Dot national standard emt intermediate 85 refresher
Download
1 / 50

DOT National Standard EMT-Intermediate/85 Refresher - PowerPoint PPT Presentation


  • 197 Views
  • Uploaded on

Welcome!. DOT National Standard EMT-Intermediate/85 Refresher. MEDICAL EMERGENCIES. Allergic reaction Possible overdose Near-drowning ALOC Diabetes Seizures Heat & cold emergencies Behavioral emergencies Suspected communicable disease. HEAT EMERGENCIES heat cramps heat exhaustion

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' DOT National Standard EMT-Intermediate/85 Refresher' - avedis


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Dot national standard emt intermediate 85 refresher

Welcome!

DOT National Standard

EMT-Intermediate/85 Refresher


Medical emergencies
MEDICAL EMERGENCIES

  • Allergic reaction

  • Possible overdose

  • Near-drowning

  • ALOC

  • Diabetes

  • Seizures

  • Heat & cold emergencies

  • Behavioral emergencies

  • Suspected communicable disease


Medical emergencies1

HEAT EMERGENCIES

heat cramps

heat exhaustion

heat stroke

Perspective

Pathophysiology

Epidemiology

PE & Diagnostic Findings

S/S

Differential considerations

Tx

MEDICAL EMERGENCIES


Perspective
perspective

  • When the external temperature rises to >95F, the body can no longer radiate heat to the environment & becomes dependent on evaporation for heat transfer

  • As humidity increases, the potential for evaporation heat loss decreases

    • Sweat that drips from the skin does not provide any cooling benefit and only exacerbates dehydration


Perspective1
perspective

  • As a result, the combination of high temperature & high humidity essentially blocks the two main mechanisms that the body uses to dissipate heat


Perspective2
perspective

  • The body tends to maintain its core temperature between 96.8-100.4F

  • Native thermal regulation mechanisms begin to fail at core temp. of <95F & >104F



S s physical exam assessment diagnostics monitoring management pertinent positives
s/s, physical exam & assessment, diagnostics, monitoring, management, pertinent positives

  • HEAT CRAMPS

    • Painful, involuntary, spasmodic contractions of skeletal muscles, usu. those of the calves (thighs & shoulder can happen too)

    • These cramps usually occur in individuals who are sweating profusely & replace fluid losses w/ water or other hypotonic solutions

    • They may occur during exercise or, more commonly, during a rest period after several hours of vigorous physical activity


S s physical exam assessment diagnostics monitoring management pertinent positives1
s/s, physical exam & assessment, diagnostics, monitoring, management, pertinent positives

  • Pts w/ severe heat cramps may have hyponatremia and hypochloremia


Treatment
Treatment management, pertinent positives

  • Scene Size Up

  • ABCs & spinal immobilization

  • Secondary Assessment |Diagnostics-Monitoring-Management | Verbal Survey

  • Cooling:

    • Remove pt from hot environment to a cool area if possible

    • Remove constricting and warm clothing

    • If ALOC or severe symptoms, begin evaporative cooling

    • Don’t let cooling delay transport

  • Check glucose PRN


Treatment1
Treatment management, pertinent positives

  • Fluid and salt replacement (PO or IV) & rest in a cool environment

  • For mild cases: 0.1% to 0.2% saline solution can be given PO. Two 10-grain (650mg) salt tablets dissolved in a quart of water provides a 0.1% saline solution

  • Commercially available sport drinks can be used

  • More severe symptoms should be treated w/ IV rehydration w/ NS


  • Perspective management, pertinent positives

  • Pathophysiology

  • Epidemiology

  • PE & Diagnostic Findings

  • S/S

  • Differential considerations

  • Tx


Questions
Questions? management, pertinent positives

  • References

    • Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010.

    • Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011.

    • Wolfson, Allan B. ed. , Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.


Dot national standard emt intermediate 85 refresher1

Welcome! management, pertinent positives

DOT National Standard

EMT-Intermediate/85 Refresher


Medical emergencies2
MEDICAL EMERGENCIES management, pertinent positives

  • Allergic reaction

  • Possible overdose

  • Near-drowning

  • ALOC

  • Diabetes

  • Seizures

  • Heat & cold emergencies

  • Behavioral emergencies

  • Suspected communicable disease


Medical emergencies3

HEAT EMERGENCIES management, pertinent positives

heat cramps

heat exhaustion

heat stroke

Pathophysiology

Epidemiology

Physical Exam Findings

Diagnostic Findings

Signs and Symptoms

Differential considerations

Treatment

MEDICAL EMERGENCIES


Perspective3
perspective management, pertinent positives

  • When the external temperature rises to >95F, the body can no longer radiate heat to the environment and becomes dependent on evaporation for heat transfer

  • As humidity increases, the potential for evaporation heat loss decreases

    • Sweat that drips from the skin does not provide any cooling benefit and only exacerbates dehydration


Perspective4
perspective management, pertinent positives

  • As a result, the combination of high temperature and high humidity essentially blocks the two main mechanisms that the body uses to dissipate heat


Perspective5
perspective management, pertinent positives

  • The body tends to maintain its core temperature between 96.8-100.4F

  • Native thermal regulation mechanisms begin to fail at core temp. of <95F and >104F



S s physical exam assessment diagnostics monitoring management pertinent positives2
s/s, physical exam & assessment, diagnostics, monitoring, management, pertinent positives

  • HEAT EXHAUSTION

    • Water depletion

    • Sodium depletion


S s physical exam assessment diagnostics monitoring management pertinent positives3
s/s, physical exam & assessment, diagnostics, monitoring, management, pertinent positives

  • HA

  • N/V

  • Malaise

  • Dizziness

  • Muscle cramps

  • Tachycardia

  • Orthostatic hypotension


S s physical exam assessment diagnostics monitoring management pertinent positives4
s/s, physical exam & assessment, diagnostics, monitoring, management, pertinent positives

  • Temperature may be normal or elevated (usually not above 104F)

  • No signs of CNS impairment


Treatment2
Treatment management, pertinent positives

  • Scene Size Up

  • ABCs & spinal immobilization

  • Secondary Assessment |Diagnostics-Monitoring-Management | Verbal Survey

  • Cooling:

    • Remove pt from hot environment to a cool area if possible

    • Remove constricting and warm clothing

    • If ALOC or severe symptoms, begin evaporative cooling

    • Don’t let cooling delay transport

  • Check glucose PRN


Treatment3
Treatment management, pertinent positives

  • Oral fluids

    • Frequent small amounts of water w/ 1/4 tsp of salt or sport drink

      • Adults: Give a total of 1-L

      • 1mo-14yrs: 10ml/kg to max of 1-L

  • IV

    • Adults: 1-L LR/NS bolus, then maintenance rate (120ml/hr)

    • Pediatrics: 20ml/kg LR/NS bolus (max 1-L), then maintenance rate (2ml/kg/hr)

    • All ages: if still symptomatic after initial bolus, give second bolus


Treatment4
Treatment management, pertinent positives

  • Seizures - GO TO PROTOCOL: Seizures

  • Many factors alter the body’s ability to regulate temperature: age extremes, heart disease, medications (diuretics, beta blockers), antihistamines, alcohol, type and amount of fluid replacement, dehydration, acclimatization, humidity, altitude


Treatment5
Treatment management, pertinent positives

  • Judicious fluid replacement: in elderly pts, overzealous fluid replacement may be detrimental

  • Cooling measures

    • Evaporative cooling: the most effective. Spray or wipe skin with water and evaporate water with air using fan, fanning or wind. Applying a moist cloth that retains moisture (cotton) is effective

    • Immersion: the next most effective but potentially dangerous. Use only if you can not provide evaporative cooling.


Treatment6
Treatment management, pertinent positives

  • Immerse pt in cool/cold water for 10 minutes, remove pt and recheck temperature. Be cautious! Keep pt’s head out of the water.

  • It is difficult to protect an airway and manage a seizing pt in a stream!

  • Also it is easy to make the pt hypothermic using this method. Cool only to goal temperature of 102.5F. Cooling will continue after you stop.

  • If first attempt not successful then continue with 5 minute cycles, rechecking temperature 5 minutes after each immersion


Treatment7
Treatment management, pertinent positives

  • Adjunctive measures: placing ice or cool towels in areas of high blood flow (neck veins, armpits, groin) works but is much less effective

  • AVOID cooling below 102.5F and stop if pt starts shivering (hypothermic overshoot). Shivering increases body temperature and reflects overcooling

  • Transport any pt w/ signs of severe heat exhaustion or heat stroke.


Differential dx
Differential Dx management, pertinent positives

  • Drug OD (amphetamines, antihistamines, tricyclic antidepressants, ASA)

  • Alcohol withdrawal

  • Sepsis, febrile illness

  • DKA

  • Meningitis, encephalitis

  • Thyroid storm (hyperthyroidism)

  • Cerebral hemorrhage

  • Medication reaction (antipsychotics, e.g., Haldol)

  • Status epilepticus


  • Pathophysiology management, pertinent positives

  • Epidemiology

  • Physical Exam Findings

  • Diagnostic Findings

  • Signs and Symptoms

  • Differential considerations

  • Treatment


Questions1
Questions? management, pertinent positives

  • References

    • Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010.

    • Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011.

    • Wolfson, Allan B. ed. , Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.


Dot national standard emt intermediate 85 refresher2

Welcome! management, pertinent positives

DOT National Standard

EMT-Intermediate/85 Refresher


Medical emergencies4
MEDICAL EMERGENCIES management, pertinent positives

  • Allergic reaction

  • Possible overdose

  • Near-drowning

  • ALOC

  • Diabetes

  • Seizures

  • Heat & cold emergencies

  • Behavioral emergencies

  • Suspected communicable disease


Medical emergencies5

HEAT EMERGENCIES management, pertinent positives

heat cramps

heat exhaustion

heatstroke

Pathophysiology

Epidemiology

Physical Exam Findings

Diagnostic Findings

Signs and Symptoms

Differential considerations

Treatment

MEDICAL EMERGENCIES


Perspective6
perspective management, pertinent positives

  • When the external temperature rises to >95F, the body can no longer radiate heat to the environment and becomes dependent on evaporation for heat transfer

  • As humidity increases, the potential for evaporation heat loss decreases

    • Sweat that drips from the skin does not provide any cooling benefit and only exacerbates dehydration


Perspective7
perspective management, pertinent positives

  • As a result, the combination of high temperature and high humidity essentially blocks the two main mechanisms that the body uses to dissipate heat


Perspective8
perspective management, pertinent positives

  • The body tends to maintain its core temperature between 96.8-100.4F

  • Native thermal regulation mechanisms begin to fail at core temp. of <95F and >104F



S s physical exam assessment diagnostics monitoring management pertinent positives5
s/s, physical exam & assessment, diagnostics, monitoring, management, pertinent positives

  • HEAT STROKE

    • Acute life-threatening emergency w/ mortality rates as high as 30%-80% and is universally fatal if left untreated.

    • The cardinal features of heat stroke are hyperthermia [>104F] and altered level of consciousness

    • Classic (non-exertional) heat stroke may exhibit anhidrosis

    • The absence of sweat is not considered a diagnostic criteria, because sweat is present in over half of pts with heat stroke


S s physical exam assessment diagnostics monitoring management pertinent positives6
s/s, physical exam & assessment, diagnostics, monitoring, management, pertinent positives

  • Virtually any neurologic abnormality may be present

    • Irritability

    • Confusion

    • Bizarre behavior

    • Combativeness

    • Hallucinations

    • Posturing

    • Seizures

    • coma


Treatment8
Treatment management, pertinent positives

  • Scene Size Up

  • ABCs & spinal immobilization

  • Secondary Assessment |Diagnostics-Monitoring-Management | Verbal Survey

  • Cooling:

    • Remove pt from hot environment to a cool area if possible

    • Remove constricting and warm clothing

    • If ALOC or severe symptoms, begin evaporative cooling

    • Don’t let cooling delay transport

  • Check glucose PRN


Treatment9
Treatment management, pertinent positives

  • Oral fluids

    • Frequent small amounts of water w/ 1/4 tsp of salt or sport drink

      • Adults: Give a total of 1-L

      • 1mo-14yrs: 10ml/kg to max of 1-L

  • IV

    • Adults: 1-L LR/NS bolus, then maintenance rate (120ml/hr)

    • Pediatrics: 20ml/kg LR/NS bolus (max 1-L), then maintenance rate (2ml/kg/hr)

    • All ages: if still symptomatic after initial bolus, give second bolus


Treatment10
Treatment management, pertinent positives

  • Seizures - GO TO PROTOCOL: Seizures

  • Many factors alter the body’s ability to regulate temperature: age extremes, heart disease, medications (diuretics, beta blockers), antihistamines, alcohol, type and amount of fluid replacement, dehydration, acclimatization, humidity, altitude


Treatment11
Treatment management, pertinent positives

  • Judicious fluid replacement: in elderly pts, overzealous fluid replacement may be detrimental

  • Cooling measures

    • Evaporative cooling: the most effective. Spray or wipe skin with water and evaporate water with air using fan, fanning or wind. Applying a moist cloth that retains moisture (cotton) is effective

    • Immersion: the next most effective but potentially dangerous. Use only if you can not provide evaporative cooling.


Treatment12
Treatment management, pertinent positives

  • Immerse pt in cool/cold water for 10 minutes, remove pt and recheck temperature. Be cautious! Keep pt’s head out of the water.

  • It is difficult to protect an airway and manage a seizing pt in a stream!

  • Also it is easy to make the pt hypothermic using this method. Cool only to goal temperature of 102.5F. Cooling will continue after you stop.

  • If first attempt not successful then continue with 5 minute cycles, rechecking temperature 5 minutes after each immersion


Treatment13
Treatment management, pertinent positives

  • Adjunctive measures: placing ice or cool towels in areas of high blood flow (neck veins, armpits, groin) works but is much less effective

  • AVOID cooling below 102.5F and stop if pt starts shivering (hypothermic overshoot). Shivering increases body temperature and reflects overcooling

  • Transport any pt w/ signs of severe heat exhaustion or heat stroke.


Differential dx1
Differential Dx management, pertinent positives

  • Drug OD (amphetamines, antihistamines, tricyclic antidepressants, ASA)

  • Alcohol withdrawal

  • Sepsis, febrile illness

  • DKA

  • Meningitis, encephalitis

  • Thyroid storm (hyperthyroidism)

  • Cerebral hemorrhage

  • Medication reaction (antipsychotics, e.g., Haldol)

  • Status epilepticus


  • Pathophysiology management, pertinent positives

  • Epidemiology

  • Physical Exam Findings

  • Diagnostic Findings

  • Signs and Symptoms

  • Differential considerations

  • Treatment


Questions2
Questions? management, pertinent positives

  • References

    • Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010.

    • Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011.

    • Wolfson, Allan B. ed. , Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.


ad