Prehospital Care Report: Fill & Download for Free

Simply, to provide prehospital care and transportation. For the text book answer, responsibilities include:•Ensure safety of the EMS crew, the patient, and bystanders at the scene•Assess the patient•Safely lift and move the patient•Prepare oral and written reports•Safely transport the patient•Serve as the patient’s advocate and provide emotional support•Maintain medical and legal standards•Maintain vehicle and equipment readiness•Develop and maintain community relationsI hope this is helpful! :)

I was asked to answer this question, but since it is not my field of expertise (I am a dentist not a hematologist), I will link to a webpage on Medscape and quote what is says about ITP. Medscape has excellent information, and is meant for professional use:http://emedicine.medscape.com/article/779545-medication#showallThis answer is meant only as a reference to what Medscape lists as "Medication" for ITP. Please consult you doctor if you want to learn more about this disease.Prehospital CarePrehospital care focuses on the ABCs, which include providing oxygen, controlling severe hemorrhage, and initiating intravenous (IV) fluids to maintain hemodynamic stability.Prehospital airway control may be necessary for a large intracranial hemorrhage.EMS providers should be aware of the potential for serious bleeding complications in patients with idiopathic thrombocytopenic purpura (ITP).Emergency Department CareLife-threatening bleeding requires conventional critical care interventions.In the patient with known ITP, high-dose parenteral glucocorticoids and IV immunoglobulin (IVIg), with or without platelet transfusions, are appropriate.Platelet transfusion is indicated for controlling severe hemorrhage. Send a blood specimen to the lab for type and screen in case platelet transfusion is necessary.Platelet survival is increased if the platelets are transfused immediately after IVIg infusion.A consultation with a hematologist may be required to make a decision regarding the transfusion of platelets.Guidelines for transfusion dosage6-8 U of platelet concentrate, or 1 U/10 kg1 U of platelets to increase count of a 70-kg adult by 5-10,000/mm3 and an 18-kg child by 20,000/mm3Splenectomy is reserved for patients in whom medical therapy fails. Emergent splenectomy is indicated in patients with life-threatening bleeding in whom medical therapy fails.In patients without life-threatening complications, focus ED care on confirming the diagnosis, if possible, and initiating therapy as needed.Most patients with undiagnosed thrombocytopenia and purpura will need admission for further evaluation and treatment, since ITP is a diagnosis of exclusion.ConsultationsConsult a hematologist for assistance in confirming the diagnosis or, in the patient with known ITP, arranging disposition and follow-up care, if appropriate.Consult a neurosurgeon for intracranial hemorrhage. Consultation by other surgical specialists may be required for extensive hemorrhage at other sites.Medication SummaryGlucocorticoids and IVIg are the mainstays of medical therapy. Indications for use, dosage, and route of administration are based on the patient's clinical condition, the absolute platelet count, and the degree of symptoms. Consultation with a hematologist may be needed prior to starting therapy.Children who have platelet counts >30,000/mm3 and are asymptomatic or have only minor purpura do not require routine treatment. Children who have platelet counts < 20,000/mm3 and significant mucous membrane bleeding and those who have platelet counts < 10,000/mm3 and minor purpura should receive specific treatment.Adults with platelet counts >50,000/mm3 do not require treatment. Treatment is indicated for adults with counts < 50,000/mm3 with significant mucous membrane bleeding. Treatment also is indicated for those adults with risk factors for bleeding (eg, hypertension, peptic ulcer disease, vigorous lifestyle) and in patients with a platelet count < 20,000-30,000/mm3.IV anti-(Rh)D, also known as IV Rh immune globulin (IG), was not recommended by the 1996 American Society of Hematology practice guidelines. However, recent studies using higher dosages of IV RhIG in acute ITP in children and adults show platelet count increases at 24 hours faster than medicating with steroids and at 72 hours similar to IVIg. Although generally less toxic than IV steroids, IV RhIG is more expensive than IV steroids. Studies in children with chronic ITP show that escalating or elevated doses of IV RhIG have comparable responses to those of high-dose IVIg therapy in children. This therapy is not appropriate for patients who have undergone splenectomy. Acute intravascular hemolysis after infusing IV RhIG has been reported, with an estimated incidence of 1 in 1115 patients.Steroid use and immunosuppressives and splenectomy may be undesirable because of their associated complications. For long-term steroid use, this includes osteoporosis, glaucoma, cataracts, loss of muscle mass, and an increased risk of infection. For immunosuppressive therapy and splenectomy, risks include worsening immunosuppression and infection or sepsis. Studies of the use of multiagent therapies in refractory patients are ongoing. Some small studies have shown limited success. According to one study[3] , using a combination of weekly vincristine, weekly methylprednisolone, both until platelet counts reached 50,000/mm3, and cyclosporine orally twice daily until the platelet count is normal for 3-6 months seems promising, though larger prospective studies are needed.Other therapies, such as cyclophosphamide, danazol, dapsone, interferon alfa, azathioprine, vinca alkaloids, accessory splenectomy, and splenic radiation have been studied. Many case series discussing these treatments are too small to show sufficient evidence of a clinically significant reduction in bleeding or mortality rate; however, they serve as additional therapeutic measures in ITP refractory-to-primary therapy (eg, glucocorticoids, IVIg immunoglobulin, splenectomy). Newer studies on rituximab suggest that this agent is an effective treatment option in splenectomized refractory or relapsed ITP patients.[4, 5]Clinical trials have shown promise for agents that directly stimulate platelet production, such as thrombopoietin (TPO) receptor-binding agents. Two new agents, eltrombopag and romiplostim, are available to patients with chronic ITP who have failed other therapies.[6, 7] Both of these agents require registration in a database. While they show promise for raising platelet counts, there are potential safety concerns such as thrombocytosis and rebound thrombocytopenia. It is unlikely that emergency physicians should be prescribing these agents without being under the recommendation of a hematologist.GlucocorticoidsClass SummaryThese agents are used to treat idiopathic and acquired autoimmune disorders. They have been shown to increase platelet count in ITP.View full drug informationPrednisone (Deltasone, Orasone, Sterapred)Useful in treating inflammatory and allergic reactions; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. DOC for all adult patients with platelet counts < 50,000/mm3. Asymptomatic patients with platelet counts >20,000/mm3, or patients with counts 30,000-50,000/mm3 with only minor purpura, may not need therapy; withholding medical therapy may be appropriate for asymptomatic patients, regardless of count.Methylprednisolone (Solu-Medrol, Depo-Medrol)Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased permeability. Used as alternative glucocorticoid of choice for all patients with severe, life-threatening bleeding or children with platelet counts < 30,000/mm3. Careful observation without medical treatment may be appropriate in some asymptomatic children.Blood productsClass SummaryAdministration of IVIg may temporarily increase platelet counts in some children and adults with ITP. Consider IVIg if the situation requires a rapid, temporary rise in platelet count.Intravenous immune globulin (IVIg)DOC for severe, life-threatening bleeding or for children with platelet counts < 20,000/mm3 with minor purpura; can be used alone or in addition to glucocorticoid therapy.Thrombopoietic AgentClass SummaryThese agents directly stimulates bone marrow platelet production.[8]Eltrombopag (Promacta)Oral thrombopoietin (TPO) receptor agonist. Interacts with transmembrane domain of human TPO receptor and induces megakaryocyte proliferation and differentiation from bone marrow progenitor cells. Indicated for thrombocytopenia associated with chronic idiopathic thrombocytopenic purpura in patients experiencing inadequate response to corticosteroids, immunoglobulins, or splenectomy. Not for use to normalize platelet counts but used when clinical condition increases bleeding risk.Prescribers must enroll in Promacta Cares program. Only available through restricted distribution program. Program phone number is (877) 9-PROMACTA (877-977-6622).Romiplostim (Nplate)An Fc-peptide fusion protein (peptibody) that increases platelet production through binding and activation of the thrombopoietin (TPO) receptor, a mechanism similar to endogenous TPO. Indicated for chronic immune (idiopathic) thrombocytopenic purpura in patients who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy.Only available through the Nplate NEXUS (Network of Experts Understanding and Supporting Nplate) program, a program designed to promote informed risk-benefit decisions before initiating treatment. For more information, see www.nplate.com or call (877) NPLATE1 (877-675-2831).

Here’s a few things to know:You aren’t going to be saving lives every day. Most of your time is going to be spent doing relatively low acuity transports, paperwork, cleaning, and maintainance.The pay is not very good. Most EMS services pay not much above minimum wage, and for Paramedics, you will be paid much less than other Emergency Medical providers such as RNs and PAs. It is even worse for basic level EMTs.You will be facing dangers, but mostly from things like heart disease, stress, bad drivers, etc. If you are getting into EMS for the thrills, you will be disappointed.Sense of humor is essential. Don’t take yourself too seriously. Nobody likes a “Paragod”. EMT skills save Paramedics, so do not look down on basic EMTs.Writing a good, legible, and accurate Prehospital Care Report (PCR) is an essential skill for a Paramedic. Don’t neglect your PCR writing skills: it will literally save your butt should you have to appear in court.6. If you are getting into EMS to save the world, I suggest you find another profession. EMS is not about individuals, it’s about team effort. Showboating and egos have no place in EMS.