Jonathan Sarmiento January 29, 2008 Exam 1 Objectives Chapter One: 1-1.1 Emergency e!

ica" Systems #E S$ have been !eve"o%e! to %rovi!e %rehos%ita" care consisting o& getting traine! %ersonne" to the %atient as 'uic("y as %ossib"e an! to %rovi!e emergency care on the scene, en route to the hos%ita", an! at the hos%ita". 1-1.2 )n E *-+asic is the "o,est certi&ication "eve" &or ambu"ance %ersonne". *raining is &ocuse! on assessment an! care o& i"" an! injure! %atients. -igher E * "eve"s re'uire training in !ea"ing ,ith more a!vance! an! invasive emergency care techni'ues. 1-1.. *he most im%ortant res%onsibi"ity o& an E * is his or her o,n %ersona" sa&ety. One/s ro"e in securing this is to maintain a,areness &or %ossib"e sa&ety ha0ar!s such as !angers &rom the %atient, other %eo%"e, anima"s, &ires an! other misce""aneous environmenta" ha0ar!s. 1-1.1 Once the %ersona" sa&ety o& an E * is accounte! &or, the sa&ety o& the cre,, %atient, an! bystan!ers is then consi!ere!. *he same concerns the E * has &or his or her o,n %ersona" sa&ety are a%%"ie! to others in or!er to %revent any &urther emergencies. 1-1.2 3ua"ity im%rovement consists o& continuous se"&-revie, ,ith the %ur%ose o& i!enti&ying as%ects o& the system that re'uire im%rovement. Once a %rob"em is i!enti&ie!, a %"an is !eve"o%e! an! im%"emente! to %revent &urther occurrences o& the same %rob"em. )n E *-+/s ro"e consists o& (ee%ing care&u""y ,ritten !ocumentation, becoming invo"ve! in the 'ua"ity %rocess, obtaining &ee!bac( &rom %atients an! the hos%ita" sta&&, maintaining e'ui%ment, an! continuing e!ucation. 1-1.4 e!ica" 5irection is oversight o& the %atient-care as%ects o& the E S system by a %hysician. )n E *-+asic/s ro"e is to o%erate as a !esignate! agent acting as an extension o& the %hysician/s "icense to %ractice me!icine. *his is accom%"ishe! o&&-"ine via %rotoco"s an! stan!ing or!ers an! on-"ine in the &ie"! via ra!io or te"e%hone. 1-1.8 )n E */s attitu!e an! %ersona" con!uct shou"! be maintaine! in or!er to a",ays %resent a %ro&essiona" a%%earance an! !emeanor in the course o& their !uties. *his inc"u!es exhibiting %ersona"ity traits re&"ecting con&i!ence an! honesty ,hi"e interacting in a %"easant an! courteous manner. *he abi"ity to ta(e contro" an! exert "ea!ershi% ,hen necessary is as im%ortant as maintaining a com%assionate an! non-ju!gmenta" attitu!e. Chapter Two: 1-2.2 *he !eath o& a &ami"y member or "ove! one %"aces survivors into the various stages o& grie& an! their reaction is %re!icate! on ,hich stage they are in. *hese stages are6 !enia", anger, bargaining, !e%ression an! acce%tance. 1-2.. Severa" ste%s that can be ta(en in a%%roaching &ami"y members o& !ying or !ecease! %atients inc"u!e6 recognition o& the %atient/s nee!s, to"erance o& angry reactions, "istening em%athetica""y, avoi! giving &a"se reassurances an! o&&ering as much rea"istic com&ort %ossib"e. 1-2.2 Signs an! sym%toms o& stress inc"u!e irritabi"ity ,ith others, im%aire! cognitive &unctioning, !i&&icu"ty s"ee%ing or nightmares, "oss o& a%%etite, !iminishe! sex !rive, anxiety, in!ecisiveness, gui"t, iso"ation an! "oss o& interest in ,or(. 1-2.4 Ste%s to re!uce or a""eviate stress inc"u!e !eve"o%ing more hea"thy an! %ositive !ietary habits, exercise, re"axation techni'ues. Ste%s invo"ving the ,or(%"ace inc"u!e ta(ing on a "ighter "oa! by changing shi&ts or "ocations.

1-2.7 *he nee! to !etermine scene sa&ety is %aramount because o& the various situations that an E * maybe encounter. 5angerous situations inc"u!e ha0mat inci!ents, &ires, auto co""isions, ex%"osions, e"ectrica" acci!ents, an! vio"ent !is%utes. ) scene must be sa&e an! secure be&ore an E * can %rovi!e emergency care to the %atient. 1-2.8 +o!y substance iso"ation #+S8$ invo"ves the use o& universa" %recautions to %revent the s%rea! o& %athogens. *hese %recautions invo"ve immuni0ations, training to %revent in&ections #e.g. %ro%er han! ,ashing$, an! the use o& a%%ro%riate %ersona" %rotective e'ui%ment #99E$ such as g"oves, eye %rotection, mas(s an! go,ns. 1-2.9 9rotection &rom b"oo!borne %athogens re'uire the use o& a%%ro%riate 99E such as g"oves, staying u% to !ate on immuni0ations, an! %reventing ex%osure to o%en ,oun!s. 9revention &rom airborne contaminants inc"u!e the above measures as ,e"" as the use o& eye %rotection an! mas(s ,hen a%%ro%riate. 1-2.10 -a0ar!ous materia"s6 se"& containe! breathing a%%aratus #S:+)$ an! %rotective suit ;escue o%erations6 turnout gear, %rotective eye,ear, he"met, %uncture-%roo& g"oves <io"ent scenes6 stab-resistant, %rojecti"e-resistant bo!y armor :rime scenes6 cover an! concea"ment 9reventing ex%osure to b"oo!borne an! airborne %athogens are "iste! above in the %rece!ing ans,er. Chapter Three: 1-..1 *he sco%e o& %ractice &or an E *-+ is the co""ective set o& regu"ations an! ethica" consi!erations ,hich !e&ines the "imitations on their %ractice o& s(i""s an! me!ica" interventions !e&ine! by "oca", state, an! &e!era" "egis"ation. 1-... :onsent is the %ermission &rom the %atient &or care or other action %er&orme! by the E *+. Ex%resse! consent must be obtaine! &rom menta""y com%etent a!u"ts. :onsent to treat chi"!ren or menta""y incom%etent a!u"ts must be obtaine! &rom %arents or guar!ians. :onsent is assume! &or unconscious %atients. 1-..1 Ex%resse! consent is consent given by a!u"ts ,ho are o& "ega" age an! menta""y com%etent to ma(e a rationa" !ecision in regar! to their menta" ,e""-being. 8m%"ie! consent is consent %resume! a %atient or their %arent or guar!ian ,ou"! give i& they cou"!, such as &or an unconscious %atient or a %atient ,ho cannot be contacte! ,hen care is nee!e!. 1-..2 inors are not "ega""y a""o,e! to %rovi!e consent or re&use me!ica" care an! trans%ortation. ) %arent or guar!ian must give consent be&ore care can be given. 8& they are not %resent, care can be given base! on im%"ie! consent. 1-..4 *he im%"ications o& a %atient re&using care &or an E * is %rimari"y an issue o& "iabi"ity. 8& the %atient is menta""y com%etent, "ega""y ab"e to consent, an! is &u""y in&orme! then a re"ease &orm must be &i""e! out to re"ease E S &rom "iabi"ity. 1-..7 +attery can occur i& an E * &orces a menta""y com%etent %atient to go to the hos%ita" against their ,i"". =eg"igence is a &in!ing o& &ai"ure to act %ro%er"y in a situation in ,hich there ,as a !uty to act, nee!e! care as ,ou"! reasonab"y be ex%ecte! o& the E *-+ ,as not %rovi!e!, an! harm ,as cause! to the %atient as a resu"t. )ban!onment is "eaving a %atient a&ter care has been initiate! an! be&ore the %atient has been trans&erre! to someone ,ith e'ua" or greater me!ica" training. 1-..8 )n E * has a !uty to act ,hen they are on !uty an! are !is%atche! to a ca"". 1-..9 aintaining %atient con&i!entia"ity is im%ortant because it is unnecessary to share me!ica" in&ormation ,ith anyone not invo"ve! in the %atient/s care an! treatment. *he "ega"ity o& %atient

%rivacy is regu"ate! by &e!era" "a, in the -ea"th 8nsurance 9ortabi"ity an! )ccountabi"ity )ct #-89))$. 1-..11 )ctions an E * shou"! ta(e to %reserve a crime scene inc"u!e6 remembering ,hat you touch, minimi0ing your im%act on the scene an! ,or(ing ,ith the %o"ice. 1-..12 :on!itions that may re'uire an E *-+ to noti&y "a, en&orcement inc"u!e chi"!, e"!er, an! !omestic abuse, vio"ence an! sexua" assau"ts, an! cases re'uiring restraint such as intoxicate! or menta""y incom%etent %ersons. 1-..1. 8t is im%ortant &or an E * to be &ami"iar ,ith the various ty%es o& 5=; or!ers they may come across as ,e"" as the variety o& instructions that accom%any them. ) "ega" 5=; must be avai"ab"e an! %resent, other,ise it is %erha%s better to err on the si!e o& %rovi!ing care. 1-..11 )n a!vance !irective is a "ega" !ocument containing instructions ,ritten in a!vance o& an event. )n exam%"e is a 5=; ,hich s%eci&ies i& an! ,hen resuscitation shou"! ta(e %"ace in the case o& termina" i""ness or !isease. *he rationa"e is to ma(e sure ones ,ishes are carrie! out an! to save &ami"y an! &rien!s &rom the !istress o& ma(ing such !i&&icu"t !ecisions. 1-..12 <arying !egrees o& 5=; exist because some %eo%"e !o not ,ant to be resuscitate! at a"" ,hi"e others choose to have this attem%te! ,hen car!iac arrest is ,itnesse! an! brain !amage is un"i(e"y. Chapter Four: 1-1.1 e!ia" > to,ar! the mi!"ine o& the bo!y, "atera" > to the si!e, a,ay &rom the mi!"ine o& the bo!y, %roxima" > c"oser to the torso, !ista" > &arther a,ay &rom the torso, su%erior > to,ar! the hea!, in&erior > a,ay &rom the hea!, anterior > the &ront o& the bo!y or bo!y %art, %osterior > the bac( o& the bo!y or bo!y %art, mi!"ine > an imaginary "ine !ra,n !o,n the center o& the bo!y, !ivi!ing it into right an! "e&t bo!y ha"ves, right an! "e&t > these terms a",ays re&er to the %atient/s right or "e&t, mi!-c"avicu"ar > the "ine through the center o& each c"avic"e, mi!-axi""ary > a "ine !ra,n vertica""y &rom the mi!!"e o& the arm%it to the an("e. 1-1.2 *he res%iratory system/s %rimary &unction is to %rovi!e gas exchange &or the bo!y. Oxygen &rom outsi!e air is inha"e! through the mouth, into the trachea, !o,n through the bronchi into the "ungs an! into the a"veo"i ,here gas exchange occurs. :arbon !ioxi!e is exchange! &or oxygen at the ca%i""aries "ining the a"veo"i. *he circu"atory system/s %rimary &unction is to circu"ate the b"oo! ,hich acts as a me!ium &or nutrition, ,astes an! immune &unctions to trave" throughout the bo!y. *he heart acts as the %um% ,ith the vesse"s moving b"oo! a,ay &rom the heart ca""e! arteries an! b"oo! moving to,ar!s the heart are ca""e! veins. ?as exchanges ta(es %"ace at the sma""est b"oo! vesse"s ca""e! ca%i""aries. 8n genera", arteries carry oxygenate! b"oo! an! veins carry !eoxygenate! b"oo!, exce%t &or the %u"monary arteries an! veins ,hich are the reverse. +"oo! enters the heart through the vena cavae into the right atrium, through the tricus%i! va"ve into the right ventric"e through the %u"monary semi-"unar va"ve into the %u"monary trun( an! into the "ungs via the %u"monary arteries. )&ter the "ungs, b"oo! returns to the heart via the %u"monary veins ,hich enter the "e&t atrium then go though the mitra" va"ve into the "e&t ventric"e an! &ina""y out the aortic semi-"unar va"ve into the aorta an! out to the rest o& the bo!y. *he muscu"os(e"eta" system consists o& musc"es, bones, "igaments, ten!ons, an! joints ,hich su%%ort an! %rotect the bo!y an! %ermit movement. @igaments connect bone to bone an! ten!ons connect bone to musc"e. *he nervous system consists o& the brain, s%ina" cor! an! nerves ,hich transmit in&ormation to an! &rom the bo!y. *he centra" nervous system consists o& the brain an! s%ina" cor!, everything e"se com%rises the %eri%hera" nervous system. *he %eri%hera" nervous system inc"u!es the autonomic nervous system ,hich

governs the viscera" motor nerves. *hen en!ocrine system inc"u!es the organs ,hich %ro!uce hormones that he"% to regu"ate the bo!y/s activities an! &unctions. Chapter Five: 1-4.1 +o!y mechanics re&ers to the %ro%er usage o& the bo!y to &aci"itate "i&ting an! moving an! %revent injury. 1-4.2 ?ui!e"ines to "i&ting %atients sa&e"y inc"u!e %ositioning your &eet %ro%er"y, using your "egs, never turn or t,ist, !o not com%ensate ,hen "i&ting ,ith one han!, (ee% the ,eight c"ose to your bo!y, or as c"ose as %ossib"e, use a stair chair ,hen carrying a %atient on stairs ,henever %ossib"e. 1-4.7 ?ui!e"ines &or reaching are to (ee% your bac( in a "oc(e! %osition, avoi! t,isting ,hi"e reaching, avoi! reaching more then 12 to 20 inches in &ront o& your bo!y, an! avoi! %ro"onge! reaching ,hen strenuous e&&ort is re'uire!. 1-4.9 ?ui!e"ines &or %ushing or %u""ing are to %ush, rather then %u"", ,henever %ossib"e, (ee% your bac( "oc(e!-in, (ee% the "ine o& %u"" through the center o& your bo!y by ben!ing your (nees, (ee% the ,eight c"ose to your bo!y, i& the ,eight is be"o, your ,aist "eve", %ush or %u"" &orm a (nee"ing %osition, avoi! %ushing or %u""ing overhea!, an! (ee% your e"bo,s bent an! arms c"ose to your si!es. 1-4.10 ?enera" consi!erations &or moving %atients inc"u!e !etermining the ,eight o& the object, ,hether he"% ,i"" be re'uire!, any %hysica" characteristics or "imitations, an! communication ,ith a %artner to coor!inate a %"an. 1-4.11 *hree situations that may re'uire use o& an emergency move are6 1$ the scene is ha0ar!ous, 2$ care o& "i&e-threatening con!itions re'uires re%ositioning, an! .$ you must reach other %atients ,ith "i&e-threatening %rob"ems. 1-4.1. *he im%ortance o& %ro%er"y "i&ting an! moving %atients a""o,s the %atient to be move! sa&e"y in a manner ,hich !oes not cause injury to the E *s nor to the %atient. Chapter Nine: 1-2.1 *he com%onents o& the vita" signs are %u"se, res%iration, s(in co"or, tem%erature an! con!ition #ca%i""ary re&i"" in in&ants an! chi"!ren$, %u%i"s an! b"oo! %ressure. 1-2.. Ahen assessing res%iratory rate, the t,o 'ua"ities to be observe! are res%iratory 'ua"ity an! res%iratory rhythm. 1-2.4 Sha""o, breathing occurs ,hen there is on"y s"ight movement o& the chest or ab!omen. @abore! breathing can be recogni0e! by signs such as an increase in the ,or( o& breathing, the use o& accessory musc"es, nasa" &"aring, an! retraction above the co""arbones or bet,een the ribs, es%ecia""y in in&ants an! chi"!ren. Stri!or, grunting on ex%iration an! gas%ing may a"so be hear!. =oisy breathing is obstructe! breathing such as snoring, ,hee0ing, gurg"ing, an! cro,ing. 1-2.9 8n "ight-s(inne! %atients the norma" s(in co"or is %in(. 8n !ar(-s(inne! %atients this %in( co"or can be seen in the inner eye"i!s, "i%s, an! nai" be!s. )bnorma" s(in co"ors are %a"e, b"uegray, re!, ye""o,, an! jaun!ice!. 1-2.10 9a"e s(in co"or is in!icative o& constricte! b"oo! vesse"s %ossib"y resu"ting &rom b"oo! "oss, shoc(, hy%otension, an! emotiona" !istress. +"ue-gray #cyanotic$ s(in co"or may occur &rom "ac( o& oxygen in b"oo! ce""s an! tissues resu"ting &rom ina!e'uate breathing or heart &unction. ;e! #&"ushe!$ s(in co"or can be cause! by ex%osure to heat or emotiona" excitement. Be""o, #jaun!ice!$ s(in co"or is sym%tomatic o& "iver abnorma"ities.

1-2.11 =orma" s(in tem%erature is ,arm to the touch. )bnorma" s(in tem%erature can be coo", c"ammy, moist, co"!, !ry, or hot. 1-2.11 =orma" ca%i""ary re&i"" shou"! ta(e no more than 2 secon!s. )bnorma" res%onses inc"u!e %ro"onge! an! absent ca%i""ary re&i"". *his vita" sign may not be re"iab"e ,hen ex%ose! to co"! tem%eratures. 1-2.17 Ahen %u%i"s are !i"ate!, more "ight can enter the eye an! i& &u""y !i"ate! it can be !i&&icu"t to !etermine the eye co"or. :onstricte! %u%i"s are the o%%osite, the co"or o& the iris is obvious an! very "itt"e "ight is entering the eye. 5i"ate! %u%i"s may be !ue to b"oo! "oss, &right or !rugs. :onstricte! %u%i"s may be !ue to narcotics or %rescri%tion !rugs. 1-2.18 ;eactive %u%i"s constrict ,hen ex%ose! to a bright "ight source. =onreactive %u%i"s !o not change in si0e ,hen ex%ose! to the same "ight. *his may occur !ue to !rugs or "ac( o& oxygen to the brain. E'ua" %u%i"s occur ,hen both are the same si0e. Cne'ua" %u%i" si0e is ,hen they are o& !is%arate si0e an! may occur !ue to stro(e, hea! injury, eye injury, or an arti&icia" eye. 1-2.20 Systo"ic b"oo! %ressure is the %ressure create! ,hen the heart contracts an! &orces b"oo! out into the arteries. 1-2.21 5iasto"ic b"oo! %ressure is the %ressure remaining in arteries ,hen the "e&t ventric"e o& the heart is re"axe! an! re&i""ing. 1-2.22 )uscu"tation &or b"oo! %ressure invo"ves the use o& a stethosco%e in "istening &or a %u"se ,hi"e !e&"ating the s%hygmomanometer. 9a"%ation &or b"oo! %ressure invo"ves the %a"%ation o& a %u"se instea! o& the use o& a b"oo! %ressure cu&&. 1-2.2. :om%onents o& the S) 9@E history are6 S > Signs an! sym%toms, ) > )""ergies, > e!ications, 9- 9ertinent %ast history, @ > @ast ora" inta(e, an! E > Events "ea!ing to the injury or i""ness. 1-2.21 ) sign is objective > something you can see, hear, &ee", an! sme"" ,hen examining the %atient. ) sym%tom is subjective > an in!ication you cannot observe but that the %atient &ee"s an! te""s you about. 1-2.22 8t is im%ortant to accurate"y obtain a base"ine measurement o& vita" signs so that an! tren!s in the %atient/s con!ition can be i!enti&ie! an! treate! a%%ro%riate"y. 1-2.24 )!!itiona" me!ica" i!enti&ication is im%ortant to search &or because it ,ou"! revea" any a""ergies, con!itions, or me!ications a&&ecting the %atient. 1-2.27 *he va"ue o& %er&orming base"ine vita" signs are in estab"ishing a re&erence %oint &or any %ossib"e tren!s an! changes in the %atient/s con!ition. *his a""o,s &or a measure o& %rogress to com%are the e&&ectiveness o& various treatment mo!a"ities. 1-2..0 )!!itiona" sets o& vita" signs are im%ortant &or monitoring any changes in the %atient/s con!ition. <ita" signs &or stab"e %atients shou"! be ta(en every 12 minutes an! every 2 minutes &or unstab"e %atients. 1-2..1 *he S) 9@E history gives va"uab"e in&ormation about the %atient/s con!ition. *he im%ortance o& this history is in the event that the %atient "oses consciousness, they ,i"" be unab"e to give a history at the hos%ita".