emergency medical technician final review barry barkinsky ems-i, paramedic

EMERGENCY EMERGENCY MEDICAL MEDICAL

TECHNICIANTECHNICIANFINAL REVIEWFINAL REVIEW

Barry BarkinskyBarry Barkinsky

EMS-I, ParamedicEMS-I, Paramedic

Medical EmergenciesMedical Emergencies RespiratoryRespiratory

Common ProblemsCommon Problems

Signs and SymptomsSigns and Symptoms

Adequate / InadequateAdequate / Inadequate

TreatmentTreatment

Obstructive Lung DiseaseObstructive Lung Disease

TypesTypes EmphysemaEmphysema Chronic BronchitisChronic Bronchitis AsthmaAsthma

CausesCauses Genetic DispositionGenetic Disposition Smoking & Other Risk FactorsSmoking & Other Risk Factors

EmphysemaEmphysema

PathophysiologyPathophysiology Exposure to Noxious SubstancesExposure to Noxious Substances

Exposure results in the destruction of the Exposure results in the destruction of the walls of the alveoli.walls of the alveoli.

Weakens the walls of the small Weakens the walls of the small bronchioles and results in increase bronchioles and results in increase residual volume.residual volume.

Increased Risk of Infection and Increased Risk of Infection and DysrhythmiaDysrhythmia

EmphysemaEmphysema

AssessmentAssessment HistoryHistory

Recent weight loss, dyspnea with Recent weight loss, dyspnea with exertionexertion

Cigarette and tobacco usageCigarette and tobacco usage

Lack of CoughLack of Cough

EmphysemaEmphysema

AssessmentAssessment Physical ExamPhysical Exam

Barrel chest.Barrel chest. Prolonged Prolonged

expiration and expiration and rapid rest rapid rest phase.phase.

Thin.Thin. Pink skin due to Pink skin due to

extra red cell extra red cell production.production.

Hypertrophy of Hypertrophy of accessory accessory muscles.muscles.

““Pink Puffers.”Pink Puffers.”

RESPIRATORYRESPIRATORY

Chronic BronchitisChronic Bronchitis

PathophysiologyPathophysiology Results from an increase in mucus-Results from an increase in mucus-

secreting cells in the respiratory tree.secreting cells in the respiratory tree. Alveoli relatively unaffected.Alveoli relatively unaffected. Decreased alveolar ventilation.Decreased alveolar ventilation.

AssessmentAssessment HistoryHistory

Frequent respiratory infections.Frequent respiratory infections. Productive cough.Productive cough.

Chronic BronchitisChronic Bronchitis

Physical ExamPhysical Exam Often overweight.Often overweight. Rhonchi present on Rhonchi present on

auscultation.auscultation. Jugular vein Jugular vein

distention.distention. Ankle edema.Ankle edema. Hepatic congestion.Hepatic congestion. ““Blue Bloater.”Blue Bloater.”

Physical ExamPhysical Exam Often overweight.Often overweight. Rhonchi present on Rhonchi present on

auscultation.auscultation. Jugular vein Jugular vein

distention.distention. Ankle edema.Ankle edema. Hepatic congestion.Hepatic congestion. ““Blue Bloater.”Blue Bloater.”

RESPIRATORYRESPIRATORY

Bronchitis & EmphysemaBronchitis & Emphysema

ManagementManagement Maintain airway.Maintain airway. Support breathing.Support breathing.

Find position of comfort.Find position of comfort. Monitor oxygen saturation.Monitor oxygen saturation. Be prepared to ventilate.Be prepared to ventilate.

Administer medications.Administer medications. Bronchodilators.Bronchodilators.

AsthmaAsthma

PathophysiologyPathophysiology Chronic Inflammatory DisorderChronic Inflammatory Disorder

Results in widespread but variable air Results in widespread but variable air

flow obstruction.flow obstruction.

The airway becomes hyperresponsive.The airway becomes hyperresponsive.

Induced by a trigger, which can vary by Induced by a trigger, which can vary by

individual.individual.

Trigger causes release of histamine, Trigger causes release of histamine,

causing bronchoconstriction and causing bronchoconstriction and

bronchial edema.bronchial edema.

AsthmaAsthma

AssessmentAssessment Identify immediate threats.Identify immediate threats.

Obtain history.Obtain history. SAMPLE & OPQRST HistorySAMPLE & OPQRST History

History of asthma-related hospitalization?History of asthma-related hospitalization? History of respiratory failure/ventilator use?History of respiratory failure/ventilator use?

AsthmaAsthma

Physical ExamPhysical Exam Presenting signs may include Presenting signs may include

dyspnea, wheezing, cough.dyspnea, wheezing, cough. Wheezing is not present in all asthmatics.Wheezing is not present in all asthmatics. Speech may be limited to 1–2 consecutive Speech may be limited to 1–2 consecutive

words.words.

Look for hyperinflation of the chest Look for hyperinflation of the chest and accessory muscle use.and accessory muscle use.

Carefully auscultate breath sounds.Carefully auscultate breath sounds.

AsthmaAsthma

ManagementManagement Treatment goals:Treatment goals:

Correct hypoxia.Correct hypoxia. Reverse bronchospasm.Reverse bronchospasm. Reduce inflammation.Reduce inflammation.

Maintain the airway.Maintain the airway. Support breathing.Support breathing.

High-flow oxygen or assisted ventilations High-flow oxygen or assisted ventilations as indicated.as indicated.

RESPIRATORYRESPIRATORY(Trauma)(Trauma)

Medical EmergenciesMedical Emergencies Cardiac CompromiseCardiac Compromise

Cardiac EmergenciesCardiac Emergencies

TreatmentTreatment

Angina PectorisAngina Pectoris Myocardial InfarctionMyocardial Infarction Heart FailureHeart Failure Hypertensive EmergenciesHypertensive Emergencies Cardiogenic ShockCardiogenic Shock Cardiac ArrestCardiac Arrest Peripheral Vascular and Other Peripheral Vascular and Other

Cardiovascular EmergenciesCardiovascular Emergencies

Managing Specific Managing Specific Cardiovascular EmergenciesCardiovascular Emergencies

Angina PectorisAngina Pectoris

Causes of Chest PainCauses of Chest Pain Cardiovascular, including acute coronary Cardiovascular, including acute coronary

syndrome, or thoracic dissection of the aortasyndrome, or thoracic dissection of the aorta

Respiratory, including pulmonary embolism, Respiratory, including pulmonary embolism, pneumothorax or pneumonia.pneumothorax or pneumonia.

Gastrointestinal, including pancreatitis, hiatal Gastrointestinal, including pancreatitis, hiatal hernia, esophageal disease, gastroesophageal hernia, esophageal disease, gastroesophageal reflux, peptic ulcer disease.reflux, peptic ulcer disease.

Musculoskeletal, chest wall trauma.Musculoskeletal, chest wall trauma.

Field AssessmentField Assessment Signs of ShockSigns of Shock

Chest DiscomfortChest Discomfort Typically sudden onset, which may radiate Typically sudden onset, which may radiate

or be localized to the chest.or be localized to the chest. Patient often denies chest pain.Patient often denies chest pain.

DurationDuration Episodes last 3–5 minutes.Episodes last 3–5 minutes. Pain relieved with rest and/or Pain relieved with rest and/or

nitroglycerin.nitroglycerin.

BreathingBreathing

HistoryHistory Past episodes of angina:Past episodes of angina:

Episodes of angina that are increasing in Episodes of angina that are increasing in frequency, duration, or severity are frequency, duration, or severity are significant.significant.

ManagementManagement Relieve anxiety:Relieve anxiety:

Place the patient in a position of physical and Place the patient in a position of physical and emotional comfort.emotional comfort.

Administer oxygen.Administer oxygen.

Consider medication administration:Consider medication administration: Nitroglycerin tablets or sprayNitroglycerin tablets or spray

Special ConsiderationsSpecial Considerations Patients with new-onset often require Patients with new-onset often require

hospitalization.hospitalization. Symptoms not relieved by rest, Symptoms not relieved by rest,

nitroglycerin, and oxygen may indicate nitroglycerin, and oxygen may indicate an overall worsening of the disease or an overall worsening of the disease or the early stages of a myocardial the early stages of a myocardial infarction.infarction.

Patients may refuse transport after pain Patients may refuse transport after pain is relieved, even though the underlying is relieved, even though the underlying problem is not addressed.problem is not addressed.

Myocardial InfarctionMyocardial Infarction PathophysiologyPathophysiology

Death and necrosis Death and necrosis of heart muscle due of heart muscle due to inadequate to inadequate oxygen supply.oxygen supply.

Causes may include Causes may include occlusion, spasm, occlusion, spasm, acute volume acute volume overload, overload, hypotension, acute hypotension, acute respiratory failure, respiratory failure, and trauma.and trauma.

Location and size Location and size dependent on the dependent on the vessel involved.vessel involved.

Myocardial InfarctionMyocardial Infarction

Effects of a Myocardial InfarctionEffects of a Myocardial Infarction DysrhythmiasDysrhythmias Heart FailureHeart Failure

Goals of TreatmentGoals of Treatment Pain ReliefPain Relief ReperfusionReperfusion

Field AssessmentField Assessment BreathingBreathing Signs of ShockSigns of Shock Chief ComplaintChief Complaint

Typically related to chest pain.Typically related to chest pain.

Evaluate using OPQRST:Evaluate using OPQRST: Discomfort > 30 minutes.Discomfort > 30 minutes. Radiation to arms, neck, back, or epigastric region.Radiation to arms, neck, back, or epigastric region.

Patients may minimize symptoms.Patients may minimize symptoms.

Feelings of “impending doom.”Feelings of “impending doom.”

Other SymptomsOther Symptoms Nausea and vomitingNausea and vomiting DiaphoresisDiaphoresis

Myocardial Infarctions & the ECGMyocardial Infarctions & the ECG Dysrhythmias:Dysrhythmias:

VF, VT, Asystole, PEA.VF, VT, Asystole, PEA.

Dysrhythmias are the leading cause of death in MI.Dysrhythmias are the leading cause of death in MI.

ManagementManagement TransportTransport

Rapid transport indicated when acute MI Rapid transport indicated when acute MI suspectedsuspected

PrehospitalPrehospital Administer oxygen.Administer oxygen.

Consider medication administration:Consider medication administration: AspirinAspirin NitroglycerinNitroglycerin

NitroglycerineNitroglycerine

IndicationsIndications

ContraindicationsContraindications

Side effectsSide effects

DosageDosage

Heart FailureHeart Failure

Left Ventricular Left Ventricular FailureFailure PathophysiologPathophysiolog

yy Results in Results in

increased back increased back pressure into pressure into the pulmonary the pulmonary circulation.circulation.

Right Right Ventricular Ventricular FailureFailure PathophysiologyPathophysiology

Results in Results in increased back increased back pressure into pressure into the systemic the systemic venous venous circulation.circulation.

Pulmonary Pulmonary EmbolismEmbolism

Congestive Heart FailureCongestive Heart Failure PathophysiologyPathophysiology

Reduction in the heart’s stroke volume Reduction in the heart’s stroke volume causes fluid overload throughout the causes fluid overload throughout the body’s other tissues.body’s other tissues.

Field AssessmentField Assessment Pulmonary Edema:Pulmonary Edema:

Cough with copious amounts of clear or pink-Cough with copious amounts of clear or pink-tinged sputum.tinged sputum.

Labored breathing, especially with exertion.Labored breathing, especially with exertion. Abnormal breath sounds, including rales, Abnormal breath sounds, including rales,

rhonchi, and wheezes.rhonchi, and wheezes.

Paroxysmal Nocturnal Dyspnea (PND)Paroxysmal Nocturnal Dyspnea (PND)

Medications:Medications: Diuretics.Diuretics. Medications to increase cardiac contractile force.Medications to increase cardiac contractile force. Home oxygen.Home oxygen.

Mental StatusMental Status Mental status changes indicate impending Mental status changes indicate impending

respiratory failure.respiratory failure.

BreathingBreathing Signs of labored breathing.Signs of labored breathing. Tripod positioning.Tripod positioning. ““Number of pillows.”Number of pillows.”

SkinSkin Color changes.Color changes. Peripheral and/or sacral edema.Peripheral and/or sacral edema.

ManagementManagement

General management:General management:

Avoid supine positioning.Avoid supine positioning.

Avoid exertion such as standing or Avoid exertion such as standing or

walking.walking.

Maintain the airway.Maintain the airway.

Avoid patient refusals if at all possible.Avoid patient refusals if at all possible.

Hypertensive Hypertensive EmergenciesEmergencies

Hypertensive EmergencyHypertensive Emergency CausesCauses

Typically occurs only in patients with a Typically occurs only in patients with a history of HTN.history of HTN.

Primary cause is noncompliance with Primary cause is noncompliance with prescribed antihypertensive medications.prescribed antihypertensive medications.

Also occurs with toxemia of pregnancy.Also occurs with toxemia of pregnancy.

Risk FactorsRisk Factors Age-related factorsAge-related factors Race-related factorsRace-related factors

Field AssessmentField Assessment Initial AssessmentInitial Assessment

Alterations in mental stateAlterations in mental state

Signs & SymptomsSigns & Symptoms Headache accompanied by nausea and/or Headache accompanied by nausea and/or

vomitingvomiting Blurred visionBlurred vision Shortness of breathShortness of breath EpistaxisEpistaxis VertigoVertigo

HistoryHistory Known history of hypertensionKnown history of hypertension Compliance with medicationsCompliance with medications

ExamExam BP > 160/90BP > 160/90 Signs of left ventricular failureSigns of left ventricular failure Strong, bounding pulseStrong, bounding pulse Abnormal skin color, temperature, and Abnormal skin color, temperature, and

conditioncondition Presence of edemaPresence of edema

ManagementManagement

Maintain airway.Maintain airway.

Cardiogenic ShockCardiogenic Shock

PathophysiologyPathophysiology GeneralGeneral

Inability of the heart to meet the body’s Inability of the heart to meet the body’s metabolic needs.metabolic needs.

Often remains after correction of other problems.Often remains after correction of other problems. Severe form of pump failure.Severe form of pump failure. High mortality rate.High mortality rate.

CausesCauses Tension pneumothorax and cardiac tamponade.Tension pneumothorax and cardiac tamponade. Impaired ventricular emptying.Impaired ventricular emptying. Impaired myocardial contractility.Impaired myocardial contractility. Trauma.Trauma.

Chief ComplaintChief Complaint Chief complaint is typically chest pain, Chief complaint is typically chest pain,

shortness of breath, unconsciousness, or shortness of breath, unconsciousness, or altered mental state.altered mental state.

Onset may be acute or progressive.Onset may be acute or progressive.

HistoryHistory History of recent MI or chest pain episode.History of recent MI or chest pain episode. Presence of shock in the absence of Presence of shock in the absence of

trauma.trauma.

Mental StatusMental Status Restlessness progressing to confusionRestlessness progressing to confusion

Airway and BreathingAirway and Breathing Dyspnea, labored breathing, and coughDyspnea, labored breathing, and cough PND, tripod position, accessory muscle PND, tripod position, accessory muscle

retraction, and adventitious lung soundsretraction, and adventitious lung sounds

CirculationCirculation HypotensionHypotension Cool, clammy skinCool, clammy skin

ManagementManagement Maintain airway.Maintain airway. Administer oxygenAdminister oxygen Identify and treat underlying Identify and treat underlying

problem.problem.

Cardiac ArrestCardiac Arrest

Sudden DeathSudden Death CausesCauses

Electrolyte or acid–base imbalancesElectrolyte or acid–base imbalances ElectrocutionElectrocution Drug intoxicationDrug intoxication HypoxiaHypoxia HypothermiaHypothermia Pulmonary embolismPulmonary embolism StrokeStroke DrowningDrowning TraumaTrauma

Unresponsive, apneic, pulseless patientUnresponsive, apneic, pulseless patient ECGECG

DysrhythmiasDysrhythmias HistoryHistory

Prearrest eventsPrearrest events Bystander CPRBystander CPR ““Down time”Down time”

ManagementManagement ResuscitationResuscitation Return of Spontaneous CirculationReturn of Spontaneous Circulation Role of Basic Life SupportRole of Basic Life Support General GuidelinesGeneral Guidelines

Manage specific Dysrhythmias.Manage specific Dysrhythmias. AEDAED CPR.CPR.

AED AED (Automatic External (Automatic External

Defibrillator)Defibrillator)

ContraindicatioContraindicationsns

JoulesJoules

# of Shocks# of Shocks

If If NO SHOCKNO SHOCK AdvisedAdvised

AneurysmAneurysm PathophysiologyPathophysiology

Ballooning of an arterial wall, usually the aorta, Ballooning of an arterial wall, usually the aorta, that results from a weakness or defect in the wallthat results from a weakness or defect in the wall

TypesTypes AtheroscleroticAtherosclerotic DissectingDissecting TraumaticTraumatic

Peripheral Vascular and Peripheral Vascular and Other Cardiovascular Other Cardiovascular

EmergenciesEmergencies

Abdominal Aortic Abdominal Aortic AneurysmAneurysm

Often the result Often the result of atherosclerosisof atherosclerosis

Signs and Signs and symptomssymptoms

Abdominal painAbdominal pain Back/flank painBack/flank pain HypotensionHypotension Urge to defecateUrge to defecate

Dissecting Aortic AneurysmDissecting Aortic Aneurysm Caused by degenerative changes in Caused by degenerative changes in

the smooth muscle and elastic tissue.the smooth muscle and elastic tissue. Blood gets between and separates Blood gets between and separates

the wall of the aorta.the wall of the aorta. Can extend throughout the aorta and Can extend throughout the aorta and

into associated vessels.into associated vessels.

Acute Pulmonary EmbolismAcute Pulmonary Embolism PathophysiologyPathophysiology

Blockage of a pulmonary artery by a blood Blockage of a pulmonary artery by a blood clot or other particle.clot or other particle.

The area served by the pulmonary artery The area served by the pulmonary artery fails.fails.

Signs and SymptomsSigns and Symptoms Dependent upon size and location of the Dependent upon size and location of the

blockage.blockage. Onset of severe, unexplained dyspnea.Onset of severe, unexplained dyspnea. History of recent lengthy immobilization.History of recent lengthy immobilization.

Medical EmergenciesMedical Emergencies Altered Mental Status (AMS)Altered Mental Status (AMS)

CausesCauses

TreatmentTreatment

Medical EmergenciesMedical Emergencies

DiabetesDiabetes

Most common causeMost common cause

TreatmentTreatment

SeizuresSeizures

Generalized SeizuresGeneralized Seizures

Tonic-ClonicTonic-Clonic AuraAura

Loss of ConsciousnessLoss of Consciousness

Tonic PhaseTonic Phase

Clonic PhaseClonic Phase

PostseizurePostseizure

PostictalPostictal

SeizuresSeizures

Partial SeizuresPartial Seizures Simple Partial SeizuresSimple Partial Seizures

Involve one body area.Involve one body area. Can progress to generalized seizure.Can progress to generalized seizure.

Complex Partial SeizuresComplex Partial Seizures Characterized by auras.Characterized by auras. Typically 1–2 minutes in length.Typically 1–2 minutes in length. Loss of contact with surroundings.Loss of contact with surroundings.

SeizuresSeizures

AssessmentAssessment Differentiating Between Syncope & Differentiating Between Syncope &

SeizureSeizure Bystanders frequently confuse syncope Bystanders frequently confuse syncope

and seizure.and seizure.

SeizuresSeizures

Patient HistoryPatient History History of SeizuresHistory of Seizures History of Head TraumaHistory of Head Trauma Any Alcohol or Drug AbuseAny Alcohol or Drug Abuse Recent History of Fever, Headache, or Stiff Recent History of Fever, Headache, or Stiff

NeckNeck History of Heart Disease, Diabetes, or StrokeHistory of Heart Disease, Diabetes, or Stroke Current MedicationsCurrent Medications

Phenytoin (Dilantin), phenobarbitol, valproic acid Phenytoin (Dilantin), phenobarbitol, valproic acid (Depakote), or carbamazepine (Tegretol)(Depakote), or carbamazepine (Tegretol)

Physical ExamPhysical Exam Signs of head trauma or injury to tongue, alcohol or Signs of head trauma or injury to tongue, alcohol or

drug abusedrug abuse

SeizuresSeizures ManagementManagement

Scene safety & BSI.Scene safety & BSI. Maintain the Maintain the

airway.airway. Administer high-Administer high-

flow oxygen.flow oxygen. Treat hypoglycemia Treat hypoglycemia

if present.if present. Do not restrain the Do not restrain the

patient.patient. Protect the patient Protect the patient

from the from the environment.environment.

Maintain body Maintain body temperature.temperature.

SeizuresSeizures ManagementManagement

Position the Position the

patient.patient.

Suction if Suction if

required.required.

Provide a quiet Provide a quiet

atmosphere.atmosphere.

Transport.Transport.

SeizuresSeizures

Status EpilepticusStatus Epilepticus Two or More Generalized SeizuresTwo or More Generalized Seizures

Seizures occur without a return of Seizures occur without a return of consciousness.consciousness.

ManagementManagement Management of airway and breathing is critical.Management of airway and breathing is critical. Monitor the airway closely.Monitor the airway closely.

Stroke (CVA)Stroke (CVA)

Stroke & Intracranial Stroke & Intracranial HemorrhageHemorrhage

Occlusive StrokesOcclusive Strokes Embolic & Thrombotic Embolic & Thrombotic

StrokesStrokes Hemorrhagic StrokesHemorrhagic Strokes

Occlusive StrokesOcclusive Strokes Embolic & Thrombotic Embolic & Thrombotic

StrokesStrokes Hemorrhagic StrokesHemorrhagic Strokes

SignsSigns Facial DroopingFacial Drooping HeadacheHeadache Aphasia/Aphasia/

DysphasiaDysphasia HemiparesisHemiparesis ParesthesiaParesthesia Gait DisturbancesGait Disturbances IncontinenceIncontinence

SymptomsConfusionAgitationDizzinessVision Problems

Transient Ischemic AttacksTransient Ischemic Attacks Indicative of carotid artery disease.Indicative of carotid artery disease. Symptoms of neurological deficit:Symptoms of neurological deficit:

Symptoms resolve in less than 24 hours.Symptoms resolve in less than 24 hours. No long-term effects.No long-term effects.

Evaluate through history taking:Evaluate through history taking: History of HTN, prior stroke, or TIA.History of HTN, prior stroke, or TIA. Symptoms and their progression.Symptoms and their progression.

ManagementManagement Scene safety & BSIScene safety & BSI Maintain the airway.Maintain the airway. Support breathing.Support breathing. Obtain a detailed history.Obtain a detailed history. Position the patient.Position the patient. Protect paralyzed extremities.Protect paralyzed extremities.

Allergic Reaction Allergic Reaction (Anaphylaxis)(Anaphylaxis)

Allergies and Allergies and AnaphylaxisAnaphylaxis

Allergic ReactionAllergic Reaction An exaggerated response by the An exaggerated response by the

immune system to a foreign immune system to a foreign substancesubstance

AnaphylaxisAnaphylaxis An unusual or exaggerated allergic An unusual or exaggerated allergic

reactionreaction A life-threatening emergencyA life-threatening emergency

AnaphylaxisAnaphylaxis CausesCauses

Focused History & Physical ExamFocused History & Physical Exam Focused HistoryFocused History

SAMPLE & OPQRST HistorySAMPLE & OPQRST History Rapid onset, usually 30–60 seconds following Rapid onset, usually 30–60 seconds following

exposure.exposure. Speed of reaction is indicative of severity.Speed of reaction is indicative of severity. Previous allergies and reactions.Previous allergies and reactions.

Physical ExamPhysical Exam Presence of severe respiratory difficulty is Presence of severe respiratory difficulty is

key to differentiating anaphylaxis from key to differentiating anaphylaxis from allergic reaction.allergic reaction.

Assessment Findings Assessment Findings in Anaphylaxisin Anaphylaxis

Physical ExamPhysical Exam Facial or laryngeal edemaFacial or laryngeal edema Abnormal breath soundsAbnormal breath sounds Hives and urticariaHives and urticaria Hyperactive bowel soundsHyperactive bowel sounds Vital sign deterioration as Vital sign deterioration as

the reaction progressesthe reaction progresses

Assessment Assessment Findings in Findings in AnaphylaxisAnaphylaxis

Scene safetyScene safety Protect the Protect the

airway.airway. Support Support

breathing.breathing. Establish IV Establish IV

access.access. Administer Administer

medications:medications: EpinephrineEpinephrine

Management of Allergic Management of Allergic ReactionsReactions

Epi-Auto InjectorEpi-Auto Injector

ContraindicatioContraindicationsns

DosageDosage

ActionsActions

Side EffectsSide Effects

AdministrationAdministration

Medical EmergenciesMedical Emergencies Poisons and OverdosePoisons and Overdose

How they enter the bodyHow they enter the body TreatmentTreatment

EnvironmentalEnvironmental HeatHeat ColdCold Water EmergenciesWater Emergencies

Trauma EmergenciesTrauma Emergencies

BleedingBleeding

External Types, External Types, Treatment ( In Treatment ( In

order)order)

Hemorrhage ClassificationHemorrhage Classification

CapillaryCapillary Slow, even Slow, even

flowflow

ArterialSpurting bloodPulsating flowBright red color

VenousSteady, slow flowDark red

BleedingBleeding

Internal, S/S, Internal, S/S, TreatmentTreatment

Hemorrhage ControlHemorrhage Control

Internal HemorrhageInternal Hemorrhage HematomaHematoma

Pocket of blood between muscle and Pocket of blood between muscle and fasciafascia

Humerus or Tibia/Fibula fracture: Humerus or Tibia/Fibula fracture: 500-750mL500-750mL

Femur fracture: 1,500mLFemur fracture: 1,500mL UNEXPLAINED SHOCK is BEST UNEXPLAINED SHOCK is BEST

attributed to abdominal traumaattributed to abdominal trauma General ManagementGeneral Management

Immobilization, Stabilization, ElevationImmobilization, Stabilization, Elevation

Hemorrhage ControlHemorrhage Control

Internal HemorrhageInternal Hemorrhage Epistaxis: Nose BleedEpistaxis: Nose Bleed

Causes: Trauma, HypertensionCauses: Trauma, Hypertension Treatment: Lean forward, pinch nostrilsTreatment: Lean forward, pinch nostrils

HemoptysisHemoptysis Esophageal VaricesEsophageal Varices Chronic HemorrhageChronic Hemorrhage

AnemiaAnemia

ShockShock

SHOCK is…SHOCK is…INADEQUATEINADEQUATE

TISSUETISSUEPERFUSIONPERFUSION

In a Nutshell…..

Stages of ShockStages of Shock

Compensated ShockCompensated Shock Minimal ChangeMinimal Change

Decompensated ShockDecompensated Shock System beginning to failSystem beginning to fail

Irreversible ShockIrreversible Shock Ischemia and death imminentIschemia and death imminent

Etiology of ShockEtiology of Shock

Hypovolemic ShockHypovolemic Shock Loss of blood volumeLoss of blood volume

Distributive ShockDistributive Shock Prevent appropriate Prevent appropriate

distribution of nutrients distribution of nutrients and removal of wastesand removal of wastes

AnaphylacticAnaphylactic SepticSeptic HypoglycemiaHypoglycemia

Obstructive ShockObstructive Shock Interference with the Interference with the

blood flowing through blood flowing through the cardiovascular the cardiovascular systemsystem

Tension PneumothoraxTension Pneumothorax Cardiac TamponadeCardiac Tamponade Pulmonary EmboliPulmonary Emboli

Cardiogenic ShockPump failure

Respiratory ShockRespiratory system not able to bring oxygen into the alveoli

Airway obstructionPneumothorax

Neurogenic ShockLoss of nervous control from CNS to peripheral vasculature

Cardiogenic ShockPump failure

Respiratory ShockRespiratory system not able to bring oxygen into the alveoli

Airway obstructionPneumothorax

Neurogenic ShockLoss of nervous control from CNS to peripheral vasculature

Soft TissueSoft Tissue

Skin is the largest, most important Skin is the largest, most important organorgan

16% of total body weight16% of total body weight FunctionFunction

ProtectionProtection SensationSensation Temperature RegulationTemperature Regulation

AKA: Integumentary SystemAKA: Integumentary System

Introduction to Introduction to Soft-Tissue InjurySoft-Tissue Injury

EpidemiologyEpidemiology Open WoundsOpen Wounds

Over 10 million wounds present to EDOver 10 million wounds present to ED Most require simple care and some suturingMost require simple care and some suturing Up to 6.5% may become infectedUp to 6.5% may become infected

Closed WoundsClosed Wounds More CommonMore Common Contusions, Sprains, StrainsContusions, Sprains, Strains

Introduction to Introduction to Soft-Tissue InjurySoft-Tissue Injury

A&P of Soft Tissue A&P of Soft Tissue InjuriesInjuries

Skin LayersSkin Layers EpidermisEpidermis

Outermost layer Outermost layer Helps prevent infectionHelps prevent infection

DermisDermis Upper Layer (Papillary Layer)Upper Layer (Papillary Layer)

Loose connective tissue, capillaries and nervesLoose connective tissue, capillaries and nerves Lower Layer (Reticular Layer)Lower Layer (Reticular Layer)

Integrates dermis with SQ layerIntegrates dermis with SQ layer Blood vessels, nerve endings, glandsBlood vessels, nerve endings, glands

Sebaceous & Sudoriferous GlandsSebaceous & Sudoriferous Glands SubcutaneousSubcutaneous

Adipose tissueAdipose tissue Heat retentionHeat retention

Pathophysiology of Pathophysiology of Soft-Tissue InjurySoft-Tissue Injury

Closed WoundsClosed Wounds ContusionsContusions

EcchymosisEcchymosis HematomasHematomas Crush InjuriesCrush Injuries

Closed WoundsClosed Wounds ContusionsContusions

EcchymosisEcchymosis HematomasHematomas Crush InjuriesCrush Injuries

Open WoundsAbrasionsLacerationsIncisionsPuncturesImpaled ObjectsAvulsionsAmputations

Penetrating Penetrating InjuriesInjuries

EviscerationEvisceration

Impaled ObjectImpaled Object

AmputationAmputation

Objectives of Wound Dressing & Objectives of Wound Dressing & BandagingBandaging Hemorrhage ControlHemorrhage Control

Direct PressureDirect Pressure ElevationElevation Pressure PointsPressure Points ConsiderConsider

IceIce Constricting BandConstricting Band TourniquetTourniquet

USE ALL COMPONENTS TOGETHERUSE ALL COMPONENTS TOGETHER

Management of Management of Soft-Tissue InjurySoft-Tissue Injury

Objectives of Wound Dressing & BandagingObjectives of Wound Dressing & Bandaging SterilitySterility

Keep the wound as clean as possibleKeep the wound as clean as possible If wound is grossly contaminated consider If wound is grossly contaminated consider

cleansingcleansing ImmobilizationImmobilization

Prevents movement and aggravation of woundPrevents movement and aggravation of wound Do not use an elastic bandage: TQ effectDo not use an elastic bandage: TQ effect Monitor distal pulse, motor, and sensationMonitor distal pulse, motor, and sensation

(continued)

Pain & Edema ControlPain & Edema Control Cold packsCold packs Moderate pressure over woundModerate pressure over wound

Sterile & Non-sterile DressingsSterile & Non-sterile Dressings Sterile: Direct wound contactSterile: Direct wound contact Non-sterile: Bulk dressing above sterileNon-sterile: Bulk dressing above sterile

Occlusive/Non-occlusive DressingsOcclusive/Non-occlusive Dressings Adherent/Non-adherent DressingsAdherent/Non-adherent Dressings

Adherent: stick to blood or fluidAdherent: stick to blood or fluid Absorbent/Non-absorbentAbsorbent/Non-absorbent

Absorbent: soak up blood or fluidsAbsorbent: soak up blood or fluids Wet/Dry DressingsWet/Dry Dressings

Wet: Burns, postoperative wounds (Sterile NS)Wet: Burns, postoperative wounds (Sterile NS) Dry: Most commonDry: Most common

Dressing & Bandage Dressing & Bandage MaterialsMaterials

Trauma EmergenciesTrauma Emergencies BurnsBurns

ClassificationClassification SuperficialSuperficial Partial-ThicknessPartial-Thickness Full-ThicknessFull-Thickness

SeveritySeverity DepthDepth Body Surface Area (BSA)Body Surface Area (BSA)

Burn DepthBurn Depth

Superficial Burn:Superficial Burn:1st Degree Burn1st Degree Burn Signs & Signs &

SymptomsSymptoms Reddened skinReddened skin Pain at burn sitePain at burn site Involves only Involves only

epidermisepidermis

Partial-Partial-Thickness Burn: Thickness Burn: 2nd Degree 2nd Degree BurnBurn Signs & Signs &

SymptomsSymptoms Intense painIntense pain White to red skinWhite to red skin BlistersBlisters Involves Involves

epidermis & epidermis & dermisdermis

Full-Thickness Full-Thickness Burn: 3rd Burn: 3rd Degree BurnDegree Burn Signs & Signs &

SymptomsSymptoms Dry, leathery skin Dry, leathery skin

(white, dark (white, dark brown, or charred)brown, or charred)

Loss of sensation Loss of sensation (little pain)(little pain)

All dermal All dermal layers/tissue may layers/tissue may be involvedbe involved

Trauma Emergencies Trauma Emergencies (Burns)(Burns)

Rule of Nines (Adult)Rule of Nines (Adult)

Head and Neck:Head and Neck: 9 %9 % Each Upper Ext: Each Upper Ext: 9 %9 % Anterior Trunk: Anterior Trunk: 18 %18 % Posterior Trunk: Posterior Trunk: 18 %18 % Each Lower Ext: Each Lower Ext: 18 %18 % Genitalia:Genitalia: 1 % 1 %

Trauma Emergencies Trauma Emergencies (Burns)(Burns)

Rule of Nines (Child)Rule of Nines (Child)

Head and Neck:Head and Neck: 18 % 18 % Each Upper Ext:Each Upper Ext: 9 % 9 % Anterior Trunk: Anterior Trunk: 18 %18 % Posterior Trunk: Posterior Trunk: 18 %18 % Each Lower Ext: Each Lower Ext: 14 %14 % Genitalia:Genitalia: 1 %1 %

Trauma EmergenciesTrauma Emergencies BurnsBurns

Rule of PalmRule of Palm LocationLocation Preexisting Medical ProblemsPreexisting Medical Problems AgeAge

5 – 555 – 55 SourceSource TreatmentTreatment

Rule of PalmsRule of Palms

A burn equivalent to the size of A burn equivalent to the size of the patient’s hand is equal to 1% the patient’s hand is equal to 1% body surface area (BSA)body surface area (BSA)

Pathophysiology of BurnsPathophysiology of Burns

Types of BurnsTypes of Burns ThermalThermal ElectricalElectrical ChemicalChemical RadiationRadiation

Thermal BurnsThermal Burns

Heat changes the molecular Heat changes the molecular structure of tissuestructure of tissue Denaturing (of proteins)Denaturing (of proteins)

Extent of burn damage depends Extent of burn damage depends onon Temperature of agentTemperature of agent Concentration of heatConcentration of heat Duration of contactDuration of contact

Systemic ComplicationsSystemic Complications

HypothermiaHypothermia Disruption of skin and its ability to Disruption of skin and its ability to

thermoregulatethermoregulate HypovolemiaHypovolemia

Shift in proteins, fluids, and electrolytes to Shift in proteins, fluids, and electrolytes to the burned tissuethe burned tissue

General electrolyte imbalanceGeneral electrolyte imbalance EscharEschar

Hard, leathery product of a deep full Hard, leathery product of a deep full thickness burnthickness burn

Dead and denatured skinDead and denatured skin

Systemic ComplicationsSystemic Complications

InfectionInfection Greatest risk of burn is infectionGreatest risk of burn is infection

Organ FailureOrgan Failure Special FactorsSpecial Factors

Age & HealthAge & Health Physical AbusePhysical Abuse

Elderly, Infirm or YoungElderly, Infirm or Young

PainPain Changes in skin Changes in skin

condition at affected condition at affected sitesite

Adventitious soundsAdventitious sounds BlistersBlisters Sloughing of skinSloughing of skin HoarsenessHoarseness

Assessment of Thermal Assessment of Thermal BurnsBurns

General Signs & SymptomsGeneral Signs & Symptoms

Burnt hairEdemaParesthesiaHemorrhageOther soft tissue injuryMusculoskeletal injuryDyspneaChest pain

Assessment of Thermal Assessment of Thermal BurnsBurns

Any partial or full thickness burn involving hands, feet, joints,face, or genitalia

>30% BSAPartial Thickness

Inhalation Injury

>10% BSAFull Thickness

Critical

>2% BSAFull Thickness

>50% BSASuperficial

<2% BSAFull Thickness

<15% BSAPartial Thickness

<50% BSASuperficial

>15% BSAPartial Thickness

Moderate

Burn SeverityBurn Severity

Local & Minor BurnsLocal & Minor Burns Local coolingLocal cooling

Partial thickness: <15% of BSAPartial thickness: <15% of BSA Full thickness: <2% BSAFull thickness: <2% BSA

Remove clothingRemove clothing Cool or Cold water immersionCool or Cold water immersion

Management of Management of Thermal BurnsThermal Burns

Moderate to Severe BurnsModerate to Severe Burns Dry sterile dressingsDry sterile dressings

Partial thickness: >15% BSAPartial thickness: >15% BSA Full thickness: >5% BSAFull thickness: >5% BSA

Maintain warmthMaintain warmth Prevent hypothermiaPrevent hypothermia

Consider aggressive fluid therapyConsider aggressive fluid therapy Moderate to severe burnsModerate to severe burns

Moderate to Severe BurnsModerate to Severe Burns Caution for fluid overloadCaution for fluid overload

Frequent auscultation of breath soundsFrequent auscultation of breath sounds Prevent infectionPrevent infection

Inhalation InjuryInhalation Injury

Provide high-flow O2 by NRBProvide high-flow O2 by NRB

Consider intubation if swellingConsider intubation if swelling

Consider hyperbaric oxygen therapyConsider hyperbaric oxygen therapy

Electrical InjuriesElectrical Injuries SafetySafety

Turn off powerTurn off power Energized lines act as whipsEnergized lines act as whips Establish a safety zoneEstablish a safety zone

Lightning StrikesLightning Strikes High voltage, high current, high energyHigh voltage, high current, high energy Lasts fraction of a secondLasts fraction of a second No danger of electrical shock to EMSNo danger of electrical shock to EMS

Assessment & Management of Assessment & Management of Electrical, Chemical & Radiation Electrical, Chemical & Radiation

BurnsBurns

Chemical BurnsChemical Burns Scene size-upScene size-up

Hazardous materials teamHazardous materials team Establish hot, warm and cold zonesEstablish hot, warm and cold zones Prevent personnel exposure from Prevent personnel exposure from

chemicalchemical Specific ChemicalsSpecific Chemicals

PhenolPhenol Dry LimeDry Lime SodiumSodium Riot Control AgentsRiot Control Agents

BurnsBurns

Specific ChemicalsSpecific Chemicals PhenolPhenol

Industrial cleanerIndustrial cleaner Alcohol dissolves PhenolAlcohol dissolves Phenol Irrigate with copious amounts of waterIrrigate with copious amounts of water

Dry LimeDry Lime Strong corrosive that reacts with waterStrong corrosive that reacts with water Brush off dry substanceBrush off dry substance Irrigate with copious amounts of cool Irrigate with copious amounts of cool

waterwater Prevents reaction with patient tissuesPrevents reaction with patient tissues

BurnsBurns

Riot Control AgentsRiot Control Agents AgentsAgents

CS, CN (Mace), Oleoresin, Capsicum (OC, pepper CS, CN (Mace), Oleoresin, Capsicum (OC, pepper spray)spray)

Irritation of the eyes, mucous membranes, Irritation of the eyes, mucous membranes, and respiratory tract.and respiratory tract.

No permanent damageNo permanent damage General Signs & SymptomsGeneral Signs & Symptoms

Coughing, gagging, and vomitingCoughing, gagging, and vomiting Eye pain, tearing, temporary blindnessEye pain, tearing, temporary blindness

ManagementManagement Irrigate eyes with normal salineIrrigate eyes with normal saline

BurnsBurns

Radiation BurnsRadiation Burns Notify Hazardous Materials TeamNotify Hazardous Materials Team Establish Safety ZonesEstablish Safety Zones

Hot, Warm, & ColdHot, Warm, & Cold Personnel positioned Upwind and Personnel positioned Upwind and

UphillUphill Decontaminate ALL rescuers, Decontaminate ALL rescuers,

equipment and patientsequipment and patients

BurnsBurns

MusculoskeMusculoskeletal letal

SystemSystem

Joint InjuryJoint Injury SprainSprain SubluxationSubluxation DislocationDislocation

Bone InjuryBone Injury Open FractureOpen Fracture Closed FractureClosed Fracture Hairline FractureHairline Fracture Impacted FractureImpacted Fracture

Pathophysiology of the Pathophysiology of the Musculoskeletal SystemMusculoskeletal System

MusculoskeletalMusculoskeletal

LigamentLigament

MusculoskeletalMusculoskeletal

TendonTendon

Pediatric ConsiderationsPediatric Considerations Flexible natureFlexible nature

Geriatric ConsiderationsGeriatric Considerations OsteoporosisOsteoporosis

Pathological FracturesPathological Fractures Pathological diseasesPathological diseases

General Considerations with General Considerations with musculoskeletal injuriesmusculoskeletal injuries Neurological compromiseNeurological compromise Decreased stabilityDecreased stability Muscle spasmMuscle spasm

Bone Repair CycleBone Repair Cycle Osteocytes produce osteoblastsOsteocytes produce osteoblasts Deposition of saltsDeposition of salts Increasing strength of matrixIncreasing strength of matrix

General PrinciplesGeneral Principles Protecting Open WoundsProtecting Open Wounds Positioning the limbPositioning the limb Immobilizing the injuryImmobilizing the injury Checking Neurovascular FunctionChecking Neurovascular Function

Musculoskeletal Injury Musculoskeletal Injury ManagementManagement

Trauma EmergenciesTrauma Emergencies InjuriesInjuries

Painful, swollen, deformed extremitiesPainful, swollen, deformed extremities AssessmentAssessment

Signs and SymptomsSigns and Symptoms SplintingSplinting

Upper ExtremitiesUpper Extremities Lower ExtremitiesLower Extremities Hip / PelvisHip / Pelvis

Splinting DevicesSplinting Devices Rigid splintsRigid splints Formable SplintsFormable Splints Soft SplintsSoft Splints Traction SplintsTraction Splints Other Splinting AidsOther Splinting Aids

Vacuum SplintsVacuum Splints Air SprintsAir Sprints Cravats or Velcro SplintsCravats or Velcro Splints

Fracture CareFracture Care Joint CareJoint Care Muscular & Connective Tissue CareMuscular & Connective Tissue Care

Injuries to HeadInjuries to Head Nervous SystemNervous System Brain InjuriesBrain Injuries

DirectDirect IndirectIndirect

Patient AssessmentPatient Assessment Signs and SymptomsSigns and Symptoms Neurological AssessmentNeurological Assessment

Injuries to SpineInjuries to Spine MOIMOI AssessmentAssessment

Signs and SymptomsSigns and Symptoms TreatmentTreatment ImmobilizationImmobilization

HelmetsHelmets CollarsCollars LSB LSB Seated PatientSeated Patient

Care for Specific Joint InjuriesCare for Specific Joint Injuries HipHip KneeKnee AnkleAnkle FootFoot ShoulderShoulder ElbowElbow Wrist/HandWrist/Hand FingerFinger

Joint Injuries

Alert for neurological Compromise

TriageTriage

Command at Command at Mass-Casualty Mass-Casualty

IncidentsIncidents

Incident Commander (IC)Incident Commander (IC)

Coordinates all scene activitiesCoordinates all scene activities Also called Incident Manager (IM) Also called Incident Manager (IM)

Officer in Charge (OIC)Officer in Charge (OIC)

The first on-scene unit must assume The first on-scene unit must assume command and direct all rescue command and direct all rescue

efforts at a mass-casualty incident efforts at a mass-casualty incident (MCI)(MCI)

Singular Singular vs.vs. Unified Command Unified Command

Singular commandSingular command One person coordinates the incident.One person coordinates the incident. Most useful in smaller, single-Most useful in smaller, single-

jurisdictional incidents.jurisdictional incidents. Unified commandUnified command

Managers from different jurisdictions Managers from different jurisdictions share command.share command. Fire, EMS, law enforcementFire, EMS, law enforcement

Establishing Establishing CommandCommand

First arriving unit establishes First arriving unit establishes command.command.

Assign command early in an Assign command early in an incident.incident.

Establish a command post.Establish a command post.

EMS Branch EMS Branch FunctionsFunctions

TriageTriage TreatmentTreatment TransportTransport

TriageTriage Sorting of patients based upon the Sorting of patients based upon the

severity of their injuriesseverity of their injuries Primary triagePrimary triage Secondary triageSecondary triage

Triage TagsTriage Tags

Alerts care providers to patient Alerts care providers to patient prioritypriority

Prevents re-triage of the same Prevents re-triage of the same patientpatient

Serves as a tracking systemServes as a tracking system

The METTAGThe METTAG

TreatmentTreatment

Red treatment unitRed treatment unit Yellow treatment unitYellow treatment unit Green treatment unitGreen treatment unit

TriageTriage

Priority 1Priority 1

(RED)(RED)

TriageTriage

(Yellow)(Yellow)

TriageTriage

(Green)(Green)

OB / GYNOB / GYN

OB / GYNOB / GYN LaborLabor Bloody ShowBloody Show CrowningCrowning Predelivery EmergenciesPredelivery Emergencies

LaborLabor Stage One Stage One

(Dilation)(Dilation) Stage Two Stage Two

(Expulsion)(Expulsion) Stage Three Stage Three

(Placental (Placental Stage)Stage)

Management of a Patient Management of a Patient in Laborin Labor

Transport the patient in labor unless Transport the patient in labor unless delivery is imminent.delivery is imminent.

Maternal urge to push or the Maternal urge to push or the presence of crowning indicates presence of crowning indicates imminent delivery.imminent delivery.

Delivery at the scene or in the Delivery at the scene or in the ambulance will be necessary.ambulance will be necessary.

Transport the patient in labor unless Transport the patient in labor unless delivery is imminent.delivery is imminent.

Maternal urge to push or the Maternal urge to push or the presence of crowning indicates presence of crowning indicates imminent delivery.imminent delivery.

Delivery at the scene or in the Delivery at the scene or in the ambulance will be necessary.ambulance will be necessary.

Field DeliveryField Delivery

Set up delivery area.Set up delivery area. Give oxygen to mother Give oxygen to mother

and start and start Drape mother with Drape mother with

toweling from OB kit.toweling from OB kit. Monitor fetal heart Monitor fetal heart

rate.rate. As head crowns, apply As head crowns, apply

gentle pressure.gentle pressure.

Suction the mouth and then the nose.Clamp and cut the cord.Dry the infant and keep it warm.Deliver the placenta and save for transport with the mother.

OB / GYN ( Normal OB / GYN ( Normal Delivery)Delivery)

Head Delivers

Suction mouth, nose.

Delivery of Shoulders

Chest Delivers

Legs and Feet Deliver

Cutting the Cord

Cutting Umbilical Cord

Apgar ScoringApgar Scoring

Care of Care of NewbornNewborn

OB / GYN OB / GYN (Resuscitation)(Resuscitation)

HR Less than HR Less than 100100

HR less than HR less than 8080

HR less than HR less than 6060

Neonatal ResuscitationNeonatal Resuscitation

If the infant’s respirations are below 30 If the infant’s respirations are below 30 per minute and tactile stimulation does per minute and tactile stimulation does not increase rate to normal range, not increase rate to normal range, assist ventilations using bag valve mask assist ventilations using bag valve mask with high-flow oxygen.with high-flow oxygen.

If the heart rate is below 80 and does If the heart rate is below 80 and does not respond to ventilations, initiate not respond to ventilations, initiate chest compressions.chest compressions.

Transport to a facility with neonatal Transport to a facility with neonatal intensive care capabilities.intensive care capabilities.

Causes of Bleeding Causes of Bleeding During PregnancyDuring Pregnancy

AbortionAbortion Ectopic pregnancyEctopic pregnancy Placenta previaPlacenta previa Abruptio placentaeAbruptio placentae

AbortionAbortion

Termination of pregnancy before Termination of pregnancy before the 20th week of gestation.the 20th week of gestation.

Different classifications.Different classifications. Signs and symptoms include Signs and symptoms include

cramping, abdominal pain, cramping, abdominal pain, backache, and vaginal bleeding.backache, and vaginal bleeding.

Treat for shock.Treat for shock. Provide emotional support.Provide emotional support.

Ectopic PregnancyEctopic Pregnancy

Assume that any female of Assume that any female of childbearing age with lower childbearing age with lower abdominal pain is experiencing an abdominal pain is experiencing an ectopic pregnancy.ectopic pregnancy.

Ectopic pregnancy is life-Ectopic pregnancy is life-threatening. Transport the patient threatening. Transport the patient immediately.immediately.

Placenta PreviaPlacenta Previa Usually presents Usually presents

with painless with painless bleeding.bleeding.

Never attempt Never attempt vaginal exam.vaginal exam.

Treat for shock.Treat for shock. Transport Transport

immediately—immediately—treatment is treatment is delivery by delivery by c-section.c-section.

Abruptio PlacentaeAbruptio Placentae Signs and Signs and

symptoms vary.symptoms vary. Classified as Classified as

partial, severe, or partial, severe, or complete.complete.

Life-threatening.Life-threatening. Treat for shock, Treat for shock,

fluid resuscitation.fluid resuscitation. Transport left Transport left

lateral recumbent lateral recumbent position.position.

Abnormal Delivery Abnormal Delivery SituationsSituations

OB / GYN (Abnormal OB / GYN (Abnormal Deliveries) Deliveries)

BreechBreech

Breech PresentationBreech Presentation

The buttocks or both feet present The buttocks or both feet present first.first.

If the infant starts to breath with If the infant starts to breath with its face pressed against the its face pressed against the vaginal wall, form a “V” and push vaginal wall, form a “V” and push the vaginal wall away from the vaginal wall away from infant’s face. Continue during infant’s face. Continue during transport.transport.

OB / GYN (Abnormal OB / GYN (Abnormal Deliveries) Deliveries)

Prolapsed Prolapsed CordCord

Prolapsed CordProlapsed Cord The umbilical cord precedes the fetal The umbilical cord precedes the fetal

presenting part.presenting part. Elevate the hips, administer oxygen, and Elevate the hips, administer oxygen, and

keep warm.keep warm. If the umbilical cord is seen in the vagina, If the umbilical cord is seen in the vagina,

insert two gloved fingers to raise the fetus insert two gloved fingers to raise the fetus off the cord. Do not push cord back.off the cord. Do not push cord back.

Wrap cord in sterile moist towel.Wrap cord in sterile moist towel. Transport immediately; do not attempt Transport immediately; do not attempt

delivery.delivery.

OB / GYN (Abnormal OB / GYN (Abnormal Deliveries)Deliveries)

Limb Limb PresentationPresentation

Limb Presentation Limb Presentation With limb presentation, With limb presentation,

place the mother in knee–place the mother in knee–chest position, administer chest position, administer

oxygen, and transport oxygen, and transport immediately. Do not attempt immediately. Do not attempt

delivery.delivery.

Other Abnormal Other Abnormal PresentationsPresentations

Whenever an abnormal presentation or Whenever an abnormal presentation or position of the fetus makes normal position of the fetus makes normal delivery impossible, reassure the delivery impossible, reassure the mother.mother.

Administer oxygen.Administer oxygen. Transport immediately.Transport immediately. Do not attempt field delivery in these Do not attempt field delivery in these

circumstances.circumstances.

Whenever an abnormal presentation or Whenever an abnormal presentation or position of the fetus makes normal position of the fetus makes normal delivery impossible, reassure the delivery impossible, reassure the mother.mother.

Administer oxygen.Administer oxygen. Transport immediately.Transport immediately. Do not attempt field delivery in these Do not attempt field delivery in these

circumstances.circumstances.

Other Delivery Other Delivery ComplicationsComplications

Multiple Multiple BirthsBirths

Multiple BirthsMultiple Births

Follow normal guidelines, but Follow normal guidelines, but have additional personnel and have additional personnel and equipment.equipment.

In twin births, labor starts earlier In twin births, labor starts earlier and babies are smaller.and babies are smaller.

Prevent hypothermia.Prevent hypothermia.

MeconiumMeconium

Meconium StainingMeconium Staining

Fetus passes feces into the Fetus passes feces into the amniotic fluid.amniotic fluid.

If meconium is thick, suction the If meconium is thick, suction the hypopharynx and trachea using an hypopharynx and trachea using an endotracheal tube until all endotracheal tube until all meconium has been cleared from meconium has been cleared from the airway.the airway.

Maternal Maternal Complications of Labor Complications of Labor

and Deliveryand Delivery

Postpartum HemorrhagePostpartum Hemorrhage

Defined as a loss of more than Defined as a loss of more than

500 cc of blood following delivery.500 cc of blood following delivery. Treat for shock as necessary.Treat for shock as necessary. Follow protocols if applying Follow protocols if applying

antishock trousers.antishock trousers.

Uterine RuptureUterine Rupture

Tearing, or rupture, of the uterus.Tearing, or rupture, of the uterus. Patient complains of severe abdominal Patient complains of severe abdominal

pain and will often be in shock. pain and will often be in shock. Abdomen is often tender and rigid.Abdomen is often tender and rigid.

Fetal heart tones are absent.Fetal heart tones are absent. Treat for shock.Treat for shock. Give high-flow oxygen.Give high-flow oxygen. Transport patient rapidly.Transport patient rapidly.

Infants and ChildrenInfants and Children AirwayAirway

ManeuversManeuvers

FBAOFBAO

AdjunctsAdjuncts

Infants and ChildrenInfants and Children TraumaTrauma

Common CausesCommon Causes TypesTypes

ShockShock CausesCauses AssessmentAssessment TreatmentTreatment

Anatomical and physiological Anatomical and physiological considerations in the infant and considerations in the infant and

child.child.

a. In the supine position, an infant’s a. In the supine position, an infant’s or child’s larger head tips forward, or child’s larger head tips forward,

causing airway obstruction. causing airway obstruction. b. Placing padding under the b. Placing padding under the

patient’s back and shoulders will patient’s back and shoulders will bring the airway to a neutral or bring the airway to a neutral or

slightly extended position.slightly extended position.

General General Approach to Approach to

Pediatric Pediatric AssessmentAssessment

Basic ConsiderationsBasic Considerations Much of the initial patient Much of the initial patient

assessment can be done during assessment can be done during visual examination of the scene.visual examination of the scene.

Involve the caregiver or parent as Involve the caregiver or parent as much as possible.much as possible.

Allow to stay with child during Allow to stay with child during treatment and transport.treatment and transport.

Scene Size-UpScene Size-Up Conduct a quick scene size-up.Conduct a quick scene size-up. Take BSI precautions.Take BSI precautions. Look for clues to mechanism of Look for clues to mechanism of

injury or nature of illness.injury or nature of illness. Allow child time to adjust to you Allow child time to adjust to you

before approaching.before approaching. Speak softly, simply, at eye level.Speak softly, simply, at eye level.

SuctioningSuctioning Decrease suction pressure to less Decrease suction pressure to less

than 100 mm/Hg in infants.than 100 mm/Hg in infants. Avoid excessive suctioning time—Avoid excessive suctioning time—

less than 15 seconds per attempt.less than 15 seconds per attempt. Avoid stimulation of the vagus nerve.Avoid stimulation of the vagus nerve. Check the pulse frequently.Check the pulse frequently.

Inserting an oropharyngeal airway in a Inserting an oropharyngeal airway in a child with the use of a tongue blade.child with the use of a tongue blade.

VentilationVentilation Avoid excessive bag pressure and volume.Avoid excessive bag pressure and volume. Obtain chest rise and fall.Obtain chest rise and fall. Allow time for exhalation.Allow time for exhalation. Flow-restricted, oxygen-powered devices Flow-restricted, oxygen-powered devices

are contraindicated.are contraindicated. Do not use BVMs with pop-off valves.Do not use BVMs with pop-off valves. Apply cricoid pressure.Apply cricoid pressure. Avoid hyperextension of the neck.Avoid hyperextension of the neck.

CirculationCirculation

Two problems lead to Two problems lead to cardiopulmonarycardiopulmonary

arrest in children:arrest in children:

ShockShock Respiratory failureRespiratory failure

Signs and symptoms of Signs and symptoms of shock (hypoperfusion) in shock (hypoperfusion) in

a child.a child.

Respiratory Respiratory EmergenciesEmergencies

InfectionsInfections Upper airway distressUpper airway distress

CroupCroup EpiglottitisEpiglottitis

Lower airway distressLower airway distress AsthmaAsthma BronchiolitisBronchiolitis

a. Croup and a. Croup and b. Epiglottitisb. Epiglottitis

Positioning of the child with epiglottitis. Positioning of the child with epiglottitis. Often there will be excessive drooling.Often there will be excessive drooling.

The child with epiglottitis should be The child with epiglottitis should be administered humidified oxygen and administered humidified oxygen and

transported in a comfortable transported in a comfortable position.position.

Poisoning and Toxic Poisoning and Toxic ExposureExposure

Accidental poisoning is a common Accidental poisoning is a common childhood emergency.childhood emergency.

Leading cause of preventable Leading cause of preventable death in children.death in children.

SeizuresSeizures

Trauma EmergenciesTrauma Emergencies FallsFalls Motor vehicle crashesMotor vehicle crashes Car vs. pedestrian injuriesCar vs. pedestrian injuries Drowning and near drowningDrowning and near drowning Penetrating injuriesPenetrating injuries BurnsBurns Physical abusePhysical abuse

Falls are the most common Falls are the most common cause of injury in young cause of injury in young

children.children.

A deploying airbag can propel a A deploying airbag can propel a child safety seat back into the child safety seat back into the

vehicle’s seat, seriously injuring the vehicle’s seat, seriously injuring the child secured in it.child secured in it.

SIDSSIDS

Sudden Infant Death Sudden Infant Death Syndrome (SIDS)Syndrome (SIDS)

SIDS is the sudden death of an

infant during the first year of life

from an illness of unknown etiology.

Child Abuse Child Abuse and Neglectand Neglect

The stigmata of child abuse.The stigmata of child abuse.

Infants and Children Infants and Children with with

Special NeedsSpecial Needs Common home-care devicesCommon home-care devices

Tracheostomy tubesTracheostomy tubes Apnea monitorsApnea monitors Home artificial ventilatorsHome artificial ventilators Central intravenous linesCentral intravenous lines Gastric feeding and gastrostomy Gastric feeding and gastrostomy

tubes tubes ShuntsShunts

MeningitisMeningitis

SummarySummary

Questions ?Questions ?

emergency medical technician final review barry barkinsky ems-i, paramedic

respiratory slide

respiratory trauma slide

dysrhythmia slide

paramedic slide

asthma assessment assessment

respiratory tree

symptoms signs

rhonchi present

Documents

ems technician certification - hussmann corporation...

potential procedures for response to ems agency request for...

paramedic treatment guidelines - ct ems councils - ct ems

ems educational institution emergency medical technician...

emergency medical technician paramedic

arkansas tech university-ozark campus paramedic/ems clinical...

paramedic program application process › academics ›...

osdh ems paramedic - oklahoma paramedic standard.pdf · the...

cleveland clinic regional hospitals ems · ems protocol...

paramedic technology - east central collegeparamedic 4...

2014 national ems practice analysis public … national...

rn to paramedic bridge · the rn to paramedic bridge...

temple college ems professions1 communications emergency...

an exclusive supplement to firehouse and ems magazines...

blinn college ems paramedic program · 2020-04-28 · blinn...

maine ems paramedic interfacility transfer (pift - maine.gov

paramedic education standards · ems systems paramedic...

vernon college fire/ems program · vernon college fire/ems...

paramedic technician and emt-paramedic · truck which can...

protocol update alabama ems protocols paramedic edition 5...