2d • Paramedic Talk
Today's tips for success!
Parkland Burn Formula
Used to estimate fluid resuscitation needs in burn patients during the first 24 hours after injury.
Formula: 4 mL × body weight (kg) × % TBSA burned
Fluid type: Lactated Ringer’s (preferred)
Administration:
- Half given in the first 8 hours
- Remaining half over the next 16 hours
Example: 70 kg patient with 30% burns
4 × 70 × 30 = 8,400 mL
- 4,200 mL in first 8 hrs
- 4,200 mL over next 16 hrs
Key exam pearl: Time starts from the burn injury, not EMS arrival.
Compartment Syndrome
Occurs when pressure builds within a muscle compartment, reducing blood flow and causing tissue ischemia.
Common causes:
- Fractures
- Crush injuries
- Burns
- Tight casts or dressings
Early Signs (most tested)
- Severe pain
- Pain with passive stretch
- Tight swollen compartment
Late Signs
- Pallor
- Paresthesia
- Paralysis
- Pulselessness (very late)
EMS considerations:
- Remove constrictive items
- Elevate limb to heart level
- Rapid transport
Shark Fin Waveform (Capnography)
A “shark fin” waveform on capnography indicates airflow obstruction.
Common causes:
- Asthma
- COPD
- Bronchospasm
- Anaphylaxis
Why it happens: Bronchospasm causes slow and uneven exhalation, producing the slanted “fin” appearance.
EMS management:
- Bronchodilators
- Oxygen
- Treat underlying cause
Pleural Effusion
A collection of fluid in the pleural space surrounding the lungs.
Common causes:
- Congestive heart failure
- Cancer
- Infection
- Liver disease
Symptoms:
- Shortness of breath
- Diminished breath sounds
- Dullness to percussion
- Chest discomfort
Exam clue: Often confused with pneumothorax, but effusion usually presents with dullness rather than hyperresonance.
Guillain-Barré vs Multiple Sclerosis
Guillain-Barré Syndrome (GBS)
Cause: Autoimmune attack on peripheral nerves.
Key features:
- Ascending paralysis
- Begins in legs
- May progress to respiratory failure
- Often follows a viral infection
Reflexes: Decreased or absent
Multiple Sclerosis (MS)
Cause: Autoimmune destruction of myelin in the central nervous system.
Key features:
- Neurological deficits that come and go
- Vision problems
- Weakness
- Numbness
Common population: Young adults, especially females
Commotio Cordis
A sudden cardiac arrest caused by a blunt blow to the chest.
Occurs when impact hits the chest during the vulnerable repolarization phase of the cardiac cycle (R-on-T phenomenon).
Common scenarios:
- Baseball
- Hockey
- Lacrosse
Result: Ventricular fibrillation
Treatment:
- Immediate CPR
- Rapid defibrillation
Survival depends on fast AED use.
Blast Injury Phases
Explosions cause multiple injury patterns.
Primary Blast Injury
Caused by the pressure wave.
Most affected organs:
- Lungs
- Ears
- GI tract
Examples:
- Pulmonary barotrauma
- Ruptured eardrums
Secondary Blast Injury
Caused by flying debris and shrapnel.
Examples:
- Penetrating trauma
- Lacerations
Tertiary Blast Injury
Occurs when the patient is thrown by the blast wind.
Examples:
- Fractures
- Head injuries
Quaternary Blast Injury
All other explosion-related injuries.
Examples:
- Burns
- Crush injuries
- Toxic inhalation
Purpose of Kussmaul Respirations
Kussmaul respirations are deep, rapid breathing seen in severe metabolic acidosis.
Common cause:Diabetic ketoacidosis (DKA).
Purpose:The body attempts to blow off carbon dioxide (CO₂) to reduce acidity and help correct the pH imbalance.
Exam clue:
- Deep
- Rapid
- Labored breathing
Blood Cells
Erythrocytes (Red Blood Cells)
Function: Transport oxygen and carbon dioxide.
Key component: Hemoglobin
Life span: Approximately 120 days
Leukocytes (White Blood Cells)
Function: Fight infection and support the immune system.
Common types:
- Neutrophils
- Lymphocytes
- Monocytes
- Eosinophils
- Basophils
Thrombocytes (Platelets)
Function: Blood clotting
Role:
- Form platelet plugs
- Activate the clotting cascade
- Prevent excessive bleeding
Low platelets increase risk of bleeding disorders.
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Today's tips for success!
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