In this installment I wanted to cover a wider range of topics. Read on to see how these well covered topics are sometimes overlooked.

Eviscerations – The reason I chose this topic is to point out how even though the injury is the same, the treatment can differ from state to state. Some protocols want you to cover the evisceration with saline moistened dressings and then cover with dry bulky dressings. Others state to cover with clear occlusive type dressings. Which is better?

While I am by no means an expert or have detailed studies on this subject. My basic research shows that the primary goal is to keep the exposed organs moistened and to maintain body heat. So by using either of the moistening techniques you satisfy this objective. By using an occlusive dressing with either foil or clear wrap you can also maintain the wetting agent. Using dry bulky dressings helps to keep the area warm.

So, always use saline moistened sterile dressings as your first line of treatment. Then follow your local guidelines. Whether occlusive or more dressings, keep the area warm, do not try and push the exposed organ back into the cavity and if possible, allow the patient to bend his/her knees slightly to relieve tension on the abdomen whenever possible.

EKG’s – Performing 12 lead EKG’s in the field is becoming more and more a standard of care. It just isn’t enough to stick the pasties on and print out a strip. You need to have an understanding of what you are looking at and for.

Consider a right sided assessment as well, especially for those hypotensive chest pain patients. If time allows, perform a 12 lead on patients exhibiting shortness of breath not related to asthma or COPD. Studies have shown that while many of these SOB patients may not have chest pain, they can be experiencing an AMI without pain. Of course we always want to treat the patient and not the monitor. However, by doing a 12 lead on these shortness of breath patients, it can help determine the possible cause of the SOB. Then by consulting with medical control, perhaps nitrates can be administered by what the 12 lead presents and the patients signs and symptoms.

Lastly, repeat the 12 Lead after your treatment and any changes in the patients’ status. You will many times see an improvement in the EKG. This is a big motivator to do a little bit more and see the fruits of your labor with the patient.

Just some food for thought on the uses of 12 leads other than strictly sub sternal chest pain complaints.

Everybody – Determining when to perform a 12 lead, what drug to give or withhold and any other treatment BLS or ALS depends on one primary factor. That is a “standard approach to the patient”. Too many times we go by the call type or what the main patient complaint is. We should be doing a detailed vectored exam and looking for any other factors that may be causing the initial call for assistance.

The first time seizure – fever, trauma, bleed?
Tachycardia – sepsis, shock, PSVT?
Respiratory Distress – asthma, COPD, pneumonia, CHF?

You can see that by having a standard approach to every patient you encounter will help you make the right decision regarding the patients’ treatment. It will also help you do it in a quick and efficient manner without delaying that treatment.

I know that in past installments of this series I have mentioned similar themes. I am a big supporter of the basics. All the advanced techniques we can do are useless or even harmful if we do not stick with the basics.

Do your ABC’s, give oxygen, really look at the EKG’s and most of all listen to and observe your patient. You will find that by sticking to the basics it will always help you be a better EMS provider and keep you focused on the patient in front of you.