West Coast EMT Final Exam Study Guide

AMI AMI (Heart attack): Death of heart muscle following obstruction of blood flow to it; in this context the attack is "new" or "happening right now." A heart attack is a medical emergency. A heart attack usually occurs when a blood clot blocks blood flow to the heart. Without blood, tissue loses oxygen and dies. Symptoms include tightness or pain in the chest, neck, back, or arms, as well as fatigue, light- headedness, abnormal heartbeat, and anxiety. Women are more likely to have atypical symptoms than men. Treatment ranges from lifestyle changes and cardiac rehabilitation to medications, stents, and bypass surgery. Oxygenation Oxygenation: The process of delivering oxygen to the blood by diffusion form the alveoli following inhalation into the lungs patient care report (PCR) Patient Care Report (PCR): The legal document used to record all patient care activities. This report has direct patient care functions, but also administrative and quality control functions. Also known as prehospital care reports. Respiration Respiration: The physiologic process of exchanging oxygen and carbon dioxide, or, in the context of environmental emergencies, the loss of body heat as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled. Supraventricular Tachycardia (SVT) Supraventricular Tachycardia: A faster than normal heart rate beginning above the heart's two lower chambers. Supraventricular tachycardia is a rapid heartbeat that develops when the normal electrical impulses of the heart are disrupted. There may be symptoms like heart palpitations, or there may be no symptoms at all. Ventilation Ventilation: Exchange of air between the lungs and the environment, spontaneously by the patient or with assistance from another person, such as an EMT. Perfusion Perfusion: The circulation of oxygenated blood through body tissues and vessels. Aspiration Aspiration: In the context of airway, the introduction of vomitus or other foreign material into the lungs. Intracranial Pressure (ICP) Intracranial Pressure (ICP): The pressure within the cranial vault. Exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. Brain injury or another medical condition can cause growing pressure inside your skull. automated external defibrillator (AED) Automated External Defibrillator (AED): A device that detects treatable life- threatening cardiac arrythmias (ventricular fibrillation and ventricular tachycardia) and delivers the appropriate shock to the patient. Thrombus/Thrombosis Thrombus/Thrombosis: A blood clot, either in the arterial or venous system. When the clot occurs in a cerebral artery, it may result in the interruption of cerebral blood flow and subsequent stroke. aneursym Aneurysm: An abnormal enlargement of the wall of a blood vessel that results from weakening of the vessel wall. Aneurysms often occur in the aorta, brain, back of the knee, intestine, or spleen. A ruptured aneurysm can result in internal bleeding, stroke, and can sometimes be fatal. Aneurysms often have no symptoms until they rupture. Treatment varies from watchful waiting to emergency surgery. The choice depends on the location, size, and condition of the aneurysm. Embolism/ Embolus Embolism/Embolus: A blood clot or other substance in the circulatory system that travels to a blood vessel where it causes a blockage. Atherosclerosis Atherosclerosis: A disorder in which cholesterol and calcium build up inside the walls of blood vessels, forming plaque, eventually leading to a partial or complete blockage of blood flow. Hypoglycemia Hypoglycemia: An abnormally low blood glucose level. 80mg/dL hyperglycemia Hyperglycemia: An abnormally high blood glucose level. 120mg/dL Functional (behavioral) disorder Functional (behavioral) Disorder: A physiologic disorder that impairs bodily function when the body seems to be structurally normal. Something has gone wrong, but the root cause cannot be identified. Schizophrenia, anxiety conditions, and depression are good examples of functional disorders. organic brain syndrome(disorder) Organic Brain syndrome(disorder): A temporary or permanent dysfunction of the brain caused by a disturbance in the physical or physiologic functioning of brain tissue. Causes of organic brain syndrome include 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. Contusion Contusion: A bruise from an injury that causes bleeding beneath the skin without breaking the skin BSA BSA: Body surface area. Commonly used in classifying burns. Ecchymosis Ecchymosis: A buildup of blood beneath the skin that produces a characteristic blue or black discoloration as the result of an injury. hemoptysis Hemoptysis: The coughing up of blood. Hematemesis vomiting blood recovery position (lateral recumbent position) Recovery position: A side-lying position used to maintain a clear airway in unconscious patients who are breathing adequately and do not have suspected injuries to the spine, hips, or pelvis. defibrillate/defibrillation Defibrillate/Defibrillation: To shock a fibrillating (chaotically beating) heart with specialized electric current in an attempt to restore a normal, rhythmic beat. Medical Director Medical Director: The physician who authorizes or delegates to the EMT the authority to provide medical care in the field. Air-reactive solids Air Reactive solids: Dangerous when exposed to air. class 9 material. 1000lb rule for labels or placards. Flammable Liquids Flammable liquids: liquids that can easily ignite. class 9 material. 1000lb rule for labels or placards. water reactive solids Water-reactive solids: extremely hazardous; reactive to water; any amount of material being shipped requires the use of placards or labels. Nonflammable gasses Nonflammable gases: class 9 material. 1000lb rule for labels or placards. Cardiac Output (CO) Cardiac output (CO): A measure of the volume of blood circulated by the heart in 1 minute, calculated by multiplying the stroke volume by the heart rate. SVxHR=CO Sepsis Sepsis: Sepsis is a potentially life-threatening condition caused by the body's response to an infection. The body normally releases chemicals into the bloodstream to fight an infection. Sepsis occurs when the body's response to these chemicals is out of balance, triggering changes that can damage multiple organ systems. Can lead to Septic shock. Ventricular Fibrillation Ventricular Fibrillation: Disorganized, Ineffective quivering of the ventricles, resulting in no blood flow and a state of cardiac arrest. Pulseless ventricular tachycardia Pulseless ventricular tachycardia: A life-threatening cardiac arrhythmia in which coordinated ventricular contractions are replaced by very rapid but ineffective contractions, leading to insufficient organ perfusion and heart failure. Pulseless ventricular tachycardia is a medical emergency. pelvic inflammatory disease (PID) Pelvic Inflammatory Disease (PID): An infection of the fallopian tubes and the surrounding tissues of the pelvis. It usually occurs when sexually transmitted bacteria spread from the vagina to the womb (uterus), fallopian tubes, or ovaries. ovarian cysts Ovarian cysts: A solid or fluid-filled sac or pocket (cyst) within or on the surface of an ovary. Ovarian cysts usually disappear in a few months but can cause complications if they don't. Most ovarian cysts don't cause symptoms. In some cases, menstrual irregularities, pain during intercourse, or irregular bowel movements can occur. Many cysts go away on their own. If not, treatments are birth control pills or surgery. Gonorrhea Gonorrhea (the clap): A sexually transmitted disease caused by Neisseria gonorrhoea. Regular screening can help detect instances when an infection is present despite having no symptoms. Symptoms include painful urination and abnormal discharge from the penis or vagina. Men may experience testicular pain and women may experience pain in the lower belly. In some cases, gonorrhea has no symptoms. Bacterial Vaginosis Bacterial Vaginosis: An overgrowth of bacteria in the vagina; characterized by itching, burning, or pain, and possibly a "fishy" smelling discharge. Chlamydia Chlamydia: A sexually transmitted disease caused by the bacterium Chlamydia trachomatis. Chlamydia affects people of all ages but is most common in young women. Many who have chlamydia don't develop symptoms, but they can still infect others through sexual contact. Symptoms may include genital pain and discharge from the vagina or penis. Uterine Rupture Uterine rupture: Spontaneous tearing of the uterus that may result in the fetus being expelled into the peritoneal cavity. Uterine rupture is rare. It can occur during late pregnancy or active labor. Uterine rupture occurs most often along healed scar lines in women who have had prior cesarean deliveries. Can cause severe bleeding in the mother and can suffocate the baby. Ectopic Pregnancy Ectopic pregnancy: A pregnancy that develops outside the uterus, typically in a fallopian tube. Ovarian Abscess Ovarian abscess: An ovarian abscess is a pus-filled pocket in an ovary. An ovarian abscess is usually caused by bacteria that travel from another part of your body. Can develop in women who have PID. Hypertension Hypertension: Blood pressure that is higher than the normal range. Varies with age 130 systolic adults Hypotension Hypotension: Blood pressure that is lower than the normal range. Varies with age. 90 systolic adults Polyuria Polyuria: The passage of an unusually large volume of urine in a given period; In diabetes, this can result from the wasting of glucose in the urine. polydipsia Polydipsia: Excessive thirst that persists for long periods, despite reasonable fluid intake; often the result of excessive urination. Polyphagia Polyphagia: Excessive eating; In diabetes; the inability to use glucose properly can cause a sense of hunger. Tachycardia Tachycardia: A rapid heart rate, more than 100 beats/min. Bradycardia Bradycardia Urticaria Urticaria (Hives): Small areas of generalized itching and/or burning that appear as multiple raised areas on the skin. continuous positive airway pressure (CPAP) Continuous Positive Airway Pressure (CPAP): A method of ventilation used primarily in the treatment of critically ill patients with respiratory distress; can prevent the need for endotracheal intubation. Macrodrip (IV set up) Macrodrip (IV Set up): It is for infusing large volumes or to infuse fluids quickly Microdrip (IV set up) Microdrip (IV set up): It is used for infusing small or very precise amounts of fluids. Abruptio Placenta Abruptio placenta: Premature separation of the placenta from the wall of the uterus. Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients. Symptoms include vaginal bleeding, belly pain, and back pain in the last 12 weeks of pregnancy. Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a cesarean section. Placenta Previa Placenta previa: A condition in which the placenta develops over and covers the cervix. Placenta previa risk factors include a previous delivery, age older than 35, and a history of previous surgeries, such as a cesarean section (C-section) or uterine fibroid removal. The main symptom is bright red vaginal bleeding without pain during the second half of pregnancy. The condition can also cause severe bleeding before or during delivery. Bed rest is recommended. A cesarean section is often needed. Platlets Platelets: Tiny, disc shaped elements that are much smaller than the cells; they are essential in the initial formation of a blood clot, the mechanism that stops bleeding. Capillaries Capillaries: The small blood vessels that connect arterioles and venules; various substances pass through the capillary walls, into and out of the interstitial fluid, and then onto the cells. Artery Artery: A blood vessel, consisting of three layers of tissue and smooth muscle, that carries oxygenated blood away from the heart to the rest of the body. Veins Veins: The blood vessels that carry deoxygenated blood from the tissues to the heart. Arterioles Arterioles: The smallest branches of arteries leading to the vast network of capillaries. Venules Venules: Very small, thin-walled blood vessels. Carry deoxygenated blood from the capillaries into the veins. Incident commander (IC) Incident Commander (IC): the person responsible for all aspects of an emergency response; including quickly developing incident objectives, managing all incident operations, application of resources as well as responsibility for all persons involved. rapid extrication technique Rapid extrication technique: A technique to move a patient from a sitting position inside a vehicle to supine on a backboard in less than 1 minute when conditions do not allow for standard immobilization. sinoatrial (SA) node Sinoatrial (SA) node: Normal Atrial impulses begin in the SA node (sinus node), which is the upper part of the right atrium. The pulses travel across both atria, stimulating them to contract. atrioventricular (AV) node Atrioventricular (AV) node: Between the atria and the ventricles, the impulses cross a bridge of special electrical tissue (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. internodal pathways Internodal pathways: Paths between the SA and AV node Bundle of HIS Bundle of HIS: After the AV node, impulses are spread throughout both ventricles via this route. L & R bundle branches L&R bundle branches: carry impulses from bundle of HIS to Purkinje fibers. Purkinje System (Fibers) Purkinje system (fibers): Part of left and right bundle branches, Cause the ventricular muscle cells to contract. Cerebrum Cerebrum: The largest part of the three subdivisions of the brain, sometimes called the gray matter; made up of several lobes that control movement, hearing, balance, speech, visual perception, emotions, and personality. Meninges Meninges: Three distinct layers of tissue that surround and protect the brain and spinal cord within the skull and the spinal canal. The dura mater, arachnoid, and pia mater Central Nervous System (CNS) Central Nervous System (CNS): Controls most functions of the body and mind. It consists of two parts: the brain and the spinal cord. The brain is the center of our thoughts, the interpreter of our external environment, and the origin of control over body movement. parasympathetic nervous system (PNS) Parasympathetic Nervous System (PNS): A subdivision of the autonomic nervous system, involved in control of involuntary functions such as digestion of food and relaxation, mediated largely by the vagus nerve through the chemical acetylcholine. Prone Prone: lying face down Supine Supine: lying face up cardiopulmonary resuscitation (CPR) Cardiopulmonary resuscitation (CPR): The combination of chest compressions and rescue breathing used to establish adequate ventilation and circulation in a patient who is not breathing and has no pulse. Pediatric Assessment Triangle (PAT) Pediatric assessment triangle (PAT): A structured assessment tool used to rapidly form a general impression of the infant or child without touching him or her; consists of assessing appearance, work of breathing, and circulation to the skin. Hyperthermia Hyperthermia: A condition in which the body core temperature rises to 101F (38.3C) or more. A dangerously overheated body, usually in response to prolonged, hot, humid weather. Hyperthermia occurs when the body's heat-regulating mechanisms don't work effectively. Older age, certain illnesses, and medications increase the risk of developing hyperthermia. A temperature of 40 °C (104 °F) or higher is life-threatening. Confusion, nausea or vomiting, and rapid breathing are some symptoms. Hypothermia Hypothermia: A condition in which the internal or core body temperature falls below 95F (35C). When the body loses heat faster than it can produce heat, causing a dangerously low body temperature. Hypothermia can have causes that aren't due to underlying disease. Examples include cold exposure or extreme physical exertion. Drownjng Drowning: The process of experiencing respiratory impairment from submersion or immersion in liquid. Typically occurs silently, with only a few people able to wave their hands or call for help. Symptoms following rescue may include breathing problems, vomiting, confusion, or unconsciousness. Anaphylaxis Anaphylaxis: A severe, potentially life-threatening systemic allergic reaction. The reaction can occur within seconds or minutes of exposure to an allergen. Symptoms include a skin rash, nausea, vomiting, difficulty breathing, and shock. If not treated right away, usually with epinephrine, it can result in unconsciousness or death. Glucagon Glucagon: Glucagon is a hormone that works with other hormones and bodily functions to control glucose levels in the blood. It comes from alpha cells found in the pancreas and is closely related to insulin-secreting beta cells, making it a crucial component that keeps the body's blood glucose levels stable. Insulin Insulin: A hormone produced by the islets of Langerhans (endocrine gland located throughout the pancreas) that enables glucose in the blood to enter cells; used in synthetic form to treat and control diabetes mellitus. definitive treatment Definitive Treatment: The treatment plan for a disease or disorder that has been chosen as the best one for a patient after all other choices have been considered. Dextrose Dextrose: The name of a simple sugar that is made from corn and is chemically identical to glucose, or blood sugar. critical incident stress management (CISM) Critical Incident Stress Management: An intervention protocol developed specifically for dealing with traumatic events. It is a formal, highly structured and professionally recognized process for helping those involved in a critical incident to share their experiences, vent emotions, learn about stress reactions and symptoms and given referral for further help if required. It is not psychotherapy. It is a confidential, voluntary and educative process, sometimes called 'psychological first aid'. nephritis Nephritis: is a condition in which the nephrons, the functional units of the kidneys, become inflamed. This inflammation can adversely affect kidney function. hepatomegaly Hepatomegaly: Is an enlarged liver that can have causes that aren't due to underlying disease. Lifestyle changes may help to reduce inflammation. Hydrocephalus Hydrocephalus: A build-up of fluid in the cavities deep within the brain. The extra fluid puts pressure on the brain and can cause brain damage. It's most common in infants and older adults. Hydrocephalus is characterized by head enlargement in infants. Adults and older children experience headache, impaired vision, cognitive difficulties, loss of coordination, and incontinence. Treatment is often a tube (shunt) inserted surgically into a ventricle to drain excess fluid. Down Syndrome Down syndrome: A genetic chromosome 21 disorder causing developmental and intellectual delays. Down syndrome is a genetic disorder caused when abnormal cell division results in extra genetic material from chromosome 21. Down syndrome causes a distinct facial appearance (round head with a flat occiput and slanted wide-set eyes), intellectual disability, developmental delays, and may be associated with thyroid or heart disease. Medical specialists will conduct additional screenings. Early intervention programs with a team of therapists and special educators who can treat each child's specific situation are helpful in managing Down syndrome. Mass Casualty Incident (MCI) Mass Casualty Incident (MCI): An emergency situation involving three or more patients or that can place a great demand on the equipment or personnel of the EMS system or has the potential to produce multiple casualties. Tension pneumothorax Tension Pneumothorax: An accumulation of air or gas in the pleural space that progressively increases pressure in the chest that interferes with cardiac function with potentially fatal results. Symptoms include shortness of breath. JVD, diminished/absent lung sounds, tracheal deviation towards unaffected side, poor BVM compliance Hemothorax Hemothorax: A collection of blood in the pleural cavity. Usually a consequence of blunt or penetrating trauma. Pain Dyspnea Distant heart sounds Hypotension Tachycardia Shock - depending on amount of blood lost Hemopneumothorax Hemopneumothorax: A combination of two medical conditions: pneumothorax and hemothorax. Hemopneumothorax most often occurs as a result of a wound to the chest, such as from a gunshot, stabbing, or broken rib. Pneumothorax Pneumothorax: A partial or complete accumulation of air in the pleural space. -Chest pain -Dypnea -Diminished breath sounds (if large) -Decreased tactile fremitus (if large) If tension: -Tachycardia -Hypotension -Mediastinal or tracheal shift (towards the good side) recumbent position Recumbent position: Lying down. Most often used when describing right lateral recumbent position (lying on their right side) or left lateral recumbent (lying on their left side). Behavioral Crisis Behavioral crisis: The point at which a person's reactions to events interfere with activities of daily living; this becomes a psychiatric emergency when it causes a major life interruption, such as attempted suicide. Psychiatric Emergency Psychiatric emergency: An acute disturbance of behavior, thought or mood of a patient which if untreated may lead to harm, either to the individual or to others in the environment. Radiation Radiation: The transfer of heat to colder objects in the environment by radiant energy; for example, heat gained from a fire. Convection Convection: The loss of body heat caused by air movement. (eg. A breeze blowing across the body) Conduction Conduction: The loss of body heat through direct contact (eg. When a body part comes into contact with a colder object) Evaporation Evaporation: The conversion of water or another fluid from liquid to gas. Affect to influence Behavior Behavior: How a person functions or acts in response to his or her environment. Neurosis Neurosis: a relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behavior, hypochondria) but not a radical loss of touch with reality. Psychosis Psychosis: A mental disorder characterized by the loss of contact with reality. Psychosis may occur as a result of a psychiatric illness like schizophrenia. In other instances, it may be caused by a health condition, medications, or drug use. Possible symptoms include delusions, hallucinations, talking incoherently, and agitation. The person with the condition usually isn't aware of his or her behavior. Treatment may include medication and talk therapy. Osteoporosis Osteoporosis: A generalized bone disease, commonly associated with postmenopausal women, in which there is a reduction in the amount of bone mass leading to fractures after minimal trauma in either sex. Acetabular separation Acetabular Separation: Pertaining to the acetabulum, the cup-shaped socket of the hip joint which is a key feature of the pelvis is separates(dislocated). Croup Croup: An inflammatory disease of the upper respiratory system that may cause a partial airway obstruction and is characterized by a barking cough; usually seen in children. In addition to a barking cough, symptoms include fever, hoarseness, and labored or noisy breathing. Most cases clear up with home care in three to five days. Asthma Asthma: An acute spasm of the smaller air passages, called bronchioles, associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages. Asthma can be minor, or it can interfere with daily activities. In some cases, it may lead to a life-threatening attack. Asthma may cause difficulty breathing, chest pain, cough, and wheezing. The symptoms may sometimes flare- up. Asthma can usually be managed with rescue inhalers to treat symptoms and controller inhalers that prevent symptoms. Severe cases may require longer-acting inhalers that keep the airways open, as well as oral steroids. Bronchitis Bronchitis: An acute or chronic inflammation of the lung that may damage lung tissue; usually associated with cough and production of sputum and, depending on its cause, sometimes fever. Acute bronchitis is often caused by a viral respiratory infection and improves by itself. Symptoms of bronchitis include coughing up thickened mucus and shortness of breath. Treatments usually includes soothing remedies to help with coughing, which may last weeks. Antibiotics are not usually recommended. Epiglottis Epiglottitis: A potentially life-threatening condition that occurs when the tissue protecting the windpipe becomes inflamed. Epiglottitis is commonly caused by an infection. The resulting inflammation causes swelling, which blocks air to the lungs. Symptoms often include shortness of breath, difficulty swallowing, and sore throat. Fever is commonly seen in cases of infection. When an infection is present, treatment includes antibiotics. A breathing tube and ventilator may be needed in severe cases. APGAR Apgar: Standard scoring system used to assess the status of a newborn. This system assigns a numeric value to 5 areas of activity of the newborn: Appearance, Pulse, Grimace or irritability, Activity or muscle tone, respirations. Vesicants/Vesicant agents Vesicants/Vesicant agents: A blister agent, or vesicant, is a chemical compound that causes severe skin, eye and mucosal pain and irritation. They are named for their ability to cause severe chemical burns, resulting in painful water blisters on the bodies of those affected. The primary route of entry for this agent is through the skin. triage supervisor Triage supervisor: In Incident command, the person in charge of the incident command triage sector who directs the sorting of patients into triage categories in a mass-casualty incident. Cardiogenic shock Cardiogenic shock: A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions. Aortic Aneurysm Aortic aneurysm: A weakness in the wall of the aorta that makes it susceptible to rupture. An abdominal aortic aneurysm (AAA) can be life-threatening if it bursts. Abdominal aortic aneurysms are most common in older men and smokers. An abdominal aortic aneurysm often grows slowly, without symptoms. As it grows, some people may notice a pulsating feeling near the navel. Pain in the back, belly, or side may be signs of impending rupture. Stopping smoking may slow their growth. Small ones may only need monitoring. Aneurysms that are too large or growing too quickly should be repaired with surgery. Tidal Volume (TV) Tidal Volume: The amount of air (in milliliters) that is moved in or out of the lungs during one relaxed breath; about 500mL for an adult. Residual Volume (RV) Residual Volume: The air that remains in the lungs after maximal expiration. Inspiratory Reserve Volume (IRV) Inspiratory reserve volume: The amount of air that can be inhaled after a normal inhalation; the amount of air that can be inhaled in addition to the normal tidal volume. Expiratory Reserve Volume (ERV) Expiratory reserve: The amount of air that can be exhaled following a normal exhalation; average volume is about 1,200 mL in the average adult man. Motor Nerve Neuropathy Motor Nerve Neuropathy: A disorder of the nerves of the peripheral nervous system in which the function and structure of the motor nerves are impaired. Symptoms include Muscle Weakness, cramps, spasms, loss of balance, and a loss of coordination. Functions of a PCR 1. Continuity of care 2. Legal Documentation 3. Education 4. Administrative information 5. Essential research record 6. Evaluation and continuous quality improvement PCR contains A good PCR documents any changes in the patient's condition upon arriving at the hospital. The following are examples of information collected on a PCR: ● Chief complaint ● Level of consciousness (according to the AVPU scale) or mental status ● Vital signs ● Initial assessment ● Patient demographics (age, gender, ethnic background) Narrative section of PCR - Time of events - Assessment findings - Emergency medical care provided - Changes in the patient after treatment - Observations at the scene - Final patient disposition - Refusal of care - Staff person who continued care Healthcare Insurance Portability and Accountability Act (HIPAA) Federal Legislation passed in 1996. -Its main effect in EMS is in limiting availability of patients' health care information and penalizing violations of patient privacy. HIPPA considers all patient information that you obtain in the course of providing medical treatment to a patient to be protected health information (PHI). -PHI may be disclosed for purposes of treatment, payment, or operations. This means you are permitted to report your assessment findings and treatment to other health care providers directly discover an error as you are writing, your report, draw a single horizontal line through the error, it, and write the correct information next to it. If a patient refuses care, have the patient sign a involved in the care of the patient. -Failure to abide by the provisions of HIPPA laws can result in civil and/ or criminal action against your response agency and against you personally. Each EMS system is required to have a policy and procedure manual and a privacy officer who can answer questions. Expressed Consent A type of consent in which a patient gives verbal or nonverbal authorization for provision of care or transport. Implied consent Type of consent in which a patient who is unable to give consent is given treatment under the legal assumption that he or she would want treatment. Involuntary consent consent that is assumed when the patient is either mentally incompetent or legally not permitted to make his own medical decisions When to use nasal cannula only if patient will not tolerate non-rebreather mask. (nasal cannula has low concentration of oxygen) Flow rate 1-6L/min Oxygen sat 24-44% When not to use a nasal cannula If the patient has a nasal airway obstruction If the patient will tolerate NRB When to use nonrebreather mask Given to patients who are breathing adequately but are suspected of having or showing signs of hypoxia. 90% oxygen 10-15L/min When not to use a nonrebreather mask Patient will not tolerate mask Patient requires manual ventilation When to use Bag Valve Mask? Used when you need to give oxygen to patients that are not ventilating adequately Examples-cardiopulmonary arrest, respiratory arrest, respiratory failure 100% oxygen Up to 15L/min When not to use bag valve mask Patient is ventilating adequately Patient will tolerate NRB When to use CPAP CPAP is indicated for patients experiencing respiratory distress in which their own compensatory mechanisms are not enough to keep up with oxygen demand General guidelines for candidates include ● Patient must be alert and able to follow commands. ● Patient is displaying obvious signs of moderate to severe respiratory distress (eg accessory muscle use, tripod position) from an underlying pathology such as pulmonary edema or obstructive pulmonary disease (ie, COPD) ● Patient is breathing rapidly, such that it affects overall minute volume (greater than 26 breaths/min) ● Pulse oximetry reading is less than 90% Contraindications include ● A patient who is in respiratory distress ● Signs and symptoms of a pneumothorax or chest trauma ● A patient who has a tracheostomy ● Active gastrointestinal bleeding or vomiting ● Patient is unable to follow verbal commands examples Acute pulmonary edema Obstructive lung disease Bronchospasm With beta-2 agonists Pulse Ox 90% Breathing Rate 26 V/Q ratio ventilation/perfusion ratio, how much gas is being moved and how much blood is gaining access to the alveoli What lies behind most abnormalities most oxygen and carbon dioxide exchange? A failure to match ventilation and perfusion lies behind most abnormalities in oxygen and carbon dioxide exchange. Can lead to severe hypoxemia. Requires immediate intervention to prevent cellular damage or death. Negative pressure breathing Air enters the body through the oral and nasal cavities and travels into the lungs. This occurs because a negative pressure is created in the chest (when the diaphragm contracts/moves down; causes a slight decrease in pressure and creates a slight vacuum). respiratory cycle and negative pressure breathing Air enters the body through the oral and nasal cavities and travels into the lungs. This occurs because a negative pressure is created in the chest (when the diaphragm contracts/moves down; causes a slight decrease in pressure and creates a slight vacuum). Eventually the air reaches the alveolar sacs and enters the bloodstream. At the same time, carbon dioxide diffuses from the bloodstream into the alveoli. The carbon dioxide is exhaled from the lungs, and the oxygen is transported back to the heart, where it is distributed to the rest of the body. Administrative information collected from a PCR Time the incident was reported Time the EMS unit was notified Time the EMS unit arrived at the scene Time the EMS unit left the scene Time the EMS unit arrived at the receiving facility Time the patient care was transferred hydrostatic pressure Hydrostatic pressure occurs as fluid pushes against the vessel walls to force fluid out of the capillary. oncotic pressure Oncotic pressure is the opposing force and occurs because proteins in the blood plasma cause water to be pulled into the capillary by diffusion. Capillary fluid movement The movement of fluid into and out of the capillaries occurs as follows. Blood flows into the arterial side of the capillary. Water is forced out because the pressure is high. At the same time, water is trying to enter the capillary. Pressure on the arterial side is higher, so the hydrostatic pressure is also higher, and water, carrying nutrients, leaves the capillary and enters the interstitial space. The hydrostatic pressure is greatly diminished, however, by the time the fluid reaches the venous side because the effort of pushing the fluid out of the capillary decreased its force. This decrease In pressure is beneficial because oncotic pressure is still pushing fluid into the capillary and the pressure is higher. Water, with all of the wastes from the cells, enters the venous side of the capillary. These wastes are then carried away. Adult CPR 1 Rescuer- 30 compressions per 2 breaths 2 Rescuer- 30 compressions per 2 breaths Child CPR 2 inches deep, 100 compressions/minute, 30 compressions & 2 breaths (one- rescuer), 15 chest compressions & 2 breaths (2-rescuer). Infant CPR Using two fingers, compress the sternum at least-third the anterior-posterior diameter of the chest (approximately 1.5 inches in most infants). Compress the chest at a rate of 100 to 120 per minute. 1 rescuer 30:2 2 rescuer 15:2 Signs of adequate breathing Signs of normal (adequate) breathing are as follows: ● A normal rate (between 12 and 20 breaths/min) ● A regular pattern of inhalation and exhalation ● Clear and equal lung sounds on both sides of the chest (bilateral) ● Regular and equal chest rise and fall (chest expansion) ● Adequate depth (tidal volume) Signs of inadequate breathing Signs of inadequate breathing in adult patients are as follows: ● Respiratory rate fewer than 12 breaths/minute or more than 20 breaths/minute in the presence of shortness of breath (dyspnea) ● Irregular rhythm, such as a patient taking series of deep breaths followed by periods of apnea. ● Diminishes, absent, or noisy auscultated breath sounds ● Reduced flow of expired air at the nose and mouth ● Unequal or inadequate chest expansion. Resulting in reduced tidal volume ● Increased effort of breathing (use of accessory muscles) ● Shallow depth (reduced tidal volume) ● Skin that is pale, cyanotic (blue), cool, or moist (clammy) ● Skin pulling In around the ribs or above the clavicle during inspiration (retractions) What does an awake, alert, and talking patient generally indicate in regards to airway? An adult who is awake, alert, and talking to you generally has no immediate airway or breathing problems. Cheyne-Stokes respiration Cheyne-stokes respirations are often seen in patients with stroke and patients with serious head injuries. They are an irregular respiratory pattern in which the patient breathes with an increasing rate and depth of respirations that is followed by a period of apnea, followed again by a pattern of increasing rate and depth of respiration. Emergency medical care includes airway management, supplemental oxygen, and ventilatory support. Kussmaul respirations Patients experiencing a metabolic or toxic disorder may display other abnormal respiratory patterns such as Kussmaul respirations. Kussmaul respirations are characterized as deep, rapid respirations commonly seen in patients with metabolic acidosis. Emergency medical care includes airway management, supplemental oxygen, and ventilatory support. Serious head injuries and respiratory effects Serious head injuries may also cause changes in the normal respiratory rate and pattern of breathing. The result may be irregular, ineffective respirations that may or may not have an identifiable pattern (ataxic respirations) COPD A group of lung diseases that block airflow and make it difficult to breathe. Emphysema and chronic bronchitis are the most common conditions that make up COPD. Damage to the lungs from COPD can't be reversed. Symptoms include shortness of breath, wheezing, or a chronic cough. Rescue inhalers and inhaled or oral steroids can help control symptoms and minimize further damage Emphysema The most common form of COPD. Pathophysiology ● Destruction of the airways distal to the bronchiole ● Destruction of the pulmonary capillary bed ● Decreased ability to oxygenate the blood ● Lower cardiac output and hyperventilation ● Development of muscle wasting and weight loss Emphysema S/S Tachypnea dyspnea barrel chest crackles and wheezes on inspiration decreased breath sounds clubbing(physical sign characterized by bulbous enlargement of the ends of one or more fingers or toes) mental status changes Emphysema signs/symptoms ● Thin appearance with barrel chest ● "Puffing" (pursed lip) style of breathing ● Tripod position Flail Chest and Paradoxical movement Paradoxical motion is when only one side of the chest rises on inspiration while another area of the chest falls. Paradoxical motion is associated with a fracture of several ribs (flail), causing a section of the chest to move independently from the rest of the chest wall. Flail chest If three or more ribs are fractured in two or more places or if the sternum is fractured along with several ribs, a segment of chest wall may be detached from the rest of the thoracic cage. This condition is known as flail chest. In paradoxical motion the detached portion of the chest wall moves opposite its normal. It moves in instead of out during inhalation and out instead of in during exhalation. Paradoxical motion is a late sign of flail segment. Structures lined with mucous membranes in the body The various opening in the body, including the mouth, nose, anus, and vagina, are not covered by skin. Instead these openings are lined with mucous membranes. Similar to skin, these membranes provide a protective barrier against bacterial invasion, but mucous membranes differ from skin in that they secrete a watery substance that lubricates the openings. Mucous membranes also line other tracts and structures of the body, including eyelids, trachea (windpipe) and lungs, stomach and intestines, and the ureters, urethra, and urinary bladder. cardiogenic shock Shock caused by inadequate function of the heart, or pump failure. Cardiogenic Shock Examples of potential causes ● Inadequate heart function, Disease of muscle tissue, Impaired electrical system, Disease or injury Signs/Symptoms ● Chest pain, irregular pulse, weak pulse, low blood pressure, cyanosis (lips, under nails), cool/clammy skin, anxiety, crackles (rales), pulmonary edema Treatment ● Position comfortably, administer high flow oxygen, assist ventilations, transport promptly, consider ALS. Acute Myocardial Infarction (AMI) AMI The pain of an AMI signals the actual death of cells in the area of the heart muscle where blood flow is obstructed. Signs/Symptoms ● Sudden onset of weakness, nausea, and sweating without an obvious cause ● Chest pain, discomfort, or pressure that is often crushing or squeezing and that does not change with each breath. ● Pain, discomfort, or pressure in the lower jaw, arms, back, abdomen, or neck. ● Irregular heartbeat and syncope (fainting) ● Shortness of breath, or dyspnea ● Nausea/vomiting ● Pink, frothy sputum (indicating possible pulmonary edema) ● Sudden death ● Pain ● It may or may not be caused by exertion, but can occur at any time, sometimes when a person is sitting quietly or even sleeping. ● It does not resolve in a few minutes; rather it can last between 30 minutes and several hours. ● It may or may not be relieved by rest or nitroglycerin. Consequences ● Sudden death ● Cardiogenic shock ● Congestive heart failure Angina a condition of episodes of severe chest pain due to inadequate blood flow to the myocardium Angina Chest pain does not always mean that a person is having an AMI. When, for a brief time, the heart tissues are not getting enough oxygen, the pain is called angina pectoris. Although angina can result from a spasm of an artery, it is MOST OFTEN A SYMPTOM OF ATHEROSCLEROTIC CORONARY ARTERY DISEASE. When the increased oxygen demand goes away, the pain typically goes away. Described as crushing or squeezing pain "like somebody is standing on my chest". May be associated with shortness of breath, nausea, or sweating. Usually disappears promptly with rest or nitroglycerin. Angina can be "stable" or "unstable" when it is not relieved as easily with rest or nitroglycerin. It is hard to distinguish between the pain of angina and the pain of AMI. Ischemic Heart Disease (IHD) Ischemic Heart disease Damage or disease in the heart's major blood vessels. THE USUAL CAUSE IS THE BUILDUP OF PLAQUE. This causes coronary arteries to narrow, limiting blood flow to the heart. Coronary artery disease can range from no symptoms, to chest pain, to a heart attack. Treatments include lifestyle changes, medications, angioplasty, and surgery. Axial skeleton Axial ● Forms the foundation to which the legs and arms are attached. The axial skeleton is composed of the skull, facial bones, thoracic cage, and vertebral column. ● The skull is composed of two groups of bones: the cranium and the facial bones. Four major bones make up the cranium: The occiput (posterior), Temporal bones (lateral), parietal bones (between temporal and occiput), frontal bone (forehead). The face is composed of 14 bones. The upper, non-moveable jawbones are the maxillae, the cheek bones are the zygomas, and the mandible is the lower, moveable portion of the jaw. ● The spinal column Is the central supporting structure of the body and is composed of 33 bones (vertebrae). Divided into 5 sections: Cervical spine (C1- C7), Thoracic spine (T1-T12/), Lumbar spine (L1-L5), the sacrum (5 fused), and the coccyx (four fused/tailbone) ● The thorax/chest contains the heart, lungs, esophagus and great vessels. Formed by T1-T12 and their 12 pairs of ribs. Contains the sternum (manubrium, body, xiphoid process) appendicular skeleton Appendicular ● The arms and legs, their connection points, and the pelvis. ● Wherever bones come in contact a joint (articulation) is formed, A joint consists of the ends of the bones that make up the joint and the surrounding connecting and supporting tissue. ● The upper extremities extend from the shoulder girdle to the fingertips and are composed of the arm, forearm, hand, and fingers. The joints are the shoulder, elbow, wrist, and finger joints. ● The pelvis is a closed, boney ring that consists of three bones: the sacrum and two pelvic bones. Each pelvic bone is formed by the fusion of three separate bones: the ileum, ischium, and pubis. ● The major parts of the lower extremities include the femur, femoral head, greater and lesser trochanters, patella (kneecap), tibia, fibula, and foot. The joint that connects the upper leg to the lower leg is the knee. The ankle is the joint that connects the lower leg to the foot. Vesicant Agents Vesicant agents (Blister agents) The primary route of exposure of blister agents is the skin (contact); however, if vesicants are left on the skin or clothing long enough, they produce vapors that can enter the respiratory tract. The vesicant agents consist of sulfur mustard (H/mustard gas), lewisite (L), and phosgene oxime (CX). Mustard gas is a mutagen, which means that it mutates, damages, and changes the structures of cells. H will not produce s/s for 4-6 hours. L and CX have a rapid onset of symptoms. Signs of vesicant exposure on the skin include the following: ● Skin irritation, burning, and reddening ● Immediate, intense skin pain (with L and CX) ● Formation of large blisters ● Gray discoloration of the skin (a sign of permanent damage seen with L and CX) ● Swollen and closed or irritated eyes ● Permanent eye injury (including blindness) If vapors were inhaled: ● Hoarseness and stridor ● Severe cough ● Hemoptysis (coughing up blood) ● Severe dyspnea ICS command ● The incident commander is the one in charge of the overall incident. The IC will assess the incident, establish the strategic objectives. A single command system is one in which one person is in charge, even if multiple agencies respond. Large incidents require a multiagency or multijurisdictional response and need to use a unified command system. Agencies have a shared responsibility for decision making. An IC may transfer command to someone with more experience in a critical area ICS Finance Finance ● Responsible for documenting all expenditures at an incident for reimbursement ICS Logistics Logistics ● Responsible for communications equipment, facilities, food and water, fuel, lighting, and medical equipment/supplies for patients and emergency responders. ICS Operations Operations ● At a very large or complex incident, the operations section is responsible for managing the tactical operations usually handled by the IC. ICS plannign Planning ● This section solves problems as they arise Obtains data about the problem, analyzes the previous incident plan, predicts what or who is needed to make the new plan work, works closely with the operations, finance, and logistics sections. Another function is to develop an incident action plan, which is the central tool for planning during a response to a disaster emergency ICS Command Staff Command staff ● The safety officer monitors the scene for conditions or operations that may present a hazard to responders and patients. He or she has the authority to stop an emergency operation whenever a rescuer is in danger. A safety officer should remove hazards to EMS personnel and patients before the hazards cause injury. ● The public information officer (PIO) provides the media with clear and understandable information. ● The liaison officer relays information and concerns among command, the general staff, and other agencies. ICS Span of Control Span of control One of the organizing principles of the ICS is limiting the span of control of any one individual. 3-7 persons (possible 8 depends on some books). The ideal number is five employees/members answering to one officer. The organizational levels may include sections, branches, and divisions/groups (shown below). Generally, the larger the incident the more divisions there will be. START triage Simple Triage And Rapid Treatment. Uses a limited assessment of the patient's ability to walk, respiratory status, hemodynamic status (pulse), and neurologic status. First step is to call out to patients and direct them to an easily identifiable landmark. Injured persons are the walking wounded and are considered minimal (green) priority, or third-priority patients. The second step is directed toward non-walking patients. Move to the first non- ambulatory patient and assess the respiratory status. If the patient is not breathing, open the airway by using a simple manual maneuver. A patient who still does not begin to breathe is triaged as expectant (black). If the patient begins to breathe, tag him or her as immediate (red), place the patient in the recovery position, and move on to the next. If the patient is breathing, make a quick estimation of the respiratory rate. The next step is to assess the hemodynamic status of the patient by checking for bilateral radial pulses. The final assessment is to assess the patient's neurologic status by assessing the patient's ability to follow simple commands JumpSTART triage JumpSTART triage for pediatric patients. Intended for use in children younger than 8 years or who appear to weigh less than 100 lb. Begin by identifying the walking wounded. Infants or children not developed enough to walk or follow commands (including children with special needs) should be taken as soon as possible to the treatment sector for immediate secondary triage. There are several differences within the respiratory status assessment compared with that in START. If you find that a pediatric patient is not breathing, immediately check the pulse. If there is no pulse, label the patient as expectant (black). If the patient is not breathing but has a pulse, open the airway with a manual maneuver. If the patient does not begin to breathe, give five rescue breaths and check respirations again. A child who does not begin to breathe should be labeled expectant. The next step is to assess the approximate rate of respirations. The next assessment is the hemodynamic status of the patient. Assess the pulse that you feel the most competent and comfortable checking. If the pediatric patient has a respiratory rate of 40 breaths/min the EMT should assess for a distal pulse. If there is an absence of a distal pulse, label the child as an immediate priority and move to the next patient. The final assessment is for neurologic status. A modified AVPU score is used. Triage Special Considerations 1. Patients who are hysterical and disruptive to rescue efforts may need to be handled as an immediate priority and transported off the site, even if they are not seriously injured. 2. A responder who becomes sick or injured during the rescue effort should be handled as an immediate priority and be transported off the site as soon as possible. 3. Hazardous materials (HazMat) and weapons of mass destruction incidents force the HazMat team to identify patients as contaminated or decontaminated before the regular triage process. Croup Inflammation and swelling of pharynx, larynx, and trachea. Stridor and seal-bark cough. Responds well to humidified oxygen. Secondary to an acute viral infection of the upper respiratory tract and is typically seen in children between the ages 6 months and 3 years. It is easily passed between children. Croup is rarely seen in adults because of larger breathing passages. Epiglottitis Epiglottitis A life-threatening inflammatory disease of the epiglottis, the small flap of tissue at the back of the throat that protects the larynx and trachea during swallowing. Bacterial infection is the most common cause. A potentially life-threatening condition that occurs when the tissue protecting the windpipe becomes inflamed. Symptoms often include shortness of breath, difficulty swallowing, and sore throat. Fever is commonly seen in cases of infection. Focus your treatment on maintaining a patent (adequate) airway, and provide prompt transport to the ED. -excessive drooling is the universal sign -in addition, the child will have a sudden onset of dysphagia or difficulty swallowing, stridor, and high-grade fever. -the child may also be in the TRIPOD POSITION upon arrival Types of oxygen cylinders Types of oxygen cylinders, and min operating PSI before you should go out of service (M&D tank) The oxygen that you will give to patients is usually supplied as a compressed gas in green, seamless, steel or aluminum cylinders. The two sizes that you will most often use are the D (or jumbo D) and M cylinders. The D (or jumbo D) cylinder can be carried from your unit to the patient. The M tank remains on board your unit as a main supply tank. Other sizes you will see are A, E, G, H, and K. M=Medical. Most portable cylinders have a maximum pressure of approximately 2,000 psi. Most EMS systems consider a cylinder with less than 500 to 1,000 psi to be too low to keep in service. Oxygen tank minimums The portable unit should be located near a door or in the jump kit, for easy use outside the ambulance with a minimum capacity of 500L of oxygen. The mounted oxygen unit should have a capacity of 3,000L of oxygen. Single issue groups Single Issue Groups These include antiabortion groups, animal rights groups, anarchists, racists, and even ecoterrorists who threaten or use violence as a means to protect the environment. (terrorist group) Assessment techniques of noncritical pediatric patients Stay at the child's level when assessing them Start at toes and move to the head Keep their caregiver nearby Allow them to bring a toy if it brings them comfort Remember most pediatric emergencies are respiratory in nature stages of pregnancy and development 1. Fertilization 2. Embryonic development 3. Fetal development 4. Childbirth First stage of pregnancy 1-3 months, egg begins to divide within 40 hours of fertilization, blastocyst become an embryo after two weeks, end of second month the embryo is a fetus and is recognizable as a human being Second stage of pregnancy 4-6 months, fetus requires a great amount of nourishment from the placenta, length is 14 inches and weight is 2 pounds, all systems are in action, it is possible for the fetus to be born in the 5th and 6th months to survive. Third stage of pregnancy 7-9 months, fetus gains most of its weight during this time, baby needs a good amount of calcium, nitrogen and iron to develop blood and bone, relies on the immunities from the mother's blood first stage of labor the initial stage of childbirth in which regular contractions begin and the cervix dilates second stage of labor the stage during which the baby moves out through the vagina and is delivered third stage of labor delivery of placenta fourth stage of labor the first 1-4 hours after delivery of the placenta, recovery pregnancy blood volume and trauma During pregnancy blood volume increases 40-50% This means a pregnant woman can bleed out more before going into decompensated hemorrhagic shock Expected blood loss during delivery 500mL Expected blood loss during C-section 1000mL Postpartum Care for hemorrhaging following a delivery Massaging the uterus by hand Your provider can massage the uterus to help it contract, lessen bleeding and help the body pass blood clots. Your provider may also give you medications like oxytocin to make the uterus contract and lessen bleeding. Getting oxygen by wearing an oxygen mask. Gravida (gravidity) The total number of times a woman has been pregnant, regardless of whether the pregnancy resulted in a termination or if multiple infants were born from a pregnancy. ● Gravida indicates the number of times a woman is or has been pregnant, regardless of the pregnancy outcome. A current pregnancy, if any, is included in this count. Multiple pregnancy is counted as 1. para(parity) Para (parity) ● Parity, or "para", indicates the number of pregnancies reaching viable gestational age (including live births and stillbirths). The number of fetuses does not determine the parity. Twin pregnancy carried to viable gestational age is counted as 1. G3P2 or G4P what does it mean? G3P2 3 pregnancies, 2 births G4P 4 pregnancies, 0 births acute coronary syndrome (ACS) Acute Coronary Syndrome Many patients who call for EMS assistance because of chest pain have acute coronary syndrome. ACS is a term used to describe a group of symptoms caused by myocardial ischemia; a decrease in blood flow to the heart which leads to chest pain through reduction of oxygen and nutrients to the tissues of the heart. This can be a temporary situation known as angina pectoris, or a more serious condition, an AMI. Signs and symptoms of compensated shock Signs and Symptoms of compensated shock ● Agitation ● Anxiety ● Restlessness ● Feeling of impending doom ● Altered mental status ● Weak, rapid (thread), or absent pulse ● Clammy (pale, cool, moist) skin ● Pallor, with cyanosis about the lips ● Shallow, rapid breathing ● Air hunger (shortness of breath), especially if there is a chest injury ● Nausea or vomiting ● Capillary refill of longer than 2 seconds in infant and children ● Marked thirst ● Narrowing pulse pressure Signs and symptoms of decompensated shock Decompensated ● Falling blood pressure (systolic blood pressure of 90mm Hg or lower in an adult) ● Labored or irregular breathing ● Ashen, mottled, or cyanotic skin ● Thready or absent peripheral pulses ● Dull eyes, dilated pupils ● Poor urinary output How do pediatric patients respond to fluid loss? How do they present shock? Pediatric patients respond differently than adults to fluid loss. They may respond by increasing their heart rate, increasing respirations, and showing signs of pale skin (pallor) or blue skin (cyanosis). Signs of shock in infants and children are as follows: ● Tachycardia ● Poor capillary refill (2 seconds) ● Mental status changes When a child is struck by a car The area of greatest injury depends mostly on the size of child and height of the bumper BVM rate for adults every 5-6 seconds BVM rate for children every 3-5 seconds Two Person BVM Technique With two-person BVM ventilation, you hold the mask in place while your partner squeezes the bag with two hands until the patient's chest rises adequately. Best location to assess breath/lung sounds of a pediatric patient The best way to auscultate breath sounds in pediatric patients is to listen on both sides of the chest at the level of the armpit. Behavior Behavior What you can see of a person's response to the environment: his or her actions. Most of the time people respond to the environment in reasonable ways. Sometimes it is obvious what is causing a person's response. Sometimes it is less clear. In some cases, the reaction is acute, but in other cases it develops over time. Both situations can create a crisis. CHF A disorder in which the heart loses part of it's ability to effectively pump blood, usually as a result to damage to the heart muscle and usually resulting in a backup of fluid into the lungs. Left sided CHF S/S Left Lungs become congested with fluid once the heart fails to pump the blood effectively. Blood tends to back up in the pulmonary veins, increasing the pressure in the capillaries of the lungs. When the pressure in the capillaries exceeds a certain level, fluid (mostly water) passes through the walls of the capillary vessels and into the alveoli (pulmonary edema). It may occur suddenly as an AMI, or slowly over months, as in chronic CHF. Sometimes, in patients with acute onset of CHF, severe pulmonary edema will develop, in which the patient has pink, frothy sputum and sever dyspnea. Right sided CHF Right Fluid collects in the body, often showing up as swelling in the feet and legs. Since the righty side of the heart supplies the preload for the left side of the heart, right heart failure can result an inadequate supply of blood to the left ventricle resulting in a drop in systemic blood pressure. Left sided often leads to right sided. Patients may display signs of both. Dependent Edema (pedal edema) Jugular Vein Distention (JVD) Liver engorgement (ascites) What is motor nerve neuropathy and the associated signs and symptoms? Neuropathy: A 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 of it affecting the motor nerves include muscle weakness, cramps, spasms, loss of balance, and loss of coordination. Signs and symptoms of a ruptured diaphragm Breath sounds on the side of the rupture may be diminished respiratory distress may be present chest or abdomen may be painful Orthopnea (shortness of breath when lying flat) coughing In people with herniation of abdominal organs, signs of intestinal blockage or sepsis in the abdomen may be present. Bowel sounds may be heard in the chest, and shoulder or epigastric pain may be present. When the injury is not noticed right away, the main symptoms are those that indicate bowel obstruction. These people present months later, with vague symptoms that do not necessarily relate to an injury. Why are ingested poisons impossible to dilute/remove from the body? The body absorbs these poisons. It is possible to use an adsorbent which prevents the body from absorbing anymore of the toxin if allowed by local protocol. effects of osteoporosis in the elderly when dealing with trauma As a result of bone loss from osteoporosis, older patients are prone to fractures, especially of the hip. More common among women. People with osteoporosis may fracture a hip from a standing fall (pathologic fracture) Cincinnati Prehospital Stroke Scale Facial droop Droop-1 No droop-0 Arm drift Drift-1 No drift-0 Abnormal speech Slurred-1 Not slurred-0 How do you transport a stroke patient? If you suspect the patient is experiencing a stroke, provide rapid transport to an appropriate facility. Prompt treatment is a critical action to minimize the disability caused by an ischemic stroke. Transport the Pt with a paralyzed extremity in the recumbent position (L/R recumbent). 5 ways the body can lose heat There are five ways the body can lose heat: ● Conduction: The loss of heat by direct contact (Body part comes in contact with a colder object). ● Convection: Loss of body heat caused by air movement (breeze blowing across body). ● Evaporation: Conversion of water or another fluid from a liquid to a gas. ● Radiation: Transfer of heat to colder objects in the environment by radiant energy; heat gain from a fire. Covering a patient's head will significantly minimize radiation heat loss. ● Respiration: The physiologic process of exchanging oxygen and carbon dioxide, or, in the context of environmental emergencies, the loss of body heat as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled. High humidity and the body's ability to lose heat High humidity reduces heat loss through evaporation (reduces evaporation). Activated Charcoal Action-adsorbs toxic substances in the digestive tract Indications-most oral poisons, overdose Contraindications-decreased LOC, overdose of corrosives, caustics, or petroleum substances Route-PO Side effects-nausea, emesis, constipation, black stools Interactions-bonds with and inactivates most medications/substances in the digestive tract Adult dose 1-2g/kg Aspirin Action- anti-inflammatory agent and anti-fever agent; prevents platlets from clumping; thereby decreasing formation of new clots Indications-relief of mild pain, headache, muscle aches, chest pain of cardiac origin Contraindications-hypersensitivity, recent bleeding Routes-PO Side effects-nausea, vomiting, stomach pain, bleeding, allergic reactions Interactions-caution should be used in patients who are taking anticoagulants Adult dose- 160-325 mg, 160-