EMT all flashcards which term need to be studied

Object stuck to the cornea or lying under the upper lid

- Gentle irrigation usually will not wash out foreign bodies that are stuck to the cornea or lying under the upper eyelid - To examine the undersurface of the upper eyelid: pull the lid upward and forward - If you spot a foreign object on the surface of the eyelid, may be able to remove it with a moist, sterile, cotton-tipped applicator - Never attempt to remove a foreign body that is stuck to the cornea

How to treat a person who has been raped

- Give the option of being treated by a female EMT - 3 components of treatment: - Medical treatment: is she injured + life threats + pain - Psychologic treatment: don't try to obtain info for police + no interrogation - Preserve evidence (crime scene): don't cut through any clothing + place everything in paper (not plastic -> mold -> destroy evidence) bags + discourage pt to clean herself/urinate/change cloth. If she refuses, accept it + compassion - Expose and examine the vaginal area only if there is evidence of bleeding that needs to be treated - If the patient refuses transport, offer to call the local rape crisis center for her

Critical organs

- Heart - Brain (4-6 min) - Lungs (15-20 min) - Kidneys (45 min) -> quickly die if interruption in blood flow

Pathophysiology - pb in brain VS heart/lungs

- Heart and lungs: entire brain affected - Brain: only 1 side of body affected - Low O2 in blood: entire brain

Acute pulmonary edema

- Heart injured -> left side can't remove blood from lung -> Fluid collects in the spaces between the alveoli and capillaries -> disturbs normal gas exchange - Usually the result of CHF - Rapid/shallow respirations + frothy pink sputum - Risk factors: CHF (risk factor: hypertension) + history of coronary artery disease + poisoning + trauma injury

Sources of radiant energy in a burn

- Heat - Toxic chemicals - Electricity

GEMS diamond

- Help you remember what is different about older patients - Acronym for the issues to be considered when assessing every older patient

Carbon dioxide retention

- High CO2 level in blood -> respiratory center no longer responds to high blood levels of CO2 - Causes: chronic lung disease -> can't eliminate CO2 through exhalation -> hypoxic drive ("backup system")

Smallpox: communicability, symptoms, PPE, vaccine or not?

- Highly contagious, mainly when blisters begin to form - Symptoms: first high fever + body aches, then rash + blisters - PPE: gloves + HEPA + eye protection - There's a vaccine but with side effects

How to assess the level of danger of a violent pt

- History - Posture - Scene - Vocal activity - Physical activity

Cylinders

- Hold liquids and gases - Uninsulated compressed gas cylinders are used to store substances such as nitrogen, argon, helium, and oxygen

Control zone labels

- Hot - Warm - Cold

Communicability

- How easily the disease is able to spread from one human to another human - HIV: low because difficult to spread by routine contact - Smallpox: high

Sympathomimetics signs and symptoms

- Hypertension - Tachycardia - Dilated pupils - Agitation or seizures - Hyperthermia

Thermoregulation

- Hypothalamus regulates mechanisms of heat production and temperature loss using thermoreceptors - Thermolysis and thermogenesis

Triage special considerations

- Hysterical -> immediate + transport off the side (even if not seriously injured) - Responder becomes sick -> immediate + transport off the side to avoid negative impact to the morale of other responders - Pts that contaminated (e.g., radiation) are identified before the triage starts

Types of injected poisons

- IV drug abuse - Envenomation by insects, arachnids, and reptiles

How can hypoglycemia occur

- If a person with diabetes takes his insulin as prescribed but fails to eat enough food; or - If a person with diabetes takes too much medication -> low blood glucose

4 categories of triage

- Immediate: red - Delayed: yellow - Minimal: green - Expectant: black) -> IDME

IgE antibodies

- Immunoglobin E - Antibody that gets rid off the allergen

3 ways the rate and amount of heat loss/gain can be modified

- Increase/decrease heat production: increase the rate of metabolism of its cells (e.g., shivering) - Move to an area where heat loss is decreased/increased - Wear the appropriate clothing for the environment

Other changes during pregnancy

- Increased chances of vomiting and aspiration - Looser joints - Change in body CG -> more likely to slip or fall

Glaucoma

- Increased intraocular pressure - Causes headache with nausea and vomiting and visual disturbances

2 of the signs of meningitis in infant

- Increased irritability - Bulging of the fontanelle without crying

Bleeding in the brain - increasing BP

- Increasing BP to compensate (force more O2) or as a cause of bleeding -> Increasing BP sign of bleeding - BP drops -> sign that condition worsens

MDI and SVN - indications and contraindications

- Indications: MDI is asthma, and a small-volume nebulizer is used in asthma, bronchiolitis, COPD, and anaphylaxis - Contraindications: - Unable to help coordinate inhalation with trigger or too confused - No permission from medical control - Med expired

Apparent life-threatening event (ALTE)

- Infants who have cyanosis and apnea and are unresponsive when found by their families sometimes resume breathing and color with stimulation -> ALTE - Also characterized by a distinct change in muscle tone (limpness) and choking or gagging - Always transport, even if looks healthy again - Called near-miss SIDS in the past

Respiratory sincytial virus (RSV)

- Infection in the lungs and breathing passages - Can lead to bronchiolitis and pneumonia - Highly contagious (droplets can survive on surfaces) -> schools -> look for sign of dehydration (often refuse to drink) + humidified O2

Diphteria

- Infection of the throat and upper respiratory tract - Difficulty breathing and swallowing - Sore throat - Thick gray buildup in throat or nose - Fever

Appendicitis

- Inflammation of the appendix - Can eventually cause the tissues to die and/or rupture, causing an abscess, peritonitis, or shock - Initially, the pain is generalized, dull, and diffuse and may center in the umbilical area. The pain later localizes to the RLQ - A classic symptom of appendicitis is rebound tenderness - Markle test: dropping from standing on the toes to the heels

Bronchiolitis

- Inflammation of the bronchioles - Often the result of RSV - Airway can become blocked - More in boys < 2 years - Winter and spring - Wheezing (think lower airway obstruction since it's the bronchioles) -> humidified O2 + position of comfort

Avulsion

- Injury that separates various layers of soft tissue so they become either completely detached or hang as a flap - Significant bleeding - If you can, replace the flat avulsed flap in its original position as long as it is not visibly contaminated with dirt and/or other foreign materials - If an avulsion is complete, you should wrap the separated tissue in sterile gauze and take it with you to the ED -> infection concerns - Never remove an avulsion skin flap, regardless of its size

Zone of injury

- Injury to bones and joints is often associated with injury to the surrounding soft tissues, especially to the adjacent nerves and blood vessels - The entire area is known as the zone of injury

Breech delivery with legs and buttocks only visible in vaginal opening during crowning

- Instruct not to push - High flow O2 - Place hand on presenting part to keep from delivery - Immediate transport - Contact medical control or ALS backup

What happens to the intercostal muscles and the diaphragm when we inhale

- Intercostal muscles contract -> rib cage elevate and expand - Diaphragm contracts (or flattens) -> pushes the contents of the abdomen down

GI system in peds

- Internal organs (e.g., liver and spleen) are proportionally larger and situated more anteriorly -> prone to bleeding and injury - Because the internal organs are positioned in a closer proximity to each other, there is a higher risk for multiple organ injury - The liver, spleen, and kidneys are more frequently injured in children than in adults

How to treat seizure caused by eclampsia

- Lay on the left side - Maintain airway - Suction if vomit - O2 - Transport

Left VS right heart failure

- Left: leads to CHF -> cough + blood/frothy sputum + rales + noisy breathing - Right: blood backs up to organs -> edema (e.g., feet) + jugular vein distention. Usually caused by left heart failure - Most common is left heart failure

Retinal detachment

- Medical emergency requiring prompt surgical treatment to preserve vision - The retina is pulled away from the choroid, a thin layer of blood vessels that supply nutrients and oxygen to the retina -> Retinal cells deprived of oxygen -> permanent vision loss - Signs: floaters, debris in the visual field, sudden flashes of light or shadow, or visual blurring

Treatment for diabetes

- Medications and injectable hormones that lower the patient's blood glucose level - These hormones and medications, whether administered correctly or incorrectly, can create a medical emergency for the patient with diabetes - Hyperglycemia and hypoglycemia can occur with both diabetes mellitus type 1 and type 2

Peritoneum

- Membrane that lines the abdominal cavity and covers the organs within it - Parietal peritoneum: lines the walls of the abdominal cavity - Visceral peritoneum: covers the organs themselves

Classifications of burns

- Minor - Moderate - Severe

Classification of Burns in Infants and Children

- Minor: partial-thickness burns < 10% - Moderate: partial-thickness burns 10-20% - Severe Burns: any full-thickness burn or partial-thickness burns > 20%

Advantages of vacuum mattress over backboard

- Molds to the body -> reduce pressure -> better comfort - Thermal insulation -> Great for old adults or patients with abnormal curvature of the spine

Food - allergen

- Most common source of anaphylactic reactions - Shellfish, peanuts - 30% death - Teenagers and young adults - Maybe take over 30 min to appear - Signs: hives or more severe

Antitote

- Most poisons don't have one - naloxone (Narcan) is the most common one for EMTs -> opioid overdose

Most common MOIs for blunt trauma

- Motor vehicle crashes - Falls

Brain VS muscle

- Muscle: can store muscle and use fats, proteins and carbs as fuel - Brain: can't store glucose, only fuel is glucose, no insulin required for glucose entry

Administering IM epinephrine

- Needle + syringe - Concentration: 1:1,000 - Midanterolateral thigh - Adult: 0.3 mg - Pediatric: weight based, most common 0.15 mg with EpiPen Jr, max 0.3 mg

Limb presentation

- Neither head nor buttocks - Can't do a successful delivery like this onsite -> surgery required -> transport

Systolic BP versus age

- Neonate: 1 day to 4 days -> 60 to 76 - Neonate: 4 days to 1 month -> 67 to 84 - Infant: 1 month to 3 months -> 73 to 94 - Infant: 3 months to 6 months -> 78 to 103 - Infant: 6 months to 1 year -> 82 to 105 - Child: 1 year to 2 years -> 85 to 104 - Child: 2 years to 7 years -> 88 to 106 - Child: 7 years to 15 years -> 96 to 115 - Adolescent: 15 years to 18 years -> 110 to 131

Evolution of weight

- Neonate: 6-8 lb (3-3.5 kg), head 25% of weight - 1st week: 5-10% loss of weight due to fluid loss - 2nd week and so on: 1 oz (30 g) per day -> 4-6 months: double weight -> 1 year: triple weight

Neurocognitive and cognitive disorders

- Neurocognitive: decreased mental function due to a medical disease other than a psychiatric illness (wrong syn: dementia) -> organic, sth is physically happening - Cognitive: disorder of thinking -> delirium and dementia

Other types of blast injuries

- Neurologic injuries and head trauma - Subarachnoid and subdural hematomas - Concussion, intracerebral bleeding, air embolism - Bradycardia and hypotension - Extremity injuries: amputations -> die if no tourniquet very rapidly

Ricin: from what, what system it attacks depending on the route + incubation

- Neurotoxin derived from mash that is left from the castor bean (seed is the most toxic part of the bean) - Causes pulmonary edema and respiratory and circulatory failure leading to death - Least toxic by oral route -> Hemorrhage and necrosis of the liver, spleen, kidneys, and gastrointestinal tract -> Symptoms 4-8h after exposure

If there is an object protruding from the wound

- Never remove it unless it is in the cheek and blocking the patient's airway - Apply bulky dressings to stabilize the impaled object in place + pressure as best you can for at least 5 min without interruption

Bruises color

- New bruises are pink or red - Over time, bruises turn blue, then green, then yellow-brown and faded

HR in peds

- Newborn to 3 months: 85 to 205 - 3 months to 2 years: 100 to 190 - 2 years to 10 years: 60 to 140 - >10 years: 60 to 100

Bradycardia definition for children

- Newborns: < 100 - Children: < 80

Nitroglycerin

- Nitrostat (tablets), Nitrolingual (spray), Nitrobid - nitroglycerin - Nitrate - Causes vasodilation and coronary artery dilation, decreasing work and oxygen demand on the heart - Chest pain of cardiac origin (ischemia) - Hypotension (<90 systolic), hypersensitivity, recent use of erectile dysfution (24h) (Viagra, Cialis, Levitra), intracranial bleeding - Headache, tachycardia, hypotension, dizziness - 0.4 mg (spray or table), repeat every 3-5 min, up to 3 doses

Do you ever remove a dressing?

- No - Only a physician should do it

Depression in geriatrics

- Not part of normal aging, but rather a medical disease - Risk factors: nursing facilities, women (3x), history of depression, chronic disease, and loss - Contributing factors: substance abuse, isolation, prescription medication use, and chronic medical conditions - Treatable with medication and therapy

Treatment of HAPE or HACE

- O2 (potentially BVM or CPAP for HAPE) - Descend - Transport

Hydrogen sulfide examples

- Occurs naturally in sewers, swamps, volcanoes, and crude petroleum - Method used to commit suicide, referred to as chemical or detergent suicide - Workers in industrial settings may experience low-level exposure

Sprain

- Occurs when a joint is twisted or stretched beyond its normal range of motion -> injury to ligaments and tendons crossing the joint - Considered a partial dislocation - Mild: ligament stretching - Severe: ligament tearing - Common: knee, shoulder, ankle

Potentiation

- One drug increasing the effect of another - Example (maybe): alcohol enhances the analgesic activity of aspirin

Pupil

- Opening in the center of the iris, which allows light to move to the back of the eye - Becomes smaller and larger when the person is looking at objects near at hand and farther away - Anisocoria: pupils that are not equal

Vagina

- Outermost cavity of the female reproductive system - Lower part of the birth canal - 3 to 5 inches long, beginning at the cervix

Abortion

- Passage of the fetus and placenta before 20 weeks - Complications: bleeding and infection

Primary assessment for diabetes

- Patients with an altered mental status and impaired ability to swallow should be transported promptly - Patients who have the ability to swallow and are conscious enough to maintain their own airway may be further evaluated on scene and interventions performed

Treatment of airway infection

- People with a common cold who have underlying problems such as asthma or heart failure may experience a worsening of their condition as a result of the additional stress of the infection - Upper airway infection with dyspnea: humidified O2. No suction + no oropharyngeal airway if epiglottitis

4 factors that affect how a person deals with a cold or hot environment

- Physical condition - Age - Nutrition and hydration - Environmental conditions

Command section of the ICS

- Position that oversees the incident, establishes the objectives and priorities, and from there develops a response plan - Include the public information officer (PIO), safety officer, and liaison officer

Difference cardio system peds VS adults

- Pretty similar - Peds larger proportional amount of circulating blood BUT more dependent on the actual cardiac output of the heart - Peds may be in a state of shock while displaying a normal blood pressure - Peds have less blood circulating so the loss of even a small volume of fluid or blood may lead to shock

4 different mechanisms of blast injuries

- Primary blast injuries - Secondary blast injuries - Tertiary blast injuries - Quaternary blast injuries

Hernia

- Protrusion of an organ through a hole into a body cavity where it does not belong - If incarcerated, its contents may become seriously compressed by the surrounding tissue, eventually compromising the blood supply -> "strangulation"

Blood vessels and nerves in the dermis

- Provide the skin with nutrients and oxygen - Small branches reach up to the germinal cells, but do not penetrate farther into the epidermis - There are also specialized nerve endings within the dermis

Documenting restraints

- Reason for the restraint - Type of restraint - Technique that was used

Typical skin reaction in early stags of anaphylaxis

- Red, hot skin is typical in the early stages, suggesting a systemic reaction as the blood vessels lose their ability to constrict and blood moves outward and closer to the skin - Then, as the condition worsens -> cyanosis

How skin looks like with mustard gas

- Reddening of the affected area, then large blisters - Blisters very similar to those associated with thermal second-degree burns - Liquid in blisters doesn't contain any agent but the skin on top might

Neglect in child abuse

- Refusal or failure on the part of the parent or caregiver to provide life necessities, such as food, water, clothing, shelter, personal hygiene, medicine, comfort, and personal safety - Children who are dirty or too thin or appear developmentally delayed because of a lack of stimulation

Cluster headaches

- Release of histamine from tissues - Symptoms: periodic bursts (clusters), unilateral, nasal congestion, tearing, last 30 min-2h

Injuries to the cheek

- Remove impaled object if you can't control the bleeding and it compromises the airway - Direct pressure to inside and outside of cheek

Pulmonary agent treatment

- Remove the patient from the contaminated atmosphere - ABC (CPAP might help) - Do not allow the patient to be active - Position of comfort with his or her head elevated - There are no antidotes

Treatment of sting from marine animals

- Remove the patient from the water and remove the tentacles by scraping them off with a credit card - Do not try to manipulate the remaining tentacles - Soak the area in hot water for 30 min

Examples of MCIs

- Residential building fire confined to one apartment that may only produce one patient but that has the potential to generate dozens of patients from among the responders and residents - Loss of power to a hospital or nursing home with ventilator-dependent and nonambulatory victims is considered an MCI, although no one is injured

Drowning

- Respiratory impairment from immersion - Near drowning: pt survives at least 24h - Risk factors: alcohol, seizure, geriatric patients with cardiovascular disease, and unsupervised access to water

Chest injury in kids

- Rib cage flexible and does not provide the same level of protection -> injury of the rib cage masked because the ribs give way to the pressure and do not fracture - Organs below the rib cage have been exposed to that force and are likely injured - Only indication you may have of compromise is increased work of breathing or alterations in vital signs

3 types of splints

- Rigid - Formable - Traction

Bleeding from the nose, ears, and mouth -> risks

- Risk for airway obstruction or aspiration -> Maintain clear airway + suction

Command staff

- Safety officer - Public information officer - Liaison officer

Cholinergic agents - effects SLUDGEM

- Salivations, sweating - Lacrimation (excessive tearing of the eye) - Urination - Defecation, drooling, diarrhea - Gastric upset and cramps - Emesis (vomiting) - Muscle twitching/ miosis (pinpoint pupils) + bradycardia

GCS for infants and children

- Same as for adults, but verbal is a bit different - Verbal in infants: - 5: Coos, babbles - 4: Irritable cry - 3: Cries to pain - 2: Moans to pain - 1: No response - Verbal in children: same as adults

Types of head injury

- Scalp lacerations - Skull fracture - Traumatic brain injuries - Intracranial pressure - Concussion - Contusion

How to apply a tourniquet

- See Skill Drill 25-2 p. 893 - Proximal to the bleeding (axillary region for arms, groin for legs) - Click the buckle - Turn clockwise until on palpable distal pulse or until bleeding is controlled - Mark the time it was applied - Do not remove unless instructed to do so by medical control

How to position the airway in a ped

- See Skill Drill 34-1 p. 1231 - Towel under shoulders and back

Psychological changes in toddlers and preschoolers

- Separation anxiety peaks between 10-18 m - 36 m: basic language is mastered - Begin to play and interact with others - 18-24 m: understand cause and effect + gender differences

Scene assessment with potential SIDS

- Signs of illness, including medications, humidifiers, or thermometers - The general condition of the house - Signs of poor hygiene - Family interaction. - The site where the infant was discovered: pillows, stuffed animals, toys, and small objects

Difference COPD VS CHF symptoms

- Similar - CHF: - Wet -> rhonchi, crackles - Pink frothy sputum - jugular vein distention - COPD: - Dry -> wheezes (because of bronchial constriction) - Chronic cough + thick sputum - Long-term smoker + barrest chest - Slower onset of symptoms

2 types of carbs

- Simple: fructose, galactose, glucose - Complex: lactose, sucrose, starch -> both types transform into glucose after digestion

Reproductive changes

- Size and bloodflow to the uterus increase - Mucous plug in cervix (bloody show) - Breast enlargement

Respiratory changes in older adults

- Size of the airway increases - Surface area of the alveoli decreases - Elasticity of the lungs decreases -> need to use intercostal muscles - Strength of intercostal muscles and diaphragm decreases - Cough and gag reflexes decrease - Collapsing airway - Increased risk of lung infections - Vital capacity decreases + residual volume increases -> more prompt to infection getting bad - 75 y: vital capacity 50% of young adult

3 types of muscle

- Skeletal - Smooth - Cardiac

How to restraint

- Skill Drill 22-1 p. 814 - Supine or left lateral position

Integumentary system in peds

- Skin is thinner with less fat + tends to burn more deeply - Larger body-surface-area-to-body-mass ratio -> significant fluid and heat losses

Axial part of the skeletal system

- Skull, spine and thorax - Support and protect internal organs

Umbilical cord around the neck - nuchal cord

- Slip the cord over the fetus's head - If not possible, cut the cord by placing 2 clamps 2 in apart and cutting between the clamps -> fetus doesn't have O2 until it breathes by itself -> then speed the delivery by asking the woman to push harder/more often

Dementia

- Slow onset of progressive disorientation, shortened attention span, and loss of cognitive function -> delusions, hallucinations, or aggressive behavior - Result of neurologic diseases: Alzheimer, Parkinson, strokes, and genetic factors

COPD

- Slow process of dilation and disruption of the airways and alveoli caused by chronic bronchial obstruction - Umbrella term to describe a few lung diseases such as emphysema and chronic bronchitis - Often the result of smoking - Sputum + chronic cough + difficulty exhaling + long expiration - Lung sounds: crackles, rhonchi, wheezing - Similar to CHF but wet VS dry lungs

Sedative-hypnotics signs and symptoms

- Slurred speech - Sedation or coma - Hypoventilation - Hypotension

Urinary system

- Solid organ: kidneys - Hollow organ: ureters, bladder, and urethra

Naloxone via intranasal

- Some EMS systems allow EMT to administer it - Only be used when the patient has agonal respirations or apnea - Oral or nasal airway + BVM prior to administering naloxone -> watch the pt: if LOC improves, might not tolerate oral airway -> remove airway to prevent aspiration

What type 2 meds do

- Some encourage the pancraes to create insulin - Some encourage the cell receptor to accept insulin - Some inhibit the secretion fo glucagon so that the glucose stored in the liver is not released in the blood

Ankle injuries

- Sometimes difficult to tell a nondisplaced ankle fracture from a simple sprain -> radiograph - Most frequent MOI: twisting -> stretches or tears the ligaments - Extensive twisting -> fracture of malleoli - Dislocation associated with fractures of malleoli

LUQ organs

- Stomach - Spleen - Pancreas (posterior)

Examples of internal bleeding

- Stomach ulcer - Lacerated liver - Ruptured spleen - Broken bones (especially ribs , pelvis, and femur (1L!))

Goals in treating patients with burns

- Stop the burning process - ABC - Transport Note: O2 is mandatory for inhalation burns and large body surface area burns

Hemorrhagic stroke - risk factors

- Stress or exertion - Very high BP or long-term untreated elevated BP - Born with a weakness in the artery walls -> aneurysm -> worst headache

Caustics

- Strong acids and bases - Examples: bleach, metal cleaners, paint removers

Cerebral edema

- Swelling of the brain - May not develop until several hours following the initial injury - Low O2 aggravates edema

Delirium

- Temporary state that often has a physical or mental cause (eg, infection, changes in medications, hypoxia) and may be reversed with proper treatment. - Delirium is a symptom, not a disease.

Synergism

- The combined effects of two or more drugs has an overall greater effect than one by itself -> both drugs have similar effects - Example: Advil and Tylenol

Scalp lacerations

- The most minor type of head trauma - Scalp is highly vascular -> profuse bleeding -> hypovolemic shock (especially in kids) - Indicator of more serious injuries

2 types of food poisoning

- The organism itself causes disease - The organism produces toxins that cause disease

Bone flexibility and sprains in peds

- The younger the child, the more flexible the bone structures are to trauma - If a pediatric patient is unable to place weight on an extremity or favors an extremity, suspect injury until proven otherwise - Sprains are uncommon in this age group because the ligaments are more developed than the larger long bones

Evolution of HR and RR

- The younger the person, the faster the HR and RR - At birth: HR 90-180, RR 30-60, tidal volume 6 to 8 mL/kg - Within the first half hour after birth, HR drops to 120, RR falls to 30-40 - 1 year old, RR 20-30, tidal volume 10 to 15 mL/kg

Percentage of woman who have been raped

- 18% - 25% sexually abused, often before 12 years old

How to apply a rigid splint

- 2 EMTs needed - See Skill Drill 31-2 p. 1106

Orbit (eye socket)

- 2 facial bone: maxilla and zygoma - Also includes the frontal bone of the cranium

How many hemispheres and lobes in the cerebrum

- 2 hemispheres - 4 lobes

Delayed triage category

- 2nd priority - Need treatment and transport, but can be delayed - Multiple injuries to bones or joints, including back injuries with or without spinal cord injury

Spinal column

- 33 bones, called vertebrae - 5 sections: cervical, thoracic, lumbar, sacral, and coccygeal

Platelets

- 4-7% of total blood volume - Blood clot -> stop bleeding

Leading cause of death in middle adults

- 41-44: unintentional injuries (accidents) - 45-60: cancer

Ischemic stroke

- 80-85% of all strokes - Blood clot - Thrombosis or embolus - Atherosclerosis: often the cause of ischemic stroke

Symptomatic hyperglycemia

- A state of unconsciousness resulting from several problems, including ketoacidosis or HHNS - Occurs when blood glucose levels are very high - Hyper in type 1 -> ketoacidosis - Hyper in type 2 -> nonketotic hyperosmolar dehydration (see HHNS flashcard) -> both lead to dehydration

Pediatric assessment triangle (PAT)

- A structured assessment tool that allows you to rapidly form a general impression of the child without touching him - Appearance: muscle tone and mental status - Work of breathing - Circulation to the skin

Incident command system

- A system implemented to manage disasters and MCIs - Section chiefs, including finance, logistics, operations, and planning, report to the incident commander - Also referred to as the incident management system

Aortic aneurysm

- A weakness in the wall of the aorta that makes it susceptible to rupture - The aorta dilates at the weakened area -> more susceptible to rupture

Ingested poisons - treatment

- ABC - O2 + CPR if necessary (opioid, sedative or barbiturate -> depress CNS) - Activated charcoal

Injected poisons - treatment

- ABC - O2 if needed - Be alert for nausea and vomiting - Remove rings, watches, and bracelets from areas around the injection site if swelling occurs - Transport with containers and labels

Management of hypothermia as an EMT

- ABC - Prevent further heat loss

Pelvic inflammatory disease (PID) - symptoms

- Abdominal pain during or after menstruation -> ask date of last menstrual period - Achy, worse when walking - Vaginal discharge, fever and chills, pain on urination + weird walking

Decision points in the JumpSTART triage

- Ability to walk (except in infants) - Presence of spontaneous breathing - RR < 15 or > 45 - Palpable peripheral pulse - Appropriate response to painful stimuli on the AVPU scale

Preschool-age child: language, walk, toilet, thoughts, behavior

- Able to use simple language -> most rapid increase in language occurs during this stage of development - Walk and run well and begin throwing, catching, and kicking during play - Toilet training is mastered - Believe that their thoughts can cause injury to themselves or to others. May believe that an injury is the result of a bad deed they did earlier in the day - Learning which behaviors are appropriate and which behaviors will lead to a "time out"

Dysrhythmia

- Abnormal heart rhythm - Tachycardia, bradycardia, Vtach, Vfib

Vaginal bleeding causes

- Abnormal menstruation - Vaginal trauma - Ectopic pregnancy - Spontaneous abortion (miscarriage) - Cervical polyps - Cancer

Tension pneumothorax

- Accumulation of air in the pleural cavity -> Increases pressure in the chest -> Lungs collapses and mediastinum pushed in the opposite pleural cavity -> Blood can't return through the vena cavae to the heart -> Shock - Occurs when there's lots of air in the pleura space

Atherosclerosis

- Accumulation of fat and cholesterol in the arteries - Complications: heart attack, stroke, hypertensions and bowel infarction - Affects more than 60% of people older than 65 years

Large intestine

- Also called the colon

Sinus headaches - treatment

- Analgesics - Antihistamines - Antibiotics

Type 1 diabetes

- Autoimmune disorder: immune system produces antibodies against the pancreatic beta cells -> not enough insulin in body - Pt cannot survive without insulin -> implanted insulin pump - Insulin pumps can malfunction -> emergency

6-12 months

- Babble - By 12 months, can say their first word. - Sit without support, progress to crawling, and finally begin to walk - Teething and prone to explore their world by picking things up and placing them in their mouths - Begin to cry if separated from their parents or caregivers -> separation anxiety -> let the parent hold the infant as you start your physical assessment

Chlamydia

- Bacterium Chlamydia trachomatis - Most common STD - Symptoms mild or absent, or: lower abdominal pain, low back pain, nausea, fever, pain during sexual intercourse, and/or bleeding between menstrual periods - Can spread to the rectum, leading to rectal pain, discharge, or bleeding

Causes of epistaxis

- Basilar skull fx - Hypertension - Digital trauma - Blunt trauma -> No NPA if basilar fx

Fibula

- Behind and beside the tibia - Anchor for ligaments surrounding the knee joint - Forms the lateral side of the ankle joint.

Lens, retina, and optic nerve

- Behind the iris - Focuses images on the light-sensitive area at the back of the globe -> retina - Within the retina: numerous nerve endings, which respond to light by transmitting nerve impulses through the optic nerve to the brain

Postpartum complications

- Bleeding > 500 mL - Pulmonary embolism (pregnant clots better + bed rest for long)

Intracerebral hematoma

- Bleeding within the brain tissue (parenchyma) - Also called an intraparenchymal hematoma - High mortality rate - Penetrating injury or deceleration force

Signs of injuries to the urinary bladder

- Blood at the urethral opening - Physical signs of trauma on the lower abdomen, pelvis, or perineum

Hyperglycemia definition + 3 Ps

- Blood glucose > 120 mg/dL - Polyuria + polydipsia + polyphagia

Subdural or epidural bleeding

- Blood near the skull presses on the brain, because of head trauma - Dura: covering of the brain next to the skull - Epidural: vein just above the dura bleeds -> faster (minutes to hours, "lucid interval") - Subdural: vein just below the dura bleeds -> slower (several days)

Hematoma

- Blood that has collected within damaged tissue or in a body cavity - Occurs whenever a large blood vessel is damaged and bleeds rapidly - In severe cases, the hematoma may contain more than a liter of blood

Supplemental O2 options for peds

- Blow-by technique at 6 L/min -> a bit more than 21% (1-2 in from face) - Nasal cannula at 1 to 6 L/min -> 24-44% - Nonrebreathing mask at 10 to 15 L/min -> up to 95% - BVM (with oxygen reservoir) at 15 L/min -> 100%

What causes a pneumothorax

- Blunt or penetrating injury - Exertion, coughing and air travel (spontaneous)

Maxillary fractures

- Blunt-force, high-energy impacts such as an unrestrained driver striking the steering wheel, a fall, or a direct blow from an object such as a pipe. - Signs: massive facial swelling, instability of the facial bones, and misalignment of the teeth

Histamine

- Bronchoconstriction - Vasodilation - Capillary permeability

Highly persistent agent

- Can stay in the envt for weeks to months - Example: VX (nerve agent)

Lightning - emergency medical care

- Can strike in the same place twice! - Move pt to sheltered area - If imminent striking: make yourself as small as possible (squat down), move away from tree

Impulse control disorder

- Cannot control their impulses to engage in certain behaviors - Examples: Kleptomania, pyromania, pathologic gambling - Different from addition in which you think it's going to make you feel better (in ICD you don't care about your health, you just do it because you have the impulse to do it)

Penetrating injuries to the neck

- Cause profuse bleeding from laceration of great vessels of neck (carotid and jugular veins) -> Can lead to exsanguination - Air might also enter these blood vessels -> air embolism if in vein -> cardiac arrest (not for blunt, only penetrating) - Apply direct pressure over the bleeding site with finger then sterile occlusive dressing + secure with roller gauze under opposite shoulder

Migraine

- Caused by changes in blood vessel size in the base of the brain (constrict or dilate) - Women are three times as likely as men to experience migraines - Pounding, throbbing, or pulsating - Associated with nausea and vomiting, flashing lights or partial vision loss - Several hours to days

Sinus headaches

- Caused by pressure that is the result of fluid accumulation in the sinus cavities - Cold-like signs: nasal congestion, cough, and fever - Increased pain when bend over or when head moved forward

Traumatic aortic disruption

- Caused by sudden decelerations and massive blunt force: vehicle collisions, falls from heights, crushing chest trauma, blunt chest trauma, animal kicks - Rupture usually occurs just beyond left subclavian artery

Types of abused inhalants

- Cetone, toluene, xylene, and hexane, which are found in glues, cleaning compounds, paint thinners, and lacquers - Gasoline and various halogenated hydrocarbons, such as Freon

First sign of heat stroke

- Change in behavior - Then unresponsive or seizure - Pulse rapid and strong then weaker and BP falls - Danger: when no more sweat

Divings physics laws

- Charles' Law: p prop T - Boyles Law: V prop 1/p (cst T) - Henry's Law: As the body is exposed to higher pressure, more gas will be absorbed. - Dalton's Law: ratio of gasses will remain the same as pressure increases or decreases

Leukotrienes

- Chemical substances that contribute to anaphylaxis - Cause tightening of airway muscles and the production of excess mucus and fluid

Kidney stones

- Chemicals may crystallize in the urine and form kidney stones (renal calculi) - Pressure will build up behind the kidney stone and cause swelling in the kidney - Symptoms: - Flank or groin pain - Dysuria - Urinary frequency - Hematuria

Symptoms and other indicators of abuse

- Child is withdrawn, fearful, or hostile - Child refuses to discuss how an injury occurred - Conflicting stories

Activated charcoal dose for peds

- Child: 1g/kg - Pediatric: 12.5 to 25g

Risk factors of heat emergency

- Children - Geriatric patients - Heart disease - COPD - Diabetes - Dehydration - Obesity - Those with limited mobility

Age with regard to temperature

- Children/old adult more likely to experience temperature-related illness - Infants heat up and cool down faster - Old adults: - Loss of subcutaneous tissues -> reduced amount of insulation - Poor circulation -> increased heat loss

Cirrhosis

- Chronic disease of the liver - Initial symptoms: fatigue, weakness, weight loss - Late symptoms: jaundice, CI bleeding, abdominal swelling

4 types of motion in joints

- Circular (shoulder) - Hinge (elbow, knee) - Minimal (sacroiliac, sternoclavicular) - None (sutures)

Cerebrospinal fluid (CSF)

- Circulates throughout the brain and spinal cord - If nose blood or drainage contains CSF: characteristic staining (halo test) - Halo test: - Use a piece of gauze to absorb blood that is flowing from the nose or ears - The blood will be surrounded by a lighter ring of fluid - If drain from nose or ear: fracture at the base of the skull

2 main types of head injuries

- Closed - Open

Different roles in the ICS

- Command - Finance - Logistics - Operations - Planning

Hazards of improper splinting

- Compression of nerves, tissues, and blood vessels - Delay in transport of a patient with a life-threatening injury - Reduction of distal circulation - Aggravation of the injury - Injury to tissue, nerves, blood vessels, or muscles as a result of excessive movement of the bone or joint

Salmonellosis

- Condition characterized by severe GI symptoms within 72 hours of ingestion: nausea, vomiting, abdominal pain, and diarrhea. - Also: fever and generalized weakness - Bacterium: Salmonella -> cooking kills it + cleaning kills on uncooked food

2 parts of the head

- Cranium - Face

Digestive system changes in older adults

- Decrease in taste and smell senses - Saliva secretion decreases - Ability of the intestines to contract and move food along decreases -> constipated or not hungry - Gallstones more common - Fecal incontinence because anal sphincter less elastic

Changes in the endocrine system in geriatrics

- Decreased metabolism of thyroxine -> hypothyroidism -> slower heart rate, fatigue, drier skin and hair, cold intolerance, and weight gain - More antidiuretic hormone -> fluid imbalance - Hyperglycemia - Increase in norepinephrine -> harmful effect on the cardiovascular system

Touch changes in geriatrics

- Decreased sense of touch and pain perception from the loss of the end nerve fibers -> injured and not know it - Decreased sensation of hot and cold. - Especially acute problem in diabetes

Mood disorders

- Depression - Bipolar disorder (manic depression): periods of elevated mood interspersed with periods of depression

Helmets

- Designed to protect against impact forces to the head - But do not protect from cervical injury

Diabetes - gestational diabetes - pregnancy

- Diabetes develops during pregnancy in many women who have not had diabetes previously - Resolves after delivery - Same treatment as normal diabetes

Different ways a force causes fractures

- Direct blows - Indirect forces - Twisting forces - High-energy injuries

Methods to control external bleeding

- Direct pressure - Pressure dressing or splints - Tourniquets

Placenta

- Disk-shaped structure attached to the uterine wall that provides nourishment to the fetus - Connected to the fetus by the umbilical cord - Blood normally does not mix between the fetus and the pregnant woman because of the placental barrier -> however it allows nutrients/meds to pass

Fundal height

- Distance from the pubic bone to the top of the uterus -> used to evaluate stage in pregnancy - After week 24 the fundal height matches the number of weeks of pregnancy. Examples: 27 weeks pregnant -> fundal height ~ 27 cm - At belly button: 20 weeks - At xiphoid process: 36 weeks

Barotrauma

- Diving emergency - Changes in pressure alter hollow, air filled organs and cause trauma

Precautions when applying a tourniquet

- Do not apply a tourniquet directly over any joint - Make sure the tourniquet is tightened securely - Never use wire, rope, a belt, or any other narrow material that could cut into the skin - If it is possible to do so without causing a delay, add padding under the tourniquet - Never cover a tourniquet with a bandage. Leave it in full view

Cold zone

- Don't need to wear any special protective clothing - Personnel staging, the command post, EMS providers, and the area for medical monitoring, support, and/or treatment after decontamination are all located in the cold zone

Orthostatic hypotension

- Drop in blood pressure with a change in position (20 mm Hg) - Also called postural hypotension

Nerve agent antidote

- DuoDote - ATNAA

Dysconjugate/conjugate

- Dys: both eyes look outwards - Con: both eyes look down

Electrocardiogram

- ECG waves: - P wave: atrial depolarization -> SA node fires and the two atria contract - QRS complex: ventricular depolarization -> the two ventricles contract - T wave: ventricular repolarization -> the two ventricles relax

Follicles

- Each ovary contains thousands of follicles, and each follicle contains an egg - During each menstrual cycle, only one follicle (out of 10 to 20 that attempt the process each month) will be successful at maturing and releasing an egg - Stimulated by the release of hormones

AED

- Electrically stun the heart and allow it to resume normal function - The operator also has to push a button to deliver a sock, regardless of the model - There are few fully automatic AEDs (which would deliver a shock without the operator pressing a button) left. All manufacturers are now producing only semiautomated external defibrillators - Advantages: fast, simple - Doesn't work if pulseless activity and asystole - Stay clear while the AED is analyzing the heart rhythm and delivering shock - Only apply to unresponsive patients

Compartment syndrome

- Elevation of pressure within a closed fascial compartment - Frequently seen in fractures below the elbow or knee in children - Develops within 6 to 12 hours after injury, usually as a result of excessive bleeding, a severely crushed extremity, or the rapid return of blood to an ischemic limb

Cranial nerves

- Emerge from the brainstem and transmit information directly to or from the brain - Sight, smell, taste, hearing, and facial expressions

Peds pharmacology

- Epinephrine: 0.15 mg IM - Tylenol: 15 mg/kg PO/PR, q 4-6 hours, max single dose 325 mg - Benadryl: 1 mg/kg, q 4-6 hours, max of 300 mg/day - Activated charcoal & oral glucose: same as adult - Aspirin: contraindicated

Bath salts effects

- Euphoria, increased mental clarity, and sexual arousal - Teeth grinding, appetite loss, muscle twitching, lip-smacking, confusion, gastrointestinal conditions, paranoia, headache, elevated heart rate, and hallucinations - Last up to 48h

Changes in the respiratory system in geriatrics

- Even a minor lung infection can become a life-threatening event - Weakening of the airway musculature that can cause decreased breathing capacity -> less help from muscles in the chest wall when they have trouble breathing - Alveoli become enlarged and the elasticity decreases, making it harder to expel used air (air trapping) -> decreased ability to exchange O2 and CO2 - Chemoreceptors, which monitor the changes in O2 and CO2 in the blood, slow with age -> body responds more slowly to hypoxia - Cough and gag reflexes decrease -> decreases ability to clear secretions - Decrease in the number of cilia that line the bronchial tree -> decrease ability to cough and clear secretions -> increase chances of infection - Vital capacity decreases by 50% - Silent heart attack more common

History taking - pregnant woman

- Expected due date - Any complications she is aware of - Have you been receiving prenatal care - Frequency of contractions - History of previous pregnancies/complications - Has the water broken - was the fluid green (= meconium = fetal stool -> newborn distress) - Complete medical history (SAMPLE)

Fallopian tubes

- Extend out laterally from the uterus, with one tube associated with each ovary. - When an egg is released from the ovary, it travels through the fallopian tube to the uterus

Full-thickness (third-degree) burns

- Extend through all skin layers and may involve subcutaneous layers, muscle, bone, or internal organs - The burned area is dry and leathery - Can feel hard to the touch - Clotted blood vessels or subcutaneous tissue may be visible under the burned skin - If the nerve endings have been destroyed -> no feeling and the surrounding less severely burned areas may be extremely painful

Acts of omission

- Failure to act - Examples: denying an older person adequate nutrition or medical care.

Penetrating trauma: important elements to determine as EMT

- First determine the number of penetrating injuries -> you don't want to miss any wound - Try to determine the length of the penetrating object

Assessment during treatment of pregnant woman

- Focus on the woman, not the fetus - Determine the gestational age (number of weeks) - When transport: left side. If spinal injury (blackboard): tilt the blackboard 30° to the left

Common allergens

- Food - Medication - Plants - Chemicals - Insect bites and stings

Antigen

- Foreign substance that stimulates the body's immune system to produce antibodies. So it's a generic term. Allergen is a type of antigen -> stimulate the immune system to produce antibodies, which result in an allergic reaction

Tricyclic antidepressants

- Form of anticholinergic agents - May cause more serious and life-threatening effects than anticholinergics: cardiac dysrhythmias + seizures

Smooth muscle

- Found in the walls of most tubular structures of the body, such as the GI tract and the blood vessels - Contracts and relaxes to control the movement of the contents within these structures - Performs much of the automatic work of the body - Not under voluntary control of the brain -> also called involuntary muscle

Hollow organs of the abdominal cavity

- Gallbladder, stomach, small intestine, large intestine, and urinary bladder - If perforation -> leak in the abdominal cavity

Radiation

- Transfer of heat by radiant energy. Radiant energy is a type of invisible light that transfers heat. - Examples: when a person stands in a cold room, when a person stands by a fire

Cornea and iris

- Transparent that allows light to enter the eye - Iris: muscle that lies behind the cornea with an opening in its center and adjusts the size of the opening to regulate the amount of light that enters the eye - The iris is pigmented

Female reproductive system - internal structures

- Vagina - Uterus - Fallopian tubes - Ovaries

How is rebound tenderness often discovered

- You do not need to produce rebound tenderness intentionally when examining the patient - Often discovered when moving the patient onto the stretcher or into the ambulance

Leave the helmet on the head of the pt if...

1. There are no impending airway or breathing problems 2. It does not interfere with assessment and treatment of airway or ventilation problems 3. You can properly immobilize the spine 4. There is any chance that removing it will further injure the patient

Middle adult ages

41-60 years old

Geriatrics definition

> 65 years old

Priority in treating an open injury

Begin lifesaving interventions -> controlling the bleeding

Hematuria

Blood in the urine (like uremia)

Emergency doctrine

Consent is implied because of the necessity for immediate emergency treatment

DKA treatment

Insulin

Deformity

The limb may appear to be shortened, rotated, or angulated at a point where there is no joint

Aorta

The main artery leaving the left side of the heart, which receives blood from the left ventricle and delivers it to all the other arteries

Preschool ages

3-6 years old

Status asthmaticus

A prolonged, extremely severe, life-threatening asthma attack -> give O2 and transport Asthma attack is exhausting -> if stopped feeling anxious or struggling breathing -> not a good sign actually -> critical stage -> going to stop breathing -> open airway + O2 + transport + ALS

Wheal

A raised, swollen, well-defined area on the skin resulting from an insect bite or allergic reaction

Simple pneumothorax

Any pneumothorax that does not result in major changes in the patient's cardiac physiology -> Hard to diagnose

Dysbarism injuries

Any signs and symptoms caused by the difference between the surrounding atmospheric pressure and the total gas pressure in the body

Poison

Any substance whose chemical action can damage body structures

Most dangerous between arterial and venous bleeding

Blood flowing freely from veins in a large gash can be as much of a threat as blood spurting from an artery

Rhabdomyolysis

Breakdown of skeletal muscle releasing myoglobin, K+, and fluid shift into muscles

Vest to identify the IC

Brightly colored vest labeled with the word COMMAND

Ok to take photos of an accident

But deleted them after review by health care providers + never on social media

Breech presentation

Buttocks delivered first -> trauma risk for fetus + prolapsed cord more likely -> delivery longer than vertex so transport but if buttocks out then delivery on site. if no delivery 10 min after buttocks presentation then transport - Delivery: same as normal childbirth. Make a V with hands

Rear-end crashes

Cause whiplash injuries

Cardiac problem clues for NOI

Chest pain, difficulty breathing, sudden loss of consciousness

National Fire Protection Association (NFPA)

Classifies hazardous materials according to: - Health hazard or toxicity levels - Fire hazard - Chemical reactive hazard - Special hazards: such as radiation and acids

Levine sign

Clenched fist held over the chest to describe ischemic chest pain

LLQ pain

Diverticulitis

Don't focus only on the chest wound

Do an entire head to toe assessment

Can you use toilet paper/facial tissue/etc on open wound with evisceration

Do not use any material that is adherent or loses its substance when wet, such as toilet paper, facial tissue, paper towels, or absorbent cotton

Diplopia

Double vision

Sympathomimetics examples

- *Epinephrine, albuterol, cocaine, amphetamine, methamphetamine* (also called *meth* or ice), phentermine hydrochloride (appetite suppressant), amphetamine sulfate (Benzedrine, weight control/narcolepsy/chronic fatigue), *caffeine* and phenylpropanolamine (nasal decongestant), designer drugs such as 3,4- methylenedioxymethamphetamine (*MDMA, known as ecstasy* or Molly) - By mouth or injected - I think it's the same as stimulants

White blood cells

- 0.1-0.2% of total blood volume - Collect dead cells - If healthy, low amount. If infection, lots of them

18-24 months

- 18 m: 10 to 15 words, 24 m: 100 words - When you point to a common object, able to name it - Understand cause and effect with such activities as playing with pop-up toys (jack-in-the-box) and turning on and off a light switch - Running and climbing develop - Cling to their parents + special object such as a blanket or teddy bear that comforts them -> use any comforting objects when available to calm them - Trouble describing pain - Like to play -> e.g., give a tongue depressor to play with while you assess them - Assessment TOE to HEAD

Medications - allergen

- 2nd most common source of anaphylactic reactions - Antibiotics (penicillin), nonsteroidal anti-inflammatory drugs (NSAIDs) - Less than 30 min if injected, can take more than 30 min if oral

Stroke - facts

- 5th leading cause of death in the U.S. - Contributing factors: family history, ethnicity (African Americans, Hispanics and Asians more likely)

Leading cause of death in older adults

- 61-64: cancer - 65+: heart disease

How many ED visits and deaths every year due to chest injuries

- 700,000 visits - 18,000 deaths

Palpating pulse in children VS infants

- < 1 year: brachial or femoral - > 1 year: carotid

When a child should ride in the rear seat

- < 4 feet 9 inches (1m 45) - Or, in the case of a pickup truck or other single-seated vehicle, the air bag should be turned off.

Postterm pregnancy

- > 42 weeks - Larger fetus, 5 kg -> more difficult labor + risk of infection + meconium aspiration

Suspect head injury in how high of a fall

- >20 feet (adult) - >10 feet (pediatric)

Partial (focal) seizure

- A seizure affecting a limited portion of the brain - Simple or complex - Simple: no change in LOC. Visual changes/smell/twitching of muscles (not dramatic), brief paralysis - Complex: ALOC. Results from abnormal discharges from the temporal lobe of the brain. Lip smacking, eye blinking, isolated convulsions/jerking of body, unpleasant smell and hallucinations, fear, constant sitting/standing

Islets of Langerhans, alpha and beta cells

- A small portion of the pancreas is filled with the islets of Langerhans. Within these islets are alpha and beta cells - Alpha cells produce glucagon - Beta cells produce insulin

Complications associated with sickle cell disease

- Anemia - Gallstones - Jaundice - And others

Only two situations when you should put the hand into the vagina

- Breech presentation - Prolapse of the umbilical cord

Fracture

- Broken bone - Open or closed - Displaced (deformity) or nondisplaced ("hairline", simple crack, need radiograph)

Febrile seizures

- Common 6 months - 6 years - Most peds seizures are the result of fever alone -> febrile seizure - Occur on the first day of a febrile illness - Characterized by generalized tonic-clonic seizure activity, and last less than 15 minutes with a short postictal phase or none at all - All febrile seizures need to go to the hospital

Abdominal injuries in peds

- Common in children - Children can compensate for significant blood loss better than adults without signs or symptoms of shock developing - Signs of shock due to abdo injury: - Weak, rapid pulse - Cold, clammy skin - Decreased capillary refill (early sign) - ALOC - Decreased systolic blood pressure (late sign)

Spinal nerves

- Conduct sensory/motor impulses from/to the skin and other organs from/to the spinal cord - Brachial plexus controls the arms - Lumbosacral plexus controls the legs

Umbilical cord

- Contains two arteries and one vein: - Vein carries oxygenated blood from the placenta to the heart of the fetus - Arteries carry deoxygenated blood from the heart of the fetus to the placenta - Oxygen and other nutrients cross from the woman's circulation through the placenta and then through the umbilical cord to support the fetus as it grows

Toxycology in geriatrics

- Decreased kidney function, altered gastrointestinal absorption, and decreased vascular flow in the liver -> old people more susceptible to toxicity - Polypharmacy -> overdosing and negative medication interaction - Medication noncompliance

Operators errors in using AEDs

- Failing to apply the AED to a patient in cardiac arrest - Not pushing the analyze or shock buttons when the machine advises you to do so - Pushing the power button instead of pushing the shock button when a shock is advised

Trust and mistrust

- From birth to about 18 months - Involves an infant's needs being met by his parents or caregivers -> gain thrust in them

Falls in old people

- Injuries not necessarily from high - Osteoporosis -> weaker bones -> fracture easier

Symptoms of a pneumothorax

- Pain - Dyspnea - Unilateral decreased or absent breath sounds - Subcutaneous emphysema

Heat cramp

- Painful muscle spasms that occur after vigorous exercise - Usually occur in the leg or abdominal muscles

Scorpion stings

- Rare in the US (Southwest) - Painful but not dangerous except Centruroides sculpturatus

Changes in skin in geriatrics

- Skin less pliable -> bruises more common - Less fat under skin - Pressure ulcers = bedsores or decubitis ulcers

Protective covering of the skull and spinal cord

- Skull covered by layers of muscle, superficial fascia, and thick skin - Superficial fascia connects the muscle to the skin and contains white blood cells - Meninges protect the brain and spinal cord - Spinal canal surrounded by a thick layer of skin and muscles

JumpSTART triage system

- Triage system that was created to be used on any patient who appears to be a child - < 8y or < 100 lb - Peds not able to walk during a disaster -> immediate delivery to the treatment area - 4 categories of urgency: green, yellow, red, and black tags - The original START triage system did not take into account the developmental and physiologic differences in children

Rupture of amniotic sac

- Usually ruptures at beginning - If not, during contractions -> water balloon from vagina -> life threatening for the fetus (suffocation) -> puncture it with a clamp or tear by twisting with fingers - puncture only if head is crowning

Vapor and contact hazards

- Vapor hazard: enter the body through the respiratory tract - Contact hazard (or skin hazard): enter the body through the skin

Changes in musculoskeletal system in geriatrics

- Widening and weakening of bones - Greater probability of fractures with minor mechanisms of injury

Immobilizing the cervical spine

1. Kneel behind the patient and firmly place your hands around the base of the skull on either side 2. Jaw-thrust maneuver 3. Continue to support head while partner places cervical collar -> manual support until secured on backboard or vacuum mattress - See Skill Drill 28-1 p. 1005

Securing a patient on a backboard

1. Maintain manual cervical stabilization. Assess distal functions in all extremities 2. Apply a cervical collar 3. Rescuers kneel on one side of the patient and place hands on the far side of the patient 4. On command, rescuers roll the patient toward themselves, quickly examine the back, slide the backboard under the patient, and roll the patient onto the backboard 5. Center the patient on the backboard 6. Secure the upper torso first 7. Secure the pelvis and upper legs 8. Begin to secure the patient's head using a commercial immobilization device or rolled towels 9. Place tape across the patient's forehead to secure the immobilization device 10. Check all straps and readjust as needed. Reassess distal functions in all extremities - See Skill Drill 28-3 p. 1007

Absorbed and surface contact poisons - signs and symptoms

History of exposure, liquid or powder on a patient's skin, burns, itching, irritation, redness of the skin in light- skinned people, or typical odors of the substance

Gallblader

Hollow pouch located beneath the liver that acts as a reservoir for bile

START triage

2 differences from book: no capillary refill in book and in book RR is > 30 or < 10

5 factors that determine the severity of a burn

2 most important: - Depth - Extent Then: - Critical areas involved - Preexisting conditions - age < 5 y or > 55 y

How many injuries to consider as a trauma

2 or more injured extremities

Dealing with standing patient with spinal/head injury

Immobilize the patient to a long backboard before proceeding with assessment: - 3 EMTs - Manual stabilization + cervical collar. - Position the board upright directly behind the patient - The EMTs should be positioned with one on either side of the patient, and the third directly behind the patient, maintaining in-line stabilization - The 2 EMTs at the patient's sides grasp the handholds at shoulder level or slightly above by reaching under the patient's arms - Carefully lower the patient as a unit under the direction of the EMT at the head - The EMT at the head must ensure that the patient's head stays against the board and must carefully rotate his or her hands as the patient is being lowered to maintain in-line stabilization

If evisceration, don't log roll the pt

Instead, keep the patient in the supine position and allow him to flex the knees when possible to help relieve tension on the abdomen

Guarding

Involuntary muscle contractions (spasms) of the abdominal wall in an effort to protect an inflamed abdomen; a sign of peritonitis.

Heart muscle

Involuntary muscle with its own regulatory system

Principal condition that results from drowning

Lack of O2

Blast injuries

Mines, shipyards, chemical plants, and terrorist activities

Once you have applied a splint

Monitor pulse and motor and sensory function in the distal extremity

Safety officer

Monitors the scene for conditions or operations that may present a hazard to responders and patients -> Remove hazards

Side effects of oral glucose

None - if you don't really need glucose but take it, you won't be harmed

How to treat penetrating wounds of the neck, chest, back, and upper abdomen

Occlusive dressing to prevent the possible movement of air into the vascular space, thoracic cavity, and abdominal cavity

Fractures about the knee

Occur at the distal end of the femur, at the proximal end of the tibia, or in the patella

Immersion foot

Occurs after prolonged exposure to cold water -> hikers/hunters long time in lake/river

Secure attachment

Occurs when an infant understands that parents or caregivers will respond to their needs

What is a burn/when does it happen by definition

Occurs when the body, or a body part, receives more radiant energy than it can absorb, resulting in an injury

Ovulation when wrt menstruation

Ovulation 2 weeks before menstruation

Mcburney's point

Point on the lower right quadrant of the abdomen at which tenderness is maximal in cases of acute appendicitis

Most reliable indicators of an underlying fracture

Point tenderness and severe pain with or without gross instability

Logistics section of the ICS

Responsible for communications equipment, facilities, food and water, fuel, lighting, and medical equipment and supplies for patients and emergency responders

Finance section of the ICS

Responsible for documenting all expenditures at an incident for reimbursement

Removing a helmet on children

Small airway + big head -> padding is important -> under the shoulders + blanket rolls between the child and the sides of the backboard (unless backboard size if for kids)

Gallstones

Small crystals that form from bile in the gallbladder -> can cause cholecystitis or even rupture of gallbladder -> pain in RUQ

Cardiac notch

Space for heart on left lung

Automaticity

The ability of the heart to contract without stimulation from the nervous system (at a slower rate though)

Evenomation

The act of injecting venom

Stroke volume

The amount of blood ejected from the heart in one ventricular contraction

MDI and SVN for shortness of breath - dose

The dose is one puff for an MDI and continuation of the small-volume nebulizer until all the medication has been administered or the patient no longer feels the need for the medication

Sport helmets

The mask can be removed without affecting helmet position by simply cutting the straps that hold it to the helmet -> access to the airway

Difference hypoglycemia VS seizure

The mental status of a patient who has had a typical seizure is likely to improve soon after the seizure stops. In a patient with hypoglycemia, on the other hand, mental status is not likely to improve, even after several minutes

Glenoid fossa

The part of the scapula that joins with the humeral head to form the glenohumeral joint

Hemodialysis

The patient's blood circulates through a dialysis machine that functions in much the same way as the normal kidneys.

Presentation - labor

The position in which an infant is born or the body part that is delivered first

Articular cartilage

Thin layer that covers the surfaces of bones where they come together to form joints

Never leave the scene with patients if there are still other patients present who are sick

This would leave patients at the scene without medical care and can be considered abandonment

Cephalic or vertex presentation

When a fetus is positioned head first in the birth canal -> most cases

If bleeding a lot

While most wounds are simple and can be managed with direct pressure, do not spend time trying to use pressure, elevation, and pressure dressings on a wound that is hemorrhaging profusely. -> Apply a tourniquet early

Expression "splinting to death"

You are so involved in splinting fractures that the patient dies from other injuries

If the injury was caused by a very high-velocity missile from a rifle

You may see a small, harmless-looking entrance wound with a large, gaping exit wound

Words not to use in reports about LOC

"Obtunded" or "dazed" have different meanings to different people and should not be used in either written or verbal reports.

Lumen

- Inside diameter of the artery - Narrows if atherosclerosis -> can't accomodate increased blood flow during times of max need

Psy meds

- Anti-psychotic (for mental disorder): - Zyprexa - Lithium - Cymbalta - Anti-depressant: Zoloft

Evolution of BP

- BP directly corresponds to weight -> increases with age - At birth, systolic 50-70 - 1 year old, systolic 70-95

Osteoporosis

- Decrease in bone mass -> reduction in bone strength -> more likely to fracture - Faster in women after menopause - Treatment: hormone (balance menopause), calcium, vitamin D, exercise

Changes in the musculoskeletal system in geriatrics

- Decrease in bone mass, especially among postmenopausal women - Bones become more brittle and tend to break more easily - The disks between the vertebrae of the spine begin to narrow -> decrease in height by 2-3 in - Ligaments and joints lose their flexibility and may be further immobilized by arthritic changes -> > 50% old people have arthritis - A decrease in the amount of muscle mass -> less strength

Life expectancy

- In the early 1900s: 47 - Now: 78, max 120

Cystitis

- Inflammation of the bladder -> UTI - Lower quadrant pain - Urgency and frequency in urination and pressure and pain around the bladder - Pt feels tenderness when palpating the abdomen over the bladder (just above the pubic bone)

Bronchitis

- Inflammation of the bronchi - Chronic cough (with sputum production) - Wheezing - Cyanosis - Tachypnea

Left ventricular assist device (LVAD)

- Internal pump unit and external battery pack - Enhance the pumping of the left ventricle

Dieffenbachia

- Irritation of the skin. If chewed: irritation of upper airway -> difficulty breathing and speaking - Resembles elephant ears - Also called Dumb Cane -> maintain open airway + O2 + transport

JumpSTART triage process

todo check with p. 39 cause there might be differences - or take the one from the slides of REMSA

Methamphetamine (meth)

- Manufacturing process is called "cooking" - Toxic fumes and highly inflammable

Secondary device

A secondary explosive used by terrorists, set to explode after the initial bomb

Appendicular part of the skeletal system

- Extremities, shoulders and pelvis - Posture and movement

Bleeding - miscarriage

- Spontaneous abortion - Bleeding in early stages

In-line traction

Act of pulling on a body structure in the direction of its normal alignment.

Narrowest part of airway in peds

Cricoid cartilage

Infarction

Death of tissue

Common finding if kidney is injured

Hematuria

Dilation

If oxygen demands increases, then dilation of the coronary arteries

Thyroid function

Regulates metabolism

Cavitation

Injury to internal organs distant to the actual path of the bullet because of pressure waves

Assume spinal injury if head injury

Spinal injuries can be hard to detect

Acute abdomen

Sudden onset of abdominal pain

Platinum 10

Time on-scene should be < 10 min

Pelvic binder

Used to splint the bony pelvis

Sympathomimetics effects

- "Feel good", improve task performance - Suppress appetite, or prevent sleepiness - Cause irritability, anxiety, fear, paranoia, delusions

Generalized seizure

- A seizure characterized by severe twitching of all of the body's muscles that may last several minutes or more; formerly known as a grand mal seizure - Can also be a brief lapse of consciousness: stare and not respond ("petit mal" or "absence seizure") - Sudden loss of consciousness followed by chaotic muscle movement and tone - < 5 min followed by a lengthy period (5-30 min) = postictal state -> gradually regains consciousness

RUQ pain

- Cholecystitis - Pancreatitis

Most common MOI of head injury

- Motor vehicle crash - 2/3 of car crash lead to a head injury

Thermogenesis

- Vasoconstriction - Shivering

Protection needed for each toxicity level

0: none 1, 2: SCBA (level C suit) 3: Full protection, with no exposed skin (level A or B suit) 4: Special HazMat gear (level A suit)

Treatment of pulmonary edema

100% O2 and CPAP

When is infant able to walk with assistance and know his name

12 months

Percent of population 65 years of age and over

12%

Early adult ages

19-40 years old

How long after start of anaphylaxis do people die

2/3 of population die within 30 min

Stinger injects venom for how long

20 minutes -> if you don't remove the stinger, it continues to inject venom for 20 min

Number of bones

206

Normal weight at birth

3 kg (7 lbs)

Hypoglycemia definition

Blood glucose < 60 mg/dL

AED: if shock is not advised

5 cycles of CPR (2 minutes)

Tympanic membrane ruptures at what pressures

5-7 psi above atmospheric pressure

Older adult ages

61 years old and older

Percentage of population with PTSD at some point in their life

7% to 8%

Systolic BP as a function of age - equation for peds between 1-10 years old

70 + (2 x child's age in years) -> lower limit

Survival rate from respiratory arrest in the prehospital setting in children

70%

Abnormal body temperatures definition

> 100.4°F (38°C)

Survival rate from cardiac arrest in the prehospital setting in children

8%

Ingested poisoning is the most common poisoning

80% of all poisoning occur by mouth

Normal blood glucose levels

80-120 mg/dL (above 70 mg/dL in neonates)

Normal body temperature

98°F (36.7°C)

Acute blood loss qty the body can tolerate

< 20% of total blood volume -> ~1L (2 pints) in adult, 100-200 mL in child

JumpSTART triage - which population

< 8 y or < 100 lb

Coup-contrecoup brain injury

A brain injury that occurs when force is applied to the head and energy transmission through brain tissue causes injury on the opposite side of original impact

Contusion

A bruise from an injury that causes bleeding beneath the skin without breaking the skin

Ecchymosis

A buildup of blood beneath the skin that produces a characteristic blue or black discoloration as the result of an injury

Contact burn

A burn caused by direct contact with a hot object

Crepitus

A crackling or grating sound when fractured bones rub together

Acute Myocardial Infarction (AMI)

A heart attack; death of heart muscle following obstruction of blood flow to it (thromboembolism). Acute in this context means "new" or "happening right now."

Allergen

A substance that causes an allergy

Medication

A substance that is used to treat or prevent disease or relieve pain

Laying the bike down

A technique used to separate the rider from the body of the motorcycle and the object to be hit -> prevents the rider from being trapped between the bike and the object

Most important sign of brain injury

ALOC

Thrombosis

Abnormal condition of a blood clot

Kidney failure

Acute or chronic - Chronic: often caused by diabetes or hypertension. Irreversible. Kidney tissue shrinks and function diminishes -> high incidence of heart disease -> need dialysis or kidney transplant

2 types of trauma centers

Adult or pediatric

Golden hour or Golden period

After the first 60 minutes, the body has increasing difficulty in compensating for shock and traumatic injuries

Empty nest syndrome

After years of having children living at home, parents must readjust their lifestyle as children leave home

Presbycusis

Age-related hearing loss

Drowning prevention

All swimming pools should be surrounded by a fence that is at least 6 feet (2 m) high, with slats no farther apart than 3 inches (8 cm), and self-closing, self-locking gates

False motion

Also called free movement, false motion is a point in the limb where there is no joint. It is a positive indication of a fracture

Be careful: some chemicals reach with water

Although small amounts can usually be flushed safely with large quantities of water, larger amounts of such chemicals can give off toxic fumes or explode when wet

Elder abuse

Any action on the part of an older person's family member, caregiver, or other associated person that takes advantage of the older person's person (for example, physical abuse), property, or emotional state

Vector (of a virus)

Any agent that acts as a carrier or transporter -> Basically, the thing that carries the virus and contaminates you

RLQ pain

Appendicitis

Mediastinum

Area between the lungs containing the heart, aorta, venae cavae, esophagus, and trachea

Perineum

Area between the vagina and the anus

Angiodema

Areas of localized swelling

Coronary arteries

Arteries that carry blood to the heart muscle. They start at the first part of the aorta, just above the aortic valve. The right coronary artery supplies blood to the right atrium and right ventricle and, in most people, the bottom part, or inferior wall, of the left ventricle. The left coronary artery supplies blood to the left atrium and left ventricle and divides into two major branches, just a short distance from the aorta.

Anticholinergic agents - examples

Atropine, antihistamines such as diphenhydramine (Benadryl), Datura stramonium (jimsonweed), and certain tricyclic antidepressants such as amitriptyline (Elavil)

Anticholinergics examples

Atropine, diphenhydramine, chlorpheniramine, doxylamine, Datura stramonium [jimsonweed]

index of suspicion

Awareness that unseen life-threatening injuries may exist when determining the mechanism of injury

Treatment for air embolism and decompression sickness

BLS + recompression in hyperbaric chamber

Clostridium difficile (C diff)

Bacterium responsible for the most common cause of hospital-acquired infectious diarrhea

Brain stem

Basic functions: breathing, blood pressure, swallowing, pupil constriction

Why it's important to report the type of firearm used

Because it gives an indication of the speed of the bullet and speed is an important factor in kinetic energy

Why we usually cover both eyes in an eye injury

Because of the sympathetic movement (I think it means because the two eyes move together)

Why we need the JumpSTART triage

Because the START triage does not take into account the differences of pediatric patients

Hymenoptera stings

Bees, wasps, yellow jackets, and ants

Melena

Black tarry stool containing blood

Most common cause of death from blast injury

Blast lung

Hemorrhage

Bleeding

Exsanguination

Bleeding to death

Gastrointestinal hemorrhage

Bleeding within the gastrointestinal tract

Hemopneumothorax

Blood + air in the pleural space

2 categories of traumatic injuries

Blunt trauma and penetrating trauma

Immersion hypothermia

Body cannot compensate for drop in temp due to immersion in water <77 °F

Unified command system

Large MCIs, such as a HazMat incident, require a multiagency response -> unified command system

Musculoskeletal system

Bones and voluntary muscles

What type (blunt or penetrating) can injure hollow organs

Both blunt and penetrating

How to peds respond to hypoxia

Bradycardia (not tachy)

Peritoneal dialysis

Large amounts of specially formulated dialysis fluid are infused into (and back out of) the abdominal cavity.

Gray Turner's sign

Bruising around the flank area

Cullen's sign

Bruising around the umbilicus

Battle sign

Bruising behind an ear over the mastoid process that may indicate a skull fracture

Raccoon eyes

Bruising under the eyes that may indicate a skull fracture

GERD

Burning sensation within the chest (heartburn)

Burping a tension pneumothorax

Burping the dressing involves lifting one side to make sure any pressure buildup is relieved, as occasionally the dressing can become adhered to the skin, which may lead to a tension pneumothorax

Pulmonary edema

CHF -> blood back up in the pulmonary veins -> pressure in capillaries increases -> fluid (mostly water) passes into the alveoli

Tolerance

Over time, a person who routinely misuses a substance may need increasing amounts of it to achieve the same result

If the child is clearly deceased but family members are so distraught that they insist that resuscitation efforts be made

CPR + transport

Pulse points

Carotid (neck) Femoral (groin) Radial (wrist) Brachial (below bicep) Posterior tibial (ankle) Dorsalis pedis (foot)

Jacksonian seizure

Caused by unusual electrical activity that affects only a small area of the brain. The person maintains awareness during the seizure -> so basically it's like a simple partial seizure

Incident action plan

Central tool for planning during a response to a disaster emergency

Fetal alchohol syndrome

Condition seen in infants born to women who have abused alcohol

Ligaments

Connect bone to bone

Counting respirations in an infant

Count the number of times the abdomen rises instead of concentrating solely on the chest rise

If open injury in the chest, upper abdomen or upper back

Cover it with an occlusive dressing

Primary method of communicating in infants

Crying

Most common complication of type 1 diabetes

DKA

Secondary blast injuries

Damage to the body results from being struck by flying debris (up to 3,000 mph)

Pain that is following the angle from the lateral hip to the midline of the groin

Damage to the kidneys or the ureters

Sedative

Decreases activity and excitement

Pathophysiology of nervous system in geriatrics

Dementia, delirium, syncope, Alzheimer neuropathy

3 phases of dive emergencies

Descent, bottom, and ascent

Extrication or rescue supervisor

Determine the type of equipment needed for the situation -> Victims may need to be extricated by specially trained personnel before they can be triaged and treated

Sprain and strains

Difficult to differentiate among the various types of injuries -> treat every severe sprain as if it is a fracture -> RICES

Plants - allergen

Dust, pollen, mold, mildew

Ventricle

Each of the two lower chambers of the heart where the blood exits from. One-way valve for proper direction

Atrium

Each of the two upper chambers of the heart that receives blood that comes into the heart. One-way valve for proper direction

Organ most sensitive to blast injuries

Ear

If doubt about pt has hypo or hyper

Err on the side of giving glucose and contact medical control (hypo more dangerous than hyper)

Kyphosis

Excessive outward curvature of the spine, causing hunching of the back

Preferred WMD for terrorists

Explosive devices

Vacuum splint indications

Extremity fractures or dislocations

PPE for labor

Face shield + gown + gloves

FAST

Facial drooping, arm weakness, speech difficulties, time (time to call 911 now)

Full metal jacket VS fragmentation bullets

Full metal jacket bullets cause less damage than fragmented rounds because of their tendency to pass through the body's tissues

Glucogenogenis

Generation of glucose from certain non-carbohydrate carbon substrates

Cystic Fibrosis

Genetic disorder that affects the lungs and digestive system - Disrupt sweat flans -> mucus becomes thick, sticky and hard to move -> lungs become infected

PPE for burns

Gloves + eye protection

Secondary asst with significant trauma affecting multiple systems

Head to toe DCAP-BTLS (e.g., if genitourinary injury but with major trauma, don't focus on genitals only)

Conditions that may mimic strokes

Hypoglycemia/diabetes, postictal state (post seizure state), subdural or epidural bleeding

Estimating the amount of external blood

Hard because blood will look different on different surfaces, such as when it is absorbed in clothing, when it has been diluted in water, or when the environment is dark

Pulse and BP - measure hypothermia

Hard to palpate

Myocardium

Heart muscle

Rigid splints

Help immobilize fractures as well as reduce pain and further damage to soft tissues

Opioids examples

Heroin, methadone, oxycodone

Medical emergency

Illnesses or conditions not caused by an outside force

Anterograde (posttraumatic) amnesia

Inability to remember events after an injury

Hypnotic

Induces sleep

Treatment for hyperglycemia

Insulin + IV fluid + transport

Insulin

Insulin is necessary for glucose to enter the cells for metabolism. "Key to the door"

Ataxic (Biot) respirations

Irregular rate, pattern, and volume of breathing with intermittent periods of apnea

Stroke in geriatrics

Leading cause of death in older people

Pain management in peds

Limited to the following interventions: positioning, ice packs, and extremity elevation

Largest organ in the abdomen

Liver

Majority of civilian gunshot injuries are the result of what type of weapon

Low-velocity weapons

Cervix

Lower third of the uterus

Emergency Medical Care for Hematologic Disorders

Mainly supportive: O2 if inadequate breathing or ALOC (NRB 12-15L/min) + position of comfort + transport

Chemicals - allergen

Makeup, latex, soap, hair dye

Altered mental status

Many causes, including: intoxication, head injury, hypoxia, stroke, metabolic disturbances

Hematoma

Mass of blood that has collected in the soft tissues beneath the skin

Plasma

Mixture of water, salts, nutrients, and proteins

Temperatures when heat stroke can occur

Most heat stroke cases occur when the temperature is 80°F and the humidity is 80%

Anaphylactic reactions

Most occur within 30 min

Epistaxis

Nosebleed

orthopnea

Not being able to breathe while lying down

Tension headaches - treament

OTC NSAID

Impaled objects

Objects that penetrate the skin but remain in place

Thermal burn

Occur when the skin exposed to T > 111°F (44°C)

What are biologic agents

Organisms that cause disease

Cholinergics examples

Organophosphates, pilocarpine, nerve gas

Treating fractures of the forearm

Padded board, air, vacuum, or pillow splint

LUQ pain

Pancreatitis

One way to now if it's a terrorist attack or not

Patients will generally exhibit the same signs and symptoms in a terrorist attack

Second leading cause of trauma death

Penetrating trauma

Self-concept

Perception of ourselves

Chronic depression

Persistent feeling of sadness and despair

2 types of leukocytes

Phagocytes and lymphocytes

Be careful with PPV if...

Pneumothorax -> can make it worse but if the pt needs it then give it (if benefits > costs)

If signs of shock in pregnant woman

Position her on her left side - not supine

Risk associated with restraints

Positional asphyxia, aspiration, severe acidosis, and sudden cardiac death

If bleeding on the head/neck

Pressure with a dry sterile dressing

Does elevation stops bleeding?

Previously, elevation of the extremity was also recommended, but there is no evidence it helps control bleeding and it may aggravate other injuries

Vial of Life Project

Program that recommends creating a medication history for caregivers or EMS personnel

Scene size up with neuro emergencies

Pt can't reliably tell you what is wrong, and there may be more than one cause.

Saying in rescue water

Reach, throw, and row, and only then go

AED - after 5 cycles (2 min) of CPR

Reanalyze the cardiac rhythm

AED - CPR cycle

Repeat the cycle of 2 minutes of CPR, one shock (if indicated) and 2 minutes of CPR

Role of the EMT with the hot/warm/cold zones

Report to a designated area outside of the hot and warm zones and provide triage, treatment, transport, or rehabilitation when HazMat team members bring patients to you

Peristalsis

Rhythmic movement in the large intestine that moves the waste matter through the intestines

Transport of multisystem trauma

SAMPLE + secondary assessment

PPE if toxic gas

Self-contained breathing apparatus

Chemical burns and contamination in open wound injury

Should be flushed to remove remaining chemicals -> done in hospital usually

How to splint fractures of the clavicle and scapula and AC separations

Sling and swathe

Silent MI

Some patient do not feel pain but other complaints, such as fatigue

Hematology

Study of blood diseases

Toxicology

Study of poisonous substances

Hypertension

Systolic > 140 or diastolic > 90

Sucking reflex

The infant starts sucking when his lips are stroked

EpiPen - medical control

To use, or help the patient use, the auto-injector, you should first receive a direct order from medical control or follow local protocol

Reel splint

Traction splint that is also used by the US military -> lower extremity

Plasma

Transport red + white + platelets + proteins + minerals

Where the 4 quadrants are divided from

Two imaginary lines intersect at the umbilicus, dividing the abdomen into four quadrants

Casualty collection point

Tx area for when pts cannot be safely moved or transport is delayed. Security provided by PD

What aspects of a container can give you clues about the substance inside

Type and size of container, and material of construction

Causes of acute abdominal pain

Ulcers, gallstones, pancreatitis, appendicitis, gastrointestinal hemorrhage, esophagitis, esophageal varices, Mallory-Weiss tear, gastroenteritis, diverculitis, hemorrhoids,

Anisocoria

Unequal pupil size

Birth canal

Vagina + cervix

Hematemesis

Vomiting blood

Aura

Warning sign of seizure: visual change/hallucination/smell

Can you bleed in the abdomen without having pain

Yes

How to make sure you don't ventilate too fast a child

- "Squeeze, release, release" - Say "Squeeze" as you squeeze the bag - When you see the chest start to rise, release pressure on the bag and slowly say "Release, release."

Revised trauma score (RTS)

- 0-12 (12 best) - A scoring system used for patients with head trauma - Includes: - GCS - RR - Systolic BP

Psychological changes in early adults

- 3 words best describe: work, family, stress

Pelvic binder

- A device to splint the bony pelvis to reduce hemorrhage from bone ends, venous disruption, and pain - Good for open-book pelvic fracture

4 colors of JumpSTART

- Able to walk: green - Breathe spontaneously, have a peripheral pulse, and appropriately responsive to painful stimuli: yellow -> treatment and transport can be delayed - Breathing but pulseless, apneic and responsive to positioning or rescue breathing, or inappropriately responsive to painful stimuli: red -> immediate care and transport - Both apneic and pulseless, or apneic and unresponsive to rescue breathing: black -> deceased or expectant deceased

Migraine - treatment

- Anti-hypertensives - Anti-depressants - Caffeine containing meds

Cluster headaches - treatment

- Antihistamines - Corticosteroids - Calcium channel blockers

2 issues that must be addressed at a HazMat incident

- Any trauma that has resulted from other related mechanisms, such as vehicle crash, fire, or explosion - The injury and harm that have resulted from exposure to the hazardous substance

Large blood vessels in the chest

- Aorta - Superior and vena cava - Pulmonary arteries + 4 main pulmonary veins

If commercial tourniquet not available

- Apply a tourniquet using a triangular bandage and a stick or rod - Fold a triangular bandage until it is 4 inches (101 mm) wide and six to eight layers thick - Wrap the bandage around the extremity twice - Tie one knot in the bandage. Then place a stick or rod on top of the knot, and tie the ends of the bandage over the stick in a square knot - Use the stick or rod as a handle, and twist it to tighten the tourniquet until the bleeding has stopped; then stop twisting - Secure the stick in place, and make the wrapping neat and smooth - Write "TK" (for "tourniquet") and the exact time (hour and minute) that you applied the tourniquet on a piece of adhesive tape - Securely fasten the tape to the patient's forehead or write the time directly on the forehead with a marker

How to prevent a wound from drying

- Apply sterile dressings moistened with sterile saline solution - Then cover the moist dressing with a dry, sterile dressing

Hot zone

- Area immediately surrounding a hazmat incident - Extends far enough to prevent adverse effects outside the zone - All personnel and equipment must be decontaminated when they leave the hot zone

Assessment and management of child with potential SIDS

- As you assess, pay special attention to any marks or bruises on the child before performing any procedures, including CPR - If no apparent death: ABC + interventions (including CPR) + transport - If apparent death (rigor mortis, ...): call medical control

Common blood thinners

- Aspirin - warfarin (Coumadin) - rivaroxaban (Xarelto) - dabigatran (Pradaxa) - apixaban (Eliquis) - clopidogrel (Plavix)

Plant poisoning - what to do

- Assess the patient's airway and vital signs - Notify the regional poison center for assistance in identifying the plant - Take the plant to the ED - Transport

Drums

- Barrel-like containers used to store a wide variety of substances, including food-grade materials, corrosives, flammable liquids, and grease - Low-carbon steel, polyethylene, cardboard, stainless steel, nickel, or other materials

Cyanide: patho, odor/color, where it's found

- Binds with cells, preventing oxygen from being used - Colorless gas - Smell of almonds, garlic or bleach - Found in many industrial settings (unlike nerve agents): gold and silver mining, photography, and plastics processing, even found in the pits of many fruits

Intracranial hemorrhage

- Bleeding inside the skull also increases the ICP - Bleeding can occur between the skull and dura mater, beneath the dura mater but outside the brain, or within the tissue of the brain itself

Subarachnoid hemorrhage

- Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates - Results in bloody CSF and meningeal irritation (neck rigidity, headache) - Causes: trauma and rupture of an aneurysm - Sudden severe headache then increased ICP -> ALOC + changes in pupils + vomiting + seizures

Examples of nontraumatic internal bleeding

- Bleeding ulcers - Bleeding from the colon - Ruptured ectopic pregnancy - Aneurysms

Lewisite (L) and phosgene oxime (CX): symptoms compared to H

- Blister wounds similar mustard gas - Highly volatile + rapid onset of symptoms compared to mustard gas -> Immediate intense pain - Skin: grayish discoloration - Don't cause the secondary cellular injury that is associated with mustard gas (bone marrow and respiratory)

Acute abdomen in geriatrics - non-GI complaints

- Blood loss - Abdominal aortic aneurysm (AAA), especially if hyper tension and atherosclerosis

Air embolism

- Bubbles of air in blood vessels -> prevent flow of blood to body - Diver hold his breath during the ascent -> P in lungs > P outside -> alveoli rupture -> pneumothorax or pneumomediastinum or air emboli - Can occur in shallow water (2 m)

Inhaled poisons - signs and symptoms

- Burning eyes - Sore throat, cough - Chest pain - Hoarseness, wheezing - Respiratory distress - Dizziness, confusion - Headache - Stridor in severe cases - Seizures - ALOC (remember: oximetry might be inaccurate)

PEEP indications

- COPD - Pulmonary edema

Air splints

- Can control internal or external bleeding associated with severe extremity injuries, such as fractures - Can also immobilize the fracture - Acts like a pressure dressing applied to an entire extremity rather than to a local area - Not as effective as tourniquets and should never be used when a tourniquet is otherwise indicated - Also called soft splints or pressure splints

Traumatic Brain Injury (TBI)

- Can happen as a trauma secondary to the explosion of an improvised explosive device (IED) - Similar symptoms as PTSD

Heat exhaustion

- Caused by hypovolemia as the result of the loss of water and electrolytes from heavy sweating - Causes: heat exposure, stress, and fatigue - Most common heat emergency - Also called heat prostration or heat collapse

Bacterial meningitis

- Central nervous system infection - Inflammation of the meninges caused by a bacterial infection - Headache, stiff neck, fever, and sensitivity to light - Provide dark envt, no lights and siren

Nervous system general structure

- Central: brain and spinal cord - Peripheral: - Voluntary (somatic) - Involuntary (autonomic): sympathetic + parasympathetic

Alzheimer

- Common cause of dementia - Results in loss of brain tissue - Symptoms: memory loss, lack of spontaneity, subtle personality changes, disorientation, impaired thinking, restlessness, agitation, wandering, impaired judgment, and inappropriate social behavior - In late stages: indifference to food, an inability to communicate, incontinence, and seizures

Autonomic system adjusts the blood flow

- Constricts or dilates blood vessels - Redirects blood away from other organs to the heart, brain, lungs, and kidneys (in an emergency)

Type 2 treatment

- Exercise and diet - Oral meds. Careful: some meds increase the secretion of insulin -> hypoglycemia - Examples of meds: Glucotrol, DiaBeta

Types of motor vehicle crashes

- Frontal (head-on): down-and-under or up-and-over - Rear-end - Lateral (T-bone) - Rollover - Rotational (spins) -> typically series of 3 collisions

MDI and SVN for shortness of breath - side effects

- HR increase - Nervous - Muscle tremo

Physical changes in middle adults

- HR ~70, RR 12-20, systolic 90-140 - Vulnerable to vision and hearing loss - Cardiovascular health + diabetes + hypertension + cholesterol also becomes an issue - Greater incidence of cancer - Many of the effects of aging can be diminished with exercise and a healthy diet

3 forms of heat emergency

- Heat cramps - Heat exhaustion - Heat stroke

Thyroid disorders

- Hypothyroidism: metabolism + HR + digestion decrease. Weakness and cool dry skin - Hyperthyroidism: metabolism + HR + digestion increase. Tremors and warm moist skin

Only cases when you should remove an impaled object

- Impaled through the cheek or mouth causing airway obstruction - In the chest that directly interfere with performing CPR on a patient who is already in cardiac arrest

Pneumonia

- Inflammation of the lungs -> impair O2/CO2 exchange - 75% are bacterial infections - It's usually a secondary infection - start with upper respiratory tract infection from cold or sore throat - Intubation can increase the risk of pneumonia - Risk factors: nursing home, hospitalization, chronic disease (renal infection), immune system compromise (cancer), COPD - Rapid and labored breathing - Lips blue/gray - Lung sounds: wheezing, crackles, rhonchi - If attacks lower part of lungs: fever + abdominal pain + vomit rather than dyspnea - Bacterial worse than viral (can even lead to seizure if high fever) -> provide O2

Lacerations to the eye

- Laceration to eyelid: control with gentle manual pressure because heavy bleeding - Laceration to globe: 1. Never exert pressure 2. Apply moist sterile dressing to prevent drying 3. Cover with protective metal eye shield, cup, or sterile dressing (soft dressings to both eyes) - Displacement of eye from socket: do not attempt to replace it, cover with moist sterile dressing (both eyes), transport in supine position

Shaken baby syndrome

- Life-threatening injury that occurs when an infant is forcefully shaken back and forth, a motion that ruptures blood vessels in the brain and breaks neural connections - Unconscious without evidence of trauma

Endometrium

- Lining of the inside of the uterus - Immediately following ovulation, it begins to thicken in preparation for the potential implantation of a fertilized egg - If the egg is not fertilized within 36 to 48 hours after it has been released from the follicle, it will simply die -> the thickened endometrium will be shed because it is not needed -> periods -> 28th day of a woman's cycle

Referred pain to the shoulder

- Liver - Spleen - Bleeding into the peritoneal space

Orbital fracture symptoms

- Loss of sensation above or below the eye - Visual disturbances - Diplopia - Nasal drainage - Fixed upward gaze

Bones of the orbit of the eye

- Lower edge of the frontal bone of the skull - Zygoma - Maxilla - Nasal bone

Types of burns in peds

- Minor: < 10% of the body surface - Moderate: 10-20% of the body surface - Severe: > 20% of the body surface or full-thickness burn or any burn involving the hands, feet, face, airway, or genitalia

Quaternary blast injuries

- Miscellaneous injuries - Includes burns from hot gases or fires started by the blast; respiratory injury from inhaling toxic gases; suffocation; poisoning; medical emergencies incurred as a result of the explosion; crush injuries from the collapse of buildings; contamination of wounds from environmental, chemical, or toxic substances; and mental health emergencies

Syndromic surveillance

- Monitoring of patients presenting to emergency departments and alternative care facilities, recording of EMS call volume, and use of over-the-counter medications - Usually performed by health departments

Risk factors of SIDS

- Mother younger than 20 years - Mother smoked during pregnancy - Low birth weight

Fractured and avulsed teeth

- Motor vehicle crashes or an assault - Teeth fragments -> airway obstruction -> remove from the patient's mouth immediately

Changes in the GI system in geriatrics

- Mouth: - Less saliva -> mouth dry - Dental loss -> Increase the risk of choking. + poor nutrition - Gastric secretions are reduced + poor muscle tone of the sphincter between the esophagus and stomach -> Increase the risk of aspiration + acid reflux - Slower peristalsis -> constipation - Blood flow to the liver declines -> decreased metabolism + how meds affect pt - Rectal sphincter weak -> fecal incontinence

Pt position in labor

- Move pt to a sturdy, flat surface or the floor is she allows it - Pillow under hips to elevate 2-4 in + pillows to support head, neck and upper back - Another position (e.g., on the side) is ok if both you and the woman are ok with it

Critical injuries

- Multiple open fractures of the limbs - Suspected pelvic fractures with hemodynamic instability

Capillary refill time

- Need to be < 2 s - Used to assess end-organ perfusion - Reliable < 6 years - Cold temperatures affect it

Newborn, neonate and infant

- Newborn: first few hours of life - Neonate: birth-4 weeks (28 days) -> 140 BPM, 40-60 breaths/min - Infant: 1 month-1 year

Risk factors of coronary artery disease

- Non-modifiable risk factors: age, male sex, race, significant family history - Modifiable risk factors: cigarette smoking, high blood pressure, elevated cholesterol/glucose levels, inactivity

AMI pain is different from angina pain in 3 ways

- Not necessarily caused by exertion, can occur at any time (even sleeping) - Doesn't get better in a few minutes (30 min to several hours) - Not necessarily relieved by rest or NTG

High- altitude cerebral edema (HACE)

- Occurs in climbers and may accompany HAPE - Symptoms: severe, constant, throbbing headache; ataxia (lack of muscle coordination and balance); extreme fatigue; vomiting; and loss of consciousness - Similar symptoms as HAPE

Decompression sickness/bends

- Occurs when bubbles of nitrogen obstruct the blood vessels - When the diver ascends, the external pressure is decreased, and the dissolved nitrogen forms small bubbles - Caused by too rapid ascent from a dive, too long of a dive at too deep a depth, or repeated dives within a short period of time

Injuries to the ear

- Often injured, but rarely bleed very much - If local pressure does not control the bleeding: - Soft padded dressing between the back of the ear and the scalp - Roller dressing - If ear avulsion: wrap the avulsed part in a moist sterile dressing + put it in a plastic bag + keep it cool - Ruptured tympanic membrane due to rapid pressure change -> pain, ringing, difficulty earing

Three scales to assess ped's LOC

- PAT - AVPU - GCS

3 layers of uterus

- Perimetrium, myometrium, endometrium (most exterior to most interior)

When to use BVM on peds

- RR < 12 or > 60 - ALOC - Inadequate tidal volume

Extent of a burn

- Rule of palm: palm is 1% - Rule of nines (head of an infant is > head adult and small legs) - When you calculate the extent of burn injury, include only partial- thickness (second-degree) and full-thickness (third-degree) burns - Still document superficial (first-degree) burns though

Signs of injuries to the kidneys

- Shock signs - Hematuria - Flank pain

Esophageal varices

- Swollen veins in the esophagus - Occur when the amount of pressure within the blood vessels surrounding the esophagus increases, frequently as a result of liver failure

Amniotic sac

- The fetus develops inside a fluid-filled, bag-like membrane called the amniotic sac, or bag of waters - Amniotic fluid helps protect the fetus - When the sac ruptures, usually at the beginning of labor, the amniotic fluid is released in a gush -> "water broke"

Mucous membranes

- The various openings in the body, including the mouth, nose, anus, and vagina, are not covered but are lined with mucous membranes - Provide a protective barrier against bacterial invasion, - Differ from skin in that they secrete a watery substance that lubricates the openings -> moist (skin is dry)

Resuscitation after drowning

- Try for one hour (can survive for a long time) + warm up pt as you do it - Don't resuscitate if unwitnessed drowning who's in state of decomposition

Uremia

- Urine in the blood - Failure of kidney -> waste product, which is normally excreted into the urine, remains in the blood

How EMT assists with delivery - pre-delivery summary

1. Position patient 2. Administer Oxygen 3. Create sterile field 4. Monitor for vomiting 5. Assess for crowning 6. Support baby's head 7. Tear sac if needed 8. Assess for nuchal cord

Golden principles of prehospital trauma care

1. Your safety then crew then patient 2. Need for additional resources 3. MOI 4. Life threats 5. ABC 6. Spinal immobilization

What percentage of all trauma patients have some form of genitourinary injury?

10%

Structures of the ear

3 parts: external, middle, inner

When is infant is able to sit upright and begins to make cooing and babbling sounds

6 months

School-age children age

6-12 years

School ages

6-12 years old

Bleeding - ectopic pregnancy + miscarriage + abruptio placenta + placenta previa

= When an embryo develops outside of the uterus, most often in a fallopian tube -> Unilateral pain in the lower abdomen

Flash burn

A burn caused by a brief exposure to intense heat: explosion or lightning

Chest injuries in peds

A child's ribs are softer and more flexible than an adult's. As a result, they may compress the lungs and heart if there is blunt trauma, causing serious injury with no obvious external damage

Open-book pelvic fracture

A life-threatening fracture of the pelvis caused by a force that displaces one or both sides of the pelvis laterally and posteriorly

Nonepileptic seizure

A seizure that stems from psychological causes rather than electrical disturbances in the brain

Paradoxical motion

Abnormality associated with multiple fractured ribs, in which one segment (often referred to as a flail segment) of the chest wall moves opposite the remainder of the chest -> Out with expiration and in with inspiration

Inflammation

Additional cells move into the damaged area to begin repair: - White blood cells combat pathogens - Lymphocytes (a type of white blood cell) destroy bacteria and other pathogens - Mast cells release histamine (early stages of inflammation) -> dilates blood vessels, increasing blood flow to the injured area and resulting in a reddened, warm area immediately around the site. Histamine makes capillaries more permeable, and swelling may occur as fluid seeps out of these "leaky" capillaries. - Inflammation ultimately leads to the removal of foreign material, damaged cellular parts, and invading microorganisms from the wound site.

Stimulant

Agent that produces an excited state

Behavioral crisis

Agitated, violent, or uncooperative behavior or who are a danger to themselves or others

Treatment for viral agents

Although some viral agents do have vaccines, there is no treatment of a viral infection other than antiviral medications for some agents -> Terrorists are likely to use viral agents

When should you give O2 to a suspected head injury

Always -> reduces hypoxia, cerebral edema, and overall brain damage -> Start immediately (don't wait for cyanotic)

Casualty collection area

An area set up by physicians, nurses, and other hospital staff near a major disaster scene where patients can receive further triage and medical care -> that happens if the hospitals say they can't treat all pts at their facility -> ex: wharehouse -> same functioning as an ICS (same branches and areas of operation)

Embolus

Anything in the circulatory system that moves from its point of origin to a distant site and lodges there, obstructing subsequent blood flow in that area

Acute pain in the entire abdomen + rebound ternderness

Blood and fluid from damaged organs flow into the peritoneal cavity -> Peritonitis -> Rebound tenderness

Hemothorax

Blood collects in the pleural space from bleeding around the rib cage or from a lung or great vessel -> Nothing you can do (no needle)

Retrograde amnesia

Can remember everything except the events leading up to the injury

Wong-Baker FACES Scale

Can use it to show to peds > 3 y to ask them to identify their level of pain

What has been the weak point at major incidents

Communication

Leading cause of death in neonates

Congenital/genetic anomalies: low birth weight, respiratory distress syndrome, maternal pregancy complications

Most significant factor to suicide

Depression

Persistency and volatility

Describes how long a chemical agent will stay on a surface before it evaporates (both words have the same meaning) According to REMSA slides: - P = How long they will remain on a surface - V = Their tendancy to evaporate

Most common cause of epistaxis

Digital trauma

Seizures - medications

Dilantin Keppra Depakote Tegretol

Ageism

Discrimination based on age

One way to distinguish containers

Divide them into two categories based on their capacity: bulk and nonbulk storage containers

Septum

Divides the right and left sides of the heart

2nd cause of unintentional death 1-4 years old

Drowning

Secondary containment

Engineered method to control spilled or released product if the main containment vessel fails

2 main layers of skin

Epidermis and dermis (3rd layer: subcutaneous tissue)

Face

Eyes, ears, nose, mouth, and cheeks

Pulsus paradoxus

Fall of systolic blood pressure of >10 mmHg during the inspiratory phase

3 major energy sources

Fats, proteins and carbs

Intestinal mesentery

Fold of tissue that contains a web of vessels, both arteries and veins, as well as nerves and lymphatic tissues -> Connects the small intestine to the posterior of the abdominal wall -> Severe bleeding if injured

Where the brains connects to the spinal cord

Foramen magnum

2 groups of seizures

Generalized and partial (focal)

Dangerous complication of type 2 diabetes

HHNS

HAZWOPER

Hazardous Waste Operations and Emergency Response, published by OSHA -> Must meet specific additional training requirements before becoming involved in HazMat incidents -> EMT needs training at the First Responder Awareness Level

When should you give O2

High-flow O2 via NRB if LOC is less than alert and oriented. Also, transport

Self-esteem

How we feel about ourselves and how we "fit in" with our peers

Diabetes 2 is the most common cause of...

Hyperglycemia

Diabetes 1 is the most common cause of...

Hypoglycemia

ALOC causes

Hypoglycemia, hypoxemia, intoxication, delirium, drug overdose, unrecognized head injury, brain infection, body temperature abnormalities, brain tumors, and overdoses and/or poisonings

Swelling

Indicates bleeding from a fracture

5 stages of childhood

Infancy, the toddler years, preschool years, school-age years, and adolescence

Conjunctivitis

Inflammation of the conjunctiva

Vasoocclusive crisis

Ischemia and pain caused by sickle-shaped red blood cells that obstruct blood flow to a portion of the body.

Span of control

Keeping the supervisor/worker ratio at 1 supervisor for 3-7 workers

Forms of chemical agents

Liquid, powder, and vapor

Forms of chemical warfare agents

Liquid, powder, and vapor

2 good indicators of the possible presence of a hazardous material

Location and type of building

Seizure - possible causes

May occur as a result of a recent or prior head injury, brain tumor, metabolic disease, fever, or a genetic disposition

Opiates examples

Morphine, codeine

Gastrointestinal System

Mouth -> salivary glands secrete saliva + begin to break down the food -> esophagus -> stomach -> small intestine -> large intestine -> rectum -> anus

Multisystem trauma

Multiple traumatic injuries involving more than one body system such as head and spinal trauma, chest and abdominal trauma, or chest and multiple extremity trauma -> high level of mortality

If infant in car seat with head injury

Must be removed to a short backboard or pediatric immobilization device prior to transport

Glycogen

Name of the glucose stored in the liver

Examples of inhaled poisons

Natural gas, sewer gas, certain pesticides, carbon monoxide, and chlorine

Neurovascular bundle

Network of nerves, arteries, and veins lying closely along the inferior of and slightly posterior to the lowest margin of each rib -> Source of significant bleeding into the pleural space -> hemothorax

Key is to stop the burning process, not to...

Not cool the skin -> Use cool water and not cold water. Cold water or ice water -> injury to the tissue

Treatment for pleural effusion

O2

Treatment for pneumothorax

O2 + sitting up (or most comfortable) + transport

Scene size-up for diabetes

Often use syringes to administer insulin. It is possible you may be stuck by a used needle that was not disposed of properly.

Spider bites

Only 2 can be life threatening: female black widow and brown recluse

Easier to assess open or closed injury

Open, because you can see the injury

Dyspareunia

Pain during sexual intercourse

Dysuria

Pain during urination

Reproducible pain

Pain that can be reproduced by palpation

Incident commander (IC)

Person in charge of the overall incident

Categories of elder abuse

Physical, psychological, and financial

Digital trauma

Picking the nose with a finger

Leading cause of death in children in the world

Pneumonia

Ectopic pregnancy

Pregnancy that develops outside the uterus, most often in the fallopian tube

Contamination

Presence of pathogens or foreign bodies, such as dirt, gravel, or metal, in the wound

Dementia

Progressive deterioration of mental function including memory

PMS

Pulse, Motor, Sensory

Liaison officer

Relays information and concerns among command, the general staff, and other agencies -> Questions and input should be given through the liaison officer

RPM

Respirations, perfusion, mental status

Gynecologic emergencies - primary assessment

Risk of hypovolemic shock because of bleeding -> weak or rapid pulse or has pale, cool, or diaphoretic skin -> supine position + blanket + transport

Securing a patient on a vacuum mattress

See Skill Drill 28-4 p. 1009

Embryo

Stage 0-10 weeks after fertilization

Fetus

Stage from 10 weeks until delivery

Opiate

Subset of the opioid family, and refers to natural, non-synthetic opioids

3 consequences of AMI

Sudden death (40%), cardiogenic shock, and CHF

Medical branch director

Supervise the primary roles of the medical branch: - Triage - Treatment - Transport of injured people

International terrorism

Terrorism that is carried out by people in a country other than their own; also known as cross-border terrorism

Moro reflex (startle reflex)

The baby startles in response to a loud sound or sudden movement -> open his arms, spread fingers

Ecchymosis

The buildup of blood produces a characteristic blue or black discoloration in a contusion

Kidney response to high blood glucose

The kidney's filtration system becomes overwhelmed and glucose spills into the urine

Guarding

The muscles around the fracture contract in an attempt to prevent any movement of the broken bone

Uterus

The muscular organ where the fetus grows, also called the womb; responsible for contractions during labor

Evisceration

The organs protrude through the wound

Thyroxine

Thyroid hormone that affects the body's metabolism, temperature, growth, and heart rate

Signs of impending lightning strike

Tingling sensation or hair stands on end -> the area around you has become charged -> imminent striking

Berry aneurism and subarachnoid hemorrhages

Tiny balloon -> overstreches and ruptures -> subarachnoid hemorrhages

Leading cause of death < 44 y

Traumatic injuries and unintentional injuries

Carotid, subclavian, brachial, radial and ulnar arteries

Two major arteries branching from the upper aorta supply blood to the head and arms. The right and left carotid arteries supply the head and brain with blood. The right and left subclavian arteries (under the clavicles) supply blood to the upper extremities. As the subclavian artery enters each arm, it becomes the brachial artery, the major vessel that supplies blood to each arm. Just below the elbow, the brachial artery divides into two major branches: the radial and ulnar arteries, supplying blood to the lower arms and hands.

Number 1 cause of unintentional deaths in peds

Unintentional injuries

Leading cause of death in adolescents

Unintentional injuries (accidents)

Leading cause of death in early adults

Unintentional injuries (accidents)

Leading cause of death in school-age children

Unintentional injuries (accidents)

Fundus

Upper end of the uterus -> what you massage after delivery to slow down bleeding (encourages the fetus to contract)

BP in less than 3 years old

Usually not taken -> look at skin to assess circulatory status

Behavior

What you can see of a person's response to the environment: his or her actions

Overdose

When a patient takes a toxic or lethal dose of a substance

Positional asphyxia

When a patient's physical position restricts chest wall movements or causes airway obstruction

Termination of command

When an incident draws to a close, there should be a termination of command

Palmar grasp

When something is placed in the infant's palm, the infant grasps the object

Rooting reflex

When something touches an infant's cheek, the infant instinctively turns his or her head toward the touch

Aortic valve

When the left ventricle relaxes, the aortic valve closes and blood flow between the left ventricle and the aorta stops

Joints

Where two bones come into contact

Size of blood elements

White > red > platelets

Vernix caseosa

White cheesy substance covering the skin of the fetus

Other def for disaster

Widespread event that disrupts functions and resources of a community and threatens lives and property -> not necessarily injuries (ex: drought causing crop damage)

Elder abuse occurs most often in what type of population

Women > 75 y

Naloxone (Narcan)

antidote that reverses the effects of opiate or opioid overdose given intravenously, intramuscularly, or intranasally. Ideally, naloxone is administered intravenously if lots of scaring (heroin) -> intranasal route preferred

Pulmonary system evolution in an infant

- "Nose breathers" -> prone to nasal congestion -> upper respiratory infections -> if choking make sure the nasal passages are clear - Rib cage less rigid and the ribs sit horizontally -> diaphragmatic breathing ("belly breathing") - Tongue larger + airway narrower -> airway obstruction more common - Fragile lungs fragile -> ventilations that are too forceful can result in trauma from pressure, or barotrauma - Large occiput + increased flexibility of the trachea -> airway can get blocked by incorrect positioning - Number of alveoli is low but infant needs less O2 - Infants who struggle to breathe can quickly tire and become overheated and even dehydrated

Special Atomic Demolition Munitions (SADM)

- "Suitcase nuke" - Small suitcase-sized nuclear weapons designed to destroy individual targets, such as important buildings, bridges, tunnels, and large ships. - Some of these are believed to be missing - Information or updates on the whereabouts of these devices have not been made public

Structure of the eye

- 1 in in diameter, located within a bony socket in the skull called the orbit - The orbit is composed of the adjacent bones of the face and skull - More than 80% of the eyeball is protected within this bony orbit - Between and below the orbits: nasal bone and the sinuses, respectively

Single command system

- 1 person is in charge, even if multiple agencies respond - Used with incidents in which one agency has the majority of responsibility for incident management - For short duration

How you should stage for a potential terrorist incident

- 1 to 2 blocks away - Upwind and uphill

Trauma score

- 1-16 (16 best) - Likelihood of patient survival (except head injury -> RTS) - Includes: - GCS - RR - Respiratory expansion - Systolic BP - Capillary refill

% of children who have asthma

- 10% - Rare < 1 year old

Separation anxiety

- 10-18 months - Fear of unfamiliar places and people - As infants become accustomed to their homes and families, they begin to need the security of a predictable environment -> If environment is too unpredictable, the infant may despair and become withdrawn, which leads to trust issues

Tote or intermediate bulk container

- 119-703 gallons - Most common 350 and 550 gallons - In plastic but surrounded by a stainless steel web - Contain any type of chemical, including flammable liquids, corrosives, food-grade liquids, or oxidizers

Nerves

- 12 cranial nerves: directly from the brain to various parts of the head (eyes, ears, nose, face) - Remaining nerves: exit the brain from the foramen magnum and join in the spinal cord - Spinal nerves: two nerves leave each vertebra - carry signals to/from the body

2 anatomic parts of the peripheral nervous system

- 12 pairs of cranial nerves - 31 pairs of spinal nerves

Face

- 14 bones - Maxillae, zygomas, and mandible

Chlorine (Cl): fact, smell and color, symptoms

- 1st chemical agent ever used in warfare - Bleach smell + green haze when released as a gas - Upper airway irritation + choking sensation

Immediate triage category

- 1st priority - Need immediate care and transport - Problems with the ABCs, head trauma, or signs and symptoms of shock

Trimesters

- 1st trimester (1-12 week): - + prego test - Palpable fundus - Audible fetal heat tones with doppler - Organ systems begin to develop - 2nd trimester (13-27 week): - Ascending fundus - Fetal movements - Fetal heart tones audible with fetoscope - Lungs ready with surfactant - 3rd trimester (28 week - birth): - Pupillary light reflex - Descending fundus - Rupture of amniotic sac

Inside of the nose

- 2 chambers divided by the nasal septum (cartilage) - Within each nasal chamber: layers of bone called the turbinates, covered with a moist lining - Air moves through the nasal chambers and is humidified as it passes over the turbinates - Directly above the nose are the frontal sinuses and, on either side, the orbit of the eye

Psychological changes of infant

- 2 m: recognizes familiar faces; tracks objects with the eyes - 3 m: brings objects to the mouth; smiles and frowns 4 m: reaches out to people; drools - 5 m: sleeps throughout the night; recognizes family members from strangers - 6 m: teething begins; sits upright; speaks one-syllable words - 7 m: afraid of strangers; mood swings - 8 m: responds to "no"; can sit alone; plays peek-a-boo - 9 m: pulls up to stand; places objects in mouth to explore them - 10 m: responds to his or her name; crawls efficiently - 11 m: starts to walk without help; frustrated with restrictions - 12 m: knows his or her name; walks

Middle ear

- 3 bones (the hammer, anvil, and stirrup) that move in response to sound waves hitting the tympanic membrane - Connected to the nasal cavity by the eustachian tube, which is the internal auditory canal -> equalization of pressure in the middle ear when external atmospheric pressure changes

Meninges

- 3 distinct layers of tissue that suspend the brain and the spinal cord within the skull and the spinal canal - Outer layer: dura -> tough fibrous (like leather), small opening through which the peripheral nerves exit - Inner 2 layers: - Arachnoid and the pia mater - Contain the blood vessels that nourish the brain and spinal cord

Mass-casualty incident (MCI)

- 3 or more patients - Great demand on the EMS system - Potential to produce multiple casualties

Small intestine

- 3 sections: the duodenum, jejunum, and ileum - Duodenum: where digestive juices from the pancreas and liver mix together - Jejunum: large amount of the surface area of the small intestine and does much of the work - Ileum: absorbs nutrients that were not absorbed earlier

Cardiac monitoring

- 3-lead or 12-lead ECG - Careful to artifact (interference) - Attach the electrodes to the ECG cables before placement - After all elec in place, turn on monitor + print (count to 6 or 7) -> pt should be supine or semi-Fowler

Minimal triage category

- 3rd priority - No field or only minimal treatment - "Walking wounded" at the scene, soft-tissue injuries such as contusions, abrasions, and lacerations - Also called the hold category

PPE level

- 4 levels: A, B, C, and D - A: fully encapsulated, chemical-resistant + SCBA + special sealed equipment - B: nonencapsulated protective clothing + eye protection + SCBA - C: nonpermeable clothing + eye protection + face mask - D: work uniform (e.g., overalls) that affords minimal protection -> All levels required glove. 2 pairs in case one pair must be removed because of heavy contamination

Red blood cells

- 42-47% of total blood volume - Contain hemoglobin - carries 97% of O2 and some CO2 - Live for 110-120 days (sickle disease much shorter)

How often you need to reassess neurovascular function

- 5-10 min - Before and after splinting

Stages of hypothermia

- 93-95°F: - Shivering - Constricted blood vessels + rapid HR - Withdrawn LOC - 89-92°F: - No shivering + muscle stiff - Slow RR/HR - Confused + lethargic - 80-88°F: - Coma - Weak pulse + dysrhythmia + very slow RR - Unresponsive - <80°F: - Apparent death - Cardiac arrest - Unresponsive

Hypoxic drive

- A "backup system" to control respiration; senses drops in the oxygen level in the blood - Frequently found in end stage of COPD - Be careful when providing O2 (increased O2 might cause respiratory arrest)

Blood groups

- A (get A or O), B (get B or O), AB (get anything), O (get only O) - Universal donor: O- - Universal receiver: AB+

Deep vein thrombosis (DVT)

- A blood clot in a deep vein, most often an extremity - Risk factors: sedentary patients (long ravel, bus driver) or who have had recent injury or surgery (joint replacement) - Life-threatening if clot travels to the lung -> pulmonary embolus - Treatment: anticoagulants

Thromboembolism

- A blood clot that has formed within a blood vessel and is floating within the bloodstream -> reaches an area too narrow to pass -> block the blood flow - If blockage occurs in a coronary artery: acute myocardial infarction -> death of hear muscle -> heart not able to pump -> can't completely stop pumping = cardiac arrest

Commotio cordis

- A blunt chest injury caused by a direct blow to the chest that occurs only during the critical portion of a person's heartbeat -> Vfib then cardiac arrest - Treatment: AED within 2 min of Vfib

Coup-contrecoup injury

- A brain injury that occurs when force is applied to the head and energy transmission through brain tissue causes injury on the opposite side of original impact - Coup injury occurs at the point of impact - Contrecoup injury occurs on the opposite side of impact, as the brain rebound - Can also happen in a lateral collision

Flame burn

- A burn caused by a flame - Often a deep burn, especially if a person's clothing catches fire

Steam burn

- A burn caused by exposure to hot steam - Causes airway burns - Example: uncovering the plastic wrap from microwaved food

Scald burn

- A burn caused by hot liquids - Children and handicapped adults - Often cover large surface areas of the body because liquids can spread quickly - Example: when cooking

Hemostatic agents

- A chemical compound that slows or stops bleeding by assisting with clot formation - 2 forms: powder or gauze impregnated with a clay substance - Can be used with direct pressure when direct pressure alone is ineffective or when tourniquet is impossible - We're not sure yet it works. Mostly used in military setting

Fractures of the proximal femur

- A common fracture especially among the elderly - Often called hip fracture but doesn't involve the hip joint - The leg is usually rotated and the injured leg is usually shorter than the uninjured limb - Patients are typically unable to walk - Traction splint but if old then only backboard/scoop with pillow to support - Risk: blood loss

Causes of symptomatic hypoglycemia

- A correct dose of insulin with a change in routine (the patient exercised more, consumed a meal later than usual, or skipped the meal) - More insulin than necessary - A correct dose of insulin without the patient eating a sufficient amount - A correct dose of insulin and the patient developed an acute illness

Arteriosclerosis

- A disease that causes the arteries to thicken, harden, and calcify - Contributes to systolic hypertension - Consequence of disease states such as diabetes, atherosclerosis, and renal compromise, and it is associated with an increased risk of cardiovascular disease, dementia, and death - Compliance of the vascular walls depends on the production of collagen and elastin, proteins that are the primary components of muscle and connective tissue. An increase in pressure (normal hypertension seen with aging) leads to overproduction of abnormal collagen and decreased quantities of elastin; these actions contribute to vascular stiffening -> Widening pulse pressure, decreased coronary artery perfusion, and changes in cardiac ejection efficiency

Atherosclerosis

- A disorder in which cholesterol and calcium build up inside the walls of the blood vessels, forming plaque, which can block blood flow. An accumulation of fat and cholesterol in the arteries - I think a synonym is coronary artery disease (45-64 years old mostly)

Acute Coronary Syndrome (ACS)

- A group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction - Chest pain is due to the reduction of O2 and nutrients in the tissues of the heart

Hemophilia

- A hereditary disease where blood does not coagulate to stop bleeding -> acute bleeding and swelling - Rare, mostly males - Complications: - Joint pbs - Bleeding in brain - Thrombosis

Common conditions in geriatrics

- A hip fracture from a low-mechanism fall is common, more likely to occur when bones are weakened by osteoporosis or infection - Sedentary behavior while healing can predispose the patient to pneumonia and blood clots that may interfere with healing and can cause death - Arthritis - Heart disease - Cancer - Diabetes mellitus - Asthma - Chronic bronchitis or emphysema - Stroke

When to be suspicious of meth

- A house with all of the windows covered, glass cookware with a powdery residue, or a strong smell of an unusual odor like ammonia, cat urine, or nail polish - Vehicle with paint peeling off the back, especially around the seams where the trunk closes

Postictal state

- A period following a seizure that lasts between 5 and 30 minutes; characterized by labored respirations and some degree of altered mental status - Position + maintain airway + suction - Can be characterized by hemiparesis = weakness on one side of the body (like a stroke)

Pregnancy term duration + term gestation

- A pregnancy is considered full term once it reaches 39 weeks but has not gone beyond 40 weeks, 6 days - A pregnancy that has reached full term is referred to as term gestation -> between 39 weeks 40 weeks + 6 days

Emergency Response Guidebook (ERG)

- A preliminary action guide for first responders operating at a hazardous materials incident - Developed by the DOT, the Secretariat of Communications and Transportation of Mexico, and Transport Canada

Anaphylactoid reaction

- A reaction to a foreign substance that resembles an anaphylactic reaction that may occur on first exposure to the substance, without immune system sensitization (i.e., not caused by IgE-mediated immune responses) - Causes: contrast dyes, NSAID's, aspirins, opiates

Acromioclavicular (AC) joint

- A simple joint where the scapula and the clavicle meet at the top of the shoulder - Separated during sports -> "AC separation"

Hemorrhagic stroke

- A sudden, severe headache, often described as the worst pain the patient has ever had, could be a sign of a hemorrhagic stroke - The blood from a ruptured blood vessel irritates the tissues of the brain and can cause increased intracranial pressure, resulting in severe headache pain - Suspect a hemorrhagic stroke in patients with a severe headache, seizures, and altered mental status - Early signs: headache, vomiting, altered mental status, and seizures - 13% of all strokes - Often fatal (50-80% mortality rate)

Sedative-hypnotics - treatment

- ABC - O2 - Transport

Alcohol - treatment

- ABC with O2 - If vomit -> suction - Hypovolemia because of sweating, fluid loss, insufficient fluid intake, or vomiting associated with DTs -> Clear the airway, turn the pt head to one side to prevent aspiration during transport

UTI symptoms

- ABD/flank pain - Hematuria - Dysuria/Dyspareunia - Urinary urgency - Genital pain

Difference dissecting aneurysm VS AMI

- AMI preceded by other symptoms: nausea, indigestion, weakness, sweating - AMI symptoms come gradually - AMI feels like "pressure", aneurysm feels like "stabbing"

Skin turgor

- Ability of the skin to resist deformation - Tested by pinching skin on the forehead or back of the hand - Normally the skin will quickly flatten out. If the patient is dehydrated, the skin will remain tented (poor skin turgor)

START triage criteria

- Ability to walk - Respiratory status - Hemodynamic status (pulse) - Neurologic status -> "Simple Triage And Rapid Treatment"

Cerebrum

- Above the cerebellum - Divided into the right and left cerebral hemispheres - Front: emotion and though - Middle: sensation and movement - Back - occipital lobe: sight - Left (near the center): speech

4 types of open soft tissue wounds

- Abrasions - Lacerations - Avulsions - Penetrating wounds/Punctures - Amputations

Asystole

- Absence of a heartbeat - If uncorrected, Vfib or Vtach will lead to asystole - Nearly all patients with asystole die

Pneumothorax

- Accumulation of air in the pleural space because air escape from lungs -> lungs collapse - Pleuritic chest pain: sharp stabbing pain on one side - Breath sounds: absent or decreased on affected side - Jugular vein distention + cyanosis - Risk factor: emphysema, asthma, tall thin men

Subdural hematoma

- Accumulation of blood beneath the dura mater but outside the brain - Usually after a fall or strong deceleration force - More common than epidural hematoma - Results from rupture of the veins that bridge the cerebral cortex and dura - Venous bleeding -> increased ICP develop more gradually than with an epidural hematoma - Fluctuating level of consciousness or slurred speech

Epidural hematoma

- Accumulation of blood between the skull and dura mater - Almost always result of direct flow to head with linear fracture to temporal lobe -> arterial bleeding -> rapid increased ICP - Immediate loss of consciousness - Then brief period of consciousness (lucid interval) - Then back into unconsciousness - Meanwhile, as the ICP increases, the pupil on the side of the hematoma becomes fixed and dilated -> Death if no surgery

Activated charcoal

- Actidose with sorbitol, Liqui-Char, Actidose-Aqua - activated charcoal - Adsorbant - Blind to and absorbs ingested toxins and prevents their absorption through the GI tract. Once the toxin is bound, the complex is eliminated - Ingestion of drugs or toxins within 1h - Altered mental status, inability to swallow, unable to protect airway, ingestion of acids or alkalis - Nausea, vomiting, black stools - 1 g/kg of body weight

Involuntary activities

- Actions that are not under our conscious control - Example: breathing

Voluntary activities

- Actions that we consciously perform - For example, reaching across the table for a salt shaker or to pass a dish

Asthma

- Acute spasm of the bronchioles associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages - Mostly 5-17 years old - Wheezing when exhale - Severe if cyanosis - Causes: stress, exercises, infection -> Assist with inhaler or nebulizer

Landmarks in the neck

- Adam's apple = upper part of the larynx (thyroid cartilage) - Cricoid cartilage: firm ridge of cartilage, only complete circular cartilage structure of the trachea -> below the thyroid cartilage, - Between the thyroid cartilage and the cricoid cartilage: soft depression called the cricothyroid membrane -> thin sheet of connective tissue (fascia) - Below the larynx: palpable ridges palpable -> cartilage rings of the trachea

Metabolic agents: patho, examples

- Affect the body's ability to use oxygen - Examples: hydrogen cyanide (AC), cyanogen chloride (CK)

Frostnip

- After prolonged exposure to the cold, the skin may freeze whereas the deeper tissues are unaffected - Painless

Chemical Transportation Emergency Center (CHEMTREC)

- Agency that provides technical information for first responders on chemical incidents - 1-800-262-8200

Symptoms differences between air embolism and decompression sickness

- Air embolism: occurs immediately on return to surface - Decompression sickness: may not occur for several hours

Pneumothorax

- Air enters through a hole in the chest as the patient attempts to breathe -> lung on that side collapses - As a result, any blood that passes through the collapsed portion of the lung is not oxygenated -> hypoxia + diminished breath sounds on that side - Absent breath sounds are a significant finding in chest trauma and may indicate the development of a tension pneumothorax --> open

Neck injury

- Air might get in the vein -> block the flow of blood into the lungs -> cardiac arrest -> air embolism - Cover the wound with an occlusive dressing - Apply manual pressure, but do not compress both carotid vessels at the same time -> impair circulation to the brain and cause a stroke

Pertussis (whooping cough)

- Airborne bacterial infection that affects mostly children younger than 6 years - Highly contagious - Coughing spells - "Whooping" sound on inspiration (kids, not adults) - Don't want to drink -> dehydration

ABCDE for peds

- Airway - Breathing - Circulation - Disability - Exposure

How to treat open pneumothorax

- Airway + O2 - Seal the open wound with a 3 sided occlusive dressing

How to treat pneumothorax

- Airway + O2 - Seal the open wound with a 3 sided occlusive dressing

Cholinergics signs and symptoms

- Airway compromise - SLUDGEM or DUMBELS

EMT main role in treatment of poisoning

- Airway management - Symptomatic care - Transport

Deadly dozen chest injuries

- Airway obstruction - Bronchial disruption - Diaphragmatic tear - Esophageal injury - Open pneumothorax - Tension pneumothorax - Massive hemothorax - Flail chest - Cardiac tamponade - Thoracic aortic dissection (leakage from a traumatic aneurysm of the portion of the aorta that lies within the chest) - Myocardial contusion - Pulmonary contusion

AEIOU-TIPS (causes of ALOC)

- Alcohol - Endocrine, epilepsy, electrolytes - Insulin - Overdose - Uremia (kidney failure) - Trauma, temperature - Infection - Poisoning - Stroke, shock, seizure, syncope, subarachnoid hemorrhage

True or False

- All patients experiencing a myocardial infarction will present with chest discomfort -> False, 25% of MI's are "silent" - All chest pain that is reproducible upon palpation is musculoskeletal in nature -> False, 10% of MI's have reproducible pain - All MI's can be detected using a cardiac monitor and 12-lead ECG -> False, 50% of MI's are undetected by monitors

Routes of entry of radiation

- All routes - Once inside the body, the radiation source will irradiate the person from within rather than from an external source (such as x-ray equipment)

Signs of tension pneumothorax

- All signs of a pneumothorax - Absent or severely decreased lung sounds on the affected side - JVD + tracheal deviation away from injured side - Shock signs: rapid weak pulse + low/narrowing BP

Hay fever

- Allergic response usually to outdoor airborne allergens such as pollen or sometimes indoor allergens such as dust mites or pet dander; also called allergic rhinitis - Spring and summer - Atopic: means more likely to have other allergies in addition to hay fever

Fontanelles

- Allow the head to be molded when the neonate passes through the birth canal - The posterior fontanelle normally fuses by the third month - The anterior fontanelle fuses between 9 and 18 months - If the fontanelles are depressed, the infant is most likely dehydrated

Different types of radiation

- Alpha: cannot penetrate through most objects (skin stops it) - Beta: layer of clothing stops it - Gamma: travel faster, easily penetrate through the human body, require lead or several inches of concrete to stop it - Neutron: most powerful forms of radiation, penetrate through lead and require several feet of concrete to stop it

3 types of radiation

- Alpha: little penetrating - stopped by the skin - Beta: greater penetrating - penetrate the skin but blocked by special clothing - Gamma: very penetrating = go through body and solid materials (proportional to wavelength)

Cocaine

- Also called crystal, snow, freebase, rock, gold dust, blow, and lady - Inhaled or IV or subcutaneous - Effects: excitement and euphoria in less than an hour

Mental Health Crisis Packet

- Also known as the Legal 2000 (L2K) - Form recognizing that the patient is a potential harm to themselves or others - Can the pt refuse transport

Hallucinogens

- Alter sensory perceptions - LSD, PCP (angel dust), mushrooms - Cause visual hallucinations, intensify vision and hearing, and separate from reality - "Bad trip": hypertension, tachycardia, anxiety, and paranoia

PPE when dealing with blood

- Always: gloves + eye protection - If risk of splatter: gown and mask

Anxiety disorders

- Among the most common mental health disorders - Include: - Generalized anxiety disorder - Panic disorder - Social and other phobias - Posttraumatic stress disorder (PTSD) - Obsessive-compulsive disorder (OCD)

Documenting/reporting in bleeding

- Amount of blood loss that has occurred - How rapidly it occurred

Documenting burns

- Amount of body surface area involved - Depth - Location - Example: 25% superficial burns to the chest

Sternal fractures

- Amount of force required to break the sternum is significant -> suspect injury to underlying organs (lungs, heart, great vessels) - Consequences: - Pulmonary and myocardial contusions - Flail chest - Disruption of major blood vessels - Treatment: tip backboard up to relieve pressure

Peptic ulcer disease

- An abrasion of the stomach or small intestine - More common in geriatrics, especially those who use NSAIDS - Signs: gnawing, burning pain in the upper abdomen that improves after eating but returns later - Complications: bleeding, anemia, and bowel perforation

Psychiatric emergency

- An emergency in which abnormal behavior threatens a person's own health and safety or the health and safety of another person, for example when a person becomes suicidal, homicidal, or has a psychotic episode - More serious than a typical behavioral crisis that causes inappropriate behavior

Improvised occlusive dressings

- An improvised occlusive dressing may be taped to the patient on only three sides of the dressing to simulate a flutter valve - Can also be taped on all four sides of the dressing, depending on your local protocol - But for a tension pneumothorax, tape only of 3 sides

Tuberculosis

- An infectious disease that may affect almost all tissues of the body, especially the lungs (but also kidneys, spine, lining of brain) - Can be inactive and become active with weaker immune system - fever, coughing, fatigue, night sweats, weight loss, bloody sputum - Risk factors: close contact (prison), IV drugs - PPE: gloves + eye protection + N95

Disease vector: def, plague/smallpox/West Nile

- Animal that spreads disease, once infected, to another animal - Example: bubonic plague can be spread by infected rats; smallpox by infected humans; and West Nile virus by infected mosquitoes

Foot 3 bones

- Ankle: tarsals - Foot: metatarsal - Toe: phalanges - Largest of the tarsal bones: heel bone (or calcaneus) -> axial loading injuries, such as when a person jumps from a height and lands on the feet

Eating disorders

- Anorexia Nervosa: - Obsession w/ losing weight & controlling food intake - Often emaciated (thin, weak) - Use dietary restriction, diuretics, laxatives, exercise, vomiting - Bulimia Nervosa: - Obsession w/ losing weight - Often normal weight - Use "bing and purge" cycle - Binge eating: - Excessive eating - Often obese

Anterior and posterior nose traumas

- Anterior: - Originate from the area of the septum - Bleed slowly - Posterior: - More severe - Cause blood to drain into throat -> vomit - Cause: trauma to the face and skull (basilar skull fracture) -> nasal airway might not be advised (local protocols)

Secondary response - allergic reaction

- Antigen comes back - Binds to antibodies on mast cells and basophils - Histamine and leukotrienes are released into the body

Important signs of chest injury

- Any change in normal breathing (e.g., tachypnea, dyspnea) - Pleuritic pain - Hemoptysis - Rapid weak pulse + low BP (hypovolemic shock) - Cyanosis

Bulk storage containers

- Any container other than nonbulky storage containers - Examples: fixed tanks, highway cargo tanks, rail tank cars, totes, and intermodal tanks - Found in manufacturing facilities and often surrounded by a secondary containment system to help control an accidental release

Radiologic dispersal device (RDD) or "dirty bomb"

- Any container that is designed to disperse radioactive material -> This requires the use of a bomb -> "dirty bomb. - The destructive capability of a dirty bomb is limited to the explosives that are attached to it -> If the explosive is sufficient to kill 10 people without radioactive material, it will also kill 10 people with the radioactive material added - There may be long-term injuries and illness associated with the use of an RDD, yet not much more than the bomb by itself would create -> Dirty bomb is an ineffective WMD

Disaster

- Any situation that overwhelms your resources -> A single incident with two critical patients can constitute a disaster if there is only one EMS unit available to respond

Left hemisphere affected

- Aphasia - Trouble understanding speech but speak clearly OR understand the question but cannot produce the right sounds

Apgar score - how to calculate

- Appearance: - 2: all body pink - 1: body is pink, but hands and feet are blue - 0: all body is blue or pale - Pulse: - 2: > 100 - 1: < 100 - 0: no pulse - Grimace: - 2: cries and move foot away from snap - 1: weak cry in response to stimulus - 0: no cry and no reaction to stimulus - Activity: - 2: resists to straighten hips and knees - 1: weak attempts to resist - 0: completely limp, no muscle tone - Respiration - 2: rapid - 1: slow - 0: no respiration

Electrical burn

- Appears where the electricity enters (small) and exits (large and deep) the body - 2 dangers: - Large amount of deep tissue injury (alway more severe than external signs indicate) + fractures - Cardiac or respiratory arrest

Restraint protocol

- Appropriateness of restraint, the types of restraints, and care provided to the patient following restraint - Soft: sheets, wide wristlets, and chest harnesses - Hard: plastic ties, handcuffs, or leather restraints (wrist only)

Difference between arterial, venous, and capillary bleedings

- Arterial: - Bright red (oxygen rich) - Spurts with the pulse -> hard to control - BP drops and eventually spurts too - Venous: - Dark - Slow or rapid (depending on size of the vein) - Less pressure -> easier to mange but can be profuse - Capillary: - Dark - Oozes from a wound steadily and slowly - Venous and capillary blood is more likely to clot spontaneously than arterial blood

Pathophysiology of the musculoskeletal system in geriatrics

- Arthritis (50% of pt) - Kyphosis (66% of pt) - Osteoporosis - Osteoarthritis

Miscellaneous drugs

- Aspirin: nausea, vomiting, hyperventilation, ringing in the ears, anxiety, tachypnea, hyperthermia, seizure - Acetaminophen: liver failure - Alcohols: - Methyl alcohol (=methanol): dry gas products and stove kits (Sterno, windshield washer fluid) - Ethylene glycol: antifreeze products -> tachypnea, blindness (methyl alcohol), renal failure (ethylene glycol)

Secondary assessment - pregnant woman

- Assess for fetal movement by asking the patient whether she can feel the fetus moving - Assess the length and frequency of contractions by asking the patient and by placing your hand on the abdomen - If you suspect that delivery is imminent, check for crowning - If you do not suspect an imminent delivery and the patient reports other problems unrelated to delivery, you should not visually inspect the vaginal area - Childbirth is a natural process that usually does not require your assistance.

Safety guidelines for a behavioral crisis or a psychiatric emergency

- Assess the scene - Ensure you have a means of communication - Know where the exits are - Don personal protective equipment - Have a definite plan of action - Urgently de-escalate the patient's level of agitation - Calmly identify yourself - Be direct - Be prepared to spend extra time - Stay with the patient - Do not get too close to a potentially volatile patient - Express interest in the patient's story - Avoid fighting with the patient - Be honest and reassuring - Do not judge

Sexual abuse in children

- Assessment limited to: - Determining the type of dressing any injuries require - Treating any bruises or fractures - Do not examine the genitalia unless bleeding or injury - Do not allow the child to wash, urinate, or defecate - Ensure that an EMT or police officer of the same gender remains with the child - Transport all children who are victims of sexual assault

3 tasks as rescuer facing SIDS

- Assessment of the scene - Assessment and management of the patient - Communication and support of the family

Staging supervisor

- Assigned when an MCI or disaster requires a multivehicle or multiagency response - Emergency vehicles must have permission from the staging supervisor to enter an MCI scene and should drive only in the directed area

Facial fractures

- Assume if: patient has sustained direct blow to mouth or nose, bleeding in mouth, inability to swallow or talk, absent/loose teeth, loose/movable bone fragments, report that jaw closing "doesn't feel right" - Remove and save loose teeth/bone fragments - Beware of clots lodging in upper airway, swelling especially within first 24 hours -> airway obstruction - Damage can be repaired if treated within 7 to 10 days

DuoDote

- Atropine & 2-pam, DuoDote - atropine & pralidoxime - Parasympatholytic - Inhibit the parasympathetic nervous system, allowing the sympathetic nervous system to take over - Organophosphate or nerve gas poisoning - Hypersensitivity - Tachycardia, HTN, palpitations, dysrhythmias, H/A, dizziness, anticholinergic effects, N/V, flushed skin - 600 mg pralidoxime & 2 mg Atropine in prefilled duodote, IM

Skeletal muscle

- Attaches to the bones and usually crosses at least one joint - Under direct voluntary control of the brain -> also called voluntary muscle - Makes up the largest portion of the body's muscle mass - Primary functions: movement and posture - Also called striated muscle

Diabetic ketoacidosis

- BGL > 400 mg/dL (book, 350 slides) - Not enough insulin -> lot of glucose in blood, not in cells -> body uses fat as energy since no glucose -> creates fatty acids and ketones = metabolic acidosis

Hypertensive emergencies

- BP > 180 -> stroke or aneurysm - Sudden severe headache "worst ever felt" - Bounding pulse, ringing in ears, nausea, dizziness, warm skin, nosebleed, altered MS, pulmonary edema -> Monitor BP + head elevated + transport

Differences between bacteria and viruses

- Bacteria don't need a host to survive - Bacteria much more complex and larger than viruses (can be 100 times larger) - Most bacterial infections can be treated with antibiotics

Vancomycin-resistant enterococci (VRE)

- Bacteria normally present in the human intestines and the female reproductive tract - Can cause infection - Antibio: vancomycin, but some are resistant to it

Anthrax: what/where, routes, antibio/vaccine?

- Bacteria that lay dormant in a spore - Routes of entry: inhalation, cutaneous, and gastrointestinal - Inhalation form = pulmonary anthrax -> Most deadly, presents as a severe cold - Antibiotics can be used to treat anthrax successfully - There is also a vaccine to prevent anthrax infections

Swathe

- Bandage that passes completely around the chest - To fully stabilize the shoulder region, a swathe must be used to bind the arm to the chest wall - Leave the patient's fingers exposed so that you can assess PMS

Sedative-hypnotics - actions and effects

- Barbiturates and benzodiazepines - CNS depressants and alter the LOC (like alcohol) -> drowsy, peaceful, or intoxicated - In general, taken by mouth - "Knock-out" drink or "Mickey Finn": chloral hydrate - Date rape or club drugs

Complications of burns

- Barrier to protect from the envt is destroyed -> Infection, hypothermia, hypovolemia, and shock - Burns to the airway: loose mucosa in the hypopharynx can swell and lead to complete airway obstruction. - Circumferential burns of the chest can compromise breathing - Circumferential burns of an extremity can lead to compartment syndrome -> neurovascular compromise and irreversible damage

Control zones

- Based on the chemicals material + environmental factors + general layout of the scene - If incident inside a structure: control points = ingress and egress (entry and exit)—doors - If incident outside: control intersections, on and off ramps, service roads, and other access routes to the scene

Pathophysiology of the heart

- Basic idea: blockage of blood flow in the coronary arteries -> heart doesn't get enough O2 and nutrients -> heart tissue dies -> ischemic heart disease - Atherosclerosis, acute coronary syndrome, cardiogenic shock, congestive heart failure, hypertension

Aspirin

- Bayer - aspirin - Platelet inhibitor - Inhibits blood platelet aggregation and prostaglandin synthesis, preventing existing clots from becoming larger and further clots from forming - Fever, pain, inflammation, chest pain of cardiac origin - Allergies, bleeding disorders, GI bleeding, children - GI bleeding, stomach irritation - 160-325 mg PO, every 4-6h

ABC in suspected head injury

- Before anything, manually hold the head - Then assess the airway. Open with jaw-thrust. If unable to open the airway then ok to use head tilt-chin lift - If vomit, roll to the side the body in a straight line

School-age child

- Begin to act more like adults - Can think in concrete terms, respond sensibly to direct questions, and help take care of themselves - Begin to understand that death is final, but understanding of what death is and why it occurs is still unrealistic

12-18 months

- Begin to walk and to explore their environment - Imitate the behaviors of older children and parents and may express a desire to dress like their mommies or daddies - Knows major body parts when you point to them - Speaks 4 to 6 words - Not able to fully chew their food before swallowing -> increased risk of choking - End assessment with where the pain is, don't start where the pain is

Fertilization

- Begins in the vagina, where sperm from the male penis are deposited - The sperm pass through the cervix into the uterus and eventually up the fallopian tubes - As the ovum moves slowly down the fallopian tube, sperm moving up the tube can surround it, and one sperm fertilizes it -> in distal 1/3 of fallopian tube - When an ovum is fertilized in the fallopian tube, the developing embryo travels into the uterus where the lining of the walls of the uterus has become engorged with blood in anticipation of receiving a fertilized ovum - Here, the embryo attaches to the uterine wall and continues to grow -> implants in uterine wall about 7 days after fertilization

Second stage of labor - delivery of fetus

- Begins when the fetus enters the birth canal (or when cervix is full dilated), ends with delivery of the newborn - During this stage, you will have to make a decision about whether to help the woman deliver at the scene or provide transport to the hospital - Contractions are usually closer together and last longer - Pressure on the rectum may make the woman feel as if she needs to have a bowel movement -> don't let the woman sit on the toilet - Lasts ~1h

Third stage - delivery of placenta

- Begins with the birth of the newborn, ends with the delivery of the placenta - During this stage, the placenta must separate completely from the uterine wall - Contractions continue, assisting the separation process - May take up to 30 minutes

1st stage of labor - dilation

- Begins with the onset of contractions and ends when the cervix is fully dilated - Lasts ~16h for a first delivery - Onset of labor starts with contraction of the uterus. Other signs: bloody show and water breaking - Initially, contractions not at regular interval. Then every 30-60s - Transport the woman if she is in the first stage of labor

Cerebellum

- Behind the brain stem - Muscle and body coordination: walking, writing, playing the piano

Can a patient be radioactive

- Being exposed to a radiation source does not make a patient contaminated or radioactive - However, when patients have a radioactive source on their body (such as debris from a bomb that dispersed radioactive material) -> HazMat

Benadryl

- Benadryl, Antihistamine - diphenhydramine - Antihistamine - Blocks histamine release - Allergic reactions, anaphylaxis - Allergies, altered LOC (except if because of allergy!) - Drowsiness, dry throat and mucous membranes - 25-50 mg PO, every 4-6h, max 400 mg/day. Children 1 mg/kg, every 4-6h, max 300 mg/day

Emergency medical care with neuro emergencies

- Best is to maintain ABC - Seizure: - If still ongoing when you arrive (e.g., status epilepticus): protect from envt/don't restrain, suction, BVM, transport - If ended when you arrive: protect from harm, maintain clear airway, O2, spinal immobilization - Headaches: - Be concerned if sudden onset or ALOC or high fever or hear trauma - Migraine: O2, dark and quiet - Stroke: ABC (including O2), transport. Aspirin but only if ischemic, not hemorrhagic stroke, so be careful

Different kinds of weapons of mass destruction B-NICE

- Biologic - Nuclear - Incendiary - Chemical - Explosive weapons (or CBRNE for chemical, biologic, radiologic, nuclear, and explosive weapons)

Blunt trauma to the eye: black eye, hyphema, retinal detachment, blow-out

- Black eye - Hyphema: bleeding into the anterior chamber of the eye, that obscures part or all of the iris (between cornea and iris) -> Cover the eye + transport - Retinal detachment -> painless but flashing lights or "floaters" - Blow-out fracture fracture of the orbit -> double vision -> Protect with a metal shield + cover the other eye to minimize movement on the injured side + transport

Bleeding due to bone fracture

- Bleeding because the sharp ends of the bones cut muscles and other tissues -> Immobilizing a fracture and decreasing movement will help control bleeding -> simple splint might be enough - If the patient is unstable, however, do not waste time splinting a fracture

Bleeding - abruptio placenta

- Bleeding in later stages - The placenta separates prematurely from the wall of the uterus - Causes: hypertension and trauma - Severe pain - Vaginal bleeding may not be heavy - Signs of shock: weak, rapid pulse and pale, cool, diaphoretic skin

Nerve agents: patho, class/where we find, toxicity

- Block an enzyme in the nervous system -> Organs become overstimulated and burn out -> Cardiac arrest within seconds to minutes - Class: organophosphates -> household bug sprays, agricultural pesticides, and some industrial chemicals - Not readily available to the general public + extremely toxic and rapidly fatal

Anticholinergic agents

- Block the parasympathetic nerves - "Hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter" -> hyperthermia, dilated pupils, dry skin and mucous membranes, reddened skin, and agitation or delirium

Pulmonary embolism

- Blood clot formed in a vein, usually in the legs or pelvis, that breaks off and circulates through the venous system - The clot moves through the right side of the heart and into the pulmonary artery, where it becomes lodged, significantly decreasing or blocking blood flow - May result from damage to lining of vessels, slow blood flow in a lower extremity (long term bed rest)

Changes in the cardiovascular system in geriatrics

- Blood vessels become stiff -> higher systolic BP ->left ventricle becomes thicker and loses elasticity -> decreased filling of the left ventricle -> decreased cardiac output - Number of the cells in the SA node decrease by 90% at 75 y -> dysrhythmia more likely - Max pulse decreases (220 minus age) - Arteriosclerosis - Atherosclerosis - Aneurysm - Orthostatic hypotension - Venous stasis

Musculoskeletal system in peds

- Bones softer, weaker and more flexible -> prone to fracture with stress - Immobilize extremities with suspected sprains or strains because they may actually be stress fractures - The fontanelles of an infant can be a useful assessment tool for such issues as increased cranial pressure (bulging with a noncrying infant) or dehydration (a sunken appearance). - Thoracic cage in children is highly elastic and flexible -> fractures are rare

Inner ear

- Bony chambers filled with fluid. As the head moves, so does the fluid - Fine nerve endings within the fluid send impulses to the brain indicating the position of the head and the rate of change of position

Nervous system changes in older adults

- Brain weight may shrink 10% to 20% by age 80 - Motor and sensory neural networks become slower - Metabolic rate in the older brain does not change, however - Fewer brain cells (neurons) today than yesterday -> change in sleep patterns -> nap but don't sleep fully at night -> byphasic sleep cycle - Vois between the brain and the outermost layer of the meninges -> brain can move -> bridging veins can rupture

Breath sounds in children VS adults

- Breath sounds in children are easier to hear because of their thinner chest walls - But because less air is exchanged with each breath, detection of poor air movement or complete absence of breath sounds may be more difficult

Sulfur mustard (H): color, odor, route, mutagen, intubation, other name

- Brown/yellow - Smell like garlic or mustard - RouteS: skin and mucous membranes - Considered a mutagen -> mutates and changes the structures of cells - Very persistent - No symptoms for first 4-6h - Also called mustard gas

Contusion

- Bruise - Injury that causes bleeding beneath the skin but does not break the skin - Contusions result from blunt forces striking the body - The epidermis remains intact, but cells within the dermis are damaged, and small blood vessels are usually torn - As fluid and blood leak into the damaged area: swelling and pain

Contusion

- Bruise in the brain - More serious than a concussion -> permanent damage

Types of bruises that can be suspicious for child abuse

- Bruises to the back, buttocks, or backs of the arms and legs - Bruises in various stages of healing -> Color and location are important

Blunt myocardial injury

- Bruising of the heart muscle - Blunt trauma may injure the heart itself -> unable to maintain adequate BP - Also called myocardial contusion

Burns to children VS adults

- Burns to children are generally considered more serious than burns to adults - Reason: infants and children have more surface area relative to total body mass -> Greater fluid and heat loss - Other reason: children do not tolerate burns as well as adults do - Children are also more likely to go into shock, have hypothermia develop, and experience airway difficulties

Burns in child abuse

- Burns to the penis, testicles, vagina, or buttocks are usually inflicted by someone else, as are burns that encircle a hand or foot to look like a glove - Also, cigarette burns or grid pattern burns

Primary assessment pulse check + skin - hypothermia

- C in ABC: check pulse for 60s before potential CPR. CPR if no pulse and no breathing - Skin will not be helpful in determining shock

Secondary assessment of COPD VS CHF

- CHF: high BP + swollen legs/feet (pedal edema) - COPD: > 50y, recurring lung pbs, smoker, tightness in chest, fatigue, barrel, accessory muscle, pursed lips, digital clubbing

Alcohol actions and effects

- CNS depressant - Sedative - Hypnotic - May cause hypoglycemia - Internal bleeding -> shock (hypoperfusion) because blood might not clot effectively

Opioids/opiates actions and effects

- CNS depressant -> respiratory depression - Nausea, vomiting - Low BP - Sedated or unconscious - Cyanosis - Pinpoint pupils -> most typical sign of opiate abuse

Sympathomimetics

- CNS stimulants that mimic the effects of the sympathetic (fight-or-flight) NS - Cause hypertension, tachycardia, and dilated pupils

Nonbulk storage vessels

- Can hold a few ounces to 119 gallons (450 L) - Include vessels such as drums, bags, compressed gas cylinders, cryogenic containers - Hold used commercial and industrial chemicals such as solvents, industrial cleaners, and compounds

STD

- Can lead to more serious conditions. Example: untreated gonorrhea and chlamydia often progress to PID - Examples: chlamydia, bacterial vaginosis, gonorrhea

Posttraumatic stress disorder (PTSD)

- Can occur after exposure to a traumatic event - Examples: sexual or physical assault, child abuse, a serious accident, a natural disaster, war, loss of a loved one, or stressful life changes - 7-8% of population. 10-30% of soldiers

When can gynecologic emergencies occur + what EMT can do

- Can occur at any age during a woman's lifetime - Not much EMT can do -> focus on ABC + transport

Foot injuries

- Can result in dislocation or fracture of the tarsals, metatarsals, or phalanges of the toes - Toe fractures are especially common - Of the tarsal bones, the calcaneus, or heel bone, is the most frequently fractured -> if pt lands directly on the heel - Can lead to a fracture of the lumbar spine (transmission of impact force through the legs) - Significant swelling but rarely with gross deformity - Vascular injuries are uncommon

Assessment with preschool-age children

- Can understand directions, be more specific in describing their sensations, and identify painful areas when questioned - But much of the child's history will still be obtained from parents or caregivers. - Keep in mind that the preschool-age child can be very literal -> Asking if you may "take" his blood pressure may lead the child to believe that you will not give it back - Appealing to the preschool-age child's imaginative thinking may allow treatment to go a bit smoother -> have the child pretend to be a superhero inhaling special powers while breathing in oxygen - Never lie - FEET to HEAD - Use adhesive bandages to cover the site of an injection or other small wound -> otherwise might be worried about keeping his body together in one piece

Central pulses

- Carotid and femoral pulses - Strong -> child is not hypotensive BUT can still be in compensated shock - Absent -> CPR

Gonorrhea

- Caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply rapidly in the warm, moist areas of the reproductive tract, including the cervix, uterus, and fallopian tubes in women and in the urethra in women and men - The bacterium can also grow in the mouth, throat, eyes, and anus. - Symptoms appear approximately 2 to 10 days after exposure: painful urination, with associated burning or itching; a yellowish or bloody vaginal discharge, usually with a foul odor; and blood associated with vaginal sexual intercourse - More severe (progress to PID): cramping and abdominal pain, nausea and vomiting, and bleeding between menstrual periods - Rectal infections: anal discharge and itching and occasional painful bowel movements with fecal blood spotting - Infection of the throat: mild symptoms consisting of painful or difficult swallowing, sore throat, swollen lymph glands, and fever. Headache and nasal congestion may also be present - If untreated, progress to other body parts, e.g. brain

Closed chest injury

- Caused by blunt trauma. Examples: strikes a steering wheel or an air bag in a motor vehicle crash, is struck by a falling object, or is struck in the chest by some object during a fight - Significant contusions in both the cardiac muscle (cardiac contusion) and the lung tissue (pulmonary contusion) -> heart pump ineffective -> cardiogenic shock -> lung ineffective -> hypoxia, hypercarbia -> broken ribs lacerate lungs -> internal bleeding -> hemoptysis + hypovolemic shock

Supine hypotensive syndrome

- Caused by compression of the inferior vena cava by the pregnant uterus when the patient lies supine -> reduces the amount of blood that is returned to the heart -> hypotension -> Any patient in the third trimester of pregnancy should always be positioned on her left side during transport except during delivery

Tension headache

- Caused by muscle contractions in the head and neck and are attributed to stress - Squeezing, dull, or an ache

Open chest injury

- Caused by penetrating trauma - Don't remove the object because: - It occludes the hole in the vessel that has been punctured -> heavy bleeding if remove - As the object get removed, it can cause more damage

Chemical burns

- Caused by strong acids or strong alkalis - Treatment: - Remove any chemical from the patient - Brush off dry chemicals from the skin and clothing before flushing the patient with water (burn might be stronger under water than dry) - Remove clothing

Light burns to the eye

- Causes: infrared rays, eclipse of sun, laser burns - May not be painful but may cause permanent damage - Superficial burns: snow blindness, sunlamp or UV may not be painful for up to 3 to 5 hours later + conjunctivitis - Cover each eye with a sterile, moist pad and an eye shield - Transport with patient laid down

Large intestine

- Cecum - Colon - Rectum

What other cells (than skin cells) mustard gas attacks

- Cells within the bone marrow -> body can't reproduce white blood cells -> decreased resistance to infections - Can also attack the airway (mustard gas is persistent but releases some vapors too)

What causes a tension pneumothorax

- Closed blunt injury to the chest -> Fractured rib lacerates a lung or bronchus - Very rarely spontaneous

3 types of soft-tissue injuries

- Closed injuries: damage occurs beneath the skin but the surface remains intact - Open injuries: break in the surface of the skin, exposing deeper tissues to potential contamination - Burns: thermal heat, frictional heat, toxic chemicals, electricity, or nuclear radiation

Cataract

- Clouding of the lenses or their surrounding membranes - Interfere with vision and make it difficult to distinguish colors and see clearly - Increases the likelihood of falls, accidents, and mistakes in taking medications

Pleural effusion

- Collection of fluid outside the lung on one or both sides of the chest. It compresses the lung or lungs and causes dyspnea - Decreased breath sounds over the region of the chest where fluid has moved the lung away from the chest wall - Sit upright

2 types of occlusive dressing

- Commercial vented occlusive dressings - Improvised occlusive dressings

Different types of fractures

- Comminuted: more than two fragments - Epiphyseal: occurs in a growth section of a child's bone -> growth abnormalities - Greenstick: incomplete fracture that passes only partway through the shaft of a bone -> children - Incomplete: does not run completely through the bone -> nondisplaced partial crack - Oblique: bone is broken at an angle across the bone. - Pathologic: in weakened bones (osteoporosis, infection, or cancer) - Spiral: twisting force -> long spiral-shaped break -> abuse in young children - Transverse: straight across the bone -> direct blow injury

Head injuries in peds: brain, signs, backboard*2

- Common in children because the size of a child's head, in relation to the body, is larger - An infant also has a softer, thinner skull, which may result in injury to the underlying brain tissues - Signs: nausea and vomiting (that's how it differs from signs on adults) - Beginning at ages 8 to 10 years, children no longer require padding underneath the torso to create a neutral position. Instead, they can simply lie supine on the backboard - Also: A child's body is narrower than an adult's; therefore, padding will be required along the sides of the backboard

Methicillin-resistant Staphylococcus aureus (MRSA)

- Common infection in nursing homes - Found in decubitus ulcers (bedsores), on feeding tubes, and on indwelling urinary catheters - Symptoms: mild infections on the skin or invade the bloodstream, lungs, or the urinary tract - Spread primarily by broken skin-to-skin contact or by touching objects that have the bacteria on them

Endocrine system

- Communication system that controls functions inside the body - Maintain homeostasis

Cardiac arrest

- Complete stopping of heart activity (electrical or mechanical) - Indicated in the field by no carotid pulse

Spine injuries

- Compression (fall): herniation of disks, subsequent compression on the spinal cord and nerve roots, and fragmentation into the spinal canal - Rotation-flexion (rapid acceleration): C1/C2 -> no body and soft-tissue support - Hyperextension (hanging): leads to fracture of vertebrae and liganent/muscle injuries - Deformities ("step-off") -> DCAP-BTLS before backboard

Paroxysmal nocturnal dyspnea

- Condition that is characterized by a sudden attack of respiratory distress that wakes the person at night when the patient is in a reclining position - Caused by fluid accumulation in the lungs - Coughing, feeling suffocated, and cold sweats, and tachycardia

5 ways of heat loss

- Conduction - Convection - Radiation - Evaporation (e.g., sweating) - Respiration

Ureter

- Connect the kidneys to the bladder - Peristalsis: process that moves the urine to the bladder

How are ribs connected (back and front)

- Connected in the back to the vertebrae - Connected in the front to the sternum, through the costal cartilages

Reflex arc

- Connecting nerves in the spinal cord form a reflex arc - If a sensory nerve in this arc detects an irritating stimulus, such as heat, it will bypass the brain and send a message directly to a motor nerve -> Response such as pulling away from the heat

Burns in children VS adults

- Considered more serious than burns to adults because more surface area relative to body mass -> greater fluid and heat loss - Be careful to infection (burned skin less able to fight infection)

Signs of child abuse

- Consistency of the injury with the child's developmental age - History inconsistent with injury - Inappropriate parental concerns - Lack of supervision - Delay in seeking care - Affect - Bruises of varying ages - Unusual injury patterns - Suspicious circumstances - Environmental clues -> CHILD ABUSE mnemonic

Pectoral girdle/shoulder girdle

- Consists of two scapulae and two clavicles - Scapula (shoulder blade): flat, triangular bone held to the rib cage - Clavicle (collarbone): - S-shaped bone attached by ligaments to the sternum on one end and to the acromion process on the other - Acts as a strut to keep the shoulder propped up - Vulnerable to injury

Brain stem CO2 level

- Constantly senses the level of CO2 in arterial blood - If CO2 level low: breath slower and less deeply -> less CO2 is expired -> CO2 level increases - If CO2 level high: pH acid, breath faster and more deeply

3 primary functions of dressing and bandages

- Control bleeding - Protect the wound from further damage - Prevent further contamination and infection

Treating amputations

- Control bleeding and treat for shock (doesn't always bleed a lot though) - Partial amputations: stabilize the part with bulky compression dressings and a splint - Complete amputation: - Wrap the clean part in a sterile dressing and place it in a plastic bag - Put the bag in a cool container filled with ice - Lay the wrapped part on a bed of ice; do not pack it in ice - Goal is to keep the part cool without freezing or frostbite

Autonomic (involuntary) nervous system

- Controls the body functions that occur without conscious effort - Controls the functions of many of the body's vital organs, over which the brain has no voluntary control.

Assessing RR in peds

- Count for 30 seconds - If the patient yawns, sighs, coughs, or talks during the 30- second period, wait a few seconds and begin again. - If < 3 years, look at the rise and fall of the abdomen

How to treat evisceration

- Cover with moist sterile dressing then cover with occlusive dressing - Do NOT use individual 4 x 4's

Inner surface of the eyelids and exposed surface of the eye

- Covered by the conjunctiva (membrane) - Kept moist by fluid produced by the lacrimal glands (tear glands) - Humans blink: sweeps fluid from the lacrimal glands over the surface of the eye - The tears drain on the inner side of the eye through two lacrimal (tear) ducts into the nasal cavity -> need to blow nose when crying

2 groups of bones in the skull

- Cranium - Facial bones

Upper respiratory emergencies

- Croup - Epiglottis

Classic signs of heart attack

- Crushing pain, bad chest pain - Not reproducible - Pale, cool, clammy skin - Pain radiation - Nauseous - Vital signs: HR increases, RR increases, BP increases - Levine sign

Angina pectoris - pain feels like

- Crushing, squeezing, "somebody standing on my chest" - Felt in the mid portion of the chest, under the sternum - Can radiate to the jaw, the arms (left), mid-portion of the back of epigastrium (upper-middle abdomen) - Pain last 3-8 min, less than 15 min. Associated with dyspnea, nausea, or sweating

How to assess a trauma to the chest

- DCAP-BTLS - Lung sounds - Chest rise and fall

Symptoms of nerve agents

- DUMBELS or SLUDGEM - Most common: miosis

Frostbite

- Damage to tissues as the result of exposure to cold; frozen or partially frozen body parts - Important factors: duration of exposure, temperature, wind velocity - Hard, waxy feel to the touch

Cardiovascular changes in older adults

- Decline, mainly because of atherosclerosis (60% of > 65+) - HR + cardiac output decrease - Diastolic increases + blood vessels get stiffer - Bone marrow replaced with fatty tissue -> decrease ability to make blood cells

Treating radiation burns

- Decontaminate the wound as if it were a chemical burn to remove any radioactive particulate matter - Then treat it as a burn - Limit your duration of exposure, increase your distance from the source, and attempt to place shielding between yourself and sources of gamma radiation

Excited delirium/agitated delirium/exhaustive mania

- Delirium: condition of impairment in cognitive function that can present with disorientation, hallucinations, or delusions - Agitation: behavior characterized by restless and irregular physical activity - Idiopathic (cause unknown) - Symptoms: - Hyperactive irrational behavior with possible vivid hallucinations -> violent - Hypertension, tachycardia, diaphoresis, and dilated pupils -> can lead to cardiac arrest

Macular degeneration

- Deterioration of the macula, which is in the central portion of the retina - Causes a vision loss in the central part of the visual field - Affects > 50 y

Compartment syndrome

- Develops when edema and swelling result in increased pressure within a closed soft-tissue compartment -> interferes with circulation -> pain - The longer this situation persists, the greater the chance for tissue death - Develops in the extremities - Continually reassess skin color, temperature, and pulses distal to the injury site during transport if crush injury is suspected - Muscles, nerves and vessels at and distal to site become ischemic

Complications of pregnancy

- Diabetes - Hypertensive disorders - Bleeding - Abortion - Domestic violence and abuse - Substance abuse

Placards

- Diamond-shaped indicators (27 cm per side) placed on the 4 sides of highway transport vehicles, railroad tank cars, and other forms of transportation carrying hazardous materials - Labels are smaller versions ( 10 cm per side) of placards, placed on the four sides of individual boxes and smaller packages being transported

Cholinergic agents - effects DUMBELS

- Diarrhea - Urination - Miosis (constriction of the pupils), muscle weakness - Bradycardia, bronchospasm, bronchorrhea (discharge of mucus from the lungs) - Emesis (vomiting) - Lacrimation (excessive tearing) - Seizures, salivation, sweating

Basilar skull fractures

- Diffuse impact to the head (e.g., falls, motor vehicle crashes) - Result from extension of a linear fracture to the base of the skull - Difficult to diagnose with an x-ray - Signs: CSF from the ears, raccoon eyes, battle sign

percutaneous transluminal coronary angioplasty (PTCA)

- Dilate, rather than bypass, the coronary artery - Also called angioplasty - Tiny balloon attached to the end of a tube - No scar on the chest

Acute mountain sickness

- Diminished O2 pressure above 5,000 feet (1.5 km) -> hypoxia - Symptoms: headache, light- headedness, fatigue, loss of appetite, nausea, difficulty sleeping, shortness of breath during physical exertion, and a swollen face - Treatment: stop climbing and descend

Taste changes in geriatrics

- Diminished because of a decrease in the number of taste buds - Lessened interest in eating, which can lead to weight loss, malnutrition, and complaints of fatigue

Diabetes mellitus

- Disorder of glucose metabolism, such that the body has an impaired ability to get glucose into the cells to be used for energy - The patient with diabetes has either impaired insulin production or not enough functional receptors on the surface of the cells for the insulin to bind to. Glucose cannot get into the cell, the cell goes unfed, and the level of glucose in the blood remains and continues to rise

Neuropathy

- Disorder of the nerves of the peripheral nervous system in which function and structure of the peripheral motor, sensory, and autonomic neurons are impaired - Symptoms: - Motor nerves: muscle weakness, cramps, spasms, loss of balance, and loss of coordination - Sensory nerves: tingling, numbness, itching, and pain; burning, freezing, or extreme sensitivity to touch - Autonomic nerves: affect involuntary functions that could include changes in blood pressure and heart rate, constipation, bladder and sexual dysfunction

Dislocation

- Disruption of a joint in which ligaments are damaged and the bone ends are no longer in contact - Fingers, shoulder, elbow, hip, and knee

Signs and symptoms of heat exhaustion

- Dizziness - Onset while working vigorously - Onset, even at rest, in the older and infant - Cold, clammy skin with ashen pallor - Dry tongue and thirst - Normal vital signs, although the pulse is often rapid and weak and the diastolic BP low - Normal or slightly elevated body temperature; on rare occasions, as high as 104°F (40°C).

AC and CK symptoms

- Dizziness, headache, and vomiting - Other that are worse (dyspnea, tachycardia, seizure, coma, cardiac arrest) - Normal SpO2! -> appear within minutes

Nosebleed (or bleeding from the ear) due to head injury

- Do not attempt to stop the blood flow -> could increase pressure on the brain - Loosely cover the bleeding with a gauze pad + wrap loosely around the head - Cerebrospinal fluid: characteristic staining like a target or halo shape

Cervical collar

- Do not fully immobilize the cervical spine -> Maintain manual support until the patient has been completely secured on backboard - Make sure correct size - Should rest on the shoulder girdle

If a bandage has already been applied before you arrrive

- Do not remove bandage -> ask pt or bystanders about the wound and amount of bleeding - If blood has seeped through the dressing, do not remove it -> apply a clean dressing on top of the first one

How to treat wound with an impaled object

- Do not remove the object - Stabilize the object - Remove clothing covering the injury - Control bleeding: direct pressure + bulky dressing to stabilize the object - If object is in the chest, neck, or back: occlusive dressing around the object to prevent air from entering the wound - Protect the impaled object with a plastic cup - See Skill Drill 26-1 p. 920 Note: if object is long, cut off the exposed portion

Abdominal wounds

- Do not touch or move the exposed organs - Cover the wound with sterile gauze moistened with sterile saline solution - Secure with an occlusive dressing - If you do not have gauze compresses, use moist sterile dressings, covered and secured in place with a bandage and tape - Do not use any material that is adherent or loses its substance when wet, such as toilet paper, facial tissue, paper towels, or absorbent cotton

Treatment for hyperventilation

- Don't breath into a bog - Reassure + O2 + transport

Treating ankle injuries

- Dress all open wounds - Assess distal PSM - Correct any gross deformity by applying gentle longitudinal traction to the heel. Before releasing traction, apply a splint - You can use a padded rigid splint, an air splint, or a pillow splint. Make sure it includes the entire foot and extends up the leg to the level of the knee joint

PEEP principle

- During expiration the alveoli contracts down. It does not completely collapse, partly due to the presence of surfactant - Unfortunately, ventilation of a patient tends to inactivate the pulmonary surfactant which then leads to collapse of the alveoli, making gas exchange more difficult as the surface area of the lung is now reduced. - >The alveoli are opening and collapsing much more than they would normally and will also be subject to higher pressures in order to reopen them with each breath -> damage the alveoli - PEEP is a pressure applied by the ventilator at the end of each breath to ensure that the alveoli are not so prone to collapse. This 'recruits' the closed alveoli in the sick lung and improves oxygenation

Signs of pneumothorax

- Dyspnea, tachypnea, accessory muscle use - Decreasing SpO2 - Crackling sensation on palpation (= subcutaneous emphysema) - Decreased breath sounds on the injured side - Cyanosis

Treating a tension pneumothorax

- EMT: burping - ALS: needle through the rib cage into the pleural space = Thoracostomy

EMT must report child abuse

- EMTs in all states must report all cases of suspected abuse, even if the ED fails to do so - Supervisors are generally forbidden to interfere with the reporting of suspected abuse, even if they disagree with the assessment - You do not have to prove that there has been abuse

Breech delivery is imminent and inevitable - legs and buttocks already delivering

- Early MD contact - Instruct to push hard during contractions - May be instructed to do Pinard or Mariceau maneuver - Pinard: external rotation of each thigh combined with rotating the pelvis in the opposite direction resulting in the flexion of the knee and the delivery of each leg

Signs of peritonitis

- Early: severe abdominal pain, tenderness, and muscular spasm - Late: bowel sounds diminish or disappear as the bowel stops functioning

Symptoms of diaphragmatic hernia

- Empty, scaphoid appearing abdomen - Bowel sounds present in chest - Dullness to percussion

Menopause

- End of menstrual activity - Around 50 years old

Ionizing ratiation

- Energy that is emitted in the form of rays, or particles - Found in radioactive material, such as rocks and metals - Decay: natural process in which a material that is unstable attempts to stabilize itself by changing its structure -> Meanwhile, the substance is radioactive

Epinephrine

- EpiPen, Adrenalin - epinephrine - Sympathomimetic - Activates the sympathetic nervous system causing vasoconstriction, bronchodilation, and increased cardiac output - Severe allergic reaction (anaphylaxis) - None in emergency setting (previous: chest pain of cardiac origin; hypothermia; hypertension) - Hypertension, tachycardia, pallor, nausea, vomiting, headache, excitability and anxiousness - 0.3 mg IM for adult; 0.15 mg IM for children (< 30 kg)

Types of intracranial pressure injuries (types of intracranial hemorrhages)

- Epidural hematoma - Subdural hematoma - Intracerebral hematoma - Subarachnoid hemorrhage

Causes of seizures

- Epilepsy, high fever ("febrile seizures" - kids), structural pbs in the brain (tumor, scar tissue), metabolic/chemical pbs in body (low sodium, hypoglycemia, poison, drug, overdose) - Idiopathic: means cause of seizure is unknown

4 components of blood

- Erythrocytes (red blood cells) - Leukocytes (white blood cells) - Platelets - Plasma

After 3 questions of scene size up at ICS...

- Establish command by the most senior official - Then, notify other responders - Then, ask for additional resources

Rehabilitation supervisor and rehabilitation area

- Establishes an area that provides protection for responders from the elements and the situation - Rehabilitation area: away from exhaust fumes and crowds (especially members of the media) and out of view of the scene itself -> Where a responder's needs for rest, fluids, food, and protection from the elements are met

Allergic reaction

- Exaggerated response of the immune system - Mild and local, or severe and systemic (= anaphylaxis)

Points of distribution (PODs)

- Existing facilities that are used as mass distribution sites for antibiotics, antidotes, vaccinations, and other medications and supplies during an emergency - "Push packs": delivery time of 12h

Structure of the ear: pinna, tragus, and mastoid process

- Exposed portion: only cartilage - External, visible part: pinna - Tragus: small, rounded, fleshy bulge immediately anterior to the ear canal - The superficial temporal artery can be palpated just anterior to the tragus - 1 in posterior to the external opening of the ear: mastoid process = bony mass at the base of the skull

Intercostal muscles: def + which vertebrae

- Extends between the ribs - Innervated from the spinal nerves originating in the cervical region C6 and C7 -> Spinal injury -> unable to move them -> breathe entirely with the diaphragm = belly breathing -> sign of cord damage at or above C6 and C7 (except in kids -> belly breathing normal)

Thermal burns to the eye

- Eye usually closes if face get burned -> burns of the eyelid - Cover both eyes with sterile dressing moistened with sterile saline - Apply eye shields over dressing - Transport

Glasgow Coma Scale

- Eye/Verbal/Motor -> 4/5/6 - Eye Opening Response 4. Spontaneous 3. To verbal stimuli 2. To pain 1. None - Verbal Response 5. Oriented 4. Confused but able to answer questions ("confused") 3. Inappropriate words/incoherent ("words") 2. Incomprehensible speech ("sounds") 1. None - Motor Response 6. Obeys commands 5. Localizes pain 4. Withdraws in response to pain ("normal flexion") 3. Flexion in response to pain ("abnormal flexion") 2. Extension in response to pain 1. None

Eyeball (globe), vitreous humor, and aqueous humor

- Eyeball keeps its global shape as a result of the pressure of the fluid contained within its 2 chambers - Vitreous humor: clear, jellylike fluid near the back of the eye - Aqueous humor: in front of the lens, clear fluid

Soft tissue injuries of the face and neck

- Face and neck are extremely vascular -> heavy swelling and bleeding - A blunt injury that does not break the skin may cause a break in a blood vessel wall -> blood collects under the skin = hematoma - Avulsion: a flap of skin is peeled back from the underlying muscle and fascia

Signs and symptoms of stroke

- Facial drooping - Sudden weakness or numbness in the face, arm, leg or one side of the body - Loss of movement and sensation on one side of the body - Speech disorders - Aphasia - Sudden and severe headache - Trouble walking - Confusion, combativeness - Tongue deviation

Factitious & Somatoform Disorders

- Factitious Disorders - Intentional infliction of physical or psychological signs & symptoms - Examples: Munchausen's & Munchhausen's by proxy -> make yourself (or other (e.g., mom with kids)) sick to get attention - Somatoform Disorders: - Physical symptoms w/o apparent physiological cause - Examples: Hypochondriasis, conversion disorders, body dysmorphia -> your mind is telling you you're sick but you're not

3 most common errors in using AEDs

- Failure of the machine to shock fine V fib - Applying the AED to a patient who is moving, squirming, or being transported - Turning off the AED before analysis or shock is complete.

Syncope

- Fainting - Often caused by an interruption of blood flow to the brain - Other causes: - Dysrhythmias and heart attack - Vascular and volume changes - Stroke

Clavicle fractures

- Fall on outstretched arm - Significant damage to the large neurovascular bundle it protects is possible - Suspect upper rib fractures in medial clavicle fractures + pneumothorax - Treatment: - Sling and swathe - Hold it in position of comfort

Assessment of falls in geriatrics

- Falls are a leading cause of injury in geriatrics - Important to find out why the fall occurred - Cardiac, neurologic, and metabolic issues can create weakness, dizziness, or syncope, resulting in a fall - Traumatic and medical factors are much more interconnected in older people - Sometimes, a recent history of starting or stopping blood pressure medication is enough to cause a patient to become dizzy and fall

What is considered a significant MOI for a child

- Falls of greater than 10 feet (3 m), or 2 to 3 times the height of the child - Medium- to high-speed vehicle crash (>25 mph) -> Young children are top-heavy, so they tend to land on their heads even from short fall

Signs and symptoms of PTSD

- Feelings of helplessness, anxiety, anger, and fear - May avoid things that remind them of the trauma, including loud noises or smells, and sometimes avoid interactions with other people - Nightmares, flashbacks (seconds to hours) - Combat veterans may have heart disease earlier than expected, a higher incidence of type II diabetes, and a loss of brain gray matter. High cholesterol and hypertension too. - Sympathetic NS gets triggered but it should not

Femur

- Femoral head: ball-shaped part that fits into the acetabulum. Connected to the shaft (diaphysis), or long tubular portion of the femur, by the femoral neck - Femoral neck: common site for fractures (hip fractures) - Bony protuberances below the femoral neck and just above the shaft of the femur: greater trochanter and lesser trochanter

Fertilization

- Fertilization, which occurs when a sperm meets an egg, usually takes place when the egg is inside the fallopian tube - The fertilized egg then continues to the uterus where it develops into an embryo, then a fetus

Sympathetic nervous system

- Fight-or-flight - Causes the pupils to dilate, smooth muscle in the lungs to dilate, heart rate to increase, and blood pressure to rise - Also causes the body to shunt blood to vital organs and to skeletal muscle - Epinephrine (adrenaline) is released

Renal system changes in older adults

- Filtration function of kidneys declines by 50% from age 20 to 90 - Kidney size decreases by 20% 20 y from 90 y - Number of nephrons decreases -> decreased ability to clear waster from body + to conserve fluids

Understanding the MOI after a frontal crash

- First, determine type of restraint: seat belt, air bag -

Examples of thermal burns

- Flame burn - Scald burn - Contact burn - Steam burn - Flash burn

Splint

- Flexible or rigid device that is used to protect and maintain the position of an injured extremity -> Prevents motion - If no splinting material - Arm: bound to chest wall - Let: bound to other leg

High-altitude pulmonary edema (HAPE)

- Fluid collects in the lungs -> block O2 from into the bloodstream - Above 8,000 feet (2 km) or greater - Symptoms: shortness of breath, cough with pink sputum, cyanosis, and a rapid pulse

Psychological changes in middle adults

- Focus on achieving life's goals - Empty nest syndrome - Finances become a worrisome issue (retirement coming up)

Flail chest

- Fracture of 3 ribs or more adjacent ribs in 2 places or more or sternum is fractured + several ribs -> segment of the chest wall detached from the thoracic cage - Can cause pulmonary contusion - Treatment: - Airway + PPV if necessary + assess for possible pneumothorax - External splinting: pillows & arm + tape/dressing

Elbow injury

- Fracture of the distal humerus (also called supracondylar or intercondylar) - Dislocation: athlete (rare in young kids) -> ulna and radius displaced posteriorly relative to the humerus - Elbow joint sprain - Fracture of the olecranon process of the ulna - Fracture of the radial head

Injuries to the chest

- Fracture ribs or the sternum -> interferes with ability to breath - Heart bruises + massive bleeding - Lung bruises -> interfere with respiration - Pneumothorax: air accumulates between the lung tissue and the chest wall -> lung collapses + heart collapses - Hemothorax

Femoral shaft fractures

- Fractures of the femur can occur in any part of the shaft - Large muscles of the thigh spasm in an attempt to splint the unstable limb - Muscle spasms often produce significant deformity of the limb - There is always significant blood loss after a shaft femur fracture (500 - 1000 mL) - Traction splint (Sager)

Fractures in child abuse

- Fractures of the humerus or femur do not normally occur without major trauma, such as a fall from a high place or a motor vehicle crash - Falls from a bed are not usually associated with fractures - Children are more likely to experience greenstick (incomplete) fractures, as opposed to complete fractures, due to their soft and pliable bones -> be suspicious if femur fracture or a complete fracture of any bone

Different types of breech presentation

- Frank (Hips flexed, knees extended) - Complete (Hips and knees flexed) - Incomplete (Hips flexed, one of both feet present)

Abdominal distention or swelling that occurs between the xiphoid process and the groin

- Free fluid, blood, or organ contents spilling into the peritoneal cavity - Gases from the bowel or from infection

Reflective listening

- Frequently used by mental health professionals to gain insight into a patient's thinking - It involves repeating, in question form, what the patient has said, encouraging the patient to expand on his or her thoughts

Vertebral body, and spinal canal

- Front of each vertebra: round, solid block of bone called the vertebral body - Back part forms a bony arch - From one vertebra to the next, the series of arches form a tunnel running the length of the spinal column -> spinal canal - The spinal canal encases and protects the spinal cord

DKA symptoms

- Fruity, acetone odor on breath - Dry, flushed skin - Tachycardia - Kussmaul respirations - The 3 P's

Moderate burns

- Full-thickness burns 2-10% of body's total surface (excluding hands, feet, face, genitalia, and upper airway) - Partial-thickness burns 15-30% - Superficial burns > 50%

Minor burns

- Full-thickness burns < 2% of body's total surface - Partial-thickness burns < 15% - Superficial burns < 50%

Severe burns

- Full-thickness burns involving the hands, feet, face, upper airway, or genitalia or circumferential burns of other areas - Full-thickness burns > 10% of body's total surface - Partial-thickness burns > 30% - Burns associated with respiratory injury (smoke inhalation or inhalation injury) - Burns complicated by fractures - Burns on patients younger than 5 years or older than 55 years that would be classified as "moderate" on young adults

Examples of nerve agents

- G agents - Sarin (GB) - Soman (GD) - Tabun (GA) - V agents (VX)

GPA score

- G: how many times the woman has been pregnant - P: how many times she's given birth (twins count as 1) - A: how many times she has had an abortion - Example: G3 P1 A1 -> 3 times pregnant, 1 birth, 1 abortion

Pathophysiology of the GI system in geriatrics

- GI bleeding -> hematemesis + melena + hemorrhoids - Diverticulitis - Peptic ulcer disease - Gallbladder disease - Bowel obstruction -> vagus nerve -> vasovagal response (HR drops)

Pulmonary agents

- Gases -> pulmonary edema, dyspnea, tachypnea - Examples: chlorine (Cl) and phosgene

Consequences of overventilation

- Gastric distention - Impair function of the lungs - Increase intrathoracic pressure -> reduce cardiac output + pneumothorax - Acid-base imbalance (remove too much CO2)

AMI and cardiac compromise: appearance, pulse, BP, respiration, mental status

- General appearance: frightened, nausea, vomiting, sweat, skin pale or ashen grey or cyanosis - Pulse: HR increases (response to pain, stress, fear, injury to heart), can be irregular - BP: decreases because left ventricle can't pump. But most patient have normal BP - Respiration: normal, except if CHF (rapid and labored with cyanosis and frothy sputum) - Mental status: confusion, agitation, feeling of impending doom "I think I'm going to die"

GEMS details

- Geriatric patients: old different from young - Environmental assessment: too hot/cold, home secure, hazards -> old don't notice hazards as well - Medical assessment: numerous meds -> obtain thorough medical history - Social assessment: smaller social network (died), social agencies that can help with ADLs (activities of daily life_

Endocrine glands

- Glands to release hormones in the blood - When the hormone arrives, the organ receives the message and an action takes place

Carboys

- Glass, plastic, or steel containers, ranging in volume from 5 to 15 gallons - Nitric acid, sulfuric acid, and other strong acids are often transported and stored in thick glass carboys

PPE during delivery

- Gloves - Eye protection - Face protection

PPE for gynecologic emergencies

- Gloves - Mask - Eye protection

PPE for airway infection

- Gloves, eye protection, and a surgical mask or a high-efficiency air particulate (N-95) respirator should be mandatory - Place a surgical mask on patients with suspected or confirmed respiratory disease

Oral glucose

- Glutose, Insta-glucose - oral glucose - Carbohydrate - Increases blood glucose levels - Low blood glucose (hypoglycemia) - Unconscious, unable to swallow, unable to protect airway - Hyperglycemia - 15 g buccal

Heat stroke treatment

- Goal: lower the temperature - Move to cooler location (ambulance with max AC) - Remove clothing - Ice bath if available or wet towels + fan pt - Don't overcool: shiver creates more heat -> bad

Gravidity and parity

- Gravidity: number of pregnancies - Parity: number of pregnancies that have gone past 20 weeks (i.e., viable)

Viral hemorrhagic fevers (VHF): types, patho

- Group of diseases caused by viruses that include the Ebola, Rift Valley, Marburg, and yellow fever - Cause the blood in the body to seep out from the tissues and blood vessels

Pathophysiology of the endocrine system in geriatrics

- HHNS -> osmotic diuresis + shift of fluid to the intravascular space -> dehydration

Secondary assessment in geriatrics

- HR should be in the normal adult range but may be compromised by medications such as beta-blockers - Weak and irregular pulses are common in older patients - Blood pressure tends to be higher -> ask what the normal BP is for the pt - RR should be in the same range as in a younger adult, but chest rise will be compromised by increased chest wall stiffness - More inaccurate oximetry (poor circulation, vasoconstriction, hypotension, hypothermia, lack of red blood cells)

Marijuana

- Half of Americans say they have tried marijuana - THC is the chemical in the marijuana plant that produces its high - Synthetic ("spice"): looks like THC (similar high) but no medical benefit + high potential for abuse. Examples: K2 and Skunk -> more dangerous

Delirium tremens (DT)

- Hallucinations - Can develop 1-7 days after a person stop drinking

Avulsed tooth

- Handle it by its crown and not by the root - Place it in a special tooth storage solution or in cold milk or sterile saline - Reimplantation is recommended within 20 minutes to 1 hour

Diverticulitis

- Hard stool requires more intestinal contractions -> pressure within the colon -> pouches in the colon, called diverticula -> feces become trapped in these pouches -> bacteria grow there -> inflammation and infection - Most common cause of lower GI bleeding - Bright red, painless - Pain in LLQ

2 of the lessons learned from 9/11

- Have multiple backups to your ability to communicate with your dispatcher - Refrain from using the radio unless you have something important to transmit -> don't want to congest the radio

4 types of motorcycle impacts

- Head-on crash - Angular crash -> lower extremity injuries -> amputation - Ejection - Controlled crash -> "laying the bike down"

Congestive heart failure (CHF)

- Heart can't pump blood because ventricule damaged so can't keep up with blood from atria-> backup of fluid into the lungs - Can occur at any time after AMI (few hours to few days) or because of long stranding high BP - Heart first tries to compensate: HR increases, left ventricle expands. But then it fails -> CHF - "Congestive" -> lungs are congested with fluid

Leading causes of death in geriatrics

- Heart disease - Cancer - Chronic lower respiratory disease - Stroke - Alzheimer - Diabetes mellitus - Influenza and pneumonia

Difference in skin heat exhaustion VS heat stroke

- Heat stroke: skin is hot - Heat exhaustion: skin temperature is normal or even cool and clammy

Headaches that can be life threatening

- Hemorrhagic stroke (bleeding in the brain), brain tumor, and meningitis - Be concerned if the patient reports a sudden-onset, severe headache or a sudden-onset headache that has associated symptoms - Headaches accompanied by fever, stiff neck, seizures, or altered mental status or following a head trauma are potentially life threatening

Type 2 diabetes symptoms

- High blood glucose - Recurrent infection - Change in vision - Numbness in the feet

Cocaine overdose

- High risk for seizures, cardiac dysrhythmias, and stroke - BP as high as 250/150 - Hallucinations -> "cocaine bugs"

Depressed skull fractures

- High-energy direct trauma to a small surface area of the head with a blunt object (e.g., baseball bat) - Bony fragments being driven into the brain, causing injury - Frontal and parietal bones of the skull most susceptible - Often neurologic signs (e.g., unconscious)

Hydrogen sulfide

- Highly toxic, colorless, and flammable gas with a distinctive rotten-egg odor - Affects all organs, but it has the most impact on the lungs and CNS - Inhaled - No antidote

Scalp lacerations

- Highly vascular -> bleed a lot - Usually not severe enough to cause shock unless large artery or children

Where radioactive material can be found

- Hospitals and other health care facilities with radiology departments - Colleges and universities - Nuclear power plants - Chemical and industrial sites -> Not all is guarded well (especially radioactive waste) -> appealing to terrorist

Questions to determine if delivery is imminent

- How long have you been pregnant? - When are you due? - Is this your first pregnancy? - Are you having contractions? How far apart are the contractions? How long do the contractions last? - Have you had any spotting or bleeding? - Has your water broken? - Do you feel as though you need to have a bowel movement? - Do you feel the need to push?

Questions when considering whether the call is an MCI

- How many seriously injured or ill patients can I care for effectively and transport in the ambulance? - What happens when I have three patients to manage? - How long will it take for additional help to arrive? - What happens if the number of patients exceeds the number of available ambulances?

Antepartum emergencies

- Hyperemesis gravidarum (weeks 4-6) - Spontaneous abortion (< week 20) - Placenta previa - Abruptio placentae - Ectopic pregnancy - Preeclampsia & Eclampsia - Uterine Rupture - Trauma

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

- Hyperglycemia -> the body rids off glucose by putting it in the urine -> dehydration -> unconscious + seizure + urine dark - BGL > 600 mg/dL - Occurs in type 2, similar to DKA in type 1 - Symptoms: - Hyperglycemia - Altered mental status, drowsiness and lethargy - Severe dehydration, thirst, dark urine - Visual or sensory deficits - Partial paralysis or muscle weakness - Seizures

Opiates and opioids signs and symptoms

- Hypoventilation or respiratory arrest - Pinpoint pupils - Sedation or coma - Hypotension

2 key indicators of TBI

- Hypoxemia - Hypotension

Premature birth

- If < 8 months (36 weeks) or < 2 kg (5 lbs): premature - Newborn smaller and thinner. Head is larger. Less hair - Prematures as small as 0.5 kg have survived

Cushing triad

- If TBI, signs of Crushing triad: - Hypertension - Bradycardia - Irregular respirations: Cheyne-Stokes or Biot respirations -> All of this because of increased ICP - Also called herniation syndrome - Treatment: PPV 20/min or with target of etCO2 30-35 mm Hg

Chest pain - primary assessment

- If chest pain + O2 < 94% -> O2 at 4L/min via cannula. If no improvement, increase concentration with a NRB at 15L/min. Goal is 95-99% - If not breathing or inadequate: BVM with 100% O2 - If pulmonary edema: BVM or CPAP - Comfortable position (sitting up)

Treatment for hypoglycemia

- If conscious and able to swallow: oral glucose paste or tablets. Otherwise, juice or drink with sugar. Don't be afraid to give too much sugar - If unconscious or risk of aspiration: IV glucose or IM/IN glucagon. Only ALS so your role is to transport - or injection of glucose (dextrose) or glucagon by ALS

History taking with neuro emergencies

- If in postictal state, can't be get history from pt - Stroke: extremely important to know time beginning of onset -> 3h window beyond which harder to save the pt - Seizure: ask if history of seizures. If no history then it's a concern (tumor, intracranial bleeding or infection)

Consent with psy emergency

- If mentally incompetent -> implied consent - But it has to to be a life-threatening emergency -> if not sure, ask medical control or law enforcement - If you think the patient would harm himself, herself, or others without your intervention, then your intervention can be considered as essential and implied consent can apply

Dependent edema

- If right side of heart is damaged -> fluid collects in body -> feet/legs swollen - Right side supplies the preload for the left side so if right fails then not enough supply to left ventricle so drop in systemic BP

Large volume horizontal tanks

- If stored above ground = "aboveground storage tanks" - If placed underground = "underground storage tanks" - Can hold a few hundred gallons to several million gallons of product - Made of aluminum, steel, or plastic

Open pneumothorax

- If the hole is in the chest wall, you can hear a sucking sound as the patient inhales and the sound of rushing air as he or she exhales - Air will travel into pleural space if left unoccluded - Also called sucking chest wound

If fertilization doesn't occur - menstrual flow

- If the ovum is not fertilized in the fallopian tube, it continues to travel into the uterus - Because fertilization has not occurred within about 14 days of ovulation, the lining of the uterus begins to separate and menstruation occurs - The menstrual flow consists of blood from the separated lining of the uterus and lasts about 1 week

History taking for diabetes

- If the patient has eaten but has not taken insulin, it is more likely that hyperglycemia is developing - If the patient has taken insulin but has not eaten, the problem is more likely to be hypoglycemia - Check if the pt has an emergency medical identification device—a wallet card, necklace, or bracelet

Emergency medical care for gynecologic emergencies

- If the patient is in a public place, move her to the ambulance - Determining the cause of the bleeding os less important than treating for shock and transporting - Most women will use sanitary pads before you arrive, so you may continue that approach. Document number of sanitary pads - If the woman has a tampon in place, it is not necessary to have her remove it

When to prepare for imminent delivery

- If the patient says that she is about to deliver, says she has to move her bowels, or feels the need to push - Regular contraction lasting 60-90s at 1-2 min intervals - Bloody show - Firm abdomen - Crowning

Treating fractures about the knee

- If there is an adequate distal pulse and no significant deformity, splint the limb with the knee straight - If there is an adequate pulse and significant deformity, splint the joint in the position of deformity - If the pulse is absent below the level of the injury, suspect possible vascular and nerve damage, and contact medical control immediately for further instructions - Never use a traction splint if you suspect a fractured knee

Cracked ribs

- If upper four: sign of major MOI (protected by clavicle and scapula) - If lacerate lung: pneumothorax, tension pneumothorax, hemothorax, hemopneumothorax - Signs: tenderness and pain when breathing -> shallow breaths - Treatment: - High flow O2 if respiratory distress - Encourage deep breathing - External splinting: sling and swathe + padding

Poisoning - secondary assessment

- If you suspect a person has ingested a poison, inspect the mouth for indications of poisoning - Are there burns from caustic chemicals? - Are there plant or pill fragments? - If the person's skin came in contact with a poison, is there a rash or burns? How large an area is involved? - If a respiratory exposure occurred, auscultate the lungs. Is there good air movement in and out of the lungs? Do you hear any wheezing or crackles?

Injuries to the extremities in peds

- Immature bones with active growth centers. Growth of long bones occurs from the ends at specialized growth plates - These growth plates are potential weak spots in the bone and are often injured as a result of trauma - Children's bones bend more easily than adults' bones -> greenstick (incomplete) fractures can occur - Do not attempt to use adult immobilization devices on a pediatric patient unless the pediatric patient is large enough to properly fit in the device

Coronary artery bypass graft

- In a coronary artery bypass graft, a blood vessel from the chest or leg is sewn directly from the aorta to a coronary artery beyond the point of the obstruction - Long scar on the chest

Difference of DKA and HHNS

- In both case: hyperglycemia - DKA: hyperglycemia because not enough insulin (type 1) - HHNS: hyperglycemia because cells are insulin resistant (type 2)

Triage supervisor

- In charge of counting and prioritizing patients - Triage division primary duty: ensure that every pt receives initial assmt -> you can't begin treatment until all pts are triaged

Thrombophilia

- Inability to maintain the viscosity and smooth flow of blood -> blood clotting more easily than normal - Results from either inherited (genetic) disorders, medications, or other factors - Risk factor: cancer

Airway infection

- Inadequate oxygen delivery to the tissues is a problem of oxygenation. Infections may cause dyspnea by obstructing airflow - Mucus and secretions (colds, diphtheria) or by causing swelling of soft tissues located in the larger, upper airways (epiglottitis, croup). Infections may also impair exchange of gases between the alveoli and the capillaries (pneumonia).

How to stimulate baby to breath

- Include positioning of the airway, drying, warming, suctioning with bulb syringe or French catheter, and tactile stimulation - Tips: newborn on this back with head down + suction with bulb syringe or French catheter + rub newborn's back and slap the soles of feet -> If no breathing after 10-15s of stimulation: resuscitation needed

Dive descent emergencies

- Increase pressure -> pain in lungs, sinus, middle ear, teeth and area of the face surrounded by the mask -> Perforated tympanic membrane = ruptured eardrum

Changes in the immune system in geriatrics

- Increased risk of infection - Maybe no fever but actually hypothermic as as result of infection - Signs of infection: anorexia, fatigue, weight loss, falls, ALOC - Pneumonia and UTI -> common in patients who are bedridden

Cushing reflex

- Increased systolic blood pressure, decreased pulse rate, and irregular respirations - Means increased ICP - To remember: think that increased intracranial pressure <-> increased blood pressure

Pediatric respiratory rates

- Infant: 30 to 60 - Toddler: 24 to 40 - Preschool-age: 22 to 34 - School-age: 18 to 30 - Adolescent: 12 to 16

Respiratory syncytial virus (RSV) in geriatrics

- Infection of the upper and lower respiratory tracts - Typically in children but can cause serious illness in older people - Symptoms: similar to the common cold but can be more severe and last longer - Highly contagious: direct contact with droplets and by touching a contaminated surface.

Pelvic inflammatory disease (PID)

- Infection of the upper female reproductive organs—specifically, the uterus, ovaries, and fallopian tubes—that occurs almost exclusively in sexually active women - Disease-causing organisms enter the vagina during sexual activity and migrate through the opening of the cervix and into the uterine cavity - The infection may then expand to the fallopian tubes, eventually involving the ovaries - Seldom a threat to life, it can lead to an ectopic pregnancy or an abscess, which can cause death

Bubonic plague: target system, patho, communicability

- Infects the lymphatic system - May spread through the body -> sepsis and possibly death - Not contagious + not likely to be seen in a bioterrorist incident

Croup

- Inflammation and swelling of pharynx, larynx and trachea (virus) - 6m to 3y kids (rarely in adults) - Late fall + winter - Barking cough (sounds like whisteling) - Stridor (because of narrowing of the windpipe) -> humidified O2. Not bronchodilator

Epiglottitis

- Inflammation of the epiglottis (bacteria Haemophilus influenzae (vaccine exists)) - High fever - Severe sore throat - Drooling - Tripod or sniffing position - Stridor (late sign) -> don't do anything that cause kid to cry + position of comfort + patent airway + O2 + transport. Nothing in their mouth

Esophagitis

- Inflammation of the esophagus - Due to infection or gastroesophageal reflux disease (GERD) ("acid reflux") - Pain with swallowing and feeling like an object is stuck in his or her throat

Cholecystitis

- Inflammation of the gallbladder - Murphy's sign (pain when pressing on gallbladder) - Pain: - RUQ - Referred pain to right shoulder (also in back or flank) - Increases after fatty meals and at night - 5 F's: female, fat, forty, fertile and fair!

Pancreatitis

- Inflammation of the pancreas - Caused by obstructing gallstone, alcohol abuse, and other diseases - Pain in LUQ and RUQ, radiates in the back - Abdominal distention and tenderness

Gastroenteritis

- Inflammation of the stomach and small intestine - Bacterial or viral - May also be caused by noninfectious conditions such as adverse reactions to medications, exposure to certain toxins, or chemotherapy

Material Safety Data Sheet (MSDS)

- Info about a particular chemical - All facilities that use or store chemicals are required by law to have an MSDS on file for each chemical used or stored in the facility

Most common cause of food poisoning

- Ingestion of powerful toxins produced by bacteria, often in leftovers - Example: bacterium Staphylococcus on food prepared in advance and kept too long, even in the fridge -> GI symptoms from 2-3h to 8-12h after ingestion: nausea, vomiting, and diarrhea

Rollover crashes

- Injury patterns vary - Most life-threatening: ejection from the vehicle - Large trucks and some sport utility vehicles, are more prone to rollover crashes because of their high center of gravity

Penetrating wound

- Injury resulting from a piercing object, such as a knife, ice pick, splinter, or bullet - If the wound is to the chest or abdomen, the injury can cause rapid, fatal bleeding - Concerns: amount of damage to structures deep inside the body and presence of foreign materials deep inside the tissue

Significant MOI examples

- Injury to more than one body system (multisystem trauma) - Falls from heights - Motor vehicle and motorcycle crashes - Car VS pedestrian (or bicycle or motorcycle) - Gunshot wounds - Stabbings

Concussion

- Injury to the brain caused by a blow - Also called mild TBI - 90% without loss of consciousness - Confused, amnesis or retrograde amnesia

Dermis

- Inner layer of skin - Below the germinal cells of the epidermis - Contains the structures that give the skin its appearance: hair follicles, sweat glands, and sebaceous glands

Dissecting aneurysm

- Inner layer of the aorta separate -> blood flows between layers - Hypertension is primary cause - Sudden chest pain (anterior part of chest or in the back between shoulder blades)

Cerebrovascular accident (CVA)/stroke

- Interruption of blood flow to an area within the brain that results in the loss of brain function - Brain cells lack of O2 -> die within minutes - If O2 decreased but not absent -> damage more slowly (several hours) - If normal blood flow is restored to that area of the brain in time, the cells will not die and the patient may regain full use and control of the arm.

Blunt injuries to the neck

- Involve larynx or trachea - Often caused by collision with steering wheel, attempted suicide by hanging, clothesline injury while riding bike - Can lead to: loss of voice, difficult swallowing, sever/fatal airway obstruction, leakage of air into soft tissues of neck (air comes from inside the neck, not from outside) (subcutaneous emphysema) - If subcutaneous emphysema: maintain airway + transport (no occlusive dressing -> only for penetrating) - Spinal immobilization may be required

Superficial (first-degree) burns

- Involve only the top layer of skin, the epidermis. - The skin turns red but does not blister or burn through this top layer - The burn site is often painful - Sunburn is a good example of a superficial burn

Partial-thickness (second-degree) burns

- Involve the epidermis and some portion of the dermis - Do not destroy the entire thickness of the skin nor is the subcutaneous tissue injured - Skin is moist, mottled, and white to red - Blisters are present - Intense pain

2 points that define terrorism

- Involves violent acts or acts dangerous to human life that violate federal or state law - Appears to be intended (i) to intimidate or coerce a civilian population; (ii) to influence the policy of a government by intimidation or coercion; or (iii) to affect the conduct of a government by mass destruction, assassination, or kidnapping

Peritonitis and ileus

- Irritation of the peritoneum - Causes ileus = paralysis of the muscular contractions that normally move the food through the intestine -> abdominal distention -> emesis

2 types of strokes

- Ischemic: blood flow in cerebral arteries is blocked - Hemorrhagic: blood vessel ruptures -> blood accumulates -> increased pressure in brain

Once the labor has begun

- It cannot be slowed or stopped. Never attempt to hold the patient's legs together - Do not let her go to the bathroom - Open the OB kit and continue to prepare for the delivery

Scene size-up - heat emergency

- It is harmful to allow heat to persist -> cooling prior to transport is indicated if facilities such as an ice bath are available -> monitor the patient in the water + do not remove the patient until temperature is between 101°F and 102°F

Delivering the head

- It may take many contractions from the time the head begins to crown until the head delivers - Place your sterile gloved hand over the emerging bony parts of the head, avoid the eyes and fontanelles - The risk of perineal tearing can be reduced by applying gentle pressure across the perineum

Drawbacks of vacuum mattress over backboard

- Its thickness -> careful patient movement to maintain spinal stabilization during the application procedure - Can't be used if > 350 lb

Signs of cardiac tamponade - Beck's Triad

- JVD both sides of the trachea - Narrowing pulse pressure - Muffled heart sounds Another sign of cardiac tamponade (not in Beck's triad) is pulsus paradoxus

Laceration

- Jagged cut in the skin caused by a sharp object or a blunt force that tears the tissue - Lacerations and incisions may appear linear (regular) or stellate (irregular) - Different from whereas an incision, which is a sharp, smooth cut

Unconscious pt with eye injury

- Keep the eyelids closed - Drying of the ocular tissue can cause permanent injury and may result in blindness - Cover the lids with moist gauze or hold them closed with clear tape - Normal tears will then keep the tissues moist

Emergency medical care for internal bleeding

- Keeping the patient as still and quiet as possible assists the body's clotting process - O2 + cover with a blanket - You can usually control internal bleeding into the extremities by splinting the extremity with an air splint - Never use a tourniquet to control the bleeding from closed, internal, soft-tissue injuries

Changes in the renal system in geriatrics

- Kidney weigh less, due to loss of functioning nephron units, or tubule degeneration -> Smaller filtering surface - Renal blood flow decreases by 50% with time - Decreased bladder capacity, decline in sphincter muscle control, decline in voiding senses, increase in nocturnal voiding, and, in men, benign prostatic hypertrophy (enlarged prostate)

Primary assessment in gastro and uro emergencies

- Knees drawn up to help alleviate the pain associated with acute abdomen pain - Ask the patient about blood in the vomit (hematemesis) or black, tarry stools (melena)

Resuscitation of newborn - metrics

- Labored breathing or persistent cyanosis + HR ≥ 100 bpm -> position and clear airway + titrated O2 - HR < 100, apneic or gasping -> PPV 40-60/min (450 mL) with room air O2 -> after 90s, if no improvement , PPV with 100% O2 - HR < 60 (after 30s of ventilation and HR not increasing) -> PPV 100% -> after 90s, if no improvement, PPV + CPR = 2 hands encircling or 2 fingers just below nipple line + 1/3rd chest + 3:1 ration + 120/min ("120 actions")

Treating bleeding of the head

- Laceration: apply pressure with dry sterile dressing -> If soaked, don't remove but place a second dressing then roller bandage - Skull fracture: no excessive pressure - Bandages should not cover the mastoid process -> can see if there's a basilar skull fracture - Do not cover the mouth, nose, or jaw -> avoid limiting access to the airway

Seat belt positioning for a pregnant woman

- Lap belt: under the abdomen and over the pelvic bones (iliac crests) - Shoulder belt : between the breasts

LLQ organs

- Large and small intestines (descending colon + left half of the transverse colon)

Tibia (shinbone)

- Larger than the fibula - Front of the lower leg - Connects to the patella (knee cap) via the patellar tendon just below the knee joint

Sciatic nerve

- Largest nerve in the lower extremity - Controls the activity of muscles in the posterior thigh and below the knee and the sensation in most of the leg and foot

Injuries to the neck and throat

- Larynx or trachea injury -> airway problem + air leaks into the soft tissue -> subcutaneous emphysema -> crackling sound or feeling when palpated - Tracheal deviation (late sign) - Jugular vein distention - Air can enter the vein -> air embolism -> cardiac arrest -> occlusive dressing

Expectant triage category

- Last priority - Dead or minimal chance of survival - Cardiac arrest, open head injury, for example. Respiratory arrest too if limited resources - Treatment and transport only after patients in the other 3 categories have received care

Position of restraint

- Lateral decubitus - One arm above the head and the other below the waist; however, four- point restraints (both arms and both legs) are preferred - Restraining the hips, thighs, and chest inhibits movement - Do not place anything over the patient's face, head, or neck - If spit: surgical mask. If bite: cervical collar - Never in prone position -> asphyxia

Suicide

- Leading cause of death between 15-24 y/o - Males 4x as likely to commit suicide, females make 3x as many attempts - Females more likely to use poisonings and overdose - Elderly over 85 y/o have 1.8x rate of suicide than general population

Communication and support of the family in SIDS

- Learn and use the child's name rather than the impersonal "your child." - Speak to family members at eye level, and maintain good eye contact with them. - Use the word "dead" or "died" when informing the family of the child's death. No "passed away" or "gone" - Acknowledge the family's feelings ("I know this is devastating for you,"), but never say "I know how you feel," even if you have experienced a similar event - Offer to call other family members or clergy if the family wishes. - Keep any instructions short, simple, and basic - Ask whether they want to hold the child. Wrap the dead child in a blanket, as you would if he or she were alive, and stay with family members while they hold the child. Ask them not to remove tubes or other equipment that was used in an attempted resuscitation.

Psychological changes in school-age children

- Learn various types of reasoning -> preconventional, conventional, and postconventional reasonings - Develop their self-concept and self-esteem

Injuries to the scapula/shoulder blade

- Less frequent (protected bu muscles) - Cause: blow to the back, directly over the scapula - Risk of breathing problem

Kidneys

- Lie on the posterior muscular wall of the abdomen behind the peritoneum in the retroperitoneal space - Play an important role in the regulation of acid-base balance (the body's pH) and blood pressure - Also rid the body of toxic wastes and control the body's balance of fluid and electrolytes - Waste products and water are constantly filtered from the blood to form urine

Severe injuries

- Limb amputations - Bilateral femur fractures - Multiple closed fractures

Types of skull fractures

- Linear - Depressed - Basilar: base of the skull - Open

RUQ organs

- Liver - Gallbladder - Duodenum of the intestines - Small portion of the pancreas

Solid organs of the abdominal cavity

- Liver, Kidneys, Ovaries, Pancreas, and Spleen - Contain a lot of blood -> can result in bleeding and shock

Treatment supervisor

- Locate and set up the treatment area with a tier for each priority of patient - Ensures that secondary triage of patients is performed and that adequate patient care is given - Also assists with moving pts to the transporting area

Bone marrow

- Located in the center of each bone, - Produces red blood cells, white blood cells and platelets

Blunt abdominal injury treatment

- Log roll the pt to a supine position onto a backboard - Monitor vitals for shock: pallor, cold sweat, rapid, thready pulse, low BP -> If any of these signs: O2 vis NRB or BVM

If the diaphragm is penetrated or ruptured -> diaphragmatic hernia

- Loops of bowel may herniate into the thoracic cavity (rupture through the diaphragm) -> Displace lung tissue -> Dyspnea -> Lungs can't fully expand - More common on the left side - Keep pt upright

Presbyopia

- Lose the ability to see up close and may have to get eyeglasses for the first time - Caused by a loss of elasticity of the crystalline lens - Affect > 40 y

Breath holding syncope

- Loss of consciousness caused by a decreased stimulus for breathing - Happens if breathe in and out rapidly and deeply before entering the water in an effort to expand their capacity to stay underwater - Increase O2 but decrease CO2 -> swimmer doesn't feel the need to breath even after using up all the O2 -> drowning - Same treatment as for drowning

Emphysema

- Loss of elasticity in lungs because alveoli are stretched too much - Barrel chest - Pursed lip breathing - Dyspnea on exertion - Cyanosis - Wheezing/decreased breath sounds - Risk factor: smoking

Venous stasis

- Loss of proper function of the veins in the legs -> blood clots -> DVT -> pulmonary embolism - Usually exhibit edema, or swelling, of the legs and ankles - Feeling of fullness, aching, or tiredness in legs, especially when standing - Red-brown discoloration of the skin + skin ulcers

Zygomatic fracture symptoms

- Loss of sensation below the orbit - Flattened cheek - Fixed upward gaze - Visual disturbances

3 types of radiation exposure

- Low exposure: nausea, vomiting, diarrhea, dizziness, headache - Moderate exposure: first-degree burns, hair loss, compromised immune system (death of white blood cells), and cancer - Severe exposure: second- and third-degree burns, cancer, and death

3 levels of velocity in traumatic injuries caused by gun shots (or knife)

- Low-velocity: hand-held or handpowered objects such as knives - Medium-velocity: smaller caliber handguns and shotguns - High-velocity: larger weapons such as high-powered rifles and higher-powered handguns

Common passenger injuries

- Lower extremity fractures -> knees into the dashboard -> hip fracture/dislocation - Rib fractures -> rib cage into the steering wheel -> chest and abdo injuries - Head trauma -> head into the windshield -> head and spinal injuries

Pneumonic plague: target organ, route, communicability and toxicity, other name

- Lung infection - Results from inhalation of plague bacteria - Contagious and has a much higher death rate than the bubonic form - Also known as plague pneumonia

Primary response - Sensitization - allergic reaction

- Macrophages consume antigen - White blood cells develop IgE antibodies - Antibodies are distributed throughout body and attach to mast cells (connective tissue) and basophils (blood) - These cells contain chemical mediators including histamine and leukotrienes

Stomach

- Main organ of the digestive system - Most digestion takes place in the stomach: gastric juices break down food to a form that can be used by the body

Bandages

- Mainly used to to keep dressings in place during transport. Can also use splints to hold dressings - Types: soft roller bandages, rolls of gauze, triangular bandages, or adhesive tape - The self-adherent, soft roller bandages are probably easiest to use - Adhesive tape holds small dressings in place and helps secure larger dressings - Do not use elastic bandages to secure dressings. - Always check a limb distal to a bandage for signs of impaired circulation and loss of sensation

Pacemaker

- Maintain a regular cardiac rhythm and rate - Inserted when the electrical control system doesn't work well - Left upper portion of the chest

Quantity of blood in body

- Male: 6L (70 mL/kg) - Female: 65 mL/kg - 1 y: 800 mL

Genital system

- Male: testicles, epididymis, vasa deferentia, seminal vesicles, prostate gland, and penis - Female:ovaries, fallopian tubes, uterus, cervix, and vagina

Risk factors for meningitis in peds

- Males - Newborn infants - Children with compromised immune systems (such as HIV/AIDS or cancer) - Children who have any history of brain, spinal cord, or back surgery - Children who have had head trauma - Children with shunts, pins, or other foreign bodies within their brain or spinal cord - VP shunt

Dental injuries

- Mandible fractures - Maxillary fractures - Fractured and avulsed teeth

Airway management in ALOC

- May not have a gag reflex -> cannot expel foreign object + tongue obstructs the airway -> Lateral recumbent position

Toxicity levels

- Measures of the health risk that a substance poses to someone who comes into contact with it. 0 to 4 - 0: little, if any, health hazard - 1: irritation on contact but only mild residual injury, even without treatment (slightly hazardous) - 2: temporary damage or residual injury unless prompt medical treatment is provided (slightly hazardous) - 3: extremely hazardous to health - 4: so hazardous that minimal contact will cause death

Types of tourniquet

- Mechanical advantage tourniquet (MAT) - Combat application tourniquet (CAT) - Ratcheting medical tourniquet (RMT) - Special weapons and tactics tourniquet (SWAT-T)

3 types of lightning injuries

- Mild: loss of consciousness, tingling - Moderate: seizure, respiratory arrest, dysrhythmias, superficial burns - Severe: cardiac arrest, death

Transcient Ischemic Attack (TIA)

- Mini stroke, where neurological function are regained quickly with time (24h) -> no actual death of tissue - May be a warning sign that a major stroke may occur in the future - 1/3 of TIA results in a stroke

Musculoskeletal injury grading system

- Minor - Moderate - Serious - Severe, life-threatening (survival is probable) - Critical (survival is uncertain)

Minor injuries

- Minor sprains - Fractures or dislocations of digits

2-6 months

- More active, begin to smile and make eye contact, and recognize parents or caregivers - Strong sucking reflex, active extremity movement, and a vigorous cry - Follow a bright light or turn their heads toward a loud sound or a familiar voice. - 70% of infants will sleep through the night by 6 months - Begin to roll over - Lack of eye contact -> significant illness, depressed mental status, or a delay in development

Dive ascent emergencies

- Most common injuries is during the ascend - 2 main emergencies: air embolism and decompression sickness

MDI and SVN - meds and difference

- Most common meds for shortness of breath are inhaled beta-agonists - MDI: albuterol (Proventil, Ventolin), albuterol/ipratropium (Combivent), metaproterenol (Alupent, Metaprel), and terbutaline (Brethine). - SVN: albuterol, metaproterenol, and epinephrine - Unlike an MDI, a small-volume nebulizer must be assembled prior to use. An oxygen tank is also required to administer the aerosolized medication

Bacterial vaginosis

- Most common vaginal infection in women age 15 to 44 - Normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms - Symptoms: itching, burning, or pain and may be accompanied by a "fishy," foul-smelling discharge. - Premature babies or babies born with low birth weight

Formable splints

- Most common: air splint - Others: vacuum splints, pillow splints, structural aluminum malleable (SAM) splints, a sling and swathe, and pelvic binders for pelvic fractures - Drawbacks: in cold weather or high altitude, the zipper can stick or freeze (not all air splints have a zipper though) - See Skill Drills 31-3, 31-4, and 31-5 p. 1108-1109

Sign of PID

- Most common: generalized lower abdominal pain - Abnormal and often foul-smelling vaginal discharge - Increased pain during sexual intercourse - Fever, general malaise, and nausea and vomiting

Signs of internal bleeding

- Most common: pain - Swelling and bruising - Intra-abdominal: pain and distention - Chest cavity: dyspnea, tachycardia, hemoptysis, and hypotension - Soft tissues: hematoma - Bright red bleeding from the mouth or rectum or urine -> serious internal injury or disease - Melena

Changes in the nervous system in geriatrics

- Most common: thinking speed, memory, and posture stability - Slower central processing of sensory stimuli and language, and longer retrieval times for short- and long-term memory - Brain weight decreases (10% to 20%) and volume decreases -> increases the amount of space in the cranium -> increases the chance for head injuries - 5% to 50% loss of neurons -> motor and sensory neural networks slow down -> affects the control of the rate and depth of breathing, heart rate, blood pressure, hunger, thirst, and body temperature - However, less neuron doesn't mean less smart - Senses of taste, smell, vision, hearing, and touch diminish

Injuries to the clavicle

- Most commonly fractured bone - Examples: - Children when they fall on an outstretched hand - Crush injuries of the chest - Lies directly over major arteries, veins, and nerves -> neurovascular compromise

Lightning

- Most commonly struck by lightning include boaters, swimmers, and golfers - Large, open area increases the risk of being struck by lightning - Can be indirectly struck when standing near an object that has been struck by lightning, such as a tree (splash effect) - Cardiovascular and nervous systems are most commonly injured - Burns are superficial

Neurotoxins: fact, what produces them, routes, contagious?, WMD?, examples

- Most deadly substances known to humans - Produced from plants, marine animals, molds, and bacteria - Routes of entry: ingestion, inhalation from aerosols, or injection - Unlike viruses and bacteria, neurotoxins are not contagious and the onset of symptoms is faster - Have not been used successfully as a WMD - Examples: botulinum, ricin

Cholinergic agents - treatment

- Most important: avoid exposure -> decontamination more important than transport - ABC (in particular, suction) - DuoDote Auto-Injector or ATNAA (military)

Snake bites

- Most in the US are not venomous - Venomous examples: rattlesnake, copperhead (same type: pit viper) - Most bites between April and October

0-2 months

- Most of the time sleeping or eating. Sleep up to 16 hours a day - Respond mainly to physical stimuli such as light, warmth, hunger, and sound - Should be aroused easily from a sleeping state -> emergency if this is not the case - Unable to tell the difference between parents or caregivers and strangers - Hearing well developed at birth -> calm and reassuring talk - Sign of significant illness if can't stop crying - Have a sucking reflex for feeding - Head control is limited, but can turn their heads and focus on faces - Poor thermoregulation + large heads -> predispose to hypothermia

Tenderness

- Most reliable indicator of an underlying fracture - But it does not tell you the type of fracture

Botulism

- Most severe form of toxin ingestion - Often fatal - Results from eating improperly canned food - Bacterium Clostridium - Symptoms within 24h-4 days after ingestion (neurologic mainly): blurring of vision, weakness, and difficulty in speaking and breathing, muscle paralysis, fatal when it reaches the muscles of respiration

Spinal cord

- Mostly made of fibers that extend from the brain's nerve cells. - Carries messages between the brain and the body via the gray and white matter of the spinal cord - Gray matter is composed of neural cell bodies and synapses, which are connections between nerve cells. - White matter consists of fiber pathways

Ibuprofen

- Motrin - ibuprofen - NSAID - Inhibits inflammatory response by blocking formation of COX-2, a chemical mediator of inflammatory chemicals such as prostaglandins - Mild to moderate pain and fever - Hypersensitivity - Gastrointestinal irritation and bleeding - 200-400 mg PO, every 4-6h. Pediatric 5-10 mg/kg PO every 6-8h

General management of cold emergencies

- Move pt out fo cold area - Don't allow the pt to walk (to prevent damage to feet) - Remove wet clothing + put dry blankets - Give warm humidified O2 - Don't massage the extremities - Don't allow the pt to eat or use stimulants (coffee, tea, tobacco etc) -> vasoconstrictors

Inhaled poisoning - treatment

- Move to fresh air - Suction if vomit - O2 (NRB or BVM) - Transport with containers and labels

Factors affecting blood's clotting

- Movement - Disease - Meds (e.g., blood thinners) - Removal of bandages - Body temperature - Environment

Serious injuries

- Multiple digit amputations - Multiple hand and foot fractures - Displaced long bone fractures - Open long bone fractures - Displaced pelvic fractures - Dislocations of major joints - Laceration of major nerves or blood vessels

Factors that complicate assessment of geriatrics

- Multiple diseases - Rales may be caused by bed ridden state -> do not confuse with pulmonary edema - Loss of skin elasticity may give appearance of dehydration - Ankle edema may be caused by varicose veins and inactivity/position -> do not confuse with congestive heart failure - Minimal or absent fever with severe infection - Meds errors - Drugs aleter cardio functions (beta blockers, calcium channel blockers slow down HR)

Narcan

- Narcan - naloxone - Narcotic antagonist - Competes for and displaces narcotics from opiate receptors in the brain, inhibiting further narcotic effects and reversing respiratory depression - Respiratory depression from narcotic overdose - Hypersensitivity - Withdrawal symptoms, hypotension, HTN, N/V, cardiac dysrhythmias - 0.4-2 mg IN. Pediatric 0.1 mg/kg IN - Precautions: opiate dependency

If increasing pressure on the heart from the pleural space or the pericardial space

- Narrowing pulse pressure -> Inability of the heart to fill with an adequate volume of blood and contract normally

6 bones of the face

- Nasal bone - 2 maxillae: upper jaw bones - 2 zygomas: cheek bones - Mandible: jaw bone

Plague: vector, types

- Natural vectors: rodents and fleas - Bubonic plague and pneumonic plague

Gastrointestinal changes

- Nausea - Vomiting - Constipation - Bloating (belly feels swollen after eating) - Heartburn

Endocrine system changes in older adults

- Need more insulin because people get fatter but not able to create more insulin because you're old -> diabetes mellitus - Men: sperm creation until 80 year old - Women: size of uterus and vagina decrease - Sexual desire doesn't stop but decreases

Are placards and labels always required by the DOT

- No - "1,000 pound rule" -> Placards are required only when the shipment weighs more than 1,000 lb - But some chemicals are very hazardous -> placards no matter how much chemicals. Ex: explosives, poisonous gases, radioactive substances, water-reactive solids -> 4 digit United Nation number -> identifies the material being shipped -> list of UN numbers in Emergency Response Guidebook

Antitotes for sulfur mustard (H), lewisite (L), and phosgene oxime (CX)

- No antidotes for mustard gas or CX - British anti-lewisite is the antidote for agent L -> not carried by civilian EMS

Pertinent negatives when examining the chest

- No shortness of breath - No rapid breathing - No absent or abnormal breath sounds - No areas of deformity or abnormal movement - Equal expansion of the chest and movement of the rib cage and the diaphragm

Should you remove material from an open wound

- No, no matter how dirty the wound is - Rubbing, brushing, or washing an open wound can cause additional bleeding - However, small wound surfaces without significant bleeding can be flushed with sterile saline prior to applying a dressing

Linear skull fractures

- Nondisplaced skull fractures - 80% of all fractures to the skull - Usually in the temporal-parietal region - Risk of bleeding + infection if associated with laceration (otherwise, not life threatening)

Treatment of asthma, hay fever and anaphylaxis

- Normal or high HR + BP slightly high + RR increases - Asthma: pb is getting air out, not in - No BVM unless last resort - If stinger: first step is to remove it by scraping it off (don't pinch or squeeze-> inject venom) - WIth a kid they don't like face mask so to the blow by oxygen method (hold the mask close to the face) - Asthma in older patients -> bronchospasm, swelling of the lining of airways and accumulation of secretions

Epistaxis

- Nosebleed - Can cause blood loss great enough to send a patient into shock - The blood that is visible may be only a small part of the total blood loss - Much of the blood may pass down the throat into the stomach as the patient swallows -> Vomit blood, which is sometimes confused with internal bleeding

Dental loss

- Not a normal result of the aging process, but rather the result of disease of the teeth and gums - Contributes to nutritional and digestive problems

Cardiogenic shock

- Not enough O2 is delivered to the body, caused by low output of blood from the heart - More likely if AMI affects the left ventricle because it provides blood to the majority of the body - Can occur immediately or as late as 24h after the AMI

Nervous system in peds: brain and spinal injuries

- Not well developed, not well protected - Larger head -> more risk of trauma - Less cushion for the brain (smaller subarachnoid space) - More prone to bleeding of brain tissues - Spinal cord injuries are less common -> if injury then probably of the ligaments

Types of skilled care facilities

- Nursing home - Age-restricted apartments - Independent living facility: like the appartment + meals and social events - Assisted living facility: like the independent + daily meds with 24h assistance (including for Alzheimer and dementia)

Emergency care for chest pain

- O2 according to flashcard "Chest pain - primary assessment" - Low-dose aspiring (baby aspirin) - 81 mg chewable (not allergic or GI bleeding) - Assist with nitroglycerin (tablet SL, spray SL, patch) -> take BP every 4 min. If systolic < 100 don't give

Anxious-avoidant attachment

- Observed in infants who are repeatedly rejected. - Children show little emotional response to their parents and treat them as they would strangers - Develop an isolated lifestyle

Psychological changes in adolescents

- Obvious - They want to be treated like an adult, yet they want to be cared for like a young child - Antisocial 14-16 y - Higher risk for suicide and depression

Type of dressing for all penetrating injuries to the chest

- Occlusive dressing - Can be taped on 3 sides to allow air to escape during exhalation

Nontraumatic nosebleeds

- Occur from sites in the septum - Pinch the nostrils together to stop the bleeding with pt sitting and head tilted forward (stops the blood from going down the throat or being aspirated into the lungs) -> pressure for 15 min -> preferred method - Can also use a 4 in X 4 in rolled gauze bandage between the upper lip and gum - Can also apply ice over the nose

Crush syndrome

- Occurs when an area of the body is trapped for longer than 4h and arterial blood flow is compromised - When a patient's tissues are crushed beyond repair, muscle cells die and release harmful substances into the surrounding tissues - These harmful substances are released into the body's circulation after the limb is freed and blood flow is returned - For this reason, when possible, ALS administer IV fluid before the crushing object is lifted off the body - Freeing the limb -> release of harmful products + cardiac arrest and renal failure

Crushing injury

- Occurs when significant force is applied to the body - Cuts off circulation - For example, if a patient's legs are trapped under a collapsed pile of rocks, damage to the leg tissues will continue until the rocks are removed

Cardiac tamponade

- Occurs when the protective membrane around the heart (pericardium), the pericardial sac, fills with blood from a ruptured coronary artery or vein -> Heart less able to fill with blood during each relaxation phase -> cannot pump -> decrease in cardiac output - The pericardial sac can also fill as a result of cancer or an autoimmune disease such as lupus - More common with penetrating chest trauma, bust possible with blunt trauma - Also called pericardial tamponade

Injuries of the tibia and fibula

- Often both bones fracture at the same time - Tibia is located just beneath the skin -> open fractures common - Sometimes associated with vascular injury -> realign limb to restore blood flow

Fractures of the pelvis

- Often results from direct compression in the form of a heavy blow that literally crushes the pelvis - Might be life-threatening if loss of blood from the laceration of blood vessels -> hypotension, shock, death - Open fracture uncommon (muscles)

Thyroid gland

- On either side of the lower larynx and upper trachea - Not palpable (unless enlarged)

Eyes injury following head injury

- One pupil larger than the other - The eyes not moving together or pointing in different directions - Failure of the eyes to follow the movement of your finger as instructed - Bleeding under the conjunctiva, which obscures the sclera (white portion) of the eye - Protrusion or bulging of one eye

Structure of the nose

- Only the proximal third of the nose is formed by bone -> this part of the nose is called the bridge - Remaining two-thirds: cartilage

Menarche

- Onset of menstruation - 11-16 years old - Any female who has reached menarche is capable of becoming pregnant

Evisceration

- Open abdominal injury that goes through the skin and muscle layer -> organs protrude from the peritoneum - Cut the clothing around the wound - Never pull on any clothing stuck inside the wound channel - Moist sterile dressings - Occlusive dressing

Moderate injuries

- Open fractures of digits - Nondisplaced long bone fractures - Nondisplaced pelvic fractures - Major sprains of a major joint

Ulcers

- Open sores in the lining of the digestive system - Peptic ulcer disease (PUD) - Risk factors: chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, smoking - Burning or gnawing pain in the stomach that diminishes immediately after eating and then reemerges 2 to 3 hours later

Open and closed incidents

- Open: not yet contained -> patients who have yet to be located and the situation may be ongoing, producing yet more patients - Closed: contained, all casualties are accounted for -> Closed can turn into an open

Parasympathetic nervous system

- Opposite effect on the body as the SNS - Causes blood vessels to dilate, slowing the heart rate, and relaxing the muscle sphincters - The body shunts blood to the organs of digestion

2 categories of diagnosis - psychiatric

- Organic (physical): Organic brain syndrome and ALOC - Functional (psychological)

Tissues at risk in a blast injury

- Organs that contain air, such as the middle ear, lung, and gastrointestinal tract -> most susceptible to pressure changes - Ear most sensitive: ringing, pain, loss of hearing, blood - Also, junction between tissues of different densities and exposed areas such as head and neck tissues

Sternocleidomastoid muscles

- Originate from the mastoid process of the cranium - Allow movement of the head

Vagina

- Outermost cavity of a woman's reproductive system - Connects the uterus with the vulva - Lower part of the birth canal

Cardiovascular system changes during pregnancy

- Overall blood volume gradually increases throughout the pregnancy to allow for adequate perfusion of the uterus (up to 50% increase) - The number of red blood cells also increases, which increases the woman's need for iron - Pregnant women often take prenatal vitamin supplements containing iron to avoid becoming anemic - The speed of blood clotting increases to protect against excessive bleeding during delivery - Heart rate increases up to 20% to accommodate the increase in blood volume -> cardiac output is significantly increased by the end of the pregnancy - BP decreases

Hyperventilation

- Overbreathing to the point that the level of arterial carbon dioxide falls below normal - Patient with diabetes who has a high blood glucose level, a patient who has taken an overdose of aspirin, or a patient with a severe infection is likely to hyperventilate - Trying to compensate for acidosis -> can result in alkalosis (buildup of excess base) - Alkalosis is the cause of hyperventilation syndrome (panic attack), can't catch your breath -> try to calm down and have the pt breath slower. If doesn't work, give O2 and transport

Cholinergic agents

- Overstimulate the normal body functions controlled by the parasympathetic nervous system - Sarin gas attack - Also occur in garden care

Causes that can lead to similar symptoms as SIDS

- Overwhelming infection - Child abuse - Airway obstruction from a foreign object or as a result of infection Meningitis - Accidental or intentional poisoning - Hypoglycemia (low blood glucose level) - Congenital metabolic defects

Oxygen

- Oxygen - oxygen - Inert gas - Odorless, colorless, tasteless gas. It enters the body through the respiratory system and is transported to the cells for energy - Hypoxia, ischemic chest pain - None in the emergency setting (previous: very rarely used in patients with COPD) - Respiratory irritation, dried mucous membranes - 10-15 Lpm via NRB, 1-6 Lpm via cannula

Once you have recognized the incident as one involving hazardous materials and have called for the HazMat team...

- PA to alert people to move far from danger - Set up a perimeter to stop traffic

Treating foot injuries

- PMS - If pulse: splint, leaving the toes exposed so that you can periodically assess neurovascular function -> rigid padded board splint, an air splint, or a pillow splint, stabilizing the ankle joint and the foot -> on the stretcher, elevate the foot 6 in to minimize swelling -> supine position to allow for elevation of the limb - If fall with heel pain: backboard to immobilize any suspected spinal injury in addition to splinting the foot - If no pulse: medical control and discuss reduction of dislocation if the local scope of practice permits.

Treating elbow injuries

- PMS - Splint in position you found it + wrist sling -> 2 padded board splints with soft roller bandages; or - Mold a padded wire ladder splint or a SAM splint to the shape of the limb - If no pulse and significantly deformed: traction to decrease deformity -> restores pulse, otherwise splint

Examples of rigid splints

- Padded board - Molded plastic and metal - Padded wire ladder - Folded cardboard

Treating fractures of the tibia and fibula

- Padded rigid long leg splint or an air splint that extends from the foot to the upper thigh - Then secure with the opposite leg - Traction splints not indicated - Correct severe deformity before splinting by applying gentle longitudinal traction -> Goal: restore a position that will take a standard splint; not to get back to original anatomic position

Signs of open injury

- Pain - Late: tachycardia (compensate for blood loss) - Later: shock signs

6 Ps of musculoskeletal assessment

- Pain - Pressure - Paralysis - Paresthesia (numbness or tingling) - Pallor - Pulselessness

Acute myocardial infarction (AMI)

- Pain = death of cells in the area where blood flow is obstructed. Can't be revived -> scar tissue = burden to the beating heart - 20 after obstruction: cells begin to die. 2h: hald of cells dead. 4-6h: 90% dead - Clot-busing (thrombolytic) meds and angioplasty (mechanical clearing) -> prevent permanent damage if within few hours -> they open the coronary artery - More likely to occur in the left ventricle

Pleuritic pain

- Pain and tenderness are common in a chest injury - Breathing usually aggravates pain - Damage to the pleural surfaces causes a characteristic sharp with each breath -> pleuritic pain - Also called pleurisy

Referred pain

- Pain that is felt in a location other than where the pain originates - Result of connections between the two separate nervous systems. The nerves connecting the somatic nervous system and autonomic nervous system cause the stimulation of the autonomic nerves to be perceived as stimulation of the spinal sensory nerves. - Examples: - Right shoulder in cholestytitis - Jaw pain from myocardial infarction

Symptoms of compartment syndrome

- Pain that is out of proportion to the injury - Pain on passive stretch of muscles within the compartment - Pallor - Decreased sensation - Decreased power (decreased strength or complete paralysis) -> If fracture below the elbow or the knee, be on the lookout for these symptoms

Signs of vasoconstriction in peds

- Pallor (early sign) - Weak distal (eg, radial or pedal) pulses in the extremities - Delayed capillary refill - Cool hands or feet

Abdominal pain - two types of nerves

- Parietal peritoneum: same nerves as on the skin (those from the spinal chord) -> can locate pain easily - Visceral peritoneum: nerves from autonomous system -> can't locate pain accurately

Spleen

- Part of the lymphatic system - Assists in the filtration of blood, aids in the development of red blood cells, and serves as a blood reservoir - Also produces antibodies

Delivery - labor - general

- Partner at head to comfort + help if pt vomits + O2 if pt wants - Have insight the perineal area - Time the contractions: frequency + duration by feeling the abdomen - Ask the pt to take quick short breaths during each contraction but not to strain - Ask the pt to rest and breathe deeply though her mouth between contractions

Personality disorders

- Patients have persistent, maladaptive ways of perceiving, thinking, and relating to others. Non- functional in society and often oblivious to their disorder - Clusters A, B, and C (A worse)

AED - after a shock

- Patients who do not regain a pulse on the scene usually do not survive - If paramedics or another ALS service is responding to the scene, the best option usually is to stay where you are and continue the sequence of shocks and CPR. Administering CPR while patients are being moved or transported is usually not very effective - If no ALS, transport when one of the following occurs: - The patient regains a pulse - 6 to 9 shocks have been delivered - 3 consecutive messages (separated by 2 minutes of CPR) that no shock is advised - AED cannot analyze the rhythm while the vehicle is in motion -> car to a complete stop if more shocks are needed

When is activated charcoal not indicated/effective

- Patients who have ingested alkali poisons, cyanide, ethanol, iron, lithium, methanol, mineral acids, or organic solvents - Don't give if ALOC or unable to protect airway

Pathophysiology of the renal system in geriatrics

- Pbs in fluid and electrolyte balance, e.g., sodium deficiency -> severe dehydration - Capacity of the bladder decreases -> need to go to bathroom faster - 2 types of incontinence: - Stress: occurs during activities such as coughing, laughing, sneezing, lifting, and exercise - Urge: triggered by hot or cold fluids, running water, and even thinking about going to the bathroom -> Treatment of incontinence: meds, PT, surgery - Opposite of incontinence: urinary retention and difficulty urinating (prostate larger in men -> pressure on urethra) -> UTI + renal failure

Car seat

- Peds < 40 pounds (18 kg) who do not require spinal immobilization should be transported in a car seat - If spinal immobilization or cardiac arrest: don't use a car seat -> long backboard or other immo device - Don't use pt's own car seat - Not in front of ambulance - Mount it to stretcher or captain's chair - < 2 y: rear-facing position because weak neck muscles

Layers of the heart

- Pericardium: tough protective layer. Between peri and myo: epicardium - Myocardium: muscle - Endocardium: inner lining -> heart | endo | myo | epi | peri

Incubation

- Period of time between the person becoming exposed to the agent and the appearance of the first symptoms -> Does not mean the person is not contagious! Ex: Covid

Glucose metabolism

- Person eats, blood glucose level rises, pancreas secretes insulin into the blood, glucose enters body's cells and is used for energy, glucose is also stored as glycogen in the liver and skeletal muscles for use later, blood glucose levels return to normal, insulin stops being secreted - Person becomes hungry but does not eat, message is sent to the pancreas to secrete glucagon, glucagon stimulates liver and skeletal muscles to release glycogen, converts glycogen back to glucose for use as cellular fuel

Gynecologic emergencies - secondary assessment pertinent findings

- Pertinent findings: - Vital signs: blood pressure, pulse, skin color, - Orthostatic vital signs - Abdomen: distention and tenderness - Genitourinary: visible bleeding - Neurologic: mental status - Only examine the genitalia if it is necessary to do so to treat the patient - Focus on the NOI and CC - Ask about quality and quantity of bleeding -> keep hypoperfusion and shock in mind

Physical dependence vs psychological dependence

- Physical dependence: the body becomes unable to function normally without the drug and the person is said to be addicted -> "the body has to have it" - Psychological dependence: the belief that the drug is needed to continue a feeling of emotional well being -> "it makes me feel good"

Functional disorder

- Physiological disorder that impairs bodily function when the body seems to be structurally normal -> Something has gone wrong, but the root cause cannot be identified. - Examples: schizophrenia, anxiety conditions, and depression

External ear

- Pinna (or auricle): part lying outside of the head, - External auditory canal: leads in toward the tympanic membrane, or eardrum.

Treating bites

- Place a dry, sterile dressing over the wound - If an arm or leg was injured, splint that extremity - Transport

How to assess the abdomen

- Place the patient in a supine position with the legs drawn up and flexed at the knees to relax the abdominal muscles - Palpate in a clockwise direction beginning with the quadrant after the one the patient indicates is painful; end with the quadrant the patient indicates is painful. - Palpate and wait for the patient to respond, looking for a facial grimace or a verbal "ouch." Do not ask the patient, "Does it hurt here?" as you palpate. - Rebound tenderness: indicator of peritonitis

Delivery of placenta

- Placenta attached to the end of the umbilical cord - Placenta will deliver itself - Round, 7 in diameter, 1 in thick - Wrap it in towel -> plastic bag and bring to hospital - Sterile pad over vagina + slow bleeding by massaging abdomen in a circular motion

Type 1 diabetes - symptoms

- Polyuria - Polydipsia - Polyphagia - Weight loss - Fatigue

RLQ organs

- Portions of the large and small intestines that include the ascending colon and the right half of the transverse colon - Appendix (distal end of the descending colon)

Preconventional, conventional, and postconventional reasonings

- Preconventional: children act almost purely to avoid punishment and to get what they want - Conventional: they look for approval from their peers and society - Postconventional: they make decisions guided by their conscience

Hypertensive disorders - (pre-)eclampsia - pregnancy

- Pregnancy induced hypertension - Can develop after the 20th week - Symptoms of preeclampsia: hypertension + headache + impaired vision + hand/feed swelling - Eclampsia: seizures as a result of hypertension

5 major NIMS components

- Preparedness - Communications and information management - Resource management - Command and management - Ongoing management and maintenance

Mean Arterial Pressure (MAP)

- Pressure that propels blood to tissues - (systolic + 2*diastolic)/3

Intracranial pressure (ICP)

- Pressure within the cranial vault (i.e., inside the skull) - Increased ICP squeezes the brain against bony prominences within the cranium - Signs: Cheyne-Stokes or ataxic (Biot) respirations - Other sign: Cushing reflex

3 factors of the MOI of a blast injury

- Primary blast injury - Secondary blast injury - Tertiary blast injury

Vesicants (blister agents): route, symptoms, types, targeted areas

- Primary route: skin - Can also produce vapors - Cause burn-like blisters to form on the victim's skin and in the respiratory tract - Consist of sulfur mustard (H), lewisite (L), phosgene oxime (CX), and sulfur (the symbols H, L, and CX are military designations for these chemicals) - Mainly damage to damp or moist areas: armpits, groin, and respiratory tract

Primary and secondary TBIs

- Primary: injury to the brain that results instantaneously from impact to the head - Secondary: - Multitude of processes that increase the severity of a primary brain injury - Most common causes: hypoxia and hypotension - Other causes: cerebral edema, intracranial hemorrhage, increased intracranial pressure, cerebral ischemia, and infection -> Few minutes to several days following the initial head injury

Primigravida and multigravida

- Primigravida: being pregnant for the first time - Multigravida: woman who has experienced more than one pregnancy

Life threats

- Problems with the ABCs - Poor initial general impression - Unresponsiveness - Potential hypoperfusion or shock - Chest pain associated with a low blood pressure - Severe pain anywhere - Excessive bleeding

Botulinum

- Produced by bacteria - Most potent neurotoxin - Affects the nervous system's ability to function and causes botulism -> Accessory muscles and diaphragm paralyzed -> Respiratory arrest

Cerebral spinal fluid (CSF)

- Produced in a chamber inside the brain, called the third ventricle - CSF is located in the subarachnoid space below the arachnoid - 125-150 mL of CSF in the brain - CSF primarily acts as a shock absorber -> the brain and spinal cord essentially float in this fluid, buffered from injury

PASTE

- Progression - Associated chest pain - Sputum - Talking tiredness - Exercise tolerance

Osteoarthritis

- Progressive disease of the joints that destroys cartilage, promotes the formation of bone spurs in joints, and leads to joint stiffness - Hands, knees, hips, and spine - Pain gets worse with exertion - Cause: "wear and tear" and, in some cases, from repetitive trauma to the joints - Affects 35-45% > 65 y - Treatment: anti-inflammatory meds + PT

Delivery complications - summary

- Prolapsed cord presentation - Meconium staining - Nuchal cord - Breech delivery - Limb presentations - Postpartum hemorrhage - Pulmonary embolism - Prolapsed uterus

Functions of the skeleton

- Protects our vital internal organs - Allows us to move - Produce blood cells in the bone marrow - Reservoir for minerals and electrolytes

Functions of the skin

- Protects the body by keeping pathogens out and fluids in - Helps regulate body temperature - The nerves in the skin report to the brain on the environment and on many sensations

Cranium

- Protects the brain - 80% brain tissue, 10% blood supply, and 10% CSF - 4 bones: occiput, temples or temporal regions, parietal regions, and frontal regions

Albuterol

- Proventil, Ventolin - albuterol - Beta-2 agonist - Activates the sympathetic nervous system by stimulating beta-2 adrenergic receptors, causing bronchodilation - Asthma or COPD - Hypersensitivity, unable to hold device, unable to inhale - Tachycardia, anxiety, tremors - 1-2 puffs via inhalation

Public information officer (PIO) and joint information center

- Provides the public and media with clear and understandable information - Positions his headquarters away from the incident to minimize distractions + keep media safe from incident - The designated PIO may cooperate with PIOs from other agencies in a joint information center (JIC)

Fractures of the humerus

- Proximally: falls in old people - In the midshaft: young pts - Distally at the elbow - Treatment: sling and swathe supplemented by a padded board splint on the lateral aspect of the arm

Schizophrenia

- Pt has lost touch with reality - Onset typically occurs during early adulthood - Symptoms: become prominent over time. Delusion, hallucinations, lack of interest in pleasure, and erratic speech

Secondary assessment in gastro and uro emergencies

- Pts are comfortable only when lying in one particular position, which tends to relax muscles adjacent to the inflamed organ and thus lessen the pain (appendicitis may draw up the right knee, pancreatitis may lie curled up on one side) - A normal abdomen is soft and not tender to the touch. Pain and tenderness are the most common symptoms of an acute abdomen - You will find tenderness on palpation of the abdomen or when the patient moves

Strain

- Pulled muscle - Stretching or tearing of the muscle and/or tendon - Difference with sprain: - No ligament or joint damage occurs - Swell less than a sprain

Phosgene: how it's produced, symptoms, incubation

- Pulmonary agent that is a product of combustion, resulting from a fire at a textile factory or house or from metalwork or burning Freon - Symptoms: vomiting, tightness in chest, cough (with pulmonary edema), dyspnea on exertion - Very potent agent + delayed onset of symptoms (hours)

Pulmonary blast injuries

- Pulmonary trauma that results from short-range exposure to the detonation of explosives - Tightness/pain in the chest + cough up blood + tachypnea - Subcutaneous emphysema (crackling under the skin) -> air in the thorax -> pneumothorax - Arterial air embolism - Provide O2 but not PPV (increase damage to lungs). Be careful with IV (cause pulmonary edema)

Pulmonary and systemic circulations

- Pulmonary: between heart and lungs - Systemic: between heart and body tissues

Pulseless activity VS asystole

- Pulseless activity: cardiac arrest but organized electrical activity - Asystole: no electrical activity (flatline)

Crack

- Pure cocaine - Smoked - Effects in a few seconds -> most rapid means of absorption

Preparing the delivery field - labor

- Put on PPE + towels around for body fluids - Open the OB - Sterile gloves on - Use the sterile sheets and drapes from the OB kit - 1 drape under buttocks, and unfold it toward her feet. Wrap another behind back and drape it over each thigh, and drape one sheet across her abdomen

Common questions following the death of a child

- Q: Was there pain? A: This often can be answered by a simple "No." If you are uncertain, you may give an indirect answer such as, "We really don't know what patients feel in these circumstances." - Q: What did the child die of? A: Do not answer this question; you would probably be guessing. - Q: Why did this happen? A: Do not answer this question either, as the answer depends on one's own individual philosophy or religion. "I wish I had an answer for you," is usually the most appropriate response. - Q: What happens now? A: This question usually concerns the next few minutes or the next hour. If you know, give the family a general idea of what will happen. For example, if there is no history of illness, you can say, "A medical examination will be done, and then [child's name] will be taken to the mortuary."

Electrocardiogram PR interval and QRS complex

- QRS complex: - Time for the electrical impulse to spread through the ventricles. - 0.06-0.12 s - PR interval: - Time between the onset of atrial and ventricular depolarizations - 0.12-0.2 s

Peripheral pulses

- Radial, brachial, posterior tibial, and dorsalis pedis pulses - Weak or absent -> decreased perfusion

Breech delivery - head entrapped following delivery of the baby

- Rapid transport - High flow oxygen - Insert gloved hand and push vaginal wall away from face, creating "V" airway - Consider MD contact

Respiratory system changes during pregnancy

- Rapid uterine growth occurs during the second trimester -> pushes up on the diaphragm -> increased respiratory rates and decreased minute volumes - The pregnancy also increases the patient's overall demand for O2 to support the developing fetus

Dive bottom emergencies

- Rare - Inadequate mixing of O2 and CO2

Fracture of the femur in peds

- Rare in pediatric patients - When it does occur, it is a source of major blood loss - Older children and adolescents are prone to long bone fractures (femur and humerus) because they tend to take more risks during physical activities - Goal: immobilize + pain relief once ALS is here

Injuries to the uterus, ovaries, and fallopian tubes

- Rarely damaged: small and deep in the pelvis - Exception: pregnant -> uterus enlarges so more vulnerable

Injuries to testicles

- Rarely life-threatening - Referred pain to lower abdomen

Destination decisions in MCI

- Red or yellow -> ground ambulance or air ambulance to the most appropriate facility (trauma, burn, or pediatric center, etc) - Red: 2 pts at a time - Yellow: 2 or 3 pts at a time - Green: bus (if lots of people) to a clinic far from the MCI to avoid overwhelming the local area hospitals. 1 EMT or medic onboard - Transport red then yellow then green then black if still alive (if not then local protocols deal with them)

Level I trauma care

- Regional resource center and generally serves large cities or heavily populated areas - Provide every aspect of trauma care from prevention through rehabilitation - Most Level I facilities are university-based teaching hospitals

How well body can compensate for blood loss

- Related to how rapidly the blood loss occurs. Also to age and preexisting health - 1 unit, or roughly 1 pint (500 mL) of blood within 15 to 20 minutes is ok - But if this same volume lost quicker -> hypovolemic shock

Types of terrorist groups

- Religious extremist groups/doomsday cults - Extremist political groups: separatist groups + those who seek political, religious, economic, and social freedom - Cyber terrorists - Single-issue groups: antiabortion groups, animal rights groups, anarchists, racists, and ecoterrorists

How to deal with bystanders with a violent pt

- Remove everyone from the scene who is not needed, such as family, friends, or bystanders - If a family member has a positive influence on the patient, they can stay and help

How to perform secondary assemt examination on pt with abdo injury

- Remove or loosen clothes - Provide privacy - If no suspected spinal injury: position of comfort (legs pulled up toward the abdomen or fetal position) - If spinal injury, blankets under the his knees to help alleviate tension on the abdominal wall - DCAP-BTLS starting with quadrant farthest away from the quadrant with pain. Light palpation first, then deeper

Absorbed and surface contact poisons - treatment

- Remove substance from pt - Remove all clothing that has been contaminated - If dry powder: brush off the powder + flush the skin with water for 15-20 min + wash with soap - If liquid: flood the affected part for 15-20 mins - If in the eyes: irrigate them quickly and rapidly. Make sure the fluid runs from the bridge of the nose outward -> to avoid contaminating the other eye

Urinary changes

- Renal blood flow increases - Filtration increases - Anterior/superior displacement of urinary bladder - Polyuria

Shipping papers

- Required whenever materials are transported from one place to another - Include the names + addresses of shipper/receiver + material + quantity/weight - Shipping papers for road and highway transportation are called bills of lading or freight bills -> Located in the cab of the vehicle + on driver if chemicals are transported

Type 2 diabetes

- Resistance to the effects of insulin at the cellular level -> the lock is unable to accept the key - Risk factor: obesity

Lower respiratory emergencies

- Respiratory Syncytial Virus - Bronchiolitis - Pneumonia - Pertussis - Pulmonary Edema - COPD - Covid-19 - Asthma

2 differences between a disaster and MCI

- Responders on the scene of a disaster for days to weeks and sometimes months (Hurricane Katrina) - You can "declare" an MCI as an EMT, but only an elected official can declare a disaster

RICES

- Rest: keep the patient as quiet and comfortable as possible. - Ice: use ice or cold packs to slow bleeding by causing blood vessels to constrict and also to reduce pain. - Compression: apply pressure over the injury site to slow bleeding by compressing the blood vessels. - Elevation: raise the injured part just above the level of the patient's heart to decrease swelling. - Splinting: immobilize a soft-tissue injury or an injured extremity to decrease bleeding and reduce pain. -> mnemonics to treat a closed soft-tissue injury -> also be alert for shock

Right sided VS left sided heart failure

- Right-sided heart failure: - Fluid backs up into the body - Jugular vein distention - Ascites (fluid in the abdomen) - Peripheral edema in the body tissues - Enlarged liver - Often caused by left-sided heart failure - Left-sided heart failure: - Fluid backs up into the lungs - Causes pulmonary edema - Severe shortness of breath and hypoxia with crackles in the lungs - Paroxysmal nocturnal dyspnea

Pacemaker firing rate for each node

- SA: 60-100 - AV: 40-60 - Purkinje fibers: 20-40

Mandible fractures

- Second only to nasal fractures - Result of vehicle collisions and assaults - Strong probability additional facial trauma and/or cervical injuries - Signs: misalignment of the teeth, numbness of the chin, and an inability to open the mouth

Liver

- Secretes bile -> used for digestion of fats - Filters toxic substances produced by digestion, - Creates glucose stores - Produces substances for blood clotting and immune function

Pancreas

- Secretes juice containing enzymes that help break down starches, fats, and proteins - Example: Amylase, which breaks down starches into sugar - Produces bicarbonate and insulin. Bicarbonate neutralizes the stomach acid in the duodenum, and insulin helps regulate the levels of glucose in the bloodstream

Organizational levels of ICS

- Sections: responsible for a major functional area such as finance, logistics, planning, or operations - Branches: managed by the branch director, may be functional or geographic in nature. -> Established when span of control is a problem; for example, at larger incidents, where more oversight may be needed. In charge of activity directly related to the section (ie, fire, law enforcement, EMS, operations, etc) - Divisions: align resources and/or crews under one supervisor. Divisions usually refer to crews working in the same geographic area. Groups usually refer to crews working in the same functional area, but possibly in different locations

How to administer oral glucose

- See Skill Drill 19-1 - You put the paste on a bite stick that you then put between the cheek and gum (gel touches the cheek) - The pt shouldn't swallow -> faster effect when dissolved in mouth than ingested

How to apply cervical collar

- See Skill Drill 28-2 p. 1005

How to insert oral airway in peds

- See Skill Drill 34-2 p. 1246 - Measure from angle of jaw to front of teeth or use the Broselow tape - Insert the airway by depressing the tongue with a tongue blade applied to the base of the tongue and inserting the airway directly over the tongue blade - If no tongue blade available then 180° maneuver (like an adult)

Hearing changes in geriatrics

- Sensory change that affects the most older people - Wear and tear on the ears from noise damages the inner ear - Main factors: heredity and long-term exposure to loud noises - Can also cause problems with balance and make falls more likely - Presbycusis

2 major types of peripheral nerves + connecting nerves

- Sensory nerves: information from the body to the brain via the spinal cord - Motor nerves: - information from the CNS to the muscles - 1 for each muscle - Connecting nerves: - Found only in the brain and spinal cord - Connect the sensory and motor nerves with short fibers, which allow the cells on either end to exchange simple messages

Sensory neurons, motor neurons, and interneurons

- Sensory: impulse -> NS - Motor: NS -> impulse - Interneuron: connect sensory and motor neurons

Level III trauma care

- Serve communities that do not have access to Level I or II facilities - Level III facilities provide assessment, resuscitation, emergency care, and stabilization - Must have transfer agreements with a Level I or II trauma center and must have protocols in place to transfer patients

Abused inhalants

- Several of the same CNS effects as do other sedative- hypnotics, but these agents are inhaled instead of ingested or injected -> "huffing" - Not medications. Rather, displace oxygen in the brain and cause a rush of euphoria - Cheap so used by teenagers

Traumatic asphyxia

- Severe compression is applied to the chest -> Forces blood from the great vessels back into the head and neck - Signs: - Distended neck veins - Cyanosis - Hemorrhage into the sclera of the eye - Treatment: O2 + transport

Symptomatic hypoglycemia

- Severe hypoglycemia resulting in changes in mental status - Occur when pt injects insulin or use oral medications that stimulate the pancreas to produce more insulin -> glucose is rapidly taken out of the blood to fuel the cells -> not enough glucose remaining for the brain -> ALOC + brain damage - Occurs much more quickly than hyperglycemia

Intermodal tanks

- Shipping and storage vessels - 5,000-6,000 gallons - Can also be used to ship and store gaseous substances that have been chilled until they liquefy, such as liquid nitrogen

Upper extremity

- Shoulder to fingertips - Upper arm (humerus) - Elbow - Forearm: - Radius: larger than ulna - Ulna - Parallel -> if one is broken, this other one too - Hand - Joins the shoulder girdle at the glenohumeral joint

Lateral whiplash injury

- Shoulders and head whip toward the intruding vehicle - Thrust the shoulder, thorax, and upper extremities, and, the skull against the doorpost or the window - The cervical spine has little tolerance for lateral bending

Shoulder dystocia

- Shoulders larger than head and unable to fit through birth canal -> "turtle sign" - Management: - McRoberts maneuver = flexing the mother's thighs toward her shoulders - Gaskin maneuver = inserting the fingers and rotating the shoulder toward the fetal chest - Suprpubic pressure = pressure from the side of the fetal back just above the mum pubis - Instruct mom not to push + call MD + transport if above doesn't work

3 types of blood diseases

- Sickle cell disease (also called hemoglobin S disease) - Hemophilia A (also called classic hemophilia or factor VIII deficiency) - Thrombophilia

Primary assessment in hematologic disorders

- Sickle cell disease: - Respirations are normal to rapid - Pulse weak and rapid - Low BP - Skin pale and clammy - Hemophilia: check for blood loss such as pallor, weak pulse, and hypotension

Signs of hemothorax

- Signs and symptoms of shock without any obvious external bleeding or apparent reason for the shock state - Decreased breath sounds on the affected side - Pink frothy sputum - Collapsed neck veins - Dullness to percussion

Signs and symptoms of abdominal injuries

- Signs: - Firmness on palpation of the abdomen - Obvious penetrating wounds - Bruises - Increased HR, increased respiratory rate, decreased BP - Shallow respirations - Symptoms: - Abdominal tenderness, - Difficulty moving because of pain

Synthetic cathinones (bath salts)

- Similar to MDMA - Commonly includes MDPV - Don't confuse with Epsom salt (Ivory Wave or Cloud Nine) - Nasal route

Maternal cardiac arrest

- Similar to nonpregnant - few minor differences - In the last month or two of pregnancy, compressions may need to be applied a little higher on the sternum than usual - 1 provider should be assigned to manually displace the uterus toward the patient's left side to facilitate blood return to the right side of the heart

Hallucinogens - treatment

- Similar to sympathomimetics - Calm, professional manner, and provide emotional support. No restraints unless you or the patient is in danger of injury.

Assessing breath sounds

- Sitting position - Normal (vesicular or bronchial), decreased, absent or abnormal (adventitious breath sounds) - Compare left and right - Between and below the scapulae - Full respiratory cycle - Not hearing flow of air -> absent lung sound -> significant finding

Prolapse of the umbilical cord

- Situation in which the umbilical cord comes out of the vagina before the fetus - Dangerous because fetus's head compress the cord -> no O2 -> don't push cord back into vagina - Keep fetus's head from compressing the cord: - Woman in supine with legs raised 6-12 in or woman in knee-chest position (kneeling and bent forward) - Insert hand into vagina to push fetus's head away from the cord

How to inser nasal airway in peds

- Size: from the tip of the nose to the tragus of the ear - The right naris is commonly larger than the left naris in most patients - Bevel towards the septum (same technique as with an adult - rotate 180° after 1 inch in if left naris)

Delivery - labor - details

- Skill Drill 33-1 p. 1197 - Support the newborn's head with the neck in a neutral position to keep the airway open - After delivery and prior to cutting the cord, if the child is gurgling or shows other signs of respiratory distress, suction the mouth

Post-delivery care

- Skin-to-skin contact -> warm and improve perfusion - Dry newborn + wrap him/her in blanket (face out only) -> newborns very sensitive to temperature - Neck neutral position so airway remains open - Newborn on one side, head slightly lower than rest of body -> always keep the head slightly downward to prevent aspiration - Umbilical cord: infection can be transmitted. Wait for cord to stop pulsating then 2 clamps 6 in from newborn and 2-4 in from each other -> cut between them - Obtain Apgar score

Cranium

- Skull - Contains the brain - Most posterior portion: occiput - Sides: temples and temporal regions (just anterior to the ear, with temporal artery) - Between the temporal regions and the occiput: parietal regions - Forehead: frontal region

Skull, thoracic cage, lower ribs and bony spinal canal -> what do they protect

- Skull: protects the brain - Thoracic cage: protects the heart, lungs, and great vessels - Lower ribs: protect the liver and spleen - Bony spinal canal: protects the spinal cord

Contact lenses

- Small, hard: easy to see - Last, soft: hard to see - Do not attempt to move or remove the lense - Exception: chemical burn - Small suction cup - 2 drops of saline in the eye - Pinch it between thumb and index and lift it off the surface of the eye - Place it in a container filled with sterile saline solution

Anatomic differences between the adult and pediatric airway

- Smaller in diameter and shorter in length - Lungs are smaller - Heart is higher in a child's chest - Glottic opening (vocal cords) is higher and positioned more anteriorly (toward the front) - The neck appears to be nonexistent - As the child develops, the neck gets proportionally longer as the vocal cords and epiglottis achieve their anatomically correct adult position - A larger, rounder occiput, or back of the head, which requires more careful positioning of the airway - A proportionately larger tongue relative to the size of the mouth and a more anterior location in the mouth - A long, floppy, U-shaped epiglottis in infants and toddlers is larger - A narrowing funnel-shaped (wide to narrow) upper airway compared to that of a cylinder-shaped (same width) lower airway.

Easy way to differentiate the smallpox rash from other skin disorders

- Smallpox: all the lesions are identical in their development - Other skin disorders: the lesions will be in various stages of healing and development - Smallpox blisters begin on the face and extremities and eventually move toward the chest and abdomen

Fontanelles

- Soft spots on the newborn's skull that will eventually become covered with bone - At birth, the brain is covered only with skin and membranes at these areas - 2 primary fontanelles: 1 on the top of the head and 1 near the back of the head

Rupture of the amniotic sac

- Some women experience a premature rupture of the amniotic sac, before the fetus is ready to be born -> may or may not go into labor - Can happen several months before they are due - Provide supportive care and transport - These patients are usually placed on bed rest and followed up closely by an obstetrician

Triage

- Sort your patients based on the severity of their injuries - Primary: initial triage done on the field -> number + category attributed - Secondary (or "retriage"): done as patients are brought to the treatment area

Spina bifida

- Spinal cord or meninges may protrude outside of the vertebrae and possibly outside of the body - Cover it with sterile dressing

Treating a shoulder dislocation

- Splint the joint in whatever position is most comfortable for the patient - Place a pillow or rolled blankets or towels between the arm and chest - Apply a sling and swathe Don't try to put it back in place -> hospital

Treating compartment syndrome

- Splint, keeping it at the level of the heart - Transport, reassessing PMS during transport - Surgery required

If struck by lightning

- Stabilize head (injuries due to electric shock) + jaw-thrust maneuver - ABC - Always transport, even if no life threats

Object impaled in the eye

- Stabilize: - Bandage the object in place to support it - Cover the eye with a moist, sterile dressing - Surround the object with a doughnut-shaped collar made from roller gauze - Transport

Stages of pressure ulcers

- Stage I: Nonblanching redness with damage under the skin - Stage II: Blister or ulcer that can affect the dermis and epidermis - Stage III: Invasion of the fat layer through to the fascia - Stage IV: Invasion to muscle or bone

Emergency medical care for COPD

- Starts with O2 2L/min (low flow) then 3L/min then 4L/min until symptoms improved - Careful: a decreased respiratory rate after giving O2 doesn't necessarily mean the pt no longer needs the O2 - might actually need more

Psychosis

- State of delusion in which the person is out of touch with reality - Live in their own reality of ideas and feelings - Voices and feelings within - Causes: mind-altering substances most common causes. Other: stress, delusional disorders, and, more commonly, schizophrenia

Direct pressure and pressure dressing

- Stops the flow of blood and permits normal coagulation - With your fingers or hand over the top of a sterile dressing - Then wrap a sterile, self-adhering roller bandage around the entire wound - 4-in × 4-in sterile gauze pads for small wounds - Sterile universal dressings for larger wounds - Bandage above and below the wound - If bleeding continues: apply more dressing - If still continues: tourniquet with patient supine. If too proximal: hold pressure until you arrive at the hospital

Bags (nonbulk storage vessels)

- Store solids and powders such as cement powder, sand, pesticides, soda ash, and slaked lime. - Plastic, paper, or plastic-lined paper - Label for pesticide bag with statement "Keep out of reach of children"

Secondary assessment with neuro emergencies - assessing if it's a stroke

- Stroke: - Cincinnati Prehospital Stroke Scale: FAST - Los Angeles Prehospital Stroke Screen - 3-item Stroke Severity Scale (LAG): Level of consciousness, Arm drift, Gaze -> each 0 to 2 (0 normal) -> 5-6 stroke

Delirium

- Sudden change in mental status, consciousness, or cognitive processes - Marked by the inability to focus, think logically, and maintain attention, potential acute anxiety - Memory remains intact - Affects 10-15% of hospitalized > 70 y - Causes: - Reversible physical ailment, such as tumors or fever - Intoxication or withdrawal from alcohol, withdrawal from sedatives - UTI, bowel obstruction - Dehydration - Fever - Cardiovascular disease - Hyper/hypoglycemia - Depression - Malnutrition or vitamin deficiencies - Environmental emergencies

Signs and symptoms of pulmonary embolism

- Sudden onset of SOB - Tachycardia - Tachypnea - Varying degrees of hypoxia - Cyanosis - Sharp pinpoint chest pain - Hemoptysis (coughing up blood)

Signs and symptoms of AMI

- Sudden onset of weakness, nausea and sweating without obvious cause - Chest pain, discomfort, or pressure - Pain, discomfort or pressure in lower jaw, arms, back, abdomen or neck - Irregular heart beat and syncope - Shortness of breath - Nausea, vomiting - Pink, frothy sputum - Sudden death

Seizure

- Sudden surge of electrical activity in the brain - Convulsion: generalized uncoordinated muscle activity - Temporary alteration in consciousness - Common cause: epilepsy

3 types of depth of a burn

- Superficial (first-degree) - Partial-thickness (second-degree) - Full-thickness (third-degree)

Structures of the neck

- Supported by the cervical spine, or the first seven vertebrae in the spinal column (C1 through C7) - The spinal cord exits from the foramen magnum - Upper part of the esophagus and the trachea lie in the midline of the neck - The carotid arteries + jugular veins + nerves on either side of the trachea

Pelvis

- Supports the body weight and protects the structures within the pelvis: the bladder, rectum, and female reproductive organs - 3 separate bones: ischium, ilium, and pubis - Fused together = innominate (or hip) bone - The two iliac bones are joined posteriorly by tough ligaments to the sacrum at the sacroiliac joints - The two pubic bones are connected anteriorly by ligaments at the pubic symphysis - Very little motion -> pelvic ring is strong and stable

Emergency obstetric (OB) kit

- Surgical scissors or a scalpel - Umbilical cord clamps - A small rubber bulb syringe - Towels, drapes, or sheets - 4-inch × 4-inch (10-cm × 10-cm) gauze sponges and/or - 2-inch × 10-inch (5-cm × 25-cm) gauze sponges - Sterile gloves - Infant blanket Sanitary pads - An infant-sized BVM Goggles - A plastic bag

Sweat glands, hair follicles, and sebaceous glands

- Sweat glands: - Primary function: cool the body - Discharge sweat onto the surface of the skin through small pores, or ducts, that pass through the epidermis - Sebaceous glands: - Produce sebum = oily material that waterproofs the skin and keeps it supple - Sebum travels to the skin's surface along the shaft of adjacent hair follicles - Hair follicles: - Small organs that produce hair - 1 follicle for each hair, each connected with a sebaceous gland and a tiny muscle - This muscle pulls the hair erect whenever a person is cold or frightened

2 most efficient methods to decrease heat

- Sweating - Dilation of blood vessels -> brings heat to the skin -> increase rate of heat radiation

Hemorrhoids

- Swelling and inflammation of the blood vessels surrounding the rectum - Internal or external - Red blood during defecation - Itching and a small mass on the rectum (clot formed in response to the mild bleeding)

2 sections of the autonomic system

- Sympathetic nervous system - Parasympathetic nervous system

List of toxidromes

- Sympathomimetic (Adrenergic) (Stimulant) - Anticholinergic - Cholinergic - Opioid - Sedative-hypnotic - Hallucinogens

Difference seizure VS syncope

- Syncope: occurs while patient is standing + no postictal state - Seizure: occurs in any position

Signs of shocks in peds

- Tachycardia - Poor capillary refill (>2 seconds) - ALOC

Anticholinergics signs and symptoms

- Tachycardia - Hyperthermia - Hypertension - Dilated pupils - Sedation, agitation, seizures, coma, or delirium - Decreased bowel sounds - "Hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter"

Treatment of local cold injuries

- Take pt out of the cold - Remove anything wet - Splint extremity and cover it - Frostbite: cover + don't rewarm the part (diff from frostnip). Can immerse in warm water (102-104°F) except if chance of freeze again on transport - Frostnip: your hands on pt's body to warm up - Foot immersion: remove wet shoes + rewarm foot gradually - Don't massage - Don't break blisters

Assessment of a child

- Talk to the child, not just the parent - HEAD to TOE (like an adult) - Give him simple, appropriate choices, such as "Would you like to sit up or lie down?" or "Would you like to take off your clothes yourself?" or "BP right or left arm?" - Can understand the difference between emotional and physical pain

Steps you can take to decontaminate the ambulance before arrival on scene

- Tape the cabinet doors shut - Any equipment kits, monitors, and other items that will not be used en route should be removed from the patient compartment and placed in the front of the ambulance or in outside compartments - Before loading the patient, turn on the power vent ceiling fan and patient compartment air-conditioning unit fan. - Unless the weather is too severe, the windows in the driver's area and sliding side windows in the patient compartment should also be partially opened

Mallory-Weiss tear

- Tear in the junction between the esophagus and the stomach, causing severe bleeding and potentially death - Primary risk factors include alcoholism and eating disorders - Symptom: vomiting

Dislocation of the platella

- Teenagers and young adults athletes - A minor twisting may be enough to produce the problem - Usually, the dislocated patella displaces to the lateral side -> Splint the knee in the position in which you found it -> Padded board splints to the medial and lateral aspects of the joint, extending from the hip to the ankle

Hyperthermia def + body response

- Temperature > 101°F (38.3°C) - Usually tachycardia and tachypnea

Organic brain syndrome

- Temporary or permanent dysfunction of the brain, caused by a disturbance in the physical or physiologic functioning of brain tissue - Causes: sudden illness; traumatic brain injury; seizure disorders; drug and alcohol abuse, overdose, or withdrawal; and diseases of the brain, such as Alzheimer dementia or meningitis.

Does the baby need resuscitation?

- Term? - Breathing or crying? 15-30s after birth + HR 120/min - Muscle tone? If yes, no resuscitation needed If not, stimulate baby

Urinary bladder

- The bladder empties to the outside of the body through the urethra - 1.5 to 2 L of urine every day

Headaches - general

- The brain and skull do not actually sense pain because neither contains pain receptors - Pain felt from the surrounding areas: scalp, meninges (membranes that cover the brain and spinal cord); larger blood vessels; and the muscles of the head, neck, and face

Injuries to the head

- The brain itself may tear or become bruised, causing bleeding - The blood vessels around the brain may also tear and produce bleeding - Bleeding or swelling inside the skull from brain injury is often life threatening

Accelerated HR or RR with chest injury

- The chest injury may be causing either a decrease in available oxygen (hypoxia) or blood loss that results in a decreased number of red blood cells that can carry oxygen (hypoxemia) - The increased RR is often associated with an obvious increase in work of breathing -In the later stages of injuries, the HR can slow as the myocardium becomes starved for oxygen and the body is no longer able to keep up with the demands - The RR may drop as the brain becomes starved for oxygen and overloaded with carbon dioxide and other waste products - These are usually signs of impending cardiopulmonary arrest

3 collisions of a typical impact

- The collision of the car against another car, a tree, or some other object -> Affect only the car but the greater the damage to the ca the greater the potential to cause injury - The collision of the passenger against the interior of the car - The collision of the passenger's internal organs against the solid structures of the body -> Not as obvious as eternal injuries but often the most life threatening

Sudden infant death syndrome (SIDS)

- The death of an infant or a young child is called SIDS when, after a complete autopsy, the cause of death remains unexplained - 3,500 a year - Reduce risks: - Place on his back on a firm mattress, in a crib that is free of bumpers, blankets, and toys - Have the baby sleep in the same room, but not in the same bed, chair, or sofa, as an adult - Pale or blue, not breathing, and unresponsive - Can occur at any time of the day; however, often discovered in the morning when the parents or caregivers go in to check on the infant

Work of breathing (WOB)

- The effort required to expand and contract the lungs - Signs of increased WOB: - Breathing noise (grunting or wheezing) - Accessory muscles - Retractions: muscles between ribs or sternum - Head bobbing: lifts and tilts back during inspiration then forward during expiration - Nasal flaring - Tachypnea - Tripod position

Fascia

- The fiberlike connective tissue that covers arteries, veins, tendons, and ligaments - Basically, tendons are extensions of the fascia that covers all skeletal muscle

Factors to take into account in a fall

- The height of the fall - The type of surface struck - The part of the body that hit first, followed by the path of energy displacement

Dislocation of the hip

- The hip joint is very stable and dislocates only after significant injury - Almost all dislocations are posterior - Result from car accidents - Injury to the sciatic nerve -> decreased sensation in leg/foot -> "foot drop" characteristic -> Splint + supine on backboard + support with rolled blanket under the flexed knee

Shoulder dislocation

- The humeral head most commonly dislocates anteriorly, coming to lie in front of the scapula -> axillary nerve compressed -> numb patch - Go behind the pt: the dislocated side is often lower than the uninjured side

Injuries of knee ligaments

- The knee is very vulnerable to injury, especially ligament - Bony elements of the knee can fracture - Splint from the hip joint to the foot, stabilizing the femur and the tibia -> padded rigid long leg splint or two padded board splints (medial and lateral)

Inhalation of toxic gases

- The less efficient the combustion process, the more toxic the gases - Examples: CO ("cherry red"), CO2, HCN (hydrogen cyanic -> paper, cotton, wool -> smell of bitter almonds)

Cervical spines and vertebrae

- The lower cervical spines are more prominent than the upper ones - More easily palpable when the neck is in flexion - Base of the neck posteriorly: most prominent spine = 7th cervical vertebra

Cervix

- The lower third, or neck, of the uterus - Narrowest portion of the uterus - Opens into the vagina

Structure of the mandible

- The mandible forms the jaw and chin - Jaw: lower border of the mouth, where the tongue and 32 teeth are located - Motion of the mandible occurs at the temporomandibular joint -> just in front of the ear - Below the ear and anterior to the mastoid process: angle of the mandible

BVM size, don't touch eyes, ped bag and pop-off valve in children

- The mask should extend from the bridge of the nose to the cleft of the chin - Make sure it doesn't press the eye - Use an infant bag, not a neonatal bag, for infants younger than 1 year; use a pediatric bag for children older than 1 year. Older children and adolescents may need an adult bag - Make sure that there is no pop-off valve on the bag; if the bag has a pop-off valve, make sure that you can hold it shut as necessary to achieve chest rise

NRB size and reservoir bag deflation in children

- The mask should extend from the bridge of the nose to the cleft of the chin - The reservoir bag should neither deflate completely nor fill to bulging during the respiratory cycle

Bleeding - placenta previa

- The placenta develops over and covers the cervix - When early labor begins and the cervix begins to dilate, the pregnant woman may experience heavy vaginal bleeding, often without significant pain

Emergency situations during delivery of placenta

- The placenta has not delivered after 30 minutes - More than 500 mL of bleeding occurs before delivery of the placenta - Significant bleeding occurs after delivery of the placenta -> transport

Ovaries

- The primary female reproductive organs that produce an ovum, or egg, that, if fertilized, will develop into a fetus - Located on each side of the lower abdomen - Female hormones produced primarily in the ovaries control the process of ovulation and menstruation

Ovulation

- The process in which an ovum is released from a follicle - Minor cramping pain during ovulation. Sometimes described as a dull pain on one side of the lower abdomen. Can be severe enough to keep them bedridden during this time

Choroid and retinal detachment

- The retina is nourished by a layer of blood vessels between it and the sclera at the back of the globe -> Layer is the choroid - If the retina detaches from the underlying choroid and sclera, the nerve endings are not nourished, and the patient experiences blindness -> retinal detachment.

Retroperitoneal space

- The space between the abdominal cavity and the posterior abdominal wall - Organs: - Kidneys - Ureters - Urinary bladder - Colon - Duodenum - Abdominal aorta + inferior vena cava - Majority of pancreas

Rotational crashes

- The vehicle spins -> can be a mix of rotational motion and lateral impact (if strikes objects) - Similar to rollovers

Abdominal Aortic Aneurysm (AAA)

- The wall of the aorta sometimes develops weak areas that swell -> aneurysm - Pulsating mass may be felt in the abdomen but hard to detect - No symptoms because occur slowly - If aneurysm ruptures -> acute peritoneal irritation and hemorrhagic shock -> severe back pain -> avoid strong palpation + do not aggressively treat for shock because these actions can cause a small tear to expand + gently handle the pt

Consideration in deciding the appropriate use of emergency air medical services for trauma patients

- There is an extended period required to access or extricate a remote (eg, injured hiker, snowmobiler, or boater) or trapped patient (eg, in a crashed car) which depletes the time window to get the patient to the trauma center by ground - Distance to the trauma center is greater than 20 to 25 miles - The patient needs medical care and stabilization at the ALS level, and there is no ALS- level ground ambulance service available within a reasonable time frame - Traffic conditions or hospital availability make it unlikely that the patient will get to a trauma center via ground ambulance within the ideal time frame for best clinical outcome - There are multiple patients who will overwhelm resources at the trauma center(s) reachable by ground within the time window - EMS systems require bringing a patient to the nearest hospital for initial evaluation and stabilization, rather than bypassing those facilities and going directly to a trauma center. This may add delay to definitive surgical care and necessitate air transport to mitigate the impact of that delay - There is a mass-casualty incident

Reassessment - psy

- There often is little you will be able to do during the short time you will be treating the patient - Your job is to diffuse and control the situation and safely transport your patient to the hospital

Tertiary blast injuries

- These injuries occur when the patient is hurled by the force of the explosion against a stationary object - "Ground shock": when the body impacts the ground

Lower extremity

- Thigh: femur - Leg: tibia and fibula - Foot

Thrombosis VS embolus

- Thrombosis: clot forms at the site of blockage - Embolus: clot forms in a remote area and travels to the site of blockage

TICLS

- To determine if pt is sick or not - Tone, Interactiveness, Consolability, Look or gaze, and Speech or cry

Toddlers and preschoolers ages

- Toddler: 1-3 y - Preschooler: 3-6 y

Physical changes in toddlers and preschoolers: vitals, cardio (lungs), immune, renal

- Toddlers: HR 90-150, RR 20-30, systolic 80-100, temperature 96.8-99.6°F (36-38°C) - Preschoolers: HR 80-140, RR 20-25, systolic 80-100 - Cardiovascular: toddler ~ adult but lungs not strong -> can't breath deep/fast for a long time - Immune system: loss of passive immunity in toddlers -> viral infections (cold or GI) - Renal: control bladder 12-15 m but ready at 18-30 m (average 28 m)

If seatbelt is worn too low or too high

- Too low: risk of hip dislocation - Too high: internal injuries (abdominal organs + lumbar spine)

Metabolic alkalosis

- Too much bicarbonate in the blood. - Can also occur due to certain kidney diseases

Nitrogen narcosis

- Too much nitrogen dissolves in the blood stream - Has a narcotic effect and the diver forgets important things. - Martini rule -> every 33 ft, it's like drinking a martini

Epidermis

- Tough, external layer that forms a watertight covering for the body - Several layers - Cells on the surface layer are constantly worn away - They are replaced by cells that are pushed to the surface when new cells form in the germinal layer at the base of the epidermis - Deeper cells in the germinal layer contain pigment granules. Along with blood vessels in the dermis, these granules produce skin color

Collagen

- Tough, fibrous protein found in scar tissue, hair, bones, and connective tissue - In the last stage of wound healing, collagen provides stability to the damaged tissue and joins wound borders -> close the open tissue - Collagen cannot restore damaged tissue to its original strength

Format

- Trade name - Generic name - Class - Action - Indications - Contraindications - Side effects - Dose

Category for apneic and pulseless pt in traditional triage VS reverse triage

- Traditional: black or expectant - Reverse (lightning): treat cardiac or respiratory arrest first

Conduction

- Transfer of heat from a part of the body to a colder object or substance by direct contact - Example: a warm hand touches cold metal or ice

Angina pectoris

- Transient (short-lived) chest discomfort caused by blockage of blood flow to the heart - Need of O2 > supply. When demand goes away, pain too - Physical/emotional stress, large meal, sudden fear

Traumatic brain injuries (TBI)

- Traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes - Most serious of all head injuries - 2 categories: primary (direct) and secondary (indirect)

Treating injuries to genital

- Treat any external lacerations/abrasions with sterile compresses with a diaper-type bandage to hold the dressings in place - Leave any foreign bodies in place after stabilizing them with bandages - Never place dressings inside the vagina

Automatic implantable cardioverter-defibrillator (AICD)

- Treat like all other patients having an AMI - Generally, the electricity from an automatic implantable cardiac defibrillator is so low that it will not have an effect on rescuers and, therefore, should not be of concern to you.

Right hemisphere affected

- Trouble moving muscles on the left side (arm) - Understand language and able to speak but words are slurred and hard to understand - Neglect parts of vision. Sit on good side of pt - Pt usually neglect and delay help

Dislocation of the knee

- True emergencies that may threaten the limb - Ligaments may be damaged - Injury to the popliteal artery - Direction of dislocation refers to the position of the tibia with respect to the femur. Posterior (hyperextension of the knee) most common - Pt reports "knee gave out" - Splint the knee in the position in which you found it - Do not realign unless medical control tells you -> 1 attempt only

True vs false labor (Braxton-Hicks)

- True: regular contractions, spaced closer together over time, stronger contractions, start in back and move to front, cervix opens and thins -> transport ro prepare for delivery depending on stage + pt's condition + transport time - False: irregular contractions that taper off, felt in the front, walking has no effect, cervix does not change -> transport

Highly volatile agent

- Turns from liquid to gas (evaporates) within minutes to seconds - Example: sarin (nerve agent)

Multiple gestation

- Twins are usually smaller than single fetuses, and delivery is typically not difficult - 2nd one 45 min after 1st one. Contractions begin 10 min after 1st delivery - Same process as with one fetus

Antagonism

- Two drugs having opposite effects on the body - Examples: - Hydrocodone/APAP (narcotic) + Naloxone - Redbull + vodka

Tylenol

- Tylenol, APAP - acetaminophen - Antipyretic, analgesic - Decreases pain and fever - Pain or fever - Hypersensitivity, liver disease - Nausea, vomiting, abdominal pain, liver damage - 325-650 mg PO, every 4-6h, max 4g/day. Children 15 mg/kg PO/PR, every 4-6h, max 4g/day

3 types of diabetes

- Type 1, type 2, and pregnancy-induced gestational diabetes - Most common: type 2 (90%)

Difference type 1 and 2 diabetes

- Type 1: no insulin is produced, so there are no keys - Type 2: there are fewer insulin receptors, so there are not enough locks

Neisseria meningitidis

- Type of meningitis - Bacterium that causes a rapid onset of meningitis symptoms, often leading to shock and death - Children typically have small, pinpoint, cherry-red spots or a larger purple or black rash - Serious risk of sepsis, shock, and death.

Opioid

- Type of narcotic medication used to relieve pain - Among the most commonly abused drugs in the United States

Sterile dressings

- Types: - Universal dressings - Gauze pads (4-inch × 4-inch and 4-inch × 8-inch) - Adhesive dressings - Soft self-adherent roller dressings - Occlusive dressings - Universal dressing: - 9 inches × 36 inches - Made of thick, absorbent material - Ideal for covering large open wounds - Gauze pads are appropriate for smaller wounds, and adhesive-type dressings are useful for minor wounds. - Occlusive dressings: - Made of petroleum (Vaseline) gauze, aluminum foil, or plastic - Prevent air and liquids from entering (or exiting) the wound - Used to cover sucking chest wounds, abdominal eviscerations, penetrating back wounds, and neck injuries

How the body stops the bleeding

- Typically bleeding stops quickly (< 10 min) - If cut -> blood vessel begin to narrow (vasoconstriction), reducing the amount of bleeding -> then a clot forms, plugging the hole = coagulation - With a severe injury, the damage to the blood vessel may be so great that a clot cannot completely block the hole - Bleeding will never stop if an effective clot does not form, unless the injured blood vessel is completely cut off from the main blood supply by direct pressure or a tourniquet

Level IV trauma care

- Typically found in remote outlying areas where no higher level of care is available - Provide advanced trauma life support prior to transfer to a higher level trauma center - Urgent care facility, with or without a physician

Level II trauma care

- Typically located in less populated areas - Provide initial definitive care, regardless of injury severity. - Academic institutions or a public/private community facility - May not be able to provide the same comprehensive care as Level I

USARs and DMATs

- USARs: rescue and initial medical stabilization to pts entrapped in confined spaces, such as from a structural collapse - DMATs provide medical care during an incident -> physicians, paramedics, nurses, and EMTs who work at a federal level -> They bring supplies enough for at least 72h

Fractures of the forearm

- Ulna and radius together - Ulna only: "nightshift fracture" - Radius only: "Colles fractures" -> silver fork deformity

Symptoms of traumatic aortic disruption

- Unexplained shock with significant blunt trauma to the chest - SXS of dissection

Flail chest symptoms

- Unilateral diminished breath sounds - Paradoxical motion: moves in instead of out during inhalation and out instead of in during exhalation (think it's a "paradox")

Units of radiation and examples of levels of radiations

- Units of radiation absorbed dose (rad) or radiation equivalent in man (rem): 100 rad = 1 gray (Gy) - The average human exposure from background radiation is 0.36 rem per year - Mild sickness: 1-2 Gy - Moderate sickness: 2-5 Gy - Severed sickness: 4-6 Gy - Exposure to more than 8 Gy is immediately fatal.

Laryngeal injuries

- Unrestrained driver strikes the steering wheel or when a snowmobile rider or off-road biker strikes a clothesline or a fixed wire strung across a property line. - The larynx becomes crushed against the cervical spine -> soft-tissue injury, fractures, and/or separation of the fascia that connects the thyroid and cricoid cartilages - Can also be found in hangings - Suspect possible cervical spine injury - Impaled objects should not be removed unless they interfere with CPR or obstruct the airway - O2 + ventilation - Cervical collar, but avoid the use of rigid collars because they may cause further damage to the soft tissues

Angina pectoris - stable or unstable

- Unstable: pain or discomfort that is caused by less exercise than usually required to produce angina -> can lead to AMI - Stable: pain that is relieved with rest of NTG

Psychosocial changes in older adults

- Until about 5 years before death, most late-stage adults retain high brain function; however, in the 5 years preceding death, mental function often declines - 95% of older adults live at home - 50% of all single women in the United States who are 60 years of age or older are living at or below the poverty level

Inhalation burn

- Upper airway damage is often associated with the inhalation of superheated gases - Lower airway damage is more often associated with the inhalation of chemicals (eg, acids, aldehydes) and particulate matter - Can cause upper airway swelling -> apply cool mist, aerosol therapy, or humidified oxygen. Or ice pack to throat

Structures in the neck that can be injured

- Upper airway: - Thyroid cartilage or Adam's apple - Cricoid cartilage - Upper part of the trachea - Carotid arteries and jugular veins - Esophagus

2 signs of anaphylaxis

- Urticaria - Angiodema

If no commercial tourniquet and no triangular bandage

- Use a blood pressure cuff as a tourniquet - Inflate it just enough to stop the bleeding. Leave the cuff inflated - Monitor the gauge continuously to make sure that the pressure is not gradually dropping - Consider wrapping the cuff with tape to prevent the Velcro from loosening under continuous high pressure

If a small foreign object is lying on the surface of the patient's eye

- Use a normal saline solution to gently irrigate the eye -> Small bulb syringe or nasal airway or cannula - Always flush from the nose side of the eye toward the outside to avoid flushing material into the other eye

Dealing with sitting patient with spinal/head injury

- Use a short backboard or other short spinal extrication device - Then secure the short backboard to the long backboard - Exceptions: no time to first secure the pt to the short backboard -> pt is in danger or need to gain immediate access to other pts or the pt's injuries justify urgent removal -> directly on long backboard using the rapid extrication technique

Polypharmacy

- Use of multiple prescription meds - Patients has many doctors but what if he does not tell each physician about all of the other medications that he takes...

Best way to protect yourself from radiations

- Use time and distance and shield yourself using buildings and walls for protection - Can't enter unless HazMat with self-contained breathing apparatus

Apgar score

- Used to assess the status of a newborn, at 1 min and again at 5 min after bith - Numeric value (0, 1, or 2) to 5 areas: - Appearance: skin pink, no cyanosis - Pulse: chest auscultation, if not then brachial pulse. Should be > 100/min, if not then ventilate. Reassess every 30s. No pulse or < 60/min -> CPR - Grimace or irritability: grimacing/crying is good sign -> test by snapping finger against sole of foot - Activity or muscle tone: indicates oxygenation of tissue. Hips/knees flexed at birth and newborn resists to straighten them -> good. Floppy/limp: bad - Respirations: regular and rapid. If not: ventilation at 5L/min 40-60 breaths/min -> Perfect score: 10. Most often: 7-8 at 1 min, 8-10 at 5 min

Traction splints

- Used to secure fractures of the shaft of the femur -> only for closed femur fractures - Examples: Hare traction splint, Sager splint (lighter) - Don't use for: - Upper extremity - Close to the knee - Pelvis - Partial amputations or avulsions with bone separation - Lower leg, foot, or ankle injuries - Requires 2 EMTs - Max force: 15 lbs - See Skill Drill 31-6, 31-7 p. 1113-1114

Chemical burns to the eye

- Usually caused by acid or alkaline solutions - Flush eye with water or sterile saline irrigation solution for 20 mins - You can even have the patient immerse his face in a basin of water and rapidly blink the affected eyelid - Apply clean dry dressing to cover the eye - Transport

Ventriculoperitoneal (VP) shunt

- VP shunts drain excess fluids from around the brain into the abdomen - These children with special needs have tubing that can usually be seen and felt just under the scalp

Female reproductive system - external structures

- Vagina posterior to the urethral opening - Labia majora - Labia minora - Clitoris at the anterior end of the labia - Anus at the posterior end of the labia - Perineum + hymen (tissue located at opening of vagina)

Ingested poisons - signs and symptoms

- Vary greatly with the type of poison, the age of the patient, and the time that has passed since the ingestion - Children: crying (acid or alkaline), burns around mouth - GI pain + vomit -> protect the patient from aspiration if ALOC - Cardiac dysrhythmias - Seizure

Thermolysis

- Vasodilation - Sweating

Types of chemical agents

- Vesicants (blister agents) - Respiratory agents (choking agents) - Nerve agents - Metabolic agents (cyanides)

Summary types of agents

- Vesicants: - Sulfur mustard (H) - Lewisite (L) - Phosgene oxime (CX) - Sulfur - Pulmonary: - Chlorine - Phosgene - Nerve: G, GB, GD, GA, VX - Metabolic: - Hydrogen cyanide (AC) - Cyanogen chloride (CK) - Biologic: - Viruses: smallpox, VHF - Bacteria: anthrax, plague - Neurotoxins: botulinum, ricin - Radiations: alpha, beta, gamma, neutron

External defibrillator vest

- Vest with built in monitoring electrodes and defibrillation pads which is worn by the patient under their clothing - Unlike the implantable defibrillator, this device uses high-energy shocks similar to an AED, so you should avoid contact with the patient - If the patient is in cardiac arrest, the vest should remain in place while CPR is being performed unless it interferes with compressions. Then use your own AED

Types of short backboard

- Vest-type device - Rigid short backboard -> Immobilize head, neck, and torso in a sitting position

Types of biologic agents

- Virus - Bacteria - Toxins

Biologic agents

- Viruses, bacteria, and neurotoxins - Example: October 2001 Amerithrax attacks involving letters laced with anthrax powder appearing in the US mail

Visceral and somatic pains

- Visceral pain: pain due to ischemia, inflammation, infection or obstruction -> "Ccrampy" pain from bowel obstruction - Somatic pain: pain due to irritation and inflammation of the peritoneal lining -> "sharp" pain from ruptured spleen

Vision changes in geriatrics

- Visual changes begin > 40 y + 50% > 65 y vision problems - Visual acuity, depth perception, and the ability of the eyes to accommodate to light decrease - Causes: diabetic retinopathy and age-related macular degeneration - Pupils require more time to adjust -> driving and walking more hazardous - Cataracts - Presbyopia - Glaucoma, macular degeneration, and retinal detachment - Decreased tear production - Inability to differentiate colors and decreased night vision -> driving more hazardous

Physical changes in school-age children: vitals + weight/size

- Vital signs and body gradually approach those observed in adulthood - HR 70-120, RR 15-20, systolic 80-100 - Grow 4 lb and 2.5 in per year

Physical changes in adolescents

- Vital signs begin to level off - Systolic 90-110, HR 60-100, RR 12-20 - 2-3y growth spurt: - Begins with hands/feet then bones of extremities then torso - Boys (end 18 y) later than girls (end 16 y) - Maturation of reproductive system

Physical changes in early adults

- Vital signs do not vary greatly - HR ~70, RR 12-20, systolic 90-140 - 19-25 y: optimal physical level

Most common causes of dehydration in peds

- Vomiting - Diarrhea -> Peds at higher risk of dehydration because of smaller fluid reserves

Treatment moderate/severe hypothermia

- Warm IV fluids - Lavage with warm fluids - Rewarming blood outside the body before reintroducing it -> Not EMT

Mechanism of injury (MOI)

- Way in which traumatic injuries occur - Describes the forces (or energy transmission) acting on the body that cause injury

Injected poisons - signs and symptoms

- Weakness - Dizziness - Fever, chills - Unresponsiveness, or the patient may be easily excited.

What are incendiary devices

- Weapons used to start fires - Examples: flamethrowers, chemicals, Molotov cocktails

Questions to determine any potential complications of labor

- Were any of your previous deliveries by cesarean section? - Have you had any problems in this or any previous pregnancy? - Do you use drugs, drink alcohol, or take any medications? - Is there a chance you will have multiple deliveries (having more than one baby)? - Does your physician expect any other complications?

3 basic questions during scene size up of an ICS

- What do I have? - What resources do I need? - What do I need to do?

Questions to ask to a pt suspected of intoxication

- What substance did you take? - When did you take it (or become exposed to it)? - How much did you ingest? - Did you have anything to eat or drink before or after you took it? - Over what period did the patient take or was the patient exposed to the substance? - Has anyone given you an antidote or any substance orally since you ingested it? - How much do you weigh?

Exposed fragements

- What you see in an open fracture - Never attempt to push the end of a protruding bone back into place -> increase the risk for infection.

Other signs of anaphylaxis

- Wheezing - Hypotension (due to visodilation) - Increased capillary permeability - GI dysfunction: nausea, vomiting, abdominal cramps

What's wheezing and why it happens during an allergic reaction

- Wheezing occurs because of narrowing of the air passages, which is mainly the result of contraction of muscles around the bronchioles in reaction to the allergen, and mobilization of mucus in an attempt to "push out" the allergen. - As the patient's condition worsens, breath sounds may even diminish to the point of being almost silent

Pressure ulcers/bedsores ulcers/decubitis ulcers

- When a patient is lying or sitting in the same position for a long time - The pressure from the weight of the body cuts off the blood flow to the area of skin -> no blood flow to the skin -> a sore develops - Prevention: pad under any bony prominences and in the voids

Lateral crashes

- When a vehicle is struck from the side -> rock away to the side -> lateral whiplash injury - Lateral chest and abdomen injuries on the side of the impact + fractures of the lower extremities, pelvis, and ribs - Common cause of death - Called T-bone crashes - 25% of all severe injuries to the aorta + 30% of all fatalities that occur in motor vehicle crashes

Convection

- When heat is transferred to circulating air, such as when cool air moves across the body surface. - Example: a person who stands outside in the wind and wears only lightweight clothing

Heat stroke

- When the body is subjected to more heat than it can handle and normal mechanisms for getting rid of the excess heat are overwhelmed - Least common but most serious heat emergency -> can lead to death

2 situations in which you must splint the limb in the position of deformity

- When the deformity is severe, as is the case with many dislocations - When you encounter resistance or extreme pain when applying gentle traction to the fracture of a shaft of a long bone -> Apply padded board splints to each side of the limb and secure them with soft roller bandages

Platelets when tissues are injured

- When tissues are injured, platelets begin to collect at the site of injury -> this causes red blood cells to become sticky and clump together - As the red blood cells begin to clump, a protein in plasma reinforces the developing clot by converting to a threadlike mesh that forms a clot

Warm zone

- Where personnel and equipment transition into and out of the hot zone - Contains control points for access to the hot zone - Decontamination area is set up in warm zone -> Anyone who leaves the hot zone must pass through the decontamination area

Immune system of infant

- While in the womb, fetuses collect antibodies from the maternal blood -> passive immunities - Can also receive antibodies via breastfeeding

Sclera

- White of the eye - Extremely tough, fibrous tissue that helps maintain the eye's globular shape and protect the more delicate inner structures

Acts of commission

- Words or actions that cause harm - Examples: verbal, physical, or sexual assault

Abrasion

- Wound of the superficial layer of the skin, caused by friction when a body part rubs or scrapes across a rough or hard surface - Usually does not penetrate completely through the dermis, but blood may ooze from the injured capillaries in the dermis - Can be extremely painful because the nerve endings are located in this area - Also known as road rash, road burn, strawberry, and rug burn

Hand 3 sets of bones

- Wrist bones: carpals - Hand bones: metacarpals - Finger bones: phalanges - Carpals vulnerable to fracture when a person falls on an outstretched hand - Phalanges vulnerable to a crush injury (slammed in a door)

Injuries to the wrist and hand

- Wrist: - X-ray required - Dislocation usually with fracture - Fracture of the carpal bone (scaphoid) -> Splint - Hand: - Do not to pop a dislocated finger back in place -> hospital - See Skill Drill 31.8 p. 1122

Can medical emergencies result in falls and fractures?

- Yes - Example: a cardiac event or stroke can cause a fall and fractured hip in an older person

Using your sense to detect hazardous material

- Yes: sight and sound -> Binocular to look at scene from far, sound of an alarm - No: "leading with your nose" -> But some highly vaporous chemicals (e.g., chlorine and ammonia) can be detected by smell from far

Date rape or club drugs

- flunitrazepam (Rohypnol or "roofies") and ketamine (Ketalar or "Special K") - Often colorless, tasteless, and odorless - Sedated and even unconscious, which may facilitate sexual assault or rape. The person later awakens, confused and unable to remember what happened

Sickle cell disease

- inherited blood disorder that affects the RBCs - RBC looks like a sickle -The odd-shaped cells protect the individual from contracting malaria -> useful in sub-Saharan African malaria but not to people in regions without malaria - Common in Africa, Caribbean, and South America - Harder for the O2 to bind to the RBC and can result in unintentional clot formation (vasoocclusive crisis) -> Hypoxia

Bloody show

-During pregnancy, the cervix contains a mucous plug that prevents contamination from the outside - When the cervix begins to dilate, this plug is discharged into the vagina as pink-tinged mucus -> bloody show -> signals the beginning of labor

Whiplash injury

-Trauma to cervical vertebrae - As the body is propelled forward, the head and neck are left behind because the head is relatively heavy, and they appear to be whipped back relative to the torso

Average BVM volume of air

1,000-1,500 mL (much greater than the ~500 mL of tidal volume of humans)

Poison control phone #

1-800-222-1222 (located in Portland)

Process when arriving at the ICS

1. Check in with the incident commander at the staging area 2. Report to advisor for initial briefing

If there are multiple patients and not enough resources to handle them without abandoning victims...

1. Declare an MCI 2. Request additional resources 3. Initiate the ICS and triage procedures -> Although this may cause some delay in initiating treatment to all patients, it will not adversely affect the patient care -> Follow local protocols

Nerve agent treatment

1. Decontaminate 2. ABC 3. DuoDote, otherwise seizures will never stop (may need multiple doses)

Cyanide agent treatment

1. Decontaminate 2. ABC with BVM (always) -> There are antidotes, usually not carried in EMS

Treating an pt exposed to radiations

1. Decontaminate (HazMat) 2. ABC 3. Treat for burn and trauma

3 stages of labor

1. Dilation of the cervix 2. Delivery of the fetus 3. Delivery of the placenta

3 principles in treating head injury

1. Establish an adequate airway. If necessary, begin and maintain ventilation and provide supplemental oxygen. 2. Control bleeding, and provide adequate circulation to maintain cerebral perfusion. CPR if necessary 3. Assess and monitor LOC -> Designed to protect and maintain the critical functions of the central nervous system

4 routes of poisoning

1. Injection 2. Inhalation 3. Absorption (surface contact) 4. Ingestion (fastest to slowest)

Remove the helmet on the head of the pt if...

1. It is a full-face helmet 2. It makes assessing or managing airway problems difficult and removal of a face guard to improve airway access is not possible 3. It prevents you from properly immobilizing the spine, 4. It allows excessive head movement 5. If cardiac arrest

Primary assessment with neuro emergencies

1. Life threatening 2. ABC: - Airway is important (stroke at risk of choking) -> recovery position if needed - Provide O2 (seizure result in lack of O2) - C include also looking for bleeding

Administering activated charcoal

1. Medical control 2. Activated charcoal should be used within 1 hour of ingestion 3. Shake the bottle 4. Give to pt in container so that fluid not visible + straw

Administering nitroglycerin

1. Medical control 2. Help the pt take it -> effects in 5 min 3. Repeat after 5 min, max of 3 doses (if systolic < 100) Careful: light damages it -> no more fizzing sensation or burning or headache (that usually follow NTG) - See Skill Drill 16-1

Type 2 evolution and insulin resistance

1. Pancreas produces more insulin in an attempt to make up for the increased levels of blood glucose 2. Over time this response becomes inefficient -> The blood glucose levels continue to rise and do not respond when the pancreas secretes insulin, a process called insulin resistance

Primary assessment in bleeding

1. Perform a rapid exam of the patient, look for life threats, and treat them as you find them 2. If the patient has obvious, life-threatening external bleeding, address it first (even before airway and breathing) by controlling it quickly 3. ABC 4. Skin color 5. AVPU 6. Spinal immobilization

How to mount a car seat to the stretcher

1. Place the head of the stretcher in an upright position 2. Place the seat so it is against the back of the stretcher 3. Secure one of the stretcher straps from the upper portion of the stretcher through the seat belt positions on the seat and strap it tightly to the stretcher 4. Repeat on the lower portion of the stretcher 5. Push the car seat into the stretcher tightly and retighten the straps

How to use a short backboard

1. Provide manual, in-line support of the cervical spine 2. PMS in all extremities 3. Assess the cervical area 4. Apply cervical collar: - Position the device behind the pt - Secure it to the torso - Evaluate the position of the head - Pad behind the head as needed to maintain neutral, in-line stabilization. - Secure head to the device 5. Once the head is secured, release manual support of the head 6. Rotate or lift the patient to the long backboard 7. PMS all four extremities 8. Secure the patient to the long backboard

Emergency care for drowning or diving emergencies

1. Remove from water 2. Immobilize spine 3. Ventilate even before out of water. Don't roll to the side (doesn't remove water from lungs) + don't suction frothy sputum 4. ABC, not CAB for drowning pt

Poisoning - emergency medical care

1. Scene safe + external decontamination 2. Remove tablets or pill fragments from the patient's mouth, and wash or brush dry poison from the patient's skin 3. ABC 4. O2 (NRB or BVM) 5. Treat for shock as necessary (blanket) 6. Transport Some cases: activated charcoal

Treatment of musculoskeletal injuries

1. Step 1: - Cover open wounds with a dry sterile dressing - Pressure to control bleeding - PMS - If needed, tourniquet 2. Step 2 - Splint - Elevate the extremity about 6 in. (15 cm) (slightly above the level of the heart) - PMS 3. Step 3: cold packs if there is swelling -> not directly on the skin 4. Step 4: - Position the patient for transport - Secure the injured area - See Skill Drill 31-1 p. 1104

Emergency medical care for burns

1. Step 1: - Move the patient away from the burning area - If any clothing is on fire, wrap the patient in a blanket, and then remove any smoldering clothing and/or jewelry - Immerse the area in cool (not cold), sterile water or saline solution, or cover with a clean, wet, cool dressing if the skin or clothing is hot. No more than 10 minutes in water 2. Step 2: provide O2 3. Step 3: - Rapidly estimate the burn's severity - Cover the burned area with a dry, sterile dressing to prevent further contamination. Sterile gauze is best if the area is not too large. You may cover larger areas with a clean, white sheet - Do not put anything else on the burned area: no ointments, lotions, or antiseptics of any kind - Do not intentionally break any blisters 4. Step 4: - Transport - Treat the patient for shock: cover with warm blankets - Do not delay transport to perform a prolonged assessment or to apply coverings to burns in a critical patient

How EMT assists with delivery - post-delivery summary

1. Suction if needed 2. Support body during delivery 3. Place baby skin to skin 4. Dry, Warm, Position, Suction, Stimulate 5. Cut the cord 6. Perform APGAR 7. Manage any vaginal bleeding

Stages of wound healing

1. Vessels, platelets, and clotting work together to stop the bleeding 2. Inflammation 3. A new layer of cells is moved to replace the damaged area 4. New blood vessels form as the body attempts to bring oxygen and nutrients to the injured tissue 5. Collagen close the open tissue

Adolescents age

12-18 years old

Removing a helmet

2 EMTs: 1 support the spine, 1 does the moves: 1. Kneel at the patient's head with your partner at one side. Open the face shield to assess airway and breathing. Remove eyeglasses if present 2. Prevent head movement by placing your hands on either side of the helmet and fingers on the lower jaw. Have your partner loosen the strap 3. Have your partner place one hand at the angle of the lower jaw and the other at the occiput 4. Gently slip the helmet about halfway off, then stop 5. Have your partner slide the hand from the occiput to the back of the head to prevent the head from snapping back 6. Remove the helmet and stabilize the cervical spine. Apply a cervical collar and secure the patient to a long backboard. Pad as needed to prevent neck flexion or extension

When is infant is able to track objects and recognize familiar faces

2 months

Association of Air Medical Services and MedEvac Foundation International

2006 white paper "Air Medicine: Accessing the Future of Healthcare" -> considerations in deciding the appropriate use of emergency air medical services for trauma patients

Most prominent and most easily palpable vertebra

7th cervical vertebra at the base of the neck

Crowning

= When the top of the fetus's head begins to appear at the vaginal opening

Emesis

= vomiting

When is a fall considered significant

> 20 ft (6 m)

Percentage of traumatic deaths that result from a head injury

> 50%

Status epilepticus

A condition in which seizures recur every few minutes or last more than 30 minutes.

Material safety data sheet (MSDS)

A form, provided by manufacturers and compounders (blenders) of chemicals, containing information about chemical composition, physical and chemical properties, health and safety hazards, emergency response, and waste disposal of a specific material; also known as a safety data sheet (SDS).

Difference hypoglycemia VS stroke

A patient who has had a stroke may be alert and attempting to communicate normally, whereas a patient with hypoglycemia almost always has an altered or decreased level of consciousness

Open chest wound

A penetration or perforation of the integrity of the chest -> air enters the chest -> pressure unbalance -> shock

Spontaneous pneumothorax

A weak area on the lung ruptures but no major injury -> Air to leaks into the pleural space

Conversion potential energy to kinetic energy to work -> injury

A worker on a scaffold has potential energy because he or she is some height above the ground. If the worker falls, potential energy is converted into kinetic energy. As the worker hits the ground, the kinetic energy is converted into work, that is, the work of bringing the body to a stop and thereby fracturing bones and damaging tissues

Kehr sign

Abdominal pain radiating to the left shoulder, due to peritoneal irritation from blood or other irritants

National Terrorism Advisory System (NTAS)

Actions that first responders, government agencies, and the public can take to maintain safety (2011)

Mutual aid response

Agreement between neighboring EMS systems to respond when local resources are insufficient to handle the response

Arterial air embolism

Air bubbles in the arteries -> coronary arteries -> myocardial injury -> cerebrovascular system -> disturbances in vision, ALOC

Most serious injuries and deaths from hazardous materials result from...

Airway and breathing problems -> Make sure to maintain airway + NRM 12-15 L/min if pt in distress or BVM if respiratory distress

Anaphylaxis

An extreme, life-threatening systemic allergic reaction that may include shock and respiratory failure

Psychiatric disorders

An illness with psychological or behavioral symptoms and/or impairment in functioning caused by a social, psychologic, genetic, physical, chemical, or biologic disturbance

Blunt trauma definition

An impact on the body by objects that cause injury without penetrating soft tissues or internal organs and cavities -> object making contact with the body

Sniffing position

An upright position in which the patient's head and chin are thrust slightly forward to keep the airway open -> 2 goals: keep trachea from kinking and maintain proper alignment if need to immobilize spine

Weapon of mass destruction (WMD) or weapon of mass casualty (WMC)

Any agent designed to bring about mass death, casualties, and/or massive damage to property and infrastructure (bridges, tunnels, airports, and seaports)

Sling

Any bandage that helps support the weight of an injured upper extremity, relieving the downward pull of gravity on the injured site.

Child abuse

Any improper or excessive action that injures or otherwise harms a child or infant; it includes physical abuse, sexual abuse, neglect, and emotional abuse

End-stage renal disease (ESRD)

Any type of kidney disease in which there is little or no remaining kidney function -> chronic renal failure -> peritoneal dialysis or hemodialysis -> patient's blood is filtered and cleansed of the toxins and then returned to the body.

Medical axiom about missing the diagnosis

Anyone who neglects to consider a gynecologic cause in a woman of childbearing age who reports abdominal pain will miss the diagnosis at least 50% of the time

Treatment of COPD

Assist with inhaler + transport

Switching rescuers when using the AED

At each defibrillation, the person performing compressions should switch places with the person providing ventilations so that neither gets overtired. Immediately after each defibrillation, resume CPR with compressions first

iliac, femoral, tibial, and peroneal arteries

At the level of the umbilicus, the descending aorta divides into two main branches called the right and left iliac arteries, which supply blood to the groin, pelvis, and legs. As the iliac arteries enter the legs through the groin, they become the right and left femoral arteries. At the level of the knee, the femoral artery divides into the anterior (front) and posterior (back) tibial arteries and the peroneal artery, supplying blood to the lower legs and feet.

Emergency Medical Care of Immunologic Emergencies

BLS + transport: - Remove by scraping the sting (e.g., credit card). Don't use tweezers or forceps -> squeeze more venom into the wound - Wash area with soap - Remove jewelry before swelling begins - Position the injection site slightly below the level of the heart - Apply cold packs to the area. Ice pack not directly on skin or for tool long -> less than 10 min - Place the pt in the supine position as indicated (e.g., shock) - Give O2 if needed - Do NOT give anything by mouth

Hemothorax

Blood in the pleural cavity

Alkalosis

Buildup of excess base

Musculosckeletal changes during pregnancy

By the 20th week of pregnancy, the top of the uterus is at or above the belly button -> increases the chance of direct fetal injury in trauma

Which vertebrae the nerves supplying the diaphragm exit from

C3, C4, and C5 -> If injury at C3 or above, can't breath at all -> If injury below C5 -> can't move intercostal muscles but diaphragm can still contract

3 main parts of the brain

Cerebrum, cerebellum, brain stem

3 of the top 5 causes of geriatric deaths

Chronic lower respiratory disease, influenza, and pneumonia

Length-based resuscitation tape (Broselow tape)

Color-coded tool to estimate weight and height in pediatric patients weighing up to 75 lb (34 kg) -> best way to estimate the correct size for airway adjuncts in children

Tendons

Connect muscle to bone

Somatic (voluntary) nervous system

Controls our voluntary activities, including almost all coordinated muscular activities

Transportation supervisor

Coordinates the transportation to appropriate receiving hospitals and helps to ensure that hospitals do not become overwhelmed

Reverse triage - lightning

Delayed respiratory or cardiac arrest is much less likely to develop in those who are conscious following a lightning strike; most of these people will survive. Therefore, you should focus your efforts on those who are in respiratory or cardiac arrest. This process, called reverse triage, differs from conventional triage, where such patients would ordinarily be classified as deceased

Sedative-hypnotics examples

Diazepam, secobarbital, flunitrazepam, midazolam

Tearing pain going from the abdomen posteriorly

Dissecting abdominal aneurysm

Narcotic

Drug that produces sleep or altered mental consciousness

Open wound to the abdomen - dry or moistened dressign

Dry, unless evisceration -> moistened

Primary blast injuries

Due entirely to the blast itself -> damage to the body is caused by the pressure wave generated by the explosion -> hollow organs in particular

If the patient's symptoms seem to resolve after epinephrine and he or she no longer desires to go to the hospital

Explain that the effects of epinephrine can wear off before the underlying allergic reaction has fully resolved, and life-threatening symptoms may recur

Trench foot

Exposure to constant cold, above freezing temp -> non-freezing

Two important underlying principles of the NIMS

Flexibility and standardization

Synovial fluid

Fluid that lubricates joints

Work

Force acting over a distance

Glycogenesis

Formation of glycogen from glucose

Pain just under ribs on the right side or between the shoulder blades

Gallbladder

Most ionizing radiation accidents involve what type of radiation

Gamma radiation or x-rays

How nerve agents enter the body

Gas or skin

3 types of oral glucose

Gel (most common), chewable tablet, and liquid

Pancreas produces two hormones

Glucagon and insulin

Chemicals released by the immune system

Histamines and leukotrienes

Urticaria

Hives, small areas of generalized itching or burning -> raised areas on the skin

Hyperglycemia VS hypoglycemia

Hyper - hot/dry - sugar high gradual Hypo - cold/clammy - needs candy rapidly Other differences: - Breathing: - Hyper: deep and rapid - DKA/Kussmaul, fruity odor - Hypo: normal to rapid, normal odor - Hunger and thirst: - Hyper: increasing, vomiting - Hypo: absent, no vomiting - Treatment: - Hyper: gradual (6-12h) - Hypo: immediate -> Both will be ALOC + pulse rapid, weak, and thready

Restraint - psy

If a police officer restrains the patient with handcuffs, the officer must ride in the back of the ambulance to release the cuffs in the case of an emergency

Assessment of an isolated abdominal injury

If the MOI suggests an isolated injury to the abdomen, focus your physical examination only on the injured area

Cardiac arrest during transport

If you are traveling to the hospital with an unconscious patient, check the pulse at least every 30 seconds. If a pulse is not present, take the following steps: 1. Stop the vehicle. 2. If the AED is not immediately ready, perform CPR, beginning with chest compressions, until it is available. 3. Call for help in the form of ALS support or any other available resources as appropriate based on circumstances and local protocol. 4. Analyze the rhythm. 5. Deliver one shock, if indicated, and immediately resume CPR. 6. Continue resuscitation according to your local protocol. If you are en route with a conscious adult patient who is having chest pain and becomes unconscious, take the following steps: 1. Check for a pulse. 2. Stop the vehicle. 3. If the AED is not immediately ready, perform CPR, beginning with chest compressions, until it is ready. 4. Analyze the rhythm. 5. Deliver one shock, if indicated, and immediately resume CPR. 6. Begin compressions, and continue resuscitation according to your local protocol, including transporting the patient.

If you must treat and transport a patient who has not been properly decontaminated

Increase the amount of protective clothing you wear: - 2 pair of gloves - Goggles of face shield - Protective coat - Respiratory protection (SCBA)

UTI

Infection to any region along the urinary tract by pathogens results in a UTI: - Urethra (Urethritis) - Bladder (cystitis) - Kidneys (pylonephritis) - Ureters

Penetrating trauma definition

Injury caused by objects, such as knives and bullets, that pierce the surface of the body and damage internal tissues and organs

Amputation

Injury in which part of the body is completely severed

Pulmonary contusion

Injury or bruising of lung tissue that results in hemorrhage -> Alveoli become filled with blood, and fluid accumulates -> hypoxia

Nonsignificant injury examples

Injury to an isolated body part or a fall without the loss of consciousness

Ischemia

Lack of blood flow

Poisoning - secondary assessment difficulties

Many poisons have no outward indications of the seriousness of the exposure -> ALOC, HR, RR, BP, and skin are more sensitive indicators that something serious is wrong

Dissemination

Means by which a terrorist will spread the agent —for example, poisoning the water supply or aerosolizing the agent into the air or ventilation system of a building

Accountability in ICS

Means keeping your supervisor advised of your location, actions, and completed tasks

Covert

Means that the public safety community generally has no prior knowledge of the time, location, or nature of the attack -> Harder to respond

Heat cramp treatment

Move to cooler location + loosen up clothing + cool spray/fan+ administer fluids or electrolyte solution (sport drink). Nothing salty

Heat exhaustion treatment

Move to cooler location + loosen up clothing + icepacks trunk of body (+ ice bath if available) + have pt drink water If no improvement: ALS with IV fluid

Wake of a bullet

Much like a boat moving through water, the bullet disrupts not only the tissues that are directly in its path but also those in its wake -> The area that is damaged by medium- and high-velocity projectiles is typically many times larger than the diameter of the projectile itself -> This is why exit wounds are larger than entrance wounds

Most common causes of death from blast injuries

Neurologic injuries and head trauma

Abandonment - behavioral crisis

Never leave a patient alone who may be experiencing a behavioral emergency

Can brain and spinal cord cells be regenerated if damaged?

No

Ketones, Kussmaul respirations, and DKA

No glucose in cell (e.g., not enough insulin) -> body burns fat for energy -> acid waste is produced = ketones -> get in urine + faster and deeper breathing to release CO2, which reduces the acid level -> Kussmaul respirations If fat and ketones continue to be produces -> DKA (glucose > 400 mg/dL)

When not to give epinephrine

No respiratory compromise or hypotension

Temperatures when hypothermia can occur

Not necessarily very cold -> many hypothermia cases occur at temperatures between 1°C and 10°C

Treatment for pulmonary embolism

O2 + sitting up (or most comfortable) + transport

Dissociative PTSD

Occurs when the person attempts to find an escape from constant internal distress or a particularly disturbing event -> able to continue functioning under negative conditions

Placing the AED pads

One just to the right of the breastbone (sternum) just below the collarbone (clavicle), the other on the left lower chest area with the top of the pad 2 inches to 3 inches below the armpit. Do not place the pads on top of breast tissue in women. If necessary, move the breast out of the way with the back of your hand and place the pad underneath.

Amputation

Partial or complete removal of a limb

ALOC - meds never by mouth

Patients with a decreased level of consciousness should not be given anything by mouth.

Differences phosgene VS chlorine

Phosgene: no irritation that would possibly cause the victim to leave the area or hold his or her breath -> smell of freshly mowed grass or hay -> gas enters the body but unnoticed

Petechiae

Pinpoint reddish-purple hemorrhages that show up on the skin

If pt is very sensitive to palpation or ticklish

Place the patient's hand on the surface of his abdomen and then palpate and compress the abdomen with the patient's hand between your hand and the patient's skin

Toxin

Poisonous substance produced by bacteria, animals, or plants that acts by changing the normal metabolism of cells or by destroying them

3 concepts of energy are typically associated with injury

Potential energy, kinetic energy, and the energy of work (not thermal energy -> burns)

National Incident Management System (NIMS)

Promote more efficient coordination between emergency responders at the regional, state, and national levels

Life expectancy factors

Public health advances, changes within diets, attitudes regarding exercise, advances in medical care, access to that medical care, and personal behavior -> where/when you are born

How to assess core body temperature (CBT)

Pull back on your glove and place the back of your hand on the patient's skin at the abdomen

Primary responsibility as an EMT for treatment of poisoning

Recognizing that poisoning has occurred

Primary systems involved in changed during pregnancy

Respiratory, cardiovascular, and musculoskeletal

Operations section of the ICS

Responsible for managing the tactical operations usually handled by the IC on routine EMS calls

Angina pectoris - treatment

Rest, O2, NTG -> decrease the need or increase the supply of O2 to the heart

Trauma emergency

Result of physical forces applied to the body

Ribs that can injure abdominal organs if injured

Ribs #8-12 -> liver, spleen, kidneys

EpiPen - skill drill

See Skill Drill 20-1 p. 762 - best to clean sin but if no time then don't clean - press until med is injected (10s) - rub for 10s - If no improvement after 5 min: 2nd dose (2 doses total max)

Levels of dehydration

See Table 34-14 p. 1260

Largest organ of the body

Skin

Diving reflex

Slowing of the heart rate caused by submersion in cold water

Tragus

Small cartilaginous projection in front of the opening of the ear

Planning section of the ICS

Solves problems as they arise during the incident. Planners obtain data about the problem, analyze the previous incident plan, and predict what or who is needed to make the new plan work

Nephrons and glomerulus

Sophisticated capillaries that perform filtering in the kidney. One of the portions of the nephron is called the glomerulus. The decreased blood supply causes more abnormal glomeruli to be present as a person ages

Transport with suspected increased ICP

Supine with head elevated 30° (blanket under backboard)

American Association of Poison Control Centers (AAPCC)

Supports the nation's poison centers in their efforts to prevent and treat poison exposures

Hypothermia def + body response

Temperature < 95°F (35°C) -> vasoconstriction (-> cyanosis) + shivering

3 types of headaches

Tension, migraine, sinus

Domestic terrorism

Terrorism that is carried out by people in their own country

State-sponsored terrorism

Terrorism that is funded and/or supported by nations that hold close ties with terrorist groups

What a command system is supposed to ensure

That resources are efficiently coordinated

Freelancing

The ICS is designed to avoid duplication of effort and freelancing, in which individual units or different organizations make independent and often inefficient decisions about the next appropriate action

As the body attempts to maintain homeostasis (balance)...

The SNS and PNS tend to balance each other so that basic body functions remain stable and effective

Weaponization

The creation of a weapon from a biologic agent generally found in nature and that causes disease; the agent is cultivated, synthesized, and/or mutated to maximize the target population's exposure to the germ

Final step in the chain of survival

The final step in the chain of survival is ALS and postarrest care. This refers to continuing ventilation at less than 12 breaths/min to achieve an etco2 of 35 to 40 mm Hg; maintaining oxygen saturation between 94% and 99%; assuring blood pressure is above 90 mm Hg; and maintaining glucose levels in the patient who is hypoglycemic

Heart's electrical system

The heart's electrical system controls heart rate and enables the atria and ventricles to work together. Normal electrical impulses begin in the sinus node, which is in the upper part of the right atrium and is also known as the sinoatrial (SA) node. The impulses travel across both atria, stimulating them to contract. Between the atria and the ventricles, the impulses cross a bridge of special electrical tissue called the atrioventricular (AV) node. Here, the signal is slowed for about one- to two-tenths of a second to allow blood time to pass from the atria to the ventricles. The impulses then exit the atrioventricular node and spread throughout both ventricles via the bundle of His, the right and left bundle branches, and the Purkinje fibers, causing the ventricular muscle cells to contract.

Labia majora

The larger outer folds of the vulva

Blood cycle

The right side of the heart receives oxygen-poor (deoxygenated) blood from the veins of the body. Blood from the vena cava enters the right atrium, which then fills the right ventricle. After contraction of the right ventricle, blood flows into the pulmonary artery and the pulmonary circulation in the lungs, where the blood is oxygenated. As the blood reaches the lungs, it receives fresh oxygen from the alveoli and carbon dioxide waste is removed from the blood and moved into the alveoli. The blood then returns to the heart through the pulmonary veins. The left side of the heart receives oxygen-rich (oxygenated) blood from the lungs through the pulmonary veins. Blood enters the left atrium and then passes into the left ventricle. The left ventricle is more muscular than the right ventricle because it must pump blood into the aorta to supply all the other arteries of the body.

Labia minora

The smaller inner folds of the vulva

Vena cava

The veins become larger and larger and eventually form the two large venae cavae: the superior vena cava and the inferior vena cava. The superior (upper) vena cava carries blood from the head and arms back to the right atrium. The inferior (lower) vena cava carries blood from the abdomen, kidneys, and legs back to the right atrium. The superior and inferior venae cavae join at the right atrium of the heart

Intervertebral disks

The vertebrae are connected by ligaments and separated by cushions, called intervertebral disks

American College of Surgeons' Committee on Trauma (ACS-COT)

They are the ones with classify trauma care (Levels I to IV)

Lightening

Toward the end of the third trimester of pregnancy, the head of the fetus normally descends into the woman's pelvis as the fetus positions for delivery -> movement down is called lightening

Critical info given by the nursing home

Transfer record that provides critical information on the patient's history, medications, allergies, and current complaint

Fallopian tubes

Tubes that extend from near the ovaries to the uterus; the primary location for fertilization of the ovum

Toxidrome

Typical signs and symptoms associated with exposure to a type of toxin

Leading cause of death in toddlers and preschoolers

Unintentional injuries (accidents)

Decision of rapid transport - splint?

Use a long backboard as a splinting device to splint the whole body rather than splinting each extremity individually

Vented occlusive dressings and flutter valve

Vented occlusive dressings contain a one-way valve, called a flutter valve, that allows air to leave the chest cavity but not return

Glenohumeral joint (shoulder joint)

Where the head of the humerus, the supporting bone of the upper arm, meets the glenoid fossa of the scapula

Morgue supervisor

Works with area medical examiners, coroners, and law enforcement agencies to coordinate the disposition of dead victims.

Do injuries to kidneys usually involve other organs

Yes -> An injury that reaches the kidneys almost always involves other organs

Which agent is there an antidote for

Yes: - Lewisite - All nerve agents (G, GB, GD, GA, VX): Duodote and ATNAA - All metabolic agents (cyanides) No: - Sulfur mustard and phosgene oxime - Pulmonary (chlorine and phosgene)

Substance abuse

misuse of any substance to produce a desired effect (for example, heroin intoxication) -> can lead to overdose