A neurological emergency caused by severe thiamine (vitamin B1) deficiency. Most commonly seen in: - Alcohol use disorder - Malnutrition - Hyperemesis gravidarum - Bariatric surgery patients - Dialysis patients - Eating disorders ⚠️ The Classic Triad (NREMTP loves this) Only 10–20% of patients show all three, but you must know them: 1. Confusion 2. Ataxia (unsteady gait) 3. Oculomotor dysfunction - Nystagmus - Lateral rectus palsy - Ophthalmoplegia 🚑 EMS / Clinical Clues - AMS - Staggering gait or unable to walk - Horizontal nystagmus - History of alcohol abuse or poor nutrition - Hypothermia - Hypotension - Memory problems 🔥 Critical EMS Treatment Give thiamine before glucose. Glucose administration without thiamine can worsen WE by accelerating thiamine consumption. Dose: - 100 mg IV/IM thiamine (commonly available in EMS kits)

You are responding to a patient who has been exposed to a poisonous powder on their skin. What is the correct procedure for managing the decontamination of this patient?

Pink Puffer = Emphysema-dominant COPD Why “pink”? - These patients maintain near-normal oxygenation (pink skin) early in the disease. - They compensate with increased respiratory rate → less cyanosis. Why “puffer”? - They breathe with pursed lips to keep airway pressure up and prevent alveolar collapse. - They are thin, barrel-chested, and work hard to breathe (air trapping). Key physiology - Loss of alveolar walls → decreased elastic recoil - Destruction of alveoli → “pink puffer” Blue Bloater = Chronic Bronchitis–dominant COPD Why “blue”? - Chronic bronchitis leads to poor oxygenation → cyanosis - Low O₂ + high CO₂ → “blue” Why “bloater”? - Chronic hypoxia → pulmonary vasoconstriction → cor pulmonale (right-sided CHF) - This causes fluid retention, edema, and a “bloated” appearance. Key physiology - Chronic cough + mucus production for ≥3 months for 2 consecutive years - Airways filled with mucus → V/Q mismatch → cyanosis and hypercapnia 🚨 Modern EMS / medicine perspective These terms are outdated and overly simplistic because: - Many COPD patients have a mixture of chronic bronchitis and emphysema. - Not everyone fits the “pink” or “blue” image. But for exams, they still test well, and the physiology holds.

Negative pressure ventilation occurs when:

Recent JEMS Commentary Highlights the EMS Body‑Camera Debate A JEMS article explores how body‑worn cameras could affect EMS practice, weighing the benefits and challenges. Proponents note that cameras can provide clear documentation of patient interactions, defend against false complaints, and support quality assurance and training. Opponents raise concerns about HIPAA compliance, privacy of sensitive patient data, and operational impacts (e.g., distraction or data management burden). Students and future EMS leaders should understand both the legal/ethical implications and potential training advantages of emerging documentation tools. 🔗 https://www.jems.com/ems-management/to-cam-or-not-to-cam-the-great-ems-bodycam-debate/ JEMS EMS Training News 2025 AHA CPR/ECC Guideline Updates Spark Field Debate The 2025 American Heart Association (AHA) Guidelines for CPR and Emergency Cardiovascular Care emphasize on‑scene resuscitation and recommend prioritizing IV access over intraosseous (IO) when feasible. The updated recommendations also discuss cautious use of mechanical CPR devices (discouraging routine use) and put greater emphasis on quality compressions and defibrillation timing. These changes are generating discussion among paramedics about practical implementation, especially in rural or small‑crew settings where IO access and mechanical devices are frequently relied upon. For students, these evolving recommendations highlight the importance of staying current with national guidelines that directly influence prehospital cardiac arrest management and patient outcomes. 🔗 https://www.jems.com/patient-care/the-ems-avenger-on-the-2025-aha-guidelines/ JEMS