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Rod Brouhard, EMT  P

First Aid Blog


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First Aid Phraseology: Emergency. Do You Know How to Tell?

Friday May 30, 2014

One of the greatest ego boosts any paramedic or EMT can get is to visit a kingergarten class to show off the ambulance. These kids treat us like rockstars. Did you know if you take the gurney out of the back, you can get more than 20 five year olds in there with the teacher and room to spare?

When we do these school visits we have a couple of important things we're trying to convey to the kids. The first -- and most important -- is not to be afraid of us. We try to make them comfortable with all our (really cool) equipment. We hook them up to the heart monitor and shock them...

Oops! I'm sorry. We only shock college kids.


First Aid Phraseology: Lacerations or Incisions, Do You Know Which Makes the Cut?

Wednesday May 28, 2014

Jagged, ripped and torn apart, lacerations bear no art.
Incisions, though, have grace and grand design.
The lowly laceration is the work of twisted metal
But only the sharpest edge may incise the surgeon's line.

Lacerations get more airplay. Incisions, however, are a cut above your average laceration. Incisions are all about precision versus the laceration's desecration.

I know, I know. Cut it out (insert eye roll here). Read More...

First Aid Phraseology: Insulin Shock vs Diabetic Coma

Wednesday May 28, 2014

Insulin shock refers to the body's reaction to too little sugar -- hypoglycemia -- often caused by too much insulin. Diabetic coma refers to a victim of high blood sugar -- hyperglycemia -- who becomes confused or unconscious.

These terms are confusing, and not because my blood sugar is too high. They don't have any connection to reality. Indeed, if I was nicknaming medical conditions today, I would switch these.

Insulin Shock

Insulin shock makes it sound like the body is in shock, which isn't true. Shock is, first and foremost, a lack of blood flow to important areas of the body, like the brain. It usually comes with a very low blood pressure. The most common symptom of low blood sugar is confusion (yeah, I know, that's supposed to go with diabetic coma -- just stay with me here), not a low blood pressure. In fact, insulin shock doesn't affect the blood pressure much at all.

Insulin shock also implies that insulin is to blame, but insulin -- at least from injections -- is not required for someone to develop low blood sugar. Plenty of diabetics take pills, which are not insulin, to control their blood sugar levels. Some diabetics control their blood sugar levels simply by watching their diets. To make it even worse, some folks get low blood sugar even though they're not diabetic at all, which means they would have no reason to take insulin.

So why is it called insulin shock? Because it sort of looks like shock. Shock, the real, low blood pressure kind, causes the body to react with what's known as the Fight or Flight Syndrome. Low blood sugar does the same thing. The Fight or Flight Syndrome is the body's normal reaction to any stress. It makes us ready to run away or fight for our lives. It causes our hearts to beat faster and it makes us sweat.

Having too little blood, too little oxygen, or too little sugar all make your body scared enough to get ready to do battle or run away. That's where the name comes from, but it sure doesn't explain much about the problem.

Diabetic Coma

At least with insulin shock, the victim usually knows about the diabetes. Diabetic coma, on the other hand, creeps up on you. It takes a lot of sugar in the bloodstream to reach confusion and unconsciousness. That doesn't happen overnight. Diabetic coma is most likely to happen to those who don't know they're diabetic yet.

Worse, high blood sugar stimulates the production of urine -- lots of urine. One of the symptoms of high blood sugar is frequent urination. Victims can urinate so often they become dehydrated, which can lead to shock.

Okay, so follow along with me here: Insulin shock causes confusion and unconsciousness very quickly and is not shock at all, but diabetic coma only causes unconsciousness after several days -- maybe weeks -- and leads to dehydration severe enough in some people to be considered shock.

Yeah. I agree. Dumb names.

First Aid Phraseology is a weekly look at the common words and phrases used in first aid and emergency medical services. Have a term you'd like to know more about? Email me and I'll touch on it in a future post.

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First Aid Phraseology: Choking vs Strangulation

Tuesday May 27, 2014

Have you ever choked on a piece of steak? Has a cow ever wrapped its hooves around your neck and tried to strangulate you?

Choking is what happens when something solid gets stuck in your trachea (windpipe). It comes from the inside. You can't move air because there's a cork in the tube.

Strangulation is what happens when something constricts the neck from the outside, blocking off blood flow as well as airflow. Strangulation can be from an attack (grabbing someone around the neck) or by accident, such as a horrible necktie accident involving an overzealous knot (or more common would be falling asleep with something constricting the neck).

So, when talking about blocking airflow, what matters is how the flow is blocked. From the outside: it's strangulation. From the inside: it's choking.

First Aid Phraseology is a weekly look at the common words and phrases used in first aid and emergency medical services. Have a term you'd like to know more about? Email me and I'll touch on it in a future post.

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First Aid Phraseology: Cells, Tissues and Organs

Monday May 26, 2014

When we talk about injuries and illnesses, we often refer to cells, tissues and organs. Cells are the smallest complete units of life, and the human body has trillions of cells -- way too many for me to count.

We rarely talk about cells individually in first aid, unless we're talking about a particular type of infection called cellulitis.

Most of the time, we think not of cells but of tissues, which are sheets of similar cells strung together. In other words, a bunch of muscle cells clumped together makes muscle tissue. Likewise, a bunch of fat cells make fatty tissue.

Tissues can be hard or soft. Soft tissues are things like skin and muscle. Hard tissue is bone. Cuts and bruises are known as soft tissue injuries, while bone injuries are generally fractures or dislocations.

Lastly, tissues work together to do more complicated functions (muscle tissues only contract, but if you build a chamber with special muscle tissues and nerves to handle the rhythm, you get a heart). Those organized combinations of tissues are known as organs.

When you hear the doctor talking about organs, bruised tissue or cellulitis, now you'll know what she means.

First Aid Phraseology is a weekly look at the common words and phrases used in first aid and emergency medical services. Have a term you'd like to know more about? Email me and I'll touch on it in a future post.

| Twitter | Facebook | Newsletter Signup | First Aid Forum |

First Aid Phraseology: Trachea, Windpipe or Airway?

Friday May 23, 2014

The ABC's of first aid used to be:

  • A for Airway
  • B for Breathing
  • C for Circulation

It was the gold standard of all first aid assessments. Heck, it was the gold standard of all medical assessments, period.

Before figuring out if a victim has a broken arm, make sure he is breathing and has good color. Before treating the headache, make sure she has an airway. Before doing chest compressions, be sure to tilt the head, lift the chin, and look, listen and feel for breathing.

The importance of airway has given way to blood flow, but make no mistake: Airway is still a foundation of first aid.

First aid is all about the airway. The concept is pretty sound: without a way for air to get into the lungs and back out again, most of the rest of the bodily functions are pretty superfluous. Not to mention, without an airway, most of the other bodily functions will cease rather quickly.

So, what is the airway? You may have heard of the lungs, those airbags that feed oxygen to the bloodstream? Well, they're placed kind of deep in the chest (like in the middle) and have to have air piped in. That passage is the way air is brought to the lungs: the airway.

The airway is not really one pipe. It's more like a tree with a bunch of branches flipped upside down. Those pipes all have names. The trunk of the tree -- the first, biggest pipe of all -- is called the trachea. That's the pipe that goes from your throat through your neck into your chest. It's the part we think of in first aid when we say "airway."

It's also known by millions as the windpipe, not to be confused with windbag, which is what some people call me.

Regardless whether you call it a windpipe, an airway or the trachea, it's arguably one of the most important organs in your body. Treat it well and stay healthy.

First Aid Phraseology is an occasional look at the common words and phrases used in first aid and emergency medical services. Have a term you'd like to know more about? Email me and I'll touch on it in a future post.

| Twitter | Newsletter Signup | First Aid Forum |

First Aid Phraseology: Heat Illness, Heat Stroke and Heat Exhaustion

Wednesday May 21, 2014

Heat illness is a catch-all term referring to several different conditions that stem from getting too hot.

There are three common heat illnesses:

  • Heat Cramps. Heat cramps are muscle spasms triggered by not having balanced electrolytes in the body. Electrolytes are mineral salts found in healthy foods. If it ends in "-ium" it's probably an electolyte; sodium, calcium and potassium are the most common. Muscles use potassium and calcium to contract, and use sodium to relax. Nerve cells work in a similar way. Calcium and potassium must remain in balance for the muscles to work correctly. Otherwise, they can cramp or become weak.
  • Heat Exhaustion. The human body strives to maintain its core temperature (the temperature deep inside) at 98.6 Fahrenheit. A swing of a degree either way isn't really a big deal, but more than 3 degrees higher or lower and the body begins to respond. Heat exhaustion is an increased core body temperature with decreased electrolytes. The body is losing water (dehydration) and electrolytes quickly as it tries to lower the core temperature by sweating. The lack of electrolytes leads to weakness and confusion. The loss of water and the body's attempt to get rid of excess heat lead to low blood pressure, which makes the whole thing worse.
  • Heat Stroke. By far the worst of the three heat illnesses, heat stroke is a complete breakdown of the body's cooling ability. Heat stroke victims have much higher core temperatures than the other two heat illnesses. They no longer sweat because the body just can't spare anymore water. In most cases, they are completely unconscious and don't respond at all.

So this summer as you're getting ready to be in the heat, don't forget to hydrate. And bring some shade.

First Aid Phraseology is an occasional look at the common words and phrases used in first aid and emergency medical services.

Teach Kids CPR - They Might Save Your Life

Tuesday April 29, 2014

Kids can learn CPR. They might not be big enough to do the skills well, but they can certainly learn the steps.

Researchers in Austria tested kids aged 9 to 18 years on their ability to retain CPR skills. What they published back in 2009 is that kids can certainly remember the steps to CPR. In fact, they remembered the steps as good as or better than adults do.

Kids were tested a few months after being taught CPR, AED and bleeding control.

Bigger kids were able to do chest compressions and mouth-to-mouth better, but age had nothing to do with it. So, a big 9 year old could do CPR and any of the kids are able to operate the AED, call 911 or control bleeding.

The authors of the study point out that teaching CPR and first aid to kids puts them in the mindset to help out, which might help change adults' reluctance to assist in an emergency.

Something notable: researchers also recognized how difficult it was to teach and learn artificial ventilation, helping to make the case for lay rescuer CPR to leave out ventilations altogether. Since then, ventilations have nearly disappeared from CPR recommendations.

First Aid Phraseology: Consent

Monday April 28, 2014

Believe it or not, just because a person has sustained a life-threatening injury doesn't mean he wants your help. In fact, if you try to treat a person without permission, it is technically an assault on his person.

However, medical permission comes in many ways. In the medical world, we call permission consent, and there are two versions of consent: expressed consent and implied consent.

Victims can express their desire to be helped. They can say, "Help me." That is known as expressed consent. Often, in the hospital or the doctor's office, you not only say it's OK to be treated, but you'll probably have to sign a form.

What happens, then, when you can't speak? What if you need help and you can't ask for it?

In that case, consent is implied. If the victim can't express her desire to be treated, the assumption is that if she could speak, she would ask for help. Sometimes, it's because the victim is completely unconscious, which should technically be called inferred consent, because it's the rescuer who is inferring the victim's desire to be treated.

On the other hand, maybe the reason the victim can't express her consent is because she doesn't speak the same language you do. Maybe you only speak Spanish and your victim only speaks Vietnamese. You'll know she's cool with you're plan to hold pressure on her massive, blood-spurting laceration when she holds her mangled limb out for you to fix.

She's implying that she wants you to help. Implied consent.

The moral of the story is that if you're ever in doubt about whether a victim wants help or not, treat him. On the other hand, if a person who is completely alert and understands what is happening doesn't want help, you must leave her alone.

First Aid Phraseology is a occasional look at the common words and phrases used in first aid and emergency medical services. Have a term you'd like to know more about? Email me and I'll touch on it in a future post.

Twister Trouble

Sunday April 27, 2014

Several tornadoes have touched down across the country today, reportedly killing at least two people.

Tornado DamageIf you live in an area prone to twisters, you should know what to do if one touches down near you. Some of the most important tips:

  • Don't get caught in a mobile home, trailer or vehicle.
  • In a permanent structure, head to the lowest level possible in the center of the building.
  • Outside, lie flat in a depression or ditch and avoid bridges and overpasses.

Image (c) Julie Denesha/Getty Images

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