EMS Protocol of the Week - Bone and Joint Injuries (Adult and Pediatric)

A lot of the meat behind the protocol for bone and joint injuries was previously due to it being where to find the options for prehospital analgesia. Now that we have a dedicated pain management protocol, it’s since been thinned out a bit, but it’s still worth a skim for a review of assessment and stabilization of broken bones, as well as instructions for how to reduce a dislocated patella (if approved by OLMC – make sure they’re describing a patellar dislocation and not a knee dislocation!).

Have fun out there! www.nycremsco.org or the protocol binder for anything else you may…knee-d. Bye!

Dave

EMS Protocol of the Week - Avulsed Tooth (Adult and Pediatric)

While EMS aren’t reimplanting extremities (yet), they ARE able to reimplant avulsed teeth! This week’s protocol goes over indications and contraindications, as well as how to best replace a tooth in a socket as a temporizing measure. Pay particular attention to the Key Points section, which also gives a refresher on appropriate storage media if implantation is impossible. 

Another short one this week, but nevertheless something to…chew on?

www.nycremsco.org or the protocol binder or honestly your cousin’s old book of puns for probably a lot of the same content.

Dave

POTD: Local Anesthetic Toxicity

Max amounts of local anesthetic:

 For a 70 kilogram, that means 35 mls of 1% Lidocaine, 49 mls of !% Lidocaine w/ epi, etc.

Mechanism of toxicity; sodium channel blockade effects block cardiac myocyte function and electrophysiology, resulting in arrhythmias. Intravascular absorption of LA also may travel to the CNS, causing its neurologic effects.

Symptoms: a prodrome of perioral numbness, tinnitus, agitation, dysarthria, and confusion. Followed by possible seizures and coma.

Cardiovascularly,  patients initially present with hypertension and tachycardia, which progresses to bradycardia and hypotension. This eventually progresses to ventricular arrhythmias and asystole.

The majority of adverse events occur within 1 minute of injection, but some cases may more than 1 hour after injection.

Bupivicaine’s higher toxicity is linked to its higher lipophilicity.

Toxicity is more common in this with hepatic and renal dysfunction, and those with heart disease and heart failure are at increased risk, as are those at the extremes of age, and in the ED setting are  most common in peripherals nerve blocks

Prevention:

Always aspirate before injection of local anesthetic.

 Treatment: