You are on page 1of 182

PA Notebook Guide EMS Chapter 8Assessment Vocabulary Kneeca A grating or grinding sensation caused by p; a fractured bone ends or joints

rubbing specia together; also air bubbles under the skin lized that produce a crackling sound or crinkly feeling.compartment syndromeInjury of bone the abdomen caused by a penetrating or that piercing instrument or force, in which the lies within skin is lacerated or perforated and the cavity is opened to the atmosphere; also the tendon called penetrating injury.One-way valve of the that allows air to leave the chest cavity quadri but not return; formed by taping three sides of an occlusive dressing to the chest ceps wall, leaving the fourth side open as a muscle valve.eustachian tubeArea of the head .point above the ears and eyes; the skull. The tender cranium contains the nessTe brain.avulsionedemaSwelling or nderne enlargement of a part of an artery, ss resulting from weakening of the arterial that wall.epistaxisecchymosisBruise, or is ecchymosis.Kinematics of TraumaA sharpl technique used to gain insight into a y patient''s thinking, involving repeating, in locali the form of a question, what the patient zed at has said.The loss of body heat as warm the air in the lungs is exhaled into the atmosphere and cooler air is site of the inhaled.evaporationA substance that injury causes an allergic reaction.referred painSwelling in the part of the body , found closest to the ground, caused by collection of fluid in the tissues; a by gently possible sign of congestive heart failure palpat (CHF).A disorder in which the heart loses part of its ability to effectively pump ing along blood, usually as a result of damage to heart muscle and usually resulting in a the backup of fluid into the bone lungs.BradycardiaComplete absence of with heart electrical the activity.HyperventilationEpiglottitisoral tip of glucoseA miniature spray canister one through which droplets or particles of finger medication may be inhaled.injection into .posit a muscle; a medication delivery ion of route.IndicationsEpinephrineMED functi channelsradio hardware containing onHand transmitter & receiver/located in a fixed positi place.Subcutaneous on in EmphysemaSAMPLE which HistoryResponsivenessOPQRSTAccessor the y Muscles 9/27/2011tance69487272.docD1er9/27/2011id not contact medical 1fo9/27/2011 not check medication f1pti

wrist Section 7. Trauma, is slight ly dorsif lexed and all finger joints are modera tely flexed .pubic symphy sisHar d bony promin ence that is found in the midlin e in the lowerm ost portio n of the abdome n.radi usBone on the thumb side of the forear m.redu ceRetu rn a disloc ated joint or fractu red bone to its normal positi on; troper 9/27/2011tance69487272.docD2er9/27/2011id not contact medical 2fo9/27/2011 not check medication f2pti

itonea l spaceT he space betwee n the abdomi nal cavity and the poster ior abdomi nal wall, contai ning the kidney s, certai n large vessel s, and parts of the gastro intest inal tract. scapul aShoul der blade. sciati c nerveM ajor nerve to the lower extrem ity; contro ls much of muscle functi on in the leg, and 9/27/2011tance69487272.docD3er9/27/2011id not contact medical 3fo9/27/2011 not check medication f3pti

sensat ion in most of the leg and foot.s keleta l muscle Muscle that is attach ed to bones and usuall y crosse s at least one joint; striat ed, or volunt ary, muscle .sling Bandag e or materi al that helps to suppor t the weight of an injure d upper extrem ity.sp lintFl exible or rigid ang damage to suppor ting ligame 9/27/2011tance69487272.docD4er9/27/2011id not contact medical 4fo9/27/2011 not check medication f4pti

nts, and someti mes pa a muscle pull.s watheB andage that passei ssue that attach es a skelet al muscle to aa struct ure.ul naInne r bone of the forear m, on the side opposi te the thumb. zone of injury Area of potent ially damage d soft tissue , adjace nt nerves , and blood vessel s surrou nding an injury to a bone or a 9/27/2011tance69487272.docD5er9/27/2011id not contact medical 5fo9/27/2011 not check medication f5pti

joint. Chapte r 30Head and Spine Injuri esante rograd e (postt raumat ic) amnesi aInabi lity to rememb er events after an injury .auton omic (invol untary ) nervou s system Part of the nervou s system that regula tes functi ons that are not contro lled by consci ous will, such as digest ion and sweati 9/27/2011tance69487272.docD6er9/27/2011id not contact medical 6fo9/27/2011 not check medication f6pti

ng.Bat tle''s signBr uising behind an ear over the mastoi d proces s that may indica te skull fractu re.bra in stemAr ea of the brain betwee n the spinal cord and cerebr um, surrou nded by the cerebe llum; contro ls functi ons, necess ary for life, ie respir ations .centr al nervou s system (CNS)B rain and spinal cord.n 9/27/2011tance69487272.docD7er9/27/2011id not contact medical 7fo9/27/2011 not check medication f7pti

ondisp laced fractu reSimp le crack in the bone that has not caused the bone to move from its normal anatom ic positi on; also called a hairli ne fractu re.fra ctureB reak in the contin uity of a bone.g lenoid fossaP art of the scapul a that joins with the humera l head to form the glenoh umeral joint. hematu riaPre 9/27/2011tance69487272.docD8er9/27/2011id not contact medical 8fo9/27/2011 not check medication f8pti

sence of blood in the urine. humeru sSuppo rting bone of the upper intPla ce where two bones come into contac t.liga mentBa nd of the fibrou s tissue that connec ts bones to bones. It suppor ts and streng thens a joint. ecchym osisDi scolor ation of the skin associ ated with a closed wound; bruisi ng.fem urThig h bone, 9/27/2011tance69487272.docD9er9/27/2011id not contact medical 9fo9/27/2011 not check medication f9pti

which extend s from the pelvis to the knee and is respon sible for format ion of the hip and knee; longes t and larges t bone in the body.f ibulad isplac ed fractu redisl ocatio nDisru ption of a joint in which ligame nts are damage d and the bone ends are comple tely displa ced.Sw elling in a confin ed space that produc es 9/27/2011tance69487272.docD10er9/27/2011id not contact medical 10fo9/27/2011 not check medication f10pti

danger ous pressu re; may cut off blood flow or damage sensit ive tissue .crepi tusclo sed fractu reFrac ture in which the skin is not broken .clavi cleart icular cartil agePea rly layer of specia lized cartil age coveri ng the articu lar surfac es (conta ct surfac es on the ends) of bones in synovi al joints 9/27/2011tance69487272.docD11er9/27/2011id not contact medical 11fo9/27/2011 not check medication f11pti

.acrom ioclav icular (A/C) jointC hapter 29peri toneal cavity Abdomi nal cavity .perit onitis hollow organs Struct ures throug h which materi als pass, such as the stomac h, small intest ines, large intest ines, ureter s, and bladde r.Pres ence of blood in the urine. Region of the lower rib cage.g uardin gDispl acemen t of organs outsid e the body.c 9/27/2011tance69487272.docD12er9/27/2011id not contact medical 12fo9/27/2011 not check medication f12pti

losed abdomi nal injury Any injury of the abdome n caused by a nonpen etrati ng instru ment or force, in which the skin remain s intact ; also called blunt abdomi nal injury .Chapt er 28spon taneou s pneumo thorax Pneumo thorax that occurs when a weak area on the lung ruptur es in the absenc e of major injury , allowi 9/27/2011tance69487272.docD13er9/27/2011id not contact medical 13fo9/27/2011 not check medication f13pti

ng air to leak into the pleura l space. suckin g chest woundO pen or penetr ating chest wall wound throug h which air passes during inspir ation and expira tion, creati ng a suckin g sound. tachyp neaRap id respir ations .pneum othora xParti al or comple te accumu lation of air in the pleura l space. perica rdial tampon adeCom 9/27/2011tance69487272.docD14er9/27/2011id not contact medical 14fo9/27/2011 not check medication f14pti

pressi on of the heart due to a buildu p of blood or other fluid in the perica rdial sac.he moptys isSpit ting or coughi ng up of blood. Eardru m, which lies betwee n the extern al and middle ear.Ch apter 27turb inates Layers of bone within the nasal cavity .Oint formed where the mandib le and craniu m meet, just in front 9/27/2011tance69487272.docD15er9/27/2011id not contact medical 15fo9/27/2011 not check medication f15pti

of the agusSm all, rounde d, fleshy bulge that lies immedi ately anteri or to the ear canal. Upper jawbon es that assist in the format ion of the orbit, the nasal cavity , and the palate , and lodge the upper teeth. occipu tforam en magnum Large openin g at the base of the skull throug h which the brain connec ts to 9/27/2011tance69487272.docD16er9/27/2011id not contact medical 16fo9/27/2011 not check medication f16pti

the spinal cord.h ematom aMass of blood in the soft tissue s beneat h the skin.m andibl eBone of the lower stoid proces sPromi nent bony mass at the base of the skull behind the aniumA ir bubble s in the blood vessel s.avul sedPul led or torn away.A dam''s appleF irm promin ence in the upper part of the larynx formed by the 9/27/2011tance69487272.docD17er9/27/2011id not contact medical 17fo9/27/2011 not check medication f17pti

thyroi d cartil age. It is more promin ent in men than in women. retina Lightsensit ive area of the eye where images are projec ted; a layer of cells at the back of the eye that change s the light image into electr ical impuls es, which are carrie d by the optic nerve to the brain. lensTr anspar ent part of the eye 9/27/2011tance69487272.docD18er9/27/2011id not contact medical 18fo9/27/2011 not check medication f18pti

throug h which images are focuse d on the retina .Muscl e and surrou nding tissue behind the cornea that dilate and constr ict the pupil, regula ting the amount of light that enters the eye; pigmen t in this tissue gives the eye its color. lacrim al glands Bleedi ng into the anteri or chambe r of the eye, 9/27/2011tance69487272.docD19er9/27/2011id not contact medical 19fo9/27/2011 not check medication f19pti

obscur ing the iris.g lobeEy eball. Eye injuri esblow out fractu reFrac ture of the orbit or of the bones that suppor t the floor of the orbit. conjun ctivaD elicat e membra ne lining the eyelid s and coveri ng the expose d surfac e of the njunct ivitis Inflam mation of the conjun ctiva. cornea rabidD escrib es an animal that is 9/27/2011tance69487272.docD20er9/27/2011id not contact medical 20fo9/27/2011 not check medication f20pti

infect ed with rabies .Rule of NinesS ystem that assign s percen tages to sectio ns of the body, allowi ng calcul ation of the amount of skin surfac e involv ed in the burn area.i ncisio nSharp or smooth cut.Ma ss of blood in the soft tissue s beneat h the skin.f ullthickn ess burnep idermi sOuter layer of skin 9/27/2011tance69487272.docD21er9/27/2011id not contact medical 21fo9/27/2011 not check medication f21pti

that acts as a watert ight protec tive coveri ng.con tamina tionPr esence of infect ious organi sms on or in object s such as dressi ngs, water, food, needle s, wounds , or a patien t''s body.c ontusi onBrui se, or ecchym osis.d ermisI nner layer of the skin, contai ning hair follic les, sweat glands , nerve ending s, and blood vessel s.ecch 9/27/2011tance69487272.docD22er9/27/2011id not contact medical 22fo9/27/2011 not check medication f22pti

ymosis Discol oratio n of the skin associ ated with a closed wound; bruisi ng.An injury in which soft tissue either is torn comple tely loose or is hangin g as a flap.b urnInj ury in which the soft tissue receiv es more energy than it can absorb withou t injury from therma l heat, fricti onal heat, toxic chemic als, electr icity, 9/27/2011tance69487272.docD23er9/27/2011id not contact medical 23fo9/27/2011 not check medication f23pti

or nuclea r radiat osed injury Develo ping a sensit ivity to a substa nce that initia lly caused no allerg ic reacti on.sep tic shockC ircula tory failur e caused by paraly sis of the nerves that contro l the size of the blood vessel s, leadin g to widesp read dilati on; seen in spinal cord injuri es.per fusion 9/27/2011tance69487272.docD24er9/27/2011id not contact medical 24fo9/27/2011 not check medication f24pti

Circul ation of oxygen ated blood within an organ or tissue in adequa te amount s to meet the cells' ' curren t needs. homeos tasisB alance of all system s of the body.h ypothe rmiaCo nditio n in which the intern al body temper ature falls below 95 degree s F (35 degree s C) after exposu re to a cold enviro nment. 9/27/2011tance69487272.docD25er9/27/2011id not contact medical 25fo9/27/2011 not check medication f25pti

hypovo lemic shockC onditi on in which low blood volume , due to massiv e intern al or extern al bleedi ng or extens ive loss of body water, result s in inadeq uate perfus ion.Pr esence of abnorm ally large amount s of fluid betwee n cells in body tissue s, causin g swelli ng of the affect ed area.L oss of water 9/27/2011tance69487272.docD26er9/27/2011id not contact medical 26fo9/27/2011 not check medication f26pti

from the tissue s of the body.c yanosi scardi ogenic shockS tate in which not enough oxygen is delive red to the tissue s of the body, caused by low output of blood from the heart. It can be a severe compli cation of a large acute myocar dial infarc tion, and other condit ions.c ompens ated shocka utonom ic nervou s system 9/27/2011tance69487272.docD27er9/27/2011id not contact medical 27fo9/27/2011 not check medication f27pti

The part of the nervou s system that regula tes functi ons, such as digest ion and sweati ng, that are not contro lled volunt arily. Chapte r 23Shoc kanaph ylacti c shockS evere shock caused by an allerg ic reacti on.ana phylax isExtr eme, possib ly lifethreat ening system ic allerg ic reacti on that may 9/27/2011tance69487272.docD28er9/27/2011id not contact medical 28fo9/27/2011 not check medication f28pti

includ e shock and respir atory failur e.aneu rysmCi rculat ion of oxygen ated blood within an organ or tissue in adequa te amount s to meet the cells' ' curren t needs. pneuma tic antish ock garmen t (PASG) hemato maMass of blood in the soft tissue s beneat h the skin.h emophi liaCon genita l condit ion in which 9/27/2011tance69487272.docD29er9/27/2011id not contact medical 29fo9/27/2011 not check medication f29pti

the patien t lacks one or more of the blood' 's normal clotti ng factor s.cont usionS mall blood vessel s that connec t arteri oles and venule s; variou s substa nces pass throug h capill ary walls, into and out of the inters titial fluid, and then on to the cells. coagul ationF ormati on of clots to plug openin 9/27/2011tance69487272.docD30er9/27/2011id not contact medical 30fo9/27/2011 not check medication f30pti

gs in injure d blood vessel s and stop blood flow.a rteryB lood vessel , consis ting of three layers of tissue and smooth muscle that carrie s blood away from the heart. potent ial energy Produc t of mass, gravit y, and height , conver ted into kineti c energy and result s in injury , such as from a fall.k inetic 9/27/2011tance69487272.docD31er9/27/2011id not contact medical 31fo9/27/2011 not check medication f31pti

energy energy of a moving object .The slowin g of an object .index of suspic ionblu nt trauma An impact on the body by object s that cause injury withou t penetr ating soft tissue s or intern al organs and caviti es.cav itatio nPheno menon in which speed causes bullet to genera te pressu re waves, which cause damage distan 9/27/2011tance69487272.docD32er9/27/2011id not contact medical 32fo9/27/2011 not check medication f32pti

t from the bullet 's path.c oupcontre coup brain injury Brain injury that occurs when force is applie d to head, energy transm ission thru brain tissue causes injury on opposi te side of origin al impact .refle ctive listen ingTem porary or perman ent dysfun ction of the brain, caused by a distur bance in the physic al or physio 9/27/2011tance69487272.docD33er9/27/2011id not contact medical 33fo9/27/2011 not check medication f33pti

logic functi oning of brain tissue .psych ogenic A sympto m or illnes s that is caused by mental factor s as oppose d to physic al ones.m ental disord erAn illnes s with psycho logica l or behavi oral sympto ms and/or impair ment in functi oning caused by a social , psycho logica l, geneti c, physic al, chemic al, or biolog 9/27/2011tance69487272.docD34er9/27/2011id not contact medical 34fo9/27/2011 not check medication f34pti

ic distur bance. behavi orHow a person functi ons or acts in respon se to his or her enviro nment. Turgor The abilit y of the skin to resist deform ation; tested by gently pinchi ng skin on the forehe ad or back of the hand.r everse triage A triage proces s in which effort s are focuse d on those who are in respir atory and 9/27/2011tance69487272.docD35er9/27/2011id not contact medical 35fo9/27/2011 not check medication f35pti

cardia c arrest , and differ ent from conven tional triage where such patien ts would be classi fied as deceas ed. Used in triagi ng multip le victim s of a lightn ing strike .Scuba Respir ationA severe constr iction of the larynx and vocal cords. near drowni nghypo thermi aA condit ion in which the intern al body temper 9/27/2011tance69487272.docD36er9/27/2011id not contact medical 36fo9/27/2011 not check medication f36pti

ature falls below 95 degree s F (35 degree s C) after exposu re to a cold enviro nment. hypert hermia A condit ion in which core temper ature rises to 101 degree s F (38.3 degree s C) or more.h yperba ric chambe rA lifethreat ening condit ion of severe hypert hermia caused by exposu re to excess ive natura l or artifi cial heat, 9/27/2011tance69487272.docD37er9/27/2011id not contact medical 37fo9/27/2011 not check medication f37pti

marked by warm, dry skin; severe ly altere d mental status ; and often irreve rsible coma.C onvers ion of water or anothe r fluid from a liquid to a ostbit eDamag e to tissue s as the result of exposu re to cold; frozen or partia lly frozen body parts. heat cramps Painfu l muscle spasms usuall y associ ated with 9/27/2011tance69487272.docD38er9/27/2011id not contact medical 38fo9/27/2011 not check medication f38pti

vigoro us activi ty in a hot enviro nment. heat exhaus tionA form of heat injury in which the body loses signif icant amount s of fluid and electr olytes becaus e of heavy sweati ng; also called heat prostr ation or heat collap se.cor e temper atureThe temper


of the centra l part of the body 9/27/2011tance69487272.docD39er9/27/2011id not contact medical 39fo9/27/2011 not check medication f39pti

(eg, the heart, lungs, and vital organs ).deco mpress ion sickne ssA painfu l condit ion seen in divers who ascend too quickl y, in which gas, especi ally nitrog en, forms bubble s in blood vessel s and other tissue s; also called "the bends. "divin g reflex Slowin g of the heart rate caused by submer sion in 9/27/2011tance69487272.docD40er9/27/2011id not contact medical 40fo9/27/2011 not check medication f40pti

cold water. drowni ngDeat h from suffoc ation by submer sion in water. electr olytes Certai n salts and other chemic als that are dissol ved in body fluids and cells. A serum that counte racts the effect of venom from an animal or insect .bends Common name for decomp ressio n sickne ss.bra dycard iaSlow heart rate, 9/27/2011tance69487272.docD41er9/27/2011id not contact medical 41fo9/27/2011 not check medication f41pti

less than 60 beats/ eathholdin g syncop eLoss of consci ousnes s caused by a decrea sed breath ing stimul us.con ductio nVomit ed materi al.Cha pter 18 Enviro nmenta l Emerai r emboli smAir bubble s in the blood vessel s.pois onA substa nce whose chemic al action could damage struct ures or impair functi 9/27/2011tance69487272.docD42er9/27/2011id not contact medical 42fo9/27/2011 not check medication f42pti

on when introd uced into the body.A sleepinduci ng effect or agent. ingest ionSwa llowin g; taking a substa nce by mouth. opioid sAny drug or agent with action s simila r to morphi ne.hem atemes isVomi ting blood. deliri um tremen s (DTs)A severe withdr awal syndro me seen in alcoho lics who are depriv ed of 9/27/2011tance69487272.docD43er9/27/2011id not contact medical 43fo9/27/2011 not check medication f43pti

ethyl alcoho l; charac terize d by restle ssness , fever, sweati ng, disori entati on, agitat ion, and seizur es; can be fatal if untrea ted.em esisVo miting .hallu cinoge nsAgen ts that produc e false percep tions in any one of the five senses .Subs Abuse/ Poison addict ionA state of overwh elming obsess ion or physic al need 9/27/2011tance69487272.docD44er9/27/2011id not contact medical 44fo9/27/2011 not check medication f44pti

to contin ue the use of a drug or agent. strido rA harsh, highpitche d, crowin g inspir atory sound, such as the sound often heard in acute laryng eal (upper airway ) obstru ction. ToxinA poison or harmfu l substa nce.Ur ticari aSmall spots of genera lized itchin g and/or burnin g that appear as multip le raised areas 9/27/2011tance69487272.docD45er9/27/2011id not contact medical 45fo9/27/2011 not check medication f45pti

on the skin; hives. enveno mation The act of inject ing venom. epinep hrineA medica tion that increa ses heart rate and blood pressu re but also eases breath ing proble ms by decrea sing muscle tone of the bronch iole tree; you may be allowe d to help the patien t selfadmini ster the medica tion.h istami nesSub stance releas ed by 9/27/2011tance69487272.docD46er9/27/2011id not contact medical 46fo9/27/2011 not check medication f46pti

the immune system in allerg ic reacti ons that are respon sible for many of the sympto ms of anaphy laxis. An extrem e, possib ly lifethreat ening system ic allerg ic reacti on that may includ e shock and respir atory failur e.alle rgic reacti onThe body'' s exagge rated immune respon se to an intern al or 9/27/2011tance69487272.docD47er9/27/2011id not contact medical 47fo9/27/2011 not check medication f47pti

surfac e agent. type II diabet esThe type of diabet ic diseas e that usuall y starts in later life and often can be contro lled throug h diet and oral medica tions. Chapte r 16Alle rgic Reacti onsall ergent ype I diabet esThe type of diabet ic diseas e that usuall y starts in childh ood and requir es insuli 9/27/2011tance69487272.docD48er9/27/2011id not contact medical 48fo9/27/2011 not check medication f48pti

n for proper treatm ent and contro l.Insu linA hormon e produc ed by the Islets of Langer hans (an exocri ne gland on the pancre as) that enable s glucos e in the blood to enter the cells of the body; used in synthe tic form to treat and contro l diabet es mellit us.ins ulin shockU nconsc iousne ss or 9/27/2011tance69487272.docD49er9/27/2011id not contact medical 49fo9/27/2011 not check medication f49pti

altere d mental status in a patien t with diabet es, caused by signif icant hypogl ycemia ; usuall y the result of excess ive exerci se and activi ty or failur e to eat after a routin e dose of insuli n.Kuss maul respir ations Deep, rapid breath ing; usuall y the result of an accumu l ation of

certai n acids when 9/27/2011tance69487272.docD50er9/27/2011id not contact medical 50fo9/27/2011 not check medication f50pti

insuli n is not availa ble in the body.P olydip siaExc essive thirst persis ting for long period s of time despit e reason able fluid intake ; often the result of excess ive urinat ion.Po lyphag iaExce ssive eating ; in diabet es, the inabil ity to use glucos e proper ly can cause a sense of hunger .Polyu riaAn abnorm 9/27/2011tance69487272.docD51er9/27/2011id not contact medical 51fo9/27/2011 not check medication f51pti

ally low blood glucos e level. ulcerP ain felt in an area of the body other than the area where the cause of pain is locate d.stra ngulat ionper itoneu mThe membra ne lining the abdomi nal cavity (parie tal perito neum) and coveri ng the abdomi nal organs (visce ral perito neum). perito nitisI nflamm ation of the perito 9/27/2011tance69487272.docD52er9/27/2011id not contact medical 52fo9/27/2011 not check medication f52pti

neum.d iverti culiti sBulgi ng out of intest inal rings in small pocket s at weak areas in the muscle walls, creati ng abdomi nal discom fort.e mesisV omitin g.guar dingIn volunt ary muscle contra ctions (spasm ) of the abdomi nal wall, an effort to protec t the inflam ed abdome n.hern iaThe protru sion of a loop of an organ or 9/27/2011tance69487272.docD53er9/27/2011id not contact medical 53fo9/27/2011 not check medication f53pti

tissue throug h an abnorm al body openin g.ileu sParal ysis of the bowel, arisin g from any one of severa l causes ; stops contra ctions that move materi al throug h the intest ncreat itisIn flamma tion of the gallbl adder. colicA cute, interm ittent crampi ng abdomi nal pain.A condit ion of sudden onset of pain within the abdome 9/27/2011tance69487272.docD54er9/27/2011id not contact medical 54fo9/27/2011 not check medication f54pti

n, usuall y indica ting perito nitis; immedi ate medica l or surgic al treatm ent is necess eurysm A swelli ng or enlarg ement of a part of an artery , result ing from weaken ing of the arteri al wall.a norexi aLack of appeti te for food.C lottin g of the cerebr al arteri es that may result in the interr uption 9/27/2011tance69487272.docD55er9/27/2011id not contact medical 55fo9/27/2011 not check medication f55pti

of cerebr al blood flow and subseq uent stroke .tonic clonic A type of seizur e that featur es rhythm ic backandforth motion of an extrem ity and body stiffn ansien t ischem ic attack (TIA)A disord er of the brain in which brain cells tempor arily stop workin g becaus e of insuff icient oxygen , 9/27/2011tance69487272.docD56er9/27/2011id not contact medical 56fo9/27/2011 not check medication f56pti

causin g stroke -like sympto ms that resolv e comple tely within 24 hours of onset. Chapte r 14 status epilep ticusA condit ion in which seizur es recur every few minute s, or last more than 30 minute s.Peri od follow ing a seizur e that lasts betwee n 5 and 30 minute s, charac terize d by labore d respir ations and 9/27/2011tance69487272.docD57er9/27/2011id not contact medical 57fo9/27/2011 not check medication f57pti

some degree of altere d mental status .recep tive aphasi aA speech disord er in which a person has troubl e unders tandin g speech but is able to speak clearl y.seiz ureGen eraliz ed, uncoor dinate d muscul ar activi ty associ ated with loss of consci ousnes s; a convul sion.i schemi c stroke One of the two 9/27/2011tance69487272.docD58er9/27/2011id not contact medical 58fo9/27/2011 not check medication f58pti

main types of stroke ; occurs when blood flow to a partic ular part of the brain is cut off by a blocka ge (eg, a clot) inside a blood vessel .Loss of bowel and bladde r contro l due to a genera lized seizur e.infa rcted cellsh ypogly cemiaA n abnorm ally low blood glucos e level. Seizur e charac terize d by 9/27/2011tance69487272.docD59er9/27/2011id not contact medical 59fo9/27/2011 not check medication f59pti

severe twitch ing of all the body'' s muscle s that may last severa l minute s or more; also known as a grand mal seizur e.hemi paresi sexpre ssive aphasi aA speech disord er in which a person can unders tand what is being said but cannot produc e the right sounds in order to speak proper ly.feb rile seizur esConv 9/27/2011tance69487272.docD60er9/27/2011id not contact medical 60fo9/27/2011 not check medication f60pti

ulsion s that result from sudden high fevers , partic ularly in childr erial ruptur eRuptu re of a cerebr al artery that may contri bute to interr uption of cerebr al blood flow.a theros cleros isA disord er in which choles terol and calciu m build up inside the walls of blood vessel s, formin g plaque 9/27/2011tance69487272.docD61er9/27/2011id not contact medical 61fo9/27/2011 not check medication f61pti

, which eventu ally leads to partia l or comple te blocka ge of blood flow and the format ion of clots that can break off and emboli ze.aur aA sensat ion experi enced prior to a seizur e; serves as a warnin g sign that a seizur e is about to occur. cerebr al emboli smObst ructio n of a cerebr al artery caused by a 9/27/2011tance69487272.docD62er9/27/2011id not contact medical 62fo9/27/2011 not check medication f62pti

clot that was formed elsewh ere in the body and travel ed to the brain. cerebr ovascu lar accide nt (CVA)A n interr uption of blood flow to the brain that result s in the loss of brain functi aA state of profou nd uncons ciousn ess from which one cannot be roused .coupcontre coup brain injury A 9/27/2011tance69487272.docD63er9/27/2011id not contact medical 63fo9/27/2011 not check medication f63pti

brain injury that occurs when force is applie d to the head and energy transm ission throug h brain tissue causes injury on the opposi te side of origin al impact .dysar thriaC hapter 13 Neurol ogic Emerge ncyabs ence seizur eSeizu re that may be charac terize d by a brief lapse of attent ion in which the patien t may stare 9/27/2011tance69487272.docD64er9/27/2011id not contact medical 64fo9/27/2011 not check medication f64pti

and does not respon d. Also known as petit mal seizur e.apha siaVen tricle One of two (right and left) lower chambe rs of heart. left ventri cle receiv es blood from left atrium (upper chambe r), delive rs blood to aorta. right ventri cle receiv es blood from right atrium , pumps into pulmon ary artery .Perfu 9/27/2011tance69487272.docD65er9/27/2011id not contact medical 65fo9/27/2011 not check medication f65pti

sionci rculat ion of oxygen ated blood within an organ or tissue in adequa te amount s to meet the cells' ' curren t needs. The inside diamet er of an artery or other hollow struct ure.My ocardi umThe heart muscle .Occlu sionBl ockage , usuall y of a tubula r struct ure such as a blood vessel .Infer iorThe part of the 9/27/2011tance69487272.docD66er9/27/2011id not contact medical 66fo9/27/2011 not check medication f66pti

body, or any body part, nearer to the feet.d epende nt edemaA blood vessel that carrie s blood and nutrie nts to the heart muscle .conge stive heart failur e (CHF)A systol eaorti c valveT he oneway valve that lies betwee n the left ventri cle and the aorta. It keeps blood from flowin g back into the left ventri 9/27/2011tance69487272.docD67er9/27/2011id not contact medical 67fo9/27/2011 not check medication f67pti

cle after the left ventri cle ejects its blood into the aorta. One of four heart valves .The front surfac e of the body; the side facing you in the standa rd anatom ic positi on.Aor taacut e myocar dial infarc tion (AMI)H eart attack ; death of heart muscle follow ing obstru ction of blood flow to it. Acute 9/27/2011tance69487272.docD68er9/27/2011id not contact medical 68fo9/27/2011 not check medication f68pti

in this contex t means "new" or "happe ning right now."C hapter 12 Cardio vascul ar Emerge ncyPot ential ly lifethreat ening viral infect ion that usuall y starts with flulike sympto ms.Str idorRh onchiC oarse breath sounds heard in patien ts with chroni c mucus in the airway s.pulm onary edemaB uildup of fluid 9/27/2011tance69487272.docD69er9/27/2011id not contact medical 69fo9/27/2011 not check medication f69pti

in lungs, usuall y as a result of conges tive heart failur e.Infe ctious diseas e of the lung that damage s lung tissue .Pneum othora xpleur itic chest painhy poxic drive" Backup system " contro lling respir ation; senses drops in oxygen in blood. Rapid or deep breath ing, lowers blood carbon dioxid e levels below normal .Emphy semaDi 9/27/2011tance69487272.docD70er9/27/2011id not contact medical 70fo9/27/2011 not check medication f70pti

sease of lungs w/extr eme dilati on, eventu al destru ction of pulmon ary alveol i w/poor exchan ge of oxygen , carbon dioxid e; one form of chroni c obstru ctive pulmon ary diseas e (COPD) .commo n coldvi ral infect ion usuall y associ ated with swolle n nasal mucous membra nes and the produc tion 9/27/2011tance69487272.docD71er9/27/2011id not contact medical 71fo9/27/2011 not check medication f71pti

of fluid from the sinuse s and nose.C rackle sCrack ling breath sound caused by the flow of air throug h liquid in the lungs; a sign of lower airway obstru ction. CroupI nfecti on of the airway below the level of vocal cords, caused by a virus. Diphth eriaIn fectio us diseas e in which a membra ne forms, lining pharyn x; this 9/27/2011tance69487272.docD72er9/27/2011id not contact medical 72fo9/27/2011 not check medication f72pti

lining can severe ly obstru ct the passag e of air into the larynx .Dyspn eaShor tness of breath or diffic ulty breath ing.Em bolusM edicat ions that are design ed to be absorb ed throug h the skin (trans cutane ously) .Chapt er 11 Respir atory Emerge ncyAll ergenS ubstan ce that causes an allerg ic reacti on.Ast hmaDis ease 9/27/2011tance69487272.docD73er9/27/2011id not contact medical 73fo9/27/2011 not check medication f73pti

of the lungs in which muscle spasm in the small air passag eways and the produc tion of large amount s of mucus with swelli ng of the mucus lining of the respir atory passag es result in airway obstru ction. carbon dioxid e retent ionA condit ion charac terize d by a chroni cally high blood level of carbon dioxid e in which 9/27/2011tance69487272.docD74er9/27/2011id not contact medical 74fo9/27/2011 not check medication f74pti

the respir atory center no longer respon ds to high blood levels of carbon dioxid e.chro nic bronch itisIr ritati on of the major lung passag eways, from either infect ious diseas e or irrita nts such as smoke. Transc utaneo usmixt ure of ground partic les that are distri buted evenly throug hout a liquid but do not dissol ve.sub lingua 9/27/2011tance69487272.docD75er9/27/2011id not contact medical 75fo9/27/2011 not check medication f75pti

l (SL)So lution liquid mixtur e, cannot be separa ted by filter ing or allowi ng mixtur e to stand. study of the proper ties and effect s of medica tions. metere d-dose inhale r (MDI)g eneric nameor iginal chemic al name of medica tion (in contra st with one of its "trade names" ); name is not capita lized. medica tion that 9/27/2011tance69487272.docD76er9/27/2011id not contact medical 76fo9/27/2011 not check medication f76pti

increa ses heart rate and blood pressu re but also eases breath ing proble ms by decrea sing muscle tone of the bronch iole tree; you may be allowe d to help the patien t selfadmini ster the medica tion.C ontrai ndicat ionsCo nditio ns that make a partic ular medica tion or treatm ent inappr opriat e, for exampl e, a condit 9/27/2011tance69487272.docD77er9/27/2011id not contact medical 77fo9/27/2011 not check medication f77pti

ion in which a medica tion should not be given becaus e it would not help or may actual ly harm a patien t.Dose oral medica tion binds & adsorb s ingest ed toxins in gastro intest inal tract for treatm ent of some poison ings & medica tion overdo ses. Charco al is ground into a very fine powder to provid e greate st 9/27/2011tance69487272.docD78er9/27/2011id not contact medical 78fo9/27/2011 not check medication f78pti

possib le surfac e area for bindin g medica tions taken by mouth; carrie d on EMS unit.A dsorpt ionpro cess of bindin g or sticki ng to a surfac e.aspi rin (acety lsalic ylic acid, or ASA)A medica tion that is an antipy retic (reduc es fever) , analge sic (reduc es pain), antiinflam matory (reduc es inflam mation 9/27/2011tance69487272.docD79er9/27/2011id not contact medical 79fo9/27/2011 not check medication f79pti

), and potent inhibi tor of platel et aggreg ation (clump ing).A bsorpt ionpro cess which medica tions travel thru body tissue s until reach bloods tream. Action The therap eutic effect of a medica tion on the body.U HF (ultra -high freque ncy)Ra dio freque ncies betwee n 300 and 3,000 MHz.VH F (very high freque ncy)Ra dio freque ncies 9/27/2011tance69487272.docD80er9/27/2011id not contact medical 80fo9/27/2011 not check medication f80pti

betwee n 30 and 300 MHz; VHF spectr um is furthe r divide d into "high" and "low" bands. Chapte r 10 Single freque ncy radio; transm ission s can occur in either direct ion but not simult aneous ly in both; when one party transm its, the other can only receiv e, party that is transm itting is unable to 9/27/2011tance69487272.docD81er9/27/2011id not contact medical 81fo9/27/2011 not check medication f81pti

receiv e.stan ding orders Writte n docume nts, signed by EMS system 's medica l direct or, outlin e specif ic direct ions, permis sions, prohib itions for patien t care; AKA protoc ols.Te lemetr yA proces s in which electr onic signal s are conver ted into coded, audibl e signal s; these signal s can then be transm 9/27/2011tance69487272.docD82er9/27/2011id not contact medical 82fo9/27/2011 not check medication f82pti

itted by radio or teleph one to a receiv er at the hospit al with a decode r.Repe aterA specia l base statio n radio that receiv es messag es and signal s on one freque ncy and then automa ticall y retran smits them on a second freque ncy.Sc annerA radio receiv er that search es or "scans " across severa l freque 9/27/2011tance69487272.docD83er9/27/2011id not contact medical 83fo9/27/2011 not check medication f83pti

ncies until the messag e is comple ted; the proces s is then repeat ed.use of a radio signal , a voice or digita l messag e transm itted to pagers ("beep ers") or deskto p monito r radios .Rappo rtFede ral Commun icatio ns Com (FCC)f ederal agency w/juri sdicti on over inters tate & intern ationa l teleph one & telegr 9/27/2011tance69487272.docD84er9/27/2011id not contact medical 84fo9/27/2011 not check medication f84pti

aph servic es & satell ite commun icatio ns, all of which may involv e EMS activi ty.Dup lexSev ere breath ing proble m in which a patien t can speak only two to three words at a time withou t pausin g to take a breath .Quick assess ment of the scene and the surrou ndings made to provid e inform ation about its safety 9/27/2011tance69487272.docD85er9/27/2011id not contact medical 85fo9/27/2011 not check medication f85pti

and the mechan ism of injury or nature of illnes s, before you enter and begin patien t care.R honchi Retrac tionsR alesCr acklin g, rattli ng, breath sound that signal s fluid in the air spaces of the lungs; also called crackl es.Abb reviat ion for key terms used in evalua ting a patien t''s signs and sympto ms: 9/27/2011tance69487272.docD86er9/27/2011id not contact medical 86fo9/27/2011 not check medication f86pti

onset, provoc ation or pallia tion, qualit y, region /radia tion, severi ty, and timing of pain.A VPUMet hod of assess ing a patien t''s level of consci ousnes s by determ ining whethe r a patien t is Awake and alert, respon sive to Verbal stimul us or Pain, or Unresp onsive ; used princi pally in the initia l assess mentBo dy 9/27/2011tance69487272.docD87er9/27/2011id not contact medical 87fo9/27/2011 not check medication f87pti

Substa nce Isolat ion (BSI)I nfecti on contro l concep t and practi ce that assume s that all body fluids are potent ially infect ious.B reath Sounds Indica tion of air moveme nt in the lungs, usuall y assess ed with a stetho scope. Capill ary Refill Abilit y of the circul atory system to restor e blood to the capill ary 9/27/2011tance69487272.docD88er9/27/2011id not contact medical 88fo9/27/2011 not check medication f88pti

system ; evalua ted by using a simple test.C hief Compla intRea son a patien t called for help. Also, the patien t''s respon se to questi ons such as "what' 's wrong? " or "what happen ed?"Co agulat eTo form a clot to plug an openin g in an injure d blood vessel and stop bleedi ng.Con juncti vaDeli cate membra 9/27/2011tance69487272.docD89er9/27/2011id not contact medical 89fo9/27/2011 not check medication f89pti

ne lining the eyelid s and coveri ng the expose d surfac e of the eye.Cr epitus Gratin g or grindi ng sensat ion or sound caused by fractu red bone ends or joints rubbin g togeth er.Cya nosisB luish color of the skin result ing from poor oxygen ation of the circul ating blood. DCAPBTLSMn emonic for assess ment in which 9/27/2011tance69487272.docD90er9/27/2011id not contact medical 90fo9/27/2011 not check medication f90pti

each area of the body is evalua ted for Deform ities, Contus ions, Abrasi ons, Punctu res/Pe netrat ions, Burns, Tender ness, Lacera tions, and Swelli ng.Det ailed Physic al ExamTh e part of the assess ment proces s in which a detail ed areabyarea exam is perfor med on patien ts whose proble ms cannot be readil y 9/27/2011tance69487272.docD91er9/27/2011id not contact medical 91fo9/27/2011 not check medication f91pti

identi fied or when more specif ic inform ation is needed about proble ms identi fied in the focuse d histor y and physic al exam.F ocused Histor y And Physic al ExamPa rt of the assess ment proces s in which the patien t''s major compla ints or any proble ms that are immedi ately eviden t are furthe r and more specif 9/27/2011tance69487272.docD92er9/27/2011id not contact medical 92fo9/27/2011 not check medication f92pti

ically evalua ted.Fr ostbit eDamag e to tissue s as the result of exposu re to cold; frozen body parts. Genera l Impres sionOv erall initia l impres sion that determ ines the priori ty for patien t care; based on the patien t''s surrou ndings , the mechan ism of injury , signs and sympto ms, and the chief compla int.Go lden 9/27/2011tance69487272.docD93er9/27/2011id not contact medical 93fo9/27/2011 not check medication f93pti

HourTi me from injury to defini tive care, during which treatm ent of shock or trauma tic injuri es should occur becaus e surviv al potent ial is best.G uardin gInvol untary muscle contra ctions (spasm ) of the abdomi nal wall, an effort to protec t the inflam ed abdome n.Hypo thermi aA condit ion in which the intern al 9/27/2011tance69487272.docD94er9/27/2011id not contact medical 94fo9/27/2011 not check medication f94pti

body temper ature falls below 95 degree s F (35 degree s C) after exposu re to a cold enviro nment. Initia l Assess mentPa rt of the assess ment proces s that helps you to identi fy any immedi ately or potent ially lifethreat ening condit ions so that you can initia te lifesa ving care.J aundic eYello w skin or sclera color 9/27/2011tance69487272.docD95er9/27/2011id not contact medical 95fo9/27/2011 not check medication f95pti

that is caused by liver diseas e or dysfun ction. Mechan ism Of Injury (MOI)F orces or energy transm ission applie d to the body that cause injury .Nasal Flarin gFlari ng out of the nostri ls, indica ting that there is an airway obstru ction. Nature Of Illnes s (NOI)G eneral type of illnes s a patien t is experi encing .Ongoi ng 9/27/2011tance69487272.docD96er9/27/2011id not contact medical 96fo9/27/2011 not check medication f96pti

Assess mentPa rt of the assess ment proces s in which proble ms are reeval uated and respon ses to treatm ent are assess ed. cerebe llumop en fractu reAny break in a bone in which the overly ing skin has been damage d.pate llaOut er and smalle r bone of the two bones of the lower leg.Fr acture in which bone fragme nts are

One of the three major subdivisions of the brain, sometimes called the "little brain"; coordinates the various activities of the brain, particularly fine body movements.

9/27/2011tance69487272.docD97er9/27/2011id not contact medical 97fo9/27/2011 not check medication f97pti

separa ted from one anothe r and not in anatom ic alignm ent.Co llarbo ne; it is latera l to the sternu m and medial to the scapul a.calc aneusH eel bone.S imple joint where the bony projec tions of the scapul a and the clavic le meet at the top of the should er.Mus culosk eletal caresu pine hypote nsive syndro meLow blood pressu re 9/27/2011tance69487272.docD98er9/27/2011id not contact medical 98fo9/27/2011 not check medication f98pti

result ing from compre ssion of the inferi or vena cava by the weight of the pregna nt uterus when the mother is supine .Infla mmatio n of the perito neum.s olid organs Solid masses of tissue where much of the chemic al work of the body takes place (eg, the liver, spleen , pancre as, and kidney s).ope n abdomi nal 9/27/2011tance69487272.docD99er9/27/2011id not contact medical 99fo9/27/2011 not check medication f99pti

injury Involu ntary muscle contra ctions (spasm ) of the abdomi nal wall in an effort to protec t the inflam ed abdome n; a sign of perito nitis. hematu riafla nkevis cerati onAbdo men & genita lia injuri estens ion pneumo thorax Accumu lation of air or gas in the pleura l cavity that progre ssivel y increa ses the pressu re in the 9/27/2011tance69487272.docD100er9/27/2011id not contact medical 100fo9/27/2011 not check medication f100pti

chest with potent ially fatal result s.pulm onary contus ionBru ise of the lung.p ericar diumFi brous sac that surrou nds the heart. hemoth oraxCo llecti on of blood in the pleura l cavity .myoca rdial contus ionBru ise of the heart muscle .occlu sive dressi ngDres sing made of Vaseli ne gauze, alumin um foil, or plasti c that preven 9/27/2011tance69487272.docD101er9/27/2011id not contact medical 101fo9/27/2011 not check medication f101pti

ts air and liquid s from enteri ng or exitin g a wound. open chest injury Injury to the chest in which the chest wall itself is penetr ated, by a fractu red rib or, more freque ntly, by an extern al object such as a bullet or knife. parado xical motion Motion of the chest wall sectio n that is detach ed in a flail chest; 9/27/2011tance69487272.docD102er9/27/2011id not contact medical 102fo9/27/2011 not check medication f102pti

the motion is exactl y the opposi te of normal motion during breath ing (ie, in during inhala tion, out during exhala tion). Chest injuri esclos ed chest injury Injury to the chest in which the skin is not broken , usuall y due to blunt trauma .dyspn eaDiff iculty breath ing.fl ail chestC onditi on in which two or more ribs are 9/27/2011tance69487272.docD103er9/27/2011id not contact medical 103fo9/27/2011 not check medication f103pti

fractu red in two or more places or in associ ation with a fractu re of the sternu m so that a segmen t of chest wall is effect ively detach ed from the rest of the thorac ic cage.f lutter valvet ympani c membra neMost poster ior portio n of the craniu m.pinn aExter nal, visibl e part of the ernocl eidoma stoid muscle sMuscl es on 9/27/2011tance69487272.docD104er9/27/2011id not contact medical 104fo9/27/2011 not check medication f104pti

either side of the neck that allow moveme nt of the head.s ubcuta neous emphys emaPre sence of air in soft tissue s, causin g a charac terist ic crackl ing sensat ion on palpat ion.te mporom andibu lar joint (TMJ)m axilla eBranc h of the intern al audito ry canal that connec ts the middle ear to the oropha rynx.e xterna l audito 9/27/2011tance69487272.docD105er9/27/2011id not contact medical 105fo9/27/2011 not check medication f105pti

ry canalE ar canal; leads to the tympan ic membra ne.air emboli smscle raToug h, fibrou s, white portio n of the eye that protec ts the more delica te inner struct ures.C hapter 26Face and Throat Injuri esreti nal detach mentSe parati on of the retina from its attach ments at the back of the eye.op tic nerveC ranial nerve that 9/27/2011tance69487272.docD106er9/27/2011id not contact medical 106fo9/27/2011 not check medication f106pti

transm its visual inform ation to the brain. orbitB ony eye socket .pupil Circul ar openin g in the middle of the iris that admits light to the back of the eye.Gl ands that produc e fluids to keep the eye moist; also called tear glands .irish yphema Transp arent tissue layer in front of the pupil and iris of the perfic 9/27/2011tance69487272.docD107er9/27/2011id not contact medical 107fo9/27/2011 not check medication f107pti

ial burnBu rn affect ing only the epider mis, charac terize d by skin that is red but not bliste red or actual ly burned throug h; tradit ionall y called a firstdegree burn.C hapter 25lace ration Jagged open wound. mucous membra neLini ng of body caviti es and passag es that are in direct contac t with the outsid e enviro 9/27/2011tance69487272.docD108er9/27/2011id not contact medical 108fo9/27/2011 not check medication f108pti

nment. occlus ive dressi ngDres sing made of Vaseli ne gauze, alumin um foil, or plasti c that preven ts air and liquid s from enteri ng or exitin g a wound. open injury Injury in which there is a break in the surfac e of the skin or the mucous membra ne, exposi ng deeper tissue to potent ial contam inatio n.part ialthickn 9/27/2011tance69487272.docD109er9/27/2011id not contact medical 109fo9/27/2011 not check medication f109pti

ess burnBu rn affect ing the epider mis and some portio n of the dermis but not the subcut aneous tissue , charac terize d by bliste rs and skin that is white to red, moist, and mottle d; tradit ionall y called a second degree burn.p enetra ting woundI njury result ing from a sharp, pointe d object 9/27/2011tance69487272.docD110er9/27/2011id not contact medical 110fo9/27/2011 not check medication f110pti

.hemat omaBur n that affect s all skin layers and may affect the subcut aneous layers , muscle , bone, and intern al organs , leavin g the area dry, leathe ry, and white, dark brown, or charre d; tradit ionall y called a thirddegree burn.e viscer ationD isplac ement of organs outsid e the body.I njury in which 9/27/2011tance69487272.docD111er9/27/2011id not contact medical 111fo9/27/2011 not check medication f111pti

damage occurs beneat h the skin or mucous membra ne but the surfac e remain s intact .compa rtment syndro meSwel ling in a confin ed space that produc es danger ous pressu re; may cut off blood flow or damage sensit ive tissue .Shock caused by severe infect ion, usuall y a bacter ial infect ockCon dition in 9/27/2011tance69487272.docD112er9/27/2011id not contact medical 112fo9/27/2011 not check medication f112pti

which the circul atory system fails to provid e suffic ient circul ation so that every body part can perfor m its functi on; also called hypope rfusio n.sphi ncters Circul ar muscle s that encirc le and, by contra cting, constr ict a duct, tube, or openin g.sync opeFai nting spell or transi ent loss of consci ousnes 9/27/2011tance69487272.docD113er9/27/2011id not contact medical 113fo9/27/2011 not check medication f113pti

s.Chap ter 24Soft tissue injuri esabra sionLo ss or damage of the superf icial layer of skin as a result of a body part rubbin g or scrapi ng across a rough or hard surfac e.psyc hogeni c shockS hock caused by a sudden , tempor ary reduct ion in blood supply to the brain that causes fainti ng (synco pe).se nsitiz ationi rrever 9/27/2011tance69487272.docD114er9/27/2011id not contact medical 114fo9/27/2011 not check medication f114pti

sible shockF inal stage of shock, result ing in deathn euroge nic shockB luishgray skin color, caused by reduce d levels of oxygen in the blood. decomp ensate d shockL ate stage of shock when blood pressu re is fallin g.dehy dratio nEarly stage of shock, in which the body can still compen sate for blood loss.A n 9/27/2011tance69487272.docD115er9/27/2011id not contact medical 115fo9/27/2011 not check medication f115pti

inflat able device that covers the legs and abdome n; used to splint the lower extrem ities or pelvis or to contro l bleedi ng in the lower extrem ities, pelvis , or abdomi nal cavity .press ure pointP oint where a blood vessel lies near a bone; useful when direct pressu re and elevat ion do not contro l bleedi ng.sho 9/27/2011tance69487272.docD116er9/27/2011id not contact medical 116fo9/27/2011 not check medication f116pti

ckCond ition in which the circul atory system fails to provid e suffic ient circul ation so that every body part can perfor m its functi on; also called hypope rfusio n.tour niquet Bleedi ng contro l method of last resort that occlud es arteri al flow; used only when all other method s have failed & the patien 9/27/2011tance69487272.docD117er9/27/2011id not contact medical 117fo9/27/2011 not check medication f117pti

t''s life is in danger .veins Blood vessel s that carry blood from the tissue s to the heart. hemorr hageBl eeding hypovo lemic shockC onditi on in which low blood volume , due to massiv e intern al or extern al bleedi ng or extens ive loss of body water, result s in inadeq uate perfus rfusio nNoseb leedDi scolor ation of the 9/27/2011tance69487272.docD118er9/27/2011id not contact medical 118fo9/27/2011 not check medication f118pti

skin associ ated with a closed wound; bruisi ng.cap illari esaort aPrinc ipal artery leavin g left side of heart and carryi ng freshl y oxygen ated blood to the body.a rterio lesSma llest branch es of arteri es leadin g to vast networ k of capill aries. Chapte r 22Blee dingme chanis m of injury (MOI)f orces or energy transm ission applie 9/27/2011tance69487272.docD119er9/27/2011id not contact medical 119fo9/27/2011 not check medication f119pti

d to body that cause injury .multi system trauma patien tA patien t who experi enced trauma that affect s more than one body system .penet rating trauma Injury caused by object s, such as knives and bullet s, that pierce surfac e of body and damage intern al tissue s and organs .Aware ness that unseen lifethreat ening injuri 9/27/2011tance69487272.docD120er9/27/2011id not contact medical 120fo9/27/2011 not check medication f120pti

es may exist when determ ining mechan ism of injury .decel eratio norgan ic brain syndro medepr ession A persis tent mood of sadnes s, despai r, and discou rageme nt; may be a sympto m of many differ ent mental and physic al disord ers, or it may be a disord er on its own.fu nction al disord erA disord er in which there 9/27/2011tance69487272.docD121er9/27/2011id not contact medical 121fo9/27/2011 not check medication f121pti

is no known physio logic reason for the abnorm al functi oning of an organ or organ system .behav ioral crisis The point at which a person ''s reacti ons to events interf ere with activi ties of daily living ; this become s a psychi atric emerge ncy when it causes a major life interr uption , such as attemp ted 9/27/2011tance69487272.docD122er9/27/2011id not contact medical 122fo9/27/2011 not check medication f122pti

suicid e.Chap ter 19 Behavi or Emerge ncyact ivitie s of daily living (ADL)T he basic activi ties a person usuall y accomp lishes during a normal day, such as eating , dressi ng, and bathin g.alte red mental status A change in the way a person thinks and behave s that may signal diseas e in the centra l nervou s system 9/27/2011tance69487272.docD123er9/27/2011id not contact medical 123fo9/27/2011 not check medication f123pti

or elsewh ere in the body.A system that delive rs air to the mouth and lungs at variou s atmosp heric pressu res, increa sing with the depth of the dive; stands for selfcontai ned underw ater breath ing appara tus.Su rvival , at least tempor arily, after suffoc ation in water. Radiat ionThe transf er of heat to colder object 9/27/2011tance69487272.docD124er9/27/2011id not contact medical 124fo9/27/2011 not check medication f124pti

s in the enviro nment by radian t energy , for exampl e heat gain from a fire.l aryngo spasmA chambe r, usuall y a small room, pressu rized to more than atmosp heric pressu re.hea tstrok eThe loss of heat by direct contac t (eg, when a body part comes into contac t with a colder object ).conv ection The loss of body 9/27/2011tance69487272.docD125er9/27/2011id not contact medical 125fo9/27/2011 not check medication f125pti

heat caused by air moveme nt (eg, breeze blowin g across the body). ambien t temper atureT he temper ature of the surrou nding enviro nment. antive ninsti mulant An agent that produc es an excite d state. substa nce abuseT he misuse of any substa nce to produc e some desire d effect .toler anceTh e need for increa sing amount s of a 9/27/2011tance69487272.docD126er9/27/2011id not contact medical 126fo9/27/2011 not check medication f126pti

drug to obtain the same effect .toxin A poison or harmfu l substa nce.vo mituss edativ eA substa nce that decrea ses activi ty and excite ment.h ypnoti cantid oteA substa nce that is used to neutra lize or counte ract a poison .Chapt er 17 WhealA raised , swolle n, welldefine d area on the skin result ing from 9/27/2011tance69487272.docD127er9/27/2011id not contact medical 127fo9/27/2011 not check medication f127pti

an insect bite or allerg ic reacti on.Whe ezingA highpitche d, whistl ing breath sound, charac terist ically heard on expira tion in patien ts with asthma or COPD.l eukotr ienesC hemica l substa nces that contri bute to anaphy laxis; releas ed by the immune system in allerg ic reacti aphyla xisThe passag e of 9/27/2011tance69487272.docD128er9/27/2011id not contact medical 128fo9/27/2011 not check medication f128pti

an unusua lly large volume of urine in a given period ; in diabet es, this can result from wastin g of glucos e in the urine. Erosio n of the stomac h or intest inal lining .Chapt er 15 Diabet ic Emerge ncyAci dosisA pathol ogic condit ion result ing from the accumu lation of acids in the body.d iabete s mellit usA 9/27/2011tance69487272.docD129er9/27/2011id not contact medical 129fo9/27/2011 not check medication f129pti

metabo lic disord er in which the abilit y to metabo lize carboh ydrate s (sugar s) is impair ed, usuall y becaus e of a lack of insuli n.diab etic comaUn consci ousnes s caused by dehydr ation, very high blood glucos e levels , and acidos is in diabet es.dia betic ketoac idosis (DKA)A form of acidos is in uncont rolled diabet 9/27/2011tance69487272.docD130er9/27/2011id not contact medical 130fo9/27/2011 not check medication f130pti

es in which certai n acids accumu late when insuli n is not availa ble.Gl ucoseO ne of the basic sugars ; it is the primar y fuel, along with oxygen , for cellul ar metabo lism.H ormone A chemic al substa nce that regula tes the activi ty of body organs and tissue s; produc ed by a gland. Hyperg lycemi aAbnor mally 9/27/2011tance69487272.docD131er9/27/2011id not contact medical 131fo9/27/2011 not check medication f131pti

high glucos e level in the blood. Hypogl ycemia Comple te obstru ction of blood circul ation in a given organ as a result of compre ssion or entrap ment; an emerge ncy situat ion causin g death of tissue .Infla mmatio n of the pancre as.cys titisI nflamm ation of the bladde r.appe ndicit isInfl ammati on of the append ix.cho 9/27/2011tance69487272.docD132er9/27/2011id not contact medical 132fo9/27/2011 not check medication f132pti

lecyst itisAc ute Abdome nacute abdome nstrok eA loss of brain functi on in certai n brain cells that do not get enough oxygen during a CVA. Usuall y caused by obstru ction of the blood vessel s in the brain that feed oxygen to those brain cells. thromb osispo sticta l statei schemi aA lack of oxygen that depriv es 9/27/2011tance69487272.docD133er9/27/2011id not contact medical 133fo9/27/2011 not check medication f133pti

tissue s of necess ary nutrie nts, result ing from partia l or comple te blocka ge of blood flow; potent ially revers ible becaus e perman ent injury has not yet occurr ed.Cel ls in the brain that die as a result of loss of blood flow to the brain. incont inence Weakne ss on one side of the body.h emorrh agic stroke 9/27/2011tance69487272.docD134er9/27/2011id not contact medical 134fo9/27/2011 not check medication f134pti

One of the two main types of stroke ; occurs as a result of bleedi ng inside the brain. genera lized seizur eThe inabil ity to pronou nce speech clearl y, often due to loss of the nerves or brain cells that contro l the small muscle s in the larynx .The inabil ity to unders tand or produc e speech .ventr icular fibril 9/27/2011tance69487272.docD135er9/27/2011id not contact medical 135fo9/27/2011 not check medication f135pti

lation Disorg anized , ineffe ctive twitch ing of the ventri cles, result ing in no blood flow and a state of cardia c arrest .ventr icular tachyc ardia (VT)Ra pid heart rhythm , electr ical impuls e begins in ventri cle (inste ad of atrium ), may result in inadeq uate blood flow, eventu ally deteri orate into cardia c 9/27/2011tance69487272.docD136er9/27/2011id not contact medical 136fo9/27/2011 not check medication f136pti

arrest .Poste riorba ck surfac e of the body; side away from you in standa rd anatom ic positi on.Sup eriorp art of the body, or any body part, nearer to the head.S yncope Fainti ng spell or transi ent loss of consci ousnes s.Tach ycardi aRapid heart rhythm , more than 100 beats/ min.Is chemia lack of oxygen that depriv es 9/27/2011tance69487272.docD137er9/27/2011id not contact medical 137fo9/27/2011 not check medication f137pti

tissue s of necess ary nutrie nts.Lu menInf arctio nDeath of a body tissue , usuall y caused by interr uption of its blood supply .Dilat ionWid ening of a tubula r struct ure such as a corona ry artery .Defib rillat eTo shock a fibril lating (chaot ically beatin g) heart with specia lized electr ical curren t in an attemp 9/27/2011tance69487272.docD138er9/27/2011id not contact medical 138fo9/27/2011 not check medication f138pti

t to restor e a normal rhythm ic beat.c oronar y artery cardio genic shockA state in which not enough oxygen is delive red to tissue s of body, caused by low output of blood from the heart. It can be a severe compli cation of a large acute myocar dial infarc tion, as well as other condit ions.S low heart rate, less than 9/27/2011tance69487272.docD139er9/27/2011id not contact medical 139fo9/27/2011 not check medication f139pti

60 beats/ rdiac arrest A state in which the heart fails to genera te an effect ive and detect able blood flow; pulses are not palpab le in cardia c arrest , even if muscul ar and electr ical activi ty contin ues in the heart. Atrium Upper chambe r of the heart. Athero sclero sisA disord er in which choles terol 9/27/2011tance69487272.docD140er9/27/2011id not contact medical 140fo9/27/2011 not check medication f140pti

and calciu m build up inside walls of blood vessel s, eventu ally leadin g to partia l or comple te blocka ge of blood flow.A rrhyth miaAn irregu lar or abnorm al heart rhythm .The princi pal artery leavin g the left side of the heart and carryi ng freshl y oxygen ated blood to the body.a ngina pector isTran sient (short 9/27/2011tance69487272.docD141er9/27/2011id not contact medical 141fo9/27/2011 not check medication f141pti

lived) chest discom fort caused by partia l or tempor ary blocka ge of blood flow to the heart muscle .Anter iorHar sh, highpitche d, barkin g inspir atory sound often heard in acute laryng eal (upper airway ) obstru ction. Wheezi ngHigh pitche d, whistl ing breath sound, charac terist ically heard on expira tion 9/27/2011tance69487272.docD142er9/27/2011id not contact medical 142fo9/27/2011 not check medication f142pti

in patien ts with asthma or COPD.s evere acute respir atory syndro me (SARS) pulmon ary emboli smBloo d clot that breaks off from a large vein and travel s to the blood vessel s of the lung, causin g obstru ction of blood flow.P artial or comple te accumu lation of air in the pleura l space. Sharp, stabbi ng pain 9/27/2011tance69487272.docD143er9/27/2011id not contact medical 143fo9/27/2011 not check medication f143pti

in the chest that is worsen ed by a deep breath or other chest wall moveme nt; often caused by inflam mation or irrita tion of the pleura .Pneum oniapl eural effusi onColl ection of fluid betwee n lung and chest wall that may compre ss lung.H ypoxia Condit ion in which the body's cells, tissue s do not have enough oxygen .Infec 9/27/2011tance69487272.docD144er9/27/2011id not contact medical 144fo9/27/2011 not check medication f144pti

tious diseas e, epiglo ttis become s inflam ed, enlarg ed, may cause upper airway obstru ction. Blood clot or other substa nce in circul atory system that travel s to a blood vessel where it causes blocka ge.chr onic obstru ctive pulmon ary diseas e (COPD) A slow proces s of dilati on and disrup tion of the airway s and alveol i, 9/27/2011tance69487272.docD145er9/27/2011id not contact medical 145fo9/27/2011 not check medication f145pti

caused by chroni c bronch ial obstru ction. Throug h the skin; a medica tion delive ry route. transd ermal medica tionst opical medica tionsL otions , creams , ointme nts applie d to the surfac e of the skin and affect only that area; a medica tion delive ry route. trade namebr and name a manufa cturer gives a 9/27/2011tance69487272.docD146er9/27/2011id not contact medical 146fo9/27/2011 not check medication f146pti

medica tion; the name is capita lized. Under the tongue ; a medica tion delive ry route. Suspen sionsu bcutan eous (SC) inject ionInj ection into the tissue betwee n the skin and muscle ; a medica tion delive ry route. side effect sAny effect s of a medica tion other than the desire d ones.p rescri ption medica tionsM edicat 9/27/2011tance69487272.docD147er9/27/2011id not contact medical 147fo9/27/2011 not check medication f147pti

ions that are distri buted to patien ts only by pharma cists accord ing to a physic ian''s order. Polyph armacy use of multip le medica tions on a regula r basis. Pharma cology per rectum (PR)Th rough the rectum ; a medica tion delive ry route. Oxygen gas that all cells need for metabo lism; the heart and brain, 9/27/2011tance69487272.docD148er9/27/2011id not contact medical 148fo9/27/2011 not check medication f148pti

especi ally, cannot functi on withou t oxygen .per os (PO)Th rough the mouth; a medica tion delive ry route; same as oral.s imple sugar readil y absorb ed by bloods tream; it is carrie d on EMS unit.o verthecounte r (OTC) medica tionsM edicat ions purcha sed direct ly by a patien t withou t a prescr iption 9/27/2011tance69487272.docD149er9/27/2011id not contact medical 149fo9/27/2011 not check medication f149pti

.OralB y mouth; a medica tion delive ry route. Nitrog lyceri nmedic ation that increa ses cardia c perfus ion by causin g arteri es to dilate ; you may be allowe d to help the patien t selfadmini ster the medica tion.i ntraos seous (IO)In to the bone; a medica tion delive ry route. intrav enous (IV) inject ioninj ection 9/27/2011tance69487272.docD150er9/27/2011id not contact medical 150fo9/27/2011 not check medication f150pti

direct ly into a vein; a medica tion delive ry route. therap eutic uses for a specif ic medica tion.I nhalat ionact ive, muscul ar part of breath ing that draws air into airway and lungs. intram uscula r (IM) inject ionHyp oglyce miaabn ormall y low blood glucos e level. Gelsem iliqui d substa nce that is admini stered 9/27/2011tance69487272.docD151er9/27/2011id not contact medical 151fo9/27/2011 not check medication f151pti

orally in capsul e form or throug h plasti c tubes. amount of medica tion given on the basis of the patien t''s size and tivate d charco alPhar magolo gySimp lexA trusti ng relati onship that you build with your patien t.VHF & UHF channe ls, FCC has design ated exclus ively for EMS use.Pa gingTh e abilit 9/27/2011tance69487272.docD152er9/27/2011id not contact medical 152fo9/27/2011 not check medication f152pti

y to transm it and receiv e simult aneous ly.ded icated linesp ecial teleph one line used for specif ic pointtopoint commun icatio ns; AKA "hot line." cellul ar teleph onelow -power portab le radio that commun icates thru an interc onnect ed series of repeat er statio ns called "cells ."Chan nelass igned freque ncy or 9/27/2011tance69487272.docD153er9/27/2011id not contact medical 153fo9/27/2011 not check medication f153pti

freque ncies used to carry voice and/or data commun icatio ns.Cha pter 9 Commun icatio n & Doc Vocabu laryba se statio n Presen ce of air in soft tissue s, causin g a charac terist ic crackl ing sensat ion on palpat ion.Tr iagePr ocess of establ ishing treatm ent and transp ortati on priori ties accord ing to severi ty of injury 9/27/2011tance69487272.docD154er9/27/2011id not contact medical 154fo9/27/2011 not check medication f154pti

and medica l need.T wo- To ThreeWord Dyspne aScler aTough , fibrou s, white portio n of the eye that protec ts the more delica te inner struct ures.S tridor Harsh, highpitche d, crowin g inspir atory sound, such as the sound often heard in acute laryng eal (upper airway ) obstru ction. Brief histor y of a patien t''s 9/27/2011tance69487272.docD155er9/27/2011id not contact medical 155fo9/27/2011 not check medication f155pti

condit ion to determ ine signs and sympto ms, allerg ies, medica tions, pertin ent past histor y, last oral intake , and events leadin g to the injury or illnes s.Scen e SizeUpCoar se, lowpitche d breath sounds heard in patien ts with chroni c mucus in the upper airway s.Move ments in which the skin pulls 9/27/2011tance69487272.docD156er9/27/2011id not contact medical 156fo9/27/2011 not check medication f156pti

in around the ribs during inspir ation. Way in which a patien t respon ds to extern al stimul i, includ ing verbal stimul i (sound ), tactil e stimul i (touch ), and painfu l stimul i.Para doxica l Motion Motion of the chest wall sectio n that is detach ed in a flail chest; the motion is exactl y the opposi 9/27/2011tance69487272.docD157er9/27/2011id not contact medical 157fo9/27/2011 not check medication f157pti

te of normal motion during breath ing (ie, in during inhala tion, out during exhala tion). Palpat eExami ne by touch. Orient ationM ental status of a patien t as measur ed by memory of person (name) , place (curre nt locati on), time (curre nt year, month, and approx imate date), and event (what happen ed).Se condar y muscle s of 9/27/2011tance69487272.docD158er9/27/2011id not contact medical 158fo9/27/2011 not check medication f158pti

respir ation Newton s first law states that object s at rest tend to stay at rest and object s in motion tend to stay in motion unless acted on by some force. Newton s second law states that force (F) equals mass (M) times accele ration (A), that is, F = M A, in which acceleratio n is the change in 9/27/2011tance69487272.docD159er9/27/2011id not contact medical 159fo9/27/2011 not check medication f159pti

veloci ty (speed ) that occurs over time. Newton s third law states that for every action , there is an equal and opposi te reacti on Chapte r 21 cerebral edemaSwelling of the brain.cerebrumLargest part of the three subdivisions of the brain, sometimes called the "gray matter"; made up of several lobes that control movement, hearing, balance, speech, visual perception, emotions, and personality.closed head injuryInjury in which the brain has been injured but the skin has not been broken and there is no obvious bleeding.concussionTemporary loss or alteration of part or all of the brain''s abilities to function without actual physical damage to the brain.connecting nervesNerves that connect the sensory and motor nerves in the spinal cord.distractionAction of pulling the spine along its length.eyes-forward positionHead position in which the patient''s eyes are looking straight ahead and the head and torso are in line.four-person log rollRecommended procedure for moving a patient with a suspected spinal injury from the ground to a long backboard.Glasgow Coma ScaleMethod of evaluating level of consciousness that uses a scoring system for neurologic responses to specific stimuli.intervertebral diskCushion that lies between two vertebrae.involuntary activitiesActions that we do not consciously control.meningesThree distinct layers of tissue that surround and protect the brain and the spinal cord within the skull and the spinal canal.motor nervesNerves that carry information from the central nervous system to the muscles of the head injuryInjury to the head often caused by a penetrating object in which there may be bleeding and exposed brain tissue.peripheral nervous systemPart of the nervous system that consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves. These peripheral nerves may be sensory nerves, motor nerves, or connecting nerves.raccoon eyesBruising under the eyes that may indicate skull fracture.retrograde amnesiaInability to remember events leading up to a head injury.sensory nervesNerves that carry sensations of touch, taste, heat, cold, pain, or other modalities from the body to the central nervous system.somatic (voluntary) nervous systemArt of the nervous system that regulates our voluntary activities, such as walking, talking, and writing.voluntary activitiesActions that we consciously perform, in which sensory input or conscious thought determines a specific muscular activity.

9/27/2011tance69487272.docD160er9/27/2011id not contact medical 160fo9/27/2011 not check medication f160pti

Chap 20 Obstetric/GynecologicInside the uterus, the developing fetus floats in the amniotic sac. The umbilical cord connects the mother and fetus through the placenta. Eventually, contractions of the uterus will propel the neonate through the birth canal. Throughout pregnancy, the body changes to accommo- date the fetus. The primary systems involved with these changes are the respiratory, cardiovascular, and muscu- loskeletal systems. As a result of enlargement of the uterus, a pregnant patients respiratory capacity changes with increased respiratory rates and decreasing minute volumes. A pregnant patients blood volume increases by as much as 50%, and the heart rate increases by 20%. Increased hormone levels affect the musculoskeletal sys- tem by making the joints more loose or less stable. First stage of labor, dilation, begins with the onset of contractions and ends when cervix is fully dilated. Second stage of labor, expulsion of the fetus, begins when the cervix is fully dilated and ends when the infant is born. Third stage of labor, delivery of placenta, begins with birth of infant and ends with delivery of placenta. Once labor has begun, it cannot be slowed or stopped; however, there is usually time to transport the patient to the hospital during the first stage of labor. During the second stage of labor, you must decide whether to deliver the infant at the scene or transport the patient. During the third stage of labor, once the
infant has been born, you will probably not transport the patient until the placenta has delivered. Complications of pregnancy include hypertensive disor- ders, bleeding, and diabetes. During a trauma call that involves a pregnant woman, you have two patients to considerthe woman and the unborn fetus. Any trauma to the woman will have a direct effect on the condition of the fetus. Abnormal or complicated deliveries include breech deliveries (buttocks first), limb presentations (arm, leg, or foot first), and

prolapse of the umbilical cord (umbili- cal cord first). Quickly transport patient w/limb presentation or prolapsed umbilical cord to hospital. You should place a finger or hand into the vagina only to keep the walls of the vagina from compressing the infants airway during a breech presentation or to push the infants head away from the cord when the cord is prolapsed. Excessive bleeding is a serious emergency. Cover the vagina with a sterile pad; change the pad as often as necessary, and take all used pads to the hospital for examination. The Apgar score is the standard scoring system used to assess the status of a newborn. This system assigns a number value (0, 1, or 2) to five areas of activity of the newborn infant: Appearance. Shortly after birth, the skin of a light- skinned newborn infant and the mucous membranes of a dark-skinned infant should turn pink. Newborn infants often have cyanosis of the extremities for a few minutes after birth, but hands and feet should pink up quickly. Blue skin all over or blue mucous membranes signal a central cyanosis. Pulse. If a stethoscope is unavailable, you can mea- sure pulsations with your fingers in the umbilical cord or at the brachial pulse. An infant with no pulse requires immediate CPR. Grimace or irritability. Grimacing, crying, or withdrawing in response to stimuli is normal in a newborn and indicates that the newborn infant is doing well. The way to test this is to snap a finger against the sole of the infants foot. Activity or muscle tone. The degree of muscle tone indicates the oxygenation of the newborn infants tissues. Normally, the hips and knees are flexed at birth, and, to some degree, the infant will resist attempts to straighten them out. A newborn should not be floppy or limp. Respirations. Normally, the newborns respirations are regular and rapid, with a good strong cry. If the respirations are slow, shallow, or labored, or if the cry is weak, the newborn infant may have respira- tory insufficiency and need assistance with ventila- tion. Complete absence of respirations or crying is obviously a very serious sign; in addition to assisted ventilation, CPR may be necessary. The total of the five numbers is the Apgar score. A perfect score is 10. The Apgar score should be calculated at 1 minute and 5 minutes after birth. Most newborn infants will have a score of 7 or 8 at one minute and a score of 8 to 10 four minutes later. Follow these steps in assessing a newborn infant: 1. Quickly calculate the Apgar score to establish a baseline on the newborns status. 2. Suctioning and stimulation should result in an immediate increase in respirations. If they do not, you must begin ventilations with a bag-mask device. Unlike adults, who may have a sudden cardiac arrest, newborn infants who are in cardiac arrest usually have a respiratory arrest first. Therefore, it is essential to keep the infant ventilating and oxygenating well. 3. If the newborn is breathing well, you should next check the pulse rate by feeling the brachial pulse or the pulsations at the base of the umbilical cord. The pulse rate should be at least 100 beats/min. If it is not, begin ventilations with a bagmask device. This alone may increase the newborn infants heart rate. Reassess respirations and heart rate at least every 30 seconds to make sure that the pulse rate is increasing and that respirations are becoming spontaneous. 4. Assess the newborns skin color. Check the newborn for central cyanosis. If present, or you do not think the skin color is normal for a newborn, adminis- ter blow-by oxygen by holding oxygen tubing at high-flow (10 to 15 L/min) close to the newborn infants face. 5. Remember, you now have two patients. You should request a second unit as soon as possible if you determine that the newborn infant is in any distress and will require resuscitation. In situations in which assisted ventilation is required, you should use a newborn bag-mask device. Cover the newborns mouth and nose with the mask, and begin ventilation with high-flow oxygen at a rate of 40 to 60 breaths/min. Make sure you have a good mask-to-face seal. With gentle pres- sure, make the chest rise with each ventilation. It may be necessary to bypass the pop-off valve to accomplish this, especially during the first few breaths. If the infant does not begin breathing on his or her own or does not have an adequate heart rate, continue CPR and rapidly transport. Once CPR has been started, do not stop until the infant responds with adequate res- pirations and heart rates or is pronounced dead by a physician. Do not give up! Many infants have survived without brain damage after prolonged periods of effec- tive CPR. If the infant presents in distress, do not waste time on the assessing the Apgar score, begin resuscitation immediately.

9/27/2011tance69487272.docD161er9/27/2011id not contact medical 161fo9/27/2011 not check medication f161pti

Apgar Scoring ScoreArea of Activity21 0Appeara nceEntire infant is pink.Body is pink, but hands & feet remain blue.Entir e infant is blue or pale.Pulse More than 100 beats/min Fewer than 100 beats/min Absent pulseGrim ace or irritability Infant cries & tries to move foot away from finger snapped against sole of foot.Infant gives a weak cry in response to stimulus.I nfant does not cry or react to stimulus. Activity or muscle toneInfant resists attempts to straighten hips and knees.Infa nt makes 9/27/2011tance69487272.docD162er9/27/2011id not contact medical 162fo9/27/2011 not check medication f162pti

weak attempts to resist straighteni ngInfant is completel y limp, w/no muscle tone.Respi rationRapi d respiration sSlow respiration sAbsent respiration s Chapter 20 AbortionD elivery of the fetus and placenta before 20 weeks; miscarriag e.Abruptio placenta A premature separation of the placenta from the wall of the uterus.Am niotic sacFluidfilled, baglike membrane in which the fetus develops. Apgar scoreScori ng system for assessing the status of a newborn that assigns a number value to 9/27/2011tance69487272.docD163er9/27/2011id not contact medical 163fo9/27/2011 not check medication f163pti

each of five areas of assessmen t.Birth canalVagi na and cervix.Blo ody showSmal l amount of blood at vagina that appears at beginning of labor and may include a plug of pinktinged mucus that is discharge d when cervix begins to dilate.Bre ech presentati onDeliver y in which the buttocks come out first.Cervi xLower third, or neck, of the uterus.Cro wningApp earance of the infant''s head at the vaginal opening during labor.Ecla mpsiaSeiz ures (convulsio ns) resulting from 9/27/2011tance69487272.docD164er9/27/2011id not contact medical 164fo9/27/2011 not check medication f164pti

severe hypertensi on in a pregnant woman.Ec topic pregnancy Pregnancy that develops outside the uterus, typically in a fallopian tube.Embr yo The fertilized egg that is the early stages of a fetus.Endo metrium The lining of the inside of the uterus.Fet al alcohol syndrome Condition of infants who are born to alcoholic mothers; characteri zed by physical and mental retardatio n and a variety of congenital abnormali ties.

9/27/2011tance69487272.docD165er9/27/2011id not contact medical 165fo9/27/2011 not check medication f165pti

FetusDeveloping, unborn infant inside the uterus.Fundus dome-shaped top of uterus.Gestational diabetesDiabetes that develops during pregnancy in women who did not have diabetes before pregnancy.Lightening sensation felt by pregnant patient when fetus positions itself for delivery.Limb presentationDelivery in which the presenting part is a single arm, leg, or foot.MeconiumDark green material in the amniotic fluid that can indicate disease in newborn; meconium can be aspirated into the infant''s lungs during delivery; baby's first bowel movement.MiscarriageDelivery of the fetus and placenta before 20 weeks; spontaneous abortion.MultigravidaWoman who has had previous pregnancies.MultiparaWoman who has had more than one live birth.Nuchal cordUmbilical cord that is wrapped around the infant''s neck.Pelvic inflammatory diseaseInfection of the fallopian tubes and the surounding tissues of the pelvis.PerineumArea of skin between the vagina and the anus.PlacentaTissue attached to uterine wall that nourishes fetus thru umbilical cord.Placenta abruptioPremature separation of the placenta from the wall of the uterus.PreeclampsiaCondition of late pregnancy that involves headache, visual changes, swelling of hands and feet; also called pregnancy-induced hypertension.Pregnancyinduced hypertensionCondition of late pregnancy that involves headache, visual changes, and swelling of the hands and feet; also called preeclampsia.Presentation Position in which an infant is born; part of infant that appears first.PrimigravidaWoman who is experiencing her first pregnancy.PrimiparaWoman who has had one live birth.Prolapse of the umbilical cord Umbilical cord comes out of the vagina before the infant.Spina bifidaDevelopmental defect in which a portion of spinal cord or meninges may protrude outside of the vertebrae and possibly even outside of body, usually at lower third of spine in lumbar areaSupine hypotensive syndromeLow blood pressure resulting from compression of inferior vena cava by weight of pregnant uterus when mother is supine.Umbilical cord Conduit connecting mother to infant via placenta; two arteries, one vein.UterusMuscular organ where fetus grows, also called womb; responsible for contractions during labor.VaginaOutermost cavity of a woman''s reproductive system; lower part of birth canal.Vertex presentation A delivery in which the head comes out first. HYPERLINK "" \o "Section 8. Special Patient Populations" SectSection 8. Special Patient Populations, 1104 HYPERLINK "" \o "Chapter 32. Pediatric Emergencies" Chapter 32. Pediatric Emergencies, 1146 HYPERLINK "" \o "Chapter 33. Geriatric Emergencies" Chapter 33. Geriatric Emergencies, 1214 HYPERLINK "" \o "Chapter 34. Patients With Special Challenges" Chapter 34. Patients With Special Challenges, 1260 Children are not only smaller than adults and more vulnerable, they are also anatomically, physiologically, and psychologically different from adults in some important ways. Infancy is the first year of life. If possible, allow the parent or caregiver to hold the infant during the assessment. The toddler is 1 to 3 years of age. Toddlers may experi- ence stranger anxiety but may be able to be distracted by a special object (blanket) or toy. Preschool-age children are 3 to 6 years of age. Preschool- age children can understand directions and can identify painful areas when questioned. Tell these children what you are going to do before you do it. This action can help prevent the development of frightening fantasies. School-age children are 6 to 12 years of age. These chil- dren are familiar with the physical examination pro- cess. Talk about their interests to distract them during a procedure. Adolescents are 12 to 18 years of age. Respect the ado- lescents modesty. Remember that even though this age group is physically similar to adults, adolescents are still children on an emotional level. General rules for dealing with pediatric patients of all ages include appearing confident, being calm, remaining honest, and keeping parents or caregivers together with the pediatric patient as much as possible. The growing bodies of the pediatric patient create some special considerations. The tongue is large relative to other structures, so it poses a higher risk of airway obstruction than in an adult. An infant breathes faster than an older child. Breathing requires the use of chest muscles and the diaphragm. The airway in a child has a smaller diameter than the air- way in an adult and is therefore more easily obstructed. A rapid heart beat and blood vessel constriction helps pediatric patients to compensate for decreased perfusion.

9/27/2011tance69487272.docD166er9/27/2011id not contact medical 166fo9/27/2011 not check medication f166pti

Childrens internal organs are not as insulated by fat and may be injured more severely, and children have less circulating blood, so that, although children exhibit the signs of shock more slowly, they go into shock more quickly, with less blood loss. Childrens bones are more flexible and bend more with injury and the ends of the long bones, where growth occurs, are weaker and may be injured more easily. Because a young child might not be able to speak, your assessment of his or her condition must be based in large part on what you can see and hear yourself. Families may be helpful in providing vital information about an acci- dent or illness. Use the pediatric assessment triangle to obtain a general impression of the infant or child. You will need to carry special sizes of airway equipment for pediatric patients. Use a pediatric resuscitation tape measure to determine the appropriately sized equipment for children. The three keys to successful use of the bag-mask device in a child are: (1) have the appropriate equipment in the right size; (2) maintain a good face-to-mask seal; and (3) ventilate at the appropriate rate and volume. Signs of shock in children are tachycardia, poor capillary refill time, and mental status changes. You must be very alert for signs of shock in a pediatric patient because they can decompensate rapidly. Febrile seizures may be a sign of a more serious problem such as meningitis. The most common cause of dehydration in children is vomiting and diarrhea. Life-threatening diarrhea can develop in an infant in hours. Fever is a common reason why parents or caregivers call 9-1-1. Body temperatures of 100.4F (38C) or higher are considered to be abnormal. Trauma is the number one killer of children in the United States. A victim of sudden infant death syndrome (SIDS) will be pale or blue, not breathing, and unresponsive. He or she may show signs of postmortem changes, including rigor mortis and dependent lividity; if so, call medical control to report the situation. Carefully inspect the environment where a SIDS victim was found, looking for signs of illness, abusive family interactions, and objects in the childs crib. Provide support for the family in whatever way you can, but do not make judgmental statements. Any death of a child is stressful for family members and for health care providers. In dealing with the family, acknowledge their feelings, keep any instructions short and simple, use the childs name, and maintain eye contact. Be prepared to respond to philosophical as well as medi- cal questions, in most cases by indicating concern and understanding; do not be specific about the cause of death. Be alert for signs of posttraumatic stress in yourself and others after dealing with the death of a child. It can help to talk about the event and your feelings with your EMS colleagues. Chapter 30PediatricsAdolescentsChildren between 12 to 18 years of age.apparent life-threatening event (ALTE) An event that causes unresponsiveness, cyanosis, and apnea in an infant, who then resumes breathing with stimulation.blanching Turning white. bradypnea Slow respiratory rate; ominous sign in a child that indicates impending respiratory arrest.central pulses Pulses that are closest to the core (central) part of the body where the vital organs are located; include the carotid, femoral, and apical pulses.child abuse A general term applying to all forms of child abuse and neglect.generalized tonic-clonic seizure A
seizure that features rhythmic back-and-forth motion of an extremity and body stiffness.infancy The first year of life.grunting An uh sound heard during exhalation; reflects the childs attempt to keep the alveoli open; a sign of increased work of breathing.nares The external openings of the nostrils. A single nostril opening is called a naris.neglect Refusal or failure on the part of the caregiver to pro- vide life necessities.Neisseria meningitides A form of bacterial meningitis charac- terized by rapid onset of symptoms, often leading to shock and death.pediatric assessment triangle (PAT) A structured assessment tool that allows you to rapidly form a general impressioof the infant or child without touching him or her; consists of assessing appearance, work of breathing, and circulation to the skin.pediatric resuscitation tape measure A tape used to estimate an infant or childs weight on the basis of length; appropri- ate drug doses and equipment sizes are listed on the tape.pediatrics A specialized medical practice devoted to the care of the young.pertussis An acute infectious disease characterized by a catarrhal stage, followed by a paroxysmal cough that ends in a whooping inspiration. Also called whooping cough.preschool-age Children between 3 to 6 years of Children between 6 to 12 years of age.shaken baby syndrome A syndrome seen in abused infants and children; the patient has been subjected to violent, whiplash-type shaking injuries inflicted by the abusing individual that may cause coma, seizures, and increased intracranial pressure due to tearing of the cerebral veins with consequent bleeding into the brain.sniffing position.Optimum neutral head position for the unin- jured child who requires airway managementsudden infant death syndrome (SIDS) Death of an infant or young child that remains unexplained after a complete

9/27/2011tance69487272.docD167er9/27/2011id not contact medical 167fo9/27/2011 not check medication f167pti

autopsy.toddler The period following infancy until 3 years of age.tachypnea Increased respiratory of breathing An indicator of oxygenation and ventila- tion. Work of breathing reflects the childs attempt to compensate for hypoxia.Chapter 31Pediatric EmergenciesadolescentsChildren between 12 to 18 years of age.apparent life-threatening event (ALTE)event that causes unresponsiveness, cyanosis, and apnea in an infant, who then resumes breathing with stimulation.child abuseAny improper or excessive action that injures or otherwise harms a child or infant; includes neglect and physical, sexual, and emotional abuse.dehydrationstate in which fluid losses are greater than fluid intake into the body, leading to shock and death if untreated.dependent lividityBlood settling to the lowest point of the body, causing discoloration of the skin.febrile seizureSeizure relating to a fever.gastrostomy tubefeeding tube placed directly through the wall of the abdomen; used in patients who cannot ingest liquids or solids.generalized tonic-clonic seizureseizure that features rhythmic back-and-forth motion of an extremity and body stiffness.hypoventilationReduced minute volume, either from reduced rate and/or depth of breathing.infancyfirst year of life.meningitisinflammation of the meningeal coverings of the brain and spinal cord; it is usually caused by a virus or a bacterium.Neisseria meningitidisform of bacterial meningitis characterized by rapid onset of symptoms, often leading to shock and death.neonatalfirst month after birth.occiputmost posterior portion of the skull.pediatricsspecialized medical practice devoted to the care of the young.pneumatic antishock garment (PASG)inflatable device that covers the legs and abdomen; used to splint the lower extremities or pelvis, or to control bleeding in lower extremities, pelvis, or abdominal cavity.preschool-ageChildren between 3 to 6 years of age.rigor mortisStiffening of the body; a definitive sign of between 6 to 12 years of age.shaken baby syndromeBleeding within the head and damage to the cervical spine of an infant who has been intentionally and forcibly shaken; a form of child abuse.shunttube that diverts excess cerebrospinal fluid from the brain to the abdomen.sudden infant death syndrome (SIDS)Death of an infant or young child that remains unexplained after a complete autopsy.toddlerperiod following infancy until 3 years of age.tracheostomy tubetube

inserted into the trachea in children who cannot breathe on their own; passes through the neck directly into the major airways.Chapter 32Pediatric Assessment and Managementanemiadeficiency of red blood cells or hemoglobin.apneaperiod of not breathing.AVPU scalemethod of assessing level of consciousness by determining whether the patient is awake and alert, responsive to verbal stimuli or pain, or unresponsive; used principally early in the assessment.blanchingTurning white.bradycardiaSlow heart rate, less than 60 beats/min.bradypneaSlow respiratory rate; ominous sign in a child that indicates impending respiratory arrest.capillary refill time (CRT)amount of time that it takes for blood to return to the capillary bed after applying pressure to the skin or nailbed; indicates the status of end-organ perfusion; reliable in children younger than 6 years.central pulsesPulses that are closest to the core (central) part of the body where the vital organs are located; include the carotid, femoral, and apical pulses.cracklesCrackling, rattling breath sounds signaling fluid in the air spaces of the lungs.croupinfectious disease of the upper respiratory system that may cause partial airway obstruction and is characterized by a barking cough; usually seen in children.cyanosisbluish-gray skin color that is caused by reduced levels of oxygen in the blood.end-organ perfusionstatus of perfusion to the vital organs of the body; determined by assessing capillary refill time (CRT).epiglottitisinfectious disease in which the epiglottis becomes inflamed and enlarged and may cause upper airway obstruction.grunting"uh" sound heard during exhalation; reflects the child''s attempt to keep the alveoli open; a sign of increased work of breathing.head bobbinghead lifts and tilts back during inspiration, then moves forward during expiration; a sign of increased work of breathing.meconiumdark green material in the amniotic fluid that can indicate disease in the newborn; the meconium can be aspirated into the infant''s lungs during delivery; the baby''s first bowel movement.naresexternal openings of the nostrils. A single nostril opening is called a naris.nasal flaringFlaring out of the nostrils, indicating that there is an airway obstruction.pediatric assessment triangle (PAT)structured assessment tool that allows you to rapidly form a general impression of the infant or child without touching him or her; consists of assessing appearance, work of breathing, and circulation to the skin.pediatric resuscitation tape measuretape used to estimate an infant or child''s weight on the basis of length; appropriate drug doses and equipment sizes are listed on the tape.retractionsMovements in which the skin pulls in around the ribs during inspiration.septumcentral divider in the nose.sniffing positionunusually upright position in which the patient''s head and chin are thrust slightly forwardstridorharsh, high-pitched, crowing inspiratory sound, such as the sound often heard in acute laryngeal (upper airway) obstruction.tachypneaRapid respirations.tentingcondition in which the skin does not quickly return to its original shape after being pinched; indicates dehydration.tidal volumeamount of air that is exchanged with each breath.tragussmall, rounded, fleshy bulge that lies 9/27/2011tance69487272.docD168er9/27/2011id not contact medical 168fo9/27/2011 not check medication f168pti

immediately anterior to the ear canal.transition phasetime period that allows the infant or child to become familiar with you and your equipment; only appropriate if the child''s condition is stable.tripod positionupright position in which the patient leans forward onto two arms stretched forward and thrusts the head and chin forward.wheezinghigh-pitched, whistling breath sound, characteristically heard on expiration in patients with asthma or of breathingindicator of oxygenation and ventilation. Work of breathing reflects the child''s attempt to compensate for hypoxia.xiphoid processnarrow, cartilaginous lower tip of the sternum. Chapter 33Geriatric EmergenciesAlthough assessment of geriatric patients involves the same basic approach as that for any other patient, you must take a more wary approach. Assessing an elderly person can be challenging because of communication issues, hearing and vision deficits, alteration in consciousness, complicated medical history, and the effects of multiple medications. To obtain an accurate history for a geriatric patient, patience and good communication skills are essential. A slow, deliberate approach to the patient history, with one EMT asking questions, is generally the best strategy. With changes in the respiratory system, such as a decreased ability to cough, geriatric patients are more likely to present with pneumonia. Changes in the cardiovascular system can lead to athero- sclerosis, aneurysm, stiffening heart valves, orthostatic hypotension, venous stasis, deep venous thrombosis, heart attack, heart failure, and stroke. Many patients do not present with the classic symptom of chest pain when experiencing a heart attack. Atypical presentations are seen mostly in women, elderly patients, and patients with diabetes. Dementia and delirium must be carefully evaluated in geriatric patients. As the body ages, the bones become more fragile. This leads to a higher risk of fracture in geriatric patients. Polypharmacy and changes in medications can cause serious problems for geriatric patients. Depression is treatable with medication and therapy but is a risk factor for suicide if it remains untreated in geri- atric patients. The risk of serious injury or death is more common in elderly patients who experience a traumatic injury. When you treat a geriatric trauma patient, assess the injuries and carefully look for the cause of the injury. A medical condition such as fainting could actually be the cause of a fall. The injuries from the fall and the medical condition will need to be addressed. When responding to nursing and skilled care facilities, you should determine the patients chief complaint on that day and what initial problem caused the patient to be admitted to the facility. Chapter 33Geriatric Emergenciesabdominal aortic aneurysm (AAA)condition in which the walls of the aorta in the abdomen weaken and blood leaks into the layers of the vessel, causing it to bulge.advance directivesWritten documentation that specifies medical treatment for a competent patient should the patient become unable to make decisions; also called living wills.aneurysm An enlargement of a part of an artery, resulting from weakening of the arterial wall.arteriosclerosisdisease that is characterized by hardening, thickening, and calcification of the arterial walls.ascites Fluid in the abdomen. cataracts Clouding of the lens of the eye or its surrounding transparent membranes.atherosclerosisdisorder in which cholesterol and calcium build up inside the walls of blood vessels, eventually leading to partial or complete blockage of blood flow.cataractsClouding of the lens of the eye or its surrounding transparent membranes.collagenprotein that is the chief component of connective tissues and bones.compensated shockearly stage of shock, the body can still compensate for blood loss.decompensated shocklate stage of shock, when blood pressure is falling.decubitus ulcers AKA bedsores. Sores caused by pressure of skin against a surface for long periods, range from a pink discoloration of skin to deep wound that may invade into bone or organs.deep venous thrombosis Formation of a blood clot within larger veins of an extremity, typically following a period of prolonged immobilization.delirium More or less sudden change 9/27/2011tance69487272.docD169er9/27/2011id not contact medical 169fo9/27/2011 not check medication f169pti

in mental status marked by the inability to focus, think logically, and maintain attention.dementia Slow onset of progressive disorientation, shortened attention span, loss of cognitive function.dyspnea Shortness of breath or difficulty breathing.elastinprotein found in elastic tissues such as skin and artery walls.elder abuse Any action on the part of an older persons family member, caregiver, or other associated person that takes advantage of the older persons person, property, or emotional state; also called granny beating and parent battering.geriatrics The assessment and treatment of disease in some- one who is 65 years or older.hypoxiadangerous condition in which the body tissues and cells do not have enough oxygen.jugular vein distention A visual bulging of the jugular veins in the neck that can be caused by fluid overload, pressure in the chest, cardiac tamponade, or tension pneumothorax.kyphosisforward curling of the back caused by an abnormal increase in the curvature of the spine.melena Black, tarry stools.Methicillinresistant Staphylococcus aurcus (MRSA)A bacterium that causes infections in different parts of the body and is often resistant to commonly used antibiot- ics; can be found on the skin, in surgical wounds, in the bloodstream, lungs, and urinary tract.neuropathy A group of conditions in which the nerves leav- ing the spinal cord are damaged, resulting in distortion of signals to or from the brain.osteoporosisgeneralized bone disease, commonly associated with postmenopausal women, in which there is a reduction in the amount of bone mass leading to fractures after minimal trauma in either sex.peptic ulcer disAbrasion of the stomach or small intestine.pneumonia Inflammation/infection of lung from a bacterial, viral, or fungal cause.polypharmacy Use of multiple medications by patient, typically seen in elderly. presbycusis
Age-related condition of ear that produces progressive bilateral hearing loss, most noted at higher frequencies.pulmonary embolism Condition causes sudden blockage of pulmonary artery by venous clot.respiratory syncytial virus Highly contagious virus causes an infection of upper and lower respiratory system.syncope A fainting spell or transient loss of consciousness, often caused by an interruption of blood flow to brain.unilateral pedal edema Pedal edema is a swelling of foot and ankle caused by fluid overload; unilateral would present in only one extremity.urinary tract infection Bacterial infection that affects the urinary tract.vasoconstrictionNarrowing of a blood vessel.vasodilationWidening of a blood vessel.

9/27/2011tance69487272.docD170er9/27/2011id not contact medical 170fo9/27/2011 not check medication f170pti

Chapter 34Geriatric Assessment and Managementacetabulumdepression on the lateral pelvis where its three component bones join, in which the femoral head fits snuglybacteremiapresence

of bacteria in the blood, whether or not a disease process is present.burst fracturesCompression fractures of the vertebrae that typically result from a higher energy mechanism such as a motor vehicle crash or fall from substantial height.central cord syndromeform of incomplete spinal cord injury in which some of the signals from the brain to the body are not received; results in weak or absent motor function, which is more pronounced in the upper extremities than the lower extremities.compression fracturesStable spinal cord injuries in which often only the anterior third of the vertebra is collapsed. This type of fracture often results from minimal trauma, from simply bending over, rising from a chair, or sitting down forcefully.polypharmacyuse of multiple medications on a regular belt-type fracturesFractures that involve flexion, with a distraction component (energy being dispersed in two opposite directions) that causes a fracture through the entire vertebral body and bony arch; typically results from an ejection or occurs in those wearing only a lap belt without a shoulder harness.septicemiadisease state that results from the presence of microorganisms or their toxic products in the bloodstream.stable spinal injuryspinal injury that has a low risk of leading to permanent neurologic deficit or structural deformity.unstable spinal injuryspinal injury that has a high risk of permanent neurologic deficit or structural deformity. Chapter 35Ambulance OperationsTodays ambulances are designed according to strict government regulations based on national standards. The six-pointed Star of Life emblem identifies vehicles that meet federal specifications as licensed or certified ambulances. An ambulance call has nine phases: Preparation for the call Dispatch En route Arrival at scene Transfer of the patient to the ambulance En route to the receiving facility (transport) At the receiving facility (delivery) En route to the station Postrun Certain items, like sterile gloves, must be available on the ambulance at all times, as dictated by state and juris- dictional requirements. Every ambulance must be staffed with at least one EMT in the patient compartment whenever a patient is being transported. However, two EMTs are strongly recommended. Some services may operate with a non-EMT driver and a single EMT in the patient compartment. Check all medical equipment and supplies at least daily, including all the oxygen supplies, the jump kit, splints, dressings and bandages, backboards and other stabiliza- tion equipment, and the emergency obstetric kit. During the postrun phase, you should complete and file any additional written reports and inform dispatch of your status, location, and availability. Perform a rou- tine inspection to ensure that the ambulance is ready to respond to the next call. Learning how to properly operate your vehicle is just as important as learning how to care for patients when you arrive on the scene. The first rule of safe driving in an emergency vehicle is that speed does not save lives; good care does. The second rule is that the driver and all passengers must wear seatbelts and shoulder restraints at all times. Air ambulances are used to evacuate medical and trauma patients. There are two basic types of air medical units: fixed-wing and rotary-wing, otherwise known as helicopters. A medical evacuation is commonly known as a medivac and is generally performed exclusively by helicopters. air ambulancesFixed-wing aircraft & helicopters modified for medical care; evacuate, transport patients w/life-threatening injuries to treatment facilities.ambulancespecialized vehicle for treating and transporting sick and injured patients.blind spotsAreas of the road that are blocked from the driver''s sight by their own vehicle or mirrors.cleaningprocess of removing dirt, dust, blood, or other visible contaminants from a surface.CPR boarddevice that provides a firm surface under the patient''s torso.cushion of safetyKeeping a safe distance between your vehicle and other vehicles to any side of you.decontaminateRemove or neutralize radiation, chemical, other hazardous material from clothing, 9/27/2011tance69487272.docD171er9/27/2011id not contact medical 171fo9/27/2011 not check medication f171pti

equipment, vehicles, personnel.disinfectionkilling of pathogenic agents by direct application of chemicals.emergency modeuse of lights and sirens.first-responder vehiclespecialized vehicle used to transport EMS equipment, personnel to scenes of medical emergencies.high-level disinfectionkilling of pathogenic agents by using potent means of disinfection.hydroplaningcondition in which tires of a vehicle may be lifted off road surface as water "piles up" under them, making vehicle feel like it is floating.jump kitportable kit contains items used in initial care of patient.medivacMedical evacuation of a patient by helicopter.spotterperson who assists a driver in backing up an ambulance to compensate for blind spots at back of vehicle.Star of Lifesix-pointed star, identifies vehicles meets federal specifications as licensed or certified ambulances.Sterilizationprocess, such as heating, that removes microbial contamination.Ambulance Types I Truck Cab Chassis with Modulalar Body/ Pass thru II Standard Van/Integrated Cab & Body III Speciality Van/Integrate Cab & Body/Driver Compartment/Pt Comp Chapter 36Gaining AccessSteps for Access c-spine Airway Oxygen Ventilate Stop bleeding Treat Critical Injuryaccessability to gain entry to an enclosed area and reach a patient.command postlocation of the incident commander at scene of an emergency, where command, coordination, control, communication are centralized.complex accessComplicated entry that requires special tools and training and includes breaking windows or using other force.danger zone (hot zone)area where of exposure to sharp metal edges, broken glass, toxic substances, lethal rays, ignition or explosion of hazardous materials.disentanglementremoval of a motor vehicle from around the patient.entrapmentTo be caught (trapped) within a vehicle, room, or container with no way out or to have a limb or other body part trapped.extricationRemoval of patient from entrapment or dangerous situation or position, ie, removal from wrecked vehicle, industrial accident, building collapse.hazardous materialAny substance that is toxic, poisonous, radioactive, flammable, or explosive and causes injury or death with exposure. incident commanderindividual who has overall command of the scene in the field.self-contained breathing
apparatus (SCBA)Respirator with independent air supply used by firefighters to enter toxic and otherwise dangerous atmospheres.simple accessAccess that is easily achieved without the use of tools or force.special weapons and tactics team (SWAT)specialized law enforcement tactical unit.structure firefire in a house, apartment building, office, school, plant, warehouse, or other building.tactical situationhostage, robbery, or other situation in which armed conflict is threatened or shots have been fired and the threat of violence remains.technical rescue groupteam of individuals from one or more departments in a region who are trained and on call for certain types of technical rescue.technical rescue situationrescue that requires special technical skills, equipment in specialized rescue areas, ie., technical rope rescue, cave rescue, dive rescue.Chapter 37Special OperationsThe National Incident Management System (NIMS) provides a consistent nationwide template to enable federal, state, and local governments, as well as private-sector and nongovernmental organizations, to work together effectively and efficiently. NIMS is used to prepare for, prevent, respond to, recover from domestic incidents, regardless of cause, size, or complexity, including catastrophic terrorism, hazardous materials (HazMat) incidents. The major NIMS components are command and management, preparedness, resource management, communications and information management, supporting technologies, and ongoing management and maintenance. The purpose of the incident command system is ensuring responder and public safety; achieving incident management goals; and ensuring the efficient use of resources. Preparedness involves the decisions made and basic plan- ning done before an incident occurs. Your agency should have written disaster plans that you are regularly trained to carry out. At incidents that have a significant medical factor, the incident commander should appoint someone as the medical group or branch leader. This person will supervise the primary roles of the medical group: triage, treatment, and

transport of the injured. A mass-casualty incident refers to any call that involves three or more patients, any situation that places such a great demand on available equipment or personnel that the system would require a mutual aid response, or any incident that has a potential to create one of the previ- ously mentioned situations. The goal of triage is to do the greatest good for the greatest number. This means that the triage assessment is brief and the patient condition categories are basic. There are four basic triage categories that can be recalled using the mnemonic IDME: Immediate (red) Delayed (yellow) Minimal (green; hold) Expectant (black; likely to die or dead) A disaster is a widespread event that disrupts functions and resources of a community and threatens lives and property. Many disasters, such as a drought, may not involve personal injuries. When you arrive at the scene of a HazMat incident, you must first step back and assess the situation. This can be very stressful, particularly if you see a patient.

9/27/2011tance69487272.docD172er9/27/2011id not contact medical 172fo9/27/2011 not check medication f172pti

A valuable resource for determining what the hazardous material is and what you should do is CHEMTREC. casualty collection areaarea set up by physicians, nurses, other hospital staff near a major disaster scene where patients can receive further triage, medical care.Chemical Transportation Emergency Center (CHEMTREC)agency that assists emergency personnel in identifying and handling hazardous materials transport incidents.command postlocation of the incident commander at scene of emergency and where command, coordination, control, and communication are centralized.danger zonearea where individuals can be exposed to toxic substances, lethal rays, or ignition or explosion of hazardous materials.decontaminationprocess of removing or neutralizing and properly disposing of hazardous materials from equipment, patients, and rescue personnel.decontamination areadesignated area in a hazardous materials incident where all patients and rescuers must be decontaminated before going to another area.disasterwidespread event that disrupts community resources and functions, in turn threatening public safety, citizens'' lives, and property.hazardous materialsAny substances that are toxic, poisonous, radioactive, flammable, or explosive and cause injury or death with exposure.hazardous materials incidentincident in which a hazardous material is no longer properly contained and isolated.incident command systemorganizational system to help control, direct, and coordinate emergency responders and resources; also known as an incident management system (IMS).incident commanderindividual who has overall command of the scene in the field.mass-casualty incidentemergency situation involving three or more patients or that can place great demand on the equipment or personnel of the EMS system or has the potential to produce multiple aid responseagreement between neighboring EMS systems to respond to mass-casualty incidents or disasters in each other''s region when local resources are insufficient to handle the response.personal protective equipment (PPE) levelsMeasures of the amount and type of protective equipment that an individual needs to avoid injury during contact with a hazardous materialrehabilitation areaarea that provides protection and treatment to fire fighters and other personnel working at an emergency. Here, workers are medically monitored and receive any needed care as they enter and leave the scene.sector commanderindividual delegated to oversee and coordinate activity in an incident command sector; works under the incident commander.toxicity levelsMeasures of the risk that a hazardous material poses to the health of an individual who comes into contact with it.transportation areaarea in a mass-casualty incident where ambulances and crews are organized to transport patients from the treatment area to receiving hospitals.transportation officerindividual in charge of the transportation sector in a mass-casualty incident who assigns patients from the treatment area to awaiting ambulances in the transportation area.treatment areaLocation in a mass-casualty incident where patients are brought after being triaged and assigned a priority, where they are reassessed, treated, and monitored until transport to the hospital.treatment officerindividual, usually a physician, who is in charge of and directs EMS personnel at the treatment area in a mass-casualty incident.triageprocess of establishing treatment and transportation priorities according to severity of injury and medical need.triage areaDesignated area in a mass-casualty incident where the triage officer is located and patients are initially triaged before being taken to the treatment center.triage officerindividual in charge of the incident command triage sector who directs the sorting of patients into triage categories in a mass-casualty incident.Tags 1 High (Red) Immediate Transport 2 Temp wait (Yellow) 3 Low (Green) walking wounded, treat on site wait for transport 4 BLACK NO POINT TO TRANSPORT Toxicity Levels Little Irrittion Temporary Damage Extreme Hazard Death on Exposure Protection Levels A Fully Encapsulated with SCBA B Non Encapsulated with SCBA C Non-permeable clouthing, Eye protection, Face Mask D Work Clothes, gloves, eye protection Homeland Security Advisory System 9/27/2011tance69487272.docD173er9/27/2011id not contact medical 173fo9/27/2011 not check medication f173pti

Red Orange Yellow Blue Green Hazmat Classes 1 2 3 4 5 6 7 8 9

Severe Severe Risk of Terrorist Attach High High Risk ElevatedSignificant Risk Guarded General Risk or Terrorist Attack Low Low Risk of Terrorist Attacks Explosives Gases Flam Liq Flam Solid Oxide Poison Radiation Corrossive Miscellaneous

Chapter 38Response to Terrorism and Weapons of Mass DestructionAs a result of the increase in terrorist activity, it is possible that you, the EMT, could witness a terrorist event. You must be mentally and physically prepared for the possibility of a terrorist event. Types of groups that tend to use terrorism include violent religious groups/doomsday cults, extremist political groups, technology terrorists, and single-issue groups. A weapon of mass destruction (WMD) is any agent designed to bring about mass death, casualties, and/or massive damage to property and infrastructure (bridges, tunnels, airports, and seaports). These can be biologic, nuclear, incendiary, chemical, and explosive weapons (B-NICE). Indicators that may give you clues as to whether the emergency is the result of a terrorist attack include the type of location, type of call, number of patients, victims statements, and preincident indicators. If you suspect that a terrorist or a weapon of mass destruction event has occurred, ensure that the scene is safe. If you have any doubt that it may not be safe, do not enter. Wait for assistance. Terrorists may set secondary devices that are designed to explode after the initial bomb, thus injuring responders and media coverage. Constantly assess and reassess the scene for safety. Chemical agents are manufactural substances that can have devastating effects on living organisms. The route of exposure is how the agent most effectively enters the body. Biologic agents are organisms that cause disease. Biologic agents include viruses such as smallpox and those that cause viral hemorrhagic fevers; bacteria such as those that cause anthrax and plague; and neurotoxins such as botulinum toxin and ricin. Nuclear or radiologic weapons can create a massive amount of destruction. Ionizing radiation is energy that can enter the human body and cause damage. Explosive and incendiary devices come in various shapes and sizes. It is important to be able to identify an object you believe is a potential device and notify the proper authorities, while safely evacuating the area. Toxicity levels are measures of the health risk that a sub- stance poses to someone who comes into contact with it. There are five toxicity levels: 0, 1, 2, 3, and 4. The higher the number, the greater the toxicity, as follows: Level 0 includes materials that would cause lit- tle, if any, health hazard if you came into contact with them. Level 1 includes materials that would cause irritation on contact but only mild residual injury, even without treatment. Level 2 includes materials that could cause tempo- rary damage or residual injury unless prompt medical treatment is provided. Both levels 1 and 2 are considered slightly hazardous but require use of selfcontained breathing apparatus (SCBA) if you are going to come into contact with them. Level 3 includes materials that are extremely hazard- ous to health. Contact with these materials requires full protective gear so that none of your skin surface is exposed. Level 4 includes materials that are so hazard- ous that minimal contact will cause death. For level 4 substances, you need specialized gear that is designed for protection against that particular hazard.

9/27/2011tance69487272.docD174er9/27/2011id not contact medical 174fo9/27/2011 not check medication f174pti

You must note that all health hazard levels, with the exception of 0, require respiratory and chemical protec- tive gear that is not standard on most ambulances and specialized training.further describes the four hazard classes. ToxicityLevels of Hazardous MaterialsLevelHealth HazardProtection Needed0Little or No HazardNone1Slightly hazardousSCBA (level C suit) only2Slightly hazardousSCBA (level C suit) only3Extremely hazardousFull protection, w/no exposed skin (level A or B suit)4Minimal exposure causes deathSpecial HazMat gear (level A Suit) NFPA PlacardsHazardous MaterialsClassifications2 (Red)Top of Diamond Fire Hazard Flash Points4 Below 73 F (Extremely flammable or volatile gases or liquids 3 - Below 100 F (Can be ignited at almost any temperature) 2 - Below 200 F Needs only moderate heat to burn 1 Above 200 F (Must be preheated to burn) 0 Will not burn1 (Yellow)Right Point of Diamond Reactivity Hazard4 Capable of detonation at normal temperature 3 Capable of detonation if exposed to heat or pressure 2 Unstable. May undergo rapid change when exposed to elevated heat or temp 1 Normally stable but may become unstable under elevated heat or pressure. 0 Normally stable.W (White)Botton of Diamond Specific HazardOxidizer- OXY Acid ACID Alkali ALK Corrosive- COR Use No Water- W Radiation Hazard Explosive EXP3 (Blue)Left Point of Diamond Health Hazard4- Lethal atmosphere. Special materials full protective clothing required. 3 Extremely Hazardous. Full protective clothing, self contained breathing appartus, boots, pants,coat, gloves, bands around legs and arms 2 - Hazardous Full face mask and eye protection required 1 Slightly Hazardous 0 No Significant Health Risk Chapter 38Response to Terrorism & WMDAlphaType of energy that is emitted from a strong radiological source; it is the least harmful penetrating type of radiation and cannot travel fast or through most objects.anthraxdeadly bacteria (Bacillus anthracis) that lays dormant in a spore (protective shell); the germ is released from the spore when exposed to the optimal temperature and moisture. The route of entry is inhalation, cutaneous, or gastrointestinal (from consuming food that contains spores).bacteriaMicroorganisms that reproduce by binary fission. These single-cell creatures reproduce rapidly. Some can form spores (encysted variants) when environmental conditions are harsh.betaType of energy that is emitted from a strong radiological source; is slightly more penetrating than alpha, and requires a layer of clothing stop it.botulinumProduced by bacteria, this is a very potent neurotoxin. When introduced into the body, this neurotoxin affects the nervous system''s ability to function and causes botulism.buboesEnlarged lymph nodes (up to the size of tennis balls) that were characteristic of people infected with the bubonic plague.bubonic plagueepidemic that spread throughout Europe in the Middle Ages, causing over 25 million deaths, also called the Black Death, transmitted by infected fleas and characterized by acute malaise, fever, and the formation of tender, enlarged, inflamed lymph nodes that appear as lesions, called buboes.chlorine (CL)first chemical agent ever used in warfare. It has a distinct odor of bleach, and creates a green haze when released as a gas. Initially it produces upper airway irritation and a choking sensation.communicabilityDescribes how easily a disease spreads from one human to another hazardhazardous agent that gives off very little or no vapors; the skin is the primary route for this type of chemical to enter the body; also called a skin hazard.contagiousperson infected with a disease that is highly communicable.covertAct in which the public safety community generally has no prior knowledge of the time, location, or nature of the attack.cross-contaminationOccurs when a person is contaminated by an agent as a result of coming into contact with another contaminated person.cyanideAgent, affects body's ability to use oxygen, colorless gas, odor similar to almonds. The effects begin on the cellular level and are very rapidly seen at the organ system level.decayNatural process, a material that is unstable attempts to stabilize itself by changing its structure.dirty bombName given to a bomb used as a radiological dispersal device (RDD).disease vectoranimal that spreads a disease, once infected, to another animal.disseminationmeans terrorist will spread a disease, ie, poisoning 9/27/2011tance69487272.docD175er9/27/2011id not contact medical 175fo9/27/2011 not check medication f175pti

of the water supply, or aerosolizing agent into the air or ventilation system of a building.domestic terrorismTerrorism carried out by native citizens of the country being attacked.G agentsEarly nerve agents, developed by German scientists in the period after WWI and into WWII. There are three agents: sarin, soman, and tabun.gamma (X-rays)Type of energy emitted from a strong radiological source, far faster and stronger than alpha and beta rays. Easily penetrate thru human body and require several inches of lead or concrete to prevent penetration.incubationDescribes time period from a person being exposed to a disease to the time when symptoms terrorismTerrorism carried out by those not of host's country; AKA cross-border terrorism.ionizing radiationEnergy emitted in the form of rays, or particles.LD50amount agent or substance that kills 50% of people exposed to this level.Lewisite (L)blistering agent w/rapid onset of symptoms and produces immediate intense pain & discomfort on contact.lymph nodesArea of the lymphatic system where infection-fighting cells are housed.lymphatic systempassive circulatory system that transports plasma-like liquid called lymph, thin fluid that bathes tissues of the body.MARK 1nerve agent antidote kit containing two auto-injector medications, atropine, 2-PAM chloride (pralidoxime chloride); AKA Nerve Agent Antidote Kit (NAAK).miosisBilateral pinpoint constricted pupils.mutagenSubstance mutates, damages, changes structures of DNA in body's cells.NAAKnerve agent antidote kit containing two autoinjector medications, atropine, 2-PAM chloride (pralidoxime chloride); AKA MARK 1-kit.nerve agentsclass of chemical called organophosphates; function by blocking an essential enzyme in nervous system, causes body's organs to overstimulate, burn out.neurotoxinsBiological agents, most deadly substances known to humans; include botulinum toxin and ricin.neutron radiationType of energy emitted from a strong radiological source; neutron energy is fastest moving, most powerful form of radiation. Neutrons easily penetrate thru lead, require several feet of concrete to stop of agent after exposure, ie., from a person's clothes exposed to agent.persistencyTerm used to describe how long a chemical agent will stay on a surface before it evaporates.phosgenepulmonary agent, product of combustion, might be produced in a fire at a textile factory or house,
or from metalwork or burning Freon. Phosgene is a very potent agent, has a delayed onset of symptoms, usually hours.phosgene oxime (CX)blistering agent that has a rapid onset of symptoms and produces immediate intense pain and discomfort on contact.pneumonic plaguelung infection, also known as plague pneumonia, that is the result of inhalation of plague bacteria.points of distribution (POD)Strategically placed facilities pre-established for mass distribution of antibiotics, antidotes, vaccinations, with other medications and supplies.radioactive materialAny material that emits radiationradiological dispersal device (RDD)Any container that is designed to disperse radioactive material.ricinNeurotoxin derived from mash that is left from the castor bean; causes pulmonary edema and respiratory and circulatory failure, leading to death.route of exposureManner by which a toxic substance enters the body.sarin (GB)nerve agent, G agents; highly volatile colorless, odorless liquid that turns from liquid to gas w/in seconds to min at room temperature.secondary deviceAdditional explosives used by terrorists, set to explode after initial bomb.smallpoxhighly contagious disease; most contagious when blisters begin to form.soman (GD)nerve agent, G agents; twice as persistent as sarin and five times as lethal; fruity odor, as a result of type of alcohol used, both as contact & inhalation hazard, can enter body thru skin absorption & respiratory tract.Special Atomic Demolition Munitions (SADM)Small suitcase-sized nuclear weapons that were designed to destroy individual targets, such as important buildings, bridges, tunnels, or large ships.state-sponsored terrorismTerrorism funded and/or supported by nations w/close ties to terrorist groups.sulfur mustard (H)vesicant; brownish-yellowish oily substance, generally very persistent; distinct smell of garlic or mustard, when released, quickly absorbed into skin and/or mucous membranes, begins irreversible process damaging cells.syndromic surveillancemonitoring,

usually by local or state health departments, of patients presenting to emergency departments and alternative care facilities, the recording of EMS call volume, and the use of over-thecounter medications.tabun (GA)nerve agent, G agents; 36 times more persistent than sarin and approx half as lethal; fruity smell, unique - components used to manufacture agent are easy to acquire, easy to manufacture.V agent (VX)G agent; clear, oily agent that has no odor, looks like baby oil; over 100 times more lethal than sarin, extremely persistent.vapor hazardagent that enters the body thru the respiratory tract.vesicantsBlister agents; primary route of entry for vesicants is thru the skin.viral hemorrhagic fevers (VHF)group of diseases that include the Ebola, Rift Valley, Yellow Fever viruses among others. This group of viruses causes the blood in the body to seep out from tissues, blood vesselsvirusesGerms that require a living host to multiply, survive.volatilityhow long a chemical agent will stay on a surface before it evaporates.weapon of mass casualty (WMC)Any agent designed to bring about mass death, casualties, and/or massive damage to property &/or infrastructure (bridges, tunnels, airports, and seaports); AKA weapon of mass destruction (WMD).weapon of mass destruction (WMD)Any agent designed to bring about mass death, casualties, and/or massive damage to property and infrastructure (bridges, tunnels, airports, and seaports); aka a weapon of mass casualty (WMC).weaponizationcreation of weapon from a biological agent generally found in nature that causes disease; agent cultivated, synthesized, and/or mutated to maximize target population's exposure to the germ.

9/27/2011tance69487272.docD176er9/27/2011id not contact medical 176fo9/27/2011 not check medication f176pti

Section 8 ALS Techniques Anatomy and Physiology of the Airway The respiratory system consists of all the structures in the body that are used for breathing. The upper airway begins with the nose, mouth, throat (pharynx), and larynx (vocal cords). The larynx is typically considered to be the dividing line between the upper and lower airway. The lower airway includes the trachea, bronchi, and lungs. The epiglottis is a leaf-shaped structure located at the glottic opening (covering the larynx) that pre- vents food and liquid from entering the lower airway during swallowing. The bronchi and other air passages branch off from the trachea, extending into each lung, subdividing into bronchioles (smaller passages) down to the alveoli, where the exchange of oxygen and carbon dioxide occurs. The mechanical process of breathing occurs through the use of the diaphragm and intercostal muscles (mus- cles between the ribs). The diaphragm is a thin, dome- shaped muscle that separates the thoracic cavity from the abdominal cavity. The diaphragm and intercostal muscles contract during the active phase of breathing (inhalation), increasing the size of the chest cavity. Contraction of the diaphragm pulls the chest cavity down; contraction of the intercostal muscles pulls the rib cage up and out. The increased size of the chest cavity allows air to flow into the lungs. During the passive phase of breathing (exhalation), air flows out of the lungs. The diaphragm and intercostal muscles relax, and the size of the chest cavity decreases. The diaphragm moves up, and the ribs move in. The respiratory system delivers oxygen to the body and removes carbon dioxide, a process that takes place on two levels: the alveolar-capillary exchange and the capillary-cellular exchange. The alveolar-capillary exchange works in the following way: 1. Air breathed in during inhalation travels through the airways to the alveoli. 2. As this oxygen-rich air enters the alveoli, oxygen-poor blood is circulated through the capillaries around each alveolus. 3. Oxygen in the alveoli crosses over into the blood-stream. Carbon dioxide in the blood from the capillaries crosses over into the alveoli, creating a shift of oxygen and carbon dioxide. The capillary-cellular exchange occurs throughout the bodys cells. Cells give up carbon dioxide into the capillaries, and capillaries give up oxygen to the cells. Each living cell in the body requires a regular supply of oxygen; some cells, such as those in the heart, brain, and nervous system, need a constant supply of oxygen to survive. Cells in the heart will be damaged if the oxygen supply is interrupted for more than a few minutes. After 4 to 6 minutes without oxygen, cells in the brain and ner- vous system begin to die. Dead brain cells can never be replaced. Brain damage and other permanent changes in the body result from damage caused by a lack of oxygen. Other cells in the body that are not as dependent on a constant oxygen supply can tolerate short periods with- out oxygen and still survive. Basic Airway Management Always assess the airway first in an injured or ill patient. This rule applies to the basic and advanced levels of airway management. Advanced airway techniques are begun only after proper basic airway management has been completed. The first step in airway management is opening a patients airway. You should use the head tiltchin lift maneuver in a patient with no suspected spinal injury and the jaw-thrust maneuver in a patient you suspect may have a spinal injury. After you have opened the airway, you should assess the airway and evaluate the need for suctioning to remove foreign bodies, liquid, and/or blood from the patients mouth. After the airway has been cleared, you need to deter- mine whether the patient needs an airway adjunct. The basic airway adjuncts that are already available to you are oropharyngeal and nasopharyngeal airways. Chapter 39Advanced Airway Managementcricoid cartilagefirm ridge of cartilage that forms the lower part of the larynx.cricoid pressuretechnique used with intubation, pressure is applied on either side of cricoid cartilage to prevent gastric distention & aspiration, allows better visualization of vocal cords; AKA Sellick maneuver.decompressTo release from pressure or compression.end-tidal carbon dioxide detectorPlastic, disposable indicator, signals by color change when an endotracheal tube is in the proper place.endotracheal intubationInsertion of an endotracheal (ET) tube directly thru larynx between vocal cords and into trachea to maintain, protect airway.Esophageal Tracheal Combitube (ETC)multilumen airway that consists of a single, dual-lumen tube with two cuffs.extubationRemoval of a tube after it has been placed.gastric tubeadvanced airway adjunct provides a channel directly into a patient's stomach, allow removal gas, blood, toxins or to instill medications, nutrition.laryngeal mask airway (LMA)advanced airway device blindly inserted into the mouth to isolate the larynx for direct ventilation; consists of a tube, mask or cuff that inflates to seal around laryngeal opening.laryngoscopeinstrument 9/27/2011tance69487272.docD177er9/27/2011id not contact medical 177fo9/27/2011 not check medication f177pti

used to give a direct view of the patient's vocal cords during endotracheal intubation.laryngospasmsevere constriction of the larynx and vocal cords.lighted styletinstrument used to aid in blind insertion of an endotracheal tube.multilumen airwaysAdvanced airway devices, ie, Esophageal Tracheal Combitube, pharyngeotracheal lumen airway, have multiple tubes to aid in ventilation, will work whether placed in trachea or esophagus.nasotrachealintubationEndotracheal intubation through the nose.orotracheal intubationEndotracheal intubation through the mouth.pharyngeotracheal lumen airway (PtL)multilumen airway consists of two tubes, two masks, a bite blockSellick maneuvertechnique used to prevent gastric distention; pressure is applied to the cricoid cartilage; AKA cricoid pressure.styletplastic-coated wire gives rigidity, shape to endotracheal tube.valleculaspace between base of tongue and epiglottis; receives tip of a curved laryngoscope blade during endotracheal intubation.Chapter 40Assisting With Intravenous Therapyaccess portsealed hub on admin set designed for sterile access to IV fluid.administration setTubing connects IV bag access port, catheter to deliver IV fluid.butterfly catheterRigid, hollow, venous cannulation device identified by plastic "wings" act as anchoring points for securing catheter.catheterFlexible, hollow structure that drains or delivers fluids.catheter shearcutting catheter by needle during improper rethreading of catheter with needle; severed piece can enter circulatory system.drip chamberarea of admin set where fluid accumulates so tubing remains filled with fluid.drip setsAnother name for administration sets.external jugular IVIV access established in external jugular vein of neck.gaugemeasure of interior diameter of catheter. It is inversely proportional to true diameter of catheter.infiltrationescape of fluid into the surrounding tissue.intraosseous (IO) needleRigid, boring catheter placed into a bone to provide IV fluids.isotonic crystalloidsMain type of fluids used in the prehospital setting for fluid replacement because of the ability to support blood pressure by remaining within the vascular compartment.Jamshedi needletype of intraosseous double needle consisting of a solid, boring needle inside a sharpened hollow needle.keep-the-vein-open (KVO) IV setupPhrase that refers to the flow rate of a maintenance IV line established for prophylactic access.local reactionMild to moderate reaction to an irritant without systemic consequence.macrodrip setAdmin set named for large orifice between piercing spike and drip chamber; allows rapid fluid flow into vascular system.microdrip setAdmin set named for small orifice between piercing spike and drip chamber; allows for carefully controlled fluid flow, ideally suited for medication admin.occlusionBlockage, usually of a tubular structure, a blood vessel.over-the-needle catheterprehospital standard for IV cannulation; consists of a hollow tube over a laser-sharpened, steel needle.phlebitisInflammation of a vein. Often assoc w/clot in vein.piercing spikehard, sharpened plastic spike on end of admin set designed to pierce sterile membrane of IV bag.proximal tibiaAnatomic location for intraosseous catheter insertion; wide portion of tibia located directly below knee.saline locktype of IV apparatus, called buff cap, heparin, heparin lock.systemic complicationModerate to severe complication affecting systems of the body; after admin of medications, reaction might be systemic.vasovagal reactionSudden hypotension, fainting assoc w/traumatic or med event.Chapter 41Assisting With Cardiac Monitoring12-lead ECGECG w/12 leads attached to patient's skin; include limb, chest.4-lead ECGECG w/4 leads attached to patient's skin; include limb leads.arrhythmiairregular or abnormal heart rhythm.asystoleComplete absence of heart electrical activity.cardiac monitoringviewing electrical activity of heart thru use of ECG machine or cardiac monitor.chest leadsLeads that are used only with a 12-lead ECG, must be placed exactly; includes leads V1, V2, V3, V4, V5, and V6.ECG Electrocardiogramelectronic tracing of the heart''s electrical activity through leads, which originate in the electrocardiograph machine and contain electrodes that attach to the patient''s chest and/or limbs.electrical conduction systemnetwork of special cells in heart thru which an electrical current flows, causing contractions of heart, produce pumping of blood.limb leadsfour leads used w/4-lead ECG; placed on or close to right arm, left arm, right leg, left leg.normal sinus rhythmrhythm that has consistent P waves, consistent P-R intervals, and a regular heart rate between 60 and 100 beats/min.sinus bradycardiarhythm that has consistent P waves, consistent P-R intervals, and a regular heart rate that is less than 60 beats/min.sinus rhythmrhythm in which the SA node acts as the pacemaker.sinus tachycardiarhythm that has consistent P waves, consistent P-R intervals, and a regular heart rate that is more than 100 beats/min.ventricular fibrillationDisorganized, ineffective twitching of the ventricles, resulting in no blood flow and a state of cardiac arrest.ventricular tachycardiapresence of three or more abnormal ventricular complexes in a row with a rate of more than 100 beats/min.

9/27/2011tance69487272.docD178er9/27/2011id not contact medical 178fo9/27/2011 not check medication f178pti

Spinal Imobilzation Seated PateientCritical Skills__ Immediately direct/take/maintain manual immobilization of the head__ Releases or orders release of manual immobilization before it was maintained mechanically__ Patient manipulated or moved excessively causing potential spinal compromise__ Devices moves excessively up, down, left or right on patients torso__ Head immobilization allows excessive movement__ Torso fixation inhibits chest rise resulting in respiratory compromise__ Upon completion of immobilization, head is not in neutral position__ Did not reaccess motor, sensory & distal circulation after immobilization__ Immobilized head to board before securing torso Process1. Take/verbalizes bsi/scene safe2 Directs assistant to place/maintain head in neutral in-line position3. Directs assistant to maintain manual immobilztion of head4. Assesss motor, sensory & distal circulation in extremeties5. Appropriately sizes and correctly applies extrication collar6 Positions immobilization device behind patient7 Secures device to pt torso (M-B-I-T-H)8 Evaluates torso fit and adjusts as needed9 Evaluates AND VERBALIZES need for padding, and pads as necessary10 Secure pt head to device11 Verbalizes moving pt to long board12 Reassesses motor, sensory, distal circulation in extremeties Immobilzxation Skills Traction SplintingCritical Criteria__ Loss of traction at any point after it was applied__ Did not reassess motor, sensory and circulatory function in the injured extremity BOTH before AND after splinting__ The foot was excessively rotated or extended after splint was applied__ Did not secure the ischial strap before taking traction__ Final Immobilization failed to support the femur or prevent rotation of the injured leg__ Secured the leg to the splint before applying mechanical traction***Note: If the Sagar splint or the Kendricks Traction Device is used without elevating the patient's leg, application of manual traction is not necessary. The candidate should be awarded one (1) point as if manual traction were applied. If the leg is elevated at all, manual traction must be applied before elevating the leg. The ankle hitch may be applied before elevating the leg and used to provide manual traction.Process1 Demonstrates / verbalizes initial or continued BSI precautions2 Assesses motor, sensory and circulatory function in the injured extremity3 Directs application of manual stabilization of the injured legApplies the distal securing device (e.g. ankle hitch)4 Positions the splint appropriately to the injured leg5 Positions / secures the support strapsPrepares/adjusts splint to the proper length measuring with the UNINJURED leg 1Directs application of manual traction ***See note belowApplies the proximal securing device (e.g. ischial strap)Applies mechanical tractionRe-evaluates the proximal / distal securing devices6 Reassesses motor, sensory and circulatory function in the injured extremityNote: examiner says "motor, sensory, circulatory function are present & normal"Note: examiner asks candidate how to prepare patient for transportVerbalizes correctly securing patient and splint to long board 1Total:13 BLEEDING CONTROL/SHOCK MANAGEMENTCritical Criteria__ Did not apply high flow oxygen with appropriate mask__ Applied a tourniquet before attempting other methods of bleeding control__ Did not control hemorrhage in a timely manner__ Did not indicate a need for immediate transportationProcessDemonstrates / verbalizes initial or continued BSI precautionsApplies direct pressure to the woundElevates the extremityApplies a dressing to the woundExaminer must now inform the candidate that the wound continues to bleed.Applies an additional dressing to the woundExaminer now informa candidate that wound continues to bleed. second dressing does not control bleeding.Locates and applies pressure to appropriate arterial pressure pointexaminer now informa candidate that bleeding is controlledBandages the woundexaminer now tells candidate patient is showing signs- symptoms indicative of hypoperfusionProperly positions the patientApplies high concentration oxygenInitiates steps to prevent heat loss from patientIndicates need for immediate transportationTotal:10 IMMOBILIZATION SKILLS(JOINT INJURY)Critical Criteria__ Did not support the joint so that the joint did not bear distal weight__ Did not immobilize the bone above and below the injured site__ Did not reassess motor, sensory and circulatory function in the injured extremity BOTH BEFORE AND AFTER splintingProcess1 Demonstrates / verbalizes initial or continued BSI precautions2 Directs application of manual stabilization of the injured joint3 Assesses motor, sensory and circulatory function in the injured extremityexaminer says "motor, sensory, circulatory function are present & normal"4 Selects the proper splinting material5 Immobilizes the site of the injury6 Immobilizes the bone above the injured joint7 Immobilizes the bone below the injured joint8 Reassesses motor, sensory and circulatory function in the injured extremityexaminer says "motor, sensory, circulatory function are present & normal"Total:11 IMMOBILIZATION SKILLS (LONG BONE INJURY)Critical Criteria__ Grossly moves the injured extremity__ Did not immobilize the joint above and the joint below the injury site__ Did not reassess motor, sensory and circulatory function in the injured extremity BOTH BEFORE AND AFTER 9/27/2011tance69487272.docD179er9/27/2011id not contact medical 179fo9/27/2011 not check medication f179pti

splintingProcess1 Demonstrates / verbalizes initial or continued BSI precautions2 Directs application of manual stabilization of the injury3 Assesses motor, sensory and circulatory function in the injured extremityexaminer says "motor, sensory, circulatory function are present & normal"4 Measures the splint5 Applies the splint6 Immobilizes the joint above the injury site7 Immobilizes the joint below the injury site8 Secure the entire injured extremity9 Immobilizes the hand/foot in the position of function10 Reassesses motor, sensory and circulatory function in the injured extremityexaminer says "motor, sensory, circulatory function are present & normal"Total:11

9/27/2011tance69487272.docD180er9/27/2011id not contact medical 180fo9/27/2011 not check medication f180pti

Cardiac Arrest Mgt AEDCritical Criteria__ Did not provide high flow / concentration of oxygen__ Did not confirm patient to be PULSELESS and APNEIC__ Did not direct initiation / resumption of ventilation / compressions at appropriate times__ Did not assure all individuals were clear of patient before delivering each shock__ Did not operate the AED properly (inability to deliver shock). MUST NOT turn off AED__ Did not correctly place pads on patientProcessDemonstrates / Verbalizes initial or continued consideration of BSI precautionsBriefly questions the rescuer about arrest eventsDirects rescuer to stop CPRVerifies absences of spontaneous pulse (skill station examiner states no pulse)Directs resumption of CPRTurns on defibrillator powerAttaches automated defibrillator to the patientDirects rescuer to stop CPR and ensures all individuals are clear of the patientInitiates analysis of the rhythmDelivers shockImmediately directs resumption of CPRVerbalizes or directs insertion of a simple airway adjunct (oral / nasal airway)Ventilates or directs ventilation of the patientAssures high flow / concentration of oxygen is delivered to the patientAssures CPR continues without unnecessary / prolonged interruptionConfirms effectiveness of CPR (ventilation and compressions)Re-evaluates patient / CPRRepeats defibrillator sequenceVerbalizes transportation of patient Cardiac Arrest Mgt AEDCritical Criteria__ Did not provide high flow / concentration of oxygen__ Did not confirm patient to be PULSELESS and APNEIC__ Did not direct initiation / resumption of ventilation / compressions at appropriate times__ Did not assure all individuals were clear of patient before delivering each shock__ Did not operate the AED properly (inability to deliver shock). MUST NOT turn off AED__ Did not correctly place pads on patientProcessDemonstrates / Verbalizes initial or continued consideration of BSI precautionsBriefly questions the rescuer about arrest eventsDirects rescuer to stop CPRVerifies absences of spontaneous pulse (skill station examiner states no pulse)Directs resumption of CPRTurns on defibrillator powerAttaches automated defibrillator to the patientDirects rescuer to stop CPR and ensures all individuals are clear of the patientInitiates analysis of the rhythmDelivers shockImmediately directs resumption of CPRVerbalizes or directs insertion of a simple airway adjunct (oral / nasal airway)Ventilates or directs ventilation of the patientAssures high flow / concentration of oxygen is delivered to the patientAssures CPR continues without unnecessary / prolonged interruptionConfirms effectiveness of CPR (ventilation and compressions)Re-evaluates patient / CPRRepeats defibrillator sequenceVerbalizes transportation of patient

9/27/2011tance69487272.docD181er9/27/2011id not contact medical 181fo9/27/2011 not check medication f181pti

Ephinephrine auto-injectorCritical Criteria__ D,

9/27/2011tance69487272.docD182er9/27/2011id not contact medical 182fo9/27/2011 not check medication f182pti