Prehospital Emergency Care Chapter 11 , 12, 13, 15, 17, 20 Key Terms

Auscultation

listening to sounds within the body with a stethoscope

baseline vital signs

the first set of vital sign measurements on a patient to which subsequent measurements can be compared

blood pressure

the force exerted by blood on the walls of blood vessels

bradycardia

heart rate less than 60 beats per minutes (adults)

capillary refill

the amount of time it takes for capillaries that have been compressed to refill with blood

ie pressing on a patient's fingernail

chief complaint

the patient complaint that is the primary reason why the EMS crew was called to the scene

clammy

a moist, or a cool and moist, condition; a skin condition often characteristic of shock

closed-ended question

a question requiring only a "yes" or "no" answer

conjunctiva

the thin covering of the inner eyelids and exposed portion of the sclera of the eye

constricted

narrowed, made small

cyanosis

A blue-gray skin color that is caused by a reduced level of oxygen in the blood.

diastolic blood pressure

the pressure exerted against the walls of the arteries when the left ventricle is at rest

dilated

expanded; made large

flushing

abnormally red skin color due to vasodilation

jaundice

condition characterized by a yellow tinge to the skin (also called xanthoderma), but also yellowness to the eyes, mucous membranes, and body fluids. Typically indicates liver failure or disease

mottling

a skin discoloration similar to cyanosis but occurring in a blotchy pattern; a possible sign of shock

open-ended question

questions that enable the patient to give detailed responses in their own words

OPQRST

Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Time

orthostatic vital signs

an increase in heart rate of 10-20 bpm and a decrease in systolic blood pressure of 10-20 mmHg when a patient moves from a supine to an upright or standing position; a positive finding for orthostatic hypotension. Also called a tilt test.

pallor

pale or abnormally white skin

palpation

feeling; as in for a pulse

pulse oximeter

electronic device used to determine the oxygen concentration in arterial blood

pulse oximetry

measurement of oxygen saturation in the blood

pulse pressure

the difference between systolic and diastolic blood pressure

pulsus paradoxus

a decrease in pulse strength during inhalation; a drop in blood pressure of more than 10 mmHg during inhalation resulting from increased pressure within the chest that suppresses the filling of the ventricles of the heart with blood

SAMPLE history

- Signs and symptoms

- Allergies

- Medications

- Pertinent past medical history

- Last oral intake

- Events leading up to injury or illness

signs

any objective evidence of medical or trauma conditions that can be seen, heard, felt or smelled in patient

sphygamomanometer

blood pressure cuff

stridor

A harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway; may be audible without a stethoscope.

symptoms

conditions that must be described by the patient because they cannot be observed by another person (subjective)

systolic blood pressure

The pressure exerted by the blood on the vessel walls during left ventricular contraction

tachycardia

a heart rate greater than 100 beats per minute (in adults)

tilt test

orthostatic vitals

vital signs

the traditional signs of life; assessments related to breathing, pulse, skin, pupils, and blood pressure

index of suspicion

an anticipation that certain types of accidents and mechanisms will produce specific types of injuries

mechanism of injury (MOI)

the factors and forces that cause traumatic injury

medical

concerning an illness (as opposed to trauma)

nature of illness (NOI)

the type of medical condition or complaint a patient is suffering from

PPE

equipment worn to protect against injury or disease (Standard Precautions or body substance isolation)

scene safety

steps taken to ensure the safety and well-being of the EMT, his partners, patients and bystanders

scene size-up

an assessment of the scene for safety hazards and to determine the nature of the patient's problem and the number of patients

trauma

concerning injury (as opposed to medical)

apnea

absence of breathing; respiratory arrest

aspiration

Breathing a foreign substance into the lungs

AVPU

Alert, Responsive to Verbal Stimulus, Responsive to Painful Stimulus, Unresponsive

blunt trauma

a force that impacts or is applied to the body but is not sharp enough to penetrate it, such as a blow or a crushing injury

brain herniation

compression and pushing of the brain through the foramen magnum

cerebrospinal fluid

a clear fluid that surrounds and cushions the brain and spinal cord

dyspnea

shortness of breath or perceived difficulty in breathing

extension posturing

a posture in which the patient arches the back and extends the arms straight out parallel to the body. A sign of serious head injury. Also called decerebrate posturing

flail segment

two or more adjacent ribs that are fractured in two or more places and thus move independently from the rest of the rib cage

flexion posturing

a posture in which the patient arches the back and flexes the arms inward toward the chest. A sign of serious head injury. Also called decorticate posturing

modified secondary assessment

a physical exam that is focused on a specific injury site, performed on a responsive patient with no significant mechanism of injury or critical injuries; or on a medical patient who is alert, oriented, and stable

occluded

closed or blocked; not patent as in an occluded airway

orthopnea

shortness of breath while lying flat

paradoxical movement

a section of the chest that moves in the opposite direction to the rest of the chest during the phases of respiration. Typically seen with a flail segment

patent

open; not blocked, as in a patent airway

penetrating trauma

a force that pierces the skin and body tissues, for example, a knife or gunshot wound

priaprism

persistent and painful erection, often due to trauma to the spinal nerves to the genitals

primary assessment

patient assessment conducted immediately after scene size-up to discover and treat immediately life-threatening conditions, determine whether the patient is injured or ill, and establish priorities for further assessment, care, and transport

rapid secondary assessment

a head-to-toe physical exam that is swiftly conducted on a trauma patient who is unresponsive or who has a significant mechanism of injury, has altered mental status, responds to verbal or painful stimuli, or is unresponsive; or on a medical patient who is not alert, is disoriented, does not respond to verbal or painful stimuli, or is unresponsive

reassessment

the continuous assessment that is conducted following the secondary assessment to detect any changes in the patient's condition, to identify any missed injuries or conditions, and to adjust emergency care as needed

self-restriction

Steps taken by a patient, without assistance, to keep his head, neck, and spine in alignment and to restrict or prevent their movement.

Spine motion restriction (SMR)

steps taken to keep the spine in anatomic alignment and to restrict movement of the spine to prevent further injury when an existing spinal injury is suspected

anaphylactic shock

a reactive release of chemical mediators that produce bronchoconstriction, vasodilation, capillary permeability and increased mucus production leading to airway and respiratory compromise and hypoperfusion

asystole

a heart rhythm indicating absence of any electrical activity in the heart.

AED

a device that can analyze the electrical activity or rhythm of a patient's heart and deliver an electrical shock (defibrillation) if appropriate

burn shock

a form of nonhemorrhagic hypovolemic shock resulting from a burn injury

cardiac arrest

the cessation of cardiac function with the patient displaying no pulse, no breathing, and unresponsiveness

cardiogenic shock

poor perfusion resulting from an ineffective pump function of the heart, typically the left ventricle

chain of survival (adult)

a series of five interventions, or links, identified by the American Heart Association as those that provide the best chance for successful resuscitation of a cardiac arrest patient. The five links of the adult chain are:

1. immediate recognition and activation

2. early CPR

3. rapid defibrillation

4. effective advanced life support

5. integrated post- cardiac-arrest care.

compensatory shock

stage of shock in which a cascade of organ and gland stimulation and hormones increases blood pressure, restores atrial wall tension, and maintains near normal blood pressure and perfusion of vital organs.

decompensatory shock

an advanced stage of shock in which the body's compensatory mechanisms are no longer able to maintain a blood pressure and perfusion of the vital organs, also known as progressive shock

defibrillation

electrical shock or current delivered to the heart through the patient's chest wall or internally from an implanted device to help the heart restore a normal rhythm

distributive shock

shock associated with a decrease in intravascular volume caused by massive systemic vasodilation and an increase in the capillary permeability

downtime

the time from when the patient goes into cardiac arrest until CPR is effectively being performed

hemorrhagic hypovolemic shock

shock from the loss of whole blood from the intravascular space

hemorrhagic shock

hemorrhagic hypovolemic shock

hypoperfusion

SHOCK, inability of the body to adequately circulate blood to the body's cells to supply them with oxygen and nutrients. Life-threatening condition

hypovolemic shock

shock caused by the loss of blood or fluid from the intravascular space resulting in a low blood volume

metabolic shock

a dysfunction in the capability of oxygen to diffuse into the blood, be carried by hemoglobin, off-loaded at the cell, or be used effectively by the cell for metabolism

multiple organ dysfunction syndrome

failure of multiple organs throughout the body from extreme and prolonged hypoxia, altered metabolism, and elevated carbon dioxide and acid levels associated with decompensatory shock

neurogenic shock

a type of distributive shock that results from massive vasodilation. Also called vasogenic shock.

nonhemorrhagic hypovolemic shock

shock caused by loss of fluid from the intravascular space with red blood cells and hemoglobin remaining within the vessels

obstructive shock

a poor perfusion state resulting from a condition that obstructs forward blood flow.

pulseless electrical activity (PEA)

a condition in which the heart's electrical rhythm remains relatively normal, yet the mechanical pumping activity fails to follow the electrical activity, causing cardiac arrest

respiratory shock

dysfunction in the ability of oxygen to diffuse into the blood, be carried by hemoglobin, and off-load at the cell for metabolism (decreased: preload, stroke volume, cardiac output, systolic bp, and tissue perfusion)

resusicitation

bringing a patient back from a potential or apparent death; an attempt to restore normal or adequate physiologic function

ROSC

Return of Spontaneous Circulation- when pulses return to a patient who has been in cardiac arrest

sepsis

exaggerated inflammatory response to an infection that overwhelms the body's normal defense and regulatory systems, causing a disruption in cell and organ function

sepsis syndrome

Sepsis with inadequate organ perfusion

septic shock

a type of distributive shock caused by an infection that releases bacteria or toxins into the blood.

shock

hypoperfusion

sudden death

death of a patient within one hour of the onset of signs and symptoms.

survival

term applied to a patient who survives cardiac arrest to be discharged from the hospital.

total downtime

the total time from when a patient goes into cardiac arrest until he is delivered to the emergency department

unwitnessed cardiac arrest

for the purposes of emergency medical services and provision of resuscitation and defibrillation, a cardiac arrest, with the patient already unresponsive, apneic, and pulseless, when EMS arrives on the scene.

vasogenic shock

neurogenic shock

ventricular fibrillation (VF or V-Fib)

a continuous, uncoordinated, chaotic rhythm that does not produce pulses (quivering)

ventricular tachycardia (VT or V-tach)

a rapid heart rhythm that may or may not produce a pulse; usually too fast to adequately perfuse body organs.