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Top 10 Ambulance Equipment

2/28/2024

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Top 10 Ambulance Equipment

Well-equipped ambulances play a crucial role in saving lives. Each piece of equipment serves a vital purpose, allowing you to provide effective care during emergencies. Here's a quick list of the essential ambulance equipment:

Patient Monitor:

Patient Monitor tracks and displays vital signs such as heart rate, blood pressure, respiratory rate, and oxygen saturation, providing real-time data for informed decisions.

Defibrillator:

Defibrillator delivers an electric shock to restore a normal heart rhythm during cardiac arrest, potentially saving lives.
Shockable cardiac arrest rhythms include: ventricular fibrillation and pulseless ventricular tachycardia.

Bag Valve Mask:

Bag Valve Mask is a manual ventilation device with a mask connected to an oxygen supply, used to deliver oxygen to patients with breathing difficulties under positive pressure.

Artificial airway devices:

Artificial airway devices include Oropharyngeal airway, Nasopharyngeal airway, supraglottic airway, and Endotracheal tube.
Oropharyngeal airway (OPA) is used for patients without a gag reflex.
Nasopharyngeal airway (NPA) is used for patients with a gag reflex.
Laryngeal mask airway (LMA) is a supraglottic airway device that is positioned in the hypopharynx to form a seal with the glottis.
Endotracheal tube (ETT) is used to deliver oxygen, maintain ventilation, and prevent aspiration

Transport Ventilator:

Transport Ventilator provides mechanical ventilation for patients unable to breathe efficiently or independently.

Neck Collar and Backboard:

Neck collar helps to prevent excessive movement of the neck, which could potentially worsen a spinal cord injury.
A backboard, also known as a long spine board, immobilizes the patient's spine and prevent further injury during transport.

Ambulance Chair:

Ambulance Chair provides safe and comfortable transport for patients in and out of the ambulance.

Suction Unit:

A Suction Unit helps remove fluids, vomitus, and secretions that impede breathing, improving airway patency.

Medication Bag:

Medication Bag is an organized pouch containing various medications for pain relief, resuscitation, and other medical emergencies.

Oxygen Supply Units:

Oxygen Supply Units are crucial in providing supplemental oxygen for patients with breathing difficulties caused by various conditions.

Nebulizer:

Nebulizer delivers medication in a mist form through a mask or mouthpiece, providing immediate relief for patients with respiratory issues, such as beta-agonist for bronchial asthma.

Hemoglucometer:

Hemoglucometer measures blood sugar levels, allowing for rapid decision-making in diabetic emergencies.
Patients with hypoglycemia may present with focal neurological deficits, such as acute hemiplegia, or more global symptoms such as confusion or coma.

Splints and Bandages:
Splints and Bandages are used to immobilize broken bones or fractures, minimizing further injury and pain.

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Diltiazem for Atrial Fibrillation

2/28/2024

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Diltiazem for Rate Control of Atrial Fibrillation:

In atrial fibrillation with rapid ventricular rate greater than 110 bpm, diltiazem may be used to reduce the ventricular rate by blocking calcium channels in the atrioventricular node.
The typical dose of diltiazem is 15 to 20 mg IV over 2 minutes, followed by a second dose of 20 to 25 mg after 15 minutes if needed.

Avoid diltiazem in the following conditions:

WPW Syndrome or other accessory pathway,
Heart failure with ejection fraction less than 35%,
Second- or third-degree AV block,
Sick sinus syndrome, and severe hypotension.
If hypotension occurs after diltiazem use, give calcium gluconate 2 g IV.
Note: Calcium administration does not reverse AV Block.

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The 2-syringe technique of adenosine administration

2/24/2024

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The 2-syringe technique of adenosine administration:

Prepare two syringes and connect the two syringes using a 3-way stopcock.
Administer the adenosine as a rapid intravenous bolus through one of the syringes.
Immediately after injecting adenosine, promptly flush with saline by opening the stopcock.
Elevate the patient’s arm to expedite medication delivery.
Observe for therapeutic response or adverse effects, which may include a temporary pause in the heart rhythm or a brief period of bradycardia.
The first dose of adenosine is 6 mg rapid IV push followed by a 20 cc normal saline bolus.

If the patient’s rhythm does not convert out of SVT within 1 to 2 minutes, a second dose of 12 mg may be given.

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CHILD ABUSE (Physical Signs)

2/24/2024

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CHILD ABUSE (Physical Signs):

This lecture aims on how to recognize key physical signs of child abuse.

Failure to thrive:

Persistent weight loss, malnutrition, and stunted growth can indicate neglect, indicative of child abuse.
Poor hygiene such as unkempt appearance, dirty clothes, and matted hair may suggest neglect or emotional abuse.

Facial injuries:

Unexplained facial Injuries such as bruises, cuts, or swelling on the face, especially in specific locations like the ears, cheeks, or lips, warrant further investigation.

Slap marks:

Slap marks or hand-shaped bruises on the face or buttocks, can be indicative of physical abuse.

Oral injuries:

Torn or bruised frenulum can occur due to "bottle jamming" during forced feeding.
Scarring or bruising around the mouth may suggest gagging or smothering.
Oral injuries such as mouth sores, chipped teeth, and sexually transmitted infections can point towards forced oral sex.

Unexplained bruises:

Be wary of unexplained bruises or wounds in unusual locations, particularly on the buttocks, thighs, abdomen, or back.
Consider the size, shape, and distribution of bruises for patterns suggestive of abuse.
Restraint marks on limbs, axilla, or neck may indicate the use of restraints.

Loop marks:

Loop marks are pathognomonic for abuse and result from striking the child with a cord, rope, or belt.
Bruises or scrapes on forearms, hands, or legs may indicate defensive injuries attempting to repel blows.

Inflicted burns:

Inflicted burns include immersion burns, scalded burns, and cigarette burns.

Immersion burns:

Immersion burns are burns with sharp lines of demarcation and no splash marks suggest submersion in hot liquid, a potential sign of abuse.

Scald burns:

Scald burns are the most common burn type in children who have been abused and the most common causative agent is tap water.
Abusive scalds tend to be distributed on the buttocks, perineum, and lower extremities, with clear upper limits and scald symmetry, especially when present on the lower extremities.

Cigarette burns:

Cigarette burns are round, well-defined burns with central charring points that can be indicative of intentional abuse.

Ear Injuries:

Ear Injuries such as bruising, bleeding, or ruptured eardrums can occur due to blows or objects inserted into the ear, suggesting potential abuse.

Ocular Injuries

Blood in the anterior chamber of the eye, hyphema, can be caused by blunt force trauma to the head.
Retinal hemorrhage is a potential indicator of abuse, it can be caused by blunt head trauma.
Retinal detachments can occur due to significant head trauma, raising concerns for abuse.

Brain Injuries:

Subdural hematoma, especially if bilateral, can be caused by significant head trauma, often linked to abuse.
Abusive head trauma, also known as Shaken baby syndrome, is a head or neck injury from physical child abuse.
It happens when someone violently shakes a baby or hits the baby against something hard, leading to brain injuries even without external signs of trauma.
Symptoms can include irritability, vomiting, lethargy, seizures, and coma.
Abusive head trauma may be associated with retinal hemorrhage, multiple fractures of the long bones, and subdural hematomas.

Skeletal Injuries:

Skeletal Injuries suggestive of child abuse include: long bone spiral fractures, corner fractures, and posterior rib fractures.

Spiral fractures:

Long bone spiral fractures are uncommon in accidental falls.
Spiral fractures are more suggestive of twisting forces, potentially caused by abuse in children.

Corner fractures:

Corner fractures, also known as bucket handle fractures, are observed in young children and are suggestive of non-accidental injury, child abuse.

Posterior rib fractures:

Most rib fractures in infants are caused by child abuse.
Posterior rib fractures, especially multiple and in younger children, are rarely accidental and warrant further investigation.

Abdominal trauma:

Abdominal trauma is the second most common cause of death in children who have been abused.
Severe abdominal injuries are unlikely to result from minor or household trauma.
Young children who present with serious abdominal injuries in the absence of major trauma, such as a motor vehicle crash, should be carefully evaluated for the possibility of physical abuse.

Sexual assaults:

Sexual assaults include genital or rectal injuries.
Bruising, tearing, bleeding, or discharge from these areas can be signs of sexual abuse.
Diagnosed sexually transmitted infections or pregnancy in pre-pubertal children are highly concerning for sexual abuse.

SUMMARY:

Healthcare professionals can play a vital role in identifying and protecting vulnerable children.
Maintain a non-judgmental and supportive approach when interacting with the child and family.
Remember, the presence of any single sign does not confirm abuse.

Report suspected abuse to the appropriate authorities as mandated by law and local protocols.

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Reduce Delirium in Elderly

2/20/2024

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Reduce Delirium in Elderly:

Physical restraints should be avoided in elderly patients to reduce the incidence of delirium.
Avoid unnecessary lines such as intravenous lines, Foley, and monitors if possible.
Avoid drugs that may cause delirium, such as Benzodiazepines and anticholinergics.
Daytime napping should be avoided in elderly patients to prevent delirium.
Avoid unnecessary NPO order, and consider feeding assistance to reduce the risk of delirium.
Adequate pain management is important in reducing the incidence of delirium in elderly patients.
Delirium in elderly patients may be due to acute urinary retention and stool impaction.
Maintaining the patient's mobility and self-care can help reduce the incidence of delirium in elderly patients.
Provide eyeglasses and hearing aids for elderly patients.

Involving family members in the care of elderly patients can help reorient delirious patients.

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Top 10 Ambulance Equipment

Diltiazem for Atrial Fibrillation

The 2-syringe technique of adenosine administration

CHILD ABUSE (Physical Signs)

Reduce Delirium in Elderly

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