EMC 360

FLUID and RESPIRATORY

EMERGENCIES ( 2 hr)

Spring 2008

Faculty:

David C. Trigg, M.D.

Medical Director

Emergency Medical Care Program

125 Moore Hall

(W) 828.227.3532 ; (M) 828.508.0578

dtrigg@email.wcu.edu

Office Hours

You may try to call me at any reasonable hour, but during the times posted here I should be scheduled to be in my office and available to you by phone, or email: DL Office Hours: MWTrF 10-11:30.

Course Description:

This course will examine the physiology, pathophysiology, and clinical presentation of various fluid, electrolyte and respiratory disorders. The course will consider the assessment and management of certain fluid, electrolyte and respiratory emergencies.

Course Objectives:

At the completion of the course, the student will:

1. To understand the basic principles of fluid resuscitation and therapy in the prehospital emergencies

2. To understand the identification and treatment of common electrolyte disturbances, including disturbances of sodium, potassium, calcium, and magnesium metabolism.

3. To understand the identification and treatment of common acid - base abnormalities

4. To understand the basic principles of emergency IV medication administration,

including bolus and drip methods. And to know the indications, contraindications, and

complications of IV therapy.

5. To understand the identification and treatment of common causes of shock;

and which interventions for shock are appropriate.

6. To understand the identification and treatment of common respiratory disturbances;

to know how to administer respiratory assistance and appropriate intervention.

7. Be proficient in endotracheal intubation and blind airway devises; as well as knowing how

to administer RSI / paralytic agents for rapid intubation.

Texts:

Handbook of Fluid, Electrolyte and Acid Base Imbalances, 1^st edition, Key and Paulanka,

Delmar Publishers, Albany, NY, 2000. ISBN 0-7668-0333-3 [ K ]

Brady's Paramedic Emergency Care, - or any other quality par textbook(s) will be referred

to as “SPT,” standard paramedic textbook [SPT ]

Emergency Medicine 6 th ed. Companion Handbook, Ma, John O., McGraw Hill, 2004 [ M ] ISBN 0-07-141025-2

Grading:

There will be 3 unit tests during the semester and a cumulative final exam.

There will be 4 unit discussion board assignments during the semester.

Quizzes* 25 %

Discussion Board Assignments (see instr.) 8.3 %

Unit Exams (3) (16.7 % each) 50 %

Final Exam** 16.7 %

Final grades will be based on the scale below [FAQ : “Why is the scale …?” Ans.: “Because it’s for your own good.”]

92.5 - 100 = A

84.5 - 92 = B

76.5 - 84 = C (In order to continue in the EMC curriculum, a minimum of 76.5 is required)

69.5 - 76 = D

< 69.5 = F

Quizzes*

Please note the quiz deadlines. Deadlines vary depending upon whether the quiz is a weekly quiz or a summative quiz. On the weekly quizzes, you’ll have two attempts; your score(s) will be averaged. On the review, summative quizzes, you’ll have unlimited attempts; your score(s) will be averaged.

Each unit will have a summative quiz covering questions from each lecture in that unit – as well as a few course review questions. There will also be two course review summative quizzes. The summative quizzes may be weighted more heavily than the weekly quizzes [ the designations of quiz point totals will show you their relative weights]

Final Exam**

Because the final is comprehensive, it may be a better reflection of what you have retained from the course. Therefore, I reserve the option of counting the final for greater than 16.7% if it would be to the student’s advantage.

Scores for Discussion Board Assignments (8.3% of final grade; note the change from syllabus draft.)

Disability Services

Western Carolina University is committed to providing equal educational opportunities for students with documented disabilities. Students who require disability services or reasonable accommodations must identify themselves as having a disability and provide current diagnostic documentation to Disability Services. All information is confidential. Please contact Kimberly Marcus for more information. (828) 227-7234 kmarcus@email.wcu.edu. Requests for reasonable accommodations must be presented to the instructor as early in the semester as possible

Academic Honesty

In accordance with the academic honesty policy presented in the Western Carolina University student handbook, you should presently be notified that the consequence of your failure to adhere to this honesty policy will result in a grade of F for the course.

NB: academic dishonesty includes knowingly allowing someone else to cheat.

Sexual Harassment

Western Carolina University adheres to statutes and ethical principles regarding sexual harassment. If ever there is any inappropriate or unwelcomed behavior that is of a sexual nature, on the part of the instructor or peers, it should be attended to and it should cease. This may require effective communication and may utilize a system for registering a complaint with faculty, department head, +/or a liaison person. Students should have a familiarity with and understanding of this policy and of the grievance procedures for individual action. Actions may be in the manner of a formal complaint procedure or in the manner of informal assistance. Students should also be aware of the availability in Health Sciences of a liaison person with whom grievances can be initially discussed.

Week of

Topic

Reading

Assignment Due

1/14 –

1/20

1.Introduction to Fluids and Electrolytes

2.Extracellular Fluid Volume Loss

3.Extracellular Fluid Volume

Excess (ECFVE; AKA: edema)

Key pp. 1-10

SPT: electrolytes

Ma p. 32-33

K pp. 11-21

K pp. 22-33

Quiz # 1 (complete quiz within WebCat by 23:00

ET* , 1/20/08 .

[ET*- East. US Time Zone. Early in semester: EST. Then later in semester: EDT. Both will be referred to as “ET”]

Quiz # 2 (complete quiz within WebCat by 23:00 ET, 1/20/08)

1/21 –

1/27

4. Extracellular Fluid Shift

(“third-spacing”)

5. Intracellular Fluid Volume Excess

(ICFVE)

6. Electrolyte priorities and Imbalances

7. Potassium and Potassium Imbalances

Key pp. 34-37 (slides)

Ma p.53-56; 60-61

Key pp. 38-45

Key pp. 47-51

Key pp. 52-70

Ma p. 36-38

Quiz # 3 (complete quiz within WebCT by 23:00 EST, 1/27)

If you want to work ahead, go to summative unit quiz (Quiz # 6) (complete this review quiz within WebCat by 23:00 ET, 2/17/08)

1/28 –

2/3

8. Sodium and Sodium Imbalances

9. Calcium and Calcium Imbalances

Key pp. 71 -85 (slides)

Ma p. 33-36

Key pp. 86-101

Ma p. 38-39

Weekly Quiz # 4 (complete quiz within WebCat by 23:00 ET, 2/3)

2/4 –

2/10

10. Phosphorus and Phosphorus Imbalances

11. Magnesium and Magnesium Imbalances

Key pp. 113-123 (slides)

Key pp. 102-112

Ma p. 39-40

Weekly Quiz # 5 (complete quiz within WebCat by 23:00 ET, 2/10)

2/11 –

2/17

12. Magnesium Disorders

- Clinical Applications

13. Introduction to Acid – Base Balance

Key pp. 102-112 (slides)

Ma p. 39-40

Key pp. 128-134 (slides)

SPT: ABGs

Ma p.40-45

Weekly Quiz # 6 [summative] (complete quiz within WebCat by 23:00 ET, 2/17)

Case study 1 discussion +/or Peer-reviewed web site 1 due. (post in discussion board by 23:00 EST, 2/17)

2/18 –

2/22

Exam # 1 .1 Schedule exam with your community college proctor.

Exam will be available 2/18-2/22

(test # 1 Study guide slide)

2/18 –

2/24

14. Acid Base II

15. Acid Base III

Key pp. 135-150 (slides)

SPT: ABGs

Ma p.40-45

ibid pp. 135-150 (slides)

Weekly Quiz # 7 (complete quiz within WebCat by 23:00 ET, 2/24)

2/25 –

3/2

16. Shock

Key pp. 232-258 (slides)

SPT: shock

Ma p.49-63

Weekly Quiz # 8 (complete quiz within WebCat by 23:00 ET, 3/2)

3/3 –

3/9

17. Peripheral IV Lines

and Administration of IV medications

18. Central IV Lines

19. IO and Administration of IO

and Administration of IO medications

20. MAST

Key pp. 151-258 (slides)

SPT

Key pp. 162-174 (slides)

SPT (slides)

Quiz # 9 [summative] (complete quiz within WebCat by 23:00 ET 3/9/08)

Case study 2 +/or Peer-reviewed web site 2 due. (post in discussion board by 23:00 on 3/9)

3/10 –

3/14

Exam # 2 .1 Schedule exam with your community college proctor.

Exam will be available 3/10-3/14

(test # 2 Study guide)

3/10 –

3/16

21. Respiratory Physiology

SPT (slides)

Weekly Quiz # 10 (complete quiz within WebCat by 23:00 ET 3/16)

3/17 –

3/23

22. Respiratory Pathophysiology

Ma p.173 (slides)

SPT

Weekly Quiz # 11 (complete quiz within WebCat by 23:00 ET 3/23)

3/24 –

3/30

24. Upper Respiratory Problems

25. Acute and Chronic Obstructive

Airway Diseases

26. Asthma

SPT (slides)

Ma p.192 (slides)

SPT

Ma p.173; (slides)

SPT

Weekly Quiz # 12 (complete quiz within WebCat by 23:00, ET 3/30/08)

If you want to work ahead, see (Quiz # 18) [summative] (complete this quiz anytime before 23:00 ET 5/2/08)

3/31 –

4/6

27. CNS dysfunction causing

respiratory distress / failure

28. Review of Respiratory Anatomy for RSI

and Cricothyrotomy

29. Rapid Sequence Induction

30. The Difficult Airway

(slides)

Ma p. 7; (slides)

Ma p. 5; (slides)

Orebaugh SL J Emerg Med. ‘02 Jan;22(1):31-48

Weekly Quiz # 13 (complete quiz within WebCat by 23:00 ET, 4/6)

Case study 3 +/or Peer-reviewed web site 3 due. (post in discussion board by 23:00, ET on 4/6)

Quiz # 14 [summative] (complete quiz within WebCat by 23:00 ET 3/9/08)

4/7 –

4/11

Exam # 3 .1 Schedule exam with your community college proctor.

Exam will be available 3/10-3/14

(Unit test # 3 Study guide)

4/7 –

4/13

31. Pneumonia

Ma p. 179 (slides)

Weekly Quiz # 15 (complete quiz within WebCat by 23:00, ET 4/13/08)

4/14 –

4/20

32. Pulmonary Embolism

33. Hyperventilation

Ma p.156 (slides)

SPT

SPT (slides)

Weekly Quiz # 16 (complete quiz within WebCat by 23:00, ET 4/20/08)

4/21 –

4/27

34. Pulmonary Edema

35. Pulmonary Edema vs. COPD, with asthma

assessment and treatment

36. Pediatric Resp. Emergencies

Ma p.140 (slides)

SPT

Ma p.340 (slides)

SPT

Weekly Quiz #17 (complete quiz by 23:00, ET 4/27/08)

Open, summative Quiz

(Quiz # 18) (complete within WebCat by 23:00 ET 5/2/08)

4/28 –

5/2

37. Pediatric Fluid Emergencies

Ma p.366 (slides)

Case study 4 +/or Peer-reviewed web site 4 due. in discussion board by 23:00 4/27

Open summative Quizzes : Quiz # 18 and Quiz # 19 (complete both quizzes within WebCat by 23:00 ET, 5/2/08)

5/03

Final Exam

(final Study guide slide)

Use study guides 1, 2, and 3 to prepare for the final exam.

Final exam at 09:00 5/03 at GTCC in Jamestown.