Commonly Used EMS Abbreviations
Commonly Used EMS Abbreviations
| ABD | Abdomen |
| ALOC | Altered Level Of Consciousness |
| ALS | Advanced Life Support |
| AMA | Against Medical Advice |
| AMR | American Medical Response |
| BLS | Basic Life Support |
| BP | Blood Pressure |
| BSI | Body Substance Isolation |
| BVM | Bag Valve Mask |
| CC | Chief Complaint (or unit of volume) |
| C/O | Complains Of |
| CVA | Cerebrovascular Accident (stroke) |
| DNR | Do Not Resuscitate |
| DOA | Dead On Arrival |
| DOB | Date Of Birth |
| ECG or EKG | Electrocardiogram |
| EMS | Emergency Medical Services |
| EMT | Emergency Medical Technician |
| ER | Emergency Room |
| EXTS | Extremities |
| Fx | Fracture |
| H/A | Headache |
| HR | Heart Rate |
| IVT | Involuntary Treatment/Transport |
| LAC | Laceration |
| LOC | Level Of Consciousness / Loss Of Consciousness |
| MI | Myocardial Infarction (heart attack) |
| MVA | Motor Vehicle Accident |
| NKDA | No Known Drug Allergies |
| NKMA | No Known Medical Allergies |
| N/V | Nausea/Vomiting |
| OD | Overdose |
| OTC | Over The Counter (medication) |
| O2 | Oxygen |
| PMHx | Past Medical History |
| Pt | Patient |
| Px | Pain |
| RR | Respiratory Rate |
| SOAP | Subjective Objective Assessment Plan (report format) |
| SOB | Shortness Of Breath |
| STHB | Said To Have Been |
| STHH | Said To Have Had |
| Sz | Seizure |
| UNK | Unknown |
| Y/O | Year-Old |
Research EMS As A Career Choice
In this article, I will discuss for those who are interested in or seeking more information about getting into the field of EMS. EMS can be a fun and exciting carrer for some and on the opposite side, a living nightmare for others.
Since I am an old school medic, I have seen many come and go in this field of work. Most always is because people do not research EMS as a career before jumping into classes. In my opinion, one should be sure to research EMS as a career before spending the time and money it takes to get into this career.
Back in the days of the television show 911, many thought by watching this show EMS would be a cool way to make a living. Unfortunately, many did not do their research before taking the first responder or EMT class. Once they actually got into a good trauma call or perhaps a saddening pediatric call, they found out what the real world of EMS is like. Like I already stated, they did not research the EMS life before they jumped in head first. “First mistake, research EMS before you choose this job as a career.”
If you are considering a career in EMS, research the job first, this may save you from something that just is not you. EMS takes a special personality as far as I am concerned. Start your research below before you decide getting into EMS.
- Ask Yourself These Questions First:
- Can I take working 24-hours shifts with less than adequate sleep?
- Can I think on the spot when time is critical to save a life?
- Can I live with myself if my patient dies? (and many do)
- Can I be committed to my job? This is not a 9 to 5 factory job!
- Am I willing to train on a continual basis and keep my skills top notch?
- Am I a good people person?
- Can I work under highly stressful situations with virtually no supervision?
- Can I follow policies and procedures?
- Can I take constructive Criticism?
- Can I seperate my job from my family life and balance both? (long and stressful hours for the pay)
- Am I going to do this for the money? (if you answer yes, stop now, this is not a career for you)
- Am I going to pick this career because I love to help people? (if you answer no, stop now, this is not a career for you)
Preparing Yourself for EMS Training
The above are a just a few of the questions you should ask yourself. If you answered no to the above questions, you may wish to seek out another career. EMS is a highly stressful and very demanding job. If you’re not ready to give it your all, this is not a good career choice.
When seeking EMS as a career, you should evaluate whether you have what it takes (see a few sample questions to ask yourself above). EMS training is intense and this career-path can potentially put you on the frontline of gruesome accidents, dangerous situations, and extremely high levels of stress. EMS jobs are physically and emotionally demanding, but can also be very exciting and rewarding if you have what it takes for this type of work. EMS is what you make of it, a good positive attitude is important for this career choice.
The recent popularity of realistic medical dramas on television has served the dual purpose of educating the public while increasing their awareness of EMS related careers. Over glamorized in my opinion, these television shows provide some insight into the type of person you need to be to succeed with EMS as a career. What these television shows usually fail to reveal is the amount of training and knowledge that EMS professionals must obtain.
Any person wishing to pursue EMS as a career should be physically and emotionally fit. You should have above average communication skills and a desire to help people. You should be a master at making instant and correct decisions under highly stessful situations. This will come with time.
You should be aware that most EMS programs require a high school diploma (or GED). Some EMS programs may also require students to be at least 18 or 21 years of age. Many require a criminal background check and drug-screening test. Requirements differ by program and by the level of certification you are seeking. As an example, EMS programs for those seeking certification as a paramedic often require one to have already obtained EMT-Basic and CPR certification. Most EMS programs if you are seeking the paramedic certification also require at some field experience as an EMT.
Those seeking to pursue EMS training should be aware of what your state requires prior to taking the different certification tests. You can find this and more information by following either of the links listed below.
National Registry of Emergency Medical Technicians
National Association of Emergency Medical Technicians
Training Levels
As I stated above, you may wish to consider starting out at the lower level and advance from there. I’ll list a brief summary of the various levels of EMS training below. Also visit the two links I posted above for even more information on the various certification levels. Please Note: All of the certification levels I have listed below are according to the National Registry of Emergency Medical Technicians
- Various Certification Levels (varies from state to state)
- First Responder
- EMT
- EMT-I
- EMT-D
- Paramedic
First Responder
A certified first responder is a person who has completed about forty to sixty hours of training in providing prehospital care for medical emergencies. They have more skill than someone who is trained in first aid but they are not emergency medical technicians. A short overview of the type of training you will receive is noted below. I will not go into the modules of training, it would make this article much more lengthy so I’ll just list a few of the modules. Do your research, that’s what this article is all about is teaching to you research EMS as a career.
- Oxygen Therapy
- Childbirth
- Triage and Multiple Trauma
- Airway Management
- Moving Patients
- Assisting Patients in using medications such as inhalers, epinephirine auto-injectors, nitroglycerin pills, etc.
- Transportation of Patients
- Assisting medical professionals
EMT and Paramedics
Formal training and certification is needed to become an EMT or paramedic. A high school diploma is typically required to enter a formal training program. Some programs offer an associate degree along with the formal EMT training. All 50 states have a certification procedure. In most states and the District of Columbia, registration with the National Registry of EMTs (NREMT) is required at some or all levels of certification. Other states administer their own certification examination or provide the option of taking the NREMT examination. To maintain certification, EMTs and paramedics must reregister, usually every 2 years. In order to reregister, an individual must be working as an EMT or paramedic and meet a continuing education requirement.
You can advance your EMS career at different certification levels. I suggest this as you can feel out this line of work and also make a few dollars while you progress up the ladder if you will.
EMT-Basic (EMT) coursework typically emphasizes emergency skills, such as managing respiratory, trauma, and cardiac emergencies, and patient assessment. Formal courses are often combined with time in an emergency room or ambulance. The program also provides instruction and practice in dealing with bleeding, fractures, airway obstruction, cardiac arrest, and emergency childbirth. Students learn how to use and maintain common emergency equipment, such as backboards, suction devices, splints, oxygen delivery systems, and stretchers. Graduates of approved EMT basic training programs who pass a written and practical examination administered by the State certifying agency or the NREMT earn the title “Registered EMT-Basic.” The course also is a prerequisite for EMT-Intermediate and EMT-Paramedic training.
EMT-Intermediate (EMT-I) training requirements vary from state to state. Applicants can opt to receive training in EMT-Shock Trauma, wherein the caregiver learns to start intravenous fluids and give certain medications, or in EMT-Cardiac, which includes learning heart rhythms and administering advanced medications. Training commonly includes 35 to 55 hours of additional instruction beyond EMT-Basic coursework, and covers patient assessment as well as the use of advanced airway devices and intravenous fluids. Prerequisites for taking the EMT-Intermediate examination include registration as an EMT-Basic, required classroom work, and a specified amount of clinical experience.
The most advanced level of training for this occupation is EMT-Paramedic (EMT-P). At this level, the caregiver receives additional training in body function and learns more advanced skills. The Technology program usually lasts up to 2 years and results in an associate degree in applied science. Such education prepares the graduate to take the NREMT examination and become certified as an EMT-Paramedic. Extensive related coursework and clinical and field experience is required. Because of the longer training requirement, almost all EMT-Paramedics are in paid positions, rather than being volunteers. Refresher courses and continuing education are available for EMTs and paramedics at all levels.
EMTs and paramedics should be emotionally stable, have good dexterity, agility, and physical coordination, and be able to lift and carry heavy loads. They also need good eyesight (corrective lenses may be used) with accurate color vision.
Advancement beyond the EMT-Paramedic level usually means leaving fieldwork. An EMT-Paramedic can become a supervisor, operations manager, administrative director, or executive director of emergency services. Some EMTs and paramedics become instructors, dispatchers, or physician assistants, while others move into sales or marketing of emergency medical equipment. A number of people become EMTs and paramedics to assess their interest in health care, and then decide to return to school and become registered nurses, physicians, or other health workers.
Summary
This article was intented for those that are considering a career in EMS. Advancement in the field of EMS is depending on how far you wish to go. As an example, I started out as an EMT Basic. I advanced to EMT Intermediate and then to the paramedic level. I was the EMS director for more than one ground service and also worked as a flight medic and an EMS educator. You can advance your career a very long way in a relatively short time frame with dedication and hard work.
As you have read throughout this article, please take the time to research EMS before you consider it as a career. EMS is not for everyone. You as an EMS professional will deal with trauma, medical health conditions, death, long hours of work, exhausting stress and much more. Research it by using the means I have suggested throughout this article. EMS can be a very rewarding career for those who have what it takes for this line of work.
Phillip Sampson
EMS Prime
http://emsprime.com
Sources:
NAEMT
US Department of Labor Occupational Outlook Handbook
My Many Years As A Paramedic, EMS Director, Flight Med and EMS Educator
EMS Education Research
Insufficient academic commitment to EMS research has also been identified as an important impediment to progress in the development of a body of scientific knowledge necessary for the support of EMS practices. Those educational institutions that chose to offer EMS training programs must integrate research into the process of developing entry-level EMS professionals. Successful integration requires using scientific evidence as the basis for education and fulfilling the traditional academic role of contributing to the evidence base.
The amount of education about research principles currently provided to EMS professionals is limited at best. Education about EMS research is virtually non-existent in most EMT-Basic programs. Although research methodology is part of the National Standard Curriculum for EMT-Paramedics, most EMS educational institutions provide little time for it in their training programs. Some degree granting paramedic education programs do include a research component in their curricula, and a few require students to complete a research project prior to completion of the program.
Educational programs are not teaching research principles because many EMS educators are not knowledgeable about the process of research and therefore are unable to teach others. There are few resources available to assist EMS educators in teaching this material. Two national efforts aimed at improving the research education of prehospital providers are the EMS research workshops offered by National Association of EMS Physicians and the Prehospital Care Research Forum. These entry level one or two day courses are offered at national EMS conferences or by themselves for interested sponsoring organizations.
Education programs for EMS providers must keep pace with the evolving basis for clinical practice. The curricula developed by the U.S. Department of Transportation National Highway Traffic Safety Administration which provide the basis for education of first responders, EMT-Basics, EMT-Intermediates, and EMT-Paramedics should be revised to include improved objectives regarding research principles. These objectives must emphasize the need to teach the importance of research as well as the principles involved in conducting EMS-related research, and should become a part of the routine education of EMS field providers and managers. The objective is not to develop every EMS provider into an EMS researcher but to help all personnel understand the need for research to enable them to be supportive.1 These educational efforts should provide a working understanding of the research process and not simply encourage memorization of methodological criteria and statistical terminology.
Exposure to the scientific literature should also be an essential component of EMS education programs. The curricula should include an introduction to the critical appraisal of scientific articles and methods for asking and answering clinical questions. The curricula should also introduce the student to the methods that practicing health care professionals use to update their knowledge and practice patterns, including routine reading of scientific journals.
EMS education systems must be compatible with an academically based approach to EMS education that parallels the education process of other allied health professions. These concepts have been addressed in the EMS Education Agenda. Academic institutions that sponsor EMS education programs must make a commitment to supporting EMS research.
The process of teaching a novice EMS professional, including skill and knowledge acquisition and retention, has not been adequately studied. EMS educators in traditional academic settings are uniquely positioned to evaluate both the content of EMS curricula adequacy and the effectiveness of teaching techniques.
Reference: NHTSA
The Golden Hour
The Golden Hour
EMS pprofessionals are trained leanring about the “Golden Hour.” The golden hour is the first sixty minutes after the occurrence of multi-system trauma. It is believed that the patient’s chances of survival are greatest if they receive definitive care within the first 60-minutes after a severe injury. Recent scrutiny has questioned the validity of the “golden hour” as a rigidly defined timeframe, although its core principle of rapid intervention in trauma cases remains universally accepted. This is no exception with EMS professionals, most EMS professionals understand and agree with the Golden Hour principal.
General Concept
In cases of severe trauma, especially internal bleeding, surgery needs to be perfomred as quickly as possible. Complications such as shock may occur if the patient is not managed appropriately and expeditiously. It is therefore necessary to transport victims as fast as possible to specialists who are most often found at a hospital trauma center. Some injuries can cause the trauma patient to decompensate extremely rapidly. The lag time between injury and treatment should ideally be kept to a bare minimum; over time, this lag time has been further clarified to a now-standard time frame of no more than 60 minutes, after which time the survival rate for traumatic patients is alleged to fall off dramatically. Hence The Golden Hour.
Origins of the Term
The late Dr. R Adams Cowley is credited with promoting the Golden Hour concept first as a military surgeon and later as head of the University of Maryland Shock Trauma Center.
The concept of the “Golden Hour” may have been derived from French military World War I data. The R Adams Cowley Shock Trauma Center section of the University of Maryland Medical Center’s website quotes Dr. R Adams Cowley as saying, “There is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later — but something has happened in your body that is irreparable.”
Controversy About The Golden Hour
While most medical professionals agree that delays in definitive care are undesirable, recent peer reviewed literature casts doubt on the validity of the ‘golden hour’ as it appears to lack a scientific basis. Dr. Bryan Bledsoe, an outspoken critic of the golden hour and other EMS “myths” like Critical Incident Stress Management, has indicated that the peer reviewed medical literature does not demonstrate any “magical time” for saving critical patients.
Proven Golden Hour Medical Conditions
Two emergency medical conditions have well-documented time-critical treatment considerations: stroke (CVA) and myocardial infarction (MI). In the case of the CVA patient, there is a window of three hours within which the benefit of clot-busting drugs outweighs the risk of major bleeding. In the case of a MI patient, rapid stabilization of fatal arrhythmias can prevent sudden cardiac death. In addition, there is a direct relationship between time-to-treatment and the success of reperfusion (restoration of blood flow to the heart), including a time dependent reduction in the mortality.
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Shock
Shock is a serious, life-threatening medical emergency. Shock must be noted and treated by EMS professionals immediately. Shock is where insufficient blood flow reaches the body tissues. (also know in the EMS setting as inadequate tissue perfusion).
As the bodies blood carries oxygen and nutrients throughout the body, reduced flow hinders the delivery of these components to the tissues. The process of blood entering the tissues is called perfusion. So when the components of the blood are not entering the bodies tissues adequately, the body will go through the state of inadequate tissue perfusion there by leading to shock. Shock is a true life threatening condition so therefor must be treated immediately by EMS professionals.
We have already determined that shock is a life-threatening medical emergency. Shock is also one of the most common causes of death for critically-ill people. Shock can have a variety of effects, all with similar outcomes, but all relate to a problem with the body’s circulatory system (inadequate tissue perfusion). Shock will lead to hypoxia (a lack of oxygen in the body tissues) if not treated immediately and eventually lead to full cardiac arrest.
Below, I have placed a chart of the stages that leads to shock. Under the chart I will list the stages of shock.
Stages of Shock:
There are four stages of shock. As it is a complex and continuous condition there is no sudden transition from one stage to the next.
- Initial
During the initial stage of shock, the hypoperfusional state causes hypoxia, leading to the mitochondria being unable to produce adenosine triphosphate (ATP). Due to the lack of oxygen, the cell membranes become damaged, they become leaky to extra-cellular fluid, and the cells perform anaerobic respiration. This causes a build-up of lactic and pyruvic acid that results in systemic metabolic acidosis. The process of removing these compounds from the cells by the liver requires oxygen, which is absent due to inadequate tissue perfusion. - Compensatory (Compensating)
This stage of shock is characterised by the body employing physiological mechanisms that includes neural, hormonal and bio-chemical mechanisms in an attempt to reverse the condition of shock. As a result of the acidosis, the patien will begin to hyperventilate in order to rid the body of carbon dioxide (CO2). CO2 indirectly acts to acidify the blood and by removing it, the body is attempting to raise the pH level of the blood. The baroreceptors in the arteries detect the resulting hypotension, and cause the release of adrenaline and noradrenaline. Noradrenaline causes predominately vasoconstriction with a mild increase in heart rate, whereas adrenaline predominately causes an increase in heart rate with a small effect on the vascular tone; the combined effect results in an increase in blood pressure. Renin-angiotensin axis is activated and arginine vasopressin is released to conserve fluid via the kidneys. These hormones also cause the vasoconstriction of the kidneys, gastrointestinal tract, and other organs to divert blood to the heart, lungs and brain (the trunk of the body), the bodies attempt to perfuse the organs. The lack of blood to the renal system causes the characteristic low urine production. The effects of the Renin-angiotensin axis take time and are of little importance to the immediate homeostatic mediation of shock. - Progressive (Decompensating)
At this point, it not aggressively treated by EMS professionals, the shock will proceed to the progressive stage and the compensatory mechanisms begin to fail. Due to inadequate tissue perfusion of the cells, sodium ions build up within while potassium ions leak out. As anaerobic metabolism continues, increasing the body’s metabolic acidosis, the arteriolar and precapillary sphincters constrict to the point that blood remains in the capillaries. Due to this, the hydrostatic pressure will increase and, combined with histamine release will lead to leakage of fluid and protein into the surrounding tissues. As the fluid is lost, the blood concentration and viscosity increase, causing sludging of the micro-circulation. The prolonged vasoconstriction will also cause the vital organs to be compromised due to rinadequate perfusion.
Refractory (Irreversable)
At this stage of shock, the vital organs have failed and the patient’s condition can no longer be reversed. Brain damage and cell death have occurred. Death imminent and will rapidly occur at this point.
Types of Shock
- Hypovolemic Shock
This is the most common type of shock and based on insufficient circulating volume. Its primary cause is loss of fluid from the circulation from either an internal or external source. An internal source may be haemorrhage. External causes may include extensive bleeding, high output fistulae or severe burns. In physiology and medicine, hypovolemia (also hypovolaemia) is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. - Cardiogenic Shock
Septic shock is a very serious medical emergency. Septic shock is caused by inadequate tissue perfusion and oxygen delivery as a result of infection and sepsis. It can cause multiple organ failure and death is imminent if not treated aggressively. Most common patient’s that present with Septic shock are children, immunocompromised individuals, and the elderly because their immune systems cannot deal with the infection as effectively as those of healthy adults. The mortality rate from septic shock is approximately 50%.
. - Septic Shock
Septic shock is caused by an overwhelming infection leading to vasodilation. - Anaphylactic Shock
Anaphylactic Shock is caused by a severe anaphylactic reaction to an allergen, antigen, drug or foreign protein causing the release of histamine which causes widespread vasodilation, leading to hypotension and increased capillary permeability. - Neurogenic Shock
Neurogenic shock is the rarest form of shock. It is caused by trauma to the spinal cord resulting in the sudden loss of autonomic and motor reflexes below the injury level. Without stimulation by sympathetic nervous system, the vessel walls relax uncontrollably resulting in a sudden decrease in peripheral vascular resistance. This leads to vasodilation and hypotension. - Obstructive Shock
- With this type of shock, the flow of blood is obstructed, this impedes circulation and can result in circulatory arrest. Several conditions result in this form of shock.
1. Cardiac Tamponade - In Cardiac Tamponade, the blood in the pericardium prevents inflow of blood into the atrium of the heart (venous return). Constrictive pericarditis, in which the pericardium shrinks and hardens and is similar in presentation.
2. Tension Pneumothorax - Tension Pneumothorax presents with intrathoracic pressure, bloodflow to the atrium of the heart is prevented (venous return).
3. Massive Pulmonary Embolism - Massive pulmonary embolism is the result of a thromboembolic incident in the bloodvessels of the lungs and hinders the return of blood to the heart.
4. Aortic Stenosis - Aortic stenosis hinders circulation by obstructing the ventricular outflow. - Endocrine Shock
This type of shock is based on endocrine disturbances of the body. Several conditions result in this form of shock.
1. Hypothyroidism - Hypothyroidism, in critically ill patients reduces cardiac output and can lead to hypotension and respiratory insufficiency.
2. Thyrotoxicosis - Thyrotoxicosis may induce a reversible cardiomyopathy.
3. Acute Adrenal Insufficiency - Acute adrenal insufficiency is frequently the result of discontinuing corticosteroid treatment without tapering the dosage. Surgery and intercurrent disease in patients on corticosteroid therapy without adjusting the dosage to accommodate for increased requirements may also result in this condition.
4. Adrenal Insufficiency - Relative adrenal insufficiency in critically ill patients where present hormone levels are insufficient to meet the higher demands.
Signs and Symptoms of Shock
There are several tell tale signs of patient’s presenting with shock. I’ll list a few below. Always study your latest EMS text books and other materials to learn and understand shock.
-
Hypovolemic Shock
- Anxiety, restlessness, altered mental state due to decreased cerebral perfusion and subsequent hypoxia.
- Hypotension due to decrease in circulatory volume.
- A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia.
- Cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction.
- Rapid and shallow respirations due to sympathetic nervous system stimulation and acidosis.
- Hypothermia due to decreased perfusion and evaporation of sweat.
- Thirst and dry mouth, due to fluid depletion.
- Fatigue due to inadequate oxygenation.
- Cold and mottled skin (cutis marmorata), especially extremities, due to insufficient perfusion of the skin.
- Distracted look in the eyes or staring into space, often with pupils dilated.
- Cardiogenic Shock (similar to hypovolaemic shock but also presnts with)
- Distended jugular veins due to increased jugular venous pressure.
- Absent pulse due to tachyarrhythmia.
- Distended jugular veins due to increased jugular venous pressure.
- Pulsus paradoxus in case of tamponade.
- Pyrexia and fever, or hyperthermia, due to overwhelming bacterial infection.
- Vasodilation and increased cardiac output due to sepsis.
- Similar to hypovolaemic shock except in the skin’s characteristics. In neurogenic shock, the skin is warm and dry.
- Skin eruptions and large welts.
- Localised edema, especially around the face.
- Weak and rapid pulse.
- Breathlessness and cough due to narrowing of airways and swelling of the throat.
- As a means of identification for medical equipment and supplies for installation and use in the Emergency Medical Care Vehicle-Ambulance.
- To point to the location of qualified medical care services and access to such facilities.
- For use on shoulder patches worn only by personnel who have satisfactorily completed DOT training courses or approved equivalents, and for persons who by title and function administer, directly supervise, or participate in all or part of National, State, or community EMS programs.
- On EMS personnel items - badges, plaques, buckles, etc.
- Books, pamphlets, manuals, reports or other printed material having direct EMS application.
- Detection
- Reporting
- Response
- On Scene Care
- Care in Transit
- Transfer to Definitive Care
- Partial Seizures
- Generalized Seizures
- Simple Partial Seizures
With the Simple Partial Seizure, no change in consciousness occurs. Patients may experience weakness, numbness, and unusual smells or tastes. Twitching of the muscles or limbs, turning the head to the side, paralysis, visual changes, or vertigo may occur. When motor symptoms spread slowly from one part of the body to another, this “epileptic march” has been termed jacksonian epilepsy (first described by Hughlings Jackson). - Complex Partial Seizures
(origonates at the temporal lobe):
Consciousness with the Complex Partial Seizure is altered during the seizure. Patients may have some symptoms similar to those in a simple partial seizure but have some change in their ability to interact with the environment. Patients may exhibit automatisms (automatic repetitive behavior) such as walking in a circle, sitting and standing, or smacking their lips together. Often accompanying these symptoms are the presence of unusual thoughts, such as the feeling of deja vu (having been someplace before), uncontrollable laughing, fear, visual hallucinations, and experiencing unusual unpleasant odors. These symptoms are thought to be caused by abnormal discharges in the temporal lobe. - Tonic-Clonic or Grand Mal Seizure:
This is the type of seizure that most people associate seizures with. Specific movements of the arms and legs and/or the face may occur with loss of consciousness. A yell or cry often precedes the loss of consciousness. Prior to this the patient may have an aura (an unusual feeling that often warns the patient that they are about to have a seizure). The patient will abruptly fall and begin to have jerking movements of their body and head. Drooling, biting of the tongue, and incontinence of urine may occur. When the jerking movements stop, the patient may remain unconscious for a period of time. The seizure normally lasts from 5 to 20 minutes. They often awaken confused and may sleep for a period of time. The patient may experience prolonged weakness after the event; this is termed Todds paralysis. - Absence Petit Mal Seizure
Loss of consciousness only occurs, without associated motor symptoms. Usually there is no aura, or warning. The loss of consciousness is usually brief and the patient may appear to be involved with the environment and briefly stop what they are doing. The patient will stare off and then continue their activity. No memory of the event exits. Subtle motor movements may accompany the alteration in consciousness. - Myoclonic Seizures
Myoclonic seizures are characterized by a brief jerking movement that arises from the central nervous system, usually involving both sides of the body. The movement may be very subtle or very dramatic. There are many different syndromes associated with myoclonic seizures, including juvenile myoclonic epilepsy, West syndrome and Lennox-Gastaut syndrome. Most cases of myoclonic epilepsy occur during the first 5 years of life. - Very low blood levels of glucose, sodium, calcium or magnesium
- Traumatic head injuries
- Using or withdrawing from drugs, including alcohol Infections such as meningitis or encephalitis
- Brain tumors
- Blood vessel malformations in the brain or strokes
- A family history of seizure disorders
- Any injury to the brain from trauma, stroke, previous infection and other causes
- Severe medical problems that affect electrolytes
- Illicit drug use Heavy alcohol use
- Simple partial seizures. These seizures don’t result in loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound.
- Complex partial seizures. These seizures alter consciousness, causing you to lose awareness for a period of time. Complex partial seizures often result in staring and nonpurposeful movements such as hand rubbing, lip smacking, arm positioning, vocalization or swallowing.
- Absence seizures (petit mal). These seizures are characterized by staring, subtle body movement and brief lapses of awareness.
- Myoclonic seizures. These seizures usually appear as sudden jerks of your arms and legs.
- Atonic seizures. Also known as drop attacks, these seizures cause you to suddenly collapse or fall down.
- Tonic-clonic seizures (grand mal). The most intense of all types of seizures, these are characterized by a loss of consciousness, body stiffening and shaking, and sometimes tongue biting or loss of bladder control.
- Phenytoin (Dilantin)
- Carbamazepin (Tegretol)
- Phenobarbital
- Primidone
- Valproic acid (Depakote)
- Ethosuximide
- Clanazepam
- Diazapam (Valium)
- Obstructive Shock (similar to hypovolaemic shock but also presnts with:)
- Septic Shock similar to hypovolaemic shock except in the first stages:
- Neurogenic Shock
- Anaphylactic shock
Prognosis of Shock
Shock is said to evolve from reversible to irreversible. The prognosis of shock depends on the underlying cause and the nature and extent of concurrent problems. Hypovolemic, anaphylactic and neurogenic shock are treatable and respond well to treatment. Septic shock is considered a grave condition with a mortality rate between 30% and 50%. The prognosis of cardiogenic shock is even worse.
Treatment for Shock
Always follow your local EMS protocols for treatment of shock. I cannot stree enough the importance of quickly cluing in on the patient condition and immediate treatment. Rapid transport is essential for the patient presenting with shock. Below is a short chart to review for the treament for the various types of shock we have discussed. Remember, follow your local EMS protocols. The chart below is not meant for you to use as your treatment gusidelins. Lastly, visit our Download Section. You will be able to download a general guide to review for treament of the patient in shock. Click here to go to our Download Section. Download Section
Medical Emergency
A medical emergency is an injury or illness that is acute and poses an immediate threat to a person’s life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the victim themselves. Dependant on the severity of the emergency, and the quality of any treatment given, it may require the involvement of multiple levels of care, from a first responder to an paramedic through to specialist semergency.
Any response to an emergency medical situation will depend strongly on the situation, the patient involved and availability of resources to help them. It will also vary depending on whether the emergency occurs whilst in hospital under medical care, or outside of medical care (for instance, in the street or alone at home).
All EMS professionals should remember, even though to you as an EMS professional and a condition may not really need emergency care the patient may feel so. Remember, you would not have been called if the patient did not feel he/she needed you in most cases. Be kind, be professional and courteous even if it is not a true medical emergency.
The Star of Life
Just as a pharmacists have the mortar and pestle and doctors have the caduceus, Emergency Medical Technicians have a symbol, its use is encouraged both by the American Medical Association and the Advisory Council within the Department of Health, Education and Welfare. The symbol applies to all emergency medical goods and services which are funded under the DOT/EMS program.
We see the “Star of Life” constantly, whether it be on ambulances or uniforms. But, how many realize what this symbol represents and how it was born? Not too many, judging from the random survey I conducted after having realized I had no idea myself.
Designed by Leo R. Schwartz, Chief of the EMS Branch, National Highway Traffic Safety Administration (NHTSA), the “Star of Life” was created after the American National Red Cross complained in 1973 that they objected to the common use of an Omaha orange cross on a square background of reflectorized white which clearly imitated the Red Cross symbol. NHTSA investigated and felt the complaint was justified.
The newly designed, six barred cross, was adapted from the Medical Identification Symbol of the American Medical Association and was registered as a certification mark on February 1, 1977 with the Commissioner of Patents and Trade-marks in the name of the National Highway Traffic Safety and Administration. The trademark will remain in effect for twenty years from this date.
Each of the bars of the blue “Star of Life” represents the six system function of the EMS, as illustrated below: The capitol letter “R” enclosed in the circle on the right represents the fact that the symbol is a “registered” certification.
The snake and staff in the center of the symbol portray the staff Asclepius who, according to Greek mythology, was the son of Apollo (god of light, truth and prophecy). Supposedly Asclepius learned the art of healing from the centaur Cheron; but Zeus - king of the gods, was fearful that because of the Asclepius knowledge, all men might be rendered immortal. Rather than have this occur, Zeus slew Asclepius with a thunderbolt. Later, Asclepius was worshipped as a god and people slept in his temples, as it was rumored that he effected cures of prescribed remedies to the sick during their dreams. Eventually, Zeus restored Asclepius to life, making him a god.
Asclepius was usually shown in a standing position, dressed in a long cloat, holding a staff with a serpent coiled around it. The staff has since come to represent medicine’s only symbol. In the Caduceus, used by physicians and the Military Medical Corp., the staff is winged and has two serpents intertwined. Even though this does not hold any medical relevance in origin, it represents the magic wand of the Greek deity, Hermes, messenger of the gods.
The staff with the single serpent is the symbol for Medicine and Health and the winged staff is the symbol for peace. The Staff with the single serpent represents the time when Asclepius had a very difficult patient that he could not cure, so he consulted a snake for advice and the patient survived. The snake had coiled around Asclepius’s staff in order to be head to head with him as an equal when talking. The Winged staff came about when Mercury saw two serpents fighting,and unable to stop them any other way placed his staff between them causing them to coil up his winged staff.
The Bible, in Numbers 21:9, makes reference to a serpent on a staff: Moses accordingly made a bronze serpent and mounted it on a pole and whenever anyone who had been bitten by a serpent looked at the bronze serpent, he recovered.
Who may use the “Star of Life” symbol? NHTSA has exclusive rights to monitor its use throughout the United States. Its use on emergency medical vehicles certifies that such vehicles meet the U.S. Department of Transportation standards and certify that the emergency medical care personnel who use it have been trained to meet these standards. Its use on road maps and highway signs indicates the location or access to qualified emergency care services. No other use of the symbol is allowed, except as listed below:
States and Federal agencies which have emergency medical services involvement are authorized to permit use of the “Star of Life” symbol summarized as follows:
The Star of Life
Each of the six “points” of the star represents an aspect of the EMS System. They are:
The staff on the star represents Medicine and Healing.
Seizures and Epilepsy
Seizures are a very common call for the EMS professional. Most EMS books will cover what you need to know as an EMS professional in order to do your job. I am going to go more in depth with this posting on seizures. AS always, I have uploaded a PDF field treatment document to go with this article. See the bottom of this page to obtain the field treament for seizures.
Seizure Defined:
Seizures are episodes of disturbed brain function that cause changes in attention or behavior. They are caused by abnormal excited electrical signals in the brain.
The vagus nerves branch off the brain on either side of the head and travel down the neck, along the esophagus to the intestinal tract. They are the longest nerves in the body, and affect swallowing and speech. The vagus nerves also connect to parts of the brain involved in seizures. In many seizures disorders, electrical stimulation of the vagus nerves may afford relief of symptoms.
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There is a wide variety of signs and symptoms for the seizure patient. It depends on what parts of the patinet’s brain is affected. Many types of seizures cause loss of consciousness with twitching or shaking of the body. Some seizures may only consist of staring spells that can easily go easily unnoticed. Occasionally, seizures can cause temporary abnormal sensations or visual disturbances to the patient.
Sometimes seizures are related to a temporary condition, such as exposure to drugs, withdrawal from certain drugs, or abnormal levels of sodium or glucose in the blood. In such cases, repeated seizures may not recur once the underlying problem is corrected. In other cases, injury to the brain (for example, stroke or head injury) causes brain tissue to be abnormally excitable. In some people, an inherited abnormality affects nerve cells in the brain, which leads to seizures. Some seizures are idiopathic, which means the cause can not be identified. Such seizures usually begin between ages 5 and 20, but they can occur at any age. People with this condition have no other neurological problems, but often have a family history of seizures or epilepsy.
Types of Seizures
There have been many attempts to categorize seizures, based on both the causes of seizures as well as the different seizure subtypes. A well-recognized classification system is the International Classification of Epileptic Seizure. This divides seizure types by the location in the brain that they originate from.
- The two main types of seizures:
Partial Seizures
Partial seizures are seizures that begin in a focal or discreet area of the brain. Below are the subdivided categories that partial seizures fall into.
Generalized Seizures
Generalized seizures involve larger areas of the brain, often both hemispheres (sides), from the onset. This type of seizure is further divided into subtypes.
West Syndrome
West syndrome involves a group of symptoms including infantile spasms, retardation of psychomotor development, and a particular abnormality on the electroencephalogram (EEG) known as hypsarrhythmia. Infantile spasms are characterized by a particular posturing of the infant’s body, in which the child assumes a jack-knife, or folded, position. These spasms may occur frequently in the course of the day or may be continuous. Neurological problems are ultimately found in most of these children.
The hypsarrhythmia pattern seen on the EEG is a grossly disorganized pattern of electrical brain activity. It is often difficult to control the seizures in this syndrome because they usually respond poorly to most anticonvulsant medications.
Lennox-Gastaut Syndrome
Lennox-Gastaut syndrome is characterized by the early onset of a common seizure type called minor motor seizures. These seizures include the aforementioned myoclonic seizures, atypical absence seizures, and atonic seizures. Atypical absence seizures may involve staring and brief episodes of unconsciousness.
Status Epilepticus
Status epilepticus is prolonged, repetitive seizure activity that lasts more than 20 to 30 minutes, during time which the patient is unconscious. Status epilepticus is a medical emergency with a significantly poor outcome; it can result in death if not treated aggressively. The causes include improper use of certain medications, stroke, infection, trauma, cardiac arrest, drug overdose, and brain tumor. This is a true medical emergency for the EMS responder to deal with, the paramedic must treat aggressively.
Febrile Seizures
Febrile seizures are convulsions brought on by a fever in infants or small children. During a febrile seizure, the patient may often loses consciousness. The patient shakes moving limbs on both sides of the body. The patient may become rigid or present with twitches in only a portion of the body, such as an arm or a leg, or on the right or the left side only. Most febrile seizures will only last a minute or two, although some can be as brief as a few seconds. Others may even last for more than 15 minutes.
Most children with febrile seizures have rectal temperatures greater than 102 degrees F. The mojaority of febrile seizures will occur during the first day of the child’s fever. Children most prone to febrile seizures are not considered to have epilepsy. Epilepsy is characterized by recurrent seizures that are not triggered by fever.
Epilepsy
Epilepsy is a neurological condition that produces brief disturbances in the normal electrical functions of the brain. Normal brain functions are made possible by millions of tiny electrical charges passing between nerve cells in the brain and to all parts of the body. When a patient has epilepsy, this normal pattern may be interrupted by intermittent bursts of electrical energy that are much more intense than usual. This may affect the patient’s consciousness, bodily movements or sensations.
The physical changes the patient goes through duting this episode is called epileptic seizures. Epilepsy is often referred to as a seizure disorder. The unusual bursts of energy may occur in just one area of the brain (partial seizures), or may affect nerve cells throughout the brain (generalized seizures). Normal brain function cannot return until the electrical bursts subside. Conditions in the brain that produce these episodes may have been present since birth, or they may develop later in life due to injury, infections, structural abnormalities in the brain, exposure to toxic agents, or for reasons that are still not known. Many illnesses or severe injuries can affect the brain enough to produce a single seizure. When seizures continue to occur for unknown reasons or because of an underlying problem that cannot be corrected, the condition is known as epilepsy. Epilepsy affects people of all ages, all nations, and all races.
Non-Epileptic
Non-epileptic seizures (NES) are used to describe seizures that often look like epileptic seizures but which have a different cause. Unlike epileptic seizures, non-eplipetic seizures are not caused by changes in brain activity. NES can take different forms and can have a range of causes.
Some non-epileptic seizures have a physical cause relating to the body such as fainting. Fainting is also known as syncope in the world of emergency medicine. Some non-epileptic seizures have a psychological cause relating to the mind such as panic attacks. Panic attacks may be presumed to be a patient faking a seizure by EMS personnel that may not understand panic attacks. Panic attacks is a true medical condition so EMS professionals should always keep this in mind.
Sometimes it can be very hard to find the reason why non-epileptic seizures occur. For some patient’s, the non-epileptic seizures may happen shortly after a specific stressful event. For others patient’s, the non-epileptic seizures may not start after any particular event. This can make finding the causes of non-epileptic seizures extremely difficult.
Some non-epileptic seizures only occur when a person feels stressed or anxious. For other people their non-epileptic seizures may start to happen in situations which are not seen as stressful to the patient.
What Do Non-Epileptic Seizures Look Like?
What happens to the patient during the non-epileptic seizures can vary. What happens during an epileptic seizure can also happen during a non-epileptic seizure. During non-epileptic seizures, like epileptic seizures, a person might fall and hurt themselves, convulse (make jerking movements) or be incontinent (wet themselves). Both types of seizures can happen suddenly and without warning. Because of this it can sometimes be hard to tell epileptic and non-epileptic seizures apart.
I have personally experienced several patient’s over and over again with the same signs and symptoms presenting in a non-epileptic seizures. The largest majority of the non-epileptic seizures I have dealth with show signs that appears to be posturing rather than convulse with some slight shaking. I have also seen quite severe muscle tightening rather seizure type activity. Most also do not respond to painful or any type of stimuli. Also several have resented with snoring resp. It all varies what you as the EMS professional may witness.
Causes of Seizures
Let me make clear, when speaking of seizures causes in this article, I am only speaking of Tonic-Clonic or Grand Mal Seizures. It would take page after page of information to cover the causes of all types of seizures. With that said, I will cover the causes of grand-mal seizures since this is the type of seizure most EMS professionals will be responding to in the field.
Grand mal seizures occur when the electrical activity in a large region of the brain becomes abnormally synchronized. The cause of the seizure remains unknown in about half of cases. Grand mal seizures are sometimes caused by underlying health problems, such as:
Risk Factors of Grand-Mal Seizures
There are many reasons a patient may be experience a grand-mal seizure. Below I have liasted a few risk factors a patient may risk.
Signs and Symptoms of the Seizure Patient
Because epilepsy is caused by abnormal activity in brain cells, seizures can affect any process your brain coordinates. A seizure can produce temporary confusion, complete loss of consciousness, a staring spell, or uncontrollable jerking movements of the arms and legs.
Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be very similar each time a seizure occurs. Some people have many different types of seizures, with different symptoms each time.
Partial Seizures
Generalized Seizures
Common Seizure Medications
The EMS professional can be clued in as to the patient’s PMHx of seizures. The following is a list of medications you may see a seizure patient taking on a regualr basis.
In Closing
Seizure disorders vary so widely, EMS professionals should assure to base their treaments in the field on the patient. Remember the basics, threat the patient and not your diagnostic equipment. Rapid transport and know what you are treating in the seizure patient is the clue with this type of call.
Treatment of Seizrues
As always, follow your local protocol. We have the generalized treatment for seizure patient’s located in our download section. Visit our download section and download the free PDF treatment sheet for seizures.
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Flail Chest
This is a true grave emergency for the EMS professional. For example, Flail Chest may occur if a patient is thrown forcefully into the steering wheel during a car accident, it may push in part of his rib cage, and break several of his ribs at the front and the back.
Flail Chest defined is as three or more ribs are broken in two or more places.
These fractures may be so aligned with one another that they isolate part of his chest wall. When the patient inspires, this part of his chest wall moves inwards also (paradoxical movement). The patient will present with dyspnea because air can now move from one lung to another, instead of being exhaled. The result is dyspnoea, hypoxia, cyanosis, and carbon dioxide retention, which are especially dangerous if the patient is older or bronchitic.
Multiple fractured ribs cause such extreme pain and muscle spasm that the patient will attempt not to cough. This in turn encourages fluid to collect in the lungs and further interupts the lungs function. Paradoxical respiration is often overlooked by EMS professionals.
Graphics to help explain Flail Chest
When the patient inspires and the chest expands, the flail section sinks in and his mediastinum moves towards the normal side. When the patient expires, the flail section moves out and the mediastinum moves to the other side. The dotted lines on the graphics below show some air moving uselessly from one lung to the other. All this greatly impairs the patient’s ability to ventilate the lungs.
A patient’s fractured ribs may be anywhere. Sometimes, the front or side of the patient’s chest moves paradoxically or the patient may have extensive fractures on either side of the spine that allows a large portion of the chest wall to be pulled downwards by the diafragm. Paradoxical movement is less severe when the patient has fractures at the apex of the rib cage or under the scapulae. This is because the shoulder girdle can splint the broken ribs.
Many broken ribs may bleed severely, and cause a large pneumothorax. Sometimes, a patient’s underyling lung is injured and becomes a pneumothorax, perhaps under tension.
How to Treat Flail Chest
Always follow your EMS service protocols. We do have the treatment for Flail Chest located in our downloads area of our site. Click the button below. When you get to our download area, simply download Flail Chest. This will cover the treament for most EMS Protocols.
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