EMT- B Module 1 notes

8
Airway Sounds:
RALES: Occurs in the alveoli, the alveoli (grape sacs) are filling with fluids.
Sounds like rice krispy/milk/popping sounds.
Ronchi: Fluids are building in the bronchi. (Bronchitis). (Sounds like
underwater). Give albuterol and atrovan.s
Stryder: In inhalation. Very distinct sound.
Must have wheezing present to administer albuterol.

Module 2:
Chapter 11: Scene Size-up –
Scene Size-up starts at the time you are dispatched out. SSU ends when the
patient’s care is transferred to the hospital and/or provider.
- Scene Safety: The only predictable thing about emergencies is they
are often unpredictable and can pose many dangers.
o Hazards
o Drugs/Intox/Weapons
o Construction
o Fire/Structural issues.
- As you are near the collision scene look for the signs. Look/listen
for other emergency units approaching. Look for signs of power
outage.
- Observe traffic flow, and look for smoke in the direction of the
collision scene.
- Within sight look for hazmat indicators, look for
victims/smoke/utility poles and/or downed wires.
- Establish a danger zone.
 - When there are no hazards, 50 feet in all directions.
- When hazards are present/fuel spilled 100 feet in all directions from
wreck AND fuel.
- Body Substance Isolation (BSI)
- Always have PPE available.
Nature of the Call:
- Mechanism of injury (Trauma)
o Force(s) that may have caused injury.
o Understanding forces can predict injury patterns.
o Can be very useful in predicting injuries associated with
certain types of motor vehicle crashes.
- MVAs
o Head on collisions-
 Check airbags.
 Starring/Webbing of the windshield. Could suspect head
injuries.
o UP and OVER injury pattern.
o Down and UNDER injury pattern.
o Rear End Collisions.
o Side impact collisions.
o Rollover collision.
o Rotational impact collisions
 Hit and car spins
- Falls
o Adult
 More than 20 feet.
o Children < 15 Y/O
 More than 10 feet (2x to 3x the child’s height.
o Important Factors
 Height from which patient fell
 Surface the patient fell onto
  Part of patient that hit the surface.
 Anything that could have interrupted the fall.
- Penetrating Trauma:
o Injury caused by object that passes through the skin or other
body issues.
o Classified by the velocity of the item that caused the injury.
o Low Velocity/High Velocity
- Blunt-force trauma
o Injury caused by a blow that strikes body but does not
penetrate skin or other body tissues.
o Signs are often subtle and easily overlooked.
o Maintain index of suspicion based on mechanism of injury.
- NATURE OF THE ILLNESS (MEDICAL)
o Reason patient called EMS.
o Information may be obtained from many sources.
 The patient themselves
 Family members or bystanders.
 The scene.
- # Of Patients
o Questions to ask?
 How many Pts present.
 Sufficient resources on hand to care for all patients.
o Try to anticipate the maximum number of patients and radio
for help accordingly.
 Follow local protocols.
Chapter 12: Primary Assessment
- Focus on life threats
- Airway (A), Breathing (B), Circulation (C)
- May vary depending on:
o Patient’s condition
o How many EMTs are on the scene
 o Other priorities you determine as you assess patient
- Order of A-B-C depends on initial impression of patient.
- Sequence will vary
o A-B-C if patient has signs of life
o C-A-B if patient appears lifeless, no pulse
o Immediate interventions may be needed.
- Any vomit in the airway that enters the lungs is very serious and
often fatal.
- Exsanguinating bleeding must be stopped immediately.
- Breathing and circulation are obviously vital for life. Make sure
your patient is breathing and breathing adequately to support life.
- General impression
o Assesses environment and patient’s chief complaint and
appearance.
o Helps determine patient severity.
o Helps set priorities for care and transport.
- Beginning spinal motion restriction
o Treat the patient’s life-threatening conditions while not
aggravating a potential spine injury.
o Apply initial SMR to the head and neck on first contact with
any patient you suspect may have an injury to the spine.
o Continue to SMR throughout the call unless a physical exam
determines it is not necessary.
- The “Look Test” – Feeling about a pt condition from the
environment.
- The Chief Complaint
o Patient’s description of why EMS was called
o May be specific
 “Abdominal pain”
o May be vague
 “Not feeling good”
 o Forming an impression of the patient
o Look
 Patient’s age, sex, and position
o Listen
 Moaning, snoring, or gurgling respirations.
o Smell
 Hazardous fumes, urine, feces, vomitus, or decay
- Assess Mental Status
o AVPU
 Alert
 Document orientation to person, place, and time
 Verbal response
 Painful response
 Unresponsive
- Order of primary assessment will vary depending on patient’s
condition
o Airway
 If patient is alert and talking clearly or crying loudly
then the airway is open (could still be obstructed)
 If airway is not open or is endangered, take measures to
open it and clear any blockages.
o Breathing
 Rate
 Depth
 Quality
 May need help if in respiratory arrest w/ a pulse.
 Is not alert w/ inadequate breathing.
 Has some level of alertness w/ inadequate breathing.
 Has adequate breathing, but signs suggesting respiratory
distress or hypoxia.
o Circulation
 Pulse
  Three results of assessing pulse.
 Within normal limits
 Unusually slow/fast
 Check for and control severe bleeding.
 Life-threat bleeds
 Skin (Condition, color, etc)
 Good circulation = warm, pink, dry skin.
 Shock = pale, clammy (cool, moist) skin
- Identify and correct life threats.
- Gather info that will help you later in your assessments.
- Determine priority.
o Treat any life-threatening ABC problems as soon as it is
discovered.
o To be stable, a patient needs to have vital signs that are in the
normal range or just slightly abnormal.
o A threat to the airway, breathing, or circulation, either actual
or imminent, rules out stable,
- !!!!!!!
- Determine if a patient is responsive or unresponsive whether the
patient is an adult, child, or infant.
- Rapidly identify the need for immediate airway intervention.
- Determine if the patient’s condition is stable enough to allow further
assessment and treatment at the scene.

Chapter 14: Principles of Assessment

- History Taking Techniques
- History is obtained by talking to the patient.
- If the patient is unable to respond, gather history from:
- Family Members
 - Bystanders
- Medications present
- Other identifying factors/things present at scene.
- Develop a rapport with the patient.
- Ask open-ended questions.
- Only use close-ended questions if you need an immediate answer.
- History taking helps you obtain a picture of what is going on w/ the
patient.
- Use the mnemonic OPQRST to learn about the chief complaint and history
of the present illness/injury.
- Onset (What were you doing?)
- Provocation (What makes it worse)
- Quality (Describe the feeling) (What does the pain feel like?)
- Region; radiation
- Severity
- Time
- Use the mnemonic SAMPLE to learn about the patient’s past medical
history.
- Signs and Symptoms (Tell what you see, ask again for any other
complaints).
- Allergies – (Do you have any allergies)
- Medications – (Are you on any medications? If so, have you taken it
today? Non prescription meds, narcotics/illegal drugs).
- Pertinent past history
- Last Oral intake (Last thing you ate/drank. What time/when)
 - Events leading to the injury or illness.
- When assessing children:
- Preschoolers can be interviewed w/ simple language.
- School-age children will be able to describe what they feel and what
happened.
- Include parents, teachers, and/or care providers in your interview.
Physical Examination Techniques
- Performed before, during, or after patient history.
- Three Primary techniques
o Observe – Look at the patient for an overall sense of patient
condition.
o Auscultate – Listen for sounds of an abnormal condition
o Palpate – Feel an area for deformities or other abnormal
findings.
- Observe the patient for an overall of the patient’s condition.
Pediatric Physical Exam
- Approach frightened children slowly.
- Start from the least invasive parts to the most invasive.
- Start with the toes or trunk and work your way toward the ehad.
- Explain all equipment to the child before use.
- Never lie to a child about something that hurts.
- Provide for the patient’s privacy.
Body System’s Examination
- Respiratory System
o The most important determination when assessing the
respiratory system is whether the patient is breathing
adequately.
 o Obtain history for existing respiratory conditions and
medications taken for each.
o Determine if medications have been taken as prescribed.
o Determine if signs and symptoms of this episode match
previous episodes.
o Mental Status
o Level of respiratory distress
o Chest wall motion
o Auscultate lung sounds
o Use pulse ox
o Observe edema
o Fever
- Cardiovascular System
o Existing cardiac conditions and medications
o Signs and symptoms of episode
o Description of chest pain using OPQRST
o Determine specific characteristics of discomfort.
o Looks for signs or conditions may be severe.
o Obtain pulse
o Obtain blood pressure
o Note pulse pressure (Systolic/Diastolic)
o Look for jugular vein distention (JVD)
o Palpate the chest
o Observe posture and breathing.
o LOOK FOR LUNG SOUNDS!!
- Nervous System
o Mental status
o Signs of dysfunction in the body
o Try to figure out normal state of mental functioning
o Obtain history of neurologic conditions
 o Note patient’s speech
o Conduct Stroke Scale
o Check peripheral sensation and movement.
o Gently palpate the spine
o Check extremity strength.
o Check patient’s pupils for equality and reactivity
o Examine the patient’s gait
- Endocrine System
o Diabetes melitus or thyroid disease history
o Current meds/taken properly
o Whether patient ahs eaten or exerted energy at an ususual
level
o Whether patient is sick
o Whether patient has taken blood glucose or uses insulin pump
- Gastrointestinal System
o Looking for – What has gone in
o What has come out
o What it looks like when it comes out
o Take history
o Pain or discomfort
o Oran intake
o History of GI Issues.
o Vomiting/or bowel movements.
o Inspect other parts of the GI System
o Inspect vomitus or feces if available.
- Immune system
- Allergic reactions/most relevant for EMS in the field.
o Anaphylaxis
o History of Allergies
 Exposure to known allergies
 What are typical reactions like?
 o History of asthma
o Symptoms of tightness in chest or throat
o GI Distress, itchiness, or rash
o Medications for allergic reaction
o Inspect point of contact w/ allergen
o Inspect patient for rash or hives
o Inspect the face, lips, and mouth for swelling
o Listen to the pt speak
o Listen to lung sounds.
- Musculoskeletal System
o Medical diseases in this system are rare
o Most musculoskeletal examinations will be performed as part
of a complete trauma exam.
o Prior injuries
o Whether patient takes blood thinners.
o Underlying diseases or conditions that make fractures more
common.
o History to determine if a medical problem caused by traumatic
injury.
Secondary Assessment
Components
- Three Categories of Patients
o Medical Patient
o Trauma Patient
o Unknown Patient
- Physical Exam
- Patient History
o History or present illness (OPQRST)
o Past medical history (SAMPLE)
- Vital Signs
 - Signs
o Something you can see
- Symptom
o Something the patient can tell you
- Reassessment is a continual process
Medical Assessments
- Tailor the exam to the specific chief complaints.
- Important information can be gained by tailoring history to patients
chief complaint.
- Ask questions pertinent to chief complaint.
- Perform a Physical Exam
o Usually Brief
o Examine areas of concern based on chief complaint.
- Obtain baseline vital signs
o Essential to assessment of medical patient.
o Later assessments of vital signs will be compared to baseline.
o Take manual blood pressure to verify accuracy of automatic
blood pressure device.
- Administer interventions and Transport the Patient
- Perform a Rapid Phys Exam
o Similar to head to toe physical exam.
o Neck
 Check for JVD, medical ID
o Chest
 Breath Sounds
o Abdomen
 Distention, firmness, rigidity
o Pelvis
 Incontinence of urine or feces
o Extremities
  Pulse, motor function, sensation, oxygen saturation,
medical ID devices.
o Check pupils and for medical ID devices.
- Obtain Baseline Vital Signs
o Pulse
o Respirations
o Skin
o Pupils
o Blood Pressure
o Pulse ox/oxygen saturation
o Take note of any abnormalities
- Consider a request for ALS
- Administer interventions and Transport patient
o Look for mechanism of injury or signs that suggest a spine
injury.
o If needed, immobilize the patient’s spine
Secondary Assessment of Trauma Patient
- Injuries can range from slight to severe
- To determine how serious an injury is consider:
o Patient’s airway status/ABCs
o Vital Signs
o MOI
o Age and/or preexisting conditions
- Patient w minor injury or low priority.
o Assessment is focused on areas patient notes are painful or
that mechanism indicated.
o Determine chief complaint.
o Obtain History
 Nature of force involved.
 Direction and strength of force
  Protective equipment used by pt. (Seatbelt, sports
equipment, helmet).
 Actions taken to prevent or minimize injury.
 Areas of pain and injuries resulting from incident.
- Perform a Physical Exam
- DCAP-BTLS
o Deformities
o Contusions
o Abrasions
o Punctures and penetrations
o Burns
o Tenderness
o Lacerations
o Swelling
Barrel Chested patients usually have a problem breathing. Tripoding
Emphysema. Skinny, small bodied.

PEDAL Edema – fluid buildup weight gain

Sacrlal Edema – Lower sacrum.
To use CPAP they MUST have a breathing rate OF 25 > OR GREATER
Must be able to create a seal. BEARS ARE A NO GO
PULSOX BELOW < 93
CPAP EPI OR NITRO can hurt your patient.
Do NOT give to vomiting. Nauseous may be ok. CPAP for COPD, chronic
asthma or bronchitis.
COPD (Chronis Obstructive Pulmonary Disease)
Broad classification of Chronic lung diseases
 - Includes emphysema, chronic bronchitis, and many undetermined
respiratory illnesses.
- Overwhelming majority that normally clear away mucus
accumulations are unable to do so.
Chronic Bronchitis:
- Bronchiole lining inflamed
- Excess mucus produced.
- Cells in bronchioles that normally clear away mucus accumulations
are unable to do so.
- Give albuterol and ipratropium. Albuterol is given in neb 6-8 LPM
Emphysema:
- Alveoli walls break down.
o Surface area for respiratory exchange is greatly reduced.
- Lungs lose elasticity.
- Results in air laden with carbon dioxide being trapped in lungs,
reducing effectiveness of normal breathing.
- EM patients live off of hypoxic drive., regular people life off of
drive to breathe off COD. Hypercapnea.
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.
- Airflow mainly restricted in one direction.
- Inhalation
o Expanding lungs exert outward pull, increasing diameter of
airway and allowing air flow into lungs.
- Exhalation –
o Opposite occurs, lungs become trapped.
Pulmonary Edema
- Abnormal accumulation of fluid in alveoli
- Patients with CHF Cong Heart failure, may experience difficulty
breathing because of this.
- Pressure builds up in pulmonary capillaries.
- Fluid crosses the thin barrier and accumulates in the alveoli.
- Fluid occupying lower airways makes it difficult for oxygen to reach
blood.
- Patient experiences dyspnea.
- Common signs and symptoms
o Dyspnea
o Anxiety
o Pale/sweaty skin
o Tachycardia
o Hypertension
o Respirations are rapid and labored
o Low oxygen saturation
o May hear gurgling even without auscultation. Sometimes
sounds like crackling. Can’t suction lower airway. If they are
wheezing, they also require a albuterol treatment.
o Patients may cough up frothy sputum, usually white, but
sometimes tinged pink
- Treatment
o Assess for and treat inadequate breathing.
o High-concentration oxygen
o If possible, keep patient’s legs in dependent position.
o CPAP may be used to push fluid back out of lungs and into
capillaries.
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.
- Signs and symptoms:
o Shortness of breath w/ or w/o exertion
o Coughing (Watch for mucus and phlegm)
o Fever and severe chills
o Chest pain (often sharp and pleuritic, worsening on inhalation)
- Treatment:
o Care mostly supportive
o Assess for and treat inadequate breathing
o If the patient is hypoxic, administer SpO2
o In some EMS systems, EMT’s apply CPAP to these patients.
o In some cases, pneumonias can ve severe enough to cause
inadequate breathing.
Spontaneous Pneumothorax
- Lung collapses w/o injury or other obvious case.
- Air in lung cavity, lung collapsed.
- Patients with COPD and smoking at highest risk. So are tall, thin
people
- Signs Symptoms:
o Sharp pain.
o Shortness of breath, easily tired. Cyanosis and low Oxygen Sat
o Tachycardia/Fast breathing
o Decreased or absent lung sounds
- Treatment:
o Contact ALS immediately if pneumothorax is suspected.
o Administer oxygen
o NO CPAP
o Transport for definitive care, as patients frequently require a
small catheter or larger chest tube
Pulmonary Embolism
- Blockage in blood supply to lungs.
- Commmonly caused by deep vein thrombosis (DVT)
- Common reasons for DVT
o Lying down or sitting in same position for a extended period
o Having active cancer
o Having a limb immobilized.
- Signs and symptoms
o Sharp, pleuritic chest pain
o Shortness of breath
o Anxiety
o Coughing
o Tachycardia
o Tachypnea
o Lightheaded/dizziness
o Pain and swelling in one or both legs.
o Hypotension and cardiac rest.
- Treatment
o Difficult to differentiate in field
o Administer oxygen and treat patient like anyone else with
shortness of breath.
o Transport to definitive care.
o HIGH Priority transport.
- Epiglottitis
o Infection causing swelling around and above the epiglottis.
o In severe cases, swelling can cause airway obstruction.
o Most commonly PEDS not adults.
o Signs Symptoms:
 Sore throat, painful or difficult swallowing.
 Tripod position
  Sick appearance
 Muffled voice
 Fever
 Drooling/Stridor.
 Blood sugar might be low. Might be fatigued.
Croup:
- Caused by a group of viral illnesses that results in inflammation of
the larynx, trachea, and bonchi
- Tissues in the airway (Upper Air) become swallow and restrict the
passage of air/
- Signs/Symptoms
o Loud, seal like barking cough.
o Hoarse voice
o Associated breathing difficulty breathing resolves when the
child moves to an upright position.
Bronchiolitis
- Small airways become inflamed because of viral infection.
- More common in PEDS .
- Most common cause is the respiratory syncytial virus, or RSV.
- Signs and symptoms
o Commonly associated with cold or flu like symptoms
o Symptoms typically progress over a few days and worsen to
include respiratory distress.
o Comon for multiple children in the house to be sick w/ similar
symptoms.
o Can cause significant resp distress and progress to inadequate
breathing.
- Treatment
o Artificial ventilation may be necessary.
 o If the patient is hypoxic or shows signs of hypoxia, treat with
SpO2
o Consider using a bulb syringe to suction the nose if it is
obstructed by mucus
o Clearing the nose of an infant can significantly improve miute
ventilation.
Cystic Fibrosis
- Genetic disease
- Causes thick, sticky mucus in accumulating in the lungs and
digestive system.
- CF patients don’t typically live that long. Mid 30’s
- Mucus can cause life-threatening lung infections and serious
digestion problems.
- Signs/Symptoms
o Coughing w/large mucus.
o Fatigue
o Abdominal pain
Viral Respiratory Infection:
- Infection of respiratory tract
- Common, 17 billion per year.
- Signs/symptoms
o Often starts with sore or scratchy throat w/ sneezing runny
nose and fatigue.
o Fever and chills
o Infection can spread into lungs, causing shortness of breath.
o Cough may be persistent.
o Supportive treatment includes Supo2 for hypoxia.
Bronchodilators for hypoxia.
o Infection is viral and cannot be helped by antibiotics.
o Practice good hygiene, mask/ppe
Prescribed Inhaler:
-
Chapter 20:
Cardiac Emergencies
Cardiac A/P – Review blood flow and composition of the blood. Veins –
Deoxygenated blood, Arteries to the body – oxygenated blood.
A/P
Heart – Only job of the heart is to pump blood
- Generation and distribution of electrical charge
- Mechanical response to create rhythmic and unceasing pumping
action
- Require constant supply of oxygen and nutrients.
- S/A Node. Pacemaker. 60-100.
- A/V Node. Backup to S/A. 40-60..
- Purkinji fibers. FAILSAFE . – 20-40
- Aorta – Right coronary Artery – Left Coronary Artery – Left
anterior descending artery – Circumflex artery
Acute Coronary Syndrome
- Sometimes called cardiac compromise.
- Refers to any time the blood supply to the cells of the heart is
blocked or disrupted.
- Heart muscle cells go w/o oxygen, causing cell death.
- Hypoxic condition of the heart is called ischemia
- Cells die quickly w/o adequate blood supply. 6-8 mins.
- Chest discomfort is best-known symptom.
o Can be described as pressure, squeezing, or aching
- Radiates to the jaw, neck, either arm, or upper abdomen.
- Dyspnea is another common finding in older patients and women.
- Other symptoms:
 o Nausea and/or vomiting
o Syncope
o Sudden onset of sweating
o Abnormal pulse (tachycardia/brady)
o Abnormal blood pressure (hyop/hypertension)
o Anxiety, feeling of impending doom.
- Perform the primary assessment.
- Explore chief complaint.
- Use OPQRST to get history of present illness.
- Obtain past med history and take baseline signs.
- Signs/Symptoms of ACS
o Pain, pressure, discomfort in the chest, jaw, neck, arms, or
upper abdomen.
o Difficulty breathing
o Palpitations
o Sudden onset of sweating and nausea or vomiting.
- Fundamentals principles of care for ACS Pts.
- Place Pt in position of comfort.
- Determine the need for oxygen:
o Respiratory failure, agonal breaths, or apneic should receive
high-concentration oxygen via ventilations.
o Low oxygen saturations receive high-concentration oxygen.
o No significant distress or pulse ox at 94 or above no oxygen.
- Care of Patient w/ ACS NITRO
o Indications for administering nitroglycerin 0.4 mg (SubLing)
 Chest pain
 History of cardiac problems
 Physician has prescribed nitroglycerin to pt
 Patient has nitroglycerin at hand.
Patient Assessment:
12 Lead ECG
 - Speed up process of recognizing the electrocardial findings
- Interpretation is outside scope of EMT
- EMT can place leads and acquire print tracing
- EMT can transmit ECG to destination hospital.
- Preparing:
o Place electrodes on chest
o Electrodes need secure contact w/ skin
o Remove clothing and jewelry
o Remove sweat/dead skin cells
o Remove hair
Cardiovascular Disorders
Coronary Artery Disease
- Conditions that narrow or block arteries of the heart.
- Often results from fatty deposit build on inner walls of arteries.
- Buildup narrows inner vessel diameter, restricting flow of blood.
- Risk factors
o Heredity
o Age, Hypertension, Weight
o Exercise. Elevated blood cholesterol and triglycerides
o Cigarette smoking
Angina Pectoris:
- Chest pain caused by insufficient blood flow to the myocardium.
- Typically due to narrowed arteries secondary to coronary artery
diseases.
- Pain usually during times of increased myocardial oxygen demand,
such as exertion or stress.
- Possession of nitro is a good indication that the pt has a history of
angina.
- Nitro dilates blood vessels so heart has less blood to pump.
Acute Myocardial Infarction
- Hardened plaque can cause rupture (aneurysm) of a blood vessel.
- Narrowing of a vessel causes blood flow to be blocked by an
occlusion.
- Thrombus:
o Occlusion of blood flow caused by formation of a clot on
rough inner surface of diseases artery.
o Can break loose and form an embolism
- Emboli can move to occlude flow of blood downstream in a smaller
artery.
- Blocking of coronary artery by thrombus or embolism is an AMI
- AMI Can Cause
o Ischemia
 Leads to injury of cells and cell death.
 Disturbs electrical function of the heart.
o Dysrhythmias
 Harmful changes to rate, rhythm, and pumping ability.
o Mechanical problems within the heart
 Cardiogenic shock
o Sudden death
 Cardiac arrest within 2 hours of the onset of symptoms.
- Treatment of AMI At hospital
o Fibrinolytics
o Balloon angioplasty
- Treatment upon discharge
o Betablockers
Heart Failure:
HF Can be:
- Congestive Heart Failure (CHF)
- Heart is unable to pump blood efficiently
 - Ability to perfuse body tissues is impaired
- Exercise-related tasks are difficult.
- Limited ability to compensate for challenge
- Causes fluid buildup.
- Left sided heart failure = blood to lungs. Pulmonary edema.
Orthopnea.
o Pressure builds up in left atrium and pulmonary vein.
o Fluid leaks into alveoli
o Gas exchange is impaired, can be life-threatening.
- Right sides heart failure = blood goes to body, el edema, JVF, Sacral
Edema.
- Aneurysm
- Weakened sections of arterial walls begin to dilate (balloon)
- Bursting can cause rapid, life-threatening internal bleeding.
Chapter 22:
Diabetic and Mental Emergencies:
Assessing the Patient w/ Altered Mental Status
Patients w/ altered mental status can be dangerous to responders.
Always consider the safety of yourself and your team.
Call L/E.
Primary Assessment:
- Always consider the possibility of an airway and/or breathing
problem in a patient w/ AMS
- Be attentive during the primary assessment.
- Watch for indications of inadequate breathing
o Be alert to the need for positioning and suctioning.
o Consider administration of high-concentration oxygen if you
suspect hypoxia.
- Be alert for indicators of hypoperfusion
 - Determine baseline mental status for patient.
o This may be accomplished by greeting the patient and
assessing their ability to respond.
o AVPU may help you quickly categorize the patient’s initial
response.
- Baseline status can be difficult to determine in children because the
answer questions differently than adults.
- Mental status is a subtle sign that indicates serious underlying
issues.
- A body system exam and complete history may reveal important
information about suspected cause.
- Interview family members and bystanders to obtain patient’s
baseline mental status.
- Review medications, bracelets, and other health-related items that
would provide you w/ relevant clues.
- Consider using the Glasgow Coma Scale to provide precise
measurement of patient responses.
Diabetes
- Glucose is a form of sugar.
o It is the body’s basis source of energy.
o Body cells require glucose to remain alive and create energy.
- After sugar and carbs are converted to glucose, glucose is absorbed
into the blood stream.
- Glucose is a large molecule and cannot pass into the cell without
insulin.
o The pancreas secretes insulin when blood glucose exceeds 90
mg/dL
o Insulin binds to receptor sites on cells and allows glucose
molecules to pass.
- Normal glucose levels in the blood are essential to maintaining
normal mental status.
 - Patients who are diabetic:
o Do not produce insulin
o Do not produce enough insulin
o Have become resistant to the insulin that is produced
Diabetes melitus results from an underproduction of insulin or the inability of
the cells to use insulin properly. Umbrella term for type 1 and 2.
- Type 1 (formerly called insulin-dependent diabetes)
o Pancreatic cells do not function properly
 Insulin is not secreted normally
o There is too little insulin to transfer circulating glucose into
cells
o Synthetic insulin is typically prescribed to supplement
inadequate natural insulin.
- Type 2 (Formerly non-insulin dependent)
o The body’s cells fail to utilize insulin properly.
o The pancreas is secreting enough insulin, but the body is
unable to use it.
o May be controlled through diet, oral antidiabetic medications,
and sometimes insulin.
- Hypoglycemia is low blood sugar
- It is caused by:
o Too much insulin
o Too little sugar intake
o Overexercising or overexertion
o Vomiting
o Increased metabolic rate
- When blood sugar is reduced, brain and body cells starve
- Hypoglycemia leads to altered mental status, unconsciousness, and
possible permanent brain damage.
- Onset is rapid and signs include:
o Abnormal behavior mimicking a drunken stupor
 o Pale, sweaty skin
o Tachycardia
o Rapid Breathing
o Seizures.
- Quick replenishment of blood sugar is critical to the outcome of a
patient w/ hypoglycemia
- Oral glucose is often used
- Hyperglycemia is high blood sugar:
- It is caused by insulin deficiency
o Body may be unable to produce insulin
o Insulin injections may be forgotten or insufficient
- Infection, stress, and increased dietary intake are factors
- Hyperglycemia develops over days or weeks
- Signs include:
o Chronic thirst and hunger
o Increased urination
o Nausea
o Dehydration
- The cells of the body slowly starve because glucose cannot enter the
cells from the blood.
Diabetic Ketoacidosis (DKA)
Starving cells begin to burn fats and proteins in a way that produces
excessive wastes.
Wastes build up and combine with dehydration to cause DKA
- Signs of DKA Include
o Profoundly Altered Mental Status
o Shock (Caused by dehydration)
o Rapid Breathing
o Acetone odor on the breath
o Kussmaul’s breathing.
 - Ensure scene safety
o Patient may be agitated or violent
- Perform a primary assessment
o Identify mental status
- Perform a secondary assessment
o Gather a history from the patient or bystanders.
- Gather a history of the present episode
o Determine how the episode occurred, the time of onset, and
duration.
o Identify associated symptoms, any mechanism of injury or any
interruptions to the episode.
Other MH Emergencies
Seizures
- If brain function is upset by injury, infection, or diseases, the brain’s
electrical activity can become irregular.
- Irregularity can bring about a sudden change in sensation, behavior,
or movement called a seizure.
- Partial seizure affects only one part of the brain
o May involve uncontrolled convulsion in a patient w/ fully alert
mental status.
o Some patients may briefly lose consciousness.
- Generalized seizures affect the entire brain and affect the
consciousness of the patient.
- EMT’s are most often called for a type of generalized seizure called
a tonic-clonic seizure.
o It is characterized by unconsciousness and major motor
activity.
o Has no warning
o The patient will thrash wildly and the entire body is involved.
- Tonic-clonic seizures have 3 phases
 o Tonic phase
 Body is rigid for up to 30 seconds
 Breathing may stop
 Bowel and bladder control may be lost
o Clonic Phase
 Body jerks violently for 1-2 minutes
 Patient may foam at the mouth
 Face and lips may become cyanotic
o Postictal phase
 Convulsions stop
 Consciousness is regained
 Patient may be drowsy or violent
- Some seizures are preceded by a sensation called an aura.
STROKE
Stroke is the death or injury of brain tissue from oxygen deprivation.
- Ischemic stroke caused by a blockage that occurs due to a clot or
embolism obstructing cerebral artery.
- Hemorrhagic stroke is caused by bleeding from a ruptured blood
vessel in the brain
o Often a result of long-standing high blood pressure
o Can also occur when a weak area of an artery bulges and
eventually ruptures.
CHAPTER 23
Allergic Reactions
Two Types of Response
- Immune
- The immune system Naturally responds to foreign substances in
body in order to get rid of them.
- An allergic reaction is an exaggerated immune response.
- An allergen is a substance that causes an allergic reaction
- Anaphylaxis: (anaphylactic shock) is a severe, life-threatening
allergic reaction
o Blood vessels dilate rapidly causing a drop in blood pressure
(hypotension)
o Cells leak fluid into the interstitial space
o Tissues swell, including the airways
o Strydor and Hypotension are indications for Epi.
- Causes of allergic reactions
o Insects (bee, yellow jacket, wasp, and hornet sting)
o Foods (nuts, eggs, milk, and shellfish)
o Plants (Poison ivy, poison sumac, and poison oak)
o Medications (penicillin)
o Others (Dust, chemicals, soap, makeup)
- Latex allergy is a particular concern in EMS
o Many patients have a latex allergy.
o Patients who have had multiple surgeries are at an increased
risk to have a latex allergy.
- An allergic reaction does not occur the first time a person encounters
an allergen
o On first exposure, the immune system forms antibodies
o On second exposure, the antibodies combine with the allergen.
- Spectrum of allergic reactions:
o Dilation of blood vessels, which reduces the amount of blood
returned to the heart
o Flushing of skin as blood vessels near the surface open up
o Development of angioedema (mouth/face)as fluid moves into
tissues
o Swelling around the vocal cords
o Develop of urticaria (hives)
o Bronchoconstriction that decreases air movement in the lungs
 o Development of thick mucus in the lungs
- The exact course of an allergic reaction is unpredictable
o Severe reaction may be immediate but can be delayed 30
minutes or more
o Mild allergic reaction can rapidly progress to anaphylaxis
- Signs/Symptoms
o Skin
 Itching, hives, flushed skin
 Swelling of face, hand, neck, throat
 Warm tingling.
o Respiratory
 Tightness in throat/chest
 Cough. Rapid, labored and/or noisy breathing
 Stidor and/or wheezing
 Hoarseness, muffled voice.
o Cardiac
 Increased heart rate
 Decreased BP
o General Findings
 Itchy, watery eyes
 Headache
 Runny nose
o Shock Signs/Symptoms
 Altered mental status
 Flushed, dry skin or pale, cool, clammy skin
 Nausea or vomiting
 Changes in vital signs, BP, HR, Respirations
- Manage the patient’s airway and breathing.
- Apply high-concentration oxygen if the patient is in distress or
appears to be in anaphylaxis
- If the patient has or develops AMS open and maintain airway.
- EPI
 - 66 POUNDS CUT OFF FOR PEDS
Chapter 26
Abdominal Emergencies
Abdominal Anatomy and Physiology
- Abdomen contains many organs from several different body
systems.
- Abdomen:
o Region between diaphragm and pelvis
o Contains many organs that provide the following functions
 Digestive
 Reproductive
 Endocrine
 Regulatory
- Abdomen is divided into 4 quadrants
o RUP, LUP, RLQ, LLQ
o Used to describe and identify areas of pain, tenderness,
discomfort, injury, and other abnormalities
- Organs of the abdomen:
o Peritoneum
 Thin membrane lining the abdominal cavity and
covering each organ
o Parietal peritoneum attached to the abdominal wall
o Visceral peritoneum covers each organ
o Most of the organs are enclosed within the parietal peritoneum
o A few lie in the extraperitoneal space (outside the peritoneum)
 Kidneys, pancreas, part of aorta lie in retroperitoneal
space, behind peritoneum.
 Bladder and part of rectum lie inferior to peritoneum
o Female reproductive organs and structures lie within abdomen
and pelvis.
  Ovaries, uterus, fallopian tubes.
o Largest blood vessels are contained.
 Aorta
 Inferior vena cava
 Hepatic artery
 Splenic artery
 Iliac artery and vein
Abdominal Pain
- Visceral Pain
o Originates from the organs within the abdomen
o Fewer nerve endings allow for only diffuse sensations of pain
o Frequently described as “dull” or “achy”
o Intermittent, crampy, or colicky pain may result from hollow
organs.
o Persistent or constant pain often originates from solid organs.
- Parietal pain
o Originates from the parietal peritoneum
o Many nerve endings allow for pain that is easier to locate and
describe
o Frequently described as sharp
o Pain is often constant and localized to a specific area
- Tearing pain
o Not the most common type of abdominal pain
o Originates in the aorta or stomach
o Separation of layers of aorta caused by aneurysm
o Retroperitoneal location of aorta causes pain to be referred to
back
o Ulcers in stomach can also cause tearing pain
- Referred pain
o 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.
Appendicitis
- Infection of appendix
- Signs and symptoms:
o Nausea and sometimes vomiting
o Pain often initially referred to umbilical region, followed by
persistent RLQ pain
- Rupture of appendix
o Sudden, severe increase in pain
o Contents releasing into abdomen causes severe 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/symptoms
o Abdominal pain and rigidity
- Hard to pinpoint the quadrant.
Cholecystitis/Gallstones
- Inflammation of the gallbladder
- Often caused by blockage of bile flow by gallstones
- Symptoms often worsened by ingestion of fatty foods
- Signs/Symptoms
o Severe RUQ or epigastric pain
o Pain often referred to shoulder.
Pancreatitis
- Inflammation of the pancreas
- Common in patients w/ chronic alcohol abuse
GI Bleeding:
- Bleeding within the GI tract, from esophagus to rectum.
- 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.
- Signs/Symptoms
o Dark-colored stool ( maroon to black), often tarry
o Frank blood from rectum
o Vomiting “coffee ground” appearing blood
o Vomiting of frank blood
o Pain can be absent to severe
Abdominal Aortic Aneurysm
- Ballooning or weakening of inner wall of the aorta
- Tears and separates from outer layers (dissection)
- Weaken vessel bulges, may continue to grow.
- May eventually rupture.
- Signs/Symptoms
o Progressive (often sharp or tearing abdominal pain)
o Frequently radiates to back
o Rupture causes rapid onset of excruciating abdominal and
back Pain
o Signs of shock usually present
o Possible inequality in pedal pulses
Hernia
 - Hole in the muscle layer of abdominal wall, allowing tissue or parts
of organs (commonly intestines) to protrude up against skin.
- May be precipitated by heavy lifting
- May cause strangulation of tissue or bowel obstruction
- Require transport to hospital for evaluation
- Signs/Symptoms
o Sudden onset of abdominal pain, often following lifting.
o Palpable mass orlump on abdominal wall or crease of groin.
Renal Colic
- Severe flank pain caused by kidney stones traveling down the ureter.
- Signs/symptoms
o Severe pain in flank or back
o Frequently radiates to groin
o Nausea, vomiting
Cardiac Involvement
- Pain from myocardial infarction may be felt as abdominal
discomfort
o Epigastric pain
o Indigestion or digestive discomfort
Ab pain associated w/ female reproductive system
- Most serious cause is ectopic pregnancy
o Occurs when fertilized embryo implants outside the uterus.
o Rupture can cause life-threatening internal bleeding.
Assessment and Care of Abdominal Pain
- Many potential causes
- Role of EMT is not to diagnose
- Focus efforts
- Type of pain and location of pain
Chapter 28
Hematologic and Renal Systems
Blood
- Blood represents it’s own organ system
- Has specific functions
o Control of bleeding by clotting
o Delivery of oxygen to cells
o Remove co2
o Remove waste products
- Made up of solid components
o Red blood cells
o White blood cells
o Platelets
o Suspended in plasma
- Medications can affect some components of blood
Blood Clotting
- Aggregation of platelets is body’s most rapid and initial response to
stop bleeding
- Clotting factors are a group of proteins produced in liver and
released into the bloodstream.
- Once activated, clotting factors from clots through clotting cascades
Coagulopathies
- Abnormla clotting of blood
- Can occur when body forms clots too readily or patient clots too
slowly
- Certain diseases make patients prone to poor clotting
o Advanced liver disease
o Hemophilia
o Von Willebrand disease
Identifying PT w/ coagulopathies
- Certain medical conditions prevent body from clotting.
- Patient’s with prescribed “blood thinners”
Care for PT w/ coagulopathies
- Emergency Treatment
o Take appropriate standard precautions
o Perform a primary assessment and care for any immediate life
threats
o Obtain a history from the patient and identify which specific
blood thinning medication he is taking, or which bleeding
disorder he suffers from.
o Notify the hospital as early as possible
o Monitor the PT for the development of the signs and
symptoms of shock or decreasing mental status.
o Administer supplemental oxygen if the patient appears to be in
shock or has a decreased mental status.
Anemia
- Lack of normal amount of RBC’s in circulation
- Acute anemia
o Sudden blood loss
- Chronic anemia
o Recurrent heavy menstrual periods
o Slow gastrointestinal bleeding
o Diseases affecting bone marrow or structure of hemoglobin.
Sickle Cell Anemia
- Genetic disease affecting RBC’s
- Most commonly occurs in patients of African descent
- Defective shape resembles a sickle
- Cells have a short life span, leading to chronic anemia.
 - Complications:
o Destruction of spleen
o Sickle pain crisis
o Acute chest syndrome
o Priapism
o Stroke
o Jaundice
- Estimated 1 in 13 African Americans have the trait.
Renal System
Components
- Two kidneys
- Two ureters
- One urethra
Kidneys Essential for life
- Filter blood
- Remove certain waste products, excessive salts, and excessive fluid.
- Maintain fluid balance
Diseases:
- Affects many different portions.
- Can be minor to severe
UTIs
- Most common disease that afflicts renal and urinary system
- Caused by bacteria
- Usually limited to the bladder
- Cause pain and frequent urination.
- If left untreated, can result in pyelonephritis
o UTI ascends up ureter into kidney
Kidney Stones
 - Usually made of calcium and formed within the kidney
- When they become dislodged, can cause several unilateral flank
pain.
Patients w/ urinary catheters
- Need for urinary catheter
o Obstruction of bladder outflow
o Neurologic disorder
- These patients use urinary catheters to drain urine
o Commonly inserted in urethra
o May be placed through skin
- Complications of UTI and local trauma at site of catheter insertion.
Renal Failure
- Occurs when kidneys lose ability to adequately filter and remove
toxins.
- Acute failure typically results from shock or toxic ingestion
- Chronis failure may be inherited or secondary to damage from
uncontrolled diabetes or hypertension
- End-stage renal disease (ESRD)
o Irreversible renal failure
o Requires dialysis
 Hemodialysis
 Peritoneal dialysis
o 90% receive hemodialysis in specialized centers.
- Vast majority of more than 450K Americans on dialysis who are
treated in dialysis centers undergo 3 treatments a week, each lasting
3-4 hours.
- Only 8% treat themselves at home
- ESRD patients often rely on EMS for transport to and from dialysis.
Hemodialysis
 - Patient connected to dialysis machine that pumps blood through
specialized filters
- Two large catheters create a circuit by which blood is removed from
the body, filtered, and returned to the body over several hours
- Two types of access to blood circulation
o Two port catheter
o A-V vistula
 Characteristic thrill when palpated
Peritoneal Dialysis:
- Uses peritoneal cavity’s 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
- CAPD
- CCPD
Medical Emergencies in ESRD
- Medical emergencies encountered in patients w/ ESRD can be
broadly divided into two groups.
o Those that arise from the loss of normal kidney function
o Those that are complications of a patients’ dialysis treatment.
- Vast majority of dialysis patients have other underlying conditions
such as diabetes and high blood pressure
Complications of ESRD
- Usually relate to patient missing dialysis
- Present w/ signs and symptoms similar to congestive heart failure
o Shortness of breath
o Edema
o Electrolyte disturbances
- Bleeding from A-V fistula site
 - Clotting and loss of function of the A-V fistula
- Bacterial infection of blood due to contamination at A-V fistula or
dialysis catheter site
o Peritonitis

TRAUMA
Chapter 29 – Bleeding/Shock
Bleeding:
Massive hemorrhage – extensive wounds open up large blood vessels or
many smaller vessels
Junctional hemorrhage – appendaged of the body connect to the trunk
Less protected
Consider tourniquets
Consider current BP
Can be accelerated by other conditions
Body temp and blood thinners
SIGNS OF SHOCK
HYPOVOLEMIA
- Massive external bleeding should be addressed in Primary
Assessment
- AMS
o Brain not receiving oxygen
- Pale, cool, clammy skin
o Shunting of blood to the core
- Nausea & Vomiting
o Blood diverted from digestive system
 - Vital Signs
o HR Increased to pump more blood then becomes weak and
threat
o Respirations increase to bring more oxygen then become
shallow
o BP will drop as a late sign, indicating a life-threat
o Narrowing of a pulse pressure
Control external bleeds by applying direct pressure which is STEP 1
Step 2 – Elevation of the limb
Step 3 – Hemostatic bleeding
Step 4 – Tourniquet
Special Situations Involving Bleading
Head Injury
- Fractured Skull
- Loss of cerebrospinal fluid (CSF)
o Ears or nose
- Avoid direct pressure
- Allow drainage to flow freely, using a gauze pad to collect it
- J
Nosebleed (epistaxis)
- Lots of tiny capillaries
- Caused by trauma, hypertension, sinus infections, digital trauma

SHOCK
Compensated
- Body senses the decreased perfusion
- Maintaning blood pressure
 - Early signs begin; increased HR, pale/cool/clammy skin
Decompensated
- Body can no longer compensate for the low blood volume or lack of
perfusion
o Failing BP
Irreversible
- Irreparable damage to vital organs
- Death
Hypovolemic – Most commonly seen by EMTs
- Uncontrolled fluid loss
- Bleeding, burns, crush injuries, dehydration
- Hemorrhagic shock is another type
Cardiogenic – Inadequate pumping of blood by the heart
- MI, heart failure
- Strength of contractions may be decreased because of damage to the
heart muscle
- Heart’s electrical system may be malfunctioning
- Low BP, edema, etc. Signs of CHF
Anaphylaxis
- BP Drops. Epi is given
- Don’t stay in compensated shock. Decompensate rapidly. HR
Increases.
- Skin is flushed, clammy, hives.
- Stridor/wheezing
Neurogenic – Uncontrolled dilation of blood vessels from nerve paralysis
caused by spinal cord injuries
- NO actual blood loss
 - BP and HR Drops.
- Above injury Pale/cool/clammy
- Below is Warm Dry
Sepsis – System-wide infection
- BP Drops, HR Increases.
- Fever
- Warm, flushed, clammy
Emergency Care of Shock
Golden hour – optimal time form infliction until the pt received definitive
care – 1 HOUR
Platinum 10 minutes – Ideal time spent on scene (w consideration to
uncontrollable delays, (weather, extrication).

CHAPTER 30
SOFT-TISSUE TRAUMA
OPEN WOUNDS
Dressing
- Should be sterile, any material applied to wound
Bandage
- Used t hold a dressing in place
Universal dressing
- Bulky
Pressure dressing
- Applied tightly to control bleeding
Occlusive Dressing
 - Forms an airtight seal
- Open wounds to abdomen, neck, chest
- Sterile preferred
- Open Pneumothorax AKA Sucking chest wound
Penetrating Trauma and Punctures
- Object passes through skin or tissue
- Often no severe external bleeding
- Internal bleeding may be perfuse
- Underlying damage that you cannot see
- Check for exit wounds?
Treatment
- Stabilize impaled objects
- Secure dressings in place
- Occlusive dressing for chest penetrations
Avulsions
- Flaps of skin and tissue are torn loose or pulled off completely
- Degloving hand- hand is caught and skinis stripped off like a glove
- Avulsed eye, ear, or nose
- Avulsed tissue will die without O2 supply.
- Common in geriatric patients
- Skin tears
Amputations
- Completely cut through or torn off
- Jagged skin and bone edges can sometimes be observed
- May be massive bleeding
o Or minimal if vessels constricted
Treatment
- Control bleeding w/ tourniquet
 - Care for amputated part
o Wrap in sterile dressing and secure plastic bag
o Keep it cool by cold packs
o Do not immerse part in water or saline OR ice
o NEVER COMPLETE AN AMPUTATION
Closed wounds
- Contusion
o Bruise
o Most frequently encountered
o Epidermis intact, but cells and vessels in the dermis are
damaged
o Pain swelling discoloration
 May be delayed or immediate
o May be indicator of significant internal bleedings
- Hematomas
o Blood collects at site of an injury
o Larger amount of tissue damage than contusion
o May be as much as a liter
- Closed crush injuries
o Force transmitted from body’s exterior to its internal
structures with skin intact
o Solid organs (liver, spleen) normally contain large amounts of
blood
o Hollow organ (GI system) leak contents into body cavities
causing inflammation and tissue damage,
- Blast injuries
o Can be open or closed
o High-velocity penetrating trauma or overpressure winds
o Most common injury: rupture of hollow organs
o Air-filled organs commonly burst (lungs, eardrum)
 - Abrasions
o Simple scraped and scratches
o Outer layer is damaged
o Skinned elbows/knees, road rash, mat burns, rug burns, brush
burns
o Possibly no detectable bleeding OR oozing blood from
capillary beds
o Pain levels vary
o Infection is great
- Lacerations
o Smooth or jagged
o Smooth are incision type. Not commonly seen
o Usually caused by sharp edge but could be from severe blow
or impact w/ blunt object
o Bleeding variable depending on vessels impacted
o Jagged is most commonly seen
CHAPTER 32
MUSCULOSKELETAL ANATOMY
Joints
- Places where bones articulate
- Body’s ability to move
Muscles – Tissues or fibers that cause movement of body parts and orgrans
- Skeletal – voluntary
- Smooth – involuntary
- Cardiac – myocardial
Cartilage – Connective tissue outside of the bond ends
Tendons – Connective tissue binding muscles to bones
Ligaments – connective tissue supporting joins (bone to bone)
Fractures and blood loss
Closed tib/fib – 500 cc blood loss
Closed femur 1000 cc blood loss
Pelvic – 1500-2000 cc blood loss
6 P’s of Musculoskeletal injuried
Pain or tenderness
Paresthesia (pins/needles)
Pallor
Pulses diminished or absent in injury extremity
Paralysis or inability to move
Pressure.

Compartment Syndrome
- Critical complication
- Caused by severe swelling in the extremity
o 1. Fracture or crush injury causes bleeding and swelling
o 2. Pressure/swelling caused by bleeding becomes so great that
body cannot perfuse tissues against pressure
o 3. Cellular damage occurs and causes additional swelling
o 4. Blood flow to the area is lost
Intracranial Pressure (ICP)
Signs
- Altered mental status
- Hypertension
- Bradycardia. Hypertension and Bradycardia are the BIG signs (I.e.
HR 40 and BP 200+)
 o Brain needs oxygen so the BP will increase to overcome
resistance to blood flow in brain
o Heart rate will slow because of compression of the vagus
nerve as the brain swells
When Carbon monoxide binds w hemoglobin its 257x

CHAPTER 35
ENVIRONMENTAL EMERGENCIES
How the body loses heat
- Conduction
o Direct contact
o Water chill
- Convection
o Air or water carry away heat
o Wind chill
- Radiation
o Heat is “picked up” by surrounding air or water.
- Evaporation
o Occurs when the body perspires or gets wet
- Respiration
o Loss of body heat through exhaled air.
Generalized Hypothermia
- Exposure to cold reduces body ead
- Body is unable to maintain proper core temperature
- May lead to death
- Predisposing factors
o Shocks
o Injuries, infection, and/or immobility
 o Diabetes w/ hypoglycemia
o Influence of drug or alcohol use
- Could be purple, cyanotic.
- Obvious and subtle exposure
o Ethanol (alcohol) ingestion
o Underlying illness
o Overdose or poisoning
o Major Trauma
o Outdoor resuscitation
o Decreased ambient temperature
Geriatric note
- The effects of cold temperature on older adults are immediate
- During winter months, many older citizens on small, fixed incomes
live in unheated rooms or rooms that are kept too cool.
o This environment plus slowing body systems and lack of
activity can lead to hypothermia
o URBAN HYPO
Pediatric note
- Because infants and young children are small with large skin surface
areas in relation to their total body mass and have little body fat,
they are especially prove to hypothermia
o Unable to shiver due to small muscle mass
Assessment of PT w/ Hypothermia
- Shivering, in early stages
- Numbness or reduced or lost sense of touch
- Stiff or rigid posture
- Drowsiness
- Rapid breathing and pulse, slow and absent breathing pulse
- Loss of motor coordination,
 - Joint/muscle stiffness or muscular rigidity.
- Decreased level of consciousness or becoming unconscious
- Cool abdominal skin temp . Red skin, pale or cyanotic skin in
prolonged cases
Passive/Active rewarming
- Passive
o Cover PT
o Remove wet clothing
- Active
o Apply external heat source
Care of PT
- Remove all wet clothing
- Actively rewarm during transport
- Provide care for shock
Extreme Hypothermia
- Patient unconscious, no discernible vital signs
o Heart rate can slow to 10 beats/minute
o Very cold to touch
- If no pulse start CPR w/ AED
- Be careful with transport/bumps in road
You’re not dead unless you’re warm and dead
Continuing care
- If patient is unresponsive or not responding appropriately
o Ensure open airway
o Provide high-concentration oxygen that has ( if possible_ been
passed through a warm-water humidifier.
o Wrap in blankets
o Transport immediately but safely
Local cold injuries/frostbite
- Most commonly affects ears, nose, face, hands, fingers, feet and
toes.
o Blood flow limited by constriction of blood vessels
o Tissues freeze/ may form ice crystals
- Early/superficial (frostnip)
o Remove from cold and cover
- Late/Deep (Frostbite)
o Oxygen
o Cover frostbitten part and handle gently
HEAT EXPOSURE
Patient w/ moist, pale, and normal or cool skin
- Condition known as heat exhaustion
- As sweating continues, the body loses salts, bringing on painful
muscle spasms (heat cramps)
- Healthy individuals may experience a form of shock brought about
by fluid and salt loss.
o Often occurs before people have been acclimatized to summer
heat
- Remove pt from hot environment
- Administer oxygen if hypoxic, loosen or remove clothing
- Apply moist towel over cramped muscles
Patient w/ Hot skin, usually dry but can be moist
- Heat stroke is a true emergency
o Temperature-regulating mechanisms fail
o The body cannot rid itself of excessive heat
o Could have fever induced seizure
- Remove patient from environment
- Apply cool packs to neck, groin, armpits.
Dangers of extreme body temp
- As body temp decrease
o Muscles shiver
o Heart is prone to dysrhythmias
o CMS Becomes sluggish
o ALOC – Altered level of consciousness
- As body temp increases
o Sweating leads to evaporation and cool skin
o If excess heat builds up, skin becomes hot
WATER RELATED EMERGENCIES
Assessment of PT in water-related accidents
- Airway obstruction
- Cardiac arrest/Signs of heart attack
- Injuries to head/neck or internal injuries
- Generalized cooling/hypothermia
- Drowning? Substance abuse?
According to the WHO
- Drowning is the process of experiencing respiratory impairment
from submersion/immersion in liquid
- Outcomes
o Death
o Morbidity
o No morbidity
o Mortality
o Remember that morbidity related to the diseases and mortality
related to death
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.
- Reflex spam of larynx is triggered, sealing airway
o Unconsciousness
o results from hypoxia
- Some who die from drowning just die from lack of air
- Most attempt a final breath, or are unconscious and water enters
lungs.
Diving accidents
- Most involve head and neck, but may also involve spine, hands, feet,
and ribs
- Emergency care is the same as for any accident pt out of water
Scuba-diving accidents
- Arterial gas embolism (gas bubbles in bloodstream)
o Diver holding breath
o May be due to inadequate training, equipment failure,
underwater emergency, or trying to conserve air

Water Rescues
- REACH
o Hold object for PT to grab
- THROW AND TOW
o Throw object that will float
- ROW
o Row boat to PT
- GO
o SWIM TO PT (LAST RESORT)
ICE RESCUES
 - Number-one rule is to protect yourself.
- Ways to reach patient
o Throw flotation device to patient.
o Toss rope with loop.
- Lay ladder flat on ice.
o
Treat for hypothermia

AUGUST 2ND, 2021

Pharmacology receptor sites
Agonist – Friend. Helps the receptor act.
Antagonist – Foe. Blocks the receptor site.
A1 – Vasoconstriction. To Increase HR.
Beta 1 – Also Vasoconstriction. To Increase HR.
Beta 2 – Bronchodilation. – Albuterol. Agonist
Epi targets A1 and B1. Epi is a sympathomimetic. Epi is an agonist.

Opioid receptors. To initiate, a patient must ingest an opiate.

Heroin/Cocaine – Street Drugs. In hospital or EMS setting: Fetanyl/Morphine
Antagonist to opiates is Narcan/naloxone.
Activated charcoal is another antagonist to ingestion/poisons.
Aspirin doesn’t affect the receptors, it attacks the platelets. Aspirin is an
antagonist.
Nitro is a potent vasodilator. – Drops BP, Drops HR. Starts to feel
lightheaded/dizzy/weakness. Headache. Lethargic, nausea/vomiting. Oxygen
demand decreases. Cardiac output decreases, so demand on heart drops heart
can relax.

Stroke volume – amount of blood being pumped out, x the heart rate.

HACE AND HAPE

High Altitude Cerebral Edema
High Altitude Pulmonary Edema