miércoles, 18 de octubre de 2017

Pinellas County EMS & Fire Administration 2017

Pinellas County EMS &Fire Administration 2017

CIANURO y su ANTIDOTO "Nithiodote". MANEJO INTOXICACION POR HUMO DE INCENDIOS. SEMICYUC / CYANOKIT

MANEJO INTOXICACION POR HUMO DE INCENDIOS. SEMICYUC

La intoxicación por humo es la principal causa de morbimortalidad en los incendios. El humo es una mezcla de partıculas carbonaceas suspendidas en aire caliente y gases toxicos. De todos ellos, el monoxido carbono (CO) y fundamentalmente el acido cianhıdrico (CNH) son los que van a provocar la anoxia tisular. Las manifestaciones clınicas de la intoxicacion por humoson variables. Algunas de las manifestaciones potenciales podrıan ser: irritacion ocular, dolor de garganta, estridor larıngeo, disfagia, esputo carbonaceo, tos, disnea, laringoespasmo, broncoespasmo, sındrome coronario, coma, hipoxemia, acidosis lactica, cianosis y muerte. En la evaluacion de estos enfermos la presencia de hollın en nariz, boca o esputo sugiere intoxicacion grave. Niveles de lactato superiores a10 mmol/l indican cifras de cianuro mayores de 40 micromol/l.La pulsicooximetrıa ha supuesto un avance importante para el diagnostico, valoracion y seguimiento de estos pacientes. En el tratamiento sera´ indispensable valorar la necesidad de una intubacion temprana. La administracion deoxıgeno al 100% sera´ esencial. Como antıdoto para el cianuro, el de primera eleccion es la hidroxicobalamina. Su administracion ha de ser precoz. Los criterios de administracion son: paciente que ha inhalado humo (restos de hollın en boca, faringeo esputo) y que tenga alteraciones neurologicas (confusion, coma, agitacion, convulsiones) y ademas presenta una de las siguiente circunstancias: bradipnea, parada respiratoria, parada cardiorrespiratoria, shock, hipotension, lactato Z8 mmol/l o acidosis lactica. Logicamente el resto del manejo sera convencional en funcion de sıntomas o

complicaciones.

CIANURO y su ANTIDOTO "Nithiodote". MANEJO INTOXICACION POR HUMO DE INCENDIOS. SEMICYUC

Un antídoto contra el cianuro

Wallace Carothers, el inventor del nylon, se suicidó en 1937 en una habitación de un hotel en Philadelfia bebiendo una mezcla de cianuro potásico con limonada.(1937). Otro gran genio, Alan Mathison Turing, creador de la teoría de la computación y padre de la inteligencia artificial, se quitó la vida en 1954 comiendo una manzana impregnada en cianuro líquido. También fue cianuro lo que utilizaron los nazis durante la Segunda Guerra Mundial para llevar a cabo genocidios en masa.

Ahora, la Comisión Europea acaba de autorizar el primer antídoto contra el cianuro para el tratamiento del envenenamiento, conocido o sospechado, tanto en adultos como en la población pediátrica. Se trata de la hidroxocobalamina (Cyanokit), previamente aprobada en Estados Unidos y Japón. Su singular mecanismo de acción se basa en su capacidad para neutralizar los iones de este popular veneno. La combinación de cianuro e hidroxocobalamina da lugar a una forma natural de vitamina B12 que se expulsa a través de la orina.

Actualmente la causa más común de intoxicación por cianuro es la inhalación de humo durante incendios de estructuras en lugares cerrados. También se producen casos de envenenamiento por la ingesta accidental o intencional, inhalación, exposición dérmica en un accidente industrial o atentados terroristas que utilicen cianuro.

http://www.hopepharm.com/prescribing/

https://www.muyinteresante.es/salud/articulo/un-antidoto-contra-el-cianuro

Download Information

For your convenience, related documents and data sheets are available as PDF downloads:

POR QUÉ HAY QUE INSTALAR DETECTORES DE HUMO EN CASA

MANEJO INTOXICACION POR HUMO DE INCENDIOS. SEMICYUC 2010

Enlace para documento completo en formato pdf

CYANOKIT

Acción Y Mecanismo

– [ANTIDOTO]. Hidroxocobalamina puede unirse firmemente a los iones cianuro (cada molécula se une a un ión cianuro mediante la sustitución del ligando hidroxi). Forma entonces cianocobalamina, compuesto estable y no tóxico que se excreta en orina.

Indicaciones

– Tratamiento de la [INTOXICACION POR CIANURO] (comprobada o presunta). Debe administrarse junto a las medidas adecuadas de descontaminación y terapia de soporte.

Posología

DOSIFICACIÓN: – Adultos, perfusión iv: * Dosis inicial: 5 g. * Dosis posterior: Según la gravedad de la intoxicación y la respuesta clínica, puede administrarse una segunda dosis igual a la inicial (5 g). * Dosis máxima: 10 g. – Niños, perfusión iv: * Dosis inicial: 70 mg/kg de peso corporal, sin exceder los 5 g. (para 5 kg de peso, administrar 350 mg; para 10 kg, 700 mg; para 20 kg, 1,4 g; para 30 kg, 2,1 g; para 40 kg, 2,8 g; para 50 kg, 3,5 g; para 60 kg, 4,2 g). * Dosis posterior: Según la gravedad de la intoxicación y la respuesta clínica, puede administrarse una segunda dosis similar a la inicial (70 mg/kg de peso corporal, sin exceder los 5 g). * Dosis máxima: 140 mg/kg, sin exceder los 10 g.

Normas Para La Correcta Administración

El polvo del vial debe ser reconstituido con el disolvente adecuado antes de ser administrado (ver Instrucciones de uso/manipulación/eliminación). Perfusión iv: administrar la dosis durante 15 minutos. La velocidad de perfusión de la segunda dosis oscila, según el estado del paciente, entre los 15 minutos (para los muy inestables) y las 2 horas. PRECAUCIONES Con frecuencia, la intoxicación por cianuros se desconoce inicialmente, siendo difícil de diagnosticar y determinar su magnitud al no existir ningún método rápido de confirmación de la presencia de cianuros en sangre. Por tanto, las decisiones terapéuticas deben tomarse en base a la historia clínica, y/o a la presencia de signos y síntomas característicos (entre ellos alteraciones del estado mental (confusión, desorientación), opresión precordial, alteraciones de la respiración, hipertensión (temprana) o hipotensión (tardía), colapso cardiovascular, midriasis, convulsiones o coma). Una vez que se tenga cierta certeza de la presencia de la intoxicación (no es necesario que sea completamente comprobada su existencia), el tratamiento con el antídoto no debe retrasarse. El tratamiento también debe incluir atención médica inmediata que garantice la permeabilidad de las vías respiratorias, una adecuada oxigenación e hidratación, atención cardiovascular y tratamiento de las convulsiones. Las medidas de descontaminación deben adecuarse a la vía de exposición. Este antídoto no sustituye ninguna de estas medidas. – Hipersensibilidad a hidroxocobalamina. Debe tenerse en cuenta la relación riesgo/beneficio ante la hipersensibilidad comprobada a la hidroxocobalamina o vitamina B12. – [HIPERTENSION ARTERIAL]. Puede producirse un aumento transitorio de la presión arterial, generalmente asintomático y que suele ser máximo hacia el final de la perfusión. – Determinación de la concentración de cianuro en sangre. Nunca debe retrasar el tratamiento con el antídoto y no es requerimiento necesario para el diagnóstico de la intoxicación, pero si se planea la determinación plasmática se recomienda extraer la muestra antes de iniciar el tratamiento, puesto que la hidroxocobalamina reducirá las concentraciones de cianuro. – Quemaduras. La hidroxocobalamina suele inducir una coloración roja de la piel que puede interferir con la evaluación de posibles quemaduras. Las lesiones cutáneas, el edema y el dolor sugieren firmemente quemaduras. – Interferencia con los análisis de laboratorio. Debido a su color rojo intenso, puede interferir con la determinación de algunos parámetros de laboratorio (bioquímica clínica, hematología, coagulación y parámetros urinarios). (Ver Análisis para datos concretos). CONSEJOS AL PACIENTE – La piel, las mucosas y la orina pueden presentar una coloración roja, que desaparece al cabo de semanas (2 semanas en el caso de la piel, 4 en el de la orina).

Advertencias Especiales

– Este antídoto no sustituye a la oxigenoterapia y no debe retrasar el establecimiento de medidas indispensables en el tratamiento de la intoxicación (ver Precauciones). – Debe tenerse en cuenta la relación riesgo/beneficio ante la hipersensibilidad comprobada a la hidroxocobalamina o vitamina B12. – Si se planea la determinación de cianuro en sangre, se recomienda extraer la muestra antes de iniciar el tratamiento (ver Precauciones). – Reconstituir y administrar por perfusión según las instrucciones del producto. – Si fuera necesaria la administración simultánea de productos hemáticos, se recomienda usar vías separadas, preferiblemente en las extremidades contralaterales. – Monitorizar la presión arterial pues puede producirse un aumento transitorio que suele ser máximo hacia el final de la perfusión. – Puede interferir con la determinación de algunos parámetros de laboratorio (ver Análisis). – El paciente debe ser informado de que no debe alarmarse ante el color rojizo de la piel, mucosas y orina. EMBARAZO Estudios en animales han mostrado efectos teratógenos después de la exposición diaria durante toda la organogénesis. No existen datos en mujeres embarazadas y se desconoce el riesgo potencial en seres humanos. Se debe tener en cuenta que no hay tratamientos alternativos, que la afección puede causar la muerte y que no deben administrarse más de dos inyecciones de hidroxicobalamina. En caso de embarazo conocido en el momento del tratamiento o después del tratamiento, se pide notificar rápidamente al titular de la autorización de comercialización o al profesional sanitario. LACTANCIA La hidroxocobalamina puede ser excretada en la leche materna. Debido a que será administrada en situaciones que pueden ser fatales, la lactancia no es una contraindicación para su uso. NIÑOS Se ha comprobado que la eficacia de la hidroxocobalamina en pacientes pediátricos es similar a la de los adultos. ANCIANOS Se ha comprobado que la eficacia de la hidroxocobalamina en pacientes de edad avanzada es similar a la de los adultos. REACCIONES ADVERSAS Se han descrito las siguientes reacciones adversas. Debido a las limitaciones de los datos disponibles, no es posible aplicar estimaciones de frecuencias: – Digestivas: molestias abdominales, [DISPEPSIA], [DIARREA], [NAUSEAS], [VOMITOS], [DISFAGIA]. – Cardiovasculares: Extrasístoles ventriculares. En pacientes intoxicados por cianuro se han observado casos de taquicardia. [HIPERTENSION ARTERIAL] transitoria, que se resuelve generalmente en pocas horas. En los pacientes intoxicados por cianuro se ha observado una disminución de la presión arterial. – Neurológicas/psicológicas: [AMNESIA], [MAREO], [ANSIEDAD]. – Respiratorias: [DERRAME PLEURAL], [DISNEA], sensación de opresión en la garganta, sequedad en la garganta, molestias torácicas. – Genitourinarias: [ALTERACION DEL COLOR DE ORINA]: todos los pacientes mostraron una coloración rojo oscura de la orina, bastante marcada durante los 3 días siguientes a la administración, pudiendo permanecer hasta 35 días después de ésta. – Alérgicas/dermatológicas: [ALERGIA], [ANGIOEDEMA], [ERUPCIONES EXANTEMATICAS], [URTICARIA] y [PRURITO]. La mayoría de los pacientes presentaron coloración roja reversible de la piel y las membranas mucosas, que puede permanecer hasta 15 días después de la administración del medicamento. [ERUPCIONES EXANTEMATICAS], que pueden permanecer varias semanas, afectando principalmente a la cara y el cuello. – Oftalmológicas: Inflamación, [IRRITACION OCULAR], [HIPEREMIA CONJUNTIVAL]. – Hematológicas: [LINFOCITOPENIA]. – Generales: [SOFOCOS], [CEFALEA], [DOLOR EN EL PUNTO DE INYECCION], [EDEMA MALEOLAR]. Decoloración roja del plasma, que puede causar un aumento o una reducción artificial de las concentraciones de algunos valores de laboratorio (ver Análisis).

Sobredosis

Síntomas: la mayor dosis administrada fue de 15 g, sin observarse reacciones adversas específicas. Tratamiento: debe estar dirigido a los síntomas. La hemodiálisis puede ser eficaz, pero sólo está indicada en caso de toxicidad significativa. INCOMPATIBILIDADES Este medicamento no debería mezclarse con otros medicamentos. – Incompatibilidad física (formación de partículas) con diazepam, dobutamina, dopamina, fentanilo, nitroglicerina, pentobarbital, fenitoína sodio, propofol y tiopental. – Incompatibilidad química con tiosulfato de sodio, nitrito de sodio y ácido ascórbico. – No se recomienda la administración simultánea de hidroxicobalamina y productos hemáticos (sangre, concentrado de eritrocitos concentrado de plaquetas y plasma fresco congelado) por la misma vía intravenosa. Si fuera necesario, administrarlos por vías separadas, preferiblemente en las extremidades contralaterales. INSTRUCCIONES DE USO Y MANIPULACIÓN Y ELIMINACIÓN Cada vial (2,5 g) debe reconstituirse con 100 ml del disolvente, usando el dispositivo de transferencia estéril suministrado. La concentración final será, por tanto, de 25 mg/ml. Disolvente recomendado: cloruro de sodio al 0,9% (9 mg/ml) en solución inyectable. Disolvente alternativo: sólo si no se dispone de cloruro de sodio 0,9%, utilizar solución de lactato de Ringer o glucosa al 5%. Mezclar la solución balanceando o invirtiendo el vial durante al menos 30 segundos. No debe agitarse ya que puede formarse espuma y dificultar la comprobación de la reconstitución. La solución reconstituida es de color rojo oscuro, por lo que es posible que no se vean algunas partículas indisolubles. Por esta razón, debe utilizarse el equipo de perfusión intravenosa proporcionado en el kit, que contiene un filtro adecuado que debe cebarse con la solución reconstituida. Si los productos hemáticos (sangre, concentrado de eritrocitos, concentrado de plaquetas y plasma fresco congelado) han de administrarse simultáneamente, se recomienda el uso de vías intravenosas separadas, preferiblemente en las extremidades contralaterales.

Precio en Espana

682,15 €

CYANOKIT Antidote for Cyanide Poisoning

GUIDES AND RESOURCES

INDICATION

CYANOKIT (hydroxocobalamin for injection) 5 g for intravenous infusion is indicated for the treatment of known or suspected cyanide poisoning. If clinical suspicion of cyanide poisoning is high, CYANOKIT should be administered without delay.

https://www.cyanokit.com

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CYANOKIT video library
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martes, 17 de octubre de 2017

MEDEVAC "HISTORY AND TRIBUTE". Video by TACMED "Tactical Medicine" España

MEDEVAC "HISTORY AND TRIBUTE". Video by TECC España

MEDEVAC

Compilation by Dr. Ramon Reyes, MD

Terminología de Evacuación

CursoTECC España

•MEDEVAC: empleado específicamente para la evacuación médica están señalizados con una Cruz Roja

–Los medios MEDEVAC no son beligerantes.

•CASEVAC: medios de evacuación de heridos no medicalizado médico

–Pueden transportar una Fuerza de Acción Rápida (QRF) y proporcionar apoyo aéreo cercano.

•Tactical Evacuation (TACEVAC): este término engloba a ambos medios de evacuación anteriormente descritos.

Curso T.E.C.C. TACTICAL EMERGENCY CASUALTY CARE . Sevilla, ESPAÑA

MEDEVAC + CASEVAC =TACEVAC

La evacuación médica o MEDEVAC es un sistema de traslado de pacientes desde una ubicación remota hasta un hospital especializado, por lo general en el medio militar.

CASEVAC (casualty evacuation) se refiere a la evacuación utilizando cualquier medio de transporte, generalmente con una limitada o nula capacidad de brindar este cuidado médico mientras se traslada al paciente, y es utilizado cuando no hay tiempo para esperar a un MEDEVAC, o cuando éste se ve imposibilitado de acceder a la zona de rescate. El CASEVAC también es ampliamente utilizado debido a que muchos rescates se efectúan en zonas "rojas" y el fuego enemigo podría causar daños al equipo y/o personal médico.

La evacuación médica o MEDEVAC es un sistema de traslado de pacientes desde una ubicación remota hasta un hospital especializado, por lo general en el medio militar. El término MEDEVAC se aplica generalmente a un vehículo aéreo, a un avión, o a un helicóptero usado como ambulancia, a veces llamada una "ambulancia aérea". Esto permite el transporte rápido de las personas seriamente lesionadas, particularmente pacientes traumatizados, desde la escena de un accidente hasta un hospital especializado.

El término MEDEVAC puede ser mal interpretado, pues puede no clarificar si se está refiriendo a un transporte por tierra o por aire, por lo que siempre se debe especificar el método de evacuación durante la comunicación con los hospitales.

La técnica tiene sus inicios en los años 20, a partir del establecimiento en Australia de un sistema aéreo de socorro civil en el interior remoto y semi-árido de Australia, ya fuera para trasladar enfermos o heridos al hospital o para acercar la ayuda médica hasta lugares inhóspitos. Los helicópteros irrumpieron en el medio militar a finales de la Segunda Guerra Mundial, pero su empleo no se hizo habitual por parte del Ejército de los Estados Unidos para el transporte de heridos hasta la Guerra de Corea. Se establecieron hospitales quirúrgicos móviles justo detrás de las líneas de combate, que permitían que los soldados heridos recibieran tratamiento médico después de un corto vuelo en helicóptero. Esta táctica militar, generalizada ya en la Guerra de Vietnam, fue popularizada en la serie televisiva M*A*S*H de los años 70.

En la terminología militar norteamericana, se distingue a menudo por la evacuación de bajas. En este contexto, se refiere al traslado asistido de un paciente, bien sea desde el punto de la lesión a una instalación médica, o bien entre los diversos niveles de asistencia médica. Un vehículo de evacuación médica está por consiguiente, dotado con material de primeros auxilios a bordo, así como con personal médico entrenado como parte de la tripulación. El vehículo está marcado con la Cruz Roja (o con la Media Luna Roja), y como tal, cubierto por la convención de Ginebra, que protege teóricamente al vehículo de ataques de cualquiera de los bandos en conflicto, y solamente autoriza a la tripulación de vuelo a portar armas personales, no así armas de guerra.

En este sentido, un MEDEVAC se refiere a la evacuación por razones médicas desde la zona de combate, suceso o accidente, o un punto de extracción, hacia la base militar general o hacia un centro médico o incluso a una zona más segura, o entre los distintos niveles de asistencia al soldado y siempre contando con asistencia médica "en ruta" (on-route care), mientras que un CASEVAC (casualty evacuation) se refiere a la evacuación utilizando cualquier medio de transporte, generalmente con una limitada o nula capacidad de brindar este cuidado médico mientras se traslada al paciente, y es utilizado cuando no hay tiempo para esperar a un MEDEVAC, o cuando éste se ve imposibilitado de acceder a la zona de rescate. El CASEVAC también es ampliamente utilizado debido a que muchos rescates se efectúan en zonas "rojas" y el fuego enemigo podría causar daños al equipo y/o personal médico.

En terminología militar australiana, un MEDEVAC se refiere a la evacuación por razones médicas de una sección, tropa o pelotón, mientras que un CASEVAC se aplica a la evacuación de una sola persona.

El término 'evacuación aeromédica' o AEROVAC también se utiliza para hablar del transporte de pacientes desde un centro asistencial médico hasta otro con un nivel más alto de cuidados o a una instalación hospitalaria fija o en el caso del combate, a un ambiente más seguro; pero el vehículo siempre debe contar con capacidad para cuidados médicos especiales durante el transporte (como el uso de los ventiladores mecánicos, monitorización, etc).

C-17 Medevac mission, BaladAB, Iraq

Modern EMS practices have their roots in Vietnam medical rescues

by Carson Frame (American Homefront) , in San Antonio, TX

Oct 05, 2017 —

The well-equipped medevac helicopters that transported injured troops in Vietnam became the model for today's air ambulance services in the U.S.

The war in Vietnam helped the U.S. perfect a rescue platform for wounded soldiers that would fundamentally change civilian emergency response systems in the U.S.

It used UH-1 "Huey" helicopters as air ambulances, manned by two pilots, a medic, and a crew chief.

Flying into active landing zones to pick up wounded soldiers was a dangerous job. Just over a third of medical aviators became casualties in their work. Medevac helicopters were shot down at more than three times the rate of other helicopter missions during the war.

Dust Off crews, the teams that manned the helicopters, had the ability to provide basic medical care en route. They could administer IV fluids, apply bandages and tourniquets, and make sure that soldiers were still breathing.

Such en route care was a change from previous wars, when helicopter fleets were mainly equipped to transport the wounded to medical facilities.

Jim Eberwine was a Dust Off pilot with the 82nd Medical Detachment back in 1966. Sometimes he and his crew would get so overwhelmed with casualties that they wouldn't even use the litters, or stretchers, onboard the helicopter.

"At one point in time I had 19 patients on board. It's designed for six. We could barely get off the ground. I thought, 'I might have a record here,'" Eberwine said.

In a long, narrow country where road networks were often dangerous, air evacuation was a lifesaver. The military had a network of combat medical centers, support hospitals, and even ships where patients could be flown.

The situation at home

Back in the U.S., emergency response systems weren't nearly as sophisticated.

"The expectation when you called an ambulance in the 1960s was a Cadillac Hearse would show up," said George Wunderlich, a historian at the Army Medical Department Museum who also has experience as an EMS first responder and firefighter.

"Two guys would get out, put you on a stretcher," he said. "They're not carrying anything else except for minor bandaging to keep the blood out of their ambulance. Then they rush you to the hospital."

This method was known as "scoop and go." It wasn't nearly sufficient to keep up with the carnage on the nation's highways at the time. In the 1960s traffic fatalities peaked at around 55,000 per year, far higher than today.

The Military Assistance to Safety and Traffic program, or MAST, was created in 1970 to mitigate the problem. MAST allowed military aviation units to help civilian communities with helicopter transport during emergencies.

Such en route care was a change from previous wars, when helicopter fleets were mainly equipped to transport the wounded to medical facilities.

"At one point in time I had 19 patients on board. It's designed for six. We could barely get off the ground. I thought, 'I might have a record here,'" Eberwine said.

The program relied on a rescue format similar to the one used during Vietnam.

"It was a helicopter manned by two pilots, a crew chief, and a medic in the back," said Lewis Barger of the Army Department Medical Museum. "It was the Vietnam evacuation platform located in the United States."

The program was given trial runs at military installations near San Antonio, TX; Colorado Springs, CO; Seattle, WA; Phoenix, Arizona; and Mountain Home, ID.

MAST offered the military a way of keeping its air crews trained while giving civilians a better chance of surviving serious accidents.

The medevac legacy

George Wunderlich says that news coverage of Vietnam medevac operations changed what Americans thought they deserved from emergency medical care. Leaders of civilian medical operations began deploying the same kinds of helicopters and first aid equipment.

"Those are all going to transfer over and start a technological cascade that brings us to where we are today," Wunderlich said.

MAST is still active, though it downsized with the Persian Gulf War and the development of civilian air-ambulance services. Partly because of that, traffic fatalities last year numbered around 40,000, roughly a thirty percent decrease from the 1960s.

The American Homefront Project is a reporting partnership of North Carolina Public Radio (WUNC), Southern California Public Radio (KPCC), WUSF - Tampa, KPBS - San Diego, and North Country Public Radio - NCPR.

Medevac mission, Balad Air Base, Iraq

US Air Force Expeditionary Aeromedical Evacuation Squadron members monitor patients during a C-17 aero-medical evacuation mission from Balad Air Base, Iraq, to Ramstein Air Base, Germany. The Boeing (formerly McDonnell Douglas) C-17 Globemaster III is a large American airlifter manufactured by Boeing Integrated Defense Systems, and operated by the United States Air Force, British Royal Air Force, the Royal Australian Air Force, and the Canadian Forces.[3] NATO and Qatar will also acquire the airlifter.

The C-17 Globemaster III is capable of rapid strategic delivery of troops and all types of cargo to main operating bases or directly to forward bases in the deployment area. It is also capable of performing tactical airlift, medical evacuation and airdrop missions. The C-17 takes its name from two previous United States cargo aircraft, the C-74 Globemaster and the C-124 Globemaster II.

Specifications (C-17:) General characteristics Crew: 3: 2 pilots, 1 loadmaster Capacity: 102 troops or 36 litter and 54 ambulatory patients Payload: 170,900 lb (77,519 kg) of cargo distributed at max over 18 463L master pallets or a mix of palletized cargo and vehicles Length: 174 ft (53 m) Wingspan: 169.8 ft (51.75 m) Height: 55.1 ft (16.8 m) Wing area: 3,800 ft² (353 m²) Empty weight: 282,500 lb (128,100 kg) Max takeoff weight: 585,000 lb (265,350 kg) Powerplant: 4× Pratt & Whitney F117-PW-100 turbofans, 40,440 lbf (180 kN) each Fuel capacity: 35,546 US gal (134,556 L) Performance Cruise speed: Mach 0.76 (450 knots, 515 mph, 830 km/h) Range: 2,420 nmi[74] (2,785 mi, 4,482 km) Service ceiling 45,000 ft (13,716 m) Max wing loading: 150 lb/ft² (750 kg/m²) Minimum thrust/weight: 0.277

As with many innovations in Emergency Medical Services (EMS), the concept of transporting the injured by aircraft has its origins in the military and the concept of using aircraft as ambulances is almost as old as powered flight itself.

The first written record of the term "air ambulance" is in Jules Verne's Robur le Conquérant (1866), which describes the rescue of shipwrecked sailors by an airship (balloon) named the Albatross. The first documented use of an air ambulance occurred during the Siege of Paris in 1870. when balloons were used to evacuate more than 160 soldiers from the besieged city.

MEDEVAC BLACK HAWK UH60

During the Great War, the first true Air Ambulance flight was made when a Serbian officer was flown from the battlefield to hospital by a plane of the French Air Service. Records kept by the French at the time indicated that, if casualties could be evacuated by air within six hours of injury, the mortality rate among the wounded would fall from 60 per cent to less than 10 per cent - a staggering reduction!

During the First World War air ambulances were tested by various military organizations. Aircraft were still primitive at the time, with limited capabilities, and the effort received mixed reviews. The exploration of the idea continued, however, and by 1936 an organized military air ambulance service was evacuating wounded from the Spanish Civil War for medical treatment in Nazi Germany.

The first recorded British ambulance flight took place in 1917 in Turkey when a soldier in the Camel Corps, who had been shot in the ankle, was flown to a hospital in a de Havilland DHH within 45 minutes. The same journey by land would have taken 3 days to complete. In Britain, sick passengers were ferried by air from the Western Isles of Scotland to the mainland in the early 1930s. The first such flight to be recorded was on May 14, 1933 when a fisherman suffering from a perforated stomach, with consequent risk of peritonitis, was flown from Islay to Glasgow's Western Infirmary in a DH Dragon owned by Midland and Scottish Air Ferries.

In Switzerland, with the increasing interest in winter sports during the early post World War 2 years, the use of air ambulances evolved from the increasing difficulties experienced in mountain rescue work. Initially fixed-wing aircraft were used, landing medical teams with equipment as close as possible to the injured parties so that rapid first aid treatment could be applied prior to evacuation.

To overcome a lack of suitable landing sites close to the incident in mountainous regions, it was even at one stage proposed to parachute medical personnel with equipment and sledges into the rescue area. Although training was undertaken, there is no documentary evidence to suggest that this technique was ever put into practice.

The first documented medevac by helicopter occurred during the second World War. In April 1944, a US Army Air Forces aircraft with three wounded British soldiers on board, was forced down in the jungle behind Japanese lines near Mawlu in Burma.A new US Army Sikorsky YR-4B helicopter, flown by Lt. Carter Harman, could carry only one passenger but, over 25-26 April 1944, four return trips were made.

Following the end of the Second World War, the first civilian air ambulance in North America was established by the Saskatchewan government in Regina, Saskatchewan, Canada. Back in the United States, 1947 saw the creation of the Schaefer Air Service, the country's first air ambulance service. Founded by J. Walter Schaefer, of Schaefer Ambulance Service in Los Angeles, Schaefer Air Service was also the first FAA-certified air ambulance service in the United States. Para-medicine was still decades away, and unless the patient was accompanied by a physician or nurse, they operated primarily as medical transportation services.

The first dedicated use of helicopters by U.S. forces occurred during the Korean War, during the period from 1950-1953. While popularly depicted as simply removing casualties from the battlefield (which they did), helicopters also expanded their services to moving critical patients to more advanced hospital ships once initial emergency treatment in field hospitals had occurred. On August 4, 1950, just one month after the start of the Korean War, the first rotorwing medical evacuation was performed with a bubble-fronted Bell 47 (as seen in the TV series M*A*S*H). The wounded were transported on basket stretchers attached to the top of the landing gear on the outside of the small helicopter (Figure 3-1). They were covered with blankets in a nearly futile effort to maintain body heat and prevent wound contamination. It is estimated that more than 20,000 injured soldiers were evacuated by helicopter. The World War II casualty/death rate of 4.5 deaths per 100 casualties dropped to 2.5 per 100 casualties during the Korean War. While there were some technological advances in medicine during that period, the improvement is largely attributed to use of the helicopter to evacuate patients to definitive care more quickly. The external litter, however, did not allow for medical care during transport.

The next major advance in AM transport occurred during the Vietnam War, where the Bell UH-1 helicopter was placed into operation. Affectionately known as the Huey, this aircraft was large enough to hold patients inside, where medical personnel could begin treatment during the flight to a field hospital. The mass deployment of these aircraft as medevac units reduced the average delay until treatment to one hour. The ability to carry patients inside the aircraft was a key element in the reduction of mortality and morbidity. Military medics performed procedures previously done only by physicians: they started central lines, inserted chest tubes, and sutured bleeding wounds. This care, coupled with the initiation of specialty hospitals for the treatment of different types of injuries, resulted in a reduction in the mortality rate to 1 death per 100 casualties.

The first known civilian application of a medical helicopter was in 1958 in Etna, California. Bill Mathews, a businessman, started a helicopter service to ferry patients for Dr. Granville Ashcraft, the town's only physician. The town druggist also used the helicopter to deliver drugs during emergencies.

By 1969, in Vietnam, the use of specially trained medical corpsmen and helicopters as ambulances led U.S. researchers to conclude that servicemen wounded in battle had better rates of survival than motorists injured on California freeways. This conclusion inspired the first experiments with the use of civilian paramedics in the world.

Two programs were implemented in the U.S. to assess the impact of medical helicopters on mortality and morbidity in the civilian arena. Project CARESOM was established in Mississippi in 1969. Three helicopters were purchased through a federal grant and located strategically in the north, central, and southern areas of the state. Upon termination of the grant, the program was considered a success and each of the three communities was given the opportunity to continue the helicopter operation. Only the one located in Hattiesburg did so, and it was therefore established as the first civilian air medical program in the United States. The second program, the Military Assistance to Safety and Traffic (MAST) system, was established in Fort Sam Houston in San Antonio in 1969. This was an experiment by the Department of Transportation to study the feasibility of using military helicopters to augment existing civilian emergency medical services. These programs were highly successful at establishing the need for such services.

Also, in 1969 the state of Maryland received a grant to purchase Bell Jet Ranger helicopters and started one of the nation's first medevac programs. The four helicopters, manned by paramedics, were strategically based throughout the state for quick response to emergency situations. When they were not carrying patients, the helicopters were used for law enforcement and traffic control.

On November 1, 1970, the first permanent civil air ambulance helicopter, Christoph 1, entered service at the Hospital of Harlaching, Munich, Germany. The first civilian, hospital-based medical helicopter program in the United States began operation in 1972. Flight For Life Colorado began with a single Alouette III helicopter, based at St. Anthony Central Hospital in Denver, Colorado. In Ontario, Canada, the air ambulance program began in 1977, and featured a paramedic-based system of care. The system, operated by the Ontario Ministry of Health, began with a single rotor-wing aircraft based in Toronto. An important difference in the Ontario program involved the emphasis of service. 'On scene' calls were taken, although less commonly, and a great deal of the initial emphasis of the program was on the interfacility transfer of critical care patients.

Mercy Flight WNY was established by Douglas H. Baker in 1981 as the first air-medical service in New York State and one of the first in the country. From day one, Mercy Flight WNY has maintained its independence of any hospital and is currently one of only a handful of remaining not-for-profit providers. The majority of other US programs are operated by either for-profit organizations or hospitals. (Right: Patient being loaded in the early 80's. Paramedic on left Margaret Ferrentino, was first female paramedic in NY State and is current Mercy Flight Vice-President/CFO.)

Helicopters continue to play a vital role in miltary medevacs. UH-60 Blackhawk helicopters have been used extensively in Iraq and Afganistan to medevac wounded soldiers from the battlefield. While both countries feature harsh desert environments that take their toll on helicopters, Afganistan's mountain peaks as high as 18,000 feet further complicate the mission. Because of the vast, mountainous terrain, evacuating casualties often extends beyond what doctors call the "golden hour": that crucial 60 minutes during which a traumatically-injured person has to reach a hospital before their survival chances plummet. So medics have begun doing emergency procedures inside helicopters that would normally wait for ER doctors.

The United States has some 200 operations whose services are paid for primarily by the patients and their insurance companies. As well as Switzerland, France, Austria, Italy Scandinavia and the former West Germany all have very successful versions of the helicopter-based EMS, the benefits of which have in some instances been particularly well-documented.

In Germany for example, there is now a network of helicopters which has evolved over the past twenty years to cover the entire country. Statistics which have been gathered over this period of time show:

An average response time to the scene of the incident of just 10 minutes.
Intensive care stays in hospital have been shorted by between five and seven days.
There are 9% fewer wound infections.
A significant reduction in the number of deaths during transport to hospital.
Head injury mortality has been reduced by 15%.

Information from http://www.mercyflight.org/content/pages/medevac

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domingo, 15 de octubre de 2017

10 obsolete EMT skills. By EMS1.com

prehospital spinal immobilization on backboards

10 obsolete EMT skills

Gather round to learn the out-of-date and obsolete EMT skills that the Ambulance Driver has outlasted during his EMS career

Jun 29, 2016

EMS1

Nothing makes me feel older than when I drop a casual reference to an EMT skill in a continuing education class and several bewildered young EMTs raise their hands hesitantly and ask, "Kelly, what are MAST pants?"

It got me to thinking how different the EMS profession is now from what it was when my career began. Medicine is a continually evolving process, and advances in technology come so rapidly that the current generation of EMS providers is working with a markedly different knowledge base and set of skills than the last one.

So gather around the campfire children and let Uncle Kelly tell you how we did it in the old days. Each of these 10 skills is something we used to commonly do, but are rarely, if ever, used any longer.

Pneumatic Anti-Shock Garments

10. Pneumatic Anti-Shock Garments
I only spell it out because if I said MAST or PASG, I’d still have to explain it to you young whippersnappers. See, back in the day we used to put these inflatable Velcro pants on shock patients, and when inflated, it raised their blood pressure. It did raise blood pressure very well — to the point that the patient bled pink from all the IV fluids we gave, but those magic pants sucked at saving lives.

Not only did we have to know the different methods of applying them, like the diaper method and the pajama method, we also had to memorize the criteria for removal. Dinosaurs, say them with me now: “Bilateral large bore IV access, two units of typed and matched blood, surgical team on standby, deflate the abdominal section for 10 seconds, recheck the blood pressure …”

Manual defibrillation paddles

9. Manual defibrillation paddles
You kids these days with your hippity-hop music and your iThings and your hands-free multifunction electrodes.… Why, in my day, when we wanted to defibrillate someone, we had these things called paddles. And you had to apply conductive gel to them and smear it around; then you had to press them on the chest with at least 25 pounds of paddle pressure

And you had your energy select dial and defib button right there on the paddles. And you did this thing called a quick look, so that you could immediately shock the patient, like, three times in a row, before you even attached the monitor leads.

And by God, we were grateful.

Esophageal Obturator Airways

8. Esophageal Obturator Airways
Imagine if a Combitube and a BVM had a baby, and the airway baby inherited the worst features of each. The EOA was a supraglottic airway that was bulky, often caused trauma on insertion, did a poor job of isolating the trachea and protecting against aspiration and still required that you maintain a mask seal.

And to think that nobody uses these beauties anymore! Crazy, right?

Oral screws

7. Oral screws
Picture — because I am afraid of what you might stumble across if you Google "oral screws" — if you will a little plastic doohickey shaped like a miniature ice cream cone with threads on the outer surface and a T-handle on the large end. And what you did was insert the small end of this doohickey between someone’s teeth when their jaws were clenched, and screwed it in until it forced their jaws apart.

We used to do this whenever someone had a seizure, in the mistaken belief that if we didn’t get their mouth open, they’d swallow their tongue.

But the real reason was that it gave paramedics with a juvenile sense of humor the opportunity to hold out their hands and bark, "Gimme an oral screw!"

I’m telling you, that one never got old.

6. Taping stuff down
When I was a paramedic student, my instructor took great pains to show us how to tear thin little strips of adhesive tape to secure IV catheters and endotracheal tubes. We fashioned elegant little chevrons of tape over the wings on our IV catheter hubs (seriously, they had wings) to secure them without obscuring the cannulation site. And we used to tear a one-inch strip of tape longitudinally for a few inches, wrapping one strip around the endotracheal tube and the other across the face like a big mustache.

And then someone would promptly rip our IV or endotracheal tube out while we were loading the patient, so we got to do it again.

Nowadays we have tube holders and IV dressings, and taping is a lost art like calligraphy and darning your socks.

5. Rotating tourniquets
Once upon a time, we used to think that acute pulmonary edema and decompensated congestive heart failure was caused by too much blood re-entering the lungs. We thought that if we could trap blood in the extremities, we’d reduce preload enough to relieve the pulmonary edema.

So we applied humongous blood pressure cuffs on three of the patient's four extremities, inflated them to just above diastolic pressure, and rotated them around the patient's extremities every 15 minutes.

And it took us only a generation or so to discover that it was stupid and didn’t work.

Trendelenburg position

4. Trendelenburg position
For many years we fervently believed the Trendelenburg position was a vital treatment for shock. We thought that elevating the feet higher than the head raised blood pressure, and maybe even caused a couple units of blood to flow from the legs to the trunk.

Turns out it doesn’t really do those things, and instead caused respiratory decompensation and a rise in intracranial pressure. Still, that doesn’t keep some EMTs working for the EMS Agency That Time Forgot from carefully applying and documenting "patient placed in Trendelenburg position."

3. Standing takedowns
Now that our current understanding of spinal cord injury acknowledges that prehospital spinal immobilization on backboards has virtually no supporting evidence and probably does more harm than good, we’re boarding far fewer people these days.

While the adage holds true that “absence of evidence does not mean evidence of absence,” and there may be some yet-undiscovered tiny subset of patients that benefit from strapping a curved body to a flat board, it’s a pretty safe bet that subset does not include people walking around the scene under their own power.

External jugular IV access

2. External jugular IV access
Honestly, I really miss this one. The EJ used to be my go-to vein in a code. I was already right there at the head intubating, and all it took was turning the patient’s head to one side a bit, sinking a 14-gauge in that fat, engorged vein, and you had the mother of all peripheral IV accesses.

You know, we did this so all those questionably beneficial drugs we gave could reach the heart that much faster. Now, with mechanical IO devices like the EZ-IO in my repertoire, I can’t remember the last time I started an EJ.

Adult IO devices have really revolutionized emergency peripheral vascular access. And not a moment too soon, either, before this intracavernous technique really caught on.

1. Radio 10 codes
Once upon a time, we used to take sadistic pleasure in rapid fire broadcasting to the brand-new dispatcher, "Dispatch, we’re 10-98, 10-8, 10-19, 10-18 to our 10-42, where we’ll be 10-7 for a few minutes for a 10-33 10-100. If we’re not 10-2 on that, we’ll be happy to 10-9."

Now that we communicate in plain English because 10 codes are confusing and vary between agencies, we get to say, "Dispatch, we’ve completed our last assignment and are available for call, but we’re heading to our station as soon as possible because my partner will be out of service taking an emergency all-he-could-eat taco buffet poop. If you didn’t copy all that, I’m willing to repeat it."

Or at least we get to say that once.

I could think of a few more EMT skills that may soon become obsolete if we don’t get better at applying them, but that’s my list of top 10 obsolete EMT skills.

Got any to add to the list? Chime in with yours in the comments.

About the author

Kelly Grayson, NREMT-P, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 18 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is a former president of the Louisiana EMS Instructor Society and board member of the LA Association of Nationally Registered EMTs.

He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver. The paperback version of Kelly's book is available at booksellers nationwide. You can follow him on Twitter (@AmboDriver) or Facebook (www.facebook.com/theambulancedriverfiles), or email him at kelly.grayson@ems1.com. Kelly is a member of the EMS1 Editorial Advisory Board.

TELEFUNKEN Desfibrilador AED, DEA, DESA

DISPONIBLE EN TODA AMERICA
6 AÑOS DE GARANTIA (ECONOMICO)
TELEFUNKEN AED DISPONIBLE EN TODA AMERICA 6 AÑOS DE GARANTIA (ECONOMICO)http://goo.gl/JIYJwk

Contactos:

+1 849 865 4142 Rep. Dominicana

+34 640 220 306 (Numero Internacional en España)

eeiispain@gmail.com

Skype: drtolete

Facebook: @drramonreyesdiaz

LinkeIn https://es.linkedin.com/in/drramonreyes

Twitter: @DrtoleteMD

Instagram: https://www.instagram.com/drtolete/

¿Por qué el Desfibrilador TELEFUNKEN?

El DESFIBRILADOR de Telefunken es un DESFIBRILADOR AUTOMÁTICO sumamente avanzado y muy fácil de manejar.

Fruto de más de 10 años de desarrollo, y avalado por TELEFUNKEN, fabricante con más de 80 años de historia en la fabricación de dispositivos electrónicos.

El desfibrilador TELEFUNKEN cuenta con las más exigentes certificaciones.

Realiza automáticamente autodiagnósticos diarios y mensuales.

Incluye bolsa y accesorios.

Dispone de electrodos de "ADULTO" y "PEDIÁTRICOS".
Tiene 6 años de garantía.
Componentes kit de emergencias
Máscarilla de respiración con conexión de oxígeno.
Tijeras para cortar la ropa
Rasuradora.
Guantes desechables.

¿ Qué es una Parada Cardíaca?

Cada año solo en paises como España mueren más de 25.000 personas por muerte súbita.

La mayoría en entornos extrahospitalarios, y casi el 80-90 % ocasionadas por un trastorno eléctrico del corazón llamado"FIBRILACIÓN VENTRICULAR"

El único tratamiento efectivo en estos casos es la "Desfibrilación precoz".

"Por cada minuto de retraso en realizar la desfibrilación, las posibilidades de supervivencia disminuyen en más de un 10%".

¿ Qué es un desfibrilador ?

El desfibrilador semiautomático (DESA) es un pequeño aparato que se conecta a la víctima que supuestamente ha sufrido una parada cardíaca por medio de parches (electrodos adhesivos).

¿ Cómo funciona ?

SU FUNDAMENTO ES SENCILLO:

El DESA "Desfibrilador" analiza automáticamente el ritmo del corazón. Si identifica un ritmo de parada cardíaca tratable mediante la desfibrilación ( fibrilación ventricular), recomendará una descarga y deberá realizarse la misma pulsando un botón.

SU USO ES FÁCIL:

El desfibrilador va guiando al reanimador durante todo el proceso, por medio de mensajes de voz, realizando las órdenes paso a paso.

SU USO ES SEGURO:

Únicamente si detecta este ritmo de parada desfibrilable (FV) y (Taquicardia Ventricular sin Pulso) permite la aplicación de la descarga. (Si por ejemplo nos encontrásemos ante una víctima inconsciente que únicamente ha sufrido un desmayo, el desfibrilador no permitiría nunca aplicar una descarga).

¿Quién puede usar un desfibrilador TELEFUNKEN?

No es necesario que el reanimador sea médico, Enfermero o Tecnico en Emergencias Sanitarias para poder utilizar el desfibrilador.

Cualquier persona (no médico) que haya superado un curso de formación específico impartido por un centro homologado y acreditado estará capacitado y legalmente autorizado para utilizar el DESFIBRILADOR (En nuestro caso la certificacion es de validez mundial por seguir los protolos internacionales del ILCOR International Liaison Committee on Resuscitation. y Una institucion de prestigio internacional que avale que se han seguido los procedimientos tanto de formacion, ademas de los lineamientos del fabricante como es el caso deeeii.edu

TELEFUNKEN en Rep. Dominicana es parte de Emergency Educational Institute International de Florida. Estados Unidos, siendo Centro de Entrenamiento Autorizado por la American Heart Association y American Safety and Health Institute (Por lo que podemos certificar ILCOR) Acreditacion con validez en todo el mundo y al mismo tiempo certificar el lugar en donde son colocados nuestros Desfibriladores como Centros Cardioprotegidos que cumplen con todos los estanderes tanto Europeos CE como de Estados Unidos y Canada

DATOS TÉCNICOS

Dimensiones: 220 x 275 x 85mm

Peso: 2,6 Kg.

Clase de equipo: IIb

ESPECIFICACIONES

Temperatura: 0° C – + 50° C (sin electrodos)

Presión: 800 – 1060 hPa

Humedad: 0% – 95%

Máximo Grado de protección contra la humedad: IP 55

Máximo grado de protección contra golpes:IEC 601-1:1988+A1:1991+A2:1995

Tiempo en espera de las baterías: 3 años (Deben de ser cambiadas para garantizar un servicio optimo del aparato a los 3 años de uso)

Tiempo en espera de los electrodos: 3 años (Recomendamos sustitucion para mantener estandares internacionales de calidad)

Número de choques: >200

Capacidad de monitorización: > 20 horas (Significa que con una sola bateria tienes 20 horas de monitorizacion continua del paciente en caso de desastre, es optimo por el tiempo que podemos permanecer en monitorizacion del paciente posterior a la reanimacion)

Tiempo análisis ECG: < 10 segundos (En menos de 10 seg. TELEFUNKEN AED, ha hecho el diagnostico y estara listo para suministrar tratamiento de forma automatica)

Ciclo análisis + preparación del shock: < 15 segundos

Botón información: Informa sobre el tiempo de uso y el número de descargas administradas durante el evento con sólo pulsar un botón

Claras señales acústicas y visuales: guía por voz y mediante señales luminosas al reanimador durante todo el proceso de reanimación.

Metrónomo: que indica la frecuencia correcta para las compresiones torácicas. con las Guias 2015-2020, esto garantiza que al seguir el ritmo pautado de compresiones que nos indica el aparato de forma acustica y visual, podremos dar RCP de ALTA calidad con un aparato extremadamente moderno, pero economico.

Normas aplicadas: EN 60601-1:2006, EN 60601-1-4:1996, EN 60601-1:2007, EN 60601-2-4:2003

Sensibilidad y precisión:

Sensibilidad > 90%, tip. 98%,

Especificidad > 95%, tip. 96%,

Asistolia umbral < ±80μV

Protocolo de reanimación: ILCOR 2015-2020

Análisis ECG: Ritmos cardiacos tratables (VF, VT rápida), Ritmos cardiacos no tratables (asistolia, NSR, etc.)

Control de impedancia: Medición9 de la impedancia continua, detección de movimiento, detección de respiración

Control de los electrodos : Calidad del contacto

Identificación de ritmo normal de marcapasos

Lenguas: Holandés, inglés, alemán, francés, español, sueco, danés, noruega, italiano, ruso, chino

Comunicación-interfaz: USB 2.0 (El mas simple y economico del mercado)

Usuarios-interfaz: Operación de tres botones (botón de encendido/apagado , botón de choque/información.

Indicación LED: para el estado del proceso de reanimación. (Para ambientes ruidosos y en caso de personas con limitaciones acusticas)

Impulso-desfibrilación: Bifásico (Bajo Nivel de Energia, pero mayor calidad que causa menos daño al musculo cardiaco), tensión controlada

Energía de choque máxima: Energía Alta 300J (impedancia de paciente 75Ω), Energía Baja 200J

(impedancia de paciente 100Ω)

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