Chapter 9 Emergency Care and Transportation of the Sick and Injured

accessory muscles

The secondary muscles of respiration. They include the neck muscles (sternocleidomastoids), the chest pectoralis major muscles, and the abdominal muscles.

altered mental status

Any deviation from alert and oriented to person, place, time, and event, or any deviation from a patient's normal baseline mental status.

auscultate

To listen to sounds within an organ with a stethoscope.

AVPU scale

A method of assessing the level of consciousness by determining whether the patient is awake and alert, responsive to verbal stimuli or pain, or unresponsive; used principally early in the assessment process.

blood pressure

The pressure that the blood exerts against the walls of the arteries as it passes through them.

bradycardia

A slow heart rate, less than 60 beats/ min.

breath sounds

An indication of air movement in the lungs, usually assessed with a stethoscope.

capillary refill

A test that evaluates distal circulatory system function by squeezing (blanching) blood from an area such as a nail bed and watching the speed of its return after releasing the pressure.

capnography

A noninvasive method to quickly and efficiently provide information on a patient's ventilatory status, circulation, and metabolism; effectively measures the concentration of carbon dioxide in expired air over time.

carbon dioxide

Carbon dioxide is a component of air and typically makes up 0.3% of air at sea level; also a waste product exhaled during expiration by the respiratory system.

chief complaint

The reason a patient called for help; also, the patient's response to questions such as "What's wrong?" or "What happened?"

coagulate

To form a clot to plug an opening in an injured blood vessel and stop bleeding.

conjunctiva

The delicate membrane that lines the eyelids and covers the exposed surface of the eye.

crackles

A crackling, rattling breath sound that signals fluid in the air spaces of the lungs.

crepitus

A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling.

cyanosis

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

DCAP-BTLS

A mnemonic for assessment in which each area of the body is evaluated for Deformities, Contusions, Abrasions, Punctures/penetrations, Burns, Tenderness, Lacerations, and Swelling.

diaphoretic

Characterized by light or profuse sweating.

diastolic pressure

The pressure that remains in the arteries during the relaxing phase of the heart's cycle (diastole) when the left ventricle is at rest.

distracting injury

Any injury that prevents the patient from noticing other injuries he or she may have, even severe injuries; for example, a painful femur or tibia fracture that prevents the patient from noticing back pain associated with a spinal fracture.

focused assessment

A type of physical assessment typically performed on patients who have sustained nonsignificant mechanisms of injury or on responsive medical patients. This type of examination is based on the chief complaint and focuses on one body system or part.

frostbite

Damage to tissues as the result of exposure to cold; frozen or partially frozen body parts are frostbitten.

general impression

The overall initial impression that determines the priority for patient care; based on the patient's surroundings, the mechanism of injury, signs and symptoms, and the chief complaint.

Golden Hour

The time from injury to definitive care, during which treatment of shock and traumatic injuries should occur because survival potential is best; also called the Golden Period.

guarding

Involuntary muscle contractions of the abdominal wall to minimize the pain of abdominal movement; a sign of peritonitis.

history taking

A step within the patient assessment process that provides detail about the patient's chief complaint and an account of the patient's signs and symptoms.

hypertension

Blood pressure that is higher than the normal range.

hypotension

Blood pressure that is lower than the normal range.

hypothermia

A condition in which the internal body temperature falls below 95°F (35°C) after exposure to a cold environment.

incident command system

A system implemented to manage disasters and mass- and multiple-casualty incidents in which section chiefs, including finance, logistics, operations, and planning, report to the incident commander. Also referred to as the incident management system.

jaundice

Yellow skin or sclera that is caused by liver disease or dysfunction.

labored breathing

Breathing that requires greater than normal effort; may be slower or faster than normal and characterized by grunting, stridor, and use of accessory muscles.

mechanism of injury (MOI)

The forces, or energy transmission, applied to the body that cause injury.

metabolism

The biochemical processes that result in production of energy from nutrients within the cells.

nasal flaring

Widening of the nostrils, indicating that there is an airway obstruction.

nature of illness (NOI)

The general type of illness a patient is experiencing.

OPQRST

A mnemonic used in evaluating a patient's pain: Onset, Provocation/palliation, Quality, Region/radiation, Severity, and Timing.

orientation

The mental status of a patient as measured by memory of person (name), place (current location), time (current year, month, and approximate date), and event (what happened).

palpate

To examine by touch.

paradoxical motion

The motion of the portion of the chest wall that is detached in a flail chest; the motion—in during inhalation, out during exhalation—is exactly the opposite of normal chest wall motion during breathing.

perfusion

The flow of blood through body tissues and vessels.

personal protective equipment (PPE)

Protective equipment that blocks exposure to a pathogen or a hazardous material.

pertinent negatives

Negative findings that warrant no care or intervention.

priapism

A painful, tender, persistent erection of the penis; can result from spinal cord injury, erectile dysfunction drugs, or sickle cell disease.

primary assessment

A step within the patient assessment process that identifies and initiates treatment of immediate and potential life threats.

pulse

The pressure wave that occurs as each heartbeat causes a surge in the blood circulating through the arteries.

pulse oximetry

An assessment tool that measures oxygen saturation of hemoglobin in the capillary beds.

reassessment

A step within the patient assessment process performed at regular intervals during the assessment process to identify and treat changes in a patient's condition. A patient in unstable condition should be reassessed every 5 minutes, whereas a patient in stable condition should be reassessed every 15 minutes.

responsiveness

The way in which a patient responds to external stimuli, including verbal stimuli (sound), tactile stimuli (touch), and painful stimuli.

retractions

Movements in which the skin pulls in around the ribs during inspiration.

rhonchi

Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways.

SAMPLE history

A brief history of a patient's condition to determine signs and symptoms, allergies, medications, pertinent past history, last oral intake, and events leading to the injury or illness.

scene size-up

A step within the patient assessment process that involves a quick assessment of the scene and the surroundings to provide information about scene safety and the mechanism of injury or nature of illness before you enter and begin patient care.

sclera

The tough, fibrous, white portion of the eye that protects the more delicate inner structures.

secondary assessment

A step within the patient assessment process in which a systematic physical examination of the patient is performed. The examination may be a systematic exam or an assessment that focuses on a certain area or region of the body, often determined through the chief complaint.

shallow respirations

Respirations characterized by little movement of the chest wall (reduced tidal volume) or poor chest excursion.

sign

Objective findings that can be seen, heard, felt, smelled, or measured.

situational awareness

Knowledge and understanding of your surroundings and situation and the risk they potentially pose to your safety or the safety of the EMS team.

sniffing position

An upright position in which the patient's head and chin are thrust slightly forward to keep the airway open.

spontaneous respirations

Breathing that occurs without assistance.

standard precautions

Protective measures that have traditionally been developed by the Centers for Disease Control and Prevention (CDC) for use in dealing with objects, blood, body fluids, and other potential exposure risks of communicable disease.

stridor

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

subcutaneous emphysema

A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissues.

symptom

Subjective findings that the patient feels but that can be identified only by the patient.

systolic pressure

The increased pressure in an artery with each contraction of the ventricles (systole).

tachycardia

A rapid heart rate, more than 100 beats/min.

tidal volume

The amount of air (in milliliters) that is moved in or out of the lungs during one breath.

triage

The process of establishing treatment and transportation priorities according to severity of injury and medical need.

tripod position

An upright position in which the patient leans forward onto two arms stretched forward and thrusts the head and chin forward.

two- to three-word dyspnea

A severe breathing problem in which a patient can speak only two to three words at a time without pausing to take a breath.

vasoconstriction

Narrowing of a blood vessel.

vital signs

The key signs that are used to evaluate the patient's overall condition, including respirations, pulse, blood pressure, level of consciousness, and skin characteristics.

wheezing

A high-pitched, whistling breath sound that is most prominent on expiration, and which suggests an obstruction or narrowing of the lower airways; occurs in asthma and bronchiolitis.

LOC

level of consciousness

ABCs

airway, breathing, circulation