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Chapters 1-39


lining of the inside of the uterus


early stages of the fetus after fertilization


the developing, unborn infant

birth canal

is made up of the vagina and the lower third , or neck of the uterus called the cervix


the lower third or neck of the uterus


is the area of the skin between the vagina and the anus of a female


disk-shaped structure, that attaches to the inner lining of the wall of the uterus and is connected to the fetus by the umbilical cord.

umbilical vein

carries oxygenated blood from the woman to the heart of the fetus

unbilical artery

carry deoxygenated blood from the heart of the fetus to the woman.

amniotic sac

also called a bag of waters, contains about 500 to 1000 mL of fluid which helps to insulate and protect the floating fetus.

Three stages of labor

dilation of the cervix
delivery of the infant
delivery of the palcenta

First stage of Labor

begins with the onset of contractions as the fetus enters the birth canal and ends with the cervix is fully dialated. Other signs may be bloody show or the rupture of the amniotic sac.


a woman who is experiencing her first pregnancy


a woman who has experienced previous pregnancies

Second Stage of Labor

begins with the fetus begins to enter the birth canal and ends when the infant is born.


when the perineum begins to bulge significantly and the top of the infant's head begins to appear at the vaginal opening

Third stage of labor

begins with the birth of the infant and ends with the delivery of the placenta. This process may take up to 30 min.


abnormal state of pregnancy characterized by hypertension and fluid retention and albuminuria

pregnancy-induced hypertension

the development of hypertension (high blood pressure) during pregnancy in women who had normal blood pressure readings prior to pregnancy. Can develp aftter the 30 week of gestation and is characterized by the following signs and
symptoms. Headache, seeing spots, swelling in the hands and feet, anxiety and high blood pressue.


condition of pregnancy characterized by seizures that occur as a result of hypertension.

Treatment of eclampsia

lie the patient on her side - preferable her left side, maintain an airway, and provide supplemental oxygen; if vomiting occurs, suction the airway, provide rapid transport and call for ALS intercept.

supine hypotensive syndrome

Dizziness and a drop in blood pressure caused when the mother is in a supine position and the weight of the uterus, infant, placenta, and amniotic fluid compress the inferior vena cava, reducing return of blood to the heart and cardiac output.

ectopic pregnancy

pregnancy resulting from gestation elsewhere than in the uterus, most often in a fallopian tube


spontaneous abortion

abruptio placenta

premature separation of the normally implanted placenta away from the uterine wall.

placenta previa

pregnancy in which the placenta is implanted in the lower part of the uterus (instead of the upper part)

gestational diabetes

develops during pregnancy; will have normal glucose levels within 6 weeks post partum; risk for developing type II diabetes in 5 to 10 years is increased; treated with nutritional therapy and then insulin therapy if that is not sufficient

Obstetrics SAMPLE

Pertinent past history - specific to prenatal care
complication relating to size or position of the fetus
due date and frequency of contractions
possibility of twins, broken water appearance for meconium.

Delivery steps

patient comfort
apply oxygen if allowed
continually assess for crowning
time patients contractions, from the beginning of one to the beginning of the next (including duration)
1. Allow the mother to push the head out, support it as it emerges, suction fluid from the mouth and nostrils
2. Guide the head down slightly, to help deliever the shoulder
3. support the head and upper body as the lower shoulder delivers
4. Support the infant and place the umbilical cord clamps 2" to 4" apart and cut between them

unruptured amniotic sac

when the amniotic sac has not ruptured causing an dangerous situation because the sac will suffocate the infant if it is not removed. Manual puncture will be required.

nuchal cord

umbilical cord around the neck

Neonatal CPR Ratio

compression to ventilation ration 3:1

Apgar Score

standard scoring system used to assess the status of a newborn assigning a number value (0,1,2) to five areas of the newborn infant
2. Pulse
3. Grimace or irritability
4. Activity or muscle tone
5. Respiration

vertex presentation

born head first

breech presentation

buttock is delivered first

V Maneuver in Breech Delivery

In this type of delivery the head is almost always face down and should be allowed to be delivered spontaneously, make a v with your gloved fingers and position them in the vagina to keep the walls of the vagina from compressing the airway.

limb presentation

*Cannot be delivered in the field
*cover limb with a sterile towel
*Treat mother for shock
*Rapid transport

Prolapse of umbilical cord

Umbilical Cord comes out first before infant
Cuts off circulation to infant depriving him of oxygen
Early labor when amniotic sac ruptures
Trendelenburg Position (supine, feet elevated)

premature infant

any infant who delivers before 8 months or (36 weeks of gestation) or weighs less than 5 lb at birth

spina bifida birth

meninges may protrude outsize of the vertebrae and possibly the body, important to cover the open are of the spinal cord with sterile, moist dressing immediately and maintain body temperature.

Assessment 0-2 months

They respond mainly to physical stimuli such as light, warmth, hunger and sound. Should be aroused easily from a resting state. Sucking reflex.

Assessment 2-6 months

Increased awareness of what is going on around them. Will use hands to examine objects, persistent crying or lack of eye contact could be sings of significant illness.

Assessment 6-12 months

First words and babble type communicative, sit without support, persistent crying, or irritability can be a symptom of serious illness, not afraid of strangers, but will prefer their parents in caregiving situations.

Assessment of Infant

Begin by viewing from a distance, let the parent hold the baby, provide sensory comfort, plan to complete any painful procedure in an efficient manner.

Assessment of Toddler

12 to 18 months and 18 to 24 months
Stranger anxiety may still develop and may resist separation from parents. They may have a hard time describing or localizing pain, restrain them as little as possible.

Assessment of Preschool age

Children 3-6
Begin your assessment with the feet and move towards the head. Remember modesty is beginning to develop as well as thoughts or wishes can cause injury or harm. Foreign body airway obstruction continues to be high risk

Assessment of School Age

Children 6-12
More like an adult assessment, talk to the child not just the parent. At this stage you may begin physical assessment at the head and move to the feet.

Assessment of Adolescents

Children 12 to 18 years
this is when puberty begins. respect their privacy at all times. Their are many changes and assessment may need to include questions involving the types of risks, unintentional trauma, dangerous sexual practices and teen pregnancy.

Differences in Pediatric Airway

-larger rounder occiput - requires more careful positioning f the airway
-proportionately larger tongue relative to the size of the mouth
-a long, floppy, U shaped epiglottis is larger relative to the airway
-less well developed rings of cartilage in the trachea
-narrowing funnel-shaped upper airway
-higher risk of tension pneumothorax and hypoxia

One cup or a small amount

A pediatric patient actually may be in a state of shock while displaying normal blood pressure, and it may take only a _____ of blood loss to go into shock.

shaken baby syndrome

a syndrome seen in abused infants and children, the patient has be subjected to violent, whiplash type shaking inflicted by the abusing individual that may cause coma, seizures, and increased intracranial pressure due to tearing of the cerebral veins

Pediatric Assessment Triangle

1. Appearance (awake, aware, upright) 2. Work of breathing (Retractions, noises) 3. Circulation (skin)

On the basis of this assessment tool you will Stay or Go

Pediatric ABC's

Hands-on ABC - You will assess and treat any life threats to;

sniffing position

an upright position in which the patient's head and chin are thrust slightly forward and the patient appears to be sniffing; most commonly seen in children


high-pitched inspiratory sound, indicates a partial upper airway obstruction


high or low pitched sound heard usually during expiration; indicates a partial lower airway obstruction


an "uh" sound heard during exhalation; reflects the pediatric patient's attempt to keep the alveoli open by increasing pressure in the chest cavity; indicated by inadequate oxygentation

Assessing Circulation Pediatric

a pulse may be difficult to palpate if it is weak, very fast or very slow. Infants palpate the brachial pulse or the femoral pulse, in children older then 1 hear palpate the carotid pulse. Strong central pulses indicate that the child is not hypotensive however this does not rule out the possibility of compensated shock

Less than 60 beats/min

Bradycardia is almost always and ominous sign in pediatric patients. If the heart rate is fast, you need to investigate the cause. If the heart rat is slow _________ or absent especially in an unconscious infant or child you must begin CPR immediately.

5 years or younger

This age of children are high risk for airway obstruction

Signs of severe airway obstruction

ineffective cough (no sound)
inability to speak or cray
increasing respiratory difficulty, with stridor
loss of consciousness
(treatment of pediatric airway should begin immediately , clear the airway and if necessary use chest compression to relive a severe airway obstruction


an acute spasm of the smaller air passages, called the bronchioles, associated with excessive mucous production and with swelling of the mucous lining of the respiratory passages.


defamation of the bronchiolitis that usually occurs in children younger than two years and is often caused by respiratory syncytial virus.

Pediatric resuscitation tape

A tape used to estimate an infant or child's weight on the basis of length; appropriate drug doses and equipment sizes are listed on the tape.

Blow by technique

Used when O2 masks frighten children, make a small hol in a 6 to 8 oz cup and connect tubing to O2 source and hold cup about 1 to 2 inches from the child's face.

Nasal cannula

oxygen delivery device that delivers 1 to 6 L/min and provides 24% to 44% oxygen concentration

Nonrebreathing mask

oxygen delivery device that provides 10 to 15 L/min up to 90% oxygen concentration unassisted ventilation

bag-mask device

oxygen delivery device that provides 15L/min and nearly 100% oxygen concentration (assisted ventilation)



Child dosages of activated charcoal

1 g / kilogram of body-weight usually the pediatric dose is 12.5 to 25 g.


Body temperatures of 100.4F (38C) or higher

Signs of shock in children

poor capillary refill
mental status changes
greater than 25% blood volume loss signification increases risk of shock.

SIDS (sudden infant death syndrome)

Death of an infant or young child that remains unexplained after a complete autopsy


is the assessment and treatment of disease in a person who is 65 years or older

Leading causes of death in geriatric patients

heart disease
chronic obstructive pulmonary disease
respiratory illness

Primary Assessment Geriatrics

Airway and Breathing- Increased chest wall stiffness, brittle bones, weakening of the airway musculature, and decreased muscle mass contribute to breathing problems.
Circulation - less responsive nerve stimulation may lower the rate and strength of the heart's contraction so lower heart rate and weaker and irregular pulse (circulation problems in older adults should be treated with oxygen as soon as possible)

GEMS Diamond

G- geriatirc
E- environmental assessment - can help give clues to the patients's condition and cause of emergency (hazards)
M-Medical assessment - older patients tend to have a variety of medical problems and may be taking multiple medication
S-Social Assessment - older people may have less of a social network (eating, dressing, bathing, toileting)


is an inflammation/infection of the lung from bacterial, viral or fungal causes. This infection is the leading cause of death from infection in Americans older then the age of 65 years.

pulmonary embolism

occlusion in the pulmonary circulation, most often caused by a blood clot (risk factors-recent surgery, history of blood clots, obesity, recent long-distance travel, and sedentary behavior. )
May present with pulse oximetry reading of 70% or lower

unilateral pedal edema

swelling of the foot and ankle caused by fluid overload-unilateral would be in only one foot


a cardiovascular disease characterized by a sac-like widening of an artery resulting from weakening of the artery wall


the most common form of CVD; a disease characterized by plaques along the inner walls of the arteries.

postural hypotension

drop in blood pressure related to change in position (supine/seated to standing), caused by pooling of blood in the veins, decrease in venous return, and decreased cardiac output

deep venous thrombosis

blood clot (thrombus) in a deep vein, usually in the lower leg or thigh; serious risks include obstruction to circulation and pulmonary embolism

Risk of Falls and Trauma in Elderly

Bone disease-Osteoporosis
Spine stiffens and vertebrae become brittle
Brain tissue shrink with age (more apt or closed head injuries)


fluid in the abdomen


clouding of the lens of the eye or its surrounding transparent membrane

decubitus ulcers

also known as bedsores. These are sores caused by the pressure of the skin against a surface for long periods. There sores can range from a pink discoloration of the skin to a deep wound that may invade into bone or organs

advance directives

written documentation that specifies medical treatment fro a competent patient should the patient become unable to make decisions; also called living wills.

abdominal aortic aneurysm

(AAA) a condition which the walls of the aorta in the abdomen weaken and blood leaks into the layers of the vessel causing it to bulge.


a more or less sudden change in mental status marked by the inability to focus, think logically and maintain attention.


the slow onset of progressive disorientation, shortened attention span, and loos of cognitive functions.

jugular vein distention

a visual bulging of the jugular veins in the neck that can be caused by fluid overload, pressure in the chest, cardiac tamponade, or tension pneumothorax


a forward curling of the back caused by an abnormal increase in the curvature of the spine

developmental disability

insufficient cognitive development of the brain, which results in a person's inability to learn and socially adapt at a normal developmental rate.


a disorder that appears in childhood and is marked by deficient communication, social interaction, and understanding of others' states of mind

Down Syndrome

A human genetic disease resulting from having an extra chromosome 21, characterized by mental retardation and heart and respiratory defects.

Sensorineural deafness

Also referred to as "nerve deafness". This condition involves the cochlear portion of the inner ear and/or the cochlear division of the acoustic nerve. Little can be done to assist these patients, although some of the newer models of cochlear implants show great promise.

conductive deafness

Hearing loss caused by damage to the middle ear, thus interfering with the transmission of sound waves to the cochlea.

cerebral palsy

a condition caused by brain damage around the time of birth and marked by lack of muscle control and paralysis especially in the limbs

spina bifida

congenital defect in the spinal column characterized by the absence of vertebral arches, often resulting in pouching of spinal membranes or tissue

tracheostomy tube

is a plastic tube placed in a surgical opening from the anterior part of the neck into the trachea. Can be temporary or permanent


displacement, dislodged, or damaged tube
obstruction of the tube
pneumothorax, pulmonary problems
equipment failure

remove the patient from the ventilator and begin ventilation with a bag-valve device

What do you do if the mechanical ventilator malfunctions?

internal cardiac pacemaker

implanted under patient's skin to regulate heart beat
These devices are typically placed on the non-dominant side of the patients chest. May also include an automated implanted cardioverter defibrilllator, which monitors the patient's heart rhythm and is able to slow down or stop accelerated heart rates.

left ventricular assist devices

mechanical pumps that siphon blood from the left ventricle and pump it into the aorta through a tube. They are used as temporary measures, until a donor heart becomes available

gastrostomy tubes

long term feedings, placed into the stomach, also called PEG tube, placed surgically


are tubes that extend from the brain to the abdomen to drain excess cerebrospinal fluid that may accumulate near the brain

vagal nerve stimulators

stimulate the vagus nerve to keep seizure activity from occurring are used in children older than 12 years. If you encounter a patient with this device, contact medical control and follow local protocol.


a device that is used to provide support to a patient who is suspected of having a hip, pelvic, spinal or lower extremity injury.


a branch of medicine concerned with the management of obesity and allied diseases

basket stretcher

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. Stokes litter

diamond carry

a carrying technique in which one EMT is located at the head end of the stretcher or backboard, one at the foot end, and one at each side of the patient; each of the two EMT's at the sides uses one hand to support the stretcher/backboard so that all are able to face forward as they walk.

emergency move

a move in which the patient is dragged or pulled from a dangerous scene before assessment and care are provided.

extremity lift

a lifting technique that is used for patients who are supine or in a sitting position with no suspected extremity or spinal injuries

68% to 78%

If a patient is lying supine on a backboard, the head end of the backboard will hold approximately _________ of the weight of the patient.

scoop stretcher

Which of the following devices should never be used to move a patient with a suspected spinal injury?


A minimum of _________ rescuers should be used to restrain a combative patient.

5 features of modern ambulance

-a drivers compartment
-a patient compartment that can accommodate tow EMT's and two supine patients, so that at least one can receive CPR
-Equipment and supplies to provide emergency medical care
-two-way radio communication so that ambulance personnel can speak with the dispatcher, the hospital, public safety and online medical control
-design and construction that ensure maximum safety and comfort

Phases of an Ambulance Call

1. the preparation phase
2. Dispatch Phase
3.En Route to the Scene
4. Arrival at the Scene
5. the Transfer Phase
6. the Transport Phase
7. the Delivery Phase
8. En route to the station
9. the Postrun Phase

type I ambulance

conventional truck cab-chassis with modular ambulance body that can be transferred to a new chassis as needed

type II ambulance

standard van, forward-control integral cab-body ambulance

type III ambulance

specialty van, forward-control integral cab-body ambulance.

Jump Kit

Also known as the 5 minute kit. Bag that can be carried to the patient that contains anything you might need in the first 5 minutes, with that patient except for the AED, O2 and portable suction.

Preparation Phase

making sure that equipment and supplies are in the their proper places and ready for use

Dispatch Phase

for every emergency:
the nature of the call
the name, present location, and call-back telephone number
the location of the patient
the number of patient and some idea of the severity of there condition
Also any special problems or pertinent information

Arrival at the scene phase

preform scene size up
relaying information to dispatch for addition support and scene info
(look for safety hazards to yourself, your partner and your patient)
(need for addition unit)
(MOI) (C-spine)(standard precaution)

safe parking

Parking about 100' before the scene to create a barrier between you and oncoming traffic, while always leaving on warning lights.

delivery phase your arrival to the triage nurse or other arrival personnel
2. physically transfer the patient from the stretcher to the bed directed for your patient
3. Present a complete verbal report at the beside to the nurse or physician who is taking over the patient's care
4. complete a detailed written report, obtain the required signatures, and leave a copy with an appropriate staff member

cushion of safety

to ensure that you have enough reaction time to to move over to the right, this entails driving about 4 to 5 seconds behind a vehicle traveling at an average speed

Principles governing-lights and siren

1. the unit must be on a true emergency call to the best of your knowledge.
2. Both audible and visual warning devices must be used simultaneously
3. The unit must be operated with due regard for the safety of all others, on and off the roadway

100 to 150 miles

At distances over or between ____ and ____ fixed wing aircraft are used


type of evacuation used with the transport time to the hospital by ground ambulance is too long considering the patient's condition

Medivac Landing zone

hard or grassy level surface that measures 100 X 100 feet and no less then 60 by 60, cleared of loose debris, clear of overhead or tall hazards such as power lines or telephone cables.


the main rotor blade of the helicopter is flexible and may dip as low as ___ feet off the ground

there are no special privileges give to emergency vehicles when proceeding through a school zone

Are there any special privileges give to emergency vehicles when driving through a school zone

KKK-A-1822F, August 2008

he federal specifications that cover basic ambulance design are known as:

5 inches

the distance of clearance around side impact air bags that have not deployed

10 inches

the distance of clearance around driver air bags that have not deployed

20 inches

the distance of clearance around passenger-side air bags that have not deployed


is the removal from entrapment or from a dangerous situation or postion


when a person is caught within a closed area with no way out or has a limb or other body part trapped

rescuer safety

the first priority in rescue


is the ongoing process of information gathering and scene evaluation to determine appropriate strategies and tactics to manage an emergency

360 degree walk-around

this will allow you to evaluate the hazards present and determine the number of patients

danger zone (hot zone)

is an area where individuals can be exposed to sharp metal edges, broken glass, toxic substances, lethal ray, or ignition or explosions of hazardous material.

Alternative Fuel vehicle/batteries

there may be more than one battery
responders must disconnect the battery
batteries have higher amperes and can injure you.

simple access

trying to get to the patient in an extrication situation as quickly and simply as possible with out using any tools or breaking any glass. (always try before you pry)

complex access

requires the use of special tools in an extrication situation such as hand, pneumatic and hydraulic devices as well as special training.

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