Houston nremt Flashcards
Components of hematology
Blood, bone marrow, liver, spleen, kidney.
The study of blood
Forming organs and include study of blood disorders. Red blood cell disorders, white blood cell disorders, platelet disorders, coagulation problems
Hematopoiesis
Making of cells
Blood volume
6 to 8 L of blood
Plasma consist of
Water 90–92% by volume, proteins 6–7% by volume, other 2–3% by volume. Fats, carbs, electrolytes, gases, and messengers.
Red blood cells: laboratory analysis of red blood cells
The number of red blood cells is called hematocrit
Red blood cells contain what
Hemoglobin which allow for oxygen transport borh effect
What do White’s blood cells do
Combat infection perform phagocytosis
Granulocytes: neutrophil basophils
Store histamine
Eosinophils
Initiate the immune response
Granulocites consist of
Neutrophil basophils eosinophil lymphocytes monocytes
Auto immune disease
Where the body destroys good and bad
Inflammatory process, platelets
Clotting mechanism (thrombocytopenia , thrombocytosis)
Immunity
Subpopulation of lynphocytes known as T cells and B cells, T cells develop cellular immunity. Be cells produce humoral immunity
Hemostasis: controlling blood loss by
Vascular spasms, platelet plugs, stable fibrin blood clots
Blood types
A, B, Ab, o
Universal donor
O
Universal recipient
Ab
Anemias
It’s a sign, not a separate disease process
Anemias signs and symptoms
May not present until the body is stressed. Differentiate chronic anemia from acute episode. Treat signs and symptoms
Anemias treatment
Maximize oxygenation and limit blood loss establish IV therapy if indicated
Sickle cell disease
Sickle cell crisis is they vaso-occlusive
Sickle cell crisis management
Two large bore IVs with IV bolus and morphine for vasodilation and pain
Polycythemia
Overproduction of erthrocytes. Occurs in 50-year-old or younger or with secondary dehydration. Results in bleeding abnormalities. Epistaxes, spontaneous bruising, G.I. bleeding.
Polycythemia management
Follow general treatment guidelines
Leukopenia/neutropenia
To view white blood cells or neutrophils. Follow general treatment guidelines and provide supportive care
Leukocytosis
And increase in the number of circulating white blood cells, often due to infection.
Leukemia
Cancer of hematopoietic cells. Initial presentation acutely ill, fatigued, febrile, week, anemic, and often have a secondary infection
Leukemia management
Follow general treatment guidelines. Utilize isolation techniques to limit risk of infection.
Lymphomas
Cancers of the lymphatic system
Lymphomas signs and symptoms
Swelling of the lymph nodes, fever, night sweats, anorexia, weight loss, fatigue
Tx lymphomas
Follow general guidelines for treatment. Utilize isolation techniques to limit risk of infection
Thrombocytosis
Abnormal increase in the number of platelets
Thrombocytopenia
Abnormal decrease in number of platelets
Hemophilia
Deficiency or absence of blood clotting factor. Deficiency is sex linked, inherited disorder.
Hemophilia signs and symptoms
Numerous bruises, deep muscle bleeding, joint bleeding
Hemophilia management
Treat patients similar to others. Administer supplemental oxygen. Establish IV access. Be alert for recurrent or prolonged bleeding. And prevent additional trauma
Disseminated intravascular coagulation
System activation of Quoggy Laois and cascade. Results from sepsis, hypotension, OB complications, severe tissue or brain damage, cancer, major hemolytic reactions
Multiple myeloma
Cancerous disorder of plasma cells. Pathological fractures are common
Mechanisms of heat gain and loss
Thermal gradient by the wind and relative humidity
Thermogenesis – heat production
Work induced, diet induced, Thermo regulatory
Thermolysis heat loss
Conduction, convection, radiation, evaporation, respiration.
Thermoregulation
Body temp 98.6 axillary. Core temp is 99.6 rectally.
The hypothalamus, heat dissipation
Sweating and vasodilation
Heat conservation
Shivering and vasoconstriction
Hyperthermia
Signs of Thermolysis, diaphoresis, increased skin temperature, signs of Thermolytic inadequacy, altered mentation or altered LOC
Manifestations
Heat cramps, isolated muscle loss of electrolytes, heat exhaustion, compensated, heatstroke, non-compensated.
Rolls of dehydration in heat disorders
That dehydration prevents Thermolysis
Signs and symptoms. Of heat disorders
Nausea, vomiting, abdominal distress, vision disturbances, decreased urine output, poor skin turgor, signs of shock
Treatment. For heat disorders
Oral fluids if the patient is alert and oriented, IV fluids if the patient has altered mental status or is nauseated
Hypothermia
Mechanisms of heat conservation And boss depends upon predisposing factors, aged patient, health of patient
Medications. Cold injuries/disorders
Prolonged or intense exposure, coexisting weather conditions
Preeventative measures
Dress warm and ensure plenty of rest. Eat appropriately or at regular intervals. Limit exposure to cold environment.
Degrees of hypothermia
Mild and severe. Mild is Compensated severe is Decompensatef
Signs and symptoms of hypothermia
ECG will have Pathognomonic J waves, Osborn waves. Eventual on set of bradycardia. Ventricular fibrillation probable below 86°F
Treatment for hypothermia
Active rewarming. Active external rewarming, active internal rewarming, rewarming shock. Cold diuresis
Resuscitation Bls
Perform pulse and respiration checks for long periods. Administer one high energy defibrillation with AEd. Follow CPR, rewarming, rapid transport.
Resuscitation ALS
Intubate and administer one plhigh energy defibrillation and possibly initial medications. Establish IV access, began rewarming, and transport rapidly. Avoid further resuscitation until the core temperature is 86°F
Tissue layers of the heart
Endocardium, myocardium, pericardium
Left coronary artery separates into two
Circumflex. And left anterior descending
Systolic pressure
Strength and volume of cardiac output
Mean arterial pressure
One third pulse pressure added to diastolic pressure
Nervous control of the heart
Sympathetic and parasympathetic
Sympathetic: catecholamines
Epinephrine and Norepinephrine
Sympathetic consist of
Catecholamines, alpha-1, alpha-2, beta-1, beta-2, Beta three.
Alpha-1
Vasoconstriction increased Peripheral vascular resistance. Increased preload
Alpha two
Inhibits the release of norepinephrine fight or flight
Beta one
Increased heart rate, force, contractility
Beta two
Bronchodilator smooth muscle dilation in bowl
Beta three
Adipose tissue/fat
Parasympathetic decreases
Heart rate, strength of contractions, blood pressure, naptime
Parasympathetic increases
Digestive system, kidneys
Chrontrophy
Rate
Introphy
Force
Stomp trophy
Electricity
Rolls of electrolytes
Sodium, potassium, calcium, magnesium.
Cardiac conductive system properties
Excitability conductivity automaticity contractibility
Cardiac depolarization
Resting potential, action potential, repolarization.
Each myocardial cell has this
Sodium – potassium pump giving it the ability to beat on it’s own
Components of cardiac conductive system
Sa node internodal artial pathways atrioventricular node av junction bundle of his left and right bundle branches (purkinje fibers)
Bipolar limb leads
Einthoven triangle: leads one, two, three
Precordial leads
V1-v6
Argumented uni polar leads
AVR, a VL, AVF
ECG components
P-wave, QRS complex, T-wave, u wave
Time intervals PR interval – PRI – or P – Q interval, P QI
0.12–0.20 seconds
QRS interval
0.08–0.12 seconds
ST segment interval
.42 seconds
QT interval
0.33–0.42 seconds
Refractory period/Absolute
Heart may not be during this time
Refractory period – relative
Heart beats on the r wave (r on t phenomenon)
ST segment changes
ST segment elevation
Associated with myocardial infarctions
Ischemia injury Nercrosis
Ischemia
Represented by T wave inversion, acid creates sub sternal, crushing chest pain
Injury
Represented by ST segment elevation this means they’re having an acute heart attack
Nercrosis
Represented by Pathological Q waves
Interpretation of rhythm five step procedure
Analyzing rate – six second method Analyzing rhythm Analyzing P waves Analyzing PR interval Analyzing QRS complex
Analyzing great – six second method
Heart rate calculator rulers – RR interval, triplicate method
Analyzing rhythm
Regular, occasionally irregular, regular irregular, irregularly irregular.
Analyzing P waves
Are P waves present? Are P waves regular? Is there one P-wave each QRS complex? Are the P waves up right or invert it? Do all P waves look alike?
Analyzing pr interval
Is it greater than 0.20 seconds?
Analyzing QRS complex
Do all the QRS complexes look like? What is the QRS duration?
Dysfunction of the spinal cord, nerves, or respiratory muscles. Pathophysiology
PNS problems affecting respiratory function may include trauma, polio,myasthenia gravis, viral infections, tumor.
Dysfunction of the spinal cord, nerves or respiratory muscles. Assessment
Rule out dramatic injury. Assess for numbness, pain, or signs of PNS dysfunction
Dysfunction of the spinal cord, nerves or respiratory muscles. Management
Follow general management principles. Maintain the airway and support breathing. You cervical spine precautions if indicated
CNS dysfunction. Pathophysiology
Causes can include Trumatic /atrumatic brain injury, tumors, and drugs.
CNS dysfunction assessment
Evaluate potentially treatable causes, such as narcotic drug overdose or CNS trauma. Carefully evaluate breathing pattern
CNS dysfunction management
Follow general management principles. Maintain the airway and support breathing use cervical spine precautions indicated
Hyperventilation syndrome assessment
Focus history and physical exam, sample and OPQrst history. Fatigue, nervousness, dizziness, dyspnea, chest pain. Numbness and tingling in hands, mouth and feet. Presence of Tachynea and tachycardia. Spasms of fingers and feet
Hyperventilation syndrome management
Maintain the airway. Support breathing. Pervide high flow oxygen or assist ventilations as indicated. Do not allow the patient to rebreather exhaled air. Reassure the patient. No paper bag coach
Spontaneous pneumothorax – pneumothorax
Occurs in the absence of want or penetrating trauma
Spontaneous pneumothorax risk factors
Young tall skinny lanky man
Spontaneous pneumothorax assessment
Focused history sample and OPQrst history. Presence of risk factors. Rapid onset of symptoms. Sharp, pleuritic chest or shoulder pain. Often precipitated by coughing or lifting
Spontaneous. Pneumothorax physical exam
Decreased or absent breath sounds on affected side Tachynea diaphoresis and Pallor
Spontaneous pneumothorax management
Maintain the airway. Support breathing. Monitor the tension pneumothorax. Plearle decompression may be indicated if patient becomes cyanotic, hypoxic, and difficult to ventilate. JVD and tracheal deviation away from the affected side
Pulmonary embolism pathophysiology
Obstruction of a pulmonary artery, so typically occurs from the right heart, and Embloi may be air, thrombus, fat or anniotic. Foreign bodies may also cause Embolus
Pulmonary embolus risk factors
Recent surgery, long bone fractures, pregnancy, pregnant, postpartum, oral contraceptive use, tobacco use.
Pulmonary embolism assessment
Focus history and physical exam, sample and OPQrst history, presence of risk factors, unexplained tachycardia, sudden onset of severe dyspena, and pain, cough up blood – Tinged
Pulmonary embolism physical exam
Anxiety, syncope, diaphoretic, JVD, hypotension warm, swollen extremities
Pulmonary embolism management
Maintain the airway. Support breathing. High flow oxygen or assisted ventilations as indicated. Intubation may be indicated. Establish IV access. Monitor vital signs closely. Transport to appropriate facility
Carbon monoxide inhalation
Carbon monoxide is an odorless colorless gas. Results from the combustion of carbon containing compounds. Often builds up to dangerous levels and confined spaces such as minds, auto’s, and poorly ventilated homes. Hazardous to rescuers
Carbon monoxide inhalation pathophysiology
Binds to hemoglobin, 200–300 times affinity than that of oxygen prevents oxygen from binding and creates hypoxia at the cellular level
Carbon monoxide inhalation assessment
Focused history and physical exam, sample and OPQrst history, determine source and length of exposure. Presence of headache, confusion, agitation, lack of coordination, loss of consciousness, and seizures.
Carbon monoxide inhalation management
Ensures scene safety. Interest seen only if properly trained and equipped. Remove the patient from the toxic environment. Maintain the airway. Support breathing. I flew oxygen or assisted ventilations as indicated. Establish IV access. Transport promptly.
Upper respiratory infection
Frequent patient complaint, common pediatric complaint, rarely life-threatening.
Upper respiratory infection pathophysiology
frequently caused by viral and bacterial infection. Affect multiple parts of the upper airway. Typically resolved after several days of symptoms.
Pneumonia
Infection of the Lungs. Problem in a immune suppressed patients
Pneumonia pathophysiology
Bacterial and viral infections, hospital acquired versus community acquired. Infection can spread throughout lungs ALveloi why may collapse resulting in a ventilation disorder
Pneumonia management
Maintain the airway. Support breathing. High flow oxygen or assisted ventilation as indicated. Monitor vital signs. Establish IV access. Avoid fluid overload. Medications – antibiotics, beta– agonist
Lung cancer pathophysiology
Majority are caused by carcinogens secondary to cigarette smoke or occupational exposure. Maystar elsewhere and spread to lungs High mortality. Types, epidermoid, small cell and large cell carcinomas
Toxic inhalation pathophysiology
Includes inhalation of heated air, chemical irritants, and steam. Airway obstruction due to edema and laryngospasm due to thermal and chemical burns
Toxic inhalation assessment
Focus history and physical exam, sample and oh history, determine nature of substance, length of exposure and LOC
Toxic inhalation management
Ensure scene safety. Enter scene only if properly trained and equipped. Remove the patient from the toxic environment. Maintain airway. Early, aggressive management may be indicated. Support breathing. IV access. Transport promptly.
Status asthnaticus
A severe prolonged attack I cannot be broken by bronchodilators. Greatly diminished breath sounds. Recognize intermittent respiratory arrest. Aggressively manage airway and breathing. Transport immediately.
Components of patient assessment. Body substance isolation
Goggles, mask, gown, breathing support, etc.
Body substance isolation
Always wear the appropriate personal protective equipment to prevent exposure to contagious diseases
Treatment for tuberculosis patient
You may place a surgical mask on the patient while you wear a niosh-approved respirator. Monitor the patient’s airway and breathing carefully
Components of patient assessment
Body substance isolation. Seen safety. Location of all patients. Mechanism of injury. Nature of illness. The initial assessment. Mental status. Airway assessment. Breathing assessment. Priority determination.
Mechanism of injury
The combined strength, direction, and nature of forces that injured your patient. With trauma, try to determine the mechanism of injury during the scene size up
Nature of illness
To determine the nature of illness, use by standards, family members, or the patient. Use the scene to give clues to the patient condition. Remember that the patient’s illness may be very different from the chief complaint.
Scene safety
Scene safety simply means doing everything possible to ensure a safe environment for yourself, your crew, other responding personnel, your patient, and any other bystanders – in that order. Look for potential hazards during scene size up. Wait for the police before entering a potentially hazardous scene
Location of all patients
Scene size up also includes a search of the area to locate all of the patients. Follow local protocol when you respond to a mass casualty incident. The incident commander to Direct the response and coordinates responses at a multiple casualty incident. But the medical director is ultimately responsible for all medical treatment
The initial assessment
The initial assessment is designed to identify and immediately correct life-threatening patient conditions of the airway, breathing, and circulation. ABC’s
Initial assessment steps
Form a general impression. Stabilize the cervical spine. Assess the baseline mental status. Assess the airway. Assess breathing. Assess circulation. Determine priority.
The general impression
The general impression is the initial, intuitive evaluation of the patient to determine the general clinical status and priority for transport
Mental status
Alert, verbal, painful stimuli, unresponsive
Airway assessment
If the patient is responsive and can speak clearly, assume the airway is patent. If the patient is unconscious, but airway may be obstructed. So open the airway. Suction fluids from your patients airway. Immediately use a bag valve mask to ventilate patients who are not moving air. Use and oropharyngeal airway for unconscious patients without a gag reflex. The nasopharyngeal airway rest between the tongue in the posterior pharyngeal wall. Endo tracheal intubation or needle cricoidthrotomy
Breathing assessment rate
Quality, pattern
The circulation assessment consist of evaluating the polls and skin and controlling hemorrhage. To assess an adult circulation, feel for a radio polls. Palpate for a carotid polls. Control major bleeding. Assess the scan. Evaluate your patients feel if you suspect circulatory compromise. Apply pneumatic antishock garments according to your local protocol.
Circulation assessment
For sure priority determination
Once the initial assessment is complete, determine the patient’s priority. In route to hospital, establish an IV.
The focused history and physical exam. Types of patients.
Trauma patients with significant mechanism of injury. Trauma patient with isolated injury. Responsive medical patient. Unresponsive medical patient.
Sustained significant mechanism of injury
Exhibits altered mental status from the incident
Predictors of serious internal injury
Injection from vehicle, death in same passenger compartment, fall from higher than 20 feet, rollover of vehicle high speed motor vehicle collision, vehicle passenger collision, motorcycle crash, penetration of the head, chest, or abdomen
Mechanism of injury considerations for infants and children
Fall from higher than 10 feet, bicycle collision, medium speed vehicle collision with resulting severe vehicle deformity.
Evaluate the trauma scene to determine the mechanism of injury
Bent steering wheel indicates potentially serious injuries
Rapid trauma assessment
Not a detailed physical exam fast, Systematic assessment for other life-threatening injuries dcap btls vital signs, skin condition, sample
The isolated trauma pt
No significant mechanism of injury, shows no signs of systemic involvement, does not require extensive history, does not require comprehensive physical exam
The responsive medical patient assessing the responsive patient with medical emergency is entirely different from assessing the trauma patient for two reasons
Reason one. The history takes precedence over the physical exam reason to. The physical exam is aimed at identifying medical complications rather than signs of injury. Begin treatment while you’re assessing your responsive medical patient
Chief complaint
The pain, discomfort, or dysfunction causing patient to call for help; what seems to be the problem?
Past medical history
General state of health, childhood and adult diseases, psychiatric illnesses, accidents and injuries, surgeries and hospitalizations patterns, exercise and leisure activities, environmental hazards, use of safety measures.
Family history
Ami cva iddm exc
Social history
Recreational drugs, quiet, disruptive
Baseline vital signs
Blood pressure, pulse, respiration, temperature, pupils, orthostatic vitals, if possibly hypovolemic.
Additional assessment techniques
Pulse oximetry, cardiac monitoring, blood glucose determination.
Assessment for the unresponsive medical patient; initial assessment.
Rapid medical assessment, brief history, ongoing assessment, detects trends and determines changes,
Ongoing assessment for unconscious patient
Mental status, airway patency, breathing rate and quality, pulse rate and quality, skin condition, transport priorities, vitals signs.
Focused assessment unresponsive patient
Effects of interventions, management plans, reevaluate the ABCs, evaluate your interventions affects, perform your focused assessment again
The prenatal period
Is the time from conception until delivery of the fetus
Reproductive system
Uterus increases in size. Vascular system. Formation of mucous plug in the cervix. Estrogen causes vaginal mucosas to thicken. Breast enlargement.
Cardiovascular system. Physiological changes of pregnancy
Cardiac output increases. blood volume increases
Physiological changes of pregnancy. Gastrointestinal system
Hormone levels. Peristalsis slowed
Physiological changes of pregnancy; urinary system
Urinary frequency is common. Never empty
Physiological changes a pregnancy Musculoskeletal system
Loosened pelvic joints
Physiological changes of pregnancy. Fetal circulation
Pulmonary system does not receive blood while in the years, baby receives blood, and nutrients by mom through the umbilical cord. When the baby is born, the pulmonary arteries are opened up to allow blood, and perfusion to take place.
General assessment of the obstetric patient. Initial assessment
History – sample – pre-existing medical conditions, diabetes, heart disease, hypertension, seizure, pain, vaginal bleeding, are they in labor, physical examination. EDC
General management of the OBsetric pt
Do not perform an internal vagina examination in the field. Always remember that your caring for two patients, the mother and the fetus. ABC, monitor for shock
Complications of pregnancy trauma
Transport all trauma patients at 20 weeks or more gestation. Anticipate the development of shock.
Complications of pregnancy trauma. Trauma management.
Apply c-collar for cervical stabilization and immobilize on a longboard. Administer high flow oxygen concentration. Initiate two large bore IVs for protocol. Place patient tilted to the left to minimize supine hypotension. Reassess patient. Monitor the fetus.
Pregnancy medical conditions
Any pregnant patient with abdominal pain should be evaluated by a physician
Causes of bleeding during pregnancy
Abortion, ectopic pregnancy, placenta previa, abruptio placenta
Abortion
Termination of pregnancy before the 20th week of gestation
Different classifications of an abortion
Less than 12 weeks is define as a spontaneous abortion
Signs and symptoms abortion
Cramping, abdominal pain, backache, vaginal bleeding
Treatment for abortion
Provide emotional support and treat for shock
ECtopic Pregnancy
Assume the any female of childbearing age with lower abdominal pain is experiencing an ECtopic pregnancy, which is life-threatening. Transport the patient immediately.
Placenta previa
Usually presents with painless bleeding. Never attend vaginal exam. Treat for shock. Transport immediately – tx is delivery by C-section
Abruptio placenta
Signs and symptoms very. Classified as partial, severe, or complete. Life-threatening. Treat for shock, fluid resuscitation. Transform left lateral recumbent position
Hypertensive disorders
Preeclampsia and eclampsia symptomatic with a blood pressure over 140/90, difference between the two seizures one is chronic hypertension, chronic hypertension superimposed with preeclampsia, transient , supine hypertensive syndrome? Treat by placing patient in left lateral recumbent position or elevate right hip, monitor fetal heart tones and maternal vital signs, if volume is depleted, initiated IV of normal saline
Gestational diabetes
Consider hypoglycemia when encountering a pregnant patient with altered mental status. Signs include diaphoresis and tachycardia, it would glucoses below 60. Drawl red top tube of blood, IV normal saline, give 25 g of D50. If blood glucose is above 200. Draw a red top tube of blood. Aminister 1 to 2 liters of ns by Iv protocol
Braxton Hicks contractions
False labor that increases in intensity and frequency but does not cause cervical changes
Maternal factors/preterm labor
Cardiovascular disease, renal disease, diabetes, uterine, cervical abnormalities, maternal infection, trauma, contributory factor
Placental factors/preterm labor
Placenta previa, abruptio placenta
Preterm labor\fetal factors
Multiple just station, excessive am atomic fluid fetal infection
Puerperium
The time. Surrounding the birth of the fetus
Stages of labor
Stage one dilation, stage to expulsion, stage three placental stage.
Management of a patient in labor
Transport the patient in labor unless delivery is imminent. Maternal urge to push or the presence of crowning indicates immediate delivery. Delivery at the scene or in the ambulance will be necessary.
Abnormal delivery situations
Breech presentation, prolapse cord, limb presentation, multiple births, cephalopelvic disproportion, precipitous delivery, shoulder dystocia,
Breach presentation
The butt or both feet present first. If the infant starts to breath with its face pressed against the vaginal wall, form a V and press the vaginal wall away from the infants face. Continue during transport.
Prolapse cord
The umbilical chord precedes the fetal presenting part. Elevate the hips, administer oxygen, and keep warm. If the umbilical cord seems in the vagina, insert to go to fingers to raise the fetus off the cord. Do not push the cord back. Wrap cord and sterile moist towel. Transport immediately; do not attempt delivery
Limb presentation
Place the mother in knee - chest position, administer oxygen in transport immediately. Do not attempt delivery.
Other abnormal presentations
Whenever an abnormal presentation or position of the fetus makes normal delivery impossible, reassure the mother. Administer oxygen. Transport immediately. Do not attempt field delivery in these circumstances.
Multiple births
Follow normal guidelines, but have additional personnel and equipment. In twin births labor starts early and babies are smaller. Prevent hypothermia
Cephalopelvic disproportion
Infants head is too big to pass through the pelvis easily. Causes include oversize fetus, hydrocephalus, canjoin twins, or fetal term tumors. If not recognize, can cause uterine rupture. Usually requires c section. Give oxygen the mother and start IV. Rapid transport.
Precipitous delivery
Occurs in less than three hours of labor. Usually in patients in grand multi para, fetal trauma, tearing of cord, or maternal ace rations. Be ready for rapid delivery, and attempt to control the head. Keep the baby warm
Shoulder dystocia
Infants shoulders are larger than his head. Turtle sign. Do not pull on Avon said. If the baby does not deliver, transport patient immediately
Maternal complications of labor and delivery\postpartum hemorrhage
Defined as loss of more than 500 mL of blood following delivery. Establish two large war IVs of normal saline. Treat for shock is necessary. Follow protocols if applying antishock trousers.
Maternal convocations of labor and delivery\ uterine rupture
Tearing or rupture of the uterus. Patient complains of severe domino pain and will often be in shock. Abdomen is often tender and rigid. Fatal heart tones are absent. Treat for shock. Give high flow oxygen and start to large bore IVs of normal saline. Transport Pt rapidly.
Field assessment left sided heart failure
Pulmonary edema. Coffee with copious amounts of clearer pink tinged sputum. Labor breathing, especially with exertion. Abnormal breath sounds. Including rails, rhonchi, wheezes. Pulses paradox and pulses alternans. Remember lower lobes are heard by auscultation of posterior thorax, proxysmal nocturnal Dyspne, Orthopnea signs and symptoms sympathetic nervous system.
Left-sided heart failure\field assessment\medications
Diuretics. Vasodilator, ace inhibitors, beta blockers, calcium channel blockers medis to increase cardiac contractial force
Field assessment right-sided heart failure
Peripheral pitting edema wherever gravity pulls it, extremities or sacral. The new system congestion, liver and spleen engorgement, JVD, ascites, fluid in the abdominal space, pericardial effusion
Heart failure field assessment management
Avoid supine positioning. Avoid exertion such as standing or walking. Maintain airway. Administer oxygen. Establish IV access. Limit fluid administration. Monitor ECG. Consider medication administration. Morphine, nitroglycerin, lasix, enalypril (vasotec) dopamine\dobutamine promethazine, nitrous oxide
Cardiac Tamponade
Results of fluid accumulation between this visceral pericardium and parietal pericardium. Increased intra-pericardial pressure impairs diastolic filling. Typically worsens progressively in till correctly
Epidemiology
Acute onset typically the result of trauma or MI. Benign presentations maybe caused by cancer, pericarditis renal disease and hypothyroidism
Field assessment patient history
Determine participating causes. Patient relates a history of dyspnea and Orthopnea
Field assessment exam
Rapid, wheat poles, decreasing systolic pressure, narrowing pulse pressures, pulses paradox, faint, muffled heart sounds, electrical alternans
Field assessment management
Maintain airway. Mr. oxygen. Establish IV access. Consider medication administration, morphine sulfate, nitrous oxide, furosemide, dopamine/dobutamine, rapid transport, pericardiocentisis, is the definite treatment, insertion of cardiac needle in aspiration of fluid from pericardium, procedures should be performed only if allowed by local protocol. Procedure should be performed only by personnel adequately trained in the procedure.
Hypertensive crisis causes
Typically occurs only in patients with history of hypertension. Primarily cause and noncompliance with prescribed antihypertensive medications. Also occurs with toxemia of pregnancy
Hypertensive emergencies risk factors
Age related factors, race related factors.
Hypertensive emergency initial assessment
change in mental status, signs and symptoms, headache accompanied by nausea and/or vomiting, blurred vision, shortness of breath, vertigo, tinnitus
Hypertensive emergency history
Known history of hypertension, uncompliance with medications
Hypertensive emergencies management
Maintain airway. Administer oxygen. Establish IV access. Consider medication administration. Morphine sulfate, furosemide, nitroglycerin, sodium nitroprudside, labetalol
Cardiogenic shock
General inability of the heart to meet the bodies metabolic needs. Often remains after correction of other problems. Severe form of pump failure. High mortality rate.
Cardiogenic shock causes
Tension pneumothorax and cardiac Tamponode impaired ventricular emptying. Impaired myocardial contractility. Trauma.
Cardiogenic shock management
Maintain airway. Administer oxygen, identifying tree underlying problem, establish IV access, consider medication administration, vasopressors, dopamine, dobutamine, levophed
Atherosclerosis
Progressive degenerative disease of the medium-sized and large arteries. Results from buildup of bats on the interior of the artery. Fatty build up results in plaques and eventual sternosis of the artery
Aneurysm
Ballooning of an arterial wall, usually the aorta, that results from a weakness or defect in the wall
Types of aneurysms
Atherosclerotic, dissecting, infectious, congenital, traumatic.
Abdominal aortic aneurysm signs and symptoms
Tearing abdominal wall, back\flank pain, numbness in legs, hypotension, urge to defecate
Abdominal aortic aneurysm
Often the result of atherosclerosis
Endocrine glands
Have systemic effects. Backed on specific target tissues in specific ways. May have single or multiple targets
Hypothalamus
Located deep within the cerebrum. Some cells relay messages from the autonomic nervous system to the central nervous system. Other cells respond as gland cells to release hormones. Body thermostat.
Posterior pituitary
ADH, Oxytocin
Anterior pituitary
Growth hormone thyroid stimulation hormone, follicles stimulation hormone
Thyroid gland
T4 t 3 calcitonin
Parathyroid gland
Pth
Thymus gland
Thymosin WBC
Pancreas
Combination Organ, exocrine tissues secrete digestive enzymes into small intestines, endocrine tissues secrete hormones. Insulin, glucagon, somatostatin
Adrenal Medulla
Inner segment of adrenal gland. Closely tied to autonomic nervous system
Adrenal cortex
Outer layers of endocrine tissue which secrete steroidal hormones
Gonads
Female\ovaries and male/testes
Pineal gland
Located in the roof of the Thalamus. Related to the body’s biological clock, melatonin. Impacted in seasonal affective disorder
Placenta
Releases hCG throughout just station
Digestive tract
Gastrin and secretin
Heart
Anh
Kidneys
Renin
Disorders of the pancreas
Diabetes mellitus glucose metabolism, metabolism, anabolism and catabolism, insulin is required for glucose metabolism, presence of enough insulin to meet cellular means. Ability to bind in a manner to stimulate the cells adequately. When unable to obtain energy from glucose, the body begins to use stored fat. This produces ketones and ketosis
Regulation of blood glucose
Hypoglycemia and hyperglycemia role of the pancreas, liver, and kidneys. Osmotic diuresis an glucosuria patient at risk for all kinds of problems, pe ami cva
Arterial fibrillation treatment
Electrotherapy\consider if ventricular rate over 150 and symptomatic. Synchronize cardioversion, diltiazem, verapamil, digoxin, beta blockers, procainamide, quinidine. Anticoagulant. (Heparin or warfarin)
Type one second degree AV block
PR interval is variable and drops a QRS complex
Type two second degree AV block
PR interval is fixed and drops a QRS complex
Third-degree AV block
No communication between atria and ventricles
AV block treatment
Transcutaneous pacing for acutely symptomatic patients. Treat symptomatic bradycardia. Avoid drugs that may further slow AV induction
Accelerated junctional rhythm. Characteristics
Inverted P waves in lead two, PRI of .12 seconds, normal QRS complex duration
Paroxysmal junctional tachycardia treatment
Vagal maneuvers, adenosine, verapamil, electrical therapy, use rate is less than 150 and patient is hemodynamically unstable. Synchronize cardioversion starting at 100 Jules
Premature ventricular contractions\malignant pvcs
More six\minutes, r on t phenomenon, couplets or runs of ventricular tachycardia, multi focal PVC PVC are associated with chest pain
Malignant PVC tx
NOn malignant PVCs do not require treatment in patients without cardiac history just administer oxygen
Ventricular tachycardia treatment
Perfusing patient, administer oxygen and establish IV access. Consider immediate synchronized cardioversion for hemodynamically unstable patients. Amiodarone 150 MG IV infused in 10 minutes maybe repeated once. Lidocaine 1.0–1.5 MG\KG IV bolus. If PVCs are not suppressed, repeat doses of 0.5–0.75 MG\KG to Max dose of 3.0 MG\KG. it PVCs are suppressed administer lidocaine drip 2–4 in mG\minute. Reduce the dose in patients with decreased output or decreased hepatic function and patients less than 70 years old
Non-perfusing patients in V tach
Follow ventricular fibrillation protocol
Torsades de pointes polymorphic v tach
Caused by the use of antidysrhythmic drugs
Torsades De pointes tx
Do not treat as standard ventricular tachycardia. Administer magnesium sulfate one – 2 g diluted in 100 ml D5W over 1–2 minutes. Amiodarone 150–300 MG
Ventricular fibrillation treatment
Initiate CPR. Witnessed\defibrillate ones at the highest energy. Non-witnessed\CPR for two minutes, defibrillate once at highest energy, control the airway and establish IV\Io access. Administer epinephrine 1:10,000 every 3–5 minutes. Consider second line drugs such as lidocaine, amiodarone, procainamide, or magnesium sulfate. Consider 40 units of vasopressin IV, one time only, either first or second line with epinephrine
Asystole treatment
Administer CPR and manage airway. Treat for ventricular fibrillation if there is any doubt about the underlying rhythm. Administer medications\epinephrine and possibly consider and treat the causes.
Pulseless electrical activity
Electrical impulses are present, but with no accompanying mechanical contractions of the heart. Treat the patient, not the monitor
Pulseless electrical activity causes
Hypovolemia, cardiac Tampanode tension pneumothorax, hypoxemia, acidosis, massive pulmonary embolism, ventricular wall rupture.
Pulseless electrical activity treatment
Prompt recognition and early treatment. Epinephrine 1 mg every 3–5 minutes
Disturbances of ventricular conduction aberrant conduction bundle branch block
QRS complex greater than 0.12 seconds
Disturbance of ventricular conduction causes
Ischemia or necrosis of a bundle branch
Disturbances of ventricular conduction pre-excitation syndromes
Excitation buying impulse that bypasses the AV node
Wolf Parkinson’s White syndrome
Short PRI and long QRS duration, delta waves, treat underlying rhythm
ECG changes due to electrolyte abnormalities and hypothermia\hyper kalemia
Tall ts suspect in patients with history of renal failure
ECG changes due to electrolyte abnormalities and hypothermia\ hypokalemia
Prominent U waves
ECG changes due to electrolyte abnormalities and hypothermia\ hypothermia
Osborne wave\J wave
Angina pectoris
Chest pain from lack of oxygen and build up of lactic acid
Angina pectoris pathophysiology
Angina occurs when the heart demand for oxygen exceeds the bloods oxygen supply. Commonly caused by artherosclerosis
Angina pectoris management
Relieve anxiety, place the patient in a position of physical and emotional comfort. Administer oxygen titrating to 94%. Establish IV access. Monitor ECG. Perform 12 lead. Consider medication administration. Nitroglycerin tablets or spray Nifedipine or other calcium channel blockers, morphine sulfate
Myocardial infarction
Death and Nercrosis of heart muscle due to inadequate oxygen supply. Location and size depending on the vessel in bald. Not relieved with nitro glycerin, oxygen, rest, last longer than 30 minutes in duration
Myocardial infarction. Goals of treatment
Pain relief and reperfusion
Myocardial infarction management\prehospital
Administer oxygen titrated to 94%. Establish IV access. Consider medication administration\aspirin, analgesics antiemetics, nitroglycerin, nitrous oxide, Nubain, antiarrhythmic medication as indicated, monitor ECG, rapid transport as indicated. Avoid patient refusals identify candidates for thrombolytic therapy and Cath Lab.
Myocardial infarction management\in hospital
Diagnostic ECGs. Inside levels. Risk assessment. Treatment\thrombolytics\retrovase Strepnakianse, cardiac catheterization, PTCA, CA BG
Cocaine induced chest pain
Sympathymimetic responses cause low cardiac output and ischemia. The treatment is benzodiazepines, Ativan, Valium, versed
Heart failure left ventricle failure
Results in increased back pressure into the pulmonary circulation
Heart failure right ventricular failure
Typically caused by Westside heart failure, results in increased back pressure into the systemic venous circulation, causing pulmonary Edema
Injury to the solid organs
Dance in less strongly held together, prone to contusion, bleeding, fracture\rupture, unrestricted hemorrhage if organ capsule is ruptured.
Spleen
Pain refered to left shoulder
Pancreas
Pain radiates to back
Kidneys
Pain radiates from flank to groin and hematuria
Liver
Pain referred to the right shoulder
Abdominal aorta and vena cava
Prone to direct blunt or penetrating trauma, maybe injured and deceleration injuries, blood accumulates beneath diaphragm, irritation of muscular structures, produces referred pain in the shoulder region, greater blood volume can be lost, presence of blood in abdomen, stimulates vagus nerve resulting in slowing of heart rate, blood can isolate in any of the abdominal spaces
Injury to mesentery and bowel
Provides bowel with circulation, innervation, and attachment, disrupt blood vessels supplying the bowel, lead to ischemia Nercrosis or rupture, blood loss minimal, peritoneal layers contained hemorrhage, tear of mesentry may rupture bowel, penetrating trauma to the lateral abdomen likely to injure large bowel
Injury to peritoneum
Delicate and sensitive lining of anterior abdomen. Peritonitis inflammation of the peritoneum due to bacterial irritation due to torn bowel or open wound, chemical irritation, Caustic nature of digestive enzymes, urine initiates inflammatory response, boy does not induce peritonitis, progression; slight tenderness at location of injury, rebound tenderness, guarding, rigid, bored like field
Injury to pelvis
Serious skeletal injury, life-threatening hemorrhage, potential injury to pelvic organs; ureters, bladder, urethra, female genitalia, prostate, rectum, anus
Injury to vascular structures general management
Position patient, position of comfort unless spinal injury, flexed knees or left lateral recumbent, general shock care, fluid resuscitation large bore IV with iso tonic solution, consider to Bolus if pulse does not slow fluid challenge 250 ML or 20 ML\KG, limit 3L titrate to S BP of 90 mmHg, PA SG application
Impaled objects or eviscerations
Treat accordingly
Penetrating abdominal trauma accounts for
36% of maternal mortality
Gunshot wounds account for
40–70% of penetrating trauma’s
The blunt trauma
Improperly worn seatbelts
Auto collisions are
Leading cause of mortality
Injury during pregnancy
Trauma is the number one killer of pregnant females, changing dimensions of uterus, protects abdominal organs, endangers uterus in fetus, maternal changes, increasing size and weight of you to race, compression of inferior vena cava, reduces venous return the heart, increasing maternal blood volume, protect mother from hypovolemia, 30–35% of blood Less necessary before signs of shock, uterus is thick and muscular, distributes forces of trauma uniformly to fetus
Injury during pregnancy part two
Reduces chances for injury, risk of uterine and fetal injury increase with links of just station, greater risk during third trimester, penetrating trauma may cause feel and maternal blood mixing
Blunt trauma complications during pregnancy
Uterine rupture, abruptio placenta, premature rupture of amniotic sack
Management of pregnant patient\injury during pregnancy
Positioning, left lateral recumbent, if on backboard tilt backboard, facilitates venous return, oxygenation, high flow O2, consider PPV by BVM if hypoxia ensures, Maintain high index of suspicion for intra-abdominal bleeding, consider IV and PSG
Layers of skin
Dermis epidermis and subcutaneous
Underlying structures of the skin
Fascia , nerves, tendons, ligaments, muscles, organs
Functions of the skin
Protection from infection, sensory organ, temperature, touch, pain, control loss and movement of fluids, temperature regulation, insulation from trauma, flexible to accommodate free body movement.
Types of burns
Thermal electrical chemical and radiation
Thermal burns
Jackson’s theory of thermal wounds, zone of coagulation – area in a burn nearest the heat source that suffers the most damage as evidenced by clotted blood and thrombosed blood vessels, throne of stasis – area surrounding zone of coagulation characterized by decreased blood flow. Some of hyperemia – periphery all areas around burn that has an increase bloodflow.
Body’s response to Burn
Emergent days\stage one
fluid shift phase\stage two
hypermetabolic phase\stage III resolution phase\stage four
Phase 1 of the body’s response to Burns
Emergent phase. Pain response, tachycardia, tachypnea mild hypertension, mild, anxiety, catecholamines
Stage two bodies response to Burns
Fluid shift’s phase length 18–24 hours, begins after emerging days, reaches peak in 6–8 hours, damage cells initiate inflammatory response, increase blood flow to cells, shift of fluid from intra-vascular to extra vascular space,, massive edema, leaky capillaries
Body response phase 3 to burn
Hyper metabolic phase last four days two weeks, large increase in the bodies need for nutrients as it repairs itself
Body response to Burns stage four
Resolution phase scar formation, general rehabilitation and progression to normal function
Electrical burns voltage
Difference of electrical potential between two points, different concentrations of electrons.
Electrical burns amperes
Strength of electrical current, resistance\OH MS, opposition to electrical flow.
Electrical burns
Skin is resistant to electrical flow so greater the current the greater the flow through the body and the greater the release of heat, greatest he occurs at point of resistance which are the entrance and exit wounds. Dry skin equal greater resistance and wet skin equals less resistance, longer the contact, the greater the potential of injury, increased damage inside body, smaller the point of contact, the more concentrated the energy, the greater the injury
Electrical current flows through the path of least resistance
Tissue of less resistance equals\blood vessels, nerve, tissue of greater resistance\muscle, bone, results in serious vascular and nervous injury, in mobilization of muscles, flash burns
Chemical burns, chemical destroys tissue two types
Acids – form a thick insoluble mass where they contact tissue. Coagulation necrosis, limits burn damage. Alkalis destroy cell membrane through liquidfication Necrosis , deep tissue penetration and deeper burn
Radiation injury different types
Radiation is transmission of injury different types\nuclear energy, ultraviolet light, visible light, heat, sound, x-rays
Radioactive substance
Admits ionizing radiation, radionuclide radioisotope
Radio injury based on physics
Protons electrons
Protons
Positive charged particles, neutrons equal in master protons, no electrical charge
Electrons
Minute electrical emitted charged particles, admitted from radioactive substances are termed beta particles
Radioactive substances
Alpha particles, beta particles, gamma rays
Alpha particles
Slow-moving low energy stops by clotting and paper. Penetrate a few cell layers on skin, minor external hazard, harmful if ingested
Beta particles
Medium moving, medium entergy, stop by clothes
Gamma rays
Highly energized, penetrate deeper than alpha and beta, extremely dangerous, penetrate thick shielding, past entirely through clothing and body, extensive cell damage, indirect damage, caused by internal tissue to emit it alpha and beta particles lead shielding
Neutrons
Highly dangerous come from nuclear core
Management of radiation Substances
Park upwind, notify radiation response or hazmat response team, look for radioactive placards, measure radioactivity, decontaminate patients before care, routine medical care, ABC’s
Frostbite; superficial frostbite
Freezing of epidermal tissue, redness followed by blanching and diminished sensation
Deep frostbite
Freezing of epidermal and subcutaneous layers, white, frozen appearance
Treatment for frostbite
Do not call the affected area if there is the possibility of refreezing. Do not massage the affected area. Administer analgesics prior to thawing. Transport; rewarm by immersion only if transformer is lengthy or delayed. Cover the thawed part with a loose, sterile dressing. Elevate immobilize thawed part. Do not puncture or drain blister. Do not rewarm fee if walking will be required.
Drowning
Drowning is that they die within 24 hours and near drowning in when they die after 24 hours dry is where the lawns do not fill with water because of laryngeal spasm and wet drowning is where they fill with water
Drowning
Freshwater causes the ALveoli to a collapse from a lack of surfactant. Saltwater causes pulmonary Edema and hypoxemia due to its hypertonic nature
Factors affecting survival rate for drownings
Cleanliness of water link of time submerged, victims age and general health, water temperature\Coldwater, mammalian diving reflex. Decreases metabolism. The Coldwater drawing patient is not dead until warm and dead.
Diving emergencies classifications of diving emergencies
Injuries on the surface or injuries during to send which causes barotrauma
Injuries on the bottom\classification of diver emergencies
Nitrogen narcosis
Classifications of diving emergencies\injuries during ascend
Decompression illness\pulmonary overpressure and subsequent arterial gas embolism, pneumothorax, pneumomediastinum
Nitrogen narcosis\dive emergencies
Occurs during a dive. Can contribute two accidents during the dog
Signs and symptoms of diver emergencies
Altered levels of consciousness and impaired judgment
Treatment for dive emergencies
Return to shallow depth. Some prevent this by the use of oxygen\helium makes during dive
Overdose TCA
Cardiotoxin causing acidosis. Treatment is sodium bicarb
Overdose\stimulants
Cocaine. Treatment is Ativan or Valium
Overdose/depressants
Barbiturates, treatment signs and symptoms
Overdose etholyne glyco antie freeze
Antidote methyl alcohol
CVA/TIA TIA
TIA call temporary sign and symptom of a stroke. Many stroke. Symptoms disappear within 24–48 hours
CVA
Blockages cerebral facile causing permanent brain damage. Important treatment is decreasing time of the incident to correction. At ER
Migraines/extreme headaches
Sign and symptom, worst take ever, photosensitive, nauseated/vomiting, vertigo, malaise , can’t handle loud noises, general treatment
Psychiatric signs and symptoms of hallucinations
Violence, hearing voices
Hallucinations/psychic treatment
Do not agree with them, stay you understand what they see your field, take vitals, treat with medications if needed
G.I. bleed upper
Will have hematoemisis coffee ground consistency and dark blood in stool
G.I. bleed lower
Will have bright red blood in stool G.I. bleed treatment treat for shock
Dialysis/renal failure and complications
Artificial cleaning up the blood and complications electrolyte imbalance, hypotension, cardiac arrhythmias, dad
Energy exchange
Between an object in the human body without intrusion through the skin
Kinetics of blunt trauma
A body in motion will remain in motion unless acted upon by an outside force. A body at rest will remAin at rest in less acted upon by an outside force.
Conservation of energy
Energy can neither be created nor destroyed. It only has changed from one form to another. Speed is the greatest determinate
Force
Emphasizes the importance of rate at which object changes speed\acceleration or deceleration.
Types of trauma
Blunt\ penetrating
Closed injury
Indirect injury to underlying structures, transmission of energy into the body, tearing of muscle, vessels and bone, ruptured of solid organs
Penetrating
Open injury, direct injury to underlying structure
Automobile crashes
Events of impact in automobile crash, vehicle collision, body collision, Oregon collision, secondary collision, object inside vehicle strike pt additional injuries when vehicle receives a second impact.
Restraints/automobile crash
Seatbelts – pt slows with the vehicle, shoulder and lapbelt must be worn together, injuries if Warn separately
Airbags
Reduce point chest trauma, cause, hand, forearm, facial injury, check for steering wheel deformity, side airbags
Child safety seats
Infants and small children – rear facing, older child – forward facing
Types of impact
Frontal. Lateral. Rotational. Left and right – front and rear, rear end. Rollover.
Type of impact Frontal
32%
Types of impact lateral
15%
Types of impact rotational
38%
Type of impact rear end left and right front and rear
9%
Types of impact roll over
6%
Frontal impact
Down and under/knee femur or, and hip fracture, chest trauma – steering wheel, paper bag syndrome. And up and over/Tenses legs equals bilateral femur fractures, hollow organ rupture and a liver laceration, similar chest trauma, axle loading
Ejection
Due to up and over pathway, contact with the vehicle and external objects
Lateral impact
15% of multiple vehicle collision but 22% of gas– upper extremity injury, rib, clavicle, humorous, pelvis, femur fracture, lateral compression, ruptured diaphragm, spleen fracture, aortic injury, evaluate the unrestrained occupant
Rotational accident
Vehicle struck at oblique angle, less serious injuries unless strike a secondary object
Rear end accidents
Seat propel the occupant forward, head is forced backwards, stretching of neck muscles and ligaments, hyperextension and hyperflexion
Roll over accident
Multiple points of impact, ejection or partial ejection, less injury With restraints
Vehicle crash analysis
Hazards, crumple zones, intrusion, deformity of vehicle, use of restraints, intoxication’s – fatal accidents 50% involve EtOH
Behave killer mortality head – internal torso - spinal and chest fracture – extremity fracture – other
Head, 48% – internal torso, 37% – spinal and chest fracture, 8% -extremity fracture, 2% – all other, 5%
Crash evaluation
Collision questions – how did the Collision occur? Direction? Speed? Similar/different sized? Secondary collisions?
Motorcycle crashes
Serious injuries can occur with high and low speed. Collision
Types of impact
Frontal angular sliding ejection
Initial bike/object collision
Rider/object, rider/ground
Pedestrian accident
Adults turn away from the car so the bumper strikes lower legs first then the victim rolls up and over and thrown Children turn toward and face the car plus they are smaller so femur, pelvis often injured, thrown away or run over
Recreational vehicle accidents
Lack structure and restraint system
Types of vehicles
Snowmobiles, personal watercraft, ATVs
Blast injuries
Dust, fumes, explosive compounds explosion fuel plus oxidant combine instantaneously making the explosion and it creates heat and pressure wave
Events of the explosion
Pressure wave, structural collapse, blast wind, burns, projectiles, personnel displacement
Blast injury faces primary
Heat of the explosion
Blast injury phases secondary
Trauma caused by projectiles
Blast injury phases tertiary
Personnel displacement and structural collapse
Blast injury assessment
Be alert for secondary device, initial scene size up important, establish incident command system, injury patterns
Injuries to body parts
Rupture of air fluid filled organs, long, wait Manifestacion/heat and pressure. Hearing loss
Blast injuries long
Forceful compression and distortion of chest cavity, compression and decompression, pulmonary embolism,dyspnea hemoptysis pneumothorax
Blast injuries abdomen
Compression decompression, release of bowel contents diaphragm rupture from pushing of organs up in the thorax area
Blast injury ears
Initial hearing loss, injury improves over time
Blast injury penetrating wounds
Care as any serious open wound or impaled object
Blast injury Burns
Treatment consisted with traditional management
Other types of blunt traumas – Falls
Falls from where? Stairs, force, surface type, landing area, surface type, body part, height of full, elderly
Other types of blunt trauma sports injuries
Various injury patterns, produced by extreme exertion, fatigue or direct trauma, Acceleration, deceleration, compression, rotational, hyperextension or hyperflexion, unconsciousness, neurological defect or decreased mental status require physician follow up
Other types of blunt trauma helmet removal
If loose remove if tight remove facemask and immobilize in place and take helmet to hospital
Other types of want trauma crush injuries
Caused by structural collapse, explosion, industrial, agricultural. Damages produced by the great force to soft tissue them bones, tissue stretching and compression, extended pressure results and anaerobic metabolism distal to compression, return of bloodflow, toxins to entire body, severe hemorrhage due to severe damage blood vessels
Care for Blunt trauma
Prolonged crush medications – sodium bicarb – reduce acidosis, dopamine – improve kidney function, morphine – pain management
Mechanisms of penetrating injury
Knives arrows nails
Mechanisms of penetrating trauma
Understanding the principles of energy exchange increase the index of suspicion associated with the mechanism of injury
Mechanisms of penetrating injury ballistics
Study of the characteristic of projectiles in motion and effects upon objects impact. Factors affecting energy exchange between a projectile and body tissue. Velocity, profile, stability, expansion, fragmentation, small impacts, sharp
Ballistics
Small and fast bullet can cause greater damage than large and slow
Hello energy/low velocity injuries
Knives and arrows, medium energy/medium velocity weapons, hang guns, shotguns, low powered rifles, two 50–400 and mps
Hi energy/high velocity
Assault rifles 600–1000 mps
Different bullets of different weights traveling at different speeds caused different injuries
Bullet spins as it travels down the barrel rifling in barrel allows bullet to travel straight with slight yaw bullet departs barrel, spinning with a slight wobble or yaw. Weapon forced backwards and absorbs energy, recoil, reminder of energy propels bullet forward at a high rate of speed
Different bullets of different weights traveling to different speeds cost different injuries
Trajectory is curved due to gravity and then as bullet strikes object it slows and energy is transferred to object loss of conservation of energy
Energy dissipation: drag
Wind resistance
Energy dissipation– cavitation
Formation of a partial vacuum and cavity within a semi fluid medium
Profile– energy dissipation
Size and shape of a projectile as it Contacts a target, larger the profile equals greater energy exchange
Expansion and fragmentation
Results in damage
Stability allows for
Straighter trajectory, decreases after striking object results in tumbling
Velocity causes trajectory – faster
Straighter trajectory
Velocity causes trajectory – slower
More curved due to gravity
Aspects of ballistics profile
Portion a bullet You see as it travels towards you, larger profile equals greater energy exchange – caliber equals Diameter of a bullet – id of gun
Bullets become unstable as a pass from
One medium to another so you have to have stability
Bullet length increases bullet tumbling
Can reduce the accuracy of the shot, reduced by rifling in barrel – spinning, yaw – gyroscopic effect on the center of the axis of the bullet that reduces tumbling, tumbling of the bullet once it strikes the object, reduces Kinetic energy and causes greater tissue damage
Expansion and fragmentation
Results in increased profile, mushrooming, initial impact forces may result in fragmenting, greater tissue damage
Secondary impacts
Bullet striking other objects can cause tumble and yaw
Body armor levlar
Transmits energy throughout entire vest resulting in blunt trauma but can cause myocardial contusion, pulmonary contusion, and rib fractures.
Shape handgun ammunition
Blunt equals tumble
Shape rifle ammunition
Pointed equals piercing
Handguns
Small caliber, short barrel, medium velocity, effective at close range, severity of injury based upon organs damaged
Rifle
High velocity, long barrel, large caliber, increased accuracy at far distances
Assault rifle
Large magazine, semi or fully automatic, similar injury to hunting rifles, multiple wounds.
Shotgun
Slug or pellets at medium velocity, larger the load, the smaller the number of projectiles, deadly at close range
Knives and arrows
Low energy and low velocity, damage related to get an angle of attack, movement of the victim can increase damage.
Damage pathway
Women attackers versus men attackers
Projectile injury process
Tip impacts tissue, tissue push forward and to the side, tissue collides with adjacent tissue, shock wave of pressure and forward and lateral, moves perpendicular to bullet Pat, rapid compression, crushes in tears tissues, cavity forms between bullet pulling in to Debris with suction
Damage pathways – direct injury
Damage done as the projectile strikes tissue, pressure shockwave – human tissue is semi fluid so solid and dance organs are damaged greatly, temporary cavity – due to cavity – permanent cavity – due to serious damage tissues.
Zone of injury
Area that extends beyond the area of permanent injury
Low velocity wounds
From knives, ice picks, arrows, flying objects or debris, injury limited to tissue impacted
Specific tissue and organ injuries
Density of tissue affects the efficiency of energy transmission, resiliency strength and elasticity. Of an object
Connective tissue
Absorbs energy and limits tissue damage
Organs
Solid organs are dense low Resilience
Bone
Resist displacement until it shatters, alters projectile path
Extremities
Injury limited to resilience of tissue – 60–80% of injuries with greater ten percent mortality
Abdomen
Includes pelvis – highly susceptible to injury and hemorrhage, bowel perforation 12 to 24 hours. Peritoneal irritation
Neck
Damages trachea and blood vessels which would cause neurological problems, sucking neck wound
Head
Cavitation all energy trapped inside skull, serious bleeding and lethal
Wound characteristics entrance wounds
Size of a bullet profile for non-deforming bullets, deforming projectiles they cause large women’s close range have powder burns – tattooing of powder, 1-2 mm circle of discoloration, localize subcutaneous emphysema
Toxic inhalation
Synthetic resin combustion, cyanide and hydrogen sulfate, systemic poisoning, more frequent then thermal inhalation burns
Carbon monoxide poisoning
Colorless odorless tasteless gas, byproduct of incomplete combustion of carbon products, suspect with faulty heating unit, 200 times greater affinity for hemoglobin and oxygen, cause hypoxemia and hypercarbia
Airway thermal burn
Supraglottic structures absorb heat and prevent lower airway burns, moist mucosa lining the upper airway, injury is common from superheated steam
Risk factors – inhalation injury
Standing in the burn environment, screaming or yelling in the burn environment, trapped in a closed burn environment
Inhalation injury – symptoms
Stridor or crowning inspiratory sounds, singed facial in nasal hairs, black sputum or facial burns, progressive respiratory obstruction and arrest due to swelling
Depth of Burns
Superficial burn, partial thickness burn, full thickness burn
Superficial burn
First degree burn – reddeden skin, pain at Burnside, and involves only epidermis.
Partial thickness burns
Second-degree burn – intense pain, white to red skin, blisters, involves epidermis and dermis
Full thickness burns
Third-degree burn – dry, leathery skin – white, dark brown, chard, loss of sensation, all dermal skin layers/tissue may be involved
Rule of nines
Best use for large surface areas, expedient tool to measure extent of burn; know your adult and pediatric rules of nine charts
Rule of Palms
This used for Burns last then 10% body surface area, a burn equivalent to the size of the patient’s hand is equal to 1% body surface area
Systemic complications
Hypothermia, disruption of skin and the ability to Thermo regulate, hypovolemia, shifting proteins fluid and electrolytes to the burn tissue general electrolyte imbalance,eschar– hard whether he product of a deep full thickness burn, dead and denatured skin, infection greater risk of burn is infection and organ failure because of release of myoglobin
Special factors in Burns
Age and health, physical abuse, elderly, young
Management of thermal burns – local and minor burns
Local cooling – partial thickness, over 15% of body surface area, full thickness burns, over 2% body surface area – remove clothing, cool or cold water immersion, consider analgesics
Moderate to severe burns
Dry sterile dressing – partial thickness burns less than 15% body surface area, full thickness, less than 5% body surface area – maintain warm, prevent hypothermia, consider aggressive fluid therapy, burns over IV sites then you may place IV in partial thickness burn site
Parkland burn formula
4 ml x patient’s weight in kilograms times percent of body surface area burned equals amount of fluid patient should receive half of this amount in the first eight hours. Reminder in 16 hours, caution for fluid overload, frequent auscultation of breast sounds, consider analgesics for pain – morphine and Nubain, prevent infection
Management of inhalation injury
Provide high flow oxygen by non-rebreather and consider intubation if swelling and consider hyperbaric oxygen therapy
Management of cyanide exposure
sodium nitrate, amyl nitrate, sodium thiosulfate forms Methemoglobin binds to cyanide, non-toxic substance secreted in urine , inhale one ampule amyl nitrate, 300 mg sodium nitrate over 2–4 minutes, 12.5 g of sodium thiosulfate
Management of electrical injuries
Safety, turn off power, energize lines act as whips, establish a safety zone, lightning strikes – high-voltage, high current, high-energy and last fraction of a second, no danger of electrical shock to EMS, assess patient, entrance and exit wounds,, remove clothing, jewelry and leather items, tree any visible injuries, thermal burns, ECG monitoring, bradycardia, tachycardia, ventricular fibrillation, the systole, AC LS protocols treat cardiac and respiratory arrest, aggressive airway, ventilation and circulatory management, consider fluid bolus for serious burns – 20 ml/kg consider sodium bicarb – 1meq/kg consider Mannitol 10 g
Management of chemical burns
Scene size up, hazardous materials team, Establish hot, warm, it’s cold zones, prevent personnel exposure
Specific chemicals
PHenol industrial cleaner, alcohol dissolves Pheno irrigate with copious amounts of water
Dry lime
Strong corrsive that reacts with water, brush off dry substance, it irrigate with copious amounts of cool water, prevents reaction with patients tissues
Sodium
Unstable metal, react vigorously with water, releases, extreme heat, hydrogen gas, ignition decontaminate – brush off dry chemical, cover the wound with oil substance
Riot control agents
Cs cn mace, olegoresin, capsicum, OC pepper spray, they cause irritation of the eyes mucous membranes and respiratory track no permanent damage, general size and symptoms include coughing, gagging and vomiting, I pain, tearing, temporary blindness
Radiation burns
Notify hazmat, establish safety zones, hot warm and cold, personnel positioned upwind and uphill, use older rescuers for recovery, decontaminate all rescuers, equipment and patients, ongoing assessment, reevaluate initial assessment and interventions
Assessment of the Gynecological pt history
initial assessment – sample. Does the patient complained of pain? Use opqrst dysmenorrhea dyspareunia associated signs or symptoms. Has she ever been pregnant? Gravida/parity/abortion, document last menstrual cycle. Medications – contraceptives
Management of gynecology emergencies
General management of gynecology emergencies is focused on supportive care. Do not pack dressing in the vagina
Gynecology abdominal pain
Pelvic inflammatory disease – from bad hygiene, chlamydia, gonorrhea, ruptured ovarian cyst, cystitis, mittelschmerz Endometriosis ectopic prego
Management of gynecology abdominal pain
Make the patient comfortable and transport. Vaginal bleeding? Nontraumatic, menorrhaiga, spontaneous abortion, treatment for vaginal bleeding, do not pack vagina, transport, initiate oxygen and IV access based on patient’s condition.
Causes of gynecology trauma
Blunt trauma. Assault. Blunt force to lower abdomen. Foreign bodies inserted in vagina. Abortion attempts.
Management of gynecology trauma
Apply direct pressure over laceration. Apply cold pack two hematoma. Establish IV if patient is severe. Transport.
Sexual assault management
Do not ask specific details of sexual assault. Do not examine the X sternal genitalia or of sexual assault victim and less there’s life-threatening hemorrhage. Protect the scene. Handle clothing as little as possible. If removing clothing, bag each item separately. Do not cut through any tears or holes and clothing. Place bloody articles in brown paper bags. Do not examine the perineal area. Do not allow patient to change clothes, bathe, or douche. Do not allow patient to comb hair, brush teeth, or clean fingernails. Do not clean wounds if possible
Documentation of gynecology trauma/sexual assault
State patient remarks accurately. Objectively state your observations of patients physical condition, environment, or torn clothing, document evidence turn over to hospital staff. Do not include your opinions as whether to been raped or not
Type one diabetes melitus
Also called juvenile or insulin-dependent diabetes mellitus. Characterized by low production of insulin. Close related to ready. Results in pronounced hyperglycemia
Symptoms of type one diabetes
Polydipsia polyuria polyphagia weight-loss and we miss untreated or noncompliant patients may progress ketosis or diabetic ketoacidosis
Type two diabetes mellitus
Also called adult onset or non-insulin-dependent diabetes mellitus results from decrease binding of insulin to cells. Related to heredity or he and obesity. Accounts for 90% of all diagnosed diabetes patient less risk of fat based metabolism. Results in less pronounce Hyperglycemia. Hyperglycemia hyperosmolar nonketotic acidosis – managed with dietary changes and oral drugs to stimulate insulin production and increased receptor effectiveness
Diabetic ketoacidosis
Results from the bodies change to fat metabolism. Continuous build up of ketones produces significant acidosis
Signs and symptoms of diabetic ketoacidosis
Dehydration and acidosis – extended period of onset – 12–24 hours. Sweet, fruity breath odor. Potassium related cardiac dysrhythmias. Kussmaul respirations. Declining mental status and coma.
Hyperglycemia hypersmolar nonketotic coma
Pathophysiology found in type two diabetics. Results in blood glucose levels up to 1000 MG/DL. Insulin activity prevents build up of ketones. Sustained hyperglycemia results in mart dehydration. Often related to dialysis, infection, and medications. Very high mortality rate
Hypoglycemia
True medical emergency resulting from low blood glucose levels; rarely seen outside of diabetics. By the time signs and symptoms develop, most of the body’s stores have been used. Diabetics with kidney failure are predisposed to hypoglycemia.
Hypoglycemia signs and symptoms
Sympathetic nervous system response, andregenic activation
Disorders of the thyroid gland
Graves’ disease thyrotoxic crisis – thyroid storm hypothyroidism myxedema
Graves’ disease
Probably hereditary in nature. Autoantibodies are generated that stimulate thyroid tissue to produce excessive hormone.
Graves’ disease signs and symptoms
Agitation, emotional changeability, insomnia, poor heat tolerance, weight-loss, weakness, dyspnea, tachycardia and new onset arterial fibrillation. Protrusion of the eyeballs or goiters
Graves’ disease assessment and management
Usually arise from cardiovascular signs and symptoms. Manage signs and symptoms.
Thyrotoxin crisis – thyroid storm
Life-threatening emergency, usually associated with severe psychologic stress or overdose of thyroid hormone. Results when thyroid hormone moves from downstate to Freestate within the board.
Thyroid storm signs and symptoms
High fever 106 Fahrenheit or higher, reflected in increased activity or sympathetic nervous system. Irritability, delirium or coma, tachycardia and hypotension, vomiting and diarrhea
Thyroid storms assessment management
Support airway, breathing, circulation. Monitor closely and expedite transport
Hypothyroidism myxedema
Can be inherited or acquired. Chronic untreated hypothyroidism creates myxedema thickening of connective tissue in skin and other tissues. Infection, trauma, CNS depressants, or a cold environment can trigger progression to a myxedema coma
Hypothyroidism myxedema signs and symptoms
Fatigue, slow mental function, cold intolerance, constipation, Lethargy, absence of a motion, thinning hair, enlarged tongue, cool, pale doughlike skin, coma, hypothermia and bradycardia, weight gain, moon faced appearance, fat accumulation on the upper back, skin changes and delayed healing of wounds, mood swings, impaired memory or concentration
Hypothyroidism myxedema assessment management
Maintain ABC’s. Closely monitor cardiac and pulmonary status. Obtain blood glucose level entry for hypoglycemia if present. Establish IV and provide aggressive fluid resuscitation. Expedite transform
Allergic reaction
Exaggerated response by the immune system to foreign substance
Anaphylaxis
And unusual or exaggerated allergic reaction, a life-threatening emergency
The immune system
Cellular immunity humoral immunity antibodies reacts to pathogens and toxins
Antibodies inmunoglobins
igA igD igE igG igM
Immune response
Exposure to antigen produces primary response with general and antibodies. Immune system develops antigen specific anti bodies and memory. Future exposures generate a faster secondary response
Natural and acquired immunity and induced active immunity
Sensitization
Hypersensitivity
Hypersensivity delayed
Results from cellular immunity and does not involve antibodies commonly results and skin rash. Results from exposure to certain drugs or chemicals
Hypersensivity immediate
Exposure quickly results in secondary response. More severe than delayed hypersensivity
The allergic reaction
Exposure generate secondary response. Large quantities of IGE are released. Allergens bind to ige. Causing chemical release. Histamine causes bronchoconstriction, vasodilation, increase gastric motility, and increased vascular permeability. Angioneurotic edema.
Management of allergic reaction
Antihistamines, epinephrine 1–1000 0.3–0.5 MG subcutaneous
Anaphylaxis
Causes are injections mostly anaphylaxis results from the injected route, Allergan rapidly distributed throughout the body, resulting in assive histamine release. Parentneal penicillin injections and insect stings. Affects cardiovascular, respiratory, gastrointestinal and integumentary systems. Significant plasma lost through increased vascular permeability. Slow reacting substance of anaphylaxis
Anaphylaxis assessment
Facial or laryngeal edema, abnormal breath sounds, hives, urticaria, hyperactive bowel sounds, model signs deterioration as the reaction progression
Anaphylaxis management
Scene safety, consider the possibility of trauma, protect the airway. Use airway adjunct with care intubate early in severe cases to prevent total occlusion of the airway. Be prepared to place a surgical airway. Support breathing hi flow oxygen or assisted ventilation if indicated. Establish IV access patient may be volume depleted due to third spacing of fluid administer crystalloid solution at corticosteroids, vasopressors, beta agonist, other agents, psychological support
Agonal respiration
Shallow slow in frequent breathing indicating brain anorxia
Disruption in ventilation
Nervous system, trauma, poisoning overdose disease
Airway sounds
Stridor. Wheezing rales rhonchi snoring crackles
Palpate Chestwall for
Tenderness, symmetry, I have normal motion, crepitus, subcutaneous emphysema
Other types of monitoring devices
Noninvasive respiratory monitoring, colorimetric in tidal CO2 detector, electronic entitle CO2 detector pulse ox esophageal detector device, if Bulb does not refill it’s improperly placed. If bulb fills upon release it indicates correct placement
Manual airway maneuvers
Head tilt chin lift, modified jaw thrust . in trauma, Jaw thrust maneuver, Sellick maneuver cricoid pressure, Jaw maneuver
Basic mechanical airways
Nasopharyngeal airway oropharyngeal airway insert oropharyngeal airway which tip facing Palate and rotate airway 180° into position
Advanced airway management
Endo tracheal intubation is performed if basic airway management is not effective
Laryngoscope blades
Macintosh blade into vallecula, Miller blade lifts up the epiglottis
Endotracheal intubation’s indications
Respiratory or cardiac arrest, unconsciousness, risk of aspiration, obstruction due to foreign bodies, trauma, burns, anaphylaxis, respiratory extremis due to disease, pneumothorax, hemothorax, hemo pneumothorax with respiratory difficulty
Endotracheal intubation complications
Equipment malfunction, teeth breakage and soft tissue lacerations, hypoxia, esophageal intubation, Endobronchial intubation, tension pneumothorax
Advantages of endotracheal intubation
Isolates trachea and permits complete control of airway impedes gastric distention, eliminates need to maintain a mask seal, offers direct route for suctioning, permits administration of some medications
disadvantages of Endotracheal intubation
Requires considerable training and experience, require specialized equipment, requires direct visual of vocal chords, bypasses upper airways functions of warming, filtering and humidifying that inhaled air
Disadvantages of endotracheal intubation
Continuously recheck in reconfirm the placement of the endotracheal tube and secured the endotracheal tube on the maxillary for decrease chance of dislodged foreign body removal with direct visualization and magill forceps
rapid sequence intubation
A patient needs intubation may be awake. RSI paralyzes the patient to faciliate endotracheal intubation
Nasotracheal intubation
Maybe useful in some situations; possibly spinal injury, clenched teeth, fractured jaw, oral injuries or recent facial surgery. Facial or airway swelling, obesity, arthritis
Other intubation device
Esophageal combitube laryngeal mask airway pharyngo tracheal lumen airway eaophageal gastric tuve esophageal obturator airway eoa
The only indication for surgical airway
Inability to establish airway by any other method
Jet ventilation with Needle cric
14 gage needle with positive pressure air delivery
Anatomical landmarks for Cric
Between the cricoid cartilage in the thyroid cartilage
Procedure for Cric
Make a 1 cm horizontal incision through the cricothyroid. Membrane
Tracheostomy cannulea
patients with stoma sites– patients who have larygectomy or tracheostomy breath through a stoma. They are often problems with excess secretions and a stoma may become plugged
Suctioning stoma. Complicate
Anticipating complications when managing airways key for successful outcomes. Be prepared to suction airways to remove blood and other secretions for the patient to vomit
Suctioning techniques
Wear protective eyewear, gloves and facemask, pre-oxygenate the patient determine depth of catheter insertion, with suction off insert catheter, turn on suction and suction removing catheter no more than 10 seconds, hyperventilate the patient
Oxygenation
Oxygen supply and regulators – green chrome white 2:5 pin index, oxidizer, oxygen label
Oxygen delivery devices
Nasal cannula simple facemask non-or breather bag valve mask
Nasal cannula
Up to 40%
Simple facemask
40 to 60%
Bag valve mask
Hundred percent with reservoir bag
ventilation methods
Mouth to mouth, mouth to nose, bag valve device, demand valve device, automatic transport ventilator
When ventilating a patient be cautious of proper title volume
5–10 CC/KG
Acute respiratory distress syndrome or acute lung injury causes
Sepsis aspiration pneumonia pulmonary injury Burns/inhalation injury, drugs high altitude hypothermia
Adult respiratory distress syndrome or acute lung injury pathophysiology
High mortality, multiple organ failure, affects interstitial fluid, causes increase in fluid in the interstitial space, disrupts diffusion and perfusion
Adult respiratory distress syndrome or acute lung injury assessment
Symptoms related to underlying cause; abnormal breast sounds and crackles and rales
Adult respiratory distress syndrome or acute lung injury management
Manage the underlying condition, provides supplemental oxygen, support respiratory effort, provide positive pressure ventilation’s if RR failure is imminent, monitor cardiac rhythm vital signs, consider medications cortical steroid
Obstructive lung disease type
Emphysema chronic bronchitis asthma
Obstructive lung disease causes
Genetic disposition, smoking and other risk factors
Emphysema pathophysiology
Exposure to noxious substances, exposure results in destruction of the walls of the avlovi atrlrcatsis causing poor perfusion we getting the walls of the small bronchioles and result in increased residual. Volume, loss of elasticity causes increased pressure, right-sided heart failure, failure – cor pulmonale polycythemia increased risk of infection dysrhythmia
Emphysema assessment
Physical exam, barrel chest, prolonged expiration and rapid rest phase, then, pink skin due to read cell production, Hyper trophy of accessory muscles pink puffers
Chronic bronchitis pathophysiology
Results from an increase in mucus secreting cells in the respiratory tree. Alveoli relatively unaffected, decreased alveolar ventilation
Calling bronchitis history
Frequent respiratory infection. Productive cough smoker has been going on for years
Chronic bronchitis physical exam
Often overweigh rhonchi presents on auscultation jugular vein distention ankle edema hepatic congestion blue bloater
Bronchitis and emphysema management
Maintain the airway support breathing oxygen titrated to 94% or less fine position of comfort monitor oxygen saturation be prepared to ventilate or intubate monitor cardiac rhythm established IV access administer medications bronchodilators corticosteroids
Asthma pathophysiology
Chronic inflammatory disorder that results in widespread variable airflow instruction the airway becomes hyper responsive and do induced by a trigger which can vary by individual. Trigger causes release of histamine, bronchoconstriction and bronchial edema 6–8 hours later immune system cells invade the bronchial mucosas and cause additional edema
Asthma physical exam
Presenting signs may include wheezing and cough dyspnea wheezing is not present in all asthmatics speech may be limited to 1 to 2 consecutive words look for hyperinflation of the chest and accessory muscle use. Carefully auscultate breath sounds and measure peak expiratory flow rate. May stop breathing because of decreased lung capacity
Uterine inversion
Uterus is turned inside out after delivery and extends through the cervix. Blood lost ranges from 800 to 1800 mL. . Begin fluid resuscitation Make one attempt to replace the uterus. If this fails cover the uterus with towels moistened with Saline and transport rapidly
Pulmonary embolism
Presents with sudden severe dyspnea and sharp chest pain administer high flow oxygen and support ventilations as needed to establish IV of normal saliene transfer immediately monitoring the heart vital signs and oxygen saturation
Neonate
An infant from the time of birth to one month of age
Newborn
A baby in the first few hours of it’s life also known as newly born infant
epidemiology
Approximately 6% of field deliveries require life-support the incident of complications increases as the birthweight decreases approximately 80% of newborns Wayne 1500 g, 3 lbs. 5 oz. at birth require resuscitation
Antipartum
Before the onset of labor
Intrapartum
Occurring during childbirth
neonatal pathophysiology
Dramatic changes occur within the newborn to prepare it for extrauterine life. Fluid in the fetal lungs will be forced out of the Lungs during delivery by compression of the chest and by entry of air into the lungs. Factors that stimulate the babies first breath. Mild acidosis initiation of stretch reflexes in the Lungs hypoxia hypothermia
Neonatal assessment
Assess the newborn immediately after birth. Ideally, one Paramedic attends the mother of all the other attends the newborn. Remember newborns will be slippery and require both hands
Neonatal normal heart rate
150–180 per minute. Slowing to 130–140 thereafter. A pulse less than 100 indicates distress. I’m respiratory rate 40–60 per minute. Evaluate skin color as well. Use Apgar score. You need to know your Apgar scores
Neonatal treatment
Establishing an airway, airway management is one of the most critical steps in caring for the newborn. Suction the baby’s mouth first, then the nose, to avoid risk of aspiration. Prevention of heat loss – he lost can be life-threatening to newborns. Most Telos results from evaporation. Core temperature can quickly drop 1°C from its original temp temperature
Neonatal cutting umbilical cord
After you stabilize the patient’s airway and minimize heat loss, clamped and cut the umbilical cord. Do not milk or strip the cord. One 5 cm away from the other 10 cm away. Apply the clamp within 30 to 40 seconds after birth.
The distress of newborn
The distress of the newborn can either be full-term or premature. Aspiration of meconium can cause significant problems and should be prevented. The most common problems experienced by newborns during the first five minutes a life involve the airway. Of the vital signs, heart rate is the most important indicator of neonatal distress. A heart rate less than 60 should be treated with chest compressions.
Inverted pyramid for resuscitation
Drying, warming, positioning, suctioning, stimulating
Neonatal oxygen
Central cyanosis is present, administer supplemental oxygen. If possible, oxygen should be warmed and humidified. Never deprive a newborn of oxygen in prehospital setting, for fear of toxicity
Neonatal ventilation
Begin positive pressure ventilation if any of the following is present heart rate less than 100 beats for minute apnea persistent central cyanosis
Endo tracheal intubation of a newborn
Should be carried out in the following situations. The Bvm does not work. Tracheal suctioning is required. Prolonged ventilation will be required. Diaphragmatic hernia is suspected
neonatal chest compressions
Initiate chest compressions if either the following conditions exist. The heart rate is less than 60 per minute that does not increase within 30 seconds of positive pressure ventilation and oxygenation
Neonatal medications and fluids
Most cardio pulmonary arrest in newborns result from hypoxia so initial therapy consist of oxygen and ventilation when oxygen and ventilation fails, fluids and medication should be administered. Vascular access can be managed by using umbilical vein
Maternal narcotic use
Complicate delivery shown to produce low birth weight infants. Such infants may demonstrate withdrawal symptoms such as trimmers startles you decreased alertness and rest for distress. Narcan is the drug of choice for rest for a depression, secondary to maternal narcotic keys
Neonatal transport
Paramedics are called upon to transport at high-risk newborn from one facility to a neonatal intensive care unit. During transport help to maintain body temperature control oxygen and maintain ventilatory status
Specific neonatal situations meconium
Stained amniotic fluid, occurs in approximately 10 to 15% of deliveries. An infant born in the presence of thin mericoium may not require treatment but those born through thick mericoium should be intubated immediately if baby is not vigorous
Neonatal apnea
Usually due to hypoxia were hyperthermia other causes include narcotic or central nervous system depressants weakness of respiratory muscles metabolic disorders or central nervous system disorders or septicemia
Diaphragmatic herniation
Most common posterolaterally a rare condition one in every 2200 verse. Survival rate is 50%. Do not use BBM, if necessary positive positive pressure ventilation’s via ET tube
Neonatal bradycardia
Most common cause by hypoxia resist the temptation to treat bradycardia a new born with pharmacological measures alone
Neonatal premature infants
Are at a greater risk of respiratory depression head injury changes in blood pressure intraventricular hemorrhage and fluctuations in fluid osmolarity
Neonatal seizures
May indicate serious illness
Neonatal fever
Uncommon and may also indicate serious underlying illness
Neonatal hypothermia
May indicate sepsis
Neonatal hypoglycemia
Check blood glucose on all sick and unhealthy infant
Neonatal vomiting and diarrhea
May cause dehydration and electrolyte imbalance
Neonatal scabies
And the poor hygiene families
Neonatal cardiac resuscitation
Post resuscitation and stabilization, neonatal cardiac arrest is related primarily to hypoxia
Neonatal risk factors
Neonatal risk factors include prematurity maternal druggies congenital diseases inteapartum hypoxemia bradycardia intrauterine asphyxia
Pediatrics role of paramedics in pediatric care
Pediatric injuries have become major concerns children are higher risk of injury and adults children are more likely to be adversely affected by the injuries they received
General approach to pediatric emergencies
Communication and psychological support treatment begins with communication and psychological support responding to the patients needs
The child’s most common reaction to an emergency is fear of
Separation removal from the family place being hurt being mutilated or disfigured, the unknown
Responding to parents or caregivers
Communication one Paramedic speaks with the adults. Introduced yourself and appear calm. Be honest and reassuring. Keep parents informed
Growth and development newborns
First hours after birth assessed with Apgar scoring system
Growth and development neonates
Birth to one month tend to lose 10% of bodyweight but we’re game in 10 days. Development centers on the reflexes. Personality begins to form. Mother occasionally father can confront child. Common illness includes a jaundice vomiting and rest for distress. Do not develop fever with minor illness. Allow patient to remain in caregivers lab
Infants 1 to 12
They stand or walk without assistance follow movements muscle development in cephalo caudal progression allow patient to remain in caregiver
Toddlers ages one-year-old to 3 years old
Great strides in minor development may stray from parents more frequently parents are the only ones who can comfort them language development begins approach approach child slowly examine from toe to head avoid asking yes or no questions allow child to hold favorite blanket or I don’t tell child if something will hurt
Preschoolers ages 3 to 5 years old
Increase in fine and gross motor skills. Children know how to talk. Fear mutilation. Seek comfort and support from within home. Distorted sense of time
Common preschooler illnesses
Croup asthma poisoning auto accidents burns child-abuse ingestion of foreign bodies drowning epiglottitis febrile seizures meningitis
School age children ages 6 to 12 years old
Active in carefree age group growth spurt are common give this age group responsibility of providing history respect modesty
Common illness and injuries in school age children
Drowning auto accidents bicycle accidents Falls fractures sports injuries child-abuse burns
Adolescents ages 13 to 18 years old
Begins with puberty which is very child specific are very body conscious may consider themselves grown-up desire to be liked and included by peers are generally good historians relationships with parents may be strained
Common adolescent injuries and illnesses
Asthma auto accidents sports injuries drug and alcohol problems suicidal gestures sexual abuse mono
Anatomical and physiological considerations in the infant and child
In the supine position and infant’s or child’s larger head tips forward causing airway obstruction
Anatomical and physiological considerations in the infant and child two
Placing padding under the patients back and shoulders will bring the airway to a neutral or slightly extended position
General approach to the pediatric assessment/basic considerations
Much of the initial patient assessments can be done during visual examination of the scene. Involve the caregiver were parent as much as as possible. Allow to stay with child during treatment and transport.
General approach to pediatric assessment/scene size up
Conductor quick scene size up. Take BSI precautions. Looks for clues to mechanism of injury or nature of illness. Allow child time to adjust to you before approaching. Speak softly simply at a high-level. Notice the components and signs in the pediatric assessment triangle. Notice the conditions that can be determined by quick observation
General approach to pediatric assessment/Glasgow coma scale
13–15 equals mild 9–12 equals moderate eight and below equals severe modifications for infants
General approach to pediatric assessment vital signs and pediatrics
Pulse respiration’s blood pressure necessary and children over three years of age
General management of pediatric patients – suctioning
Decrease suction pressure to less than 100 mm/HG in infants. Avoid excessive suctioning time – less than 15 seconds per attempt. Avoid stimulation of the Vegas nerve. Check the pulse frequently
General management of pediatric patients – oxygenation
Adequate oxygenation is the hallmark of pediatric patient management. Insertion of oral airways in an adult the airways inserted with the tip pointing to the roof of the mouth then rotated in to position
General approach to pediatric assessment – anticipating cardiopulmonary arrest
Respiratory rate greater than 60, heart rate greater than 180 or less than 80 under five years old, heart rate greater than 180 or less than 60 over five years old, respiratory distress trauma burns cyanosis altered level of consciousness seizures fever with petechiae
General management of pediatric patients – ventilation
Avoid excessive bag pressure and volume. Obtain chest rise and fall. Allow time for exhalation. Flow restriction oxygen powered devices are contraindicated. Do not use bag valve mask with pop off valves. Apply cricoid pressure. Avoid hyper extension of the neck
General management of pediatric patients advanced airway
A straight blade is preferred for greater displacement of the tongue. The pediatric airway narrows at the cricoid cartilage. Uncuffed tubes should be used in children under eight years of age. Intubation is likely to cause vagal response and children
General management of pediatric patients – pediatric endotracheal tube size
Use a resuscitation tape that estimates endo tracheal tube size based on height. Estimate the correct diameter based on the child’s little finger
General management of pediatric patients indications for intubation
Need for prolonged artificial ventilation in adequate ventilatory support with a bag valve mask cardiac or respiratory arrest control of an airway in a patient without a cough or gag reflex providing a route for drug administration access to the airway for suctioning
General management of pediatric patients circulation
Two problems lead to cardiopulmonary arrest in children shock and respiratory failure
General management of pediatric patients vascular access
Neck veins, scalp veins, arms, hands, feet , io infusion
Pediatric vascular access indications
Children less than six years of age existence of shock or cardiac arrest unresponsive patient unsuccessful peripheral IV
Pediatric vascular access contraindications
Fracture in the bone chosen for the IO fracture of the pelvis or extremity fracture of bone proximal to the chosen site
Pediatric drug administered through IO
Epinephrine atropine dopamine lidocaine sodium bicarb Dobutamine
Pediatric management fluid administration
20 cc per kilogram in pediatrics 10 cc per kilogram in infants
Pediatric management or electrical therapy
Initial dose just to joules per kilogram of body weight if on six sass full increase to 4 J per kilogram is still on successful focus on correcting hypoxia and acidosis transport to a pediatric critical care unit if possible
Respiratory emergencies pediatrics infections
Croup viral laryngotrachial bronchiolitis
Epiglottitis – bacterial
Lower airway distress
Asthma bronchiolitis
Poisoning and toxic exposure
Accidental poisoning is common childhood emergency waiting cause of preventable death in children
Trauma emergencies pediatric
Falls are most common cause of injury in young children motor vehicle crashes car versus pedestrian injuries drowning in near drowning penetrating injuries burns and physical abuse
Trauma emergencies pediatric
In the trauma victim use the combination of job thrust spine stabilization maneuver to open the airway
Sudden infant death syndrome SIDS
Unexplained death of an infant child less than one year of age
Child abuse and neglect
Beating with an electrical wire the burns on the butt ox and saw burns from submersion in hot water as a punishment cigarette burns malnutrition and poor hygiene the effects of child abuse both physical and mental can last a lifetime
Infants and children with special needs
MS SMS MD
Common homecare devices
Tracheostomy tubes apnea monitors home artificial ventilators central intervenous lines gastric feeding and gastrostomy tubes Shunts
Morals
What society deems as except the conduct of individuals right and wrong
Ethics
What profession deems is acceptable behavior right and wrong
Categories of law
Criminal civil tort
Criminal law
Federal court dealing with criminal offenses
Civil law
Two or more parties against another party
Tort law
One individual against another
Wall affecting you EMS Paramedic
Scope of practice – range of duties and skills paramedics are allowed expect to perform you may function as a paramedic only under the direct supervision of a licensed physician through the delegation of authority
Mandatory reporting requirements
Spouse abuse child abuse and neglect elder abuse sexual assault gunshot and stab wounds animal bites communicable diseases
Legal protection for the Paramedic
Good Samaritan law and the Ryan White care act
Good Samaritan law
Provide immunity certain people who assisted the scene of a medical emergency
Ryan White care act
Requires notification and assistance to the paramedics were been exposed to certain diseases local laws and regulations
Legal accountability for the Paramedic
Always exercise the degree of care skill and judgment expected under likes circumstances by a similar trained reasonable Paramedic in the same community
Negligence
Deviation from excepted standard of care recognized by law for the protection of others against unreasonable risk of harm
Components of negligent claim
Duty to act breach of duty actual damages proximate cause
Breach of duty consist of
Malfeasance misfeasance nonfeasance
Duty to act
A formal or informal legal obligation to provide care
Breach of duty
Action or in action that violates the standard of care expected from a paramedic
Malfeasance
Performance of a wrong for unlawful act by a paramedic
Misfeasance
Performance of a legal act in a harmful or injures manner
Nonfeasance
Failure to perform a required actor duty
Actual damages
Refers to physical psychological or financial harm
Proximate cause
An action or in action that immediately caused or worsen the damage is called proximate cause
Special liability concerns
Borrowed several doctrine civil rights off-duty paramedics
Borrowed Severn doctor
While supervising an EMT intermediate or EMT basic a paramedic may be liable for any negligent acts that person commits
Civil rights
If medical care is withheld due to any discriminatory reason I’m Paramedic maybe sued examples race creed color gender national origin ability to pay
Off-duty paramedics
Performing procedures that require delegation from a physician off duty may constitute practicing medicine without a license
Paramedic patient relationships legal principles
Confidentiality Deframe and slander libel
Confidentiality
Is a principle of law that prohibits the release of medical or other personal information about a patient without the patient’s consent
Defamation
Is an intentional false communication that injures another person’s reputation a good name
Libel
The act of injuring a person’s character name reputation by false statements made in writing or through mass media with malicious intent or reckless disregard for falsity of those statements
Slander
Active injuring a person’s character name reputation by false or malicious statements spoken with malicious intent or reckless disregard for the falsity of those statements
I Paramedic may be accused of invasion of privacy for the release of
Confidential information without legal justification regarding a patient’s private life which might reasonably expose the patient to ridicule embarrassment
Consent
The granting of permission to treat a patient you must have consent before treating a patient patient must be compliant to give or withhold consent
Informed consent
Consent based on full disclosure of the nature risk and benefits of a procedure must be obtained from every compliant adult for treatment may be initiated in most states of patient must be 18 years of age or older to give or withhold consent in general inpatient or guardian must give consent for children
Express consent
Verbal or nonverbal or written communication by a patient who wishes to receive treatment of active calling EMS is Generally considered an expression of the desire to receive treatment you must obtain consent for each treatment provided
Implied consent
Consent for treatment and that is present for a patient who is mentally physically or emotionally unable to give consent is assumed that the patient would want life-saving treatment if able to give consent also called an emergency doctrine
In voluntary consent
Consent for treatment granted by a court order most commonly encounter with patients who must be held for mental health evaluation or as directed by law enforcement personnel who have the patient under arrest maybe used on patients whose disease threatens a community at large
Minors
Usually a person under 18 years of age consent must be obtained from parent or legal guardian
Mentally incompetent adults
Consent must be obtained from a legal guardian for minors and mentally incompetent adults if a parent or legal guardian cannot be found treatment may be rendered under the doctrine of implied consent
Emancipated minors
Person under 18 years of age she was married pregnant apparent a member of the Armed Forces financially independent living away from home manciple did minor’s may give informed consent
Withdrawal of consent
The patient may withdrawal consent for treatment at any time but it must be an informed refusal of treatment
