Two common injuries that commonly get confused, is the difference between strain and sprain, and what associated injuries results.
If someone suffers a sTrain, than that person has an injury involving the Tendon(s) and/or muscles. And easy ways to remember is, is that their is a "T" is strain and a "T" in tendon. In addition, the tendons is what connects the muscle to bones.
Strains are diagnosed by pain, muscle weakness, muscle spasms, edema, inflammation, and cramping.
For those who suffer from a sprain, than that person has an injury involving the ligament. Their is no real "easy" way to remember this, but if you remember that strain is associated with tendon, due to the "T's", than the only part left, if the ligaments. The ligaments connect bone to bone.
Sprain are diagnosed pain, edema, bruising. The patient may also have heard or felt a "pop" or other strange noise, for the affected area. In addition, the patient will have trouble or is completely unable to move that joint.
Strains are caused by overuse of a muscle or tendon. Whereas a sprain is the overstretch, over flexion, or direct/indirect trauma to the ligament, due to knocking the joint out of place.
When treating these patient's, it is important to immobilize the joint and affected area. In addition, rest, ice, and keeping the affected area elevated, is the best method of treatment. This allows the area to try to heel itself. Yet, it is important that the person does go and see their family physician, for a follow up, or go to the ER for evaluation.
This post is NOT intended for medical advice. Consult a physician.
Monday, April 28, 2014
Saturday, April 19, 2014
Hyphema
Hypthema, or blood in the anterior chamber of the eye, is not something that EMS runs accords daily. But, it is important to understand what hyphema is.
Causes of the hyphema, include trauma to the eye or head, cancer of the eye, blood vessel rupture or damage, inflammation or infection of the eye, and sickle-cell disease. If you are treating a trauma patient, and you note hyphema, assume that the patient has a major head injury.
On assessment, you will note that their is faint or major blood pooling in the eye. This blood os accumulating in the anterior chamber of the eye. In addition, the patient may experience eye pain on the affected side, vision abnormalities, and light sensitivity.
Overall, their is really nothing we, in EMS, can do for these patients. If it is caused by trauma, than take all spinal precautions and rapid transport. But, if no trauma is suspected, than supportive care should be offered, unless otherwise specified or cause. If severe enough, these patients may need to be coded into the ED for evaluation and treatment. In minor and mild cases, the blood is usually absorbed within a few days.
Causes of the hyphema, include trauma to the eye or head, cancer of the eye, blood vessel rupture or damage, inflammation or infection of the eye, and sickle-cell disease. If you are treating a trauma patient, and you note hyphema, assume that the patient has a major head injury.
On assessment, you will note that their is faint or major blood pooling in the eye. This blood os accumulating in the anterior chamber of the eye. In addition, the patient may experience eye pain on the affected side, vision abnormalities, and light sensitivity.
Overall, their is really nothing we, in EMS, can do for these patients. If it is caused by trauma, than take all spinal precautions and rapid transport. But, if no trauma is suspected, than supportive care should be offered, unless otherwise specified or cause. If severe enough, these patients may need to be coded into the ED for evaluation and treatment. In minor and mild cases, the blood is usually absorbed within a few days.
Click on picture to enlarge it
Pneumonia
Sometimes we are called upon to treat to a patient, who is suffering from pneumonia. Pneumonia, though, can be very easy to diagnosis, and treatment is somewhat limited to the prehospital setting. Still, fast recognition, treatment, and transport are vital to patient survival.
Pneumonia is when their is fluid within one or both sides of the lungs, particular in the air sacs. This is also known as an infection. This fluid, is preventing normal gaseous exchange to occur, thus causing a reduction in the amount of oxygen that is entering into the bloodstream to our organs.
Things to look out for when assessing your patient, is the following: fever (hyperthermic) or hypothermic), chills, diaphoretic, cough that produces a yellowish color sputum (may be streaked with blood), shortness of breath, tachypnea, tachycardia, muscles aches and fatigue, weakness, nausea and vomiting may be present, and possibly a headache. If your patient meets some or all of the following, in most cases, your patient is suffering from pneumonia.
When assessing your patients lungs, during auscultation you will notice that the patient will present with rails in effected area of the lungs. Yet, wheezing and rhonchi may also be present. In addition, during auscultation if you have the patient say "E" during the assessment, and the "E" sounds like an "A," than you have a good indicator that the patient has pneumonia. During the chest wall/lung assessment, if your percuss the chest, yo may reveal dullness over effected area (area filled with the fluid).
When treating these patients, you need to make sure that you ensure a patent airway. Always follow the ABC steps. In addition, start an IV, preferably a saline lock (follow protocol), ECG monitoring, Albuterol is wheezing is present, and in some cases, if the patient's SpO2, and they meet some or all of the CPAP criteria, than you may need to place the patient on CPAP.
Overall, treatment is limited in the prehospital setting. These patient's need antibiotics. So, fast recognition and transport is vital.
Always follow local protocol.
Click on picture to enlarge it
Sunday, April 13, 2014
Subdural and Epidural Hematoma
The struggle when trying to figure out whether your patient is suffering from a subdural or an epidural hematoma. For me, to this day, I still get confused.
Let's break each one down, and try to learn something.
Subdural Hematoma:
-Caused by a head injury
-Deadliest hematoma
-Blood fills the skull, at a very rapid rate
-Signs/symptoms will be rapid
>Confused speech, difficulty walking, lethargy, LOC, N&V, Numbness, Seizure
Epidural Hematoma:
-Caused by a skull fracture
-Occurs when there is a rupture of a blood vessel (artery), which bleed into the space between the dura mater and the skull
-Onset of signs/symptoms can be within hours or longer
>Confusion, ALOC, Enlarged pupil on one side, H/A, Weakness, N&V
Click on any of the pictures below, to enlarge them
Drug Overdose
You are called for a male patient who is unresponsive. Upon arrival, you note a 18 year old male, supine on the floor, unresponsive. GCS 3. Breathing at 8 times a minute. Patient has a good pulse. Patient's mother stated that the patient took Xanax and some cold medicine, but she unsure on the total amount of either taken.
You start ventilating your patient with a BVM, and insert an OPA, which he accepts. Patient is showing sinus tach at 142 bpm, on the monitor. BP stable. IV is established. No trauma noted. You notice that the patient's eyes are pinpoint. No other drugs are noted around the patient, and family is unsure if the patient took anything else.
You administer 2mg Narcan IV. The patient starts to vomit, and his respiratory rate improves, but to 30 breaths per minute. His GCS is now 6. You load the patient and start transport.
While transporting, you administer another 2mg of Naran. No improvement of the patient after the second dose. Patient still shows sinus tach at 148b bpm, on the monitor. BP stable. Patient is left on his left-side (left-lateral recumbent), due to the vomiting and aspirations precautions. Patient is still unresponsive, and GCS 6. BVM ventilations are still being performed.
Patient is moved to the ER, where they end up intubating the patient.
-------------------
What is Xanax?
Alprazolam or Xanax, is a benzo, which in lameness terms, is used to relax someone. Xanax is given to treat anxiety, treat symptoms associated with depression, and panic disorders.
Why pinpoint pupils?
It is unsure on why exactly the patient had pinpoint pupils. Xanax will not effect the pupil response. So, since the family is unsure if the patient took anything else, if the pupils are pinpoint, you can suspect that the patient took some type of opiate as well.
What is Narcan? How does it work?
Narcan is a(n) opiate antagonist. It works by attaching to opiate receptor sites, and kicking off opiate molecules, which prevents the opiates from attaching to the opiate receptor site.
As you noticed, that not only did the patient have pinpoint pupils, but after the administration of Narcan, the patients had an improved of GCS, and he vomited. This is a sign that the patient has taken some type of opiate.
Why continue to ventilate with BVM?
Continue to ventilate your patient, with a BVM, not only because he is breathing at 30 times a minute, but also because we want to keep his oxygenated. If we reduce the oxygen that is given to patient, the patient may go into respiratory arrest, which may lead to cardiac arrest. Keep ventilating.
OPA Usage?
The OPA was used to help displace the tongue. This will allow the oxygen that we are administering to the patient, to pass into the trachea, and into the lungs. Without the OPA, the patient's tongue may block his trachea.
You start ventilating your patient with a BVM, and insert an OPA, which he accepts. Patient is showing sinus tach at 142 bpm, on the monitor. BP stable. IV is established. No trauma noted. You notice that the patient's eyes are pinpoint. No other drugs are noted around the patient, and family is unsure if the patient took anything else.
You administer 2mg Narcan IV. The patient starts to vomit, and his respiratory rate improves, but to 30 breaths per minute. His GCS is now 6. You load the patient and start transport.
While transporting, you administer another 2mg of Naran. No improvement of the patient after the second dose. Patient still shows sinus tach at 148b bpm, on the monitor. BP stable. Patient is left on his left-side (left-lateral recumbent), due to the vomiting and aspirations precautions. Patient is still unresponsive, and GCS 6. BVM ventilations are still being performed.
Patient is moved to the ER, where they end up intubating the patient.
-------------------
What is Xanax?
Alprazolam or Xanax, is a benzo, which in lameness terms, is used to relax someone. Xanax is given to treat anxiety, treat symptoms associated with depression, and panic disorders.
Why pinpoint pupils?
It is unsure on why exactly the patient had pinpoint pupils. Xanax will not effect the pupil response. So, since the family is unsure if the patient took anything else, if the pupils are pinpoint, you can suspect that the patient took some type of opiate as well.
What is Narcan? How does it work?
Narcan is a(n) opiate antagonist. It works by attaching to opiate receptor sites, and kicking off opiate molecules, which prevents the opiates from attaching to the opiate receptor site.
As you noticed, that not only did the patient have pinpoint pupils, but after the administration of Narcan, the patients had an improved of GCS, and he vomited. This is a sign that the patient has taken some type of opiate.
Why continue to ventilate with BVM?
Continue to ventilate your patient, with a BVM, not only because he is breathing at 30 times a minute, but also because we want to keep his oxygenated. If we reduce the oxygen that is given to patient, the patient may go into respiratory arrest, which may lead to cardiac arrest. Keep ventilating.
OPA Usage?
The OPA was used to help displace the tongue. This will allow the oxygen that we are administering to the patient, to pass into the trachea, and into the lungs. Without the OPA, the patient's tongue may block his trachea.
Tuesday, April 8, 2014
Septic Shock - Code Sepsis
You have a patient who presents sick. They are hot to the touch. In addition, they are hypotensive and tachycardia. They should sinus tach on the monitor.
You are interviewing the patient and their family, and they inform you that the patient has recently been citing an infection.
When the infection gets so bad, where to much toxins has entered into the body, the body starts to go into shock. Thus, you have septic shock. Due to the shock, the blood vessels, dilate, which will cause a reduction in BP, but the heart is trying to work harder and faster, so they will be tachycardic.
As the infection continues, and more and more toxins are released into the body, the body will start to shut down. Fast recognition and treat is vital to keeping this patient alive. Septic patients need high doses of antibiotics.
Now, you are called to help this patient, so now we need to treat them. They are hypotensive, at 88/52 with a heart rate of 104 bpm. This patient needs an IV (biggest gage you can fit, in the most central site), and consider starting another IV line. In addition, this patient needs oxygen, ECG monitoring, and rapid transport to the hospital. Septic patients are priority 1 patients.
Signs/Symptoms:
> Elevated Temp or Hypothermia
> Hypotension
> Tachycardic
> Tachypnea
> Altered Mental Status
> Unresponsive
> Elevated WBC
You are interviewing the patient and their family, and they inform you that the patient has recently been citing an infection.
When the infection gets so bad, where to much toxins has entered into the body, the body starts to go into shock. Thus, you have septic shock. Due to the shock, the blood vessels, dilate, which will cause a reduction in BP, but the heart is trying to work harder and faster, so they will be tachycardic.
As the infection continues, and more and more toxins are released into the body, the body will start to shut down. Fast recognition and treat is vital to keeping this patient alive. Septic patients need high doses of antibiotics.
Now, you are called to help this patient, so now we need to treat them. They are hypotensive, at 88/52 with a heart rate of 104 bpm. This patient needs an IV (biggest gage you can fit, in the most central site), and consider starting another IV line. In addition, this patient needs oxygen, ECG monitoring, and rapid transport to the hospital. Septic patients are priority 1 patients.
(click on the picture to enlarge)
Signs/Symptoms:
> Elevated Temp or Hypothermia
> Hypotension
> Tachycardic
> Tachypnea
> Altered Mental Status
> Unresponsive
> Elevated WBC
Sunday, April 6, 2014
Surfactant
Surfactant is like oil. Oil helps to lubricate the pistons in a car, which reduces friction, so the pistons can move easy. Surfactant, does the same thing. It helps to lubricate the lungs and thoracic cavity, so the lungs can expand and collapse more easily, which allows us to breath easier.
Now, if their is a decrease in surfactant, patient will have trouble breathing, an increase in breathing, and in some cases, the reduction of the surfactant can cause a pneumothorax.
Now, if their is a decrease in surfactant, patient will have trouble breathing, an increase in breathing, and in some cases, the reduction of the surfactant can cause a pneumothorax.
Adenosine with A-Fib
You are treating a patient who is complaining of chest pain. Upon your assessment, you note a 72 year old female who is stating that it feels like her heart is racing, which is causing her to have chest pain. Patient is breathing at 22 times per minute. Blood pressure is stable. You note that the patient has a heart rate of 184.
You perform a 12-lead ECG and note SVT. But, as you look more into the 12-lead, you notice that the rhythm is irregular irregular. Still, the heart rate is above 150, and is varying from 157-190, and everything in between.
You realize that your patient is stable, despite the chest pain, but everything else is normal. You decide to follow ACLS, and want to administer Adenosine. 6mg, then 12mg.
Now, let's think about this, before administering Adenosine. If your patient is in SVT, but you notice that the rhythm is irregular irregular, than it must be A-fib with RVR. We know that Adenosine works by effecting the re-entry pathways in the AV node, but, that's only with SVT. In A-fib, the atria and ventricles are not in key, so now matter how much you work on the AV node, the ventricles will still fire at will.
This patient needs a different type of antidysrhythmic, which we do not carry in the pre-hospital setting. The drug that is given, can vary.
Yet, if you do give Adenosine, it may work for a brief second, but your patient will almost always go right back into A-fib with RVR, and in some cases, may even worsen the A-fib with RVR.
Overall, you must always follow your protocol on treating SVT, and if A-fib with RVR is considered in the tachycardia protocol. My recommendation, and soly mine (ALWAYS FOLLOW PROTOCOL), is to call medical control, first, and confirm with them whether to or not to administer Adenosine.
You perform a 12-lead ECG and note SVT. But, as you look more into the 12-lead, you notice that the rhythm is irregular irregular. Still, the heart rate is above 150, and is varying from 157-190, and everything in between.
You realize that your patient is stable, despite the chest pain, but everything else is normal. You decide to follow ACLS, and want to administer Adenosine. 6mg, then 12mg.
Now, let's think about this, before administering Adenosine. If your patient is in SVT, but you notice that the rhythm is irregular irregular, than it must be A-fib with RVR. We know that Adenosine works by effecting the re-entry pathways in the AV node, but, that's only with SVT. In A-fib, the atria and ventricles are not in key, so now matter how much you work on the AV node, the ventricles will still fire at will.
This patient needs a different type of antidysrhythmic, which we do not carry in the pre-hospital setting. The drug that is given, can vary.
Yet, if you do give Adenosine, it may work for a brief second, but your patient will almost always go right back into A-fib with RVR, and in some cases, may even worsen the A-fib with RVR.
Overall, you must always follow your protocol on treating SVT, and if A-fib with RVR is considered in the tachycardia protocol. My recommendation, and soly mine (ALWAYS FOLLOW PROTOCOL), is to call medical control, first, and confirm with them whether to or not to administer Adenosine.
Wednesday, April 2, 2014
Check Your Urine
While going to the restroom, it is always a good idea to take a glance at your urine. Your urine can tell you some information about what is going on inside your body.
If you use the restroom, and you note that the color of the urine is very clear, like water, than than means that you are very hydrated. But, if your urine is dark in color, you could be dehydrated. Drinking plenty of water, will help to rehydrate your body.
But wait, your urine is very bright, as in a neon-yellow color. It's okay, this is based on the medications that you take. Some vitamins will cause your urine to turn colors.
What if you have a funny odor when you urinate? It's simple, think back to what you ate. Some foods can actually cause your urine to have a distinctive odor. This is caused by the breakdown of the food, which than releases "particles" that get filtered through the kidney.
Now, let's look at something else. Your urine smells sweet, like candy. This could be caused by the kidney releasing sugar in the urine, because the filter within the kidney, is not working properly. Sweet smelling urine, is a sign of diabetes.
You notice that their is a blood-tinged color in your urine. This could either be minor or a major issue. Basically, there is blood in the urine, and could be caused by multiple things.
Lastly, if their is pain during urination, than most likely their is a urinary tract infection (UTI) that has formed. Antibiotics are needed to help treat that UTI.
If you use the restroom, and you note that the color of the urine is very clear, like water, than than means that you are very hydrated. But, if your urine is dark in color, you could be dehydrated. Drinking plenty of water, will help to rehydrate your body.
But wait, your urine is very bright, as in a neon-yellow color. It's okay, this is based on the medications that you take. Some vitamins will cause your urine to turn colors.
What if you have a funny odor when you urinate? It's simple, think back to what you ate. Some foods can actually cause your urine to have a distinctive odor. This is caused by the breakdown of the food, which than releases "particles" that get filtered through the kidney.
Now, let's look at something else. Your urine smells sweet, like candy. This could be caused by the kidney releasing sugar in the urine, because the filter within the kidney, is not working properly. Sweet smelling urine, is a sign of diabetes.
You notice that their is a blood-tinged color in your urine. This could either be minor or a major issue. Basically, there is blood in the urine, and could be caused by multiple things.
Lastly, if their is pain during urination, than most likely their is a urinary tract infection (UTI) that has formed. Antibiotics are needed to help treat that UTI.
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