Ten Minute Medic

The early recognition of shock in the pediatric patient is imperative to the survival of your young patient. It's is important to remember that this condition does not always exhibit itself the same as it would in the adult.  In this first of a multi-podcast series, we will take a look at pathophysiology of shock and how to recognize some of the subtle symptoms. 

Watching a child struggle to breath is difficult to deal with.  However, what you do in the first few minutes of care could determine the outcome for your patient.  In this episode, we take a brief look at the issue of respiratory distress versus respiratory failure. 

Pediatric cardiac arrests are rare, but can be among the most stressful calls that the paramedic will encounter.  In this podcast, we take a look at the PALS algorithm for dealing with such high risk calls. 

The assessment skills of the paramedic are the most important ones that she posses.  In this episode, we take a look at how to have an organized assessment routine of our pediatric patients. 

Effective communication is imperative for the paramedic who is called upon to care for a pediatric patient. Failure to communicate raises both the human, social and economic costs of medicine.  In today’s podcast, we take a look at what some of the components of an effective resuscitation team are.  benefit from increased access to their medical histories, which reduces chances of medical errors.

 

For most pediatric patients, the cause of cardiac arrest can be traced to a respiratory issue.  In emergencies dealing with children, having impeccable BLS skills is critical.  In this podcast, we take a look at the importance of high quality CPR and other issues that address cardiac arrest in the pediatric patient.

It is important for the paramedic student to understand the pathophysiology that accompanies chest trauma, both blunt and penetrating.  In this podcast, we take a look at:

1.  Simple pneumothorax

2.  Open pneumothorax

3.  Tension pneumothorax

In this week's podcast, you will learn

1.  The pathophysiology behind an asthma attack

2.  The three types of asthma attacks

3.  The role of bronchodilators and corticosterioids in the treatment of asthma.

Additional Resources for Students

The Pathophysiology of Asthma-The Khan Academy

What is Asthma-Dr. Alex Thomas

Paramedic Student Review Questions:

Of the following, which would be considered an extrinsic trigger for an atopic asthma attack?

A.  Viral infection

B.  Bacterial infection

C.  Stress

D. None of the above

The correct answer is C. Stress. The other responses indicate nonatopic asthma triggers and all of them are instrinsic.

 

Why might your bronchodilator not be effective in the status asthmaticus patient?

A.  Medicine is out of date

B.  Severity of the bronchospasm

C.  Rapidity of respiratory rate

D.  Poor cardiac output

The correct answer is B.  Because the bronchospasm is so severe, there may be difficulty in getting the medicine down to the lower bronchioles. 

Trauma has become the most frequent cause of death of the OB patient in the United States. Although maternal mortality due to other causes such as infection, hemorrhage, hypertension, and thromboembolism, has declined over the years, the number of maternal deaths due to penetrating trauma, suicide, homicide and motor vehicle accidents has risen steadily. Accidental injuries occur in 6 to 7 % of all pregnant patients. Penetrating trauma accounts for as many as 36 % of maternal deaths.  In this podcast the student will:

1.  review the statistics that deal with death of mother an baby after trauma;

2.  understand the importance of aggressive resuscitation of the mother as a treatment modality;

3.  grasp the role of IV infusion and its effect on the secretion of oxytocin.

Additional Resources

Bosson, Nichole, et al. “Evaluation of Trauma Triage Criteria Performance in a Regional Trauma System.” Prehospital Emergency Care, 2019, pp. 1–10.

 

Cairo, Sarah B., et al. “Prehospital Education in Triage for Pediatric and Pregnant Patients in a Regional Trauma System without Collocated Pediatric and Adult Trauma Centers.” Journal of Pediatric Surgery, vol. 53, no. 5, 2018, pp. 1037–1041.

 

Nawrocki, Philip S., et al. “Interfacility Transport of the Pregnant Patient: A 5-Year Retrospective Review of a Single Critical Care Transport Program.” Prehospital Emergency Care, vol. 23, no. 3, 2018, pp. 377–384.

 

TMM Review

Your patient is a 25 year, 28 week gestational female.  She has been shot twice in the abdomen.  The best course of action for survival of the fetus would be to

1. apply MAST trousers and inflate the legs only
2. aggressively resuscitate the mother
3. infuse 20 cc/kg of normal saline
4. rapidly transport to the local medical center

The best course of action for the survival of the fetus after any trauma to the mother is to be aggressive in her resuscitation.  Keep in mind that the baby is dependent upon the mother for oxygenation, glucose delivery as well as waste removal.  Any disruption of this could be fatal to the fetus. 

 

A bolus of 20 cc/kg of fluid will stimulate the secretion of what hormone that may help with the reduction of bleeding in the pregnant patient?

1. Oxytocin
2. Vasopressin
3. ADH
4. Epinephrine

Because it is secreted from the same area of the pituitary gland as is vasopressin (also known as anti diuretic hormone or ADH), the administration of a bolus of fluid will stimulate oxytocin. 

Which of the following is the MOST useful in determining the fetal age?

1. Fundal height
2. Abdominal circumference
3. Conception date
4. Date of last menses

Determining fetal age is very useful when considering factors that may influence survival of the baby after an early delivery.  The MOST useful as well as the most accurate is the conception date of the fetus, although this may not be known. 

This is the second part of our Autism and What EMS Needs to Know series.    My guests are Dustin Young, Licensed Clinical Social Worker with the Tillamook Family Counseling Corporation and Nick Watts, Community Paramedic with Tillamook County EMS.  In this week’s presentation the student will

1. Identify the changes in autism as a child transitions into an adult.
2. How autistic patients learn how to self-regulatef their behavior.
3. What EMS should know to minimize confrontations with autistic patients.
4. When to and when not to restrain autistic patients.

Some resources that you might find helpful in learning more about autism include:

Auggies Hope-The idea of Auggie’s Hope is to advocate for Autism. A lot has changed in the past few years but their core belief of advocating for special needs has not. They have grown and continue to focus our mission training first responders on how to help a special needs family in crisis.

Autism Risk Management- Are you searching for autism training curriculum for police and law enforcement? Dennis Debbaudt develops current, relevant, sustainable and memorable autism and law enforcement curriculum and digital video content. Debbaudt has over two decades of experience in autism and law enforcement curriculum development.

National Autism Association-Toolbox of resources for interactions between first responders and patients with autism.