Archive for the Assessments / Interventions Category

Quote of the Week – April 19

Posted in Assessments / Interventions, Quote of the Week with tags , on April 19, 2010 by The Beaver Medic

To identify a possible fractured pelvis, place a fist between the patient’s knees and ask the patient to squeeze your fist. The patient will be able to do this without pain if the pelvic girdle is intact, but if there is a fracture anywhere, they will be unable to squeeze your fist without pain. If I get a positive result, I treat the patient as if they have a fractured pelvis without further testing. If I get a negative result, I do the standard pressing down and rocking the pelvis to determine stability.

This week’s quote of the week is an assessment tip from Dan Limmer, Joe Mistovich and Will frost of EMS Magazine. It was featured in a February, 2010 article posted on EMS responder.com. The article contains numerous ingenious tips for improving our patient assessment. I found this tip on assessing the status of our patient’s pelvic region for fracture especially insightful.

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Jonas Gustavsson Syndrome

Posted in AED/12 Lead, Cardiac with tags , , on March 29, 2010 by The Beaver Medic

A few months ago the Leaf’s new goaltender underwent two rounds of treatment for a “heart condition”. I was surprised to see his specific problem receive so little mention in the sports press. For you Toronto fans, of which I am not – Deeeeetroit, here is a look at what his heart condition was.

The monster’s condition was a cardiac arrythmia – a problem within the electrical conduction system of the heart. Most probably atrioventricular reentrant tachycardia (AVRT). AVRT is just a big scary medicalese acronym. I will explain first with an example of how a normal heart beat works.

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Framework for thinking about tachycardia

Posted in AED/12 Lead, Cardiac with tags , , , , , , on March 28, 2010 by The Beaver Medic

Supraventricular tachycardia. AV non-nodal reentrant tachycardia. SV tachycardia with aberrancy such as a bundle branch block. Bundle who? Super what?

Tachycardia is guilty of committing the sin of medicalese. An overuse of lengthy latin and greek words which make the topic appear unattainable. I certainly felt this way until I came across references that view tachycardias through a system. Although there are a few of these resources that are great (i.e. Rob Theriault’s CDI) my personal favourite is Ed Wallit’s of PodMedics.

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“In god we trust, all others must bring data.”

Posted in Assessments / Interventions, Technical Rescue with tags , , , on March 27, 2010 by The Beaver Medic

The quote comes from a man named W. Edwards Deeming, a noted management expert circa 1950s. It sums the bane of my existence as an undergrad psychology student. If it cannot be studied, proven beyond a 5% reasonable doubt and peer reviewed then it ceases to exist. There is good reason for this strict empirical approach to research. Bad things can happen when we believe good public speakers with little evidence. Consider spinal immobilization.

Boarded until proven otherwise. Such is the attitude for most spinal immobilization training in the pre-hospital environment. If the mechanism of injury suggests potential spinal involvement we break out the velcro. If the Px thinks about the words pain and neck in the same sentence we lunge to take C-spine. Our otherwise stable Px with no neurological deficits is then tightly strapped onto a rigid backboard, hands and feet bound.

There is growing evidence which suggests this all-encompassing practice has evolved not from empirical research but from dogma and fear of litigation. Dr. John Burton, of the Albany Medical Centre, discussed the over utilization of spinal immobilization in a 2008 Podcast. Among his points was a candid look at the anatomy of a spinal injury.

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Look for me in airports/hockey arenas

Posted in AED/12 Lead, Cardiac, CPR with tags , , , , on February 10, 2010 by The Beaver Medic

New international AED sign

ILCOR has announced an official international sign for automatic external defibrillators (AEDs). ILCOR chairman and cardiologist R.W. Koster described the sign as indicating the presence of an AED within a room, a container or that an AED can be found in a certain direction. The symbol purposefully has no markings to allow for international usage.

Increasingly research is indicating that the best patient outcomes do not require advanced life support (ALS), pharmacological treatment or invasive procedures. As Dr. John Burton describes, if you want to survive a heart attack out of hospital then you will want; Someone nearby to quickly begin CPR; An AED to be very close; And to have your core body temperature dropped a few degrees. Bringing AEDs closer to cardiac arrest is one of the simplest measures that can be undertaken to improve patient outcome.

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Mom was wrong – you won’t catch your death of cold

Posted in Cardiac, CPR with tags , , on January 10, 2010 by The Beaver Medic

Therapeutic hypothermia is a hot topic at this year’s ILCOR conference in Dallas. The new treatment has garnered increased attention following two papers published in the New England Journal of Medicine in 2002 (Bernard et al, 2002; the HACA group, 2002). It was also depicted in the 5th season finale of House when Wilson suggests it during an ambulance transfer of comatose Amber.

Therapeutic hypothermia is an intervention for Px who have suffered from cardiac arrest and have been successfully revived as defined by spontaneous return of circulation (SROC). It is not used to treat the arrest itself but rather to reduce the secondary injuries that ensue after the Px is brought back from the clinically dead. Basically if someone has a heart attack and is then brought back to life their body is cooled down to hypothermic levels for a day to prevent their body from hurting itself.

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CPR, CPR and more CPR

Posted in Cardiac, CPR, Respiratory with tags , , on January 7, 2010 by The Beaver Medic

A short time ago an awkward adolescent Fire Medic nerd watched his hot swim instructor demonstrate how to pinch the dummy’s nose and perform mouth to mouth respirations. It seems shocking now to consider performing such an intervention without any form of PPE/BSI. Consider other relics of resuscitation procedures. One of my former Chiefs described an 80’s EMS protocol to perform one minute of CPR, move the Px to the lawn, perform an additional minute of CPR and then continue to the ambulance. After three explanatory attempts I still do not understand the compression, ventilation and vital signs check system my Mom was taught in the early 90’s.

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