emergency medical technician final review barry barkinsky ems-i, paramedic
TRANSCRIPT
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
Signs and SymptomsSigns and Symptoms
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.
Angina PectorisAngina Pectoris
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.
Angina PectorisAngina Pectoris
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.
Angina PectorisAngina Pectoris
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
Angina PectorisAngina Pectoris
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
Myocardial InfarctionMyocardial Infarction
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.”
Myocardial InfarctionMyocardial Infarction
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.
Myocardial InfarctionMyocardial Infarction
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.
Heart FailureHeart Failure
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
Heart FailureHeart Failure
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.
Heart FailureHeart Failure
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.
Heart FailureHeart Failure
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.
Heart FailureHeart Failure
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.
Administer oxygen.Administer oxygen.
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
Hypertensive Hypertensive EmergenciesEmergencies
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
Hypertensive Hypertensive EmergenciesEmergencies
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
Hypertensive Hypertensive EmergenciesEmergencies
ManagementManagement
Maintain airway.Maintain airway.
Administer oxygen.Administer oxygen.
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.
Cardiogenic ShockCardiogenic Shock
Field AssessmentField Assessment Initial AssessmentInitial Assessment
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.
Cardiogenic ShockCardiogenic Shock
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
Cardiogenic ShockCardiogenic Shock
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
Cardiac ArrestCardiac Arrest
Field AssessmentField Assessment Initial AssessmentInitial Assessment
Unresponsive, apneic, pulseless patientUnresponsive, apneic, pulseless patient ECGECG
DysrhythmiasDysrhythmias HistoryHistory
Prearrest eventsPrearrest events Bystander CPRBystander CPR ““Down time”Down time”
Cardiac ArrestCardiac Arrest
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)
AED AED (Automatic External (Automatic External
Defibrillator)Defibrillator)
IndicationsIndications
AED AED (Automatic External (Automatic External
Defibrillator)Defibrillator)
ContraindicatioContraindicationsns
AED AED (Automatic External (Automatic External
Defibrillator)Defibrillator)
JoulesJoules
AED AED (Automatic External (Automatic External
Defibrillator)Defibrillator)
# of Shocks# of Shocks
AED AED (Automatic External (Automatic External
Defibrillator)Defibrillator)
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
Peripheral Vascular and Peripheral Vascular and Other Cardiovascular Other Cardiovascular
EmergenciesEmergencies
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.
Peripheral Vascular and Peripheral Vascular and Other Cardiovascular Other Cardiovascular
EmergenciesEmergencies
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.
Peripheral Vascular and Peripheral Vascular and Other Cardiovascular Other Cardiovascular
EmergenciesEmergencies
Medical EmergenciesMedical Emergencies Altered Mental Status (AMS)Altered Mental Status (AMS)
CausesCauses
TreatmentTreatment
Medical EmergenciesMedical Emergencies
DiabetesDiabetes
Most common causeMost common cause
Signs and SymptomsSigns and Symptoms
TreatmentTreatment
Medical EmergenciesMedical Emergencies
SeizuresSeizures
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.
Medical EmergenciesMedical Emergencies
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
Stroke & Intracranial Stroke & Intracranial HemorrhageHemorrhage
SymptomsConfusionAgitationDizzinessVision Problems
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.
Stroke & Intracranial Stroke & Intracranial HemorrhageHemorrhage
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.
Stroke & Intracranial Stroke & Intracranial HemorrhageHemorrhage
Medical EmergenciesMedical Emergencies
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
IndicationsIndications
Epi-Auto InjectorEpi-Auto Injector
ContraindicatioContraindicationsns
Epi-Auto InjectorEpi-Auto Injector
DosageDosage
Epi-Auto InjectorEpi-Auto Injector
ActionsActions
Epi-Auto InjectorEpi-Auto Injector
Side EffectsSide Effects
Epi-Auto InjectorEpi-Auto Injector
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
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
ArterialSpurting bloodPulsating flowBright red color
VenousSteady, slow flowDark red
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
Trauma EmergenciesTrauma Emergencies
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
Trauma EmergenciesTrauma Emergencies
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
Open WoundsAbrasionsLacerationsIncisionsPuncturesImpaled ObjectsAvulsionsAmputations
Trauma EmergenciesTrauma Emergencies
Penetrating Penetrating InjuriesInjuries
Trauma EmergenciesTrauma Emergencies
EviscerationEvisceration
Trauma EmergenciesTrauma Emergencies
Impaled ObjectImpaled Object
Trauma EmergenciesTrauma Emergencies
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
Management of Management of Soft-Tissue InjurySoft-Tissue Injury
(continued)
Pain & Edema ControlPain & Edema Control Cold packsCold packs Moderate pressure over woundModerate pressure over wound
Management of Management of Soft-Tissue InjurySoft-Tissue Injury
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
Burn DepthBurn Depth
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
Burn DepthBurn Depth
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
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
Minor
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
Management of Management of Thermal BurnsThermal 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
Management of Management of Thermal BurnsThermal Burns
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
Management of Management of Thermal BurnsThermal Burns
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
Assessment & Management of Assessment & Management of Electrical, Chemical & Radiation Electrical, Chemical & Radiation
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
Assessment & Management of Assessment & Management of Electrical, Chemical & Radiation Electrical, Chemical & Radiation
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
Assessment & Management of Assessment & Management of Electrical, Chemical & Radiation Electrical, Chemical & Radiation
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
Assessment & Management of Assessment & Management of Electrical, Chemical & Radiation Electrical, Chemical & Radiation
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
Pathophysiology of the Pathophysiology of the Musculoskeletal SystemMusculoskeletal System
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
Pathophysiology of the Pathophysiology of the Musculoskeletal SystemMusculoskeletal System
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
Musculoskeletal Injury Musculoskeletal Injury ManagementManagement
Trauma EmergenciesTrauma Emergencies
Injuries to HeadInjuries to Head Nervous SystemNervous System Brain InjuriesBrain Injuries
DirectDirect IndirectIndirect
Patient AssessmentPatient Assessment Signs and SymptomsSigns and Symptoms Neurological AssessmentNeurological Assessment
Trauma EmergenciesTrauma Emergencies
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
Musculoskeletal Injury Musculoskeletal Injury ManagementManagement
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)
or or
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
Priority 2Priority 2
(Yellow)(Yellow)
TriageTriage
Priority 3Priority 3
(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.
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
OB / GYN ( Normal OB / GYN ( Normal Delivery)Delivery)
Suction mouth, nose.
OB / GYN ( Normal OB / GYN ( Normal Delivery)Delivery)
Delivery of Shoulders
Chest Delivers
OB / GYN ( Normal OB / GYN ( Normal Delivery)Delivery)
Legs and Feet Deliver
OB / GYN ( Normal OB / GYN ( Normal Delivery)Delivery)
Cutting the Cord
OB / GYN ( Normal OB / GYN ( Normal Delivery)Delivery)
Cutting Umbilical Cord
Apgar ScoringApgar Scoring
OB / GYN ( Normal OB / GYN ( Normal Delivery)Delivery)
Care of Care of NewbornNewborn
OB / GYN OB / GYN (Resuscitation)(Resuscitation)
HR Less than HR Less than 100100
OB / GYN OB / GYN (Resuscitation)(Resuscitation)
HR less than HR less than 8080
OB / GYN OB / GYN (Resuscitation)(Resuscitation)
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 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
OB / GYN (Abnormal OB / GYN (Abnormal Deliveries)Deliveries)
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.
OB / GYN (Abnormal OB / GYN (Abnormal Deliveries)Deliveries)
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.
Medical EmergenciesMedical Emergencies
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.
Medical EmergenciesMedical Emergencies
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
Medical EmergenciesMedical Emergencies
MeningitisMeningitis
SummarySummary
Questions ?Questions ?