EMS Medical Terminology - Cushing's Triad

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

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.

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. https://www.ems1.com/patient-assessment/articles/unique-patient-signs-a-case-study-f4CQBuoUo9uTCHrZ/ 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

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