Education | Paramedicine 101

Patient Perceptions of Computed Tomographic Imaging and Their Understanding of Radiation Risk and Exposure – Part IV

09/12/2011 by Rogue Medic 1 Comment

Also posted over at Rogue Medic (now at EMS Blogs).

Continuing from Part I, Part II. and Part III.

After assessing what it is that the abdominal pain patients want/expect from a visit to the ED (Emergency Department), how many X-rays it takes to deliver the same radiation as an abdominal CT (Computed Tomographic imaging), whether CTs increase the lifetime risk of cancer, and how many abdominal CTs equal some sort of measure of the radiation exposure of Hiroshima survivors, the authors conclude that people do not understand the risks of radiation.^[1] This study is followed by an excellent editorial.

The easy conclusion from these ﬁndings is, unsurprisingly, that patients are ill informed, and thus efforts to improve their education and awareness should help to mitigate the overuse of imaging and its consequent risks.^[2]

Dr. Wears does not discuss the validity of assuming that there is only one right answer to the questions asked. There is also a podcast discussing this study and discussing the editorial, but the podcast is similarly missing the problem with the study taking for granted that there is a single right answer to the study’s questions.^[3]

First, the “rational person” assumption holds that, given correct information, people should arrive at consistent choices about alternatives (eg, to image or not) based on the net expectation of probabilities and outcomes.²^[2]

If we make rational decisions, why do so many of us smoke?

If we make rational decisions, why do so many of us eat to the point of obesity?

If we make rational decisions, why do so many of us spend so much time watching reality TV?

Dr. Wears cites some of the studies that show that we do not make rational decisions. To insist that we make rational decisions is also irrational. Isolated examples of decisions that appear rational do not mean that a person makes rational decisions any more than a stopped clock being right twice a day means that the stopped clock keeps accurate time.

The authors provide excellent examples of irrationality in one question they present.

Click on images to make them larger.

How a multiple choice question is presented will affect way the answers are chosen.

Why is there no choice for I don’t know?

For most people not familiar with X-rays and CTs, the only honest and rational answer is I don’t know.

When graphing the results, we can further distort the results by making the distances between numbers completely arbitrary. Why present the choices as the Same radiation (the same, or zero difference is 50 x 0), 50 times more (greater by a factor of 50 x 1), 100 times more (greater by a factor of 50 x 2), 250 times more (greater by a factor of 50 x 5), 300 times more (greater by a factor of 50 x 6), and Over 350 times more (greater by a factor of 50 x at least 7).

Why blur the distinction between 100 times and 250 times? When the numbers become blurred, the numbers lose their meaning. When there is no difference in meaning between one number and a number 2 1/2 times as large, are we providing information or are we providing confusion?

We seem to most insist on stripping information of its meaning when we create multiple choice tests. Correct answers become a simple matter of memorization separated from understanding. This is one way to create the protocol monkey – the automaton, whom we claim is rendered harmless by being prevented from thinking. This desire to prevent the use of judgment may be the ultimate irrational decision.

If the difference between 100 and 250 is the same as the difference between 250 and 300, how do we expect anyone to notice differences in dosages? 100 mg – 200 mg – 300 mg – what’s the difference? With memorized answers, the only difference is whether it is graded as correct. With real patients, the differences can be fatal.

We memorize our way to recklessness.

We do not memorize our way to safety.

Previous literature estimates the radiation dose for an abdomen-pelvis CT to be equivalent to 100 to 250 2-view chest series.^2,10-12 For the purpose of this investigation, we used the conservative estimate of 1 abdomen-pelvis CT = 100 2-view chest radiographs.^[1]

I agree with their choice to use the more conservative number, but what this still does not do is put this in a context that helps people to understand. Without understanding something about the radiation exposure of an X-ray, this is an unknown. 10 times an unknown – 100 times an unknown – 1,000 times an unknown – what’s the difference?

Presenting misleading information to medically naive people and proclaiming Eureka! is misleading. We are not finding anything. We are presenting a spectacle, although not as much of one as Archimedes did running naked through the streets (assuming the legend to be true).

The second assumption is that the problem is “out there” in patients, not “in here” in physicians. This might be viewed as a form of the psychologist’s fallacy,³ the idea that although patients’ preferences might suffer from irrationality, ignorance, or irrelevant considerations, ours (physicians’) do not.^[2]

An excellent point that should be extended to researchers.

How much of the problem is in the study design?

What are we measuring?

If the purpose of controlled trials is to examine things objectively, why use a study that seems to ~~depend~~ insist on subjectivity?

I will write more about Dr. Wears editorial later, because it covers a lot of important material on making decisions.

Footnotes:

^[1] Patient perceptions of computed tomographic imaging and their understanding of radiation risk and exposure.
Baumann BM, Chen EH, Mills AM, Glaspey L, Thompson NM, Jones MK, Farner MC.
Ann Emerg Med. 2011 Jul;58(1):1-7.e2. Epub 2010 Dec 13.
PMID: 21146900 [PubMed - indexed for MEDLINE]

Free Full Text from Annals of Emergency Medicine with links to Free Full Text PDF Download

^[2] Risk, radiation, and rationality.
Wears RL.
Ann Emerg Med. 2011 Jul;58(1):9-11. Epub 2011 Apr 2. No abstract available.
PMID: 21459481 [PubMed - indexed for MEDLINE]

^[3] What patients understand about radiation exposure from CTs
David H. Newman, MD, and Ashley Shreve (spelling?)
Annals of Emergency Medicine podcast page
2011 July
Free Podcast in MP3 format

Annals of Emergency Medicine provides a podcast that summarizes the articles published that month. This is an excellent resource. The full July 2011 podcast is – Free Full Podcast in MP3 format. The full archives of Annals of Emergency Medicine podcasts is – Page with links to podcast segments and full month podcasts.

Filed Under: Assessment, Critical Judgment, Education, Heresy, Medical Mythology, Research, Risk Management, Rogue Medic

Croup/Epiglottitis

12/19/2010 by Adam Thompson, EMT-P 6 Comments

There is nothing scarier than a sick kid. I am becoming more and more obsessed with educating myself on pediatric emergencies. This is because of that fear, and the fact that I find it is one of those areas that I am less versed in. This post is aimed at identifying and treating the child who presents with an upper respiratory infection (URI) like croup or epiglottitis. These kids sound sick, look sick, and may get even sicker.

As always, aggressive airway management may be indicated if the child appears to have impending respiratory failure. Signs of this include severe hypoxia, bradycardia, and decreasing respiratory effort.

If the patient doesn’t present with imminent signs like those mentioned above, it is pertinent to obtain a good medical history.

History:

Has the child ever had a URI in the past?

- If so, did he/she present like this?

Was the onset acute or gradual?

- Epiglottits generally presents with an acute onset.

Has the child been sick, and is he up to date with vaccinations?

- Most cases of epiglottitis are caused by haemophilus influenza or H.flu

Has the child ever been intubated?

- This helps identify whether you will need to be aggressive, and a recent intubation could be the cause of hoarseness.

Epiglittits is actually inflammation of the epiglottis–you know, that flap that covers the trachea during swallowing? If this becomes inflamed, it swells, and that swelling could cause a partial or even a complete occlusion of the trachea, thus compromising ventilation.

- Usually febrile, without cough

- Patient may be in tripod position

- Drooling present

Treatment

- Immediate intubation may be indicated (may be very difficult!)

- Epinephrine may be administered in extremis

Croup or laryngotracheobronchitis is also an upper respiratory infection that may be mild, moderate, or severe. It tends to be worse at night, and is most commonly identified by the classic “seal-bark cough”.

- Inspiratory stridor & “barking cough”

- Often preceded by flu

- More likely if they have had croup before

Treatment

- Oxygen therapy

- Nebulized Saline

- If severely hypoxic, racemic epinephrine may be indicated.

- It is often taught to take these children outside, into colder air

So who is in extremis?

- The severely hypoxic child: Cyanosis, bradycardia

- Intercostal retractions with decreasing stridor is an ominous sign of impending respiratory failure

- Decreasing mental status means decreasing respiratory drive. TREAT AGGRESSIVELY

****

Check out Justin, The Happy Medic, Schorr’s last run-in with croup in THIS POST.

Filed Under: Airway, Airway Management, Education, Medical Emergencies, Pediatrics

Prehospital Drug Calculations

11/14/2010 by Adam Thompson, EMT-P Leave a Comment

The following is a link to a tutorial that I have put together to do drug calculations.

Drug math

View more documents from Adam Thompson.

Filed Under: Education, Pharmacology

Research: Termination of Resuscitation

11/11/2010 by Adam Thompson, EMT-P Leave a Comment

Check this out…

Assessment of termination of trauma resuscitation guidelines: are children small adults? [Link]

Capizzani AR, Drongowski R, Ehrlich PF.

Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children’s Hospital, Ann Arbor, MI 48109, USA.

Abstract

BACKGROUND: Guidelines for termination of resuscitation in prehospital traumatic cardiopulmonary arrest (TCPA) have recently been published for adults. Clinical criteria for termination of care include absent pulse, unorganized electrocardiogram (ECG), fixed pupils (all at the scene), and cardiopulmonary resuscitation (CPR) greater than 15 minutes. The goal of this study was to evaluate these guidelines in a pediatric trauma population.

METHODS: Pediatric trauma patients with documented arrest were included in the study. Data assessed were duration of CPR, ECG rhythm, pulse assessment, pupil response, transport times, and standard injury criteria (eg, mechanism of injury). Survivors were compared to nonsurvivors using descriptive statistics, chi(2), and Pearson correlation.

RESULTS: Between 2000 and 2009, 30 patients were identified as having had a TCPA. Of the 30 with a prehospital TCPA, there were 9 females and 21 males (0.2-18 years old). The average (SD) injury severity score was 35.4 (20.6). Twenty-four patients (80%) did not survive. Severe traumatic brain injury was associated with nonsurvivors in 78%. One-way analysis of variances demonstrated that CPR greater than 15 minutes (P = .011) and fixed pupils (P = .022) were significant variables to distinguish between survivors and nonsurvivors, whereas ECG rhythm (P = .34) and absent pulse (P = .056) did not, 42 +/- 28 minutes for nonsurvivors and 7 +/- 3 minutes for survivors.

CONCLUSION: Criteria for termination of resuscitation correctly predicted 100% of those who died when all the criteria were met. More importantly, no survivors would have had resuscitation stopped. Duration of CPR seems to be a strong predictor of mortality in this study.

The Terminator

Whether your patient is an adult or a child, transporting them without a pulse is senseless. ACLS treatment for the pulseless patient in the hospital is not much different than in the field. How good will your chest compressions be during transport? We know that good chest compressions is the single most influential factor in cardiac arrest care. The best chance that a dying patient has to regain a pulse is on scene–almost always. It is very difficult to not work a SIDS baby. SIDS has a 100% rate of resulting in death, otherwise it would be an ALTE–apparent life threatening event. I could never judge a colleague for not feeling comfortable with calling a kid on scene. Just keep in mind that you are not doing them any favors by transporting them without a pulse.

Filed Under: Cardiac Arrest, Education, Research

Differential Diagnosis: Headache

11/04/2010 by Adam Thompson, EMT-P Leave a Comment

Differential Diagnosis: Headaches

By Adam Thompson, EMT-P

Headaches account for a large volume of EMS responses. Most are benign, but a few could be an early symptom of a life-threatening cause. It may be beneficial to differentiate between the presentations. A good history is by far the most useful tool that any clinician has in determining a headache’s malignancy.

Common types of headaches:

Tension-type headache
Migraine headaches
Cluster headaches

Tension-type the most common type of headache, and yet its causes aren’t well understood. A tension headache is generally a diffuse, mild to moderate pain that many people describe as feeling as if there’s a tight band around their head.It may feel as though muscle contractions are responsible for your head pain, but experts don’t think that’s the cause, which is why this type of headache is generally referred to as a tension-type headache. (from MayoClinic)

Migraine a common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head. Some people who get migraines have warning symptoms, called an aura, before the actual headache begins. An aura is a group of symptoms, usually vision disturbances, that serve as a warning sign that a bad headache is coming. Most people, however, do not have such warning signs. (from Google Health)

Cluster The term “cluster headache” refers to a type of headache that recurs over a period of time. People who have cluster headaches experience an episode one to three times per day during a period of time (the cluster period), which may last from two weeks to three months. The headaches may disappear completely (go into “remission”) for months or years, only to recur. A cluster headache typically awakens a person from sleep one to two hours after going to bed. These nocturnal attacks can be more severe than the daytime attacks. Attacks appear to be linked to the circadian rhythm (or “biological” clock). Most people with cluster headaches will develop cluster periods at the same time each year — either in the spring or fall or the winter or summer. (from WebMD)

Symptom	A Tension	B Migraine
Intensity, Duration and Quality of Pain
Mild or moderate pain intensity	√	√
Severe		√
Duration of headache 30 min – 7 days 4-72 hours	√	√
Intense pounding, throbbing and/or debilitating		√
Distracting but not debilitating	√
Steady ache	√
Location of Pain
One side of head		√
Both sides of head	√	√
Associated Symptoms
Nausea/vomiting		√
Sensitivity to light and/or sounds		√
Aura before onset of headache such as visual symptoms		√

Table 1

Comparing benign headaches

90% of all headaches are benign. Tension headaches are muscle-contraction headaches, and migraine or cluster headaches are vascular headaches. Below is a table of accompanying symptoms with each type.

CHARACTERISTICS	MUSCLE-CONTRACTION HEADACHES	VASCULAR HEADACHES
Incidence	Most common type, accounting for 80% of all headaches	More common in women and those with a family history of migraines Onset after puberty
Precipitating factors	Stress, anxiety, tension, improper posture, and body alignment Prolonged muscle contraction without structural damage Eye, ear, and paranasal sinus disorders that produce reflex muscle contractions	Hormone fluctuations Alcohol Emotional upset Too little or too much sleep Foods, such as chocolate, cheese, monosodium glutamate, and cured meats; caffeine withdrawal
Intensity and duration	Produce an aching tightness or a band of pain around the head, especially in the neck and in occipital and temporal areas Occur frequently and usually last for several hours	Weather changes such as shifts in barometric pressure May begin with an awareness of an impending migraine or a 5- to 15-minute prodrome of neurologic deficits, such as vision disturbances, dizziness, unsteady gait, or tingling of the face, lips, or hands Produce severe, constant, throbbing pain that’s typically unilateral and may be incapacitating Last for 4 to 6 hours
Associated signs and symptoms	Tense neck and facial muscles	Anorexia, nausea, and vomiting Occasionally, photophobia, sensitivity to loud noises, weakness, and fatigue Depending on the type (cluster headache or classic, common, or hemiplegic migraine), possibly chills, depression, eye pain, ptosis, tearing, rhinorrhea, diaphoresis, and facial flushing

Image 2 – Click the image above to enlarge

Quickie Definitions of Headaches You Never Knew Existed

Weight-lifters: Just like you’d think, this is a headache that occurs after a strenuous weight-lifting regimen.

Histamine: A headache caused by histamine overload, from a source such a histamine injection or certain wines.

Coital: A headache that occurs suddenly during sex or after orgasm. As if couples nowadays didn’t have enough issues – thankfully, these are very rare and actually occur more often in men.

Analgesic-rebound: That medication you’ve been taking for your headaches could now be the underlying cause of new headaches. Removal of the medication is required.

Hypnic: This is an oddball headache that awakens people from sleep. Clusters can do this as well but the pain of hypnic headaches are not as intense and are not localized around the eye.

High Priority Symptoms

The worst headache someone has ever had
Headache with stiff neck (especially with a high grade fever)
A headache associated with loss of consciousness or altered mental status.
A headache accompanied by severe eye or ear pain.
A headache that occurs in an individual who has experienced recent head trauma.
A headache accompanied by sudden, disabling pain or convulsions.
Headache with parasthesia or paralysis

References:

American Headache Society – Table 1

Filed Under: Clinical Discussion, Education, Neurology

Trauma Triad of Death

11/03/2010 by Adam Thompson, EMT-P 2 Comments

I was recently asked why we work so hard to keep trauma patients warm.

My answer is The Trauma Triad of Death.

From Wikipedia:

The Trauma triad of death is a medical term describing the combination of hypothermia, acidosis and coagulopathy. This combination is commonly seen in patients who have sustained severe traumatic injuries and results in a significant rise in the mortality rate (see Lewis (2000)).

The three conditions share a complex relationship; each factor can compound the others, resulting in high mortality if the cycle continues uninterrupted.

Severe hemorrhage in trauma diminishes oxygen delivery, causing the patient’s body temperature to drop (hypothermia). This in turn can halt the coagulation cascade, preventing blood from clotting (coagulopathy).

In the absence of blood-bound oxygen and nutrients (hypoperfusion), the body’s cells burn glucose for energy (lactic acidosis), which in turn increases the blood’s acidity (metabolic acidosis). Such an increase in acidity can reduce the efficiency of the heart muscles (myocardial performance), further reducing the oxygen delivery and hence triggering a deadly cycle.

Filed Under: Education, Trauma

Respiratory System

10/17/2010 by Adam Thompson, EMT-P Leave a Comment

RESPIRATORY SYSTEM

at a glance…

Upper – Nose & Pharynx

Lower – Larynx, Trachea, Bronchi, Bronchioles, Lungs

The entire respiratory system is separated into two parts, the conductive, and the respiratory parts. The conductive is everything that is connected from the nose to the terminal bronchioles. Air is moved throughout the conductive parts, but O2 and CO2 are not exchanged.

This lack of gas exchange gives rise to the name dead space. The dead space of the lungs is approximately 150 ml.

Conductive – Nose, Pharynx, Larynx, Trachea, Bronchi, Terminal Bronchioles

Respiratory – Respiratory Bronchioles, Alveolar Duct, Alveolar Sac

The tissue that the respiratory system is comprised of becomes less complex, or simpler, the closer it gets to the alveoli. The alveolar wall has a single layer of simple tissue to allow for gas exchange. Some of this is thought to occur in the thin walls of the respiratory bronchioles as well.

Ø The right primary bronchus is shorter, wider, and straighter than the left. Since it is more inline with the trachea, endotracheal tubes, that are advanced too far, commonly end up in the right primary bronchus.

Ø The right lung has three lobes, and the left has two.

The Lungs

The serous lining of the lungs is called the pleura. This reduces friction during the repetitive motion from breathing.

- Visceral Pleura is in direct contact with lung

- Parietal Pleura surrounds the visceral pleura with a space in between.

Pathologies

Pleurisy – Infection with the pleura – treated with antibiotics

Pneumothorax – Air within the pleura – treated with surgery/decompression

Pneumonia – Infection of the lung tissue – treated with antibiotics

Pleural Effusion – Fluid within the pleura – treated with thoracentesis

Pulmonary Ventilation

Pulmonary ventilation is simply the movement of air in and out of the lungs. Also known as inspiration/expiration or inhalation/exhalation.

External Intercostals – Normally used for ventilation. Increases volume of the chest.

Factors that effect ventilation:

- The amount of alveolar fluid vs. the amount of surfactant.

- Compliance of lung – ease of expansion

- Airway resistance – the lumen of the bronchioles

* When there is an increase in ventilatory effort, accessory muscles are used in an effort to increase the volume of the chest.

Accessory Muscles

- Sternocleidomastoid – Pulls on the sternum

- Scalene – Pulls on ribs one and two

- Pectoris Minor – Pulls on ribs three, four, and five

Lung Volumes

Total Lung Capacity (TLC)	6.0 L (Male) 4.7 L (Female)	The maximum volume of air that can be in the lungs at the end of maximal inspiration.
Vital Capacity (VC)	4.6 L (Male) 3.6 L (Female)	The amount of air that can be inspired after maximal inspiration
Functional Residual Capacity (FRC)	2.4 L (Male) 1.9 L (Female)	The amount of air left in the lungs after a tidal breath out.
Tidal Volume (TV)	500 ml (Male) 390 ml (Female)	The amount of air moved in and out during normal respiration.
Anatomical Dead Space	150 ml (Male) 120 ml (Female)	The volume of the conductive airways.

Filed Under: Education, Respiratory

Use of Hypertonic Fluids in Traumatic Brain Injury

10/07/2010 by 510medic 3 Comments

This post is also published at my blog:

An interesting abstract came across Google Reader just now about the prehospital use of hypertonic fluids in patients with traumatic brain injury. Before discussing the results themselves, I’d like to point out one aspect of particular note: The study authors looked at 6 month outcomes. Compare and contrast this to most of the available cardiac arrest research which is only looking at return of spontaneous circulation (ROSC). The authors in this study are clearly thinking further down the road. ROSC in and of itself does not equate to improved patient outcomes. Perhaps we could start looking at resuscitation outcomes 6 month after arrest when publishing new cardiac arrest guidelines, just a thought.

THE SCIENCE
Time for a little review. If you remember, there are three types of solutions used in medicine: Hypotonic, hypertonic and isotonic. Isotonic solutions like 0.9% “normal” saline have the same concentration of solutes (stuff dissolved in them) as the body. Hypotonic solutions have a lower concentration of solute and hypertonic solutions have a greater concentration. What does this mean in the body? Water (the solvent) tends to move to areas which have a higher concentration of solute (solids). This tendency of water to ”even out” concentration creates a force called osmotic pressure. When blood cells (as an example) are exposed to solutions with different concentrations of solute the following results are typical:

When the cells are placed in an isotonic solution, nothing changes. The flow of water into the cells is matched by the flow of water out of the cells. When the cells are placed in the hypotonic solution, water flows into the cells to offset the higher concentration inside, causing the cell to swell and break open. And finally, when the cells are placed in the hypertonic solution, water flows out of the cells in an attempt to normalize the solution outside of the cell.

APPLICATION IN MEDICINE
So what does this all mean to medicine? We carry isotonic fluids on our vehicles and routinely use them for fluid resuscitation because we want to increase blood volume without placing unneeded stress on the body’s cells. This study looked at giving a single 250cc bolus of a hypertonic solution to patient with traumatic brain injury (TBI). One of the effects of TBI is swelling of the brain or cerebral edema. The idea of giving a hypertonic solution to a TBI patient makes sense from a chemistry sense; it will keep the fluid from being taken up by the brain tissue because osmotic pressure is keeping the fluid in the blood stream. Basically a hypertonic solution has a tendency to pull water into the blood stream rather than allowing water to leave the blood stream into surrounding tissues. Giving a hypotonic solution to a TBI patient would likely increase cerebral edema.

THE STUDY
The authors of the study planned to enroll 2122 subjects who would be given a 250cc bolus of 7.5%saline/6%dextran, 7.5%saline or 0.9% “normal” saline by prehospital providers. The study was terminated after 1331 patients when the study had met “predefined futility criteria”. Not having access to the full article, I’m unaware of what those criteria were. The results, however, show that there was not a statistically significant change in patient outcomes with regard to which fluid bolus was given.

CONCLUSION
So there you have it. Prehospital administration of hypertonic fluids does not change six month outcomes in TBI patients. Hopefully the chemistry review was worthwhile. If there’s any interest in continuing these types of reviews, let me know and I’d be happy to make it a regular feature. I also think that the study design, and focusing on longer term outcomes is a beneficial approach to prehospital research. At the end of the day, getting pulses back on a cardiac arrest patient doesn’t matter much if they don’t leave the hospital and go on to live a healthy life just like an improvement for a period of hours or days for TBI patient doesn’t mean much if their long term outcome doesn’t improve. What do you think? Are there any other areas of EMS treatment which could benefit from the study of long term outcomes?

Filed Under: Cardiac Arrest, Chemestry, Clinical Discussion, Education

Learn It: Angioedema

09/05/2010 by Adam Thompson, EMT-P 5 Comments

Angioedema

Sometimes referred to as Quinke’s Edema, angioedema is that swelling we see that is most apparent around the mucosal areas of the face. Consider Hives as swelling on the surface of the skin, and angioedema as swelling beneath the skin.

The most common cause of this type of swelling without the presence of Hives is hypersensitivity to ACE inhibitors.

ACE = Angiotensin converting enzyme. This converts angiotensin one into angiotensin two.

ACE inhibitors block ACE.

Bradykinin is a peptide that has a role with all forms of angioedema. It is a potent vasodilator that increases permeability and allows the accumulation of fluid within the interstitial space.

ACE is one of the main ways that bradykinin is degraded. So when we inhibit the production of ACE, we are then inhibiting the degradation of bradykinin. We then have this run away peptide and subsequent swelling.

Many patients that suddenly present with severe angioedema have been taking ACE inhibitors, such as lisinopril, for a long period of time. They may have never had any issues before, but out of no where have this severe reaction. This type of reaction is most common in the African-American population, but may occur in anyone.

There are other types of angioedema, including the traditional allergic reaction. Those are more well known and prepared for.

Treatment

As you can see from the pictures above, swelling may be within the oropharynx. This can cause an airway obstruction, and aggressive airway management should be advocated.

This patients may be obtunded and snoring as you enter the scene. They have been confused for diabetics, or acute coronary syndrome patients due to their initial impression.

It is common for these patients to undergo cricothyrotomy due to complete glottic obstruction. Moving quickly is imperative to prevent severe hypoxia and cardiorespiratory arrest.

The usual drugs used for anaphylactic reactions are indicated.

- Epinephrine to reduce the vasodilation.

- Crticosteroids & antihistamines.

So the next time you run on a patient that is presenting with swelling in the absence of hives, think angioedema, and act fast!

Filed Under: Clinical Discussion, Education, Pharmacology, Toxicology

EMS Educast Episode 67

08/26/2010 by Adam Thompson, EMT-P Leave a Comment

Greg Friese from EMS Educast invited me to guest cohost on episode 67. On the show was David Page from the St. Paul EMS Academy.

Make sure to go check it out.

Thanks for stopping by,

Adam Thompson, EMT-P

Filed Under: Education, EMS EduCast, General Discussion

Patient Perceptions of Computed Tomographic Imaging and Their Understanding of Radiation Risk and Exposure – Part IV

Croup/Epiglottitis

Prehospital Drug Calculations

Research: Termination of Resuscitation

Assessment of termination of trauma resuscitation guidelines: are children small adults? [Link]

Abstract

Differential Diagnosis: Headache

Trauma Triad of Death

Respiratory System

Total Lung Capacity (TLC)

6.0 L (Male)

4.7 L (Female)

The maximum volume of air that can be in the lungs at the end of maximal inspiration.

Vital Capacity (VC)

4.6 L (Male)

3.6 L (Female)

The amount of air that can be inspired after maximal inspiration

Functional Residual Capacity (FRC)

2.4 L (Male)

1.9 L (Female)

The amount of air left in the lungs after a tidal breath out.

Tidal Volume (TV)

500 ml (Male)

390 ml (Female)

The amount of air moved in and out during normal respiration.

Anatomical Dead Space

150 ml (Male)

120 ml (Female)

The volume of the conductive airways.

Use of Hypertonic Fluids in Traumatic Brain Injury

Learn It: Angioedema

EMS Educast Episode 67

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Assessment of termination of trauma resuscitation guidelines: are children small adults? [Link]

Abstract

Total Lung Capacity (TLC)

6.0 L (Male)

4.7 L (Female)

The maximum volume of air that can be in the lungs at the end of maximal inspiration.

Vital Capacity (VC)

4.6 L (Male)

3.6 L (Female)

The amount of air that can be inspired after maximal inspiration

Functional Residual Capacity (FRC)

2.4 L (Male)

1.9 L (Female)

The amount of air left in the lungs after a tidal breath out.

Tidal Volume (TV)

500 ml (Male)

390 ml (Female)

The amount of air moved in and out during normal respiration.

Anatomical Dead Space

150 ml (Male)

120 ml (Female)

The volume of the conductive airways.

Sponsor

Recent Comments

Archives

Categories

Blogroll