All EMT Field Impressions

Apneic and pulseless

Symptoms: Apnea and pulselessness

Treatment: High quality CPR and rapid defibrillatio

Foreign body airway obstruction

Symptoms: Noisy breathing, coughing, stridor, universal choking hand signal

*do not treat if coughing

Asthma

Symptoms: Inspiratory/expiratory wheezing (often both in geriatrics), bronchospasms

Treatment: Oxygen, assist with use of patient's metered-dose inhaler or small volume nebulizer (med control), suction if necessary

Anaphylaxis

Symptoms: Flushed skin, urticaria (hives), generalized edema, hypotension, laryngeal edema with dyspnea, wheezing or stridor

Treatment: Oxygen, assist with use of patient's epinephrine auto-injector, suction if necessary

Bronchiolitis

Symptoms: SOB, wheezing, coughing, fever, dehydration, tachypnea, tachycardia

Treatment: Oxygen, BVM if indicated by tachypnea

Bronchitis

Symptoms: Chronic productive cough, wheezing, cyanosis, tachypnea

Treatment: Oxygen, BVM if indicated by tachypnea

Congestive heart failure (CHF)

Symptoms: Dependent edema, crackles (pulmonary edema)/wheezing, orthopnea (dyspnea while lying down), paroxysmal nocturnal dyspnea (severe SOB after hours of reclining), abdominal distension, tachycardia, tachypnea, anxiety, ashen/cyanotic, JVD, SOB, coughing can be present (especially while supine), pink frothy sputum

Treatment: Oxygen, fowler's/semi-fowler's position, suction secretions if necessary, CPAP

Common cold

Symptoms: Cough, runny/stuffy nose, sore throat

COVID-19 (SARS-CoV-2)

Symptoms: Cough, fever, dyspnea, chest pain, anosmia (inability to smell)

Treatment: Oxygen

Croup*

Symptoms: Fever, barking cough, stridor

*Mostly seen in pediatric patients

Diptheria

Symptoms: Difficulty breathing and swallowing, sore throat, thick & gray buildup in throat or nose, fever

Treatment: Oxygen

Emphysema*

Symptoms: Barrel chest, pursed lip breathing, dyspnea on exertion, cyanosis, wheezing/diminished breath sounds, tripod position

Treatment: Oxygen, CPAP

*Mostly seen in older patients

Epiglottitis*

Symptoms: Dyspnea, high fever, stridor, drooling, difficulty swallowing, severe sore throat, tripod or sniffing position

Treatment: Oxygen

*Mostly seen in pediatric patients

Pertussis (whooping cough)

Symptoms: Coughing spells, whooping sound, fever

Pneumonia

Symptoms: Dyspnea, chills/fever, cough, green/red/rust-colored sputum, localized wheezing of crackles

Treatment: Oxygen, suction if indicated

Pneumothorax*

Symptoms: Sudden chest pain with dyspnea, diminished breath sounds on affected side, subcutaneous emphysema, pleuritic chest pain

Treatment: Oxygen, if open- cover opening with occlusive dressing and tape 3/4 sides, fowler's/semi-fowler's

*More common during rigorous exercise

Pulmonary Embolism*

Symptoms: Dyspnea, acute sharp chest pain (occasional), sudden onset, tachycardia, clear breath sounds initially, tachypnea, hypoxia, cyanosis, hemotysis

Treatment: Oxygen, suction if necessary, fowler's/semi-fowler's

*Can happen after giving birth

Tension Pneumothorax

Symptoms: Severe SOB, diminished/absent breath sounds on one side, decreased/altered LOC, JVD, tracheal deviation (late sign), hypotension, signs of shock

Treatment: Oxygen, BVM, shock treatment, if open- cover opening with occlusive dressing and tape 3/4 sides, fowler's/semi-fowler's

Respiratory syncytial virus (RSV)

Symptoms: Cough, wheezing, fever, dehydration

Tuberculosis (TB)

Symptoms: Cough, fever, fatigue, productive/bloody sputum

Chronic obstructive pulmonary disease (COPD)

Symptoms: Accessory muscle use, emphysema, chronic bronchitis, possible altered LOC, JVD when heart failure is present, SOB common on exertion, ronchi, wheezing

Treatment: Oxygen, CPAP, prescribed inhaler

Hay fever (allergic rhinitis)

Symptoms: Runny nose, congestion, sneezing, sinus pressure

Treatment: Suction if necessary

Pleural Effusion

Symptoms: Dyspnea, diminished breath sounds where the lung has been pushed away from the wall

Treatment: Oxygen, fowler's/semi-fowler's position

Hyperventilation syndrome*

Symptoms: Hyperventilation, anxiety, dizziness, numbness, tingling of hands/feet, carpopedal spasms (spasms in hands or feet), feeling of not being able to catch their breath

Treatment: Try to calm patient down, Oxygen

*Commonly caused by panic attacks, but cannot be determined in field

Carbon monoxide poisoning*

Symptoms: Headache, dizziness, fatigue, nausea/vomiting, dyspnea on exertion, chest pain, nervous system symptoms (impaired judgement, confusion, hallucinations), syncope, seizure

Treatment: Oxygen

*Shows 100% SPO2

Foreign Body Aspiration*

Symptoms: Change in voice, collapsed lung, aspiration pneumonia

Treatment: Oxygen

*common in very young and old

Tracheostomy Dysfunction

Symptoms: Obstruction of tube via mucus, oral secretions, or foreign body. also caused by bleeding, leaking, dislodgement, or infection

Treatment: provide an airway. suction if necessary. if trained, replace with new tracheostomy. treat with oxygen if indicated

Cystic Fibrosis

Symptoms: Sinus congestion, wheezing, asthma-like complaints, chronic cough with thick discolored mucus, dyspnea

Treatment: Oxygen if indicated, suction if necessary

Mandibular Fracture

Symptoms: Misalignment of the teeth, numbness of the chin, inability to open mouth, swelling, bruising, missing/loosened teeth

Maxillary Fracture

Symptoms: Massive facial swelling, instability of facial bones, misalignment of teeth

Fractured/Avulsed teeth*

Symptoms: Fractured/avulsed teeth, tooth fragments causing an airway obstruction

Treatment: Remove unattached teeth and teeth fragments from mouth. direct pressure. suction if necessary

*Place teeth in special tooth storage solution, milk, or saline. notify ED

Soft tissue injuries of the face/head (not exposing brain, eye, etc)

Treatment: Manual pressure via dry sterile dressing and roller gauze around the circumference of the head. Do not apply excessive pressure if there is a chance of a skull fracture.

Avulsion

Treatment: If attached: place skin in position closest to normal and cover with dry sterile dressing. If unattached: wrap piece in sterile dressing, place in plastic bag, and keep cool. Treat open soft tissue injury as usual

Soft tissue injuries of the face/head (exposing brain, eye, etc)

Treatment: Moist sterile dressing

Soft tissue injuries of the face/head (unopen)

Treatment: ice/cold pack to reduce swelling

Foreign objects in eye

Symptoms: redness, pain, sensitivity to light/ trouble keeping eyelids open, conjunctivitis

Treatment: If on surface of eye- flush with saline, inner corner to outer corner. If on underside of eyelid- visualize underside of eyelid and remove object with a moist sterile cotton-tipped applicator

Object impaled into eye

Treatment: Bandage the object in place to stabilize it, cover eye with moist sterile gauze, surround object with eye shield or doughnut shaped collar made from gauze, secure with a roller bandage surrounding the head (covering both eyes)

Chemical burn of eye (acid or alkali)

Treatment: remove contact lens if present (hard- suction cup with saline. soft- pinched fingers. advise ED if pt has contact lenses), flush with water or saline for 20 minutes. sterile dry dressing to cover the eye(lid)

Thermal burn of eye

Usually affects eyelid

Treatment: (stop burn), moist sterile dressing covering affected eye(s)

Light burn of eye

Symptoms: conjunctivitis, pain 3-5 hours after injury

Treatment: cover eyes with moist sterile dressing and eye shield, lie down during transport to avoid further light injury

Laceration of eyelid

Treatment: gentle manual pressure, moist sterile dressing if part of eye is exposed, cover with eye shield, cover both eyes

Laceration of eye

Treatment: moist sterile dressing if part of eye is exposed, cover with eye shield, cover both eyes

Eyeball displaced from socket

Treatment: Moist sterile dressing, cover both eyes, supine during transport to prevent fluid loss from eye.

Blunt trauma to eye

Symptoms: bruising, hyphema, blow-out fracture

Treatment: Cover eye

Blunt trauma to eye (hyphema)*

Symptoms: partial or complete obscurity of iris, impaired vision

Treatment: cover eye

*blood in anterior chamber of eye

Blunt trauma to eye (blow-out fracture)

Symptoms: pain, double vision, decreased vision

Treatment: cover injured eye with eye shield and cover both eyes

Blunt trauma to eye (retinal detachment)

Symptoms: flashing lights/floaters/specks in field of vision, cloud/shade over vision

Treatment: Cover eye

Epistaxis (nosebleed)

Treatment: lean patient forward, gauze under nose applying pressure

Bleeding around ear

Treatment: direct pressure, roller gauze around head (put gauze between back of ear and scalp first to prevent pain)

Ruptured tympanic membrane

Symptoms: severe ear pain, difficulty hearing, ringing in ear

Foreign body in ear*

Symptoms: decreased hearing, ruptured tympanic membrane

*DO NOT REMOVE FOREIGN BODY

Facial fractures*

Symptoms: bleeding, deformity, inability to swallow or talk, absent/loose teeth, loose/moveable bone fragments, "it doesn't feel right" when closing their jaw (signals irregularity of bite), possible blood clots lodged in upper airway, airway swelling

Treatment: ABC's and bleeding control, direct pressure of missing teeth

*Place teeth in special tooth storage solution, milk, or saline. notify ED

Missing teeth*

Treatment: direct pressure

*Place teeth in special tooth storage solution, milk, or saline. notify ED

Impaled object in cheek

Treatment: control bleeding, remove object if it compromises airway, direct pressure on inside and outside of cheek, bandaging (do not occlude mouth or make it hard for pt to breathe)

Crushing injury to neck

Symptoms: loss of voice, difficulty swallowing, airway obstruction, subcutaneous emphysema, swelling/bleeding

Treatment: c-spine stabilization, maintain airway

Penetrating injury to neck

Symptoms: Profuse bleeding, air embolism, damage to airway/esophagus/cervical spine

Treatment: Direct pressure (above and below), sterile occlusive dressing (prevents air embolism), gauze on injury and around and under shoulder (do not wrap around neck), c-spine if indicated, shock treatment, only remove object if it compromises the airway

Laryngeal injuries

Symptoms: respiratory distress, hoarseness, pain, dysphagia (difficulty swallowing), cyanosis, pale skin, sputum in wound, subcutaneous emphysema, bleeding, bruising

Treatment: control bleeding if present, maintain airway, provide oxygen and ventilations if necessary, c-spine if indicated

Skull fracture

Symptoms: Visible crack in skull under scalp laceration, ecchymosis (bruising) under eyes (raccoon eyes), ecchymosis behind ear on mastoid process (battle sign), positive halo test

Linear skull fracture

Depressed skull fracture

Symptoms: signs of neurologic injury (such as loss of consciousness)

Basilar skull fracture

Symptoms: CSF drainage, raccoon eyes, battle sign,

Open skull fracture

Symptoms: bleeding, visible brain, visible skull

Treatment: control bleeding from laceration, cover exposed brain with moist dressing

Increased intracranial pressure

Symptoms: Cheyne-stokes respirations, ataxic (biot) respirations, central neurogenic hyperventilation (fast, deep breaths), decreased pulse rate, headache, nausea, vomiting, decreased alertness, bradycardia, sluggish/nonreactive pupils, decerebrate posturing, increased/widened pulse pressure

Cushing Triad- Increased systolic pressure, decreased heart rate, irregular breathing

Treatment: Treatment of brain injury, manage shock, maintain ETCO2 between 30 and 35 mmHg (20 breaths/min adult, 25 breaths/min child, 30 breaths/min infants <1 y/o)

Intracranial hemorrhage

Symptoms: Symptoms of increased intracranial pressure