Beyond the basics: syncope.

Whether in the hospital or prehospital environment, syncope is one of the perplexing diagnostic challenges facing clinicians. An understanding of the pathophysiology behind syncope, common causes and diagnostically significant examination items can lead to appropriate field decisions and treatment.

Beyond the basics: trauma during pregnancy.

Pregnant patients who are involved in trauma pose a special challenge to EMS. Instead of a single patient with a normal physiological response to the injuries sustained, you have two patients with special needs depending on you: the mother and her unborn fetus. Whether the trauma is minor or severe, it will require you to understand and apply your knowledge of the pregnant patient to your assessment and emergency care.

Beyond the basics: immune response.

The human immune response is arguably among the most difficult processes for an EMS provider to understand. The immune system provides front-line defense to any potentially inflammatory process, with the goal of destroying or inactivating pathogens, abnormal cells and foreign substances. The system includes the thymus, spleen, lymph nodes, lymphoid tissues (as in the GI tract and bone marrow), macrophages, lymphocytes, including B and T cells, and antibodies, among others. On the surface, the skin and stomach acid serve as physical barriers to invasion. This article will primarily concentrate on the immune response to allergies, but will discuss some other immune disorders to illustrate the role of the immune system in common disease processes.

Beyond the basics: acute abdominal pain.

Acute abdominal pain is a common presenting complaint encountered by prehospital care personnel. It can be an indication of a number of diseases and conditions involving abdominal organs and structures or associated with referred pain from organs and structures outside the borders of the abdominal cavity. However, a sudden onset and severe abdominal pain is almost always caused by some type of intra-abdominal pathology.

Beyond the basics: lightning-strike injuries.

It is estimated that a lightning flash occurs approximately 8 million times per day throughout the world. Most strikes are benign and cause little damage to property and physical structures; however, when lightning strikes a person or group of people, it is a significant medical and potentially traumatic event that could lead to immediate death or permanent disability. By understanding some basic physics of lightning and pathophysiology of injuries associated with lightning strikes, EMS providers will be better prepared to identify assessment findings, anticipate complications and provide effective emergency care.

Beyond the basics: the art of critical thinking. Part 2.

This two-part series has addressed the critical thinking process both through discussion and demonstration in the case studies presented here. Indeed, the process involves all of the decisions we make in assessment and treatment. It is not limited to advanced providers. With the exception of the ECG analysis mentioned earlier, all other decisions were based on history and physical exam and can be performed by any provider. Thinking is not limited to a particular license or certification level. We hope these articles have helped you cross a bridge into stronger critical decision-making and farther along the journey of being a true prehospital clinician at any level of certification.