Dot national standard emt intermediate 85 refresher
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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

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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


Dot national standard emt intermediate 85 refresher

  • Physiologic response to heat stress occurs through 4 primary mechanisms

    • Dilatation of blood vessels, particularly the skin

    • Increased sweat production

    • Decreased heat production

    • Behavioral heat control


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

  • 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

  • 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


Dot national standard emt intermediate 85 refresher

  • Perspective

  • Pathophysiology

  • Epidemiology

  • PE & Diagnostic Findings

  • S/S

  • Differential considerations

  • Tx


Questions

Questions?

  • 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!

DOT National Standard

EMT-Intermediate/85 Refresher


Medical emergencies2

MEDICAL EMERGENCIES

  • Allergic reaction

  • Possible overdose

  • Near-drowning

  • ALOC

  • Diabetes

  • Seizures

  • Heat & cold emergencies

  • Behavioral emergencies

  • Suspected communicable disease


Medical emergencies3

HEAT EMERGENCIES

heat cramps

heat exhaustion

heat stroke

Pathophysiology

Epidemiology

Physical Exam Findings

Diagnostic Findings

Signs and Symptoms

Differential considerations

Treatment

MEDICAL EMERGENCIES


Perspective3

perspective

  • 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

  • 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

  • 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


Dot national standard emt intermediate 85 refresher

  • Physiologic response to heat stress occurs through 4 primary mechanisms

    • Dilatation of blood vessels, particularly the skin

    • Increased sweat production

    • Decreased heat production

    • Behavioral heat control


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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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


Dot national standard emt intermediate 85 refresher

  • Pathophysiology

  • Epidemiology

  • Physical Exam Findings

  • Diagnostic Findings

  • Signs and Symptoms

  • Differential considerations

  • Treatment


Questions1

Questions?

  • 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!

DOT National Standard

EMT-Intermediate/85 Refresher


Medical emergencies4

MEDICAL EMERGENCIES

  • Allergic reaction

  • Possible overdose

  • Near-drowning

  • ALOC

  • Diabetes

  • Seizures

  • Heat & cold emergencies

  • Behavioral emergencies

  • Suspected communicable disease


Medical emergencies5

HEAT EMERGENCIES

heat cramps

heat exhaustion

heatstroke

Pathophysiology

Epidemiology

Physical Exam Findings

Diagnostic Findings

Signs and Symptoms

Differential considerations

Treatment

MEDICAL EMERGENCIES


Perspective6

perspective

  • 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

  • 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

  • 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


Dot national standard emt intermediate 85 refresher

  • Physiologic response to heat stress occurs through 4 primary mechanisms

    • Dilatation of blood vessels, particularly the skin

    • Increased sweat production

    • Decreased heat production

    • Behavioral heat control


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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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


Dot national standard emt intermediate 85 refresher

  • Pathophysiology

  • Epidemiology

  • Physical Exam Findings

  • Diagnostic Findings

  • Signs and Symptoms

  • Differential considerations

  • Treatment


Questions2

Questions?

  • 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.


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