, Eighth Edition
Nancy Caroline’s
Emergency
Care in the Streets
1 2
Preparatory
Volume
Volume
Trauma
The Human Body and Human Systems
Shock and Resuscitation
Patient Assessment
Special Patient Populations
Pharmacology
Operations
Airway Management
Career Development
Medical
,
, Eighth Edition
Nancy Caroline’s
Emergency
Care in the Streets
Series Editor:
Andrew N. Pollak, MD, FAAOS
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Barbara Aehlert, MSEd, BSPA, RN
Bob Elling, MPA, EMT-P
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Names: American Academy of Orthopaedic Surgeons, author. | Pollak, Andrew N.,
editor. | Elling, Bob, editor. | Aehlert, Barbara, editor.
Title: Nancy Caroline’s emergency care in the streets / American Academy of
Orthopaedic Surgeons ; series editor: Andrew N. Pollak ; lead editors: Bob
Elling, Barbara Aehlert.
Other titles: Emergency care in the streets
Description: Eighth edition. | Burlington, MA : Jones & Bartlett Learning,
[2018] | Preceded by Nancy Caroline’s emergency care in the streets.
7th ed. 2013. | Includes bibliographical references and index.
Identifiers: LCCN 2017024835 | ISBN 9781284457278 (casebound)
Subjects: | MESH: Emergency Treatment | Emergency Medical Services |
Emergency Medical Technicians
Classification: LCC RC86.7 | NLM WB 105 | DDC 616.02/5--dc23
LC record available at https://lccn.loc.gov/2017024835
6048
Printed in the United States of America
21 20 19 18 17 10 9 8 7 6 5 4 3 2 1
,Brief Contents
VOLUME 1 VOLUME 2
Section 1: Preparatory Section 7: Trauma
Chapter 1 EMS Systems Chapter 29 Trauma Systems and Mechanism of Injury
Chapter 2 Workforce Safety and Wellness Chapter 30 Bleeding
Chapter 3 Public Health Chapter 31 Soft-Tissue Trauma
Chapter 4 Medical, Legal, and Ethical Issues Chapter 32 Burns
Chapter 5 Communications Chapter 33 Face and Neck Trauma
Chapter 6 Documentation Chapter 34 Head and Spine Trauma
Chapter 7 Medical Terminology Chapter 35 Chest Trauma
Chapter 36 Abdominal and Genitourinary Trauma
Section 2: The Human Body Chapter 37 Orthopaedic Trauma
and Human Systems Chapter 38 Environmental Emergencies
Chapter 8 Anatomy and Physiology
Chapter 9 Pathophysiology Section 8: Shock and Resuscitation
Chapter 10 Life Span Development Chapter 39 Responding to the Field Code
Chapter 40 Management and Resuscitation of the Critical
Section 3: Patient Assessment Patient
Chapter 11 Patient Assessment
Chapter 12 Critical Thinking and Clinical Section 9: Special Patient Populations
Decision Making Chapter 41 Obstetrics
Chapter 42 Neonatal Care
Section 4: Pharmacology Chapter 43 Pediatric Emergencies
Chapter 13 Principles of Pharmacology Chapter 44 Geriatric Emergencies
Chapter 14 Medication Administration Chapter 45 Patients With Special Challenges
Section 5: Airway Management Section 10: Operations
Chapter 15 Airway Management Chapter 46 Transport Operations
Chapter 47 Incident Management and Mass-Casualty
Section 6: Medical Incidents
Chapter 16 Respiratory Emergencies Chapter 48 Vehicle Extrication and Special Rescue
Chapter 17 Cardiovascular Emergencies Chapter 49 Hazardous Materials
Chapter 18 Neurologic Emergencies Chapter 50 Terrorism Response
Chapter 19 Diseases of the Eyes, Ears, Nose, and Throat Chapter 51 Disaster Response
Chapter 20 Abdominal and Gastrointestinal Emergencies Chapter 52 Crime Scene Awareness
Chapter 21 Genitourinary and Renal Emergencies
Chapter 22 Gynecologic Emergencies Section 11: Career Development
Chapter 23 Endocrine Emergencies Chapter 53 Career Development
Chapter 24 Hematologic Emergencies
Chapter 25 Immunologic Emergencies GLOSSARY
Chapter 26 Infectious Diseases INDEX
Chapter 27 Toxicology
Chapter 28 Psychiatric Emergencies
APPENDIX: EMERGENCY MEDICATIONS
v
,Contents
VOLUME 1 Protecting Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Immunizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Personal Protective Equipment and Practices . . . . . . . 48
Management of an Exposure. . . . . . . . . . . . . . . . . . . . . 51
Section 1: Preparatory 1 Hostile Situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Traffic Incidents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
CHAPTER 1 EMS Systems 3 Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 What Triggers Stress. . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
EMS System Development. . . . . . . . . . . . . . . . . . . . . . . . . . 4 The Physiology of Acute Stress . . . . . . . . . . . . . . . . . . . 55
The History of EMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 How People React to Stressful Situations. . . . . . . . . . . 55
The 20th Century and Modern Technology. . . . . . . . . . 6 Coping With Your Own Stress . . . . . . . . . . . . . . . . . . . 58
Licensure, Certification, and Registration. . . . . . . . . . . . . . 9 Burnout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Reciprocity�������������������������������������������������������������������� 10 Coping With Death and Dying . . . . . . . . . . . . . . . . . . . . . 60
Traditional EMS Employment������������������������������������������ 10 Stages of the Grieving Process. . . . . . . . . . . . . . . . . . . . 61
The EMS System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Dealing With the Dying Patient. . . . . . . . . . . . . . . . . . 61
Levels of Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Dealing With a Grieving Family. . . . . . . . . . . . . . . . . . 62
The Dispatcher. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Dealing With a Grieving Child. . . . . . . . . . . . . . . . . . . 62
Emergency Medical Responder. . . . . . . . . . . . . . . . . . . 12 After the Call Is Over. . . . . . . . . . . . . . . . . . . . . . . . . . . 63
EMT�������������������������������������������������������������������������������� 13 Peer Support and Suicide Prevention . . . . . . . . . . . . . . . . 63
Advanced EMT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Paramedic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Paramedic Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 CHAPTER 3 Public Health 71
Initial Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Continuing Education. . . . . . . . . . . . . . . . . . . . . . . . . . 14 Role of Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Additional Types of Transports . . . . . . . . . . . . . . . . . . . . . 14 Public Health Threats. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Transport to Specialty Centers . . . . . . . . . . . . . . . . . . . 14 Injuries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Interfacility Transports. . . . . . . . . . . . . . . . . . . . . . . . . . 14 Chronic Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Working With Other Professionals . . . . . . . . . . . . . . . . . . 15 Acute Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Working With Hospital Staff. . . . . . . . . . . . . . . . . . . . . 15 The Cost of Public Health Threats. . . . . . . . . . . . . . . . . . . 74
Working With Public Safety Agencies. . . . . . . . . . . . . . 16 The Teachable Moment . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Continuity of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
National EMS Group Involvement . . . . . . . . . . . . . . . . . . 16 The 4 Es of Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . 77
Professionalism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 The Value of Passive Interventions. . . . . . . . . . . . . . . . 79
Roles and Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . 19 Why EMS Should Be Involved. . . . . . . . . . . . . . . . . . . . . . 81
Medical Direction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 How EMS Can Get Involved. . . . . . . . . . . . . . . . . . . . . . . . 81
Improving System Quality. . . . . . . . . . . . . . . . . . . . . . . . . 22 Injury and Illness Surveillance . . . . . . . . . . . . . . . . . . . 83
EMS Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 The Haddon Matrix. . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
The Research Process. . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Getting Started in Your Community. . . . . . . . . . . . . . . . . 85
Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Recognizing Injury and Illness Patterns
Types of Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 in Your Community . . . . . . . . . . . . . . . . . . . . . . 85
Research Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Prevention Programs for Children. . . . . . . . . . . . . . . . 86
Ethical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . 27 The Five Steps to Developing
Evaluating Medical Research. . . . . . . . . . . . . . . . . . . . . 28 a Prevention Program. . . . . . . . . . . . . . . . . . . . . 86
Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . . 29 Community Organizing. . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Funding a Prevention Program . . . . . . . . . . . . . . . . . . . . . 88
Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
CHAPTER 2 Workforce Safety and Wellness 37
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 CHAPTER 4 Medical, Legal, and Ethical Issues 95
Components of Well-Being . . . . . . . . . . . . . . . . . . . . . . . . 39 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Physical Well-Being. . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Medical Ethics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Mental Well-Being. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Ethics and EMS Research. . . . . . . . . . . . . . . . . . . . . . . . 99
Emotional Well-Being. . . . . . . . . . . . . . . . . . . . . . . . . . 45 The Legal System in the United States. . . . . . . . . . . . . . . 100
Spiritual Well-Being. . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Types of Law. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Disease Transmission. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 The Legal Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
vi
, Contents vii
Legal Accountability of the Paramedic . . . . . . . . . . . . . . 103 Backup Communications Systems. . . . . . . . . . . . . . . 143
The Paramedic and the Medical Director. . . . . . . . . . 103 Biotelemetry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
EMS-Enabling Legislation. . . . . . . . . . . . . . . . . . . . . . 103 Communicating by Radio . . . . . . . . . . . . . . . . . . . . . . . . 144
Administrative Regulations. . . . . . . . . . . . . . . . . . . . . 103 FCC Regulations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Medical Practice Act. . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Clarity of Transmission. . . . . . . . . . . . . . . . . . . . . . . . 144
Scope of Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Content of Transmissions. . . . . . . . . . . . . . . . . . . . . . 145
Health Insurance Portability Communications Formats Used
and Accountability Act . . . . . . . . . . . . . . . . . . . 104 During the Different Phases
Emergency Medical Treatment of the Response. . . . . . . . . . . . . . . . . . . . . . . . . 146
and Active Labor Act. . . . . . . . . . . . . . . . . . . . . 106 Relaying Information to Medical Control. . . . . . . . . 148
Emergency Vehicle Laws . . . . . . . . . . . . . . . . . . . . . . . 107 Therapeutic Communication. . . . . . . . . . . . . . . . . . . . . . 150
Transportation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Developing Rapport. . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Crime Scene and Emergency Scene Conducting the Interview. . . . . . . . . . . . . . . . . . . . . . 152
Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . 107 Strategies to Elicit Useful Reponses
Mandatory Reporting. . . . . . . . . . . . . . . . . . . . . . . . . . 108 to Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Coroner and Medical Examiner Cases. . . . . . . . . . . . 108 Common Interviewing Errors. . . . . . . . . . . . . . . . . . . 154
Paramedic–Patient Relationships. . . . . . . . . . . . . . . . . . . 109 Nonverbal Skills. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Consent and Refusal . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Special Interview Situations . . . . . . . . . . . . . . . . . . . . 154
Decision-Making Capacity . . . . . . . . . . . . . . . . . . . . . 109 Cross-Cultural Communication . . . . . . . . . . . . . . . . . . . 157
Documenting Informed Refusal. . . . . . . . . . . . . . . . . 111 Cultural Competence . . . . . . . . . . . . . . . . . . . . . . . . . 157
Minors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Cultural Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Violent Patients and Restraints. . . . . . . . . . . . . . . . . . 113 Traditional Folk Medicine
Negligence and Protection Against and Understanding of Illness. . . . . . . . . . . . . . 158
Negligence Claims. . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Language Interpretation . . . . . . . . . . . . . . . . . . . . . . . 158
Elements of Negligence. . . . . . . . . . . . . . . . . . . . . . . . 114 Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Abandonment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Patient Autonomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 CHAPTER 6 Documentation 169
Advance Directives. . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
End-of-Life Decisions . . . . . . . . . . . . . . . . . . . . . . . . . 120 Legal Implications of a PCR. . . . . . . . . . . . . . . . . . . . . . . 170
Defenses to Litigation. . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Purposes of Documentation . . . . . . . . . . . . . . . . . . . . . . 171
Good Samaritan Legislation. . . . . . . . . . . . . . . . . . . . 121 Continuity of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Governmental Immunity . . . . . . . . . . . . . . . . . . . . . . 122 Minimum Requirements and Billing. . . . . . . . . . . . . 171
Qualified Immunity. . . . . . . . . . . . . . . . . . . . . . . . . . . 122 EMS Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Employment Law and the Paramedic . . . . . . . . . . . . . . . 122 Incident Review and Quality Assurance. . . . . . . . . . . 172
Americans With Disabilities Act. . . . . . . . . . . . . . . . . 123 Types of PCRs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Title VII of the Civil Rights Act. . . . . . . . . . . . . . . . . . 123 Documentation for Every EMS Call. . . . . . . . . . . . . . . . . 173
Sexual Harassment. . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Transfer of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Additional Federal Laws Dealing Care Prior to Arrival. . . . . . . . . . . . . . . . . . . . . . . . . . . 174
With Discrimination. . . . . . . . . . . . . . . . . . . . . 123 Situations Requiring Additional
State Laws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Documentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Family and Medical Leave Act. . . . . . . . . . . . . . . . . . . 124 Refusal of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Occupational Safety and Health Workplace Injuries and Illnesses. . . . . . . . . . . . . . . . . 175
Administration. . . . . . . . . . . . . . . . . . . . . . . . . . 124 Special Circumstances. . . . . . . . . . . . . . . . . . . . . . . . . 175
Ryan White Act. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Completing a PCR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
National Labor Relations Act . . . . . . . . . . . . . . . . . . . 125 The PCR Narrative. . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Elements of a Properly Written PCR. . . . . . . . . . . . . . 181
The Consequences of Poor Documentation . . . . . . . 183
Errors and Falsification. . . . . . . . . . . . . . . . . . . . . . . . . . . 184
CHAPTER 5 Communications 133 Documenting Incident Times . . . . . . . . . . . . . . . . . . . . . 185
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Communication Theory. . . . . . . . . . . . . . . . . . . . . . . 135
Barriers to Effective Communication. . . . . . . . . . . . . 135 CHAPTER 7 Medical Terminology 191
Response to the Call for Emergency Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Medical Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Origins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
Phases of EMS Dispatch . . . . . . . . . . . . . . . . . . . . . . . 135 Eponyms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
EMS Communications Systems. . . . . . . . . . . . . . . . . . . . 138 Homonyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Basic Radio Communications Theory . . . . . . . . . . . . 139 Antonyms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Communications Systems Components . . . . . . . . . . 139 Synonyms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Interoperability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Components of a Medical Term. . . . . . . . . . . . . . . . . . . . 194
Cellular Technology. . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Prefixes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
Satellite Communications. . . . . . . . . . . . . . . . . . . . . . 142 Numerical Prefixes. . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
, viii Contents
Suffixes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Joints���������������������������������������������������������������������������� 269
Word Roots. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Axial Skeleton. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
Colors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Appendicular Skeleton . . . . . . . . . . . . . . . . . . . . . . . . 281
Combining Forms and Vowels. . . . . . . . . . . . . . . . . . 196 The Musculoskeletal System. . . . . . . . . . . . . . . . . . . . . . . 286
Compound Words . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Components of Connective Tissue. . . . . . . . . . . . . . . 287
Plural Endings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Muscle Attachments. . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Topographic Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Muscle Function. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Anatomic Planes and Axes of the Body . . . . . . . . . . . 199 Muscle Contraction. . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Specific Areas of the Body. . . . . . . . . . . . . . . . . . . . . . 200 Muscle Tone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Body Cavities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Muscle Relaxation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Directional Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Movement and Positional Terms . . . . . . . . . . . . . . . . 203 The Nervous System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Other Directional Terms. . . . . . . . . . . . . . . . . . . . . . . 204 Neurons and Impulse Transmission. . . . . . . . . . . . . . 292
Prefixes Indicating Position, Direction, Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . 295
and Location . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Peripheral Nervous System. . . . . . . . . . . . . . . . . . . . . 306
Position of the Patient. . . . . . . . . . . . . . . . . . . . . . . . . 206 Sensory Function. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
Abbreviations, Acronyms, and Symbols . . . . . . . . . . . . . 207 The Endocrine System . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Medical Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . 207 Intercellular Communication. . . . . . . . . . . . . . . . . . . 323
Error-Prone Abbreviations . . . . . . . . . . . . . . . . . . . . . 208 Hormones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Hypothalamus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Medical Terminology Related to Pharmacology. . . . . . . 209 Pituitary Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Master Tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Thyroid Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224 Parathyroid Glands. . . . . . . . . . . . . . . . . . . . . . . . . . . 328
Thymus Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
Pancreas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
Section 2: The Human Body Adrenal Glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Gonads. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
and Human Systems 227 Pineal Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
The Circulatory System. . . . . . . . . . . . . . . . . . . . . . . . . . . 332
CHAPTER 8 Anatomy and Physiology 229 Blood �������������������������������������������������������������������������� 333
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 Heart���������������������������������������������������������������������������� 337
Characteristics of Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Blood Vessels and Circulation. . . . . . . . . . . . . . . . . . . 344
Organizational Structure . . . . . . . . . . . . . . . . . . . . . . . . . 231 The Lymphatic System. . . . . . . . . . . . . . . . . . . . . . . . . 353
Chemical Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 The Respiratory System. . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Matter, Elements, Atoms. . . . . . . . . . . . . . . . . . . . . . . 231 Upper Airway. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
Chemical Bonds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 Lower Airway. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360
Compounds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Lung Volumes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
Chemical Reactions. . . . . . . . . . . . . . . . . . . . . . . . . . . 237 Ventilation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Electrolytes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 Oxygenation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366
Acids, Bases, and the pH Scale . . . . . . . . . . . . . . . . . . 239 Respiration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
Cellular Level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 Control of Breathing. . . . . . . . . . . . . . . . . . . . . . . . . . 369
Cell Structure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 The Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Life Cycle of the Cell. . . . . . . . . . . . . . . . . . . . . . . . . . 244 Abdomen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
Cellular Signaling . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246 Oral Cavity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Cellular Respiration. . . . . . . . . . . . . . . . . . . . . . . . . . . 246 Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
Body Fluid Composition. . . . . . . . . . . . . . . . . . . . . . . 248 Stomach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Cellular Transport Mechanisms . . . . . . . . . . . . . . . . . 248 Small Intestine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Tissue Level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Large Intestine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Epithelial Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Accessory Organs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
Connective Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Digestion and Absorption of Nutrients. . . . . . . . . . . 381
Muscle Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258 The Urinary System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
Nervous Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Kidneys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
Types of Membranes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Ureters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Homeostasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Urinary Bladder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Organ Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 Urethra. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
The Integumentary System. . . . . . . . . . . . . . . . . . . . . . . . 262 Fluid Balance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Skin������������������������������������������������������������������������������ 264 The Reproductive System. . . . . . . . . . . . . . . . . . . . . . . . . 388
Accessory Structures. . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Male Reproductive Anatomy. . . . . . . . . . . . . . . . . . . . 389
The Skeletal System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266 Female Reproductive Anatomy. . . . . . . . . . . . . . . . . . 392
Characteristics and Composition of Bones . . . . . . . . 267 Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
, Contents ix
CHAPTER 9 Pathophysiology 419 Adolescents (Teenagers). . . . . . . . . . . . . . . . . . . . . . . . . . 485
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420 Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
Adaptations in Cells and Tissues. . . . . . . . . . . . . . . . . . . 420 Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 486
Disturbances in Fluid Balance. . . . . . . . . . . . . . . . . . . . . 420 Early Adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Edema. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421 Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Isotonic Fluid Deficit. . . . . . . . . . . . . . . . . . . . . . . . . . 422 Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 487
Electrolyte Imbalances. . . . . . . . . . . . . . . . . . . . . . . . . . . 422 Middle Adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Sodium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422 Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Potassium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423 Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 487
Calcium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423 Late Adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488
Phosphate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424 Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488
Magnesium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425 Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 491
Disturbances of Acid-Base Balance . . . . . . . . . . . . . . . . . 425 Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494
Types of Acid-Base Imbalance. . . . . . . . . . . . . . . . . . . 426
Cellular Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
Hypoxic Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429 Section 3: Patient
Chemical Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430
Assessment 497
Infectious Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430
Immunologic and Inflammatory Injury. . . . . . . . . . . 432
Injurious Genetic Factors. . . . . . . . . . . . . . . . . . . . . . . 433 CHAPTER 11 Patient Assessment 499
Injurious Nutritional Imbalances. . . . . . . . . . . . . . . . 433 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
Injurious Physical Agents or Conditions. . . . . . . . . . 433 Sick Versus Not Sick. . . . . . . . . . . . . . . . . . . . . . . . . . . 503
Apoptosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433 Establishing a Field Impression . . . . . . . . . . . . . . . . . 503
Abnormal Cell Death . . . . . . . . . . . . . . . . . . . . . . . . . 433 Is This Medical or Trauma?. . . . . . . . . . . . . . . . . . . . . 504
Hypoperfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434 Scene Size-up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505
Types of Shock. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435 Scene Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505
Central Shock. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435 Mechanism of Injury or Nature of Illness . . . . . . . . . 508
Peripheral Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437 Standard Precautions. . . . . . . . . . . . . . . . . . . . . . . . . . 509
Management of Shock. . . . . . . . . . . . . . . . . . . . . . . . . 437 Primary Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 510
Multiple Organ Dysfunction Syndrome . . . . . . . . . . . . . 438 Examination Techniques. . . . . . . . . . . . . . . . . . . . . . . 510
The Body’s Self-Defense Mechanisms. . . . . . . . . . . . . . . 439 Form a General Impression. . . . . . . . . . . . . . . . . . . . . 510
Anatomic Barriers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439 Assess the Airway. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512
Immune Response. . . . . . . . . . . . . . . . . . . . . . . . . . . . 439 Assess Breathing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512
Inflammatory Response. . . . . . . . . . . . . . . . . . . . . . . . 446 Assess Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
Chronic Inflammatory Responses. . . . . . . . . . . . . . . . 450 Assess the Patient for Disability . . . . . . . . . . . . . . . . . 515
Variances in Immunity and Inflammation . . . . . . . . . . . 451 Expose Then Cover . . . . . . . . . . . . . . . . . . . . . . . . . . . 516
Hypersensitivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451 Make a Transport Decision. . . . . . . . . . . . . . . . . . . . . 516
Immune Deficiencies. . . . . . . . . . . . . . . . . . . . . . . . . . 454 History Taking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519
Factors That Cause Disease. . . . . . . . . . . . . . . . . . . . . . . . 455 Purpose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519
Controllable Versus Uncontrollable Patient Information. . . . . . . . . . . . . . . . . . . . . . . . . . . 520
Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 Techniques for History Taking . . . . . . . . . . . . . . . . . . 520
Analysis of Disease Risk. . . . . . . . . . . . . . . . . . . . . . . . 456 Ensuring Confidentiality. . . . . . . . . . . . . . . . . . . . . . . 525
Common Familial Diseases Protecting the Patient’s Privacy. . . . . . . . . . . . . . . . . . 525
and Associated Risk Factors . . . . . . . . . . . . . . . 456 Gathering Information From Third Parties . . . . . . . . 525
Stress and Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465 Cultural Competence . . . . . . . . . . . . . . . . . . . . . . . . . 526
General Adaptation Syndrome. . . . . . . . . . . . . . . . . . 466 Special Challenges in History Taking. . . . . . . . . . . . . 527
Effects of Chronic Stress . . . . . . . . . . . . . . . . . . . . . . . 467 Managing Age-Related Considerations. . . . . . . . . . . . 529
Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469 Responsive Medical Patients. . . . . . . . . . . . . . . . . . . . 531
Unresponsive Patients. . . . . . . . . . . . . . . . . . . . . . . . . 535
CHAPTER 10 Life Span Development 477 Trauma Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477 Review of Body Systems . . . . . . . . . . . . . . . . . . . . . . . 537
Infants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477 Critical Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539
Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 478 Clinical Reasoning. . . . . . . . . . . . . . . . . . . . . . . . . . . . 539
Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 480 Secondary Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . 540
Toddlers and Preschoolers. . . . . . . . . . . . . . . . . . . . . . . . 482 Physical Exam of Priority Patients . . . . . . . . . . . . . . . 541
Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482 Assessment Techniques. . . . . . . . . . . . . . . . . . . . . . . . 541
Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 483 Vital Signs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543
School-Age Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484 Equipment Used in the Secondary
Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484 Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547
Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 484 The Physical Exam. . . . . . . . . . . . . . . . . . . . . . . . . . . . 548
Nancy Caroline’s
Emergency
Care in the Streets
1 2
Preparatory
Volume
Volume
Trauma
The Human Body and Human Systems
Shock and Resuscitation
Patient Assessment
Special Patient Populations
Pharmacology
Operations
Airway Management
Career Development
Medical
,
, Eighth Edition
Nancy Caroline’s
Emergency
Care in the Streets
Series Editor:
Andrew N. Pollak, MD, FAAOS
Lead Editors:
Barbara Aehlert, MSEd, BSPA, RN
Bob Elling, MPA, EMT-P
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Library of Congress Cataloging-in-Publication Data
Names: American Academy of Orthopaedic Surgeons, author. | Pollak, Andrew N.,
editor. | Elling, Bob, editor. | Aehlert, Barbara, editor.
Title: Nancy Caroline’s emergency care in the streets / American Academy of
Orthopaedic Surgeons ; series editor: Andrew N. Pollak ; lead editors: Bob
Elling, Barbara Aehlert.
Other titles: Emergency care in the streets
Description: Eighth edition. | Burlington, MA : Jones & Bartlett Learning,
[2018] | Preceded by Nancy Caroline’s emergency care in the streets.
7th ed. 2013. | Includes bibliographical references and index.
Identifiers: LCCN 2017024835 | ISBN 9781284457278 (casebound)
Subjects: | MESH: Emergency Treatment | Emergency Medical Services |
Emergency Medical Technicians
Classification: LCC RC86.7 | NLM WB 105 | DDC 616.02/5--dc23
LC record available at https://lccn.loc.gov/2017024835
6048
Printed in the United States of America
21 20 19 18 17 10 9 8 7 6 5 4 3 2 1
,Brief Contents
VOLUME 1 VOLUME 2
Section 1: Preparatory Section 7: Trauma
Chapter 1 EMS Systems Chapter 29 Trauma Systems and Mechanism of Injury
Chapter 2 Workforce Safety and Wellness Chapter 30 Bleeding
Chapter 3 Public Health Chapter 31 Soft-Tissue Trauma
Chapter 4 Medical, Legal, and Ethical Issues Chapter 32 Burns
Chapter 5 Communications Chapter 33 Face and Neck Trauma
Chapter 6 Documentation Chapter 34 Head and Spine Trauma
Chapter 7 Medical Terminology Chapter 35 Chest Trauma
Chapter 36 Abdominal and Genitourinary Trauma
Section 2: The Human Body Chapter 37 Orthopaedic Trauma
and Human Systems Chapter 38 Environmental Emergencies
Chapter 8 Anatomy and Physiology
Chapter 9 Pathophysiology Section 8: Shock and Resuscitation
Chapter 10 Life Span Development Chapter 39 Responding to the Field Code
Chapter 40 Management and Resuscitation of the Critical
Section 3: Patient Assessment Patient
Chapter 11 Patient Assessment
Chapter 12 Critical Thinking and Clinical Section 9: Special Patient Populations
Decision Making Chapter 41 Obstetrics
Chapter 42 Neonatal Care
Section 4: Pharmacology Chapter 43 Pediatric Emergencies
Chapter 13 Principles of Pharmacology Chapter 44 Geriatric Emergencies
Chapter 14 Medication Administration Chapter 45 Patients With Special Challenges
Section 5: Airway Management Section 10: Operations
Chapter 15 Airway Management Chapter 46 Transport Operations
Chapter 47 Incident Management and Mass-Casualty
Section 6: Medical Incidents
Chapter 16 Respiratory Emergencies Chapter 48 Vehicle Extrication and Special Rescue
Chapter 17 Cardiovascular Emergencies Chapter 49 Hazardous Materials
Chapter 18 Neurologic Emergencies Chapter 50 Terrorism Response
Chapter 19 Diseases of the Eyes, Ears, Nose, and Throat Chapter 51 Disaster Response
Chapter 20 Abdominal and Gastrointestinal Emergencies Chapter 52 Crime Scene Awareness
Chapter 21 Genitourinary and Renal Emergencies
Chapter 22 Gynecologic Emergencies Section 11: Career Development
Chapter 23 Endocrine Emergencies Chapter 53 Career Development
Chapter 24 Hematologic Emergencies
Chapter 25 Immunologic Emergencies GLOSSARY
Chapter 26 Infectious Diseases INDEX
Chapter 27 Toxicology
Chapter 28 Psychiatric Emergencies
APPENDIX: EMERGENCY MEDICATIONS
v
,Contents
VOLUME 1 Protecting Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Immunizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Personal Protective Equipment and Practices . . . . . . . 48
Management of an Exposure. . . . . . . . . . . . . . . . . . . . . 51
Section 1: Preparatory 1 Hostile Situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Traffic Incidents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
CHAPTER 1 EMS Systems 3 Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 What Triggers Stress. . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
EMS System Development. . . . . . . . . . . . . . . . . . . . . . . . . . 4 The Physiology of Acute Stress . . . . . . . . . . . . . . . . . . . 55
The History of EMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 How People React to Stressful Situations. . . . . . . . . . . 55
The 20th Century and Modern Technology. . . . . . . . . . 6 Coping With Your Own Stress . . . . . . . . . . . . . . . . . . . 58
Licensure, Certification, and Registration. . . . . . . . . . . . . . 9 Burnout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Reciprocity�������������������������������������������������������������������� 10 Coping With Death and Dying . . . . . . . . . . . . . . . . . . . . . 60
Traditional EMS Employment������������������������������������������ 10 Stages of the Grieving Process. . . . . . . . . . . . . . . . . . . . 61
The EMS System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Dealing With the Dying Patient. . . . . . . . . . . . . . . . . . 61
Levels of Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Dealing With a Grieving Family. . . . . . . . . . . . . . . . . . 62
The Dispatcher. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Dealing With a Grieving Child. . . . . . . . . . . . . . . . . . . 62
Emergency Medical Responder. . . . . . . . . . . . . . . . . . . 12 After the Call Is Over. . . . . . . . . . . . . . . . . . . . . . . . . . . 63
EMT�������������������������������������������������������������������������������� 13 Peer Support and Suicide Prevention . . . . . . . . . . . . . . . . 63
Advanced EMT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Paramedic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Paramedic Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 CHAPTER 3 Public Health 71
Initial Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Continuing Education. . . . . . . . . . . . . . . . . . . . . . . . . . 14 Role of Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Additional Types of Transports . . . . . . . . . . . . . . . . . . . . . 14 Public Health Threats. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Transport to Specialty Centers . . . . . . . . . . . . . . . . . . . 14 Injuries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Interfacility Transports. . . . . . . . . . . . . . . . . . . . . . . . . . 14 Chronic Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Working With Other Professionals . . . . . . . . . . . . . . . . . . 15 Acute Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Working With Hospital Staff. . . . . . . . . . . . . . . . . . . . . 15 The Cost of Public Health Threats. . . . . . . . . . . . . . . . . . . 74
Working With Public Safety Agencies. . . . . . . . . . . . . . 16 The Teachable Moment . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Continuity of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
National EMS Group Involvement . . . . . . . . . . . . . . . . . . 16 The 4 Es of Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . 77
Professionalism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 The Value of Passive Interventions. . . . . . . . . . . . . . . . 79
Roles and Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . 19 Why EMS Should Be Involved. . . . . . . . . . . . . . . . . . . . . . 81
Medical Direction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 How EMS Can Get Involved. . . . . . . . . . . . . . . . . . . . . . . . 81
Improving System Quality. . . . . . . . . . . . . . . . . . . . . . . . . 22 Injury and Illness Surveillance . . . . . . . . . . . . . . . . . . . 83
EMS Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 The Haddon Matrix. . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
The Research Process. . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Getting Started in Your Community. . . . . . . . . . . . . . . . . 85
Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Recognizing Injury and Illness Patterns
Types of Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 in Your Community . . . . . . . . . . . . . . . . . . . . . . 85
Research Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Prevention Programs for Children. . . . . . . . . . . . . . . . 86
Ethical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . 27 The Five Steps to Developing
Evaluating Medical Research. . . . . . . . . . . . . . . . . . . . . 28 a Prevention Program. . . . . . . . . . . . . . . . . . . . . 86
Evidence-Based Practice. . . . . . . . . . . . . . . . . . . . . . . . . 29 Community Organizing. . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Funding a Prevention Program . . . . . . . . . . . . . . . . . . . . . 88
Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
CHAPTER 2 Workforce Safety and Wellness 37
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 CHAPTER 4 Medical, Legal, and Ethical Issues 95
Components of Well-Being . . . . . . . . . . . . . . . . . . . . . . . . 39 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Physical Well-Being. . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Medical Ethics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Mental Well-Being. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Ethics and EMS Research. . . . . . . . . . . . . . . . . . . . . . . . 99
Emotional Well-Being. . . . . . . . . . . . . . . . . . . . . . . . . . 45 The Legal System in the United States. . . . . . . . . . . . . . . 100
Spiritual Well-Being. . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Types of Law. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Disease Transmission. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 The Legal Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
vi
, Contents vii
Legal Accountability of the Paramedic . . . . . . . . . . . . . . 103 Backup Communications Systems. . . . . . . . . . . . . . . 143
The Paramedic and the Medical Director. . . . . . . . . . 103 Biotelemetry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
EMS-Enabling Legislation. . . . . . . . . . . . . . . . . . . . . . 103 Communicating by Radio . . . . . . . . . . . . . . . . . . . . . . . . 144
Administrative Regulations. . . . . . . . . . . . . . . . . . . . . 103 FCC Regulations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Medical Practice Act. . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Clarity of Transmission. . . . . . . . . . . . . . . . . . . . . . . . 144
Scope of Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Content of Transmissions. . . . . . . . . . . . . . . . . . . . . . 145
Health Insurance Portability Communications Formats Used
and Accountability Act . . . . . . . . . . . . . . . . . . . 104 During the Different Phases
Emergency Medical Treatment of the Response. . . . . . . . . . . . . . . . . . . . . . . . . 146
and Active Labor Act. . . . . . . . . . . . . . . . . . . . . 106 Relaying Information to Medical Control. . . . . . . . . 148
Emergency Vehicle Laws . . . . . . . . . . . . . . . . . . . . . . . 107 Therapeutic Communication. . . . . . . . . . . . . . . . . . . . . . 150
Transportation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Developing Rapport. . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Crime Scene and Emergency Scene Conducting the Interview. . . . . . . . . . . . . . . . . . . . . . 152
Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . 107 Strategies to Elicit Useful Reponses
Mandatory Reporting. . . . . . . . . . . . . . . . . . . . . . . . . . 108 to Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Coroner and Medical Examiner Cases. . . . . . . . . . . . 108 Common Interviewing Errors. . . . . . . . . . . . . . . . . . . 154
Paramedic–Patient Relationships. . . . . . . . . . . . . . . . . . . 109 Nonverbal Skills. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Consent and Refusal . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Special Interview Situations . . . . . . . . . . . . . . . . . . . . 154
Decision-Making Capacity . . . . . . . . . . . . . . . . . . . . . 109 Cross-Cultural Communication . . . . . . . . . . . . . . . . . . . 157
Documenting Informed Refusal. . . . . . . . . . . . . . . . . 111 Cultural Competence . . . . . . . . . . . . . . . . . . . . . . . . . 157
Minors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Cultural Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Violent Patients and Restraints. . . . . . . . . . . . . . . . . . 113 Traditional Folk Medicine
Negligence and Protection Against and Understanding of Illness. . . . . . . . . . . . . . 158
Negligence Claims. . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Language Interpretation . . . . . . . . . . . . . . . . . . . . . . . 158
Elements of Negligence. . . . . . . . . . . . . . . . . . . . . . . . 114 Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Abandonment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Patient Autonomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 CHAPTER 6 Documentation 169
Advance Directives. . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
End-of-Life Decisions . . . . . . . . . . . . . . . . . . . . . . . . . 120 Legal Implications of a PCR. . . . . . . . . . . . . . . . . . . . . . . 170
Defenses to Litigation. . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Purposes of Documentation . . . . . . . . . . . . . . . . . . . . . . 171
Good Samaritan Legislation. . . . . . . . . . . . . . . . . . . . 121 Continuity of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Governmental Immunity . . . . . . . . . . . . . . . . . . . . . . 122 Minimum Requirements and Billing. . . . . . . . . . . . . 171
Qualified Immunity. . . . . . . . . . . . . . . . . . . . . . . . . . . 122 EMS Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Employment Law and the Paramedic . . . . . . . . . . . . . . . 122 Incident Review and Quality Assurance. . . . . . . . . . . 172
Americans With Disabilities Act. . . . . . . . . . . . . . . . . 123 Types of PCRs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Title VII of the Civil Rights Act. . . . . . . . . . . . . . . . . . 123 Documentation for Every EMS Call. . . . . . . . . . . . . . . . . 173
Sexual Harassment. . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Transfer of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Additional Federal Laws Dealing Care Prior to Arrival. . . . . . . . . . . . . . . . . . . . . . . . . . . 174
With Discrimination. . . . . . . . . . . . . . . . . . . . . 123 Situations Requiring Additional
State Laws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Documentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Family and Medical Leave Act. . . . . . . . . . . . . . . . . . . 124 Refusal of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Occupational Safety and Health Workplace Injuries and Illnesses. . . . . . . . . . . . . . . . . 175
Administration. . . . . . . . . . . . . . . . . . . . . . . . . . 124 Special Circumstances. . . . . . . . . . . . . . . . . . . . . . . . . 175
Ryan White Act. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Completing a PCR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
National Labor Relations Act . . . . . . . . . . . . . . . . . . . 125 The PCR Narrative. . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Elements of a Properly Written PCR. . . . . . . . . . . . . . 181
The Consequences of Poor Documentation . . . . . . . 183
Errors and Falsification. . . . . . . . . . . . . . . . . . . . . . . . . . . 184
CHAPTER 5 Communications 133 Documenting Incident Times . . . . . . . . . . . . . . . . . . . . . 185
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Communication Theory. . . . . . . . . . . . . . . . . . . . . . . 135
Barriers to Effective Communication. . . . . . . . . . . . . 135 CHAPTER 7 Medical Terminology 191
Response to the Call for Emergency Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Medical Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Origins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
Phases of EMS Dispatch . . . . . . . . . . . . . . . . . . . . . . . 135 Eponyms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
EMS Communications Systems. . . . . . . . . . . . . . . . . . . . 138 Homonyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Basic Radio Communications Theory . . . . . . . . . . . . 139 Antonyms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Communications Systems Components . . . . . . . . . . 139 Synonyms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Interoperability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Components of a Medical Term. . . . . . . . . . . . . . . . . . . . 194
Cellular Technology. . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Prefixes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
Satellite Communications. . . . . . . . . . . . . . . . . . . . . . 142 Numerical Prefixes. . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
, viii Contents
Suffixes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Joints���������������������������������������������������������������������������� 269
Word Roots. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Axial Skeleton. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
Colors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Appendicular Skeleton . . . . . . . . . . . . . . . . . . . . . . . . 281
Combining Forms and Vowels. . . . . . . . . . . . . . . . . . 196 The Musculoskeletal System. . . . . . . . . . . . . . . . . . . . . . . 286
Compound Words . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Components of Connective Tissue. . . . . . . . . . . . . . . 287
Plural Endings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Muscle Attachments. . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Topographic Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Muscle Function. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Anatomic Planes and Axes of the Body . . . . . . . . . . . 199 Muscle Contraction. . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Specific Areas of the Body. . . . . . . . . . . . . . . . . . . . . . 200 Muscle Tone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Body Cavities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Muscle Relaxation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Directional Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Movement and Positional Terms . . . . . . . . . . . . . . . . 203 The Nervous System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Other Directional Terms. . . . . . . . . . . . . . . . . . . . . . . 204 Neurons and Impulse Transmission. . . . . . . . . . . . . . 292
Prefixes Indicating Position, Direction, Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . 295
and Location . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Peripheral Nervous System. . . . . . . . . . . . . . . . . . . . . 306
Position of the Patient. . . . . . . . . . . . . . . . . . . . . . . . . 206 Sensory Function. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
Abbreviations, Acronyms, and Symbols . . . . . . . . . . . . . 207 The Endocrine System . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Medical Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . 207 Intercellular Communication. . . . . . . . . . . . . . . . . . . 323
Error-Prone Abbreviations . . . . . . . . . . . . . . . . . . . . . 208 Hormones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Hypothalamus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Medical Terminology Related to Pharmacology. . . . . . . 209 Pituitary Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Master Tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Thyroid Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224 Parathyroid Glands. . . . . . . . . . . . . . . . . . . . . . . . . . . 328
Thymus Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
Pancreas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
Section 2: The Human Body Adrenal Glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Gonads. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
and Human Systems 227 Pineal Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
The Circulatory System. . . . . . . . . . . . . . . . . . . . . . . . . . . 332
CHAPTER 8 Anatomy and Physiology 229 Blood �������������������������������������������������������������������������� 333
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 Heart���������������������������������������������������������������������������� 337
Characteristics of Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Blood Vessels and Circulation. . . . . . . . . . . . . . . . . . . 344
Organizational Structure . . . . . . . . . . . . . . . . . . . . . . . . . 231 The Lymphatic System. . . . . . . . . . . . . . . . . . . . . . . . . 353
Chemical Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 The Respiratory System. . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Matter, Elements, Atoms. . . . . . . . . . . . . . . . . . . . . . . 231 Upper Airway. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
Chemical Bonds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 Lower Airway. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360
Compounds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Lung Volumes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
Chemical Reactions. . . . . . . . . . . . . . . . . . . . . . . . . . . 237 Ventilation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Electrolytes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 Oxygenation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366
Acids, Bases, and the pH Scale . . . . . . . . . . . . . . . . . . 239 Respiration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
Cellular Level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 Control of Breathing. . . . . . . . . . . . . . . . . . . . . . . . . . 369
Cell Structure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 The Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Life Cycle of the Cell. . . . . . . . . . . . . . . . . . . . . . . . . . 244 Abdomen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
Cellular Signaling . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246 Oral Cavity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Cellular Respiration. . . . . . . . . . . . . . . . . . . . . . . . . . . 246 Esophagus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
Body Fluid Composition. . . . . . . . . . . . . . . . . . . . . . . 248 Stomach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Cellular Transport Mechanisms . . . . . . . . . . . . . . . . . 248 Small Intestine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Tissue Level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Large Intestine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Epithelial Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Accessory Organs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
Connective Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Digestion and Absorption of Nutrients. . . . . . . . . . . 381
Muscle Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258 The Urinary System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
Nervous Tissues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Kidneys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
Types of Membranes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Ureters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Homeostasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Urinary Bladder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Organ Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 Urethra. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
The Integumentary System. . . . . . . . . . . . . . . . . . . . . . . . 262 Fluid Balance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Skin������������������������������������������������������������������������������ 264 The Reproductive System. . . . . . . . . . . . . . . . . . . . . . . . . 388
Accessory Structures. . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Male Reproductive Anatomy. . . . . . . . . . . . . . . . . . . . 389
The Skeletal System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266 Female Reproductive Anatomy. . . . . . . . . . . . . . . . . . 392
Characteristics and Composition of Bones . . . . . . . . 267 Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
, Contents ix
CHAPTER 9 Pathophysiology 419 Adolescents (Teenagers). . . . . . . . . . . . . . . . . . . . . . . . . . 485
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420 Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
Adaptations in Cells and Tissues. . . . . . . . . . . . . . . . . . . 420 Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 486
Disturbances in Fluid Balance. . . . . . . . . . . . . . . . . . . . . 420 Early Adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Edema. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421 Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Isotonic Fluid Deficit. . . . . . . . . . . . . . . . . . . . . . . . . . 422 Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 487
Electrolyte Imbalances. . . . . . . . . . . . . . . . . . . . . . . . . . . 422 Middle Adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Sodium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422 Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Potassium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423 Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 487
Calcium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423 Late Adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488
Phosphate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424 Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488
Magnesium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425 Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 491
Disturbances of Acid-Base Balance . . . . . . . . . . . . . . . . . 425 Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494
Types of Acid-Base Imbalance. . . . . . . . . . . . . . . . . . . 426
Cellular Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
Hypoxic Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429 Section 3: Patient
Chemical Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430
Assessment 497
Infectious Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430
Immunologic and Inflammatory Injury. . . . . . . . . . . 432
Injurious Genetic Factors. . . . . . . . . . . . . . . . . . . . . . . 433 CHAPTER 11 Patient Assessment 499
Injurious Nutritional Imbalances. . . . . . . . . . . . . . . . 433 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
Injurious Physical Agents or Conditions. . . . . . . . . . 433 Sick Versus Not Sick. . . . . . . . . . . . . . . . . . . . . . . . . . . 503
Apoptosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433 Establishing a Field Impression . . . . . . . . . . . . . . . . . 503
Abnormal Cell Death . . . . . . . . . . . . . . . . . . . . . . . . . 433 Is This Medical or Trauma?. . . . . . . . . . . . . . . . . . . . . 504
Hypoperfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434 Scene Size-up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505
Types of Shock. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435 Scene Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505
Central Shock. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435 Mechanism of Injury or Nature of Illness . . . . . . . . . 508
Peripheral Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437 Standard Precautions. . . . . . . . . . . . . . . . . . . . . . . . . . 509
Management of Shock. . . . . . . . . . . . . . . . . . . . . . . . . 437 Primary Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 510
Multiple Organ Dysfunction Syndrome . . . . . . . . . . . . . 438 Examination Techniques. . . . . . . . . . . . . . . . . . . . . . . 510
The Body’s Self-Defense Mechanisms. . . . . . . . . . . . . . . 439 Form a General Impression. . . . . . . . . . . . . . . . . . . . . 510
Anatomic Barriers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439 Assess the Airway. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512
Immune Response. . . . . . . . . . . . . . . . . . . . . . . . . . . . 439 Assess Breathing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512
Inflammatory Response. . . . . . . . . . . . . . . . . . . . . . . . 446 Assess Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
Chronic Inflammatory Responses. . . . . . . . . . . . . . . . 450 Assess the Patient for Disability . . . . . . . . . . . . . . . . . 515
Variances in Immunity and Inflammation . . . . . . . . . . . 451 Expose Then Cover . . . . . . . . . . . . . . . . . . . . . . . . . . . 516
Hypersensitivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451 Make a Transport Decision. . . . . . . . . . . . . . . . . . . . . 516
Immune Deficiencies. . . . . . . . . . . . . . . . . . . . . . . . . . 454 History Taking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519
Factors That Cause Disease. . . . . . . . . . . . . . . . . . . . . . . . 455 Purpose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519
Controllable Versus Uncontrollable Patient Information. . . . . . . . . . . . . . . . . . . . . . . . . . . 520
Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 Techniques for History Taking . . . . . . . . . . . . . . . . . . 520
Analysis of Disease Risk. . . . . . . . . . . . . . . . . . . . . . . . 456 Ensuring Confidentiality. . . . . . . . . . . . . . . . . . . . . . . 525
Common Familial Diseases Protecting the Patient’s Privacy. . . . . . . . . . . . . . . . . . 525
and Associated Risk Factors . . . . . . . . . . . . . . . 456 Gathering Information From Third Parties . . . . . . . . 525
Stress and Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465 Cultural Competence . . . . . . . . . . . . . . . . . . . . . . . . . 526
General Adaptation Syndrome. . . . . . . . . . . . . . . . . . 466 Special Challenges in History Taking. . . . . . . . . . . . . 527
Effects of Chronic Stress . . . . . . . . . . . . . . . . . . . . . . . 467 Managing Age-Related Considerations. . . . . . . . . . . . 529
Prep Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469 Responsive Medical Patients. . . . . . . . . . . . . . . . . . . . 531
Unresponsive Patients. . . . . . . . . . . . . . . . . . . . . . . . . 535
CHAPTER 10 Life Span Development 477 Trauma Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477 Review of Body Systems . . . . . . . . . . . . . . . . . . . . . . . 537
Infants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477 Critical Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539
Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 478 Clinical Reasoning. . . . . . . . . . . . . . . . . . . . . . . . . . . . 539
Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 480 Secondary Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . 540
Toddlers and Preschoolers. . . . . . . . . . . . . . . . . . . . . . . . 482 Physical Exam of Priority Patients . . . . . . . . . . . . . . . 541
Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482 Assessment Techniques. . . . . . . . . . . . . . . . . . . . . . . . 541
Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 483 Vital Signs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543
School-Age Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484 Equipment Used in the Secondary
Physical Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484 Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547
Psychosocial Changes. . . . . . . . . . . . . . . . . . . . . . . . . 484 The Physical Exam. . . . . . . . . . . . . . . . . . . . . . . . . . . . 548
