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EMT-B Final Review

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.
Extrication Emergency Care Stable Patient
Once entrance and access to the patient has been provided and the scene is safe, you should perform a primary assessment
1. manual stabilization of cervical spine
2. Open the airway
3. Provide high flow oxygen
4. Assist or provide for adequate ventilation
5. Control any significant external bleeding
6. Treat all critical injuries
technical rescue situation
a rescue situation that may contain hidden dangers, and personnel need special technical skills to safely enter and move around
command post
location of the incident commander
structure fire
a fire in a house, apartment building, office, school, plant, warehouse, or other building
National Incident Management System (NIMS)
provides a consistent nationwide template to enable federal, state and local governments as well as private-sector to work together effective and efficiently
Major components of NIMS
command and management
resource management
communication and information management
supporting technologies
ongoing management and maintenance
incident command system
span of control
The number of subordinates a manager can efficiently and effectively direct
incident commander
the person in charge of the overall incident
unified command system
a system for a multiagency or multijurisdiction response for large MCI's, HazMat incident
single command system
is a incident command system in which one person is in charge, even if multiple agencies respond.
logistics of incident management
the section chief that has responsibilities for communications equipment, facilities, food, water, lighting and medical equipment and supplies for patients and emergency responders.
section of incident command that is responsible for managing the tactical operations usually handled by the IC
incident action plan
the central tool for planning during a response to a disaster emergency
safety officer
monitors the scene for conditions or operations that may present a hazard to responders and patients, he or she may have the authority to stop an emergency operation whenever the rescuer is in danger
public information officer
provides the public and media with clear and understandable information
medical incident command
a branch of operations in a unified command system whose three designated sector position are triage, treatment and transport
triage supervisor
in charge of counting and prioritizing patients
treatment supervisor
will locate and set up the treatment are with a tier for each priority of patient
transportation supervisor
coordinates the transportation and distribution of patients to appropriate receiving hopsitals
staging supervisor
should be assigned when MCIs or scenes require response by numerous EMS vehicles or agencies.
sorting and allocating aid on the basis of need for or likely benefit from medical treatment or food
triage categories
red tag- first priority (immediate)
yellow tag- second priority (delayed)
green tag- third priority, minimal (walking wounded)
Black tag- fourth priority, (expectant)
red tag
patients who need immediate care and transport, treat these patients first, and transport as soon as possible
-airway and breathing difficulties
-uncontrolled or severe bleeding
-sign of shock
-severe burns
-open chest or abdominal wounds.
yellow tag
patients whose treatment and transport can be temporarily delayed
-burns with out airway
-major or multiple bone or joint injuries
-back injuries without spinal cord
green tag
patients who require minimal or no treatment and transport can be delayed until last
-minor fractures
-minor soft-tissue injuries
black tag
patients who are already dead or have little chance for survival; treat salvageable patients before treating these
hazardous material
any material that poses an unreasonable risk of damage or injury to persons, property or the environment
Agency that provides advice on hazardous materials via a hotline
HazMat Scene Operation
stay back further than you think is necessary until a HazMat team arrives.
park upwind or uphill from the incident
rapidly assess the situation and provide as much information as possible to relay to the HazMat team.
HazMat control zones
hot zone- area immediately surrounding the release, most contaminated
warm zone- where personnel and equipment transition into and out of the hot zone
decontamination area - designated near the warm zone where decontaminates are removed before an individual can go to another area.
cold zone- is a safe area where personnel do not need to wear any special protective equipment.
PPE Level A
the most hazardous, requires fully encapsulated, chemical-resistant protective clothing that provides full body protection, as well as SCBA and special, sealed equipment
PPE level B
requires nonencapsulated protective clothing that is designed to protect against a particular hazard requires breathing devices (SCBA)
PPE level C
requires the use of non-permeable clothing and eye protection in addition face mask that filter all inhaled outside air
PPE level D
requires a work uniform, such as coveralls, that affords minimal protection
incendiary, chemical
explosive weapons
(kinds of weapons of mass destruction)
agents or organisms that cause disease that are cultivated, synthesized and mutated in a laboratory and artificially maximized to increase target population's exposure.
Response Actions of WMD
scene safety - safe distance, wait for law enforcement, egress
Responder Safety - Personal protection
secondary device
additional explosives that are intended primarily to injure responders and to secure media coverage
Persistent agents
are nonvolatile agents that remain on the surface for long periods usually longer than 24 hours.
Nonpersistent agents
are volatile agents that evaporate relatively fast when left on a surface
Drugs capable of causing pain, inflammation and blistering of skin, underlying flesh and structures leading to tissue death & necrosis
sulfur mustard (H)
A vesicant; it is a brownish-yellowish oily substance that is generally considered very persistent; has the distinct smell of garlic or mustard and, when released, it is quickly absorbed into the skin and/or mucous membranes and begins an irreversible process of damaging the cells
Lewisite (L)
A blistering agent that has a rapid onset of symptoms and produces immediate intense pain and discomfort on contact
phosgene oxime (CX)
A blistering agent that has a rapid onset of symptoms and produces immediate intense pain and discomfort on contact
chlorine (CL)
The first chemical agent ever used in warfare. It has a distinct odor of bleach, and creates a green haze when released as a gas. Initially it produces upper airway irritation and a choking sensation
A pulmonary agent that is a product of combustion, such as might be produced in a fire at a textile factory or house, or from metalwork or burning Freon. Phosgene is a very potent agent that has a delayed onset of symptoms, usually hours.
g agents
Early nerve agents which were developed by German scientists in the period after WWI and into WWII. There are three such agents: sarin, soman, and tabun.
Sarin (GB)
A nerve agent that is one of the G agents; a highly volatile colorless and odorless liquid that turns from liquid to gas within seconds to minutes at room temperature.
Soman (GD)
A nerve agent that is one of the G agents; twice as persistent as sarin and five times as lethal; it has a fruity odor, as a result of the type of alcohol used in the agent, and is both a contact and inhalation hazard that can enter the body through skin absorption and through the respiratory tract.
Tabun (GA)
A nerve agent that is one of the G agents; is 36 times more persistent than sarin and approximately half as lethal; has a fruity smell and is unique because the components used to manufacture the agent are easy to acquire and the agent is easy to manufacture.
V agent (VX)
One of the G agents; it is a clear, oily agent that has no odor and looks like baby oil; over 100 times more lethal than sarin and is extremely persistent.
is used to block the nerve agent from affecting the body, but because the nerve agent remains a long time 2-PAM chloride is used to eliminate the agent from the body.
S-salivation, sweating
L- Lacrimation
D- defecation, drooling, diarrhea
G- Gastric upset and cramps
E- emesis
M- Muscle twitching and miosis (dilated pupils)
(Exposure to Nerve Agents)
Mark 1 or DuoDote Auto injector
medical treatment for nerve agent exposure
Mark 1 Nerve Agent Antidoe Kit (NAAK)
2 mg of atropine
600 mg of pralidoxime chloride
(two separate auto injectors)
DuoDote Auto-Injector
One needle - 2.1 mg of atropine and 600 mg of 2 PAM
Metabolic Agents
is a colorless gas that has an odor similar to almonds. Effects the cellular level and seen at the organ and systems levels.
nerve agents
most lethal chemical agents can kill within minutes effects are reversible with antidotes
cause large blisters to from on victim; may severly damage uppper airway if vapors are inhaled; severe, intense pain and grayish skin discolorization
pulmonary agents
causes irritation choking, severe pulmonary edema
cyanide agents
highly lethal chemical gases; can kill within minutes; effects are reversible with antidotes
is the means by which a terrorist will spread the agent.
a highly contagious viral disease characterized by fever and weakness and skin eruption with pustules that form scabs that slough off leaving scars
viral hemmorhagic fevers
members of 4 virus families; mostly found in Africa
Most are zoonotic with arthropod vectors, but some are direct contact. Viruses include Ebola, Rift Valley and Yellow fever
Infectious disease caused by a spore-forming bacterium (Bacillus anthrax), characterized by external ulcerating nodules or by lesions in the lungs.
Bubonic plague
the most common form of the plague
infects the lymphatic system (the patient's lymph nodes become infected and grow froming buboes.) Untreated can lead to sepsis and possible death.
DHS Warning RED
Severe risk of terrorist attacks
DHS Warning Orange
High risk of terrorist attacks
DHS Warning Yellow
Significant risk of terrorist attacks
DHS Warning Blue
General risk of terrorist attacks
DHS Warning Green
Low risk of terrorist attacks
Alpha Radiation
least harmful penetrating type of radiation can not move through most objects
Beta Radiation
is slightly more penetrating than alpha and requires a layer of clothing to stop it
Gamma (X ray) Radiation
Faster and stronger then Alpha and Beta, easily penetrate through the human body and require lead or several inches of concrete.
Neutron radiation
easily penetrate through lead and require several feet of concrete to stop them.
Primary Blast injury
due to the blast itself; damage to body caused by pressure generated
Secondary blast injury
damage from flying debris
tertiary blast injury
an injury from whole body displacement and subsequent traumatic impact with environmental objects
trauma emergency
emergency that occurs as a result of a physical force applied to the body.
index of suspicion
awareness and concern for potentially serious underlying and unseen injuries
Definition of Work
is a force acting over a distance
kinetic energy
this energy reflects that relationship between the mass (weight) of the object and the velocity (speed) at which it it traveling
potential energy
is the product of mass (weight), force of gravity and height and is mostly associated with the energy of falling objects
multisystem trauma
injury to more than one body system
Blunt trauma
is the result of force ( or energy transmission) to the body that causes injury without penetrating the soft tissues or internal organs and cavities
Penetrating trauma
causes injury by objects that primarily pierce and penetrate the surface of the body and cause damage to soft tissues, internal organs and body cavities
Top five causes of trauma death
motor vehicles, crashes, falls poisonings, burns and drowning
Three collisions of a car accident
1. car against another object
2. passenger against the interior of the car
3. collision of the passenger internal organs against the solid structures of the body
coup-contrecoup brain injury
compression injury (or bruising) to the anterior portion of the brain and stretching (or tearing) of the posterior portion of the brain.
Mechanism of Injury
This is one of the most crucial elements in history taking in assessing a trauma incident.
this type of injury is often seen in rear-end collisions, in which the head and or neck is not restrained by a headrest. The passengers body and torso are propelled forward and the head and neck are left behind.
Lateral collisions
This type of collision the movement is to the side and the passenger's shoulders and head whip toward the intruding vehicle. Key to remember that the cervical spine has little tolerance for lateral bending.
Four types of motorcycle impacts
1.head-on collision
2. angular collision
3. Ejection
4. controlled crash - technique used to separate the rider from the body of the vehicle
Considered a Significant fall
a fall from more than 15' or 3 times the patient's height
What other issue should be considered in a falling accident
Significant MOI in trauma with Children
1. falls greater then 10' without the loss of consciousness
2. fall of less than 10' with loss of consciousness
3. medium to high speed vehicle collision >25mph
Geriatric Patients
these types of patients are seriously injured from falls. completely assess for all possible injuries even from low-impact falls.
path the projectile takes
damage caused by the object moving inside the body and not along the suspected pathway
temporary cavitation
stretching of the tissues (ex.- acceleration of the bullet)
permanent cavitation
caused by the bullet path and remains once the projectile has passed through the tissue.
primary blast injuries
injuries due entirely to the blast itself
secondary blast injuries
injuries to the body as a result from being struck by flying debris such as shrapnel from the device or from glass or splinters
Tertiary blast injuries
injuries occurring when the patient is hurled by the force of the explosion against a stationary object.
Miscellaneous blast injuries
these type of injuries include burns from hot gases or fires started by the blast, respiratory injury
Tympanic membrane ruptures
evolved to detect minor changes in pressure and will rupture at pressures of 5 to 7 pounds per square inche
Pulmonary blast injuries
pulmonary trauma (consisting of contusions and hemorrhages) that result from short-range exposure to the detonation of explosives
Arterial air embolism
most concerning pulmonary blast injuries, which occurs on alveolar disruption with subsequent air embolization into the pulmonary vasculature.
Prehospital Trauma Care
1. ensure your safety
2. additional need for support
3. MOI and manage life threats
4. Spine immoblization
5. Patient care- ABC
6. Shock therapy -
Once patient ABC have been assessed transport immediately
Platinum 10
in patients with multisystem trauma, definitive care requires surgical interventions, on scene time should be limited to 10 minutes.
Determining Air Care
Extended period to access or extricate the patient
distance to trauma center greater then 25 miles
Patient needs ALS when no ALS is available
Traffic conditions
Multiple patients
sign of Hypovolemic shock
rapid, weak pulse
low blood pressure (late sign)
changes in mental status
cool, clammy skin
cyanosis (lips, oral membranes, nail beds)
slightly dilated pupils
capillary refill of more than 2 seconds in infants and children
hypovolemic shock
condition in which low blood volume results in inadequate perfusion and even death
arterial bleeding
blood appears bright red (high in oxygen) and tens to spurt in time with pulse
venous bleeding
blood appears darker red (low in oxygen) and flows slowly or severely does not spurt and it easy to manage
10 minutes
time it takes for venous and capillary bleeds to clot or stop bleeding
capillary bleed
bleeding is dark read and oozes form a wound steadily but slowly
a hereditary factor in which a person lacks the one or more of the blood's clotting factors.
1 liter
a broken femur can result in loss of how much blood into the soft tissues of the thigh
internal bleeding
You should always suspect internal bleeding in a patient who has penetrating injury or blunt trauma
contusion and ecchymosis
two names for a bruise
mass of blood in the soft tissues beneath the skin
vomited blood. It may be bright red or dark red it may look like coffee-grounds
black, foul-smelling, tarry stool that contains digested blood
bright red blood that is cough up by the patient
Signs and symptoms of internal bleeding
-pain, tenderness, bruising,guarding or swelling
-broken ribs, bruises over the lower part of the chest or a rigid, distended abdomen
signs of perfusion problems
a systolic blood pressure of less that 100mm Hg with a weak rapid pulse, cool, most skin that is pale or gray
Methods to control external bleeding
direct, even pressure and elevation
pressure dressings and or splints
Rules for tourniquets
-useful if a patient has substantial bleeding from an extremity injury below the axilla or groin
-Place around extremity just above the bleeding site
-tighten until pulses are no longer palpable distal or until bleeding has been controlled
-Write "TK" and exact time hour and minute that you applied the tourniquet
-do not apply directly over any joint
-make sure it is secured and never use wire, rope, belt or narrow material that could cut into the skin
-do not cover
-do not loosen
Causes of Bleeding from Nose, ears and mouth
-skull fracture
-facial injuries
-sinusitis, infections, nose drop use and abuse, dried or crack nasal mucosa
-high blood pressure
-coagualation disorders
-digital trauma (nose picking)
closed injuries
soft-tissue damage occurs beneath the skin or mucous membrane
open injuries
there is a break in the surface of the skin or the mucous membrane, exposing deeper tissues
the soft tissue damage occurs as a result from thermal heat, frictional heat, toxic chemicals or nuclear radiation
111 degrees F
the temperature at which thermal burns can occure
crushing injury
occurs when a great amount of force is applied to the body
crush syndrome
when an area of the body is trapped form longer than 4 hours and arterial blood flow is compromised. Can lead to renal failure and death
compartment syndrome
swelling that occurs whenever tissues are injured the cells then leak fluid and the interstitial pressure builds up enough to compress the tissue and cause further damage.
open injuries
penetrating wounds
wound of the superficial layer of the skin caused by friction when a body part rubs or scrapes across a rough or hard surface
jagged cut caused by a sharp object or a blunt force that tears the tissue
is a sharp, smooth cut.
injury that separate various layers of soft tissue
is an injury in which part of the body is completely severed
penetrating wound
is a injury resulting from a sharp, pointed object, such as a knife, ice pick, splinter or bullet
rules for treating an evisceration
-do not touch or move the exposed organs.
-cover the wound with sterile gauze moistened with sterile saline solution and secure with an occlusive dressing.
when organs protrude through a wound
rules for treating a impaled object
-do not attempt to move or remove the object, only if it is causing an airway obstruction or interferes with CPR.
-Remove clothing covering injury and control bleeding
-stabilize the object effectively
air emoblism
when enough air is sucked into a blood vessel, it can actually block the flow of blood in the lungs, sending the patient into cardiac arrest.
5 factors to determine burn severity
1. What is the depth of the burn
2. What is the extent of the burn
3. Are any critical areas (face, upper airway, hands, feet, genitalia) involved
4. Does the patient have any preexisting medical conditions or other injuries?
5. Is the patient younger then 5 year or older then 55 years.
superficial (first-degree) burn
burn that involves only the top layer of skin, the epidermis. The skin turns red but does not blister. Ex. Sunburn
partial thickness (second degree) burn
burn that involves the epidermis and some portion of the dermis. Typically the skin is moist, mottled, and white to red. Blisters are present.
Full-thickness (third degree) burn
burn that extends through all layers,involving subcutaneous layers, muscle, bone, or internal organs. Burn appears white, dark, brown, or even charred.
Rule to determine extent of burn
rule of nines which divides the body into section, each of which is approximately 9% the total surface area.
-Head - 9 /Toddler 12/ Infant 18
-Back -18
-Arms -9
-Legs -18/ Toddler 16.5/Infant 13.5
Rule to treat chemical burn
Stop the burning process
Remove or brush away any dry material
Remove clothing or any jewelry
Flush the burned area with water 15 to 20 minutes
thermal burn
burn caused by heat, opposed to electricity, chemicals or radiation
flame burn
often a deep burn, caused by exposure to an open flame
scald burn
burn caused by a liquid, often covers a large surface area of the body
contact burn
coming in contact with hot objects
steam burn
can produce a topical scald burn, gaseous water causes the burn and can be responsible for causing airway burns
flash burn
burn produced by an explosion
the external visible part of the ear
small, small rounded, fleshy bulge immediately anterior to the ear canal.
sternocleidomastoid muscle
muscle that orginate from the mastoid process of the cranium and insert into the medial border of each collar bone and the sternum at the base of the neck
another name for the eyeball
vitreous humor
jellylike fluid near the back of the eye
aqueous humor
in the front of the lens is clear watery fluid
delicate membrane on the surface of the eye
lacrimal glands
glands that produce tears and keep the eye moist
the white of the eye that extends over the surface of the globe and helps maintain the eye's globular shape
on the front of the eye a transparent membrane that allows light to enter the eye.
in the eye acts as a shutter in a camera that helps to regulate the amount of light that enter the eye
opening in the center of the iris which allows light to move to the back of the eye
the name of the condition in which people are born with pupils that are not equal
in the eye focus images on the light-sensitive area at the back of the globe
The light-sensitive inner surface of the eye, containing the receptor rods and cones plus layers of neurons that begin the processing of visual information
optic nerve
The nerve that carries neural impulses from the eye to the brain
retinal detachment
visual impairment resulting from the retina becoming separated from the choroid in the back of the eye
a condition in which the conjunctiva becomes inflamed and red
rules for laceration of the eye
-never exert pressure on or manipulate the injured eye in any way.
-if part of eyeball is exposed gently apply a moist, sterile dressing to prevent drying
-cover the injured eyes with protective sheild
-if eyeball is displaced out of its socket, do not attempt to re-position it, simply cover the eye and stabilized it with moist sterile dressing.
blowout fracture
blunt trauma that causes a fracture of the orbit particularly bones that from the floor and support the globe.
Rules for contact lenses
-in general you should not attempt to remove either kind of contact lens (hard or soft) from a patient. The only time that a contact lens should be removed immediately in the field is in the case of a chemical burn of the eye.
three bony projections found on the lateral walls of each nasal cavity, the middle, superior, and inferior
external auditory canal
either of the passages in the outer ear from the auricle (also called the pinna) to the tympanic membrane
tympanic membrane
The eardrum. A structure that separates the outer ear from the middle ear and vibrates in response to sound waves.
eustachian tube
A narrow tube between the middle ear and the throat that serves to equalize pressure on both sides of the eardrum
subcutaneous emphysema
leakage of air into the soft tissues produces a characteristic crackling sensation
contains 75% of the brain's total volume, controls a wide variety of activities including most voluntary motor function and conscious thought
the "little brain" attached to the rear of the brainstem; it helps coordinate voluntary movement and balance
brain stem
the part of the brain that lies between the cerebellum and spinal cord that controls the body's involuntary actions
three distinct layers of tissue that suspend the brain and the spinal cord within the skull and the spinal canal.
dura mater
thick, outermost layer of the meninges surrounding and protecting the brain and spinal cord
the middle of the 3 meninges
pia mater
thin, delicate inner membrane of the meninges
spinal nerves
31 pairs of nerves coming out from the spinal cord between two vertebrae; dorsal roots are sensory and ventral roots are motor
cranial nerves
olfactory - sense of smell

optic - visual acuity

oculomotor - extraocular movement of eye

trochlear - pupil constriction and dilation, upward and downward movement of eyeballs

trigeminal - sensory nerve to skin of face, motor nerve to jaw muscles

abducens - lateral movement of eyeballs

facial - facial expressions

auditory - hearing

glossopharyngeal - taste, ability to swallow

vagus - sensation of pharynx, movement of vocal cords

spinal accessory - movement of head and shoulders

hypoglossal - position of tongue
Function of the Sympathetic nervous system
fight or flight response, causes the pupils to dilate, smooth muscle in the lung dilate, heart rate increases, bp rises, shunts blood to vital organs and to skeletal muscle.
Function of the Parasympathetic nervous system
rest and digest, causes blood vessels to dilate, slows the heart rate, relaxes the muscle spincters, body shunts blood to the organs of digestion.
# of cervical vertebra
# of thoracic vertebra
# of lumbar vertebra
# of sacral vertebra
# of coccygeal vertebra
bruising that develops under the eyes (raccoon eyes)
Battle's sign
bruising that develops behind one ear over the mastoid process
linear skull fracture
nondisplaced skull fracture that account for approximately 80% of all fractures to the skull.
compressed skull fractures
skull fractures that result from a high-energy direct trauma to the head
basilar skull fracturs
associated with high energy trauma, but they usually occur following diffuse impact to the head.
Traumatic brain injury
traumatic insult to the brain capable of producing physical, intellectual, social and vocational changes.
primary injury
type of brain injury and injury to associated structures that result instantaneously from impact to the head
secondary injury
brain injury refers to a multitude of processes that increase the severity of a primary brain injury and negatively impact the outcome.
coup-countrecoup injury
when the brain slams into the rear of the skull creating a front-and rear injury
cerebral edema
swelling of the brain
Cushing's reflex
increased systolic blood pressure, decreased pulse rate, and irregular respiration. This triad is caused by cerebral edema and increased intracranial pressure.
epidural hematoma
accumulation of blood between the skull and dura mater.
subdural hematoma
accumulation of blood beneath the dura mater but outside the brain.
intracerebral hematoma
bleeding within the brain tissue itself
subarachnoid hemorrhage
bleeding occurs into the subarachnoid space where CSF circulates. It results in bloodly CSF and sings of meningeal irriation
known to be mild traumatic brain injuries. Generally a closed injury with a temporary loss or alteration of part or all of the brain's ability to function without demonstratable physical damage to the brain
retrograde amnesia
when the patient can remember everything but the events leading up to the injury
anterograde amnesia
inability to remember events after the injury
more serious then a concussion because it involves physical injury to the brain tissue which may sustain long-lasting and even permanent damage.
when the spin is pulled along its length. (hangings)
injury of the spine that occures when the vertebrae are no longer aligned. Sometimes refered to as "step off" where the spinous process may be palpable on physical examination.
cheyn-stokes respiration
irregular breathing
Rules for treating spinal injuries
-c spine
-oxygen delivered by NR is always indicated for patients with head and spinal injuries.
-Pulse oximeter values should be maintained above 90%
Cushing's triad
increased blood pressure, decreased heart rate and irregular respiration (central neurogenic hyperventrilation and Biot respiration). Referred as a herniation syndrome where the intracranial pressure is so great that if forces the brain stem and the midbrain through the foramen mangnum.
Rules for Helmets with Spinal injuries
-remove a helmet if it makes assessing or managing airway problems difficult and removal of a face guard is not possible
-it prevents you from properly immobilizing the spine
-it allows excessive head movement or the patient is in cardiac arrest
the body's ability to move air in and out of the chest and lung tissue.
is the exchange of gases in the alveoli of the lung tissue
Muscles controlled by C6 and C7 spinal nerves
muscles extending between the ribs, intercostals, that allow the chest to expand on contraction and allow ventilation to occur are controlled by these nerves
phrenic nerves
nerves supplying the diaphragm exit the spinal cord at C3, C4 and C5.
Damage below C5
damage to the spine below this point a patient will lose the power to move the intercostal muscles but the diaphragm will still contract
Damage at or above C3
damage to the spine at this point can cause patients to lose their ability to breath entirely
paradoxical motion
an abnormality associated with multiple fractured ribs, in which one segment of the chest wall moves opposite the remainder of the chest (often referred to as flail segment)
commonly called a collapsed lung. accumulation of air in the pleural space through a hole in the chest wall or the surface of the lung as the patient attempts to breath causing the lung on that side to collapse.
open pneumothorax
rules for treating a pneumothorax
initial emergency care, after clearing and maintain the airway and then providing oxygen, rapidly seal the open wound with a sterile occlusive dressing.
spontaneous pneumothorax
a pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space.
simple pneumothorax
any pneumothorax that does not result in major changes in the patient's physiology. (commonly the result of blunt trauma)
tension pneumothorax
A life-threatening collection of air within the pleural space; the volume and pressure have both collasped the involved lung and caused a shift of the mediastinal structures to the opposite side.
accumulation of blood in the pleural cavity (the space between the lungs and the walls of the chest)
The accumulation of blood and air in the pleural space of the chest.
cardiac tamponade
when the protective membrane around the heart (pericardium) fill with blood or fluid, perhaps from a ruptured, torn or lacerated coronary artery or vein.
flail chest
paradoxical motion, the detached portion of the chest wall moves opposite of normal. Occurs when ribs are fractured in more than one place or the sternum is fractured along with several ribs.
pulmonary contusion
when the pulmonary alveoli become filled with blood and the fluid accumulates in the injured area, leaving the patient hypoxic.
traumatic asphyxia
sudden severe compression of the chest, which produces a rapid increase in pressure within the chest
myocardial contusion
bruising of the heart muscle
commotio cordis
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. ( the result may be immediate cardiac arrest)
peritoneal cavity
abdominal cavity
Hollow organs
stomach, intestines, ureters, and bladder
solid organs
liver, spleen, pancreas, and kidneys
organs in the retroperitoneal cavity
kidneys, ureters, bladder, majority of pancreas, abdominal aorta and inferior vena cava.
Kehr sign
patients with liver and spleen injuries whom there is bleeding into the peritoneal space pain is referred to the shoulder. (injury to the spleen and pain in the tip of the left shoulder)
the patient consciously or unintentionally stiffens the muscles of the surface of the abdomen
Suspect of Kidney Damage
-abrasion, laceration, or contusion in the flank
-a penetrating wound in the region of the lower rib cage (the flank) or the upper abdomen
-fractures on either side of the lower rib cage or of the lower thoracic or upper lumbar vertebrae
-a hematoma in the flank region
supine hypotensive syndrome
in the last trimester of pregnancy, the uterus is large and may obstruct the vena cava, decreasing the amount of blood returning to the heart if the patient is placed in a supine position
suspect of damage to urinary bladder
-blood at the urethral opening
-physical signs of trauma on the lower abdomen, pelvis or perineum
-blood at the tip of the penis or a stain on the patients underwear
Grey Turner sign
bruises in the right upper quadrant, left upper quadrant or flank, might suggest an injury to the liver, spleen or kidney,
Cullen sign
bruises around the umbilicus
decrease in the size of the muscle and its inherent ability to function as a result of disease or trauma
articular cartilage
a thin layer of cartilage that covers the end of bones in moving joints
compartment syndrome
elevated pressure withing a fascial compartment or the compartment in which is surround by fibrous tissue that support muscle and neurovascular structures.
disruption of joint in which the bone ends are no longer in contact
is an incomplete dislocation of a joint
greenstick fracture
incomplete fracture that passes only partway through the shaft of a bone but may still cause substantial angulation, occurs in children
comminuted fracture
fracture in which the bone is broken into more than two fragments
pathologic fracture
a fracture of weakened or diseased bone, seen in patients with osteoporosis or cancer, generally produced by minimal force
Epiphyseal fracture
a fracture that occurs in a growth section of a child's bone and may lead to growth abnormalities
Oplique fracture
A fracture in which the bone is broken at an angle across the bone. This is usually the result of a sharp angled blow to the bone
Transverse fracture
a fracture that occurs straight across the bone. This is usually the result of a direct blow or stress fracture caused by prolonged running
spiral fracture
a fracture caused by a twisting force, causing an oblique fracture around the bone and through the bone. this is often the result of abuse in very young children
a fracture that does not run complete through the bone, a non-displaced partial crack
Signs of fracture
-deformity, tenderness, guarding, swelling, bruising, crepitus, false motion (movement where there is not joint), exposed fragments, pain, locked joint
when a joint is twisted or stretched beyond its normal range of motion. Often supporting capsule and ligament are stretched or torn. (considered a partial dislocation)
pulled muscle, an injury to a muscle and or tendon that results from a violent muscle contraction or from excessive stretching.
Assessing neurovascular status ortho injury
1. pulse -palpate a distal pulse
2. capillary refill
3. sensation -patient ability to sense light touch in the fingers or toes distal to the site of the injury
4. motor function - motion of muscle distally
Steps to Care for Musculoskeletal injury
1. remove jewelry, completely cover open wounds (dry sterile dressing), control bleeding
2. Apply the appropriate splint and elevate the extremity
3. If swelling apply cold packs
4. Prepare for transport
Function of splinting
-prevents further damage
-prevents laceration of the skin by broken ends
-restriction of distal blood flow from pressure of bone ends on blood vessels
-excessive bleeding of the tissue at the site can be controlled
-reduces risk of pain by movement of bone ends
-reduces risk of paralysis of extremities resulting from a damaged spine.
Area a splint should be applied
- in fracture of the shaft of any bone, be sure to stabilize the joints above and below the fracture
-in injuries around the joint be sure to stabilize bones above and below.
Types of Splints
-rigid splints
-Formable splints
-traction splints
-pelvic binder
Splinting the hand and wrist
1. cover all wounds with a dry, sterile dressing
2. support the injured limb, from the injured hand into the position of function
3.Soft roller bandage into the palm of the hand
4. secure the entire length of the splint with a soft roller bandage.
point tenderness
the most reliable indicator of an underlying fracture
dysbarism injuries
the signs and symptoms related to changes in barometric pressure, caused by diving and high-altitude climbing.
when the entire body temperature falls.
5 types of body heat loss
conduction- direct transfer of heat from a part of the body to a colder object
convection- occurs when heat is transferred to a circulating air
evaporation- conversion of any liquid to a gas
radiation- transfer of heat by radiant energy (invisible light)
respiration- causes body heat to be lost as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled.
Clinical hypothermia
it is diagnosed when the core temperature of the body and or organs falls below 95 degree F (35 degree C)
mild hypothermia
when the core temp is between 90 and 95. the patient is usually alert and shivering. Movement to create heat. pulse and respiratory rate are usually rapid. Skin appears red, may have blue lips or finger tips.
severe hypothermia
when the core temp is less than 90, the patient's shivering stops and muscular activity decreases, fine muscular activity ceases and as temp fall further all muscle activity stops.
exposed body parts become very cold but not frozen (also called chilblains, immersion foot). Skin is pale and cold to touch, not painful.
destruction of tissue by freezing and characterized by tingling, blistering and possibly gangrene
Management of cold emergencies
-remove the patient from the cold
-do not allow the patient to walk
-remove any wet clothing
-cover with dry blankets and, give humidified oxygen
-do not allow patient to eat or use any stimulants
-slowly rewarm the patient
abnormally high body temperature. Usually 101degree F or higher.
heat cramps
painful muscle spasms that occur after vigorous exercise
heat exhaustion
a condition marked by dizziness and nausea and weakness caused by depletion of body fluids and electrolytes
sign and symptom of heat exhaustion
-dizziness, weakness or faintness, change in LOC
-cold, clammy skin with ashen pallor
-dry tounge and thrist
-normal vital signs, often rapid weak pulse
-elevate body temp - as high as 104 F
Severe and sometimes fatal condition resulting from the failure of the temperature-regulating capacity of the body; caused by prolonged exposure to the sun or high temperatures. (body temp -106 or more and pt. may no longer perspire.
Elasticity of the skin
inhaling very small amount os either fresh water or salt water can severely irritate the larynx, send the muscles of the larynx and the vocal cords into spasm
diving reflex
slowing of the heart rate caused by submersion in cold water
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
treatment for snake bite
-immediately quiet and reassure the patient
-flush the are of the bite with 1 to 2 quarts of warm, soapy water
-do not apply ice, consider a pressure bandage
-check vital signs and monitor
-give supplemental oxygen
-transport patient promptly
hypoperfusion, describes a state of collapse and failure of the cardiovascular system.
a balance of all systems of the body
the circulation of the blood within an organ or tissue in adequate amounts to meet the cells' current needs for oxygen, nutrients and waste removal
pump (heart), container (blood vessels), contents (blood)
Three components of the cardiovascular system
epinephrine and norepinephrine
hormones released by the sympathetic nervous system that cause increase in heart rate, vasoconstriction of nonessential areas and vasodialation of main arteries and vessels.
pump failure
poor vessel function
low fluid volume
three basic causes of shock
cardiogenic shock
obstructive shock
Two types of pump failure (heart) relating to shock
cardiogenic shock
shock caused by inadequate function of the heart. This type of shock may result from low cardiac output due to high afterload, low preload, poor contractility or any combination of the three
Pulmonary edema
build of fluid within the pulmonary tissue
obstructive shock
the result of shock caused from a mechanical obstruction of the cardiac muscles that impacts pump function
cardiac tamponade or pericardial tamponade
a collection of fluid between the pericardial sac and the myocardium usually caused by blunt or penetrating trauma
tension pneumothorax
an obstructive condition caused by damage to the lung tissue which allow air normally held within the lung to escape into the chest cavity eventually putting pressure on the mediastinum
distributive shock
shock that results when there is widespread dilation of the small arterioles, small venules
septic shock
neurogenic shock
anaphylactic shock
psychogenic shock
4 types of distributive shock
Neurogenic shock
a type of shock resulting from damage to the spinal cord particularly at the upper cervical levels, which control the size and muscle tone of blood vessels
anaphylactic shock
shock that occurs when a person reacts violently to a substance to which he or she has been sensitized.
signs of anaphylactic shock
flush, itchy or burning skin
edema in face tongue and lips
dialation of blood vessels so skin is hot
wheezing and dyspena
forced expiration
psychogenic shock
shock the result of a sudden reaction of the nervous system that produces a temporary, generalized vascular dilation resulting in syncopial episode
hypovolemic shock
shock that is the resulf of inadequate amounts of fluid or volume in the system. Two types hemorrhagic and non-hemorrhagic.
Causes of non-hemorrhagic hypovolemic shock
vomiting and diarrhea - dehydration
thermal burns - loss of large amounts of intravascular plasma
hypoxemic hypoxia
when there is adequate saturation of tissues even though the tissuse are hypoxic such as CO poisoning or anemia.
compensated shock
early stage shock when blood pressure is falling
decompensated shock
late stages of shock when blood pressure is falling
irreversible shock
last stage of shock, in which it has progressed to the terminal stage and even a transfusion will not save the pt. life.
Used to determine the patients level of consciousness. Alert(to person place and time of day), verbal stimuli, responsive to pain, or unresponsvie
Rapid full body scan
This is performed when there is sign of significant trauma that has likely affected multiple body systems, in order to identify all body injuries.
Treatment of Cardiogenic shock
Treatment of this involves:
position pt. comfortably and administer O2, assist with ventilation if necessary and transport promptly
Treatment of Obstructive shock
treatment for this depends on the cause but will most likely involve ALS assist and or rapid transport
Treatment of Septic Shock
Treatment of this will involve prompt transport while administering oxygen, ventilation support, in this case consider elevating legs and keep the pt. warm.
Treatment of Neurogenic Shock
treatment of this will involve securing the airway and spinal stabilization, assisting ventilations, high flow oxygen, keeping the body warm as well as transporting quickly.
Treatment of Anaphylactic shock
treatment of this will involve managing the airway, administering high flow oxygen, determining the cause and assisting with administration of epinephrine, rapid transport
Treatment of Psychogenic (fainting) shock
determine duration of unconsciousness, recording initial vital signs and mental status, suspect head injury if pt. is confused or slow to consciousness, transport promptly
Treatment of Hypovolemic shock
treatment will involve securing an airway, assist ventilation, administer high flow O2, control external bleeding considering elevating legs and keep warm. Transport promptly
Basic Life Support
is a noninvasive emergency lifesaving care that is used to treat medical conditions, including airway obstructions, respiratory arrest, and cardiac arrest.
4 to 6 minutes
the amount of time that until permanent brain damage is possible and after this time brain damage is likely
Steps of CPR
1. First restore circulation by means of chest compression, 30 high quality compression at least 2 inches deep
2. Open the airway with proper maneuver
3. perform 2 rescue breaths checking for chest rise.
The Chain of survival
1. Early access - access EMS
2. Early CPR - immediate bystander
3. Early defibrillation
4. Early advance care - advanced airway, IV and meds
5. Integrated post-arrest care
Respiratory failure
Cardiac arrest in children is usually the result of this.
Rules for use of an AED
AED can be used on children form the ages of 1 - 8 years but the pediatric AED should be used. If not availble adult can be used
Ages 1 mo. to 1 year should be a manual AED or pedatric dose attenuated system if not available adult system can be used.
Under 1 mo of age a AED should not be used
Pediatric BLS procedures between 1 month and 1 year
check pulse : brachial artery
compressions: just below nipple
compression width: two fingers or two tumbs
compression depth: 1/3 diameter of chest depth or 1 1/2 inch
rate : 100/min
ratio: 30:2 one rescuer 15:2 two rescuer
foreign body: back slaps chest thrust
vent: 1 breath every 3 to 5 sec about 1 sec per breath
Pediatric BLS procedures between 1 year and puberty
check pulse: carotid or femoral artery
compression: in center of chest in between nipples
compression width: heel of hand
compression depth: 1/3 chest depth about 2"
rate: 100/min
ratio: 30:2 one 15:2 two
foreign body: abdominal thrust/unresponsive CPR
vent: 1 breath every 3 to 5 sec about 1 sec per breath
Adult BLS procedures puberty and above
check pulse: carotid or femoral artery
compression: in center of chest in between nipples
compression width: heel of hand
compression depth: 1/3 chest depth about 2"
rate: 100/min
ratio: 30:2
foreign body: abdominal thrust/unresponsive CPR
vent: 1 breath every 3 to 5 sec about 1 sec per breath
No more than 10 secs
The lenght of time needed to assess for a pulse in both adults and children.
Ventilating someone with a stoma
may require the covering of the mouth and nose and the use a pediatric mask over the hole
5 cycles or 2 minutes
amount of time for reassessing the pt. for sign of spontaneous breathing or pulse.
Rhythms that AED will shock
Ventricular fibrillation and Ventricular Tachycardia
common type of medical respiratory emergencies
asthma, emphysema, chronic bronchitis
common type of medical cardiovascular emergencies
heart attack, congestive heart failure
common type of GI medical emergencies
appendicitis, diverticulitis, pancreatitis
common type of Nerological medical emergencies
seizure, stroke and syncope
common type of urological medical emergencies
kidney stones
common type of endocrine medical emergencies
diabetes melllitus
common type of hematologic medical emergencies
sickle cell disease, hemophillia
common type of immunologic medical emergencies
anaphylactic reactions (server allergy to bee stings or bites), food allergies
common type of toxicologic medical emergencies
substance abuse, food or plant poisoning
common type of psychiatric medical emergencies
Alzheimer disease, schizophrenia or depression
common type of gynecological medical emergencies
vaginal bleeding, STD and PID
index of suspicion
your awareness and concern for potentially serious underlying and unseen injuries or illness
Types of patients that qualify for rapid transport
patients who are unconscious or altered mental status
patients with airway or breathing problem
patients with obvious circulation problems (bleeding or shock)
Acronym used for History
Onset, Provocation, Quality, Radiation/Region, Severity and Timing
This is what OPQRST stands for...
Limited or focused assessment based on CC
Type of physical exam that conscious medical patients should receive
Full body scan or head-to-toe examination looking possible trauma or medical tags
Type of physical exam that unconscious patients should receive
Vital signs
pulse rate, quality, and regularity
respirations rate, quality, regularity, tidal volume
blood pressure
Pupils if neurological risk is possible
Other info: blood glucose, pulse oximetry
Every 5 minutes
Time between obtaining vitals for unstable patients
Every 15 minutes
Time between obtaining additional vitals for stable patients
Administration of any medications
Each of these situations of EMT requires that direct permission be obtained from medical control
10 minutes
Critical patients need transport within how many minutes?
infectious disease
is a medical condition caused by the growth and spread of small harmful organism within the body
communicable disease
is a disease that can be spread from one person or species to another
the strength or ability of a pathogen to produce disease
is an inflammation of the meningeal coverings of the brain.
Signs of Viral Hepatitis
signs include loss of appetite, vomiting, fever, fatigue, sore throat, cough, muscle and joint pain. Weeks later jaundice and right upper quadrant abdominal pain.
chronic mycobacterial disease that usually strikes the lungs, this occurs after a primary infection, and unless in infants is not serious. Can remain dormant for years even decades, and if reactivated can be difficult to treat
Whooping cough
also called pertussis, airborne disease caused by bacteria that mostly affects children younger then 6. Signs include fever and a "whoop" sound that occurs when coughing attack
Methicillin-resistant Staphylococcus aureus
rare but deadly virus transmitted through rodent urine and dorppings and enteropathogenic Escherichia coli a common cause of pediatric diarrhea in developing countries
Primary Assessment
Transport decision should be based on this
Six disease of special concern
HIV infection
Hepatitis B
shortness of breath or difficulty breathing
exchange of oxygen and carbon dioxide
constantly monitors levels of CO2 in the arteial blood and this level of CO2 is what stimulates a person to breath
Signs of normal breathing
normal rate 12-20 breaths/min
regular pattern of inhalation ad exhalation
clear and equal lung sounds on both sides of the chest
Regular and equal chest rise and fall
Adequate tidal volume
Reason for increased CO2 levels
exhalation process may be impaired by various types of lungs which may cause the respiratory center in the brain to work less efficiently
Carbon Dioxide Retention
failure of the repiratory center in the brain to respond normally to a rise in the arterial levels of carbon dioxide
hypoxic drive
this drive develops in patients with chronically high blood carbon dioxide levels which then detect low O2 levels
collapse of alveolar lung space in the lungs
Pulmonary Edema
when the heart muscle becomes injured after a heart attack or illness and the left side can not remove the blood from the lungs as fast as the right side delivers resulting in a build up of fluid within and in between alveoli.
COPD (Chronic Obstructive Pulmonary Disease)
slow process of dilation and disruption of the airways and alveoli caused by chronic bronchial obstruction. Either causing trapped air or dilated alveolus
chronic bronchitis
ongoing irritation of the trachea and bronchi that results in excess mucus obstructing small airways and alveoli
loss of the elastic material around the air spaces as a result of chronic stretching of the alveoli eventually causing the alveoli to fall apart leaving large "holes" in the lungs
the substance that causes a exaggerated response of the body's immune system
Characteristics of COPD
lungs with shortness of breath and wheezing
home O2
usually long term smokers
chronic coughing
sputum may be thick
no jugular vein distention or dependent edema
barrel chest
Characteristics of CHF
shortness of breath, edema and weakness
diuretics often perscribed
sudden onset of shortness of breath
may not be smokers
sputum pink and frothy
jugular vein distention and dependent edema
distended abdomen
is a partial or complete accumulation of air in the pleural space, most often caused by trauma but can be seen in medical conditions
pleuritic chest pain
a sharp stabbing pain on one side that is worse during inspiration and expiration or with certain movement of the chest wall
pleural effusion
a collection of fluid outside the lung on one or both sides of the chest, can compress the lungs or lungs and causes dyspnea
Pulmonary embolism
passage of a blood clot formed in a vein, usually in the legs or pelvis, that breaks off and circulates through the venous system and can become lodged in the pulmonary artery blocking blood flow
defined as over breathing the body is trying to compensate for acidosis
is a sound that indicates construction and or inflammation in the bronchus generally heard on exhalation as a high-pitched almost musical whistling sound (Asthma or COPD)
Or crackles are the sound of air trying to pass through fluid it is this bubbling type of sound that is heard on inspiration (CHF, Pulmonary edema)
high pitched sound heard on inspiration as air tries to pass through an obstruction in the upper airway. (Foreign Body )
lower pitched sounds caused by secretion or mucus in the larger airway. Rattling or junky lungs sounds can be heard with infections.
When to administer O2
If a patient complains of breathing difficulty, should receive supplemental O2, and any breathing more than 30 or less than 8 breaths/min should receive high-flow O2 15L/min via a bag valve mask
How much O2 in patients with long term COPD
2L/min and them make adjustment to 3 and 4 L/min later
metered-dose inhaler (MDI)
a ministure spray canister used to direct such substances through the mouth and into the lungs.
Administration of O2 in patients with Pulmonary Edema
administer 100% O2 and suction any secretion from the airway. CPAP has proven to be immensely beneficial for patients experiencing this.
disease often secondary to an acute viral infection of the upper respiratory tract and typically seen in children of 6 mo to 3 years
serious inflammation of the epiglottis usually due to a bacterial infection
speicific viral illness that usually occurs in newborns and toddlers and is caused by inflammation of the the bronchioles
Cystic Fibrosis
genetic disorder that affects the lunds and digestive system, by disrupting the normal function of cells that make up the sweat glands in the skin and that line the lungs. Usually resulting in a thick mucus retention in the lungs that can lead to infection.
Sinoatrial Node
Normal impulses in the heard start a this node
AV Node
The second node that is found in the middle of the heart that from a bridge of special electrical tissue
Purkinje fibers
The final conduit for the electrical impulse of the heart
another name for heart muscle
stroke volume
the volume of blood ejected with each ventricular contraction
Right coronary artery
Supplies blood to the right ventricle and the bottom inferior wall of left ventricle
Left coronary artery
artery that divides in two major branches which supplies blood to the left ventricle
Systolic Blood Pressure
is the maximum pressure generated by the left ventricle as it contracts.
Diastolic Blood Pressure
pressure in the arteries as the left ventricle relaxes
cardiac output
the constant flow of oxygenated blood to the tissues
decreased blood flow
a disorder in which calcium and fatty material called cholesterol build up an form a plaque inside the walls of blood vessels.
a blood clot that is floating through blodd vessels until it reaches an area that is too narrow for it to pass.
Acute Myocardial Infarction (AMI)
classic heart attack, and death of tissue
Acute Coronary Syndrome
term used to describe a group of symptoms caused by myocardial ischemia.
Angina Pectoris
when for a brief time, heart tissues are not getting enough O2 can be the result of a spasm and is often a symptom of atherosclerotic cononary artery disease
rapid beating of the heart 100 beats/min or more
usually a slow beating of the heart 60 beat/min or less
Ventricular tachycardia
rapid heart rhythm usually at a rate of 150 to 200 bpm and the electrical rhythm starts in the ventricle instead of the atrium
Ventricular Fibrillation
Disorganized ineffective quivering or the ventricles, no blood is being pumped
the absence of all heart electrical rhythm
dependent edema
collection of fluid in the part of the body that is closest to the ground
Systolic greater than 140mm Hg or a diastolic greater than 90 mm Hg
Aortic aneurysm
is a weakness in the wall of the aorta, when the aorta dilates the wall ruptures
dissecting aneurysm
occurs when the inner layers of the aorta become separated allowing blood at high pressures to flow between the layers
AMI vs. Dissecting Aneurysm
AMI- gradual, tightness or pressure, increases with time, wax and wane, substernal, equal peripheral pulse
Dissecting Aneurysm- abrupt, sharp or tearing, does not abate, pain can radiate between the shoulder blades, peripheral BP discrepancy.
Rules for Aspirin
Dose: 2 (160 mg) to 4 (324 mg) oral and chewed.
Verify patient is not allergic and has not issues with internal bleeding. Confirm with medical control. This will prevent clots from forming and getting bigger
Rules for Nitroglycerin
Dose: sublingually and is one .4mg tablet or spray every 5 minutes or up to three doses. It is contraindicated for patients with BP of less than 100 mm Hg , head injury or use of ED drug within 24 hours.Must also reassess the patient BP every 5 min
Monophasic AED
Electrical defibrillator energy is sent in one direction
Biphasic AED
Electrical difibrillator energy is sent in a two directional flow.
Rhythms that can not be shocked
PEA - pulse-less electrical activity and asystole
2 minutes or 5 cycles of CPR
In cardiac arrest what should take place before applying the AED?
60 BPM
If a pacemaker does not function properly as when a battery wheres out the patient may experience syncope in which the pulse is less than
come to a complete stop
Before using an AED in route you must:
Check pulse first and every 30 sec.
If you are transporting a pt. with severe chest pain who become unconscious you should?
Cerebrovascular Accident (CVA)
a stroke, an interruption of blood flow to the brain that results in the loss of brain function
Two types of strokes
Ischemic and Hemorrhagic
Ischemic stroke
most common type of stroke, accounting for more than 80%, usually when blood flow to particular part of the brain is cut off by a blockage (clot) inside a blood vessel.
Hemorrhagic stroke
accounts for 10% to 20% of all strokes and occurs as a result of bleeding inside the brain. The free blood forms a clot which squeezes the brain tissue
a swelling or enlargement of part of an artery resulting from weakening of the arterial wall
lack of muscle coordination
slurred speech
signs and symptoms of a stroke
facial drooping, sudden weakness of numbness in face arm, leg or one side of the body, ataxia, vision loss in one eye, difficulty swallowing, dysarthria, confusion, dizziness
inability to produce or understand speech
Conditions that mimic stoke
hypoglycemia, postictal state, subdural or epidural bleeding
generalized seizure (grand mal)
characterized by unconsciousness and a generalized severe twitching of all the body's muscles that lasts several minutes
partial seizure
simple or complex no always characterized by twitching of muscles and the extremities and may spread slowly from one area of the body to the other.
a warning felt by the patient prior to seizure
tonic-clonic seizure
seizure in which bilateral movement characterized by muscle rigidity and relaxation usually last from 1 to 3 minutes.
status epilepticus
seizures that continue every few minutes without the person regaining consciousness or last longer then 30 minutes
Structural causes of seizures
tumor (benign or cancerous)
infection (brain abscess)
scar tissue from injury
head trauma
Metabolic causes of seizures
abnormal blood chemical values
drug overdose
sudden withdrawl from alcohol
Febrile cause of seizures
sudden high fever
weakness on one side of the body resembling a stroke during the postictal state
Stroke assessment
typically a 3 hour treatment window in which outcomes are greatly improved. Cincinnati stoke scale and Glasgow Coma Scale.
Transient ischemic attack (TIA)
normal processes in the body will break up a blood clot in the brain resulting in a stroke symptons that go away on there own in less than 24 hours.
Cincinnati Stroke scale
facial droop - ask the patient to show teeth or smile
Arm drift - ask patient to close eyes and hold both arms out with palms up
Speech- ask patient to say,"the sky is blue in Cincinnati"
Glasgow Coma Scale
three categories: Eye opening, best verbal response, best motor response.
onset of sign and symptoms
Glasgow Coma Scale
stroke assessment tool
changes on reassessment
Key information to document for a patient who may have had a stroke
Responsible for breaking down starches into sugar in the saliva and the duodenum
produces amylase, bicarbonate, and insulin
solid organ that is part of the lymphatic system and plays a significant role filtration of blood, development of red blood cells and a blood reservoir and also produces antibodies
this organ plays a role in the regulation of acidity and blood pressure
1.5 to 2 liters
this amount of urine forms in normal adults every day from waste extracted and concentrated from the 1,500 liters of blood that circulate through the kidneys daily
membrane that lines the abdominal cavity
acute abdomen
a medical term referring to the sudden onset of abdominal pain, often associate with severe, progressive problems
paralysis or the muscular contractions that normally propel material through the intestine
inflammation of the gallbladder
Parietal Peritoneum
in this layer of peritoneum pain can be identified and localized to a point of irritation
Visceral peritoneum
in this layer of peritoneum pain can be far less localized
referred pain
deep pain or other painful sensations that can be a result of the visceral peritoneum
inflammation of the gallbladder (symptons usually are produced about 30 minutes after a particularly fatty meal)
caused by an obstructing gallstone, alcohol abuse resulting in a inflamed pancreas.
inflammation or infection of the appendix. Pain is initially more generalized and dull and may center in the umbilical region, pain later localizes to the right lower quadrant
this occurs when the lining of the esophagus becomes inflamed by infection or from the acids in the stomach. GURD
esophageal varices
occurs when the amount of pressure within the blood vessels surrounding the esophagus increases. Blood begins to leak out of these portal vessels and dilating the vessels causing them to leak into the esophagus.
Mallory-Weiss Syndrom
vomiting the the principle symptom, the junction between the esophagus and stomach tears.
outcroppings int he intestine turn into pouches allowing bacteria to grow and causing inflammation
when a hernia is incarcerated and its contents become compressed by the surrounding tissue compromising the blood flow
radiating to the genitalia
Where will you find localization of pain for a patient with a kidney stone?
lower abdominal pain
: A bladder infection called cystitis is more common than kidney infection, especially in women. Patients with cystitis usually have:
right lower quadrant
Diverticulitis occurs in which quadrant?
endocrine glands release these chemical messengers inside the body
Medical definition for diabetes
metabolic disorder in which the body's ability to metabolize simple carbohydrates (glucose) is impaired.
a hormone produced by the endocrine glands on the pancreas that enables glucose to enter the cells
type 1 diabetes
patients that do not produce insulin and require daily injections of supplemental synthetic insulin
type 2 diabetes
usually appears later in life, patients produce inadequate amounts of insulin or the insulin produce does not function effectively
frequent and plentiful urination
80 to 120 mg/dL
normal blood glucose amounts
frequent drinking of liquid to satisfy continuous thirst following the loss of excessive amount of body water
excessive eating as a result of cellular "hunger"
when fat is used as a immediate energy source biproducts such as ketones and fatty acids are formed as waste products and are hard for the body to excrete accumulating in the blood
diabetic ketoacidosis (DKA)
signs and symptoms include weakness, nausea, vomiting abdominal pain, and a type of rapid breathing called Kussmaul respirations.
Hyperglycemic crisis (diabetic coma)
kussmaul respiration, dehydration (warm and dry), sweet or fruity odor on the breath, thready pulse, weakness, nausea and vomiting, Polyuria and polydispsia
hypoglycemic crisis (insulin shock)
pale moist clammy skin, diaphoresis, dizziness, headache, altered mental status, combative or anxious, hunger, seizure, fainting or coma.
Oral Glucose dose
one tube 30-grams
the tendency to develop blood clots
kussmaul respiration
deep rapid breath a result of hyperglycemia
histamines and leukotrines
chemicals that both are released by an exaggerated immune response during an allergic reaction
extreme allergic reaction
small areas of generalized itching or burning that appear as multiple, small raised areas on the skin
percentage of people allergic to the venom of the bee hornet, yellow jacket or wasp
Intervention rules with a allergic reaction
Epinephrine and ventilatory support are required for severe reactions milder reactions without respiratory or cardiovascular distress may only require supportive care such as O2
means mimics the sympathetic response like Epinephrine
Properties of Epinephrine
cause the blood vessels to constrict
reverses hypotension and elevates the diastolic pressure
increase heart contractility
and relieve bronchospasms in the lungs
EpiPen dosage
0.3 mg and rated for more than 66lbs
EpiPen Jr. dosage
.15 mg and rated for 33 to 66 lbes
DICE and 6 Rights
What must be done with all patient medications
When can you administer a second dose of Epi?
If the patient's sign and symptoms do not improve after 5 min and the patient has another auto injector consider a second and final dose
Injection of medications such as penicillin may cause an immediate and severe reaction. "Immediate" is described as:
30 sec
Epinephrine can have an effect within:
1 minute
study of toxic of poisonous substances
is any substance whose chemical action can damage body structures or impair body function
substance abuse
the misuse of any substance to produce a desired effect with complications leading to an overdose
At least 20 minutes
Amount of time that a area should be flushed in the case of surface contant poisons
80% of all poisons enter this way
Goal of EMT with the ingestion of a poison
to rapidly remove as much of the poison as possible from the gastrointestinal tract.
Activated Charcoal
comes as a suspension that binds to the poison in the stomach and carries it out of the system
delirium tremens
a syndrome characterized by restlessness, fever, sweating, disorientation, agitation and even seizures
Sign and symptoms of Opiods OD
Pinpoint pupils
sedation or coma
Sign and symptoms of Sympathomimetics OD
Dilated pupils
agitation or seizures
Sign and symptoms of sedative-hypnotics OD
slurred speech
sedation or coma
sign and symptoms of OD with Anticholinergics
dialated pupils
dry skin and mucus membranes
sedation, agitation, seizures, coma
decreased bowel sounds
Mad as a Hatter, Hot as a Hare, Dry as a bone, red as a Beet
Sign and symptoms of OD with Cholinergics
excess defecation or unirnation
muscle fasciculation
pinpoint pupils
excess lacrimation
airway compromise
nausea or vomiting
Examples of Opioids
Heroine, oxycodone
Examples of Sympathomimetics
epinephrine, albuterol, cocaine, meth
examples of sedative-hypnotics
diazepam (valium), secobarbital (Seconal), flunitrazepam (Rohypnol)
Examples of Anticholinergics
Atropine, Jimson Weed
Examples of Cholinergics
Pilocarpine, nerve gas
Psychiatric emergency
when the patient shows agitation or violence or becomes a threat to himself or others.
Psychiatric Disorder
an illness with psychological or behavioral symptoms that may result in impaired functioning.
Organic brain syndrome
temporary or permanent dysfunction of the brain caused by a disturbance in the physical or psychological function of the brain tissue.
Causes of Organic Brain Syndrome
sudden illness, recent trauma to the head, seizure disorders, drug and alcohol abuse, overdose, withdrawal, disease of the brain such as Alzheimers and meningitis
Functional disorder
a disorder in which the abnormal operation of an organ cannot be traced to an obvious change in the actual structure or physiology of the organ or organ system
a state of delusion in which the person is out of touch with reality
agitated delirium
hyperactive irrational behavior with inattentiveness and possible vivid hallucinations, hypertension, tachycardia, diaphoresis and dilated pupils.
When can you use restraints?
these must be ordered by a physician, a court, or a law enforcement officer
Pelvic Inflammatory Disease (PID)
is an infection of the female upper organs of reproduction, specifically the uterus, ovaries and fallopian tubes, occurs almost exclusively in women who are sexually active
common STD usually mild symptoms, including lower abdominal pain, low back pain, nausea, fever pain during intercourse
Bacterial vaginosis
most common afflction of women, increased growth of normal flora that cause inching, burning, pain accompanied by a fish foul-smelling discharge.
may not have any sign or symptoms and often grow more severe in men. 2 -10 days after exposure, painful urination, associated with burning or itching, yellowish or bloody discharge with a foul odor.
4 Basic Functions of a EMT-B
Scene size up
Patient assessment
Federally Administers EMS
Certifies Testing for EMR, EMT, AEMT and Paramedics
National Registry of Emergency Medical Technicians (NREMT) is a non-governmental agency
Medical Director
Physician who authorizes the EMTs in the service to provide medical care in the field
Medical Control
is either off line (indirect) or online (direct) authorizations given by a medical director
Indirect Medical Control
standing orders, training and supervision
Direct Medical Control
direction given over the phone or radio directly from the medical director or designated physician
Continuous Quality Improvements (CQI)
continuous internal and external reviews and audits of all aspects often directed by the medical director.
Three sources of errors for EMS
rule based failure
knowledge based failure
skill based failure
Health Insurance Portability and Accountability Act
National Highway Traffic Safety Administration
Federal source for the EMT curriculum
Scope of EMR
Oral Airway, bag mask, sellick maneuver, Jaw-thrust, head tilt chin lift, Oxygen, nasal cannula, non-rebreathing mask, manual BP
Scope of EMT skill
humidifiers, parital rebreathing mask, venturi mask, automated transport ventilators, oral and nasal airways, manual and auto BP, some medications
Proper Hand washing
simplest yet most effective way to control disease transmission
Gloves & eye protection
minimum standard for all patient care
Personal Protective Equipment (PPE)
Gloves, Gowns, Eye Protection, Mask and Respirators
Exposure to patients blood or bodily fluid
turn patient over to other EMS provider, clean exposed area, if eyes rinse for 20 minutes, talk with physician and exposure report.
General Adaptation Syndrome
three-stage response to prolonged stress (alarm response, stage of reaction and resistance, recovery)
Critical incident stress events
mass-casualty incidents
serious injury or traumatic death of a child
crash with injuries caused by emergency service providers
death or serious injury of a co-worker
Critical incident stress management (CISM)
process developed to address acute stress situations and potentially decrease the likelihood of PTSD
communicable disease
can be spread from person to person or animal to person
infectious disease
can be transmitted by contact (direct or indirect) , are either airborne, food-borne, or vector-borne
Common scene hazards
Hazardous materials
person receiving care must give permission
expressed consent
consent given verbally or otherwise that acknowledges that he or she desires care.
informed consent
permission for treatment given by a competent patient after the potential risks, benefits, and alternatives have been explained
Implied consent
when a patient who is unable to give consent is given treatment under the legal assumption the he or show would want treatment
involuntary consent
patients who are mentally ill, behavioral crisis, developmentally delayed- incompetent and unable to give informed consent (law officials can give consent for this)
forcible restraint
physically preventing an individual from initiating any physical actions. Medical control must authorize this or local law enforcement
Right to refuse treatment
adults how are conscious, alert, and appear to have decision making capacity have the right to deny treatment or withdrawal from any treatment
Advance Directives
Ex. Do Not Resuscitate (DNR). Valid written documentation from a physician giving permission to deny treatment.
Vaild Advance directives
Clear statement of patients medical problem
signature of patent or legal guardian
signature of one or more physicians
expiration date and must be 12 months valid
Initiating Care with the sign of death
absence of DNR and
body is still warm and intact except for case of hypothermia
Definitive Signs of Death
Mortal damage, dependent lividity, rigor mortis, putrefaction
Dependent lividity
blood settling to the lowest point of the body, causing discoloration of the skin
Rigor Mortis
stiffening of body muscles caused by chemical changes within muscle tissue.
Organ donors
individual that has expressed a wish to donate organs, treat in same way that you would treat any other patient
Duty to act
by statue or by function have a responsibility to provide care
failure to prove the same care that a person with similar training would provide
unilateral termination of care by the EMT without the patients consent and with out making provisions to another medical professional with equivalent or higher skills
unlawfully placing a person in fear or immediate bodily harm
unlawfully touching a person
patient autonomy
right for a patient to decide to receive care
factors determining competence
intellect, age, drug impaired, significant pain, language and rational of a patient.
Legal doctrine for negligence
It was Duty
Breach of Duty
Damage was incurred
Action and causation
Good Samaritan law
Statutory provision enacted by states that protect citizens from liability and errors in giving good faith emergency care
Gross negligence
willful or reckless disregard for a duty or standard of care
study of space and how the distance between people affect communication
open ended questions
questions in which the patient needs to provide some level of detail to give an answer.
close ended questions
question with short one word responses. Important when patients are unable to provide long or complete answers
Patient Care Report (PCR)
pre-hospital care report, the legal document used to record all aspects of the care your patient received, from initial dispatch to arrival.
Objective findings
what the observer can notice
subjective findings
what the pt. can tell about themselves
Components of PCR -patient care report
chief complaint
level of consciousness
vital signs
Initial assessment
Patient Demographics
Refusal of Care Documentation
-indicate persuasion to go to hospital
-make sure pt. is informed of decision
-willingness to return
-sign refusal form
standing orders
written documents that have been signed by the EMS system's medical director outlining specific directions
Fowler's Position
semicircular sitting position with head elevated
Trendelenburg's Position
supine position on a incline with their feet higher then their head
shock position
supine position, only lower extremities are elevated 6" to 12" to increase blood flow to the brain.
upper airway
nose, mouth, tounge, jaw, oral cavity, larynx, pharnyx
lower airway
trachea, thyroid cartilage, cricoid cartilage, carnia, bronchi, bonchioles and lungs
simple movement of air between lungs and environment
is the process of gas exchange
passive process in which molecules move from an area with higher concentration to an area of lower concentration
brain stem
controls breathing, contains pH receptors that detect the level of CO2
hypoxic drive
back up system for the CO2 receptors in the brain stem. Areas in the brain, wall of aorta and corotid arteries act as O2 sensors
Hering-Beurer reflex
special stretch receptors in the chest wall which are able to detect if the lungs are too full or too empty.
Adult Male lung capacity
6 liters
Average tidal volume
500 ml
Inspiratory reserve
deepest breath in after a normal breath about 3000ml
expiratory reserve
total exhale after a normal breath - 1200ml
Minute volume
Respiratory Rate X Tidal volume
Adult normal breathing rate
12-20 breaths/min
Child normal breathing rate
15-30 breaths/min
infant normal breathing rate
25-30 breaths/min
Normal Heart Rate
60-100 beats/min
stroke volume
amount of blood moved in one beat of the heart
Cardiac Output
amount of blood circulated in 1 min
Central pulses
Pulse at carotid artery
Pulse at femoral artery
Peripheral pulses
pulse at radial artery
pulse at brachial artery
posterior tibial artery pulse
dorsalis pedis pulse
Adult blood volume
6 liters blood
Child blood volume
2-3 liters of blood
Infant blood volume
300 ml of blood
Blood from veins
blood appears dark blueish red, steady stream
Blood from arteries
blood gushes or spurts and is bright red
Blood from capillaries
blood oozes and clotting takes place 6-10 minutes
Alpha-adrenegic receptors
receptors found in blood vessels stimulates and constricts blood vessels
Beta-adrenegic receptors
receptors found in the heart and lungs
Beta 1 receptors
heart - increase HR, contractility and CO
Beta 2 receptors
lungs- stimulate bronchi in lungs to dialate
Integumentary System (skin)
largest organ in the body
enzymes - digestion
Physiological pH
study of functional changes that occur when a body reacts to a particular disease
body not getting enough O2
increased levels of CO2
Infant age span
1 month to 1 year
Neonatal age span
birth to 1 month
Vitals for neonatals
Pulse 90-180
Breathing - 30-60
BP - 50-70 SPB
Vitals for Infants
Pulse 100-160
Breathing - 25-50
BP - 70-95 SPB
Toddler vitals
Pulse 90-150
Breathing - 20-30
BP - 80-100
Children Vitals
Pulse - 70-120
Breathing 15-20
BP - 80-110
Adult Vitals
Pulse 60-100
Breathing 12-20
BP - 90-140 SPB
moro reflex
startle reflex in neonates
steps of patient assessment
1. Scene size up
2. Primary Assessment
3. History Taking
4. Secondary Assessment
5. Reassessment
Components of Primary Assessment
General impression
Level of consciousness
rapid scan
Patient priority and transport
General impression
initial impression or immediate assessment of patient
tool for assessing the level of consciousness :
Verbal stimuli
Pain stimuli
Common test evaluates patients ability to remember four things:
Person, Place, Time and Event
Glasgow coma scale
rating system that provides baseline data on the patients overall neurological status
Level of Consciousness
Pupils Equal and Round Regular in size and React to light
Primary assessment of airway
breath sounds
rhythm, regular or irregular
quality/character of breathing
depth- tidal volume
wet breath sounds may indicate cardiac failure. Moist crackling
congested breath sounds presense of mucus in lungs. Low pitched, noisy sounds that are most prominent on expiration
brassy , crowing sound that is most prominent on inspiration, indicating airway obstruction
indentations above the clavicles and n the spaces between the ribs with use of the accessory muscles
Pulse Quality
Pulse Rhythm
skin color, temperature and moisture
capillary refill
when the skin is bathed in sweat
sensation or noise caused by fractured bone ends or joints rubbing together
History Taking
chief complaint, all times of assessments and interventions, age, sex, past medical history, patient condition and current health status
Sample history
Signs and symptoms
Past medical history
last oral intake
Events leading up to injury or illness
Provoke or palliation (pain better or worse)
Quality of pain
Radiate - does pain radiate
Severity - scale from 1 to 10
Secondary assessment
to perform a systematic physical examination of the patient, head to toe full body scan or systematic focusing on one area
spontaneous breathing
breathing that occurs with no external help
pertinent negatives
negative finds that warrant no care or interventions
is a noninvasive method that can quickly and efficiently provide information on a patient's ventilatory status
full body scan
systematic head to toe examination that happens in the secondary assessment
paradoxical motion
when only one section of the chest rises on the inspiration while another area of the chest falls
Alveolar Ventilation
subtracting the amount of dead space from the tidal volume
Dead space
portion of the tidal volume that does not reach the alveoli
Minute ventilation
amount of air moved through the lungs in 1 minute minus the dead space
shortness of breath
failure to meet the body's need for oxygen
internal respiration
exchange of oxygen and carbon dioxide between the systemic circulatory and the cells of the body
aerobic metabolism
metabolism in the presence of oxygen
anaerobic metabolism
metabolism that does not require oxygen but will result in less ATP and build of lactic acid
increased amount of carbon dioxide in the blood stream
intrapulmonary shunting
blood entering the lungs from the right side of the heart bypasses the alveoli and returns to the left side of the heart in an unoxygenated state
tension pneumothorax
life-threatening collections of air within the pleural space; volume and pressure have both collapsed the involved lung causing a shift of the mediastinal structures to the other side
lack of spontaneous breathing
respirations that are irregular respiratory patterns in which patient breaths with an increasing rate and depth of resp. followed by period of apnea
Open airway maneuvers
Head tilt-chin lift
Jaw-Trust Maneuver
Contradictions for a Oropharyngeal Airway
conscious patient
any patient who has a intact gag reflex
Contradiction for a Nasopharyngeal Airway
severe head injury with blood draining from the nose
history of fractured nasal bone
Indication for Oropharyngeal Airway
unresponsive pt. without a gag reflex
apeic patient being ventilated with bag-mask
Indication for Nasopharyngeal Airway
semiconscious or unconscious patients with a intact gag reflex
patients who would not tolerate a oropharyngeal airway
Rules for suctioning
never suction the mouth or nose for more than 15 seconds
apply suction in circular motion as you withdraw catheter
nonrebreathing mask
preferred way of giving oxygen in a prehospital setting to patients who are breathing adequately but show signs of hypoxia
nasal cannulas
delivers oxygen directly through the nostrils. Patients who can breath through mouth and may require humidification
bag mask device
oxygen delivery device that should be used when you need to deliver high concentrations of oxygen to patient who are not ventilating adequately 1 squeeze every 5 sec
Continuous Postive Airway (CPAP)
breathing apparatus indicated for patients experiencing respiratory distress who own compensatory mechanisms are not enough to keep up oxygen demand. typically pulmonary edema or obstructive pulmonary disease
Rules for dental applicances
leave dentures in place to provide more structure unless they become loose in which they should be removed
medication that causes stimulation of receptors
medications that bind to a receptor and block other medications
intended effect
therapeutic effect
reasons or conditions for which a particular med is given
situations when you should not give a medication
Unintended effects
effects that are undesirable but pose no risk to the patient
Untowards effects
effects that can be harmful to the patient
Routes of Administration
PR-per rectum
PO -oral
IV - intravenous
SC - sub cutaneous
IM - intramuscular
SL - sublingual
IN - intranasal
Six rights
Right Patient
Right med
Right dose
Right route
Right Time
Right documentation
Three types of medication EMT can administer
peer-assisted medication
patient-assisted medication
EMT-administered meds
Rules for Activated Charcoal
med not given to anyone with alter state of consciousness or who have ingested an acid or alkali or petroleum product
Rules for Oral glucose
med not given to anyone with altered state of consciousness
Rules for Aspirin
med given during potential heart-attack
med not given to children, or hypersensitivity, liver damage or asthma. (chewed in mouth)
Rules for Nitroglycerin
if erectile dysfunction med taken with 24 hours, systolic BP less than 100, HR has to be between (50-100), 3 does every 5 min. 81 mg.
Rules for Epinephrine
Med not given in persons with hypertension, hypothermia or risk or myocardial infarction.