.

Further Reading:

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

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Ebright, C. (2024) Unique Patient Signs: A Case Study. EMS1. Accessed May 1, 2024

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

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell