EMS Medical Terminology - Reye’s Syndrome

Reye’s Syndrome is a rare but serious condition that causes sudden liver and brain dysfunction. It primarily affects children and teenagers, often following a viral illness like the flu or chickenpox, especially if treated with aspirin. 

For EMS providers, understanding Reye’s Syndrome is critical because early recognition and treatment are vital to preventing severe outcomes. It is an example of an eponymous medical term.

Key Points for EMS Providers:

- Pathophysiology: Reye’s Syndrome involves a two-phase illness: initial viral infection (e.g., influenza, varicella) followed by sudden hepatic dysfunction and encephalopathy.

The exact cause is unknown, but there is a strong association with aspirin use during viral illnesses.

- Risk Factors: 

• Most common in children aged 4 to 12.
• Recent viral illness (e.g., influenza, varicella).
• Use of aspirin or salicylate-containing products.

Signs and Symptoms to Recognize in the Prehospital Setting:

- Early Stage Symptoms:

• Persistent or severe vomiting.
• Lethargy or drowsiness.
• Irritability or behavioral changes.
• Loss of energy.

- Progressive Symptoms:

• Confusion, disorientation.
• Agitation, delirium, or combativeness.
• Seizures.
• Decreased level of consciousness, progressing to coma.
• Signs of increased intracranial pressure (e.g., abnormal posturing, pupil changes).

Differentiating Reye’s Syndrome:

Reye’s Syndrome can initially mimic other conditions, such as meningitis, encephalitis, or intoxication. It’s essential to have a high index of suspicion if the history suggests recent viral illness and aspirin use.

Prehospital Assessment:

- Primary Survey: Ensure airway, breathing, and circulation are intact. Manage ABCs promptly.

- Neurological Assessment: Use tools like the Glasgow Coma Scale (GCS) to assess mental status. Look for changes in alertness, confusion, and any neurological deficits.

- History: Ask about recent viral illnesses, medications, and the use of any aspirin or salicylate-containing products.

Prehospital Management:

- Ensure Airway Protection: If the patient is altered or has a decreased level of consciousness, consider advanced airway management.

- Monitor for Seizures: Be prepared to treat seizures with benzodiazepines if they occur.

- Prevent Hypoglycemia: Reye’s Syndrome is associated with metabolic disturbances. If hypoglycemia is suspected (common in Reye’s), administer IV dextrose if appropriate.

- Minimize External Stimulation: To avoid increasing intracranial pressure.

- Rapid Transport: This is a time-sensitive condition. Transport the patient to a facility equipped to manage pediatric neurological and hepatic emergencies.

Documentation and Communication:

Clearly document the patient's history, especially recent illness and medication use.

Relay any signs of altered mental status, recent viral infections, and aspirin use to the receiving facility.

Conclusion

Reye’s Syndrome, while rare, should be considered in children and teens presenting with unexplained vomiting, altered mental status, or seizures, especially if linked to a recent viral illness and aspirin use. 

Early recognition, supportive care, and rapid transport to a higher-level facility are critical components of prehospital management.

By maintaining a high index of suspicion and providing appropriate prehospital care, EMS providers play a vital role in the early identification and management of this potentially life-threatening condition.

Who Discovered Reye’s Syndrome?

Reye’s Syndrome was first described by Dr. Ralph Douglas Kenneth Reye, an Australian pathologist, in 1963. He and his colleagues published a landmark paper detailing a series of cases involving encephalopathy and fatty degeneration of the liver in children, following viral illnesses. 

This observation led to the condition being named “Reye’s Syndrome” in his honor.

Dr. Reye’s work highlighted the connection between viral infections, brain and liver damage, and the potential risks associated with certain medications, which eventually led to further research on the syndrome’s association with aspirin use.

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

Brown, C. A. (2022) Walls Manual of Emergency Airway Management (5th Ed). Philadelphia, Pennsylvania: Lippincott, Williams & Wilkins.

Crocker, J. F, & Bagnell, P. C. (1981) Reye's Syndrome: A Clinical Review. Canadian Medical Association Journal 24(4): 375-82, 425. Accessed October 14, 2024

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

National Institute of Neurological Disorders and Stroke (2019) Reye’s Syndrome. Accessed October 14, 2024

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

Reye, R. D. K., Morgan, G., & Baral, J. (1963) Encephalopathy & Fatty Degeneration of The Viscera: A Disease Entity in Childhood. The Lancet 282(7291): 749–752. Accessed October 14, 2024

EMS Equipment - Murphy's Endotracheal Tube

For EMS providers, understanding the Murphy Endotracheal Tube and its key feature, the “Murphy Eye,” is essential for ensuring patient safety during airway management. 

The Murphy eye serves as a critical safety mechanism that prevents complete airway obstruction if the main distal opening of the tube becomes blocked. It is also an example of an eponymous medical term.

Recognizing this feature and the overall design of the endotracheal tube can help prevent complications during intubation and ensure the continued delivery of oxygen to patients in emergency situations.

The “Murphy Eye” Explained

The Murphy Eye is the eponymous term for a small hole on the side of most endotracheal tubes (ETTs). It functions as a vent, preventing complete obstruction of the patient’s airway if the primary distal opening of the ETT becomes occluded.

Dr. Francis J. Murphy (1900–1972) was a strong advocate for the continuous supply of oxygen during anesthesia. In 1941, he outlined the nine characteristics of the "ideal" endotracheal tube (ETT). In the same article, he introduced two tubes with innovative features. 

One tube was straight with two side holes, while the other was curved with one side hole. Both lacked cuffs and were made from high-quality red rubber that balanced flexibility with resistance to compression or kinking, even after multiple uses and heat sterilizations.

Although most ETTs today are made from disposable plastic, they still require a similar balance of flexibility and resistance to compression. Most continue to incorporate the crucial safety feature that bears Dr. Murphy's name: the "Murphy eye."

The featured image show the orginal tube, owned by Dr. Murphy himself, and bears his initials. It features an inflatable cuff located above the "eye," which is inflated via a small side tube attached to the ETT. 

Further Reading:

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

Brown, C. A. (2022) Walls Manual of Emergency Airway Management (5th Ed). Philadelphia, Pennsylvania: Lippincott, Williams & Wilkins.

EMS Medical Terminology - Sellick's Maneuver

EMS providers should be familiar with the Sellick Maneuver, also known as cricoid pressure, as a technique designed to reduce the risk of regurgitation and aspiration during endotracheal intubation, particularly in patients who are not fasting or at high risk of vomiting. It is an example of an eponymous medical term.

It was first described by Dr. Brian Sellick in 1961 and has been used in emergency and anesthetic situations ever since. 

However, it’s essential for EMS providers to apply the right amount of pressure and know that this technique is sometimes debated due to concerns that it may obstruct the airway or complicate intubation in some cases.

Here's what they should know:

Key Concepts

Anatomy Involved:

The cricoid cartilage is a ring-shaped structure located just below the thyroid cartilage in the neck.

When performing the Sellick Maneuver, downward pressure is applied to the cricoid cartilage, which in turn compresses the esophagus against the vertebral column, theoretically reducing the chance of regurgitation by preventing stomach contents from moving into the pharynx.

When to Use It:

Primarily used during rapid sequence intubation (RSI) to protect the airway in emergency situations, especially when there's a high risk of vomiting (e.g., trauma patients, those who have recently eaten, or have decreased consciousness).

It may also be employed during bag-valve-mask (BVM) ventilation to prevent gastric insufflation, although this use is somewhat controversial.

How to Perform It:

The provider places firm, continuous pressure using the thumb and forefinger on the cricoid cartilage (located below the Adam’s apple).

The recommended pressure is about 10 Newtons (≈1 kg of force) initially, increasing to 30-40 Newtons (≈3-4 kg of force) once the patient loses consciousness, as the risk of vomiting increases at that point.

Controversies & Limitations:

Questionable Efficacy: Studies over the years have raised doubts about the effectiveness of the Sellick Maneuver in completely preventing regurgitation or aspiration. In some cases, it may even impair ventilation or visualization of the airway during intubation, particularly in difficult airway scenarios.

Potential Complications: Incorrect application of the maneuver (too much force or misplacement of pressure) can result in airway obstruction or displacement of the esophagus laterally rather than compressing it.

Many modern airway protocols have deemphasized its routine use and instead focus on optimal intubation techniques and preparation for managing airway complications.

Training & Clinical Judgment:

EMS providers should be well-trained in applying the maneuver correctly, but also be aware that if it interferes with ventilation or intubation, it should be discontinued.

It’s essential to assess the specific patient scenario (e.g., suspected difficult airway) and weigh the benefits and risks of applying cricoid pressure.

Summary

The Sellick Maneuver was historically considered a key technique for preventing aspiration during emergency intubation, but its effectiveness is now debated. 

EMS providers should understand the anatomy, application method, and potential complications, and apply it judiciously based on the clinical situation.

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

Brown, C. A. (2022) Walls Manual of Emergency Airway Management (5th Ed). Philadelphia, Pennsylvania: Lippincott, Williams & Wilkins.

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

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