472 terms

EMT

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Medical director
main contact between EMT and hospitals and medical community; responsible for development and approval or protocols
Online contact
direct; over the phone or radio with director or physician
offline contact
standing orders and protocols
QI program
quality improvement program
CQI
continuous quality improvement; internal and external reviews and audits of all aspects of an EMS call (run reviews, data collection, and reporting); positive feedback is given to reinforce the EMT's strengths and validate the quality of patient care
CISM
Critical Incident Stress Management; when stress affects a worker during an incident , peers defuse and discuss what happened together on scene; most common
CISD
Critical Incident Stress Debriefing ; severe events are discussed within teams; peer driven process; confidential; after a major incident; conducted 24-72 hours after
direct contact
physical touching; transferring of infection from person to person
indirect contact
transmission of a disease by any medium between the host and the infected person (touching surfaces)
Hepatitis
inflammation of the liver; jaundice, fatigue; two kinds : Hep A & Hep B
Hep A
can contract through contaminated food or drink
Hep B
transmitted through contact with the blood or other bodily fluids of an infected person
Meningitis
inflammation of the brain and spinal cord membranes (meninges); caused by various infections or pathogens
signs and symptoms of meningitis
pain in the back, muscles, stiff neck, headache , fever , nausea or vomiting; blotchy or red rashes, AMS, tachypnea, tachycardia
Carbon Monoxide
major cause of fires; blocks ability of hemoglobin to carry oxygen to your bodies tissues and organs
Rescuing a pt from water rules
reach, throw, row, then go
Red placard
flammable
orange placard
explosive or blasting agent
half yellow half white placard
radioactive agents
black placard
corrosive agents
Scope of practice
the set of legal and ethical considerations that define the job of the EMT
Duty to act
A legal obligation to respond to every call for help while on duty and in your jurisdiction , whether you are paid for your services or not
The Medical Practices Act
describes the minimum qualifications of those who may engage in emergency medical care and establishes a means of certification
Advance Directives
pt has right to refuse resuscitative efforts (DNR)
HIPAA
Health Insurance Portability and Accountability Act of 1996 ; for EMT's primarily focuses on pt confidentiality
Battery
unlawfully touching another person without his or her consent
Assault
instilling fear into another person, but does not involve actually touching him or her
Negligance
when the EMT fails to act as another prudent EMT would have acted in teh same or similar situation
Abandonment
when EMT terminates pt care without the pt's consent or transfers care of a pt to a provider of lesser training
Actual consent
aka expressed consent; when the pt asks for your help outright; also includes nonverbal gestures (extending the arm to allow you to take BP)
Informed consent
explaining your proposed treatment to the pt, including the benefits and risks
Implied consent
treating an unresponsive pt or minor child (when parents are not present) based on the assumption that the pt would consent to emergency treatment
Rule of Lifting
---Keep back in a straight , upright position & lift without twisting the back (keep it locked)
---Spread legs about shoulder width apart (about 15 inches)
---bring upper body down by bending legs and knees, not waist
---palms are upright with thumbs extending up
---keep weight you are lifting as close to your body as possible (keep arms 15-20 iinches in front of torso)
---avoid hyperextending
Rapid Extrication Technique
use for pts with AMS, inadequate breathing, or shock (hypoperfusion)
Bariatrics
the branch of medicine that deals with the study and treatment of obesity; call for additiional help; never attempt to carry if you cannot
Prone position
face down
septum
divides left and right side of heart
Vasodilation
increases blood flow with a decrease in vascular resistance , causing a decrease in BP
Vasoconstriction
decreases blood flow with an increase in vascular resistance, causing an increase in BP
Coronary arteries
supply blood to the heart; located just above the aortic valve
Arteries--> veins
arteries--> arterioles--> capillaries--> venuoles --> viens

--- capillaries are the sight of oxygen and CO2 exchange
Ischemia/ Acute Coronary Syndrome (ACS)
insufficient blood supply which leads to insufficient oxygen and nutrients (blood flow to the heart is cut off); heart is deprived of oxygen;

---presents with chest pain or discomfort, diaphoresis, anxiety
Atherosclerosis
plaque and calcium build up; can block the artery , thus block blood flow; usually causes ACS
Arteriosclerosis
stiffening or hardening of the arterial wall; arteries becomes less elastic and more narrowed (BP rises) when you get older
Aneurysm
blockage forced outward, stretching vessel and causing a bubble or possibly even a rupture
Aortic dissection
when inner layers of the aorta become separated, allowing blood to flow between the layers at high pressure
Hemophilia
a condition in which the pt lacks one or more of the blood's clotting factors
Cardiac Ischemia
lack of blood flow and oxygen to the heart muscle; happens when an artery becomes narrowed or blocked for a short time, preventing oxygen-rich blood from reaching the heart
ECG/EKG reading
P wave= SA node
QRS wave= ventricular contractions (pumps)
T wave= repolarization of heart (refills)
myocardial infarction
heart attack; cells die due to lack of blood flow and oxygen; dead cells can cause blockages; cells will die quickly
S&S of MI
---sudden onset of weakness, nausea, and sweating (diaphoresis)
---chest pain that is crushing or squeezing
---arrhythmia
---SOB
--death
Angina Pectoris
heart tissue is deprived of oxygen ; pain is crushing; usually lasts from 3-8 minutes; disappears with rest and a supply of oxygen; doesn't lead to death or permanent heart damage; if untreated it can lead to MI
S&S of acute MI
---fast , irregular pulse
---low BP
--- pt appears frightened
---may have nausea, vomiting, diaphoresis
---skin appears ashen grey or cyanotic due to lack of blood flow in circulation
Other S&S of acute MI
cardiogenic shock
CHF
pulmonary edema
dependent edema (peripheral edema)
Stable Angina
relieved after rest or oxygen
Unstable angina
pain does not disappear
Differences between MI and angina
---MI may not be caused by exertion
---MI does not resolve in a few minutes ( lasts from 30 min to hours)
---MI may not be relieved by rest or NTG
Position of comfort for cardiac pts
semisitting (Semi-Fowler's) position
cardiogenic shock
shock is present when tissues do not get oxygen; caused by MI
CHF
occurs anytime after MI; left ventricle damage; lungs become congested with blood (hear crackles and pt eventually coughs up blood); decreased cardiac output ; low BP
Pulmonary edema
pink frothy sputum; fluid in lungs (blood); left sided CHF (left side of the heart cannot pump enough blood to the body; backs up in veins that take blood through the lungs; as pressure in these vessels increase, fluid fills up in alveoli sacs)
Dependent edema
increase in extracellular fluid localized in a dependent area, such as the leg; characterized by swelling; right sided CHF
Peripheral Edema
swollen ankles or legs; may be a result of right-sided heart failure since fluid cannot be pumped to the lungs at an efficient rate. In right-sided heart failure, fluid backs up in the veins, leaks out of capillaries and accumulates in tissues.
Interventions with Chest pain
---low dose "baby" aspirin
---NTG
Low dose "baby" aspirin
325mg ; aka ASA; prevents clots from forming; if pt meets criteria for both aspirin and NTG, do aspirin first then NTG
NTG
nitroglycerin; works within 5 minutes to relieve pain (faster than aspirin); can take up to 3 doses; can be a small white pill, a spray, or a patch on the skin; vasodilator (lowers BP) ; take the pt's BP before and after each dose; relaxes muscular walls of arteries and veins'
Dosage of NTG
.4mg =1 dose (3 pills); ~.13 per pill
Side effects of NTG
low BP, sudden headache; burning sensation under the tongue, bitter taste in the mouth
Contraindications of NTG
--pts with head injuries or intracranial bleeding or pts who have taken more than 3 doses; or pts who are not prescribed NTG
-- pts with less than 100 systolic pressure
---pts who are taking erectile medications (Viagra, Levitra, Cialis)
Stroke volume
the amount of blood pumped out of the heart per beat
Residual Volume (capacity)
amount of blood the heart is able to hold
Cardiac Output
amount of blood ejected from the left ventricle per minute
Angioplasty
balloon in the coronary artery
AED
Automated External Defribrillator; delivers monophasic (energy in one direction) or biphasic (energy in two directions) shock; pts must be pulseless and apneic (not breathing), and unresponsive; analyzes and detects shockable rhythms ; never place an AED over a pacemaker
Shockable rhythms for AED
V-Fib, pulseless V-tach
AICD
Automated Implantable Cardioverter-Defribrillator ; attaches to the heart; delivers low voltage; dont place an AED over an AICD
Glasgow Coma Score (GCS)
assesses three neurologic paramters:
---eye opening
---verbal response
---motor response
Cerebrovascular Accident (CVA)
aka stroke; blood flow to the brain is cut off ; 4 kinds of causes:
---Thrombosis
---Arterial rupture
---Cerebral embolism
---Embolic

2 kinds of strokes:
---Hemorrhagic
---Ischemic
Thrombosis
clotting in a cerebral artery or vein (thrombus); can be a clotting anywhere (cerebral is just an example)
Arterial rupture
rupture of a cerebral artery
Cerebral embolism
obstruction of a cerebral artery by a clot formed elsewhere and traveled to the brain
Embolic
A blockage of blood supply to part of the brain caused by a clot or debris (embolus) that traveled from elsewhere from the body; cerebral embolism is a kind of embolus
Hemorrhagic stroke
intracerebral or subarachnoid; occurs as result of bleeding inside the brain; pts have a sudden onset of a severe headache; blood forms a clot that squeezes brain tissues; high BP is a risk factor; may be caused by an aneurysm
Aneurysm
swelling or enlargement of an artery caused by the weakening of the wall ; can cause pts to complain of "the worst headache of my life"
Ischemic stroke
embolic and thrombotic; blood flow to a particular part of the brain is cut off by blockage inside a vessel; athersclorosis is often the cause; pts may experience a range of symptoms depending on location of blockage
Transient Ischemic Attack (TIA)
stroke symptoms go away in less than 24 hours because normal processes in teh body break up teh clot; every TIA is an emergency, because the TIA may be a warning sign of a larger, permanent stroke is about to occur
S&S of stroke
slow pulse
irregular resp
high BP
AMS
weakness
paralysis on one side of the body
facial droop
slurring of speech
Cushing's triad
S&S of stroke in left hemisphere
---may not be able to speak or understand speech
---may understand questions but be unable to produce sounds to answer
S&S of stroke in right hemisphere
---trouble moving the muscles on the left side of the body
---speech may be slurred
---pt may not be aware of the problem
S&S of hemorrhagic stroke
pt may have very high BP and may complain of a severe headache & ICP
Interventions of stroke pts
depends on assessment;
---fibrinolytic therapy
Fibrinolytic therapy
drugs that break up cerebral artery clots ; may reverse stroke symptoms or stop the stroke if given within 2 or 3 hours of onset of symptoms
Cincinnati Stroke Scale
a system used to diagnose a potential stroke ; assesses:
---facial droop
---arm drift
---speech
Seizure
unconsciousness and generalized skeletal muscle contractions (tonic-clonic); brief lapse of attention; use up a lot of oxygen (can cause the pt to be hypoxic)
S&S of seizure
may occur on only one side of body
loss of consciousness
chaotic muscle movement and tone
apnea
tonic phase (person stiffens up and loses consciousness , causing them to fall to the ground , eyes roll to the back of their head as back arches backwards and muscles contract)
tonic -clonic phase (bilateral movement ; lasting 1-3 minutes, tachycardia and salivation)
Causes of Seizures
high fevers (in children)
structural problems in brain
chemical or metabolic problems
Febrile Seizure
seizures caused by high fevers; most common in children from ages 6 months to 6 years
Interventions with Febrile Seizures
attempt to lower child's temp by removing his or her clothing and cooling the child with tepid water
Posticital phase
pts after the tonic-clonic phase ; muscles relax and breathing becomes labored; lethargy and confusion; pt may be combative
Causes of AMS
hypoglycemia
unrecognized heart injury
severe alcohol intoxication
psychological problems
complications from medications
infections
drug overdose or poisoning
Cushing's Triad
Cushing's reflex is a neurological response to increased intracranial pressure (ICP). Results in:

---hypertension
---bradycardia
---irregular respirations that are fast or slow and rapid or deep
Diabetes Mellitus (DM)
a disorder of glucose metabolism or difficulty in breaking down carbs, fats, and prts; lack of insulin or ineffective action of insulin; Two types:

---Type I
---TypeII

Three main symptoms of DM (Hyperglycemia) (3 P's):
---polyuria
---polydipsia
---polyphagia
Insulin
produced by pancreas; a fast acting drug that rapidly causes glucose to exit the bloodstream and enter the cell
---low insulin = high blood sugar level
---high insulin= low blood sugar level
Type I DM
pts do not produce enough or any insulin; pts require injections of insulin; autoimmune problem; most common in children and younger adults
Type II DM
usually appears later in life; pts produce inadequate amounts of insulin, or insulin does not function properly ; most pts treated with diet, exercise; easier to regulate
Glucose
natural sugar that is very important for the body; used for energy; normal level in blood = 80-120 mg/dL; moderate hypoglycemia 60-80 ; <60 life threatening; >140 hyperglycemic
Polyuria
frequent and plentiful urination; high glucose levels causes high levels of this glucose to be excreted into the urine
Polydipsia
frequent drinking of liquid (excessive thirst); follows polyuria because a lot of liquid is leaving the body
Polyphagia
excessive eating /hunger; caused by DKA;
DKA
Diabetic ketoacidsosis; the form of acidosis seen in uncontrolled diabetes; shortage of insulin; in response, the body switches to burning fatty acids and producing acidic ketone bodies taht cause most of the symptoms and complications; associated more with Type I diabetes; causes the fruity breath
Acidosis
when ketones and fatty acids accumluate in the blood and tissue
Kussmaul respirations
deep, rapid breathing with ketoacidosis
Hyperglycemia
a slow onset, a state in which the blood glucose levels is above normal; requires more management to correct
Hypoglycemia
a rapid onset; a state in which the blood glucose level is below normal; can usually be treated with glucose
S&S of Diabetic Coma (Hyperglycemia)
Kussmaul respirations
dehydration
warm, dry skin (from dehydration)
rapid, weak pulse
normal or slightly low BP
varying degrees of unresponsiveness
3 P's
S&S of Insulin Shock (hypoglycemia)
normal or rapid resp
pale, moist, skin
diaphoresis (sweating)
dizziness, headache
rapid pulse
normal or low BP
AMS (higher risk for losing gag reflex); place pt in recovery postion (lateral recumbent) and have suction ready
hunger
seizure, fainting, or coma
weakness on one side of the body
recovery position
lateral recumbent; if the pt is unconscious but is breathing adequately on their own and have no other life threatening injuries, they should be placed in this position to keep the airway open and clear
umbilical cord
attaches fetus to placenta; carries essential nutrients and such to fetus ; contains two arteries and one vein ; vein supplies fetus with oxygenated nutrient rich blood from placenta; fetal heart pumps deoxygenated nutrient depleted blood through umbilical arteries back to the placenta
Full term pregnancy
37-42 weeks (average is 40 weeks); before 37 weeks is considered premature
Stages of Birth
1) the time of onset of true labor contractions (contractions of the uterus) until the cervix is completely dilated to 10cm ; crowning represents the end of this stage (baby's head)

2) the period after the cervix is dilated to 10cm until the baby is delivered

3) begins with the delivery of the baby and until the delivery of the placenta
perineum
space between vagina and anus (bulges during labor)
Preeclampsia
typically develops after 20th week of gestation; it most commonly occurs in primigravida (first time pregnancy) women; characterized by a headache, visual distrubances, edema to hands and feet, anxiety, and hypertension; can lead to eclampisa
eclampsia
seizures that occur during a woman's pregnancy or shortly after giving birth due to high BP
Gestational diabetes
a condition in which the pregnancy hormones estrogen and progesterone impair the effects of insulin (insulin resistance); increase in blood glucose level
Supine hypotensive syndrome
a condition in which the pregnant uterus compresses the inferior vena cava and reduces cardiac output; characterized by pallor , bradycardia, sweating, nausea, low BP, and dizziness and occurs when pregnant woman lies on her back ; WHY ALL PREGNANT WOMAN MUST BE TRANSPORTED ON THEIR SIDE (left lateral recumbant) ; if there is a spinal injury place towel on lower back to prevent this syndrome
Ectopic pregnancy
when egg plants outside of the uterus
Placenta abrupta
placenta detaches from the uteran wall
placenta previa
when placenta covers the opening in the mother's cervix
Steps of Child Birth
--- support the head as it emerges; place gloved hands over bony parts of the head and exert very gentle pressure
---suction mouth than nose
---feel at neck for cord (slip cord genetly over head or shoulder one time)
---support upper body as teh shoulders deliver; do not pull on infant
---support torso
---grab baby's feet as it delivers
---keep neck in neutral position to keep airway open
---place baby on side with head slighty lower than rest of teh body
---use warm blanket
---keep the infant at teh same level as the mother's vagina until the cord is cut
---wrap teh placenta and cord in a towel and place in plaastic bag ; take to the hospital with you
---place a sterile pad over vagina
---treat any laceration, abrasions, and tears with moist sterile compresses
---treat for shock (trendelenburg position with oxygen and warmth)
Newborns
---breathe 15-20 seconds after birth
---if not, flick the soles of the feet or rub the baby's back
---if not, begin rususcitation efforts (ventilate at rate of 40-60 breaths/min)
---take APGAR score
APGAR score
appearance, pulse, grimace (flick a finger or bottom of baby's foot), activity, and respiration; should be taken 1-5 minutes after birth ; the average score is 7 ; measure pulse on cord or brachial artery
Meconium
the dark green substance forming the first feces of a newborn infant
Breech Delivery
buttox comes out first
Limb presentation
single arm or leg; must be delivered through c-section; transport immediately; cover baby with towel
Prolapsed cord
cord comes out before baby; life threatening; transport immediately; dont push cord back in; place mother on board with hips elevated; insert sterile glove and gently push babys head away from cord; wrap sterile towel with saline around vagina area
excessive bleeding after birth
massage uterus
spina bifida
portion of the spinal cord pretrudes outside of the vertebrae of the newborn in the lumbar area; cover open area with sterile moist compress after birth
abortion/miscarriage
before 24 weeks
addicted mother
ex: fetal alcohol syndrome
premature infant
before 37 weeks/8 1/2 months
fetal demise
infant died in uterus before birth (still birth)
Braxton Hicks Contractions
alleviation of pain with movement or changing positions; occurs during 6-12 weeks of pregnancy ; muscles of the uterus tighten and contract; aka "practice contractions" because they are preparation for the real event and allow to practice breathing exercises ; described as irregular in intensity, infrequent, unpredictable, non rhythmic , do not increase in intensity or frequency
subcutaneous emphysema
air leakage into the soft tissue
avulsion
a soft tissue injury in which a portion of the skin is torn away, leaving a flap of skin
laceration
jagged soft tissue injury that can be caused by glass or other sharp object
abrasion
scraping away of the epidermis, causing oozing of serous fluid from capillary bed
incision
similar to laceration, but has smooth edges; scalpels or knives are examples of instruments that could make an incision
Closed soft tissue injury care
RICE= rest, ice or cold pack to slow bleeding, compression over the site, elevation, splinting ex: hematoma (collection of fluid under the skin when larger blood vessels are ruptured; ex: blood blister), ecchymosis (bruising when small blood vessels are damaged, blood seeps into soft tissues), edema , etc.
Cyanosis
a blue or purple discoloration of the skin and signifies a low content of oxygen in the blood
Mottling
when the skin takes on blotched, purple appearance and is a sign of shock (hypoperfusion)
Open soft tissue injury care
apply a dry sterile dressing over the wound; apply pressure; splint to stabilize, be alert for signs of shock
abdominal wounds care
do not touch or move exposed organs ; cover with sterile gauze moistened with sterile saline (keep it warm); transport immediately with knees flexed (if no spinal injury) to relieve pressure on the abdomen
Neck injury care
prevent air embolism by covering the wound with an occlusive dressing; apply pressure without compressing both carotid vessels at the same time
First degree burn
top layer of skin is red but does not blister (sun burn) ; painful with touch
Partial thickness (second degree)
blistering, moist, some white, intense pain, some thickening of the skin
Full thickness (third degree)
involves all layers of skin, dry and leathery, white or dark brown; hard to the touch; clotted blood vessels or tissue are visible; may have no feeling; extremely painful
The Rule of Nines
measures how much of the body in percentage was burned ; different for infants/ children and adults
Care for burn victims
---move pt away from area and remove any smoldering clothes or jewelry
---immerse the burnt area in cool, sterile water or saline or cover with a clean, wet, cool dressing
---provide oxygen
---continually asses the airway
---cover with a dry sterile dressing (the burn)
---treat for shock
---keep patient warm
---provide prompt transport
Care for chemical burns
---wear appropriate chemical resistant gloves and eye protection; do not get the chemical on yourself or you uniform
---remove chemical from the patient
---brush off dry chemicals
---remove pts clothes
---flush with large amounts of water for 15-20 minutes
---if in eyelid, hold eyelid open while flooding eye
Fracture
a complete or partial break in a bone; external force
closed fracture
under skin
open fracture
above skin; bone lacerating skin
non-displaced fracture
hairline fracture; simple crack in the bone
displaced fracture
deformity of the bone; obvious
crepitus
a grating sound or sensation produced by friction between bone and cartilage or the fractured parts of a bone
distraction or stretching of the vertebrae or spinal cord
injury to the cervical spine following a hanging
subluxation
partial or incomplete dislocation
hyperextension
common in patients who strike their head on the windshield during a MVA
Axial loading
spinal column is compressed vertically; ex: diving head first into shallow water, lumbar spine injuries after a fall from a significant height in which pt lands feet first or head first
sprain
joint injury; partial or temporary dislocation of bone ends; stretching of ligaments
strain
muscle pull; stretching or tearing of muscle; swelling or bruising
Compartment syndrome
A painful and dangerous condition caused by pressure buildup from internal bleeding or swelling of tissues; elevated pressure within a fascial compartment ; most common in fractured tibia or forearm of children; pain out of proportion to injury; must be managed surgically
Care for fractures or other wounds
cold packs (RICE) if closed ; dry sterile dressing for open ; splint all fractures and wounds and compress and elevate
Sebum
liquid secreted by sweat glands to keep the skin hydrated and moist
Ventilation
ability to move air in and out of the chest; exchange of air between the lungs and the environment
Respiration
the exchange of oxygen and CO2 between the alveoli sacs and capillaries
Alveoli Sacs
location of CO2 and O exchange during breathing; they line against the pulmonary vessels and capillaries
upper airway
nose, mouth, pharynx (back of throat), throat, epiglottis, larynx above vocal chords
lower airway
larynx (below vocal chords), trachea, bronchi
Respiration Rate
Adult: 12-20 breaths/min
Children: 15-30
Infant: 25-50
Pleura
membrane that covers the lungs; visceral (inner most layer), parietal pleura layer (outermost layer), plueral cavity in between
inhalation
air is taken into the lungs; intercostal muscles and diaphragm contract (pressure inside chest decreases); the active, muscular part of breathing
Tidal Volume
amount of air in milliliters moved into or out of the lungs during a breath (avg for male is 500 ml); greatest TV = one rescuer mouth to mask
Minute Volume
amount of air inhaled or exhaled per minute (tidal volume x resp rate)
respiratory rate
number of breaths per minute
exhalation
air leaves the lungs through trachea ; muscles relax and pressure inside the chest increases; passive process that does not require any muscular effort
nerves for diaphragm
phrenic nerves; C3,C4,C5 keep the diaphragm alive!!
Closed injury
skin is not broken, usually caused by blunt trauma; can result in internal bleeding or hemorrhaging
open injury
chest wall is penetrated by an object
S&S of chest injury
---hemoptysis (coughing up blood)
---crepitus(grating, crackling, popping sounds in the lung); indicates air in the subcutaneous tissue
---rapid, weak pulse
---low BP
---cyanosis around lips or fingernails
---change in normal breathing
Dyspnea
irregular breathing; difficulty breathing; the feeling of SOB; one of the most common complaints encountered in the field
Causes of Dyspnea
---airway obstruction
---damage to chest wall
---improper chest expansion due to loss of normal control of breathing
---lung compression because of accumulated blood or air in the chest cavity
---upper or lower airway infection
---pneumonia
Pneumothorax
air in the pleural space; collapsed lung; causes hypoxia; can hear a suctioning sound; associated with difficulty breathing and unilaterally decreased or absent breath sounds ; jugular veins are not collapsed
Spontaneous pneumothorax
born with weakened areas of the lungs; they rupture spontaneously without trauma; air escapes into the pleural cavity and causes the lung to collapse;may occur with activity or coughing episode
S&S of Spontaneous pneumothorax
SOB
chest pain
sharp stabbing pain on one side when inhaling or exhaling
no sound on one side when pt is breathing
Tension pneumothorax
when there is significant air in pleural space; collapse of lung; prevents blood from returning from vena cava to heart; more common with blunt injury; remove dressing to relieve pressure, you may here a rush of air leave the area; JUGULAR VEIN DISTENTION (high blood flow)
Hemothorax
blood collects in plerual space and compresses the lung resulting in shock and respiratory compromise; signs of shock and decreased breath sounds on one side of the chest; one cause of pulmonary edema (cardiogenic cause)
S&S of hemothorax
---collapsed jugular veins
---labored breathing
---decreased or absent breathing sounds on one side of injury
Rib fractures
common in older pts; can lacerate the surface of the lung and can cause pneumothorax or hemothorax; can cause crepitus; pts breathe rapidly and shallowly
Flail chest
two or more ribs are fractured in more than one place; chest is displaced from the rib cage and the chest wall moves opposite direction; causes severe breathing problems and is very painful ; provide oxygen or positive pressure ventilation
pulmonary contusion
bruising of the lung from chest trauma ; damage to vessels can cause the alveoli to fill with blood, leaving pt hypoxic; can cause hemothorax
traumatic asphyxia
sudden severe compression in chest; driver who hits steering wheel; aka Perthe's syndrome; intense compression of the thoracic cavity; causes venous back flow from the right side of the heart into the veins of the neck and brain
Pericardial tamponade
compression of the heart caused by fluid, blood, clots, or gas collectiing in the sac surrounding the heart (pericardium); usually caused by penetrating chest trauma ; soft and faint heart tones, low BP, JUGULAR VEIN DISTENTION , BP decreases of inadequate filling of the heart during diastolic phase
paradoxical motion
diaphragm moves opposite to the normal directions of its movement: inhalation it relaxes , moves downward and exhalation it contracts, moves upward); stabalize this movement with large bulky dressing, treat for shock, provide rapid transport; caused by flail chest
Peritonitis
inflammation of the membrane lining of the abdominal wall and covering the abdominal organs; pain , tenderness, fever, nausea, and vomitting
Organs in each quadrant
The Left Upper Quadrant, or LUQ, contains similar organs to the RUQ. In the LUQ, you'll find the left portion of the liver, the majority of the stomach, the pancreas, the left kidney, the spleen, portions of the colon, and again, parts of the small intestine.
S&S of abdominal injury
--pain
--tachycardia
--later signs of shock (low BP, pale, cool, moist skin, changes in mental status)
--distention (may impact breathing)
--bruises
--firmness on palpation (gaurding)
--increased pulse, resp, shallow resp
--tenderness
--difficulty with movement
--restlessness and wanting to pull his or her knees up (hurts to straighten their legs)
Abdominal evisceration
visible organs outside of the abdominal cavity; don't replace it, cover with sterile, moist gauze with saline solution and secure with sterile dressing; some protocols ask fro occlusive dressing; keep organ WARM AND MOIST!
Guarding
tensing of the abdominal wall muscles to guard inflamed organs
Pediatric abdominal injury
liver and spleen are much bigger and are more easily damaged
genitalia injury
cover with a moist dressing
Left flank pain
indicates injury to the kidney
melena
passage of dark, tarry stools
Allergic reaction
exaggerated immune response to any substance
anaphylaxis
an extreme allergic reaction that is usually life threatening and typically involves multiple organ systems
S&S of anaphylaxis
---itching and burning
---wheezing
---high pitched breathing (dyspnea)
---hives (urticaria)
---anxiety
---headache
---abdominal cramps
---chest tightness and coughing
---hoarseness (upper airway swelling; most significant finding; treat right away)
---swelling of lips and tongue
---vasodilation (low BP)
---bronchoconstriction (tachypnea); bronchospasm
Diphenhydramine (Benadryl)
blocks the release of histamines
Histamine
an amine that is produced as part of a local immune response to cause inflammation.; lowers BP and can cause wheezing and swelling of the bronchioles
Antihistamines
type of pharmaceutical drug that opposes the activity of histamine receptors in the body; work slowly, from several miinutes to an hour
S&S of insect stings
---sudden pain
---swelling
---localized heat
---redness
---itching
---wheals (well defined, elevated area on the skin)
antiseptic
antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis (complication of an infection), or putrefaction
systemic vascular collapse and shock
fast pulse and low BP
Interventions
--epinephrine
--ventilator support
--oxygen
treatment of injury site
cold pack, dont overdo the ice cause it may freeze the site and assist with epi ; cold pack reduces swelling
Epinephrine
secreted by adrenal glands (adrenaline); works rapidly and is a vasoconstrictor to increase BP and HR ; bronchodilator; antidote to histamines
Dosage of Epi
Adults= .3 mg
Child/infant= .15 mg
S&S of epi injection
tachycardia
anxiety
nervousness
palpitations (pts BP will rise significantly)
Poison entry way
--inhalation
--absorption
--surface contact
--ingestion
--injection
S&S of inhalation
--burning eyes
--sore throat
--cough
--chest pain
--hoarseness (upper airway swelling)
--wheezing
--resp. distress
--dizziness
--confusin
--headache
--stridor
--seizures
--AMS
S&S of absorption
--burns
--itching or irritation
--redness of the skin
--typical odors of substance
--liquid or powder on the skin
Intervention for Ingested Posions
activated charcoal
Activated Charcoal
removes poison from GI tract; binds to poison in the stomach and carries it out of the stomach; take vitals before and after dosage ; be prepared for vomiting after ingestion
Dosage of activated charcoal
usual dose is 1g/kg of body weight

Adult= 25-50g
Child/ infant= 12.5-25 g
Contraindications of activated charcoal
--pts who have ingested an acid or alkali (ex: drain cleaner) or a petroleum product (gasoline)
--pts with a decreased LOC and cannot protect their own airway, or who are unable to swallow
S&S of injection of poison
--weakness
--dizziness
--fever and chills
--diaphoresis
--increased body temp
--unresponsiveness
--resp depression
Specific poisons
--alcohol
--narcotics
--sedative-hypnotics
--abused inhalants
--sympathomimetics (stimulants)
--marijuana
--hallucinogens
--anticholinergics
--cholinergic
--miscellaneous drugs
alcohol
most common; CNS depressant; hypnotic (induces sleep); causes aggressive and uncoordinated behavior
Narcotics (opioids)
demarol, percaset, oxycottin, heroine, morphine; CNS depressants; pinpoint pupils; appear sedated; antagonists can reverse these affects
Sedative -hypnotics
CNS depressants; effect LOC (drousy) ; pts have resp distress and may even be in acoma; used as a date rape drug
Abused inhalants
many are CNS depressants; gasoline; can cause seizures; can make heart super sensitive to their own adrenaline (can go into cardiac arrest)
Sumpathomimetics (stimulants)
CNS stimulants; tachycardia, dilated pupils, methenphedamine (causes CNS to release excessive amounts of adrenaline (epi) which increases HR and BP), suppresses appetite , causes anxiety; caffeine is an example; called "uppers"; disorganized behavior and restlessness ; cocaine is another example (taken through nose and causes nose bleeds); can cause cardiac arrhythmias and very high BP and HR

The most common stimulant medications are substituted phenethylamines: amphetamine, methylphenidate (Ritalin, Metadate, Concerta), dexmethylphenidate (Focalin), dextroamphetamine (Dexedrine, Zenzedi), mixed amphetamine salts (Adderall), dextromethamphetamine (Desoxyn) and lisdexamfetamine (Vyvanse)
Marijuana
relaxation and drowsiness; hallucinations with high doses
Hallucinogens
PCP; separate user from reality; "bad trip"
ANticholinergics
block parasympathetic nerves (Benadryl is an example beasue it blocks the CNS from releaasing histamines); tachycardia , dilated pupils, Zoloft is another example; tricyclic overdose may cause arrhythmias
Cholinergic
gases for warfare; salivation and mucous secretion; abnormal HR
Miscellaneous drugs
acetaminophen, some alcohols, other); aspirin posionings are still common ; pts are hypothermic; acetaminophen overdose symptoms don't occur until later (very bad)
Layers of the brain and spinal cord
meninges

1) dura mater
2) arachnoid
3) pia mater
PNS
peripheral nervous system; nerve fibers (sensory and motor); sensory from body to brain and motor from brain to body
CSF
cerebrospinal fluid ; acts as a shock absorber ; when pts have fluid draining from ears or nose , it is CSF and they have a head injury
SNS
somatic nervous system; voluntary
ANS
autonomic nervous system; involuntary; organs; consists of sympathetic and parasympathetic
Sympathetic
fight or flight response; epi is released in stressful situations
Parasympathetic
responsible for stimulation of activities that occur when the body is at rest, especially after eating, including sexual arousal, salivation, lacrimation (tears), urination, digestion and defecation; ex: vessels dilate and sphincters are relaxed
Concussion
temporary loss of alteration of the brains ability to function; unconsciousness, dizziness, weakness, visual changes, nausea; lasts only a short time (depends on the seriousness)
Contusions
aka bruise (ecchysmia) associated bleeding from blood vessels; increase in pressure
Intracranial bleeding
aka subdural hematoma; can cause increase in pressure of the skull (ICP)
Cerebral edema
swelling of the brain ; caused by meningitis
S&S of head injury
---lacerations, contusions, or hematomas
---soft or depressed areas of palpation
---visible fractures or deformities
---bruising around eyes or behind ears
---clear or pink CSF leakage from a wound, nose, or ears
---pupils that do not respond to light
---unequal pupil size
---loss of sensation and or motor function
---unconsciousness
---amnesia
---seizures
---numbness or tingling in extremities
---irregular resp
---dizziness
---visual complaints
---combative or other abnormal behavior
---nausea or vomiting
Spinal Injuries
Compression
hyperextension
flexion
rotation
Compression
occur as a result of a significant fall; axial loading; vertical injury of the spine
Hyperextension
When the spine is forced backwards into an exaggerated arch; most common way children injure their spinal cords;
Hyper flexion
When the spine is forced forwards into a tight curve ; "whiplash" from MVA
Rotation
MVA or other types of trauma ; Often occur alongside a flexion injury, where there is rotation of the spinal column, often in the cervical, lower thoracic and lumbar regions; ligaments are torn; MVA when vehicle is hit from the side, lap seat belts, and motorbike accidents
AVPU scale
a system by which a health care professional can measure and record a pts responsiveness, indicating their LOC
emesis
vomiting
S&S of spinal injuries
---pain in spinal area or extremities
---loss of feeling of function of extremities and other bodily functions
General principles of care for head injury
1) establish adequate airway
2) control bleeding
3) assess LOC and continue to monitor it
Stabalization of the cervical spine
---apply manual stabalization immediately
---assess P, motor function, and sensation in extremities
---assess cervical spine area and neck
---apply a collar
---maintain manual support until pt is secure on backboard
---do not force the head into a neutral, inline position
Helmet removal
if helmet is blocking access to the airway, ALWAYS remove it

---keep constant stabalization of the neck and spine
Metabolism
each cell combines nutrients and oxygen and produces energy and waste products ; every living cell in the body requires oxygen and a means of disposing of waste
Diffusion
a passive process in which molecules move from an area of higher concentration to an area of lower concentration (O moves from alveoli into capillaries cause there are fewer O molecules in the capillaries than in the alveoli; vise versa with CO2)
Primary Respiratory Drive
when levels of CO2 become too high or low, the brain (stem) adjusts breathing accordingly; low O levels in the blood is the drive to stimulate breathing
Medulla Oblongata
detects CO2 and O levels in the bloodstream and determines what changes need to happen in the body; can send nerve impulses to the heart and diaphragm
Hypoxia
the body's tissues and cells are not receiving enough oxygen; pts can die quickly if this condition is not reserved
Hypoxemia
decreased amount of oxygen in arterial blood (untreated and it will lead to hypoxia)
Anoxia
an absence of oxygen to any part of the body
S&S of Hypoxia
---restlessness
---irrability
---high HR (tachycardia) (early sign)
---cyanosis (late sign)
---SOB
---dyspnea; pts may not be able to talk in complete sentences
S&S of inadequate breathing
---resp rate less than 12 or more than 20 breaths per min
---irregular rhythm
---pale, cyanotic, cool or moist (clammy) skin
Cheyne Stokes
often seen in patients who have had a stroke with head injuries; characterized by irregular breathing pattern, increasing rate and depth, followed by a period of apnea
Best position to monitor airway
supine ; lying down
Head-tilt chin lift
for non-critical patients; one hand on forehead and two fingers under chin to lift the head
Jaw thrust maneuver
for trauma pts with suspected head or spinal injury; fingers on each side of jaw grasping it and moving it upward; use head tilt chin lift if jaw thrust does not work on a trauma pt
Oropharyngeal airway
keep tongue from blocking upper airway; easy to suction pharynx if necessary; used with BVM's; used ONLY on pts who are unconscious and without gag reflex ; apneic
Nasopharyngeal airway
better tolerated with pts with gag reflex; never force into place ( can cause nasal bleed);

Contraindications: severe head injury with blood draining from nose; any injuries to the nose
Suctioning
Adults- no more than 15 seconds
children- 10 seconds
infants- 5 seconds
Recovery position/ Lateral Recumbant
used to help maintain a clear airway in a pt that is not injured and is breathing on their own ; prevents aspiration
Patient Assessment
1) scene size-up
2) Initial Assessment
3)Focused History and Physical Exam (OPQRST&SAMPLE)
4)Rapid Physical Exam
5) Baseline Vitals
6)Detailed Physical Examination
Scene size up
--begins with dispatch info
--perform visual inspection of the scene
--look for any hazards to you, bystanders, or the pt
--determine MOI/NOI (talk with pt , family, bystanders)
--determine number of pts and their conditions
--determine any additional resources needed (ALS, fire dept, law enforcement, etc.)
--C-Spine Immobilization if necessary
Initial Assessment
--verbalizes general impression of pt
- assess environment
- consider cc, signs, symptoms
-how does pt look?
-look for MOI/NOI
- note age, race, gender
--determines responsiveness / LOC
- AVPU scale
--evaluate orientation (CAOx4)
-person (who they are)
-place (where they are)
- time (current year, month, day)
- event (what happened; MOI)
-- identify immediate life threats and determines cc
-- ABC's
- check pulse at radial or carotid for adults and children and brachial for infants
-- identifies pt priority and makes transport decision
Pulse Rate
Adults= 60-100
pediatrics the younger the faster
Focused History and Physical Exam
if pt is unresponsive or trauma is so severe, do not perform this. for pts with only one or two injuries and are not rapid transport

--SAMPLE history attempt but if you cannot take after vitals for trauma pts
- signs and symptoms
- allergies
- medications
- past history
- last oral intake
- events leading up to the incident
--OPQRST (medical)
- onset of symptoms/signs
- provocation (does anything you do make it worse?)
- quality (what does the pain feel like?)
- radiates
- severity (0-10)
- Time (when did pain start)
Rapid Physical Exam
head to toe fast exam; for pts with terrible trauma with multiple injuries who need to be transported ASAP
Baseline vital signs
P, Resp, BP
reassess every 5 minutes for critical pts
reassess every 10 minutes for stable pts
Detailed Physical Exam (reassessment)
performed only on stable pts with problems that are not identified earlier ; dont during transport; thorough head to toe examination; reassess vitals and mental status, check interventions
Patient Report Content
---identification
---receiving hospital
---patients age and gender
---patient cc
---brief history of problem
---brief findings
---brief summary of care given
---any changes en route
Pharmacology
the study of medications
Dose
the amount of medication given
Action
the therapeutic effect
Contraindications
reasons not to give a medication
Side effects
any actions other than desired
Generic name
original chemical name
Trade name
brand name
Prescription
distributed to a pt by a pharmacist according to a physician's order
OTC
Over the counter drugs; can be purchased without a prescription
Routes of Administration
-- Sublingual
--Intraosseous
--Subcutaneous
--Transcutaneous
--Per rectum
Sublingual
(SL); under the tongue
Intraosseous
(IO); into the bone; reaches the blood through bone marrow
Subcutaneous
(SC); beneath the skin; between skin and the muscles; absorbed slowly and lasts longer; medications that cannot be taken by mouth; diabetic medications use this route
Transcutaneous
through the skin; ex: nicatene patches
Per Rectum
(PR); frequently used with children; goes into blood stream quickly and effectively ; sometimes given to pts who cannot swallow or are not conscious
Oral glucose
hypoglycemia; between cheek and gum; not for unconscious pts or pts who cannot swallow or do not have a patent airway
Aspirin
prevents clots from forming; contraindication: liver damage, bleeding disorders, GI bleeding, pt is unconscious and can't handle their own airway; pts who cannot swallow; allergic to AKA , asthma, should not be given to children with fever causing illnesses
Administering Medication
4 Rights!!! + Expiration date + Time

1) Right Route (oral, etc.)
2) Right Dose
3) Right Person
4) Right Medication

** pts have a right to not take medication, they just need to sign and they need to be CAOx4**
Dysphagia
difficulty swallowing
Acute pulmonary edema
heart muscle is so injured after MI or other injury; left sided heart failure and fluid builds up in alveoli; usually happens after an MI; dyspnea with rapid shallow respirations and pink sputum from nose or mouth
Hemoptysis
coughing up blood; indicates bleeding within the lungs
Hematemesis
vomiting bright or dark red blood; indicates GI bleeding
Intraabdominal bleeding
presents with signs of shock as well as rigid, bruised, or distended abdomen
COPD
Chronic Obstructive Pulmonary Disease; common lung disease; disruption of airways and alveoli; bronchitis and emphysema are kinds of illnesses brought about by this disease
Bronchitis
inflammation of the lining of bronchial tubes; develops excess mucous
Emphysema
loss of elasticity of the lung tissue; destruction and enlargement of air spaces; pts with this are at higher risk of developing spontaneous pneumothorax
S&S of COPD
--chronic cough
--difficulty expelling air
--rhales
--crackles
--wheezing
--excessive sputum
--air trapped in lungs
-- chest have a barrel like appearance
Asthma
chronic disease that inflames and narrows the bronchioles of the airway
S&S of asthma
--wheezing
--chest tightness
--SOB
--coughing fits
Hyperventilation syndrome
over breathing to the point that levels of CO2 in arterial blood is excessive ; alkalosis
Alkalosis
an excessively alkaline condition of the body fluids or tissues that may cause weakness or cramps
Mechanisms of Heat Loss
-- conduction
--convection
--evaporation
--radiation
--respiration
Conduction
direct contact with source or object (Ex: warm hand touches metal or ice)
Convection
heat is transferred to circulating air (shivering)
Evaporation
sweating
Radiation
the transfer of heat is often between bodies, which may be separated spatially
Respiration
body heat is lost through exhalation and cold air is taken in by inhalation
Hypothermia
when bodies temp drops below normal; core temp falls below 95 degrees (35 degrees celcius ); develops rapidly or gradually; pts with burns, infection, spinal cord injury, hypoglycemia are more prone to this
Mild Hypothermia
(90-95 degrees); pt is usually alert and shivering in an attempt to generate heat; pulse rate and resp. are usually rapid; skin may be flushed (red) but may turn to pale due to bodies constriction of blood vessels at the skin to retain heat, than cyanotic; may have blue lips or fingertips
Severe Hypothermia
(less than 90 degrees); shivering stops and muscular activity decreases; pt becomes lethargic; LOC decreases; BP drops; poor condition and memory loss; reduced or complete loss of sensation of touch, mood changes, and impaired judgment; resp slow; @ 80 degrees or less, all cardiovascular activity may cease; pupil reaction is slow
Management of Cold Exposure
--remove wet clothing
--prevent conduction heat loss
--cover all exposed body parts
--prevent convention heat loss
--remove the pt from the cold environment as quickly as possible
Local Cold Injuries
--Frostnip
--Immersion foot
--Frostbite
Common Site of Cold Injury
--Face
--Hands
--Ears
--Feet
Frostnip and Immersion Foot CAre
-- remove pt from cold, wet environment
--rewarm affected part carefully
--for immersion foot, remove wet shoes, boots, and socks, and rewarm the foot gradually
Frostbite Care
-- remove pt from cold environment
--handle injured part gently
--administer oxygen
--remove wet or constricting clothing
--if early or superficial, splint the extremity
--apply dry, sterile dressings
--if late or deep , remove jewelry from injured part
-- do not break blisters
--do not rub or massage
--do not apply heat
*** if prompt transport is not available in the field for frostbite pts, immerse the frostbitten part in water between 100-105 degrees; keep the frostbitten part in water until it feels warm and sensation returns; cover with dry, sterile dressing
Gangrene
when the blood flow to a large area of tissue is cut off; turns the skin greenish-black color; severe cases of frostbite lead to this
Hyperthermia
when the body produces excess heat (101 or higher); reduction in ability to lose heat; heat cramps; heat exhaustion; heat stroke
Heat Cramps
loss of electrolytes from the cells
Emergency Care of Heat Cramps
--move to cooler environment
--loosen tight clothing
--rest cramping muscles
--replace fluids by mouth
Heat Exhaustion S&S
--dizziness
--weakness
--nausea
--headache
--pale, cold, clammy skin
--dry tongue
--thirst
--vital signs are normal
--body temp is normal or slightly elevated
Emergency Care for heat exhaustion
-- remove excess clothing
--move pt from hot environment
--give oxygen
--encourage pt to lie down and elevate legs
--it pt is alert, encourage him or her to slowly drink up to a liter of water
--transport pt on his or her side
Heat Stroke S&S
-- hot, dry, flushed skin
--skin may be moist or wet at firstt
--body temp may be up to 106 degrees
--AMS
--may become unresponsive very quickly
--pulse weakens
--BP decreases
--may be tachycardiac with increased resp. (ex: running)
Emergency Care Heat Stroke
--move pt out of hot environment
--remove clothing
--administer oxygen
--apply cool pack to the neck, groin, and armpits
--cover pt with wet towels or sheets, or spray pt with cool water and fan
--transport immediately and actively cool the pt
Drowning
death from suffocation after submersion in water; pt swallows a lot of water, causing them to accumulate a laryngospasm
Laryngospasm
a brief spasm of the vocal cords that temporarily makes it difficult to speak or breathe. The onset of vocal cord spasms is usually sudden, and the breathing difficulty can be alarming.
Near Drowning
survival, at least temporarily (24 hours) after suffocation in water
Diving reflex
This causes bradycardia and slowing of the metabolic rate and peripheral vasoconstriction. Blood is diverted from the limbs and all organs but the heart and the brain, creating a heart-brain circuit and allowing the mammal to conserve oxygen. In humans, the mammalian diving reflex is not induced when limbs are introduced to cold water.
Air Embolism
most common in diving injuries; A blockage of blood supply caused by air bubbles in a blood vessel or the heart; can travel to the heart, lungs, or brain
S&S of air embolism
--blotching
--froth at the nose and mouth
--severe pain in the muscles, joints, or abdomen
--dyspnea and/ or chest pain
--dizziness, nausea and vomiting
--dysphagia
--vision disturbances
--paralysis and or coma
--irregular pulse and even cardiac arrest
Diving Emergencies
--Descent
--@ the bottom
--Ascent
--Decompression
Descent emergencies
due to sudden increase on the pressure of the body as they dive deeper; pain is managed by returning to the surface
Emergencies at the bottom
inadequate mixing of oxygen and CO2
Ascent Emergencies
ascending from bottom; air emobolism; happens when diver holds his or her breath during a rapid ascend to the surface
Decompression Emergencies
(the bends); occurs when bubbles of gas obstruct the blood vessels (especially nitrogen gas); severe abdominal pain and joint pain; may occur up to 48 hours following dive; ex: air embolism
Positioning of Patient
if air embolism or decompression sickness, you should position the patient on the left side with the head lower than the body; if there is not spinal injury , turn the pt on the left side to allow draining of the water from the upper airway (lateral recumbant position)
Behavior
what you can see of a persons response to the environment ; his or her actions
Psychiatric emergency
when there is an immediate threat to the person involved or others should be considered this
Geriatric
individuals who are older than 65 years old
The GEMS Diamond
what to assess when treating a geriatric patient :

G= Geriatric
E= environmental assessment
M= medical assessment
S= social assessment
Physiological Changes in Geriatric Patients
Skin
Senses
Resp system
Cardiovascular System
renal system
nervous system
musculoskeletal system
GI system
Skin changes in geriatric pts
thinner, wrinkled, collagen and elastin are lost, layer of fat under the skin becomes thinner, bruising is more common
Senses changes in geriatric pts
pupils lose ability to adjust to light, cataracts (clouding of the lens; vision is cloudy), hearing problems, slowing of peripheral nervous system (slow to react when touching something hot)
Resp system changes in geriatric pts
alveoli enlarged and elastic decreases making it harder to breath; loses ability to contract after inflation, decrease in exchange of oxygen and CO2, low pulse oximetry readings because the sensitivity of chemoreceptors decreases with age; more prone to infections
Cardiovascular system changes in geriatric pts
decreased ability to increase contractions and vessels (decreased ability for the body to compensate for simple injuries), decreased ability of body to respond to keep homeostasis in changed environments; atherosclerosis and arteriosclerosis (hardening and stiffening of the arteries , causing higher BP as you get older)
Renal system changes in geriatric pts
kidney function declines because of the decrease in the number of nephrons , electrolyte disturbances occur because of the low ability of the body to filter it out causes AMS
Nervous system changes in geriatric pts
number of brain cells decrease, brain loses weight, decrease in reflex time and psychomotor skills; IMPORTANT TO COMPARE THESE PTS WITH CURRENT STATUS AND NORMAL STATUS
Musculoskeletal changes in geriatric pts
fractures are more likely because of the decrease in bone density (osteoporosis); hunch back making transport of these pts more challenging
GI system changes in geriatric pts
harder to chew and digest food; slowing of GI tract; difficult to filter our medications and alcohol
Polypharmacy
the use of multiple prescription drugs by one patient, causing the potential for negative effects such as overdosing and drug interaction
Syncope
interruption of blood flow to the brain; common in geriatric pts; should be transported to see what caused the syncope
S&S of heart attack in geriatric pts
--dyspnea
--weak feeling
--syncope
--confusion
--AMS
GI bleeding
Lower GI bleeding= black and coffee grounds looking

Upper GI bleeding= red or dark red
Delirium
inability to focus , think logically or pay attention; memory remains intact ; may be caused by fever, drug, tumors, or withdrawals, can also be caused by metabolic problems; treat for hypoxia , hypovolemia, and hypoglycemia
Dementia
slow onset of loss of cognitive function; takes a few years to develop; considered irreversible; result of many neurological diseases
Alzheimer's Disease
Alzheimer's is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks; Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60 to 80 percent of dementia cases.
Elder Abuse
an action on the part of an older individual's family member, caregiver, or associated person that takes advantage of the older individual's person, property, or emotional state
Vascular access devices (VADs)
central ines, catheters; tunnel under the skin to the vein
Ventricular shunts
CSF shunt; tube that extends from the ventricles of teh brain to the chest and abdomen ,and is designed to drain excess CSF ; can feel it under the skin behind the ear ; complications with obstructed shunts include AMS, increased ICP, and bradycardia and hypertension
Septicemia
toxic products or infectious viruses in blood system that causes sepsis; common in geriatric pts ; pts presents with flushed skin , tachycardia, and increased resp rate
Septic Shock
--fever
--chills
--burning of urination
--hypotension
--AMS
Kinetic Energy
the energy of a moving object is 1/2 mv squared
Potential energy
the product of mass, weight, force of gravity, and height ; injury occurs when potential energy is transformed into kinetic energy; "it isnt the fall that hurts you, but the landing"
MVA collision steps
1) first collision
2) second collision
3) third collision
First collision
vehicle strikes another object
Second Collision
passenger collides with the interior of the vehicle
Third Collision
occupant's internal organs collide with the solid structures of the body ; the most life threatening collision of an MVA
Significant Fall
15 ft or 3 times the patients height
Low energy penetrating trauma
may be caused accidentally or intentionally ; injuries are caused by the sharp edges of the object moving through the body
Medium and high velocity penetrating trauma
the path of teh object may not be easy to predict ; bullets may flatten out, tumble, or ricochet
Perfusion
the circulation of blood within an organ and tissue in adequate amounts to meet the cells' current needs for oxygen, nutrients, and waste removal
Arterial bleeding
bright red (highin oxygen) and spurts in time with the pulse
Venous bleeding
darker red (low in oxygen) and flows steadily
Capillary bleeding
dark red and oozes steadily but slowly
Coagulation
blood vessel edges narrow and a clot forms, sealing the injured portion of the vessel
Emergency care for external bleeding
--when caring for a partially amputated extremity, control bleeding with a bulky compression (pressure) dressings and splint the extremity to prevent further injury
--high flow oxygen
--direct pressure (for at least 5 minutes)
--elevation of extremities
--splints
--PASG
PASG
Pneumatic antishock garments; provides pressure around the lower extremities and abdomen

Contraindicated on pts who are pregnant, have pulmonary edema, acute heart failure, penetrating chest injuries, groin injuries, major head injuries, and if transport time is less than 30 minutes
Bleeding with possible skull fracture
do not apply excessive pressure to the injury; loosely cover the site with a sterile gauze pad and keep contaminants away; apply light compression by wrapping a dressing loosely around the head
Hyphema
bleeding into the anterior chamber of the eye
Hypovolemic Shock S&S
--change in mental status
--changes in skin color or pallor
--tachycardia
--weak,rapid pulse
--weakness, fainting, dizziness at rest
---thirst
--nausea and vomiting
--cold, moist (clammy) skin
--shallow, rapid breathing
--dull eyes
--low BP
Common S&S of shock
--low BP
--AMS
--cold,clammy skin, hands and feet may be blue or pale
--weak or rapid pulse
--rapid resp and hyperventilation
--decreased urine output
Compensated shock
body is able to maintain BP above 90-100 mm Hg, through the physiologic responses of tachycardia and shunting of the blood from the skin to the vital organs of the body
Decompensated shock
when the body's compensatory mechanisms fail and blood pressure drops
Cardiovascular causes of shock
--cardiogenic shock (pump failure)
--neurogenic shock (poor vessel function)
--hypovolemic shock (content failure)
--septic shock (combined vessel and content failure)
Non cardiovascular causes of shock
--resp insufficiency
--anaphylactic shock
--psychogenic shock (sudden reaction of the CNS that produces a vasodilation, reducing blood supply to the brain)
Trendelenburg position
position for shock pts
legs must be elevated 6-12 inches
Anatomical Differences between children and adults
--larger, rounder occiput (head)
--proportionally larger tongue
--floppy, U-shaped epiglottis that is larger
--less well developed rings of cartilage in trachea
--narrower, lower airway
--faster resp rate
--faster HR
--heart is higher up the chest
--lungs are smaller
--neck is shorter
Pediatric Aging
Infant (0-1 years)
Toddler (1-3 years)= when fear of strangers begins
Preschooler (3-6 years)
School age (6-12 years)
Adolescent (12-18 years)
Dehydration
when fluid loss is greater than fluid intake; most common cause in children is vomiting and diarrhea ; can lead to shock and death; fluid reserves are smaller in infants and children than adults
Child Abuse
common signs are bruising on the back, buttocks, face, thighs, or chest
Sexual abuse
--do not examine genitalia unless there is evidence of bleeding or injury
-- if child is female, try to keep a female EMT or police officer remains with her
--transport all children who are victims of sexual assault
Sudden Infant Death Syndrome (SIDS)
--usually occurs in infants younger than 6 months of age
--known risk factors
- mother younger than 20 y/o
- mother smoked during pregnancy
- low birth weight
--most are discovered in the morning
--can happen at any time of the day
Rigor Mortis
stiffening of the joints and muscles of a body a few hours after death, usually lasting from one to four days
Gastrotomy Tubes Care
transport pt sitting or lying on right side with head elevated
Pediatric Assessment Triangle (PAT)
ability to visually observe and assess without touching the child :

--Appearance (noting LOC or interactiveness and muscle tone; clues about function of the CNS)
--Work of breathing (increased work of breathing can indicate tachypnea)
--Circulation of skin (perfusion, body through vasoconstriction takes blood from areas of lesser need (skin) to areas of greater need (organs); cyanosis)
checking Pulse
Adults = carotid, brachial, or femoral
Children= carotid
Infants= brachial or femoral
Croup
laryngotracheobronchitis; infection of upper airway below vocal chords usually caused by virus ; barking cough (stridor/crowing); presents with fever
Epiglottitis
infection of airway above vocal chords usually caused by infection ; inflammation of epliglottis; SOB, difficulty swallowing (dysphagia)
Upper airway
decreased breath sounds
stridor/crowing (high pitched noise inhalation)
gurgling (upper airway fluid)
snoring (obstruction of tongue ; simply move the head and reposition it)
hoarseness (upper airway inflammation)
Lower airway
wheezing
crackles/ rales (flow of air through liquid; sounds like blowing of bubbles in liquid; indicates lower airway infection)
abdominal thrusts
recommended to relieve airway obstruction in a child who is responsive, these thrusts increase pressure in the chest creating an artifical cough that may force a foreign body in the airway ; not recommened for infants because of possibility injury to the organs
Airway obstruction in Infants care
back slaps and chest thrusts
CPR on infants
--place infant on firm surface , using one hand to keep airway open
--place two finigers on sternum, just below nipple line
--compress sternum about one third the depth of chest
--compress at a rate of 100 compression/min
--reassess after 2 minutes (5 cycles) of CPR
CPR on children
--use heel of hand instead of fingers
--compress chest one third to one half depth of chest
--deliver each ventilation over a period of 1 second
AED use in children
--applied to children over 1 year of age after the first 2 minutes of CPR
Tripod position/ Fowler's position
most common position pts with resp problems are found in
status epilepticus
a dangerous condition in which epileptic seizures follow one another without recovery of consciousness between them; request ALS backup
S&S of dehydration
dry lips and gums , decreased saliva, fewer wet diapers

severe dehydration: sunken eyes, sleepiness/irritability, poor skin turgor, sunken fontanels
Pediatric Resuscitation tape measure
can determine height and weight in pts weighing up to 34 kg (75 pounds)
Blow by technique for children
allows the parent to hold the mask or oxygen tubing near the childs' face; makes child more comfortable with treatment
Hypercarbia
excessive amount of CO2 in arterial blood (goes hand in hand with hypoexmia)
Carina
ridge of cartilage in the trachea that occurs between the division of the two main bronchii; the most sensitive area of the trachea so it generates the cough reflex
Nasal Flaring
indicates child is using muscles he usually doesn't use to breathe
Semi-Fowler Position
pts with cardiac problems are usually found in this position
emphysema care
CPAP mask (continuous positive pressure)
albuterol
prescribed inhaler for patients with asthma; bronchodilator; 2 puffs= 1 dose; beta agonist
alpha drugs
affect heart
beta drugs
affect lungs
Hemoptysis
coughing up blood
Cricoid Pressure
aka Sellick maneuver ; a technique used in endotracheal intubation to reduce the risk of regurgitation. The technique involves the application of pressure to the cricoid cartilage at the neck, thus occluding the esophagus which passes directly behind it
Cricoid cartilage
the only complete ring of cartilage around the trachea. It forms the back part of the voice box and functions as an attachment site for muscles, cartilages, and ligaments involved in opening and closing the airway and in producing speech.
chest retractions
caused by dyspnea ; suctioning of the skin in and around chest and ribcage
Fowler's position
patients with respiratory problems are usually found in this position or in Tripod position ; pt is sitting up at a 90 degree angle
Gravida
how many pregnancies the woman has had (including those that ended as miscarriages or still births)
Para
how many pregnancies that have gone to birth (including stillbirths); miscarriages do not count because it did not reach vaginal birth
Cephalic birth
normal birth
ICS
Incident Command System

"Cucumbers F***ing Love Peeling Oranges"
"Command, Finance, Logistics, Planning, Operations"
Command Officer
in charge
Command Staff
monitors the scene for conditions or operations that may present a hazard
PIO
Public Information Officer; provides media with clear information
Liasion Officer
relays information and concerns among command and the staff
Finance Officer
logs hours spent on scene; documents all expenditures at incident for reimbursement
Logistics Officer
responsible for communications, facilities, food and water, fuel, lighting and medical euipment supplies
Planning officer
solves problems as they arise and develops a plan of action
Operations Officer
at a very large incident, they manage tactical operations; supervise people working at scene (review police, fire, and EMS)
EMS Command
Triage officer
treatment sector officer
transportation sector officer
supplies sector officer
extrication sector officer
staging supervisor
rehab supervisor
extrication and special rescue
morgue supervisor
Triage officer
in charge of sorting patients; priorities level of care; in charge of counting and prioritizing patients
Treatment sector officer
stabalize and put patients in treatment sector (majority of leath care providers are located); one of teh biggest and busiest areas on scene; locates and sets up treatment area for tiers
Transportation officer
get them to the hospital; communicate wtih hospital; how many pts you are taking and where you are going
Supplies sector officer
extra gear and euipment on scene; bringing these to treatment sector usually
Staging Supervisor
depends on how big the incident is; should be assigned when scenes require response by numerous emergency vehicles or agencies
Rehab Supervisor
establishes an area that provides protection from elements; monitors responders for signs and stress
Extrication and special rescute
determines the type of equipment and resources needed for the situation
Morgue supervisor
works with medical examiners and coroners
Arrival to Scene
--establish IC
--check in with EMS command
vertex presentation
the baby's head is the first to come out during birth; normal
infant CPR
two person: use tips of thumbs (encircling hands technique)

one person: use two fingers
encephalitis
inflammation of the actual brain caused by infection ; no stiff neck