Resuscitation medicine
a branch of medicine that focuses on the management and treatment of patients in cardiac arrest or other life threatening conditions such as severe trauma or shock
2 fundamental predicaments during cardiac arrest
rapidly restart the heart after it ceases to beat and restart the brain while maintaining heart function
lucas device
delivers manual compressions
Targeted temperature management is a form of
post cardiac arrest management
what does ttm do
protects the brain and other organs, targeted temp 32C for at least 24 hours
TTM for patients with bleeding issues
higher temp
TTM for patients with cerebral edema and seizures
lower temp
is TTM performed in the pre hospital setting
no
percutaneous coronary intervention (PCI)
treatment to open a blocked artery
arteries
Blood vessels that carry oxygen rich blood through your body
most common cause of anesthesia related deaths in 1958 were because of
aspiration
Definition of Death
irreversible coma
ETCO2
end-tidal carbon dioxide
ETCO2 monitoring
provides an accurate assessment of arterial carbon dioxide retention values
bougie
plastic rod passed into trachea
Supraglottic Devices
can blindly be put in mouth. group of airway devices that can be inserted into the pharynx to allow ventilation, oxygenation, and administration of anesthetic gases without the need for endotracheal intubation
RSI
rapid sequence induction
medications used during rsi
etomidate, ketamine, rocuronium, midazolam
prevalence of stroke
number 5 cause of death in U.S, every 40 seconds someone in U.S has a stroke, leading cause of long term disability, cost of stroke care in 2010 was 71B and is estimated to be 183B by 2030
during a stroke 32,000 neurons lost
per second
during a stroke 1.9 million neurons lost
per minute
true or false, stroke accelerates again 3.1 weeks per minute
true
primary stroke center
ct capabilities, tpa administration, neurology staff available
comprehensive stroke center
verified by joint commissions, AHA, and ASA, specialized stroke care facilities, cerbrovascular capabilities, neurosurgical capabilities with neuro ICU, better rehab and outcomes for stroke patients
mobile stroke unit
specialty care ambulance equipped with portable CT scanner, mobile laboratory, and telemedicine unit
goal of mobile stroke unit
to rapidly assess and treat prehospital stroke patients
Implementation of MSU in Suffolk
contacted every dept in MSU primary response area, remsco/remac approval, working with SCEMS, NYS DOH and exec office, educational lecture
MSU staff includes
emt, paramedic, critical care RN, rad tech
NY state first, stony brook approved for
blood transfusions on ambulances
VAD
device that helps pump blood from the lower chambers of your heart to the rest of your body
VAD indications
bridge to transplant, bridge to recovery, and destination therapy
impella
percutaneous mechanical ventricular assist device
VADs provide circulatory support by
increasing cardiac output, increasing coronary perfusion, increasing end organ perfusion, decreasing ventricular workload, and decreasing myocardial O2 consumption
ECMO
blood is pumped outside of your body to a heart lung machine that removes carbon dioxide and sends oxygen filled blood back to tissues in the body
why is an ecmo done
for patients waiting for or recovering from a heart transplant and may be an option when other life support measures haven't worked
IABP
intra-aortic balloon pump consist of a think tube and balloon that a doctor inserts into the aorta leaving the heart. the inflation and deflation of the balloon pump help increase blood flow from the heart
EMS licensure levels
EMR, EMT, AEMT, Paramedic
Tiered Response
system where EMTs and paramedics respond separately
EMT description
automated external defibrillation, airway adjuncts, assisting patients with certain meds
AEMT description
IV therapy, administration of a limited number of emergency medications
Paramedic description
endotracheal intubation, emergency pharmacology, cardiac monitoring, other advanced assessment and treatment skills
History of EMS ancient times
emergency medici e
history EMS napolenic wars
birth of horse drawn ambulances, the first recorded use of aircraft for medical evacuation were hot air balloons at the Prussian siege of pari sin 1870
history of ems the US in the 19th century
1860s civillian ambulance services begin in Cincinnati and NYC, 1915 during serbian army retreat unmodified french fighter aircraft were used to ferry the injured. Crimean war: florence nightingale became known as the founder of the nursing profession
the medical director is responsible for
maintaining quality control
continuous quality improvement (CQI)
reviews and performs audits of the ems systems to identify areas of improvement and/or assign remedial training, minimizing errors is the goal
CQI uses a
plan-do-study act cycle
EMS works with public health agencies on
primary prevention and secondary prevention
In 2020the centers for medicare and medicaid services implemented a
pilot program called emergency triage, treat, and transport
online medical direction
talking directly to a medical director or agent authorized to give orders for the medical director
offline medical direction
using a book of protocols that give permission to do things without calling a doctor
just culture ems
duty to avoid causing unjustifiable risk or harm, duty to follow a procedural rule, and duty to produce an outcome
ET3
triage, treat, and transport
consent
permission to render care
expressed consent
the patient acknowledges he or she wants you to provide care or transport
implied consent
applies to patients who are unconscious or incapable or making an informed decision
involuntary consent
applies to patients who are mentally ill, in behavioral crisis, developmentally delayed. Obtain consent from guardian or conservator
If true emergency exists and no consent is available
treat the patient, consent is implied
forcible restraint
sometimes necessary with combative, legally permissible
the right to refuse treatment
conscious alert adults with decision making capacity, assess the patient's ability to make an informed decision, if the patient appears confused or delusional, you cannot assume that the decision to refuse is an informed refusal
before you leave a scene where a patient, parent, or caregiver has refused care
encourage the individual again to allow care, ask the individual to sign a refusal of care form, a witness is valuable in these situations, documents all refusals
advanced directive
specifies treatment should the patient become unconscious or unable to make decisions
a DNR order is an
advanced directive that gives permission not to resuscitate
presumptive signs of death
unresponsive to painful stimuli, lack of carotid pulse or heartbeat, absence of breath sounds, no deep tendon or corneal reflexes, absence of eye movement, no systolic blood pressure, profound cyanosis, lowered or decreased body temp
Definitive signs of death
decapitation, dependent lividity, rigor mortis, algor mortis, putrefaction
rigor mortis
stiffening, occurs between 2-12 hours after death
algor mortis
cooling of the body until it matches the ambient environment
putrefaction
occurs between 40-96 hours after death
scope of practice
outlines the care you are able to provide, usually defined by state law
standards of care
manner in which you must act or behave, it is defined as how a person with similar training would act under similar circumstances.
standards of care are established by
local custom, law, professional or institutional standards, textbooks, standards imposed by states
duty to act
individual's responsibility to provide patient care. Duty to act applies once your ambulance responds to a call, once treatment is begun
negligence
failure to provide same care that person with similar training would provide in same or similar situation
elements that must be present for negligence to apply
duty, breach of duty, damages, causation
abandonment
unilateral termination of care by health car provider without patient's consent and making provisions for continuing care
abandonment may take place
at the scene, in the emergency department
assault
unlawfully placing person in far of immediate bodily harm
battery
unlawfully touching a person
good samaritan law
if you reasonably help another orson, you will not be held liable for errors or omissions
special mandatory reporting requirements
abuse of children, dog bites
morality
it's what societies determine to be right and acceptable
ethics
philosophy of right and wrong, moral duties, and ideal professional behavior
general health, wellness, and resilience
physical, emotional, mental
wellness
active pursuit of a state of good health
resilience
capacity of an individual to cope with and recover from distress
burnout
syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed
code lavender stonybrook
can be whatever staff needs in that moment, code lavender is not formal debriefing or case review
patient safety has typically been
outcome dependent
error
failure of a planned sequence of mental or physical activities to achieve its intended outcome when these failures cannot be attributed to chance
a slip or lapse occurs when
the action conducted is not what was intended
a slip is observable
a lapse is not
human factor
an applied filed of study that examines human abilities, limitations, behaviors, and processes in order to inform human centered designs
psychophysiology of crisisL the crisis stress dynamic
homeostasis, stressor, disequilibrium
general adaptation syndrome
alarm stage, resistance stage, exhaustion stage
parasympathetic division
constricts pupil, stimulates tear glands, strong stimulation of salivary flow, inhibits heart, dilates arterioles, constricts bronchi, stimulates stomach motility and secretion, stimulates pancreas, stimulates intestinal motility, contracts bladder, stimulates erection
sympathetic division
dilates pupil, no effect on tear glands, weak stimulation of salivary flow, accelerates heart, constricts arterioles, dilates bronchi, inhibits stomach motility and secretion, inhibits pancreas and adrenals, inhibits intestinal motility, relaxes bladder, stimulates ejaculation
elder abuse is caused by
increased life expectancies, increased dependency on others, decreased productivity in later years, physical and mental impairments, limited resources for long term care of elderly, economic factors, etc
identification of elder abuse
acts of commission, acts of omission, subtle signs such as theft of victim's belongings, and obvious signs such as wounds, untreated decubitus ulcers, poor hygiene
characteristics of elder abuse
cuts across all demographic groups, people dependent on others for their care, especially among elders who are mentally or physically challenged, common causes involve elderly women abused by their sons, commonly live alone, may be mentally competent but fear asking for help, may be reluctant to give info about abusers for fear of retaliation