“Random” 1 (TM)
Employment and Freedom of Speech
Employers maintain rights to enforce standards of conduct.
Freedom of speech does not protect employees from job repercussions for expressing controversial opinions.
Example: An EMT in Orlando was fired for making a comment about women voting during a situation with a patient.
Implications: Employees are encouraged to be cautious about expressing personal opinions, especially those that may conflict with employer values.
Other examples of employees getting fired for controversial comments in various industries, including references to prominent figures or sensitive topics (e.g. Charlie Kirk).
Case Study: Nosebleed Treatment
Patient Profile: Ashley, 34 years old, calls EMS for a nosebleed occurring at 2 AM.
Initial Findings:
Oozing blood from the right nostril.
Vital signs stable, no history of sinus infection, recent use of nasal spray.
Treatment Protocol:
Positioning:
Instruct patient to lean forward to prevent blood from flowing back into the throat, which can irritate the GI tract.
Technique:
Pinch the nose, higher than the nostril area for effective pressure application.
Use of gauze pads or nasal plugs may be highlighted as interventions to manage severe cases.
Cause and Prevalence of Nosebleeds
Nosebleeds most commonly arise from trauma, such as nose picking or environmental irritants.
Statistics: Approximately 60% of the population experiences a nosebleed at some stage.
Types of Nosebleeds:
Anterior: More common, occurring from the front part of the nasal septum.
Posterior: Less common, typically more severe, can occur in deeper structures of the nasal cavity.
Medical Considerations
Thrombocytopenia:
Definition: A condition characterized by low platelet count, normal values range from 150,000 to 400,000 platelets.
Relevant reference: Thrombocytopenia can lead to increased risk of bleeding, including nosebleeds.
Other Potential Causes of Nosebleeds:
Coagulopathy: Disorders affecting blood clotting mechanisms can increase bleeding risks.
Hypertension: Rare causal factor for nosebleeds but can contribute to vascular pressures.
DIC (Disseminated Intravascular Coagulation): A severe condition that affects the blood's ability to clot, causing widespread bleeding.
Treatment and Management Strategies for Nosebleeds
Basic first Aid:
Direct pressure on the nose.
Avoid blowing the nose to prevent dislodging clots.
Possible use of nasal decongestants (sympathomimetics like oxymetazoline) to promote vasoconstriction and reduce bleeding.
Advanced Interventions:
Nasal Tampons (e.g., Rapid Rhino): Requires soaking and proper insertion techniques.
TXA (Tranexamic Acid): Usage may be indicated in severe cases of nosebleeds; the procedure and dosage must be supervised by medical control.
Follow-up assessment for bleeding sources using nasal speculum and other examination tools.
Foreign Body Obstruction in Children
Common Occurrence: Children often insert objects into their noses resulting in obstruction.
Initial Management Strategy:
Assess if the child can blow their nose effectively.
Use a ball syringe in the opposite nostril or consider transport to the ER for removal.
Throat Conditions and Concerns
Ludwig's Angina: Swelling around the neck related to dental infections that could impede airway structures.
Other Condition Types:
Laryngitis, Tracheitis, Tonsillitis: Usually benign cases but can progress to airway issues in severe infections.
Pharyngitis: Inflammation in the pharynx with common symptoms likely requiring differentiation from other causes.
Stridor: An important sign indicating potential airway obstruction requiring a differential diagnosis including
Foreign body obstruction, anaphylaxis, trauma, and croup.
Eye and Vision Issues
Common Eye Conditions:
Conjunctivitis (Pink Eye): Often mismanaged; important to differentiate from other infectious causes such as measles.
Papilledema: Swelling at the optic nerve potentially caused by hypertensive crises or tumors.
Retinal Artery Occlusion:
Sudden painless loss of vision typically unilateral and urgent requiring rapid treatment.
Glaucoma:
The chronic condition of eye pressure:
Open-Angle Glaucoma: Gradual pressure build-up, peripheral vision loss.
Angle-Closure Glaucoma: Sudden increase in eye pressure, acute emergency requiring immediate attention.
Key Summary of Emergency Diagnosis
Timely recognition of symptoms is critical:
Hoarseness or stridor can denote urgent conditions like epiglottitis, or foreign body obstruction.
Differentiation between types of acute disorders such as glaucoma, retinal artery occlusion, and urgent infectious conditions is essential to guide proper treatment pathways.
Use of techniques and medical knowledge fundamental in guiding first responders through effective patient care.