Prevention of Acute Injury and Illness Exam 1

Criteria for refusing treatment

Conscious, alert adults with decision-making capacity

Confidential information includes

-Patient history

-Assessment finding

-Tx provided

Information cannot be disclosed EXCEPT

-Pt signs a medical release

-Legal subpoena

-Needed by billing personnel

Presumptive signs of death

-Unresponsiveness to pain stimuli

-Lack of a carotid pulse

-Absence of breath sounds

-No deep tendon or corneal reflexes

Definitive signs of death

-Rigor mortis (2-12 hrs)

-Algor Mortis (body same temp. as outside)

-Putrefaction (decomposition)

Scope of practice

Outlines the care you are able to provide

Standards of care

The manner in which you must act/behave

Duty to Act

Individual’s responsibility to provide patient care

Negligence

Failure to provide same care that person with similar training would provide in same/similar situation

All 4 elements must be present for negligence to apply

-Duty

-Breach of duty

-Damages

-Causation

Res ipsa loquitur

The cause of the injury was in the control of the EMT, generally does not occur unless there is negligence

Negligence per se

The conduct of the person being sued is alleged to that occurred in clear violation of a statute

Torts

civil wrongs

Abandonment

Unilateral termination of care by EMT without:

• Patient’s consent

• Making provisions for continuing care

Assault

unlawfully placing person in fear of immediate bodily harm

Battery

unlawfully touching a person

Kidnapping

seizing, confining, abducting, or carrying away by force

False imprisonment

unauthorized confinement of a person

Defamation

Communication of false information that damages the reputation of a person

• Libel: written

• Slander: spoken

Good Samaritan conditions to be met:

• Good faith

• Without expectation of compensation

• Within the scope of training

• Did not act in grossly negligent manner

Sovereign Immunity

Provides limitations on liability and immunity is not complete

Special mandatory reporting obligation

• Abuse of children, older persons, and others

• Injury during the commission of a felony

• Drug-related injuries

• Childbirth

• Attempted suicide

• Dog bites

• Communicable disease

• Assaults

• Domestic violence

Apex

Tip(s) of a structure

Fowler position

Semi-reclining with head elevated

• Semi-Fowler (45 degree)

• High-Fowler (90 degree)

Axial Skeleton

Skull, facial bones, thoracic cage, vertebral column

Spinal Column divided into 5 sections (33 total vertebrae)

Cervical (7 vertebrae)

Thoracic (12)

Lumbar (5)

Sacrum (5)

Coccyx (4)

How many pairs of ribs?

12

Appendicular Skeleton

• joints

• Upper extremities

• Pelvis

• Lower extremities

Pelvic bone is formed by fusion of

the ilium, ischium, and pubis

Purpose of the skeletal system

• gives the body its shape

• protects fragile organs

• allows for movement

• store calcium

• helps create blood cells

Purpose of the musculoskeletal system

• Form

• Upright posture

• Movement

• Protection of vital internal organs

Types of muscle

• Skeletal (voluntary) muscle

• Smooth muscle

• Cardiac muscle

Pleura

a layer of smooth, glistening tissue that covers each lung and lines the chest cavity

Respiration

exchange of oxygen and carbon dioxide in the alveoli and tissues

Ventilation

air movement into and out of the lungs

Tidal Volume

amount of air moved into or out of the lungs during a single breath

Residual Volume

the gas that remains in the lungs to keep the lungs open

Dead space

the portion of the respiratory system that has no alveoli and where little/no exchange of gas between air and blood occurs

Normal resting heart rate

60-100 bpm

Blood composition

• plasma

• red blood cells

• white blood cells

• platelets

Systole

When the left ventricle of the heart contracts, highest pressure

Diastole

when the ventricle relax, lowest pressure

Perfusion

circulation of blood in organ/tissue in adequate amounts to meet the needs of cells

Functions of blood

• fighting infection

• transporting oxygen

• transporting carbon dioxide

• controlling pH

• Transporting wastes and nutrients

• clotting (coagulation)

Cerebrospinal fluid purpose

Cushions and protects the brain and spinal cord

Spinal cord purpose

Transmits messages between brain and body

Peripheral Nervous system divided into

• Somatic

• Autonomic

Somatic Nervous System

Transmits signals from brain to voluntary muscles

Autonomic Nervous System

• Involuntary action

• Split into sympathetic and parasympathetic nervous system

Types of nerves within peripheral nervous system

• sensory nerves carry information from body to CNS

• Motor nerves carry information from CNS to muscles

Layers of the skin

• Epidermis (superficial)

• Dermis (deeper)

3 functions of Integumentary system

• Protects the body in the environment

• Regulates body temperature

• Transmits information from environment to brain

The lymphatic system purpose

Helps to rid the body of toxins and others harmful materials

Lymph

thin, straw-colored fluid that carries oxygen and nutrients to cells and waste products away

Factors that impair ventilation

• blocked airway

• Impairment of the muscles of breathing

• Airway obstructed physiologically (asthma)

Factors that impair respiration

• change in atmosphere

• high altitudes

• Impaired movement of the gas across cell membrane

Neonates age range

Birth to 1 month

Infants age range

1 month to 1 year

Fontanelles

Spaces between the bones that eventually fuse to form the skull.

Toddler age range

1 to 3 years

Preschooler age range

4 to 6 years

Preschooler normal vitals

• Pulse: 80 to 140 bpm

• R.R: 20 to 25 bpm

• Systolic BP: 80 to 100 mmHg

Adolescents (12-18 y/o) normal vitals

• Pulse: 60 to 100 bpm

• R.R: 12 to 20 bpm

• Systolic BP: 90 to 110 mmHg

Young Adults normal vitals (19-40)

• Pulse: 60 to 100 bpm

• R.R: 12 to 20 bpm

• Systolic BP: 90 to 120 mmHg

• PO2: 94 to 99%

Main parts of Patient Assessment (in order)

1.) Scene size-up

2.) Primary assessment

3.) History taking

4.) Secondary Assessment

5.) Reassessment

Scene size-up Mnemonic

ENAMES

• Environment

• Number of Patients

• Additional resources needs/ALS backup

• Mechanism of injury(MOI)/Nature of Illness(NOI)

• Extrication/Evacuation

• Spinal Precautions

Standard Precautions

BSI

• Body Substance Isolation

Primary Assessment, looking for:

• Uncontrolled external bleeding takes priority

• ABCs: Airway, breathing, circulation

• LOC: Level of Consciousness

Mnemonic for assessing level of consciousness

AVPU

• Awake and alert

• Responsive to Verbal stimuli

• Responsive to Pain

• Unresponsive

Orientation level test

A & O x4

• Awake, Alert, and Oriented to:

  • Person

  • Place

  • Time

  • Event

High-Priority patients that need to be transported:

• Unresponsive

• Difficulty breathing

• Uncontrolled bleeding

• Severe chest pain

• Complicated childbirth

Mnemonic for History Taking to assess symptoms

OPQRST

• Onset

• Provocation/palliation

• Quality

• Region/radiation

• Severity

• Timing

Mnemonic for assessing history

SAMPLE

• Signs and Symptoms

• Allergies

• Medication

• Pertinent past medical history

• Last oral intake

• Events leading up to the injury/illness

Secondary Assessment Mnemonic

DCAP-BTLS

• Deformities

• Contusions

• Abrasions

• Punctures/Penetrations

• Burns

• Tenderness

• Lacerations

• Swelling

Term for unequal pupils

anisocoria

Pupil Assessment Mnemonic

PEARRL

• Pupils

• Equal

• And

• Round

• Regular in Size

• React to Light

Reassessment time frame

• Unstable patients: every 5 minutes

• Stable patients: every 15 minutes

Upper Airway structures

• Nose

• Mouth

• Oral cavity

• Pharynx

• Larynx

Function of upper airway

• warm

• filter

• humidify air

Lower airway structures and function

• trachea

• bronchi

• lungs

  Function: deliver oxygen to alveoli

Ventilation

The physical act of moving air into and out of the lungs

Oxygenation

The process of loading oxygen molecules onto hemoglobin molecules in the bloodstream

Respiration

The actual exchange of oxygen and carbon dioxide in the alveoli as well as the tissues of the body

Factors affecting pulmonary ventilation

• Intrinsic factors:

  • Infections, allergies, unresponsiveness

• Extrinsic

  • Trauma

Factors affecting respiration

• External:

  • Atmospheric pressure

  • partial pressure of O2

• Internal:

  • Pneumonia

  • COPD

Agonal gasps

patient may appear to be breathing after the heart has stopped

Ataxic respirations

Irregular/unidentifiable pattern

• may follow serious head injury

Kussmaul respirations

Deep, rapid respirations

• Common in patients with metabolic acidosis

Hazards of supplemental oxygen

• Combustion

• Oxygen toxicity

Gastric distension

Occurs when artificial ventilation fills the stomach with air

Respiratory system structures

• Diaphragm

• Chest wall muscles

• Accessory muscle of breathing

• Nerves to the muscles

Croup

Inflammation and swelling of the pharynx, larynx, and trachea

• Stridor and seal-bark cough

Pertussis

whooping cough

Common sign of Acute pulmonary edema

• frothy pink sputum

• “wet” lung sounds

History taking for dyspnea patients Mnemonic

PASTE

• Progression

• Associated chest pain

• Sputum

• Talking tiredness

• Exercise tolerance