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Emergency Medical Services

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Страница 1 Table of Contents List of Tables List of Illustrations Guide Pages Страница 7Страница 8Страница 9Страница 10 Contributors Страница 12Страница 13Страница 14 CHAPTER 1 History of emergency medical services Before 1966: Historical Perspectives 1966: Accidental Death and Disability: The Neglected Disease of Modern Society Box 1.1 Key findings of the 1966 NAS‐NRC report 1973: The Emergency Medical Services Systems Act Box 1.2 The Fifteen Essential EMS Components. 1973–1978: Rapid Growth of EMS Systems Personnel Physicians Prehospital Clinicians Public Education Communications Transportation Hospitals 1978–1981: EMS at Midpassage Financing Research 1981: The Omnibus Budget Reconciliation Act 1982–1996: Changing Federal Roles Emergency Medical Services for Children Program EMS Physicians 1982‐1996 Training 1982‐1996 Transportation 1982‐1996 1996‐2008: The Role of the Federal Government Matures, the United States Faces Terrorism, and EMS is at the Breaking Point EMS Agenda for the Future Box 1.3 EMS Agenda for the Future attributes of the EMS system. EMS Education for the Future: A Systems Approach National Ambulance Fee Schedule National EMS Information System September 11, 2001 Advocates for EMS Federal Interagency Committee on EMS National EMS Advisory Council Trends in Air Medical Services Institute of Medicine Report on the Future of Emergency Care 2009–2020: A Period of Incremental Progress Subspecialty in EMS Medicine EMS Clinician Education Community Paramedicine National EMS Culture of Safety Project EMS Agenda 2050 Acknowledgment References Страница 56 CHAPTER 2 EMS airway management: system considerations The skills of airway management:an illustrative vingnette Introduction Challenges of airway managementin the field Which airway, when, and how? Considerations for basic airway interventions Considerations for endotracheal intubation Is prehospital ETI associated with improved outcomes? Are adverse events common during prehospital ETI? Should EMTs perform ETI? Should EMS personnel limit the number of ETI attempts? Considerations for drug‐facilitated intubation Considerations for video laryngoscopy Considerations for SGA Considerations for surgical airways Considerations in pediatric airway management Who should manage the airway? Clinician training and competency Airway management protocol development and equipment selection Quality management Research Critical decision making: an illustrative vignette References CHAPTER 3 Airway procedures Introduction Personal protective equipment during airway interventions Basic airway interventions Oxygen cannulas and face masks Bag‐valve‐mask ventilation Demand valve ventilation Oropharyngeal and nasopharyngeal airways Noninvasive positive‐pressure ventilation Advanced airway management Tracheal intubation Orotracheal intubation Video laryngoscopy Nasotracheal intubation Other intubation techniques Supraglottic airways Laryngeal tube Laryngeal Mask Airway (LMA) Other supraglottic airways Surgical airways Cricothyroidotomy Transtracheal jet ventilation Confirmation of airway placement Methods for securing endotracheal tubes and supraglottic airways Drug‐facilitated intubation Rapid sequence intubation RSI technique Sedation Paralysis Sedation‐assisted endotracheal intubation Other drug‐facilitated techniques Conclusion References CHAPTER 4 Airway management: special situations Introduction Ground‐level airway management Face‐to‐face intubation Intubating under low light conditions Minimizing airway management equipment Telemedicine‐assisted airway management Airway management in the tactical setting Providing airway management during combat or tactical operations Surgical airways in the tactical setting Pandemic airway management Conclusion Acknowledgment References Страница 126 CHAPTER 5 Respiratory distress Introduction Prehospital assessment and diagnosis Box 5.1 Common causes of respiratory distress in the EMS setting Pulmonary Cardiovascular Upper Airway Metabolic Toxic Ingestions Other Box 5.2 History and exam findings by disease state. Asthma Chronic Obstructive Pulmonary Disease ADHF with Volume Overload ADHF with Low Cardiac Output State Sympathetic Crashing Acute Pulmonary Edema Pneumonia Pneumothorax Pulmonary Embolism with Infarction Pulmonary Embolism with Saddle Embolism General treatment Asthma Chronic obstructive pulmonary disease Acute decompensated heart failure and SCAPE Pneumonia and infectious respiratory disease Pulmonary embolus Pneumothorax Tracheotomy Summary References CHAPTER 6 Oxygenation and ventilation Introduction Assessment of Oxygenation Assessment of Ventilation Box 6.1 Conditions that impair ventilation Box 6.2 Factors that affect EtCO2 Assisting Oxygenation and Ventilation Noninvasive Positive‐Pressure Support Bag‐Valve‐Mask Ventilation Mechanical Ventilation Modes of Ventilation Ventilator Settings and Troubleshooting Pneumothorax Box 6.3 Conditions associated with pneumothorax Summary References Страница 171 CHAPTER 7 Hypotension and Shock Introduction Pathophysiology Evaluation Box 7.1 Signs and symptoms of shock Additional Modalities to Assess Shock Treatment Hypovolemic Shock Distributive Shock Obstructive Shock Cardiogenic Shock Shock of Unclear Etiology Pediatric Shock Shock Interventions Fluids Ventilation Vasopressors Other Medications Controversies Shock Science Sepsis Hemorrhagic Shock Protocol Conclusion References CHAPTER 8 Vascular access Introduction Benefits Risks PERIPHERAL IV ACCESS History Technique (See Video Clip 8.1) 1. Preparation 2. Site selection 3. Clean the site 4. Insertion of the IV 5. Removing the needle 6. Securing the IV Intraosseous Access Technique (See Video Clip 8.2) 1. Preparation 2. Identify the landmarks and site 3. Clean the site 4. Insert the IO 5. Assess IO patency 6. Secure the IO needle Central intravenous access Special considerations Accessing dialysis catheters and indwelling catheters Other Alternative Vascular Access Points Pediatric considerations Ultrasound‐guided IV access Conclusion References CHAPTER 9 Chest pain and acute coronary syndromes Introduction General approach Box 9.1 Historical aspects of chest discomfort: the PQRST method Role of emergency medical dispatch The 12‐lead electrocardiogram Prehospital electrocardiogram interpretation Box 9.2 Causes of ST‐segment elevation on 12‐lead electrocardiogram Medications Oxygen Aspirin Nitroglycerin Opiate analgesics Beta‐Blockers Prehospital fibrinolysis Systems of care for STEMI Prehospital notification/field cardiac catheterization laboratory Activation EMS transport Destination protocols Air medical evacuation of STEMI patients Expanding the role of basic life support (BLS) clinicians Other common causes of chest discomfort Box 9.3 Causes of chest discomfort that are immediate life threats Aortic dissection Pericarditis Pneumothorax Pulmonary Embolism Esophageal Perforation Summary References CHAPTER 10 Cardiac dysrhythmias Introduction Evaluation Step one: identify symptoms and how they relate to the rhythm Step two: identify stable and unstable patients Step three: classify the electrocardiogram findings Rate Regularity and duration Unstable tachydysrhythmias Step four: focus actions to evaluate stable but symptomatic and borderline patients History Physical examination Stable narrow‐complex tachydysrhythmias Stable wide‐complex tachydysrhythmias Controversies Rhythm strip versus monitor interpretation Synchronization and sedation during countershock Pediatric dysrhythmias Torsades de pointes Rhythm disturbances in renal failure patients Protocols Summary References CHAPTER 11 Cardiac procedures and managing technology Introduction Short‐term mechanical circulatory support devices Intra‐aortic balloon pump Non‐IABP percutaneous mechanical circulatory support devices Extracorporeal membrane oxygenation Long‐term mechanical circulatory support devices Ventricular assist devices Box 11.1 Examples of LVADs by generation First generation (pulsatile blood flow) Second generation (continuous flow) Third generation (centrifugal flow) Fourth generation Box 11.2 Complications encountered in LVAD patients LVAD‐specific complications LVAD‐associated complications Electrical cardiac support devices Pacemakers Box 11.3 Pacemaker codes Implantable cardioverter defibrillators Wearable cardioverter defibrillator Pericardiocentesis Conclusion Acknowledgment References CHAPTER 12 Cardiac arrest systems of care Introduction Epidemiology of Cardiac Arrest Elements of a Community Cardiac Arrest Care System Bystander Recognition of Arrest and Calling for Help Bystander Cardiopulmonary Resuscitation Public‐Access Defibrillation First‐Responder and Basic Life Support Care Basic Life Support Advanced Life Support Communicable Disease Considerations Post‐Resuscitation Care Role of the Medical Director Training and Equipment Optimizing System Design Hospital Liaison Quality Improvement Program Summary References CHAPTER 13 Cardiac arrest: clinical management Introduction Specific interventions Chest compressions Defibrillation Airway management Ventilation Medications Additional therapies Principles of management Resuscitation protocols High‐performance CPR: the pit crew approach When to initiate transport COVID‐19 considerations Withholding resuscitation Dead on arrival Termination of resuscitation Post cardiac arrest care Cardiac arrest referral centers Summary References Страница 332 CHAPTER 14 The challenge of the undifferentiated patient Introduction The Call‐Taking Process En Route to the Patient History Taking Physical Examination Adjuncts to the History and Physical Examination: Prehospital Diagnostic Tests The truly Undifferentiated Patient Transition of Care to the Receiving Facility Consequences of an Undifferentiated Condition Strategies for Minimizing Errors in Clinical Reasoning Conclusion References CHAPTER 15 Altered mental status Introduction Assessing mental status Approach to the patient with AMS Airway, ventilation, and oxygenation Other vital signs Physical exam Head Neck Chest Abdomen Neurological Skin Historical and environmental clues Initial management Presentations, etiologies, and treatments Box 15.1 Mnemonic for causes of altered mental status Pediatric altered mental status Alcohol Time‐critical causes On‐scene treatments and dispositions Box 15.2 Causes of altered mental status in alcoholics Glucose evaluation and administration Opioid overdose Refusal of care after resolution of AMS Conclusion References CHAPTER 16 Syncope Introduction Pathophysiology Assessment Differential diagnosis Treatment Disposition Summary References CHAPTER 17 Seizures Introduction Pathophysiology Differential diagnosis Box 17.1 Differential diagnosis of seizures in adults Classification of seizure types Box 17.2 Classification of seizure types Symptomatic seizures Febrile seizures Status epilepticus Box 17.3 Proposed terminology: status epilepticus Box 17.4 Differential diagnosis of generalized convulsive status epilepticus EMS evaluation and response Box 17.5 Initial EMS approach to a patient with generalized seizures Pharmacological interventions Box 17.6 Initial benzodiazepine dosing for generalized convulsive status epilepticus in adults Box 17.7 Initial benzodiazepine dosing for generalized convulsive status epilepticus in children Seizure‐associated trauma Continuing management Refractory generalized convulsive status epilepticus Conclusion References CHAPTER 18 Stroke Introduction Emergency medical dispatch Prehospital care Box 18.1 Mimics of stroke Box 18.2 Inclusion and exclusion criteria for intravenous tPA Inclusion criteria Exclusion criteria Relative contraindications Relative contraindications for the 3‐ to 4.5‐h treatment window Definitive treatment options Box 18.3 Time interval goals for fibrinolytic therapy EMS transport Innovations in prehospital stroke management Disparities Summary Acknowledgments References CHAPTER 19 Abdominal pain Introduction Approach to the patient with abdominal pain Anatomy and physiology considerations Box 19.2 Systemic causes of abdominal pain History and physical examination Box 19.3 Etiologies of abdominal pain by anatomical location Right upper quadrant Right lower quadrant Left upper quadrant Left lower quadrant Box 19.4 OPQRST questions in abdominal pain Management Disposition Special populations Elderly Females of Childbearing Age Children Immunocompromised Obesity and bariatric surgery patients Summary References CHAPTER 20 Diabetic emergencies Introduction Prehospital assessment General Other considerations Measurement of glucose Prehospital treatment Hypoglycemia Hyperglycemia Pediatric Considerations Pregnancy Medication overdose Disposition Protocols Summary References CHAPTER 21 Allergic reactions Introduction Physiology of allergic reactions Box 21.1 Types of hypersensitivity reactions and anaphylaxis production Box 21.2 Definition of anaphylaxis Causative agents Assessment and general approach Prehospital treatment Box 21.3 Common causes of allergic reactions Medications Foods Stings/bites Environmental exposures Special considerations Conclusion References CHAPTER 22 Renal failure and dialysis Introduction A brief review Renal replacement therapy Hemodialysis Peritoneal dialysis Renal transplant Complications of renal disease Fluid overload Potassium Magnesium Pericarditis Cardiovascular disease Hematologic Infection Rhabdomyolysis Complications of hemodialysis Hypotension Air embolism Uncontrolled hemorrhage from shunt site Disequilibrium syndrome Complications of peritoneal dialysis Special considerations The missed dialysis patient Hyperkalemia Rapid sequence intubation and hyperkalemia Use of dialysis access for resuscitation EMS pearls Focused history Destination selection Resource planning Convalescent Transportation References CHAPTER 23 Infectious and communicable diseases Introduction EMS Clinician and Patient General Approach and Patient Assessment Specific Illnesses Influenza Avian Influenza Tuberculosis Coronaviruses Biological Weapons Anthrax Box 23.1 Centers for Disease Control and Prevention categorization of bioterrorism agents Category A Category B Category C Botulism Plague Smallpox Tularemia Viral Hemorrhagic Fevers Varicella Zoster Virus Meningococcal Meningitis Conclusion References CHAPTER 24 Choking Introduction Pathophysiology and epidemiology Patient assessment Management Medical oversight considerations Controversies Summary References {buyButton}

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