There are three levels of burns- first degree, second degree and third degree.  First degree burns are considered the least serious and only involve the outer layer of skin.  These types of burns can usually be treated at home and do not require hospital care.  A burn cream can be applied to help relieve any pain and aid in the healing process.

Second degree burns are more severe and cause greater damage to the outer layer of skin.  This degree of burn can result in blistering of the skin and should be evaluated by an emergency medical professional if more than 5% of the person’s body is burned, or if the burns are located on the hands, feet, face, groin or buttocks areas.  First and second degree burns will usually heal without scaring unless they become infected.

Third-degree burns are the most serious type of burn and involve all of the layers of the skin, including fat and nerves.  A third degree burn can either look charred black or a dry white.  This degree of damage usually causes the nerves to be burned and results in very little pain at the area.  All third degree burns should be treated by a physician as soon as possible.  This is especially important to learn to spot if you are hoping to embark on the paramedic/EMT career path, if or when any area appears to be infected.

If you come upon someone who is burned it is important to determine the cause of the burns and remove the victim from the source of the burn.  Determine if the burn was cause by chemicals, solvents, hot liquids, steam, flames or electricity.  Be careful not to get anything that caused the burn on your self as you move the victim to a safe location.

If the victims clothes are on fire, push the victim on the ground and smother the flames with whatever blankets or clothing are at hand.  Remove only clothing that was soaked with hot liquids.  Do not remove clothing that has burned into the skin.  If possible, raise the burned area above the head to prevent swelling and to reduce the pain.

To cool any area of the skin that may still be hot right after it has been burned, run cool water over the burn for eight to 10 minutes.  Saturated sheets, towels or clothing with cool water can be used on large areas.  Gently apply them to the burned area.  You can help prevent shock by covering the victim with blankets and elevating the feet.  Smaller burns may only require the use of a burn ointment.  Beware of infection.  Possible signs include: redness, swelling, and increasing pain in a burn.

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Always ask a patient what type of medication he/she is taking.  Prescription medication, over-the-counter drugs and herbal supplements should all be documented.  It is also important to determine the dosage of these medications and whether or not the patient is following the proper dosage amounts.  If prescription bottles are available, make note of the prescription date, dosage and frequency of use.  This can help you determine if the patient is complying with the prescription protocol.

If the patient is awake and responsive, ask for pertinent past medical history.  You will want to know about any recent or past medical problems, surgeries and injuries.  You want to identify medical history that could be pertinent to the current problem you are attempting to treat.  Knowing a patient’s medical history can help you look for signs and symptoms that could be related to previous traumas, injuries or illnesses.

Identifying the last oral intake of solids or liquids may seem unnecessary but this specific information can provide you with valuable insight into the patient’s health.  You should determine if there has been any changes in eating habits or if unhealthy eating habits exist, such as over eating or not eating enough.  You will also want to know if the patient consumed alcohol or overdosed on drugs.  Knowing the last intake of solids or liquids is also important in case emergency surgery becomes necessary.

Identifying the events leading to injury or illness can provide valuable information.  Knowing the order in which symptoms occurred can give you insight into the potential problem the patient is undergoing.  For example, the patient’s main complaint may be dizziness.  The patient may tell you that before he felt dizzy he had a shooting pain in his chest.  The order of the symptoms can give a good indication of what the problem could be. The acronym OPQRST-ASPN can help you remember to focus your questions on obtaining pertinent information.    O is for onset- identify when the original onset of the illness or condition took place.  This is often when an illness or condition was originally diagnosed and not necessarily when the current episode occurred.  P stands for provocation.  Determine what provokes the patient’s signs or symptoms to improve or get worse.  Q is for quality of pain from the patient’s subjective description of his signs and symptoms.  R represents radiation- determine how far out a patients pain radiates to other locations.  S is severity- ask the patient to rate the severity of the sign or symptom.  Use a 1-to-10 scale with 1 representing no symptoms and 10 representing the worst symptoms the patient can imagine.  T stands for the length of time that the patient has been experiencing the signs and symptoms.

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When treating a patient it is important to gather concise and inclusive information about the patient and his medical problems.  There is a very helpful acronym that can help you to remember the six elements of patient history you need to obtain.  The acronym is SAMPLE and it stands for:

Signs and symptoms

Allergies

Medications

Pertinent past medical history

Last oral intake of solids or liquids

Events leading to illness or injury

Signs and symptoms should indicate what the patient’s possible problem is.  A sign is something that can be observed or identified as occurring in the patient.  Skin color, pulse, bleeding, temperature, blood pressure, respiratory condition or abdominal distention is an example of injury.  A symptom is a condition that is not visually observed but can be described by the patient.  A feeling of nausea, headache, pain and dizziness are examples of potential symptoms to bigger problems.   It is important to consider all the obvious signs and symptoms observed by you or described by the patient.  The sign and symptoms should form the basis for how you will consider treating the patient.

Before administering any medications, it is important to determine if a patient has any allergies.  Some people are allergic to certain medications like ibuprofen or penicillin.  You should also find out if they have food or environmental allergies.  Knowing this information can help you to determine if the patient is suffering from an allergic reaction or can guide you to treat them with appropriate medications.

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An infection of the middle ear is medically termed otitis media.  This type of infection occurs in the cavity between the eardrum and the delicate structure of the inner ear.  Most often a middle ear infection is caused by viruses infecting the can cause the upper respiratory tract or bacteria migrating along the passageway between the nasal passages and the middle ear.  Infections can cause the tube to become blocked.  A blocked tube creates a vacuum-like effect that prevents mucus, pus and other fluids from draining out of the middle ear.  The build up of these fluids causes pressure on the eardrum and could possibly rupture it.

Otitis media is common in children because the passageway between the nasal passages and the middle ear, called the eustachian tube, is smaller than in adults.  These types of ear infections commonly recur in the winter months.  Nasal allergies or childhood adenoids can also cause a blockage of the Eustachian tube and lead to infection.  Children with congenital problems of the facial skeleton, such as cleft lip, and children with Down syndrome have a greater risk of getting middle ear infections.  Second-hand exposure to cigarette smoke can also increase the risk of middle ear infection in children.

Symptoms of a middle ear infection include:

-Ear pain

-Some temporary hearing loss in affected ear.

-Fever.

-Dizziness.

-Nausea and vomiting.

-Pain when pulling on the earlobe.

-Persistent pus seepage

To prevent a middle ear infection it is best to wash your hands frequently with soap and warm water.  Also, wash bed linens and towels to prevent re infection .

Antibiotics are often prescribed to treat bacterial infections.  Aspirin or acetaminophen can be taken to ease pain and fever.  Children should only be given acetaminophen.  Your doctor may recommend the use of decongestants or antihistamines to treat the symptoms associated with an ear infection.  Sometimes a small incision is made in the eardrum to allow the pus to drain.  This incision usually heals itself in two to three weeks.

Have you been interested in other possible allied health fields?  Look at strength and conditioning certification.   In addition to EMT, strength and conditioning is another field that is physically involved, helps others, and doesn’t involve extensive education.

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Penicillin was discovered in 1940, over 70 years ago.  The discovery is to this date, the most effective and minimally toxic antimicrobial drug.  There are four types of penicillin.  Most penicillin is active against gram-positive bacteria and only active against some gram-negative bacteria.  There are some strains of bacteria that are resistant to penicillin.  These strains usually contain enzymes that destroy penicillian.

The four types of penicillin are:

Basic (natural), Penicillinase-resistant (resistant to beta-lactamase inactivation), Aminopenicillins (broad spectrum), and Extended-spectrum.

Penicillian is generally categorized by its ability to destroy bacterial enzymes.  There are several precautions that should be taken before penicillian is administered.  If penicillian is given by mouth, it is best to be taken an hour before and an hour after food has been eaten.  Penicillian should not be given with acidic fruit juices.  Water is best.

If penicillian is administered intravenously, it will be slowly dripped because penicillin contains large amounts of potassium that can cause heart failure in patients with renal problems.

People with allergies may experience anaphylactic shock from penicillian and should discuss their allergies with their physician before taking penicillian or any other type of medication.

Penicillian should not be taken by people with the following problems:

-Frequent bleeding

-GI diseases

-Mononucleosis

-A low-salt diet

-Impaired renal function

Penicillian can have adverse affects if taken in conjunction with other drugs, like anti-hypertensive drugs, potassium-sparing diuretics, potassium-containing drugs, or potassium supplements.

Generally, healthy patients will see improvement in their condition within 48 hours of taking penicillian.  If symptoms worsen or do not improve in 48 hours it is recommended that the patient consult his/her physician.

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As an emergency medical technician, you often come upon life threatening situations.  It is at this time that you should consider doing a focused history and physical examination of the patient.  This may be the only opportunity you will have to examine the patient from head to toe.  Always keep in mind that injuries to the trunk are usually more critical than injuries to the extremities and you should focus your efforts on stabilizing those areas first.  You will learn how to examine patients when studying EMT or Paramedic Training.  Here is a brief written summary of the steps.

Isolated injuries may not require a detailed physical examination.  For example, if a trauma patient has a cut foot, a focused history and physical examination directs you to assess and care for that specific injury.  It most likely will not be necessary to palpate other body parts such as the abdomen, pelvis, and extremities.  Patients with specific, isolated trauma do not usually require a detailed physical examination.  However, if the cause of the injury suggests further evaluation, a focused history and physical examination may be appropriate.

A detailed physical examination is similar to a focused physical examination for trauma patients.  Both assess DCAP-BTLS: Defomaties, Contusions, Abrasions, Penetrations/punctures, Burns, Tenderness, Lacerations, and Swelling.  Evaluate these eight components with detail as you inspect and palpate the entire body surface area of the patient.

Begin at the patients head.  Start on the superior surface of the head and palpitate the area.  Run your hands back to the posterior occipital area and bring your hands around to the patient’s frontal lobe.  Carefully inspect and palpitate each area.  Move toward the face and palpitate the frontal area, the zygomatic arches, the maxilla, and the mandible of the patient.  A penlight is useful to check in the ears for drainage.

The penlight should also be used to check the eyes of the patient.  Look for any discoloration.  Determine if the eyes are symmetrical and the pupils are equal.

Check the pupils and assess if they are equal in size and react to light.  Also, look for any blood or foreign bodies in the eyes.  A penlight should also be used to check a patient’s nose for any drainage.

Ask the patient to open their mouth so you can inspect for loose teeth or any other substances, such as gum, dentures, food, tobacco products, or secretions that may be causing obstruction.  Also check for swelling or ulcerations of the tongue, and for odors and discoloration.

Next, you should evaluate the patient’s neck.  If a trauma patient has an immobilized spine, you can carefully evaluate the neck region.  As soon as the patient is immobilized on a backboard with a cervical spine immobilization device in place, while your partner manually stabilizes the head, you can open the cervical spine immobilization device in front, inspecting and palpitating for DCAP-BTLS.  Also, check for jugular vein distention and crepitation.  Look at and feel the trachea to determine if it is midline.  Replace the immobilization device following this neck evaluation.

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