Dallas Dunlap

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Fun Friday: National EMS Week is officially over and here comes another long year of.......

Skill Saturday: Today, we will take the time to look at a skill or two that could pop up on an upcoming practical exam or while performing our duties, either way it is only going to benefit us all (future patients included). If there is a skill that you would like to review today, let us know and we will see if we can make that happen! Because, above all else practice makes perfect!

Skill Saturday: Pediatric Respiratory Compromise can be a very challenging event for any level of EMS professional. Many conditions that affect the respiratory status of a child are found in the upper/lower airway including obstruction. Upper airway disease like croup,epiglottitis and rarely bacterial tracheitis and lower airway disease like asthma, bronchiolitis, and pneumonia. Most cases of cardiac arrest in children are respiratory in nature, therefore they require a rapid assessment and treatment. The severity of the respiratory compromise may be classified as respiratory distress, respiratory failure and respiratory arrest. (We will cover each next post). IMPORTANT NOTE: The EMS practitioner should try to calm and reassure the child with respiratory compromise. Do not agitate the conscious pt or lay them supine; doing so may aggravate the airway condition.

Skill Saturday: Check out this flowchart for pediatric airway compromise, see if it follows your local protocols!

Scenario Scenario: EMT-Scenarios There some important things to remember when you’re doing EMT practice scenarios. You should verbalize your actions to let evaluators understand your assessment and treatment. Some of the things you should verbalize are: - Scene Safety - (BSI) precautions - Number of patients - Mechanism By verbalizing, you’ll be given proper credit and they also help organize your thoughts. You must do the scenarios as you would in the field including talking to the patient. You will be given a time limit which may vary and instructors may change or make the scenarios as realistic as possible to better meet the student’s need and make it more challenging. You should assess and treat the patient according to instructions and vital signs should be taken. A complete list of EMT skills to expect on the practical section of NREMT/State Registry Exam can be found at the Resource Forums section at MedicTests.com

Skill Saturday: Ped. Airway compromise (cont.) RESPIRATORY DISTRESS: Respiratory distress in children is the mildest form of compromise and is evident by an increase in rate & depth of breathing and the use of accessory muscles to assist vents (Silverman-Anderson scale: attached). These changes cause a slight decrease in arterial carbon dioxide levels in the blood as the rate increases. As the respiratory distress worsens the pediatric patient will quickly become exhausted. The PCO2 gradually increases as the condition gets worse. Signs & Symptoms: - altered mental status - Tachypnea - Retractions (accessory muscles) - Nasal Flaring (infant) - Poor muscle Tone - Tachycardia - Head bobbing - Grunting - Cyanosis (late) RESPIRATORY FAILURE: Results from poor ventilations or lack of oxygenation. It occurs when the heart and lungs do not exchange enough O2 and carbon dioxide, causing a decrease in PO2; leading to respiratory acidosis. Signs & Symptoms: - Irritability deteriorating to lethargy - Marked Tachypnea deteriorating to bradypnea - Retractions deteriorating to agonal respirations - Marked tachycardia deteriorating to bradycardia - Central (core) Cyanosis Respiratory failure is an ominous sign; without immediate, aggressive intervention;- respiratory arrest! RESPIRATORY ARREST: The total cessation of breathing. Good outcomes can be expected when treatment is initiated early. Without quick intervention cardiopulmonary arrest will result. Signs & Symptoms: - Unresponsive - Apnea - Limp muscle tone - Bradycardia without palpable pulse - Profound core cyanosis Providing aggressive ventilatory and circulatory support for pediatric patients in respiratory distress is critical.

Scenario Sunday: You are called to a drivers rest area on a nearby interstate for a female patient possibly in labor; complaining of contractions < 4 minutes apart. On arrival at the rest area you are directed to a parked automobile with all the doors open and an apparent female patient in the back seat while a male bystander (husband) leans in comforting the patient. You approach a safe scene and introduce yourself and affiliation. The patient is on the back seat on all fours stating that her "water" had broken earlier and the contraction pain became too much while driving to the hospital. Pt states the contractions are now worse and are coming quicker (probably < 2 minutes apart) now. Pt. states she has two other children with no problems with the previous pregnancies or deliveries. NKDA HR = 108 RR = 18 B/P = 112/60 SPO2 = 99 ra - What would be your first course of action in this situation? - The patient begs you not to move her and you notice slight crowning; do you allow the patient to deliver in the all fours position in the back seat or do you pretty much rush her onto a stretcher and run for the unit? The levels of child birth......

The Virus SARS stands for "Severe Acute Respiratory Syndrome", a collection of symptoms resulting from exposure to a coronavirus that causes the atypical pneumonia widely identified as "SARS". Coronaviruses are a group of viruses that cause respiratory ailments in humans. Coronaviruses have a halo or crown (corona) appearance when viewed in a microscope (hence the name). The virus is spread by droplet transmission (like TB) and may be transmitted by contact with a contaminated object. Go to the CDC website for the latest. The Risk Factors Those at greatest risk are recent travelers to Asia and Europe. Most of the cases have originated in China. People in close contact (including health care workers) with infected patients are also at risk of infection. The syndrome has been reported in the continents of Asia, North America and Europe. You really need to have a look at the CDC site for the latest information! Signs and Symptoms *Recent foreign travel or exposure to SARS patient. (Incubation period is 2-7 days, but may be as long as 10 days)* • Fever greater than 100.4 F. • Headache, general feeling of discomfort, body aches. • Respiratory symptoms are mild at the outset, but progress after 2 to 7 days to a dry, non-productive cough which may be serious enough to cause hypoxia. • 10% to 20% require mechanical ventilation. Prevention / Procedure As previously noted, use universal precautions and the same PPE (personal protective equipment) you would use for respiratory pathogens such as TB: • Use gloves, eye protection, N95 (TB type) respirator mask • Place a surgical mask (not a TB mask) on the patient to help control droplets expelled by the patient. WASH YOUR HANDS! • Limit exposure by reducing the number of personnel and bystanders in the same room or in the ambulance. • Provide ALL indicated basic and advanced life support. Your knowledge and PPE will protect you. • Alert the receiving facility: advise them you are "using respiratory isolation precautions" as part of the radio report. • Disinfect the unit and equipment after transporting a suspected SARS

Poisoning A poison is defined as a substance that produces harmful physiological/psychological effects to humans. Emergencies that involve poisons are a major cause of morbidity/mortality in the US. Poisons are responsible for 10% of all ER visits and 9% of all ambulance calls. More than 60 Poison control centers exist in the US. These centers help treat poisoning emergencies. Regional Poison control centers are a ready source of information for any toxicological emergency. Refer to the Resource Forums section at MedicTests.com for the general treatment guidelines supported by poison control.

Common heart attack symptoms and warning signs may include: Chest discomfort that feels like pressure, fullness, or a squeezing pain in the center of your chest; it lasts for more than a few minutes, or goes away and comes back. Pain and discomfort that extend beyond your chest to other parts of your upper body, such as one or both arms, back, neck, stomach, teeth, and jaw Unexplained shortness of breath, with or without chest discomfort Other symptoms, such as cold sweats, nausea or vomiting, lightheadedness, anxiety, indigestion, and unexplained fatigue Chest pain and discomfort are the most common heart attack symptoms for both men and women. But, women are more likely than men to also experience other symptoms, too. These might include shortness of breath, nausea and vomiting, unexplained extreme fatigue, and neck, shoulder, upper back, or abdominal pain.

What are the Adrenal Glands? Adrenal glands are triangle-shaped glands located on top of the kidneys. The outer part of the adrenal gland is called the cortex and produces steroid hormones such as cortisol, aldosterone, and testosterone. The inner part of the adrenal gland is called the medulla and produces epinephrine and norepinephrine, which are commonly called adrenaline and noradrenaline. When the glands produce more or less hormones than your body needs, you can become sick.

Did you Know? Dopamine is the primary neurotransmitter involved in the reward pathways in the brain. Thus, drugs that increase dopamine signaling may produce euphoric effects. Many recreational drugs, such as cocaine and amphetamines, alter the functionality of the dopamine transporter (DAT), the protein responsible for removing dopamine from the neural synapse. When DAT activity is blocked, the synapse floods with dopamine and increases dopaminergic signaling. When this occurs, particularly in the nucleus accumbens, increased and receptor signaling mediates the "rewarding" stimulus of drug intake. Reward pathway signaling can affect other regions of the brain as well, inducing long-term changes in regions such as the nucleus accumbens and frontal cortex; these changes can strengthen drug craving and alter cognitive pathways, with drug abuse potentially creating drug addiction.

Congenitial Heart Defects Making You Blue? Ebstein’s anomaly is a rare heart defect in which parts of the tricuspid valve are abnormal. The tricuspid valve separates the right lower heart chamber (right ventricle) from the right upper heart chamber (right atrium). In persons with Ebstein’s anomaly, the leaflets are unusually deep in the right ventricle. The leaflets are often larger than normal. The defect usually causes the valve to work poorly, and blood may go the wrong way back into the right atrium. The backup of blood flow can lead to heart swelling and fluid buildup in the lungs or liver. Sometimes, not enough blood gets out of the heart into the lungs and the person may appear blue.

Fun Friday! So true, so true; I think so, how about you!

Fun Friday: Enough said!

Fun Friday: MedicTests.com helps you get through the NREMT exam and as a bonus, we have compiled a list for you to keep near and dear the first few weeks on your new carear, you'll thank us!

Fun Friday: I would love to drop these out of airplanes in my response area, how about you?

Skill Saturday: On Scene, if the product can be identified from the driver, truck owner or from a distance with binoculars, report the findings to EOC and CHEMTRAC (if applicable). The information will be instrumental in determining the Hot/Cold Zones. When approaching the scene, be alert to environmental clues like wind direction, unusual odors, and vapor clouds. Emergency vehicles should never be driven through the "Hot" zone. In addition, personnel shouldn't enter the incident area until it has determined to be safe. Approaching the scene: • Identify the potential Hazard – placards, container labels, shipping papers, driver/owner. Evaluate and consult recommended guide page before putting yourself and partner. • Secure the scene – Without entering the immediate hazard zone, do what you can to safely prevent entry or exit of the potential “Hot” zone. • Obtain additional Resources - Advise your dispatch to notify the responsible agencies and to call for assistance from CHEMTRAC and The National Response Center, which be reached through CHEMTRAC directly. • Decide on site entry – Any efforts you make to rescue someone should be weighed against the possibility that you could become part of the problem. It is usually best to wait until all clear; regardless. Identifying the potential hazardous chemical involved is paramount. The placards that give a great deal of info.

Skill Saturday: HAZARDOUS MATERIAL PLACARD A placard provides the viewer with a variety of information through several different methods. First is the color of the placard. • Red indicates flammable, green indicates nonflammable, yellow indicates oxidizer, • Blue indicates dangerous when wet, white indicates inhalation hazard and poison, black and • White indicates corrosive (acid and caustic) • Red and white indicates flammable solid or spontaneously combustible, depending on the color pattern on the placard • White and yellow indicates radiation or radioactive, orange indicates explosives, white with black stripes indicates miscellaneous hazardous materials, and there is another red and white placard that says “dangerous” on it. A second information indicator is the number in the bottom corner of the diamond. This number refers to the hazard classes as used internationally and by the United States DOT. There are 9 classes for hazardous materials: • Class 1 explosives • Class 2 gases (flammable, nonflammable, inhalation hazard/poison, or oxygen) • Class 3 liquids that burn (flammable and combustible liquids, based on their flashpoint) • Class 4 flammable solids, spontaneously combustible, or dangerous when wet materials • Class 5 oxidizers and organic peroxides • Class 6 poison/toxic solids and liquids, infectious materials • Class 7 radioactive (three sub classes) • Class 8 corrosives (acids and bases) • Class 9 miscellaneous A third indicator is the symbol in the upper corner of the diamond. A variety of symbols are used to indicate combustion, radiation, oxidizers, compressed gas, destruction of materials and skin by corrosives, an explosion, or skull and cross bones to indicate poisons. The fourth item on a placard is the four digit United Nations (UN) number used for the Hazardous material contained in the container. There are hundreds of four digit numbers used, from 1001 (acetylene) to 9279 (hydrogen, absorbed in metal hydride). The number in some cases is specific to a chemical and in other cases reflects a variety of hazardous materials. For example, 1017 is only used for chlorine, 1005 has five chemical listings, 1993 is used for eight chemical listings and 2810 is used for 36 chemical listings.

Skill Saturday: A NFPA Guide Explanation is nice to have around when you need it.

EMS & HazMat

Skill Saturday: Control the scene The first agency on scene has several responsibilities. It's members must detect/identify the materials involved, assess the risk of exposure to rescue personnel or others, consider the potential risk of fire or explosion, gather info from others on scene as well as control and confine the threat. All while a command post is being established per the areas preplanning command structure. The next biggest safety concern is the establishment of safety zones. The hot Zone - the area of the material spill, and surrounding areas that contain smog, fire ,vapor or water(liquid). All equipment and procedures should be withheld and rescuers in this area should have full PPE and special training. The distance to the warm(yellow) zone will be determined by the proper agency depending on the material involved. The warm zone is an area around the hot zone and is considered somewhat safer all though PPE is still required it is usually considered to be safer for humans.This zone is where most EMS activities are performed such as decon and pt. treatment. Some refer to this area as the limited access zone or the yellow zone. The cold zone - the area encompassing the warm zone. The cold zone is also restricted to emergency personnel, this area is considered generally safe and only minimal protective gear is required. No contaminated gear is allowed into the col zone.

Control of normal respirations is a continuous, repetitive cycle as long as all goes right!

Cranial nerves emerge directly from the brain and transfer data directly to the desired specific cells. In contrast, all other nerves within the human body emerge from the spine and then data is transferred from the spine to the brain. The first 2 cranial nerves emerge from the cerebrum, whereas the remaining 10 cranial nerves emerge from the brain stem directly.

Your backbone, or spine, is made up of 26 bone discs called vertebrae. The vertebrae protect your spinal cord and allow you to stand and bend. A number of problems can change the structure of the spine or damage the vertebrae and surrounding tissue. They include Infections Injuries Tumors Conditions, such as ankylosing spondylitis and scoliosis Bone changes that come with age, such as spinal stenosis and herniated disks Spinal diseases often cause pain when bone changes put pressure on the spinal cord or nerves. They can also limit movement. Treatments differ by disease, but sometimes they include back braces and surgery.

What's a goiter? The term “goiter” simply refers to the abnormal enlargement of the thyroid gland. It is important to know that the presence of a goiter does not necessarily mean that the thyroid gland is malfunctioning. A goiter can occur in a gland that is producing too much hormone (hyperthyroidism), too little hormone (hypothyroidism), or the correct amount of hormone (euthyroidism). A goiter indicates there is a condition present which is causing the thyroid to grow abnormally.

Coup, Contrecoup In head injury, a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was impacted. Coup and contrecoup injuries are associated with cerebral contusions, a type of traumatic brain injury in which the brain is bruised. Coup and contrecoup injuries can occur individually or together. When a moving object impacts the stationary head, coup injuries are typical, while contrecoup injuries are produced when the moving head strikes a stationary object.