I know what you are thinking! This site hasn’t had as many updates as I would like. The reason for this is due to my commitment to completing my EMT-P/ACP certification. Further to this I have been assisting with the set up of the Alberta Paramedic Association’s new website.

I am proud to say, that after much work, it is now released! With that, the General Membership has opened up to the public.

Check it out! These guys have their heads on straight (all starting with their low membership cost of $69.99!

I just added a new listing in the must have link list. I really need to refresh it, but if you haven’t checked it out yet, one of my good friends Roger the Rogie Tewson has reopened his blog. He shares his experiences with EMS and everything that effects us.

Rogie The Medic: http://rogiethemedic.dinstudio.com/

Meanwhile, take a look at the APA’s new website

Another round of guidelines are now on the table. For practitioners across Canada this may lead to a possible change in practice. Fortunately it seems, that the changes will not be drastic.

Some interesting things to note:

• In the absence of contraindications, it may be reasonable to administer morphine sulfate intravenously to patients with NSTE-ACS if there is continued ischemic chest pain despite treatment with maximally tolerated anti-ischemic medications (Class IIb LOE B)
• Measure serial cardiac troponin I or T at presentation and 3-6 hours after symptom onset in all patients with ACS symptoms. Additional troponin levels should be obtained beyond 6 hours in patients with normal troponin levels on serial examination when ECG changes clinical presentation confer an intermediate or high suspicion for ACS. (Class I LOE A)
• If the time of symptom onset is ambiguous, the time of presentation should be considered the time of onset for assessing troponin values (Class I LOE A).
  • Further reinforcing the need for a good history while on scene.
• With contemporary troponin assays, CK-MB and myoglobin are not useful for diagnosis of ACS. (Class III LOE A)
• A 12-lead ECG should be performed and interpreted within 10 minutes of the patient’s arrival at an emergency facility to assess for cardiac ischemia or injury
  • This protocol used to indicate an experienced physician to interpret the ECG. However that has been removed. This further reinforces the need for all practitioners to know their ECG’s!

Reference: Amsterdam A, et al. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes Circulation, epub September 23, 2014.

Check out this excellent resource. These cards can help you remember the cranial nerves as well as how to test them.

There are more quizzes on this site which may help out as well.

GTC Paramedic Program: 12 Cranial Nerves

Welcome to Part 2 of the TOXIDROMES article (Part 1 can be found here).

To recap last month’s article; A drug overdose is the ingestion or application of a substance that is above and beyond the recommended or generally used amount.  Not all overdoes are fatal, and they can happen to anyone; first time or veteran drug users, purposefully or accidental, adult or child.

Understanding the common causes, basic pathophysiology and the signs and symptoms for the major TOXIDROMES is of huge benefit all levels of healthcare providers.  In the last article we covered the anticholinergic, cholinergic and sympathomimetic toxidromes.  The 2^nd part of the article will focus on Opiates, Sedative/Hypnotics and Hallucinogens.

Opiates

The Opiate toxidrome is one of the most common pre-hospital care providers will run into.  Opiates are CNS depressants, and most of the common signs and symptoms of an opiate overdose are due to this nervous system depression.  Common signs and symptoms in the Opiate toxidrome are; nausea and vomiting, dry mouth, drowsiness and miosis (pinpoint pupils) (note: an exception to this hallmark sign is Demerol, which does not cause miosis and is still classified as an opioid).  More sever overdoses can cause bradycardia, hypotension, apnea, hallucinations, delirium, loss of consciousness, seizure, coma and death.

Natural opiates are derived from the opium poppy plant, but semi-synthetic and synthetically produced opioids have existed for the most of the 20^th century.  Common opiates are morphine, heroin, codeine, Demerol, and Fentanyl.  The treatment for severe opiate overdose carried by most ALS services in Ontario is Naloxone (Narcan), which is a competitive opioid antagonist .

Sedative / Hypnotics

Also known as tranquilizers, drugs in this toxidrome act on the nervous system to produce sedation or dissociation without any specific analgesic effects (unlike opioids).  Many of the drugs in this toxidrome cause high rates of physiological or psychological dependence, and as such are commonly abused.  Signs and Symptoms of this toxidrome include; decreased LOA, delusions, ataxia, nystagmus, slurred speech and apnea (being the most serious potential complication).

There are a wide variety of substances that cause the effects of this toxidrome including; barbiturates (eg. Phenobarbital), benzodiazepines (eg. Valium, Ativan etc.), GHB, and alcohol.

Hallucinogenic

Substances in this toxidrome cause a variety of visual, tactile and auditory sensations.  Delusions, hallucinations, disorientation and panic are all potential side effects of drugs that fall into this category.  More severe complications can include hypertension, tachycardia, tachypnea, and seizures.

Common street drugs such as LSD, mushrooms, PCP, cocaine and amphetamines can all be classified under the hallucinogenic toxidrome.  Unlike many Hollywood depictions in which individuals under the influence of hallucinogens experience a complete disconnect from reality and full-scale auditory, visual and tactile hallucinations, it is important to note that many of the substances that fall into this category have less dramatic and dissociative effects.  Treatment for individuals in this toxidrome generally is limited to supportive care, allowing the substance to naturally run it’s course while protecting the patient from doing themselves or others harm.

The above toxidromes (and those covered in Part 1) are only a brief overview.  Given the myriad of substances that can have both positive and negative effects on the human body, understanding and being able to classify symptoms into the various toxidromes gives health care providers and framework on which to begin treatment of a patient.  Often, with severe overdoses, we do not have the luxury of waiting for a toxicology screen before beginning treatment.  Pre-hospital care providers often have a unique opportunity to observe patients in the setting where the overdose took place, so detailed (and safe) scene surveys are extremely important in any suspect drug / substance overdose.  Using these toxidromes, and the information found on scene, first responders and paramedics can initiate the appropriate care, and provide life saving information immediately to hospital staff.

My thanks once again to Blair Bigham for the use of his “Drugs for CERTs” presentation.

Hello all,

EMSstudent started as a fairly straightforward project.  A few classmates and I realized early into our education that there were a lot of online resources available for paramedic students, but they were scattered all over the Internet.   Even more importantly, very few students knew they existed, so they were largely (in our opinion) underutilized.

This website started as a way to amalgamate those resources, and make them easily accessible to our fellow students…but has since grown into much more.

Over the last few months, our focus has been to develop and organize as much content as possible.  We’ve collected over 50 12-lead and lead II ECGs, large number of quizzes (pharmacology and general knowlege), and more recently, a monthly Digest made up of articles from students, paramedics, pre-hospital care researchers and physicians.  The site has grown and changed in ways we hadn’t imagined, and it’s been an exciting experience along the way.

Over the next few months there are going to be some changes to the site.  We’ve decided that the best focus of our time and energy will be to develop a database of scenarios (both online and in printable format) that will highlight specific skills, situations and pathophysiology for First Responders, PCP students, and Paramedics alike.  These scenarios will be presented in an interactive format online, but will also have the option to be printed so they can be used in hands-on, practical training.  We’re excited to start building a database for students and educators to draw from, and are looking forward to the continued feedback and input from the EMS community to make these scenarios the best they can be for future paramedics.

We are also planning to expand our monthly Digest and will continue recruiting leading authors in the Emergency Medicine and Pre-Hospital Care community to provide the highest level articles and information for the site.  Upcoming Digest projects include interviews with Base Hospital physicians, Ornge paramedics, and recently hired PCPs who will share their insight into the AEMCA, the hiring process, and some of the common obstacles they’ve faced entering this profession.

All the previous content posted on the site will stay on our servers, and we encourage new visitors to the site to spend some time going through the archived ECGs, Quizzes and Articles.  At the end of the day, I’m tremendously excited at how far this site has come in a few short months, and I look forward to what the future will bring.  As always, your feedback, contributions and support are appreciated.  Please leave a comment below or email me directly at mike@emsstudent.ca with any thoughts you may have.

Mike