EMS Final Review Sheet

Signs of Adequate breathing

• — breaths per minute

• — breathing pattern

• Bilateral — and — lungs sounds

• Regular, equal chest — and —

• Adequate — —-

12-20, regular, clear equal, rise fall, tidal volume

Signs of Inadequate Breathing

• — than 12 or — than 20 breaths per minute

• Irregular rhythm

  • Agonal gasps = abnormal pattern of —-, irregular “breaths” usually after — —- has occurred

  • Cheyne-Stokes = abnormal breathing pattern characterized by —- then —- depth followed by a period of —

  • Ataxic/biot = irregular, —, no — — indicating severe compression of the ——

  • Kussmaul = —- and —- seen during ——

• —, —, or — breath sounds

• Reduced —- of air from mouth or nose

• Unequal or inadequate chest —-

• Increased —

• Skin pulling around —- or —- (accessory, neck, or abdominal muscle use)

• —, —, —, or — skin

• — chest rise

• Inadequate — —

• — or — position

• — nostrils

less, more

gasping, cardiac arrest,

increasing decreasing, apnea

chaotic, identifiable pattern, brainstem

deep rapid DKA

diminished absent noisy

flow

expansion

effort

ribs clavicles

pale cool clammy cyanotic

unequal

tidal volume

tripod sniffing

flaring

Type of lung sounds on different patients

Rhonchi = —-

Stridor = — and — due to — — airway

Wheezing = —, or sometimes ——

Rales = — —

pneumonia

epiglottitis croup, partially obstructed

asthma, anaphylaxis

pulmonary edema

Hypoxic drive

• Drive to breathe is based off of — —-

• This is the —- mechanism, may be the primary drive in —- patients

low O2, backup, COPD

S+S of Asthma

• Acute —- of —-

• Excessive —— production and —-

• Characteristic —-

• Can treat with —- or —-

spasm, bronchioles, mucus swelling, wheezing, combivent CPAP

S+S of COPD

• Slow process of —- and —- of airway and alveoli

• Caused by —- —-

• Combination of —- and —- —-

  • Emphysema = Loss of —- material in lungs

• Breath sounds —— (narrowed bronchioles) and —- (mucus)

• — and chronic —

• Easily confused with CHF

  • CHF has — lung sounds (rales/crackles)

  • COPD has — lung sounds (wheezing and rhonchi)

• Can treat with —- (helps open collapsed alveoli)

dilation disruption, bronchial, obstruction, emphysema chronic bronchitis, elastic, wheezing rhonchi, dyspnea coughing, wet dry, CPAP

S+S of CHF

• Left sided heart failure

  • — — (— and — lung sounds)

  • — — sputum

  • Paroxysmal nocturnal dyspnea (dyspnea when reclining due to fluid build up in lungs)

• Right sided heart failure

  • —/— edema

  • —

  • — and enlarged —

• Can treat with —-

pulmonary edema, rales wheezes, pink frothy, peripheral dependent, JVD, ascites, liver CPAP

Signs/symptoms of Anaphylaxis

• —/—

• — and — lung sounds

• Respiratory —- !!

• — !!

• Treatment for anaphylaxis

  • Epinephrine

  • — mg or mL for adults

  • — mg or mL for pediatrics

hives urticaria, wheezing stridor, distress hypotension

epinephrine, 0.3, 0.15

Trace a drop of blood from the left ventricle back to the left atrium

• Left ventricle pumps — blood through —

• Aorta to the —: arteries, arterioles, capillaries, venules, veins

• — and — — — return — blood to — —

• — — to — —

• — — to — — carry —- blood to —

• Lungs — blood

• — — carry —— blood to — —

• — — to — —

oxygenated aorta

body

inferior superior vena cava, deoxygenated right atrium

right atrium, right ventricle

right ventricle, pulmonary arteries, deoxygenated, lungs

oxygenate

pulmonary veins, oxygenated left atrium

left atrium left ventricle

Risk factors for Cardiac disease

• Uncontrollable

  • —

  • — and ethnicity

  • — — !!

• Controllable

  • —

  • — and —, —

  • High — — and high —-

  • —

gender, race, family history

smoking, diet exercise, obesity, blood pressure cholesterol, diabetes

S+S Angina and MI

• Angina

  • Crushing or squeezing chest pain due to —- —- to heart muscles (lack of oxygen to heart myocardium)

  • Heart — for oxygen exceeds —

  • Relieved from — and —

  • Falls under Acute Coronary Syndrome (ACS)

• MI

  • Sudden, —- blockage of — —- to heart resulting in — or —- of myocardium

  • Will —- be relieved with — or —-

  • Falls under Acute Coronary Syndrome (ACS)

temporary ischemia, need supply, rest nitroglycerin

prolonged, blood flow, injury death, not, rest nitroglycerin

S+S of Pulmonary Edema

• Build up of —- in the alveoli

• Usually result of — (— sided)

  • Can also be caused by — —, —, or missed —

• Lung sounds will be —/—-

fluid, CHF, left, decompression sickness, HAPE dialysis, crackles rales

S+S of CHF (both sides)

• Usually occurs —- after an —

• Increased heart rate and enlargement of left ventricle no longer compensate for —— heart function

• Left sided heart failure

  • — — (rales and wheezes)

  • — — sputum

  • Paroxysmal nocturnal dyspnea

• Right sided heart failure

  • —/— edema

  • —

  • — and enlarged —

days, MI, decreased

pulmonary edema, pink frothy

peripheral dependent, JVD, ascites liver

S+S of AAA

• A —- in the — of the aorta

• Dissecting aneurysm occurs when — layers become —

• Primary cause in uncontrolled —-

  • Can also be caused as a — collision injury in an motor vehicle crash

• Very sudden — pain with a — feeling

  • Comes of — —

  • Blood pressure can vary but is usually —

• NEVER PALPATE

weakness, wall, inner separated, hypertension, third, chest tearing, full force, low

Use and effects of nitroglycerin (and requirements)

• Used for — — of — — when patient has it —

• Effects

  • —

  • Increases —- —- to heart and decreases —- of the heart

• Requirements of Nitroglycerin

  • Systolic must be —- or above

  • — to patient

  • Maximum —- doses can be given every — minutes

• Side effects of nitroglycerin

  • —

  • — (remember bp must be over 120)

chest pain cardiac origin, prescribed

vasodilation, blood flow, workload

120, prescribed 3, 5

headache, hypotension

CPR and AED use

• AED

  • Purpose of defibrillation is to — — —

  • Best results when used within — —- of cardiac arrest

  • No shock advised = — —-

  • After shock administered = — —

• CPR

  • Used for a — and — patient

  • — compression to breath ratio for adults (single and two person)

    • Children and infants: — for single, —- for two person 

  • — beats per minute

  • Allow for adequate — —

  • Depth should be — of chest depth

    • Adults and children = about — to — inches

    • Infants = — inches

  • Adults and children = — hand CPR, or children can use the — of — hand

  • Infant = — — or — — compressions

restore cardiac rhythm, 2 minutes, continue CPR, continue CPR

pulseless apneic

30:2, 30:2, 15:2

100-120

chest recoil

1/3, 2-2.4, 1.5

two, heel one, thumb wrap, two finger

What parts of the brain control which functions

• Brainstem

  • Controls —, — —, — —, etc.

  • — — functions

• Cerebrum

  • Frontal lobe = — thought and — thinking

  • Occipital = —

  • Parietal = — and — awareness

  • Temporal = —, memory, —

• Cerebellum

  • —, — movements, motor —

breathing, heart rate, pupil size, basic life

conscious, complex

vision

sensation spatial

hearing, language

balance, body, coordination

S+S of Stroke

• Interruption of — — to area in the brain resulting in loss of brain —

• Difference between ischemic and hemorrhagic stroke

  • Ischemic = — of cerebral vessel by —-

  • Hemorrhagic = —- of cerebral vessel

• Most important thing we can obtain for information about a stroke patient

  • — — — —

• Signs and symptoms

  • Facial —

  • Sudden — or — in face, arm, leg or — side of body

  • Decreased or absent — and — in — side of the body

  • Lack of muscle — (—) or loss of —

  • Sudden — loss in — eye

  • Dysphasia = inability or impaired ability to — or — speech

  • Dysarthria = —- speech difficult for others to understand

  • — and — headache (hemorrhagic)

blood flow, function

blockage, clot, rupture

last known well time

drooping, numbness weakness, one

movement sensation one

coordination ataxia, balance

vision, one

produce understand

slurred

severe sudden

S+S of Seizure

• Surge of —- activity in the brain in the form of — and/or temporary alteration in —-

• Generalized

  • Abnormal electrical discharges in —- areas of the brain

  • —, generalized severe — of — muscles lasting several minutes or longer (~5 minutes)

• Absence (petit mal)

  • No changes in — activity, instead a brief lapse of — where the patient — and doesn’t —

• Focal/Partial

  • Focal-onset aware = — change in LOC, may have weakness, numbness, dizziness, visual changes, and some — or —

  • Focal-onset impaired awareness = — mental status, due to abnormal discharges in — lobe, lip smacking, eye blinking, isolated jerking, unusual smells and hallucinations

• Postictal state

  • Follows seizures (generalized and partial) and is associated with — and —, and sometimes —

• Febrile

  • Solely due to —

  • — associated with postictal state 

  • — months to — years

electrical, convulsion, consciousness

all, unconsciousness, twitching, all

motor, consciousness, stares respond

no, twitching paralysis

altered, temporal

lethargy confusion hypoglycemia

temperature, not, 6, 6

Assessment of abdominal pain

• When we assess the stomach and they have pain in a quadrant, where do we start?

  • — quadrant from location of pain (diagonal from pain) and — with painful quadrant

  • Foe example, RUQ pain = —- start palpate

• Always palpate —-, and if you suspect AAA be extra careful to palpate gently if at all

farthest, end, LLQ, gently

Diabetes

• Type 1 diabetes

  • — disorder where immune system destroys — — cells so the body —- produce insulin

  • Can result in a ——

    • Lack of insulin results in body burning —- resulting in production of —-

    • Will present with — and —- as a result of — and excess water be excreted in — (—-)

    • — breathing, —, —

• Type 2 diabetes

  • Peripheral cells do not —- to insulin

  • Can result in a — — state

    • Will present with — and — as a result of — and excess water be excreted in — (—-)

    • —

• Hypoglycemia = — — — skin, — and — pulse, and — blood pressure

• Hyperglycemia = — and — skin, —- to — and — pulse, — blood pressure

autoimmune, pancreatic beta, cannot, DKA, fat, ketones, hyperglycemia, dehydration glucose urine, polyuria, Kussmaul, seizures, hyperglycemia

respond, nonketotic hyperosmolar, hyperglycemia, dehydration glucose urine polyuria, seizures

pale cool clammy, rapid weak low

pink dry, normal rapid weak, normal

Insulin

• What does insulin do

  • — glucose from the — into the —-

• What cells produce insulin

  • — —- cells

moves blood cells

pancreatic beta

Use and effects of epi

• Used for — when the patient is showing signs of respiratory — and —

  • Can also use in case of asthma unresponsive to albuterol

• What does epinephrine do to body

  • — and —

  • — effects of anaphylaxis (undoes bronchoconstriction and vasodilation

anaphylaxis, distress hypotension

bronchodilation vasoconstriction, reverses

Definition of allergic reaction

• — — —

exaggerated immune responses

How the body maintains temperature

• Convection

  • Transfer of heat from part of the body to a colder object by — —, or vice versa if the object is warmer than the body

• Conduction

  • Transfer of heat to — —-

  • When cooler air moves across the body (—-)

• Evaporation

  • Conversion of — to —

  • Natural process of —-

  • Negated by —

• Radiation

  • Transfer of heat by —- —

  • Heat gain by standing in the hot sun, heat loss by standing in an air conditioned room

• Respiration

  • Body loses heat when —- air in lungs is exhaled and —- air is inhaled

direct contact

circulating air, wind

liquid gas, sweating, humidity

radiant energy,

warm cooler

Signs of Hypothermia

• When core temperature falls below —-°F

• Body loses ability to —- its temperature and —- body heat

• Assess by feeling patient's —

• Mild

  • Core temp is between ——°F

  • — and —

  • — pulse and respirations

  • Red, pale, or cyanotic skin

• Moderate

  • Core temp is between ——°F

  • Shivering —- at —-°F

  • Muscular activity —

• Severe

  • Core temp is less than —-°F

  • — and stops fighting

• Apparent dead or coma

  • Core temp is less than —°F

  • Pulse becomes — and —

  • Cardiac —- may occur

  • Patient may appear dead, always feel — pulse for — — before determining pulseless

    • Never assume and cold pulseless patient is dead

    • Handle patients gently in case of dysrhythmias

95, regulate generate, abdomen, 98-93.2, alert shivering, rapid

93.2-86, stops, 90, decreases

86, lethargic

80, slower weaker, dysrhythmias, carotid, 60 seconds

Signs of Hyperthermia

• When core temperature is —°F or higher

• Originally presents with —- and —

• Heat exhaustion

  • Overheating due to —- loss (hypovolemia)

  • Dizziness, weakness, syncope

  • —, —, headache

  • — — skin and ashen pallor

  • — tongue and —

  • — vitals

  • — or slightly — body temperature

• Heat stroke

  • Occurs when body is subjected to — heat than it can —-, and normal mechanisms are —

  • Untreated = — because body — sweating (cooling system fails)

  • —, —, — skin

  • Quickly — body temp

  • — changes

  • — and —

  • — and — pulse

  • — respiratory rate

  • — of sweating

101, sweating vasodilation

fluid, nausea vomiting, cold clammy, dry thirst, normal, normal elevated

more absorb overwhelmed, death, stops, hot dry flushed, rising, behavior, unresponsive, seizure, rapid weak, increased, cessation

Causes of AMS

• —

• —

• —

• — or — use

• AEIOU-TIPS

  • — and —

  • — and —

  • —

  • — and — (hypoxia)

  • — and —

  • — and —

  • —

  • — and —

  • — and —

hypoglycemia, hypothermia, hypoxia, intoxication, drug,

alcohol acidosis

epilepsy electrolytes,

insulin

overdose oxygen

uremia underdose

trauma temperature

infection

psychiatric poisons

stroke shock

Management of behavioral emergency

• Scene safety

  • Determine scene safety and if you need —- —- backup

  • Determine if patient's behavior is —- or not considering the circumstances

• Primary

  • General impression

    • From a distance

    • Use —- scale and establish — with patient

  • Transport

    • Unless there is a serious medical problem or trauma prepare to —- —- with patient

• History

  • Four major areas to consider as contributors

    • Is —- functioning properly?

    • Are —, other —, or — involved?

    • Are significant — —, —, or — involved?

    • Is there a — of behavioral health illness

  • In older patients consider — or —

  • Use — — (repeat patient statements back to them as a question)

law enforcement, normal, distance, AVPU rapport, spend time, CNS, hallucinogens, drugs alcohol, life changes, symptoms, illness, history, Alzheimer’s dementia, reflective listening

Management of behavioral emergency cont’d

• Secondary

  • Physical exam

    • Can determine emotional state from their — —, — —, and —

    • — gaze or —- moving eyes could indicate — problem

  • Fire or police should accompany during transport if possible

• Reassessment

  • Never let your —- down

  • If restraints are used, every 5 minutes must document

    • —

    • — in all restrained limbs

  • Interventions

    • — and — situation

    • Intervene only as much as needed to accomplish tasks

    • Contact — early if pharmacologic restraint may be needed

  • Give receiving hospital — notice

facial expressions pulse rate respirations, blank rapidly CNS

guard, respirations, PMS, diffuse control, ALS advanced

Stages of labor

• Dilation of cervix

  • Begins with onset of —- and ends when cervix is — — and baby has descended into — (—)

• Delivery of fetus

  • Begins when fetus begins to encounter — — and ends when newborn is —

  • Baby will be — (top of head appears at — opening)

• Delivery of placenta

  • Begins with — of newborn and ends with delivery of —

  • Placenta needs to — from uterine wall

  • Takes up to — —-, any longer may be an emergency

contractions fully dilated, pelvis lightening

birth canal born crowning vaginal

birth placenta, separate 30 minutes

Purpose of Amniotic fluid, Placenta and uterus

• Amniotic fluid

  • — and — fetus

• Uterus

  • A muscular organ that encloses and — the fetus as it grows

  • Produces — during labor and helps — baby through the birth canal

• Placenta

  • Attaches to — — and connects to fetus via — —

  • Provides — and — and removes — to the fetus

  • Umbilical veins carry — blood from — to —

  • Umbilical arteries carry — blood from the — to the —

insulate protect

protects contractions push

uterine wall, umbilical cord, oxygen nutrients waste, oxygenated placenta fetus, deoxygenated fetus placenta

Complications of pregnancy and management of same

• Unruptured amniotic sac

  • If it does not rupture by time of —, it will protrude from the vaginal canal and can — the fetus

  • — sac with clamp or tear it with fingers

    • Clear nose and mouth immediately

• Umbilical cord around neck

  • Once head is delivered, feel around neck to see if cord is —- around the neck

  • Try to — it over baby's head, if you can't you need to — it

    • Once cut try to speed deliver as the baby's — supply has now been —

• Emergency situations

  • More than — — elapse and the placenta has not delivered

  • There is more than —- mL of bleeding — delivery of the placenta.

  • There is — bleeding — the delivery of the placenta.

crowning, suffocate, puncture

wrapped, slip cut, blood removed

30 minutes, 500 before significant after

Complications of pregnancy and management of same

• Resuscitation efforts of the newborn

  • Use — — technique is chest compressions are needed

    • Bag-mask ventilate after every 3rd compression (—-)

    • Per minute you're doing — compressions and — ventilations

  • Clear any — before attempting ventilations

thumb wrap, 3:1, 90, 30, meconium

Complications of pregnancy and management of same

• Breech delivery

  • Most infants are born headfirst.

  • Occasionally, the —- are delivered first.

    • Called a breech presentation

  • Breech deliveries usually take —-, so you will often have time to transport the pregnant woman to the hospital.

    • If the buttocks have passed through the —-, the delivery has begun.

    • Allow the buttocks and legs to deliver —-, supporting them with your hand.

    • The head is almost always —- and should be allowed to deliver spontaneously.

    • Make a “V” with your gloved fingers and position them in the vagina to keep the walls from compressing the fetus’s ——-

buttocks, longer, vagina, spontaneously, facedown, airway

Complications of pregnancy and management of same

• Presentation complications

  • Limb presentation

    • Presenting part of the fetus is a single arm, leg, or foot

    • — be delivered in field

      • Cover limb with — —- and place patient on her back, head down, and pelvis —

  • Prolapse of umbilical cord

    • Cord comes out of vagina —- fetus

    • The fetus's head will — the cord and cut off its own —

      • Do not try to push the cord back in

      • Insert gloved hand into vagina and push fetus's head — from cord to provide — for baby

      • Place mother —- with foot-end of stretcher elevated higher than head, wit hips —- or in the knee-chest position

cannot, sterile towel, elevated before, compress, circulation, away airway, supine, elevated

Complications of pregnancy and management of same

• Spina bifida

  • Developmental defect in which a portion of the — — or — may protrude — of the vertebrae

    • Cover the open area of the spinal cord with a —, — dressing.

    • Maintenance of body — is important when applying moist dressings.

• Premature birth

  • Any newborn who delivers before — months (— weeks) or weighs less than — lb at birth is considered premature.

  • A premature newborn is smaller and thinner, and the head is proportionately —.

    • The vernix caseosa will be — or —.

    • There will be less body hair.

  • Premature newborns require special care to survive.

    • Often require —- efforts, which should be performed unless it is physically impossible

spinal cord meninges outside

sterile moist temperatuer

8 36 5 larger absent minimal resuscitation

Complications of pregnancy and management of same

• Post-term pregnancy

  • Pregnancies lasting longer than —- weeks

  • Fetuses can be —, sometimes weighing — lb or more.

  • Can lead to problems with the woman and fetus

    • A more — labor and delivery

    • Increased chance of — to the fetus

    • Increased likelihood of — section

    • Woman is at risk for perineal — and —.

    • Post term newborns have increased risks of — aspirations, —, and being —.

    • Newborns may not have developed normally.

41 larger 10

difficult, injury, cesarean, tears infection meconium infection stillborn

Complications of pregnancy and management of same

• Postpartum complications

  • If bleeding continues after delivery of placenta

    • Keep —- uterus

    • Bleeding usually caused because uterus is not — enough

    • Cover vagina with sterile — - change as often as possible and do NOT discard soaked pads

  • Postpartum patients are at an increased risk of an —.

    • Most commonly a pulmonary embolism

    • Results from a — that travels through the bloodstream and becomes lodged in the —- circulation

    • Consider when a woman complains of sudden — breathing or — of breath following delivery

massaging, contracting, pad embolism

clot, pulmonary, difficulty shortness

Start Triage

• What do we do in triage for MCI

  • — injuries based on —

  • Primary triage is done in —, secondary is done in the —- —- 

• First step is to designate area for —- patients

• What do we do in treatment sector for triage

  • Treat by —- of injuries

• What do we do in transportation sector for triage

  • — patient from —

• JumpSTART triage is for pediatric patients

  • Less than — years old and less than —lbs

  • Differs in — status assessment

sort severity, green field treatment area

severity, remove scene

8 100 respiratory

Colors of Start Triage

• Green = —/— injuries (transported 3rd)

  • Able to —, not in need of immediate transport

• Yellow = — treatment (transported 2nd)

  • — breathing and peripheral — and — to — stimuli

• Red = — treatment (transported 1st)

  • Apnea responsive to — or — breathing

  • Respiratory —

  • Breathing — a pulse (agonal)

  • — painful response

• Black = —- or — deceased (transported last)

  • Apneic —- pulse, or apneic and — to rescue breathing

minor minimal, walk,

delayed, spontaneous, pulse, responsive painful

immediate, positioning rescue failure without inappropriate

deceased expected without unresponsive

MOI/NOI

• Mechanism or injury is for — patients

• Nature of illness is for — patients

trauma, medical

What is kinetic energy? Potential?

• KE = Energy of — object

• PE = —- energy in an object (based off of — and —)

moving, stored, height weight

Symptoms and Treatment of: Chest Injuries

• S+S

  • —

  • — or — breath sounds

  • — in wound

  • — movement

• Open/sucking chest wound = — — or — — with — —

• Flail chest and pneumothorax = —-

dyspnea, diminished absent, bubbling, paradoxical

chest seal, occlusive dressing flutter valve

BVM

Symptoms and Treatment of: Head Injuries

• Symptoms

  • Cushing triad

    • —(3)—-

    • Indicates increasing —-

  • — around — (raccoon eyes) or — ear over — — (battle sign) usually indicating — —

  • — or — — leaking from scalp wound, nose, or ear

  • — and — (most common sign in —-)

  • Amnesia, seizures, posturing (decorticate and decerebrate)

• Treatment

  • High flow —

  • — — to open airway

  • Assume — injury and apply — stabilization and — — and place on —

  • — — on any open bleeding wounds

hypertension, bradycardia, irregular respirations ICP

ecchymosis eyes, behind mastoid process skull fracture

clear pink CSF

nausea vomiting, pediatrics

oxygen, jaw thrust, spinal, manual cervical collar backboard, direct pressure

Symptoms and Treatment of: Sepsis

• SS:

  • —

  • —

  • —

  • — — — skin

• Treat for shock: High flow —, keep the patient —, lay patient —

fever, tachycardia tachypnea pale cool clammy

oxygen, warm, supine

Symptoms and Treatment of: Shock

• Compensated

  • Early stage when body is still compensating for blood loss

  • Agitation, anxiety, restlessness

  • — (except in neurogenic)

  • Feeling of impending doom

  • —, —, — skin (except in neurogenic)

  • — pulse pressure

  • — and — respirations (distress)

  • — capillary refill >— seconds (most useful for pediatrics)

  • — and —

• Decompensated

  • Late stage when body cannot compensate and systems begin to fail

  • — mental status

  • — and — breathing (failure)

  • —, —, — skin

  • —/— or — pulse

  • — pupils

• Keep the patient —

• Provide high flow —

• Lay patient —

• Transport —

tachycardia, pale cool clammy, narrowing, rapid shallow, delayed 2, nausea vomiting

altered, labored irregular, ashen mottled cyanotic thready weak absent dilated

warm, oxygen supine rapidly

Symptoms and Treatment of: Burns

• SS: —-, pain, swelling, —, charring

• Airway burns get — oxygen

• — then — for dry chemicals, — for liquid chemicals

• — — dressing (not moist in order to preserve heat) and give high flow —-

  • If electrical burns, have —- ready

redness, blisters

humidified

brush flush , flush

dry sterile oxygen AED

Symptoms and Treatment of: Soft Tissue Injuries

• Closed

  • RICES: ——-

  • Watch for signs of —

• Open

  • — — for life threatening bleeding

  • Cover wounds of chest, upper abdomen, or upper back with — —

  • — to control bleeding of extremity even if not fracture

  • For eviscerations keep organs — and —, cover in — — dressing and secure with — —

  • — impaled objects unless they interfere with — or obstruct the —

  • Occlusive dressing for — wounds, especially — veins (— pressure can suck in — and cause — —)

rest ice compression elevation splint, shock

direct pressure, occlusive dressing, splint, moist warm, moist sterile occlusive dressing, stabilize CPR airway, neck, jugular, negative air air embolism

Symptoms and Treatment of: Amputation

• SS: — from — severing of an —

• Apply — — and — if bleeding cannot be controlled

• Try to save limb - wrap and place on ice, but not directly on ice

hemorrhage, complete extremity, direct pressure tourniquet

Symptoms and Treatment of: Electrocution

• SS: — burns, cardiac —, loss of —, respiratory or cardiopulmonary —

• Keep yourself —- and wait for power to be shut off

• Have an —- ready

• If lightning strike do —- triage

  • CPR and AED for severe lightning injuries before treating moderate and mild injuries

superficial, dysrhythmias, consciousness, arrest

safe, AED, reverse

Symptoms and Treatment of: Hemo/Pneumothorax

• SS: —, — or — breath sounds on affected side, — — (tension)

  • May see signs of —- with a hemopneumothorax

• Give — — ventilations and look for signs of — pneumothorax

dyspnea, diminished absent, tracheal deviation, shock

positive pressure, tension

Symptoms and Treatment of: Abdominal Injuries

• SS: pain, —- and —, —, abdominal — and —-

• Open

  • — — dressing for all wounds or — dressing or — dressing for larger wounds

  • — penetrating objects

• Closed

  • Evaluate for —

  • — and ventilation assist if needed

  • Be suspicious of tachycardia as early sign of —

• Evisceration

  • — — dressing over organs and place — — to seal, keep organs — and —

nausea vomiting, tachycardia, rigidity distension

dry sterile, hemostatic occlusive, stabilize

shock, oxygen, shock

moist sterile, occlusive dressing, moist warm

Symptoms and Treatment of: Fractures

• Provide —- stabilization and gentle — if tolerated

• Control any external —-

• — the fracture

• Place patient on —- for any leg fractures to stabilize the hip joint

manual, traction, bleeding, splint, backboard

Rule of 9’s

• Extent of burns

  • Estimated body surface area burned using rule of 9s or rule of palms

    • Proportions differ for adults vs children vs infants

    • Includes only — and — thickness burns

  • Adult Proportions

    • Entire Head and Neck = —%

    • Anterior Trunk (chest and abdomen) = —%

    • Posterior trunk (Back and Glutes) = —%

    • Entire arm = —%

    • Entire leg = —%

    • Genitalia = —%

    • Difference for children: Entire Head and Neck is —% and Entire Legs are —%

    • Difference for infants: Entire Head and Neck is —% and Entire Legs are —%

partial full

9, 18, 18, 9, 18, 1

12, 16.5

18, 13.5

Arterial vs venous bleeding

• Artery

  • — red blood that — in time with —

  • — to control

• Venous

  • — red blood that bleeds — or — depending on the — of vein

  • — to control

bright, spurts pulse, difficult

dark slowly rapidly size easier

Complication to lacerated jugular vein

• — — due to — pressure

• Prevent by applying an —- —-

air embolism negative

occlusive dressing

Typical waste products of cellular metabolism

• — —

• —

Build up of lactic acid leads to?

• Indicator of —

• — —

lactic acid CO2

sepsis, lactic acidosis

Biggest problem with any injury to the skin

• Losing ability to fight —

infection

Vertebrae numbers

• — total

• — - cervical

• — - thoracic

• — - lumbar

• — - sacral

• —- coccygeal

33

7

12

5

5

4

How to assess a child differently than adult (assessment of peds and adults)

• Newborn through preschooler age (6) from — to —

• Adult is — to —-

feet head

head to toe

Most common cause of dehydration in children

— and —

diarrhea vomiting

Most common ages for febrile seizure

— — to — —

6 months 6 years

Can we honor a living will

• Only if we contact —- —- for permission

• The only form we can honor is a —/— or general out of hospital —

medical control, MOLST POLST DNR

Different types of shock

• Cardiogenic

  • Inadequate —- of heart, usually due to an —

  • Backup of blood into — vessels = pulmonary —

  • When heart cannot maintain sufficient — to meet demands of body

• Obstructive

  • — obstruction prevents adequate volume of blood from — heart chambers

  • Cardiac tamponade

    • Collection of —- or — between pericardial sac and myocardium and prevents vesicles from filling

    • Beck triad = —(3)—-

  • Tension pneumothorax

    • Air — in chest cavity and — escape

    • Lung collapses and puts — on the nearby organs, including the — and — —

  • Pulmonary embolism

    • — that blocks flow of blood through — vessels

    • Leads to complete backup in — —

function MI, pulmonary, edema, output

mechanical, filling, fluid blood, muffled heart sounds JVD hypotension, accumulates cannot, pressure heart great vessels, clot, pulmonary right ventricle

Different types of shock

• Distributive shock

  • Widespread —- of small arterioles, venules, or both

• Septic shock

  • Occurs as a result of severe —- in which — are generated by bacteria or by infected body tissues

  • Toxins damage vessel —-, causing increased cellular —-.

  • Vessel walls —- and are unable to —- well.

  • Widespread —- of vessels, in combination with —- loss through the vessel walls, results in shock.

• Neurogenic shock

  • Usually the result of — — —- injury

  • Nerve impulses to blood vessels —- the level of the injury are blocked.

  • All vessels cut off from nerve impulses will —-, causing the blood to pool.

dilation

infections, toxins, walls, permeability, leak contract, dilation plasma

high spinal cord, below, dilate

Different types of shock

• Anaphylactic shock

  • Occurs when a person reacts violently to a substance to which he or she has been sensitized

  • Sensitization means becoming sensitive to a substance that did not initially cause a reaction.

  • Each subsequent exposure tends to produce a more —- reaction.

  • Characterized by —- and —-

• Psychogenic shock

  • Caused by a sudden —- of the nervous system

  • Produces temporary, generalized vascular —-

  • Results in —- (syncope)

  • Life-threatening causes include — heartbeat and brain —.

  • Non–life-threatening events include receipt of bad news or experiencing fear or unpleasant sights (such as blood).

• Hypovolemic Shock 

  • Result of an inadequate amount of — or — in the circulatory system

  • Hemorrhagic causes and nonhemorrhagic causes

  • Occurs with severe thermal —-

severe, bronchoconstriction, vasodilation

reaction, dilation, fainting, irregular aneurysm

fluid volume, burns

Different types of fractures

• Comminuted

  • A fracture in which the bone is broken into — than — fragments

• Epiphyseal

  • A fracture in the — section of a child’s bone

• Greenstick

  • An type of — fracture that passes only — through the — of a bone

  • Usually seen in —

• Incomplete

  • A fracture that does — run completely — the bone

• Oblique

  • A fracture in which the bone is broken at an — — the bone

• Pathologic

  • A fracture of — or — bone (osteosarcomas, osteoporosis)

  • Usually seen in — people

• Spiral

  • A fracture caused by a — force, causing an — fracture — and — the bone

• Transverse

  • A fracture that occurs — — the bone

more two

growth

incomplete partway shaft children

not through

angle across

weakened diseases older

twisting oblique around through

straight across

How to splint

• ***Biggest rules for splinting***

  • Secure above and below —- and above and below the —

  • Always check —- BEFORE and AFTER

• A splint is a flexible or rigid device that is used to protect and maintain the position of an injured extremity.

  • Splint all fractures, dislocations, and sprains —- moving the patient, unless he or she is in — —.

  • Splinting reduces — and makes it — to transfer and transport the patient.

• Splinting will help to prevent:

  • — damage to muscles, the spinal cord, peripheral nerves, and blood vessels

  • — of the skin

  • Restriction of distal — —

  • Excessive — of the tissues

  • Increased —

  • — of extremities

injury joint, PMS

protect position, before, immediate danger, pain easier

further, laceration blood flow, bleeding, pain paralysis

How to splint

• General principles of splinting

  • Remove — from the area.

  • Note and record the patient’s — status.

  • Cover open wounds with a —, — dressing.

  • Do not move the patient — splinting an extremity unless there is —.

  • — the joints.

  • — all rigid splints.

  • Maintain — stabilization.

  • If you encounter resistance, splint the limb in its —- position.

  • Immobilize all suspected spinal injuries in a —, —- position.

  • When in doubt, —.

• Hazards of improper splinting

  • — of nerves, tissues, and blood vessels

  • — in transport of a patient with a life-threatening injury (if the patient is in shock do NOT splint, place on backboard and transport!!)

  • Reduction of — circulation

  • Aggravation of the injury

  • Injury to tissue, nerves, blood vessels, or muscles

clothing, neurovascular, dry sterile before danger stabilize pad manual, deformed, neutral in-line, splint

compression, delay, distal,

Anatomy of CNS and the protective structures

• Includes the — and — —

• The brain controls the body and is the center of consciousness.

• Brain is divided into three major areas:

  • Cerebrum

  • Cerebellum

  • Brainstem

• Cerebrum

  • Controls a wide variety of activities, including most —- motor function, —- interpretation, and —- thought

  • Contains about 75% of the brain’s total volume

  • Divided into two hemispheres with four lobes

• Cerebellum

  • Coordinates —- and body —

• Brainstem

  • Controls most functions necessary for —

  • Best—- part of the CNS

brain spinal cord,

voluntary sensory, conscious

balance movement

life protected

Anatomy of CNS and the protective structures

• Spinal cord

  • Made up of fibers that extend from the brain’s —- cells

  • Carries messages between the — and the —- via the grey and white matter of the spinal cord

• Protective coverings

  • The entire CNS is contained within a protective framework.

  • The thick, bony structures of the skull and spinal canal withstand injury very well.

  • The CNS is further protected by the —-.

• Meninges

  • Outer layer (—- —) is a tough, fibrous layer that forms a sac to contain the CNS.

  • Inner two layers (arachnoid mater and pia mater) contain the — — and —-

• Cerebrospinal fluid (CSF)

  • Produced in a chamber inside the brain called the — —

  • Approximately 125 to 150 mL of CSF in the brain at any time

  • Primarily acts as a — —

nerve, brain body

meninges

dura mater, blood vessels CSF

third ventricle, shock absorber

Pneumothorax

• Commonly called a collapsed lung

• Accumulation of —- in the — space

  • Blood passing through the collapsed portion of the lung is not —.

  • You may hear —-, —-, or abnormal breath sounds.

• Open chest wound

  • Often called an — pneumothorax or a — chest wound

  • Wounds must be rapidly sealed with an — —. 

  • A flutter valve is a — —- valve.

  • Carefully monitor the patient for —- pneumothorax.

• Simple pneumothorax

  • Does —- result in major changes in the patient’s cardiac physiology

  • Commonly due to —- trauma that results in — —, but can also be spontaneous due to — lungs

  • Can often worsen, deteriorate into —- pneumothorax, or develop complications

air pleural, oxygenated, diminished absent

open sucking, occlusive dressing one way tension

not, blunt fractured ribs weakened, tension

Tension Pneumothorax

• Results from ongoing — —- in the pleural space that —- escape

• Increased pressure in the chest:

  • Causes complete collapse of the —- lung

  • Mediastinum is pushed into the — pleural cavity

    • Will see —- —- on the opposite side of the lung that collapsed

    • This puts pressure on the —- and — —-

• Commonly caused by a blunt injury where a — — lacerates a — or —

• Not much we can do when this happens

  • We have to bag them to allow them to breathe but it will inevitably worsen the tension pneumothorax

  • Request ALS

air accumulation cannot

unaffected, opposite, tracheal deviation heart great vessels, blunt, fractured rib, lung bronchus

Hemothorax

• — collects in the — space from bleeding around the — — or from a — or — —.

• Signs and symptoms

  • — without any obvious external bleeding or apparent reason for shock

  • — or —- breath sounds on the affected side

  • Will NOT hear —- sounds because blood is not aerated

• Prehospital treatment

  • Rapid transport

• Hemopneumothorax: the presence of — and — in the pleural space

• Best treatment is — —- ventilations but definitive care is surgery

blood pleural rib cage lung great vessel

shock, diminished absent gurgling, air blood

positive pressure

Difference between avulsion, abrasion, incision, laceration

• Abrasion

  • A wound of the —- layer of the skin.

  • Caused by —- when a body part rubs or scrapes across a rough or hard surface

• Laceration

  • A — cut. 

• Incision

  • A —, — cut.

  • Caused by something specifically — to cut

• Avulsion

  • — various — of soft tissue so that they become either completely — or hang as a —.

• Amputation

  • An injury in which part of the body is — severed.

• Penetrating wound

  • An injury resulting from a — object.

superficial, fraction

jagged

sharp smooth created

separates layers detached flap

completely

piercing

Types of burns

• Superficial (first-degree) burns

  • Involve only the —- layer of skin

• Partial-thickness (second-degree) burns

  • Involve the —- and some portion of the —

  • — are present.

• Full-thickness (third-degree) burns

  • Extend through —- skin layers

  • — are destroyed so pain may be absent

top

epidermis dermis blisters

all nerves

Know battle sign and what it indicates

• Presence of — (bruising, discoloration) — the ear over the — —

• Indicates a — —, likely —-

ecchymosis, behind mastoid process

skull fracture basilar

What would make you suspicious for child abuse

• CHILD ABUSE mnemonic

  • — of injury with child's age

  • — inconsistent with injury

  • — parental concern

  • — of supervision

  • — in seeking care

  • —

  • — of varying age and location

  • — injury pattern

  • — circumstances

  • — clues

consistency

history

inappropriate

lack

delay

affect

bruises

unusual

suspicious

environmental

Signs and symptoms of croup and epiglottitis

• Croup

  • Inflammation and swelling of —, —, and —

  • — and — — cough

  • Responds well to — oxygen

  • — infection

• Epiglottitis

  • — infection causing inflammation of —

  • Children are often found in — position and — because they can't swallow

  • Position comfortably and provide —- oxygen.

  • Severe swelling of the epiglottis which could — the airway

    • Do not put anything into throat (no OPA or NPA) … any stimulation of epiglottis can cause it to swell further and block airway further

pharynx, larynx trachea , stridor seal bark humidified viral

bacterial, epiglottis, tripod drooling humidified obstruct

What is a DNR

• A DNR is a type of — —-

• Advanced directive is defined as

  • Specific legal papers that direct relatives and caregivers about what kind of — — may be given to patients who cannot — for themselves.

• May take the form of a do not resuscitate (DNR) order

  • Gives you permission not to attempt —- for a patient in cardiac arrest

  • DNR does not mean “do not treat.”

    • Basic —- should still be provided.

advanced directive

medical treatment speak

resuscitation ABCs

Organs of abdomen (hollow vs solid)

• Hollow organs

  • When ruptured or lacerated the —- spill into — cavity

    • Can cause — reaction and — such as —

  • Intestinal blood supply comes from —-

    • Mesentery connects — — to the —- —

    • Injuries can cause — into the — cavity

• Solid organs (POLSK)

  • POLSK = ———

  • Perform chemical work of body: enzymes, blood cleansing, energy production

  • Rich blood supply so any injury can cause severe —-

contents peritoneal inflammatory infection peritonitis, mesentery, small intestine abdominal wall bleeding peritoneal

pancreas ovaries liver spleen kidneys

hemorrhage

GCS

• Eye opening

  • Spontaneously = 4

  • In response to —/—- = 3

  • In response to —/—- = 2

  • None = 1

• Verbal response

  • — conversation = 5

  • — conversation = 4

  • — words = 3

  • Incomprehensible — = 2

  • None = 1

• Motor skills

  • — commands = 6

  • — pain = 5

  • — from pain = 4

  • Abnormal — (—) = 3

  • Abnormal — (—) = 2

  • None = 1

speech sound, pain pressure

oriented, confused inappropriate sounds

obeys, localizes withdraws flexion decorticate, extension decerebrate

Airway and resp management

Positioning

• — — — —

• — — for head and neck trauma

Recovery position

• Used to maintain a clear airway in an — patient who is —- injured and is breathing on their —

• Also called — — position

Adjuncts

• OPA

  • Prevents —- from obstructing airway

  • Makes —- easier

  • Not indicated in — patients or those with a — —

• NPA

  • Used for — patients or those — gag reflex

  • Not indicated in patients with — or —- injury or history of — surgery

Suctioning

• Ensure pressure of —mmHg or more

• No more than —- seconds for adults, —- second for children, and —— seconds for infants or else it can result in —

• If secretions or being produced quicker than can be suctioned then — — —-

head tilt chin lift, jaw thrust

unconscious not own lateral recumbent

tongue, easier, conscious gag reflex

conscious with, head facial nose

300, 15, 10, 5, hypoxia, turn on side

Airway and resp management cont’d

Oxygen

• Nasal cannula

  • — L/min provides —-% oxygen but no more than 44% even if set higher than 6 L/min

  • — hypoxia or nausea

  • A patient who breathes through the —- or has a — obstruction will not benefit

• Nonrebreathing

  • Preferred way to give oxygen, and used if nasal cannula is not bringing O2 up to 94% or more

  • — L/min gives —% oxygen

  • Prevents patient from rebreathing — —- from exhalation

• Partial rebreathing

  • Similar to nonrebreathing masks but there is no one way valve so patient rebreathes some CO2

• Tracheostomy masks

  • Cover —- hole

• BVM

  • Provides —-% oxygen to patient and used to give — — ventilations

  • For those with —- respiration rate (<12 or >20), —- or —- LOC, or inadequate —- —-

  • Also used for trauma patients with chest injuries  

1-6, 24-44, mild, mouth nasal

12-15, 95 carbon dioxide

tracheostomy

100, positive pressure, inadequate, unconscious altered tidal volume

Airway and resp management cont’d

CPAP

• Used in patients with —, —, and —

• — pressure in lungs

• — collapsed alveoli and provides — —- during —-

• Forces — —- back into pulmonary circulation

• Indications

  • Patient — and follows —

  • In — to — respiratory distress

  • Respiratory distress after — incident

  • —

  • Respiratory drive —

• Contradictions

  • Respiratory —

  • —

  • — or — follow commands

  • Cannot — airway

  • — (BP must be 120 or higher)

  • — or chest —

  • —

  • Active GI — or —

  • Facial —

  • — shock (low BP)

  • Cannot sit —

COPD asthma CHF, increases, opens, back pressure exhalation, interstitial fluid

alert commands, moderate severe, submersion tachypnea present

arrest hypoventilating unresponsive cannot, protect hypotension, pneumothorax trauma, tracheostomy bleed vomiting trauma cardiogenic upright

Airway and resp management cont’d

• Interventions for respiratory issues

  • COPD, asthma, and CHF (pulmonary edema) = give —-

  • Asthma = —- or —- if unresponsive to treatment

CPAP combivent, epinephrine