ImpactEMS

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Whether you are preparing for a test for FPC/CFRN, or out there battling the grim reaper trying to save your patient's life...... Here are some common reversal agents you may need to know. YES.... some of these are not available in the back of a helicopter or ambulance, but knowing if your local hospital carries these medications or if you need to bypass to get to definitive care can help save a life! As always follow local protocols and guidelines for treatment! #ems #paramedic #nurse #nursesoftiktok #paramedicsoftiktok #emslife #paramedicstudent #emtstudent #nursingstudent #criticalcarenurse #CFRN #FPC #nremtprep #nremt #emstiktok #flightnurse #medicalstudent

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WHAT IS A CRUSH INJURY? Any injury resulting from direct physical crushing/pressure on skeletal muscle. When this CRUSHING pressure happens to the skeletal muscle, the skeletal cells will begin to RUPTURE, and myoglobin is released. WHY DO SKELETAL MUSCLE CELLS RUPTURE? Decreased perfusion to the area due to compression of the vasculature means less oxygen and blood supply to the cells. When the skeletal muscle cells do not receive adequate oxygenation or blood flow, cells SWITCH from aerobic metabolism to anaerobic metabolism ☠️. Lactic acid is also produced once the cell switches to anaerobic metabolism. This stressed state on the skeletal cell can only last so long before cells rupture. Inside the skeletal muscles are also potassium, acids, and enzymes such as creatine kinase (CK) and lactate dehydrogenase (LDH), which are released when the cell ruptures. ☣️TOXIC: When the ruptured skeletal muscles release K+, LDH, CK, lactate, and myoglobin into the vasculature. Fluid begins to shift (the body tries to maintain homeostasis), and the kidneys (your filtering system) attempt to clear all the released particles from the blood. BUT unfortunately, the kidneys get too bogged down and quit working effectively or at all. KIDNEYS: With the kidneys full of myoglobin and other toxins, urine output decreases. Potassium is now unable to be excreted from the body. K+ levels and lactate levels continue to rise. Elevated lactate can lead to vasodilation, decreasing perfusion to the kidneys. The heart tries to compensate for hypotension and now is at risk of developing lethal arrhythmias due to hyperkalemia. RHABDOMYOLYSIS: *Elevated CK levels *Tea colored urine *Decreased urine output/no urine output TREATMENT FOR RHABDO: IV fluids, potential dialysis, some may give sodium bicarbonate (promotes alkalization of the urine) or mannitol (renal vasodilator that may help promote diuresis) ⚠️COMPARTMENT SYNDROME: When the crushed injury site is a limb, patients are at a higher risk for compartment syndrome. The decrease in blood flow, skeletal muscle breakdown, or separation of muscle groups with associated injuries from the crush (broken bones) can lead to swelling and inflammation. With the release of the crushing pressure and RAPID rushing of blood and fluid back to the damaged area, swelling may occur. This swelling, trapped in an enclosed compartment can cut off the blood supply, place pressure on nerve endings, and can cause what is known as acute compartment syndrome. THE 5 P’s- Physical Exam Findings When assessing your patient with concern for compartment syndrome be on the lookout for the 5 P’s Pain- Increased pain that may seem out of proportion for the injury. This can be related to the increased pressure placed on the nerve endings. Pulse- Decreased pulse or no pulse is palpable/doppler to the extremity. With no perfusion or oxygen delivery to the area due to swelling, the extremity will become cold. Pallor- With decreased blood flow, the limb becomes pale 👻 or ashen in color. The skin may also look shiny***** Paresthesia- With pressure on the nerve endings the patient may report feelings of numbness/tingling or “pins and needles” sensation in the extremity. Paralysis- If the swelling and ischemic injury become severe enough, the patient may have paralysis to the extremity and be unable to feel anything or move anything distal to the injury site. TREATMENT: 🩸Restoring blood flow to the area is ESSENTIAL! How do you restore blood flow to the area you ask??? Decompression of the injured site with a fasciotomy may occur. A fasciotomy is when the physician (usually a surgeon) will cut into the fascia layer of the skin using a scalpel to relieve the pressure in the compartment. This will allow the tissues to expand, relieve pressure that is obstructing blood flow, and restore perfusion. #ems #paramedic #nurse #nursesoftiktok #paramedicsoftiktok #emslife #paramedicstudent #emtstudent #nursingstudent #nremtprep #emstiktok

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Shock Index HR / SBP = Shock Index A shock index greater than 0.7 can indicate a need for blood transfusion or IV fluid administration in you patient depending on their underlying pathology. REMEMBER: If a patient is on a beta blocker that blocks the bodies ability to increase the heart rate you may not have a positive shock index which can mask your patients signs of shock. If your patient is losing blood, give blood. If your patient has dehydration or sepsis give fluids! #ems #paramedic #nurse #nursesoftiktok #paramedicsoftiktok #emslife #paramedicstudent #emtstudent #nursingstudent #nremtprep #emstiktok #criticalcarenurse #CFRN #FPC #nremt #flightnurse #medicalstudent #criticalcareparamedic #CCRN #CEN