Welcome to Small City Open Prehospital Education
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SCOPE Education

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Here to break down the WHYs of medicine for prehospital and hospital providers.

Brown-Sequard syndrome occurs due to hemisection of the spinal cord. Some common causes include trauma (blunt/penetrating), disk herniation, iatrogenic (surgery), vertebral artery dissection, abscess/tumor. Classic findings: 1️⃣ Loss of pain and temperature on the contralateral side of the injury 2️⃣ Hemiparesis on the ipsilateral side (same side as the injury) 3️⃣ Loss of vibration and proprioception on the ipsilateral side You obtain these findings due to loss of the Spinothalmic tract, Corticospinal tract, and posterior columns. The loss of pain and temperature on the contralateral side is noticed 2-3 segments below the level of the lesion. Literature 📚 https://www.ncbi.nlm.nih.gov/books/NBK538135/#:~:text=Brown%252DS%C3%A9quard%2520syndrome%2520is%2520a,sensation%2520on%2520the%2520contralateral%2520side. https://emedicine.medscape.com/article/321652-overview https://radiopaedia.org/articles/brown-sequard-syndrome-1?lang=us Uptodate #FOAMed #nurse #paramedic #ems #emt #medical #meded #medicaleducation #criticalcare #flightnurse #criticalcaremedicine #criticalcaretransport #nursing #emergencynursing #intensivecare #medicine #flightparamedic #ambulance #physician #physicianassistant #PANCE #PANCEprep #nremt #brownsequardsyndrome #trauma
Happy nurses week from your friends at SCOPE! We are giving away some of our ECG cards! Tag a friend for your chance to win. Our drawings will be done on May 12th.
You are intubating a hypotensive shock patient and push your induction agent, paralytic agent, and intubate. Next thing you know the patient arrests. So what happened? A patient staring off hypotensive is one of the biggest predictors of post intubation cardiac arrest. Here are some factors to be aware of: 1️⃣ Induction agents on their own can cause a drop in blood pressure. 2️⃣ Intubation converts our normal negative pressure into positive pressure. This increases intrathoracic pressure thus impeding our venous return. This causes a drop in cardiac output and causes hypotension. 3️⃣ Sympatholysis can occur and blunt the compensatory sympathetic drive causing hypotension. This can even happen with ketamine administration. A study by Michael D April et al. in 2020 showed that clinicians shouldn’t prefer etomidate or ketamine over the other just because of the potential hemodynamic impacts. 4️⃣ Paralytics given in a hypotensive patient can have a prolonged time to effect due to the delay of the medication reaching the peripheral musculature. What to do: Resuscitate before you intubate is the most important (fluids, blood product, pressors) PEARLS A shock index of 0.90+ can be utilized as an indication that the patient is more likely to suffer from post intubation hypotension. There can be a delay on the SPO2 probe which can give falsely high SPO2 numbers in severe hypotension. Watch out for pH decompensation If limited time, bolus fluid or blood (depending on indication), consider push dose phenylephrine. Literature 📚 April MD, Arana A, Schauer SG, et al. Ketamine Versus Etomidate and Peri-intubation Hypotension: A National Emergency Airway Registry Study. Acad Emerg Med. 2020;27(11):1106-1115. doi:10.1111/acem.14063 Miller, Matthew, et al. "Hemodynamic response after rapid sequence induction with ketamine in out-of-hospital patients at risk of shock as defined by the shock index." Annals of emergency medicine 68.2 (2016): 181-188. Johnson, Ken B., et al. "The Influence of Hemorrhagic Shock on Etomidate: a Pharmacokinetic and Pharmacodynamic Analysis." Anesthesia & Analgesia 96.5 (2003): 1360-1368. Ting-Hao Yang et al. "Risk factors for peri-intubation cardiac arrest: A systematic review and meta-analysis" Biomedical Journal (2023) https://doi.org/10.1016/j.bj.2023.100656. April MD, Arana A, Reynolds JC, et al. Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study. Resuscitation. 2021;162:403-411. doi:10.1016/j.resuscitation.2021.02.039 Thanks to @armyemdoc on instagram for the collaboration #FOAMed #nurse #paramedic #ems #emt #medical #meded #medicaleducation #criticalcare #flightnurse #criticalcaremedicine #criticalcaretransport #nursing #emergencynursing #intensivecare #medicine #flightparamedic #ambulance #physician #physicianassistant #PANCE #PANCEprep #nremt #intubation
Arrhythmogenic Right Ventricular Cardiolyopathy (ARVC), formerly called Arrhythmogenic Right Ventricular Dysplasia (ARVD) occurs when there is fibrous or fatty replacement of the myocardium. In the past these were reported in the outflow tract, inflow tract, and apex of the right ventricle but more recent reports say it can impact the left side as well. ARVC is a rare cause of sudden cardiac death in young adults. ECG findings: 1️⃣ Epsilon wave (delayed depolarization of the right ventricle and is seen in 5-30% of patients and can be seen in other pathologies) 2️⃣ QRS widening in V1-V3 3️⃣ T wave inversions in V1-V3 4️⃣ Prolonged S wave upstroke of 55ms V1-V3 You can use Fontaine leads to better see Epsilon waves as well #FOAMed #nurse #paramedic #ems #emt #medical #meded #medicaleducation #criticalcare #flightnurse #criticalcaremedicine #criticalcaretransport #nursing #emergencynursing #intensivecare #medicine #flightparamedic #ambulance #physician #physicianassistant #PANCE #PANCEprep #nremt #ARVC #ARVD #epsionwave #cardiology
Answer: This is hidden atrial flutter! Atrial flutter is a reentrant circuit that mostly occurs in the right atrium. The usual ECG findings include your “sawtooth” waves. In this case, you look at lead V1 it’s placement is over the right atrium and is the best lead to see atrial activity. Dr. Amal Mattu calls this your “Money lead”. You see atrial activity around a rate of 300 BPM. The only thing that can do this is atrial flutter because of the reentry circuit. #FOAMed #nurse #paramedic #ems #emt #medical #meded #medicaleducation #criticalcare #flightnurse #criticalcaremedicine #criticalcaretransport #nursing #emergencynursing #intensivecare #medicine #flightparamedic #ambulance #physician #physicianassistant #PANCE #PANCEprep #nremt #ECG #EKG #atrialflutter
What’s your interpretation? I will post the answer at the end of the day!
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