In the medical community, summertime involves a unique set of medical issues along with an increase in trauma patients. First responders must be prepared to treat these patients quickly and efficiently so that morbidity and mortality can be minimized.
Lauren Mutter, MD, is a pediatric emergency medicine fellow at Le Bonheur Children's Hospital.
Mark Meredith, MD, is associate professor of pediatric emergency medicine at Le Bonheur Children's Hospital.
Wasp sting: Inflammation & Relief by Topical Natural PhytochemicalsKevin KF Ng
Wasp sting, wasp venom composition, immune response, local reactions, severe reactions, anaphylaxis, treatment with home remedies and OTC products, rational treatment with topical phytochemicals.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Mortality rates are calculated from information collected in the birth histories of the Women’s Questionnaires. All interviewed women were asked whether they had ever given birth, and if yes, they were asked to report the number of sons and daughters who live with them, the number who live elsewhere, and the number who have died.
Anaphylaxis in children and adolescents-one-year survey in an immunoallergy d...Natacha Santos
Santos N, Gaspar A, Piedade S, Santa-Marta C, Pires G, Sampaio G, Borrego LM, Arêde C, Morais-Almeida M, Anaphylaxis in children and adolescents: one-year survey in an Immunoallergy department. Allergy 2012;67(Suppl.96):154.
Wasp sting: Inflammation & Relief by Topical Natural PhytochemicalsKevin KF Ng
Wasp sting, wasp venom composition, immune response, local reactions, severe reactions, anaphylaxis, treatment with home remedies and OTC products, rational treatment with topical phytochemicals.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Mortality rates are calculated from information collected in the birth histories of the Women’s Questionnaires. All interviewed women were asked whether they had ever given birth, and if yes, they were asked to report the number of sons and daughters who live with them, the number who live elsewhere, and the number who have died.
Anaphylaxis in children and adolescents-one-year survey in an immunoallergy d...Natacha Santos
Santos N, Gaspar A, Piedade S, Santa-Marta C, Pires G, Sampaio G, Borrego LM, Arêde C, Morais-Almeida M, Anaphylaxis in children and adolescents: one-year survey in an Immunoallergy department. Allergy 2012;67(Suppl.96):154.
GEMC - Gastrointestinal Bleeding in the Pediatric PatientOpen.Michigan
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
presentation regarding investigations and treatment of heart failure in pediatrics, including the management of an emergency , and includes brief description about even drugs used
Anaphylaxis Management: Problems with the Current Paradigm and the need for ...Michael Langan, M.D.
Michael Langan, MD
Geriatrician, MGH Senior Health
September 10, 2012
Epi-Port (cartridge housing, portable, fashionable, easy to use)
Epi-Pod (cartridge, removable, replaceable)
A new drug delivery system for treatment of anaphylactic shock
Twist, Turn, Push (TTP)
From concept to patent to market
1:30P.M.-2:30P.M.
Fox Hill Village Auditorium
Sponsored by the MGH Wellness Center
*************************
I need an article not copied on the internet talks about allergic .pdfmohdjakirfb
I need an article not copied on the internet talks about \"allergic reaction\"
Solution
allergic reactions
allergic reaction : it is a the body\'s method for reacting to an \"intruder.\" When the body detects
an outside substance, called an antigen, the insusceptible framework is activated. The immune
framework typically shields the body from destructive operators, for example, microscopic
organisms and poisons. Its overcompensation to a safe substance (an allergen) is known as a
touchiness response, or a hypersensitive reaction.
Responses may happen in one spot, for example, a little restricted skin rash, bothersome eyes,
confront knocks, or all over, as in an entire body rash, for example, hives.
Most hypersensitive responses are minor, for example, a rash from toxic substance ivy, mosquito
or other bug chomps, or sniffling from feed fever.The kind of response relies on upon the
individual\'s insusceptible framework reaction, which is some of the time eccentric. In
uncommon cases, a hypersensitive response can be life-undermining (known as
hypersensitivity).
The Asthma and Allergy Foundation of America (AAFA) gauges that no less than one in 50
Americans (1.6%), and upwards of one in 20 (5.1%), have had hypersensitivity happen, bringing
about a normal of 186-225 passings for each year. The AAFA states that hypersensitivities
influence 50 million Americans, are the fifth driving unending malady in the U.S., and the third
driving interminable ailment among kids under 18 years old. More than 40 million individuals
have indoor/open air sensitivities as their essential hypersensitivity. In 2012, more than 11
million individuals in the U.S. gone to their specialist for unfavorably susceptible rhinitis, and
hypersensitivities to nourishment represent 200,000 visits to the crisis room and 10,000
hospitalizations every year.
Practically anything can trigger an allergic reaction.The body\'s safe framework includes the
white platelets, which deliver antibodies. At the point when the body is presented to an antigen
(an outside body, for example, dust that can trigger an invulnerable reaction), a perplexing
arrangement of responses starts.
The white platelets deliver a neutralizer particular to that antigen. This is called
\"\"sensitization.\" The employment of the antibodies is to white platelets recognize and crush
substances that cause malady and disorder. In unfavorably susceptible responses, the counter
acting agent has a place with the class of immunoglobulins known as immunoglobulin E or IgE.
This neutralizer sort advances creation and arrival of chemicals and hormones called
\"mediators.\"
Mediators have impacts on neighborhood tissue and organs notwithstanding initiating more
white platelet safeguards. It is these impacts that cause the side effects of the response.
Histamine is one of the better-known hypersensitivity , mediators delivered by the body.
In the event that the arrival of the mediators is sudden or broad, the unfavorably susceptibl.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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2. OBJECTIVES
Review Bites & Stings
Review Drowning
Review Heat Exposure Spectrum
Understand common pediatric summertime emergencies and
their pathophysiology.
Know the treatment methods for each emergency.
Review initial stabilization and safe transport for each specific
emergency.
3. Key Terms
Anaphylaxis: An exaggerated, life- threatening hypersensitivity
reaction to a previously encountered antigen.
Drowning: Death by asphyxia after submersion.
Heat stroke: Life-threatening failure of the body's temperature-
regulating mechanisms after exposure to high or prolonged heat stress.
Laryngospasm: A sudden, temporary closure of the larynx.
4. Treating Pediatric Summertime
Emergencies
EMS is called to a daycare for a 4-year-old
child with difficulty breathing. On arrival,
they find a 33-lb child in moderate distress
with inspiratory and expiratory wheezing. A
quick history reveals that a bee stung the
patient 15 minutes prior to arrival. Ten
minutes later, the patient vomited and started
wheezing.
5. Treating Pediatric Summertime
Emergencies
The patient is quickly placed on a monitor
and vital signs show a heart rate of 160,
respiratory rate of 40, oxygen saturation of
88% and a blood pressure of 80/40. His
physical exam reveals a patient in obvious
distress, moist mucous membranes and
normal oropharynx without tongue swelling.
6. Treating Pediatric Summertime
Emergencies
His heart is tachycardic with a regular rhythm.
Auscultation of the chest shows the patient is
tachypneic with inspiratory and expiratory wheezing
coupled with intercostal and substernal retractions.
His abdomen is soft, non- tender and non-
distended. An examination of the skin show a
blanching, raised, erythematous rash around the
sting site on his leg that has spread to his trunk. The
patient is quickly placed on oxygen. The steps that
are taken next save this patient's life.
7. Deadly Season
Summer, a much-anticipated season of the year for
both adults and children, is unfortunately a time for
significant unintentional injury and death to kids.
This is secondary to a combination of children being
out of school and spending more time outdoors,
coupled with decreased adult supervision. Statistics
from the National SAFE Kid Campaign Study reveal
that nearly half of the unintentional deaths of
children under 14 years of age occur between May
and August, with a peak occurring in July.
8. Deadly Season
During these summer months approximately 9
million children are seen in EDs across the country
and over 9,000 children will die as a result of these
injuries.1 Through proper assessments and symptom
identification, first responders can provide key
initial stabilization for common summertime
emergencies and prevent further mortality.
9. Deadly Season
Children are at higher risk for traumatic injuries
based on anatomy alone. A smaller body size can
lead to multiple injuries from just a single impact.
Children also have a decreased circulating blood
volume indicating that hypovolemic shock can
result from a relatively small blood loss. A relatively
cartilaginous skeleton can lead to visceral and brain
injuries that are common in the absence of bony
injuries.
10. Bites & Stings
Reactions to insect stings are seen commonly in
pediatric practice, ranging from simple local
reactions to systemic anaphylaxis. Both warmer
weather and spending more time outdoors are risk
factors. Though a rare occurrence from a sting, one
has to be prepared for anaphylaxis when
transporting these patients. Stinging insects include
honeybees, bumblebees, wasps, yellow jackets,
hornets, harvester ants and fire ants. Biting insects
include mosquitoes, fleas, horseflies, ticks and
chiggers.
11. Bites & Stings - anaphylaxis
How it occurs: Immediately after contact with the
insect, a local reaction occurs at that site with
associated edema and pruritic local erythema.
Irritant substances concentrated in insect saliva
cause these local reactions in an insect bite. In insect
stings, the female insect has a barbed stinging
apparatus that becomes lodged in the skin and rips
away, along with the venom sac, from the insect's
body following a sting event.
12. Bites & Stings - anaphylaxis
Treatment: These local reactions usually last several
hours and respond to the application of cool
compresses. Antihistamines such as
diphenhydramine (Benadryl) and analgesics may
also be helpful. Stingers should be removed as
rapidly as possible using something stiff--such as
thick paper or a credit card--because venom can
continue to be released for several seconds.
13. Bites & Stings - anaphylaxis
Treatment (continued): The area should then be
washed with soap and water and elevated if on an
extremity. Larger local reactions can also occur,
involving areas of approximately 5–10 cm in
diameter that are adjacent to the site of the sting.
The swelling generally peaks in 24–48 hours, but the
reactions can last up to 10 days. Steroids are usually
not indicated for insect stings unless there's
anaphylaxis.
14. Bites & Stings - anaphylaxis
Severe cases: Although systemic reactions to insect
stings and bites are the exception with less than 1%
of children experiencing them, they can be life-
threatening.2 Anaphylaxis is a serious allergic or
hypersensitivity reaction that's rapid in onset and
may cause death secondary to rapid mast cell
degranulation. In order to have an anaphylactic
reaction, one must have had a previous sting.
Higher-risk patients are immunocompromised
patients (e.g. AIDS, cancer, medically fragile) or
patients with known anaphylaxis or severe allergies.
15. Bites & Stings - anaphylaxis
Severe cases: Per the latest guidelines from the American Academy
of Allergy, Asthma, and Immunology, there are different ways to diagnose
anaphylaxis but the important points are that it can be an abrupt or
delayed onset and usually two of the following criteria have to be met:
Skin or mucosal involvement;
Respiratory compromise such as wheezing or persistent cough;
Hypotension;
Persistent vomiting or diarrhea; or
End organ dysfunction.
16. Bites & Stings - anaphylaxis
Severe cases: The immediate initial therapy for
anaphylaxis is epinephrine (1:1,000) 0.01 mg/kg, with
max of 0.3 mg intramuscularly in the anterolateral
thigh. Please note that this is a change from the past
when epinephrine was given subcutaneously. Giving
it intramuscularly provides more rapid absorption.
17. Bites & Stings - anaphylaxis
Severe cases: In patients with true anaphylaxis,
intramuscular epinephrine should be given first
before IV access is obtained. Epinephrine can be
repeated if needed. Once IV access is established, an
antihistamine such as diphenhydramine should be
administered. A normal saline bolus should be
considered if the patient has decreased capillary
refill or is hypotensive.
18. Bites & Stings - anaphylaxis
Severe cases: Nebulized albuterol can be used if the
patient is wheezing or in respiratory distress. If EMS
protocol allows, a corticosteroid such as solumedrol
at a dose of 2 mg/kg should be given to a maximum
dose of 60 mg.
19. Bites & Stings - anaphylaxis
Severe cases: Patients who meet criteria for
anaphylaxis should never been left on the scene and
should always be transported to the nearest
appropriate ED, even if there's dramatic
improvement or complete resolution of symptoms
after epinephrine. This is because there's a rebound
phenomenon that can occur approximately 4–6
hours after the initial exposure.
21. Drowning
Drowning is the second leading
cause of injury related death in
children less than 15 years old.1
Recent studies conducted by the
CDC reveal that the rates of
drowning deaths in children less
than 19 years of age have decreased
in the past 10 years, but drowning
still remains the number one cause
of unintentional injury leading to
death in boys ages 1--4. Between the
months of May and August, two
thirds of all deaths from drowning
occur, with most of them occurring
on the weekends.
22. Drowning
Statistics for nonfatal drowning are even more
difficult to obtain, but nonfatal drowning events
may occur several hundred times as frequently as
reported drowning deaths.
23. Drowning
Risk factors: Risk factors for drowning include
inability to swim, as well as risk-taking behaviors,
particularly in adolescents. There's a bimodal age
distribution, which includes children less than 5
years of age and those 15--19 years of age who are
more likely to drown.
24. Drowning
Risk factors (continued): The location of the
drowning accident is also age dependent; children
less than 1 year of age drown most frequently in the
bathtub, children ages 1–4 drown in swimming
pools, and adolescents and teens are most likely to
drown in natural bodies of water.
25. Drowning
Risk factors (continued): Children of low-to-
middle income background account for 90% of all
drownings, indicating that children of lower
economic status are at higher risk.1 Various primary
medical conditions preclude some children to
drowning accidents such as children with seizures,
who are 4 times more likely to drown. Likewise,
children with a primary cardiac arrhythmia are at
high risk, particularly if it is a cold- water drowning
or a significant amount of exercise is involved.
26. Drowning
Pathophysiology: Both fatal and non- fatal
drownings begin with a period of panic. Contrary to
popular belief, the victim won't wave his or her arms
and call for help. With panic, there will be a loss of
the normal breathing pattern, air hunger and
periods of breath holding.
27. Drowning
Pathophysiology (continued): The patient will
be holding himself upright with arms extended
laterally to assist with posture and lung expansion,
and may be mistaken for playing or splashing as
they struggle to stay above water. The struggle for
children to remain above water may only last for 10
seconds, while adults may struggle for 60 seconds.
28. Drowning
Pathophysiology (continued): In 20% of cases, reflexive
laryngospasm occurs and water isn't aspirated into the lungs.3 The
combination of hypoxia, hypercarbia and acidosis can decrease
myocardial contractility, elevate pulmonary artery and systemic
vascular resistance, and produce cardiac arrhythmias, seizures and
death.
29. Drowning
Initial assessment and transport: The initial
presentation of a victim of a submersion injury is
quite varied, depending on initial submersion time
and resulting hypoxemia. Signs and symptoms may
include loss of consciousness, apnea, dyspnea,
tachypnea, tachycardia, altered mental status,
seizures, coughing or decreased breath sounds on
exam.
30. Drowning
Initial assessment and transport (continued):
Initial treatment of the potential drowning child
includes supporting the ABC's (airway, breathing
and circulation) by providing high-quality CPR. If
the patient doesn't have an adequate respiratory
effort, it's acceptable to provide bag-mask
ventilation if good chest rise is noted and transport
time is short.
31. Drowning
Initial assessment and transport (continued):
If the patient aspirated a significant amount of
water, they may require a slightly higher pressure
(positive end-expiratory pressure) to bag. Should the
patient be difficult to bag or there will be a
prolonged transport time, intubation should be
considered.
32. Drowning
Initial assessment and transport (continued):
If intubation isn't necessary, the patient should be
placed on a non-rebreather mask with 100% oxygen
to help correct hypoxia.
33. Drowning
Initial assessment and transport (continued):
One should avoid the Heimlich or other techniques
to remove water as they haven't proven to
demonstrate any benefit. Correction of the hypoxia
is the key to a positive patient outcome.
34. Drowning
Initial assessment and transport (continued):
Near-drowning patients should always be
transported to the nearest appropriate ED given the
risk of rapid decompensation. Even the
asymptomatic near-drowning victim requires
observation of at least four hours.
35. Heat Exposure Spectrum
Heat illnesses occur along a spectrum of very minor
(heat rash, cramps) to life-threatening conditions
such as heat stroke. Most episodes of heat illness
occur during times of increased environmental heat
as well as increased exposure to heat. The heat
exposure spectrum includes heat rash (miliaria),
heat cramps, heat edema, heat syncope, heat
exhaustion and heat stroke.
36. Heat Exposure Spectrum
Pathophysiology: A normal body temperature of
98.6 degrees F is maintained within a narrow range
by balancing heat load and dissipation. As the
body's core temperature rises from hot weather or
exercise, heated blood is transferred to the skin
surface if it's cooler.
37. Heat Exposure Spectrum
Pathophysiology (continued): In an effort to more
rapidly dissipate heat, the body dilates blood vessels
and pores and evaporates sweat to help with cooling.
Unfortunately, this mechanism becomes ineffective
once the relative humidity is over 75%. With heavy
work, the body may lose 1--2 liters of fluid.
38. Heat Exposure Spectrum
Pathophysiology (continued): After several hours
of fluid loss, a person may start to become
symptomatic with loss of endurance, increased
thirst and becoming uncomfortable. After 3–5 hours,
the body has decreased blood to circulate to the rest
of the body, which may lead to decreased alertness,
nausea, muscle cramps, headache and/or loss of
strength.
39. Heat Exposure Spectrum
Pathophysiology (continued): If not treated with
fluid resuscitation, this may lead to heat stroke.
Heatstroke by definition is a core temperature
greater than 105 degrees F, decreased level of
consciousness and an environment consistent with
heat stroke.
40. Heat Exposure Spectrum
Initial assessment and transport: The key to
treating heat exposure spectrum is to identify
approximately where the patient is on the spectrum.
Heat rash presents with a possibly pruritic
maculopapular rash treated by cool baths, loose
clothing and removing the patient from the
environment.
41. Heat Exposure Spectrum
Initial assessment and transport (continued):
Heat cramps present as brief, intermittent muscular
cramps that are relieved by increased salt intake. If
they're more severe they may require IV fluids.
42. Heat Exposure Spectrum
Initial assessment and transport (continued):
Heat syncope is a temporary loss of consciousness
associated with vasodilation and venous pooling. It
occurs usually after standing a long time or a quick
adjustment in position. These patients usually have
a normal core temperature and mental status will
quickly improve once supine and IV fluids are
administered.
43. Heat Exposure Spectrum
Initial assessment and transport (continued):
The definition of heat exhaustion involves a known
heat exposure and core temperature between 37--40
degrees C. These patients present with evidence of
mild tomoderate volume depletion, variable
nonspecific symptoms including nausea, fatigue,
confusion, headache and tachycardia. Treatment
consists of removal from the heat to a cool
environment, removal of excessive clothing, chilled
oral rehydration with salt containing fluids or IV
hydration.
44. Heat Exposure Spectrum
Initial assessment and transport (continued):
Central nervous system dysfunction is the hallmark
for heat stroke. When first assessing these patients,
the ABCs are paramount as these patients may need
an airway intervention. Wet sheets without air
movement tend to increase the core temperature
and should be avoided.
45. Heat Exposure Spectrum
Initial assessment and transport (continued):
When treating these patients, it's helpful to recall
the treatment mantra of Corey Slovis, MD, chairman
of emergency medicine at Vanderbilt Medical
Center: "Wet and windy." Use ice packs on the groin
and the axilla, fans to help with convection cooling,
and IV fluids as needed for hydration. Those
patients with altered mental status, vital sign
changes or evidence of dehydration should be
transferred to the nearest hospital for observation
and further treatment.
46. Conclusion
In the medical community, summertime involves a
unique set of medical issues along with an increase
in trauma patients. First responders must be
prepared to treat these patients quickly and
efficiently so that morbidity and mortality can be
minimized.
Lauren Mutter, MD, is a pediatric emergency medicine fellow at Le
Bonheur Children's Hospital.
Mark Meredith, MD, is associate professor of pediatric emergency
medicine at Le Bonheur Children's Hospital.
47. References
Unintentional Drowning: Get the facts. (Oct. 24, 2014.) Centers for Disease
Control and Prevention. Retrieved May 4, 2015, from
www.cdc.gov/HomeandRecreationalSafety/Water-Safety/waterinjuries-
factsheet.html.
Curtis J. Insect sting anaphylaxis. Pediatr Rev. 2000;21(8):256.
Salomez F, Vincent JL. Drowning: A review of epidemiology, pathophysiology,
treatment and prevention. Resuscitation. 2004;63(3):261–268.
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Campbell RL, Li JT, Nicklas RA. Et al. Emergency department diagnosis and
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Jardine DS. Heat illness and heat stroke. Pediatr Rev. 2007;28(7):249–258.