Most of us learned that hypotension is our main indication that a pneumothorax has progressed to a tension pneumothorax. What does the research say thus far?......IT DEPENDS!  The presentation of a tension pneumothorax depends on the answer to one simple question: "Is the patient breathing on their own or not?" Before diving into the research, let's review some pathophysiology.

Image: created by Bahnijit Barman; altered by paramedmovement 

What are STEMI equivalents? Why do I need to know them? Great questions! In order to answer these questions we first need to talk about how much the STEMI criteria sucks! Okay, maybe that was a little harsh, the STEMI criteria is something we all must know and utilize. But lets just say there are some new kids on the block.... who are not so new....they just don't get enough attention.

My name is Sam! I'm an ER RN at a level II trauma and comprehensive stroke center. I have been in the background, assisting with ParaMed but today, I'd like to introduce a case study of an interesting patient that I've cared for in the ED setting. While not explicitly exciting (no gnarly blood or limb loss here), this case study illustrates the importance of focusing on the fine details and reassessing your patient! Without further ado...

"Watson, we have been assigned a case...appears it involves some angina pectoralis."

Sepsis is a life-threatening condition caused by an infection in the body that spreads to the blood stream. Our body's immune system responds by sending inflammatory markers and white blood cells to identify and kill this foreign invader. Unfortunately, this response happens systemically leading to vasodilation throughout the body; our blood vessels become more permeable causing fluid to leak into the interstitial space. This cascade of events is SIRS (systemic inflammatory response syndrome). Sepsis can lead to septic shock, which is a type of distributive shock. Rapid identification and early treatment of this life-threatening condition correlates to better outcomes. 

You and your partner are taking care of a 55 year old male patient having a severe asthma attack, and they are not improving. "We threw everything at him! What else can we do?"....you take a glance at your protocol...."Ah thats right, IM epinephrine, but......I have to call for orders." You call medical control for orders and they are denied due to the patient having a history of coronary artery disease (CAD).

If you have not read our blog "The Trickster," I highly encourage you check it out before reading this blog; it is a good refresher on hyperkalemia emergencies. We will be using what we learned from "The Trickster" blog to show how we suspect hyperkalemia. IMPORTANT REMINDER: do not wait until you have point of care electrolyte results to treat this emergency; if we have high suspicion we must not delay treatment. Waiting can put the patient at risk of cardiovascular collapse. Let's jump right into it with our first case!

You may be asking yourself how Loki "the god of mischief" has anything to do with a medical blog. Well for one I am a huge Marvel fan and in the movies Loki is a trickster. He fools the audience - and other characters - into thinking he is dead several times and in one movie he actually does die.....but then he is back again because the Avengers travel back in time setting off an alternate time line. It's awesome!

You may have heard that intubation in the prehospital environment is at risk of being taken out of our scope of practice.

Ventilating a patient with a BVM is an easy skill; you open the airway, use adjuncts, get a good seal, squeeze the bag and voila! Intubation and supraglottic airways are awesome and way more important. That's what I thought early on in my EMS career as an EMT. Wrong! When you listen to the airway gurus/masters: Scott Weingart, Jim Ducanto, Reuben Strayer, Rich Levitan, and many others...you see that they mastered ventilating a patient with a BVM before they became highly skilled/successful at laryngoscopy and intubation. You can be an airway master too with a few key points and correcting some bad habits:

Part 1: The EMT Partner

Back in 1996, the first EMS agenda was created. This agenda was a vision for the future of our profession and hadn't been updated until, January 2019 by NHTSA. This large document houses bold predictions of where the EMS profession will be in 2050, ultimately outlining six principles guiding our profession to a more people-centered system.

Part 2: The Paramedic Partner