FIRST AID AND WATER SURVIVAL Mod.3 - 29

FIRST AID AND WATER SURVIVAL
MODULE 3
PSSg Jonathan D Peregrino

Emergency Medical Technician – Basic (EMT-B)
Instructor
SCHOOL: PLT College of Guinobatan, Inc.

COURSE: BS Criminology
SUBJECT: FIRST AID AND WATER SURVIVAL (DefTac 3)
INSTRUCTOR: PSSg JONATHAN D PEREGRINO
Jonathan D Peregrino
Instructor
MODULE 3
FIRST AID AND WATER SURVIVAL
(DefTac3)
OBJECTIVES:
1. In this module, the students
will know the anatomic terms COURSE OUTLINE:
being used in emergency rescue
including the body systems. MODULE 3 – THE HUMAN BODY
LESSON 1: Anatomic terms

2. It is important to know the
LESSON 2: Body systems
baseline vital signs
LESSON 3: Baseline vital signs
3. The student will know the LESSON 4: SAMPLE History

SAMPLE History while giving
emergency care.
Instructor
MODULE 3
THE HUMAN BODY
LESSON 1: Anatomic terms
THE ANATOMIC POSITION
To communicate effectively, healthcare professionals follow medical

conventions of language. The most basic concept is the anatomic position. All
directional and anatomic terms for the human body assume that the patient is
standing upright and facing forward, with palm facing forward (see the figure above).
Obviously, patients are rarely found in the anatomical position, but agreement on
what is “normal” enables us to accurately describe parts of the body in relation to this
fixed standard. For example, an injury “above the elbow” is still referred to as “above”
even if the hand and arm are pointing up and the injury would, in nonmedical
language, seem at that moment “below” the elbow. Using the anatomical position
removes any doubt what directional terms mean.
Instructor
The body can be divided by a number of imaginary lines. These lines are very
useful when you are describing the specific location of injuries on the torso (trunk).
The midline is an imaginary line through the middle of the body that starts at the top
of the head and goes through the nose and the umbilicus (belly button). The midline
divides the body into right and left halves. Whenever you refer to the sides of the
body, you always refer to the patient’s right or left. For example, the heart lies
immediately to the left of the midline.
The term bilateral is used when describing both the right and left sides
relative to each other. For example, the right side of the chest rising at the same time
and to the same degree as the left side is called equal chest rise, bilaterally. An
injury or finding on one side of the body as called unilateral.
The left and right midclavicular lines are imaginary lines that divide the
clavicles (collar bones) in two and extended down the trunk through the nipples. The
midaxillary line extends vertically from the armpits to the ankles. The midaxillary
line divides the body into anterior (front) and posterior (back) halves.
Special terms are used to describe the terms and legs. The back of the hands
and the top of the feet are called the dorsal side. The palm of the hand is the
palmar side and the sole of the foot is the plantar side. Proximal and distal mean
“closer to” and “farther from” and are used to describe places on the arm and legs
closer or farther from where they attach to the body. For example, the statements
that the hand is distal to the elbow, and the elbow is proximal to the hand are both
true since the hand is farther from the body than the elbow.
Descriptive Anatomic Terms

The directional terms in table shown below are important for communicating
with fellow First Aid rescuers and other healthcare providers. This terminology can
be used to accurately describe physical examination findings and the location of pain
or injuries. Notice how these terms works in pairs of opposites. It is important that
you integrate these words into your vocabulary so that they become second nature
when talking with other health professionals.
Instructor
Many terms are used to describe the position of the whole body. As an
emergency rescuer you must be familiar with at least the five positions described in
the pictures below. These terms are useful as you explain how patients are
positioned when you find them or how you position them for transportation.
Prone Position
The patient is lying flat on the stomach.
Supine Position
The patient is lying flat on the back.
Fowler’s Position
The patient is lying on the back with an approximately 45º bend at the hips.
Trendelenburg position
Instructor
The patient is lying flat on the back, on an incline, and with feet elevated
approximately 12 inches above the head.
Shock Position
The patient is lying flat on the back, bent at the hips with feet lifted
approximately 12 inches off of the ground.
LESSON 2:
Body systems
Instructor
The body system is the envy of modern engineering. Never has an engineer
even come close to creating anything as well designed and constructed. The
complexity of the human body can be better understood by considering its separate
parts, although no body system functions independently. A body system is a group of
organs that works together to perform a function. Although each body system is
described in the following sections as an independent component, they are all
interconnected.
THE RESPIRATORY SYSTEM

The respiratory system plays a crucial role in the delicate balance of life. The
body is composed of trillions of cells that convert sugar to energy in the presence of
oxygen. This process gives off carbon dioxide as a waste product. The respiratory
system takes oxygen from the air and makes it available for the blood to transport to
every cell and rids the body of excess carbon dioxide.
The Airway
Air enters and exits the respiratory system through the mouth and the nose
(see figure above). These two structures play an important role in warming, cleaning,
and humidifying inhaled air. The pharynx is a muscular tube commonly referred to as
the throat.
The pharynx resembles a tube running from behind the nose to the epiglottis
and is divided into three areas: the nasopharynx, the oropharynx, and the
laryngopharynx. The nasopharynx lies directly behind the nose. The oropharynx is
just behind the mouth; the laryngopharynx, the lowest portion, extends from the
oropharynx to the level of the epiglottis. The epiglottis is a leaflike flap that prevents
food and liquid from entering the trachea (windpipe) during swallowing. The pharynx
is a common pathway for both food and air. Because air and food pass through the
pharynx, it is often the location of airway obstructions by foreign bodies.
Instructor
Just opening to the epiglottis is the opening to the trachea. The larynx, or
voice box, is just below this opening. The vocal cords are bands of cartilage that
vibrate when we speak. The most prominent structure of the larynx is the thyroid
cartilage, which forms the Adam’s apple. The cricoid cartilage is a firm cartilage ring
just inferior to the lower portion of the larynx. The delicate cartilages of the larynx lie
beneath the skin on the anterior surface of the neck. Any injury to the neck could
result in damage or blockage of the larynx, making it impossible for the patient to
breathe. This life-threatening condition must be immediately recognized and treated
by the emergency rescuers.
The Lungs
The trachea extends inferiorly from the cricoid cartilage and is the common
pathway for the air that enters the lungs. The trachea splits into two main-stem
bronchi, which are the major branches into each lung. The bronchi subdivide into
smaller and smaller air passages until they end at the alveoli, which are the
microscopic air sacs of the lungs.
Gas exchange occurs in the alveoli. These air sacs are only one cell thick and
are surrounded by capillaries. The alveoli increase the surface area of the lungs so
that respiration is adequate to deliver enough oxygen to the body (see the figure
below, Anatomy of the trachea and lungs). The average adult human lungs have a
total inside surface area equivalent to the size of tennis court!
The process of ventilating the lungs with a constant supply of fresh air occurs
when the chest walls expand. This expansion is done by contracting two muscles:
the diaphragm is the large, dome-shaped muscle separating the thoracic and
abdominal cavities. When muscle fibers in the diaphragm contract, the dome of the
diaphragm flattens and lowers, making the chest larger. During normal breathing,
only the diaphragm contracts. Watch someone breathing normally. Notice that the
chest expands very little but the amount of chest rise is enough for a person at rest.
Instructor
The intercostal muscles are located between each rib. Because of how they
are attached to the ribs, contraction of the intercostal muscles moves the ribs upward
and outward. When a person needs more air, the intercostal muscles contract with
the diaphragm, expanding the chest even more. Air is pulled into the lungs through
the mouth and nose, much like pulling the plunger back on a syringe. Inhalation is an
active process resulting from muscle contraction, and therefore the muscles must act
for inhalation to occur.
Exhalation begins with the relaxation of the intercostal muscles and
diaphragm. As these muscles relax and return to their resting position, the size of the
thoracic cavity is decreased and air rushes out through the mouth and nose.
Normally, exhalation is a passive process, and muscle action is therefore not needed
for exhalation to occur. In some cases of disease or obstructions, exhalation
becomes an active process. A cough is one example of a forced exhalation.
Gas exchange. There are two sites for the exchange of oxygen and carbon
dioxide: the alveolar/capillary interface and the capillary/cellular interface. During
inhalation, air is drawn into the lungs. Normally, air contains 21% oxygen and almost
no carbon dioxide. As this oxygen-rich air enters the alveoli, blood with low levels of
oxygen and high levels of carbon dioxide is flowing through the capillaries
surrounding the alveoli. Gases move from areas of greater concentration to areas of
lesser concentration, and therefore oxygen enters the blood, and carbon dioxide is
removed.
The oxygenated blood is then pumped by the heart to the rest of the body. As
this oxygen-rich blood approaches its destination, the blood vessels decrease in size
until they branch into thin-walled capillaries. At the tissue level, the blood is highly
oxygenated and low in carbon dioxide. Blood in the capillaries gives up oxygen to the
cells, and the cells give carbon dioxide to be taken back to the lungs. The blood is
then collected in the veins and returned to the lungs for re-oxygenation.
Normal Breathing
Instructor
A healthy adult breathes between 12 and 20 times a minute when at rest. The
oxygen needs of infants and children are greater than that of adults, and therefore
they must breathe faster.
Under normal conditions, the respiratory cycle occurs at regular intervals.

Irregularities in breathing rhythm may be a sign of an abnormality.
Normally, when a person takes a breath, both lungs inflate equally. The
movement of air in and out of the lungs creates breath sounds that can be heard by
placing a stethoscope on the chest wall. These sounds should be bilaterally equal in
volume and pitch.
If breath sounds on either side of the chest are diminished or absent, some
condition is affecting the amount of air that is reaching that lung. Absent or
diminished breath sounds in one or both lungs is an important sign of inadequate
breathing.
Equal expansion of both lungs can also be assessed by watching the chest
rise. Both sides of the chest should rise and fall equally with each breathing cycle.
Breathing should not require excessive effort. When breathing becomes labored,
additional muscles, accessory muscles, are used to draw more air into the chest.
The use of abdominal or neck muscles is regarded as a sign of respiratory distress.
An adequate amount of air must be exchanged with each breath. This volume
of air per breath is the tidal volume, which is the measure of how deeply the patient
is breathing. When the body is at rest, and needs less oxygen, breathing is quiet and
the tidal volume is smaller. When the body is exercising or injured, more oxygen is
required, and breathing frequency and depth will increase.
THE CIRCULATORY SYSTEM

In the growing fetus, the heart begins to pump in the fourth week of
development and on average will keep beating continuously for the next 75 years!
Contracting over 100,000 times a day, the heart is a marvel of endurance and
reliability. The heart pumps blood to the body organs through the cardiovascular
system. This process is so vital to life that any interruption for more than a few
minutes can mean death.
The Heart
The heart is a pump consisting of four chambers. Two of the chambers are
the atria, which function to fill the ventricles. The two ventricles pump blood out of
the heart. Because of one-way valves between the chambers, heart contraction
propels blood in only one direction.
Instructor
The left ventricle pumps blood rich in oxygen to the body to be used by the
cells. After the oxygen is used, blood I returned to the heart into the right atrium,
which fills the right ventricle. The right ventricle pumps this oxygen-poor blood to the
lungs for oxygenation. The oxygen-rich blood is returned into the left atrium. The left
atrium fills the left ventricle, and the circuit starts all over again (see the figure
above).
The heart has specialized cells that generate electrical impulses and serve as
the heart’s pacemaker. Electrical signals are carried through the heart by conductive
tissue. These signals give the heart the amazing ability to beat on its own. The
number of times the heart beats per minute is the heart rate, which varies with age,
physical condition, situation, and a number of other factors.
Blood Vessels
Blood vessels are the “pipe” of the body. These vessels carry blood to every
oxygen organ. Arteries carry blood away from the heart; the major artery of the body
is the aorta, which is a vessel about the diameter of your thumb. It originates from
the heart and arches in front of the spine, then descends through the thoracic and
abdominal cavities.
Figure shows the location of the

major arteries in the body.
Instructor
Arteries contain smooth muscle, which allows for change of the internal
diameter of the vessel. Arteries are designed to expand and contract with each heart
beat to help push blood throughout the body. When an artery passes near the skin, a
pulse can be felt. The pulses are used to measure how fast the heart is beating and
how well blood is travelling through the body. Pulsations in the carotid arteries can
be felt on either side of the larynx in the neck. The femoral arteries can be palpated
in the groin area, at the crease between the abdomen and the thigh. In the arm, the
brachial artery is used to take a pulse or the blood pressure in an infant. The radial
artery is very useful for taking the patient’s pulse and can be felt along the thumb
side of the wrist. Pulsations in the posterior tibial artery and the dorsalis pedis artery
are important for assessing lower extremity circulation. However, you may not be
able to feel these pulses if the heart is beating weakly or the lower extremity is
injured.
Arteries branch as they get farther away from the heart. The smallest branch
of an artery is an arteriole. Arterioles contain smooth muscle, which can change the
internal diameter of the blood vessel. Arterioles play an important role in regulating
blood flow and blood pressure.
The arterioles lead the
capillaries, which are the smallest
blood vessels in the body. The
exchange of oxygen and
nutrients for carbon dioxide and
other wastes occurs in the thin-
walled capillaries (See the figure
on the side). The capillaries are
the microscopic structures, only
about 1/25 of an inch in length
and just one cell thick, but they
are present in astronomical
numbers. If all of the capillaries in
your body were placed end to end, they would extend for 62,000 miles!
Many capillaries join together to form a
venule, which is the smallest branch of a vein. The
venules in turn form veins. Most veins carry oxygen-
poor blood back to the heart (See figure on the side
showing the location of the major veins).
Blood
An average-sized adult man has about 5 to 6
liters of blood circulating on his body. This complex
fluid serves many functions and contains many
components. The red blood cells give blood its
characteristic color. They contain hemoglobin,
Instructor
which is the protein that carries oxygen in the blood and releases it when it reaches
the tissues.
Platelets play an important role in blood clotting. The white blood cells are a
main part of the body’s defense against inspection. White blood cells increase in
number when the body is fighting invasion from microorganisms.
Plasma is the fluid component of the blood, providing a fluid medium for the
red and white blood cells and platelets. Plasma also carries nutrients to the tissues
and plays an important role in the elimination of the waste products of metabolism.
The Circulation of Blood

As the left ventricle contracts, pumping blood to the body, a wave of pressure
is sent through the arteries. This pressure wave can be felt anywhere an artery
passes close to the skin and over a bone. These locations are called pulse points
and occur both in the extremities, it is a peripheral pulse; when it is in or near the
trunk, it is a central pulse.
Blood Pressure is a measure of the pressure exerted against the walls of the
arteries. Blood pressure is generally measured in millimeters of mercury (mm Hg).
This standard method of measuring blood pressure reflects the force to support a
column of mercury in the measurement device.
Because a rise in this pressure occurs during each ventricular contraction,
there are two pressures. The systolic pressure, which is the first number reported in
a blood pressure, is the pressure in the arteries when the heart contracts, causing
blood to flow through the artery. The diastolic pressure, which is the second number,
is the pressure in the arteries when the heart is at rest.
The blood pressure reported as 138/86 means that a pressure equivalent to
the weight of 138 mm Hg is pushing on the arteries during heart contraction and that
the equivalent of 86 mm Hg is pushing on the arteries when the heart is relaxed.
Blood pressure varies depending on age and various individual factors.
For the body’s cells to function properly, they must have a continuous supply
of oxygenated blood. This supply requires adequate pressure to circulate the blood
to all parts of the body. The process of circulating blood to the organs, delivering
oxygen, and removing wastes is perfusion. When perfusion is inadequate, a taste
known as shock develops. Shock is a widespread depression of perfusion and is
also known as hypoperfusion.
THE MUSCULOSKELETAL SYSTEM

The Skeleton
The skeletal system is the scaffolding of the body. Not only do bones give the
body shape and rigidity, but they also protect the vital internal organs. For example,
the skull completely surrounds the delicate brain and protects it from everybody
bumps and bruises. The ribs, sternum, and vertebrate also play important roles in
protecting the heart and other important organs from damage.
Along with the muscles, the bones also serve as attachment points to enable
the body to move. The skeleton creates levers and fulcrums throughout the body.
Instructor
The contraction of muscles moves theses levers with incredible precision. The figure
below shows the major bones of the body.
The Skull
This structure consists of the cranium and the bones of the face. The brain is
the most important organ in the human body and is housed completely within the
rigid bony box called the cranium. The cranium consists of eight bones. These flat
bones fit together with very tight joints, very much like a jigsaw puzzle. These joints,
called sutures, enable the bones to move slightly without a breaking. This feature
provides the brain with excellent protection from external forces.
The face is formed by fourteen bones fitting together in a tremendously
intricate three-dimensional puzzle. Some of these bones are very thin and are easily
damaged in traumatic injuries. The following are the major bones of the face:
 The orbits form the eye sockets.
 The nasal bones are a collection of bones that create the nose.
 The zygomatic bones form the cheek bones.
 The maxilla is the main bones of the upper jaw.
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 The mandible is commonly referred to as the jaw.
The Spinal Column and Rib Cage

The spinal column serves four main functions:
 Supporting the weight of the head and trunk
 Protecting the spinal cord
 Allowing spinal nerves to branch off the spinal cord
 Allowing for movement of the head and trunk
The bones of the spinal column are the

vertebrae (see figure on the side showing the
vertebral column and the single vertebra). The
vertebrae of the neck and back each have a
vertical holes hole in them. These vertebrae stack
on top of each other separated by soft
intervertebral discs. The holes of the vertebra and
disc line up to create a tube for the spinal cord. If
one of these bones becomes misaligned or
damaged, it can cause damage to the spinal cord.
CLINICAL PEARL: The soft intervertebral
discs of the lower back become thorn with age or
after an injury. These damaged or “slipped” disc
can push into the hole occupied by the spinal
cord, which causes great pain.
The 33 vertebrae of the spinal column are
divided into five regions: seven small cervical
vertebrae in the neck; twelve thoracic vertebrae,
which attach to the ribs in the upper back; five heavy lumbar vertebrae, which
support the weight of the head and trunk in the lower back; five fused sacral
vertebrae, which form the back of the pelvis; and four coccyx, which fuse together to
form the tailbone.
The thorax contains 12 pairs of ribs. Each rib is attached posteriorly to one of
the thorax vertebrae. The first through the tenth ribs are attached anteriorly to the
sternum. The eleventh and twelfth ribs are the floating ribs because they simply
extend laterally from the vertebrae. The floating ribs help protect the kidneys. The
attached ribs provide protection to all of the organs in the thorax and assist in
breathing.
The sternum, commonly called the breastbone, protects the heart and gives
rigidity to the thoracic cage. The superior portion of the sternum is the manubrium.
The body of the sternum comprises the remainder of the sternum. The xiphoid
process extends from the posterior end of the sternum. This bony joint is sharp and
delicate and if broken can damage important organs (such as the liver) during
cardiopulmonary resuscitation.
Instructor
The pelvis and lower extremities. The sacral vertebrae form the back of the
pelvis. Six fused bones create the pelvic girdle. The iliac crests are the wings of the
pelvis. The pubis bones join anteriorly at the pubic symphysis. The ischium bones
are the posterior portion of the pelvis and are the two looped bones on which we sit.
The acetabulum is the socket of the hip joint.
The head of the femur, the long bone of the thigh, is spherical and fits into the
acetabulum to form the hip joint. The neck of the femur joins the body at the greater
trochanter, which can be felt over your hip. The patella (kneecap) forms the anterior
portion of the knee and allows the muscles of the thigh to straighten the lower leg.
CLINICAL PEARL: The neck of the femur
is the weakest portion of the hip joint and may
become brittle with age. If alder individuals fall,
they might fracture the neck of the femur. When
this occurs, the hip muscles pull the femur
superiorly and the leg appears slightly shorter
than the uninjured side.
The lower leg has two bones. The tibia
(shin) is the main weight-bearing bone of the
lower leg and forms the rounded medial
malleolus of the ankle joint. The posterior tibial
pulse may be felt behind the medial malleolus.
The fibula does not bear weight but assists in
the movement of the ankle. The distal portion of
the fibula forms the lateral malleolus.
The tarsal and metatarsal bones provide
structure to the foot, and the calcaneus is the
bony prominence at the heel. The phalanges
are the skeletal support for the toes. (See figure
beside).
The upper extremities. The arms join the

trunk at the shoulder girdle. The shoulder girdle
consists of two bones: the scapula posteriorly
and the clavicle, or collarbone, anteriorly. The
acromion process can be felt at the tip of the
shoulder. The humerus is the bone of the upper
arm. The shoulder joint is designed for great
flexibility. To achieve this flexibility, the connection of the humerus to the scapula is
loose, causing this joint to be disclosed more easily than other joints in the body.
The olecranon process of the ulna, which is the medial bone of the forearm,
along with the distal end of the humerus, makes up the elbow. The radius is the
lateral bone in the forearm. The carpals are tiny bones in the wrist that enables the
hand to move in many intricate positions. The metacarpals and the phalanges form
the hand and fingers. (See the figure below).
Instructor
Joints
A joint is a place
where bones come
together. Joints serve
many functions, but most
importantly, they provide
a system of fulcrums and
levers that makes
movement of the body
possible. There are many
types of joints, but the two
most common and most
important for EMTs are
the hinge and the ball-
and-socket joints.
Hinge joints
consists of a cylinder that
fits into a cradle. Hinge
joints allow movement
only in one plane and are
Instructor
found in the elbow, knee, and all the fingers and toes. Ball-and-socket joints exist
when the head of one bone fits into a socket of another bone (or combination of
bones). This type of joint allows for movement in many directions and is found in the
shoulder and the hip.
Muscles
No movement in the body could occur without muscles. Every physical
activity, from riding a bike to turning the pages of this book, occurs with the
contraction of muscles. Additionally, muscles protect vital organs and help give the
body shape.
There are three types of muscles found in the human body: skeletal, smooth,
and cardiac. All three types of muscle have the unique ability to contract (shorten).
A. Skeletal muscle attaches to bone. B. Smooth muscle is located in organs such

as the stomach and intestine. C. Cardiac muscle is located in the heart.
Skeletal muscles. As the name implies, these muscles are attached to bones.
When these muscles shorten, they provide the force to move the levers of the
skeletal system (see the figure below). Skeletal muscles make up the major muscle
mass of the body. Weight lifters and athletes exercise to strengthen and develop
skeletal muscles. Every skeletal muscle is connected to a nerve that will cause it to
contract when stimulated. If this nerve is damaged, then the muscle will die and
shrink.
Instructor
Tap your right foot three times. To accomplish this task, your brain sent a
signal to the muscles in your calf to shorten, and your foot extended. Then your brain
told your calf to relax and the muscles in the front of your lower leg to contract, and
this process was repeated twice more. Although you did not have to consciously
think about each step, it was voluntary because you chose to do it. Therefore,
skeletal muscles are called voluntary muscles.
Smooth muscles. These muscles are found in the walls of tubular structures in
the gastrointestinal tract, the urinary system, the blood vessels, and the bronchi.
Because they are circular, contraction changes the inside diameter of the tube (see
figure below). This contraction is very important for controlling flow through the tubes
of the body.
For instance, when you are cold, the body decreases blood flow to the arms
and legs because significant body heat can be lost from the blood through the skin in
these areas. The blood flow to the extremities is reduced by contracting the smooth
muscles in the arteries that lead to the arms and legs.
You have no control over this process. Smooth muscles carry out many of the
automatic muscular functions such as digestion, blood vessel control, and modifying
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the diameter of your airway. Because no conscious thought is required for these
activities, the smooth muscles are called involuntary.
Cardiac muscle. The heart is the most important muscle in the body. The
heart muscle has tremendous stamina. Imagine squeezing a tennis ball 60 times per
minute. How long do you think that you could keep up with the pace? Certainly not
60 times per minute, 24 hours a day like the heart.
To accomplish this amazing feat of stamina, the heart must have a continuous
supply of blood. The coronary arteries deliver oxygen and nutrients to the heart
muscle. Cholesterol in the bloodstream is deposited in plaques on the inside walls of
the coronary arteries. When these plaques rupture, a clot forms and blood flow to a
portion of the heart is decreased. If this flow of blood is interrupted for more than a
few minutes, part of the heart will be damaged. The damaged muscle causes the
most common sign of a heart attack – chest pain. When cardiac muscle dies, it is
replaced by connective tissue. This tissue cannot contract or help in the pumping of
blood, leaving the person’s heart weaker than before the heart attack occurred.
These patients may develop long-term cardiac disease.
Because your heartbeat is not under conscious control, cardiac muscle is also
involuntary, but cardiac muscle has the unique property of being able to contract on
its own. This phenomenon, known as automaticity, helps to ensure that the heart will
continue to deliver blood to the body even if other body systems are damaged.
THE NERVOUS SYSTEM

The human nervous system is incredibly well developed and complex. It is the
root of all thought, memory, and emotion. It also controls the voluntary and
involuntary activities of the body. Anatomically, the nervous system has two
components: the central nervous system and the peripheral nervous system (see the
figure below).
Instructor
The central nervous system consists of the brain, which is located within the
cranium, and the spinal cord, which is located within the spinal column from the base
of the skull to the lumbar vertebrae. The central nervous system is responsible for all
higher mental functions, such as thought, decision making, and communication, and
also has an important role in the regulations of the body functions.
The peripheral nervous system consists of sensory and motor nerves that lie
outside the skull or spinal cord. These nerves serve as wires, carrying information
between the central nervous system and every organ and muscle in the body.
Sensory nerves carry information from
the body to the central nervous system. They
provide information about the environment,
pain, pressure, and body position to the brain
for decision making. Motor nerves carry
information from the central nervous system to
the body. Signals from the motor nerves cause
contraction of skeletal muscles, which are
responsible for all body movement (see the
figure on the right side).
THE SKIN
Most people think of the skin as just a covering for the body. In reality it is a
very important organ that performs many functions. The skin protects the body from
the environment. Not only does it keep us from drying out, it also serves as a barrier
to prevent invasion of the body by bacteria and other organisms.
The skin also plays a crucial role in temperature regulation. When you are too
hot, the blood vessels dilate and the skin secretes sweat, which evaporates and
cools the body. When you are cold, the blood vessels to the skin contract to
decrease the heat loss to the environment.
Skin is also an important sensory organ. Special receptors in the skin can
detect heat, cold, touch, pressure, and pain. Information from these receptors is
transmitted to the central nervous system by sensory nerves.
The skin has
three layers (see the
The epidermis is the
outermost layer. The
dermis is the deeper
layer, containing the
sweat glands, hair
follicles, blood vessels,
and nerve endings. The
subcutaneous layer lies
just below the dermis
and connects the skin to
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the underlying tissue. The subcutaneous layer also stores fat, which serves an
important function in insulation and storing energy.
THE DIGESTIVE SYSTEM

Food provides our bodies with
substances that cells need to produce energy
and build new tissue. The digestive system
breaks down food so that it can be absorbed
into the blood and delivered to the cells as
nutrients, vitamins, and minerals (see the
Food passes through the hollow organs
of the digestive system from the mouth to the
anus. The breakdown of food begins in the
mouth as the food is chewed and mixes with
saliva. This breakdown continues in the
stomach where the food is churned and
combined with stomach acids. Chemicals from
the liver and pancreas further breakdown food into its component parts.
Once food has been broken down, the nutrients are absorbed into the blood
as the food passes through the small intestine. Liquid is removed from the food as it
passes through the large intestine, which is also called the colon. Undigestible
material is eliminated from the body as feces.
THE ENDOCRINE SYSTEM

The endocrine system is a very
complicated system, consisting of a
number of glands inside the body (see
the figure on the right side) that
produce chemicals called hormones.
These chemicals, when secreted in to
the bloodstream, regulate body
activities and functions in many body
systems. Two examples of such
hormones are epinephrine, which
helps prepare the body for
emergencies, and insulin, which is
crucial for the body’s use of sugars.
Instructor
LESSON 3: Baseline vital signs
The baseline vital signs are those vital signs you measure or assess when
you first encounter the patient, these baseline vital signs can then be used for
comparison with other measurements as the patient’s condition changes. Trending
is the process of comparing sets of vital signs or other assessment information over
time. A single set of vital signs does not provide as much information as does a trend
in the patient’s vital signs.
Record vital signs accurately. Record these assessment specifics as you take
each vital sign, rather than trying to remember all the numbers and recording them
later. Some EMTs prefer to record the vital signs on an available piece of paper
during the assessment, and then copy them later into the pre-hospital care report.
BREATHING
Breathing is assessed by observing the patient’s chest rise and fall. One
breath is one complete cycle of breathing in and out. You assess the patient’s
breathing rate and quality. Breathing is also call respiration.
RATE
You can determine the patient’s rate by counting the number of breaths in 30
seconds and multiplying by two. If the patient’s breathing rate is irregular, count the
respirations for 1 full minute to obtain a more accurate rate of breathing if they know
you are monitoring their respirations, do not tell the patient that you are assessing
the breathing rate. A good way to avoid telling the patient is to count respirations
immediately after you assess the pulse. Keep your hand in contact with the patient’s
wrist, and the patient generally thinks you are still taking the pulse and will not think
about breathing or subconsciously alter respirations.
A patient’s respiratory rate is affected by the patient’s age, size, and
emotional state at the time. Patients often breathe faster than normal when they are
ill or injured. The average range of respiratory rates for adults is 12 to 20 breaths per
minute. Average ranges by age are listed in table below.
Average Vital Sign Ranges by Age

AGE PULSE RESPIRATIONS BLOOD PRESSURE
Newborn 120-160 40-60 80/40
1 year 80-140 30-40 82/44
3 years 80-120 25-30 86/50
5 years 70-115 20-25 90/52
7 years 70-115 20-25 94/54
10 years 70-115 15-20 100/60
15 years 70-90 15-20 110/64
Adult 60-80 12-20 120/80
Instructor
QUALITY
The quality of breathing is the second part of the respiratory assessment.
There are four basic categories for the quality of breathing; normal, shallow, labored,
and noisy.
Normal respirations are characterized by average chest wall motion, (i.e.,
the chest moves outward and downward in a smooth regular manner). The rhythm of
normal breathing is regular and even. Normal breathing is effortless. As the work of
breathing increases, accessory muscles are used. To determine if a patient is using
accessory muscles, watch the abdominal, shoulder, and neck muscles for excessive
movement. Also look at the muscles between the ribs. If the patient is working hard
to breath, these accessory muscles may be used.
Shallow Respiration has slight chest or abdominal wall motion and usually
indicates that the patient is moving only small volumes of air into the lungs. Even
when the breathing rate is within the average range, patients with shallow
respirations may not be receiving enough oxygen with each respiration to support
the needs of their bodies.
Labored Respiration indicates a
dramatic increase in the patient’s effort to
breathe. Grunting and stridor are often
present. Grunting is the sound created when
the patient forcefully exhales against a closed
glottic opening, which traps air and keeps the
alveoli open. This sound often indicates
respiratory distress. Stridor is a loud, high-
pitched sound usually heard during
inspiration. Stridor typically indicates an upper
airway obstruction. Accessory muscles are
used predominantly when the patient has
difficulty breathing (see the figure on the right
side). Patients may also seem to be gasping
for air. Nasal flaring (the widening of the
nostrils during inhalation) and
supraclavicular and intercostal retractions
also indicate labored respirations, especially
in infants and children (see the figure on the
right side). Because children and infants
normally rely heavily on their diaphragm for
breathing, do not assume that the abdominal
motion of their breathing automatically
indicates labored breathing.
Noisy respirations are abnormal
respiratory sounds. Any time you hear noisy
Instructor
breathing, something is obstructing the flow of air. Noisy breathing includes snoring,
wheezing, gurgling, and crowning.
Snoring is a sign that the patient cannot keep the airway fully open. The
tongue is falling back into and partially obstructing the upper airway. Wheezing is a
high-pitched whistling sound that is usually caused by constriction of smaller airways
or bronchioles. Gurgling indicates liquid in the airway. Crowning is a long high-
pitched sound when breathing in.
A noisy airway always indicates a respiratory problem. Any abnormal
breathing quality is always an emergency, and you need to intervene to manage the
patient’s airway and/or breathing. Chapter 8 discusses the techniques to maintain an
open airway and administer oxygen.
PULSE
The pulse is the wave of pressure in the blood generated by the pumping of
the heart. You can feel the pulse whenever an artery passes over a bone near the
surface of the skin. The figure below shows the location of key pulse points in the
body. The pulse should be assessed for both rate and quality.
RATE
The pulse rate is the number of heartbeats in 1 minute. The pulse is assessed
by counting the number of beats you feel in 30 seconds and multiply by two. The
pulse rate is affected by factors such as the patient’s age, physical condition, blood
Instructor
loss, and anxiety. The average range for a resting pulse in adults is 60 to 80. An
individual normal pulse may not fall within this average range, however. For
instance, a well-conditioned athlete may have a resting pulse of 50; although this
pulse is outside the average range, it is normal for this patient. When you measure
the pulse and obtain low or high rates outside the average range, ask patients if they
know their normal resting pulse.
QUALITY
The quality of the pulse is defined by its strength and regularity. The strength
of the pulse can be strong or weak. The rhythm can be regular or irregular.
The pulse should feel strong as you palpate with your fingertips. If the heart is
not pumping effectively, or if there is a low volume of blood, the pulse may feel weak.
Weak pulses in an early sign of shock (hypo perfusion), which may help you
prioritize the patient.
The pulse should also feel regular. A regular pulse does not speed up or slow
down but has a constant time between beats. If there is not a constant time between
beats, the pulse is irregular. An irregular pulse rate may indicate cardiovascular
compromise.
Initially, assess the
radial pulse in all responsive
patients 1 year of age or
older (see the figure on the
right side). The radial pulse
is the pulse in the wrist on
the thumbs side of the
forearm. Using two fingers,
slide your fingertips from the
center of the patient’s
forearm just proximal to the
point where the wrist bends, toward the thumb side of the arm. By applying moderate
pressure, you should be able to feel the beats of the pulse. If the pulse is weak,
applying more pressure may help you feel the pulse. Too much pressure, however,
may occlude the artery, and you will not be able to feel the pulse. If you cannot feel a
radial pulse in one arm, try the other arm.
If you are unable to feel a radial pulse in
either arm, use the carotid pulse (see figure on the
right side). The carotid pulse is felt in the neck
along the carotid artery. Locate the Adam’s apple
in the center of the patient’s neck. Never exert
excessive pressure on the neck when feeling for a
carotid pulse, especially with older patients.
Excessive pressure may dislodge a clot, with
serious effects in the body. You should never
assess the carotid pulse on both sides of the neck at the same time because this
Instructor
could cause a drop in the patient’s heart rate. For patients less than 1 year of age,
assess the brachial pulse (see the figure below). The carotid pulse is normally
difficult to locate due to the small size of the infant’s neck.
Instructor
To assess the pulse, follow these steps:
Locate the radial pulse for patients 1 year of age or older, and locate the
brachial pulse for those less than 1 year of age.
Instructor
Count the number of beats in 30 seconds and multiply this number by two to
determine the pulse rate.
Characterize the quality of the pulse as strong or weak and as regular or
irregular.
SKIN
The patient’s skin color, temperature, and condition are assessed because
they are good indicators of the patient’s perfusion. Capillary refill is also assessed in
infants and children less than 6 years of age.
Color
Assess skin color in the nail beds, oral mucosa (inside the mouth), and
conjunctiva (inside the lower eyelid). These places accurately reflect the level of
oxygen in the blood and are easy to assess because the capillary beds run close to
the surface of the skin. The normal skin color in these areas is pink for patients with
light or dark skin. For infants and children, assess the soles of the feet or the palms
of the hands.
Abnormal skin colors include pale, cyanotic (blue gray), flushed (red), or
jaundiced (yellow). Pale skin color indicates poor perfusion, which is caused by a
lack of effective blood flow reaching all body tissues. Cyanosis (blue-gray color)
indicates inadequate oxygenation (lack of oxygen reaching the cells) or poor
perfusion. Flushed skin indicates exposure to heat or carbon monoxide poisoning.
Finally, a jaundiced or yellow skin color indicates the patient’s liver may not be
functioning properly.
Temperature
Assess skin temperature by placing the back of your hand against the
patient’s skin (see the figure below). The back of your hands is more sensitive to
temperature changes than the palm. Assess the skin temperature in more than one
location and compare findings. The patient’s extremities are more susceptible to
environmental changes in temperature than the trunk. Normally the skin is warm. Hot
skin indicates a fever or exposure to heat. Cool skin indicates poor perfusion or
exposure to cold. If the skin is cold,
the patient has been exposed to
extreme cold.
Instructor
Condition
The condition of the skin is normally dry-but not so dry that is appears
cracked. Wet, moist, or extremely dry skin conditions are abnormal. Extremely dry
skin may be a sign of dehydration. When the skin is cool and moist, the skin is
termed clammy. Clammy skin is a sign of shock (hypoperfusion).
Capillary Refill
Capillary refill is the time it takes for
the capillary beds to fill after being blanched
(see the figure on the right side). Capillary
refill is checked only in patient’s less than 6
years of age because it is not reliable
indicator of the signs and symptoms of shock
(hypoperfusion) in older patients.
To assess capillary refill, press on the
nail beds, release the pressure, and
determine the time it takes for the nail bed to
return to its initial color. If the capillary refill time is less than 2 seconds, then the
capillary refill is normal. Any capillary refill time longer than 2 seconds is abnormal
and indicates poor perfusion.
PUPILS
The pupils are the dark centers of the eye, which react to changes in the
amount of light reaching the eye by constricting (getting smaller) or dilating (getting
bigger). The pupils should constrict when exposed to light and dilate when covered
from light. Normally both eyes react in the same manner. Sometimes, head injuries
or neurological problems can cause the pupils not to be reactive to light (termed
nonreactive) or cause one pupil to react as expected and the other to be non-
reactive (termed unequally reactive). The pupils are normally midsize, which is
neither constricted nor dilated.
To assess the pupils, follow these steps:
Instructor
Look at the patient’s pupils and
determine how the pupils look in the
ambient light. Note if the pupils are
dilated, constricted, or normal.
Using a penlight, pass the light across
each pupil and note the response. Each
pupil should constrict to the same extent
(see the figure on the right side)
If the area is brightly lit, such as in
bright sunlight, a penlight may not cause
the pupils to react. In this case, cover
each eye from the light for a few seconds and then uncover it. Note the reaction of
the pupils. Head injuries, eye injuries, or drugs can all influence the size and
reactivity of the pupils. Note all assessment findings.
This figure shows constricted pupils, uneven

pupils, and dilated pupils.
The figure shows the assessment of pupils.

Normal pupils are equal and reactive, neither
dilated nor constricted.
BLOOD PRESSURE
Blood pressure is a measurement of the force the blood exerts against the
walls of the blood vessels during the heart’s contraction and relaxation phases. The
systolic blood pressure is a measurement of the pressure exerted against the
walls of the arteries as the wave of blood produced by the contraction of the heart
passes that point in the artery. During each contraction of the heart, the pressure
rises momentarily as blood is pumped through the arteries.
The diastolic blood pressure is the force exerted against the walls of the
blood vessels as the heart relaxes. It represents the pressure exerted against the
walls of the arteries between the waves of blood passing through the arteries.
It is important to understand that one blood pressure reading is not valuable,
unless it is extremely high or low. Changes in successive blood pressure readings,
however, may provide valuable clues about the patient’s condition. This information
must be documented on the prehospital care report. Any values outside the average
range or significant changes should be included in your verbal and written reports.
Instructor
There are two methods for obtaining a patient’s blood pressure. Auscultation
or listening is the preferred method for assessing blood pressure. This method uses
a blood pressure cuff and stethoscope (see figure below)
Palpation or feeling is an alternate method to

measure blood pressure. You measure the systolic blood
pressure by feeling for return of the pulse with deflation of
the cuff. You can use the palpation method in situations
when you cannot hear stethoscope sounds well because
the patient’s pulse is too weak or because the
environment is too noisy. The figure on the right side
explains this method.
Blood pressure should be measured in all patients
more than 3 years of age. The average ranges of blood
pressures for adults and children are listed in the table
above on the average vital signs. Remember that these
are only average ranges and that a blood pressure outside of these ranges can still
be normal for that individual. Ask patients if they know the usual range of their blood
pressure.
VITAL SIGN REASSESSMENT

With stable patients, reassess the vital signs every 15 minutes. Stable
patients are alert and oriented, have vital signs within the normal limits, and do not
show signs that their conditions is worsening. Vital signs in unstable patients should
be reassessed every 5 minutes as your monitor their condition constantly. Patients
Instructor
are unstable when they have mental status changes, poor vital signs outside
average limits, or a worsening condition. Also assess patient’s vital signs before and
after every intervention. If the transport time is less than 15 minutes, at least obtain a
baseline set of vital signs and one more set before arrival at the hospital.
Remember that your general assessment of the patient, especially an infant
or a child, is more important than the vital signs. Notice if the patient appears sick, is
in respiratory distress, or is unresponsive. These are the better assessments of
status than vital signs.
Remember that the vital signs numbers provided in this module are only
average ranges. For any individual person, a blood pressure, pulse, or respiratory
rate not within the average limits can still be appropriate for them. Trends in vital
signs allow us to track changes in the patient’s condition.
LESSON 4: SAMPLE History

A patient history is a concise and inclusive set of information you gather
about patients and their medical problems. The acronym SAMPLE stands for the six
elements of the history:
Signs and symptoms
Allergies
Medications
Pertinent past medical history
Last oral intake (solid or liquid)
Events leading to injury or illness
Signs and symptoms are different kinds of indications of a possible problem.

A sign is any medical or trauma condition EMTs can observe and identify in the
patient. For example, signs include skin color and temperature, blood pressure,
pulse, respirations, lacerations, bleeding, or a rigid abdomen. A symptom is any
non-observable condition described by the patient. For example, patients may state
that they feel nauseous, have a headache, or just feel sick. You cannot see these
symptoms and can only ask the patient about them. Sometimes a patient may state
symptoms that are unclear or not specific, or they may have reported several
symptoms that seem equally important. Encourage them to state clearly the problem
that caused them to call ambulance. Signs and symptoms are important because
they form the basis for how you care for the patient.
Ask the patient about any allergies to medications, foods, or environmental
factors, and always look for a medical alert tag. Some people are allergic to certain
medications such as penicillin or sulfa drugs. Other people may be allergic to
shellfish or other foods such as milk. Try to obtain specific information from the
patient about allergies. This information may lead you to suspect that an allergic
reaction has occurred and to guide appropriate treatment. In addition, if the patient’s
mental status changes en route to the hospital, you can provide the receiving facility
staff with this valuable information.
Instructor
Identify any medications the patient is taking. Ask about medications that
have been prescribed for the patient. Determine if the patient is taking any over-the-
counter medications or herbal treatments. It is important to determine what
medications the patient maybe taking, but it is also important to determine the
dosage and how frequently that medication is taken. Another important consideration
with medications is patient’s compliance with the dosage. Ask the patient or family
members if the medications are being taken as prescribed. Ask the patient if the
medications are current or recent and if they have been prescribed. If prescription
bottles are present, check the prescription label for the date prescribed and how
often the patient should take the medication. This may allow you to determine if the
patient is complying with the prescription. Again, look for a medical identification tag.
The medical direction physician may authorize you to assist with certain prescribed
medications. Determining that the patient is taking a medication and investigating
this information may enable you to provide additional care. Each year a listing of the
200 most commonly prescribed medications is published. By becoming familiar with
this type of information, you may be able to correlate medication lists with specific
clinical problems. The listing can be found on several internet sites and is also
published as a text.
Ask for pertinent past medical history including recent or past medical
problems, surgeries, and injuries. Keep the patient focused on recent or pertinent
medical history. Surgery on a patient’s ankle 20 years ago, for example, usually is
not relevant to the patient’s chief complaint. However, heart surgery 5 years ago
might be important to the patient’s current problem. This information may guide you
to look for subtle signs and symptoms that may not be obvious at first. In addition,
give this information to the medical direction physician, who may request additional
care for the patient.
Last oral intake includes the time and quantity of both solid and liquid food.
Get specific information about any recent change in eating habits or lack of eating.
Some patients may intentionally not eat or may overeat. Also consider alcohol intake
or ingestion of other nonfood substances. The time of last oral intake is relevant in
case emergency surgery is required. Any solids or liquids in the patient’s stomach
have the potential to cause airway compromise if the patient is unable to protect his
or her own airway.
Events leading to the injury or illness should be identified. Chest pain with
exertion or at rest should be noted. Other symptoms such as dizziness or confusion
may also provide the receiving facility with important information. Sometimes the
order in which the symptoms occurred is important. For example, dizziness may be
the chief complaint, but the patient may state that it occurred after chest pain began.
An acronym to help focus your questioning regarding the present illness or injury is
OPQRST-ASPN. This is most helpful in patients with medical complaints and helps
in obtaining more information regarding symptoms. Keep in mind not all signs and
symptoms fit into this acronym.
Instructor
O is for onset – the original onset of the patient’s illness or condition, such as the
original diagnosis of heart disease, not necessarily the specific episode the patient is
now experiencing.
P is for provocation – what makes the sign or symptom better or worse.
Q represents quality – the patient’s subjective description of the sign or symptom.
R is for radiation – question the patient to determine if the pain radiates to any other
location.
S is severity – it is helpful to ask the patient to rate the severity of the sign or
symptom. A 1-to-10 scale with 1 meaning no symptoms and 10 meaning the worst
the patient can imagine will help you judge the symptoms.
T represents time – the length of time that the signs or symptoms have been
present.
ASPN is used to help you remember to ask about associated symptoms and
pertinent negatives. Other symptoms associated with the chief complaint or other
illness can help determine a clearer picture of the patient’s condition, allowing you to
make a more accurate field impression. Pertinent negatives are clinical signs and
symptoms that assist in determining a clear field impression. Their absence may
help you distinguish specific clinical conditions. For example, patients with chest pain
who deny shortness of breath, nausea, or non-cardiac pain.
The information you gather in the SAMPLE history can help provide care to
the patient. Knowing information about past medical problems, allergies, and
medications can help the medical direction physician give you guidance. Should a
patient become unresponsive after the initial contact with EMS, you will have gained
valuable information that helps the receiving facility make decisions in patient care.
Instructor

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FIRST AID AND WATER SURVIVAL

PSSg Jonathan D Peregrino

SCHOOL: PLT College of Guinobatan, Inc.

LESSON 1: Anatomic terms

LESSON 3: Baseline vital signs

3. The student will know the LESSON 4: SAMPLE History

LESSON 1: Anatomic terms

THE ANATOMIC POSITION

To communicate effectively, healthcare professionals follow medical

Descriptive Anatomic Terms

THE RESPIRATORY SYSTEM

Under normal conditions, the respiratory cycle occurs at regular intervals.

THE CIRCULATORY SYSTEM

Figure shows the location of the

The Circulation of Blood

THE MUSCULOSKELETAL SYSTEM

The Spinal Column and Rib Cage

The bones of the spinal column are the

The upper extremities. The arms join the

A. Skeletal muscle attaches to bone. B. Smooth muscle is located in organs such

THE NERVOUS SYSTEM

THE DIGESTIVE SYSTEM

THE ENDOCRINE SYSTEM

Average Vital Sign Ranges by Age

To assess the pupils, follow these steps:

This figure shows constricted pupils, uneven

The figure shows the assessment of pupils.

Palpation or feeling is an alternate method to

VITAL SIGN REASSESSMENT

LESSON 4: SAMPLE History

Signs and symptoms are different kinds of indications of a possible problem.

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