TEST BANK For Paramedic Care -
Principles and Practice, 6th Edition,
Volume 1 - 5 by Bledsoe,
Surveillance - answer-- Surveillance is the process of collecting data in order to identify
the existence, significance, and characteristics of disease.
- As energy stores from the liver and muscle glycogen are exhausted, the core body
temperature will drop.
Active rewarming - answer-- rewarmed using active external methods.
- warmed blankets and/or heat packs placed over areas of high heat transfer with the
core: the base of the neck, the axilla, and the groin.
- insulate between the heat packs and the skin
- Intravenous fluid heaters can be used to heat the IV fluid to 95°F to 100°F (35°C to
38°C)
- Warm-water immersion in water between 102°F and 104°F (39°C to 40°C) may be
used, but can induce rewarming shock.
- Active rewarming of the severely hypothermic patient is best carried out in the hospital.
Active rewarming should not be attempted in the field unless travel to the emergency
department will take more than 15 minutes.
- Rough handling of the hypothermic patient may also induce ventricular fibrillation
- warmed (102°F to 104°F or 39°C to 40°C) humidified oxygen and administration of
warmed IV fluids (also warmed to 102°F to 104°F, or 39°C to 40°C)
Rewarming Shock - answer-- application of external heat, as with heat packs, is usually
not recommended in the prehospital setting.
,- Causes reflex peripheral vasodialation; This reflex vasodilation causes the return of
cool blood and acids from the extremities to the core. This may cause a paradoxical
"afterdrop" core temperature decrease and further worsen core hypothermia. This, in
turn, may cause the blood pressure to fall, especially when there is also volume
depletion.
- Administration of warmed IV fluids during rewarming can prevent the onset of
rewarming shock.
Cold Diuresis - answer-- Volume depletion can occur as a result
Pathophysiology of drowning - answer-- As patient is submerged in water they attempt
to breathe, and either they aspirate water or their larynx spasms ("Laryngospasm") and
causes them to suffocate
Epidemiology - answer-Study of factors that influence the frequency, distribution, and
causes of injury, disease, and other health related events in a population.
Risk Analysis - answer-A process to examine a disease and determine the various
factors that affect its development, course, and consequences.
- A tool to identify risk elements associated with trauma is the Haddon Matrix
Haddon Matrix - answer-A framework developed by William Haddon, Jr, MD as a
method to generate ideas about injury prevention that address the host, agent, and
environment and their impact in the pre-event, event, and post-event phases of the
injury process
Intervention Development - answer-- The creation or modification of programs to reduce
both the incidence and the seriousness of trauma
Implementation - answer-the act of placing an intervention into practice.
Ex: enforcing traffic laws, reducing speed limits in hazardous areas, modifying highways
to be safer, building safer vehicles, establishing gun safety programs and workplace
safety codes.
Evaluation - answer-- process of repeating the surveillance that took place before an
intervention to identify benefits of the intervention.
Level I Trauma Center - answer-- Regional Trauma Center
- Commits resources to address all types of specialty trauma 24 hours a day, 7 days a
week.
,Level II Trauma Center - answer-- Area Trauma Center
- Commits the resources to address the most common trauma emergencies with
surgical capability available 24 hours a day, 7 days a week; stabilizes and transports
specialty cases to the regional trauma center.
Level III Trauma Center - answer-- Community Trauma Center
- Commits to special emergency department training and has some surgical capability
but usually stabilizes and transfers seriously injured trauma patients to a higher-level
trauma center as needed.
Level IV Trauma Center - answer-- Trauma Facility
- In remote areas, a small community hospital or medical care facility can be designated
a trauma receiving facility, meaning that it stabilizes and prepares seriously injured
trauma patients for transport to a higher-level facility.
Specialty Centers - answer-- Specialty centers have made a commitment to have
trained personnel, equipment, and other resources to provide services not usually
available at a general or trauma hospital.
- Ex: neurocenters, burn centers, pediatric trauma centers, and centers specializing in
hand and limb replantation by microsurgery, hyperbaric oxygenation.
Scene Safety - answer-- Many scene hazards go unnoticed
- Do not enter an Unsafe scene
- Request additional resources to ensure a safe scene and then await their arrival.
Mechanism of Injury Analysis - answer-- MOI
- Combined strength, direction, and nature of forces that injured a person; The manner
in which trauma occurs
Index of suspicion - answer-The anticipation of injury to a body region, organ, or
structure based on analysis of the mechanism of injury.
Trauma Triage Criteria - answer-- Guidelines to aid prehospital personnel in determining
which trauma patients require urgent transportation to a trauma center.
Physiologic Criteria - Trauma Center Criteria - answer-- Glasgow Coma Scale (GCS)
score less than or equal to 13,
- Systolic blood pressure (SBP) of less than 90 mmHg,
, - Respiratory rate of less than 10 or more than 29 breaths per minute (< 20 in infant
aged <1 year), or need for ventilatory support.
Anatomic Criteria - Trauma Center Criteria - answer-- All penetrating injuries to head,
neck, torso, and extremities proximal to elbow or knee
- Chest wall instability or deformity
- Two or more proximal long-bone fractures
- Crushed, degloved, mangled, or pulseless extremity
- Amputation proximal to wrist or ankle
- Pelvic fracture
- Open or depressed skull fractures
- Paralysis
Mechanism of injury - Trauma Center Criteria - answer-- Falls: Adults = > 20 feet; Peds
= > 10 feet or 2 to 3 times the height of the child
- High-risk auto crash: Intrusion > 12 inches; Ejection (partial or complete) from
automobile; Death in same passenger compartment; Vehicle telemetry data consistent
with a high risk for injury
- Automobile vs. pedestrian/bicyclist thrown, run over, or with significant (> 20 mph)
impact; or motorcycle crash > 20 mph
Special Considerations - answer-- Older adults: risk for injury/death increases after age
55 years, SBP < 110 might represent shock after age 65 years, low-impact mechanisms
(e.g. ground level falls) might result in severe injury.
- Children: Should be triaged preferentially to pediatric capable trauma centers.-
Anticoagulants and bleeding disorders: patients with head injury are at high risk for
rapid deterioration.
- Burns: without other trauma mechanisms = triage to burn facility; with trauma
mechanisms = triage to trauma center
- Pregnancy > 20 weeks
- EMS provider judgment
Principles and Practice, 6th Edition,
Volume 1 - 5 by Bledsoe,
Surveillance - answer-- Surveillance is the process of collecting data in order to identify
the existence, significance, and characteristics of disease.
- As energy stores from the liver and muscle glycogen are exhausted, the core body
temperature will drop.
Active rewarming - answer-- rewarmed using active external methods.
- warmed blankets and/or heat packs placed over areas of high heat transfer with the
core: the base of the neck, the axilla, and the groin.
- insulate between the heat packs and the skin
- Intravenous fluid heaters can be used to heat the IV fluid to 95°F to 100°F (35°C to
38°C)
- Warm-water immersion in water between 102°F and 104°F (39°C to 40°C) may be
used, but can induce rewarming shock.
- Active rewarming of the severely hypothermic patient is best carried out in the hospital.
Active rewarming should not be attempted in the field unless travel to the emergency
department will take more than 15 minutes.
- Rough handling of the hypothermic patient may also induce ventricular fibrillation
- warmed (102°F to 104°F or 39°C to 40°C) humidified oxygen and administration of
warmed IV fluids (also warmed to 102°F to 104°F, or 39°C to 40°C)
Rewarming Shock - answer-- application of external heat, as with heat packs, is usually
not recommended in the prehospital setting.
,- Causes reflex peripheral vasodialation; This reflex vasodilation causes the return of
cool blood and acids from the extremities to the core. This may cause a paradoxical
"afterdrop" core temperature decrease and further worsen core hypothermia. This, in
turn, may cause the blood pressure to fall, especially when there is also volume
depletion.
- Administration of warmed IV fluids during rewarming can prevent the onset of
rewarming shock.
Cold Diuresis - answer-- Volume depletion can occur as a result
Pathophysiology of drowning - answer-- As patient is submerged in water they attempt
to breathe, and either they aspirate water or their larynx spasms ("Laryngospasm") and
causes them to suffocate
Epidemiology - answer-Study of factors that influence the frequency, distribution, and
causes of injury, disease, and other health related events in a population.
Risk Analysis - answer-A process to examine a disease and determine the various
factors that affect its development, course, and consequences.
- A tool to identify risk elements associated with trauma is the Haddon Matrix
Haddon Matrix - answer-A framework developed by William Haddon, Jr, MD as a
method to generate ideas about injury prevention that address the host, agent, and
environment and their impact in the pre-event, event, and post-event phases of the
injury process
Intervention Development - answer-- The creation or modification of programs to reduce
both the incidence and the seriousness of trauma
Implementation - answer-the act of placing an intervention into practice.
Ex: enforcing traffic laws, reducing speed limits in hazardous areas, modifying highways
to be safer, building safer vehicles, establishing gun safety programs and workplace
safety codes.
Evaluation - answer-- process of repeating the surveillance that took place before an
intervention to identify benefits of the intervention.
Level I Trauma Center - answer-- Regional Trauma Center
- Commits resources to address all types of specialty trauma 24 hours a day, 7 days a
week.
,Level II Trauma Center - answer-- Area Trauma Center
- Commits the resources to address the most common trauma emergencies with
surgical capability available 24 hours a day, 7 days a week; stabilizes and transports
specialty cases to the regional trauma center.
Level III Trauma Center - answer-- Community Trauma Center
- Commits to special emergency department training and has some surgical capability
but usually stabilizes and transfers seriously injured trauma patients to a higher-level
trauma center as needed.
Level IV Trauma Center - answer-- Trauma Facility
- In remote areas, a small community hospital or medical care facility can be designated
a trauma receiving facility, meaning that it stabilizes and prepares seriously injured
trauma patients for transport to a higher-level facility.
Specialty Centers - answer-- Specialty centers have made a commitment to have
trained personnel, equipment, and other resources to provide services not usually
available at a general or trauma hospital.
- Ex: neurocenters, burn centers, pediatric trauma centers, and centers specializing in
hand and limb replantation by microsurgery, hyperbaric oxygenation.
Scene Safety - answer-- Many scene hazards go unnoticed
- Do not enter an Unsafe scene
- Request additional resources to ensure a safe scene and then await their arrival.
Mechanism of Injury Analysis - answer-- MOI
- Combined strength, direction, and nature of forces that injured a person; The manner
in which trauma occurs
Index of suspicion - answer-The anticipation of injury to a body region, organ, or
structure based on analysis of the mechanism of injury.
Trauma Triage Criteria - answer-- Guidelines to aid prehospital personnel in determining
which trauma patients require urgent transportation to a trauma center.
Physiologic Criteria - Trauma Center Criteria - answer-- Glasgow Coma Scale (GCS)
score less than or equal to 13,
- Systolic blood pressure (SBP) of less than 90 mmHg,
, - Respiratory rate of less than 10 or more than 29 breaths per minute (< 20 in infant
aged <1 year), or need for ventilatory support.
Anatomic Criteria - Trauma Center Criteria - answer-- All penetrating injuries to head,
neck, torso, and extremities proximal to elbow or knee
- Chest wall instability or deformity
- Two or more proximal long-bone fractures
- Crushed, degloved, mangled, or pulseless extremity
- Amputation proximal to wrist or ankle
- Pelvic fracture
- Open or depressed skull fractures
- Paralysis
Mechanism of injury - Trauma Center Criteria - answer-- Falls: Adults = > 20 feet; Peds
= > 10 feet or 2 to 3 times the height of the child
- High-risk auto crash: Intrusion > 12 inches; Ejection (partial or complete) from
automobile; Death in same passenger compartment; Vehicle telemetry data consistent
with a high risk for injury
- Automobile vs. pedestrian/bicyclist thrown, run over, or with significant (> 20 mph)
impact; or motorcycle crash > 20 mph
Special Considerations - answer-- Older adults: risk for injury/death increases after age
55 years, SBP < 110 might represent shock after age 65 years, low-impact mechanisms
(e.g. ground level falls) might result in severe injury.
- Children: Should be triaged preferentially to pediatric capable trauma centers.-
Anticoagulants and bleeding disorders: patients with head injury are at high risk for
rapid deterioration.
- Burns: without other trauma mechanisms = triage to burn facility; with trauma
mechanisms = triage to trauma center
- Pregnancy > 20 weeks
- EMS provider judgment
