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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
1.1 Define key terms introduced in this chapter. Slides
16-18, 2627, 4244
1.2 Give an overview of the historical events leading to
the development of modern emergency medical
services (EMS). Slides 1013, 19
1.3 Describe the importance of each of the National
Highway Traffic Safety Administration standards for
assessing EMS systems. Slides 1418
1.4 Describe the components of an EMS system that
must be in place for a patient to receive emergency
medical care. Slides 2127
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
1.5 Compare and contrast the training and
responsibilities of EMRs, EMTs, AEMTs, and
Paramedics. Slides 2833
1.6 Explain each of the specific areas of responsibility for
the EMT. Slides 2829, 3133
1.7 Give examples of the physical and personality traits
that are desirable for EMTs. Slides 3439
1.8 Describe various job settings that may be available to
EMTs. Slide 40
1.9 Describe the purpose of the National Registry of
Emergency Medical Technicians. Slide 41
continued
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Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
1.10 Explain the purpose of quality improvement
programs in EMS programs. Slides 4243
1.11 Explain EMTs role in the quality improvement
process. Slides 4243
1.12 Explain medical direction as it relates to EMS
systems. Slide 44
1.13 List ways in which research may influence EMT
practice. Slide 45
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
1.14 Give examples of how EMS providers can play a
role in public health. Slide 46
1.15 Given scenarios, decide how an EMT may
demonstrate professional behavior. Slides 29, 32
33, 47
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Limmer OKeefe Dickinson
MULTIMEDIA
Slide 19 The Long and Winding Road of Ambulance
Service Video
Slide 48 Emergency Medical Services for Children
Video
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Limmer OKeefe Dickinson
The chain of human resources that forms
the EMS system
How the public activates the EMS system
Your roles and responsibilities as an EMT
The process of EMS quality improvement
(QI)
CORE CONCEPTS
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Topics Topics
The Emergency Medical Services System
Components of the EMS System
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The Emergency Medical The Emergency Medical
Services System Services System
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Limmer OKeefe Dickinson
How It Began How It Began
1790sNapoleonic Wars
Civil War
World War IVolunteer ambulance corps
Korea/VietnamMASH-type units and
helicopter transport from battlefield
continued
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(Bettmann/CORBIS.)
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Limmer OKeefe Dickinson
How It Began How It Began
Non-military ambulance services began
operating in early 1900s in U.S.
Often operated by hospitals, fire
departments, or funeral homes
No requirements or standards for
equipment, crew training, or ambulance
design
You call, we haul, thats all!
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Limmer OKeefe Dickinson
Development of Todays EMS Development of Todays EMS
1966Department of Transportation
charged with developing EMS standards
1970Founding of National Registry of
EMTs (NREMT)
1973National Emergency Medical
Service Systems Act (NEMSSA)
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NHTSA Standards NHTSA Standards
for EMS Systems for EMS Systems
1. Regulation and Policy
Each state establishes laws, policies, and
regulations
2. Resource Management
Centralized coordination of emergency
treatment and transport resources
continued
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NHTSA Standards NHTSA Standards
for EMS Systems for EMS Systems
3. Human Resources and Training
Assure EMS personnel are trained and
certified to minimum standard by qualified
instructors
4. Transportation
Provide safe, reliable transportationground,
air, or other means
continued
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NHTSA Standards NHTSA Standards
for EMS Systems for EMS Systems
5. Facilities
Must be transported to closest appropriate
facility
6. Communications
Universal access number (911), dispatch to
ambulance, ambulance to ambulance,
ambulance to hospital, hospital to hospital
continued
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NHTSA Standards NHTSA Standards
for EMS Systems for EMS Systems
7. Trauma Systems
Develop trauma triage, transport, and
treatment protocols
8. Evaluation
Establish program for assessing and
improving quality of care provided (QI, QA,
TQM)
continued
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NHTSA Standards NHTSA Standards
for EMS Systems for EMS Systems
9. Public Information and Education
Educate public about role of EMS, increase
public awareness, participate in injury
prevention programs
10.Medical Direction
Medical director oversees, is accountable for
EMS personnel within system
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Click here to view a video on the topic of the history of EMS.
Back to Directory
The Long and Winding The Long and Winding
Road of Ambulance Service Video Road of Ambulance Service Video
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Limmer OKeefe Dickinson
Components Components
of the EMS System of the EMS System
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Components Components
of the EMS System of the EMS System
Emergency Department/Hospital
Doctors, nurses, allied health personnel
continued
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Components Components
of the EMS System of the EMS System
Other specialized
care facilities
Trauma centers
Burn centers
Stroke centers
Cardiac centers
Labor and delivery/
pediatrics
Poison control
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Think About It Think About It
What medical services are available in
your community?
How important is it that EMS personnel
know the capabilities of community
medical facilities?
What are the possible consequences of
transporting a patient to a facility not
equipped to handle the problem?
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Chain of Human Chain of Human
Resources in EMS System Resources in EMS System
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Accessing EMS System Accessing EMS System
911 telephone access
Available in most but not all areas
Enhanced 911
Provides caller number and location for
landline phones
Cell phones
Newer models may provide location in some
areas
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Emergency Emergency
Medical Dispatchers Medical Dispatchers
Can provide instructions to callers on how
to provide emergency care until EMS
personnel arrive
EMD certification required in some
jurisdictions
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Critical Decision Making Critical Decision Making
Critical decision making is very important
in EMS
Information must be gathered, patients
assessed, and determination made on
treatment and transport options
Decisions often time-critical
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Examples of Critical Decisions Examples of Critical Decisions
Is it better to take patient to closest
hospital or to one farther away but more
appropriate for the condition?
Is patient stable enough for further
evaluation on scene, or should patient be
transported immediately?
Will this treatment make patient better or
worse?
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Levels of EMS Training Levels of EMS Training
Emergency Medical Responder (formerly
First Responder)
Emergency Medical Technician (formerly
EMT Basic)
Advanced EMT (formerly EMT
Intermediate)
Paramedic (formerly EMT Paramedic)
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Roles and Roles and
Responsibilities of EMTs Responsibilities of EMTs
Personal safety
Safety of crew, patient, and bystanders
Patient assessment
Patient care
Lifting and moving
Transport
Transfer of care
Patient advocacy
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Think About It Think About It
How would it impact elderly patient if
transported to the hospital without glasses,
hearing aid, or dentures?
On a routine call, would taking the time to
gather these items have a negative effect
on the patients care?
How about assuring the home is secure
and locked before leaving?
continued
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Think About It Think About It
Could the concept of patient advocacy
also extend to the community (fall
prevention programs for elderly, poisoning
awareness, pool and water safety
programs for children)?
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Physical Traits Physical Traits
of a Good EMT of a Good EMT
Ability to lift and carry equipment and
patients
Good eyesight (distance and reading) and
color vision
Good communication skills (oral and
written)
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Personal Traits Personal Traits
of a Good EMT of a Good EMT
Pleasant
Sincere
Cooperative
Resourceful
continued
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Personal Traits Personal Traits
of a Good EMT of a Good EMT
Self starter
Emotionally stable
Able to lead
Neat and clean
continued
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Personal Traits Personal Traits
of a Good EMT of a Good EMT
Good moral character
Respectful of others
Control of personal habits
Control of conversation
Able to communicate
properly
Able to listen to others
Nonjudgmental and fair
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Education Education
Maintain up-to-date knowledge and skills
Read EMS magazines; join EMS
organizations
Refresher courses for recertification
Continuing education to supplement
original training
continued
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Education Education
Conferences, seminars, lectures, classes,
videos, and demonstrations
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Job Opportunities Job Opportunities
Ambulance
services
Fire departments
Medical facilities
Rural/wilderness
teams
Industrial settings
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National Registry National Registry
of EMTs (NREMT) of EMTs (NREMT)
Registration for EMRs, EMTs, AEMTs, and
paramedics who successfully complete
NREMT examinations
May help in reciprocity (transferring to
another state or region)
Considered favorably when applying for
employment
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Quality Improvement Quality Improvement
Continuous self-review to identify areas for
improvement
Develop plans to address areas
continued
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Quality Improvement Quality Improvement
Everyone in organization has a role
Prepare careful documentation
Involved in quality process
Get feedback from patients, hospital staff
Maintain equipment
Continuing education
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Medical Direction Medical Direction
Medical Director: ultimate responsibility for
patient care aspects of EMS system
All patient care performed under direction
of Medical Director
Oversees training; develops treatment
protocols
Off-line medical control (standing orders)
On-line medical control
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Research Research
Vitally important; more needed in EMS
field
Care should be based on evidence-based
research rather than tradition
Goal is improving patient outcomes
Form a hypothesis, review literature,
evaluate evidence, and adopt practice if
evidence supports it
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EMS Role in Public Health EMS Role in Public Health
Injury prevention for
geriatric patients and
youth
Blood pressure clinics
File of life
Public vaccination
programs
Disease surveillance
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Think About It Think About It
How will you refresh your knowledge and
stay current once you are out of the
classroom?
What qualities would you like to see in an
EMT who is caring for you? How can you
come closer to being this kind of EMT?
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Emergency Medical Emergency Medical
Services for Children Video Services for Children Video
Click here to view a video on the topic of emergency medical services
for children.
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Chapter Review
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Chapter Review Chapter Review
EMS system includes 911 or other
emergency access system, dispatchers,
EMTs, hospital emergency department,
physicians, nurses, physicians assistants,
and other health professionals.
EMTs responsibilities include safety;
patient assessment and care; lifting,
moving, and transporting patients; transfer
of care; and patient advocacy.
continued
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Chapter Review Chapter Review
EMT must have certain personal traits to
ensure the ability to do the job.
Education, quality improvement
procedures, and medical direction are all
essential to maintaining high standards of
EMS care.
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Remember Remember
EMS dates back to Napoleonic times.
Modern EMS standards come from
1960s1970s and National Emergency
Medical Service Systems Act (NEMSSA).
There is a chain of human resources
involved in EMS. Critical decisions are
made by each member of the chain.
continued
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Remember Remember
There are certain personal and physical
traits that help you to be a successful EMS
provider.
An EMS provider should actively pursue
opportunities to improve personal
knowledge and abilities as well as the
units overall quality.
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Questions to Consider Questions to Consider
What innovation was introduced in the
Korean and Vietnam wars that is now
common in many EMS systems?
What are the four levels of EMS
providers?
Requesting orders from a physician by
radio is an example of what kind of
medical control?
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Critical Thinking Critical Thinking
Your patient is hesitant to go to the
hospital because she is worried about her
dog. What can you do to assist in this
situation? What part of your role as an
EMT is this an example of?
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Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
2.1 Define key terms introduced in this chapter. Slides
1720, 2426, 34, 4147, 5253, 5960
2.2 Describe health habits that promote physical and
mental well-being. Slide 15
2.3 Given an example of a patient care situation,
determine the appropriate personal protective
equipment to prevent exposure to infectious
disease. Slides 1720, 2426
continued
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OBJECTIVES OBJECTIVES
2.4 Describe proper procedures for hand washing and
using alcohol-based hand cleaners. Slides 2123
2.5 Discuss the health concerns related to exposure to
hepatitis B, hepatitis C, tuberculosis, and AIDS.
Slides 2830
2.6 Access the Centers for Disease Control website to
obtain the latest information on diseases of concern
to EMS providers. Slides 3233
continued
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OBJECTIVES OBJECTIVES
2.7 Explain the essential provisions of OSHA, the CDC,
and the Ryan White CARE Act as they relate to
infection control in EMS. Slides 3237
2.8 Describe the indications for use of an N-95 or HEPA
respirator. Slide 26
2.9 Describe the purpose of the tuberculin skin test
(TST). Slide 38
continued
6/28/2011
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OBJECTIVES OBJECTIVES
2.10 Give examples of common stressors in EMS work.
Slides 4748
2.11 Describe the stages of the stress response system,
including the effect of each stage on the body.
Slides 4243
2.12 Differentiate between acute, delayed, and
cumulative stress reactions. Slides 4446
2.13 List lifestyle changes that can be used to manage
stress. Slide 51
continued
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OBJECTIVES OBJECTIVES
2.14 Explain the purpose of critical incident stress
management (CISM). Slides 5253
2.15 Given a scenario, recognize a patients or family
members reaction to death and dying. Slides 5455
2.16 Given a scenario involving death or dying, use
effective techniques for interacting with the patient
and family members. Slide 56
continued
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OBJECTIVES OBJECTIVES
2.17 List indications of the potential for danger to yourself
or others at the scene of an EMS call. Slide 59
2.18 Outline proper responses to incidents including
hazardous materials incidents, terrorist incidents,
rescue operations, and violence. Slides 6064
2.19 Given a scenario of an emergency response
involving a safety threat, describe actions you
should take to protect yourself and other EMS.
Slides 6164
continued
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OBJECTIVES OBJECTIVES
2.20 Identify with the feelings of a patient who has a
communicable disease. Slides 2832
2.21 Promote the importance of safety on EMS calls.
Slides 5864
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MULTIMEDIA
Slide 39 AIDS: Etiology and Pathophysiology Video
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CORE CONCEPTS
Standard Precautions, or how to protect
yourself from transmitted diseases
The kinds of stress caused by involvement
in EMS and how they can affect you, your
fellow EMTs, and your family and friends
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CORE CONCEPTS
The impact that dying patients have on
you and others
How to identify potential hazards and
maintain scene safety
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Topics Topics
Well-Being
Personal Protection
Diseases of Concern
Emotion and Stress
Scene Safety
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Well Well--Being Being
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Importance of Well Importance of Well--Being Being
Keeping yourself prepared for demands
and risks of EMT is very important
If unable to function for any reason,
patients will not get needed care
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Maintaining Well Maintaining Well--Being Being
Maintain solid personal relationships
Exercise
Sleep
Eat right
Limit alcohol and caffeine intake
Have regular checkups and keep up-to-
date on vaccines
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Personal Protection Personal Protection
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Standard Precautions Standard Precautions
Standard precautions include steps to
protect self from infectious material
Scene size-up and protocols provide
information on precautions to take
Refer to local protocols for wearing
personal protective equipment
When in doubt, wear it!
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Personal Protective Equipment Personal Protective Equipment
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Personal Protective Personal Protective
Equipment: Gloves Equipment: Gloves
Always have gloves on your person when
responding
May need to change gloves during call if
they become torn or when treating multiple
patients
Due to latex allergies, many providers are
now switching to non-latex gloves
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Personal Protective Equipment: Personal Protective Equipment:
Gloves and Arm Covers Gloves and Arm Covers
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Hand Washing Hand Washing
Hand washing is still important even if
gloves were worn during patient care
Remove jewelry and watch
Use soap and rub hands vigorously
Rinse well
Pat hands dry
continued
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Hand Washing Hand Washing
continued
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Hand Washing Hand Washing
Alcohol-based hand sanitizers can be
used if soap and water are not available
Follow up with hand washing as soon as
possible
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Eye Protection Eye Protection
Use if at risk from splashes
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Eye and Face Protection Eye and Face Protection
Use when at risk from splashes or
spraying fluids
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Masks and Gowns Masks and Gowns
NIOSH-approved HEPA (High Efficiency
Particulate Air) mask meeting N95
standard
May also wear gown to protect clothing
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Diseases of Concern Diseases of Concern
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Hepatitis B and C Hepatitis B and C
Hardy, infectious viral disease affecting the
liver
Can live on surfaces in dried blood for
several days
Hepatitis B (HBV) deadly; killed hundreds
of health care workers each year before
vaccine available
Hepatitis C (no vaccine yet) poses same
risk
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Tuberculosis (TB) Tuberculosis (TB)
Often infects lungs
Can be highly contagious
Can be spread through air
Consider precautions with any patient
having productive cough
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HIV/AIDS HIV/AIDS
HIV: attacks immune system, leaving
patient unable to fight off infection
AIDS: set of conditions that can result from
HIV infection
Lower risk for health care workers than
hepatitis or TB
Contact with blood usual route of infection
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Emerging Conditions Emerging Conditions
and Diseases and Diseases
West Nile Virus
Spread by mosquitoes
Flu-like symptoms (mild cases); infection of
brain and meninges (severe cases)
Severe Acute Respiratory Syndrome
(SARS)
Spread through respiratory droplets
Fever, dry cough, difficulty breathing
continued
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Emerging Conditions Emerging Conditions
and Diseases and Diseases
Influenza
Around for hundreds of years
1918 pandemic killed 30-50 million worldwide
Avian flu
Found in poultry; can affect humans
Swine (H1N1) flu
Caused widespread illness and panic
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Infection Control and the Law Infection Control and the Law
EMS personnel, other health care workers
at high risk of coming in contact with
infectious diseases
Guidelines for workplace safety developed
by OSHA and other federal, state, and
local agencies
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Occupational Exposure Occupational Exposure
Control Plan Control Plan
OSHA standard on bloodborne pathogens
(1992) requires infection control be joint
responsibility of employer and employee
EMS agencies provide training, protective
equipment, and vaccinations to employees
Employees participate in infection
exposure control plan
6/28/2011
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Occupational Exposure Occupational Exposure
Control Plan Content Control Plan Content
Adequate education and training
Hepatitis B vaccination
Personal protective equipment
Methods of control
Housekeeping
Labeling of containers
Post-exposure evaluation, follow-up
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Ryan White CARE Act Ryan White CARE Act
Allows EMS providers to seek to
determine if exposure to infectious disease
has occurred
Agencys Infection Control Officer gathers
facts about exposures
continued
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Ryan White CARE Act Ryan White CARE Act
Officer notifies EMS provider of exposure
Agency refers EMS provider to health care
professional for evaluation and follow-up
6/28/2011
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Immunizations Immunizations
Immunizations for hepatitis B, other
infectious diseases should be available
through agency
Regular TB testing may also be required
Local system protocols vary
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AIDS: Etiology and AIDS: Etiology and
Pathophysiology Video Pathophysiology Video
Click here to view a video on the subject of AIDS.
Back to Directory
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Emotion and Stress Emotion and Stress
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Stress Stress
Stress inevitable in EMS profession
Recognizing signs of stress and
developing strategies to deal with stress
are very important to EMS career
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Stages of Stress Stages of Stress
First stage: Alarm reaction (fight or flight)
Second stage: Resistance (coping)
Third stage: Exhaustion (loss of ability to
resist or adapt to the stressor)
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Acute Stress Reaction Acute Stress Reaction
Often linked to catastrophe
Occurs in EMTs and patients
Signs and symptoms develop soon after
incident
Physical, cognitive, emotional, and
behavioral symptoms
continued
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Acute Stress Reaction Acute Stress Reaction
Normal reactions to extraordinary situation
May require immediate intervention from
physician or mental health professional
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Delayed Stress Reaction Delayed Stress Reaction
Post-traumatic stress disorder (PTSD)
Signs and symptoms not evident until long
after incident
Delay makes dealing with reaction much
harderpatient may not recognize what is
causing problem
Requires intervention by mental health
professional
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Cumulative Stress Reaction Cumulative Stress Reaction
Results from years of sustained low-level
stressors
Early signs: vague anxiety, emotional
exhaustion
Progresses to physical complaints, loss of
emotional control, depression
May present as severe withdrawal or
suicidal thoughts requiring long-term
psychological intervention
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Causes of Stress Causes of Stress
Multiple casualty
incident (MCI)
Call involving
infants or children
Severe injury
continued
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Causes of Stress Causes of Stress
Abuse and neglect
Death of a co-worker
Work-related issues involving family and
loved ones
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Signs and Symptoms of Stress Signs and Symptoms of Stress
Irritability
Inability to concentrate
Lack of interest in activities
Changes in sleep patterns/nightmares
Changes in appetite
Guilt
Isolation
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Think About It Think About It
If your partner is beginning to show signs
of stress, what should you do?
What possible risk could there be to your
partner, you, or a patient if stress is left
unresolved?
Do you have an obligation to act to help
your partner?
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Ways of Dealing with Stress Ways of Dealing with Stress
Healthy diet
Exercise
Devote time to relaxing away from work
Change shift or location for lighter call
volume, different call types, more family
time
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Critical Incident Critical Incident
Stress Management Stress Management
Comprehensive system
Includes education and resources to
prevent stress
Ways to deal with
stress appropriately
when it occurs
6/28/2011
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Critical Incident Critical Incident
Stress Debriefing (CISD) Stress Debriefing (CISD)
Designed to help responders defuse
after incident
Team of trained peer counselors and
mental health professionals meet with
rescuers and health care providers
involved in major incident
Helps responders deal with stress
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Death and Dying Death and Dying
Dont usually see dead people except at
funeral
Dont normally see person die
Often most difficult part of job
Dealing with family may be more difficult
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Emotional Stages Emotional Stages
of Death and Dying of Death and Dying
Denial (Not me!)
Anger (Why me?)
Bargaining (Okay, but first let me)
Depression (Okay, but I havent)
Acceptance (Okay, Im not afraid.)
6/28/2011
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Dealing with Dealing with
Patients and Family Patients and Family
Think of how you want to be treated
Recognize patients needs
Be tolerant of angry reactions from patient
or family
Listen empathetically
Do not falsely reassurebe honest
Offer as much comfort as you can
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Scene Safety Scene Safety
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Scene Safety Scene Safety
EMS not usually a dangerous profession
Being aware of potential dangers always a
priority
Determining scene safety will be the most
important decision on any call
6/28/2011
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Potential Safety Potential Safety
Threats at Scene Threats at Scene
Hazardous materials incidents
Terrorist incidents
Rescue operations
Violence
Weapons
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Staging Staging
If not safe to approach scene, stop in a
secure area away from scene
Wait until cleared to enter by appropriate
authorities
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Response to Danger: Plan Response to Danger: Plan
Wear safe clothing
Prepare your equipment
Carry portable radio whenever possible
Decide on safety roles
6/28/2011
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Response to Danger: Observe Response to Danger: Observe
Survey scene on approach
Dont announce arrivalturn off lights and
siren
Drive few feet past residence so you can
see front and sides
continued
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Response to Danger: Observe Response to Danger: Observe
Violence
Alcohol or drug use
Weapons
Family members
Bystanders
Perpetrators
Pets
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React to Danger: Three Rs React to Danger: Three Rs
Retreat
Radio
Reevaluate
6/28/2011
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Chapter Review
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Chapter Review Chapter Review
Your well-being is important.
Safety and Standard Precautions are
important decisions you will make at least
once at each scene.
Protect yourself from violence and scene
hazards.
Protect yourself from disease.
continued
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Chapter Review Chapter Review
Stress may be an immediate reaction from
a call or cumulative from life and EMS.
Seek help.
Treat people under stress fairly and
compassionately.
continued
6/28/2011
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Chapter Review Chapter Review
You will see death and reactions to death.
Each is personal to those involved.
Emotional stages of death and dying are
denial, anger, bargaining, depression, and
acceptance.
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Remember Remember
Scenes are dynamic and can change in an
instant.
Assessment of scene safety is an ongoing
process.
Dont be so focused on the patient that
you lose perception of what is happening
around you.
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Questions to Consider Questions to Consider
What precautions must I take if I am
dealing with a patient who has an open
wound?
What can I do to help deal with stress?
A patient who refuses to believe she has a
terminal disease is in what stage of
dealing with it?
6/28/2011
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Critical Thinking Critical Thinking
You are called to an unknown emergency
at a tavern. As you approach the scene,
you see a man lying supine in the parking
lot, apparently bleeding profusely. Two
other men are scuffling, and one seems to
have a gun. What actions must you take?
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Limmer OKeefe Dickinson
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www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
3.1 Define key terms introduced in this chapter. Slides
911, 14, 1617, 27, 31, 33, 4245, 50
3.2 Describe the factors that you must consider before
lifting any patient. Slides 1114
3.3 Use principles of proper body mechanics when
lifting and moving patients and other heavy objects.
Slides 1214, 17
continued
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OBJECTIVES OBJECTIVES
3.4 Demonstrate the power lift and power grip when
lifting a patient-carrying device. Slide 14
3.5 Follow principles of good body mechanics when
reaching, pushing, and pulling. Slides 1517
3.6 Give examples of situations that require emergency,
urgent, and non-urgent patient moves. Slides 19,
26, 29
continued
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OBJECTIVES OBJECTIVES
3.7 Demonstrate emergency, urgent, and non-urgent
moves. Slides 2025, 2729
3.8 Given several scenarios, select the best patient
lifting and moving devices for each situation. Slides
3140
3.9 Demonstrate proper use of patient lifting and
carrying devices. Slides 3140
continued
6/28/2011
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OBJECTIVES OBJECTIVES
3.10 Differentiate between devices to be used to lift and
carry patients with and without suspected spinal
injuries. Slides 4145
3.11 Identify with the feelings of a patient EMS personnel
are lifting or carrying. Slides 41, 4648
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MULTIMEDIA MULTIMEDIA
Slide 17 Body Mechanics During Moving and
Transferring Video
Slide 50 Prehospital Lifting of Patients Video
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How using body mechanics to lift and
move patients can help prevent injury
When it is proper to move a patient, and
how to do so safely
The various devices used to immobilize,
move, and carry patients
CORE CONCEPTS
6/28/2011
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Topics Topics
Protecting Yourself: Body Mechanics
Protecting Your Patient: Emergency,
Urgent, and Non-Urgent Moves
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Protecting Yourself: Body Protecting Yourself: Body
Mechanics Mechanics
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Protecting Yourself: Protecting Yourself:
Body Mechanics Body Mechanics
6/28/2011
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Before Beginning the Lift Before Beginning the Lift
Estimate weight
Know own limitations
Plan and communicate with partner
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Rules for Lifting Rules for Lifting
Position feet properly
Use legs
Never turn or twist
Do not compensate when lifting with one
hand
continued
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Rules for Lifting Rules for Lifting
Keep weight as
close to your body
as possible
Whenever possible,
use stair chair
when carrying
patient on stairs
6/28/2011
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Power Lift and Power Grip Power Lift and Power Grip
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Reaching Reaching
Keep back in locked-in position
Avoid twisting while reaching
Avoid reaching more than 1520 inches in
front of body
Avoid prolonged reaching when strenuous
effort is required
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Pushing or Pulling Pushing or Pulling
Push, dont pull
Back locked in
Line of pull through center of body
Weight close to body
When weight is below waist, use kneeling
position
Avoid pushing or pulling overhead
Elbows bent, arms close to sides
6/28/2011
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Body Mechanics During Body Mechanics During
Moving and Transferring Video Moving and Transferring Video
Click here to view a video on the subject of body mechanics during
moving and transferring patients.
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Protecting Your Patient: Protecting Your Patient:
Emergency, Urgent, and Non Emergency, Urgent, and Non--
Urgent Moves Urgent Moves
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Emergency Move Situations Emergency Move Situations
Hazardous scene
Repositioning required to care for life-
threatening conditions
Must reach other patients
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Emergency Move: Emergency Move:
Clothes Drag Clothes Drag
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Emergency Move: Emergency Move:
Head First Drag Head First Drag
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Emergency Move: Emergency Move:
Firefighters Drag Firefighters Drag
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Emergency Move: Emergency Move:
Firefighters Carry Firefighters Carry
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Emergency Move: Emergency Move:
One One--Rescuer Assist Rescuer Assist
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Emergency Move: Emergency Move:
Two Two--Rescuer Assist Rescuer Assist
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Urgent Moves Urgent Moves
Required treatment can be performed only
if patient is moved
Patients condition deteriorating
Performed with precautions for spinal
injury
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Urgent Move: Urgent Move:
Onto Long Spine Board Onto Long Spine Board
Used if immediate threat to life and
suspicion of spine injury
Patient supine, log-roll onto side
Place spine board next to body; log-roll
onto board
Lift onto stretcher
Secure to stretcher; load into ambulance
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Urgent Move: Urgent Move:
Rapid Extrication Rapid Extrication
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Non Non--Urgent Move Urgent Move
Patient stable
No immediate life threat
Patient can be assessed, treated, and
moved in normal way
Take all required precautions not to
aggravate existing conditions
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Patient Patient--Carrying Devices Carrying Devices
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Wheeled Ambulance Stretcher Wheeled Ambulance Stretcher
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Power Stretcher Power Stretcher
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Bariatric Stretcher Bariatric Stretcher
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Stair Chair Stair Chair
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Short Spine Board Short Spine Board
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Vest Vest--Type Extrication Device Type Extrication Device
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Scoop Stretcher Scoop Stretcher
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Basket Stretcher Basket Stretcher
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Flexible Stretcher Flexible Stretcher
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Vacuum Mattress Vacuum Mattress
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Think About It Think About It
How do you choose the appropriate
patient-carrying device?
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Moving Patients Moving Patients
With Suspected Spinal Injury With Suspected Spinal Injury
Immobilize head, neck, and spine before
move
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Moving Patients Moving Patients
Without Suspected Spinal Injury Without Suspected Spinal Injury
Extremity lift
Used to carry
patient to stretcher
or stair chair
Can be used to lift
patient from
ground or from
sitting position
continued
6/28/2011
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Moving Patients Moving Patients
Without Suspected Spinal Injury Without Suspected Spinal Injury
Direct ground lift
Lifting from ground to stretcher
continued
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Moving Patients Moving Patients
Without Suspected Spinal Injury Without Suspected Spinal Injury
Draw sheet method (shown)
Direct carry method
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Recovery Position Recovery Position
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Position of Comfort Position of Comfort
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Positioning for Shock Positioning for Shock
Place patients believed to be in shock in
supine position
Do not lower head
Do not elevate legs
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Transferring the Transferring the
Patient to a Hospital Stretcher Patient to a Hospital Stretcher
6/28/2011
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Prehospital Lifting Prehospital Lifting
of Patients Video of Patients Video
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patients.
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Lifting and moving patients requires
planning, proper equipment, and careful
attention to body mechanics to prevent
injury to patient and yourself.
Emergency moves may aggravate spine
injuries and, therefore, are reserved for
life-threatening situations.
continued
6/28/2011
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Chapter Review Chapter Review
Urgent moves are used when the patient
must be moved quickly but there is time to
provide quick, temporary spinal
stabilization.
Non-urgent moves are normal ways of
moving a patient to a stretcher after
performing a complete on-scene
assessment.
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Remember Remember
Proper lifting technique is important
wellness strategy.
Biomechanics and rules of lifting help
prevent injuries associated with lifting.
Many different patient-carrying devices
exist. Choose the correct device based
upon particular patient and needs of
particular movement.
continued
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Remember Remember
Use proper technique to move patients
onto patient-carrying devices and position
them for transport based upon their
condition.
6/28/2011
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Questions to Consider Questions to Consider
Why are body mechanics so important
when lifting and moving patients?
Why is using the appropriate patient-
carrying device an important
consideration?
When would an emergency move be
necessary?
In what ways can proper positioning help a
patients condition?
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Critical Thinking Critical Thinking
You arrive at a vehicle crash and find an
elderly driver slumped over the wheel.
Upon examination you determine the
patient is in respiratory arrest, but not
trapped in the vehicle. Which move would
be appropriate for this patient?
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additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
4.1 Define key terms introduced in this chapter. Slides
1112, 14, 1622, 24, 2632, 3435, 39
4.2 Describe your scope of practice as an EMT. Slides
1112
4.3 Differentiate between scope of practice and
standard of care. Slide 12
4.4 Given a variety of scenarios, determine which type
of patient consent applies. Slides 1619
continued
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OBJECTIVES OBJECTIVES
4.5 Given a variety of ethical dilemmas, discuss the
issues that must be considered in each situation.
Slides 13, 30
4.6 Explain legal and ethical considerations in situations
where patients refuse care. Slides 2023
4.7 Discuss the EMTs obligations with respect to
advance directives, including do not resuscitate
orders. Slide 24
continued
6/28/2011
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OBJECTIVES OBJECTIVES
4.8 Given a variety of scenarios, identify circumstances
that may allow a claim of negligence to be
established. Slides 2730
4.9 Explain the purpose of Good Samaritan laws. Slide
30
4.10 Identify situations that would constitute a breach of
patient confidentiality. Slide 32
continued
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Objectives
continued
OBJECTIVES OBJECTIVES
4.11 Identify situations that would constitute libel or
slander. Slide 32
4.12 Recognize medical identification devices and organ
donor status. Slides 3334
4.13 List items that may be considered evidence at a
crime scene. Slide 39
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OBJECTIVES OBJECTIVES
4.14 Describe ways in which you can minimize your
impact on evidence while meeting your obligations
to care for your patient. Slides 36, 38
4.15 Recognize situations that may legally require
reporting to authorities. Slide 39
4.16 Given a scenario involving an ethical challenge,
decide the most appropriate response for an EMT.
Slides 22, 4546
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MULTIMEDIA MULTIMEDIA
Slide 14 Legal Issues in Healthcare Video
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The scope of practice of an EMT
How a patient may consent to or refuse
emergency care
The legal concepts of negligence, torts,
and abandonment
What it means to have a duty to act
The responsibilities of an EMT at a crime
scene
CORE CONCEPTS
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Topics Topics
Scope of Practice
Patient Consent and Refusal
Other Legal Issues
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Scope of Practice Scope of Practice
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Scope of Practice Scope of Practice
Regulations and ethical considerations
that define extent or limits of job duties
May include skills and procedures
Determined by national, state, local laws,
statutes, and protocols
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Standard of Care Standard of Care
Care expected from EMT with similar
training for patient in a similar situation
Meeting standard of care reduces risk of
legal action
Scope of practice: what you can do
Standard of care: how you should do it
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Ethics Ethics
Morals or standards governing actions
Not always required by law
Golden Rule standard
Very important in EMS
Good ethical behaviorwhat you do when
no one is looking
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Legal Issues Legal Issues
in Health Care Video in Health Care Video
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Patient Consent and Refusal Patient Consent and Refusal
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Patient Consent Patient Consent
Permission from patient to assess, treat,
and transport
Expressed consent
Must be informed
Implied consent
Assumed consent
Follow local laws and protocols
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Consent for Children Consent for Children
Minors not permitted to provide consent
for treatment
Obtain from parent or legal guardian
Possible exceptions (check local law)
In loco parentis
Emancipated minors
Life-threatening illness or injury
Minors who have children
Minors serving in armed forces
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Consent for Consent for
Mentally Incompetent Adults Mentally Incompetent Adults
Adult patients incapable of informed
decisions about care
State and local laws and protocols permit
transport of such patients under implied
consent
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Involuntary Transportation Involuntary Transportation
Patient considered threat to self or others
Court order
Usually requires decision by mental health
professional or police officer
If patient restrained, must not risk legal
liability
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Refusal of Care Refusal of Care
Patient may refuse care or transport
Legally able to consent
Mentally competent and oriented
Fully informed of risks
Sign release form
Despite all precautions, EMT may still be
held liable
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If in Doubt About Refusal If in Doubt About Refusal
Discuss decision with patient
Ensure patient understands risks
Consult medical direction
Ask to contact family member
Contact law enforcement
Listen to patient to determine why refusing
care
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Think About It Think About It
What are the risks of beginning treatment
and/or transport without getting consent
from the patient?
What if the patient refuses to sign the
refusal of care form?
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Things to Things to
Consider During Refusal Consider During Refusal
Have witnesses to refusal
Inform patient that if changes mind, can
call back
If possible have friend or relative remain
with patient
Document, document, document
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Advance Directives Advance Directives
Legal document expressing patients
wishes if patient unable to speak for self
Do not resuscitate order (DNR)
Living will
Health care proxy
Does not prevent EMT from providing
comfort measures
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Other Legal Issues Other Legal Issues
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Duty to Act Duty to Act
Obligation to provide care
While on duty, EMT obligated to provide
care if no threat to safety
Duty to act not always clear
Off duty
On duty, out of jurisdiction
Follow local laws and protocols
Follow own conscience
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Negligence Negligence
Something was not done, or was done
incorrectly
Must prove:
EMT had duty to act
Breach of dutyEMT failed to provide
standard of care expected or failed to act
Proximate causationpatient suffered harm
because of EMT action or inaction
continued
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Negligence Negligence
Negligent EMT may be required to pay
damages
Res ipsa loquitur (the thing speaks for
itself): legal concept important in
negligence cases
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Abandonment Abandonment
Once care initiated, may not be
discontinued until transferred to medical
personnel of equal or greater training
Failure to do so may constitute
abandonment
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Good Samaritan Laws Good Samaritan Laws
Grant immunity from liability if person acts
in good faith within level of training
Rarely applies to on-duty personnel
May not cover EMTs in some situations
Does not protect persons from gross
negligence or violations of law
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Think About It Think About It
You arrive on the scene of a patient in
cardiac arrest. The family says she has a
DNR, but dont know where it is. How
should you handle this?
You are off duty and arrive on the scene of
a vehicle crash. Police and EMS have not
yet arrived. Are you legally obligated to
stop and render aid?
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Confidentiality Confidentiality
Information on patients history, condition,
treatment considered confidential
Can be shared with other health care
personnel as part of patients continuing
care
Otherwise must be obtained through
subpoena
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Medical Identification Devices Medical Identification Devices
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Organ Donor Organ Donor
Person with completed legal document
allowing donation of organs and tissues in
event of death
May be identified by family members,
donor card, drivers license
Receiving hospital and/or medical
direction should be advised per protocol
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Safe Haven Laws Safe Haven Laws
Allow person to drop an infant or child at
any fire, police, or EMS station
States have different guidelines for ages of
children included
Protect children who may otherwise be
abandoned or harmed by parents unwilling
or unable to care for them
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Crime Scenes Crime Scenes
Location where crime
was committed or
anywhere evidence may
be found
Once police have made
scene safe, EMTs
priority is patient care
Know what evidence is
Take steps to preserve
evidence
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Examples of Evidence Examples of Evidence
Condition of scene
Patient
Fingerprints and footprints
Microscopic evidence
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Evidence Preservation Evidence Preservation
Remember what you touch
Minimize impact on scene
Work with police
If patient transported on your stretcher,
stretcher sheet may be valuable source of
evidence
Document thoroughly
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Mandatory Mandatory
Reporting Guidelines Reporting Guidelines
Child, elderly, or domestic abuse
Sexual assault
Stab/gunshot wounds
Animal attacks
Check local laws and protocols
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Medical, legal, ethical issues part of every
EMS call.
Morals are how a person expresses
beliefs of right and wrong.
Consent may be expressed or implied
continued
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Chapter Review Chapter Review
If a competent patient refuses care or
transport, you should make every effort to
persuade him, but you cannot force him to
accept care or go to the hospital.
Negligence is failing to act properly when
you have a duty to act.
continued
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Chapter Review Chapter Review
Abandonment is leaving a patient after you
have initiated care and before you have
transferred the patient to a person with
equal or higher training.
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Remember Remember
EMTs must use good judgment and
decision-making skills when dealing with
patient consent and refusal.
Avoiding negligence implies using good
judgment; critical thinking is an essential
component for avoiding liability.
continued
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Remember Remember
EMTs hold responsibility for patients
protected health information; exercising
care when dealing with this information is
a legal and ethical obligation.
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Questions to Consider Questions to Consider
Define scope of practice, negligence, duty
to act, abandonment, and confidentiality.
What steps must you take when a patient
refuses care or transportation?
What types of evidence may be found at a
crime scene? How should you act to
preserve evidence?
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Critical Thinking Critical Thinking
You respond to a motor vehicle crash and
find a seriously injured patient. He has no
pulse and you are about to begin CPR
when someone says, Dont do that! Hes
got cancer and a DNR! No one has the
DNR at the scene. Do you start CPR and
transport the patient?
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Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
5.1 Define key terms introduced in this chapter. Slides
12, 20, 31, 41, 48, 6573
5.2 Describe the importance of the proper use of
medical terminology. Slides 12, 1617
5.3 Apply definitions of common prefixes, suffixes, and
roots to determine the meaning of medical terms.
Slides 1215
continued
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continued
OBJECTIVES OBJECTIVES
5.4 Recognize the meaning of acronyms and
abbreviations commonly used in EMS. Slide 16
5.5 Give examples of when it is better to use a common
or lay term to describe something than it is to use a
medical term. Slide 17
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OBJECTIVES OBJECTIVES
5.6 Use anatomical terms of position and direction to
describe the location of body structures and position
of the body. Slides 2229
5.7 Utilize topographical anatomical landmarks as
points of reference. Slide 24
continued
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continued
OBJECTIVES OBJECTIVES
5.8 Describe the structures and functions of each of the
following body systems: musculoskeletal,
respiratory, cardiovascular, nervous, digestive,
integumentary, endocrine, renal, and male and
female reproductive. Slides 3173
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OBJECTIVES OBJECTIVES
5.9 Given a series of models or diagrams, label the
anatomical structures of each of the following body
systems: skeletal, respiratory, cardiovascular,
nervous, skin, endocrine, renal/urinary, and male
and female reproductive. Slides 3238, 41, 4952,
6566, 6870, 7273
continued
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OBJECTIVES OBJECTIVES
5.10 Describe differences in the respiratory anatomy of
children as compared to adults. Slides 47
5.11 Apply understanding of anatomy and physiology to
explain the function of the life support chain. Slide
20
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MULTIMEDIA MULTIMEDIA
Slide 17 Medical Term Components Video
Slide 18 Terms Involved With Medical Specialties Video
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Medical terminology and how terms are
constructed
Directional terms
Positional terms
The structure and function of major body
systems
CORE CONCEPTS
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Topics Topics
Medical Terminology
Anatomy and Physiology
Anatomical Terms
Body Systems
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Medical Terminology Medical Terminology
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Components of Medical Terms Components of Medical Terms
Words made from parts
Root: pnea, arthr
Root with combining form: therm-o + meter =
thermometer
Prefix: dys-pnea, tachy-pnea
Suffix: arthr-itis, hemophil-iac
Compounds of two or more words:
smallpox
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Word Component Example Word Component Example
tachy (fast) cardia (heart)
tachycardia (fast heart rate)
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Word Component Example Word Component Example
hemo (blood) thorax (chest)
hemothorax (blood in chest cavity)
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Word Component Example Word Component Example
cardio
(heart)
ology
(study of)
ist
(specialist)
cardiologist
(doctor specializing in cardiac care)
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Acronyms and Abbreviations Acronyms and Abbreviations
Acronym: abbreviation made up of initials
that can be pronounced as a word
CPAP (see-pap): Continuous Positive Airway
Pressure
Abbreviation: letters or symbols used in
place of words or phrases
DNR: Do Not Resuscitate
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Medical Term Medical Term
Components Video Components Video
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Terms Involved Terms Involved
With Medical Specialties Video With Medical Specialties Video
Click here to view a video on the topic of terms involved with medical
specialties.
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Anatomy and Physiology Anatomy and Physiology
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Anatomy and Physiology Anatomy and Physiology
Anatomystudy of body structure
Physiologystudy of body function
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Anatomical Terms Anatomical Terms
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Anatomical Position Anatomical Position
Facing forward,
hands at sides, palms
facing forward
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Anatomical Planes Anatomical Planes
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Abdominal Quadrants Abdominal Quadrants
Horizontal and vertical
lines through navel
Right upper quadrant
(RUQ)
Left upper quadrant
(LUQ)
Right lower quadrant
(RLQ)
Left lower quadrant (LLQ)
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Positional Terms Positional TermsSupine Supine
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Positional Terms Positional TermsProne Prone
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Positional Terms Positional Terms
Recovery Position Recovery Position
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Positional Terms Positional Terms
Fowler/Semi Fowler/Semi--Fowler Position Fowler Position
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Positional Terms Positional Terms
Trendelenburg Position Trendelenburg Position
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Body Systems Body Systems
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Musculoskeletal System Musculoskeletal System
Gives body shape
Protects body organs
Allows for movement
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Skeletal System Skeletal System
Extends into all
parts of body
Consists of skull
and spine, ribs and
sternum, shoulders
and upper
extremities, pelvis
and lower
extremities
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Skull Skull
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Spinal Column Spinal Column
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Thoracic Cavity Thoracic Cavity
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Pelvis Pelvis
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Lower Extremities Lower Extremities
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Upper Extremities Upper Extremities
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Joints Joints
Ball-and-socket joint Hinge joint
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Muscle Muscle
Voluntary (skeletal)
Involuntary
(smooth)
Cardiac
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Respiratory System Respiratory System
Brings in oxygen via inhalation
Excretes carbon dioxide via exhalation
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Respiratory Physiology Respiratory Physiology
Inhalation (active process)
Diaphragm and intercostal muscles contract;
diaphragm moves downward
Negative pressure pulls air into lungs
Exhalation (passive process)
Diaphragm and intercostal muscles relax
Positive pressure pushes air out of lungs
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Inhalation Inhalation
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Exhalation Exhalation
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Ventilation and Respiration Ventilation and Respiration
Ventilation: movement of gases to and
from alveoli
Respiration: exchange of gases between
cells and bloodstream
continued
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Ventilation and Respiration Ventilation and Respiration
Oxygenated blood travels from lungs to
heart, then is pumped to rest of the body
At capillary level, oxygen (O
2
) is
exchanged with cells for waste carbon
dioxide (CO
2
)
Deoxygenated blood returns to the heart,
then to lungs to exchange waste CO
2
for
O
2
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Pediatric Differences: Pediatric Differences:
Respiratory System Respiratory System
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Cardiovascular System Cardiovascular System
Heart
Blood
Circulatory system
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Heart Heart
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Conduction System Conduction System
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Coronary Arteries Coronary Arteries
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Circulation of the Blood Circulation of the Blood
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Composition of the Blood Composition of the Blood
Plasma
More than half of bloods volume
Red blood cells
RBCs, erythrocytes, red corpuscles
White blood cells
WBCs, leukocytes, white corpuscles
Platelets
Help with clotting
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Pulse Pulse
Wave of blood flowing down an artery
when the left ventricle contracts
Can be felt when an artery is near the
surface of the skin and over a bone
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Peripheral and Central Pulses Peripheral and Central Pulses
Peripheral (outer parts of body)
Radial
Brachial
Posterior tibial
Dorsalis pedis
Central (core of body)
Carotid
Femoral
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Central Pulses Central Pulses
Pulses near the center or core of the body
Carotid
Femoral
Carotid pulse should be used to determine
pulselessness rather than a peripheral
pulse
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Carotid Pulse Carotid Pulse
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Brachial Pulse Brachial Pulse
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Radial Pulse Radial Pulse
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Femoral Pulse Femoral Pulse
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Dorsalis Pedis Pulse Dorsalis Pedis Pulse
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Blood Pressure Blood Pressure
Pressure inside
arteries
Systolic (upper
reading)arterial
pressure when left
ventricle contracts
Diastolic (lower
reading)pressure
when left ventricle
refills
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Perfusion Perfusion
Adequate circulation of blood and
exchange of oxygen and waste products
Hypoperfusion (shock): when flow
becomes inadequate
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Think About It Think About It
How is the function of the respiratory
system related to the function of the
circulatory system?
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Central Nervous System Central Nervous System
Brain
Spinal cord
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Peripheral Nervous System Peripheral Nervous System
Sensory
Messages from
body to brain
Motor
Messages from
brain to body
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Digestive System Digestive System
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Integumentary Integumentary
System SystemFunctions Functions
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Integumentary System Integumentary SystemLayers Layers
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Endocrine System Endocrine System
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Renal System Renal System
Helps body regulate fluid levels,
chemicals, and pH levels
Kidneys
Bladder
Ureters
Urethra
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Male Reproductive System Male Reproductive System
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Female Reproductive System Female Reproductive System
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Chapter Review Chapter Review
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continued
Chapter Review Chapter Review
Medicine has a language of its own. You
will frequently communicate with medical
professionals who speak this language.
Medical terms generally consist of a root
with a prefix and/or suffix.
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Chapter Review Chapter Review
Your knowledge of the anatomy, or
structure, and the functions, or physiology,
of the body will be important in allowing
you to assess your patient and
communicate your findings with other EMS
personnel and hospital staff accurately
and efficiently.
continued
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Chapter Review Chapter Review
Major body systems with which you should
be familiar are musculoskeletal,
respiratory, cardiovascular, nervous,
digestive, integumentary, endocrine, renal,
and reproductive.
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Remember Remember
Medical terminology is the language of
health care. Roots, prefixes, and suffixes
can lend clues to the meaning of many
terms.
Understanding anatomy and physiology is
like reviewing the owners manual for the
body.
continued
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Remember Remember
Anatomical terminology brings precision
and accuracy to descriptions.
Understanding an overview and the basic
function of body systems will improve both
assessment and treatment of patients.
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Questions to Consider Questions to Consider
Is my use of medical terms accurate and
descriptive?
Can I identify critical organs and structures
that reside in an area where a patient has
a complaint or traumatic injury?
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Critical Thinking Critical Thinking
You respond to a teenage boy who has
taken a hard fall from his dirt bike. He has
a deep gash on the outside of his left arm
halfway between shoulder and elbow and
another on the inside of his right arm just
above the wrist. His left leg is bent at a
funny angle about halfway between hip
and knee.
continued
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Critical Thinking Critical Thinking
When you cut away his pants leg, you see
a bone sticking out of a wound on the front
side. How will you describe your patients
injuries over the radio to the hospital staff?
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
6.1 Define key terms introduced in this chapter. Slides
11, 15, 17, 26, 27, 31, 33, 37, 4042, 44, 45, 51, 58
6.2 Describe the basic roles and structures of body
cells. Slides 1320
6.3 Describe the roles of water, glucose, and oxygen in
the cell. Slides 1418
continued
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continued
OBJECTIVES OBJECTIVES
6.4 Describe conditions that can threaten
cardiopulmonary function. Slides 2630, 3334, 37,
4244
6.5 Explain how impaired cardiopulmonary function
affects the body. Slides 2630, 3334, 37, 4244
6.6 Discuss the mechanisms the body uses to
compensate for impaired cardiopulmonary function.
Slides 31, 37, 42
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OBJECTIVES OBJECTIVES
6.7 Explain the pathophysiology of shock. Slide 45
6.8 Identify signs and symptoms that indicate the body
is attempting to compensate for impaired
cardiopulmonary function. Slide 46
6.9 Describe ways in which the bodys fluid balance can
become disrupted. Slide 50
continued
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OBJECTIVES OBJECTIVES
6.10 Recognize indications that the bodys fluid balance
has been disrupted. Slide 51
6.11 Describe ways in which the nervous system may be
impaired. Slide 52
6.12 Recognize indications that the nervous system may
be impaired. Slide 53
continued
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OBJECTIVES OBJECTIVES
6.13 Describe the effects on the body of endocrine
dysfunction, digestive system dysfunction, and
immune system dysfunction. Slides 55, 5758
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MULTIMEDIA MULTIMEDIA
Slide 20 Cell Structure Video
Slide 47 Transport of Carbon Dioxide Animation
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The cell, cellular metabolism, and results
of the alteration of cellular metabolism
The respiratory system and the
importance of oxygenation and ventilation
The cardiovascular system and the
movement of blood
CORE CONCEPTS
continued
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The principles of perfusion, hypoperfusion,
and shock
Disrupted physiology of major body
systems
CORE CONCEPTS
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Topics Topics
The Cell
The Cardiopulmonary System
Pathophysiology of Other Systems
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Introduction to Pathophysiology Introduction to Pathophysiology
Study of how disease processes affect
function of body
Understanding helps you recognize
changes patient is going through due to
illness or injury
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The Cell The Cell
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Structure of the Cell Structure of the Cell
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ATP ATP
Mitochondria convert glucose and other
nutrients into adenosine triphosphate
(ATP)
ATPfuel for cell functions
Without ATP many of the cells specialized
structures cannot function
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Water and the Cell Water and the Cell
Cells need the correct balance of water
inside and outside
Too little water: cell dehydrated and dies
Too much water: cell systems dont work
properly
Water also affects levels of electrolytes
Impacts electrical functions
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Think About It Think About It
Draw an analogy between cell metabolism
and how a refinery turns crude oil into
gasoline for use in automobiles.
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Oxygen and the Cell Oxygen and the Cell
Aerobic metabolismcellular functions
using oxygen
Anaerobic metabolismcellular functions
not using oxygen
Creates much less energy and much more
waste
Body becomes acidic, impairing many body
functions
continued
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Oxygen and the Cell Oxygen and the Cell
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Cell Membrane Cell Membrane
Many diseases alter the permeability of
membrane
Negatively impacts membranes ability to
transfer fluids, electrolytes, and other
substances in and out
Also allows toxins to enter cell
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Cell Structure Video Cell Structure Video
Click here to view a video on the subject of cell structure.
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The Cardiopulmonary System The Cardiopulmonary System
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Cardiopulmonary System Cardiopulmonary System
Respiratory and cardiovascular systems
work together
Bring oxygen into body
Distribute to cells
Remove waste products
Any breakdown can result in system
failure
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Airway Airway
continued
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Airway Airway
continued
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Airway Airway
Must have an open (patent) airway for
system to function
Upper airway obstructions are common
Caused by foreign bodies, infection, and
trauma
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The Lungs The Lungs
Part of lower airway
Tidal volumevolume of air moving in and
out during each breath cycle
Tidal volume x respiratory rate = minute
volume
Amount of air moved in and out of lungs in
one minute
continued
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The Lungs The Lungs
Any change in tidal volume or respiratory
rate reduces minute volume
Respiratory dysfunction occurs any time
something interferes with minute volume
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Disruption of Disruption of
Respiratory Control Respiratory Control
Respirations controlled in brain by the
medulla oblongata
Any event impacting function of the
medulla oblongata can affect minute
volume
Infection, drugs, toxins, trauma
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Disruption of Pressure Disruption of Pressure
If wall of thorax is compromised
(punctures, rib fractures), ability to inhale
and exhale is impacted and minute volume
is reduced
Air or blood accumulating in chest (pleural
space) also compromises respiration
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Disruption of Lung Tissue Disruption of Lung Tissue
Trauma or medical problems can
compromise the ability of alveoli to
exchange gases
Less O
2
gets in, less CO
2
gets out
Can result in low oxygen levels (hypoxia)
and high carbon dioxide levels
(hypercapnia)
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Respiratory Compensation Respiratory Compensation
Body attempts to compensate for changes
Chemoreceptors detect changing O
2
and
CO
2
levels
Brain stimulates respiratory system to
increase rate and/or tidal volume
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The Blood The Blood
Four parts
Plasma (liquid)
Red blood cells (contain oxygen-carrying
hemoglobin)
White blood cells (fight infection)
Platelets (form clots)
continued
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The Blood The Blood
Plasma oncotic pressureproteins in
plasma attract water away from cells and
into bloodstream
Hydrostatic pressurewater pushed back
out of bloodstream
Problems with these proteins can cause
an imbalance
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Blood Dysfunction Blood Dysfunction
Less blood (hypovolemia), less gas
exchange
Fewer red blood cells (anemia), less gas
exchange
Fewer water-retaining proteins, less
volume
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Blood Vessels Blood Vessels
continued
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Blood Vessels Blood Vessels
Take oxygenated blood from lungs via
heart to capillaries
Where gas exchange takes place
(between cells and capillaries)
Return blood to lungs via heart for gas
exchange (between capillaries and alveoli)
continued
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Blood Vessels Blood Vessels
Need adequate pressure to make cycle
work
Pressure controlled by changing diameter
of blood vessels
Stretch receptors monitor pressure
Pressure can be increased or decreased
depending on situation
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Blood Vessel Dysfunction Blood Vessel Dysfunction
Loss of tone
Vessels lose ability to constrict and dilate
Pressure drops
Causes: trauma, infection, allergic reaction
continued
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Blood Vessel Dysfunction Blood Vessel Dysfunction
Permeability
Capillaries leak
fluid out their walls
Caused by severe
infection (sepsis)
and certain
diseases
continued
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Blood Vessel Dysfunction Blood Vessel Dysfunction
Systemic vascular resistance (SVR)
pressure inside vessels
Various conditions lead to abnormal
constriction of vessels, leading to
dangerously high pressures (hypertension)
Major risk factor in stroke and heart
disease
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The Heart The Heart
Pump with stroke volume (output) of about
60 ml blood per contraction
Stroke volume is based on:
Preloadamount of blood returning to heart
Contractilityhow hard heart squeezes
Afterloadpressure in vessels (SVR)
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Cardiac Output Cardiac Output
Stroke volume x beats per minute =
cardiac output
Slowing heart rate or decreasing stroke
volume reduces cardiac output
Rapid heart rates reduce cardiac output
Inadequate time for heart to refill between
contractions
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Heart Dysfunction Heart Dysfunction
Mechanical problems
Physical trauma
Squeezing forces
Cell death (heart attack)
Electrical problems
Damage to hearts ability to regulate rate
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V/Q Match V/Q Match
Entire cardiopulmonary system must work
together to maintain life
Must be a balance between ventilation (V)
and perfusion (Q) for system to work
properly
Any breakdown in system impacts ratio
causing possible life-threatening situation
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Shock Shock
Perfusionregular delivery of oxygen and
nutrients to cells and removal of waste
products
Hypoperfusionbreakdown in system
Can result in death of patient
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Recognizing Compensation Recognizing Compensation
When problems arise, body attempts to
compensate
Signs of compensation:
Increased heart rate
Increased respiratory rate
Dilated pupils
Pale, cool, clammy skin
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Transport of Transport of
Carbon Dioxide Animation Carbon Dioxide Animation
Click here to view an animation on the subject of the transport of
carbon dioxide.
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Pathophysiology of Other Pathophysiology of Other
Systems Systems
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Fluid Balance Fluid Balance
Body is 60% water
Intracellular (70%)
Intravascular (5%)
Interstitial (25%)
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Fluid Regulation Fluid Regulation
Brain controls thirst
Kidneys control elimination of fluid
Blood plasma proteins pull fluid into the
bloodstream
Cell membrane and capillary permeability
regulate flow in and out
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Fluid Disruption Fluid Disruption
Fluid loss (dehydration)
Decrease in total water volume
Fluid distribution
Water not getting to where its needed
Edema
Too much water in some parts of the body
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Nervous System Nervous System
Brain and spinal cord are well-protected by
skull and spine
Covered by several protective layers
(meninges) and a layer of shock-absorbing
fluid (cerebrospinal fluid)
Still subject to damage from trauma or
disease
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Nervous System Dysfunction Nervous System Dysfunction
Trauma causes
Penetrating trauma to head
Damage to spine
Swelling tissue has no room
Medical causes
Strokes
Infection (meningitis, encephalitis)
Disease (Lou Gehrigs disease, MS)
Low blood sugar (hypoglycemia)
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Endocrine System Endocrine System
Glands secrete hormones
Hormones send chemical messages to the
body to control body functions
Major organs of system:
Brain
Kidney
Pancreas
Pituitary
Thyroid, adrenal glands
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Endocrine Dysfunction Endocrine Dysfunction
Organ or gland problems
Present at birth or result of illness
Too many hormones
Hyperthyroidism (too much thyroid hormone)
Problems with heart rate and temperature
regulation
Too few hormones
Diabetes
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Digestive System Dysfunction Digestive System Dysfunction
Impacts hydration levels and nutrient
transfer
Gastrointestinal (GI) bleeding
Can be slow; chronic bleeding
Can be massive, with rectal bleeding and/or
vomiting blood
continued
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Digestive System Dysfunction Digestive System Dysfunction
Vomiting and diarrhea
Most common disorders
Variety of causes
May result in malnutrition and dehydration
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Immune System Dysfunction Immune System Dysfunction
Hypersensitivity
Allergic reaction to certain food, drugs, other
substances
Result of exaggerated immune response
Chemicals affect more than just invader
Edema
Drop in blood pressure
Can be life-threatening
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Chapter Review Chapter Review
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continued
Chapter Review Chapter Review
Pathophysiology allows us to understand
how negative forces impact the normal
function of the body.
Pathophysiology helps us understand how
common disorders cause changes in the
body.
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Chapter Review Chapter Review
Understanding how the body compensates
for insults sheds light on the signs and
symptoms we may see during
assessment.
Understanding what compensation looks
like helps us rapidly identify potentially life
threatening problems.
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Remember Remember
Cellular metabolism requires a constant
supply of oxygen and glucose. Absence of
either component disrupts normal
metabolism.
Cardiopulmonary system combines the
functions of respiratory and cardiovascular
systems to provide oxygen at the cellular
level.
continued
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continued
Remember Remember
Shock occurs when the cardiopulmonary
system fails and cells become
hypoperfused.
The body is composed primarily of water,
and this fluid is distributed throughout the
body systems.
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Questions to Consider Questions to Consider
When evaluating a patient with a cardiac
problem, consider the impact on the
respiratory system. When evaluating a
patient with a respiratory problem,
consider the impact on the cardiovascular
system. What impacts do problems in
these systems have on each other?
continued
6/28/2011
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Questions to Consider Questions to Consider
Shock must be recognized immediately.
What is the pathophysiology of shock?
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Critical Thinking Critical Thinking
You are treating a patient who was
recently released from the intensive care
unit with a massive infection (sepsis). This
has impaired the patients ability to
regulate the size of the blood vessels.
continued
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Critical Thinking Critical Thinking
How might this affect the patients ability to
compensate for any additional illnesses?
What steps should you take to help this
patient compensate?
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
7.1 Define key terms introduced in this chapter. Slides
9, 11, 14, 16, 20, 23, 27, 32, 35, 38
7.2 Describe the physical and psychological
characteristics, including normal vital signs, for
individuals in each of the following age groups:
Infant, Toddler, Preschool Age, School Age,
Adolescent, Early Adult, Middle Adult, and Late
Adult. Slides 913, 18, 22, 25, 29, 34, 37, 40
continued
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OBJECTIVES OBJECTIVES
7.3 Describe the typical psychosocial characteristics
and concerns of individuals at each stage during the
life span. Slides 14, 19, 22, 25, 30, 34, 37, 40
7.4 Use knowledge of physical, physiological, and
psychosocial development to anticipate the needs
and concerns of patients of all ages. Slides 914,
1819, 22, 25, 2931, 34, 37, 40
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MULTIMEDIA MULTIMEDIA
Slide 15 Growth and Development: Major Life
TransitionInfant Video
Slide 26 School-aged Children Health Promotion Video
Slide 41 Cognitive Function of Older Adults Video
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The physiological (physical) characteristics
of different age groups from infancy
through late adulthood
The psychosocial (mental and social)
characteristics of different age groups from
infancy through late adulthood
CORE CONCEPTS
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Topics Topics
Infancy (Birth to 1 Year)
Toddler Phase (1236 Months)
Preschool Age (35 Years)
School Age (612 Years)
Adolescence (1318 Years)
Early Adulthood (1940 Years)
Middle Adulthood (4160 Years)
Late Adulthood (61 Years and Older)
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Infancy (Birth to 1 Year) Infancy (Birth to 1 Year)
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Infancy (Birth to 1 Year) Infancy (Birth to 1 Year)
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Physiological Characteristics Physiological Characteristics
3.03.5 kg (6.67.7 lb) at birth
Weight doubles by 6 months; triples by 12
months
Head 25% of body weight
Airway narrow; easily obstructed
Nose and diaphragm used for breathing
continued
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continued
Physiological Characteristics Physiological Characteristics
Antibodies passed from mother to child in
pregnancy
Antibodies also passed through
breastfeeding
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Physiological Characteristics Physiological Characteristics
Moro reflex (startle)
Throws arms out, spreads fingers, grabs with
fingers and arms
Palmar reflex
Grasps objects placed in palm
Rooting reflex (hunger)
Turns toward side of head touched
continued
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Physiological Characteristics Physiological Characteristics
Sucking reflex
Sucks when lips are stroked
Sleep patterns
Begin to regulate after 24 months
Then sleeps through night
Extremities grow from a combination of
growth plates and epiphyseal plates
continued
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Physiological Characteristics Physiological Characteristics
Fontanelles not fused at birthstill soft
until 918 months
Sunken fontanelles: indicate dehydration
Bulging fontanelles: indicate increased
pressure inside skull
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Psychosocial Characteristics Psychosocial Characteristics
Bonding
Trust vs. mistrust
Scaffolding
Temperament
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Growth and Development: Growth and Development:
Major Life Transition Major Life TransitionInfant Video Infant Video
Click here to view a video on the subject of an infants growth and
development.
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Toddler Phase (12 Toddler Phase (1236 Months) 36 Months)
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Toddler Phase (12 Toddler Phase (1236 Months) 36 Months)
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Physiological Characteristics Physiological Characteristics
Pulmonary system
Nervous system
Musculoskeletal system
Immune system
Teeth
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Psychosocial Characteristics Psychosocial Characteristics
Begins to understand
cause and effect
Highly curious and
investigating
Separation anxiety
Begins to develop
magic thinking,
imagination, and
ability to role play
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Preschool Age (3 Preschool Age (35 Years) 5 Years)
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Preschool Age (3 Preschool Age (35 Years) 5 Years)
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Physiological and Physiological and
Psychosocial Characteristics Psychosocial Characteristics
Physiological
Body systems continue to develop
Psychosocial
Developing interactive and social skills
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School Age (6 School Age (612 Years) 12 Years)
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School Age (6 School Age (612 Years) 12 Years)
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Physiological and Physiological and
Psychosocial Characteristics Psychosocial Characteristics
Physiological
Loss of baby teeth
Psychosocial
Less general supervision
Developing decision-making skills
More awareness of self-esteem
Values opinions of peers (positive or negative)
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School School--Aged Children Aged Children
Health Promotion Video Health Promotion Video
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lifestyle in school-age children.
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Adolescence (13 Adolescence (1318 Years) 18 Years)
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Adolescence (13 Adolescence (1318 Years) 18 Years)
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Physiological Characteristics Physiological Characteristics
Growth spurt
Sexual maturity
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Psychosocial Characteristics Psychosocial Characteristics
Strives for independence
Concern about body image and peer
pressure
May be prone to self-destructive behaviors
Developing personal code of ethics
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Think About It Think About It
Adolescents are often injured because of
risk taking
May be resistant to disclose what
happened
Must be encouraged to explain
circumstances surrounding an incident
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Early Adulthood (19 Early Adulthood (1940 Years) 40 Years)
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Early Adulthood (19 Early Adulthood (1940 Years) 40 Years)
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Physiological and Physiological and
Psychosocial Characteristics Psychosocial Characteristics
Physiological
Lifelong habits formed
Reaches peak physical condition
Psychosocial
Job and family stress
Marriage, childbirth, child rearing
Accidents leading cause of death
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Middle Adulthood Middle Adulthood
(41 (4160 Years) 60 Years)
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Middle Adulthood Middle Adulthood
(41 (4160 Years) 60 Years)
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Physiological and Physiological and
Psychosocial Characteristics Psychosocial Characteristics
Physiological
May need vision correction
Cancer, heart disease often develop
Weight control more difficult
Psychosocial
Empty-nest syndrome
Caring for elderly parents
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Late Adulthood Late Adulthood
(61 Years and Older) (61 Years and Older)
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Late Adulthood Late Adulthood
(61 Years and Older) (61 Years and Older)
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Physiological and Physiological and
Psychosocial Characteristics Psychosocial Characteristics
Physiological
Body systems less efficient
Psychosocial
Living environment
Self-worth
Financial burdens
Death and dying
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Cognitive Function Cognitive Function
of Older Adults Video of Older Adults Video
Click here to view a video on the subject of cognitive function of
older adults.
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Understanding basic physiological and
psychosocial development for each age
group will assist you in communicating
with and assessing patients of various
ages.
continued
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Chapter Review Chapter Review
Physiological differences between ages
will affect your care (for example:
differences in respiratory systems; effects
of pre-existing conditions).
Infants and young children have less-
developed, smaller respiratory structures
which can worsen respiratory conditions.
continued
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Chapter Review Chapter Review
Communicating with patients will depend
on their stage of development: could be
fear of strangers, separation anxiety,
embarrassment, denial, depression.
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Remember Remember
Infants present massive bursts of
anatomical and psychosocial development
in the first year of life.
Although preschoolers begin to develop
independence and reason, in many ways
they still resemble the psychosocial
development of toddlers.
continued
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Remember Remember
School-age children often are independent
and logical, but that may crumble with
illness or injury.
Adolescents are reaching physiological
maturity, but they often face difficult
psychosocial challenges.
continued
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Remember Remember
Early, middle, and late adults vary greatly
in terms of physiological development and
conditioning; they also face psychosocial
challenges unique to adulthood.
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Questions to Consider Questions to Consider
How do I approach a patient most
effectively based on developmental
characteristics?
Does the age of my patient pose any
assessment or care challenges based on
physiologic development?
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Critical Thinking Critical Thinking
You are called for abdominal pain in a 16-
year-old girl. She is with friends at the
park. She seems hesitant to answer any of
your questions. What characteristic of
adolescent development is most likely the
cause of this? How could you overcome
it?
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Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
8.1 Define key terms introduced in this chapter. Slides
1215, 21, 24, 31-34, 39, 40, 54
8.2 Describe the anatomy and physiology of the upper
and lower airways. Slides 1216
8.3 Given a diagram or model, identify the structures of
the upper and lower airways. Slides 13, 15
continued
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OBJECTIVES OBJECTIVES
8.4 Describe common pathophysiologic problems
leading to airway obstruction. Slides 1821
8.5 Demonstrate assessment of the airway in a variety
of patient scenarios. Slides 2226
8.6 Associate abnormal airway sounds with likely
pathophysiologic causes. Slide 24
continued
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OBJECTIVES OBJECTIVES
8.7 Identify patients who have an open airway but who
are at risk for airway compromise. Slide 23
8.8 Recognize patients who have an inadequate airway.
Slide 25
continued
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continued
OBJECTIVES OBJECTIVES
8.9 Demonstrate manually opening the airway in
pediatric and adult medical and trauma patients:
head-tilt, chin-lift maneuver, jaw-thrust maneuver.
Slides 3134
8.10 Describe the indications, contraindications, use, and
potential complications of airway adjuncts, including
oropharygneal airway and nasopharyngeal airway.
Slides 3952
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OBJECTIVES OBJECTIVES
8.11 Recognize the indications for suctioning of the
mouth and oropharynx. Slide 54
8.12 Describe risks and limitations associated with
suctioning the mouth and oropharynx. Slides 5862,
6667
continued
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OBJECTIVES OBJECTIVES
8.13 Demonstrate the following airway management
skills: inserting an oropharyngeal airway; inserting a
nasopharyngeal airway; suctioning the mouth and
oropharynx. Slides 4547, 5152, 6567
8.14 Describe modifications in airway management for
pediatric patients, patients with facial trauma, and
patients with airway obstruction. Slides 7480
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MULTIMEDIA MULTIMEDIA
Slide 27 Responding to an Adult with an Obstructed
Airway Video
Slide 68 SuctioningOral Pharyngeal Video
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CORE CONCEPTS
Physiology of the airway
Pathophysiology of the airway
How to recognize an adequate or an
inadequate airway
How to open an airway
How to use airway adjuncts
Principles and techniques of suctioning
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Topics Topics
Airway Physiology
Airway Pathophysiology
Opening the Airway
Airway Adjuncts
Suctioning
Keeping an Airway Open: Definitive Care
Special Considerations
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Airway Physiology Airway Physiology
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Upper Airway Upper Airway
Begins at mouth and nose
Air is warmed and humidified in nasal
turbinates
Pharynx
Oropharynx, nasopharynx, and
laryngopharynx
Ends at glottic opening
continued
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Upper Airway Upper Airway
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Lower Airway Lower Airway
Begins at glottic opening
Trachea
Bronchial passages
Alveoli
continued
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Lower Airway Lower Airway
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Alveoli Alveoli
Tiny sacs in grapelike bunches at the end
of the airway
Surrounded by pulmonary capillaries
Oxygen and carbon dioxide diffuse
through pulmonary capillary membranes
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Airway Airway Pathophysiology Pathophysiology
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Airway Obstructions Airway Obstructions
Variety of obstructions interfere with air
flow
Foreign bodies: food, small toys
Liquids: blood, vomit
Obstruction may result from poor muscle
tone caused by altered mental status
continued
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Airway Obstructions Airway Obstructions
Obstructions can be acute or chronic
Providers must initially evaluate airway
and monitor patency over time
continued
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Airway Obstructions Airway Obstructions
Acute
Foreign bodies
Vomit
Blood
Occurring over time
Edema from burns, trauma, or infection
Decreasing mental status
continued
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Airway Obstructions Airway Obstructions
Bronchoconstriction
Disorder of lower airway
Smooth muscle constricts internal diameter of
airway
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Airway Assessment Airway Assessment
Addressed in primary assessment
Two questions must be answered
Is airway open?
Will airway stay open?
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Will Airway Stay Open? Will Airway Stay Open?
Airway assessment is not just a moment in
time
Must give constant consideration
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Findings Indicating Findings Indicating
Airway Problems Airway Problems
Inability to speak
Unusual raspy quality to voice
Stridor
Snoring
Gurgling
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Signs of Inadequate Airway Signs of Inadequate Airway
Foreign bodies in airway
No air felt or heard (air exchange below
normal)
Absent or minimal chest movements
Abdominal breathing
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Pediatric Airway Assessment Pediatric Airway Assessment
Retractions
Nasal flaring
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Responding to an Adult Responding to an Adult
with an Obstructed Airway Video with an Obstructed Airway Video
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in an adult.
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Opening the Airway Opening the Airway
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Patient Care: Patient Care:
Airway Management Airway Management
When primary assessment indicates
inadequate airway, a life-threatening
condition exists
Take prompt action to open and the
maintain airway
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Open Airway Open Airway
If airway is not open, use position to open
it
Head-tilt, chin-lift maneuver and jaw-thrust
maneuver move airway structures into
position allowing air movement
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Head Head--Tilt Tilt
Chin Chin--Lift Maneuver Lift Maneuver
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Performing Head Performing Head--Tilt Tilt
Chin Chin--Lift Maneuver Lift Maneuver
1. Place one hand on forehead and
fingertips of other hand under patients
lower jaw
2. Tilt head
3. Lift chin
4. Do not allow mouth to close
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Jaw Jaw--Thrust Maneuver Thrust Maneuver
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Performing Performing
Jaw Jaw--Thrust Maneuver Thrust Maneuver
1. Place one hand on each side of patients
lower jaw at angles of jaw below ears
2. Using index fingers, push angles of
patients lower jaw forward
3. Do not tilt or rotate patients head
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Patient Care: Patient Care:
Airway Management Airway Management
After airway has been opened, position
must be maintained to keep airway open
Airway must be cleared of secretions and
other obstructions
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Pediatric Note: Pediatric Note:
Opening the Airway Opening the Airway
Infants and small children often have
larger occipital regions of their heads
Lying flat may cause hyperflexion of neck
and airway occlusion
Evaluate need to pad behind patients
shoulders to achieve neutral airway
position
continued
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Pediatric Note: Pediatric Note:
Opening the Airway Opening the Airway
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Airway Adjuncts Airway Adjuncts
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Patient Care: Patient Care:
Airway Adjuncts Airway Adjuncts
Airway position and maneuvers are short-
term solutions
Airway adjunct provides longer term air
channel
Two most common airway adjuncts:
Oropharyngeal airway (OPA)
Nasopharyngeal airway (NPA)
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Rules for Using Rules for Using
Airway Adjuncts Airway Adjuncts
Use OPA only on patients not exhibiting
gag reflex
Open patients airway manually before
using adjunct device
When inserting airway, take care not to
push patients tongue into pharynx
continued
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Rules for Using Rules for Using
Airway Adjuncts Airway Adjuncts
Have suction ready
Do not continue inserting airway if patient
gags
Maintain head position after adjunct
insertion
continued
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Rules for Using Rules for Using
Airway Adjuncts Airway Adjuncts
Patient may regain consciousness
Be prepared to remove adjunct and have
suction ready
Use infection control practices while
maintaining airway
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Oropharyngeal Airway Oropharyngeal Airway
Device used to move tongue forward as it curves
back to pharynx
Sizes: infant to large adult
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Sizing Oropharyngeal Airways Sizing Oropharyngeal Airways
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Inserting OPA Inserting OPA
Open mouth with crossed-finger technique
Position airway with tip pointing toward
roof of mouth
continued
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Inserting OPA Inserting OPA
1. Insert until you meet resistance
2. Gently rotate airway 180so tip is
pointing down into pharynx
3. Check that flange of airway is against lips
4. Monitor patient closely
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Pediatric Note: Pediatric Note:
Inserting OPA Inserting OPA
Use tongue depressor or rigid suction tip
and insert OPA directly
Do not rotate into place
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Nasopharyngeal Airway Nasopharyngeal Airway
Soft, flexible tube inserted through nostril
and into hypopharynx
Moves tongue and soft tissue forward to
provide a channel for air
continued
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Nasopharyngeal Airway Nasopharyngeal Airway
Can be used in patients with intact gag
reflex or clenched jaw
Contraindicated if clear (cerebrospinal)
fluid coming from nose or ears
continued
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Nasopharyngeal Airway Nasopharyngeal Airway
Come in various
sizes
Must be measured
Typical adult sizes:
34, 32, 30, and 28
French
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Inserting NPA Inserting NPA
1. Lubricate outside of tube with water-
based lubricant before insertion
continued
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Inserting NPA Inserting NPA
2. Push tip of nose upward; keep head in
neutral position
3. Insert into nostril;
advance until
flange rests firmly
against nostril
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Suctioning Suctioning
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Patient Care: Suctioning Patient Care: Suctioning
Obvious liquids (blood, secretions, vomit)
must be removed from airway to prevent
aspiration into lungs
Use vacuum device to remove liquids from
airway
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Components of Suction Unit Components of Suction Unit
Suction source
Collection container
Tubing
Suction tips or catheters
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Suction Systems Suction Systems
Fixed or portable
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Suction Device Requirements
Must furnish air
intake of at least 30
Lpm at open end of
collection tube
Must generate
vacuum of no less
than 300 mmHg
when collecting tube
is clamped
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Rigid Pharyngeal Suction Tip Rigid Pharyngeal Suction Tip
Also called Yankauer Tip
Larger bore than flexible catheters
continued
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Rigid Pharyngeal Suction Tip Rigid Pharyngeal Suction Tip
Suction only as far as you can see
Do not lose sight of distal end
Careful insertion helps prevent gag reflex
or vagal stimulation
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Flexible Suction Catheter Flexible Suction Catheter
Designed to be used when a rigid tip
cannot be used
Can be passed through a tube such as the
nasopharyngeal or endotracheal tube
Can be used for suctioning the
nasopharynx
continued
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Flexible Suction Catheter Flexible Suction Catheter
Come in various sizes identified by a
number French
Larger the number, larger the catheter
continued
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Flexible Suction Catheter Flexible Suction Catheter
Not typically large enough to suction
vomitus or thick secretions
May kink
In event of copious, thick secretions
consider removing tip or catheter and
using large bore, rigid suction tubing
continued
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Flexible Suction Catheter Flexible Suction Catheter
Measured in similar way as OPA
Length of catheter that should be inserted
into patients mouth equals distance
between corner of patients mouth and
earlobe
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Measuring Flexible Suction Measuring Flexible Suction
Catheter Catheter
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Suctioning Techniques
Use appropriate infection control
practices while suctioning
Protective eyewear, mask,
disposable gloves
continued
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Suctioning Techniques Suctioning Techniques
Suction no longer than 10 seconds at a
time
Prolonged suctioning can cause hypoxia
and bradycardia
If patient vomits for longer than 10
seconds, continue suction
continued
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Suctioning Techniques Suctioning Techniques
Place tip or catheter where you want to
begin suctioning
Suction on the way out
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Suctioning Suctioning
Oral Pharyngeal Video Oral Pharyngeal Video
Click here to view a video on the subject of suctioning.
Back to Directory
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Keeping an Airway Open: Keeping an Airway Open:
Definitive Care Definitive Care
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Keeping an Keeping an
Airway Open: Definitive Care Airway Open: Definitive Care
Keeping the airway open may exceed
capabilities of a basic EMT
Medications and/or surgical procedures
may be necessary to resolve airway
obstruction
continued
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Keeping an Keeping an
Airway Open: Definitive Care Airway Open: Definitive Care
Rapidly evaluate and treat airway
problems
Quickly recognize when more definitive
care is necessary
May be advanced life support intercept
May be closest hospital
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Think About It Think About It
If you were not able to manage an airway
at the basic level, what advanced
resources might be available to you?
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Special Considerations Special Considerations
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Facial Injuries Facial Injuries
Frequently result in severe swelling or
bleeding that may block or partially block
airway
Bleeding may require frequent suctioning
or more definitive airway
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Obstructions Obstructions
Many suction units are not adequate for
removing solid objects
Objects may have to be removed with
manual techniques: abdominal thrusts,
chest thrusts, finger sweeps
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Dental Appliances Dental Appliances
Leave in place during airway procedures
when possible
Partial dentures may become dislodged
during an emergency
Be prepared to remove if airway
endangered
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Pediatric Patients Pediatric Patients
Present a variety of anatomical differences
to consider when managing the airway
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Pediatric Pediatric
Anatomical Considerations Anatomical Considerations
Smaller mouth and nose
Larger tongue
Narrow, flexible trachea
continued
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Pediatric Pediatric
Anatomical Considerations Anatomical Considerations
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Pediatric Pediatric
Management Considerations Management Considerations
Open airway gently
Do not hyperextend neck
Consider adjuncts when other measures
fail
Use rigid tip with adjunct, but do not touch
back of airway
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Chapter Review Chapter Review
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Chapter Review Chapter Review
The airway is the passageway by which air
enters the body during respiration, or
breathing.
A patient cannot survive without an open
airway.
Maintaining an open airway is the first
priority of emergency care.
continued
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Chapter Review Chapter Review
Airway adjuncts can help keep the airway
open.
It may be necessary to suction the airway
or to use manual techniques to remove
fluids and solids from the airway before,
during, or after artificial ventilation.
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Remember Remember
Always use proper personal protective
equipment when managing an airway.
Airway assessment must be an ongoing
process. Airway status can change over
time.
Airway management should start simply
and become more complicated only if
necessary.
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Questions to Consider Questions to Consider
Name the main structures of the airway.
Explain why care for the airway is the first
priority of emergency care.
Describe the signs of an inadequate
airway.
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Questions to Consider Questions to Consider
Explain when the head-tilt, chin-lift
maneuver should be used and when the
jaw-thrust maneuver should be used to
open the airwayand why.
Explain how airway adjuncts and
suctioning help in airway management.
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Critical Thinking Critical Thinking
On arrival at the emergency scene, you
find an adult female patient with gurgling
sounds in the throat and inadequate
breathing slowing to almost nothing. How
do you proceed to protect the airway?
continued
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Critical Thinking Critical Thinking
When evaluating a small child you hear
stridor. What does this sound tell you?
What are your immediate concerns
regarding this sound?
continued
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Critical Thinking Critical Thinking
When assessing an unconscious patient,
you note snoring respirations. Should you
be concerned with this and if so, what
steps can you take to correct this
situation?
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Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
9.1 Define key terms introduced in this chapter. Slides
1516, 18, 2022, 25, 29, 39, 60, 95
9.2 Explain the physiological relationship between
assessing and maintaining an open airway,
assessing and ensuring adequate ventilation, and
assessing and maintaining adequate circulation.
Slides 1422
9.3 Describe the mechanics of ventilation. Slides 1519
continued
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OBJECTIVES OBJECTIVES
9.4 Explain mechanisms that control the depth and rate
of ventilation. Slides 1519
9.5 Explain the relationships between tidal volume,
respiratory rate, minute volume, dead air space, and
alveolar ventilation. Slides 2021
9.6 Describe the physiology of external and internal
respiration. Slides 2122
continued
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OBJECTIVES OBJECTIVES
9.7 Recognize patients at risk for failure of the
cardiopulmonary system. Slides 2535
9.8 Differentiate between adequate breathing,
inadequate breathing (respiratory failure), and
respiratory arrest. Slides 2533
9.9 Use information from the scene size-up and patient
assessment to anticipate hypoxia. Slides 2935
continued
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OBJECTIVES OBJECTIVES
9.10 Given a variety of scenarios, differentiate between
patients who require artificial ventilation and those
who do not. Slides 3036, 41
9.11 Identify patients who require administration of
supplemental oxygen. Slides 3036, 41
continued
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OBJECTIVES OBJECTIVES
9.12 Discuss the potential negative effects of positive
pressure ventilation, and how to minimize
complications from positive pressure ventilation.
Slides 3940
continued
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continued
OBJECTIVES OBJECTIVES
9.13 Demonstrate the following techniques of artificial
respiration for pediatric (as applicable) and adult
medical and trauma patients: Mouth-to-mask, Two-
rescuer bag-valve mask (BVM), Flow-restricted,
oxygen-powered ventilation device, One-rescuer
BVM, Automatic transport ventilator (as permitted by
local protocol). Slides 4359, 6265
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OBJECTIVES OBJECTIVES
9.14 Assess the adequacy of artificial ventilations. Slides
56, 61
9.15 Demonstrate the application of cricoid pressure.
Slide 57
9.16 Modify artificial ventilation and oxygen techniques
for patients with stomas. Slides 6061
continued
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OBJECTIVES OBJECTIVES
9.17 Discuss considerations for selecting the best device
for delivering oxygen for a variety of patient
scenarios. Slides 7685
9.18 Demonstrate administration of oxygen by:
Nonrebreather mask, nasal cannula. Slides 7680
continued
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OBJECTIVES OBJECTIVES
9.19 Describe the purpose and use of partial rebreather
masks, Venturi masks, and tracheostomy masks.
Slides 8185
9.20 Demonstrate safe transport, storage, and use of
oxygen. Slides 6975
9.21 Describe the purpose of each part of an oxygen
delivery system. Slides 6971, 7485
9.22 Describe the use of humidified oxygen. Slide 86
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MULTIMEDIA MULTIMEDIA
Slide 87 Oxygen DeliverySimple Mask Video
Slide 99 In-Hospital Endotracheal Intubation Video
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CORE CONCEPTS
Physiology and pathophysiology of the
respiratory system
How to recognize adequate and
inadequate breathing
Principles and techniques of positive
pressure ventilation
Principles and techniques of oxygen
administration
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Topics Topics
Physiology and Pathophysiology
Respiration
Positive Pressure Ventilation
Oxygen Therapy
Special Considerations
Assisting with Advanced Airway Devices
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Physiology and Physiology and
Pathophysiology Pathophysiology
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Ventilation Ventilation
Process of moving air into and out of chest
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Inhalation Inhalation
Active process
Negative pressure
pulls air into lungs
continued
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Exhalation Exhalation
Passive process
Muscles relax; size
of chest decreases
Positive pressure
created; air pushed
out
continued
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Respiration Terminology Respiration Terminology
Tidal volumeamount of air moved in one
breath
Dead space airair moved in ventilation
not reaching alveoli
Alveolar ventilationair actually reaching
alveoli
Ventilationboth inhaling and exhaling
continued
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Respiration Terminology Respiration Terminology
Diffusionmovement of gases from high
concentration to low concentration
External respirationdiffusion of oxygen
and carbon dioxide (exchange of gases)
between alveoli and circulating blood
Internal respirationexchange of gases
between blood and cells
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In the Cells In the Cells
Oxygen from blood
diffused into cell
Carbon dioxide
diffused from cell
into blood
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Categories of Categories of
Respiratory System Failure Respiratory System Failure
Mechanics of breathing disrupted
Gas exchange interrupted
Circulation problems
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Respiration Respiration
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Evaluating Respiration Evaluating Respiration
Brain and body cells need a steady supply
of oxygen
Hypoxia: low oxygen level in cells
Carbon dioxide must be continuously
removed
Hypercapnea: high carbon dioxide level
continued
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Evaluating Respiration Evaluating Respiration
Assesses how well cardiopulmonary
system is accomplishing oxygenation and
carbon dioxide removal
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Respiratory Compensation Respiratory Compensation
Compensation for hypoxia or hypercapnea
is predictable
Signs
Shortness of breath (symptom)
Increased respiratory rate and depth
Increased heart rate
continued
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Respiratory Compensation Respiratory Compensation
Early on, steps of compensation can meet
the needs of the body despite respiratory
challenge
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Respiratory Distress Respiratory Distress
Body compensating
for a respiratory
challenge and
meeting metabolic
needs
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Patient Assessment: Patient Assessment:
Signs of Respiratory Distress Signs of Respiratory Distress
Relatively normal mental status
Relatively normal oxygen saturation and
end tidal carbon dioxide
Relatively normal skin color
Shortness of breath
Increased respiratory rate and heart rate
Accessory muscle use and position
changes
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Respiratory Failure Respiratory Failure
Occurs when challenge overcomes
compensation or compensatory steps can
no longer continue
Also known as inadequate breathing
Exceptionally important to recognize; often
a precursor to respiratory arrest
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Patient Assessment: Patient Assessment:
Signs of Respiratory Failure Signs of Respiratory Failure
Signs of respiratory distress
Evidence that compensation is no longer
effective
Signs of poor oxygenation and/or poor
removal of CO
2
Signs of decompensation
continued
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Patient Assessment: Patient Assessment:
Signs of Respiratory Failure Signs of Respiratory Failure
Signs of failed oxygenation and/or removal
of CO
2
Altered mental status
Cyanosis
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Patient Assessment: Patient Assessment:
Signs of Decompensation Signs of Decompensation
No or poor air movement
Diminished or absent breath sounds
Breathing rate too rapid, too slow, or
irregular
Patient unable to speak
Unusual noises (wheezing, crowing,
stridor, snoring, gurgling, gasping)
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Signs of Respiratory Signs of Respiratory
Failure: Pediatric Note Failure: Pediatric Note
In addition to other signs, look for
retractions and nasal flaring
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Critical Decisions: Critical Decisions:
When to Intervene When to Intervene
Often respiratory failure patients will be
breathing and conscious
Identify adequacy of breathing
If breathing is inadequate, immediate
intervention is necessary
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Think About It Think About It
What signs might identify the need to
intervene in a breathing patient?
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Positive Pressure Ventilation Positive Pressure Ventilation
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Positive Pressure Ventilation Positive Pressure Ventilation
Forcing air or oxygen into lungs when a
patient has stopped breathing or has
inadequate breathing
Uses force exactly opposite of how the
body normally draws air into the lungs
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Negative Side Effects of Negative Side Effects of
Positive Pressure Ventilation Positive Pressure Ventilation
Decreasing cardiac output/dropping blood
pressure
Gastric distention
Hyperventilation
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Key Concerns with PPV Key Concerns with PPV
Do not ventilate patient who is vomiting or
has vomitus in airwayPPV will force
vomitus into patients lungs
Watch chest rise and fall with each
ventilation
Ensure rate of ventilation is sufficient
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Ventilating a Ventilating a
Breathing Patient Breathing Patient
Explain procedure to patient
After sealing mask on patients face,
squeeze bag with patients inhalation
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Mouth to Mask Ventilation Mouth to Mask Ventilation
Performed using a pocket face mask
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Performing Mouth Performing Mouth
to Mask Ventilation to Mask Ventilation
1. Open airway
2. Connect oxygen and run at 15 Lpm
3. Position mask on patients face
Apex over bridge of nose
Base between lower lip and prominence of
chin
continued
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Performing Mouth Performing Mouth
to Mask Ventilation to Mask Ventilation
4. Hold mask firmly in
place; maintain
head tilt
5. Exhale into mask
port
6. Allow passive
exhalation
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Achieving Tight Mask Seal Achieving Tight Mask Seal
Position thumbs over top of mask, index
fingers over bottom of mask, and
remaining fingers under patients jaw
Position thumbs along side of mask and
remaining fingers under patients jaw
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Bag Bag--Valve Mask (BVM) Valve Mask (BVM)
Handheld
ventilation device
Used to ventilate
nonbreathing
patient and/or
patient in
respiratory failure
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Standard Features of BVM Standard Features of BVM
Self-refilling shell that is easily cleaned
and sterilized
Non-jam valve that allows an oxygen inlet
flow of 15 Lpm
Nonrebreathing valve
continued
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Standard Features of BVM Standard Features of BVM
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Mechanics of BVM Mechanics of BVM
Supply of 15 Lpm O
2
attached and enters
reservoir
When squeezed, air inlet closed and
oxygen delivered to patient
When released, passive expiration by
patient occurs
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Two Two--Rescuer BVM Ventilation Rescuer BVM Ventilation
Strongly recommended by AHA
Most difficult part of BVM ventilation is
obtaining adequate mask seal
Hard to maintain seal while squeezing bag
One rescuer squeezes bag; other rescuer
maintains seal
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Two Two--Rescuer BVM Rescuer BVM
Ventilation: No Trauma Suspected Ventilation: No Trauma Suspected
1. Open airway with head-tilt, chin-lift
maneuver
2. Select correct bag-valve mask size
3. Kneel at patients head; position thumbs
over top half of mask, index fingers over
bottom half
continued
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Two Two--Rescuer BVM Rescuer BVM
Ventilation: No Trauma Suspected Ventilation: No Trauma Suspected
4. Place apex of
triangular mask
over bridge of
nose; lower mask
over mouth and
upper chin
continued
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Two Two--Rescuer BVM Rescuer BVM
Ventilation: No Trauma Suspected Ventilation: No Trauma Suspected
5. Use middle, ring, and little fingers to bring
patients jaw up to mask
Maintain head-tilt, chin-lift maneuver
continued
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Two Two--Rescuer BVM Rescuer BVM
Ventilation: No Trauma Suspected Ventilation: No Trauma Suspected
6. Second rescuer
connects and
squeezes bag
7. Second rescuer
releases bag;
patient exhales
passively
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Two Two--Rescuer BVM Rescuer BVM
Ventilation: Trauma Suspected Ventilation: Trauma Suspected
1. Open airway using jaw-thrust maneuver
2. Select correct bag-valve mask size
3. Kneel at patients head; place thumb
sides of your hands along mask to hold it
firmly on patients face
continued
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Two Two--Rescuer BVM Rescuer BVM
Ventilation: Trauma Suspected Ventilation: Trauma Suspected
4. Use remaining
fingers to bring jaw
upward toward
mask, without tilting
head or neck
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One One--Rescuer Rescuer
BVM Ventilation BVM Ventilation
1. Open airway
2. Select correct size mask
3. Position mask on patients face
4. Squeeze bag
5. Release pressure on bag and let patient
exhale passively
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If Chest Does Not If Chest Does Not
Rise During BVM Ventilation Rise During BVM Ventilation
1. Reposition head
2. Check for escape of air around mask;
reposition fingers and mask
3. Check for airway obstruction or
obstruction in BVM system
4. Use alternative method
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Artificial Ventilation Artificial Ventilation
of a Stoma Breather of a Stoma Breather
1. Clear mucus plugs
or secretions from
stoma
2. Leave head and
neck in neutral
position
continued
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Artificial Ventilation Artificial Ventilation
of a Stoma Breather of a Stoma Breather
3. Use pediatric-sized mask to establish
seal around stoma
4. Ventilate at appropriate rate for patients
age
5. If unable to artificially ventilate through
stoma, seal stoma and attempt artificial
ventilation through mouth and nose
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Flow Flow--Restricted Restricted,
Oxygen-Powered Ventilation Device
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Using Flow Using Flow--Restricted, Restricted,
Oxygen Oxygen--Powered Ventilation Device Powered Ventilation Device
Use on adults only
Follow same procedures for mask seal as
for BVM
Trigger device until chest rises
continued
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Using Flow Using Flow--Restricted, Restricted,
Oxygen Oxygen--Powered Ventilation Device Powered Ventilation Device
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Automatic Transport Automatic Transport
Ventilator (ATV) Ventilator (ATV)
Provides automated ventilations
Can adjust ventilation rate and volume
Provider must assure appropriate
respiratory rate and volume for patients
size and condition
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Think About It Think About It
How would you decide which positive
pressure delivery method to use for your
patient?
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Oxygen Therapy Oxygen Therapy
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Conditions Requiring Conditions Requiring
Supplemental Oxygen Supplemental Oxygen
Respiratory or cardiac arrest
Heart attacks and strokes
Shock
Respiratory distress and lung diseases
Head injuries
Other serious injuries
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Oxygen Systems Oxygen Systems
Portable or installed
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Oxygen System Components Oxygen System Components
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Oxygen Cylinders Oxygen Cylinders
Come in various sizes
Dabout 350 L of O
2
Eabout 625 L of O
2
Mabout 3,000 L of O
2
Gabout 5,300 L of O
2
Habout 6,900 L of O
2
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Oxygen Safety Oxygen Safety
Use pressure gauges, regulators, and
tubing intended for use with oxygen
Use non-sparking wrenches
Replace disposable gaskets each time a
cylinder is changed
Properly secure oxygen cylinders in a
cool, ventilated space
Never drop cylinder or move by dragging
continued
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Oxygen Safety Oxygen Safety
Never leave cylinder in upright position
without being secured
Never allow smoking around oxygen or
use oxygen equipment around open flame
Never use grease or adhesive tape on a
cylinder
Test cylinders hydrostatically every 5 years
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Pressure Regulator Pressure Regulator
continued
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Pressure Regulator Pressure Regulator
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Delivery Devices: Delivery Devices:
Nonrebreather Mask Nonrebreather Mask
Best way to deliver high concentrations of
oxygen to a breathing patient
continued
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Delivery Devices: Delivery Devices:
Nonrebreather Mask Nonrebreather Mask
continued
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Delivery Devices: Delivery Devices:
Nonrebreather Mask Nonrebreather Mask
Provides oxygen concentrations of 80%
100%
Minimum flow rate 8 Lpm
Maximum flow rate 1215 Lpm
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Delivery Devices: Delivery Devices:
Nasal Cannula Nasal Cannula
Best choice for a patient who refuses to
wear an oxygen face mask
continued
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Delivery Devices: Delivery Devices:
Nasal Cannula Nasal Cannula
Provides oxygen concentrations of 24%
44%
Should deliver no more than 46 liters per
minute
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Delivery Devices: Delivery Devices:
Partial Rebreather Mask Partial Rebreather Mask
Very similar to nonrebreather mask
No one-way valve in opening to reservoir
bag
Delivers 40%60% oxygen at 910 Lpm
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Delivery Devices: Delivery Devices:
Venturi Mask Venturi Mask
Delivers specific concentrations of oxygen
by mixing oxygen with inhaled air
Some have set percentage and flow rate;
others have adjustable Venturi port
continued
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Delivery Devices: Delivery Devices:
Venturi Mask Venturi Mask
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Delivery Devices: Delivery Devices:
Tracheostomy Mask Tracheostomy Mask
Placed over stoma or tracheostomy tube
to provide supplemental oxygen
Connected to 810 Lpm
continued
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Delivery Devices: Delivery Devices:
Tracheostomy Mask Tracheostomy Mask
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Humidifier Humidifier
Connected to
flowmeter
Provides moisture
to dry oxygen from
supply cylinder
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Oxygen Delivery Oxygen Delivery
Simple Mask Video Simple Mask Video
Click here to view a video on the subject of oxygen delivery using a
simple mask.
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Special Considerations Special Considerations
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Facial Injuries Facial Injuries
Bleeding and swelling can disrupt
movement of air
Aggressive suction and advanced airway
maneuvers may be necessary
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Obstructions Obstructions
Foreign bodies can impede ventilation of
patients
If unable to ventilate always consider the
possibility of obstruction
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Pediatric Notes Pediatric Notes
Hypoxia often occurs rapidly
Children burn oxygen at twice the rate of
adults
Account for many anatomical differences
associated with airway
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Ventilating Pediatric Patients Ventilating Pediatric Patients
Avoid excessive pressure and volume
Use properly sized face masks
Flow-restricted, oxygen-powered
ventilation devices contraindicated
Gastric distention may impair adequate
ventilations
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Assisting with Advanced Assisting with Advanced
Airway Devices Airway Devices
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Types of Types of
Advanced Airway Devices Advanced Airway Devices
Devices requiring direct visualization
Devices inserted blindly
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Assisting with Intubation Assisting with Intubation
Maximize oxygenation prior to procedure
Position patient in sniffing position
Cricoid pressure
Confirmation
Securing tube in place
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Ventilating Ventilating
the Intubated Patient the Intubated Patient
Very little movement can displace an
endotracheal tube
Pay attention to resistance to ventilations;
report changes
If patient is defibrillated, carefully remove
bag from tube
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Assisting with Assisting with
a Trauma Intubation a Trauma Intubation
Provide manual in-line stabilization
throughout procedure
Position hands to hold stabilization, but
allow for movement of jaw
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Blind Insertion Devices Blind Insertion Devices
Examples
King LT-Dairway
Combitube

Laryngeal Mask Airway (LMA)


Usually do not require head to be placed
in sniffing position
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In In--Hospital Hospital
Endotracheal Intubation Video Endotracheal Intubation Video
Click here to view a video on the subject of in-hospital
endotracheal intubation.
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Respiratory failure (inadequate breathing):
breathing is insufficient to support life.
A patient in respiratory failure or
respiratory arrest must receive artificial
ventilations.
Oxygen can be delivered to the
nonbreathing patient as a supplement to
artificial ventilation.
continued
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Chapter Review Chapter Review
Oxygen can also be administered as
therapy to the breathing patient.
Supplemental oxygen is indicated when
breathing is inadequate or in patients that
have a condition that would benefit from
additional oxygen delivery.
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Remember Remember
Always use proper personal protective
equipment when managing an airway.
Assessment of breathing must be an
ongoing process. Respiratory status can
change over time.
Inadequate breathing requires immediate
action.
continued
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Remember Remember
Positive pressure ventilations are very
different than normal breathing and can
have negative side effects.
Select the most appropriate method of
positive pressure ventilations based upon
the needs of the individual.
continued
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Remember Remember
Always use appropriate safety measures
when handling oxygen.
Select the appropriate delivery device to
provide supplemental oxygen.
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Questions to Consider Questions to Consider
What are the signs of respiratory distress?
What are the signs of respiratory failure?
For BVM ventilation, what are
recommended variations in technique for
one or two rescuers?
continued
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Questions to Consider Questions to Consider
How does the way positive pressure
ventilation moves air differ from how the
body normally moves air?
Describe a patient problem that would
benefit from administration of oxygen and
explain how to decide what oxygen
delivery device should be used.
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Critical Thinking Critical Thinking
On arrival at the emergency scene, you
find an adult female patient who is
semiconscious. Her respiratory rate is 7
per minute. She appears pale and slightly
blue around her lips
continued
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Critical Thinking Critical Thinking
Is this patient in respiratory failure, and if
so what signs and symptoms indicate this?
Does this patient require artificial
ventilations?
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
10.1 Define key terms introduced in this chapter. Slides
12, 19, 23, 3134
10.2 Explain the ongoing nature of scene size-up beyond
the initial moments at the scene. Slide 12
continued
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continued
OBJECTIVES OBJECTIVES
10.3 Given a scene-arrival scenario, list several
examples of potential hazards for which the EMT
should actively search. Slides 1520
10.4 Describe considerations in establishing a danger
zone at the scene of a vehicle collision. Slide 19
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OBJECTIVES OBJECTIVES
10.5 Recognize indications of possible crime scenes and
the potential for violence. Slide 20
10.6 Use information from the scene size-up to make
decisions about the use of standard precautions to
protect against disease exposure. Slide 18
continued
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OBJECTIVES OBJECTIVES
10.7 Use information from the scene size-up to determine
the mechanism of injury or nature of the illness.
Slides 2335
10.8 Explain the importance of determining the number of
patients and the need for additional resources in the
scene size-up. Slides 3637
continued
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OBJECTIVES OBJECTIVES
10.9 Given a number of scenarios, perform a scene size-
up, including recognizing potential dangers, making
decisions about body substance isolation,
determining the nature of the illness or mechanism
of injury, determining the number of patients, and
determining the need for additional resources.
Slides 1520, 2237
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MULTIMEDIA MULTIMEDIA
Slide 39 Physical AssessmentMechanism of Injury
Video
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CORE CONCEPTS
Identifying hazards at a scene
Determining if a scene is safe to enter
Mechanisms of injury and how they relate
to patient condition
Determining what additional assistance
may be needed at a scene
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Topic Topic
Scene Size-Up
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Scene Size Scene Size--Up Up
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Scene Size Scene Size--Up Up
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Elements of Scene Size Elements of Scene Size--Up Up
Checking scene safety
Taking standard precautions
Noting the mechanism of injury or nature
of patients illness
Determining the number of patients
Deciding what additional resources may
be necessary
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Scene Safety
The only predictable thing about
emergencies is they are often
unpredictable and can pose many dangers
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Think About It
What are potential threats to emergency
providers at an EMS scene?
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Scene Safety Considerations Scene Safety Considerations
Upon approaching scene
Look and listen for other emergency units
approaching
Look for signs of a collision-related power
outage
Observe traffic flow
Look for smoke in the direction of the collision
scene
continued
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Scene Safety Considerations Scene Safety Considerations
When within sight of
scene
Look for clues to
escaped hazardous
materials
Look for collision victims
on or near the road
Look for smoke not seen
at a distance
Look for broken utility
poles and downed wires
continued
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Scene Safety Considerations Scene Safety Considerations
When within sight of scene
Be alert for persons walking along side of
road toward collision scene
Watch for signals of police officers and other
emergency service personnel
continued
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Scene Safety Considerations Scene Safety Considerations
As you reach scene
Follow instructions of
incident commander
Don appropriate
personal protective
equipment
continued
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Scene Safety Considerations Scene Safety Considerations
Establish danger zone
Evaluate hazard and restrict area based on
threat level
Different hazards require different-sized
danger zones
continued
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Scene Safety Considerations Scene Safety Considerations
Evaluate for threat of violence
Fighting or loud voices
Weapons visible or in use
Signs of alcohol or other drug use
Unusual silence
Knowledge of prior violence
continued
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Think About It Think About It
Although any call can present a potential
safety hazard, what types of calls might
pose the highest threats of potential
violence?
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Nature of the Call Nature of the Call
Determining why EMS has been called
Mechanism of injury
Nature of illness
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Forces that caused injury
Understanding forces can predict injury
patterns
continued
Mechanism of Injury
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Mechanism of Injury Mechanism of Injury
Mechanism of Injury
Can be very useful in predicting injuries
associated with certain types of motor
vehicle crashes
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Mechanism of Injury: Head Mechanism of Injury: Head--on on
Collision Collision
Mechanism of Injury: Mechanism of Injury:
Head Head--on Collision on Collision
Up Up--and and--over injury pattern over injury pattern
continued
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Mechanism of Injury: Mechanism of Injury:
Head Head--on Collision on Collision
Down-and-under injury pattern
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Mechanism of Injury: Mechanism of Injury:
Rear Rear--end Collision end Collision
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Mechanism of Injury: Mechanism of Injury:
Rollover Collision Rollover Collision
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Mechanism of Mechanism of
Injury: Severe Fall Injury: Severe Fall
Adult: more than 20 feet
Child under 15 years: more than 10 feet
(23 times childs height)
continued
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Mechanism of Mechanism of
Injury: Severe Fall Injury: Severe Fall
Important factors
Height from which patient fell
Surface patient fell onto
Part of patient that hit ground
Anything that interrupted fall
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Mechanism of Mechanism of
Injury: Trauma Injury: Trauma
Low-velocity (knife) injuries
Damage limited to area penetrated
May be multiple wounds
continued
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Mechanism of Mechanism of
Injury: Penetrating Trauma Injury: Penetrating Trauma
Medium-velocity (handgun/shotgun) and
high-velocity (rifle) injuries may be
anywhere in the body
Damage from the bullet itself
Damage from cavitation
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Mechanism of Mechanism of
Injury: Blunt Injury: Blunt--Force Trauma Force Trauma
Injury caused by a blow that strikes body
but does not penetrate skin or other body
tissues
Signs are often subtle and easily
overlooked
Maintain index of suspicion based on
mechanism of injury
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Nature of the Illness Nature of the Illness
Reason patient
called EMS
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Nature of the Illness Nature of the Illness
Information may be obtained from many
sources
Patient
Family and bystanders
Scene
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Number of Patients Number of Patients
How many patients present?
Sufficient resources on hand to care for all
patients?
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Other Additional Resources Other Additional Resources
Does the situation require specialized
resources?
Fire
Technical rescue
Hazardous materials response
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Think About It Think About It
What are the potential risks to me as a
responder on a poisoning or overdose
call?
What are the routes of entry into the body?
What are some things EMS can do to
prevent poisonings, especially in children?
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Physical Assessment Physical Assessment
Mechanism of Injury Video Mechanism of Injury Video
Click here to view a video on the subject of mechanism of injury.
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Scene size-up is the first part of the patient
assessment process.
Scene size-up first assures your safety
and the safety of fellow rescuers.
Scene size-up then assures that
appropriate resources have been
assembled to deal with the situation.
continued
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Chapter Review Chapter Review
Finally, you must take into account the
number of patients and other factors at the
scene to determine if you will need
additional help.
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Remember Remember
Determine what, if any, threats there may
be to your own safety and to the safety of
others at the scene.
Take appropriate Standard Precautions.
continued
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Remember Remember
Determine the nature of the call by
identifying the mechanism of injury or
nature of a patients illness.
Determine the number of patients and any
additional resources necessary.
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Questions to Consider Questions to Consider
For each of these dangers, what actions
must be taken to remain safe at a collision
scene?
Leaking gasoline
Toxic or hazardous material spill
Vehicle on fire
Downed power lines
continued
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Questions to Consider Questions to Consider
What are common mechanism-of-injury
patterns for the following situations?
Head-on collision
Rear-end collision
Fall from a height
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Critical Thinking Critical Thinking
You are called to the scene of a shooting
at a fast food restaurant. En route, you
plan your scene size-up strategy. What
actions do you anticipate taking on arrival?
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additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
11.1 Define key terms introduced in this chapter. Slides
1112, 14, 1921, 28
11.2 Explain the purpose of the primary assessment.
Slides 1113
continued
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continued
OBJECTIVES OBJECTIVES
11.3 Discuss the difference in first steps to assessment if
the patient is apparently lifeless (C-A-B approach) or
if the patient has signs of life, including a pulse
(A-B-C approach). Slides 1113
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OBJECTIVES OBJECTIVES
11.4 Given several scenarios, do the following: form a
general impression, determine the chief complaint,
determine the patients mental status, assess the
airway, assess breathing, assess circulation,
determine the patients priority for transport.
Slides 1829
continued
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OBJECTIVES OBJECTIVES
11.5 Recognize findings in the primary assessment that
require immediate intervention. Slides 22, 27
continued
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OBJECTIVES OBJECTIVES
11.6 Differentiate the approach to the primary
assessment based on the following: mechanism of
injury/nature of the illness and level of
responsiveness, patients age (adult, child, or
infant). Slides 3435
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MULTIMEDIA MULTIMEDIA
Slide 31 Prehospital Patient Video
Slide 32 Initial Assessment Procedures Video
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CORE CONCEPTS
Deciding on the approach to the primary
assessment
Manual stabilization of the head and neck
The general impression
Assessment of mental status using the
AVPU scale
The ABCs as part of the assessment
process
How to make a priority decision
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Topics Topics
Primary Assessment
Patient Characteristics and Primary
Assessment
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Primary Assessment Primary Assessment
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Approach to the Approach to the
Primary Assessment Primary Assessment
Focus on life threats
Airway (A), breathing (B), circulation (C)
May vary depending on
Patients condition
On the scene resources
Other
continued
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Approach to the Approach to the
Primary Assessment Primary Assessment
Order of A-B-C depends on initial
impression of patient
Sequence will vary
A-B-C if patient has signs of life
C-A-B if patient appears lifeless, no pulse
Immediate interventions may be needed
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Primary Assessment Steps Primary Assessment Steps
Forming a general impression
Assessing mental status
Assessing airway
Assessing breathing
Assessing circulation
Determining patient priority
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General Impression General Impression
Assesses environment, patients chief
complaint, and appearance
Helps determine patient severity
Helps set priorities for care and transport
continued
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General Impression General Impression
Look Test: feeling
from environmental
observations as
well as first look at
patient
continued
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General Impression General Impression
Findings that indicate critical patient
Altered mental status
Anxiety
Pale, sweaty skin
Obvious trauma to head, chest, abdomen,
pelvis
Specific positions indicating distress
continued
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General Impression General Impression
Patients appearing lifeless
Resuscitate by beginning CPR compressions
Prepare AED as soon as possible
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Forming a General Impression Forming a General Impression
Look
Patients age, sex, and position
Listen
Moaning, snoring, or gurgling respirations
Smell
Fumes, urine, feces, vomitus, or decay
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Chief Complaint Chief Complaint
Patients description of why EMS was
called
May be specificabdominal pain
May be vaguenot feeling good
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Assess Mental Status: AVPU Assess Mental Status: AVPU
Alert
Document orientation to person, place, and
time
Verbal response
Painful response
Unresponsive
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Assess ABCs Assess ABCs
Order of primary
assessment will
vary depending on
patients condition
Airway
Breathing
Circulation
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Airway Airway
If airway is not
open or is
endangered, take
measures to open
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Breathing Breathing
Situations calling for breathing assistance
Respiratory arrest
Not alert, inadequate breathing
Some alertness, inadequate breathing
Adequate breathing, but signs suggesting
respiratory distress or hypoxia
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Circulation Circulation
Assess pulse
Assess skin
Assess bleeding
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Circulation Circulation
Three results of assessing pulse
Within normal limits
Unusually slow
Unusually fast
continued
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Circulation Circulation
Assessing skin
Good circulation: warm, pink, dry skin
Shock: pale, clammy (cool and moist) skin
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Immediate Intervention Immediate Intervention
Treat any life-
threatening ABC
problem as soon
as discovered!
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Determining Patient Priority Determining Patient Priority
Stable
Vital signs in normal range
Potentially unstable
Potential for deterioration can indicate
potentially unstable category
Unstable
Threat to ABCs rules out stability
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Need for Priority Transport Need for Priority Transport
Initiate priority transport if a life-threatening
problem cannot be controlled or threatens
to recur
Continue assessment and care en route
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Think About It Think About It
Why must you continue to re-evaluate the
primary assessment?
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Prehospital Patient Video Prehospital Patient Video
Click here to view a video on the subject of assessment of the
prehospital patient.
Back to Directory
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Initial Assessment Initial Assessment
Procedures Video Procedures Video
Click here to view a video on the subject of initial assessment
procedures.
Back to Directory
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Patient Characteristics and Patient Characteristics and
Primary Assessment Primary Assessment
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Patient Characteristics Patient Characteristics
Patient characteristics determine the form
of assessment
Medical or traumatic problem?
Altered mental status?
Child or adult?
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Pediatric Note Pediatric Note
Adjust assessment to social and
physiological norms of children
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Think About It Think About It
How might normal findings in a primary
assessment differ for a child compared
with an adult?
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Steps of Primary Assessment Steps of Primary Assessment
Despite patient characteristics, follow
primary assessment steps systematically
General impression
Mental status
ABCs
Priority for transport
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Primary assessment is a systematic
approach to quickly find and treat
immediate threats to life.
General impression, although subjective,
can provide extremely useful information
regarding urgency of a patients condition.
Determination of mental status follows the
AVPU approach.
continued
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Chapter Review Chapter Review
Evaluating airway, breathing, and
circulation quickly but thoroughly will
reveal immediate threats to life that must
be treated before further assessment.
Patients priority describes how urgent
patients need to be transported is and
how to conduct the rest of the
assessment.
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Remember Remember
Determine if a problem is medical or
traumatic in nature.
Determine if a patient is responsive or
unresponsive; an adult, child, or infant.
Rapidly identify the need for immediate
airway intervention.
continued
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Remember Remember
Determine if the patients condition is
stable enough to allow further assessment
and treatment at the scene.
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Questions to Consider Questions to Consider
What factors will you take into account in
forming a general impression of a patient?
How should you assess a patients mental
status with regard to the AVPU levels of
responsiveness?
continued
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Questions to Consider Questions to Consider
How should you assess airway, breathing,
and circulation during the primary
assessment?
What is meant by the term priority
decision?
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Critical Thinking Critical Thinking
A middle-aged male is lying on the street
after being hit by a car. He appears
unresponsive as you approach. You notice
that he is bleeding from a laceration on his
forearm and making gurgling sounds from
his airway.
continued
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Critical Thinking Critical Thinking
If you are alone, what factors do you
consider in deciding what to do first?
Why?
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Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
12.1 Define key terms introduced in this chapter. Slides
1315, 17, 2122, 26, 28, 30, 3233, 35, 44, 4748,
50, 55, 60
12.2 Identify the vital signs used in prehospital patient
assessment. Slide 13
12.3 Explain the use of vital signs in patient care decision
making. Slide 11
continued
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OBJECTIVES OBJECTIVES
12.4 Integrate assessment of vital signs into the patient
assessment process, according to the patients
condition and the situation. Slides 1314
12.5 Discuss the importance of documenting vital signs
and the times they were obtained in the patient care
record. Slides 31, 36, 59
continued
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OBJECTIVES OBJECTIVES
12.6 Demonstrate assessment of pulse, respirations,
skin, pupils, blood pressure, oxygen saturation, and
blood glucose. Slides 16, 2530, 36, 38, 4042, 44
46, 4856, 5965
12.7 Integrate assessment of mental status and ongoing
attention to the primary assessment while obtaining
vital signs. Slides 11, 14
continued
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OBJECTIVES OBJECTIVES
12.8 Differentiate between vital signs that are within
expected ranges for a given patient, and those that
are not. Slides 1820, 34, 3940, 4243, 46, 59,
61, 67
12.9 Discuss situations in which assessing body
temperature may be appropriate and acceptable
methods of measuring body temperature.
Slides 5859
continued
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OBJECTIVES OBJECTIVES
12.10 Compare and contrast the techniques of
assessment and expected vital sign values for
pediatric and adult patients. Slides 29, 41
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MULTIMEDIA MULTIMEDIA
Slide 69 Health and Physical Assessment: Vital Signs
Video
Slide 70 Blood Pressure Assessment Video
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CORE CONCEPTS
How to obtain vital signs, including pulse,
respirations, blood pressure, skin,
temperature, and pupils
How to document vital signs on a
prehospital care report
How to use various monitoring devices
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Topics Topics
Gathering the Vital Signs
Vital Signs
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Gathering the Vital Signs Gathering the Vital Signs
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Importance of Vital Signs Importance of Vital Signs
Outward signs of what is going on inside
the body
Identify important conditions or trends in
patient conditions
Gathered on virtually every EMS patient
Patient severity and treatment priorities
may prevent acquisition
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Vital Signs Vital Signs
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What Are Vital Signs? What Are Vital Signs?
Pulse
Respiration
Skin color, temperature, and condition
(plus capillary refill in infants and children)
Pupils
Blood pressure
continued
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What Are Vital Signs? What Are Vital Signs?
Baseline vital signs: first vital signs
obtained
Repeat vital signs: gain further information
by establishing trends
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Pulse Pulse
Palpable pressure of heart beating,
causing blood to move through arteries in
waves
continued
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Pulse Pulse
Can be felt by
placing fingertip
over artery where it
lies close to bodys
surface and
crosses over bone
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Pulse Rate Pulse Rate
Number of beats of heart per minute
Varies among individuals
continued
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Pulse Rate Pulse Rate
Normal rate for adult at rest is between 60
and 100 beats per minute
Rate above 100 beats per minute is rapid
Tachycardiarapid pulse
continued
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Pulse Rate Pulse Rate
Rate below 60 beats per minute is
considered slow
Bradycardiaslow pulse
continued
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Pulse Rate Pulse Rate
Above 120 beats or below 50 beats per
minute is considered a serious finding
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Think About It Think About It
What normal situations might account for a
heart rate outside the normal range?
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Pulse Quality Pulse Quality
Two factors determine pulse quality
Rhythm
Force
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Pulse Rhythm Pulse Rhythm
Reflects regularity
Regular when intervals between beats are
constant
Irregular when intervals are not constant
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Pulse Force Pulse Force
Pressure of pulse wave as it expands
artery
Pulse should feel strong
Threadywhen pulse feels weak and thin
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Common Pulse Locations Common Pulse Locations
Radial
Brachial
Carotid
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Radial Pulse Radial Pulse
Used in patients older than 1 year
Wrist pulse
continued
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Radial Pulse Radial Pulse
Found by placing
first three fingers
on thumb side of
patients wrist just
above the crease
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Brachial Pulse Brachial Pulse
Used in patients younger than 1 year
Upper arm pulse
continued
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Brachial Pulse
Found by placing three fingers on patients
anterior upper arm (between bicep and triceps
muscle) just distal to armpit
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Carotid Pulse Carotid Pulse
Felt along large carotid artery on either
side of the neck
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Assessing Pulse Assessing Pulse
Count pulsations for 30 seconds and
multiply by 2
If rate, rhythm, or force is not normal,
continue with count for full 60 seconds
Judge rhythm and force
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Respirations Respirations
With regard to vital signs, respiration
means the act of breathing in and out
Measurement includes both rate and
quality
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Respiratory Rate Respiratory Rate
Respiratory ratenumber of breaths the
patient takes in 1 minute
Rate of respiration is classified as normal,
rapid, or slow
continued
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Respiratory Rate Respiratory Rate
Normal rate for adult at rest: 1220
breaths per minute
Age, sex, size, physical conditioning, and
emotional state influence breathing rates
Rates above 24 breaths per minute (rapid)
or below 8 breaths per minute (slow) are
potentially serious findings
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Respiratory Quality Respiratory Quality
Four categories
Normal
Shallow
Labored
Noisy
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Assessing Respirations Assessing Respirations
Count respirations after assessing pulse
rate
Count number of breaths taken over 30
seconds and multiply by 2
Note rate, quality, and rhythm of
respiration
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Skin Skin
Color, temperature, and condition of skin
can provide valuable information regarding
circulation
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Skin Color Skin Color
Best places to assess skin color
Nail beds
Inside of cheek
Inside of lower eyelids
continued
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Skin Color Skin Color
Abnormal skin colors
Pale
Cyanotic (blue-gray)
Flushed (red)
Jaundiced (yellow)
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Skin Temperature Skin Temperature
Feel patients skin with back of hand
Note if skin feels normal (warm), hot,
cool, or cold
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Skin: Pediatric Note
For children under 6
years, also evaluate
capillary refill
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Evaluating Capillary Refill Evaluating Capillary Refill
Press on nail bed or top of hand or foot
and release
Observe how long it takes normal pink
color to return
Normalless than 2 seconds
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Pupils Pupils
Black center of eye
Dim environmentpupil will dilate
Bright environmentpupil will constrict
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Note baseline size
Cover one eye and shine a light
into other eye
Repeat with other eye
continued
Assessing Pupils Assessing Pupils
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Assessing Pupils Assessing Pupils
Look for
Size
Equality
Reactivity
continued
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Constricted pupils Dilated pupils
Unequal pupils
Assessing Pupils Assessing Pupils
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Blood Pressure Blood Pressure
Change is more significant than one
measurement
Normal pressure
Systolic no greater than 120 mmHg
Diastolic no greater than 80 mmHg
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Measuring Blood Pressure Measuring Blood Pressure
Measured with a sphygmomanometer and
stethoscope
Cuff should cover two thirds of upper arm
continued
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Measuring Blood Pressure Measuring Blood Pressure
Wrap cuff around patients upper arm
Lower edge of cuff placed about 1 inch
above crease of elbow
Center of bladder placed over brachial
artery
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Assessing Blood Assessing Blood
Pressure by Auscultation Pressure by Auscultation
Position cuff and stethoscope
Palpate brachial artery at crease of elbow
Position stethoscope
continued
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continued
Assessing Blood
Pressure by Auscultation
Place diaphragm of
stethoscope
directly over
brachial pulse or
medial anterior
elbow
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Assessing Blood Assessing Blood
Pressure by Auscultation Pressure by Auscultation
Inflate cuff
Listen and inflate until gauge reads 30 mm
higher than the point the pulse sound
disappeared
continued
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Assessing Blood Assessing Blood
Pressure by Auscultation Pressure by Auscultation
Obtain systolic pressure
Slowly release air from cuff
When you hear the first of these sounds, note
the reading on gauge
continued
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Assessing Blood Assessing Blood
Pressure by Auscultation Pressure by Auscultation
Obtain diastolic pressure
Continue to deflate cuff
When sounds turn to dull, muffled thuds, the
reading on the gauge is diastolic pressure
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Assessing Blood Pressure Assessing Blood Pressure
by Palpation by Palpation
Position cuff and
find radial pulse
Inflate cuff
continued
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Obtain and record
systolic pressure
Slowly deflate cuff
Note reading when
radial pulse returns
(systolic pressure)
Assessing Blood Pressure Assessing Blood Pressure
by Palpation by Palpation
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Pediatric Note: Pediatric Note:
Blood Pressure Blood Pressure
Difficult to obtain on infants and children
younger than 3 years
Use age/size-appropriate cuff
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Temperature Temperature
Narrow range of temperature allows
chemical reactions and other activities to
take place inside the body
Core temperature reflects level of heat
inside trunk
continued
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Temperature Temperature
Normal
temperature
depends on
Time of day
Activity level
Age
Where measured
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Oxygen Saturation
Measurement of proportion of
oxygen attached to hemoglobin
Measured with pulse oximeter
continued
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Oxygen Saturation Oxygen Saturation
Normal: 96%100%
Mild hypoxia: 91% 95%
Significant or moderate hypoxia: 86%
90%
Severe hypoxia: 85% or less
continued
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Oxygen Saturation Oxygen Saturation
Accuracy of reading can be affected by
Shock, hypothermia
Carbon monoxide, certain other uncommon
types of poisoning
Excessive movement, nail polish, anemia
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Blood Glucose Blood Glucose
Measures quantity of glucose in the
bloodstream
Can help identify some diabetic
emergencies
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Blood Glucose Monitor
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Blood Glucose Measurement Blood Glucose Measurement
Permission from medical direction or by
local protocol is required to perform blood
glucose monitoring using a blood glucose
meter
Monitors must be calibrated and stored
according to manufacturers
recommendations
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Acquiring Blood Acquiring Blood
Glucose Measurement Glucose Measurement
1. Prepare device, test strip, and lancet
2. Cleanse patients finger with alcohol
3. Perform finger stick with lancet
4. Wipe away first drop of blood
5. Apply blood to test strip
6. Use glucose meter to analyze sample
and provide reading
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Blood Glucose Levels Blood Glucose Levels
Normal level
Usually at least 6080 mg/dL
No more than 120 or 140 mg/dL
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Vital Signs: Pediatric Note Vital Signs: Pediatric Note
Age is one of the most important factors
determining normal range
Infants and children: faster pulse and
respiratory rates, and lower blood
pressures than adults
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Health and Physical Health and Physical
Assessment: Vital Signs Video Assessment: Vital Signs Video
Click here to view a video on the subject of assessing vital signs.
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Blood Pressure Blood Pressure
Assessment Video Assessment Video
Click here to view a video on the subject of assessing blood pressure.
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Can gain a great deal of information about
patients condition by taking complete set
of baseline vital signs, including pulse,
respirations, skin, pupils, and blood
pressure.
EMT must become familiar with normal
ranges for pulse, respirations, and blood
pressure in adults and children.
continued
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Chapter Review Chapter Review
Trends in patients condition will become
apparent only when vital signs are
repeated, an important step in continuing
assessment.
How often you repeat vital signs will
depend on patients condition: at least
every 15 minutes for stable patients and at
least every 5 minutes for unstable
patients.
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Remember Remember
Consider if there is time to obtain vital
signs or if you must wait to obtain them
en route to the hospital.
Consider when to apply a pulse oximeter.
Should you apply it to a patient with
difficulty breathing? Without difficulty
breathing?
continued
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Remember Remember
Consider whether abnormal vital signs are
a result of an illness or injury or the result
of some other factor.
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Questions to Consider Questions to Consider
Name the vital signs.
Explain why vital signs should be taken
more than once.
How much time should the EMT spend
looking for a pulse when the radial pulse is
absent or extremely weak?
continued
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Questions to Consider Questions to Consider
How should you react when the blood
pressure monitor gives a reading that is
extremely different from previous
readings?
How can you get an accurate pulse
oximeter reading on a patient with thick
artificial nails?
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Critical Thinking Critical Thinking
Sometimes a patients heart will have an
electrical problem and beat more than 200
times a minute. Why is the pulse so weak
in such a patient?
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www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
13.1 Define key terms introduced in this chapter. Slides
15, 26, 32, 3536, 39, 46
13.2 Differentiate between trauma patients with
significant mechanism of injury and those without a
significant mechanism of injury. Slides 14, 24, 3134
continued
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continued
OBJECTIVES OBJECTIVES
13.3 Conduct a systematic secondary assessment of the
trauma patient with no significant mechanism of
injury. Slides 1423
13.4 Select the appropriate physical examination for a
patient with no significant mechanism of injury.
Slides 1620
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OBJECTIVES OBJECTIVES
13.5 Recognize patients for whom manual stabilization of
the cervical spine and application of a cervical collar
are indicated. Slides 2730
13.6 Conduct a systematic secondary assessment of an
unstable or potentially unstable trauma patient, or
patient with a significant mechanism of injury. Slides
3141
continued
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OBJECTIVES OBJECTIVES
13.7 Explain the purpose of the rapid trauma
assessment. Slide 32
13.8 Recognize significant findings in the rapid trauma
assessment. Slides 3441
13.9 Recognize situations in which you should consider
requesting advanced life support personnel to assist
with the management of a trauma patient. Slide 41
continued
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OBJECTIVES OBJECTIVES
13.10 Incorporate a detailed physical examination of the
unstable or potentially unstable trauma patient at the
appropriate time for a given scenario. Slides 4647,
5051
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MULTIMEDIA MULTIMEDIA
Slide 44 Multiple System/Trauma: Paramedic Video
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CORE CONCEPTS
The difference between assessment
procedures for a trauma patient with no
significant mechanism or injury and for a
patient with a significant mechanism or
injury
continued
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CORE CONCEPTS
How to conduct a history of the present
illness for a trauma patient
How to perform a physical exam for a
trauma patient
continued
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CORE CONCEPTS
How to obtain a past medical history for a
trauma patient
How to perform a rapid trauma
assessment
When and how to perform a detailed
physical examination for a trauma patient
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Topics Topics
Secondary Assessment of the Trauma
Patient
Detailed Physical Exam
Comparing Assessments
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Secondary Assessment of the Secondary Assessment of the
Trauma Patient Trauma Patient
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Components of Components of
Secondary Assessment Secondary Assessment
Focused history gathering
Physical examination
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Patient with Patient with
No Significant MOI No Significant MOI
Assessment focused on areas patient
notes are painful or that MOI indicates
Chief complaint (why patient called EMS)
History of present illnessinformation on
how injury occurred
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Elements of Elements of
History of Present Illness History of Present Illness
Nature of force involved
Direction and strength of force
Protective equipment used by patient
Actions taken to prevent or minimize injury
Areas of pain and injuries resulting from
incident
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Physical Examination
Areas assessed depend on
injuries and chief complaint
Mechanism of injury may point
to potential injuries
Three techniques: inspection,
palpation, auscultation
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Physical Physical
Examination: Inspection Examination: Inspection
Look for
Abnormalities in symmetry
Color
Shape
Movement
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Physical Physical
Examination: Palpation Examination: Palpation
Feel for
Abnormalities in shape
Temperature
Texture
Sensation
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Physical Physical
Examination: Auscultation Examination: Auscultation
Listen for
Decreased or absent breath sounds
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Physical Physical
Examination: DCAP Examination: DCAP--BTLS BTLS
Deformities
Contusions
Abrasions
Punctures and penetrations
Burns
Tenderness
Lacerations
Swelling
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Punctures/Penetrations
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Swelling Swelling
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Secondary Assessment Secondary Assessment
No Significant MOI No Significant MOI
Obtain baseline vital signs
Obtain past medical history
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Baseline Vital Signs Baseline Vital Signs
Signsobjective
Things you see, hear, feel, smell during exam
Vital signs
Sweaty skin, staggering, vomiting
Symptomssubjective
Patient feels and tells you about
Chest pain, dizziness, nausea
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Past Medical History Past Medical History
SAMPLE
Signs and symptoms
Allergies
Medications
Pertinent past history
Last oral intake
Events leading to injury or illness
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Apply Cervical Collar Apply Cervical Collar
Apply if MOI, history, or signs and
symptoms indicate use
Make sure collar is correct size
continued
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Apply Cervical Collar Apply Cervical Collar
Assess patients neck prior to placing
collar
Reassure patient
Size collar
Remove jewelry and move hair
continued
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Apply Cervical Collar
Slide collar into
place from front continued
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Apply Cervical Collar Apply Cervical Collar
Collar alone does not provide adequate in-
line immobilization
Must be paired with manual stabilization or
fixation to long board
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Secondary Assessment:
Significant MOI
Continue manual stabilization
Request ALS
Complete head-to-toe rapid trauma
assessment instead of focused exam
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Rapid Trauma Assessment Rapid Trauma Assessment
Requires only a few moments
Should be performed at scene
Care provided en route will be based on
this assessment
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Components of Components of
Rapid Trauma Assessment Rapid Trauma Assessment
Head
Neck
Chest
Abdomen
Pelvis
Back
Extremities
Baseline vital signs
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General Principles General Principles
In all areas look for DCAP-BTLS or other
abnormal findings
Communicate with patient
Expose injured area before examining it
Assume spinal injury
Stop or alter assessment process to
provide care
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Head and Neck Head and Neck
In addition to DCAP-BTLS, look for
Cerebrospinal fluid in ears and nose
Unequal pupils
Jugular venous distention
Consider applying cervical collar
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Chest and Abdomen
In addition to DCAP-BTLS,
look for
Paradoxical motion
Crepitation
Equal breath sounds
Distention
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Assessing the Chest
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Assessing the Abdomen
Palpate all four quadrants
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Pelvis and Extremities Pelvis and Extremities
In addition to DCAP-BTLS, look for
Priapism
Distal circulation, sensation, and motor
function
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Assess Distal Circulation, Assess Distal Circulation,
Sensation, Motor Function Sensation, Motor Function
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Posterior/Back
Roll patient to assess back
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Think About It Think About It
What criteria would you use to decide
whether to perform a focused exam or a
rapid trauma exam?
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Trauma Assessment: Trauma Assessment:
Pediatric Note Pediatric Note
Lesser mechanisms can cause significant
damage
Need to explain assessments more
thoroughly in this population
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Multiple System/ Multiple System/
Trauma: Paramedic Video Trauma: Paramedic Video
Click here to view a video on the subject of managing treatment of a
trauma patient.
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Detailed Physical Exam Detailed Physical Exam
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Detailed Physical Exam Detailed Physical Exam
Typically completed en route to hospital
Gathers additional information
Complements primary and secondary
assessments
Performed after all critical interventions
completed
Primary assessment re-evaluated again
before initiating
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Performing Performing
Detailed Physical Exam Detailed Physical Exam
Expose patient
Work around immobilization equipment
Components similar to rapid trauma exam
More detail and focus
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Think About It Think About It
Is it necessary to always complete a
detailed assessment on a trauma patient
with no significant mechanism or injury?
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Comparing Assessments Comparing Assessments
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Responsive Child: Responsive Child:
No Significant MOI No Significant MOI
Chief complaint
Physical exam
Baseline vital signs
History
Detailed physical exam and further care
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Unresponsive Adult: Unresponsive Adult:
Significant MOI Significant MOI
History of present illness
Manual stabilization of head and neck
ALS request
Rapid trauma assessment
Baseline vital signs
Past medical history
Detailed physical exam
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Chapter Review Chapter Review
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Chapter Review Chapter Review
The patient without significant MOI
receives history of present illness and
physical exam focused on areas patient
complains about and areas you think may
be injured based on MOI.
Gather a set of baseline vital signs and a
past medical history.
continued
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Chapter Review Chapter Review
For patient with significant injury or MOI,
ensure continued manual stabilization of
the head and neck, consider whether to
call ALS (if available), get a brief history of
the present illness, and then perform a
rapid trauma assessment.
continued
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Chapter Review Chapter Review
Look for wounds, tenderness, deformities,
plus additional signs appropriate to part
being assessed.
Systematically examine head, neck, chest,
abdomen, pelvis, extremities, posterior
body.
After assessing neck, apply cervical collar.
continued
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Chapter Review Chapter Review
After completing physical assessment,
immobilize patient to spine board and get
baseline set of vital signs and past medical
history.
After performing appropriate critical
interventions and transport has begun,
patient may receive detailed physical
exam en route to hospital.
continued
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Chapter Review Chapter Review
Detailed physical exam is very similar to
the rapid trauma assessment, but there is
time to be more thorough.
Detailed physical exam does not take
place before transport unless transport is
delayed.
continued
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Chapter Review Chapter Review
Detailed physical exam is most
appropriate for trauma patient who is
unresponsive or has significant injury or
unknown MOI.
Responsive trauma patient with no
significant injury or MOI will seldom
require detailed physical exam.
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Remember Remember
Use MOI to determine the need for a rapid
trauma assessment.
Assume spinal injury.
Work as a team to complete the
assessment.
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Questions to Consider Questions to Consider
How do the focused history and physical
exam of a trauma patient with a significant
MOI differ from those for a trauma patient
with no significant MOI?
continued
6/28/2011
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Questions to Consider Questions to Consider
List the steps and areas covered in the
rapid trauma assessment. How are these
steps different in the detailed assessment?
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Critical Thinking Critical Thinking
You are assessing a patient who fell three
stories. He is unresponsive and bleeding
into his airway. The driver of the
ambulance is positioning the vehicle and
bringing equipment to you.
continued
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Critical Thinking Critical Thinking
How do you balance the patients need for
airway control (he requires frequent
suctioning) with the need to assess his
injuries?
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
14.1 Define key terms introduced in this chapter. Slides
1112, 15
14.2 Adapt the secondary assessment process to both
responsive and unresponsive medical patients.
Slides 1120, 2226, 3031
14.3 Collect a systematic history of the present illness.
Slides 1315
14.4 Collect a relevant past medical history. Slides 1617
continued
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OBJECTIVES OBJECTIVES
14.5 Adapt the secondary assessment process to
specific patient complaints. Slides 1317
14.6 Adapt your approach to secondary assessment of
the medical patient to overcome challenges,
according to the circumstances. Slides 1317
14.7 Conduct a rapid physical examination for the
unresponsive medical patient. Slides 2324
continued
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OBJECTIVES OBJECTIVES
14.8 Explain the importance of checking baseline vital
signs in the unresponsive medical patient.
Slides 24, 31
14.9 Recognize situations in which you should consider
requesting the assistance of advance life support
personnel for a medical patient. Slide 25
continued
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OBJECTIVES OBJECTIVES
14.10 Identify other sources of patient information for the
unresponsive or uncooperative medical patient.
Slides 22, 2627
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MULTIMEDIA MULTIMEDIA
Slide 28 Physical Examination Techniques; Inspection,
Palpation, Auscultation, and Percussion Video
Slide 32 EMS Initial Patient Assessment: Paramedic
Video
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CORE CONCEPTS
The difference between assessment
procedures for a responsive medical
patient and for an unresponsive medical
patient
How to perform a secondary assessment
for a responsive medical patient
continued continued
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CORE CONCEPTS
How to tailor the physical exam for a
responsive medical patient using a body
systems approach
How to perform a secondary assessment
for an unresponsive medical patient
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Topics Topics
Secondary Assessment of the Medical
Patient
Comparing Assessments
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Secondary Assessment of the Secondary Assessment of the
Medical Patient Medical Patient
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Responsive vs. Responsive vs.
Unresponsive Patient Unresponsive Patient
Assessment varies depending on patients
ability to communicate
Responsive medical patient: focus on chief
complaint
Unresponsive medical patient: focus on
physical findings
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Secondary Assessment Secondary Assessment
of Responsive Medical Patient of Responsive Medical Patient
History of present illness
Past medical history
Focused physical exam
Baseline vital signs
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History of Present Illness
Obtain from patient
Obtain from family or bystanders
Ask open-ended questions
continued
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History of Present Illness History of Present Illness
Chief complaint
Why patient activated EMS
What is bothering patient most
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History of History of
Present Illness Present IllnessOPQRST OPQRST
Onset: What were you doing when it
started?
Provokes: What makes pain worse?
Quality: Describe pain.
Radiation: Where is pain? Does it seem to
spread?
Severity: How bad is pain? (110 scale)
Time: When did pain start?
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Past Medical History
Symptoms
Allergies
Medications
Pertinent past history
Last oral intake
Events leading to illness
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Tailoring Past History Tailoring Past History
Important information can be gained by
tailoring history to patients chief complaint
Ask questions pertinent to complaint
Body systems approach: focus
questioning and examination on particular
body system most likely involved
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Pediatric Note Pediatric Note
Gathering History Gathering History
Get on same level with child
Put questions in simple language
Gather information from caregivers
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Perform Focused
Physical Exam
Usually brief
Examine areas of concern
based on chief complaint
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Obtain Baseline Vital
Signs
Essential to assessment of
medical patient
Later assessments of vital signs
will be compared to baseline
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Think About It Think About It
Where would you focus your physical
examination on a patient complaining of
shortness of breath?
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Secondary Assessment of Secondary Assessment of
Unresponsive Medical Patient Unresponsive Medical Patient
Inability to communicate shifts initial focus
from chief complaint and history taking
Begin with physical exam and baseline vital
signs
Gather history from bystanders or family
members
Do rapid assessment of entire body
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Rapid Physical Exam Rapid Physical Exam
Similar to physical exam for trauma patient
Assess head, neck, chest, abdomen,
pelvis, extremities, and posterior
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Important Physical Findings Important Physical Findings
Neck: JVD, medical identification devices
Chest: breath sounds
Abdomen: distention, firmness or rigidity
Pelvis: incontinence of urine or feces
Extremities: pulse, motor function,
sensation, oxygen saturation, medical
identification devices
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Determine if ALS Required Determine if ALS Required
Obtain baseline vital signs
Consider a request for ALS personnel
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History of Present History of Present
Illness and Past Medical History Illness and Past Medical History
Question bystanders
What is patients name?
What happened?
Did you see anything else?
Did patient complain before this happened?
Does patient have any illnesses or problems?
Is patient taking medications?
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Think About It Think About It
What other
mechanisms might
you have to obtain
patient history
other than
speaking to
bystanders?
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Physical Examination Physical Examination
Techniques Video Techniques Video
Click here to view a video on the subject of physical
examination techniques.
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Comparing Assessments Comparing Assessments
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Responsive Adult Responsive Adult
Medical Patient Medical Patient
Primary assessment
Patient alert; no life-threatening problems
Secondary assessment
History of present illness
Past medical history and physical exam
Vital signs
Transport
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Unresponsive Unresponsive
Adult Medical Patient Adult Medical Patient
Primary assessment
Patient not alert; ABCs compromised
Rapid physical exam
Vital signs
Past medical history from family
Transport
Prepared for more detailed exam en route
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EMS Initial Patient EMS Initial Patient
Assessment: Paramedic Video Assessment: Paramedic Video
Click here to view a video on the subject of information gathered from
patient assessment.
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Chapter Review Chapter Review
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Chapter Review Chapter Review
The history and physical exam of the
medical patient takes two forms,
depending on whether the patient is
responsive.
continued
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continued
Chapter Review Chapter Review
You assess the responsive patient by
getting a history of the present illness and
a past medical history, then performing a
physical exam of affected parts of the
body before getting baseline vital signs.
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Chapter Review Chapter Review
Since unresponsive medical patients
cannot communicate, it is appropriate to
start the assessment with a rapid physical
exam. Baseline vital signs come next, and
then you interview bystanders, family, and
friends to get any history that can be
obtained.
continued
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Chapter Review Chapter Review
You may not change any field treatment as
a result of the information gathered here,
but the results of the assessment may be
very important to the emergency
department staff.
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Remember Remember
Determine if the patient is responsive
enough to provide a history.
If a patient cannot provide a history, can
someone present at the scene do so?
continued
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Remember Remember
Consider what kind of history and physical
exam the patients chief complaint
suggests.
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Questions to Consider Questions to Consider
Explain how and why the history and
physical exam for a medical patient differs
from the history and physical exam for a
trauma patient.
continued
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Questions to Consider Questions to Consider
Explain how and why the history and
physical exam for a responsive medical
patient differs from the history and
physical exam for an unresponsive
medical patient.
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Critical Thinking Critical Thinking
You are trying to get information from the
very upset son of an unresponsive man.
He is the only available family member. He
is so upset that he is having difficulty
talking to you.
continued
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Critical Thinking Critical Thinking
How can you quickly get him to calm down
and give you his fathers medical history?
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
15.1 Define key terms introduced in this chapter.
Slides 9, 20
15.2 Explain the importance of reassessment.
Slides 910
15.3 Identify the proper points in the patient care process
at which reassessment should be performed. Slides
2122
continued
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OBJECTIVES OBJECTIVES
15.4 Discuss the purpose of each of the components of
reassessment. Slides 1213, 15, 17, 19
15.5 Adapt the reassessment process and frequency of
reassessment based on patients conditions. Slides
1922
continued
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OBJECTIVES OBJECTIVES
15.6 Recognize both obvious and subtle changes in
patient condition. Slides 1922
15.7 Assign meaning to trends in patient condition over
time. Slides 1920
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MULTIMEDIA MULTIMEDIA
Slide 23 Ongoing Assessment Video
Slide 27 Detailed Assessment Video
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CORE CONCEPTS
How to perform reassessment
The significance of changes in vital signs
over time
The difference in reassessments for stable
versus unstable patients
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Topics Topics
Reassessment
Comparing Assessments
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Reassessment Reassessment
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Reassessment Reassessment
Continues on initial steps of assessment
Identifies changes and trends
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What Reassessment What Reassessment
Identifies Identifies
Changes (subtle and profound)
Trends
Deterioration
Improvement
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Communicate with Patient Communicate with Patient
Explain process
Consider patients feelings, such as
anxiety or embarrassment
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Repeat Primary Assessment Repeat Primary Assessment
Recheck for life-threatening problems
Reassess mental status
Maintain open airway
Monitor breathing (rate and quality)
Reassess pulse (rate and quality)
Monitor skin color and temperature
Re-establish patient priorities
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Reassess Vital Signs Reassess Vital Signs
Compare results with baseline
measurements
Re-evaluate oxygen
Document findings to record and identify
trends
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Think About It Think About It
Think of an example of a problem that
might develop into a life threat to the
patient on the way to the hospital.
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Repeat Focused Assessment Repeat Focused Assessment
Chief complaint may change, especially
with regard to severity
Ask about changes in symptoms,
especially ones anticipated because of
treatments administered
Repeat physical exam to identify changes
from baseline
Check any interventions
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Repeat Focused Assessment Repeat Physical Exam
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Check Interventions Check Interventions
Ensure adequacy of
oxygen delivery and
artificial ventilation
Ensure management
of bleeding
Ensure adequacy of
other interventions
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Think About It Think About It
Describe an example of an intervention
that might need to be reevaluated and
discuss your process for examining it.
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Observing Trends
Repeat reassessment steps frequently
Establish and document trends
continued
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Observing Trends
Trending: observing patterns that have
emerged among vital signs
Trends may indicate new treatments or
adjustments to ongoing treatments.
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Reassessment for Reassessment for
Stable and Unstable Patients Stable and Unstable Patients
Patient condition, as well as length of time
with patient, will determine how often you
reassess
The more serious patients condition, the
more often you reassess
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When to Reassess When to Reassess
Every 15 minutes for stable patient
Every 5 minutes for unstable or potentially
unstable patient
If you believe there may have been a
change in patients condition, repeat at
least primary assessment
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Ongoing Assessment Video Ongoing Assessment Video
Click here to view a video on the subject of managing
ongoing assessment.
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Comparing Assessments Comparing Assessments
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Reassessment: Reassessment:
Stable Medical Patient Stable Medical Patient
Repeat primary assessment
Repeat and record vital signs
Repeat pertinent parts of history and
physical exam
Check interventions you performed
Repeat all steps every 15 minutes
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Reassessment: Reassessment:
Unstable Trauma Patient Unstable Trauma Patient
Repeat primary assessment to check for
life-threatening problems
Repeat and record vital signs
Repeat trauma assessment
Check interventions you performed
Repeat all steps every 5 minutes
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Detailed Assessment Video Detailed Assessment Video
Click here to view a video on the subject of a detailed exam
of a patient.
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Reassessment is the last step in your
assessment of a patient.
You should reassess a stable patient at
least every 15 minutes and an unstable
patient at least every 5 minutes.
continued
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Chapter Review Chapter Review
Elements of reassessment include the
primary assessment, vital signs, pertinent
parts of the history and physical exam,
and checking the interventions you
performed for the patient.
Interventions you need to check include
oxygen, bleeding, spine immobilization,
and splints.
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Remember Remember
Assess if the patients condition changed
in any way, indicating the need for new
interventions. Is the airway clear? Is
breathing adequate? Is circulation intact?
Check the interventions you performed.
Are they functioning as they should?
Adjust interventions if necessary.
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Questions to Consider Questions to Consider
Name the four steps of reassessment and
list what assessments you will make
during each step.
Explain the value of recording, or
documenting, your assessment findings,
and explain the meaning of the term
trending.
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Critical Thinking Critical Thinking
What must you do if your reassessment
turns up one of these findings?
Gurgling respirations
Bag on nonrebreather mask collapses
completely when patient inhales
Snoring respirations
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
16.1 Define key terms introduced in this chapter. Slides
1416
16.2 Compare and contrast EMTs and physicians
diagnoses. Slides 1216
16.3 Explain the relationship between critical thinking and
diagnosis. Slide 9
16.4 Explain typical steps used in the basic approach to
reaching diagnoses. Slide 13
continued
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OBJECTIVES OBJECTIVES
16.5 Explain how diagnosis in emergency situations may
differ from traditional approaches to diagnosis.
Slides 1416
16.6 Identify some of the special challenges to EMS
providers in the diagnostic process. Slides 1415
16.7 Discuss the relationship between diagnosis and
treatment in emergency situations. Slide 18
continued
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OBJECTIVES OBJECTIVES
16.8 Discuss the benefits and pitfalls of diagnostic
shortcuts (heuristics). Slide 18
16.9 Identify heuristics commonly used by highly
experienced physicians. Slide 18
16.10 Describe ways in which EMTs can improve their
critical thinking processes. Slides 2123
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MULTIMEDIA MULTIMEDIA
Slide 10 Obstacles to Problem Solving Video
Slide 19 Decision-Making Information Video
Slide 25 Leadership Video
Slide 26 Delegating Authority Video
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CORE CONCEPTS
What an EMT diagnosis is
The role of critical thinking in EMS
How you as an EMT can improve your
critical thinking skills
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Topics Topics
EMT Diagnosis and Critical Thinking
How a Clinician Reaches a Diagnosis
How an EMT Can Learn to Think Like an
Experienced Physician
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EMT Diagnosis and Critical EMT Diagnosis and Critical
Thinking Thinking
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EMT Diagnosis EMT Diagnosis
and Critical Thinking and Critical Thinking
Diagnosis is label for
condition
Based on history,
physical examination,
vital signs
Involves both physical
and intellectual
activity
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Obstacles to Obstacles to
Problem Solving Video Problem Solving Video
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How a Clinician Reaches a How a Clinician Reaches a
Diagnosis Diagnosis
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How a Clinician How a Clinician
Reaches a Diagnosis Reaches a Diagnosis
Clinicians have different levels of training,
experience, time, resources
Techniques vary among types of clinicians
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Traditional Traditional
Approach to Diagnosis Approach to Diagnosis
Assess patient
List of conditions or
diagnoses
Differential diagnosis
Further evaluation
Reevaluate the
differential
Final diagnosis
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Emergency Medicine Emergency Medicine
Approach to Diagnosis Approach to Diagnosis
Quickly rule out and treat immediate life
threats
Stabilize patient
Return to gather additional information
Focus on ruling out worst-case scenario
Red flags suggest problem serious
May be responsible for multiple patients
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EMS Approach to Diagnosis EMS Approach to Diagnosis
Must be very efficient
Be available for another call as soon as
possible
Work in uncontrolled environment
Limited tools and skill set
Narrow educational focus
continued
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EMS Approach to Diagnosis EMS Approach to Diagnosis
Follows same steps as emergency
physician
Most are abbreviated or limited
Considers most serious conditions
associated with patient
Rules them in or out
Creates a differential
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Think About It Think About It
You can reach a diagnosis, but your work
is not done. Why?
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The Experienced Clinician The Experienced Clinician
Experienced clinicians learn heuristics
(shortcuts)
Pattern recognition
Features narrowing possibilities
Allows efficient diagnosis and prompt
treatment
Realizes limitations of shortcuts
Understands common biases of heuristics
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Decision Decision--Making Making
Information Video Information Video
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How an EMT Can Learn to How an EMT Can Learn to
Think Like an Experienced Think Like an Experienced
Physician Physician
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Thinking Like an Thinking Like an
Experienced Physician Experienced Physician
Love ambiguity
Uncertainty natural part of EMS
Understand limitations
Peoples limitations
Technologys limitations
continued
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Emergency Care, Twelfth Edition
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continued
Thinking Like an Thinking Like an
Experienced Physician Experienced Physician
Utilize different methods
No one single way always right
Remain open-minded and flexible
Learn from others
Form strong foundation of knowledge
Be familiar with conditions
Remain up-to-date
Continue learning
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Thinking Like Thinking Like
an Experienced Physician an Experienced Physician
Be organized
Be a lifelong
student
Reflect on what
you have learned
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Think About It Think About It
What are some of the important things to
remember as you learn how to make a
diagnosis and improve your critical
thinking skills in EMS?
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Leadership Video Leadership Video
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Delegating Authority Video Delegating Authority Video
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Chapter Review Chapter Review
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Chapter Review Chapter Review
EMTs make some diagnoses in the field,
although they are not as extensive or
detailed as physicians diagnoses.
continued
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Chapter Review Chapter Review
The traditional approach to reaching a
diagnosis is to assess the patient, draw up
a list of differential diagnoses, assess
further to rule in or rule out different
conditions, and narrow the list until you
reach a conclusion.
continued
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Chapter Review Chapter Review
Highly experienced physicians dont
always use the traditional approach. They
use heuristics and their experience and
training to speed up the process of
reaching a diagnosis.
Heuristics has limitations.
continued
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Chapter Review Chapter Review
Learn to think more critically by accepting
ambiguity, understanding limitations of
people and technology, forming a strong
foundation of knowledge, and organizing
data in your mind.
When considering the cause of a patients
condition, dont let your search for a cause
delay your treatment of the patient.
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Remember Remember
Critical thinking an analytical process.
Organized and efficient way to solve problem.
Reflective, reasonable, focused thinking.
EMT must be efficient, yet accurate.
Patients often have more than one thing
wrong.
Do not stop looking.
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Questions to Consider Questions to Consider
What is a differential diagnosis based on?
What is an emergency physicians first
priority when formulating a differential?
How are heuristics helpful in critical
thinking?
How can we as providers enhance our
critical thinking and diagnostic skills?
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Critical Thinking Critical Thinking
A 52-year-old man complains of chest pain
while sitting at his desk at work. He
appears alert and oriented. He tells you he
thinks it may just be stress. How would
you arrive at a diagnosis?
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
17.1 Define key terms introduced in this chapter. Slides
1315, 3031
17.2 Describe the role of communication technology in
EMS systems. Slide 13
17.3 Describe various types of communication devices
and equipment used in EMS system
communication. Slides 1415
continued
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OBJECTIVES OBJECTIVES
17.4 Explain the role of the Federal Communications
Commission as it relates to EMS system
communication. Slide 16
17.5 Discuss how to communicate effectively by radio
with dispatch and hospital personnel. Slides 1722
continued
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OBJECTIVES OBJECTIVES
17.6 Provide a thorough, organized, concise report of
pertinent patient information when giving a radio
report or requesting orders. Slides 2527
17.7 Explain the importance of asking for information to
be repeated for confirmation and clarification.
Slide 28
continued
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OBJECTIVES OBJECTIVES
17.8 Deliver an organized, complete, and concise report
of pertinent patient information when giving a verbal
report to receiving hospital personnel. Slides 3031
17.9 Demonstrate principles and techniques of effective
verbal and nonverbal interpersonal communication.
Slides 3638
continued
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OBJECTIVES OBJECTIVES
17.10 Adapt communication principles for effective
interaction with patients of various ages and
cultures. Slide 39
17.11 Complete a prehospital care report in the format or
formats required by your service. Slides 4253
17.12 Understand legal issues and special situations
associated with documentation. Slides 5657,
6061
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MULTIMEDIA MULTIMEDIA
Slide 32 Effective Communication Video
Slide 40 Alternate Methods of Communication With
Children Video
Slide 54 Understanding Cultural Perspectives Video
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CORE CONCEPTS
Radio procedures used at various stages
of the EMS call
Delivery and format of a radio report to the
hospital
Delivery and format of a verbal hand-off
report to the hospital
continued
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CORE CONCEPTS
Communication skills used when
interacting with other members of the
health care team
Communication skills used when
interacting with the patient
Components and procedures for the
written prehospital care report
continued
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CORE CONCEPTS
Legal aspects and benefits of
documentation
Documentation concerns in patient refusal
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Topics Topics
Communication Systems and Radio
Communication
The Verbal Report
Interpersonal Communication
Prehospital Care Report
Special Documentation Issues
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Communication Systems and Communication Systems and
Radio Communication Radio Communication
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Communication Systems Communication Systems
EMS uses various communication
systems:
Radios
One-way pagers
Cell phones
Traditional telephones (landlines)
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Radio Systems Radio Systems
EMS radio systems consist of:
Base station
Mobile radios
Portable radios
Repeaters
Microwave transmissions
Digital radio signals
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Repeaters Repeaters
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Radio Radio
Communication Regulation Communication Regulation
Regulated by the Federal Communications
Commission (FCC)
Assign and license designated radio
frequencies
Establish rules regarding appropriate
language
Monitor radio traffic
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Principles of Principles of
Radio Communication Radio Communication
Radio on and volume adjusted properly
Reduce background noise
Ensure frequency is clear before starting
Press PTT (press to talk) button on radio;
wait 1 second before speaking
continued
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Principles of Principles of
Radio Communication Radio Communication
Lips about 23 inches from microphone
Use unit names or numbers
Call units attention first; wait for go
ahead
Unit may say stand by until ready
continued
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Principles of Principles of
Radio Communication Radio Communication
Speak slowly and clearly
Keep it brief
Use plain English, avoid codes
Avoid unnecessary words (be advised or
please)
continued
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Principles of Principles of
Radio Communication Radio Communication
If number might be unclear, say number
and repeat individual digits
Never use patients name over radio
Never use profanities or slander
Use objective, impartial statements
continued
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Principles of Principles of
Radio Communication Radio Communication
Use we instead of I
Affirmative and negative preferred over
yes and no
Give assessment information about
patient; avoid offering diagnosis
continued
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Principles of Principles of
Radio Communication Radio Communication
After transmitting, say Over
Avoid slang or unauthorized abbreviations
Use EMS frequencies for authorized EMS
communication only
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Other Radio Procedures Other Radio Procedures
If two units transmit simultaneously, only
one will be heard by listeners
Dispatch often confirms receipt of
transmission by repeating part of it back
Dispatch may end transmission with time
for documentation
continued
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Other Radio Procedures Other Radio Procedures
Carry portable radio whenever you leave
unit
Radios need proper care and maintenance
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Medical Radio Reports Medical Radio Reports
Report must be given to destination
hospital so it can prepare for arrival
Usually done by radio
Structured to present
only most important
information
Speak clearly and slowly
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Parts of Medical Report Parts of Medical Report
1. Unit identification and level of provider
2. Estimated time of arrival (ETA)
3. Patients age and sex
4. Chief complaint
5. Brief, pertinent history of present
illness/injury
6. Major past illnesses
continued
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Parts of Medical Report Parts of Medical Report
6. Mental status
7. Baseline vital signs
8. Pertinent findings of physical exam
9. Emergency care given
10.Response to medical care
11.Medical direction if required, or if
questions
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Communicating Communicating
With Medical Control With Medical Control
Give information clearly and accurately
After receiving order or denial for
medication or procedure, repeat back
word for word
If order unclear, ask physician to repeat
If order seems inappropriate, question
physician
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The Verbal Report The Verbal Report
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Detailed Verbal Report Detailed Verbal Report
Given upon arrival at destination
Introduce patient by name
Give complete and detailed report
continued
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Detailed Verbal Report Detailed Verbal Report
Elements of report
Chief complaint
History of present illness/injury
Assessment findings, including pertinent
negatives
Treatment given and response
Complete vital signs
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Effective Communication Video Effective Communication Video
Click here to view a video on the subject of effective communication.
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Interpersonal Communication Interpersonal Communication
6/28/2011
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Team Communication Team Communication
EMT must communicate with others
involved in patients care
First responders
Advanced EMTs, paramedics
Home healthcare aides, family
Speak candidly and respectfully
Collect information about patient
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Therapeutic Communication Therapeutic Communication
Communication techniques learned by
experience
May be more difficult with those in crisis
Everyone can improve communication skills
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Communication Techniques Communication Techniques
Use eye contact
Shows interest, comfort, and respect
Be aware of position and body language
Face patient at eye level, arms down
continued
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Communication Techniques Communication Techniques
Use appropriate language
Ensure patient understands
Be honest
Dishonesty ruins confidence and rapport
continued
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Communication Techniques Communication Techniques
Use patients proper name
Sign of respect, especially with older patients
Listen
Important to establish trust
continued
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Communication Techniques Communication Techniques
Special considerations
Always be compassionate and respectful
Mentally disabled
Visual or hearing impaired
Language barriers
Pediatric patients
Come down to their level
Be truthful
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Alternate Methods of Alternate Methods of
Communication With Children Video Communication With Children Video
Click here to view a video on the subject of communicating
with children.
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Prehospital Care Report Prehospital Care Report
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Prehospital Prehospital
Care Report (PCR) Care Report (PCR)
Written documentation of everything that
happened during call
Several forms
Handwritten
Laptop
Electronic tablet
Web based
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Functions of PCR Functions of PCR
Patient care record
Documents findings and treatment
Conveys picture of scene
Entered into patients permanent medical
record
continued
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Functions of PCR Functions of PCR
Legal document
Can be subpoenaed and used as evidence
May help patient win a case
May be used against you in case of
negligence
continued
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Functions of PCR Functions of PCR
Administrative
Demographic information
Insurance information
Billing address
continued
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Functions of PCR Functions of PCR
Education and research
Clinical research
Statistics
Continuing education
Tracking EMTs personal experience
continued
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Functions of PCR Functions of PCR
Quality improvement
Routine call review
Ensures compliance to standards
Can reveal providers deserving special
recognition
Can reveal opportunities for improvement
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continued
Elements of PCR Elements of PCR
Run data
Agency name, date, times, call number,
unit personnel, certification levels, other
information mandated by service
Use official time given by dispatch so all
times in report match
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continued
Elements of PCR Elements of PCR
Patient information
Name, address, phone number
Gender, age, date of birth
Weight
Race and/or ethnicity
Billing and insurance information
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Elements of PCR Elements of PCR
Information gathered during call
General impression of patient
Narrative summary of call
Patient history and treatment as required
by service
Transport information
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Elements of Elements of
Narrative Summary Narrative Summary
Objective information
Observable, measurable, verifiable
Subjective information
Subject to interpretation or opinion (often
reported by patient)
continued
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Elements of Elements of
Narrative Summary Narrative Summary
Chief complaint
Primary complaint, as stated by patient
Best recorded as a direct quote
Pertinent negatives
Important negative findings
continued
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Elements of Elements of
Narrative Summary Narrative Summary
Plain English and approved abbreviations
Avoid codes and unofficial abbreviations
Legible; correct spelling and grammar
Information must be read easily and
accurately
PCR is a reflection of your care
Appropriate medical terminology
If it happened, record it
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Understanding Understanding
Cultural Perspectives Video Cultural Perspectives Video
Click here to view a video on the subject of sensitivity to
cultural diversity.
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Special Documentation Issues Special Documentation Issues
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Documentation Issues Documentation Issues
Confidentiality
Covered by HIPAA
Accountability and security
Refusals
High liability
Document all details in a refusal of care form
continued
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Documentation Issues Documentation Issues
Falsification
Covering up errors
Recording something you forgot to do
Correction of errors
Mistakes in documentation
Additions
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Think About It Think About It
You respond to a call for an unconscious
male. Upon arrival the patient is awake,
alert, and walking away. He states he was
just sleeping, and does not need or want
treatment or transport.
continued
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Think About It Think About It
Is this a patient?
Is a complete assessment and physical
exam needed?
How will you document this call?
Should you obtain a formal patient
refusal?
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Special Situation Reports Special Situation Reports
Multiple casualty incidents
Logistical problem for EMS
Many patients
Care and evaluation by several providers at
different times and locations
continued
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Special Situation Reports Special Situation Reports
Provider exposures
Provider injuries
Hazardous or unsafe scenes
Referrals to social service agencies
Reports of abuse
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Radio report should include unit ID and
provider level; ETA; patients age and sex;
chief complaint; pertinent HPI; major past
illnesses; mental status; baseline vital
signs; physical exam findings; emergency
care given and response; request to
contact medical direction.
continued
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continued
Chapter Review Chapter Review
PCR should include patients name,
address, date of birth, age, and sex; billing
and insurance information; nature of call;
MOI; location patient was found; treatment
given before EMT arrival.
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Chapter Review Chapter Review
PCR may be a legal document in a court
proceeding.
Data from PCRs may help determine
future treatments, trends, research, and
quality improvement.
continued
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Chapter Review Chapter Review
Your report should paint a picture of your
patient and their condition, accurately
describing your contact with the patient
throughout the call.
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continued
Remember Remember
Emergency medical communication
comes in many forms and is essential to
team-based patient care.
The medical radio report is structured to
present pertinent facts about the patient
without providing more detail than
necessary.
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Remember Remember
A proper verbal report will include the chief
complaint, any history that was not given
previously, additional treatment given, and
additional vital signs taken en route.
continued
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Remember Remember
Interpersonal communication is often
challenging in EMS. Adopting best
practices can improve communication
capabilities significantly.
Confidentiality, patient refusals, and
falsification of records are all-important
legal concepts that an EMT must consider
when documenting a call.
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Questions to Consider Questions to Consider
How can you improve your interpersonal
communication with patients and team
members?
What is objective and subjective
information in the narrative portion of the
PCR?
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Critical Thinking Critical Thinking
Organize this random information, and
present a radio report to the hospital.
Chest pain radiating to shoulder
56 years old
Oxygen applied at 15 L/minute via
nonrebreather
Alert and oriented
Female
continued
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Critical Thinking Critical Thinking
Came on 20 minutes ago while mowing lawn
History of high blood pressure and diabetes
Pulse 86, respirations 22, skin cool and moist,
blood pressure 110/66, SpO
2
96%
Oxygen relieved pain slightly
Denies difficulty breathing
Requesting orders from medical direction
You are on Community BLS Ambulance 4
continued
6/28/2011
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Critical Thinking Critical Thinking
Lung sounds equal on both sides
Placed in a position of comfort
ETA20 minutes
continued
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Critical Thinking Critical Thinking
Write a narrative report for the same call.
Will you use different information?
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Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
18.1 Define key terms introduced in this chapter. Slides
1320, 26, 34
18.2 List the drugs in your scope of practice. Slides
1322
continued
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continued
OBJECTIVES OBJECTIVES
18.3 For each medication you may administer or assist a
patient in self-administering, describe the following:
generic and common trade names; indication(s);
contraindications; side effects and untoward effects;
form(s); route(s) of administration. Slides 2526,
3233
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OBJECTIVES OBJECTIVES
18.4 Follow principles of medication administration
safety, including the five rights of medication
administration. Slides 2730
18.5 Discuss the importance of looking up medications
and requesting information from medical direction
when needed. Slides 2628, 37
continued
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OBJECTIVES OBJECTIVES
18.6 Identify the type of medical direction (on-line or off-
line) required to administer each medication in the
scope of practice. Slide 28
18.7 Describe the characteristics of the oral, sublingual,
inhaled, intravenous, intramuscular, subcutaneous,
and endotracheal routes of administration. Slides
3233
continued
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OBJECTIVES OBJECTIVES
18.8 Identify special considerations in medication
administration related to patients ages and weights.
Slide 34
18.9 Explain the importance of accurate documentation
of drug administration and patient reassessment
following drug administration. Slide 35
continued
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OBJECTIVES OBJECTIVES
18.10 Discuss the importance of having readily available
references to identify drugs commonly taken by
patients. Slide 37
18.11 Discuss the steps an EMT may take in assisting with
IV therapy. Slides 4149
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MULTIMEDIA MULTIMEDIA
Slide 23 Oral Glucose Administration Video
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CORE CONCEPTS
Which medications may be carried by the
EMT
Which medications the EMT may help
administer to patients
What to consider when administering any
medication
continued
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CORE CONCEPTS
The role of medical direction in medication
administration
How the EMT may assist in IV therapy
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Topics Topics
Medications EMTs Can Administer
General Information About Medications
Medications Patients Often Take
Assisting in IV Therapy
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Medications EMTs Can Medications EMTs Can
Administer Administer
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Aspirin
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Oral Glucose
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Oxygen
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Activated Charcoal
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Bronchodilator
Inhaler
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Prescribed Prescribed
Bronchodilator Inhalers Bronchodilator Inhalers
Used in patients with asthma,
emphysema, and chronic bronchitis
Enlarges constricted breathing tubes
Side effects: increased heart rate, patient
jitteriness
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Nitroglycerin
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Prescribed Nitroglycerin Prescribed Nitroglycerin
Taken by patients with history of chest
pain of cardiac origin
Helps dilate coronary vessels
Contraindications: low blood pressure or
taking medications for erectile dysfunction
(Viagra, Levitra, Cialis, or similar)
Vasodilator
Side effect: dropping blood pressure
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Epinephrine
Auto-Injector
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Prescribed Prescribed
Epinephrine Auto Epinephrine Auto--Injectors Injectors
Prescribed and used for patients with
severe allergic reactions classified as
anaphylaxis
Vasoconstrictor; relaxes smooth muscles
and airway passages
Side effects: increased heart rate and
blood pressure
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Oral Glucose Oral Glucose
Administration Video Administration Video
Click here to view a video on the subject of oral glucose
administration.
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General Information About General Information About
Medications Medications
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Drug Names Drug Names
Each drug is listed by a generic name
Each drug has at least three names
Chemical name
Generic name
Brand name (one or more trade names given
to the drug by manufacturers)
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What You Need to What You Need to
Know When Giving a Medication Know When Giving a Medication
Indications
Contraindications
Side effects
Untoward effects
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Medication Safety Medication Safety
and Clinical Judgment and Clinical Judgment
Administering or assisting with
medications is a serious responsibility
Know the medication
Use good judgment
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Medication Authorization Medication Authorization
Off-line medical direction
Do not speak to physician
Use standing orders
On-line medical direction
Speak directly to physician
Listen to order; then repeat order back
Ask for clarification if necessary
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The Five Rights The Five Rights
of Medications of Medications
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The Five Rights The Five Rights
1. Do I have the right patient?
2. Is it the right time to administer this
medication?
3. Is this the right medication?
4. Is this the right dose?
5. Am I giving this medication by the right
route of administration?
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Think About It Think About It
What would be the potential risk to the
patient if each of the five rights were not
checked prior to administration?
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Routes of Administration Routes of Administration
Oral (swallowed)
Sublingual (dissolved under tongue)
Inhaled (breathed into lungs), usually as
tiny aerosol particles such as from an
inhaler or as a gas such as oxygen
Intravenous (injected into vein)
continued
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Routes of Administration Routes of Administration
Intramuscular (injected into muscle)
Subcutaneous (injected under skin)
Intraosseous (injected into bone marrow
cavity)
Endotracheal (sprayed directly into tube
inserted into trachea)
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Age Age-- and and
Weight Weight--Related Considerations Related Considerations
Pharmacodynamics
Study of effects of medications on body
What effect will medication have on this
patient?
Patient-specific factors change how
medication works
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Reassessment Reassessment
and Documentation and Documentation
After administering medication, reassess
patient
Clearly document medications
administered
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Medications Patients Medications Patients
Often Take Often Take
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Medications Medications
Patients Often Take Patients Often Take
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Herbal Agents and Basic Uses Herbal Agents and Basic Uses
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Assisting in IV Therapy Assisting in IV Therapy
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Ways of Ways of
Administering IV Fluids Administering IV Fluids
Heparin (saline) lock
Catheter placed into vein
Cap (lock) placed over end of catheter
Lock has port for administering medications
Traditional IV bag
Hangs above patient
Constantly flows fluids and medications into
patient
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IV Fluid Administration Set IV Fluid Administration Set
Clear plastic tubing connecting fluid bag to
needle or catheter
Three important parts
Drip chamber
Flow regulator
Drug or needle port
Extension set (extra tubing)
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Setting Up an IV Fluid
Administration Set
continued
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Setting Up an IV Fluid
Administration Set
continued
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Setting Up an IV Fluid
Administration Set
continued
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Setting Up an Setting Up an
IV Fluid Administration Set IV Fluid Administration Set
continued
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Setting Up an Setting Up an
IV Fluid Administration Set IV Fluid Administration Set
continued
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Setting Up an Setting Up an
IV Fluid Administration Set IV Fluid Administration Set
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Maintaining an IV Maintaining an IV
Troubleshoot flow problems
Constricting bands left in place by mistake
Flow regulator left closed
Clamp closed on tubing
Tubing kinked
Line pinched under backboard (trauma)
Adjust flow rate properly
Monitor IV sites for infiltration
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Aspirin, oral glucose, charcoal, and
oxygen are medications carried on the
ambulance that the EMT may administer
to a patient under specific conditions.
Inhalers, nitroglycerin, and epinephrine in
auto-injectors are medications that, if
prescribed, the EMT may assist the patient
in taking
continued
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Chapter Review Chapter Review
You may need to have permission from
medical direction to administer or assist
the patient with a medication. Follow local
protocols.
continued
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Chapter Review Chapter Review
Find out what medications a patient is
taking when you take the SAMPLE. Your
main purpose in finding this out is to report
this information to your Medical Director or
hospital personnel.
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Remember Remember
EMTs administer aspirin, oral glucose,
activated charcoal, and oxygen as part of
patient care.
EMTs may assist with inhaled respiratory
medications, nitroglycerine, and
epinephrine auto-injectors.
continued
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Remember Remember
EMTs should understand the names,
indications, contraindications, and side
effects of medications that they intend to
administer.
EMTs must have appropriate authorization
to give a drug and always must follow the
five rights of medication administration.
continued
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Remember Remember
Reassessment and documentation are
important elements of medication
administration.
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Questions to Consider Questions to Consider
Should I administer a medication?
How can I get more information about a
drug?
What are the necessary steps that must
occur after medication administration?
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Critical Thinking Critical Thinking
A patient is complaining of chest pain.
Heres some nitroglycerin, says a family
member. Give him that. What do you do?
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Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
19.1 Define key terms introduced in this chapter. Slides
1415, 41, 54
19.2 Describe the anatomy and physiology of respiration.
Slides 1315
19.3 Differentiate between adequate and inadequate
breathing based on the rate, rhythm, and quality of
breathing. Slides 1618
continued
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OBJECTIVES OBJECTIVES
19.4 Discuss differences between the adult and pediatric
airways and respiratory systems. Slide 20
19.5 Recognize signs of inadequate breathing in pediatric
patients. Slide 19
19.6 Provide supplemental oxygen and assisted
ventilation as needed for patients with inadequate
breathing. Slides 2223
continued
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OBJECTIVES OBJECTIVES
19.7 Assess the effectiveness of artificial ventilation.
Slides 2223
19.8 Discuss how to recognize and assess the patient
with difficulty breathing. Slides 2738
19.9 Discuss the care to provide for the patient with
difficulty breathing. Slides 3940
continued
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OBJECTIVES OBJECTIVES
19.10 Recognize the indications, contraindications, risks,
and side effects of CPAP. Slides 4143
19.11 Use CPAP to assist the patient with difficulty
breathing, as permitted by medical direction. Slides
4447
continued
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OBJECTIVES OBJECTIVES
19.12 Assist a patient with administration of a prescribed
bronchodilator by inhaler or small volume nebulizer,
as permitted by medical direction. Slides 8387,
9091
continued
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OBJECTIVES OBJECTIVES
19.13 Describe the pathophysiology, signs, and symptoms
of COPD, asthma, pulmonary edema, pneumonia,
spontaneous pneumothorax, pulmonary embolism,
epiglottitis, cystic fibrosis, and viral respiratory
infections. Slides 4979
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MULTIMEDIA MULTIMEDIA
Slide 80 Chronic Obstructive Pulmonary Diseases
Video
Slide 81 Spontaneous Pneumothorax Video
Slide 88 Using a Metered Dose Asthma Inhaler and
Spacer Video
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CORE CONCEPTS
How to identify adequate breathing
How to identify inadequate breathing
How to identify and treat a patient with
breathing difficulty
Use of continuous positive airway
pressure (CPAP) to relieve difficulty
continued
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CORE CONCEPTS
Use of a prescribed inhaler and how to
assist a patient with one
Use of a prescribed small-volume
nebulizer and how to assist a patient with
one
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Topics Topics
Respiration
Breathing Difficulty
Respiratory Conditions
The Prescribed Inhaler
The Small-Volume Nebulizer
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Respiration Respiration
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Respiratory A&P Respiratory A&P
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Inspiration Inspiration
Active process: uses muscle contraction to
increase size of chest cavity
Intercostal muscles and diaphragm
contract
Diaphragm moves down; ribs move
upward and outward
Air is pulled into lungs
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Expiration Expiration
Passive process
Muscles and diaphragm relax
Size of chest cavity decreases
Air flows out of lungs
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Adequate Breathing Adequate Breathing
Breathing sufficient to support life
Signs
No obvious distress
Ability to speak in full sentences
Normal color, mental status, and orientation
continued
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Adequate Breathing Adequate Breathing
May be determined by observing rate,
rhythm, quality
1220 breaths/minute for adult
1530 breaths/minute for child
2550 breaths/minute for infant
Rhythm usually regular
Breath sounds normally present and equal
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Inadequate Breathing Inadequate Breathing
Breathing not sufficient to support life
Signs
Rate out of normal range
Irregular rhythm
Diminished or absent lung sounds
Poor tidal volume
continued
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Inadequate Breathing Inadequate Breathing
Signs of inadequate breathing in infants
and children
Nasal flaring
Grunting
Seesaw breathing
Retractions
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Pediatric Note Pediatric Note
Structure of an infants and childs airway
differs from that of an adult
Smaller airway easily obstructed
Proportionately larger tongues
Smaller, softer, more flexible trachea
Less developed, less rigid cricoid cartilage
Heavy dependence on diaphragm for
respiration
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Patient Care: Patient Care:
Inadequate Breathing Inadequate Breathing
Assisted ventilation with supplemental
oxygen
Pocket face mask with supplemental oxygen
Two-rescuer/one rescuer BVM with
supplemental oxygen
Flow-restricted, oxygen-powered ventilation
device
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Artificial Ventilation Artificial Ventilation
Can be adequate or inadequate
Chest rise and fall should be visible with
each breath
Adequate artificial ventilation rates
12 breaths per minute for adults
20 breaths per minute for infants and children
continued
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Artificial Ventilation Artificial Ventilation
Increasing pulse rates can indicate
inadequate artificial ventilation in adults
Decreasing pulse rates can indicate
inadequate artificial ventilation in pediatric
patients
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Think About It Think About It
How might you recognize the progression
from adequate breathing to inadequate
breathing in the assessment of your
patient?
How might your patient change during this
transition?
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Breathing Difficulty Breathing Difficulty
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Breathing Difficulty Breathing Difficulty
Patients subjective perception
Feeling of labored, or difficult, breathing
Amount of distress felt may or may not
reflect actual severity of condition
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OPQRST OPQRST
OnsetWhen did it begin?
ProvocationWhat were you doing when
this came on?
QualityDo you have a cough? Are you
bringing anything up with it?
continued
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OPQRST OPQRST
RadiationDo you have pain or
discomfort anywhere else in your body?
SeverityOn a scale of 1 to 10, how bad
is your breathing trouble?
TimeHow long have you had this
feeling?
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Assessment: Observation Assessment: Observation
Altered mental status
Unusual anatomy
Barrel chest
Patients position
Tripod position
Sitting with feet dangling, leaning forward
continued
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Assessment: Observation Assessment: Observation
Work of breathing
Retractions
Use of accessory muscles
Flared nostrils
Pursed lips
Number of words patient can say without
stopping
continued
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Assessment: Observation Assessment: Observation
Pale, cyanotic, or flushed skin
Pedal edema
Sacral edema
Coughing
continued
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Assessment: Observation Assessment: Observation
continued
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Assessment: Observation Assessment: Observation
Noisy breathing
Audible wheezing (heard without stethoscope)
Gurgling
Snoring
Crowing
Stridor
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Assessment: Auscultation Assessment: Auscultation
Lung sounds on
both sides during
inspiration and
expiration
continued
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Assessment: Auscultation Assessment: Auscultation
Wheezeshigh-pitched sounds created
by air moving through narrowed air
passages
Cracklesfine crackling caused by fluid in
alveoli or by opening of closed alveoli
continued
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Assessment: Auscultation Assessment: Auscultation
Rhonchilow sounds resembling snoring
or rattling, caused by secretions in larger
airways
Stridorhigh-pitched, upper-airway
sounds indicating partial obstruction of
trachea or larynx
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Assessment: Assessment:
Vital Sign Changes Vital Sign Changes
Increased or
decreased pulse rate
Changes in breathing
rate
Changes in breathing
rhythm
Hypertension or
hypotension
Oxygen saturation
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Patient Care Patient Care
Assure adequate
ventilations
If breathing is
inadequate, begin
artificial ventilation
If breathing is
adequate, non-
rebreather mask at
15 Lpm
continued
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Patient Care Patient Care
Place patient in position of comfort
Administer prescribed inhaler
Administer continuous positive airway
pressure (CPAP)
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Patient Care: CPAP Patient Care: CPAP
Simple principles
Blowing oxygen or air continuously at low
pressure into airway
Prevents alveoli from collapsing at end of
exhalation
Can prevent fluid shifting into alveoli from
surrounding capillaries
continued
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Patient Care: CPAP Patient Care: CPAP
Common uses
Pulmonary edema
Drowning
Asthma and COPD
Respiratory failure in general
continued
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Patient Care: CPAP Patient Care: CPAP
Contraindications
Severely altered mental status
Lack of normal, spontaneous respiratory rate
Hypotension/shock
Nausea and vomiting
Penetrating chest trauma
Upper GI bleeding
Conditions preventing good mask seal
continued
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Patient Care: CPAP Patient Care: CPAP
Side effects
Hypotension
Pneumothorax
Increased risk of aspiration
Drying of corneas
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Patient Care: Patient Care:
Using CPAP Using CPAP
Explain procedure to patient
Start with low level CPAP
continued
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Patient Care: Patient Care:
Using CPAP Using CPAP
Reassess mental
status, vital signs,
and dyspnea level
frequently
Raise CPAP level if
no relief within a
few minutes
continued
6/28/2011
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Patient Care: Patient Care:
Using CPAP Using CPAP
If patient
deteriorates,
remove CPAP and
ventilate with bag-
mask
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Respiratory Conditions Respiratory Conditions
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Chronic Obstructive Chronic Obstructive
Pulmonary Disease Pulmonary Disease
Broad classification of chronic lung
diseases
Includes emphysema, chronic bronchitis,
and black lung
Overwhelming majority of cases are
caused by cigarette smoking
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COPD: Chronic Bronchitis COPD: Chronic Bronchitis
Bronchiole lining inflamed
Excess mucus produced
Cells in bronchioles that normally clear
away mucus accumulations are unable to
do so
continued
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COPD: Chronic Bronchitis COPD: Chronic Bronchitis
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COPD: Emphysema COPD: Emphysema
Alveoli walls break downsurface area for
respiratory exchange is greatly reduced
Lungs lose elasticity
Results in air being trapped in lungs,
reducing effectiveness of normal breathing
continued
6/28/2011
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COPD: Emphysema COPD: Emphysema
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Asthma Asthma
Chronic disease with episodic
exacerbations
During attack, small bronchioles narrow
(bronchoconstriction); mucus is
overproduced
Results in small airway passages
practically closing down, severely
restricting air flow
continued
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Asthma Asthma
Air flow mainly restricted in one direction
Inhalationexpanding lungs exert outward
pull, increasing diameter of airway and
allowing air flow into lungs
Exhalationopposite occurs and air
becomes trapped in lungs
continued
6/28/2011
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Asthma Asthma
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Pulmonary Edema Pulmonary Edema
Abnormal accumulation of fluid in alveoli
Congestive heart failure (CHF) patients
may experience difficulty breathing
because of this
continued
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Pulmonary Edema Pulmonary Edema
Pressure builds up in pulmonary
capillaries
Fluid crosses the thin barrier and
accumulates in and around alveoli
Fluid occupying lower airways makes it
difficult for oxygen to reach blood
Patient experiences dyspnea
continued
6/28/2011
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Pulmonary Edema Pulmonary Edema
Common signs and symptoms
Dyspnea
Anxiety
Pale and sweaty skin
Tachycardia
Hypertension
Low oxygen saturation
continued
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Pulmonary Edema Pulmonary Edema
Common signs and symptoms
In severe cases, crackles or sometimes
wheezes may be audible
Patients may cough up frothy sputum, usually
white, but sometimes pink-tinged
continued
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Pulmonary Edema Pulmonary Edema
Treatment
Assess for and treat inadequate breathing
High-concentration oxygen
If possible, keep patients legs in dependent
position
CPAP
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Think About It Think About It
Might it be possible for a patient to have
multiple respiratory disorders?
Could a person with an underlying
diagnosis of COPD also have pulmonary
edema?
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Pneumonia Pneumonia
Infection of one or both lungs caused by
bacteria, viruses, or fungi
Results from inhalation of certain microbes
Microbes grow in lungs and cause
inflammation
continued
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Pneumonia Pneumonia
Signs and symptoms
Shortness of breath with or without exertion
Coughing
Fever and severe chills
Chest pain (often sharp and pleuritic)
Headache
Pale, sweaty skin
Fatigue
Confusion
continued
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Pneumonia Pneumonia
Treatment
Care mostly supportive
Assess for and treat inadequate breathing
Oxygenate
Transport
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Spontaneous Pneumothorax Spontaneous Pneumothorax
Lung collapses without injury or other
obvious cause
Tall, thin people, and smokers are at
higher risk for this condition
continued
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Spontaneous Pneumothorax Spontaneous Pneumothorax
Signs and symptoms
Sharp, pleuritic chest pain
Decreased or absent lung sounds on side
with injured lung
Shortness of breath/dyspnea on exertion
Low oxygen saturation, cyanosis
Tachycardia
continued
6/28/2011
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Spontaneous Pneumothorax Spontaneous Pneumothorax
Treatment
Transport for definitive care, as patients
frequently require chest tube
Administer oxygen
CPAP contraindicated
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Pulmonary Embolism Pulmonary Embolism
Blockage in blood supply to lungs
Commonly caused by deep vein
thrombosis (DVT)
Increased risk from limb immobility, local
trauma, abnormally fast blood clotting
continued
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Pulmonary Embolism Pulmonary Embolism
Signs and symptoms
Chest pain
Shortness of breath
Low oxygen saturation/cyanosis
Tachycardia
Wheezing
continued
6/28/2011
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Pulmonary Embolism Pulmonary Embolism
Treatment
Difficult to differentiate in field
Transport to definitive care
Oxygenate
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Epiglottitis Epiglottitis
Infection causing swelling around glottic
opening
In severe cases, swelling can cause
airway obstruction
continued
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Epiglottitis Epiglottitis
Signs and symptoms
Sore throat, drooling, difficult swallowing
Preferred upright or tripod position
Sick appearance
Muffled voice
Fever
Stridor
continued
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Epiglottitis Epiglottitis
Treatment
Keep patient calm and comfortable
Do not inspect throat
Administer high-concentration oxygen if
possible without alarming patient
Transport
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Cystic Fibrosis Cystic Fibrosis
Genetic disease typically appearing in
childhood
Causes thick, sticky mucus accumulating
in the lungs and digestive system
Mucus can cause life-threatening lung
infections and serious digestion problems
continued
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Cystic Fibrosis Cystic Fibrosis
Signs and symptoms
Coughing with large amounts of mucus
Fatigue
Frequent occurrences of pneumonia
Abdominal pain and distention
Coughing up blood
Nausea
Weight loss
continued
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Cystic Fibrosis Cystic Fibrosis
Treatment
Caregiver often best resource for baseline
assessment of patient
Caregivers can often guide treatment
Assess for, and treat, inadequate breathing
Transport
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Viral Respiratory Infections Viral Respiratory Infections
Infection of respiratory tract
Usually minor but can be serious,
especially in patients with underlying
respiratory diseases like COPD
continued
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Viral Respiratory Infections Viral Respiratory Infections
Often starts with sore or scratchy throat
with sneezing, runny nose, and fatigue
Fever and chills
Infection can spread into lungs, causing
shortness of breath
Cough can be persistent; may produce
yellow or greenish sputum
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Chronic Obstructive Chronic Obstructive
Pulmonary Diseases Video Pulmonary Diseases Video
Click here to view a video on the subject of chronic obstructive
pulmonary diseases.
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Spontaneous Spontaneous
Pneumothorax Animation Pneumothorax Animation
Click here to view an animation on the subject of
spontaneous pneumothorax.
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The Prescribed Inhaler The Prescribed Inhaler
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The Prescribed Inhaler The Prescribed Inhaler
Metered-dose inhaler
Provides a metered (exactly measured)
inhaled dose of medication
Most commonly prescribed for conditions
causing bronchoconstriction
continued
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The Prescribed Inhaler The Prescribed Inhaler
Before administering
inhaler
Right patient, right
medication, right dose,
right route
Check expiration date
Shake inhaler vigorously
Patient alert enough to
use inhaler
Use spacer device if
patient has one
Art: Emergency Care 11 Ch. 16 PPT Slide 83
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Spacer Device
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The Prescribed Inhaler The Prescribed Inhaler
To administer inhaler
Have patient exhale
deeply
Have patient put lips
around opening
Press inhaler to activate
spray as patient inhales
deeply
Make sure patient holds
breath as long as
possible so medication
can be absorbed
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Using a Metered Dose Asthma Using a Metered Dose Asthma
Inhaler and Spacer Video Inhaler and Spacer Video
Click here to view a video on the subject of using a
metered dose inhaler.
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The Small The Small--Volume Nebulizer Volume Nebulizer
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The Small The Small--Volume Nebulizer Volume Nebulizer
Medications in metered-dose inhalers can
also be administered by a small-volume
nebulizer (SVN)
Nebulizingrunning oxygen or air through
liquid medication
Patient breathes vapors created
continued
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The Small The Small--Volume Nebulizer Volume Nebulizer
Produces continuous flow of aerosolized
medication that can be taken in during
multiple breaths over several minutes
Gives patient greater exposure to
medication
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Chapter Review Chapter Review
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Chapter Review Chapter Review
It is important to understand the anatomy,
physiology, pathophysiology, assessment
and care for patients experiencing
respiratory emergencies.
Patients with respiratory complaints may
exhibit inadequate breathing.
continued
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Chapter Review Chapter Review
Very slow and shallow respirations are
often the end-point of a serious condition
and are a precursor to death.
continued
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continued
Chapter Review Chapter Review
The history usually provides significant
information about the patients condition.
In addition to determining a pertinent past
history and medications, determine the
patients signs and symptoms with a
detailed description including OPQRST
and events leading up to the episode.
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Chapter Review Chapter Review
Important physical examination points
include the patients work of breathing,
accessory muscle use, pulse oximetry
readings, assuring adequate and equal
lung sounds bilaterally, and examining for
excess fluid and vital signs.
There are several medications which may
help a patients difficulty breathing.
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Remember Remember
Determine if the patients breathing is
adequate, inadequate, or absent.
Choose the appropriate oxygenation or
ventilation therapy.
continued
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Remember Remember
Consider whether to assist a patient with
or administer respiratory medications.
Do I have protocols and medications that may
help this patient?
Does the patient have a presentation and
condition that may fit these protocols?
Are there any contraindications or risks to
using medications in my protocols?
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Questions to Consider Questions to Consider
What would you expect a patients
respiratory rate to do when the patient
gets hypoxic? Why?
What would you expect a patients pulse
rate to do when the patient gets hypoxic?
Why?
List the signs of inadequate breathing.
continued
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Questions to Consider Questions to Consider
Would you expect to assist a patient with
their prescribed inhaler when they are
experiencing congestive heart failure?
Why or why not?
List some differences between adult and
infant/child respiratory systems.
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Critical Thinking Critical Thinking
A 72-year-old female complains of severe
shortness of breath. Her husband notes
she is confused. You note respiratory rate
of 8 breaths/minute and cyanosis. Patient
has a history of COPD and CHF. Discuss
the treatment steps to assist this patient.
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Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
20.1 Define key terms introduced in this chapter. Slides
14, 20, 23, 3435, 3738, 4042, 5051
20.2 Describe the anatomy and physiology of the
cardiovascular system. Slides 1417
20.3 Define acute coronary syndrome and discuss its
most common signs and symptoms. Slides 2024
continued
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OBJECTIVES OBJECTIVES
20.4 Discuss the management of a patient with acute
coronary syndrome. Slides 2527
20.5 Discuss the indications, contraindications, dosage,
and administration of nitroglycerin to a patient with
chest pain. Slides 2526
continued
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continued
OBJECTIVES OBJECTIVES
20.6 Discuss the indications (including conditions that
must be met), contraindications, and administration
of aspirin to a patient with chest pain. Slides 2728
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continued
OBJECTIVES OBJECTIVES
20.7 Discuss the following conditions and how each may
lead to a cardiac emergency: coronary artery
disease (CAD), aneurysm, electrical malfunctions of
the heart, mechanical malfunctions of the heart,
angina pectoris, acute myocardial infarction (AMI),
and congestive heart failure (CHF). Slides 3346
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OBJECTIVES OBJECTIVES
20.8 Discuss the following factors in the chain of survival
and how each may contribute to patient survival of
cardiac arrest: immediate recognition and activation,
early cardiopulmonary resuscitation (CPR), rapid
defibrillation, effective advanced life support, and
integrated post-cardiac arrest care. Slides 4854
continued
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OBJECTIVES OBJECTIVES
20.9 List the skills necessary for the EMT to manage a
patient in cardiac arrest. Slides 5557
20.10 Discuss types of automated external defibrillators
(AEDs) and how AEDs work. Slides 5866
20.11 Discuss the effective coordination of CPR and AED
for a patient in cardiac arrest. Slides 6774
continued
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OBJECTIVES OBJECTIVES
20.12 Discuss special considerations for AED use,
including general principles, coordination with
others, and post-resuscitation care. Slides 7576
20.13 Discuss the purpose and use of mechanical CPR
devices. Slide 77
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MULTIMEDIA MULTIMEDIA
Slide 78 Using an AED Video
Slide 79 Cardiac Arrest Video
Slide 80 AEDs Video
Slide 81 Understanding Myocardial Infarctions Video
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CORE CONCEPTS
Aspects of acute coronary syndrome
(ACS)
Conditions that may lead to a cardiac
emergency
Cardiac arrest and the chain of survival
Management of a cardiac arrest patient
Use of an automated external defibrillator
(AED)
continued
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CORE CONCEPTS
Special considerations in AED use
Use of mechanical cardiopulmonary
resuscitation (CPR) devices
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Topics Topics
Cardiac Anatomy and Physiology
Acute Coronary Syndrome
Causes of Cardiac Conditions
Cardiac Arrest
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Cardiac Anatomy and Cardiac Anatomy and
Physiology Physiology
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Cardiac A&P Cardiac A&P
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Four Chambers of the Heart Four Chambers of the Heart
Right Atrium
Right Ventricle
Left Atrium
Left Ventricle
Receives blood from
veins; pumps to right
ventricle.
Receives blood
from lungs; pumps
to left ventricle.
Pumps blood to
the lungs.
Pumps blood through
the aorta to the body.
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Cardiac Conduction System Cardiac Conduction System
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Blood Vessels Blood Vessels
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Think About It Think About It
How does the normal function of the heart
and blood vessels relate to blood pressure
and distal pulses?
How is shock related to the function of the
heart and blood vessels?
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Acute Coronary Syndrome Acute Coronary Syndrome
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Acute Coronary Acute Coronary
Syndrome (ACS) Syndrome (ACS)
Sometimes called cardiac compromise
Refers to any time the heart may not be
getting enough oxygen
Many different kinds of problems under the
ACS heading
continued
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Acute Coronary Acute Coronary
Syndrome (ACS) Syndrome (ACS)
Symptoms often mimic non-cardiac
conditions
Treat all patients with ACS-like signs and
symptoms as though they are having a
heart problem
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Symptoms Symptoms
Chest pain is best-known symptom
Can be described as crushing, dull,
heavy, or squeezing
Sometimes described only as pressure or
discomfort
Radiates to arms, upper abdomen, jaw
continued
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Symptoms Symptoms
Dyspnea also
found in ACS
May be the only
finding in some
patients
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Other Signs and Symptoms Other Signs and Symptoms
Anxiety, feeling of impending doom
Nausea and pain or discomfort in upper
abdomen (epigastric pain)
Sweating
Abnormal pulse (tachycardia/bradycardia)
Abnormal blood pressure
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Assessment Assessment
Perform primary assessment
Obtain history and physical exam
Use OPQRST to get history of present
illness
Obtain SAMPLE history
Take baseline vital signs
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Treatment Treatment
Place patient in position of
comfort (typically sitting up)
Apply high-concentration oxygen
Transport
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Treatment Treatment
If trained, equipped, and authorized to do
so, obtain a 12-lead electrocardiogram
(ECG)
Follow local protocol as to whether to
transmit it to hospital for interpretation
continued
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Treatment Treatment
Indications for administering nitroglycerin
Chest pain
History of cardiac problems and prescribed
nitroglycerin
Patient has nitroglycerin
Medical direction
authorizes administration
continued
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Treatment Treatment
Contraindications for administering
nitroglycerin
Systolic blood pressure less than 90100
(consult local protocol)
Patient has taken Viagra or similar drug for
erectile dysfunction within 4872 hours
continued
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Treatment Treatment
Indications for administering aspirin
Chest pain
Ability to safely swallow
Medical control authorization
continued
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Treatment Treatment
Contraindications for administering aspirin
Inability to swallow
Allergy to aspirin
History of asthma
Patient already taking other anti-clotting
medications
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Causes of Cardiac Conditions Causes of Cardiac Conditions
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Causes of Cardiac Conditions Causes of Cardiac Conditions
Heart problems caused by a number of
disorders affecting condition and function
of blood vessels and heart
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Coronary Artery Disease Coronary Artery Disease
Conditions that narrow or block arteries of heart
Often result from fatty deposit build-up on inner
walls of arteries
Build-up narrows inner vessel diameter, restricts
flow of blood
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Coronary Artery Disease Coronary Artery Disease
Thrombusocclusion of blood flow
caused by formation of a clot on rough
inner surface of diseased artery
Thrombus can break loose and form an
embolism
Emboli can move to occlude flow of blood
downstream in a smaller artery
continued
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Coronary Artery Disease Coronary Artery Disease
Reduced blood supply to myocardium
causes emergency in majority of cardiac-
related medical emergencies
Chest pain is most common symptom of
reduced blood supply
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Aneurysm Aneurysm
Weakened
sections of blood
vessels begin to
dilate (balloon)
Bursting can cause
rapid, life-
threatening internal
bleeding
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Electrical Electrical
Malfunction of the Heart Malfunction of the Heart
Malfunction of hearts electrical system
generally results in dysrhythmia
Dysrhythmias include bradycardia,
tachycardia, and rhythms that may be
present when there is no pulse
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Mechanical Mechanical
Malfunctions of the Heart Malfunctions of the Heart
Angina pectoris
Acute myocardial infarction (AMI)
Congestive Heart Failure (CHF)
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Angina Pectoris Angina Pectoris
Chest pain caused by insufficient blood
flow to the myocardium
Typically due to narrowed arteries
secondary to coronary artery disease
Pain usually during times of increased
myocardial oxygen demand, such as
exertion or stress
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Acute Myocardial Acute Myocardial
Infarction (AMI) Infarction (AMI)
Death of a portion of the myocardium due
to lack of oxygen
Coronary artery disease is usually the
underlying reason
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Congestive Congestive
Heart Failure (CHF) Heart Failure (CHF)
Inadequate pumping of the heart
Often leads to excessive fluid build-up in
lungs and/or body
May be brought on by diseased heart
valves, hypertension, obstructive
pulmonary disease
Often a complication of AMI
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Progression of CHF Progression of CHF
Patient sustains AMI
Myocardium of left ventricle dies
Because of damage to left ventricle, blood
backs up into pulmonary circulation and
lungs
If untreated, left heart failure commonly
causes right heart failure
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Signs and Signs and
Symptoms of CHF Symptoms of CHF
Tachycardia
Dyspnea and cyanosis
Normal or elevated blood pressure
Diaphoresis
Pulmonary edema
continued
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continued
Signs and Signs and
Symptoms of CHF Symptoms of CHF
Anxiety or confusion due to hypoxia
Pedal edema
Engorged, pulsating neck veins (late sign)
Enlarged liver and spleen
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Signs and Signs and
Symptoms of CHF Symptoms of CHF
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Cardiac Arrest Cardiac Arrest
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The Chain of Survival The Chain of Survival
Five elements
1. Immediate recognition and activation
2. Early CPR
3. Rapid defibrillation
4. Effective advanced life support
5. Integrated post-cardiac arrest care
Teamwork
Coordination
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Immediate Immediate
Recognition and Activation Recognition and Activation
Requires prompt notification of EMS
system
Most likely a bystander responsibility
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Early CPR Early CPR
Increases survival chances significantly
Three ways CPR can be delivered earlier
Get CPR-trained professionals to patient
faster
Train laypeople in CPR
Train dispatchers to instruct callers how to
perform CPR
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Rapid Defibrillation
Sooner defibrillator arrives, more likely
patient will survive cardiac arrest
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Effective Effective
Advanced Life Support Advanced Life Support
Generally EMT-paramedics who respond
to scene or rendezvous with BLS unit en
route to hospital
Rapid transport to hospital may be the
most time-efficient means of obtaining ALS
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Integrated Integrated
Post Post--Cardiac Arrest Care Cardiac Arrest Care
Coordinating numerous means of
assessment and interventions that
together maximize the chance of
neurologically intact survival
continued
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Integrated Integrated
Post Post--Cardiac Arrest Care Cardiac Arrest Care
Maintaining adequate oxygenation
Avoiding hyperventilation
Performing 12-lead ECG
Managing treatable causes of arrest
Appropriate destination for patient
Possibly inducing hypothermia
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Management of Cardiac Arrest Management of Cardiac Arrest
EMT provides two links in chain of survival
Early CPR
Rapid defibrillation
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Treatment of Cardiac Arrest Treatment of Cardiac Arrest
Standard Precautions
ALS (when available)
One- and two-rescuer CPR
Using an automated external defibrillator
continued
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Treatment of Cardiac Arrest Treatment of Cardiac Arrest
Artificial ventilations and airway
management
Interviewing bystanders and family
members
Lifting and moving patients
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Automated Automated
External Defibrillator (AED) External Defibrillator (AED)
Semiautomatic
Advises EMT to press button that causes
machine to deliver shock through pads
Fully automatic
Does not advise EMT to take any action;
delivers shock automatically
continued
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Automated Automated
External Defibrillator (AED) External Defibrillator (AED)
Classified by type of shock delivered
Monophasic: sends single shock from
negative pad to positive pad
Biphasic: sends shock in one direction and
then the other
continued
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Automated External
Defibrillator (AED)
Analyzes cardiac rhythm to determine
whether shock is indicated
continued
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Automated Automated
External Defibrillator (AED) External Defibrillator (AED)
Most common conditions resulting in
cardiac arrest are shockable rhythms
Ventricular fibrillation
Ventricular tachycardia
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AED Safety AED Safety
Do not defibrillate soaking-wet patient
Do not defibrillate if patient is touching
anything metallic that other people are
touching
Remove nitroglycerin patches before
defibrillating
continued
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AED Safety AED Safety
Verbally and visually CLEAR patient
before defibrillating
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AED Safety AED Safety
Defibrillation can be performed on patient
with an implanted device
Position defibrillation pads on patients
chest to avoid contact with the device
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AED Maintenance AED Maintenance
Use checklist at beginning of every shift to
ensure you have all supplies and AED is
functioning properly
Make sure battery is charged and you
have a spare with defibrillator
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AED Quality Improvement AED Quality Improvement
Involves multiple functions
Medical direction
Initial training
Maintenance of skills
Case review
Trend analysis
Strengthening links in chain of survival
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Coordinating CPR and AED Coordinating CPR and AED
Interrupt CPR only when absolutely
necessary and for as short a period as
possible
CPR must be paused for rhythm analysis
and defibrillation
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Patient Assessment
Perform primary assessment
If bystanders are doing CPR when
you arrive, have them stop
Verify pulselessness, apnea, absence
of other signs of life no longer than 10
seconds
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Patient Care
Apply AED
Bare patients chest; quickly shave
area where pads will be placed if
necessary
If available, use pediatric AED pads
If using adult pads, do not overlap
continued
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Patient Care
Use AED
Turn on AED
Attach pads to cables and
then to patient
Stop CPR and analyze
Clear patient and shock if
indicated
continued
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Patient Care
Immediately begin CPR after delivering a shock
Reassess patient after providing 2 minutes or 5
cycles of CPR
continued
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Patient Care Patient Care
If AED finds no shockable ECG rhythm,
will advise that no shock is indicated
Pulseless electrical activity
Asystole
Resume CPR immediately
continued
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Patient Care Patient Care
When providing CPR
Compressions must not be interrupted for any
longer than 10 seconds
Compressions at least 2 inches deep for adult
and at least one-third depth of chest for
infants and children with full chest recoil
Rate should be at least 100 per minute
Rotate personnel through compressor
position to prevent fatigue
continued
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Patient Care Patient Care
If patient wakes or begins to
move
Obtain baseline vital signs
Administer high-concentration
oxygen
Transport
continued
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Post Post--Resuscitation Care Resuscitation Care
Patient has a pulse
Manage airway; avoid hyperventilation
Keep defibrillator on patient during transport
in case patient goes back into arrest
Reassess frequently (every 5 minutes)
Consider hypothermia protocols
continued
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Post Post--Resuscitation Care Resuscitation Care
Patient goes back into cardiac arrest
Stop vehicle, resume CPR
Analyze rhythm as soon as possible
Deliver shock if indicated
Continue with 2 shocks separated by 2
minutes (5 cycles)
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Mechanical CPR Devices Mechanical CPR Devices
Mechanical devices assist EMTs to
provide high-quality compressions
Thumper

Auto-Pulse
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Using an AED Video Using an AED Video
Click here to view a video on the subject of how to use an AED.
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Cardiac Arrest Video Cardiac Arrest Video
Click here to view a video on the subject of cardiac arrest.
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Click here to view a video on the subject of AEDs.
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AEDs Video AEDs Video
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Click here to view a video on the subject of myocardial infarctions.
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Understanding Understanding
Myocardial Infarctions Video Myocardial Infarctions Video
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Chapter Review Chapter Review
6/28/2011
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Chapter Review Chapter Review
Patients with cardiac compromise or ACS
can have many different presentations.
Some complain of pressure or pain in the
chest with difficulty breathing. Others may
have just mild discomfort that they ignore
or that goes away and returns.
continued
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Chapter Review Chapter Review
Between 10%20% of heart attack
patients have no chest discomfort.
Because of these possibilities and the
severe complications of heart problems,
have a high suspicion and treat patients
with these symptoms for cardiac
compromise.
continued
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Chapter Review Chapter Review
ACS patients need high-concentration
oxygen and prompt, safe transportation to
definitive care.
You may be able to assist patients who
have their own nitroglycerin.
continued
6/28/2011
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Chapter Review Chapter Review
To provide maximum chance of survival for
patients in cardiac arrest, EMS agencies
must strengthen their performance of the
chain of survival: immediate recognition
and activation, early CPR, rapid
defibrillation, effective ALS, and integrated
post-cardiac arrest care.
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continued
Remember Remember
The heart is a simple pump that moves
deoxygenated blood to the lungs and
oxygenated blood to the body. Pressure
within the cardiovascular system is critical
to the moving of blood.
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continued
Remember Remember
Acute coronary syndrome (ACS) is a
blanket term that refers to a number of
situations in which perfusion of the heart is
inadequate.
Although there are common symptoms of
ACS, EMTs must recognize atypical
findings and err on the side of caution.
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continued
Remember Remember
Oxygen, nitroglycerine, and aspirin are key
medications indicated to treat ACS.
However, the definitive treatment is
transportation of the patient to a facility
that can open the blocked artery.
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continued
Remember Remember
Most cardiac conditions are caused by
arterial problems. Angina pectoris and
acute myocardial infarction are caused by
inadequate perfusion of the heart.
Heart failure can be caused by either
electrical or mechanical problems.
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continued
Remember Remember
The most important element of cardiac
arrest care is the administration of high-
quality chest compressions.
The American Heart Associations chain of
survival describes the key elements
necessary to maximize the cardiac arrest
patients chance of survival.
6/28/2011
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Remember Remember
AED provides early defibrillation in cardiac
arrest patients with ventricular tachycardia
and ventricular fibrillation.
Post-cardiac arrest care is an essential
element of cardiac arrest care.
Mechanical CPR devices provide
automated chest compressions in cardiac
arrest settings.
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Questions to Consider Questions to Consider
What position is best for a patient with:
Difficulty breathing and a blood pressure of
100/70?
Chest pain and a blood pressure of 180/90?
Describe how to clear a patient before
administering a shock.
continued
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Questions to Consider Questions to Consider
List three safety measures to keep in mind
when using an AED.
List the steps in the application of an AED.
6/28/2011
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Critical Thinking Critical Thinking
A 78-year-old male has been complaining
of severe shortness of breath for 20
minutes prior to your arrival. When you
arrive, you find the patient unconscious
and not moving. What are your immediate
priorities?
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Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
21.1 Define key terms introduced in this chapter. Slides
13, 26, 2829, 32, 39, 5255, 6364, 79
21.2 Consider several possible causes of altered mental
status when given scenarios involving patients with
alterations in mental status. Slide 15
21.3 Describe the basic physiological requirements for
maintaining consciousness. Slides 1314
continued
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OBJECTIVES OBJECTIVES
21.4 Perform primary and secondary assessments on
patients with altered mental status. Slides 1923
21.5 Describe the pathophysiology of diabetes and
diabetic emergencies. Slides 2939
21.6 Determine a patients blood glucose level using a
blood glucose meter, as allowed by local protocol.
Slides 4345
continued
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OBJECTIVES OBJECTIVES
21.7 Develop a plan to manage patients with diabetic
emergencies involving hyperglycemia and
hypoglycemia. Slides 4649
21.8 Recognize the signs, symptoms, and history
consistent with other causes of altered mental
status, including seizures, stroke, dizziness, and
syncope. Slides 5288
continued
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OBJECTIVES OBJECTIVES
21.9 Given a variety of scenarios involving patients with
seizures, search for potential underlying causes.
Slides 52, 56
21.10 Develop a plan to assess and manage patients who
are having or who have just had a seizure. Slides
5863
21.11 Explain the causes of strokes. Slide 64
continued
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continued
OBJECTIVES OBJECTIVES
21.12 Develop a plan to assess and manage patients who
are exhibiting signs and symptoms of a stroke.
Slides 6576
21.13 Given a scenario of a patient complaining of
dizziness or syncope, search for potential underlying
causes. Slides 7784
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OBJECTIVES OBJECTIVES
21.14 Develop a plan to assess and manage patients with
complaints of dizziness and syncope. Slides 8588
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MULTIMEDIA MULTIMEDIA
Slide 50 DiabetesEtiology and Pathophysiology
Video
Slide 90 Transient Ischemic Attacks Video
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CORE CONCEPTS
General approaches to assessing the
patient with an altered mental status
Understanding the causes, assessment,
and care of diabetes and various diabetic
emergencies
Understanding the causes, assessment,
and care of seizure disorders
continued
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CORE CONCEPTS
Understanding the causes, assessment,
and care of stroke
Understanding the causes, assessment,
and care of dizziness and syncope
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Topics Topics
Pathophysiology
Assessing the Patient with Altered Mental
Status
Diabetes
Other Causes of Altered Mental Status
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Pathophysiology Pathophysiology
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Mental Status Regulation Mental Status Regulation
Regulated by neurologic circuits in brain
that comprise reticular activating system
(RAS)
RAS responsible for functions of staying
awake, paying attention, and sleeping
RAS keeps person alert and oriented
6/28/2011
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Requirements Requirements
to Maintain Mental Status to Maintain Mental Status
Oxygen to perfuse brain tissue
Glucose to nourish brain tissue
Water to keep brain tissue hydrated
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Causes of Causes of
Altered Mental Status Altered Mental Status
Deficiences in oxygen, glucose, water to
brain tissue
Trauma, infection, chemical toxins harming
brain tissue
Primary brain problem (stroke)
Problem within another system (hypoxia
due to asthma)
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Assessing the Patient with Assessing the Patient with
Altered Mental Status Altered Mental Status
6/28/2011
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Safety Safety
Patient with altered mental status can be
dangerous to responders
Always consider safety of yourself and
your team before approaching a patient
Use law enforcement when necessary
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Primary Assessment Primary Assessment
Hypoxia is one of the most common
causes of altered mental status
Always consider the possibility of an
airway and/or breathing problem
continued
6/28/2011
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Primary Assessment Primary Assessment
Identify and treat life-threatening problems
Consider oxygen administration
Be alert to the need for positioning and
suctioning if patient requires it or if mental
status worsens
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Secondary Assessment
Thoroughly examine patient exhibiting new,
unusual behavior
Even slightly altered mental status indicates
serious underlying issues
continued
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Secondary Assessment Secondary Assessment
Body systems exam and complete history
may reveal information about the
suspected cause of altered mental status
Interview family members and bystanders
to obtain patients baseline mental status
Family may provide information patient is
unable to give
continued
6/28/2011
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Secondary Assessment Secondary Assessment
Patients medicines may point to relevant
medical history
Look for medic alert bracelets or other
health-related items at scene
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Think About It Think About It
What kind of information about a patients
altered mental status might you obtain
from the scene?
How might bystanders help you identify
the cause of altered mental status?
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Diabetes Diabetes
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Glucose Glucose
Form of sugar
Bodys basic source of energy
Body cells require glucose to remain alive
and create energy
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Glucose and the Glucose and the
Digestive System Digestive System
Glucose molecule is large
Will not pass into cell without insulin
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Insulin Insulin
Produced by pancreas
Binds to receptor sites on cells
Allows large glucose molecule to pass into
cells
Sugar intakeinsulin production balance
allows body to use glucose effectively as
energy source
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Diabetes Mellitus Diabetes Mellitus
Two types
Type 1
Underproduction of insulin by pancreas
Type 2
Inability of bodys cells to use insulin properly
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Type 1 Diabetes Type 1 Diabetes
Pancreatic cells do not function properly
Insulin not secreted normally
Not enough insulin to transfer circulating
glucose into cells
Synthetic insulin typically prescribed to
supplement inadequate natural insulin
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Type 2 Diabetes Type 2 Diabetes
Bodys cells fail to utilize insulin properly
Pancreas is secreting enough insulin, but
body is unable to use it to move glucose
into cells
Condition often controlled through diet
and/or oral antidiabetic medications
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Diabetic Emergencies Diabetic Emergencies
Hypoglycemia (low blood sugar)
Hyperglycemia (high blood sugar)
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Hypoglycemia: Causes Hypoglycemia: Causes
Diabetic takes too much insulin
Diabetic does not eat
Diabetic overexercises or overexerts
Diabetic vomits
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Hypoglycemia: Signs Hypoglycemia: Signs
Very rapid onset
May present with abnormal behavior
mimicking drunken stupor
Pale, sweaty skin
Tachycardia
Seizures
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Hypoglycemia: Results Hypoglycemia: Results
Starvation of brain cells
Altered mental status
Unconsciousness
Permanent brain damage
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Hyperglycemia: Causes Hyperglycemia: Causes
Decrease in insulin
May be due to bodys inability to produce
insulin
May exist because insulin injections not given
in sufficient quantity
Infection
Stress
Increasing dietary intake
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Hyperglycemia: Signs Hyperglycemia: Signs
Develops over days or weeks
Chronic thirst and hunger
Increased urination
Nausea
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Hyperglycemia: Results Hyperglycemia: Results
Profound dehydration
Excessive waste products released into
system
Diabetic ketoacidosis (DKA)
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Diabetic Ketoacidosis: Diabetic Ketoacidosis:
Signs and Symptoms Signs and Symptoms
Profoundly altered mental status
Shock (caused by dehydration)
Rapid breathing
Acetone odor on breath
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Assessment Assessment
Scene safety
Primary assessment
Identify altered mental status
continued
6/28/2011
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Assessment Assessment
Secondary assessment
History of present episode
How episode occurred, time of onset,
duration, associated symptoms, any MOI or
other evidence of trauma, any interruptions to
episode, seizures, or fever
continued
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Assessment Assessment
Secondary assessment
SAMPLE
Determine if history of diabetes
Question patient or bystanders
Look for medical identification bracelet
Look in refrigerator or elsewhere at scene for
medications such as insulin
continued
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Assessment
Blood glucose meter
Measures amount of glucose in bloodstream
Often used by patients at home
Sometimes used by EMTs (follow local protocol)
continued
6/28/2011
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Assessment Assessment
Blood glucose measurement
Less than 6080 mg/dL in symptomatic
diabetic: hypoglycemia
Less than 50 mg/dL: significant alterations in
mental status
Over 140 mg/dL: hyperglycemia
Over 200300 mg/dL for prolonged time:
dehydration, other more serious symptoms
continued
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Assessment Assessment
Special glucometer readings
May display word instead of number
High or HI: indicates extremely high level,
usually greater than 500 mg/dL
LOW: indicates
extremely low level,
often less than
15 mg/dl
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Patient Care Patient Care
Occasionallycan treat person with mild
hypoglycemia and minor altered mental
status by simply giving something to eat
Never administer food or liquids to patient
at risk for aspiration
continued
6/28/2011
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Patient Care Patient Care
Oral glucosecriteria for administration
History of diabetes
Altered mental status
Awake enough to swallow
continued
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Patient Care
Oral glucose
Patient squeezes glucose from tube directly
into mouth
EMT can administer glucose using tongue
depressor
continued
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Patient Care Patient Care
Oral glucose
Reassess after administration
If condition does not improve, consult medical
direction about whether to administer more
6/28/2011
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Diabetes DiabetesEtiology Etiology
and Pathophysiology Video and Pathophysiology Video
Click here to view a video on the subject of the etiology and
pathophysiology of diabetes.
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Other Causes of Altered Mental Other Causes of Altered Mental
Status Status
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Seizure Disorder Seizure Disorder
If normal brain function is upset by injury,
infection, or disease, the brains electrical
activity can become irregular
Irregularity can bring about seizure:
sudden change in sensation, behavior, or
movement
Seizure is a sign of underlying defect,
injury, or disease
6/28/2011
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Tonic Tonic--Clonic Seizure Clonic Seizure
Unconsciousness and major motor activity
Tonic phasebody rigid up to 30 seconds
Clonic phasebody jerks violently for 12
minutes
Postictal phaseafter convulsions stop;
often slow period of regaining
consciousness
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Aura Aura
Some seizures preceded by aura
(sensation patient has just before it is
about to happen)
Patient may note smell, sound, or just a
general feeling right before seizure
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Partial Seizure Partial Seizure
Not all seizures present as generalized
tonic-clonic
Partial seizure: uncontrolled muscle
spasm or convulsion while patient is fully
alert
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Causes of Seizure Causes of Seizure
Hypoxia
Stroke
Traumatic brain injury
Toxins
Hypoglycemia
continued
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Causes of Seizure Causes of Seizure
Brain tumor
Congenital brain defects
Infection
Idiopathic
Epilepsy
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Scene Safety: Scene Safety:
Seizure Disorder Seizure Disorder
Multiple patients seizing at the same
timemajor red flag
Possibility of chemical weapon or similar
weapon of mass destruction
Take appropriate precautions
6/28/2011
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Assessment: Assessment:
Seizure Disorder Seizure Disorder
What was person doing before seizure
started?
Exactly what did person do during
seizure?
How long did seizure last?
What did person do after seizure?
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Patient Care: Patient Care:
When Seizure Occurs When Seizure Occurs
Place patient on floor or ground
Loosen restrictive clothing
Remove objects that may harm patient
Protect patient from injury, but do not try to
hold patient still during convulsions
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Patient Care: Patient Care:
After Convulsions End After Convulsions End
Protect airway
If no possibility of spine injury, position
patient on side
If patient is cyanotic, ensure open airway
and provide artificial ventilations with
supplemental oxygen
continued
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Patient Care: Patient Care:
After Convulsions End After Convulsions End
Seizure usually only 13 minutes long
Patient breathing adequately may be given
oxygen by mask or nasal cannula
Treat injuries patient may have sustained
during convulsions
Transport
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Status Epilepticus Status Epilepticus
Two or more convulsive seizures lasting
510 minutes or more without regaining
full consciousness
High-priority emergency requiring
immediate transport to hospital and
possible ALS intercept
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Stroke Stroke
Death or injury of brain tissue from oxygen
deprivation
Causes
Blockage of artery supplying blood to part of
the brain
Bleeding from a ruptured blood vessel in the
brain
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Signs of Stroke Signs of Stroke
One-sided weakness (hemiparesis): very
common
Headache caused by bleeding from
ruptured vessel: less common, but very
important
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Other Signs and Other Signs and
Symptoms of Stroke Symptoms of Stroke
Confusion
Dizziness
Numbness, weakness, or paralysis
(usually on one side of body)
Loss of bowel or bladder control
Impaired vision
High blood pressure
continued
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Other Signs and Other Signs and
Symptoms of Stroke Symptoms of Stroke
Difficult respiration or snoring
Nausea or vomiting
Seizures
Unequal pupils
Headache
Loss of vision in one eye
Unconsciousness (uncommon)
6/28/2011
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Communicating Communicating
with a Stroke Patient with a Stroke Patient
Often difficult to communicate with a
stroke patient
Damage to brain can cause partial or
complete loss of the ability to use words
Aphasia: general term meaning difficulty in
communication
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Transient Transient
Ischemic Attack (TIA) Ischemic Attack (TIA)
Small clots temporarily block circulation to
part of brain
Causes stroke-like symptoms
Symptoms resolve when clots break up
Complete resolution of symptoms without
treatment within 24 hours (usually much
sooner)
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Assessment: Stroke Assessment: Stroke
Cincinnati
Prehospital Stroke
Scale
Ask patient to
grimace or smile
Stroke patient more
likely to show
abnormal response
continued
6/28/2011
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Assessment: Stroke Assessment: Stroke
Cincinnati Prehospital
Stroke Scale
Ask patient to close
eyes and extend arms
straight out in front for
10 seconds
Stroke patient is more
likely to show an
abnormal response
continued
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Assessment: Stroke Assessment: Stroke
Cincinnati Prehospital Stroke Scale
Ask patient to say something: The sky is blue
in Cincinnati.
Stroke patient is more likely to give abnormal
or no response
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Patient Care: Stroke Patient Care: Stroke
For conscious patient who can maintain
airway
Calm and reassure patient
Monitor airway
Administer high-concentration oxygen
Transport patient in semi-sitting position
continued
6/28/2011
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Patient Care: Stroke Patient Care: Stroke
For unconscious patient or patient who
cannot maintain airway
Maintain open airway
Provide high-concentration oxygen
Transport with patient lying on affected side
continued
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Patient Care: Stroke Patient Care: Stroke
Transport suspected stroke patient to
hospital with capabilities for managing
stroke patient
Capabilities must include CT scan at
minimum
continued
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Patient Care: Stroke Patient Care: Stroke
Determine and document exact time of
onset of symptoms
Document contact information if person
other than patient provides time of onset
6/28/2011
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Dizziness and Syncope Dizziness and Syncope
Can indicate serious or life-threatening
problems
May be impossible to diagnose true cause
of syncope
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Dizziness Dizziness
Common term meaning different things to
different people
Vertigo: sensation of surroundings
spinning around you
Lightheadedness: sensation you are about
to pass out (pre-syncope)
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Syncope Syncope
Brief loss of consciousness with
spontaneous recovery
Typically very shorta few seconds to a
few minutes
Patients often have some warning that
syncopal episode (fainting spell) is about
to occur
6/28/2011
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Causes of Causes of
Dizziness and Syncope Dizziness and Syncope
Hypovolemic
Metabolic
Environmental/ toxicological
Cardiovascular
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Hypovolemic Causes Hypovolemic Causes
Low fluid/blood volume causes dizziness
or syncope, especially when patient
attempts to sit up or stand
Source of bleeding may not be obvious
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Metabolic and Metabolic and
Structural Causes Structural Causes
Alterations in brain chemistry or structure
can lead to diminished level of
consciousness
Inner and middle ear problems also cause
dizziness or syncope
6/28/2011
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Environmental/ Environmental/
Toxicological Causes Toxicological Causes
Alcohol and drugs can cause fluctuations
in consciousness
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Cardiovascular Causes Cardiovascular Causes
Bradycardia and tachycardia can cause
decreased cardiac output and syncope
Vasovagal syncope is thought to be the
result of stimulation of the vagus nerve,
which signals the heart to slow down;
decreased cardiac output causes syncope
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Assessment: Assessment:
Dizziness and Syncope Dizziness and Syncope
Rapidly identify and treat life threats
Gather important information that will
assist in overall treatment
Ask:
Have you had any similar episodes in the
past?
What do you mean by dizziness?
continued
6/28/2011
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Assessment: Assessment:
Dizziness and Syncope Dizziness and Syncope
Ask:
Did you have any warning?
When did it start?
How long did it last?
What position were you in when the episode
occurred?
continued
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Assessment: Assessment:
Dizziness and Syncope Dizziness and Syncope
Ask:
Are you on medication for this kind of
problem?
Did you have any other signs or symptoms;
nausea?
Did you witness any unpleasant sight or
experience a strong emotion?
Did anyone witness involuntary movements of
the extremities (like seizures)?
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Patient Care: Patient Care:
Dizziness and Syncope Dizziness and Syncope
Administer high-concentration oxygen
Call for ALS
Loosen tight clothing around neck
Lay patient flat
Treat associated injuries patient may have
incurred from fall
6/28/2011
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Think About It Think About It
Is the seizure or syncope a symptom of a
larger problem?
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Transient Transient
Ischemic Attacks Video Ischemic Attacks Video
Click here to view a video on the subject of transient ischemic attacks.
Back to Directory
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Chapter Review Chapter Review
6/28/2011
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Chapter Review Chapter Review
Diabetic emergencies are usually caused
by poor management of the patients
diabetes.
Diabetic emergencies are often brought
about by hypoglycemia, or low blood
sugar.
The chief sign of this hypoglycemia is
altered mental status.
continued
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Chapter Review Chapter Review
Whenever a patient has an altered mental
status and a history of diabetes, and can
swallow, administer oral glucose.
Seizures may have a number of causes.
Assess and treat for possible spinal injury,
protect the patients airway, and provide
oxygen as needed.
continued
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Chapter Review Chapter Review
Gather information about the seizure to
give to hospital personnel.
A stroke is caused when an artery in the
brain is blocked or ruptures.
continued
6/28/2011
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continued
Chapter Review Chapter Review
Signs and symptoms of stroke include
altered mental status, numbness or
paralysis on one side, speech difficulty.
For stroke patients, ensure open airway
and provide supplemental oxygen.
Determine exact time of onset of
symptoms and transport promptly.
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Chapter Review Chapter Review
Dizziness and syncope (fainting) may
have a variety of causes.
For syncope, administer oxygen, loosen
clothing around neck, and place patient
flat with raised legs if there is no reason
not to. Treat injuries and transport.
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Remember Remember
Determine if the patients altered mental
status is being caused by hypoxia.
In a patient with a hypoglycemic
emergency, determine whether the mental
status will allow the administration of oral
glucose.
continued
6/28/2011
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Remember Remember
Assess the seizure patient to determine
the need for artificial ventilation.
Determine when the symptoms of the
stroke began.
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Questions to Consider Questions to Consider
List the chief signs and symptoms of a
diabetic emergency.
Explain how you can determine a medical
history of diabetes.
Explain what treatment may be given by
an EMT for a diabetic emergency and the
criteria for giving it.
continued
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Questions to Consider Questions to Consider
Explain the care that should be given to a
conscious and to an unconscious patient
with suspected stroke.
Explain the care that should be given to a
patient who has experienced dizziness or
syncope.
6/28/2011
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Critical Thinking Critical Thinking
A 62-year-old male is witnessed to have a
tonic-clonic seizure. You find him actively
seizing. His skin is pale and moist and
slightly cyanotic. Discuss the immediate
treatment necessary.
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Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
22.1 Define key terms introduced in this chapter. Slides
10, 14, 19, 37, 39
22.2 Differentiate between the signs and symptoms of an
allergic reaction and an anaphylactic reaction.
Slides 1824
22.3 Describe the relationship between allergens and
antibodies necessary for an allergic reaction to
occur. Slides 1113
continued
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OBJECTIVES OBJECTIVES
22.4 Describe the effects of histamine and other
chemicals in producing the signs and symptoms of
anaphylaxis. Slides 1314
22.5 List common allergens. Slides 1516
22.6 Prioritize the steps in assessment and management
of patients with allergic and anaphylactic reactions.
Slides 2528
continued
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OBJECTIVES OBJECTIVES
22.7 Recognize the indications for administering and
assisting a patient in the use of an epinephrine auto-
injector. Slides 29, 31
22.8 Describe the desired effects and side effects
associated with the administration of epinephrine.
Slides 3738
continued
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OBJECTIVES OBJECTIVES
22.9 Demonstrate administration of epinephrine by auto-
injector. Slides 3941
22.10 Describe the considerations in reassessment of
patients with allergic and anaphylactic reactions.
Slides 3031
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MULTIMEDIA MULTIMEDIA
Slide 34 Allergic ReactionAnaphylaxis Video
Slide 35 Information About Allergic Rhinitis Video
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CORE CONCEPTS
How to identify a patient experiencing an
allergic reaction
Differences between a mild allergic
reaction and anaphylaxis
How to treat a patient experiencing an
allergic reaction
Who should be assisted with an
epinephrine auto-injector
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Topics Topics
Allergic Reactions
Self-Administered Epinephrine
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Allergic Reactions Allergic Reactions
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Allergic Reactions Allergic Reactions
Immune system naturally responds to
foreign substances in body
Allergic reaction: exaggerated response to
foreign substance
Allergen: substance causing exaggerated
effect
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Bodys Reaction to Allergen Bodys Reaction to Allergen
First exposure
Immune system forms antibodies
Antibodies identify and attack particular
foreign substance
Antibodies combine only with allergen they
were formed in response to
continued
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Bodys Reaction to Allergen Bodys Reaction to Allergen
Second (and subsequent) exposures
Antibodies exist
Antibody combines with allergen, leading to
release of histamine and other chemicals into
bloodstream
Chemicals cause harmful effects
continued
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Bodys Reaction to Allergen Bodys Reaction to Allergen
Effects of histamine and other chemicals
Inflammation (swelling)
Bronchoconstriction
Vasodilation
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Anaphylaxis Anaphylaxis
Severe, life-threatening allergic reaction
Can cause:
Dilation of blood vessels (hypotension)
Airway swelling (airway obstruction)
Bronchoconstriction (respiratory failure)
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Common Allergens Common Allergens
Insects
Foods
Plants
Medications
Others
Dust, makeup,
soap, etc.
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Latex Allergy Latex Allergy
Common concern in EMS
Many patients have latex sensitivity
Providers can develop latex allergy from
prolonged exposure
6/28/2011
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Course of Reaction Course of Reaction
No way to predict exact course of an
allergic reaction
Severe reaction often takes place
immediately, but can be delayed 30
minutes or more
Mild allergic reaction can rapidly progress
to anaphylaxis
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Signs and Signs and
Symptoms: Skin Symptoms: Skin
Swelling
Flushing (red skin)
Warm, tingling feeling
in face, mouth, chest,
feet, or hands
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Signs and Symptoms: Hives
6/28/2011
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Signs and Signs and
Symptoms: Respiratory Symptoms: Respiratory
Tightness in throat or chest
Cough
Rapid, labored, and/or noisy breathing
Hoarseness, muffled voice, loss of voice
Stridor
Wheezing
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Signs and Signs and
Symptoms: Cardiac Symptoms: Cardiac
Increased heart rate
Decreased blood pressure
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Signs and Signs and
Symptoms: Generalized Symptoms: Generalized
Itchy, watery eyes and/or runny nose
Headache
Feeling of impending doom
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Signs and Symptoms: Signs and Symptoms:
Anaphylactic Shock Anaphylactic Shock
Altered mental status
Flushed, dry skin or pale, cool, clammy
skin
Nausea or vomiting
Changes in vital signs
Increased pulse, respirations
Decreased blood pressure
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Distinguishing Anaphylaxis Distinguishing Anaphylaxis
from Mild Allergic Reaction from Mild Allergic Reaction
Any of previous signs and symptoms can
be associated with an allergic reaction
Anaphylaxis: patient has either respiratory
distress or signs and symptoms of shock
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Assessment Assessment
Primary assessment
Identify and treat life-threatening problems
Airway
Breathing
Circulation
continued
6/28/2011
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Assessment Assessment
History and physical exam
History of allergies
Exposure
What was the patient exposed to?
How (what method/route) was the patient
exposed?
Signs and symptoms
Progression
Interventions
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Treatment Treatment
Manage patients airway and breathing
Apply high-concentration oxygen
Provide artificial ventilations if patient is
not breathing adequately
Consider assisting patient with
epinephrine auto-injector
continued
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Treatment Treatment
If patient is not wheezing or showing signs
of respiratory distress or shock
Continue with assessment
Consult medical direction regarding use of
auto-injector
6/28/2011
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Use of Auto Use of Auto--Injector Injector
When use of auto-injector may be
appropriate
If patient has come in contact with substance
that caused allergic reaction in the past
If patient also has respiratory distress or
exhibits signs and symptoms of shock
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After Administering
Auto-Injector
Record administration
of auto-injector
Transport patient
Reassess
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Additional Doses Additional Doses
of Epinephrine of Epinephrine
Reassessment may show patient condition
deteriorating
Additional doses of epinephrine may be
necessary
Requires on-line medical control
Requires bringing patients additional auto-
injectors in ambulance
continued
6/28/2011
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Additional Doses of Additional Doses of
Epinephrine Epinephrine
If no auto-injector available
Request ALS intercept
Treat for shock
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Think About It Think About It
Should you administer an auto-injector for
a simple allergic reaction?
What assessment findings would indicate
the need for epinephrine?
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Allergic Reaction Allergic Reaction
Anaphylaxis Video Anaphylaxis Video
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Information About Information About
Allergic Rhinitis Video Allergic Rhinitis Video
Click here to view a video on the subject of allergic rhinitis.
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Self Self--Administered Epinephrine Administered Epinephrine
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Epinephrine Epinephrine
Commonly prescribed to patients with a
history of allergy
Auto-injectors are common for people to
carry or have at home
Hormone produced by body
Constricts blood vessels
Dilates bronchioles
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Side Effects of Epinephrine Side Effects of Epinephrine
Increased heart rate
Increased cardiac workload
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Auto Auto--Injector Injector
Spring-loaded needle and syringe with a single
dose of epinephrine
Upon administration, medication automatically
releases and injects
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Administering Auto Administering Auto--Injector Injector
Injection site typically anterior-medial thigh
(midway between waist and knee)
Remove clothing from site if possible
Use standard precautions
Remove cap
continued
6/28/2011
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Administering Auto Administering Auto--Injector Injector
Press tip of auto-injector firmly against
patients thigh
Once needle is deployed, allow full
injection of medication before removing
from injection site
Carefully discard
auto-injector into
sharps container
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Pediatric Note Pediatric Note
Two sizes of auto-injectors
Adult dose: 0.3 mg
Childrens dose (for child less than 66
pounds): 0.15 mg
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Chapter Review Chapter Review
6/28/2011
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Chapter Review Chapter Review
Allergic reactions are common.
Anaphylaxis, a true life-threatening allergic
reaction, is rare.
The most common symptom in these
cases is itching. Patients with anaphylaxis
will also display life-threatening difficulty
breathing and/or signs and symptoms of
shock.
continued
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Chapter Review Chapter Review
Patients with anaphylaxis will be extremely
anxious. Their bodies are in trouble and
are letting them know it.
The signs and symptoms of anaphylaxis
result from physiological changes:
vasodilation, bronchoconstriction, leaky
capillaries, and thick mucus.
continued
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Chapter Review Chapter Review
By quickly recognizing the condition,
consulting medical direction, and
administering the appropriate treatment,
you can literally make the difference
between life and death for these patients.
6/28/2011
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Remember Remember
In an allergic reaction, the bodys immune
system overreacts to an allergen and
causes potentially harmful side effects.
Anaphylaxis is a severe, systemic form of
allergic reaction; it is a life-threatening
emergency.
continued
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continued
Remember Remember
EMTs must use assessment to
differentiate a localized allergic reaction
from a systemic anaphylactic reaction.
Epinephrine is useful in anaphylaxis
because it constricts dilated blood vessels
and opens bronchial passages.
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Remember Remember
Epinephrine has potentially dangerous
side effects and should be used only in the
event of anaphylaxis.
6/28/2011
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Questions to Consider Questions to Consider
What are the indications for administration
of an epinephrine auto-injector?
List some of the more common causes of
allergic reactions.
continued
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Questions to Consider Questions to Consider
List signs or symptoms of an anaphylactic
reaction associated with each of the
following:
Skin
Respiratory system
Cardiovascular system
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Critical Thinking Critical Thinking
A 24-year-old male ate a meal that he
believes contained shellfish. He is allergic
to shrimp. He is sweating and nervous. He
appears to be breathing adequately. You
do not note any wheezing or stridor.
continued
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Critical Thinking Critical Thinking
His face is slightly red. His pulse is 88
strong and regular, respirations 24, blood
pressure 108/74, and skin warm and
moist. Should you administer epinephrine?
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additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
23.1 Define key terms introduced in this chapter. Slides
12, 16, 23, 31, 46, 55, 5963
23.2 Describe ways in which poisons can enter the body.
Slide 15
23.3 Identify potential dangers to EMS providers and
others at scenes where poisoning, alcohol abuse, or
substance abuse is involved. Slides 32, 35, 52, 72
continued
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OBJECTIVES OBJECTIVES
23.4 Collect key elements in the history of a patient who
has been poisoned. Slides 1720, 34
23.5 Describe the use of activated charcoal in the
management of ingested poisons. Slides 2327
23.6 Explain the management of patients who have
ingested a poison. Slides 2223
continued
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OBJECTIVES OBJECTIVES
23.7 Develop a plan for managing patients who have
inhaled poisons. Slides 35, 40, 43
23.8 Develop a plan for managing patients who have
absorbed poisons through the skin. Slide 47
23.9 Describe the health risks associated with alcohol
abuse. Slides 5052
continued
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OBJECTIVES OBJECTIVES
23.10 Recognize the signs and symptoms of alcohol
abuse and withdrawal. Slides 5456
23.11 Recognize signs, symptoms, and health risks
associated with abuse of substances, including
stimulants, depressants, narcotics, volatile
chemicals, and hallucinogens. Slides 5969
continued
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OBJECTIVES OBJECTIVES
23.12 Given a variety of scenarios, develop a treatment
plan for patients with emergencies related to alcohol
and substance abuse. 57, 7072
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MULTIMEDIA MULTIMEDIA
Slide 73 Cocaine Video
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CORE CONCEPTS
How to know if a patient has been
poisoned
Assessment and care for ingested poisons
Assessment and care for inhaled poisons
Assessment and care for absorbed
poisons
continued
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CORE CONCEPTS
Assessment of injected poisons
Assessment and care for alcohol abuse
Assessment and care for substance abuse
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Topics Topics
Poisoning
Alcohol and Substance Abuse
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Poisoning Poisoning
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Poison Poison
A poison is any substance that can harm
the body
The harm it can cause can result in a
medical emergency
All things are poison and nothing is
without poison, only the dose permits
something not to be poisonous.
Paracelsus
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Common Poisons Common Poisons
Medications
Petroleum products
Cosmetics
Pesticides
Plants
Food
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Effects of a Poison Effects of a Poison
Harm to body based on nature of poison,
concentration, route of entry, patients age
and health
Damage to skin and tissues from contact
Suffocation
Localized or systemic damage to body
systems
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Classification of Classification of
Poisons (By Routes of Entry) Poisons (By Routes of Entry)
Ingested
Inhaled
Absorbed
Injected
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Ingested Poison Ingested Poison
Child: may accidentally eat or drink a toxic
substance
Adult: often an accidental or deliberate
medication overdose
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Assessment: Assessment:
Ingested Poisons Ingested Poisons
What substance was involved?
Look for container; check labels
Transport with patient to hospital
When did exposure occur?
Quick-acting poison requires faster treatment
ER personnel need to know for appropriate
testing and treatment
continued
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Assessment: Assessment:
Ingested Poisons Ingested Poisons
How much was ingested?
Estimate missing pills by looking at
prescription label
Over how long a time?
Treatments may vary
Was medication taken for very first time?
Was medication being taken chronically?
continued
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Assessment: Assessment:
Ingested Poisons Ingested Poisons
What interventions have been taken?
Treatments indicated on label,
Other home remedies (syrup of ipecac)
What is patients weight?
Rate of onset of toxic effects is related to
weight
continued
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499
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Assessment: Assessment:
Ingested Poisons Ingested Poisons
What effects has patient experienced?
Nausea, vomiting, altered mental status,
abdominal pain, diarrhea, chemical burns
around mouth, unusual breath odors
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Food Poisoning Food Poisoning
Can be caused by improperly handled or
prepared food
Symptoms: nausea, vomiting, abdominal
cramps, diarrhea, fever
May occur within hours of ingestion, or a
day or two later
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Treatment Treatment:: Food Poisoning Food Poisoning
Activated Charcoal
Antidotes
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Activated Charcoal Activated Charcoal
Works through adsorption, allowing
substances to attach to its surface
Not an antidote: prevents or reduces
amount of poison absorbed by body
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Treatment: Activated Charcoal Treatment: Activated Charcoal
continued
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Treatment: Activated Charcoal Treatment: Activated Charcoal
continued
6/28/2011
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Treatment: Activated Charcoal Treatment: Activated Charcoal
continued
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Treatment: Activated Charcoal Treatment: Activated Charcoal
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Think About It Think About It
Think about your own home. Is it safe for a
small child?
Are there potential poisons within three
feet of the floor, or behind unlocked doors?
Are there household cleaners that look like
juices and drinks familiar to children?
continued
6/28/2011
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Think About It Think About It
Can flavored childrens medications be
mistaken for candy?
What sense does a small child typically
use to identify things?
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Public Education Public Education
Many EMS agencies are involved in
educating the public to the dangers of
child poisoning
Child-proofing homes
Mr. Yuk
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Inhaled Poisons Inhaled Poisons
Common types
Carbon monoxide
Ammonia
Chlorine
Agricultural chemicals and pesticides
Carbon dioxide
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503
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Scene Safety Scene Safety
Approach scene with
caution
Protective clothing
and self-contained
breathing apparatus
may be required
If not trained or
equipped, call for
additional resources
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Signs and Signs and
Symptoms: Inhaled Poisons Symptoms: Inhaled Poisons
Difficulty breathing
Chest pain
Coughing
Hoarseness
Headache, confusion, altered mental
status
Seizures
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Assessment: Inhaled Poisons Assessment: Inhaled Poisons
What substance is involved (exact name)?
When did exposure occur?
Over how long did exposure occur?
What interventions has anyone taken?
Remove patient?
Ventilate area?
What effects is patient experiencing?
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Treatment: Inhaled Poisons Treatment: Inhaled Poisons
Move patient from unsafe environment
using trained and equipped personnel
Open airway; provide high flow oxygen
History, physical exam, vital signs
Transport with all containers, bottles, and
labels
Ongoing assessment en route
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Carbon Monoxide Carbon Monoxide
(CO) Poisoning (CO) Poisoning
Colorless, odorless, tasteless gas created
by combustion
Can be caused by improper venting of
fireplaces, portable heaters, generators
Common cause of death during winter and
power outages
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Signs and Signs and
Symptoms: CO Poisoning Symptoms: CO Poisoning
Headache (band around head)
Dizziness/nausea
Breathing difficulty
Cyanosis
May be multiple patients with similar
symptoms in confined area together
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CO Monitor CO Monitor
Some fire/EMS
systems have
monitoring devices
that allow crews to
determine CO
exposure levels in
the field
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CO Detectors CO Detectors
Public education programs should
encourage people to have both smoke and
CO detectors in their homes to reduce the
risk of injury and death
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Treatment: CO Poisoning Treatment: CO Poisoning
High flow oxygen is appropriate treatment,
but CO bonds to red blood cells much
more strongly than oxygen does
Can take several hours or days to wash
CO from bloodstream
6/28/2011
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Smoke Inhalation Smoke Inhalation
Smoke from burning materials can contain
poisonous and toxic substances, including
CO, ammonia, chlorine, cyanide
Substances can irritate skin and eyes,
damage lungs, and progress to respiratory
or cardiac arrest
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Signs and Signs and
Symptoms: Smoke Inhalation Symptoms: Smoke Inhalation
Difficulty breathing
Coughing
Smoky or chemical smell on breath
Black (carbon) residue in mouth, nose or
sputum
Singed nasal or facial hair
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Treatment: Smoke Inhalation Treatment: Smoke Inhalation
Move patient to safe area
Maintain airway; provide high flow oxygen
Monitor patient closelyairway burns may
lead to swelling of airway
6/28/2011
507
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Detergent Suicides Detergent Suicides
Method of suicide started in Japan and
becoming more common in the U.S.
Mix two easily-obtained chemicals to
release hydrogen sulfide gas
Commonly released inside enclosed
space such as a car
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Detergent Suicides: Detergent Suicides:
Scene Safety Scene Safety
Exposure to fumes may injure EMS
personnel
Warning note may be left on vehicle, but
this is not assured
May need to treat first as a hazmat scene
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Absorbed Poisons Absorbed Poisons
Can be absorbed through skin
May or may not cause damage to skin
Patient may require decontamination prior
to treatment
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Treatment: Absorbed Poisons Treatment: Absorbed Poisons
Assess for immediate life threats
History, physical exam, vital signs
Brush off powder, then irrigate
Irrigate skin and eyes for at least 20
minutes and during transport
Transport with all containers
Ongoing assessment en route
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Poison Control Centers Poison Control Centers
Excellent resource
Information on poisons, signs and
symptoms, and treatments
Follow local protocol for contact
procedures
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Alcohol and Substance Abuse Alcohol and Substance Abuse
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509
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Alcohol and Substance Abuse Alcohol and Substance Abuse
See many patients whose conditions are
caused either directly or indirectly by
alcohol or substance abuse
Abuse of alcohol and other drugs crosses
all geographic and economic boundaries
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Alcohol Abuse Alcohol Abuse
Potent drug affects central nervous system
Can be addictive
Emergencies may result from recent
consumption or years of abuse
Treat patients as any others
Abuse can lead to or worsen other medical
conditions
continued
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Alcohol Abuse Alcohol Abuse
Alcohol often consumed with other drugs,
which can result in a serious medical
emergency
Impaired patients can be uncooperative or
combative
Contact law enforcement if safety concern
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Assessment: Alcohol Abuse Assessment: Alcohol Abuse
Many medical conditions mimic alcohol
intoxication
Intoxicated patients may also have
medical problems
All patients receive full assessment
regardless of suspicion of intoxication
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Signs and Signs and
Symptoms: Alcohol Abuse Symptoms: Alcohol Abuse
Alcohol odor on breath
Unsteady on feet
Slurred, rambling speech
Flushed, complaining of being warm
Nausea/vomiting
Poor coordination
Blurred vision
Confusion/altered mental status
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Alcohol Withdrawal Alcohol Withdrawal
Abrupt cessation of drinking may cause
some alcoholics to suffer from delirium
tremens (DTs)
Can be serious, resulting in tremors,
hallucinations, and seizures
6/28/2011
511
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Signs and Signs and
Symptoms: Alcohol Withdrawal Symptoms: Alcohol Withdrawal
Confusion and restlessness
Unusual behavior, demonstrating insane
behavior
Hallucinations, gross tremor of hands,
profuse sweating
Seizures
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Patient Care: Alcohol Abuse Patient Care: Alcohol Abuse
Vomiting common; standard precautions
are essential
Keep suction ready
Stay alert for airway and respiratory
problems
Monitor vital signs
Gather history from patient, bystanders
Stay alert for seizures
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Substance Abuse Substance Abuse
Any chemical substance taken for other
than therapeutic (medical) reasons
Includes illicit
drugs, prescription
medications,
industrial
chemicals
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Uppers Uppers
Stimulants that affect the nervous system
Cocaine
Amphetamines
May be snorted, smoked, or injected
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Downers Downers
Central nervous system depressants
Barbiturates
Rohypnol (Roofies)
GHB
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Narcotics Narcotics
Used to relieve pain or help with sleep
Opiates
Heroin, codeine, morphine
Oxycodone
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Hallucinogens Hallucinogens
Create intense state of excitement and
distorted perception
LSD, PCP, XTC
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Volatile Chemicals Volatile Chemicals
Produce vapors
that are inhaled
Initial rush, then
can act as central
nervous system
depressant
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Assessment: Assessment:
Substance Abuse Substance Abuse
May be difficult
Patients level of consciousness
Patient may have taken more than one type of
drug
Patient may be uncooperative or
combative
Be aware of a possibility of contaminated
needles and the presence of chemicals
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Signs and Symptoms: Downers Signs and Symptoms: Downers
Sluggishness, poor coordination
Decreased pulse and respirations
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Signs and Signs and
Symptoms: Uppers Symptoms: Uppers
Excitement, restlessness
Increased pulse and respirations
Sweating
Hyperthermia
No sleep for a long time, possibly days
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Signs and Signs and
Symptoms: Narcotics Symptoms: Narcotics
Lethargy (patient very sleepy)
Pinpoint pupils
Cool skin
Respiratory depression
Coma
6/28/2011
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Signs and Signs and
Symptoms: Hallucinogens Symptoms: Hallucinogens
Rapid pulse
Dilated pupils
Flushed face
Seeing or hearing things
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Signs and Signs and
Symptoms: Volatile Chemicals Symptoms: Volatile Chemicals
Dazed/disoriented
Swollen membranes in nose or mouth
Numbness or tingling sensation inside
head
Changes in heart rhythm
May be residue of chemical on face or in
bag
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Treatment: Substance Abuse Treatment: Substance Abuse
Be aware of possible airway problems and
respiratory distress
Provide oxygen and assist respirations as
needed
Treat for shock
Talk to patient to keep them calm and
cooperative
continued
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Treatment: Substance Abuse Treatment: Substance Abuse
Perform physical
exam
Look for evidence
of injection sites
(track marks)
continued
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Treatment: Substance Abuse Treatment: Substance Abuse
Transport as soon as possible
Consult with medical control on further
treatment
Follow local protocol concerning
consideration for restraint
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Cocaine Video Cocaine Video
Click here to view a video on the subject of cocaine dependency.
Back to Directory
6/28/2011
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Perform primary assessment and
immediately treat life-threatening
problems. Ensure an open airway.
Administer high-concentration oxygen if
the poison was inhaled or injected.
continued
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continued
Chapter Review Chapter Review
Perform a history and physical exam,
including baseline vital signs. Find out if
the poison was ingested, inhaled,
absorbed, or injected; what substance was
involved; how much poison was taken in,
when, and over how long a period; what
interventions others have already done;
and what effects the patient experienced.
6/28/2011
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Chapter Review Chapter Review
Consult medical direction. As directed,
administer activated charcoal, water, or
milk for ingested poisons.
Remove patient who has inhaled poison
from the environment and administer high-
concentration oxygen; remove poisons
from skin by brushing off or diluting.
continued
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Chapter Review Chapter Review
Transport patient with all containers,
bottles, and labels from substance.
Reassess patient en route.
Carefully document all information about
poisoning, interventions, and patients
responses.
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Remember Remember
Safety is always the first concern when
dealing with a poisoning or substance-
abuse patient.
Poisonings are generally classified by
route of exposure. Effects vary greatly,
depending upon type of poison and
method of entrance into body.
continued
6/28/2011
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Remember Remember
EMTs must use thorough assessment,
including scene clues, to help identify the
nature and severity of poisoning.
Poison control centers offer a wealth of
resources to assist in assessment and
treatment of poisoning patient.
continued
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Remember Remember
Alcohol is a common underlying issue with
patients. In some patients it may be the
most significant problem.
The effects of substance abuse can vary
greatly, based on the type of substance.
Determining the type of drug ingested can
shed light on effects to come.
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Questions to Consider Questions to Consider
What are potential risks to the responder
on a poisoning or overdose call?
What are the routes of entry into the body?
What are some things EMS can do to
prevent poisonings, especially in children?
6/28/2011
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Critical Thinking Critical Thinking
A farmer calls 911 because one of his farm
hands has tried to clean up spilled
pesticide powder with his hands. On
arrival, you find that the patient insists he
has brushed all the powder off, feels fine,
and doesnt need to go to the hospital.
continued
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Critical Thinking Critical Thinking
As he talks, he continues to make
brushing motions at his jeans on which
you can see the marks of a powdery
residue. How do you manage the
situation?
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
24.1 Define key terms introduced in this chapter. 13, 15,
18, 2022
24.2 Describe the location, structure, and function of the
organs in the abdominal cavity. Slides 1116
24.3 Explain the origins and characteristics of visceral,
parietal, and tearing pain. Slides 18, 2122
continued
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OBJECTIVES OBJECTIVES
24.4 Associate areas of referred pain with the likely
origins of the pain. Slide 21
24.5 Recognize the common signs and symptoms of
abdominal conditions, including appendicitis,
peritonitis, cholecystitis, pancreatitis, ulcers,
abdominal aortic aneurysm, hernia, and renal colic.
Slides 2435
continued
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OBJECTIVES OBJECTIVES
24.6 Discuss the type of abdominal pain that may
indicate cardiac involvement. Slide 36
24.7 Discuss appropriate assessment and management
of patients complaining of abdominal pain. Slides
3847
continued
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OBJECTIVES OBJECTIVES
24.8 Elicit key information in the history of patients
complaining of abdominal pain, including history
specific to female patients. Slides 4143
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MULTIMEDIA MULTIMEDIA
Slide 50 Abdominal Aortic Aneurysm Video
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CORE CONCEPTS
Understanding the nature of abdominal
pain
Becoming familiar with abdominal
conditions that may cause pain or
discomfort
How to assess and care for patients with
abdominal pain
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Topics Topics
Abdominal Anatomy and Physiology
Abdominal Pain or Discomfort
Abdominal Conditions
Assessment and Care of Abdominal Pain
or Discomfort
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Introduction Introduction
Abdomen contains many organs, from
several different body systems
Can cause confusion when determining
the cause of abdominal emergencies
Thorough patient assessment key
Specific diagnosis may not be necessary;
treatment is the same for most conditions
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Abdominal Anatomy and Abdominal Anatomy and
Physiology Physiology
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Abdomen Abdomen
Region between diaphragm and pelvis
Contains many organs and organ systems
Digestive
Reproductive
Endocrine
Regulatory
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Organs of the Abdomen Organs of the Abdomen
continued
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Organs of the Abdomen Organs of the Abdomen
Peritoneum: thin membrane lining the
abdominal cavity and covering each organ
Parietal peritoneum lines abdominal cavity
Visceral peritoneum covers each organ
continued
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Organs of the Abdomen Organs of the Abdomen
Most enclosed within parietal peritoneum
A few lie in extra-peritoneal space (outside
the peritoneum)
Kidneys, pancreas, part of aorta lie in
retroperitoneal space, behind peritoneum
Bladder and part of rectum lie inferior to
peritoneum
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Peritoneal and Peritoneal and
Extraperitoneal Space Extraperitoneal Space
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Abdominal Quadrants Abdominal Quadrants
Abdomen divided
into quadrants
RUQ, LUQ, RLQ,
LLQ
Epigastric region
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Abdominal Pain or Discomfort Abdominal Pain or Discomfort
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Visceral Pain Visceral Pain
Originates from the visceral peritoneum
Fewer nerve endings allow for only diffuse
sensations of pain
Frequently described as dull or achy
continued
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Visceral Pain Visceral Pain
Colic (intermittent pain) may result from
distention and/or contraction of hollow
organs
Persistent or constant pain often originates
from solid organs
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Parietal Pain Parietal Pain
Originates from the parietal peritoneum
Many nerve endings allow for specific,
efficient sensations of pain
Frequently described as sharp
Pain is often severe, constant, and
localized to a specific area
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Referred Pain Referred Pain
Perception of pain in skin or muscles at
distant locations
Abdomen has many nerves from different
parts of the nervous system
Nerve pathways overlap as they return to the
spinal cord
Pain sensation is transmitted from one system
to another
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Tearing Pain Tearing Pain
Originates in the aorta
Separation of layers of this large blood
vessel caused by aneurysm
Retroperitoneal location of aorta causes
pain to be referred to back
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Abdominal Conditions Abdominal Conditions
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Appendicitis Appendicitis
Infection of appendix
Appendectomy is usually indicated
Signs and symptoms
Persistent RLQ pain
Pain often initially referred to umbilical region
Rupture of appendix
Sudden, severe increase in pain
Contents released into abdomen causes severe
peritonitis
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Peritonitis Peritonitis
Irritation of peritoneum, usually caused by
foreign material in peritoneal space
Parietal peritoneum is sensitive, especially
to acidic substances
Irritation causes involuntary contraction of
abdominal muscles
Signs and symptoms
Abdominal pain and rigidity
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Cholecystitis Cholecystitis
Inflammation of the gallbladder
Often caused by blockage of its outlet by
gall stones (cholecystolithiasis)
Symptoms often worsened by ingestion of
fatty foods
Signs and symptoms
Sharp RUQ or epigastric pain
Pain often referred to shoulder
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Pancreatitis Pancreatitis
Inflammation of the pancreas
Common with chronic alcohol abuse
Signs and symptoms
Epigastric pain
Often referred to back or shoulder
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Gastrointestinal (GI) Bleeding Gastrointestinal (GI) Bleeding
Hemorrhage within the lumen of the GI
tract
May be minor to severe
Blood eventually exits (mouth or rectum)
Often painless
Gastric ulcers (holes in GI system from
highly acidic gastric juices) can cause
severe pain and peritonitis
continued
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Gastrointestinal (GI) Bleeding Gastrointestinal (GI) Bleeding
Signs and symptoms
Dark-colored stool (maroon to black), often
tarry (Melena)
Frank blood from rectum (hemorrhoid)
Vomiting coffee ground appearing blood
Vomiting frank blood
Pain: absent to severe
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Abdominal Aortic Abdominal Aortic
Aneurysm (AAA) Aneurysm (AAA)
Weakening of inner wall of the aorta
Tears and separates from outer layers
(dissection)
Weakened vessel bulges, may continue to
grow
May eventually rupture
continued
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Abdominal Aortic Abdominal Aortic
Aneurysm (AAA) Aneurysm (AAA)
Signs and symptoms
Progressive (often tearing) abdominal pain
Frequently radiates to back (lumbar)
Palpable abdominal mass, possibly pulsating
Possible inequality in pedal pulses
continued
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Abdominal Aortic Abdominal Aortic
Aneurysm (AAA) Aneurysm (AAA)
Signs and symptoms
Sudden, severe increase in pain may indicate
rupture
High aortic pressure causes rapid internal bleeding
Sudden progression of shock
Likely exsanguination (fatal hemorrhage)
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Hernia Hernia
Hole in the abdominal wall, allowing tissue
or parts of organs (commonly intestines) to
protrude under skin
May be precipitated by heavy lifting
May cause strangulation of tissue or bowel
obstruction
May require surgical repair
continued
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Hernia Hernia
Signs and symptoms
Sudden onset of abdominal pain, often
following exertion
Palpable mass or lump on abdominal wall or
crease of groin (inguinal hernia)
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Renal Colic Renal Colic
Severe pain caused by kidney stones
traveling down the ureter
Signs and symptoms
Severe, cramping, intermittent pain in flank or
back
Frequently referred to groin
Nausea, vomiting
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Cardiac Involvement Cardiac Involvement
Pain of myocardial infarction can produce
Nausea or vomiting
Epigastric pain
Indigestion
Always consider the possibility of a cardiac
emergency as a cause of abdominal
symptoms
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Assessment and Care of Assessment and Care of
Abdominal Pain or Discomfort Abdominal Pain or Discomfort
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Assessment and Care of Assessment and Care of
Abdominal Pain or Discomfort Abdominal Pain or Discomfort
Many potential causes of abdominal pain
Role of EMT is not to diagnose
Focus efforts
Perform thorough history and physical exam
Identify serious or life-threatening conditions
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Scene Size Scene Size--Up Up
Protect self from blood-borne pathogens
Be aware of odors
Determine if patients condition is medical,
trauma, or both
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Primary Assessment Primary Assessment
General impression
ABCs
Level of consciousness
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History of the Present Illness History of the Present Illness
O: When did it begin? What were you doing?
P: What makes it better or worse? Movement?
Position?
Q: Describe your discomfort.
R: Point to its location. Does it radiate or
move?
S: How bad is the pain on a scale of 110?
T: Do you have pain all the time? Is it
intermittent? Has it changed?
continued
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History of the Present Illness History of the Present Illness
Female patients
Where in your cycle are you?
Is your period late?
Are you experiencing vaginal bleeding?
Is your flow normal?
Have you experienced this pain before?
Is it possible you are pregnant?
Are you using birth control?
6/28/2011
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Past Medical History Past Medical History
S: Symptoms
A: Allergies
M: Medications
P: Pertinent past history
L: Last oral intake
E: Events leading to emergency
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Geriatric Note: Assessment Geriatric Note: Assessment
Decreased ability to perceive pain
More serious causes of abdominal pain
More likely to be life-threatening
May be complicated by medications
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Physical Exam Physical Exam
Inspection
Distention
Discoloration
Protrusions
Palpation (use fingertips; painful area last)
Rigidity
Pain
Guarding
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Vital Signs Vital Signs
Baseline, then every 5 minutes
Pulse
Blood pressure
Respirations
Skin condition, color, temperature
Mental status
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Patient Care Patient Care
Maintain airway
Be prepared to suction
Administer oxygen
15 LPM via NRB
Position of comfort
LLR for airway protection
Transport to appropriate facility
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Think About It Think About It
An 89-year-old female with a history of
diabetes, hypertension, and gallstones is
complaining of nausea and dizziness
about 20 minutes after eating.
continued
6/28/2011
537
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Think About It Think About It
What are the concerns with this patient?
Is this an abdominal emergency, a diabetic
emergency, or a cardiac emergency?
How will you know?
What will your treatment be?
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Abdominal Aortic Abdominal Aortic
Aneurysm Video Aneurysm Video
Click here to view a video on the subject of abdominal
aortic aneurysm.
Back to Directory
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Chapter Review Chapter Review
6/28/2011
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Chapter Review Chapter Review
Abdominal complaints must be treated as
serious emergencies requiring transport.
Diagnosis is difficult; your responsibility is
to assess the patient and report findings.
Assessment should include thorough
history, physical exam, and vital signs.
continued
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Chapter Review Chapter Review
Quickly identify life-threatening
emergencies: aneurysms, internal
bleeding, shock.
Care consists of airway management,
oxygen, positioning, transport.
Use standard precautions, including
disinfecting equipment.
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Remember Remember
Abdominal organs provide a variety of
important functions to the body.
The abdomen can be divided into four
quadrants, with reference to the midline
and umbilicus.
Classifications of pain can help identify
specific abdominal dysfunctions.
continued
6/28/2011
539
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Remember Remember
Assessment and management always
take a higher priority than determining the
exact cause of abdominal pain.
Knowledge of the characteristics of
specific abdominal disorders can aid
differential diagnosis when assessing a
patient with abdominal pain.
continued
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Remember Remember
Care for a patient with abdominal pain
should include treatment of immediate life
threats, administration of oxygen, placing
patient in a position of comfort, and
appropriate transport.
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Questions to Consider Questions to Consider
What are five signs and symptoms of
abdominal distress?
Describe the difference between visceral
and parietal pain. Describe a condition that
may be responsible for each.
continued
6/28/2011
540
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Questions to Consider Questions to Consider
What is the emergency care for a patient
experiencing abdominal pain or distress?
Name the four abdominal quadrants. How
are the quadrants determined?
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Critical Thinking Critical Thinking
You are called to a patient with abdominal
pain. He describes the pain as severe and
says it has been on and off over the past
several days, becoming severe within the
last hour.
continued
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Critical Thinking Critical Thinking
What additional questions would you ask
the patient?
In what position would he likely be most
comfortable?
6/28/2011
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Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
25.1 Define key terms introduced in this chapter. Slides
13, 3637
25.2 Recognize behaviors that are abnormal in a given
context. Slide 13
25.3 Discuss medical and traumatic conditions that can
cause unusual behavior. Slides 1415
continued
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OBJECTIVES OBJECTIVES
25.4 For a patient whose abnormal behavior appears to
be caused by stress, discuss techniques to calm the
patient and gain his cooperation. Slides 1617
continued
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OBJECTIVES OBJECTIVES
25.5 Discuss the assessment of a patient who appears to
be suffering from a behavioral or psychiatric
emergency. Slide 21
25.6 Discuss the steps in managing a patient presenting
with a behavioral or psychiatric emergency. Slides
2223
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OBJECTIVES OBJECTIVES
25.7 Describe factors often associated with a risk of
suicide. Slide 24
25.8 Discuss care for a patient who is a potential or
attempted suicide. Slides 2526
25.9 Recognize indications that a patient may become
violent. Slide 29
continued
6/28/2011
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OBJECTIVES OBJECTIVES
25.10 Explain considerations in using force and restraint
when managing behavioral emergency calls. Slides
3235
25.11 Explain considerations when faced with a behavioral
emergency patient who refuses treatment and
transport. Slide 39
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MULTIMEDIA MULTIMEDIA
Slide 41 SafetyRestraints Video
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CORE CONCEPTS
The nature and causes of behavioral and
psychiatric emergencies
Emergency care for behavioral and
psychiatric emergencies
Emergency care for potential or attempted
suicide
continued
6/28/2011
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CORE CONCEPTS
Emergency care for aggressive or hostile
patients
How to restrain a patient safely and
effectively
Medical/legal considerations in behavioral
and psychiatric emergencies
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Topics Topics
Behavioral and Psychiatric Emergencies
Emergency Care for Behavioral or
Psychiatric Emergencies
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Introduction Introduction
Patients may present
with unexpected or
dangerous behavior
May result from
Stress
Physical trauma or
illness
Drug or alcohol abuse
Psychiatric condition
6/28/2011
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Behavioral and Psychiatric Behavioral and Psychiatric
Emergencies Emergencies
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What Is a What Is a
Behavioral Emergency? Behavioral Emergency?
Behavior
Manner in which a person acts or performs
Behavioral emergency
Abnormal behavior (in a given situation)
unacceptable or intolerable to patient, family,
or community
Behavioral patients may appear confused
and have altered mental status
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Psychiatric Causes of Psychiatric Causes of
Behavioral Emergencies Behavioral Emergencies
Psychiatric condition (mental disorder)
Anxiety or panic disorder
Depression
Bipolar disorder
Schizophrenia
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Physical Causes of Physical Causes of
Behavioral Emergencies Behavioral Emergencies
Non-psychiatric
causes of altered
mental status can
be life-threatening
and must be
considered first
Altered
Mental
Status
Hypoglycemia
Hypoxia
Stroke
Headtrauma
Substance
abuse
Hypothermia
Hyperthermia
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Situational Stress Reactions Situational Stress Reactions
Normal reactions to stressful situations
produce emotions
Fear
Grief
Anger
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Caring for Patients Caring for Patients
with Situational Stress Reactions with Situational Stress Reactions
Do not rush
Tell patient you are there to help
Remain calm
Keep emotions under control
Listen to patient
Be honest
Stay alert for changes in behavior
6/28/2011
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Emergency Care for Behavioral Emergency Care for Behavioral
or Psychiatric Emergencies or Psychiatric Emergencies
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Behavioral and Behavioral and
Psychiatric Patient Presentations Psychiatric Patient Presentations
Range of presentations
Withdrawn, not communicating
Talkative, agitated
Bizarre or threatening behavior
Wish to harm selves or others
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General Rules for Interactions General Rules for Interactions
Identify yourself and role
Speak slowly and clearly
Eye contact
Listen
Dont judge
Open, positive body language
Dont enter patients space (3 ft)
Alert for behavior changes
6/28/2011
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Assessment Assessment
Perform careful scene size-up
Identify yourself and your role
Perform primary assessment
Perform focused physical exam
Gather thorough history
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Common Patient Presentations Common Patient Presentations
Panic or anxiety
Unusual appearance (disordered clothing,
poor hygiene)
Agitated or unusual activity
Unusual speech patterns
Bizarre behavior or thought patterns
Self-destructive behavior
Violence or aggressive behavior
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Patient Care Patient Care
Treat life-threatening problems
Consider medical or traumatic causes
Follow general rules for positive
interactions
Encourage patient to discuss feelings
Never play along with hallucinations
Consider involving family or friends
6/28/2011
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Suicide Suicide
Eighth leading
cause of death
Third leading
cause in 1524-
year-olds
Rising numbers in
geriatric population
Suicide
Factors
Depression
Age
Suicide Plan
Stress levels
Sudden
Improve-
ment
Recent
emotional
trauma
Substance
Abuse
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Suicide Patient Assessment Suicide Patient Assessment
Explore the following possibilities
Depression
High stress levels (current or recent)
Recent emotional trauma
Age (1525 and 40+ highest risk)
Drug or alcohol abuse
Threats of suicide
Suicide plan
Previous attempts or threats
Sudden improvement from depression
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Suicide Patient Care Suicide Patient Care
Personal interaction is important
Do not argue, threaten, or indicate using
force
1. Scene safety
2. Identify, treat life-threatening problems
3. Perform history, physical exam
Detailed exam only if safe
4. Reassess frequently
5. Notify receiving facility
6/28/2011
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Think About It Think About It
Patient is 23-year-old male. His girlfriend
called 911 after a domestic dispute. He is
uncooperative and refusing treatment. The
girlfriend reports patient is depressed and
suicidal. He owns a gun and has
threatened to shoot himself.
continued
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Think About It Think About It
Can you treat the patient if he did not call?
Should you believe the girlfriend?
Does the patient need treatment or
transport?
Can you treat and transport the patient
against his will?
What should you do?
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Aggressive or Aggressive or
Hostile Patients Hostile Patients
Consider clues
Dispatch information
Information from family or bystanders
Patients stance or position in room
Ensure escape route
Do not threaten patient
Stay alert for weapons of any type
6/28/2011
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Aggressive or Aggressive or
Hostile Patient Assessment Hostile Patient Assessment
Ensure safety
Calm patient
Perform a thorough assessment
Restrain patient if necessary
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Aggressive or Aggressive or
Hostile Patient Care Hostile Patient Care
Scene size-up
Request additional help if necessary
Seek advice from medical control if
necessary
Watch for sudden changes in behavior
Reassess frequently
Consider restraint
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Reasonable Reasonable
Force and Restraint Force and Restraint
Reasonable force: force necessary to
keep patient from injuring self or others
Reasonable determined by
Patients size and strength
Type of behavior
Mental status
Available methods of restraint
continued
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Reasonable Reasonable
Force and Restraint Force and Restraint
Some systems do not
allow restraint without
police or medical
control orders
Never attempt
restraint without
proper legal authority
and sufficient
assistance
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Restraining a Patient Restraining a Patient
Have adequate help
Plan actions
Stay beyond patients reach until prepared
Act quickly
One EMT talks to and calms patient
Requires four persons, one at each limb
Restrain all limbs with approved leather
restraints in supine position ALWAYS
continued
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Restraining a Patient Restraining a Patient
EMT is responsible for restrained patients
airway
Ensure patient is adequately secured
throughout transport
Apply a surgical mask to spitting patients
Reassess frequently
Document thoroughly
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Excited Delirium Excited Delirium
Extremely agitated or psychotic behavior
during struggle, followed by cessation of
struggling, respiratory arrest, then death
Patient is often hyperthermic and shouting
incoherently
Usually preceded by cocaine use
continued
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Excited Delirium Excited Delirium
Often linked to improper restraint in a
position where patient cannot expand
chest to breathe adequately (positional
asphyxia)
Be alert for this sequence of events
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Transport to Transport to
Appropriate Facility Appropriate Facility
Not all hospitals are prepared to treat
behavioral emergencies
Choose correct facility based on
capabilities and local protocol
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Medical/Legal Considerations Medical/Legal Considerations
Consent
Refusals and restraints cause significant
medical/legal risk
Laws typically allow providers to treat and
transport patients against their will if a danger
to selves or others
Local protocol may require medical control
contact and/or police presence
continued
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Medical/Legal Considerations Medical/Legal Considerations
Sexual misconduct
Behavioral patients, especially those requiring
physical contact such as restraint, sometimes
accuse EMS providers
Have same-sex provider attend to patient
Have third-party witness present at all times,
on scene and during transport
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Safety SafetyRestraints Video Restraints Video
Click here to view a video on the subject of proper use of
soft restraints.
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Ensure your own safety when caring for
violent or potentially violent patients.
Patients with behavioral problems are in
crisis and need compassionate care.
Always consider abnormal behavior to be
altered mental status, with a medical or
traumatic cause.
continued
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Chapter Review Chapter Review
Because treatment of these patients
usually requires long-term management,
little medical intervention can be done in
the acute situation, but how you interact
with them is crucial for their continued
well-being.
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Remember Remember
Safety is the first priority when
approaching a patient with altered mental
status.
Psychiatric and behavioral emergencies
are prevalent in our society. EMTs should
treat them as they would any other
potentially life-threatening disorder.
continued
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Remember Remember
Assessment of altered mental status
should rule out physical causes first.
Psychiatric and behavioral emergencies
can present differently, depending upon
the disorder. There are best practices
EMTs employ in approaching, assessing,
and treating such patients.
continued
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Remember Remember
Follow local protocols and use appropriate
procedures to restrain patients when
necessary.
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Questions to Consider Questions to Consider
What methods help calm the patient
suffering a behavioral or psychiatric
emergency?
What can you do when scene size-up
reveals it is too dangerous to approach the
patient?
What factors help assess the patients risk
for suicide?
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Critical Thinking Critical Thinking
You respond to an intoxicated minor who
is physically aggressive, threatens suicide,
and whose parents permit you to treat, but
not transport the patient. How would you
manage this patient?
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www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
26.1 Define key terms introduced in this chapter. Slides
1314, 2122, 2426, 31
26.2 Describe the structure and function of the
hematologic system. Slides 1112
26.3 Identify medications that can interfere with blood
clotting. Slide 12
continued
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OBJECTIVES OBJECTIVES
26.4 Explain the pathophysiology and complications of
sickle cell anemia. Slides 1415
26.5 Discuss assessment and management for patients
with emergencies related to sickle cell anemia.
Slide 16
26.6 Describe the structure and function of the renal
system. Slide 20
continued
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OBJECTIVES OBJECTIVES
26.7 Describe the causes and consequences of acute
and chronic renal failure. Slides 2122
26.8 Explain the purpose of hemodialysis and peritoneal
dialysis. Slides 2426
continued
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continued
OBJECTIVES OBJECTIVES
26.9 Recognize patients with complications of end-stage
renal disease, dialysis, and missed dialysis. Slides
2730
26.10 Provide treatment for patients with complications of
end-stage renal disease, dialysis, and missed
dialysis. Slide 31
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OBJECTIVES OBJECTIVES
26.11 Describe special considerations for patients who
have received a kidney transplant. Slide 32
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MULTIMEDIA MULTIMEDIA
Slide 18 Sickle Cell Anemia Video
Slide 33 Information About Renal Failure Video
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CORE CONCEPTS
Disorders of the hematologic system
Disorders of the renal system
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Topics Topics
The Hematologic System
The Renal System
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The Hematologic System The Hematologic System
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Blood Blood
Represents its own organ system
Has specific functions
Clotting
Delivery of oxygen and removal of CO
2
Removal and delivery of waste products to
organs that remove them
continued
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Blood Blood
Made up of solid components
Red blood cells
White blood cells
Platelets
Plasma
Medications can affect some components
of blood
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Anemia Anemia
Lower-than-normal amount of red blood
cells
Acute anemia
Sudden blood loss
Chronic
Excessive menstrual periods
Slow gastrointestinal bleeding
Diseases affecting bone marrow
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Sickle Cell Anemia Sickle Cell Anemia
Genetic disease affecting RBCs
More prevalent in certain ethnicities
African Americans
Indian or Middle Eastern descent
Defective shape resembles a sickle
Cells have a short life span leading to
anemia
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Complications of Complications of
Sickle Cell Anemia Sickle Cell Anemia
Destruction of spleen
Sickle pain crisis
Acute chest syndrome
Priapism
Stroke
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Treatment of Treatment of
Sickle Cell Anemia Sickle Cell Anemia
High flow
supplemental oxygen
Monitor for respiratory
distress
Monitor for signs of
hypoperfusion
Transport to stroke
center if stroke is
suspected
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Think About It Think About It
One in twelve African Americans have the
sickle cell trait.
Sickle cell trait doesnt always lead to
complications.
Possible to lead a normal life with sickle
cell trait.
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Sickle Cell Anemia Video Sickle Cell Anemia Video
Click here to view a video on the subject of sickle cell anemia.
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The Renal System The Renal System
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Components and Functions Components and Functions
Components
Two kidneys
Two ureters
One urethra
Responsible for filtering blood and
removing waste
Maintains fluid balance
Maintains acid/base balance
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Renal Failure Renal Failure
Occurs when kidneys lose ability to
adequately filter and remove toxins
Acute failure typically results from shock or
toxic ingestion
Chronic failure may be inherited or
secondary to damage from uncontrolled
diabetes or hypertension
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End End--Stage Stage
Renal Disease (ESRD) Renal Disease (ESRD)
Irreversible renal failure
Requires dialysis
Hemodialysis
Peritoneal dialysis
90% receive hemodialysis in specialized
centers
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Think About It Think About It
More than 350,000 people in America
receive some type of treatment for ESRD.
Only 8% treat themselves at home.
ESRD patients often rely on EMS for
transport to and from dialysis.
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Hemodialysis Hemodialysis
Patient connected to a machine that
pumps blood through specialized
membranes
Treatments last several hours, multiple
times a week
continued
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Hemodialysis Hemodialysis
Two types of access to blood circulation
Two-port catheter
A-V fistula
Two-port catheter A-V fistula
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Peritoneal Dialysis Peritoneal Dialysis
Uses peritoneal cavitys large surface area
Special fluid infused into abdominal cavity
and left for several hours to absorb waste
and excess fluid
Fluid is removed and
discarded
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Medical Medical
Emergencies in ESRD Emergencies in ESRD
Two broad groups
Loss of kidney function
Complication of dialysis
Most dialysis patients have underlying
medical factors
Diabetes
Hypertension
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Complications of ESRD Complications of ESRD
Usually relate to patient missing dialysis
Present with signs and symptoms similar
to congestive heart failure
Shortness of breath
Edema
Electrolyte disturbances
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Missed Dialysis Missed Dialysis
Assess ABCs
Be aware of fistulas
Administer oxygen
Monitor vital signs closely and have AED
ready
Transport to facility capable of dialysis
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Complications of Dialysis Complications of Dialysis
Bleeding fromA-V fistula
Clotting and loss of A-V fistula function
Infection
Peritonitis
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Treatment of Treatment of
Dialysis Complications Dialysis Complications
Assess ABCs
Control bleeding
Contact medical control if necessary
Administer oxygen
Treat for shock
Keep patient supine and warm
If peritonitis is suspected, transport
dialysis fluid for confirmation
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Kidney Transplant Patients Kidney Transplant Patients
Kidneys are the most-transplanted organs
Approximately 16,000 transplants per year
Patients spend their lives on specialized
medications
Help prevent organ rejection
Increased susceptibility to infections
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Information Information
About Renal Failure Video About Renal Failure Video
Click here to view a video on the subject of renal failure.
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Blood consists of red cells, white cells, and
plasma.
Anemia is lack of red blood cells in
circulation.
continued
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Chapter Review Chapter Review
Sickle cell anemia is an inherited disease
in which a defect in the hemoglobin results
in sickle shape to red blood cells. This
misshaping inhibits movement of red blood
cells through capillaries, causing
sludging and blockages in smaller blood
vessels.
continued
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Chapter Review Chapter Review
The renal system is comprised of the
kidneys, ureters, and urethra.
The kidneys perform vital filtering of the
blood to remove waste products. They
also help maintain water balance within
the body.
continued
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Chapter Review Chapter Review
Problems with the renal system include
infection, kidney stones, and renal failure.
Renal failure is a condition in which the
kidneys are unable to filter waste and
provide a balance of fluids in the body.
continued
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Chapter Review Chapter Review
In dialysis, an external system filters the
blood and removes excess fluid from the
body. Dialysis may be performed in either
of two ways: hemodialysis or peritoneal
dialysis.
continued
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Chapter Review Chapter Review
Dialysis at dialysis centers is generally
performed three times per week.
The main complications with patients in
end stage renal disease generally occur
after the patient has missed a dialysis
appointment.
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Remember Remember
Blood has specific cellular components.
Abnormal blood cells can significantly
affect patients.
The renal system is critical to maintaining
homeostasis.
Renal failure can be chronic or acute.
End stage renal disease is managed
through dialysis.
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Questions to Consider Questions to Consider
Does my patient have a history of sickle
cell disease or ESRD?
Does my patient have an A-V fistula?
Will I need to make an early request for
ALS because of complications from a
missed dialysis appointment?
6/28/2011
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Critical Thinking Critical Thinking
You have a patient who is transported
routinely for dialysis three times per week.
She was sick and canceled the trip
yesterday. Now she calls saying she cant
breathe and feels like she is going to die.
Is it possible that she has a legitimate
complaint after missing dialysis by only
one day?
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Limmer OKeefe Dickinson
Please visit Resource Central on
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additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
27.1 Define key terms introduced in this chapter. Slides
17, 21, 2830, 47, 49, 5254
27.2 Describe the structure and function of the circulatory
system, including the functions of the blood. Slides
1216
27.3 Explain the concept of perfusion. Slide 17
continued
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Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
27.4 Compare and contrast arterial, venous, and capillary
bleeding. Slide 21
27.5 Discuss causes and effects of severe external
bleeding. Slides 2021, 3436
27.6 Discuss assessment and management of external
bleeding, including methods of controlling external
bleeding. Slides 2331, 3335
continued
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Limmer OKeefe Dickinson
continued
OBJECTIVES OBJECTIVES
27.7 Identify patients at risk for internal bleeding. Slides
3839
27.8 Recognize signs of internal bleeding and discuss
patient care for internal bleeding. Slides 4044
27.9 Discuss the causes of shock and its effects on the
body. Slides 4750
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OBJECTIVES OBJECTIVES
27.10 Explain the concepts of compensated,
decompensated, and irreversible shock. Slide 49
27.11 Discuss the types of shock. Slides 5154
27.12 Relate the signs and symptoms of shock to the
bodys attempts to compensate for blood loss.
Slide 55
continued
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OBJECTIVES OBJECTIVES
27.13 Discuss the management of patients in shock.
Slides 5659
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MULTIMEDIA MULTIMEDIA
Slide 45 Bleeding Control/Shock Management Video
Slide 60 Shock Video
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CORE CONCEPTS
How to recognize arterial, venous, and
capillary bleeding
How to evaluate the severity of external
bleeding
How to control external bleeding
continued
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Limmer OKeefe Dickinson
CORE CONCEPTS
Signs, symptoms, and care of a patient
with internal bleeding
Signs, symptoms, and care of a patient
with shock
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Topics Topics
The Circulatory System
Bleeding
Shock
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The Circulatory System The Circulatory System
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Circulatory System Circulatory System
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Arteries Arteries
Carry oxygen-rich blood away from the
heart
Comprised of thick, muscular walls that
enable dilation and constriction
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Veins Veins
Carry oxygen-depleted blood rich in
carbon dioxide back to the heart
Contain one-way valves to prevent back
flow of blood
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Capillaries Capillaries
Microscopic blood vessels
Vital exchange site: oxygen, nutrients
passed through
capillary walls in
exchange for
carbon dioxide
from cells
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Functions of Blood Functions of Blood
Transportation of gases
Nutrition
Excretion
Protection
Regulation
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Perfusion
Hypoperfusion
(Shock)
Adequate
circulation of
blood
throughout
body
Inadequate
circulation of
blood to
tissues and
organs
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Bleeding Bleeding
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Types of Bleeding Types of Bleeding
External
Internal
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External Bleeding External Bleeding
Spurting Steady
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External Bleeding External Bleeding
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Think About It Think About It
How severe is the bleeding? Is it
exsanguinating hemorrhage? If so, how
does that affect the priorities of treatment?
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Patient Assessment Patient Assessment
Open
Airway
Standard
Precautions
Monitor
Respirations
Ventilate
if Necessary
Control Bleeding
Skin: Color, Temp,
Condition,
Check Pulses
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Methods to Methods to
Control External Bleeding Control External Bleeding
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Direct Pressure Direct Pressure
Apply firm pressure to wound with gloved
hand and gauze bandage
Hold pressure until bleeding is controlled
If necessary, add dressings when lower
ones are saturated
continued
6/28/2011
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Direct Pressure Direct Pressure
Never remove bandageseven when
bleeding is controlled
When controlled, check for pulse distal to
wound
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Elevate Elevate
Elevate injured extremity above level of
the heart while applying direct pressure
Do not elevate if musculoskeletal injury is
suspected
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Pressure Dressing Pressure Dressing
Place several gauze pads on wound
Hold dressings in place with self-adhering
roller bandage wrapped tightly over
dressings and above and below wound
site
Create enough pressure to control
bleeding
6/28/2011
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Hemostatic Agents Hemostatic Agents
Commonly, dressing containing substance
that absorbs and traps red blood cells
Can be wadded up and inserted into
wound
May be a powder poured directly into the
wound
Manual pressure is always necessary
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Tourniquet Tourniquet
Use if bleeding is uncontrollable via direct
pressure
Use only on
extremity
injuries
continued
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Tourniquet Tourniquet
Once applied, do not remove or loosen
Attach notation to patient alerting other
providers tourniquet has been applied
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Think About It Think About It
Is the current method of bleeding control
working? Do you need to move on to a
more aggressive step? How would you
evaluate this?
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Other Ways to Stop Bleeding Other Ways to Stop Bleeding
Splinting
Cold application
Pneumatic anti-shock
garment (PASG)
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Special Bleeding Situations Special Bleeding Situations
Head injury
From increased intracranial pressure, not
direct trauma
Stopping bleeding only increases intracranial
pressure
6/28/2011
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Special Bleeding Situations Special Bleeding Situations
Nosebleed
(Epistaxis)
Have patient sit
and lean forward
Apply direct
pressure to fleshy
portion of nostrils
Keep patient calm
and quiet
continued
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Limmer OKeefe Dickinson
Special Bleeding Situations Special Bleeding Situations
Nosebleed (Epistaxis)
Do not let patient lean back
If patient becomes unconscious, place patient
in recovery position and be prepared to
suction
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Limmer OKeefe Dickinson
Internal Bleeding Internal Bleeding
Damage to internal organs and large blood
vessels can result in loss of a large
quantity of blood in short time
Blood loss commonly cannot be seen
Severe blood loss can even result from
injuries to extremities
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Blunt Trauma Blunt Trauma
Leading cause of internal bleeding
Falls
Motor vehicle crashes
Automobilepedestrian collisions
Blast injuries
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Penetrating Trauma Penetrating Trauma
Common penetrating injuries
Gunshot wounds
Stab wounds
Impaled objects
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Signs of Internal Bleeding Signs of Internal Bleeding
Injuries to surface of body
Bruising, swelling, or pain over vital organs
Painful, swollen, or deformed extremities
Bleeding from mouth, rectum, or vagina
continued
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Signs of Internal Bleeding Signs of Internal Bleeding
Tender, rigid, or distended abdomen
Vomiting coffee-ground or bright-red
material
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Pediatric Considerations Pediatric Considerations
Infants and childrenefficient
compensating mechanisms maintain blood
pressure until half of volume is depleted
Potential for shock must be recognized
and treated before tell-tale signs appear
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Cultural Considerations Cultural Considerations
Places on body to look to assess
circulation via skin color
Fingernails and lips
Conjunctiva in eyes
Palms of hands; soles of feet
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Treatment of Internal Bleeding Treatment of Internal Bleeding
Maintain
ABCs Administer
Oxygen
Control
External
Bleeding
Rapid Transport to
Appropriate Medical
Facility
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Bleeding Control/ Bleeding Control/
Shock Management Video Shock Management Video
Click here to view a video on the subject of controlling bleeding and
shock management.
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Shock Shock
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Shock Shock
Inability to supply
cells with oxygen
and
nutrients
Inadequate
removal
of waste
products from
cells
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Limmer OKeefe Dickinson
Causes of Shock Causes of Shock
Failure of any component of circulatory
system
Heart: loses ability to pump
Blood vessels: dilate, making too large a
container to fill
Blood: loses volume from bleeding
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Severity of Shock Severity of Shock
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Types of Shock Types of Shock
Hypovolemic
Cardiogenic
Neurogenic
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Hypovolemic Shock Hypovolemic Shock
Results from a decreased volume of
circulating blood and plasma
Called hemorrhagic shock if caused by
uncontrolled bleeding (internal or external)
Can be caused by burns or crush injuries
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Cardiogenic Shock Cardiogenic Shock
Seen in patients suffering myocardial
infarction
Results from inadequate perfusion to
heart, decreasing strength of contractions
Hearts electrical system may malfunction,
causing heartbeat that is too slow, too fast,
or irregular
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Neurogenic Shock Neurogenic Shock
Results from inability to control dilation of
blood vessels because of nerve paralysis
No blood loss, but vessels dilated so much
that blood volume cant fill them
Rarely seen in the field
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Signs and Symptoms of Shock Signs and Symptoms of Shock
Altered mental status
Pale, cool, clammy skin
Nausea and vomiting
Vital sign changes
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Care for Shock Care for Shock
Aggressive airway maintenance
Administer high-concentration oxygen
Attempt to stop cause of shock
Apply and inflate PASG if approved
continued
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Care for Shock Care for Shock
Splint any suspected bone or joint injuries
Prevent loss of body heat
Deliver patient to appropriate medical
facility within golden hour
Speak calmly and reassure throughout
assessment and care
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PASGApplication PASGApplication
Step 1 Step 2
Step 3
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PASGApplication PASGApplication
Step 4
Step 5
Step 6
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Shock Video Shock Video
Click here to view a video on the subject of shock.
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Almost all external bleeding can be
controlled by direct pressure and
elevation. If these dont work, apply
tourniquet if bleeding is on an extremity.
Emergency care for internal bleeding is
based on prevention and treatment of
shock.
continued
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Chapter Review Chapter Review
Early signs of shock: restlessness, anxiety,
pale skin, rapid pulse and respirations.
If shock is uncontrolled, patients blood
pressure falls (late sign of shock).
Signs and symptoms may not be evident
early; treatment based on MOI may be life-
saving.
continued
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Chapter Review Chapter Review
Treat shock by airway maintenance;
administration of high-concentration
oxygen; controlling bleeding; and keeping
the patient warm. One of most important
treatments is early recognition of shock
and immediate transport.
6/28/2011
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Remember Remember
The circulatory system is designed to
ensure adequate perfusion of body
tissues.
The classification of hemorrhage is directly
related to the type of vessel ruptured and
the pressure within that vessel.
continued
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Limmer OKeefe Dickinson
continued
Remember Remember
Treatment of external hemorrhage
includes progression through the following
steps: direct pressure, elevation,
tourniquet application, use of hemostatic
agents.
Internal bleeding is impossible to evaluate.
The most appropriate treatment must be
rapid transport to an appropriate facility.
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Remember Remember
Shock develops if the heart fails, blood
volume is lost, or blood vessels dilate,
resulting in inadequate perfusion.
Signs of shock reflect the bodys attempts
at compensating for inadequate perfusion.
continued
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continued
Remember Remember
The most significant treatment for the
shock patient is early recognition and
prompt transport to a hospital where the
patient will receive definitive care.
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Questions to Consider Questions to Consider
What can I use for a tourniquet that will
control bleeding but not damage tissue?
When treating a patient with shock, what
should I do at the scene and what should I
do en route to the hospital?
continued
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Questions to Consider Questions to Consider
Is a patient with pale, cool skin,
tachycardia, and rapid, shallow
respirations in shock or just under stress?
How will continuing assessment help in
making that decision?
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Critical Thinking Critical Thinking
A patient has been involved in a motor-
vehicle collision. There is considerable
damage to the vehicle. The steering
column and wheel are badly deformed.
The patient complains of a sore chest.
You note no external bleeding.
continued
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Critical Thinking Critical Thinking
The patients vital signs are pulse 116,
respirations 20, blood pressure 106/70.
How would you proceed to assess and
care for this patient?
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Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
28.1 Define key terms introduced in this chapter. Slides
13, 1617, 22, 4345
28.2 Describe the structure and function of the skin.
Slide 13
28.3 Describe types of closed soft tissue wounds and the
assessment and management of closed soft tissue
wounds. Slides 1620
continued
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Limmer OKeefe Dickinson
continued
OBJECTIVES OBJECTIVES
28.4 Predict internal injuries that may be indicated by
various contusion (bruise) types and locations.
Slide 18
28.5 Describe types of open soft tissue wounds and
general assessment and care for open soft tissue
wounds. Slides 22, 2425
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OBJECTIVES OBJECTIVES
28.6 Describe specific treatment for abrasions and
lacerations, puncture wounds, impaled objects,
avulsions, amputations, and genital injuries.
Slides 2739
28.7 Discuss complications associated with burns.
Slide 41
continued
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OBJECTIVES OBJECTIVES
28.8 Classify burns by agent, source, depth, and severity.
Slides 4245
28.9 Describe specific treatment for thermal burns and
chemical burns. Slides 4749
continued
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OBJECTIVES OBJECTIVES
28.10 Describe assessment and management for
electrical burns. Slides 5153
28.11 Describe considerations in the dressing and
bandaging of open wound. Slides 5659
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MULTIMEDIA MULTIMEDIA
Slide 14 Integumentary Anatomy Video
Slide 54 Electrical Injuries Video
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CORE CONCEPTS
Understanding closed wounds and
emergency care for closed wounds
Understanding open wounds and
emergency care for open wounds
Understanding burns and emergency care
for burns
continued
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CORE CONCEPTS
Understanding electrical injuries and
emergency care for electrical injuries
How to dress and bandage wounds
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600
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Topics Topics
Soft Tissues
Closed Wounds
Open Wounds
Treating Specific Types of Open Wounds
Burns
Electrical Injuries
Dressing and Bandaging
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Soft Tissues Soft Tissues
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Soft Tissues Soft Tissues
Skin
Fatty tissues
Muscles
Blood vessels
Fibrous tissues
Membranes
Glands
Nerves
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601
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Skin Skin
Protection
Water balance
Temperature
regulation
Excretion
Shock absorption
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Integumentary Anatomy Video Integumentary Anatomy Video
Click here to view a video on the subject of skin layers and wounds.
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Closed Wounds Closed Wounds
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602
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Closed Wounds Closed Wounds
Contusion
Bruise
Hematoma
Similar to contusion
More tissue
damage
Involves larger
blood vessels
continued
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Closed Wounds Closed Wounds
Closed crush injury
Excessive force
crushing or rupturing
internal (generally
solid) organs
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Assessment: Assessment:
Closed Wounds Closed Wounds
Bruising may be
internal injury or
bleeding
Consider
mechanism of
injury
Crush injuries are
difficult to identify
6/28/2011
603
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Treatment: Treatment:
Closed Wounds Closed Wounds
Take appropriate Standard Precautions
Manage airway, breathing, and circulation
Always manage for internal bleeding and
shock if there is a possibility of internal
injuries
continued
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Treatment: Treatment:
Closed Wounds Closed Wounds
Splint extremities that are painful, swollen,
or deformed
Stay alert for vomiting
Continuously monitor for changes and
transport
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Open Wounds Open Wounds
6/28/2011
604
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Open Wounds Open Wounds
Abrasion
Laceration
Puncture
Avulsion
Amputation
Crush injury
Blast injury
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Think About It Think About It
Does an open wound necessitate using
more than just gloves as standard
precautions?
Can an open injury affect the patients
airway or breathing?
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Treatment: Open Injuries Treatment: Open Injuries
Expose wound
Clean surface of wound
Control bleeding
Provide care for shock
Prevent further contamination
continued
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605
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Treatment: Open Injuries Treatment: Open Injuries
Bandage dressings in place after bleeding
is controlled
Keep patient still
Reassure patient
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Treating Specific Types of Treating Specific Types of
Open Wounds Open Wounds
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Treatment: Treatment:
Abrasions and Lacerations Abrasions and Lacerations
Reduce wound contamination
Hold direct pressure to control bleeding
Always check pulse, motor, and sensory
function distal to injury to assure function
Never open edges of laceration to see
inside or further clean wound
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Treatment: Treatment:
Puncture Wounds Puncture Wounds
Use cautionobjects may be embedded
deeper than they appear
Check for exit wounds
May require immediate care
Bullets can fracture bones as they enter
Stab wounds are considered serious if in a
vital area of body
continued
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Limmer OKeefe Dickinson
Treatment: Treatment:
Puncture Wounds Puncture Wounds
Reassure patient
Search for exit
wound
Assess need for
shock care
Follow local
protocols regarding
spinal immobilization
Transport patient
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Treatment: Treatment:
Impaled Objects Impaled Objects
Do not remove object; may cause severe
bleeding
Expose wound area
Control profuse bleeding by direct
pressure
Apply several layers of bulky dressing to
splint object in place
continued
6/28/2011
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continued
Treatment: Treatment:
Impaled Objects Impaled Objects
Secure dressings
Treat for shock
Provide rapid transport
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Limmer OKeefe Dickinson
Treatment: Treatment:
Impaled Objects Impaled Objects
Splint object Secure dressings
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Emergency Care, Twelfth Edition
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Impaled Object in Cheek Impaled Object in Cheek
Take care that object does not enter oral
cavity, causing airway obstruction
If cheek wall is perforated, profuse
bleeding into mouth and throat can cause
nausea and vomiting
External wound care will not stop the flow
of blood into the mouth
6/28/2011
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Treatment: Treatment:
Impaled Object in Cheek Impaled Object in Cheek
Examine wound site, both inside and
outside mouth
If you find the perforation and can see
both ends, remove
object
If object is impaled
into another structure,
stabilize in place
continued
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Treatment: Treatment:
Impaled Object in Cheek Impaled Object in Cheek
Position patient to allow for drainage
Monitor patients airway
Dress outside of wound
Provide oxygen
Provide care for shock
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Treatment: Avulsions Treatment: Avulsions
Clean wound surface
Fold skin back into normal position
Control bleeding and dress with bulky
dressings
If avulsed parts are completely torn away,
save in sterile dressing and keep moist
with sterile saline
6/28/2011
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Treatment: Amputations Treatment: Amputations
Apply pressure dressing over stump
Use pressure points to control bleeding;
use tourniquet only if all other methods fail
continued
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Treatment: Amputations Treatment: Amputations
Wrap amputated part in sterile dressing
and place in plastic bag; put bag in pan
with water and cold packs
Do not immerse amputated part directly in
icy cold water
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Treatment: Genital Injuries Treatment: Genital Injuries
Control bleeding
Preserve avulsed parts
Consider if injury suggests another,
possibly more serious, injury
Calm, professional manner
Maintain patients dignity
Dress and bandage wound
6/28/2011
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Burns Burns
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Burns Burns
May involve more than just skin-level
structures
If respiratory structures are affected,
swelling may occur, causing life-
threatening obstruction
Dont let burn distract from spinal damage
or fractures
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Assessment: Burns Assessment: Burns
Classifying burns
Agent and source
Depth
Severity
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Burns: Depth Burns: Depth
Superficial (1st Degree)
Involves only epidermis
Reddening with minor swelling
Partial Thickness (2nd Degree)
Epidermis burned through, dermis damaged
Deep, intense pain
Blisters and mottling
continued
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Burns: Depth Burns: Depth
Full Thickness (3rd Degree)
All layers of skin burned
Blackened areas surrounded by dry and white
patches
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Burns: Severity Burns: Severity
Rule of Nines
Helps estimate extent of burn area
Adult body is divided into 11 main areas
Each represents 9 percent of body surface
6/28/2011
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Burns: Burns:
Geriatrics and Pediatrics Geriatrics and Pediatrics
Minor burn area in a young adult can be
fatal to a geriatric adult
Infants and children have a much greater
relationship of body surface area to total
body size, resulting in greater fluid and
heat loss from burned skin
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Treatment: Thermal Burns Treatment: Thermal Burns
Use sterile dressings
Never apply ointments, sprays, or butters
Do not break blisters
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Treatment: Chemical Burns Treatment: Chemical Burns
Wash away
chemical with
copious amounts
of flowing water
If dry chemical,
brush away, then
flush with water
continued
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Treatment: Chemical Burns Treatment: Chemical Burns
Remove contaminated clothing
Apply sterile dressings
Treat for shock
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Electrical Injuries Electrical Injuries
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Electrical Injuries Electrical Injuries
Severe damage through body by
disrupting nerve pathways
Entry and exit burns are possible
Respiratory/cardiac arrest are possible
Bones may fracture from violent muscle
contractions
6/28/2011
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Treatment: Electrical Injuries Treatment: Electrical Injuries
Provide airway care
Be alert and prepared for cardiac rhythm
changes; be ready to defibrillate
Treat for shock and provide oxygen
continued
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Treatment: Electrical Injuries Treatment: Electrical Injuries
Care for spinal and head injuries as well
as extremity fractures
Evaluate burn sites
Cool burning areas and apply sterile
dressings
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Electrical Injuries Video Electrical Injuries Video
Click here to view a video on the subject of injuries
caused by electricity.
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Dressing and Bandaging Dressing and Bandaging
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Dressing and Bandaging Dressing and Bandaging
Dressing: any
material applied to
wound to control
bleeding and
prevent
contamination
Pressure Dressing
Occlusive Dressing
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Dressing and Bandaging Dressing and Bandaging
Bandage: any
material used to
hold dressing in
place
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Dressing Open Wounds Dressing Open Wounds
Expose wound
Completely cover wound area
Dressings should not be removed unless
bulky dressing is blood soaked and new
one must be applied to maintain direct
pressure
Control bleeding by direct pressure or
pressure dressings
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Bandaging Open Wounds Bandaging Open Wounds
Do not bandage too
tightly or too loosely
Do not leave loose
ends
Do not cover tips of
fingers or toesmust
observe distal skin
color changes
Cover all edges of
dressings
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Chapter Review Chapter Review
6/28/2011
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Chapter Review Chapter Review
Soft-tissue injuries may be closed or open.
Closed injuries include contusions,
hematomas, and crush injuries. Open
wounds include abrasions, lacerations,
avulsions, amputations, and crush injuries.
continued
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Limmer OKeefe Dickinson
Chapter Review Chapter Review
For open wounds, expose the wound,
control bleeding, and prevent further
contamination.
For both open and closed injuries, take
appropriate Standard Precautions.
continued
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Limmer OKeefe Dickinson
Chapter Review Chapter Review
Burn severity is determined by considering
the source, the region affected, depth of
burn, extent of burn, age of the patient,
and other patient illnesses or injuries.
continued
6/28/2011
618
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continued
Chapter Review Chapter Review
Care for burns includes stopping the
burning, covering a thermal burn with a dry
sterile dressing, flushing a chemical burn
with sterile water, protection of the airway,
administration of oxygen, treatment for
shock, and transport.
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Chapter Review Chapter Review
For treatment of electrical injuries, be sure
that you and the patient are in a safe zone
away from possible contact with electrical
sources. Protect airway, breathing, and
circulation. Be prepared to care for
respiratory or cardiac arrest. Treat for
shock, care for burns, and transport.
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Remember Remember
The soft tissue of the body is made up of
skin, fatty tissues, muscles, blood vessels,
fibrous tissues, membranes, glands, and
nerves.
The skin provides protection, water
balance, temperature regulation,
excretion, and shock absorption.
continued
6/28/2011
619
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Limmer OKeefe Dickinson
continued
Remember Remember
Open or closed in reference to a soft-
tissue injury is dictated by whether or not
the skin is still intact.
Closed injuries must be evaluated with
consideration to underlying anatomy and
mechanism of injury.
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Remember Remember
Open injuries typically are easier to
visualize, but they often can mask
underlying injuries.
Burns involve immediate destruction of
tissue but also can have a long-term
effect, both physically and emotionally.
continued
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Remember Remember
Safety must be a key concern when
treating a patient with a burn or an
electrical injury.
The goal of dressing and bandaging
wounds is to control bleeding and to
prevent infection.
6/28/2011
620
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Questions to Consider Questions to Consider
Does the patient have a patent airway and
is breathing adequate?
If the wound is penetrating, is there an exit
wound?
What is the best way to immobilize an
impaled object?
continued
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Questions to Consider Questions to Consider
Is there respiratory involvement with the
burn?
Have we irrigated the chemical burn
sufficiently?
Does the electrical burn have an exit
wound?
Is the bandage securely fastened to hold
the dressing?
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Critical Thinking Critical Thinking
A 21-year-old male lacerated his anterior
elbow when he fell through a window.
There is a lot of blood around the patient.
Bystanders have applied numerous towels
and washcloths over the wound (at least 3
inches thick).
continued
6/28/2011
621
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Critical Thinking Critical Thinking
There are so many dressings on the
wound that you cant tell if it is still
bleeding. The patient is alert, but pale and
anxious. The radial pulse on his uninjured
arm is weak and rapid. How much
assessment of the wound should you do
and how do you do it without making
things worse?
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
6/28/2011
622
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OBJECTIVES OBJECTIVES
29.1 Define key terms introduced in this chapter. Slides
11, 15, 18, 27
29.2 Describe mechanisms of injury commonly
associated with chest injuries. Slides 910
continued
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Limmer OKeefe Dickinson
continued
OBJECTIVES OBJECTIVES
29.3 Describe specific chest injuries, including flail chest,
open chest wounds, pneumothorax, tension
pneumothorax, hemothorax, hemopneumothorax,
traumatic asphyxia, cardiac tamponade, aortic
injury, commotio cordis, and the assessment and
management for each of these specific injuries.
Slides 1116, 1824
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Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
29.4 Discuss mechanisms and types of abdominal injury.
Slide 27
29.5 Demonstrate the assessment and management of
patients with blunt and penetrating abdominal
injuries, including management of evisceration.
Slides 2833
6/28/2011
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MULTIMEDIA MULTIMEDIA
Slide 25 Open Pneumothorax and Hemothorax Video
Slide 34 Liver Injuries Video
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CORE CONCEPTS
Understanding chest injuries and
emergency care for chest injuries
Understanding abdominal injuries and
emergency care for abdominal injuries
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Topics Topics
Chest Injuries
Abdominal Injuries
6/28/2011
624
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Chest Injuries Chest Injuries
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Chest Injuries Chest Injuries
Blunt trauma
Can fracture ribs, sternum, and costal (rib)
cartilages
Compression
Occurs when severe blunt trauma causes the
chest to rapidly compress
continued
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Chest Injuries Chest Injuries
Penetrating objects
Bullets, knives,
pieces of metal or
glass, steel rods,
pipes, other objects
Can damage
internal organs and
impair respiration
6/28/2011
625
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Closed Chest Injuries Closed Chest Injuries
Flail Chest
Paradoxical Motion
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Assessment: Flail Chest Assessment: Flail Chest
Mechanism of injury
Difficulty breathing/hypoxia
Chest wall muscle contraction
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Treatment: Flail Chest Treatment: Flail Chest
Primary assessment for life threats
Administer oxygen
Use bulky dressing to stabilize flail
segment
Monitor patient for respiratory rate and
depth
Assist ventilations if too shallow
6/28/2011
626
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Open Chest Injuries Open Chest Injuries
Difficult to tell what is injured from
entrance wound
Assume all wounds are life-threatening
Open wounds allow air into chest
Sets imbalance in pressure
Causes lung to collapse
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Assessment: Assessment:
Open Chest Wound Open Chest Wound
Sucking chest
wound
Direct entrance
wound to chest
May or may not be
a sucking sound
May be gasping for
air
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Limmer OKeefe Dickinson
Treatment: Treatment:
Open Chest Wounds Open Chest Wounds
Maintain open
airway
Seal wound
Occlusive dressing
Administer oxygen
Treat for shock
Immediate transport
Consider ALS
6/28/2011
627
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Think About It Think About It
Does the patients chest injury need to be
treated during the primary assessment?
Does the open chest injury require an
occlusive dressing?
Does the patients injury necessitate
immediate transport to a trauma center?
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Limmer OKeefe Dickinson
Flutter Valve
Injuries Within the Chest Cavity Injuries Within the Chest Cavity
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Traumatic Asphyxia Traumatic Asphyxia
Sudden compression of chest forcing
blood out of organs and rupturing blood
vessels
Neck and face are a darker color than rest
of the body
May cause bulging eyes, distended neck
veins, broken blood vessels in face
6/28/2011
628
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Cardiac Tamponade Cardiac Tamponade
Direct injury to heart causing blood to flow
into the pericardial sac around the heart
Pericardium is a tough sac that rarely
leaks
Increased pressure on heart so chambers
cannot fill
continued
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Cardiac Tamponade Cardiac Tamponade
Blood backs up into veins
Usually a result of penetrating trauma
Distended neck veins
Shock and narrowed pulse pressure
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Aortic Injury Aortic Injury
Aorta is the largest blood vessel in the
body
Penetrating trauma can cause direct
damage
Blunt trauma can sever or tear the aorta
Damage can cause high-pressure
bleeding; often fatal
continued
6/28/2011
629
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Aortic Injury Aortic Injury
Patient complains of pain in chest,
abdomen, or back
Signs of shock
Differences in blood pressure between
right and left arms
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Commotio Cordis Commotio Cordis
Uncommon condition
Trauma to chest when heart is vulnerable
Ventricular fibrillation (VF)
Treat like VF patient: CPR, defibrillation
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Limmer OKeefe Dickinson
Open Pneumothorax and Open Pneumothorax and
Hemothorax Video Hemothorax Video
Click here to view a video on the subject of open pneumothorax
and hemothorax.
Back to Directory
6/28/2011
630
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Abdominal Injuries Abdominal Injuries
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Abdominal Injuries Abdominal Injuries
Can be open or closed
Internal bleeding can be severe if organs
or blood vessels are lacerated or ruptured
Serious, painful
reactions if hollow
organs rupture
Evisceration may
occur
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Assessment: Assessment:
Abdominal Injuries Abdominal Injuries
Pain, initially mild but rapidly becoming
intolerable as bleeding worsens
Nausea
Weakness
Thirst
continued
6/28/2011
631
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Limmer OKeefe Dickinson
Assessment: Assessment:
Abdominal Injuries Abdominal Injuries
Indications of blunt trauma to chest,
abdomen, or pelvis
Coughing up or vomiting blood
Rigid and/or distended abdomen
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Treatment: Treatment:
Abdominal Injuries Abdominal Injuries
Carefully monitor airway in presence of
vomiting
Place patient on back with knees flexed to
reduce tension on abdominal muscles
Administer oxygen
Treat for shock
continued
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Treatment: Treatment:
Abdominal Injuries Abdominal Injuries
If allowed, utilize pneumatic anti-shock
garments (PASG)
Nothing to patient by mouth
Continuously monitor vital signs
6/28/2011
632
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Treatment: Evisceration Treatment: Evisceration
Do not touch or replace eviscerated
organs
Apply sterile dressing moistened with
sterile saline over wound site
For large evisceration, maintain warmth by
placing layers of bulky dressing over
occlusive dressing
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Treatment: Treatment:
Impaled Object Impaled Object
Do not remove
Stabilize with bulky dressings bandaged in
place
Leave patients legs in position found to
avoid muscular movement that may move
impaled object
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Limmer OKeefe Dickinson
Liver Injuries Video Liver Injuries Video
Click here to view a video on the subject of liver injuries.
Back to Directory
6/28/2011
633
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Chapter Review Chapter Review
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Chapter Review Chapter Review
An open chest or abdominal wound is
considered to be one that penetrates not
only the skin but the chest and abdominal
wall to expose internal organs.
Open chest and abdominal wounds are life
threatening.
continued
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Chapter Review Chapter Review
A flail chest is characterized by
paradoxical motion.
Seal an open chest wound with an
occlusive dressing taped on three sides to
make a one-way valve.
Closed chest wounds are difficult to
distinguish.
continued
6/28/2011
634
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Chapter Review Chapter Review
A patient who collapses in cardiac arrest
after a force to the center of the chest
should receive CPR.
If a patient develops signs of tension
pneumothorax, arrange immediately for
ALS intercept.
continued
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Chapter Review Chapter Review
When solid abdominal organs are injured,
life threatening amounts of blood loss can
occur.
When hollow abdominal organs are
injured, their contents spill into the
abdominal cavity causing irritation.
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Remember Remember
Blunt trauma, penetrating trauma, and
compression are mechanisms that can
injure the chest and abdomen.
Open or closed pertains to the integrity of
the chest or abdominal wall after injury.
Seal open chest wounds to prevent air
from entering the chest cavity.
continued
6/28/2011
635
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continued
Remember Remember
Closed chest and abdominal wounds bear
a high risk for underlying organ system
damage and internal bleeding. Use
mechanism of injury and patient
assessment to recognize the signs and
symptoms of shock.
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Remember Remember
EMTs should learn signs and symptoms,
and treatment procedures for specific
chest and abdominal injuries.
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Questions to Consider Questions to Consider
Is the patients breathing adequate,
inadequate, or absent?
Is the patient displaying signs of shock?
Is there an open wound in the chest that
needs to be sealed?
continued
6/28/2011
636
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Questions to Consider Questions to Consider
Is the patient displaying signs of a tension
pneumothorax?
Is there an open wound in the abdomen
that needs to be dressed and covered?
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Critical Thinking Critical Thinking
You are caring for a patient who was shot
in the chest with a nail gun. You applied an
occlusive dressing around the wound. The
patient is suddenly deteriorating. He is
having extreme difficulty breathing and his
color has worsened.
continued
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Critical Thinking Critical Thinking
Breath sounds have become almost totally
absent on the side with the impaled nail.
What complication might you suspect is
causing his worsening condition? How
could this be corrected?
6/28/2011
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Limmer OKeefe Dickinson
Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
30.1 Define key terms introduced in this chapter. Slides
1112, 1920, 2223, 37
30.2 Describe the anatomy of elements of the
musculoskeletal system. Slides 1116
30.3 Associate mechanisms of injury with the potential for
musculoskeletal injuries. Slide 18
continued
6/28/2011
638
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OBJECTIVES OBJECTIVES
30.4 Describe the four types of musculoskeletal injury
(fracture, dislocation, sprain, and strain) and define
open and closed extremity injuries. Slides 1921
30.5 Discuss the assessment of musculoskeletal injuries,
including compartment syndrome. Slides 2224
continued
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OBJECTIVES OBJECTIVES
30.6 Discuss the general care of musculoskeletal injuries.
Slides 2627
30.7 Discuss specific considerations for splinting. Slides
2837
continued
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OBJECTIVES OBJECTIVES
30.8 Discuss considerations in the assessment and
management of specific types of injuries, including
shoulder girdle injuries, pelvic injuries, hip
dislocation, hip fracture, femoral shaft fracture, knee
injury, tibia or fibula injury, ankle or foot injury.
Slides 3952
6/28/2011
639
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MULTIMEDIA MULTIMEDIA
Slide 53 Hip Fractures Video
Slide 54 Immobilizing a Long Bone Video
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CORE CONCEPTS
Understanding bones, muscles, and other
elements of the musculoskeletal system
Understanding general guidelines for
emergency care of musculoskeletal
injuries
continued
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CORE CONCEPTS
Purposes and general procedures for
splinting
Assessment and care of specific injuries to
the upper and lower extremities
6/28/2011
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Topics Topics
Musculoskeletal System
General Guidelines for Emergency Care
Emergency Care of Specific Injuries
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Emergency Care, Twelfth Edition
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Musculoskeletal System Musculoskeletal System
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Emergency Care, Twelfth Edition
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Components of Components of
Musculoskeletal System Musculoskeletal System
Bones
Joints
Muscles
Cartilage
Ligaments
Tendons
6/28/2011
641
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Physiology of Physiology of
Musculoskeletal System Musculoskeletal System
Bones: framework
Joints: bending
Muscles: movement
Cartilage: flexibility
Ligaments: connect bone to bone
Tendons: connect muscle to bone
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Bones Bones
Formed of dense
connective tissues
Vascular and
susceptible to
bleeding on injury
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Shapes of Bones Shapes of Bones
Irregular
Long
Short
Flat
6/28/2011
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Self Self--Healing Nature of Bone Healing Nature of Bone
Break causes soft tissue swelling and a
blood clot in the fracture area
Interruption of blood supply causes the
bone section to die
Cells further from fracture divide rapidly
forming tissue that heals the fracture and
develops into new bone
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Muscles, Cartilage, Muscles, Cartilage,
Ligaments, and Tendons Ligaments, and Tendons
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General Guidelines for General Guidelines for
Emergency Care Emergency Care
6/28/2011
643
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Mechanisms of Mechanisms of
Musculoskeletal Injury Musculoskeletal Injury
Direct force
Indirect force
Twisting
(rotational) force
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Injury to Injury to
Bones and Connective Tissue Bones and Connective Tissue
Fracture: any break in a bone (open or
closed)
Comminutedbroken in several places
Greenstickincomplete break
Angulatedbent at angle
Dislocation: coming apart of a joint
continued
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continued
Injury to Injury to
Bones and Connective Tissue Bones and Connective Tissue
Sprain: stretching and tearing of ligaments
Strain: overstretching of muscle
6/28/2011
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Injury to Injury to
Bones and Connective Tissue Bones and Connective Tissue
Not all injuries can
be confirmed as a
fracture in the field
Splinting an
extremity with a
suspected fracture
helps prevent
blood loss from
bone tissues
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Assessment: Assessment:
Musculoskeletal Injuries Musculoskeletal Injuries
Rapidly identify and treat life-threatening
conditions
Be alert for injuries besides grotesque
wound
Pain and tenderness
Deformity and angulation
continued
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Assessment: Assessment:
Musculoskeletal Injuries Musculoskeletal Injuries
Grating (crepitus)
Swelling
Bruising
Exposed bone ends
Nerve/blood vessel compromise
(decreased CMS)
Compartment syndrome
6/28/2011
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Six Ps of Assessment Six Ps of Assessment
Pain or tenderness
Pallor (pale skin)
Parasthesia (pins and needles)
Pulses diminished or absent
Paralysis
Pressure
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Think About It Think About It
Do my patients musculoskeletal injuries
add up to serious multiple trauma?
Does my patient have circulation,
sensation, and motor function distal to the
suspected fracture or dislocation?
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Treatment: Treatment:
Musculoskeletal Injuries Musculoskeletal Injuries
Take standard
precautions
Perform primary
assessment
Take spinal
precautions, if
necessary
continued
6/28/2011
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Treatment: Treatment:
Musculoskeletal Injuries Musculoskeletal Injuries
Splint any
suspected
extremity fractures
after treating life-
threatening
conditions
Cover open
wounds with sterile
dressings
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Advantages of Splinting Advantages of Splinting
Minimizes movement of disrupted joints
and broken bone ends
Prevents additional injury to soft tissues
(nerves, arteries, veins, muscles)
Decreases pain
Minimizes blood loss
Can prevent a closed fracture from
becoming an open fracture
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Principles of Splinting Principles of Splinting
Care for life-threatening problems first
Expose injury site
Assess distal CSM
Align long-bone injuries to anatomical
position
Do not push protruding bones back into
place
continued
6/28/2011
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Principles of Splinting Principles of Splinting
Immobilize both injury site and adjacent
joints
Choose splinting method based on
severity of condition and priority decision
Apply splint before moving patient to
stretcher
Pad voids
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Realigning Realigning
Deformed Extremity Deformed Extremity
Assists in restoring
effective circulation to
extremity and to fit it
to splint
If not realigned, splint
may be ineffective,
causing increased
pain and possible
further injury
continued
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Realigning Realigning
Deformed Extremity Deformed Extremity
If not realigned, increased chance of
nerves, arteries, and veins being
compromised
Increased pain is only momentary
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Hazards of Splinting Hazards of Splinting
Splinting patient to deathsplinting
before life-threatening conditions
addressed
Not ensuring ABCs
Too tightcompresses soft tissues
Too looseallows too much movement
Splinting in deformed position
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Treatment: Treatment:
Splinting Long Bone and Joints Splinting Long Bone and Joints
Select splint
appropriate to
injury
Standard
precautions
Manually stabilize
injury site
continued
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continued
Treatment: Treatment:
Splinting Long Bone and Joints Splinting Long Bone and Joints
Assess circulation,
sensation, and
motor function
Realign injury if
deformed or if
distal extremity is
cyanotic or
pulseless
6/28/2011
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Treatment: Treatment:
Splinting Long Bone and Joints Splinting Long Bone and Joints
Measure or adjust
splint; move it into
position
Apply and secure
splint to immobilize
injury site, adjacent
joints
Reassess CSM
distal to injury
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Treatment: Traction Splint Treatment: Traction Splint
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Emergency Care of Emergency Care of
Specific Injuries Specific Injuries
6/28/2011
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Shoulder Girdle Injuries Shoulder Girdle Injuries
Assessment
Pain in shoulder
Dropped shoulder
Severe blow to
back over scapula
continued
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Shoulder Girdle Injuries Shoulder Girdle Injuries
Treatment
Assess distal CSM
Use sling and
swathe
Do not attempt to
straighten or
reduce
Reassess distal
CSM
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Forearm, Forearm,
Wrist, and Hand Injuries Wrist, and Hand Injuries
Signs
Forearm: deformity and tenderness
Wrist: deformity and tenderness
Hand: deformity and pain; dislocated fingers
6/28/2011
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continued
Splinting Forearm, Splinting Forearm,
Wrist, and Hand Injuries Wrist, and Hand Injuries
Padded rigid splint
From elbow past fingertips
Roll of bandage placed in hand
Sling and swathe
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Splinting Forearm, Splinting Forearm,
Wrist, and Hand Injuries Wrist, and Hand Injuries
Soft splint
Roll of bandage
placed in hand
Tie forearm, wrist, and
hand into fold of one
pillow or between two
pillows
Tape finger to adjacent
uninjured finger
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Pelvic Injuries Pelvic Injuries
Assessment
Pain in pelvis, hips, or groin
Pain when pressure applied
Cannot lift legs
Lateral rotation of foot
Unexplained pressure in bladder
continued
6/28/2011
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Pelvic Injuries Pelvic Injuries
Treatment
Move patient as little as possible
Determine CSM distal to injury
Straighten lower limbs to anatomical position
Stabilize lower limbs
Assume spinal injuries
Treat for shock
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Hip Dislocation/Fracture Hip Dislocation/Fracture
Assessment
Anterior hip dislocation
Posterior hip dislocation
Rotation of leg and foot
Pain and unable to stand
continued
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Hip Dislocation/Fracture Hip Dislocation/Fracture
Treatment
Assess distal CSM
Move patient onto spine board
Immobilize limb with
pillows and blankets
Secure patient to
spine board
Reassess distal CSM
6/28/2011
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Femoral Shaft Fracture Femoral Shaft Fracture
Assessment
Intense pain
Possibly open
fracture
Injured limb may be
shortened
Treatment
Control bleeding
Assess distal CSM
Apply traction splint
Reassess distal
CSM
Treat for shock
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Knee Injury Knee Injury
Assessment
Pain and tenderness
Swelling
Deformity with swelling
Treatment
Assess distal CSM
Immobilize in current position
Reassess distal CSM
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Tibia/Fibula Injury Tibia/Fibula Injury
Assessment
Pain and tenderness
Swelling
Possible deformity
Treatment
Air inflated splint
Two-splint method
Single splint with ankle hitch
6/28/2011
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Ankle/Foot Injury Ankle/Foot Injury
Assessment
Pain
Swelling
Possible deformity
continued
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Ankle/Foot Injury Ankle/Foot Injury
Treatment
Assess distal CSM
Stabilize limb
Lift limb
Place cravats under ankle
Lower limb into pillow
Tie pillow around ankle
Apply ice pack as needed
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Hip Fractures Video Hip Fractures Video
Click here to view a video on the subject of hip fractures.
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Immobilizing Immobilizing
a Long Bone Video a Long Bone Video
Click here to view a view a video on the subject of splinting a
long bone injury.
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Bones bleed. Fractures cause blood loss
within the bone.
Splinting of long bone fractures involves
immobilizing adjacent joints.
Splinting protects the patient from further
injury.
continued
6/28/2011
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Chapter Review Chapter Review
You may need to be creative while
splinting. There are many correct ways to
splint the same extremity.
Injuries to bones and joints should be
splinted prior to moving the patient.
continued
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Chapter Review Chapter Review
If patient has multiple trauma or appears
to have shock do not waste time splinting
individual fractures. Place patient on long
spine board and secure limbs to board.
Splint individual fractures en route if time
and priorities allow.
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Remember Remember
Bones, joints, muscles, cartilage, tendons,
and ligaments make up the
musculoskeletal system.
Bones provide the body with structure,
store metabolic materials, and produce red
blood. Joints are the places where bones
articulate to create movement.
continued
6/28/2011
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continued
Remember Remember
Fractures, dislocations, sprains, and
strains are musculoskeletal injuries that
are caused by direct force, indirect force,
and twisting force. Injuries should be
splinted prior to moving the patient.
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Remember Remember
A closed extremity injury is one in which
the skin has not been broken. An open
extremity injury is one in which the skin
has been broken.
Pelvic fractures and femoral shaft
fractures often indicate more severe
internal injuries.
continued
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Remember Remember
EMTs must learn specific techniques for
immobilizing particular injuries but at the
same time must foster creativity while
applying the general rules of splinting.
6/28/2011
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Questions to Consider Questions to Consider
Have I fully addressed life threats and
maintained my priorities even in the
presence of a grossly deformed extremity?
Does the patient have an injury that
requires splinting?
continued
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Questions to Consider Questions to Consider
Does the patient have multiple fractures,
multiple trauma, or shock?
Does the patient have adequate CSM
distal to the musculoskeletal injury?
Should I align the angulated extremity
fracture?
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Critical Thinking Critical Thinking
Patients who suffer fractures can be in
extreme pain. Pain can cause anxiety and
elevated pulse rates. How could you
differentiate between a patient with a rapid
pulse and anxiety from pain versus a
patient with rapid pulse and anxiety from
shock?
6/28/2011
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
31.1 Define key terms introduced in this chapter. Slides
1315, 17, 19, 28
31.2 Describe the components and function of the
nervous system and the anatomy of the head and
spine. Slides 1315
31.3 Describe types of injuries to the skull and brain.
Slides 1719, 22
continued
6/28/2011
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continued
OBJECTIVES OBJECTIVES
31.4 Describe the general assessment and management
of skull fractures and brain injuries. Slides 2223
31.5 Describe specific concerns in the management of
cranial injuries with impaled objects. Slide 21
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OBJECTIVES OBJECTIVES
31.6 Describe specific concerns in the management of
injuries to the face and jaw. Slide 21
31.7 Define nontraumatic brain injuries. Slide 22
31.8 Explain the purpose and elements of the Glasgow
Coma Scale. Slide 23
continued
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continued
OBJECTIVES OBJECTIVES
31.9 Discuss the assessment and management of open
wounds to the neck. Slides 2526
31.10 List types and mechanisms of spine injury. Slide 28
31.11 Discuss the assessment and management of spine
and spinal cord injury. Slides 2931
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OBJECTIVES OBJECTIVES
31.12 Discuss issues in the immobilization of the head,
neck, and spine, specifically for the following:
applying a cervical collar; immobilizing a seated
patient, including rapid extrication for high priority
patients; applying a long backboard; rapid
extrication from a child safety seat; immobilizing a
standing patient; and immobilizing a patient wearing
a helmet. Slides 3439
continued
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OBJECTIVES OBJECTIVES
31.13 Discuss issues in selective spine immobilization.
Slides 28, 3031
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MULTIMEDIA MULTIMEDIA
Slide 32 Spinal Injuries Video
Slide 40 KED Overview Video
6/28/2011
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CORE CONCEPTS
Understanding the anatomy of the nervous
system, head, and spine
Understanding skull and brain injuries and
emergency care for skull and brain injuries
Understanding wounds to the neck and
emergency care for neck wounds
continued
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CORE CONCEPTS
Understanding spine injuries and
emergency care for spine injuries
Understanding immobilization issues and
how to immobilize various types of
patients with a potential spine injury
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Topics Topics
Nervous and Skeletal Systems
Injuries to the Skull and Brain
Wounds to the Neck
Injuries to the Spine
Immobilization Issues
6/28/2011
663
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Nervous and Skeletal Systems Nervous and Skeletal Systems
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Nervous System Nervous System
Controls thought, sensations, and motor
functions
Central nervous system
Brain, spinal cord
Peripheral nervous system
Vertebral nerves
Cranial nerves
Bodys motor and sensory nerves
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Anatomy of the Head Anatomy of the Head
Cranium
Facial Bones (14)
Mandible
Maxillae
Nasal bones
Malar (zygomatic)
6/28/2011
664
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Anatomy of the Spine Anatomy of the Spine
Vertebrae
Cervical (7)
Thoracic (12)
Lumbar (5)
Sacral (5)
Coccyx (4)
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Injuries to the Skull and Brain Injuries to the Skull and Brain
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Injuries to the Skull and Brain Injuries to the Skull and Brain
Scalp injuries
Lots of blood
vessels
Profuse bleeding
Skull injuries
Open head injury
Closed head injury
6/28/2011
665
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Brain Injuries Brain Injuries
Traumatic Brain Injuries (TBI)
Concussion
Contusion
Coup
Contrecoup
Laceration
Hematoma
Subdural Hematoma
Epidural Hematoma
Intracerebral Hematoma
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Intracranial Pressure Intracranial Pressure
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Think About It Think About It
Does my patient have a serious or
potentially serious head injury? Should the
patient be transported to a trauma center?
Do my patients complaint and MOI
indicate spinal stabilization? Is
immobilization warranted?
6/28/2011
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Injuries to the Head and Face Injuries to the Head and Face
Cranial injuries with impaled objects
Stabilize object in place
Injuries to the face and jaw
Primary concern: Airway
When possible, position to allow for drainage
from mouth
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Nontraumatic Brain Injuries Nontraumatic Brain Injuries
Many signs of brain injury may be caused
by an internal brain event (hemorrhage,
blood clot)
Signs are the same as for traumatic injury,
except no evidence of trauma and no MOI.
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Glasgow Coma Scale (GCS) Glasgow Coma Scale (GCS)
May use GCS in addition to AVPU for
ongoing neurological assessment
Considerations for use of GCS
Eye opening
Verbal response
Motor response
Do not spend extra time at the scene
calculating GCS
6/28/2011
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Wounds to the Neck Wounds to the Neck
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Wounds to the Neck Wounds to the Neck
Large, major vessels close to surface
create the potential for serious bleeding
Pressure in large vein is lower than
atmospheric pressure
Great possibility of air embolus being
sucked through
Treatment: stop bleeding, prevent air
embolism
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Treatment: Open Neck Wound Treatment: Open Neck Wound
Ensure open airway
Place gloved hand over wound
Apply occlusive dressing
Apply pressure to stop bleeding
Bandage dressing in place
Immobilize spine if MOI suggests cervical
injury
6/28/2011
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Injuries to the Spine Injuries to the Spine
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Injuries to the Spine Injuries to the Spine
Assume possible cervical-spine injury if
MOI exerts great force on upper body or if
soft-tissue damage to head, face, or neck
Spinal cord is a relay between most of
body and brain for sending messages
Neurogenic shock: form of shock resulting
from nerve paralysis; causes uncontrolled
dilation of blood vessels
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Assessment: Spinal Injury Assessment: Spinal Injury
Paralysis of extremities
Pain without movement
Pain with movement
Tenderness anywhere along spine
Impaired breathing
Deformity
Priapism
Loss of bowel or bladder control
6/28/2011
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Treatment: Spinal Injury Treatment: Spinal Injury
Provide manual in-line stabilization
Assess ABCs
Rapidly assess head and neck; apply
rigid cervical collar
Rapidly assess for sensory and motor
function
continued
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Treatment: Spinal Injury Treatment: Spinal Injury
Apply appropriate spinal immobilization
device
Reassess sensory and motor function
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Spinal Injuries Video Spinal Injuries Video
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Immobilization Issues Immobilization Issues
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Applying a Cervical Collar Applying a Cervical Collar
Always maintain
manual
stabilization
Use in conjunction
with a long
backboard
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Immobilizing a Seated Patient Immobilizing a Seated Patient
Low priority: Use a
short board or
vest-immobilization
device
High priority:
Maintain manual
stabilization while
moving patient
6/28/2011
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Applying a Long Backboard Applying a Long Backboard
Log roll patient
Pad voids between board and head/torso
Secure head last
If pregnant, tilt board to left after
immobilizing
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Standing Patient Standing Patient
Rapid takedown
Requires three providers, cervical collar, and
long backboard
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Patient Found Patient Found
Wearing a Helmet Wearing a Helmet
When to leave helmet in place
Fits snugly, allowing no movement
Absolutely no impending airway or breathing
issues
Removal would cause further injury
Proper spinal immobilization can be done with
helmet in place
continued
6/28/2011
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Patient Found Patient Found
Wearing a Helmet Wearing a Helmet
When to remove helmet
Interferes with ability to assess and manage
airway
Improperly fitted
Interferes with immobilization
Cardiac arrest
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KED Overview Video KED Overview Video
Click here to view a video on the use of a vest-style extrication device.
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Chapter Review Chapter Review
6/28/2011
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Chapter Review Chapter Review
The two main divisions of the nervous
system are the central nervous system
and the peripheral nervous system.
Maintain a high index of suspicion for head
or spine injury whenever there is a
relevant mechanism of injury.
continued
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Limmer OKeefe Dickinson
continued
Chapter Review Chapter Review
Provide cervical spine stabilization before
beginning any other patient care when
head or spine injury is suspected.
Altered mental status is an early and
important indicator of head injury. Monitor
and document your patients mental status
throughout the call.
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Chapter Review Chapter Review
A traumatic brain injury is any injury that
disrupts function of the brain and may
include anything from a slight concussion
to a severe hematoma.
Always secure the torso to the backboard
before the head.
6/28/2011
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Remember Remember
The key components of the nervous
system are the brain and the spinal cord.
These organs regulate thought,
sensations, and motor functions.
The skull, vertebrae, and cerebrospinal
fluid efficiently protect the brain and spinal
cord.
continued
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continued
Remember Remember
In a closed head injury, the skull remains
intact. This is dangerous, for the skull is a
closed container with little room for
bleeding or swelling.
Neck wounds are at risk for massive
bleeding and air entry, causing emboli.
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Remember Remember
The spine is injured most often by
compression or excessive flexion, by
extension, or rotation from falls, by diving
injuries, and by motor-vehicle collisions.
These injuries can interrupt nervous
system control of body functions.
continued
6/28/2011
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Remember Remember
In-line immobilization of 33 spinal bones is
the essential component of spinal injury
immobilization.
Specific procedures apply to different
immobilization and extrication situations.
EMTs should be proficient in handling the
basics of these procedures.
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Questions to Consider Questions to Consider
Does my patient have a mechanism of
injury that would indicate the need for
spinal immobilization?
Do my patients potential head or spine
injuries require prompt transport to a
trauma center?
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Critical Thinking Critical Thinking
You are treating a patient with a head
injury. He has an altered mental status and
a significant MOI to the head. Your partner
thinks you should hyperventilate. When
should you hyperventilate? What are the
signs and symptoms that would indicate
this is necessary?
6/28/2011
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Limmer OKeefe Dickinson
Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
32.1 Define key terms introduced in this chapter.
Slides 12, 24
32.2 Describe the considerations for teamwork, timing,
and transport decisions in assessing and managing
patients with multisystem trauma or multiple trauma.
Slides 1819
continued
6/28/2011
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OBJECTIVES OBJECTIVES
32.3 Discuss the physiologic, anatomic, and mechanism
of injury criteria for determining patient severity with
regard to trauma triage and transport decisions.
Slides 1316
continued
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OBJECTIVES OBJECTIVES
32.4 Recognize special patient considerations that
increase the patients priority for transport, such as
age, anti-coagulation bleeding disorders, burns,
time-sensitive extremity injuries, end-stage renal
disorders requiring dialysis, and pregnancy.
Slides 1316
continued
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OBJECTIVES OBJECTIVES
32.5 Discuss general principles of multisystem trauma
management. Slides 2023
32.6 Describe the purposes of trauma scoring systems.
Slides 2426
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MULTIMEDIA MULTIMEDIA
Slide 27 Emergency: Gunshot Wound Video
Slide 28 Multiple System Injuries in Front-end Collisions
Video
Slide 29 Mechanism of Injuries in Vehicle Collisions
Video
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CORE CONCEPTS
How to balance the critical trauma
patients need for prompt transport against
the time needed to treat all the patients
injuries at the scene
How to determine the severity of the
trauma patients condition, priority for
transport, and appropriate transport
destination
continued
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CORE CONCEPTS
How to select the critical interventions to
implement at the scene for a multiple-
trauma patient
How to calculate a trauma score
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Topics Topics
Multisystem Trauma
Managing the Multisystem Trauma Patient
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Multisystem Trauma Multisystem Trauma
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Multisystem Trauma Multisystem Trauma
Patient with one or more injuries serious
enough to affect more than one body
system
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Determining Patient Severity Determining Patient Severity
Physiologic criteria
Anatomic criteria
Mechanism of injury
continued
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Determining Patient Severity Determining Patient Severity
Physiologic criteria
Altered mental status (GCS <14): head injury
Hypotension (systolic <90mmHg): shock,
internal bleeding
Abnormally slow respiratory rate: head injury,
later stages of shock
Abnormally high respiratory rate: shock
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Anatomic Criteria Anatomic Criteria
Injury to specific a body part/area requiring
immediate surgical intervention
Injuries to the head and chest
Multiple musculoskeletal injuries
Amputations
Severely mangled extremities
Pelvic injuries
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Mechanism of Injury Mechanism of Injury
In absence of anatomic or physiologic
signs, MOI is considered if severe
Fall
High-risk auto crash
Automobile-pedestrian crash
Motorcycle crash
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Managing the Multisystem Managing the Multisystem
Trauma Patient Trauma Patient
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Preparing for Preparing for
Multisystem Trauma Patients Multisystem Trauma Patients
Practice with crew: determine roles
En route to call, review roles each member
of the crew will have
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Scene Safety Scene Safety
Scene safety is paramount
Different trauma is associated with
different dangers
Auto crash will have passing traffic
Penetrating traumaassailant may still be
on the scene
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Treating Treating
Multisystem Trauma Multisystem Trauma
Follow priorities determined by primary
assessment
Attend to threats to life
Reassess what to treat on scene and what
needs definitive care
Call hospital so they can prepare
continued
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Postpone
vitals
Alert hospital
Treating Treating
Multisystem Trauma Multisystem Trauma
continued
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Treating Treating
Multisystem Trauma Multisystem Trauma
Limit scene treatment
Suction airway
Insert oral or nasal airway
Restore patent airway
Ventilate with bag-valve mask
Administer oxygen
Control bleeding
Immobilize patient
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Expect the Unexpected Expect the Unexpected
Adapt to situation
Do what is necessary to ensure an open
airway
Perform urgent or emergency moves as
necessary
If part of patients body is not accessible,
assess part of the body you can reach
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Trauma Scoring Trauma Scoring
Numerical rating system for trauma
Assigns number to certain patient
characteristics to create a score
Objectively describes severity
Helps determine transport to a trauma
center or local hospital
Helps trauma centers evaluate the care of
similar patients
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Revised Trauma Score (RTS) Revised Trauma Score (RTS)
Components
Glasgow Coma Scale (GCS)
Systolic blood pressure
Respiratory rate
Follow local protocol for use of the trauma
scoring system
Do not let it interfere with patient care
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Sample RTS Form Sample RTS Form
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Emergency: Emergency:
Gunshot Wound Video Gunshot Wound Video
Click here to view a video on the subject of treating gunshot wounds.
Back to Directory
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Multiple System Injuries Multiple System Injuries
in Front in Front--end Collisions Video end Collisions Video
Click here to view a video on the subject of trauma due to
front-end collisions.
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Mechanism of Mechanism of
Injuries in Vehicle Collisions Video Injuries in Vehicle Collisions Video
Click here to view a view a video on the types of injuries in
motor vehicle collisions.
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Multisystem trauma is a serious condition
in which two or more major body systems
are injured or affected.
Recognizing multisystem trauma, triaging
properly, transporting promptly, and
choosing the correct destination are vital
for the survival of your patient.
continued
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continued
Chapter Review Chapter Review
The CDC has issued guidelines for trauma
triage and transport. These are a guide
and should be used in conjunction with
your protocols.
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Chapter Review Chapter Review
The revised trauma score (RTS) is one
method of classifying trauma patients by
severity and includes the Glasgow Coma
Score (GCS), systolic blood pressure, and
respiratory rate.
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Remember Remember
Your primary assessment should
determine whether your patient is
seriously injured or potentially seriously
injured.
Limit scene treatment to life-threatening
conditions.
The golden hour begins from the time of
trauma.
continued
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Remember Remember
Use patient severity (physiologic criteria,
anatomic criteria, MOI) to decide whether
to transport to a trauma center or local
hospital.
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Questions to Consider Questions to Consider
Is my patient seriously injured or
potentially seriously injured?
Should I expedite my scene time?
What is the most appropriate transport
destination for my patient?
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Critical Thinking Critical Thinking
A patient was involved in a car crash with
significant intrusion into the area where
the patient was sitting. The patient is alert
and complains of pain in the ribs. Pulse:
96 and regular; respirations: 30 and
adequate; blood pressure: 100/62; pupils:
equal and reactive; skin: cool and dry.
continued
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Critical Thinking Critical Thinking
Your partner says the patient is stable and
could be easily transported to the
community hospital nearby. You think the
patient should be transported to the
trauma center. How would you justify your
decision to your partner?
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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OBJECTIVES OBJECTIVES
33.1 Define key terms introduced in this chapter. Slides
1314, 17, 29, 32, 38
33.2 Describe the process of heat loss and heat
production by the body. Slides 13, 21
33.3 Recognize predisposing factors and exposure
factors in relation to hypothermia. Slides 1415
continued
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OBJECTIVES OBJECTIVES
33.4 Recognize signs and symptoms of hypothermia.
Slide 16
33.5 Describe the indications, contraindications, benefits,
and risks of passive and active rewarming
techniques. Slide 17
continued
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continued
OBJECTIVES OBJECTIVES
33.6 Prioritize steps in assessment and management of
patients with varying degrees of hypothermia.
Slides 16, 18
33.7 Discuss assessment and management for early or
superficial local cold injury and for late or deep local
cold injury. Slide 19
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OBJECTIVES OBJECTIVES
33.8 Discuss the effects of heat on the human body.
Slide 21
33.9 Differentiate between assessment and management
priorities for heat emergency patients with moist,
pale, normal-to-cool skin, and those with hot skin
that is either dry or moist. Slides 2225
continued
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continued
OBJECTIVES OBJECTIVES
33.10 Anticipate the types of injuries and medical
conditions that may be associated with water-related
accidents. Slide 27
33.11 Discuss the assessment and management of the
following water-related emergencies: drowning
(including rescue breathing and care for possible
spinal injuries), diving accidents, and scuba diving
accidents. Slides 2832
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OBJECTIVES OBJECTIVES
33.12 Discuss the assessment and management of the
following types of bites and stings: insect bites and
stings, snakebites, and poisoning from marine life.
Slides 3840
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MULTIMEDIA MULTIMEDIA
Slide 36 Emergency: Near Drowning Video
Slide 41 Effects of Venomous Snake Bites Video
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CORE CONCEPTS
Effects on the body of generalized
hypothermia; assessment and care for
hypothermia
Effects on the body of local cold injuries;
assessment and care for local cold injuries
continued
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CORE CONCEPTS
Personal effects on the body of exposure
to heat; assessment and care for patients
suffering from heat exposure
Signs, symptoms, and treatment for
drowning and other water-related injuries
Signs, symptoms, and treatment for bites
and stings
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Topics Topics
Exposure to Cold
Exposure to Heat
Water-Related Emergencies
Bites and Stings
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Exposure to Cold Exposure to Cold
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How the Body Loses Heat How the Body Loses Heat
Conduction
Convection
Radiation
Evaporation
Respiration
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Generalized Hypothermia Generalized Hypothermia
Exposure to cold reduces body heat
Body is unable to maintain proper core
temperature
May lead to death
Predisposing factors of hypothermia
Injury
Chronic illness
Geriatric/pediatric
continued
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Generalized Hypothermia Generalized Hypothermia
Obvious and subtle
exposure
Alcohol ingestion
Underlying illness
Overdose or
poisoning
Major trauma
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Assessment: Hypothermia Assessment: Hypothermia
Shivering, in early stages
Numbness
Stiff or rigid posture
Drowsiness
Rapid breathing or pulse
Loss of motor coordination
Joint/muscle stiffness
Unconsciousness
Cool abdominal skin temperature
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Rewarming Rewarming
Passive
Cover patient
Remove wet clothing
Active
Apply external heat
source
Central
Apply heat to lateral
chest, neck, armpits,
and groin
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Extreme Hypothermia Extreme Hypothermia
Patient unconscious, no discernible vital
signs
Heart rate can slow to 10 beats/minute
Very cold to touch
If no pulse, start CPR with AED
If pulse present, care as for any
unresponsive patient
Youre not dead until youre warm and
dead
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Localized Cold Injuries Localized Cold Injuries
Most commonly affects ears, nose, face,
hands, and feet
Blood flow limited by constriction of blood vessels
Tissues freeze, may form ice crystals
Early/superficial (frostnip)
Remove from cold and cover
Late/deep (frostbite)
Cover and immobilize gently
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Exposure to Heat Exposure to Heat
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Effects of Heat on Body Effects of Heat on Body
Heat not needed for temperature
maintenance, and not lost, creates
hyperthermia
Left unchecked, leads to death
Heat cramps and heat exhaustion
Moist, pale, normal-to-cool skin
Heat stroke
Hot, dry, or possibly moist skin
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Heat Exhaustion: Heat Exhaustion:
Signs and Symptoms Signs and Symptoms
Muscular cramps
Weakness or exhaustion
Rapid, shallow breathing
Weak pulse
Heavy perspiration
Loss of consciousness
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Heat Exhaustion: Treatment Heat Exhaustion: Treatment
Remove from hot environment
Administer oxygen
Loosen or remove clothing
Position supine
Small sips of water
Transport
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Heat Stroke: Heat Stroke:
Signs and Symptoms Signs and Symptoms
Rapid, shallow breathing
Full, rapid pulse
Generalized weakness
Little or no perspiration
Altered mental status
Dilated pupils
Seizures
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Heat Stroke: Treatment Heat Stroke: Treatment
Remove from hot environment
Remove clothing
Apply cool packs to neck, groin, and
armpits
Administer oxygen
Transport immediately
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Water Water--Related Emergencies Related Emergencies
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Types of Accidents Types of Accidents
Occurring on or Near Water Occurring on or Near Water
Boating
Water-skiing
Wind surfing
Jet-skiing
Diving
Scuba-diving
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Drowning Drowning
Often begins as person struggles to keep
afloat
When they start to submerge, they try to
take one more deep breath
Water may enter airway, followed by
coughing and swallowing, and involuntary
swallowing of more water
continued
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Drowning Drowning
Reflex spasm of larynx is triggered,
sealing airway; unconsciousness results
from hypoxia
Some who die from drowning die just from
lack of air
Most attempt a final breath (or are
unconscious) and water enters lungs
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Drowning Drowning: Treatment : Treatment
Begin rescue breathing without delay
If you reach a non-breathing patient in
water, support patient in semi-supine
position and provide ventilations
May encounter airway resistance; will
probably have to ventilate more forcefully
than other patients
Do not delay transport
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Diving Accidents Diving Accidents
Most involve head and neck, but many
also involve spine, hands, feet, and ribs
Emergency care is the same as for any
accident patient out of water
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Scuba Scuba--Diving Accidents Diving Accidents
Arterial gas embolism (gas bubbles in
bloodstream): diver holding breath
May be due to inadequate training, equipment
failure, underwater emergency, or trying to
conserve air
Decompression sickness: diver surfacing
too quickly from deep, prolonged dive
Takes 148 hours to appear
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Diver Alert Network (DAN) Diver Alert Network (DAN)
Formed to assist rescuers with care of
underwater diving accident patients
Gives EMT or dispatcher information on
assessment, care, and how to transfer
patient to hyperbaric trauma care center
Emergency: 919-684-8111
Non-Emergency: 919-684-2948
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Water Rescue Water Rescue
Reach
Hold object for patient
to grab
Throw
Throw object that will
float
Row
Row boat to patient
Go
Swim to patient (last
resort)
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Ice Rescue Ice Rescue
Throw flotation device to patient
Toss rope with loop
Push out flat bottomed aluminum boat
Lay ladder flat on ice to distribute weight of
rescuer
Treat patient for hypothermia
Always transport
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Emergency: Emergency:
Near Drowning Video Near Drowning Video
Click here to view a video on the subject of a near drowning.
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Bites and Stings Bites and Stings
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Spider and Spider and
Insect Bites and Stings Insect Bites and Stings
All spiders are poisonous
Insect stings and bites are rarely
dangerous
Anaphylactic shock
is a major concern
Remove stinger
quickly
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Snakebites Snakebites
Require special care but are not usually
life-threatening
Death is not sudden unless anaphylactic
shock develops
Stay calm
Keep patient calm
and at rest
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Marine Life Poisoning Marine Life Poisoning
Can occur in variety of ways
Eating improperly prepared seafood or
poisonous organisms
Stings and punctures
Fresh water activates toxins on skin,
increasing pain
Use salt water to rinse affected area
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Effects of Effects of
Venomous Snake Bites Video Venomous Snake Bites Video
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Chapter Review Chapter Review
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Chapter Review Chapter Review
Patients suffering from exposure to heat or
cold must be removed from the harmful
environment as quickly and as safely as
possible.
Generalized cold injuries involve cooling
the entire body (hypothermia). Treatment
is based on whether the patient has
normal or altered mental status.
continued
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continued
Chapter Review Chapter Review
Patients who have hypothermia with
altered mental status are considered to
have severe hypothermia.
Local cold injury involves an isolated part
or parts of the body (frostbite). Early injury
may be rewarmed gently.
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continued
Chapter Review Chapter Review
Late local cold injury involves freezing of
tissue. Transport rather than rewarming
unless transport is significantly delayed or
if advised by medical direction.
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continued
Chapter Review Chapter Review
Hyperthermia is a heat emergency.
Severity is determined by skin
temperature. Skin which is normal to cool
is considered less severe than skin which
is hot to the touch. All heat emergency
patients should be removed from the heat
and cooled.
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continued
Chapter Review Chapter Review
Altered mental status in the setting of
hyperthermia indicates a life-threatening
emergency.
Follow local protocols in reference to
rewarming or cooling procedures.
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Chapter Review Chapter Review
Immediate resuscitation of a water-related
emergency patient may require quick,
persistent intervention. Always assure your
own safety before attempting any rescue.
For injection or ingestion of poisons of
insects, spiders, snakes, and marine life,
call medical direction and follow local
protocol.
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Remember Remember
Heat is lost and gained through
convection, conduction, evaporation,
respiration, and radiation. Certain
illnesses, medications, and underlying
conditions make patients more susceptible
to heat and cold injuries.
continued
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continued
Remember Remember
Actively rewarm alert and responsive
hypothermia patients. Passively rewarm
hypothermic patients with an altered level
of consciousness.
In a patient with signs of heat exhaustion
and altered mental status, the EMT must
assume heat stroke is present. Active
cooling is essential.
6/28/2011
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continued
Remember Remember
Providers never should attempt a water
rescue unless they have been properly
trained to do so.
The two special problems seen in scuba-
diving accidents are arterial gas emboli
and decompression sickness.
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Remember Remember
When treating a scuba-related injury,
EMTs should contact medical control to
determine the most appropriate
destination.
Certain species of spiders, scorpions, and
snakes can be poisonous to humans.
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Questions to Consider Questions to Consider
Is the scene safe from heat, cold, or
venomous creatures?
How can I get the patient from the water
safely?
Hypothermia: Does the patient have an
altered mental status?
Hyperthermia: Is the patients skin
temperature cool to normal, or hot?
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Critical Thinking Critical Thinking
You are with your family at a local lake.
You observe a boat capsize near the
middle of the lake. Screams can be heard
from the scene. You are a marginal
swimmer. Several civilians begin
swimming out to the site. Apply the
concepts learned in scene size-up to this
scene.
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Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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708
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OBJECTIVES OBJECTIVES
34.1 Define key terms introduced in this chapter. Slides
17, 22, 25, 34, 36, 39, 51, 60, 6569, 7475
34.2 Identify the anatomy of the female reproductive
system and fetal development. Slides 1619
34.3 Explain the physiology of pregnancy. Slide 21
continued
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OBJECTIVES OBJECTIVES
34.4 Explain and describe measures to prevent or correct
supine hypotensive syndrome. Slide 22
34.5 Describe the three stages of labor. Slides 2527
34.6 Discuss the assessment of a patient in labor,
including history and physical examination.
Slides 3133
continued
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OBJECTIVES OBJECTIVES
34.7 Discuss how to decide if delivery is imminent or if
the patient in labor should be transported to a
medical facility for delivery. Slides 3334
34.8 State findings that may indicate the need for
neonatal resuscitation. Slides 3536
continued
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OBJECTIVES OBJECTIVES
34.9 Discuss the role of the EMT in normal childbirth,
including preparation and delivery. Slides 3943,
4549
34.10 Describe the normal steps in care of the neonate.
Slides 5153
continued
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OBJECTIVES OBJECTIVES
34.11 Explain the indications and procedures for neonatal
resuscitation, following the inverted pyramid order of
priorities. Slides 5556
34.12 Discuss after-delivery care of the mother, including
delivery of the placenta, controlling vaginal bleeding,
and providing comfort to the mother. Slides 5962
continued
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continued
OBJECTIVES OBJECTIVES
34.13 Describe and discuss the special care required for
complications of delivery, including: breech
presentation, limb presentation, prolapsed umbilical
cord, multiple birth, premature birth, and meconium.
Slides 6570
6/28/2011
710
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continued
OBJECTIVES OBJECTIVES
34.14 Describe and discuss the special care required for
emergencies in pregnancy, including: excessive
prebirth bleeding, ectopic pregnancy, seizures in
pregnancy, miscarriage and abortion, trauma in
pregnancy, stillbirths, and accidental death of a
pregnant woman. Slides 7281
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OBJECTIVES OBJECTIVES
34.15 Describe and discuss the special care required for
gynecological emergencies, including: vaginal
bleeding, trauma to the external genitalia, and
sexual assault. Slides 8587
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MULTIMEDIA MULTIMEDIA
Slide 29 Information About Childbirth Video
Slide 82 Information About Preeclampsia Video
Slide 83 Ectopic Pregnancy Video
6/28/2011
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CORE CONCEPTS
Anatomy and physiology of the female
reproductive system
Physiologic changes in pregnancy
Care of the mother and baby during labor
and childbirth
Care of the neonate
Post-delivery care of the mother
continued
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CORE CONCEPTS
Complications of delivery
Emergencies in pregnancy
Gynecological emergencies
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Topics Topics
Anatomy and Physiology
Physiologic Changes in Pregnancy
Labor and Delivery
Patient Assessment
Normal Childbirth
The Neonate
Care After Delivery
continued
6/28/2011
712
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Topics Topics
Childbirth
Complications
Gynecological
Emergencies
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Anatomy and Physiology Anatomy and Physiology
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6/28/2011
713
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Female Genitalia Female Genitalia
External
Labia
Perineum
Mons pubis
Internal
Vagina
Ovaries
Fallopian tubes
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Female Reproductive Cycle Female Reproductive Cycle
Menstruation
Stimulated by estrogen and progesterone
Ovaries release ovum
Uterus walls thicken
Fallopian tubes move egg (peristalsis)
Uterine walls expelled (bleeding 35 days)
continued
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Female Reproductive Cycle Female Reproductive Cycle
Fertilization
Sperm reaches ovum
Ovum becomes embryo
Embryo implants in uterus
Fetal stage begins
6/28/2011
714
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Physiologic Changes in Physiologic Changes in
Pregnancy Pregnancy
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Changes in the Changes in the
Reproductive System Reproductive System
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Supine Hypotensive Syndrome Supine Hypotensive Syndrome
Placenta, infant, and amniotic fluid total
2024 lbs.
When supine, mass compresses inferior
vena cava
Cardiac output decreases
Dizziness and drop in blood pressure
6/28/2011
715
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Think About It Think About It
How does the development of the fetus
affect other body systems?
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Labor and Delivery Labor and Delivery
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First Stage
6/28/2011
716
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Second Stage Second Stage
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Third Stage
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Think About It Think About It
Why is childbirth such an exhausting
ordeal for the mother?
6/28/2011
717
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Information Information
About Childbirth Video About Childbirth Video
Click here to view a video on the subject of childbirth.
Back to Directory
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Patient Assessment Patient Assessment
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6/28/2011
718
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Assessing the Assessing the
Woman in Labor Woman in Labor
Assessment focused on imminent delivery
Name, age, expected due date
First pregnancy?
Seen doctor about pregnancy?
When did labor pains start?
continued
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Assessing the Assessing the
Woman in Labor Woman in Labor
Feel the urge to push?
Examine for crowning
Feel for uterine contractions
Take vital signs
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Crowning Crowning
6/28/2011
719
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Findings Indicating Findings Indicating
Possible Need for Resuscitation Possible Need for Resuscitation
No prior prenatal care
Premature delivery
Labor induced by trauma
Multiple births
continued
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Findings Indicating Findings Indicating
Possible Need for Resuscitation Possible Need for Resuscitation
History of pregnancy problems (especially
placenta previa and breech presentation)
Labor induced by drug use (especially
narcotics) and alcohol
Meconium staining when water breaks
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Think About It Think About It
How can you get necessary information
from a patient who may be having
uncontrolled pain from contractions?
6/28/2011
720
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Normal Childbirth Normal Childbirth
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Cephalic Delivery Cephalic Delivery
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Imminent Delivery Imminent Delivery
Control scene
Proper PPE
Place mother on bed, floor, or ambulance
stretcher
Remove clothing obstructing vagina
Position assistant and OB kit
6/28/2011
721
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Preparing Mother for Delivery Preparing Mother for Delivery
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Preparing the OB Kit
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Off Off--Duty Delivery Supplies Duty Delivery Supplies
Clean sheets and towels
Heavy, flat twine or new shoelaces
Towel or plastic bag (for placenta)
Clean, unused rubber gloves and eye
protection
6/28/2011
722
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Think About It Think About It
Are there legal/moral/ethical concerns for
an off-duty delivery?
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Delivering the Baby
continued
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Delivering the Baby Delivering the Baby
continued
6/28/2011
723
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Delivering the Baby Delivering the Baby
continued
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Emergency Care, Twelfth Edition
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Delivering the Baby Delivering the Baby
continued
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Delivering the Baby Delivering the Baby
6/28/2011
724
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The Neonate The Neonate
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Assessing the Neonate Assessing the Neonate
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Keeping the Baby Warm Keeping the Baby Warm
Heat retention is high priority
Dry baby
Discard wet blankets
Wrap baby in a dry blanket (infant
swaddler or space blanket)
Cover head
6/28/2011
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Cutting the Umbilical Cord Cutting the Umbilical Cord
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Think About It Think About It
Why is it so important to stimulate the
baby?
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Neonatal Resucitation Neonatal Resucitation
continued
6/28/2011
726
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Neonatal Resucitation Neonatal Resucitation
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Think About It Think About It
What are the first steps in neonatal
resuscitation?
What is central cyanosis?
When is artificial ventilation required, and
what is the rate of artificial ventilations?
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Care After Delivery Care After Delivery
6/28/2011
727
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Caring for the Mother Caring for the Mother
Mother at risk for serious bleeding,
infection, emboli
Deliver placenta
Control vaginal bleeding
Comfort
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Delivering the Placenta Delivering the Placenta
Afterbirth: placenta with umbilical cord,
amniotic sac membranes, and tissues
lining uterus
Placental delivery starts with labor pains
May take 30 minutes or longer
Begin transport in 10 minutes (do not wait
to deliver placenta)
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Controlling Vaginal Bleeding Controlling Vaginal Bleeding
6/28/2011
728
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Providing Providing
Comfort to the Mother Comfort to the Mother
Take vital signs frequently
Acts of kindness will be appreciated and
remembered
Wipe face and hands with damp washcloth
Replace blood-soaked sheets and
blankets
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Think About It Think About It
What are your responsibilities in caring for
the mother?
What is considered to be the usual blood
loss?
Give examples of acts of kindness toward
the mother.
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Childbirth Complications Childbirth Complications
6/28/2011
729
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Breech Presentation Breech Presentation
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Limb Presentation Limb Presentation
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Prolapsed Umbilical Cord Prolapsed Umbilical Cord
6/28/2011
730
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Multiple Birth Multiple Birth
Have appropriate resources
Clamp or tie cord of first baby
Assist with delivery of second baby
Placenta and cord care are same as single
delivery
Keep babies and mother warm
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Premature Birth Premature Birth
Keep baby warm
Keep airway clear
Provide ventilations and chest
compressions
Watch umbilical cord for bleeding
Oxygen (blow by)
Call ahead to emergency department
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Meconium Meconium
Dont stimulate infant before suctioning
Suction mouth, then nose
Maintain open airway
Provide ventilations and/or chest
compressions
6/28/2011
731
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Think About It Think About It
Why is it important to have your partner or
another person (birthing coach or other
adult acceptable to the mother) observing
as you help the mother through childbirth?
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Emergencies in Pregnancy Emergencies in Pregnancy
Excessive prebirth bleeding
Ectopic pregnancy
Seizures in pregnancy
Miscarriage and abortion
Trauma in pregnancy
Stillbirths
Accidental death of pregnant woman
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Excessive Prebirth Bleeding Excessive Prebirth Bleeding
Main sign is unusually profuse bleeding
Abdominal pain may or may not be felt
Assess for signs of shock
High-concentration oxygen and transport
Place sanitary napkin over vagina
continued
6/28/2011
732
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Excessive Prebirth Bleeding Excessive Prebirth Bleeding
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Ectopic Pregnancy Ectopic Pregnancy
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Seizures in Pregnancy Seizures in Pregnancy
Existing preeclampsia
Elevated blood pressure
Excessive weight gain
Excessive swelling to face, ankles hands,
and feet
Altered mental status or headache
6/28/2011
733
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Miscarriage and Abortion Miscarriage and Abortion
Cramping, abdominal pains
Bleeding: moderate to severe
Discharge of tissue and blood from vagina
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Trauma in Pregnancy Trauma in Pregnancy
Pulse 1015 beats faster than non-
pregnant women
Blood loss may be 30%35% before
signs/symptoms appear
Ask patient if she received blows to
abdomen
continued
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Trauma in Pregnancy Trauma in Pregnancy
6/28/2011
734
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Stillbirths Stillbirths
Do not resuscitate if it is obvious the baby
died some time before birth
Resuscitate if baby is born in cardiac or
respiratory arrest
Prepare to provide life support
Emotional support for family
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Accidental Accidental
Death of Pregnant Woman Death of Pregnant Woman
Chance to save unborn child
Begin CPR on mother immediately
Continue CPR until emergency cesarean
section can be performed or you are
relieved in emergency department
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Limmer OKeefe Dickinson
Information About Information About
Preeclampsia Video Preeclampsia Video
Click here to view a video on the subject of preeclampsia.
Back to Directory
6/28/2011
735
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Limmer OKeefe Dickinson
Ectopic Pregnancy Video Ectopic Pregnancy Video
Click here to view a video on the subject of ectopic pregnancy.
Back to Directory
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Gynecological Emergencies Gynecological Emergencies
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Vaginal Bleeding Vaginal Bleeding
Treat as potential life threat
Check for associated abdominal pain
Monitor for hypovolemic shock
6/28/2011
736
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Trauma to External Genitalia Trauma to External Genitalia
Observe MOI
Look for signs of severe blood loss and
shock
Consider additional internal injuries
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Sexual Assault Sexual Assault
Treat immediate life threats
Do not disturb potential evidence
Examine genitals only if severe bleeding is
present
Discourage bathing, voiding, or cleansing
wounds
Fulfill mandated reporting requirements
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Think About It Think About It
When arriving at a crime scene, what are
the key things to keep in mind as you
respond?
6/28/2011
737
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Chapter Review Chapter Review
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Emergency Care, Twelfth Edition
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Chapter Review Chapter Review
Although birth is a natural process that
usually takes place without complications,
involvement of EMS usually indicates
something unusual has happened.
The EMTs role at a birth is generally to
provide reassurance and to assist the
mother in the delivery of her baby.
continued
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Limmer OKeefe Dickinson
Chapter Review Chapter Review
During normal delivery, determine if there
should be immediate transport or if birth is
imminent and will take place at the scene.
If birth is to take place at the scene, have
equipment ready and appropriate
resources on hand. Always be prepared
for resuscitation.
continued
6/28/2011
738
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Chapter Review Chapter Review
Complications of delivery are a true
emergency. Be prepared to initiate rapid
transport.
There may also be pre-delivery
emergencies or emergencies associated
with pregnancy that you must be prepared
to treat.
continued
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Limmer OKeefe Dickinson
Chapter Review Chapter Review
Stillbirth and death of the mother and
sexual assault are difficult emergencies
the EMT is occasionally called upon to
manage. Emotional care for these issues
may be as important as medical care.
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Remember Remember
Female reproductive organs present new
anatomy and specific potential
emergencies. EMTs should recognize the
different anatomy and be prepared to
address reproductive emergencies.
A growing fetus creates massive change
to the mothers body. All systems undergo
major alterations.
continued
6/28/2011
739
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Limmer OKeefe Dickinson
continued
Remember Remember
Assessment of the woman in labor is
designed to predict imminent delivery and
to recognize likely resuscitation.
The urge to push and crowning indicate
imminent delivery. Transport typically
should be deferred for a home delivery.
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
continued
Remember Remember
Lack of prenatal care, premature labor,
multiple gestation, and underlying
conditions indicate a likelihood of neonatal
resuscitation.
Childbirth requires a high level of personal
protective equipment.
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Limmer OKeefe Dickinson
continued
Remember Remember
The most important aspect of care for a
neonate is keeping the baby warm.
Resuscitation may be indicated by
assessing breathing and heart rate.
After delivery there are two patients to
care for: the infant and the mother.
6/28/2011
740
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Remember Remember
EMTs should be familiar with the
pathophysiology and emergency treatment
of the various complications of childbirth.
Care of the sexual assault patient must
include medical, legal, and psychological
considerations.
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Questions to Consider Questions to Consider
What is the difference between abruptio
placenta and placentae previa?
How do you care for a prolapsed cord?
What do you do if the bag of water is still
intact during delivery?
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Critical Thinking Critical Thinking
You are called to a pregnant woman in
labor. During your evaluation you find that
it is the womans first pregnancy, the
babys head is not crowning, and
contractions are 10 minutes apart.
continued
6/28/2011
741
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Critical Thinking Critical Thinking
You ask the mother if she feels the need to
move her bowels, and she says no. Do
you prepare for delivery at the scene? Or
do you transport the mother to the
hospital?
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Limmer OKeefe Dickinson
Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
6/28/2011
742
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OBJECTIVES OBJECTIVES
35.1 Define key terms introduced in this chapter. Slides
19, 21, 54
35.2 Describe the anatomic and physiologic
characteristics of infants and children compared to
adults and the implications of each for assessment
and care of the pediatric patient. Slides 1926
continued
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Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
35.3 Discuss the normal vital signs ranges for infants and
children. Slide 19
35.4 Adapt history-taking and assessment techniques to
patients in each pediatric age group. Slides 2830
continued
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Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
35.5 Discuss special considerations in dealing with
adolescent patients. Slide 31
35.6 Discuss the importance of involving caretakers in
the assessment and emergency care of pediatric
patients and anticipate reactions of parents and
caregivers in response to an ill or injured child.
Slides 3435
continued
6/28/2011
743
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
continued
OBJECTIVES OBJECTIVES
35.7 Discuss the use of the pediatric assessment triangle
in assessing pediatric patients. Slides 3840
35.8 Explain special aspects of the steps of assessment
for pediatric patients, including the scene size-up,
primary assessment, secondary assessment with
physical exam, and reassessment. Slides 4258
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Limmer OKeefe Dickinson
continued
OBJECTIVES OBJECTIVES
35.9 Demonstrate adaptations to techniques and
equipment to properly manage the airway,
ventilation, and oxygenation of pediatric patients.
Slides 6069
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Limmer OKeefe Dickinson
continued
OBJECTIVES OBJECTIVES
35.10 Compare and contrast the causes, presentation,
and management of shock in pediatric and adult
patients. Slides 7072
35.11 Recognize the particular concern for preventing heat
loss in pediatric patients. Slide 73
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Limmer OKeefe Dickinson
continued
OBJECTIVES OBJECTIVES
35.12 Recognize the signs, symptoms, and history
associated with common pediatric medical
emergencies including: difficulty breathing, croup,
epiglottitis, fever, meningitis, diarrhea and vomiting,
seizures, altered mental status, poisoning,
drowning, and sudden infant death syndrome
(SIDS). Slides 7691
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Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
35.13 Discuss injury patterns common in pediatric trauma
patients. Slides 94107
35.14 Discuss care for burns in pediatric patients.
Slides 109110
continued
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Limmer OKeefe Dickinson
continued
OBJECTIVES OBJECTIVES
35.15 Recognize indications of child abuse and neglect,
and explain your ethical and legal responsibilities
when you suspect child abuse or neglect.
Slides 112117
6/28/2011
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Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
35.16 Manage pediatric patients with special challenges,
including those dependent on tracheostomy tubes,
home artificial ventilators, central intravenous lines,
gastrostomy tubes, and shunts. Slides 120126
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Limmer OKeefe Dickinson
MULTIMEDIA MULTIMEDIA
Slide 32 Communicating With Toddlers Video
Slide 36 Caring and Empathy Video
Slide 92 Information About SIDS Video
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Limmer OKeefe Dickinson
CORE CONCEPTS
Anatomic and physiologic characteristics
of children
Psychological and personality
characteristics of children of different ages
How to interact with pediatric patients and
their supporters and caregivers
continued
6/28/2011
746
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Limmer OKeefe Dickinson
CORE CONCEPTS
continued
How to assess the pediatric patient
How to identify and treat special concerns
with the ABCs, shock, and potential
hypothermia
How to assess and care for various
pediatric medical emergencies, especially
respiratory disorders
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Limmer OKeefe Dickinson
CORE CONCEPTS
How to assess and care for various
pediatric trauma emergencies
How to deal with issues of child abuse and
neglect and children with special needs
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Topics Topics
Developmental Characteristics of Infants
and Children
Supporting the Parents or Other Care
Providers
Assessing the Pediatric Patient
Special Concerns in Pediatric Care
Pediatric Medical Emergencies
continued
6/28/2011
747
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Limmer OKeefe Dickinson
Topics Topics
Pediatric Trauma Emergencies
Child Abuse and Neglect
Infants and Children With Special
Challenges
The EMT and Pediatric Emergencies
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Limmer OKeefe Dickinson
Developmental Characteristics Developmental Characteristics
of Infants and Children of Infants and Children
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Limmer OKeefe Dickinson
Pediatric Age Categories Pediatric Age Categories
Newborns and infants: birth to 1 year
Toddlers: 13 years
Preschool: 36 years
School age: 612 years
Adolescent: 1218 years
6/28/2011
748
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Anatomic and Anatomic and
Physiologic Differences Physiologic Differences
Infants and children differ from adults in
psychology, anatomy, and physiology
Understanding differences will help you
assess and care for young patients
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Limmer OKeefe Dickinson
The Head The Head
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Limmer OKeefe Dickinson
Airway and Airway and
Respiratory System Respiratory System
6/28/2011
749
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Chest and Abdomen Chest and Abdomen
Less developed, more elastic in young
patients
Infants and children: abdominal breathers
Abdominal organs less protected than in
adults
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Body Surface Body Surface
Larger than adults in proportion to body
mass
More prone to heat loss through skin
More vulnerable to hypothermia
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Limmer OKeefe Dickinson
Blood Volume Blood Volume
6/28/2011
750
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Psychological Psychological
and Personality Characteristics and Personality Characteristics
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Think About It Think About It
What techniques would you utilize when
attempting to assess a crying infant?
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Limmer OKeefe Dickinson
Interacting with the
Pediatric Patient
continued
6/28/2011
751
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Limmer OKeefe Dickinson
Interacting Interacting
with the Pediatric Patient with the Pediatric Patient
Identify yourself
Let child know that someone has called or
will call parents
If no life threats, continue at a calm pace
during the evaluation process
Let child have a nearby toy
Kneel at childs eye level
continued
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Limmer OKeefe Dickinson
Interacting Interacting
with the Pediatric Patient with the Pediatric Patient
Smile
Touch or hold childs hand or foot
Do not use equipment without first
explaining what you will do with it
Let child see your face
Stop occasionally to find out if child
understands
Never lie to child
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Limmer OKeefe Dickinson
The Adolescent Patient The Adolescent Patient
6/28/2011
752
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Communicating Communicating
With Toddlers Video With Toddlers Video
Click here to view a video on the subject of communicating with
toddlers.
Back to Directory
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Limmer OKeefe Dickinson
Supporting the Parents or Supporting the Parents or
Other Care Providers Other Care Providers
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Limmer OKeefe Dickinson
6/28/2011
753
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Limmer OKeefe Dickinson
Supporting the Supporting the
Parents or Other Care Providers Parents or Other Care Providers
Possible reactions to childs illness/injury:
denial, shock, crying, screaming, anger,
self-blame, guilt
May interfere with care of child
Ask to help by holding/comforting child
and giving medical history
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Limmer OKeefe Dickinson
Caring and Empathy Video Caring and Empathy Video
Click here to view a video on the subject of caring and empathy for
patient and family.
Back to Directory
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Limmer OKeefe Dickinson
Assessing the Pediatric Patient Assessing the Pediatric Patient
6/28/2011
754
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Pediatric Assessment Triangle Pediatric Assessment Triangle
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Limmer OKeefe Dickinson
Scene Size Scene Size--Up Up
and Safety and SafetyPediatric Pediatric
6/28/2011
755
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Primary Assessment: Primary Assessment:
Pediatric Care Pediatric Care
Rapidly identifies critical patient
Essential component of pediatric
assessment
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Limmer OKeefe Dickinson
Forming a General Impression Forming a General Impression
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Assessing Mental Status Assessing Mental Status
Alert
Verbal
Painful
Gently tap unresponsive infant or child
6/28/2011
756
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Assessing Airway Assessing Airway
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Assessing Breathing Assessing Breathing
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Assessing
Circulation
6/28/2011
757
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Limmer OKeefe Dickinson
Identifying Priority Patients Identifying Priority Patients
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Secondary Secondary
Assessment: Pediatric Assessment: Pediatric
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Limmer OKeefe Dickinson
Physical Exam: Pediatric Physical Exam: Pediatric
Start with toes/trunk and work way toward
head.
If no injuries, patient should be held in
parents lap
Protect childs modesty
Explain why each piece of clothing must
be removed
6/28/2011
758
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Physical Exam: Head Physical Exam: Head
Do not apply pressure to soft spots
Meningitis and head trauma can cause
bulging of fontanelle
Sunken fontanelle may be due to
dehydration
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Limmer OKeefe Dickinson
Physical Exam::
Nose and Ears
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Physical Exam: Neck Physical Exam: Neck
Vulnerable to spinal cord injuries
Children have proportionately larger and
heavier heads
Muscles and bone structures are less
developed
May be sore, stiff, or swollen
6/28/2011
759
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Physical Exam:: Airway
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Physical Exam: Chest Physical Exam: Chest
Be alert for wheezes and other noises
Check for symmetry
Check for bruising
Check for paradoxical motion and
retraction
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Limmer OKeefe Dickinson
Physical Exam: Physical Exam:
Abdomen and Pelvis Abdomen and Pelvis
Abdomen
Note if rigid
Check for distension or discoloration
Abdominal injury may impede movement of
the diaphragm
Pelvis
Check for stability of pelvic girdle
6/28/2011
760
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Physical Exam: Extremities Physical Exam: Extremities
Capillary refill
Distal pulse
Pulses
Motor
Sensory
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Reassessment: Pediatric Reassessment: Pediatric
Mental status
Maintain open airway
Monitor breathing
Reassess pulse
continued
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Limmer OKeefe Dickinson
Reassessment: Pediatric Reassessment: Pediatric
Monitor skin color, temperature, and
moisture
Reassess vital signs
Ensure all appropriate care and treatment
are being given
6/28/2011
761
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Special Concerns in Pediatric Special Concerns in Pediatric
Care Care
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Limmer OKeefe Dickinson
Maintaining an Open Airway Maintaining an Open Airway
Align and open airway
Use head-tilt, chin-lift if no trauma; jaw-
thrust with spinal immobilization if trauma
is suspected
Suction
Check blockage of airway by tongue
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Limmer OKeefe Dickinson
Oropharyngeal Airway
6/28/2011
762
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Nasopharyngeal Airway
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Limmer OKeefe Dickinson
Clearing an Airway Obstruction Clearing an Airway Obstruction
Identify type: partial or complete
Partial obstruction
Place patient in position of comfort
Offer high-flow oxygen
Transport
Complete obstruction
Perform airway clearance techniques
continued
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Limmer OKeefe Dickinson
Clearing an Airway Obstruction
continued
6/28/2011
763
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Limmer OKeefe Dickinson
Clearing an
Airway
Obstruction
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Providing Supplemental Providing Supplemental
Oxygen and Ventilations Oxygen and Ventilations
continued
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Limmer OKeefe Dickinson
Providing Supplemental Providing Supplemental
Oxygen and Ventilations Oxygen and Ventilations
continued
6/28/2011
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Limmer OKeefe Dickinson
Providing Supplemental Providing Supplemental
Oxygen and Ventilations Oxygen and Ventilations
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Providing Supplemental
Oxygen and Ventilations
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Common Causes Common Causes
of Shock in Pediatric Patients of Shock in Pediatric Patients
Diarrhea and/or vomiting
Infection
Trauma (especially abdominal injuries)
Blood loss
Allergic reactions
Poisoning
Cardiac events (rare)
6/28/2011
765
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Signs and Symptoms Signs and Symptoms
of Shock in Pediatric Patients of Shock in Pediatric Patients
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Limmer OKeefe Dickinson
Caring for Caring for
Shock in Pediatric Patients Shock in Pediatric Patients
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Limmer OKeefe Dickinson
Protecting Protecting
Against Hypothermia Against Hypothermia
Cover patients head and body
Keep patient compartment warm
Avoid rough handling
Consult medical control about active
rewarming of patient
6/28/2011
766
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Limmer OKeefe Dickinson
Think About It Think About It
How do you balance the need to examine
a hypothermic patient with the need to
keep the patient covered to maintain
warmth?
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Limmer OKeefe Dickinson
Pediatric Medical Emergencies Pediatric Medical Emergencies
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Respiratory Disorders Respiratory Disorders
Likeliest cause of cardiac arrest in a child,
other than trauma
Distinguish whether probable cause is
upper or lower airway problem
Care for upper airway obstruction not
indicated for lower airway disorder
Critical to be alert for early signs of
respiratory failure
6/28/2011
767
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Limmer OKeefe Dickinson
Signs of Breathing Difficulty Signs of Breathing Difficulty
Nasal flaring
Retractions
Use of abdominal muscles
Stridor (high-pitched, harsh sound)
Audible wheeze
Grunting
More than 60 breaths/min
continued
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Limmer OKeefe Dickinson
Signs of Breathing Difficulty Signs of Breathing Difficulty
Altered mental status
Slowing or irregular respiratory rate
Cyanosis
Decreased muscle tone
Poor peripheral perfusion
Decreased heart rate
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
continued
Differentiating Upper and Differentiating Upper and
Lower Airway Disorders Lower Airway Disorders
Upper airway disorder
Affects mouth, throat, larynx
Foreign body obstructions, trauma, swelling
from burns and infections
Commonly identified by difficulty breathing,
stridor, or difficulty speaking
6/28/2011
768
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Limmer OKeefe Dickinson
Differentiating Upper and Differentiating Upper and
Lower Airway Disorders Lower Airway Disorders
Lower airway disorder
Affects large and small bronchiole tubes,
alveoli
Asthma, pneumonia, other respiratory
infections
Commonly identified by difficulty breathing,
wheezing lung sounds
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Limmer OKeefe Dickinson
Croup Croup
Mild fever and some soreness (daytime)
Loud seal-bark cough
Difficulty breathing
Restlessness
Paleness with cyanosis
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Limmer OKeefe Dickinson
Epiglottitis Epiglottitis
Sudden onset of high fever
Painful swallowing (child often drools)
Tripod position
Patient sits very still
Appears more ill than with croup
6/28/2011
769
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Fever Fever
Remove childs clothing
Cover in towel soaked in tepid water
Monitor for shivering
Follow protocols for water or ice chips
Dont submerge in cold water
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Meningitis Meningitis
Monitor ABCs, vital signs
Provide high-concentration oxygen by
nonrebreather mask
Ventilate with BVM or pocket mask if
necessary
Provide CPR
Be alert for seizures
Transport immediately
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Limmer OKeefe Dickinson
Diarrhea and Vomiting Diarrhea and Vomiting
Maintain open airway
Provide oxygen
Contact medical control if signs of shock
are present
Immediate transport
6/28/2011
770
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Limmer OKeefe Dickinson
Seizures Seizures
Maintain open airway (not oral airway)
Position on side if no spinal injury
Be alert for vomiting
Provide oxygen
Transport
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Limmer OKeefe Dickinson
Altered Mental Status Altered Mental Status
Be alert for MOI
Be alert for signs of shock
Look for evidence of poisoning
Attempt to get history of diabetes and
seizure disorder
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Limmer OKeefe Dickinson
Poisoning Poisoning
Contact poison control center
Consider activated charcoal
Provide oxygen
Transport
Continue to monitor responsiveness
6/28/2011
771
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Limmer OKeefe Dickinson
Care for Unresponsive Care for Unresponsive
Poisoning Patient Poisoning Patient
Ensure open airway
Provide oxygen
Be prepared to provide artificial ventilation
Transport
Rule out trauma
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Limmer OKeefe Dickinson
Drowning Drowning
Provide artificial ventilation or CPR
Protect airway
Consider spinal immobilization
Protect against hypothermia
Treat any trauma
Transport
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Limmer OKeefe Dickinson
Sudden Infant Death Syndrome Sudden Infant Death Syndrome
No accepted reason why these babies die
Treat as any patient in cardiac or
respiratory arrest
Resuscitate unless there is rigor mortis
Give emotional support for parents
6/28/2011
772
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Limmer OKeefe Dickinson
Information About SIDS Video Information About SIDS Video
Click here to view a video on the subject of Sudden Infant Death
Syndrome (SIDS).
Back to Directory
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Pediatric Trauma Emergencies Pediatric Trauma Emergencies
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Pediatric Injury Patterns Pediatric Injury Patterns
During motor vehicle collisions
Unrestrained: head and neck
Restrained: abdominal, lower spinal
When struck by vehicle
Head
Abdominal, possible internal bleeding
Lower extremity, possible fractured femur
continued
6/28/2011
773
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Limmer OKeefe Dickinson
Pediatric Injury Patterns
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Examine Head
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Examine Eyes
6/28/2011
774
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Emergency Care, Twelfth Edition
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Examine Neck
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Examine
Chest
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Contents of Thorax Contents of Thorax
6/28/2011
775
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Auscultate for Breath Sounds
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Examine
Abdomen
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Abdominal Quadrants Abdominal Quadrants
6/28/2011
776
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Examine
Pelvis
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Examine Arms
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Examine Legs
6/28/2011
777
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Emergency Care, Twelfth Edition
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Examine Back and Spine
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Immobilizing Child With KED Immobilizing Child With KED
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Burns Burns
Identify candidates for burn centers
Cover burn with nonadherent sterile
dressing
Ensure open airway
Suction as needed
Immobilize spine
Transport immediately
continued
6/28/2011
778
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Limmer OKeefe Dickinson
Burns Burns
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Child Abuse and Neglect Child Abuse and Neglect
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
6/28/2011
779
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Emergency Care, Twelfth Edition
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Signs of Possible Signs of Possible
Physical and Sexual Abuse Physical and Sexual Abuse
Slap marks, bruises, abrasions,
lacerations, incisions
Broken bones
Head injuries
Abdominal injuries
Bite marks
Burn marks
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Limmer OKeefe Dickinson
Possible Indicators Possible Indicators
That Adult Is Abuser That Adult Is Abuser
Inappropriate concern about child
Trouble controlling anger
Appears to be in deep depression
Indications of alcohol or drug abuse
Suicidal thoughts
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Care for Abuse Patients Care for Abuse Patients
Dress and provide other appropriate care
Preserve evidence
Transport
6/28/2011
780
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Limmer OKeefe Dickinson
Role of EMT in Cases of Role of EMT in Cases of
Suspected Abuse or Neglect Suspected Abuse or Neglect
Gather information from adults without
judgment
Talk with child separately
Plainly and clearly report to medical staff
any finding or suspicion regarding physical
or sexual abuse
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Role of EMT in Cases of Role of EMT in Cases of
Suspected Abuse or Neglect Suspected Abuse or Neglect
Use terms suspected and possible even
when talking to partner, hospital staff,
police, and superiors
Contact state child abuse reporting hotline
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Think About It Think About It
What should be your concern if a parent in
a possible child abuse case reveals
suicidal ideas?
6/28/2011
781
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Infants and Children With Infants and Children With
Special Challenges Special Challenges
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Common Special Challenges Common Special Challenges
Premature infants with lung disease
Infants and children with heart disease
Infants and children with neurological
disease
Children with chronic disease or altered
function from birth
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Tracheostomy Tubes Tracheostomy Tubes
Potential complications
Obstruction
Bleeding from or around tube
Air leaking around tube
Infection
Dislodged tube
continued
6/28/2011
782
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Tracheostomy Tubes
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Home Artificial Ventilators Home Artificial Ventilators
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Central Intravenous Lines
6/28/2011
783
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Care for Patients With Care for Patients With
Gastrostomy Tubes Gastrostomy Tubes
Be alert for altered mental status
Ensure open airway
Suction airway as needed
Provide oxygen if needed
Transport sitting or on right side
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Care for Patients With Shunts Care for Patients With Shunts
Maintain open airway
Ventilate with pocket mask or BVM and
high-concentration oxygen
Transport patient
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
The EMT and Pediatric The EMT and Pediatric
Emergencies Emergencies
6/28/2011
784
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Limmer OKeefe Dickinson
Psychiatric Effects on EMT Psychiatric Effects on EMT
Pediatric calls are among the most
stressful
May identify patient with own children
May be anxious about dealing with
children
Most serious stresses over very sick,
injured, or abused child, or child who dies
during or after emergency care
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Dealing With Stress Dealing With Stress
Communicating with and treating children
can be learned
Care mostly consists of applying
knowledge of adult patients and adjusting
for children
Talk with other EMTs
Talk with your services counselor
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Limmer OKeefe Dickinson
Chapter Review Chapter Review
6/28/2011
785
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Chapter Review Chapter Review
Assessment and treatment of children is
often different than for adults.
Children often differ from adults both
anatomically and psychosocially.
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Chapter Review Chapter Review
Assessment and treatment procedures
must take into account these specific
differences.
As an EMT, you must learn these
differences to enable you to better serve
this special population.
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Remember Remember
Pediatric patients present unique anatomy
and psychosocial development. EMTs
must develop an understanding of core
differences to best establish assessment
baselines and expectations.
continued
6/28/2011
786
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Limmer OKeefe Dickinson
continued
Remember Remember
Caregiver interaction sets the tone for
scene management. Be professional with
a calm demeanor.
Pediatric assessment triangle allows rapid
assessment of severity of injury or illness
by reviewing appearance, work of
breathing, and skin.
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Remember Remember
Proper pediatric assessment takes into
account differences in anatomy and
psychosocial development.
Airway and breathing maintenance, shock
care, and prevention of hypothermia are
universal points of importance in pediatric
care.
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
continued
Remember Remember
Shock is subtle in children. Learn to
recognize the signs of compensation.
Recognize respiratory failure in children,
and differentiate upper and lower airway
disorders.
6/28/2011
787
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
continued
Remember Remember
Different anatomy leads to slightly different
patterns of traumatic injury in pediatric
patients. Use your knowledge of pediatric
A&P to enhance assessment and
treatment.
Be alert for findings of potential abuse.
Treat medical issues first, then document
and report.
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Remember Remember
Many children have special health care
needs. Most caregivers are trained to
handle emergencies and can be important
resources for assessment. Be prepared for
unusual circumstances.
Critical incident stress management is
essential to an EMTs well-being plan.
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Questions to Consider Questions to Consider
How do you plan to approach your first
pediatric call?
How do you determine appropriate mental
status for a child?
Given certain situations, how would you
involve the parent or caregiver in
treatment?
6/28/2011
788
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Limmer OKeefe Dickinson
Critical Thinking Critical Thinking
You are called to a home for a 3-year-old
child who has been running a low-grade
fever all day and now is drooling. As you
enter the childs bedroom, you hear what
you think is a seal-like bark.
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Critical Thinking Critical Thinking
What do you suspect is wrong with this
patient? How will you and your partner
treat this patient and handle the situation?
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Limmer OKeefe Dickinson
Please visit Resource Central on
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additional resources for this text.
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Limmer OKeefe Dickinson
Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
36.1 Describe common changes in body systems that
occur in older age. Slide 9
36.2 Discuss adaptations that may be required in
communicating with and assessing older patients.
Slides 1012, 1422
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
continued
OBJECTIVES OBJECTIVES
36.3 Discuss the need for awareness of and the special
considerations regarding medical conditions and
injuries to which older patients are prone, including
effects of medications, shortness of breath, chest
pain, altered mental status, gastrointestinal
complaints, dizziness/weakness/malaise,
depression/suicide, rash, pain, flulike symptoms,
and falls and the possible significance of general or
nonspecific complaints in older adults. Slides 2433
6/28/2011
790
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Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
36.4 Recommend changes to improve safety in the home
of an elderly person. Slide 13
36.5 Discuss possible indications of elder abuse. Slide 34
36.6 Discuss psychosocial concerns of older patients,
including the fear of loss of independence. Slide 35
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Limmer OKeefe Dickinson
MULTIMEDIA MULTIMEDIA
Slide 37 Information About Alzheimers Disease Video
Slide 38 Elder Mistreatment and Abuse Video
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
CORE CONCEPTS
Age-related changes in the elderly
Communicating with older patients
Assessing and caring for older patients
Illness and injury in older patients
6/28/2011
791
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Limmer OKeefe Dickinson
Topics Topics
The Geriatric Patient
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
The Geriatric Patient The Geriatric Patient
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Age Age--Related Changes Related Changes
After age 30, organ systems lose 1
percent of function each year
Maximum heart rate declines
Older patient with internal bleeding wont
exhibit heart rate as rapid as expected
If unaware, EMT may miss that older
patient is in shock
6/28/2011
792
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Communicating Communicating
with Older Patients with Older Patients
Causes of patients communication
difficulties
Changes in hearing, vision, memory
Loss of teeth
Loss of brain function (Alzheimers most
common)
First assume altered mental status result
of present injury/illness
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Limmer OKeefe Dickinson
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
History and History and
Assessment of Older Adult Patient Assessment of Older Adult Patient
Scene size-up and safety
Primary assessment
Secondary assessment
6/28/2011
793
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Limmer OKeefe Dickinson
Scene Size Scene Size--up and Safety up and Safety
Look inside and outside residence for
clues to physical and mental abilities
Condition of residence
Half-eaten food
House dirty or clean
Items left out that patient can trip on
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Primary Assessment Primary Assessment
General
impression
Mental status
Airway
Breathing
Circulation
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Identifying
Priority Patients
6/28/2011
794
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Limmer OKeefe Dickinson
Secondary Assessment Secondary Assessment
History
Take time needed to get full information
Find out whether patient is compliant with
medical advice
Ask family members, others familiar with
patients condition
Physical exam
Baseline vital signs
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Components of Physical Exam Components of Physical Exam
Head and neck
Chest and abdomen
Pelvis and extremities
Spine
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Head and Neck Head and Neck
6/28/2011
795
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Limmer OKeefe Dickinson
Chest and Abdomen
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Limmer OKeefe Dickinson
Pelvis and Extremities Pelvis and Extremities
Hip and proximal femur commonly
fractured in fall
Weakening of bone results in injuries to
wrists and proximal humerus, also
Check extremities for edema and swelling
When significant, these can be signs of
underlying heart, vascular, or liver disease
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Spine Spine
Very commonly injured in motor-vehicle
collisions
Abnormal curvature may make
immobilization challenging
Do best to keep vertebrae in alignment
and reduce patients discomfort
6/28/2011
796
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Limmer OKeefe Dickinson
Reassessment
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Limmer OKeefe Dickinson
Think About It Think About It
What is commonly seen when assessing
an elderly patients blood pressure?
What is most commonly fractured in
female elderly patients?
What are some challenges you might face
in immobilizing elderly patients?
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Illness and Illness and
Injury in Older Patients Injury in Older Patients
Elderly patients prone to some problems
because of age-related changes
Problems present differently than in
younger patients
May present with vague signs or
symptoms
6/28/2011
797
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Limmer OKeefe Dickinson
Medication Side Medication Side
Effects and Interactions Effects and Interactions
Drug-patient
interactions
Drug-drug
interactions
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Shortness of Breath Shortness of Breath
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Chest Pain Chest Pain
6/28/2011
798
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Limmer OKeefe Dickinson
Altered Mental Status
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Abdominal Pain and
Gastrointestinal Bleeding
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Limmer OKeefe Dickinson
Dizziness, Dizziness,
Weakness, and Malaise Weakness, and Malaise
Dont take complaints lightly
Can be associated with a number of
serious conditions
Can be life threatening
Be diligent in assessment, even for vague
symptoms
6/28/2011
799
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Limmer OKeefe Dickinson
Depression and Suicide Depression and Suicide
Causes in elderly patients
Conditions that limit activity
Medications that sap energy
Loss of friends and spouse
Biochemical imbalance
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Rash, Pain, Flulike Symptoms Rash, Pain, Flulike Symptoms
Shingles
Virus reawakens after years
Appears as belt-like band around torso
Scabs over after a few days
Pain on side of torso
EMT can contract it from fluid
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Falls Falls
Death may result from complications of fall
Bruised ribs, cant cough because of pain,
develops pneumonia
May indicate more serious problem
Abnormal heart rhythm, stroke, internal
bleeding
Assess for cause of fall as well as injuries
from fall
6/28/2011
800
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Limmer OKeefe Dickinson
Elder Abuse
and Neglect
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Limmer OKeefe Dickinson
Loss of Independence Loss of Independence
Help patient who is losing independence
due to illness/injury
Treat patient with dignity
Dont minimize fears and concerns
Lock up house
Arrange for care for pets
Be reassuring
Empathize
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Think About It Think About It
What are some important facts to
remember when treating elderly patients?
What are the best preventative measures
for an EMT who comes in contact with
shingles?
What is a side effect of NSAID use?
6/28/2011
801
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Limmer OKeefe Dickinson
Information About Information About
Alzheimers Disease Video Alzheimers Disease Video
Click here to view a video on the subject of Alzheimers disease.
Back to Directory
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Elder Elder
Mistreatment and Abuse Video Mistreatment and Abuse Video
Click here to view a video on the subject of elder
mistreatment and abuse.
Back to Directory
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Chapter Review Chapter Review
6/28/2011
802
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Chapter Review Chapter Review
Despite generalizations, older people are
individuals who can differ significantly in
their health needs.
The prevalence of many diseases
increases with age, increasing the portion
of the older population that requires health
care.
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Chapter Review Chapter Review
Age-related decline in system function
alters the bodys response to illness and
injury, requiring modified interpretation of
assessment findings and complaints.
Multiple medical problems and
medications can lead to unpredictable
problems and drug interactions.
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Chapter Review Chapter Review
Nervous system changes, along with
isolation, financial problems, loss of loved
ones, and chronic health problems
increase the risk for depression in the
elderly. This can interfere with a persons
self-care and ability to communicate.
6/28/2011
803
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Limmer OKeefe Dickinson
Remember Remember
Aging produces common body changes,
with different impacts on different patients.
Evaluate older patients individually.
In some cases, EMT must adapt
assessment and treatment procedures to
account for age-related anatomic and
psychosocial changes.
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Remember Remember
Medication difficulties are common in older
patients. EMTs must keep this in mind
when assessing and treating this age
group.
Elder abuse is a far too common problem.
EMTs must learn to recognize the signs of
abuse and neglect.
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Questions to Consider Questions to Consider
What size blood pressure cuff might be
better suited to an elderly patient?
What challenges might you encounter
when assessing the mental status of an
elderly patient?
6/28/2011
804
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Limmer OKeefe Dickinson
Critical Thinking Critical Thinking
You are called to the nursing facility for an
85-year-old female who is having trouble
breathing and is very confused. What do
you suspect may be wrong with this
patient? What actions would you take in
treating this patient?
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Please visit Resource Central on
www.bradybooks.com to view
additional resources for this text.
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Introduction to Emergency Introduction to Emergency
Medical Care Medical Care
11
6/28/2011
805
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Limmer OKeefe Dickinson
OBJECTIVES OBJECTIVES
37.1 Define key terms introduced in this chapter. Slides
10, 12, 14, 33, 35, 37, 40, 42, 44, 47, 50, 53, 55, 59
37.2 Describe special challenges patients may have,
including various disabilities, terminal illness,
obesity, homelessness/poverty, and autism.
Slides 1019
37.3 Describe general considerations in responding to
patients with special challenges. Slides 2226
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
continued
OBJECTIVES OBJECTIVES
37.4 Recognize physical impairments and common
medical devices used in the home care of patients
with special challenges, including respiratory
devices, cardiac devices, gastrourinary devices,
central IV catheters and discuss EMT assessment
and transport considerations for each. Slides 2930,
3262
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Limmer OKeefe Dickinson
continued
OBJECTIVES OBJECTIVES
37.5 Explain why patients with special challenges are
often especially vulnerable to abuse and neglect
and what the EMTs obligations are in such
situations. Slides 6466
6/28/2011
806
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Limmer OKeefe Dickinson
MULTIMEDIA MULTIMEDIA
Slide 20 Autism Video
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Limmer OKeefe Dickinson
CORE CONCEPTS
The variety of challenges that may be
faced by patients with special needs
Types of disabilities and challenges
patients may have
Special aspects of prehospital care for a
patient with special needs
continued
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Limmer OKeefe Dickinson
CORE CONCEPTS
Congenital and acquired diseases and
conditions
Types of advanced medical devices
patients may rely on
How to recognize and deal with cases of
abuse and neglect
6/28/2011
807
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Topics Topics
Patients with Special Challenges
General Considerations in Responding to
Patients with Special Challenges
Diseases and Conditions
Advanced Medical Devices
Abuse and Neglect
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Limmer OKeefe Dickinson
Patients with Special Patients with Special
Challenges Challenges
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Disability Disability
Condition interfering with the ability to
engage in activities of daily living
Developmental disability
Cerebral palsy, Down syndrome
Result of traumatic injury or medical
condition
Multiple sclerosis, Parkinsons, stroke,
traumatic brain injury, spinal cord injury
6/28/2011
808
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Limmer OKeefe Dickinson
Terminal Illness Terminal Illness
End stage cancer, heart failure, kidney
failure, progressive fatal diseases
(Huntingtons, Lou Gehrigs)
May depend on technology to sustain life
or relieve pain
Advance directives
Special emotional needs
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Limmer OKeefe Dickinson
Obesity Obesity
Increases risk of multiple diseases
Special measures to care for obese
patient
Allow patient to assume comfortable
position for breathing
Have enough assistance when lifting or
moving patient
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Homelessness and Poverty Homelessness and Poverty
Serious health problems related to
homelessness and poverty
Mental health problems
Malnutrition
Substance abuse problems
HIV/AIDS
Tuberculosis
Pneumonia
6/28/2011
809
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Limmer OKeefe Dickinson
Autism Autism
Affects 1 in 91 children
Affects ability to communicate
May need to modify assessment
techniques and treatment protocols
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Limmer OKeefe Dickinson
ABCS of ABCS of
Dealing with Autistic Patients Dealing with Autistic Patients
Awareness
Basic
Calm
Safe
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Awareness Awareness
EMT must adapt approach and strategies
to patient
Disruption of routine not well tolerated by
patient
Communication can be challenging
May have escalation or meltdown
involuntary tantrum-like behavior
6/28/2011
810
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Limmer OKeefe Dickinson
Basic Basic
Instructionssimple, clear precise
Questionsshort, closed-ended
Equipmentkeep to minimum; do not
overstimulate
Treatmentdefer interventions that are
precautions rather than necessary
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Calm Calm
Calm creates calm
Start with one-to-one contact
Clear, controlled voice
Empathy, compassion
Take extra timeunless life-threatening
emergency, follow patients timeline
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Safe Safe
Begin treatment where patient is found
Remove things that may aggravate child
Do toe-to-head survey, one step at a time
Consider taking breaks during exam
Let patient tell you when ready for next
step
6/28/2011
811
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Limmer OKeefe Dickinson
Autism Video Autism Video
Click here to view a video on the subject of autism.
Back to Directory
Copyright 2012 by Pearson Education, Inc.
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
General Considerations in General Considerations in
Responding to Patients with Responding to Patients with
Special Challenges Special Challenges
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Limmer OKeefe Dickinson
Advanced Medical Advanced Medical
Devices in the Home Devices in the Home
6/28/2011
812
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Limmer OKeefe Dickinson
Knowledgeable Caregivers Knowledgeable Caregivers
Caregivers likely trained on device
Ask: Has problem occurred before? What
fixed it?
Have you been taught how to fix this
problem?
Have you tried to fix this problem? What
happened?
How do you normally move patient?
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Limmer OKeefe Dickinson
Knowledgeable
Patients
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
EMT
Assessment and Transport
6/28/2011
813
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Following Protocols Following Protocols
Is the problem with the device life
threatening?
Do I have the knowledge to fix this
problem?
Do I have supplies needed to fix this
problem?
Is it within my protocols or within medical
control authorization?
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Limmer OKeefe Dickinson
Think About It Think About It
What is important to do with an autistic
child who is escalating?
What would be the most important
question to ask yourself when a medical
device fails?
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Limmer OKeefe Dickinson
Diseases and Conditions Diseases and Conditions
6/28/2011
814
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Limmer OKeefe Dickinson
Types of Diseases Types of Diseases
Congenital
Congenital heart disease, cleft palate,
congenital deafness
Acquired
COPD, AIDS, traumatic spinal cord injury,
deafness
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Limmer OKeefe Dickinson
Special Concerns Special Concerns
Patient with a chronic disease may
experience sudden worsening of disease
Patient may also develop acute illness
Acute illness may be more devastating
because of coexisting chronic disease
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Limmer OKeefe Dickinson
Advanced Medical Devices Advanced Medical Devices
6/28/2011
815
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Limmer OKeefe Dickinson
Respiratory Devices Respiratory Devices
Continuous positive airway pressure
devices
Tracheostomy tubes
Home ventilators
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Continuous Positive Airway
Pressure Devices (CPAP)
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Limmer OKeefe Dickinson
EMT EMT
Assessment and Transport Assessment and Transport
Problems not usually related to machine
Patient may wish to bring machine to
hospital
Alert ER staff of use in radio report
6/28/2011
816
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Tracheostomy Tubes Tracheostomy Tubes
Surgical opening through neck into
trachea in which breathing tube is placed
BVM fits on end of tube
Mucus build-up in tube
Patient may or may not be able to speak
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
EMT EMT
Assessment and Transport Assessment and Transport
Check tube
If clogged, clear using whistle tip catheter
Patient may buck during suction
May need to ventilate with BVM
During transport, elevate patients head to
allow drainage
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Home Ventilators Home Ventilators
6/28/2011
817
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
EMT EMT
Assessment and Transport Assessment and Transport
Make sure vent tube has no mucus
build-up
Assure that BVM is connected to oxygen
If transporting ventilator, secure device
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Cardiac Devices Cardiac Devices
Implanted pacemaker
Automatic implanted cardiac defibrillator
(AICD)
Left ventricular assist device (LVAD)
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Limmer OKeefe Dickinson
Implanted Pacemaker Implanted Pacemaker
6/28/2011
818
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Implanted
Pacemaker
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
AICD AICD
Implanted in upper left chest or upper left
abdominal quadrant
Detects life-threatening cardiac rhythms
Delivers shock to correct dysrhythmia
Shock very painful to patient
Cannot be felt by caregivers
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
EMT EMT
Assessment and Transport Assessment and Transport
May want to request ALS
Treat as high-risk cardiac patient
High-concentration oxygen
Frequent reassessment
If cardiac arrest, use CPR and AED as
indicated
6/28/2011
819
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Left Ventricular Assist Device Left Ventricular Assist Device
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
EMT EMT
Assessment and Transport Assessment and Transport
Battery failure: plug into AC source
Pump failure: use hand or foot pump
Battery should be secured so as not to pull
tubing
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Gastrourinary Devices Gastrourinary Devices
Feeding tubes
Urinary catheters
Ostomy bags
6/28/2011
820
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Feeding Tubes
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Feeding Tubes
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
EMT EMT
Assessment and Transport Assessment and Transport
Secure tube to patients body with tape
prior to transport
Keep nutrients higher than tube
Put protective cap in place to prevent
leakage
6/28/2011
821
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Urinary Catheters
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Urinary Catheters Urinary Catheters
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
EMT EMT
Assessment and Transport Assessment and Transport
During transport, keep catheter bag lower
than patient (not on floor)
Document any urine discoloration or odor
Empty bag if one-third to one-half full
Document amount emptied
6/28/2011
822
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Ostomy Bags Ostomy Bags
Connected to site of colostomy or
ileostomy
Not visible through clothing
Common problems: infection at stoma site,
blockage, dislodgement
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
EMT EMT
Assessment and Transport Assessment and Transport
Use care when transporting patient
Object is to prevent breakage or
dislodgement of bag
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Dialysis Dialysis
Patient has renal failure
Dialysis replaces functions of kidney:
waste removal and fluid removal
Two forms of dialysis
Hemodialysis
Peritoneal dialysis
6/28/2011
823
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Limmer OKeefe Dickinson
Hemodialysis Hemodialysis
Performed by attaching patient to external
machine (dialyzer)
Usually at dialysis center
Large needles and tubing remove and
return blood
Complications: bleeding fromA-V fistula,
infection
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Peritoneal Dialysis Peritoneal Dialysis
Permanent catheter implanted through
abdominal wall into peritoneal cavity
Dialysis solution runs into abdominal
cavity and is absorbed by intestines
Complications: dislodging of catheter,
infection (peritonitis)
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
EMT EMT
Assessment and Transport Assessment and Transport
Dont take blood pressure on any arm with
shunt, fistula, or graft
Rupture of shunt, fistula, or graft causes
fast, significant blood loss
Direct pressure to control bleeding
Treat for shock
Transport
6/28/2011
824
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Central IV Catheters Central IV Catheters
Surgically inserted for long-term delivery of
medications or fluids
IV chemotherapy, parenteral nutrition
Peripherally inserted central catheter
(PICC)
Central venous line
Implanted port
Complication: infection at site
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
EMT EMT
Assessment and Transport Assessment and Transport
Use of central IV usually restricted to
hospital personnel
Be aware of type of catheter
Avoid tugging
Avoid contamination
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Physical Impairments Physical Impairments
Hearing, sight, speech, walking, standing
Each limitation requires different
assessment/treatment approaches
Physical impairment does not mean
mental impairment
Impairment may be partial or complete
6/28/2011
825
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
EMT EMT
Assessment and Transport Assessment and Transport
Provide necessary assistance
Assess impairmentbaseline or new
Determine comfort level
Explain actions and treatments
When transporting, bring all aids required
by patient
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Abuse and Neglect Abuse and Neglect
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Vulnerable Population Vulnerable Population
Patients dependent on others
More vulnerable to physical and sexual
abuse, exploitation, neglect
May be children or adults
Elderly especially vulnerable
6/28/2011
826
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Limmer OKeefe Dickinson
What to Look For What to Look For
Stories that are inconsistent with injuries
Multiple injuries in various stages of
healing
Repeated injuries
Caregivers indifference to patient
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Limmer OKeefe Dickinson
What to Do What to Do
Do not make accusations
Do best to get patient out of environment
Report suspicions according to
requirements of jurisdiction
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Think About It Think About It
How does your approach in cases of
possible abuse or neglect differ from your
approach in other cases?
6/28/2011
827
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Chapter Review Chapter Review
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
Chapter Review Chapter Review
Patients with special challenges include
those who are homeless or living in
poverty, are very obese, have sensory
impairments, are terminally ill, have
developmental disorders, and who are
technology-dependent.
continued
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Emergency Care, Twelfth Edition
Limmer OKeefe Dickinson
continued
Chapter Review Chapter Review
A disability is a condition that interferes
with a persons ability to engage in
everyday activities, such as working or
caring for oneself.
The homeless, poor, and obese are at
increased risk for health problems.
6/28/2011
828
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Limmer OKeefe Dickinson
Chapter Review Chapter Review
Do not a