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Endocrinology Gastrointestinal Disorders Renal-Urology Disorders Rhythm Review PowerPoint Presentation

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Description : Check out this medical titled "Endocrinology, Gastrointestinal Disorders, Renal/Urology Disorders, Rhythm Review" by S. Hopkins, RN, BSN, EMT-P.

This medical talks about endocrinology, the study of the endocrine system, which is responsible for producing and secreting hormones that regulate various physiological functions in the body. Some common endocrine disorders include diabetes, thyroid disorders, adrenal gland disorders, and pituitary gland disorders.

Gastrointestinal Disorders: Gastrointestinal disorders refer to a range of conditions that affect the digestive system, including the esophagus, stomach, intestines, liver, pancreas, and gallbladder. Some common gastrointestinal disorders include acid reflux, inflammatory bowel disease, irritable bowel syndrome, celiac disease, and colon cancer.

Renal/Urology Disorders: Renal/urology disorders refer to conditions that affect the kidneys, bladder, and urinary tract. Some common renal/urology disorders include urinary tract infections, kidney stones, bladder cancer, prostate cancer, and chronic kidney disease.

Rhythm: In the medical context, rhythm refers to the regularity or irregularity of various bodily functions, including the heartbeat, breathing, and sleep-wake cycles. Abnormal rhythms in these functions can be indicative of underlying health conditions, such as arrhythmia or sleep apnea.

Tags : endocrinology, endocrine system, diabetes, thyroid disorders, adrenal gland disorders, pituitary gland disorders, Gastrointestinal Disorders, Renal Disorders, Urology Disorders, arrhythmia, sleep apnea, endocrinology

Published on : Apr 21, 2023 | Views : 1474 | Downloads : 1

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Slide 1-

Endocrinology, Gastrointestinal Disorders, Renal/Urology Disorders, Rhythm Review Condell Medical Center EMS System ECRN CE Prepared by: S. Hopkins, RN, BSN, EMT-P
Slide 2-

Objectives Upon successful completion of this module, the ECRN should be able to: identify the function of the endocrine system distinguish a variety of medical disorders of the endocrine system describe the type of pain experienced for gastrointestinal and genitourinary disorders identify and appropriately state interventions for a variety of EKG rhythms understand a variety of Region X SOP’s and the ECRN impact successfully complete the quiz with a score of > 80%
Slide 3-

Endocrine System Composed of glands that secrete hormones into the circulatory system Helps regulate various metabolic functions Hormones function in a lock and key fashion All hormones operate within a feedback system
Slide 4-

Hormones Act on target organs elsewhere in the body Control and coordinate wide spread processes on organs, tissues, or general effects on the entire body homeostasis reproduction growth & development metabolism response to stress
Slide 5-

Endocrine Glands Hypothalamus located deep within the cerebrum of the brain; serves as a connection between the central nervous system (CNS) and the endocrine system secretes hormones that make other endocrine glands secrete hormones Pituitary - anterior & posterior located in the brain; size of a pea secretes hormones essential to growth, reproduction, and water balance in the body
Slide 6-

Endocrine Glands cont’d Thyroid 2 lobes located in anterior neck plays important role in controlling metabolism Parathyroid normally 4 glands found next to thyroid gland secretes hormone to increase blood calcium levels
Slide 7-

Endocrine Glands cont’d Thymus gland located in mediastinum behind sternum during childhood secretes a hormone critical in maturing T lymphocytes (cells responsible for cell-mediated immunity) Pancreas located in upper retroperitoneum behind stomach secretes digestive enzymes for digestion of fats & proteins controls production or inhibition of the hormones glucagon & insulin
Slide 8-

Endocrine Glands cont’d Adrenal gland located on superior surface of each kidney adrenal medulla - secretes the catecholamine hormones epinephrine & norepinephrine adrenal cortex - secretes 3 steroidal hormones Gonads chief responsibility for sexual maturation or puberty and subsequent reproduction ovaries produce eggs testes produce sperm
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Regulation of Hormone Secretion Hormones operate within a positive or negative feedback system to maintain homeostasis Negative feedback Most common feedback mechanism Usually refers to an increase in the serum level of hormone or hormone-related substance that suppresses further hormone output Hormone production is stimulated when the serum levels fall
Slide 11-

Negative Feedback Mechanism
Slide 12-

Specific Disorders of the Endocrine System Disorders of the endocrine system arise from: the effects of an imbalance in the production of one or more hormones the effects of an alteration in the body’s ability to use the hormones produced
Slide 13-

Specific Disorders of the Endocrine System Clinical effects of endocrine gland imbalance are determined by: the degree of dysfunction the age and gender of the affected person
Slide 14-

Disorders of The Thyroid Gland Usually seen more as part of the medical history than as a medical emergency Complications of thyroid disorders more likely to be seen hyperthyroidism - too much thyroid hormone in the blood (goiter) thyrotoxicosis - prolonged exposure to excess thyroid hormones (Grave’s disease) hypothyroidism - inadequate thyroid hormone myxedema - long term exposure to inadequate levels of thyroid hormones
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Grave’s Disease A type of excessive thyroid activity characterized by a generalized enlargement of the gland (goiter), leading to a swollen neck and often protruding eyes (exophthalmos) More common in women than men (6 times) Typical onset young adulthood (20’s & 30’s) May be due to an autoimmune process in which an antibody stimulates the thyroid cells Strong hereditary role in predisposition of the disorder
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Slide 19-

Grave’s Disease Impact on EMS providers & ED staff cardiac dysfunction is a common event prompting an ED visit tachycardia or new-onset atrial fibrillation in absence of cardiac history Other signs & symptoms agitation, emotional changeability, insomnia, poor heat tolerance, weight loss with increased appetite, weakness, dyspnea
Slide 20-

Thyrotoxicosis A term that refers to any toxic condition that results from prolonged excess thyroid hormone Thyroid storm is a heightened and life-threatening manifestation of thyroid hyperfunction A relatively rare condition; can be fatal Usually associated with exposure to physiological stress (trauma, infection) signs & symptoms indicate extreme hypermetabolic state (high fever (1060F), irritability, delirium or coma, tachycardia, hypotension, vomiting, diarrhea) EMS field care - supportive, rapid transport
Slide 21-

Myxedema Rare condition of long term exposure to inadequate levels thyroid hormones 4 times more common in women Low metabolic state with poor organ function Lethargy, cold intolerance,  mental function, puffy face, thin hair, pale & cool skin Triggers for myxedema coma infection, trauma, cold temp
Slide 22-

Myxedema Coma Myxedema coma difficult to identify Impact on EMS providers & ED staff Heart failure not uncommon Focus on maintenance of ABC’s Monitor pulmonary and cardiac systems closely Rapid transport from the field is important Active rewarming in field not indicated may cause cardiac dysrhythmias vasodilation may cause cardiovascular collapse
Slide 23-

Disorders of Adrenal Glands Adrenal cortex - outer portion of adrenal gland Secretes steroidal hormones glucocorticoids - increase blood glucose levels mineralocorticoids - contributes to salt & fluid balance androgenic hormones - influences similar to the gonads (role in puberty and reproduction) Two medical emergencies of the adrenal cortex Cushing’s syndrome Addison’s disease
Slide 24-

Cushing’s Syndrome Caused by an abnormally high circulating level of corticosteroid hormones produced naturally by the adrenal glands May be produced: Directly by an adrenal gland tumor By prolonged administration of corticosteroid drugs (ie: Prednisone, hydrocortisone) By enlargement of both adrenal glands due to a pituitary tumor Relatively common problem of adrenals
Slide 25-

Kidneys Adrenal glands Adrenal glands
Slide 26-

Cushing’s Syndrome Characteristic appearance Face appears round (“moon-faced”) and red Trunk tends to become obese from disturbances in fat metabolism; “buffalo hump” on back Limbs become wasted from muscle atrophy Mood swings , impaired concentration Purple stretch marks may appear on the abdomen, thighs, and breasts Skin often thins and bruises easily Weakened bones are at increased risk for fracture
Slide 27-

Moon Face
Slide 28-

Cushing’s Syndrome Signs & Symptoms
Slide 29-

Management of Cushing’s Syndrome FYI: higher incidence of cardiovascular disease stroke hypertension Fragile skin caution with IV starts handle the patient carefully to avoid trauma to their skin Treat symptoms as presented
Slide 30-

Addison’s Disease Pathophysiology Reduction in Adrenal steroids Glucocorticoids Mineralocorticoids Androgens Most common cause is idiopathic atrophy of adrenal tissue (cause unknown) Less common causes include hemorrhage, infarctions, fungal infections, auto immune disease, therapy with steroids (ie: prednisone)
Slide 31-

Addison’s Disease Signs and symptoms Progressive weakness, fatigue Decreased appetite & weight loss Hyperpigmentation of skin, especially over sun-exposed skin areas Disturbances in water & electrolyte balance Low blood volume EKG changes Abrupt stoppage of steroids may trigger Addisonian crisis with cardiovascular collapse
Slide 32-

Addison’s Disease Management Evaluate ABC’s & correct issues Cardiac status - watch for dysrhythmias and circulatory collapse Fluid resuscitation Respiratory status - evaluate SaO2 levels Blood glucose levels Hypoglycemia very common
Slide 33-

Diabetes Mellitus Disease marked by inadequate insulin activity in the body Glucose is important to all body cells but critical for the brain Glucose only substance used by the brain for energy Insulin maintains normal blood glucose levels Enables body to store energy as glycogen, protein & fats Action of insulin allows glucose to flow into cells
Slide 34-

Typical Blood Glucose Levels Healthy persons Overnight fast - 80-90 mg/dL 1st hour after a meal - 120-140 mg/dL <80mg/dL reflects hypoglycemia >140 mg/dL reflects hyperglycemia Intervention necessary Hypoglycemia -blood glucose <60 mg/dL Hyperglycemia - blood glucose >300mg/dL not uncommon
Slide 35-

Type I Diabetes Low or absent production of insulin in the pancreas Too much sugar, not enough insulin Patients require supplemental insulin If untreated, glucose levels rise excess glucose spills into urine; patient loses large amounts of water (becomes dehydrated); fatty acids used as energy source resulting in ketosis from fat catabolism
Slide 36-

Untreated Type I Diabetes Signs & symptoms due to elevated blood glucose levels Polydipsia (constant thirst) Polyuria (excessive urination) Polyphagia (ravenous appetite) Weakness Weight loss Above signs & symptoms are what usually prompt people to seek a medical checkup for “not feeling well”
Slide 37-

Type II Diabetes More common than Type I diabetes (90% of cases) Moderate decline in insulin production and inefficient use of the insulin that is produced Risk factors: heredity, obesity Treatment: dietary changes, increased exercise, oral hypoglycemics (to stimulate insulin production), possible addition of insulin if necessary
Slide 38-

Diabetic Ketoacidosis(Diabetic Coma) Too much sugar, not enough insulin Onset slow (12 - 24 hours) Increased urination; dehydration (warm, dry skin) Excessive hunger and thirst Tachycardia & weakness (volume depletion) Ketoacidosis  Kussmaul’s respirations (deep and rapid) to exhale & get rid of increased CO2 levels (an acid) Decline in mental function Low potassium - cardiac dysrhythmias
Slide 39-

Diabetic Coma - Hyperglycemia ABC’s addressed Search for medic alert bracelet (EMS should check for insulin in refrigerator at home) Elevated blood glucose levels (not uncommon to be >300) Fluid resuscitation to treat dehydration The higher the glucose level, the more critical the situation and the sicker the patient
Slide 40-

Insulin Shock - Hypoglycemia Too much insulin, not enough sugar Onset rapid Bizarre, unusual, inappropriate behavior Diaphoretic, tachycardic Seizures at critically low glucose levels These seizures are most effectively treated by administering Dextrose to restore the glucose levels Rapid recovery with correct treatment supplemental glucose
Slide 41-

Insulin Shock - Hypoglycemia ABC’s addressed Search for medical alert bracelet (EMS to check for insulin in refrigerator at home) Treated when blood sugar drops below 60 Obtain IV access to administer dextrose (EMS dosing) Adult - D50% (50 ml) Child (1to 15) - D25% (2 ml/kg) Child <1 - D12.5% (4 ml/kg) 1:1 dilution of D25% and normal saline Lack of IV access (EMS dosing protocol) Glucagon IM: adult 1 mg; peds 0.1 mg/kg (max 1mg)
Slide 42-

Glucagon vs Dextrose Glucagon a hormone, not a sugar helps release stores of sugar if there are any in the liver; does not supply sugar itself is not always effective; can take up to 20 minutes EMS calls and states they had no IV access, Glucagon was given, patient remains with an altered level of consciousness and now they have IV access. Can they give Dextrose IVP? The ECRN should order EMS to recheck the glucose level and, if indicated (<60), administer Dextrose
Slide 43-

Gestational Diabetes Onset can occur during pregnancy While pregnant, most women require 2-3 times more insulin than would usually be required when not pregnant During pregnancy, must be treated with insulin vs oral medication insulin does not cross placental barrier; oral diabetic medication does After delivery blood glucose levels usually return to normal
Slide 44-

Gastrointestinal System
Slide 45-

Gastrointestinal Emergencies GI system includes from the mouth to anus and all parts in between Risk factors for disease (usually self-induced) excessive alcohol consumption excessive smoking increased stress ingestion of caustic substances poor bowel habits Pain is the hallmark of acute abdominal problems visceral, somatic, or referred
Slide 46-

Visceral Pain Caused by inflammation, distention (inflation of the organ), or ischemia (inadequate blood flow) Pain vague, dull, or crampy Is generally diffuse and difficult to localize Examples (most often hollow organs) gallbladder (cholecystitis) appendix (appendicitis) Presentation (from sympathetic stimulation) nausea & vomiting diaphoresis tachycardia
Slide 47-

Somatic Pain Produced by bacterial or chemical irritation of nerve fibers in the peritoneum (peritonitis) Is usually constant and localized to a specific area Often described as sharp or stabbing Examples ruptured appendix perforated ulcer inflamed pancreas Peritonitis can lead to sepsis & death
Slide 48-

Somatic Pain Presentation Patient often hesitant to move Lies on their back or side with legs flexed to prevent additional pain from stimulation of the peritoneal area Often exhibits involuntary guarding of the abdomen Rebound tenderness often noted during the physical examination
Slide 49-

Referred Pain Pain in a part of the body considerably removed from the tissues that cause the pain Results from neural pathways from various organs passing thru or over a region where the organ was initially formed in the fetal stage Examples diaphragm injury refers pain to neck or shoulders dissecting abdominal aneurysm refers pain between shoulder blades appendicitis refers pain to periumbilical area gallbladder refers pain to right shoulder
Slide 50-

Referred Pain: Anterior View
Slide 51-

Referred Pain: Posterior View
Slide 52-

Disease Entities Upper GI Disease: Gastroenteritis Gastritis Peptic ulcer disease Lower GI Disease: Colitis Crohn’s disease Diverticulitis Bowel obstruction Other Organ Disease: Appendicitis Cholecystitis Pancreatitis Acute hepatitis
Slide 53-

Gastroenteritis Inflammation of the stomach and intestines that accompanies numerous GI disorders Causes: bacteria or viral infections, chemical toxins, and other conditions Signs and symptoms: anorexia (loss of appetite), nausea, vomiting, abdominal pain EMS Field Management supportive
Slide 54-

Gastritis An acute or chronic inflammation of the gastric mucosa Causes hyperacidity alcohol or drug ingestion infection Signs and symptoms: epigastric pain nausea and vomiting bleeding
Slide 55-

Peptic Ulcer Disease Erosions in the GI tract from gastric acid Duodenal ulcers - most frequently in proximal duodenum most common 25-50 years old & in those under stress pain at night when the stomach is empty Gastric ulcers - in the stomach more common over 50 years of age & in jobs requiring physical activity usually no pain at night; pain on full stomach
Slide 56-

Peptic Ulcer Disease Causes of peptic ulcer disease H. pylori infection (treated with antibiotics) Nonsteroidal anti-inflammatory drug use aspirin, Motrin, Advil Acid stimulating products alcohol, nicotine Acid secreting tumor Zollinger-Ellison syndrome
Slide 57-

Colitis An inflammatory condition of the large intestine characterized by severe diarrhea and ulceration of the mucosa of the intestine (ulcerative colitis) Incidence - most often 20-40 year olds Cause is unknown Signs and symptoms Nausea, vomiting, weight loss Significant pain - cramping & colicky Grossly bloody stools or stool containing mucus
Slide 58-

Crohn’s Disease A chronic, inflammatory bowel disease thought to be of autoimmune etiology, usually affecting the ileum, the colon, or both structures Exact cause unknown Most prevalent in: white females, those under stress, and in the Jewish population The diseased segments associated with Crohn’s disease may be separated by normal bowel segments or skip areas Formation of fistulas from the diseased bowel to the anus, vagina, skin surface, or to other loops of bowel are common
Slide 59-

Crohn’s Disease Signs and symptoms: GI bleeding frequent diarrhea abdominal cramping diffuse abdominal pain nausea/vomiting/diarrhea fever and chills weakness, anorexia, weight loss
Slide 60-

Diverticulitis A diverticulum is a sac or pouch that develops in the wall of the colon Common development with advancing years Associated with diets low in fiber Diverticulitis is inflammation of diverticula Signs and symptoms: Fever, anorexia, nausea, lower left sided pain, bright-red rectal bleeding Complications: Hypovolemic shock and sepsis
Slide 61-

Bowel Obstruction A partial or complete blockage of the large or small intestines Causes: adhesions, hernias, fecal impaction, polyps, tumors Signs and symptoms: decreased appetite, nausea and vomiting, diffuse abdominal pain, constipation, and abdominal distention If untreated can lead to death
Slide 62-

Appendicitis A common abdominal emergency that occurs when the opening between the lumen of the appendix and the cecum is obstructed by fecal material or from inflammation from viral or bacterial infection Signs and symptoms: early abdominal pain is diffuse, colicky, & in periumbilical area (later RLQ), abdominal tenderness & guarding, nausea, vomiting, chills, low-grade fever, anorexia If ruptured, increased risk of peritonitis
Slide 63-

Cholecystitis Inflammation of the gallbladder, most often associated with the presence of gallstones Incidence more common in women 30-50 Signs & symptoms pain, often colicky, in RUQ with referral to right shoulder pain often after high fat content meal nausea, vomiting common pale, cool, clammy skin (sympathetic response) Giving Morphine may increase spasms
Slide 64-

Pancreatitis Inflammation of the pancreas Alcoholism causes 80% of cases in the USA Signs and symptoms: severe abdominal pain localized to LUQ or referred to back or epigastric area nausea and uncontrolled vomiting & retching abdominal tenderness and distention fever, tachycardia, diaphoresis sepsis & shock possible, 30-40% mortality
Slide 65-

Acute Hepatitis Inflammation of the liver Signs & symptoms related to severity of disease Associated with the sudden onset of malaise, weakness, anorexia, intermittent nausea and vomiting, and dull right upper quadrant pain or referral to right shoulder Usually followed within 1 week by the onset of jaundice of skin & sclera, dark urine, clay colored stool
Slide 66-

Risk Factors for Hepatitis A Spread by fecal-oral route Health care practice without BSI (body substance isolation) or infection control precautions Household or sexual contact with an infected person Living in an area with HAV outbreak Traveling to developing countries Poor handwashing hygiene practice especially after toileting Disease often self-limiting, lasts 2-8 weeks, low mortality rate
Slide 67-

Risk Factors for Hepatitis B “Serum hepatitis” transmitted as bloodborne pathogen - can stay active in body fluids outside body for days Health care practice without infection control precautions Infant born to HBV infected mother Engaging in sex with infected partners and/or multiple partners Drug use by injection Patients receiving hemodialysis Incidence  with vaccine use
Slide 68-

Risk Factors for Hepatitis C Health care practice without infection control precautions Blood transfusion recipients before July 1992 Engaging in sex with infected partners and/or multiple partners Drug use by injection Patients receiving hemodialysis #1 reason for liver transplant need in USA Currently no vaccine 1991
Slide 69-

Abdominal Pain - What Could It Be? Naval area small intestine appendix Upper middle abdomen (called “epigastric” area) stomach disorders Left upper quadrant uncommon area for pain colon, stomach, spleen, pancreas Right upper quadrant gallbaldder, liver Lower middle abdomen colon disorder for women: UTI, PID Lower left abdomen lower colon Lower right abdomen colon, appendicitis Right shoulder gallbladder Between shoulder blades pancreas
Slide 70-

Assessing Abdominal Pain Onset - when did it begin Provocation/palliation - what makes the pain worse/better Quality - described in the patient’s own words Region/radiation - if the patient can use one finger the pain is localized; if the patient rubs their hands over the general entire abdomen it is diffuse Severity - on a scale of 0-10 (0 being no pain and 10 being the worse) Time - how long has the pain been present?
Slide 71-

Management of GI Problems Majority of care is supportive and aimed at treating signs and symptoms presented Position of comfort with ability to protect airway in the case of vomiting Abdominal pain control - EMS needs to contact medical control for medication orders (Morphine 2 mg IVP every 2 minutes, max 10 mg) IV to replace fluid loss (vomiting, diarrhea, internal hemorrhage) Shock (hypovolemic, septic) possible and then aggressive care required
Slide 72-

Renal/ Urology System Functions of the urinary system maintains blood volume maintains proper balance of water, electrolytes and pH retains key compounds in the bloodstream excretes waste controls arterial blood pressure Leading causes of end-stage renal failure poorly controlled diabetes uncontrolled or inadequately controlled  B/P
Slide 73-

Renal Calculus (Kidney Stones)
Slide 74-

Renal Calculus Crystal aggregation in kidney’s collecting system Severe pain due to movement of stone through the urinary system Kidney stones recognized as one of the most painful of human problems Pain starts subtle and quickly escalates
Slide 75-

Kidney Stone Pain starts vague over 1 flank & quickly becomes sharp in flank and radiating down and around toward the groin Patient agitated, uncomfortable, restless Skin cool, pale, clammy B/P and heart rate elevated due to pain Nausea & vomiting due to pain
Slide 76-

EMS Management-Kidney Stones Majority of care is supportive and aimed at treating signs and symptoms presented Position of comfort with ability to protect airway in the case of vomiting Flank pain - EMS needs to contact medical control for medication orders (ie: morphine) (Abdominal/Flank Pain SOP) If patient is unstable with B/P <100mmHg, establish IV sites and give fluid challenge (200 ml increments)
Slide 77-

Prevention Strategies for Renal Calculus Increase water consumption Take daily supplements of Vitamin B6 and magnesium (to reduce formation of oxalates) Avoid foods that raise uric acid levels (ie: anchovies, sardines) Reduce uric acid by eating a low-protein diet Limit salt intake to reduce the level of calcium oxalate in the urine Avoid foods containing calcium oxalate (ie: chocolate, celery, grapes, strawberries, beans, asparagus
Slide 78-

Identifying a variety of EKG rhythms and knowing the Region X SOP for that particular rhythm
Slide 79-

Rhythm Identification What is this rhythm? What is your intervention?
Slide 80-

Ventricular Tachycardia If stable with pulse: Amiodarone 150 mg diluted in 100 ml D5W IVPB over 20 minutes or (EMS choice) Lidocaine 0.75 mg/kg IVP bolus Contact Medical Control for further bolus/drip orders If no pulse - treat like ventricular fibrillation emphasis on good quality CPR switch CPR compressor every 2 minutes to keep CPR effective all shocks given at max joules & singular
Slide 81-

Rhythm Identification What is this rhythm? What intervention is necessary?
Slide 82-

EMS Tx-Ventricular Fibrillation If arrest <4-5 minutes, CPR until defibrillator ready If arrest >4-5 minutes, CPR for 2 minutes Single shocks at max output of unit Epinephrine 1:10,000 1 mg every 3-5 minutes EMS choice of one antidysrhythmic alternated with Epinephrine: Amiodarone 300 mg rapid IVP 1st dose repeat 150 mg IVP in 5 minutes (2nd dose) OR Lidocaine 1.5 mg/kg IVP 1st dose repeat 0.75 mg/kg in 5 minutes (2nd dose)
Slide 83-

What is this rhythm? What intervention is necessary? Rhythm Identification
Slide 84-

EMS Tx-Third Degree Heart Block If stable patient (B/P & LOC) - monitor If unstable patient & narrow complex (QRS) Atropine 0.5 mg rapid IVP May repeat every 3-5 minutes to max of 3mg TCP if Atropine not effective If unstable patient & wide complex (QRS) Begin TCP (Valium for comfort) If TCP ineffective, then Atropine 0.5 mg repeated every 3-5 minutes to a max of 3 mg “When they’re alive, give them 0.5”
Slide 85-

Rhythm Identification What is this rhythm?
Slide 86-

EMS Tx-Third Degree Heart Block (Complete) In bradycardias, always need to ask 2 questions: #1 - Is the patient stable or unstable? Stable needs monitoring Unstable needs intervention #2 - Is the QRS narrow or wide? Narrow treated initially with Atropine Wide treated initially with TCP
Slide 87-

Rhythm Identification What is this rhythm? What intervention is necessary?
Slide 88-

EMS Tx-Second Degree Type II If stable patient - monitor If unstable patient & narrow complex (QRS) Atropine 0.5 mg rapid IVP May repeat every 3-5 minutes to max of 3mg TCP if Atropine not effective If unstable patient & wide complex (QRS) Begin TCP (Valium for comfort) If TCP ineffective, then Atropine 0.5 mg repeated every 3-5 minutes to a max of 3 mg “When they’re alive, give them 0.5”
Slide 89-

Rhythm Identification What is this rhythm? What intervention is necessary?
Slide 90-

Second Degree Type I - Wenckebach If stable patient - monitor If unstable patient & narrow complex (QRS) Atropine 0.5 mg rapid IVP May repeat every 3-5 minutes to max of 3mg TCP if Atropine not effective If unstable patient & wide complex (QRS) Begin TCP (Valium for comfort) If TCP ineffective, then Atropine 0.5 mg repeated every 3-5 minutes to a max of 3 mg “When they’re alive, give them 0.5”
Slide 91-

Rhythm Identification What is this rhythm (the patient has no pulse)? What intervention is necessary? There is no pulse!
Slide 92-

EMS Tx - PEA (rate under 60) Emphasis will be on good quality CPR CPR is 30:2 (compressions to ventilations) After intubation, breaths delivered once every 6-8 seconds, compressor doesn’t stop Search for causes (6 H’s, 5 T’s) & treat them! Epinephrine 1:10,000 1 mg every 3-5 minutes If rate <60, Atropine 1 mg every 3-5 minutes (max 3 mg) If rate >60, just Epinephrine & good CPR
Slide 93-

Scenario #1 EMS calls with report of a 56 year-old female with left sided abdominal pain Based on the report, the ED MD informs you to tell EMS they must transport this patient to the closest facility. The patient is alert and oriented and requests transport to a farther hospital Can the ED MD force EMS to transport this patient to the closest facility?
Slide 94-

Scenario #1 A patient who is alert and oriented and can understand the risks and benefits has the right to request and expect transportation to the facility of their choice EMS should have the patient sign the release for not going to the closest facility Time should not be wasted in the field arguing with a patient about the facility to transport to As in the ED, not all patients make the same choice you would for healthcare issues but they do have the right to make THEIR choice
Slide 95-

Scenario #2 EMS is on the scene with a patient who had a diabetic reaction with a blood sugar initially of 45. The current blood sugar is now 80. EMS calls to inform the ED that they are obtaining a release/refusal for further care and transportation How is the ECRN to respond to this radio call?
Slide 96-

Scenario #2 Verify if EMS needed any special orders Often times EMS calls in to document that Medical Control was aware of the release especially if there was something unusual about the call Releases/refusals/AMA’s in the field can be obtained in regards to assessment, treatment, and/or transportation of the patient
Slide 97-

Scenario #3 EMS calls in and reports that they have a critical patient and will be providing an abbreviated radio report What does it mean to receive an abbreviated report and what information can you expect to receive as the ECRN?
Slide 98-

Scenario #3 An abbreviated radio report (SOP page #4) may be provided to Medical Control in situations where manpower is limited and/or the patient’s condition is critical Time in the field is more importantly spent with all focus on caring for the patient; often all available personnel need to be caring for the patient and the driver needs to focus on driving to get everyone to the hospital as safe and fast as possible
Slide 99-

Scenario #3 Contents of an abbreviated radio report Identification of provider name, vehicle number and receiving hospital Nature of situation and protocol being followed Age and sex of patient Chief complaint and brief history of present illness/injury Airway and vascular access status Current vital signs Major interventions completed or being attempted ETA to receiving hospital EMS to provide detailed information upon ED arrival
Slide 100-

THE END Complete quiz and return ASAP