When administering or assisting in the administration of medication, it is important that you follow six steps. Before beginning, you must
obtain an order from medical direction
the 6 rights
gasping type respirations that have no pattern and occur very infrequently; a sign of impending cardiac or respiratory arrest. Also called atonal breathing.
small air sacs in the lungs that fill with air on inspirations and are the point of gas exchange with the pulmonary capillaries
automatic transport ventilator (ATV)
a positive pressure ventilation device that delivers ventilations automatically
bag-valve-mask devise (BVM)
a positive pressure ventilation device that consist of a bag with non-rebreather valve and a mask. The bag-valve device is connected to the mask or other airway. The bag is squeezed to deliver a ventilation to the patient
smaller branches of the bronchi. They continue to branch and get smaller, eventually leading into alveolar sacs.
sense organs within the body, such as carotid and aortic bodies, that are sensitive to chemical changes in the blood, especially to levels of oxygen, carbon dioxide, and hydrogen, and that, in response, play a role in the regulation of respiration.
the most inferior portion of the larynx and only full cartilaginous bring of the upper airway. It is felt immediately below the thyroid cartilage.
pressure applied to the cricoid cartilage to compress the esophagus. Also call the Sellick maneuver.
a sound similar to that of a cawing crow that indicates that the muscles around the larynx are in spasm and beginning to narrow the opening into the trachea
a bluish color of the skin and mucous membranes that indicates poor oxygenation of tissue.
dead air space
inspired air that fills the respiratory tract but never reaches the alveoli of the lungs.
the major muscles of respiration that separates the chest cavity from the abdominal cavity. (makes up 60% - 70% Oxygen intake)
a small flap of cartilaginous tissue that acts as a valve and closes over the trachea during swallowing.
a tubular structure that serves as a passageway for food and liquids to enter the stomach.
flow-restricted, oxygen-powered ventilation device (FROPVD)
a device that consists of ventilation valve and trigger or button and is driven directly by oxygen. It is used to provide positive pressure ventilation.
head-tilt, chin-lift maneuver
a manual technique used to open the airway. The head is tilted back by one hand. The tips of the fingers of the other hand are placed under the chin and used to lift it up and forward.
a complex protein molecule found on the surface of the red blood cell that is responsible for carrying a majority oxygen in the blood.
a one-gauge regulator that is used to power the flow restricted, oxygen powered ventilation device. The flow rate cannot be adjusted.
the insufficient supply of oxygen and other nutrients to some the body's cells that result from inadequate circulation of blood. Also called shock.
a manual technique used to open the airway in the patient with a suspected spinal injury. The fingers are place at the angles of the jaw and used to life the jaw up and forward
a surgical procedure in which a patient's larynx is removed. A stoma is crates for the patient to breathe through.
the part of the air passage that connects the pharynx with the trachea. Also, it is considered the orang of the voice since it contains the vocal cords.
the portion of the reparatory system that extends from the trachea to the alveoli of the lungs
the amount of air breathed in and out in one minute. Also called minute ventilation.
Minute volume (MV) = Respiratory Rate (f)
X Tidal Volume (Vt)
Minute volume = (12) breaths per minute x (500) ml per breath
Minute volume = 6,000 ml or 6 liters
an oxygen delivery device that consists of two prongs that are inserted into the nose of the patient. The oxygen concentration delivered is from 22% - 44%.
nasopharyngeal airway (NPA)
a curved, hollow rubber tube with a flange or flare at the top end and a bevel at the distal end that is inserted into the nose. It fits in the nasopharynx and extends into the pharynx providing a passage for air.
an oxygen delivery device that consists of an reservoir and one-way valve. it can deliver up to 100% oxygen to the patient
oropharyngeal airway (OPA)
a semicircular hard plastic device that is inserted in to the mouth and holds the tongue away from the back of the pharynx.
a portion of the pharynx that extends from the mouth to the oral cavity at the base of the tongue
a container that is filled with sterile water and connected to the oxygen regulator to add moisture to the dry oxygen prior to being delivered to the patient.
a small space between the visceral and parietal pleura that is at negative pressure and filled with serous fluid.
a plastic mask placed over the patient's nose and mouth through which ventilations can be delivered.
positive pressure ventilation (PPV)
method of aiding patient whose breathing is inadequate by forcing air into lungs.
the exchange of oxygen and carbon dioxide the takes place during inhalation and exhalation
a condition in which a person is working harder than normally to breathe. Also called breathing difficulty.
depressions seen in the neck, above the clavicles, between the ribs, or below the rib cage from excessive muscle use during breathing. It is an indication of respiratory distress.
a rigid plastic tubes that is part of a suctioning system, commonly referred to as the (tonsil tips) or (tonsil sucker).
fluid that acts as a lubricant to reduce to reduce the friction between the parietal and visceral pleura
a sound that is heard when the base of the tone or relaxed tissues in the pharynx partially block the upper airway; also called (sonorous sound).
flexible tubing that is part of a suctioning system, also called a (French catheter).
a device that controls the flow and pressure of oxygen from the tank to allow for a consistent ant delivery of oxygen by liters per minute.
the bulky cartilage that forms the anterior portion of the larynx; see Adam's apple
a tubular structure that serves as the passageway for air to enter into the lungs; the windpipe.
a surgical opening into the trachea in which a tube in inserted for the patient to breathe through; see also stoma
a hollow tube that is inserted into a tracheostomy to allow fro the patient to breathe.
the portion of the respiratory system that extends from the nose and mouth to the larynx.
What does the amniotic sign do
Holds 500 to 1000 mL of water which helps to insulate and protect the fetus
How long till the uterus gets to the level of the umbilicus
20 weeks, so there is decreased respir rates and decreased minute volume
Decent called lightening is what
When the infant moves into the pelvis; also makes it easier for mother to breath
Leading cause of death in first trimester
Internal hemorrhage following rupture of ectopic pregnancy
term for a pregnancy that develops outside the uterus, most often in a fallopian tube
Location and quality of pain from ectopic pregnancy
Sudden stabbing and unilateral pain in the lower abdomen
First stage of pregnancy
Begins with onset of contractions when the fetus enters the birth canal and ends when the cervix is fully dilated
Second stage of pregnancy
Begins when fetus enters the birth canal and ends when the infant is born
Third stage of pregnancy
Begins with the birth of the infant and ends with the delivery of the placenta
What to do if you see umbilical cord around neck during birth
First, attempt to remove with finger
If that fails, then clamp and cut
What level to keep neonate at after pregnancy
The level of the birth canal until the umbilical cord is cut
Three emergency situations with placenta
-More than 30 minutes elapsed and the placenta has not birthed
-More than 500 mL of blseconds enforce delivery of placenta
- There is significant bleeding after delivery of placenta
Term for spinal cord or meninges protruding outside of vertebrae and possibly outside the body
During multiple gestation what are time periods
Contractions for second begin about 10 min
Second child born aprox within 45 min
How to help stop bleeding after birth
Massage abdomen (Fundus Massage)
Also suggest breast feeding
when the mucous plug at the uterine/cervix opening discharges into the vagina as a pink-tinged mucus
Where should two EMTs locate when assisting a pregnant patient
One at the head and one at the feet
how to reduce chance of precipitous birth and tearing of the peritoneum
One finger in peritoneum and gentle pressure on the baby's head to keep it from tearing
how to initiate breathing if it does not occur naturally within 15 sec
- position on back with towel under shoulders
- suction mouth and nose
- dry infant vigorously with towels, rub back, and flick feet
- bag mask at 40 to 60 b/min
what to do during a breech delivery
allow spontaneous delivery;
make a "V" with fingers and position them in the vagina to keep the walls of the vagina from collapsing the air way
Specific types of shock
Hemorrhagic Hypovolemic Shock
Nonhemorrhagic Hypovolemic Shock
Nonhemorrhagic Hypovolemic Shock
The loss of water, plasma protiens, and electrolytes from the intervascular space.
infection that releases bacteria and or toxins into the blood, causing the vessels to diolate and become permiable.
Due to heart attack, congestive heart faliure, abnormal cardiac rhythm, or overdose on drugs.
direct nerve stimulation symptoms
increased heart rate
increase in force of ventricular contraction (stroke volume)
release of epinephrine and norepinephrine
first stage: increased heart rate, pale cool skin, slightly increased respitory rate, decreased body temperature
apathy, confusion, rapid heart rate, decreased blood pressure, dilated pupils, more...
virus caused by human herpesviruses 1 and 2, characterized by small blisters whose location depends on the type of virus. Type 1, blisters on non genital area, Type 2, blisters on genital area.
an infammation of the meningeal coverings of the brain and spinal cord; it is usually caused by a virus or a bacterium.
a chronic bacerial disease that usually affects the lungs but can also affect other organs such as the brain and kidneys
the buildup of excess acid in the blood or body tissue that results from a primary illness
an acute spasm of the smaller air passages, called bronchioles,swelling of the mucous lining of the respiratory passages
inflammation of the bronchioles that usually occurs in children younger than 2 years.
a slow process of dilation and disruption of the airways and slveoli caused by chronic bronchial obstruction
an infectious disease in which membrane forms , lining the pharynx;can severely obstruct the passage of air into the larynx
disease of the lungs, extreme dilation and eventual destruction of the pulmonary alveoli
backup system to control respirations when oxygen levels fall; low blood oxygen levels
an airborne bacterial infection that effects mostly children younger than 6 years
a collection of fluid between the lung and chest wall that may compress the lung;abnormal accumulation of fluid in the pleural space
pleuritic chest pain
sharp,stabbing pain in the chest that is worsened by a deep breath; often caused by inflammation of the pleura
a disease that can lay dormant in a persons lungs for decades,man strains are resistant to antibiotics
acute coronary syndrome
a term used to describe a group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction
one of two (right and left) upper chambers of the heart. The right atrium receives blood from the vena cava and delivers it to the right ventricle. The left atrium receives blood from pulmonary veins and delivers it to the left ventricle
a measure of the volume of blood circulated by the heart in 1 minute. calculated by multiplying the stroke volume by the heart rate
congestive heart failure
a disorder in which the heart loses part of its ability to effectively pump blood; results from damaged heart muscles and results in backup of fluid into the lungs
swelling in the part of the body closest to the ground, caused by collection of fluid in the tissues, a possible sign of congestive heart failure
a condition in which the inner layers of artery such as the aorta, become seperated allowing blood o flow between the layers
a lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; reversible because permanent injury has not yet occurred
a blood cot that has formed within a blood vessel and is floating within the bloodstream
one of two (right and left) lower chambers of the heart. The left ventricle receives blood fromt he left atrium and delivers blood to the aorta. the right ventricle receives blood from the right atrium and pumps it inot the pulmonary artery
disorganized, ineffective twitching of the ventricles, resulting in no blood flow and a state of cardiac arrest
a swelling or enlargement of part of a blood vessel resulting from weakening of the vessel wall
a seizure characterized by severe twitching of all of the body's muscles that may last several minutes
one of the two main types of strokes; occurs as a result of bleeding inside the brain
one of the two main types of stroke; occurs when blood flow to a particular part of the brain is cut off by a blockage inside a blood vessel
clotting of the cerebral arteries that may result in the interruption of cerebral blood flow and subsequent stroke
transient ischemic attack
a disorder of the brain in which brain cells temporarily stop working because of insufficient oxygen, causing strokelike symptoms that resolve within 24 hours
a condition of sudden onset of pain within the abdomen, usually indicating peritonitis;
solid crystalline masses formed in the kidney resulting from an excess of insoluble salts or uric acid; trapped anywhere along the urinary tract
severe kidney failure resulting in the build up of waste products; eventually brain functions will be impaired
a condition in which the body stops producing red blood cells ; caused by infection
ametabolic disorder in which the ability to metabolize carbohydrates is impaired; usually lack of insulin
diabetic ketoacidosis (DKA)
a form of hyperglycemia in uncontrolled diabetes in which certain acids accumulate when insulin is not available; more typical in Diabeties type 1
a rapid destruction of red blood cells that occurs faster than the body's ability to create new cells
a state of unconsciousness resulting from several problems, including ketoacidosis, dehydration because of excessive urination and hyperglycemia
deep rapid breathing usually the result of certain acids when insulin is not available in the body; helps blow off excess acids
type 2 diabetes
typically develops in later life and often can be controlled through diet and oral medication
vaso occlusive crisis
ischemia and pain caused by sickle shaped red blood cells that obstruct blood flow to a portion of the body
substances released by the immune system in allergic reactions that are responsible for anaphylaxis and vasodilation
small spots of generalized itching,burning that appear as multiple raised areas on the skin; hives
a raised, swollen, well defined area on the skin resulting from an insect bite or allergic reaction
a genetic disorder that effects the lungs and digestive system; predisposes the child to repeat lung infections
paroxysmal nocturnal dyspnea
Sudden attacks of SOB that usually occur during sleep. Person wakes gasping forbreath and sits up to relieve symptoms; associated with left ventricular heart failure.
a blood clot that is floating through blood vessels until it reaches an area too narrow for it to pass
rapid heart rhythm, rate 150-200. electrical activity starts in the ventricle instead of the atrium not allowing adequate time between to fill with blood
disorganized, ineffective quivering of the ventricles. no blood is pumped, patient unconscious within seconds
Congestive heart failure
can occur any time after a heart attack; Cpap is the most effective way to treat
Organ near the stomach that produces, stores, and eliminates blood cells. produces antibodies
either of two bean-shaped excretory organs that filter wastes (especially urea) from the blood and excrete them and water in urine; regulates blood pressure by removing sodium, thus water from the body
a condition of disorientation, confusion, and possible hallucinations coupled with restless activity.
altered mental status
a change in the way a person thinks and behaves hat may signal disease in the central nervous system or elsewhere in the body
a disorder in which there is no known physiologic reason for the abnormal functioning of an organ system
organic brain syndrome
temporary or permanent dysfunction of the brain caused by sudden illness, recent head trauma,seizure disorders, drug/alcohol, overdose or withdrawal
bacteria characterized by itching, burning, or pain, and possibly a fishy smelling discharge
a sexually transmitted disease, the most common in developed countries, caused by the bacterium Chlamydia trachomatis. Often producing no symptoms, it can cause infertility, chronic pain, or a tubal pregnancy if left untreated.
pelvic inflammatory disease (PID)
an infection of the fallopian tubes and the surrounding tissues of the pelvis
basket stretcher/Stokes litter
a rigid stretcher commonly used in technical and water rescues that surrounds and supports the patient yet allows water to drain through holes in the bottom
first responder vehicles
specialized vehicles used to transport EMS equipment and personnel to the scenes of medical emergencies
star of life
the six pointed star that identifies vehicles that meet federal specifications as licensed or certified ambulances
the location of the incident commander at the scene of an emergency and where command, coordination, control and communication are centralized.
complicated entry that requires special tools and training and includes breaking windows or using other force
danger zone (hot zone)
an area where individuals can be exposed to electrical hazards such as sharp metal edges, broken glass, toxic substances, lethal rays, ignition or explosion of hazardous materials
removal of a patient from entrapment or a dangerous situation of position, such as removal from a wrecked vehicle,industrial accident or building collapse
any substances that are toxic, poisonous, radioactive, flammable, or explosive and cause injury or death with exposure
self contained breathing apparatus (SCBA)
repirator with independent air supply used by fire fighters to enter toxic and otherwise dangerous atmospheres
a hostage, robbery, or other situation in which armed conflict is threatened or shots have been fired, threat of violance
technical rescue situation
a rescue that requires special technical skills and equipement such as rope rescue, cave rescue and dive rescue
a stretcher that is a rigid carrying device when secured around a patient but can be folded or rolled when not in use
a stretcher that is designed to be split into two or four sections that can be fitted around a patient who is lying on the ground or other relatively flat surface;orthopedic stretcher
bills of lading
the shipping papers used for transport of chmicals over roads and highways; also known as freight bills
casualty collection area
an area set up by physicians, nurses, and other hospital staff near a major disaster scene for triage and medical care
areas at a hazardous materials incident that are designated as hot, warm or cold based on degree of hazard
portable, compressed gas containers used to hold liquids and gases. ranges in size and internal pressures
the process of directing responders to return to their facilities when the disaster has finished
Emergency response guidebook
a preliminary action guide for first responders operating at a hazardous materials incident in coordination with the US Department of Transportation. US, Mexico and Canada
Incident comand system (ICS)
a system implemented to manage disasters and mass casualty incidents in which section chiefs, including finance, logistics, operations, and planning, report to the incident commander
mass casualty incident
an emergency situation involving 3 or more patients; greatly taxes or depletes a systems available resourses
National Incident Management System (NIMS)
a department of homeland security system designed to enable federal, state, and local governments and private sectors to effectively prepare for, prevent, respond to and recover from domestic incidents; including acts of terrorism
signage required to be placed on all four sides of highway transport vehicles that identifies hazardous contents.
A patient sorting process that stands for simple triage and rapid treatment and uses a limited assessment of the patient's ability to walk, respiratory status, hemodynamic status, and neurologic status
an act in which the public safety community generally has no proir knowledge of the time, location or nature of attack
Occurs when a person is contaminated by an agent as a result of coming into contact with another contaminated person
the means by which a terrorist will spread a disease, for example poisoning the water supply
gamma (x rays)
a type of energy that is emitted from a strong radiologic source that is far faster, stronger than alph and beta rays
a passive circulatory system that transports a liquid called lymph, a thin fluid that bathes the tissues of the body
primary blast injury
injuries caused by an explosive pressure wave on the hollow organs of the body
pulmonary blast injuries
pulmonary trauma resulting from short range exposure to the detonation of high energy explosives
a neurotoxin derived from mash that is left from the castor bean; caused pulmonary edema and respiratory death
secondary blast injury
a penetrating or nonpenetrating injury caused by projectiles or secondary missiles
brownish yellowish oily substance that is persistent; quickly absorbes into the skin
tertiary blast injury
an injury from whole body displacement and subsequent traumatic impact with environmental objects
creation of a weapon from biologic agent that comes from nature, causes disease such as viruses, bacterias and toxins.
Product of weight, force of gravity and height (mostly assoc. with energy of falling objects)
Force to the body that causes injury without penetrating the soft tissues or internal organs and cavities
Injury by objects that primarily peirce and penetrate the surface of he body and cause damage to soft tissues, internal organs and body cavities.
coup-contrecoup brain injury
A brain injury that occurs when force is applied to the head and energy transmission through brain tissue causes injury on the opposite side of original impact.
Speed causes a bullet to generate pressure waves,
which cause damage distant from the bullet's path
The eardrum; a thin, membrane in the middle ear that detects minor changes in pressure and will rupture at pressures of 5 to 7 pounds per square inch above atmospheric pressure
Pulmonary blast injuries
Defined as pulmonary trauma (consisting of contusions and hemorrhages). They can occur from . short range exposures. Patient may complain tightness in chest and cough up blood.
Level 1 trauma patient
Blood pressure less than 90; Respiratory compromise or obstruction, receiving blood to maintain vital signs, glasgow coma scale of 8 or less, gunshot wound to the abdomen, neck or chest
Level 2 trauma patient
Glasgow less than 14; respiratory rate of less than 10 or more than 29 breaths/min;penetrating wounds to the head, neck torso; flail chest;2 or more proximal long bone fractures; limb paralysis or spinal cord injury;amputation to wrist or ankle
Newtons first law
an object at rest will stay at rest, an object that is moving will stay moving unless disturbed by an un balanced force.
Newtons second law
the net force of an object is equal to the product of it's acceleration and mass.
Miscellaneous blast injuries
Include burns from hot gases or fires started from the blast; respiratory injury.
1st-car hitting object. 2nd- the body hitting the inside of car. 3rd-internal organs against the solid structures of the body
Arteriole (smalles branches of arteries leading to the vast network of capillaries)
Capillaries(link the arterioles and the venules) Venules(small thin walled vessels)
veins(carry blood from the tissues to the heart)
Perfusion and hypoperfusion (shock)
Perfusion-the circulation of blood within an organ or tissue in adequate amounts to meet the cells current need for oxygen. Hypoperfusion-when the system fails to provide sufficient circulation.
Survival times of organs
The heart requires constant perfusion. The brain and spinal cord can be injured after 4 to 6 minutes without perfusion. The kidneys can be damaged after 45 minutes. Skeletal muscle will last up to 2 hours.
The body will not tolerate blood loss greater than 20% of blood volume.Significant symptoms of blood loss will occur after only 100-200 m. of blood loss. hypovolemic shock
Characteristics of bleeding
Arterial bleeding is bright red (high in Oxygen). Venous bleeding is darker (low oxygen). Capillary blood is dark red and oozes slowly. Venous blood is likely to clot.
Liver damage goes to right shoulder and spleen damage goes to the left shoulder. (think of the "l" in spleen for left, and "r in liver for right.)
Heart and Blood
Aorta (largest artery in body)
Ventricle (lower chamber)
Atrium (upper chamber)
Blood (delivers nutrients to cells and tissue)
Blood enters the right atrium from the vena cava and the left atrium from the lungs.
A condition in which low blood volume due to massive internal or external bleeding or loss of body water, result in inadequate perfusion. Symptoms; rapid, weak pulse,low blood pressure, change in mental status, cool, clammy skin, increased respiratory rate.
bleeding control method used when a wound continues to bleed despite the use of direct pressure and elevation. Useful for a partial or complete amputation.
swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissues./an injury that occurs when a great amount of force is applied to the body
loss or damage of the superficial layer of skin from a body part rubbing or scraping across a rough surface.
when soft tissue is torn completely loose or is hanging as a flap. separates layers of soft tissue
crushing injury/crush syndrome
an injury that occurs when a great amount of force is applied to the body /derangement that develops when crushed extremities or body parts remain trapped for prolonged periods. can lead to renal failure or death.
displacement of organs outside the body. do not touch or move organs; cover with sterile gauze moistened with sterile saline solution. then occlusive dressing.
10,000 deaths a year. full thickness(3rd)-affects all skin layers and may affect the subcutaneous layers,muscle, bone, and internal organs. Dry, leathery, white, dark brown or charred.
partial-thickness(2nd)- affecting the epidermis, some dermis but not the subcutaneous tissue. Blisters and white to red, moist skin. (most painful)
superficial(1st)-affecting only the epidermis. red skin.
3 types of ionizing radiation; Alpha (can be stopped by skin)Beta (can penetrate skin, but blocked by protective wear). Gamma (very penentration and easily passes through body and solid materials
skin; tough, external layer that forms a watertight covering for the body that protects by keeping pathogets out and water in and assisting in body temp. regulation. A break allows bacteria to enter and possible infection.
Deformities, contusions, abrasions,punctures/penetrations, burns, tenderness, laceration and swelling
The presence of air in the veins, which can lead to cardiac arrest if enters the heart
this fracture occurs when an eye is pushed hard back and downward into the eye socket
cornea;transparent tissure layer in front of the pupil and iris of the eye/ Iris; muscle surrounding tissue behind the cornea that dialate and constrict the pupil, regulates amount of light, pigment give the eye color/Lens;images are focused in the retina/Pupil; circular opening in the middle of the iris that admits light to back of the eye. / Retina; light sensitive area where images are projected, changes light image into electrical impulses,which are carried by optical nerve to brain
the muscles on either side of the neck that allow movement of the head
Six Bones of face
nasal bone; two maxillae (upper jaw bones); two zygomas (cheek bones) and the mandible (jawbone)
light burns to the eye
infrared rays; eclipse of sun; laser burns. my not be painful but may cause permanent damage. superficial burns; snow blindness,sunlamp or ultra violet rays may not be painful for up to 3 to 5 hours later
larynx injuries signs
include respiratory distress;hoarseness;pain;difficulty swallowing cyanoisi;pale skin;sputum in the wound;subcutaneous emphysema;hematoma,bruising of the neck
basilar skull fracture
usually occurs following impact to the head (such as falls, car crash) hard to diagnose without xray
traumatic brain injury (TBI)
A traumatic insult to the brain capable of producing physical, intellectual, emotional, social and vocational changes.
concussion (mild traumatic brain injury)
temporary loss of brains abilities to function without actual damage to the brain
linear skull fractures
account for 80% of skull fractures; also referred to as ondisplaced skull fractures
contains 75% of the brains total volume, controls most voluntary motor functions and conscious thought
found only in the brain and spinal cord connect the sensory and motor nerves, which allow the cells to exchange simple messages
somatic nervous system
Voluntary actions. the brain interprets the sensory information and responds by sending signals to the voluntary muscles.
peripheral nervous system
the sensory and motor neurons that connect the central nervous system to the rest of the body, peripheral nerves include the connecting nerves, sensory nerves and motor nerves.
secondary injury (indirect)
cerebral edema, intracranial hemorrhage, increased intracranial pressure, cerebral ischemia. can occur from a few minutes to a few days following the injury
convulsion (or seizure)
result of excessive excitability of the brain caused by direct injury or fluid within the brain (edema).
Cushing's reflex (triad) aka herniation syndrome
increased sysolic blood pressure, decreased pulse rate, and irregular respirations. often caused by cerebral edema and increased intracranial pressure
Cardiac tamponade (pericardial tamponade)
compression of the heart as the result of buildup of blood or other fluid in the pericardial sac, leading to decreased cardiac output.
distended or engorged jugular veins seen on both sides of the trachea,a narrowing pulse pressure (the difference between systolic and diastolic) and muffled heart sounds, found with Cardiac tamponade
A blunt chest injury caused by a sudden direct blow to the chest that occurs only during the critical portion of a person's heartbeat-commonly in sports injury.
more than 2 ribs are fractured in two or more places, as well as a fracture of the sternum so that a segment of the chest wall is detached from the rest of the thoracic cage,it moves in instead of out during inhalation. secure with large bulky dressing
pulmonary alveoli become filled with blood and fluid accumulates in the injured area, leaving the patient hypoxic, usually accompanies flail chest
a wound dressing; formed by taping three sides on an occlusive dressing, leaving the fourth side open as a one way valve
a pneumothorax with rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessels. can lead to cardiac arrest
supply the diaphragm and exit the spinal cord at C3,C4 and C5. Patients with spinal cord injuries at or above C3 can lose their ability to breath. Below C5 will lose power to move muscles
normally 500 to 700ml by the number of breaths/min. In the case of chest injury when the patient has small, short breaths you will need to compensate the lack of minute volume.
This is the name of a watery fluid produced in the thoracic cavity. The fluid comes from the blood. It has three major functions: lubrication, reducing heat buildup, and to create surface tension which causes the lungs to remain against the thoracic wall.
Upper right quadrant
liver, gallbladder, duodenum of the intestines and a small portion of the pancreas
Right lower quadrant
large and small bowel (ascending and right half of the transverse) the appendix.
acromioclavicular joint (AC)
a simple joint where the bony projections of the scapula and the clavicle meet at the top of the shoulder
a pearly layer of specialized cartilage covering the articular surfaces(contact surfaces of the ends)of bones in synovial joints
extreme pain,out of proportion to the injury.pain on stretching of muscles and decreased power. frequently seen in fractures below the elbow or knee in children, typically develops 6 to 12 hours after injury; excess bleeding.
a grating or grinding sensation or sound caused by fractured bone ends or joints rubbing together
used to splint the bony pelvis to reduce hemorrhage from bone ends,venous disruption and pain
position of function
a hand position in whichfingers are slightly flexed and wrist is cocked slightly upward.
The area in the abdomen between the abdominal cavity and the posterior wall containing the aorta, vena cava, pancreas, kidneys, ureters, and portions of the duodenum and large intestine
major nerve to the lower extremities , controls much of muscle function in the leg and sensation in most of the leg and foot
a joint injury, when a joint is twisted or stretched to far. Ligaments are stretched or torn.
ankle region. metatarsal is right behind the toes (phalanges) and before the arch.
types of fractures
Greenstick;children-incomplete fracture. Epiphyseal; children-growth section, growth abnormalities. Comminuted;broken in more than 2 fragments. Pathological; weakened or diseased bone. Oblique; across the bone, angled. Transverse; across bone from direct blow or running. Spiral; twisting force. Incomplete; partial crack.
open fractures of digits; non-displaced long bone fractures; nondisplaced pelvic fractures;major sprains of a major joint.
displaced long-bone fractures;multiple hand and foot fractures;open long bone fracture;displaced pelvic fractures;multiple digit amputations ;laceration of major nerves or blood vessels
life threatening injuries
Multiple closed fractures;limb amputations;fractures of both long bones of the legs.
multiple open fractures of the limbs;suspected pelvic fractures with hemodynamic instability.
6 P's of musculoskeletal assessment
Pain,Paralysis,Paresthesias (numbness or tingling),Pulselessness,Palor and Pressure.
when nitrogen comes out of a solution and forms bubbles in blood vessels, which is very painful and dangerous, also known as decompression sickness; the joint pain is so severe the patient doubles over (bends)
ANY SIGNS AND SYMPTOMS CAUSED BY THE DIFFERENCE BETWEEN THE SURROUNDING ATMOSPHERIC PRESSURE AND THE TOTAL GAS PRESSURE IN VARIOUS TISSUES, FLUIDS AND CAVITIES OF THE BODY.
heat injury in which the body loses significant amounts of fluid and electrolytes because of heavy sweating.
MORE HEAT THAN THE BODY CAN HANDLE. core temp to 106 or more. factors that increase possibility include medications, diabetes,alcohol abuse, malnutrition,parkinsonism,hyperthyroidism, obesity . most heat stroke cases occur when the temp is 80 degrees and humidity is 80 %.
core temperature usually 101 degrees or higher, in severe cases (heatstroke) it can get to 106.
core temperature of the body falls below 95 degrees;Below 90 is more severe and below 85 is critical. may happen between 30-50 degrees
A triage process in which efforts are focused on those who are in respiratory and cardiac arrest, and diffrent from conventional triage where such patients would be classified as deceased. Used in triaging multiple victums of a lightning strike
the ability of the skin to resist deformation tested by gently pinching skin on the forehead or back of the hand.
fluid collects in the lungs, it occurs in altitudes of 10,000'. signs and symptoms are shortness of breath, cough with pink sputum, cyanosis and rapid pulse
usually occurs with climbers above 12,000', High Altitude Cerebral Edema. constant throbbing headache, loss of muscle coordination,extreme fatigue,vomiting and loss of consciousness
bees, wasps, ants and yellow jacket stings. painful but only a medical emergency if the patient is allergic to the venom.
Pit Vipor snakes
Rattlesnakes, copperheads, and cottonmouths are all pit vipers. The fangs are special hollow teeth that act much like hypodermic needles.
rocky mountain fever occurs 7 to 10 days after a bite by an infected tick; nausea, vomiting, headache, paralysis and possibly cardiorespiratory collapse
rash begins about 3 days after the bite of the infected tick, resembles a target bull's eye pattern.
The process by which medications travel through body tissues until they reach the bloodstream.
An oral medication that binds and adsorbs ingested toxins in the gastroiintestinal tract for treatment of some poisonings and medication overdoses. Charcoal is ground into a very fine powder that provides the greatest possible surface area for binding medications that have been taken by mouth; it is carried on the EMS unit.
Aspirin (acetylsalicylic acid or ASA)
A medication that is an antipyretic (reduces fever), analgesic (reduces pain), anti-inflammatory (reduces inflammation), and potent inhibitor of platelet aggregation (clumping).
Conditions that make a particular medication or treatment inappropriate, for example, a condition in which a medication should not be given because it would not help or may actually harm a patient.
A medication that increases heart rate and blood pressure but also eases breathing problems by decreasing muscle tone of the bronchiole tree; you may be allowed to help the patient self-administer the medication.
The original chemical name of a medication (in contrast with one of its "trade names"); the name is not capitalized.
A DELIVER ROUTE IN WHICH A MEDICATION IS PUSHED THROUGH A SPECIALIZED ATOMIZER DEVICE CALLED A MUCOSAL ATOMIZER DEVICE (MAD) INTO THE NARE.
Intravenous (IV) injection
Injected directly into the vein (Immediate absorption); a medication delivery route.
Metered-dose inhaler (MDI)
A MINIATURE SPRAY CANISTER THROUGH WHICH DROPLETS OR PARTICLES OF MEDICATION MAY BE INHALED.
Mucosal atomizer device (MAD)
A device that is used to change a liquid medication into a spray and pushes it into a nostril.
A medication that increases cardiac perfusion by causing arteries to dilate; you may be allowed to help the patient self-administer the medication.
A SIMPLE SUGAR THAT IS READILY ABSORBED BY THE BLOODSTREAM; IT IS CARRIED ON THE EMS UNIT.
Over-the-counter (OTC) medications
medications that may be purchased directly by a patient without a prescription
A gas that all cells need for metabolism; the heart and brain, especially, cannot function without oxygen.
MEDICATIONS THAT ENTER THE BODY BY A ROUTE OTHER THEN THE DIGESTIVE TRACT, SKIN, OR MUCOUS MEMBRANES.
MEDICATIONS THAT ARE DISTRIBUTED TO PATIENTS ONLY BY PHARMACISTS ACCORDING TO A PHYSICIANS ORDER.
Subcutaneous (SC) injection
INJECTION INTO THE TISSUE BETWEEN THE SKIN AND MUSCLE; A MEDICATION DELIVERY ROUTE.
A mixture of ground particles that are distributed evenly throughout a liquid but do not dissolve.
LOTIONS, CREAMS AND OINTMENTS THAT ARE APPLIED TO THE SURFACE OF THE SKIN AND AFFECT ONLY THAT AREA. A MEDICATION DELIVERY ROUTE.
apparent life-threatening event (ALTE)
an event that causes unresponsiveness, cyanosis, and apnea in an infant, who then resumes breathing with stimulation
any improper or excessive action that injures or otherwise harms a child or infant; includes neglect and physical, sexual, and emotional abuse
a state in which fluid losses are greater than fluid intake into the body, leading to shock and death if untreated
a feeding tube placed directly through the wall of the abdomen; used in patients who cannot ingest liquids or solids
generalized tonic-clonic seizure
a seizure that features rhythmic back-and-forth motion of an extremity and body stiffness
a form of bacterial meningitis characterized by rapid onset of symptoms, often leading to shock and death
pneumatic antishock garment (PASG)
an inflatable device that covers the legs and abdomen; used to splint the lower extremities or pelvis, or to control bleeding in lower extremities, pelvis, or abdominal cavity
shaken baby syndrome
bleeding within the head and damage to the cervical spine of an infant who has been intentionally and forcibly shaken; a form of child abuse
sudden infant death syndrome (SIDS)
death of an infant or young child that remains unexplained after a complete autopsy
a tube inserted into the trachea in children who cannot breathe on their own; passes through the neck directly into the major airways
Does AICD (automatic implanted cardiac defibrillator) shock you when touching patient when shock occurs
Patients muscles twitch but provider will NOT be shock
How do you prevent pneumothax or tension pneumothax
Occlusive dressing prevent air in chest cavity
What year will we have 5% at least what age
The year 2040 we will have 5% at least 65 years of age
What is LVAD (left ventricle assist device)
Battery powered mechanical pump implanted in the body, that assist w/failing left ventricle in pumping blood to the body
Normal HR 60-100, inadequate HR, what can be implanted to assist
LVAD (left ventricle assist device) to assist failing left ventricle with pumping blood into the body
What leaf shaped structure closes during swallowing to prevent foods and foreign objects from entering the trachea?
What is the name of the cartilaginous ridge in the trachea at which the right and left lungs split?
The ring shaped structure that forms the lower portion of the larynx is called the
What is the name of the muscular structure that divides the chest cavity from the abdominal cavity?
Larynx (life threatening)
Some neck injuries are potentially fatal. One such life threatening condition occurs when there is damage or blockage in the
The lungs contain small sacs in which gas exchange takes place with the blood stream. These sacs are called
What is the name of the passageway shared by the digestive and respiratory systems for air and food?
What is the name of the hollow, flexible tube that carries inhaled air from the larynx to the lungs?
ACUTE CORONARY SYNDROME
A TERM USED TO DESCRIBE A GROUP OF SYMPTOMS CAUSED BY MYOCARDIAL ISCHEMIA; INCLUDES ANGINA AND MYOCARDIAL INFARCTION
ACUTE MYOCARDIAL INFARCTION
A HEART ATTACK; DEATH OF HEART MUSCLE FOLLOWING OBSTRUCTION OF BLOOD FLOW TO IT. ACUTE IN THIS CONTEXT MEANS "NEW" OR "HAPPENING RIGHT NOW"
TRANSIENT (SHORT-LIVED) CHEST DISCOMFORT CAUSED BY PARTIAL OR TEMPORARY BLOCKAGE OF BLOOD FLOW TO THE HEART MUSCLE.
THE MAIN ARTERY, WHICH RECEIVES BLOOD FROM THE LEFT VENTRICLE AND DELIVERS IT TO ALL THE OTHER ARTERIES THAT CARRY BLOOD TO THE TISSUES OF THE BODY.
THE ONE-WAY VALVE THAT LIES BETWEEN THE LEFT VENTRICLE AND THE AORTA AND KEEPS BLOOD FROM FLOWING BACK INTO THE LEFT VENTRICLE AFTER THE LEFT VENTRICLE EJECTS ITS BLOOD INTO THE AORTA; ONE OF THE FOUR HEART VALVES.
A DISORDER IN WHICH CHOLESTEROL AND CALCIUM BUILD UP INSIDE THE WALLS OF THE BLOOD VESSELS, EVENTUALLY LEADING TO PARTIAL OR COMPLETE BLOCKAGE OF BLOOD FLOW.
ONE OF TWO (RIGHT AND LEFT) UPPER CHAMBERS OF THE HEART.THE RIGHT ATRIUM RECEIVES BLOOD FROM THE VENA CAVA AND DELIVERS IT TO THE RIGHT VENTRICLE. THE LEFT ATRIUM RECEIVES BLOOD FROM PULMONARY VEINS AND DELIVERS IT TO THE LEFT VENTRICLE.
THE ABILITY OF CARDIAC MUSCLE CELLS TO CONTRACT WITHOUT STIMULATION FROM THE NERVOUS SYSTEM.
AUTONOMIC NERVOUS SYSTEM
THE PART OF THE NERVOUS SYSTEM THAT CONTROLS THE INVOLUNTARY ACTIVITIES OF THE BODY SUCH AS THE HEART RATE, BLOOD PRESSURE AND DIGESTION OF FOOD.
A STATE IN WHICH THE HEART FAILS TO GENERATE EFFECTIVE AND DETECTABLE BLOOD FLOW; PULSES ARE NOT PALPABLE IN CARDIAC ARREST, EVEN IF MUSCULAR AND ELECTRICAL ACTIVITY CONTINUES IN THE HEART.
A STATE IN WHICH NOT ENOUGH OXYGEN IS DELIVERED TO THE TISSUES OF THE BODY CAUSED BY LOW OUTPUT OF BLOOD FROM THE HEART. IT CAN BE A SEVERE COMPLICATION OF A LARGE ACUTE MYOCARDIAL INFARCTION, AS WELL AS OTHER CONDITIONS.
A MEASURE OF THE VOLUME OF BLOOD CIRCULATED BY THE HEART IN 1 MINUTE, CALCULATED BY MULTIPLYING THE STROKE VOLUME BY THE HEART RATE.
CONGESTIVE HEART FAILURE (CHF)
A DISORDER IN WHICH THE HEART LOSES PART OF IT'S ABILITY TO EFFECTIVELY PUMP BLOOD, USUALLY AS A RESULT OF DAMAGE TO THE HAET MUSCLE AND USUALLY RESULTING IN A BACKUP OF FLUID INTO THE LUNGS.
TO SHOCK A FIBRILLATING (CHAOTICALLY BEATING) HEART WITH SPECIALIZED ELECTRICAL CURRENT IN AN ATTEMPT TO RESTORE A NORMAL, RHYTHMIC BEAT..
SWELLING IN THE PART OF THE BODY CLOSEST TO THE GROUND, CAUSED BY COLLECTION OF FLUID IN THE TISSUES; A POSSIBLE SIGN OF CONGESTIVE HEART FAILURE.
A CONDITION IN WHICH THE INNER LAYERS OF AN ARTERY, SUCH AS THE AORTA BECOME SEPARATED, ALLOWING BLOOD (AT HIGH PRESSURES) TO FLOW BETWEEN THE LAYERS.
AN EMERGENCY SITUATION CREATED BY EXCESSIVELY HIGH BLOOD PRESSURE, WHICH CAN LEAD TO SERIOUS COMPLICATIONS SUCH AS STROKE OR ANEURYSM.
A LACK OF OXYGEN THAT DEPRIVES TISSUES OF NECESSARY NUTRIENTS, RESULTING FROM PARTIAL OR COMPLETE BLOCKAGE OF BLOOD FLOW; POTENTIALLY REVERSIBLE BECAUSE PERMANENT INJURY HAS NOT YET OCCURRED.
PARASYMPATHETIC NERVOUS SYSTEM
THE PART OF THE AUTONOMIC NERVOUS SYSTEM THAT CONTROLS VEGETATIVE FUNCTIONS SUCH AS DIGESTION OF FOOD AND RELAXATION.
SYMPATHETIC NERVOUS SYSTEM
THE PART OF THE AUTONOMIC NEROUS SYSTEM THAT CONTROLS ACTIVE FUNCTIONS SUCH AS RESPONDING TO FEAR (FIGHT OR FLIGHT SYSTEM).
A BLOOD CLOT THAT HAS FORMED WITHIN A BLOOD VESSEL AND IS FLOATING WITHIN THE BLOOD STREAM.
DISORGANIZED, INEFFECTIVE TWITCHING OF THE VENTRICLES, RESULTING IN NO BLOOD FLOW AND A STATE OF CARDIAC ARREST.
A RAPID HEART RHYTHM IN WHICH THE ELECTRICAL IMPULSE BEGINS IN THE VENTRICLE (INSTEAD OF THE ATRIUM), WHICH MAY RESULT IN INADEQUATE BLOOD FLOW AND EVENTUALLY DETERIORATE INTO CARDIAC ARREST.
The process by which oxygenated blood is delivered to the body's tissue and wastes are removed from the tissue.
What are the four elements of the Fick principle.
1. Inspiration of adequate oxygen in the atmospheric air.
2. On-loading of oxygen to the red blood cells at the lungs.
3. Delivery of the red blood cells to the tissue cells.
4. Off-loading of oxygen from the red blood cells to the tissue cells.
State of collapse and failure of the cardiovascular system that leads to inadequate circulation. Without adequate blood flow, cells can't get rid of metabolic wastes. Result is hypoperfusion to cells that cause organ, then organ systems, to fail
Perfusion triangle (3 problems)
Pump (Heart): Damage to heart means it can't move blood adequately to support perfusion. Container (blood vessels): If all vessels dilate at once, normal amount of blood volume is not enough to fill the system and provide adequate perfusion to body. Content (blood): If blood or plasma is lost, volume of container is not enough to support perfusion.
Basic progression of shock (3)
1. Compensated (body compensates for blood loss) 2. Decompensated shock (late state of shock when BP falls) 3. Irreversible shock (terminal stage)
How can you tell if it's shock?
Shock begins inside. When it becomes visible to EMT, it's already developed. Altered mental status is MOST SENSITIVE indicator!
Blood flow in shock
Non-essential organs lose blood flow: Skin (pale, clammy), intestines (abd pain, N/V). Essential organs gain blood flow: Heart, lungs, brain, liver, kidneys
Basic signs of compensated shock (4)
1. Change in mental status 2. Rapid pulse 3. Decreased pulse strength (thready) 4. Pale, cool, clammy skin
How body compensates
Vasoconstriction from Autonomic Nervous System. Insulin and Epinephrine (hormones)
Basic signs of decompensated shock (6)
1. Falling BP (less than 90 in adult) 2. Labored, irregular breathing 3. Ashen, mottled, cyanotic skin 4. Thready or absent pulse 5. Dull eyes, dilated pupils 6. Poor urinary output
Terminal stage of shock. Vital organs have failed (brain, heart, kidneys, liver). Nothing will save patient's life.
Hypovolemic shock (content failure)
Results from fluid loss, blood loss, burns, or dehydration. Bleeding can be internal or external. Severe burns cause plasma loss.
Stages of hypovolemic shock
2. Sympathetic NS kicks in (epi response). Classic signs become visible: HR+, pale/cool/clammy skin, thready pulse, dizziness, altered LOC, SOB
3. Decompensation. Very high HR (heart trying hard to maintain BP) and RR. BP drops.
4. Circulatory collapse. Vessels become exhausted from dilating and BP drops further. HR/RR continue to rise. Cardiac arrest looms.
Neurogenic shock (poor vessel function)
Damage to the spinal cord may affect control of the size and muscular tone of blood vessels. Blood vessels dilate below injury. Unable to sweat or manage temp below injury.
Cardiogenic shock (pump failure)
Inadequate function of heart or pump failure. Causes backup of blood in lungs (pulmonary edema). Pulmonary edema leads to respiratory distress. Look for JVD, irregular pulse, bradycardia.
Septic shock (vessel and content failure)
Some patients with severe bacterial infections, toxins, or infected tissues contract septic shock. Toxins damage vessel walls, causing leaking and impairing ability to contract. Leads to dilation of vessels and loss of plasma, causing shock
Septic shock and Septicemia
Blood poisoning (mostly bacterial). Common in immunosuppressed patients (most often UTI; infection gets into bloodstream). Inflammatory response gets out of control.
Shock from respiratory insufficiency
Patient with a severe chest injury or airway obstruction may be unable to breathe adequate amounts of oxygen. ▪Hyperventilation ▪Toxic inhalation. Insufficient oxygen in the blood will produce shock.
Occurs when person reacts violently to substance (injections, stings, ingestion, inhalation)
Caused by sudden reaction of the nervous system that produces a temporary, generalized vascular dilation (e.g. loss of blood to brain that causes syncope). Can be caused from irregular heartbeat or brain aneurysm, but also from fear, bad news, unpleasant sights.
When to expect shock
Multiple severe fractures, Abdominal or chest injuries, Spinal injuries, Severe infection, Major heart attack, Anaphylaxis
Treat cardiogenic shock
2. Assist ventilations if needed
3. Suction if needed
Treat hypovolemic shock
1. Secure airway
3. Control bleeding
5. Raise legs 6-12"
6. Rapid ttransport
Treat septic shock
1. BSI face mask/HEPA
2. Transport as promptly as possible
3. Support airway
5. Transport in shock position
6. Use blankets to conserve body heat (unless high fever!)
Treat respiratory insufficiency
1. Secure airway
2. Clear airway
3. Ventilate if needed
Treat anaphylactic shock
1. Apply oxygen
2. Administer epi
4. Be prepared for second dose of epi
5. Support airway
Treat psychogenic shock
1. Keep patient supine with legs elevated until mentation and skin color improve
2. Assess for injuries from fall
3. Get up in stages
4. Suspect another problem if patient has difficulties regaining consciousness
bleeding from an artery, which is characterized by bright red blood and as rapid, profuse, and difficult to control.
bleeding from capillaries, which is characterized by a slow, oozing flow of blood.
shock, or lack of perfusion, brought on not by blood loss, but by inadequate pumping action of the heart. It is often the result of a heart attack or congestive heart failure.
when the patient is developing shock but the body is still able to maintain perfusion.
occurs when the body can no longer compensate for low blood pressure volume or lack of perfusion. Late signs such as decreasing blood pressure become evident.
3 categories of severity for shock:
Compensated shock, decompensated shock, and irreversible shock
When the body has lost the battle to maintain perfusion to vital organs. Even if the adequate vital signs returnn, the patient may die days later due to organ failure.
hypoperfusion due to nerve paralysis (sometimes caused by spinal cord injuries) resulting in the dilation of blood vessels that increases the volume of the circulatory system beyone the point where it can be refilled.
the supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries.
a bulky dressing held in position with a tightly wrapped bandage to apply pressure to help control bleeding.
a site where a main artery lies near the surface of the body and directly over a bone. Pressure on such a point can stop distal bleeding.
The inability of the body to adequately circulate blood to the body's cells to supply them with oxygen and nutrients. A lifethreatening condition.
a device used for bleeding control that contricts all blood flow to and from an extremity.
bleeding from a vein, which is characterized by dark or maroon blood and as a steady flow, easy to control.