EMS Training Opportunity - Prehospital Trauma Life Support (PHTLS)

 

Colorado Cardiac CPR are offering a PHTLS at the start of March (3 & 4). This is a great opportunity for emergency medical responders, EMTs, Paramedics, Nurses, Physician Assistants and Doctors.

Description: The mission of PHTLS is to promote excellence in trauma patient management by all providers involved in the delivery of prehospital care. PHTLS is developed by NAEMT in cooperation with the American College of Surgeons' Committee on Trauma.

PHTLS is the global gold standard in prehospital trauma education and is taught in over 80 countries. 

Content: The aim of PHTLS courses is to improve the quality of trauma care and decrease patient mortality. 

The program is based on a philosophy stressing the treatment of the multi-system trauma patient as a unique entity with specific needs. 

The course covers the following topics:

• Physiology of life and death
• Scene Assessment
• Patient Assessment
• Hemorrhage Control
• Airway, Breathing, Ventilation & Oxygenation
• Circulation & Shock
• Special Populations

The course emphasizes application of trauma education through case studies, skills practice, and patient simulations.

Date: March 3 & 4, 2025 9:00 AM to 5:00 PM

Cost: $315.00

Discount: 3CPR

Location: Littleton (Broadway & Davies), Colorado

Outcome: Upon successful course completion you will be issued an NAEMT PHTLS provider card and receive 16-hours of CAPCE credits.

For more information and to register, access this link:

https://3cpr.enrollware.com/enroll?id=10735378

EMS Ethics - Key Concepts for Prehospital Healthcare Providers Part One

Ethics play a crucial role in the field of Emergency Medical Services (EMS), where decisions must often be made quickly and under pressure. 

As prehospital care responders, EMS providers are frequently faced with challenging situations that require a strong understanding of ethical principles to ensure that patient care is delivered effectively and compassionately. 

Ethics in EMS encompass various concepts that guide providers in respecting patient rights, ensuring informed decision-making, and protecting their confidentiality, all while striving to do good and avoid harm. 

This piece outlines part one of essential ethical principles that every EMS provider should understand to provide the highest standard of care in prehospital settings.

1. Autonomy

Also known as self-determination, autonomy refers to the right of the patient to make decisions about their own medical care. In EMS, we often encounter this ethical concept when well-meaning family members attempt to supersede the wishes of a patient who is otherwise capable of making their own choices. 

Aside from situations where an inability to make appropriate decisions has been demonstrated (e.g. threat of suicide), a patient who is alert, oriented, and able to comprehend the gravity of their situation has the right to determine the course of their own medical care.

2. Informed Consent

A patient exercising autonomy can only make appropriate decisions regarding their medical care if they possess enough information to make informed choices. 

It is, therefore, the ethical obligation of EMS providers to present a full and accurate picture to our patients of the risks and benefits of their self-determined healthcare decisions.

3. Confidentiality

Information received while in a patient-provider relationship must remain protected from those who do not need to know. Consequences for the negligent disclosure of private medical information include embarrassment to the patient; the erosion of trust between EMS providers and the public we serve; and hefty fines to the agency. 

In the case of HIPAA violations, fines can be as high as $50,000 per infraction, with a maximum penalty of $1.5 million per year.

4. Beneficence

The term beneficence describes actions that are carried out for the benefit of others. Administering D50 to a hypoglycemic patient while on the scene, instead of immediately transporting them to the hospital while unconscious, is an example of beneficence in EMS. 

In this situation, providing IV dextrose with the knowledge that the patient could very likely return to consciousness and be left safely in their home is beneficial in terms of lower cost to the patient, and less of their time wasted waiting for an unnecessary ER evaluation.

5. Non-Maleficence

Primum Non Nocere - first, do no harm - is the original guiding principle of medicine. If faced with a choice between doing nothing or taking an action that will cause more harm, the correct decision in most cases is to take no action. 

Similarly, if inaction would likely result in harm befalling a patient, EMS providers are obligated to take appropriate steps for the protection of those in our care.

Conclusion

Ethical considerations are integral to the practice of EMS and are essential for maintaining trust between providers and the communities they serve. By adhering to ethical principles such as autonomy, informed consent, confidentiality, beneficence, and non-maleficence, EMS providers ensure that they are making decisions that respect patient rights and promote well-being. 

Understanding and applying these concepts helps providers navigate the complex and often unpredictable nature of prehospital care, ultimately leading to better patient outcomes and a more ethical healthcare environment. 

As the field of EMS continues to evolve, ongoing education and reflection on ethical practices will remain vital for all providers.

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, J. F. (1999) Ethics, Emergency Medical Services, and Patient Rights: System and Patient Considerations. Topics in Emergency Medicine 21 (1): 49-57 Accessed August 9, 2024

Harris, D. (2014) Contemporary Issues in Healthcare Law and Ethics (4th Ed). Illinois: Health Administration Press.

Iserson, K. V. (2006)  Ethical Principles - Emergency Medicine. Emergency Medicine Clinics of North America 24(3): 513 - 545   Accessed August 9, 2024

Larkin G. L. & Fowler, R. L. (2002) Essential Ethics for EMS: Cardinal Virtues and Core Principles. Emergency Medicine Clinics of North America 20 (4): 887-911. Accessed August 9, 2024

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

Moskop, J. C. (2006) Informed Consent and Refusal of Treatment: Challenges for Emergency Physicians. Emergency Medicine Clinics of North America 24 (3): 605-618. Accessed August 7, 2024

National Association of Emergency Medical Technicians (2013) Code of Ethics for EMS Practitioners. Accessed August 7, 2024

Winston, B. & Moskop, J. C. (2014) A Review of the Updated NAEMT Code of Ethics. Journal of Emergency Medical Services 39 (6): 50-53 Accessed August 9, 2024

EMS Neurological Emergencies - Seizure Disorder Pathophysiology

The pathophysiology of seizures involves complex changes in the electrical activity of the brain, leading to abnormal synchronization of neuronal firing and the generation of seizure activity. 

While the precise mechanisms underlying seizures can vary depending on the type of seizure and the underlying cause, there are several key components involved in the pathophysiology of seizures:

Neuronal Hyperexcitability: Seizures are characterized by abnormal, excessive, and synchronous neuronal activity in the brain. 

This hyperexcitability can arise from various factors, including changes in ion channel function, neurotransmitter imbalance, or alterations in neuronal connectivity.

Ion Channel Dysfunction: Ion channels play a crucial role in regulating the flow of ions (such as sodium, potassium, calcium, and chloride) across neuronal cell membranes, which is essential for maintaining normal neuronal excitability and function. 

Dysfunction of ion channels, either through genetic mutations or acquired alterations, can lead to abnormalities in neuronal excitability and contribute to seizure generation.

Imbalance of Excitatory & Inhibitory Neurotransmission: Normal brain function relies on a delicate balance between excitatory and inhibitory neurotransmission. 

Excitatory neurotransmitters, such as glutamate, promote neuronal activation, while inhibitory neurotransmitters, such as gamma-aminobutyric acid (GABA), dampen neuronal activity. 

Imbalances in the relative levels or function of these neurotransmitters can disrupt the normal inhibitory control of neuronal firing and contribute to seizure generation.

Aberrant Synchronization of Neuronal Firing: Seizures result from the abnormal synchronization of neuronal firing, leading to hypersynchronous activity within neuronal networks. This synchronized firing can spread rapidly throughout the brain, resulting in the characteristic clinical manifestations of seizures.

Network Dysfunction: Seizure activity often involves multiple brain regions and networks. 

Abnormalities in the connectivity and communication between different brain regions can facilitate the propagation of seizure activity and contribute to the generation of seizures.

Excitotoxicity & Neuroinflammation: Prolonged or recurrent seizure activity can lead to excitotoxicity, a process in which excessive release of excitatory neurotransmitters, such as glutamate, results in neuronal damage and cell death. 

Additionally, seizures can trigger neuroinflammatory processes, further exacerbating neuronal dysfunction and contributing to seizure generation.

Structural & Metabolic Factors: Structural abnormalities in the brain, such as tumors, vascular malformations, or cortical dysplasia, can disrupt normal neuronal circuitry and increase the likelihood of seizure activity. 

Metabolic disturbances, such as hypoglycemia, electrolyte imbalances, or mitochondrial disorders, can also trigger seizures by affecting neuronal function.

Overall, the pathophysiology of seizures involves a complex interplay of genetic, molecular, cellular, and network-level processes that lead to abnormal neuronal excitability and synchronization. 

Understanding these mechanisms is essential for developing targeted therapies aimed at preventing or controlling seizure activity.

Further Reading:

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

Huff, J.S. & Murr, N (2023) Seizure. Treasure Island, Florida: StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK430765/ Accessed April 24, 2024

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

Images of EMS - In The Midnight Hour

 

EMS Celebrations - International Women’s Day

Did you know that women make up around 30% of EMS Providers in the USA?

Let’s take a moment to recognize the incredible females of EMS. Their unwavering dedication, leadership, and role modelling play a crucial role in prehospital emergency care.

Raise a cheer to all the strong and resilient women saving lives on the frontlines as we celebrate International Women's Day.

#InternationalWomensDay #EMS #WomenInHealthcare #NREMT #EMR #EMT #AEMT #Paramedic

EMS Medication Administration - The Six Rights in EMS Practice

EMS Providers frequently encounter situations where prompt administration of pharmacologic agents can be life-saving for patients in the pre-hospital environment. Despite often operating under less than optimal conditions, EMS providers play a crucial role in delivering timely and appropriate medications to address life-threatening emergencies. 

However, to ensure patient safety and uphold professional standards, it is imperative for EMS practitioners to adhere to best practices in medication administration throughout their careers.

One fundamental framework for safe medication administration is the concept of the Six Rights. Be aware that in some healthcare texts these rights have expanded to cover close 15 rights.

The Six Rights of Drug Administration:

Right Patient:

In the dynamic environment of EMS, ensuring the right patient receives the right medication is paramount. This involves not only confirming the patient's identity but also verifying allergies and contraindications to medications. Even in scenarios involving multiple patients, meticulous attention must be paid to prevent medication errors.

Right Rx:

Selecting the appropriate medication for the patient's condition is essential to achieve desired therapeutic outcomes. EMS providers must be knowledgeable about the indications, contraindications, and potential adverse effects of each medication in their formulary. Additionally, confirming the integrity and expiration date of the medication before administration is crucial for patient safety.

Right Dose:

Medications must be administered in precise doses as determined by medical control protocols. EMS practitioners should be proficient in calculating dosages accurately, particularly considering variations based on patient demographics such as weight and age. Additionally, ensuring the correct interpretation of medical orders and understanding any dosage adjustments based on patient-specific factors is essential.

Right Time:

Timeliness in medication administration can significantly impact patient outcomes. EMS providers must assess the urgency of medication administration based on the patient's condition and clinical presentation. Furthermore, consideration of potential drug interactions, including recent medication history, is vital to avoid adverse effects and optimize therapeutic efficacy.

Right Route:

Selecting the appropriate route of medication administration is crucial for ensuring optimal drug absorption and efficacy while minimizing the risk of complications. EMS providers must be proficient in various administration routes, such as intravenous, intramuscular, subcutaneous, and oral, and understand the specific indications for each route based on the medication and patient's condition.

Right Documentation:

Accurate documentation of medication administration is essential for maintaining continuity of care, facilitating communication among healthcare providers, and ensuring legal compliance. EMS practitioners must document the medication administered, dosage, route, time of administration, patient response, and any adverse reactions or complications. Timely and comprehensive documentation is critical for ongoing patient assessment and quality improvement efforts.

Conclusion:

Adhering to the Six Rights of Drug Administration is fundamental to promoting patient safety and optimizing outcomes in EMS practice. By following these principles rigorously, EMS providers can mitigate the risk of medication errors, enhance the quality of care delivered, and uphold professional standards throughout their careers. Continuous education and training in medication administration are essential to ensure proficiency and competence among EMS practitioners, ultimately benefiting the patients they serve.

Addendum:

Right To Refuse Medication:

In the realm of medication administration in EMS, it's essential to acknowledge and respect the patient's right to refuse treatment, including medication. While EMS providers are trained to prioritize patient safety and offer appropriate interventions, they must also recognize and honor the autonomy of the individual. 

Understanding the circumstances under which a patient may refuse medication is crucial, as it may stem from various factors such as personal beliefs, cultural considerations, or concerns about potential side effects. EMS practitioners should engage in effective communication with the patient, explaining the rationale behind the recommended treatment and addressing any questions or concerns they may have. 

However, if a patient refuses medication despite being informed of the potential risks and benefits, their decision should be respected, documented, and communicated to appropriate medical personnel for further evaluation if necessary. 

Upholding the patient's right to refuse medication reinforces the principles of patient-centered care and ethical practice in EMS.

Further Reading:

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice Volume 1 (6th Ed) Pearson.  

Bledsoe, B. E. & Clayden, D. (2018) Prehospital Emergency Pharmacology (8th Ed). Pearson. 

Coughlin, C. (2019) Paramedic Crash Course (1st Ed) Research & Education Association 

Guy, J. S. (2019) Pharmacology for the Prehospital Professional (2nd Ed) Jones & Bartlett Learning. 

EMS History - The American Heart Association

The American Heart Association (AHA) was established in 1924 by a group of six cardiologists in response to the growing concern over the lack of research and information about heart disease. At the time of its founding, heart disease was becoming a leading cause of death in the United States, yet there was limited understanding of its causes and prevention methods.

The rationale behind the establishment of the AHA stemmed from the need to address this gap in knowledge and to advocate for increased awareness, research, and education about heart health. The founders recognized the urgent need for a centralized organization dedicated to combating heart disease, promoting cardiovascular research, and disseminating information to both healthcare professionals and the general public.

The AHA's mission focuses on reducing disability and death caused by cardiovascular diseases and stroke. To achieve this mission, the association engages in various activities, including funding research grants, developing guidelines for the treatment and prevention of heart disease and stroke, advocating for public policies that promote heart health, and providing educational resources and programs to communities and healthcare professionals.

Over the years, the AHA has played a crucial role in advancing cardiovascular science and improving public health outcomes. Its initiatives have led to significant advancements in the prevention, diagnosis, and treatment of heart disease and stroke. Through partnerships with medical professionals, policymakers, advocacy groups, and the public, the AHA continues to work towards its goal of building healthier lives, free of cardiovascular diseases and stroke.

Further Reading:

American Heart Association (ND) History of CPR - Highlights from the 16th Century to the 21st Century. Retrieved from https://cpr.heart.org/en/resources/history-of-cpr 

EMS Patient Assessment - Referred Pain (2)

Referred pain is a phenomenon where pain is perceived at a location different from the actual site of the underlying problem or injury. This occurs because the same nerve pathways that carry pain signals from one area of the body can overlap or converge with the nerve pathways from another area. 

As a result, when pain signals are generated in one region, they can be misinterpreted by the brain as originating from a different area that shares nerve connections.

Referred pain can be confusing because it can lead to the misdiagnosis of the source of pain.

Cardiac Referred Pain: One of the classic examples of referred pain is related to the heart. When the heart muscle (myocardium) is deprived of oxygen and nutrients, such as during a heart attack, the brain often interprets this pain as originating in the left side of the chest, left arm, or even the jaw.

- Levine's Sign: Named after Dr. Samuel Levine, this sign is related to cardiac referred pain. It's a characteristic clutching of the chest seen in patients experiencing angina or a heart attack.

Gallbladder Referred Pain: Gallbladder issues, like gallstones or cholecystitis, can cause referred pain to the right shoulder or between the shoulder blades. This is because the same nerves that supply the gallbladder also connect to these areas.

- Murphy's Sign: Named after Dr. John Benjamin Murphy, this sign is used to diagnose gallbladder-related pain. It involves the patient experiencing increased pain or discomfort when the doctor palpates the area beneath the ribcage on the right side during deep inspiration.

Spleen Referred Pain: Referred pain from the spleen typically presents as discomfort in the left upper abdominal quadrant, just beneath the ribcage. Conditions that can cause spleen-related referred pain include splenomegaly and conditions that lead to trauma or rupture of the spleen.

- Kehr's Sign: Named after Dr. Hans Kehr, this sign relates to pain in the left shoulder that can occur due to irritation of the diaphragm, often resulting from conditions like a ruptured spleen or other sources of abdominal bleeding. In such cases, Kehr's Sign is used to describe both the referred pain and its association with spleen-related issues.

Appendicitis: Inflammation of the appendix can often cause pain around the navel or the upper abdomen before it eventually migrates to the right lower quadrant, which is the classic location for appendicitis pain.

- McBurney's Point: Named after Dr. Charles McBurney, this is a location used to diagnose appendicitis, which corresponds to the location of the base of the appendix.

Kidney Stone Pain: Pain caused by kidney stones can be felt not only in the lower back and side, where the kidneys are located but also radiate down to the groin area or the abdomen.

- Costovertebral Angle (CVA) Tenderness: While not named after a specific individual, this is an important sign to check for when evaluating kidney-related pain, such as kidney stones. Tenderness in the CVA, located on the back, just below the ribcage, is indicative of renal issues.

Diaphragm Referred Pain: Irritation of the diaphragm muscle can cause pain in the shoulder, especially the left shoulder. This is because it shares nerve connections with the shoulder area.

Liver Referred Pain: Liver inflammation or congestion can lead to referred pain in the right shoulder or upper back due to the shared nerve pathways.

Understanding referred pain is important for healthcare professionals as it can sometimes make diagnosing the underlying condition more challenging. It's crucial to consider referred pain in the diagnostic process to identify and treat the actual source of the problem accurately.

EMS Patient Assessment - Referred Pain (1)

EMS Providers should have a comprehensive understanding of referred pain to effectively assess and manage patients in the field. 

Here are key points they should know:

Definition and Mechanism: A phenomenon where pain is felt in an area of the body that is different from the actual source of the pain. It occurs due to the convergence of nerve pathways, where signals from one area of the body are interpreted as originating from another area that shares nerve connections.

Common Examples: EMS providers should be familiar with common examples of referred pain, such as cardiac referred pain (e.g., chest pain radiating to the left arm or jaw during a heart attack), gallbladder referred pain (e.g., pain in the right shoulder or between the shoulder blades with gallstones or cholecystitis), and spleen referred pain (e.g., left shoulder pain with spleen-related issues).

Recognition: Recognizing patterns of referred pain can aid EMS providers in diagnosing the underlying cause of a patient's symptoms. Understanding the characteristic locations of referred pain associated with specific conditions can help differentiate between different potential diagnoses.

Clinical Signs: Some conditions have specific clinical signs associated with referred pain, such as Levine's Sign for cardiac referred pain (clutching of the chest) or Murphy's Sign for gallbladder-related pain (increased pain during palpation beneath the ribcage on the right side).

Diagnostic Considerations: Referred pain can complicate the diagnostic process by masking the true source of the pain. EMS Providers should be aware of this possibility and consider a broad range of differential diagnoses when assessing patients presenting with symptoms of referred pain.

Treatment Implications: Understanding referred pain can influence the treatment approach for patients. EMS Providers should consider the underlying cause of the pain when administering interventions and be prepared to manage the primary condition contributing to the referred pain.

Communication: Effective communication with receiving facilities is crucial when transferring patients with suspected referred pain. Providing a clear and accurate description of the patient's symptoms, including any associated referred pain, can help guide further evaluation and treatment at the receiving facility.

By being knowledgeable about referred pain and its clinical implications, EMS Providers can enhance their ability to assess, manage, and provide appropriate care for patients experiencing this phenomenon in the prehospital setting.

EMS Gastrointestinal Emergencies - Particular Patient Presentations

In the realm of emergency medical service provision, encountering gastrointestinal emergencies is not uncommon. From gastrointestinal bleeding to acute appendicitis, EMS Providers must be prepared to assess, manage, and provide timely intervention for these critical conditions. Understanding the signs, symptoms, and underlying causes of such emergencies is essential for swift and effective patient care.

Here are some examples of gastrointestinal emergencies an EMT might encounter:

Gastrointestinal Bleeding:

Signs and Symptoms: Hematemesis (vomiting blood), Melena (black, tarry stools), Hematochezia (bright red or maroon-colored stools), weakness, lightheadedness, and abdominal pain.

Examples: Peptic ulcers, Esophageal varices, Gastritis, Diverticulosis, colorectal cancer.

Appendicitis:

Signs and Symptoms: Right lower quadrant abdominal pain, nausea, vomiting, low-grade fever, rebound tenderness.

Example: Inflamed or infected appendix.

Gastroenteritis:

Signs and Symptoms: Diarrhea, vomiting, abdominal cramps, fever, dehydration.

Example: Viral or bacterial infection of the gastrointestinal tract.

Bowel Obstruction:

Signs and Symptoms: Abdominal pain and distension, nausea, vomiting (may be feculent), constipation, inability to pass gas.

Example: Blockage of the intestines, often due to adhesions, hernias, or tumors.

Pancreatitis:

Signs and Symptoms: Severe abdominal pain radiating to the back, nausea, vomiting, abdominal tenderness.

Example: Inflammation, often due to gallstones or excessive alcohol consumption.

Cholecystitis:

Signs and Symptoms: Right upper quadrant pain, nausea, vomiting, fever, tenderness.

Example: Inflammation of the gallbladder, often due to gallstones.

Diverticulitis:

Signs and Symptoms: Left lower quadrant abdominal pain, fever, nausea, change in bowel habits.

Example: Infection or inflammation of small pouches (diverticula) in the colon.

Gastrointestinal Perforation:

Signs and Symptoms: Sudden, severe abdominal pain, rigid abdomen, guarding, rebound tenderness.

Example: A hole or tear in the gastrointestinal tract, often due to trauma or ulceration.

Gastrointestinal (GI) emergencies pose significant challenges for EMS Providers in the field and can vary widely in terms of severity and presentation. Whether managing cases of GI bleeding or identifying and responding to appendicitis, quick and accurate assessment is essential for ensuring positive patient outcomes.

EMS Providers should follow local assessment protocols and communicate effectively with the receiving facility to ensure the best possible care for the patient. Additionally, maintaining good infection control practices and ensuring proper hygiene is essential when dealing with gastrointestinal emergencies, as many are infectious in nature.

By familiarizing themselves with the signs, symptoms, and potential causes of these emergencies, EMS providers can better navigate these critical situations and provide timely and effective care to those in need.

EMS Equipment - Traction Splints Addendum

For open femur fractures, it is essential to follow the principles of advanced trauma life support (ATLS) and local trauma management protocols.

These protocols typically recommend initial hemorrhage control, wound care, and expedited transport to a trauma center for definitive care.

According to the organization, International Trauma Life Support (ITLS), they advocate for the use of traction devices for open midshaft femur fractures.

ITLS reports the use of a traction device for open midshaft femur fractures can help reduce the risk of neurovascular injuries and alleviate patient pain. It highlights the importance of considering the patient's extrication and transportation needs when selecting a traction device.

In situations where the patient will be transported by air, the ITLS update suggests that a HARE traction splint may be preferred over a Sager traction splint. This is likely due to the design and ease of application of the HARE traction splint, which may be better suited for air transport scenarios.

It's important to note that guidelines and recommendations can vary across different organizations and regions. Therefore, it's crucial to consider the specific guidelines and protocols established by your local EMS authority or trauma organization when managing open midshaft femur fractures.

Bibliography

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

Davis, D. D., Ginglen, J. G., Kwon, Y. H., & Kahwaji, C. I. (2023) EMS Traction Splint. StatPearls. https://pubmed.ncbi.nlm.nih.gov/29939619/ Accessed February 19, 2023

International Trauma Life Support (2011) Utilization of Traction Splints with Open Femur Fracture. https://www.itrauma.org/.../UtilizationofTractionSplintsw... Accessed November 14, 2023

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

The Bone School (ND) Femoral Shaft Fractures. http://www.boneschool.com/lower-limb/hip/femur-fractures/femoral-shaft-fractures Accessed February 19, 2024

EMS Equipment - Traction Splints

Traction splints are devices used in prehospital settings to provide stabilization and immobilization for certain types of fractures, specifically femur fractures.

Their purpose is to help alleviate pain, reduce bleeding, and prevent further damage to surrounding tissues.

Some common brands of traction splints include the HARE traction splint, Sager traction splint, and Thomas traction splint.

These brands have variations in design and application method, but they all serve a similar purpose.

Recommendations for using traction splints typically include cases where there is a suspected or confirmed mid-shaft femur fracture.

The use of traction splints can help align the fractured bone ends and provide relief by reducing muscle spasm and restoring limb length.

Femur fractures are serious injuries that we often encounter in the field.

Recognizing Femur Fractures: Look for signs like severe pain, swelling, deformity (leg may appear shorter or rotated), inability to move the leg, and sometimes, bruising.

High-Impact Injuries: Remember, the femur is the strongest bone in the body. A fracture usually results from high-impact trauma, like motor vehicle accidents or significant falls.

Check for Complications: Be vigilant for potential complications such as bleeding (femoral artery damage), fat embolism, or shock, especially in high-impact traumas.

Immobilization is Key: Stabilize the leg with a traction splint if indicated. Proper immobilization reduces pain, bleeding, and the risk of further injury.

Monitor Vitals: Keep a close eye on the patient’s vital signs. Femur fractures can cause significant pain and shock, which may lead to changes in pulse, blood pressure, and respiratory rate.

Transportation Considerations: Handle with care during transport. Smooth movements and careful handling can prevent further injury and pain.

Communication with Hospital: Inform the receiving facility about the nature of the injury, your interventions, and the patient's response to treatment.

However, there are certain contraindications and situations where traction splints should not be used.

These include:

Proximal or Distal Femur Fractures: Traction splints are designed for mid-shaft femur fractures and may not be effective or appropriate for fractures closer to the hip or knee joint.

Pediatric Patients: Traction splints are generally not recommended for pediatric patients due to differences in bone anatomy and the risk of causing additional injury.

Inability to Apply Properly: If the EMS provider is unable to properly apply or use the traction splint, it should not be used. In such cases, alternative methods of immobilization will need to be considered.

Therefore, it is important to note that the decision to use a traction splint should be based on the specific circumstances of the patient and the availability of appropriate resources.

EMS providers should consider factors such as the mechanism of injury, the location and type of femur fracture, and the patient's overall condition.

It's always advisable for EMS providers to adhere to local protocols and guidelines, as they may vary depending on the region and specific healthcare system.

These protocols are typically established based on current evidence, best practices, and expert consensus to ensure optimal patient care.

EMS Patient Monitoring - Capnography 4

Understanding the capnography waveform is essential. A consistent waveform indicates proper ventilation, while irregularities may signal airway or respiratory issues.

Considerations:

Equipment Calibration: Regular calibration of capnography equipment is essential to maintain accuracy in CO2 measurements.

Interference with Nasal Cannula: Nasal cannulas may result in lower ETCO2 readings due to air dilution. Consider using an alternative sampling method if necessary.

Low Perfusion States: In low perfusion states, such as during cardiac arrest, capnography may be less reliable in reflecting true ETCO2 levels.

Temperature Compensation: Capnography measurements are temperature-dependent. Providers should be aware of the need for temperature compensation to ensure accurate readings.

Limitations:

Airway Anomalies: Some airway anomalies or pathologies may affect capnography readings. Providers should be cautious in interpreting results in such cases.

Equipment Malfunction: Malfunctions in the capnography equipment can lead to inaccurate readings. Regular maintenance and checks are necessary.

Rebreathing: Rebreathing or partial rebreathing masks can result in elevated ETCO2 levels, affecting the accuracy of monitoring.

Sampling Rate: Inadequate sampling rates may result in delayed detection of changes in ETCO2 levels. Ensure the capnography device has an appropriate sampling rate.

Pulmonary Embolism: In cases of massive pulmonary emboli, capnography may show a decrease in ETCO2 due to reduced perfusion to the lungs.

EMS providers should undergo proper training to interpret capnography data accurately and be aware of the limitations and special considerations in various clinical scenarios.

Regular education and updates on capnography technology are crucial to providing optimal patient care.

Further Reading:

Capnography: Principles and Practice by Michael K. Copeland

Capnography, King of the ABC’s: A Systematic Approach for Paramedics" by Troy Valente

Paramedic Care: Principles & Practice: by Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry

EMS Patient Monitoring - Capnography 1

Widely embraced across diverse medical settings, including the exigencies of emergency medical services, the precision of intensive care units, the intricacies of operating rooms, and the nuanced demands of procedural sedation, capnography emerges as a multifaceted sentinel for healthcare providers.

Capnography is an indispensable asset within the realm of prehospital and emergency medical care, serving as a dynamic window into a patient's physiological landscape. This monitoring technique engages in the continuous, real-time measurement and graphical representation of carbon dioxide (CO2) concentration, specifically known as end-tidal CO2 (ETCO2), within a patient's exhaled breath.

By offering an unbroken stream of insights into both respiratory and circulatory dynamics, capnography provides a comprehensive understanding of a patient's evolving physiological status.

End-Tidal CO2 (ETCO2), the focal point of capnography, unveils the partial pressure or concentration of carbon dioxide at the culmination of each exhaled breath. This metric, expressed in millimeters of mercury (mmHg) or as a percentage, furnishes EMS providers with real-time, actionable information regarding a patient's respiratory well-being.

As a consequence, ETCO2 monitoring emerges as a linchpin in the delivery of timely and informed interventions, ensuring the optimization of patient care in critical and time-sensitive situations.

The word ‘capnography’ has its roots in Greek. The term is derived from the Greek word ‘kapnos’ meaning ‘smoke’, and the suffix ‘-graphy’, which refers to the process of recording. The name reflects its focus on the measuring of carbon dioxide which, historically, has been associated with the term ‘smoke’ due to its visible presence in combustion processes

Further Reading:

Capnography: Principles and Practice by Michael K. Copeland

Capnography, King of the ABC’s: A Systematic Approach for Paramedics" by Troy Valente

Paramedic Care: Principles & Practice" by Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry

EMS Pharmacology - Common Medication (Rx) Forms

Medications come in various dosage forms, each designed to deliver the medication in a specific way.

Some of the most common Rx dosage forms include:

Tablets and Capsules: These are solid dosage forms that contain the active ingredient(s) along with other inactive ingredients. They are taken orally and come in various shapes, sizes, and colors.

Liquid Solutions and Suspensions: These are liquid dosage forms where the active ingredient(s) are dissolved (solution) or suspended (suspension) in a liquid medium. They are often measured with a dropper or a measuring cup and can be administered orally.

Topical Preparations: These dosage forms are applied externally to the skin or mucous membranes and include creams, ointments, gels, lotions, and patches. They deliver medication locally to the affected area.

Injectables: These are dosage forms that are administered via injection into the body, either subcutaneously (under the skin), intramuscularly (into the muscle), or intravenously (into the vein). They include solutions, suspensions, and emulsions.

Suppositories: These are solid dosage forms that are inserted into the rectum, vagina, or urethra, where they dissolve or melt to release the medication. They are often used when oral administration is not feasible or when rapid absorption is needed.

Nasal Sprays and Inhalers: These are dosage forms designed for administration through the nasal passage or inhalation into the lungs. They deliver medication directly to the respiratory tract and are commonly used for conditions such as asthma or allergies.

Eye Drops and Ear Drops: These are liquid dosage forms administered directly into the eyes or ears. They are used to treat various eye and ear conditions and deliver medication locally to these areas.

Powders for Reconstitution: Some medications are supplied as powders that need to be mixed with a liquid (such as water or saline) before administration. These are often used for oral solutions or suspensions.

The choice of dosage form depends on various factors including the route of administration, the intended site of action, patient preference, and the characteristics of the medication itself.