Studied by 4 people
Hemothorax
can be the result of blunt or penetrative trauma to the chest/open or closed injuries
Early signs and symptoms are the same for shock
Treatment
Same for pneumothorax and shock
Traumatic asphyxia
when severe and sudden compression of the thorax causes a rapid increase in chest pressure
Signs and symptoms
bluish/purple discoloration of the face, head, neck, and shoulders
JVD
Bloodshot eyes that are protruding from the socket
Cyanotic and swollen tongue and lips
Bleeding of conjunctiva
Treatment
Emergency care for any chest wounds and shock
Cardiac contusion
when the heart is violently compressed between the sternum and spinal column
Signs and symptoms
Chest pain/discomfort
Signs of blunt trauma to the chest (swelling, bruising, crepitation, deformity)
Tachycardia
Irregular pulse
Treatment: rapid transport
Commotio cordis
sudden cardiac arrest from blunt trauma
Treatment: CPR and early defibrillation
Pericardial tamponade
trauma causes bleeding to the sac surrounding the heart = inward compression of the heart = decreased cardiac output
Signs and symptoms
Similar to a tension pneumothorax
Except breath sounds are normal
Worsen as pericardial sac fills with more blood
PVD
Signs of shock (hypoperfusion)
Tachycardia
Decreased BP
Narrow pulse pressure
Weak pulses
Dyspnea
Cyanosis
Treatment
Early recognition
Rapid transport
Maintain airway and use NRB
Flail Chest
2+ ribs are broken in 2+ places
Creates a segment of the chest that is unattached to the rest of the rib cage
Contraindicated
Placing the patient on the injured side
Stabilizing patient with devices that compromise chest wall motion
Ideal treatment: CPAP/positive airway ventilation using BVM
Used only if the patient shows signs of respiratory distress/failure
Sucking Chest Wounds
open chest wound that pulls air into the thoracic cavity
Treatment
Cover wound with gloved hand
Dress wound and tape on 3 sides
Tension pneumothorax
caused by air leaking into the chest cavity from a damaged lung with no opening through the outer chest
Signs
Rapid deterioration
Severe respiratory distress
Signs of shock
Absent breath sounds on one side
Cyanosis
Unequal movement of the chest
Distended neck veins
Deviation of trachea to the uninjured side
Treatment
Early recognition and rapid transport
Informed consent
Signing documents
I.e. scheduled surgery
Expressed Consent
Doing actions that demonstrate they want to be helped
Implied Consent
If they could make a decision, they would want to be helped
Minor Consent
Parent making decision for the child
Involuntary Consent
Treating someone who doesn't want treatment but needs it
I.e. suicidal patient
eupnea
normal respirations
tachypnea
fast breathing
bradypnea
slow breathing
Biot’s breathing pattern
quick breathing but spaced out
brain damage
wheezing lung sounds
lower airway
need stethoscope
narrowing/inflammation = bronchiole diameter reduced
rales/crackles lung sounds
lower airway
need stethoscope
fluid in/around alveoli
snoring lung sounds
upper airway
dont need stethoscope
partial obstruction by tongue
stridor/ crowing lung sounds
upper airway
dont need stethoscope
“crow cawing”
partial obstruction at larynx
gurgling lung sounds
upper airway
dont need stethoscope
fluid in airway
rhonchi lung sounds
lower airway
need stethoscope
mucus blocks larger bronchioles
cushing’s reflex
Increased intracranial pressure: opposite of shock
Increased systolic BP
Decreased pulse
Decreased respirations
Presence of a closed head injury and signs of shock mean?
cushing’s reflex
another injury present
reasons for splinting
Prevents movement of bone fragments, bone ends, and dislocated joints = reduced chance for further injury
Reduce pain and minimize common complications from bone and joint injuries
general splinting rules
Assess CMS
Cut away clothing to expose injury site
Place sterile dressing over the open wound
Align extremity with gentle traction if there is a severe deformity, absent pulses, or cyanosis
Pad the splint
Maintain manual traction
Assess CMS
Types of fractures
Open fracture: fracture with an associated open wound
Closed fracture: no break in the skin
Hairline fracture: small crack in the bone that does not create instability
bones
skull bones
Compensatory shock
Body is able to maintain near-normal blood pressure and perfusion of vital organ
Blood is shunted away from non-vital areas (i.e. skin and gastrointestinal tract)
Pulse pressure may be narrowed
Pulse pressure = systolic - diastolic
Projectile vomiting is a sign of?
head injury → trauma >:C
suction technique for liquid (blood, vomitus, secretions), food particles, or small objects
suction out
suction technique for thick vomitus, solid objects (teeth, foreign bodies, food)
place pt on side and perform finger sweep
evisceration treatment
Expose the wound
Position the patient
Prepare a moist dressing and cover with an occlusive dressing
Administer high concentration via NRB
Be prepared to treat for shock
S&S of basilar skull fracture
Signs
Battle’s signs: bruising behind the ear
Raccoon eyes: bruising under the eyes
CSF rhinorrhea: CSF leakage from nose
CSF otorrhea: CSF leakage from ear
Haemotympanum: blood in ear
Bump
Cranial nerve pulses
Optic nerve problems: optic nerve gets stuck in tract/orbit
Symptoms
Glasgow coma scale
3 minimum, 15 max
Eye opening
Spontaneous → 4
To verbal command → 3
To pain → 2
No response → 1
Verbal response
Oriented and converses → 5
Disoriented and converses → 4
Inappropriate words → 3
Incomprehensible sounds → 2
No response → 1
Motor response
Obeys verbal commands → 6
Localizes pain → 5
Withdraws from pain (flexion) → 4
Abnormal flexion in response to pain (decorticate rigidity) → 3
Extension in response to pain (decerebrate rigidity) → 2
No response → 1
Oxygen NC vs. NRB vs. BVM
NC: 1-6 lpm
NRB: 15 lpm
BVM: artificial ventilation/respirations + high flow O2
abdominal anatomy
Hollow organs
(hollow) will not bleed but will spill contents into the abdominal cavity
Stomach
Gallbladder
Urinary bladder
Ureters
Internal urethra
Fallopian tubes
Small intestine
Large intestine
Solid organs
major bleeding and severe shock
Liver
Spleen
Pancreas
Kidneys
vascular structures
large stationary structures that carry lots of blood
Abdominal aorta and its branches
Inferior vena cava
tort
civil wrong that causes harm or injury to another person
assault
willful threat to inflict harm on a patient
Does not have to be physical
battery
touching a patient unlawfully without his consent
Negligence
no intent to do any harm to the patient but breaches the duty to act
duty of care
breach
causation
damages
eye anatomy
orbital fracture S&S
Diplopia: double vision
Decrease in vision
Loss of sensation above the eyebrow, over the cheek, upper lip
Nasal discharge
Tenderness to palpate
Bony step-off
Patient is unable to follow finger upward
lid injury S&S
Control bleeding with light pressure from a dressing
Cover lid with gauze soaked in saline
globe injury S&S
Best treated at the hospital
Apply patches lightly to both eyes
No cold packs
corneal injury S&S
Flush with sterile water/saline
Do not attempt to remove object if flushing is not effective
Place eye patch and transport
Chemical eye burns S&S
Immediately irrigate with water/saline and continue for at least 20 min/arrival at the hospital
Contacts must be removed
impaled object in the eye/extruded eyeball S&S
Stabilize object/extruded eyeball
Cover both eyes
Types of Hypovolemic Shock
(inadequate volume)
Hemorrhagic shock: loss of RBC
Non-hemorrhagic shock: loss of fluid without RBC
Types of Distributive Shock
(inadequate vessel tone)
Septic shock
Anaphylactic shock
Psychogenic shock
Neurogenic shock
septic shock
infection = vessels cant contract
anaphylactic shock
chemicals released in anaphylactic reaction = vasodilation and increased capillary permeability
Psychogenic shock
sudden nervous system reaction = temporary vascular dilation = drop in BP = fainting
Neurogenic shock
muscles in blood vessels are cut of from nerve impulses = no contraction
inadequate pump function
Cardiogenic shock: something wrong with the heart
Obstructive shock: something blocking heart function
complete spinal cord injury
total loss of motor and sensory function below level of injury
incomplete spinal cord injuries types
spinal cord is injured but not completely through all 3 major tracts (motor, light touch, pain tracts)
central cord syndrome
anterior cord syndrom
brown-sequard syndrom
central cord syndrome
middle of the spinal cord is injured = weakness/paralysis and loss of pain sensation to the upper extremities but good function in the lower extremities
anterior cord syndrome
loss of sensation to pain and motor function below site of injury but able to feel light touch
Brown-Sequard syndrom
loss of motor and sensation below injury, but the effects differ on each side of body
I.e. patient loses motor and light touch on right side but loses pain sensation on left side
position of comfort for abdominal injuries
supine with legs bent at the knees
If injury to lower extremities, hips, pelvis, or spine is not suspected
Mechanics of lifting and moving
Keep the weight of the object as close to the body as possible
To move a heavy object, use the leg, hip, and gluteal muscles plus contracted abdominal muscles
“Stack”: shoulders, hips, feet as one unit
Reduce the height/distance through which the object must be moved
portable stretcher
standard stretcher
stair chair
used in narrow spaces, small elevators, stairways
Backboard
Short backboards: immobilize noncritical sitting patients before moving them
Full body vacuum mattress
Scoop stretcher
advantage is that it can be used in confined areas that are too small for conventional stretchers
reeves
rapid spine motion restriction in tight spaces
Electrical burn
Produced by electrical current flow in the body
High voltage electricity
Entry and exit wound: everything in between is damaged
Chemical burns
Produced by acids, alkalis, and other heat-generating chemicals
Severity is dependent on
Type of chemical
Chemical concentration
Duration of exposure to the chemical
Treatment: immediately flush area with saline
Thermal burns
Associated with heat applied to the body
Severity is dependent on
Time exposed to the heat source
Temperature of the heat
Potential for inhalation injury
Flame burn
caused by flame :/
Contact burn
Touching something hot
E.g. touching a stove
Scald burn
caused by hot liquid, superficial
flash burn
Something explodes and flashes
Lighting a fire with too much gas
other types of burns
steam burn
gas burn
chemical burns
Rules of Nines
Voluntary muscles (skeletal)
Most are attached at one or both ends of the skeleton
Muscles become shorter and thicker = muscle contraction
Involuntary muscles (smooth)
Found in walls of organs
Help move food through digestive system
Cardiac
Only found in walls of the heart
When does an EMT straighten a fracture?
Severe deformity
Distal extremity is cyanotic or lacks pulses
What joints should an EMT not attempt to straighten a deformity?
Wrist
Elbow
Knee
Hip
Shoulder
*major nerves are arteries are close to these joints*
central pulses
Carotid
Femoral
peripheral pulses
Radial
Brachial
Posterior tibial
Dorsalis pedis
On-line medical direction
EMS provider and physician communicate directly in real time providing immediate feedback
On-scene medical direction
feedback and medical direction regarding the diagnosis, condition, and emergency care provided by the physician who is on-scene with crew
off-line medical direction
following local protocol
stages of grief
Denial: not me.
Anger: why me?
Bargaining: okay, but first let me…
Depression: okay, but I haven't…
Acceptance: okay, I am not afraid
3 meninges
layers of tissue that enclose the brain, brainstem, and spinal cord (outer to inner)
Dura mater
Arachnoid
Pia mater
CSF
produced and circulated throughout the brain
cushions/protects
Combats infection
Cleanses brain and spinal cord
Scene safety
Be sure to not approach scenes that appear unsafe, can call the police or get someone to make the scene safe first
When knocking on the door, stand to the side of the door and on the side w/ the door handle
If someone answers the door with a weapon, can run away if you feel unsafe
ALWAYS PROTECT YOU AND YOUR PARTNER FIRST
vehicle
Do have stop at bus stops when the sign is out
Careful when driving through intersections, where most accidents happen
Do not trust other people’s cars to stop, drive in a way that is not going to hurt people
Ambulances can pass in no passing lanes, proceed past a stop sign/red light only having made sure it is safe to do so, can make sounds and have lights to warn people, can go above the speed limit (safely)
Make sure to check the ambulance after every call to stock and make sure all equipment that is needed is there
Five rights of medication administration
Right patient
Right medication
Right route
Right dose
Right date (time)
START Triage
C-Spine injury S&S
MOI = car accidents, falls in adults that are greater than 20 feet, when force was applied to the body
Not only looking for neurological deficits, can be physical symptoms
Signs = crepitus in the cervical spine region, pt cannot move their neck w/out pain, fails C-spine clearance test, unconscious after traumatic MOI
Symptoms = neck pain, impaired coordination/balance, difficulty breathing, loss of bladder control
kinematics of trauma
Science of analyzing mechanisms of injury (MOI)
Kinetics = deals with the movement of bodies and VELOCITY is super important
Faster change in speed results in more force extended
Impacts = energy is absorbed
Can be through a vehicle, body, organ
In falls, the impact is transmitter through the body and skeletal system
In penetrating = the velocity determines the damage
In blast injuries = there is a pressure wave, blast wave, patient displacement, then take care of HAZMAT
In crashes = look where the majority of the damage to car was done
Front = look at the up and over pathway and down and under pathway
Rear = the head and neck will be pushed back
Lateral = the patient endured the brunt of the impact, injuries everywhere
Rollover = multisystem trauma if not restrained
Pedestrian = extent of injury depends on where the person was hit (still a priority one)
Motorcycle = impact can be angular, head-on, involve ejection from vehicle
Note 
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