1. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training DOT National Standard EMT-Intermediate/85 Refresher DOT National Standard EMT-Intermediate/85 Refresher Welcome!

2. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training MEDICAL EMERGENCIES Allergic reaction Possible overdose Near-drowning ALOC Diabetes Seizures Heat & cold emergencies Behavioral emergencies Suspected communicable disease Allergic reaction Possible overdose Near-drowning ALOC Diabetes Seizures Heat & cold emergencies Behavioral emergencies Suspected communicable disease

3. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training MEDICAL EMERGENCIES BEHAVIORAL EMERGENCIES Perspective Pathophysiology Epidemiology PE & Diagnostic Findings S/S Differential considerations Tx

4. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training perspective Depression & suicidal ideation Anxiety Disorders panic attacks Schizophrenia Bipolar disorder The agitated or violent pt Factitious illness Malingering Conversion disorder Depression & suicidal ideation Anxiety Disorders panic attacks Schizophrenia Bipolar disorder The agitated or violent pt Factitious illness Malingering Conversion disorder

5. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Differential Dx The agitated or violent pt –Identify causes Hypoglycemia Severe amphetamine or cocaine toxicity Hypoxia Hyperthermia Anticholinergic toxicity Alcohol intoxication or withdrawal The agitated or violent pt –Identify causes Hypoglycemia Severe amphetamine or cocaine toxicity Hypoxia Hyperthermia Anticholinergic toxicity Alcohol intoxication or withdrawal

6. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Differential dx Finger stick glucose determination Oxygen saturation PE Verbal survey Finger stick glucose determination Oxygen saturation PE Verbal survey

7. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training treatment Consider verbally controlling the pt –Physical restraint to a back board –Chemical restraint Consider verbally controlling the pt –Physical restraint to a back board –Chemical restraint

8. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Treatment Physical restraints –Use only when necessary and in those situations where the pt is exhibiting behavior deemed to present danger to him/herself or to the field personnel Minimum restraint necessary to accomplish necessary pt care & safe transport Circulation to the extremities (distal to the restraints) should be evaluated frequently Physical restraints –Use only when necessary and in those situations where the pt is exhibiting behavior deemed to present danger to him/herself or to the field personnel Minimum restraint necessary to accomplish necessary pt care & safe transport Circulation to the extremities (distal to the restraints) should be evaluated frequently

9. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Chemical restraint Tx Indications: to reduce combative behavior that endangers the pt or caregivers –Contraindications: Absolute –sensitivity to diphenhydramine or midazolam –SBP <90mm Hg (adult) Relative –N/V –Depressed mentation –Suspected drug/alcohol intoxication –Multiple systems trauma –Head injury –Concomitant narcotic administration »These MAY be the proximate cause for the condition that requires proposed sedation. The best judgment of the medic is necessary to evaluate the need for sedation Indications: to reduce combative behavior that endangers the pt or caregivers –Contraindications: Absolute –sensitivity to diphenhydramine or midazolam –SBP <90mm Hg (adult) Relative –N/V –Depressed mentation –Suspected drug/alcohol intoxication –Multiple systems trauma –Head injury –Concomitant narcotic administration »These MAY be the proximate cause for the condition that requires proposed sedation. The best judgment of the medic is necessary to evaluate the need for sedation

10. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Treatment IndicationsMedication : dose/route Mild sedation -behavior -motion sickness -mild anxiety Diphenhydramine Adult: 50mg IM or 25mg IV Pediatric: 1mg/kg IM to a max of 50mg or 0.5mg/kg to a max 25mg Moderate sedation -more serious anxiety -Fx/dislocation mtg Midazolam Adult: -IV 1-2mg SIVP. May repeat x2, q 5min, max 6mg. -IM 2-4mg. May repeat x 1, q 30 min Pediatric: -IV 0.05mg/kg slow. Titrate to desired sedation. May repeat x2, q 5min, max 3mg -IM 0.1mg/kg. May repeat x 1, q 30min

11. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Treatment IndicationsMedication : dose/route Profound Sedation -airway mtg - anatomic or physiologic state that interferes w/ essential airway mtg (e.g., trismus) MIDAZOLAM Adult: -IV/IO 2mg slowly. Titrate to desired degree of sedation- may repeat 1-2mg x 2, q 5min (max 0.1mg/kg) -IM 0.1mg/kg, may repeat x 1, q 30min Pediatric (>5kg or <40mg): -IV/IO 0.05mg/kg slowly. Titrate to desired degree of sedation. May repeat x 2, q 5min -IM 0.1mg/kg may repeat x 1, q 30min

12. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Perspective Pathophysiology Epidemiology PE & Diagnostic Findings S/S Differential considerations Tx Perspective Pathophysiology Epidemiology PE & Diagnostic Findings S/S Differential considerations Tx

13. ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Questions? References –Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010. –Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011. –Wolfson, Allan B. ed., Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010. References –Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA 2010. –Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York 2011. –Wolfson, Allan B. ed., Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.