EMS World

AUG 2011

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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| By Scott R. Snyder, BS, NREMT-P, Sean M. Kivlehan, MD, MPH, NREMT-P, & Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT Immune System The Immunologic Complications Our immune system is designed to protect us from harmful pathogens; here’s what you need to know about how it works CONTINUING EDUCATION T i E Marie, a paramedic, and her EMT partner, Don, are This CE activity is approved by EMS World, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS), for 1.5 CEUs. OBJECTIVES • Review the innate immune system • Describe types of allergic reactions • Discuss conditions associated with immunocompromised patients • Review prehospital care options for these patients KEVIN COLLOPY and SCOTT SNYDER are featured speakers at EMS World Expo 2011, Aug. 29–Sept. 2, at the Las Vegas Convention Center, Las Vegas, NV. For more information, visit EMSWorldexpo.com. dispatched to an “unknown medical problem” at a resi- dential address. Upon arrival, they are met at the door by the patient’s wife, who tells them, “My husband doesn’t want to go to the doctor, but I know he’s not feeling well.” The patient, a 60-year-old male, is lying on the couch complaining of abdominal pain. He says the pain started about four days ago, and describes it as “crampy,” non- radiating, non-reproduceable and 3 on a scale of 0–10. The patient has no other complaints. He has a past medical history of hypertension, lupus and diverticulosis, for which he is prescribed Adalat (nifedipine), prednisone and Imuran (azathioprine). A physical exam reveals slight pain with palpation to the patient’s upper left quadrant and a temperature of 99.2°F. The patient’s vital signs are stable and within normal limits. As Marie attempts to administer oxygen via a nasal cannula, the patient says, “Thanks for coming out here, but I just have a stomach bug and certainly do not need to go to the hospital.” This situation is certainly plausible, if not common in EMS. The crew is presented with a patient who has a seemingly minor complaint, is stable and does not want to go to the hospital for an evaluation. Understanding both his past medical history and his medications would alert EMS providers that this patient is high risk for infection 44 AUGUST 2011 | EMSWORLD.com Figure 1: Types of Immunity as a result of an immune system impaired by disease and medication. Overview of the Immune System Over millions of years of evolution, the human immune system has evolved into a highly effi cient body system designed to protect humans from harmful pathogens (see Figure 1). The immunologic response in humans is coordi- nated by two separate immune systems: the ancient innate (natural) immune system and the more recently evolved acquired (adaptive) immune system. and

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