Thursday, May 5, 2016

EMT Training: Respitory emergency assessment based approach

Each time a EMT goes on scene they perform an assessment of the patient or patients. When the dispatcher says that it is a respitory emergency, what should the emergency medical technician be looking for when they arrive on scene.

An EMT should:
Form a general impression of the mental status of the patient, airway, breathing, and circulation.

Check patients position, face, speech and mental status.

Are they sitting in a tripod position? Are they using their neck muscles to breath? Is there a retraction of the muscles between the ribs? Does the EMT see Cyanosis, Diapharesis, and Pallor. Is the patients nasal passages flaring?

 

EMT Training: Geriatrics, Pediatrics, and Respitory Emergencies

Once you have been on a few scenes, you will find that there is always special consideration to Geriatric patients and Pediatric patients. One generation is still growing while the other generation is getting weaker. So there are a few things that Emergency Medical Technicians need to remember when assessing and managing these types of patients.

Pediatric Patients
Respitory failure is usually caused by both respitory arrest and cardiac arrest. The root cause is either upper airway blockage or a lower airway disease.

It's important to recognize early signs of respitory distress.

Because respitory distress can rapidly deteriorate into respitory failure, prompt intervention and transport is critical.

Geriatric Patients
Dyspnea is a common complaint.
Elderly already have a diminished respitory function so respitory distress will happen often.
Additional burden can overwhelm the respitory system causing respitory distress or respitory failure.

EMT Training: Respitory Emergency Medications

There are several medications that a patient can take when they are faced with a Respitory emergency. Some act differently than others. It is important for an EMT to know which one is appropriate to use and when.

So how does an Emergency Medical Technician differentiate between short acting beta 2 agonist and other respiratory medicines?

Medications that are for emergencies are fast acting. They are medications such as Buterol, Xopenex, and Bronkosol.

Medications that are not meant for emergency uses are long acting Beta 2 specific drugs (salmeterol xinafoate) that also contains a steroid (fluticasone propionate)

EMT Refresher: Abnormal breathing sounds

As an Emergency Medical Technician listens to a patients lungs they will either hear clear breathing or abnormal breathing sounds. There are three basic types of abnormal breathing sounds. They are wheezing, Rhonchi, and Rales (Crackling sound). So what do these three abnormal breathing styles sound like to a EMT?

Wheezing
High pitched musical whistling sound
Wheezing is usually heard in asthma, emphysema, and chronic bronchitis
What is causing the wheezing is a swelling and constriction of the bronchi

Rhonchi
Snoring or rattling noises coming from the nose or lungs
Obstruction of the larger conducting airways by mucus.
Rhonchi signifies chronic bronchitis, emphysema, aspirations and pneumonia

Rales (Crackles
Bubbly or crackling sound in the lungs
Fluid that has surrounded or filled the bronchioles
Indication of pulmonary edema or pneumonia

EMT Training: Where to assess breathing sounds

An EMT comes to a scene and they need to listen to a persons lungs. This is called assessment of breath sounds or assessing the lungs. There are four different locations where assessment of breath sounds can be made. I'm sure everyone has been to the doctors where the nurse, nurse practitioner, or doctor has taken a stethoscope to four different areas of your lungs.

One area is the second intercostal space, midclavical line
Sounds here represent airflow through the larger conducting airways.
Airway structures are still supported by cartilage.
Abnormal breathing heard here include stridor and rhonchi

Assessment can be made at the third intercostal space found near the anterior axillary.

Fourth intercostal space on the Midaxillary line. Sounds heard here represent airflow through smaller conducting airways (Bronchioles). You may also be able t hear some airflow into the air sacs (alveoli). Abnormal breathing sounds heard here are crackles (rales)

Midscapular Line
While patient sitting upright, the sounds heard here represent airflow into the alveoli. This is the best location to hear alveolar airflow. Abnormal sounds would be crackling sounds coming from the lungs. This is also known as rales.

Wednesday, May 4, 2016

EMT Refresher: Structure and function of the respitory system

The lovely lungs. For Emergency Medical Technicians it's the respitory system. What makes up the respitory system? What is the function of the respitory system. You will be surprised the respitory system is not just about breathing. Without breath there is no oxygenated blood and without oxygenated blood, there is no life.

The respitory system can be divided into three different sections.

Section 1 and 2
Upper and lower airways
The vocal chords being the medium between them both.
The upper and lower airways bring air into and out of the lungs.

Section 3
Consist of the lungs and accessory structures
Allow for the oxygenation of blood cells and elimination of carbon dioxide from the blood stream.

In the next EMT Refresher post, We will be discussion where to assess breathing sounds in a patient. It's important to listen carefully because certain breathing sounds will give an EMT clues to what the patient is dealing with.

Why is it important to recognize respitory emergencies

An EMT has arrived to a scene and the patient has a medical illness. Why is it important to be able to quickly recognize and treat patients with respitory emergencies.

It's important to recognize the signs and symptoms of respitory emergencies because if a patient does not receive emergency treatment it can ultimately lead to respitory failure and eventually cardiac arrest.

In the next couple of posts we will be discussing the structure of the respitory system, the function of the respitory system, how to assess breathing sounds, what is an abnormal breathing sound, medications, and how to assist in delivering medications to the patient.

If there is anything that you have questions about, please let me know in the EMT comments. Of course, I'm not perfect in the field. So if you are an Emergency Medical Technician and you think I missed something, please let me know. We are an EMS family. Family helps family even if we're EMS in another state.

Tuesday, May 3, 2016

Cardiac Conduction System Key Points

Every day we are given little tidbits of information. Here are some tidbits for Emergency Medical Technicians, Paramedics, Nurses, and Firefighters. These are some key points on the heart, veins, and Cardiac Conduction System.

The electrocardiogram is a graphic representation of the hearts electrical activity.

Agina Pectoris is a symptom of inadequate oxygen supply to the heart muscle or myocardium.

Diabetics, the elderly and women are more prone to an atypical presentation of symptoms when suffering a heart attack.

Coronary heart disease is now the single largest cause of death of females in the United States.

Patients suffering heart failure will say that they are taking a "water pill" or diuretic.

Some patients have chronically elevated blood pressures. The EMT should only elevate a patients current blood pressure in light of what "normal" blood pressure is for the patient.