Nremt study guide

What are some causes of delayed cap refill times?
Moderate blood loss, decrees in fluid uptake, decreed omg body tempture

What is in the right upper abdominal quadrant
Liver
Right kidney
Colon
Pancreas
Gallbladder

What organs are in the left upper abdominal quadrant
Liver
Spleen
Left kidney
Stomach
Colon
Pancreas

What organs are in the left lower abdominal quadrant
Right kidney
Colon
Small intestine
Major veins and arteries to right leg ureter
Appendix

What organs are in the right lower abdominal quadrant
Left kidney
Colon
Small intestine.
Major veins and arteries to leg
Ureter

Ligaments
Connect bine to bone

Tendons
Connect muscle to bone

Cervical spine
Neck, 7 vertebrae

Thoracic spine
Thorax, ribs, upper back, 12 vertebrae

Lumbar spine
Lower back, 5 vertebrae

Sacral spine/ sacrum
Back wall of pelvis, 5 vertebrae

Coccyx
Tailbone, 4 vertebrae

Respiratory system
Oropharynx/ nasopharynx- pharynx- larynx- trachea- ( lungs) bronchi- alveoli

Epiglottis
The leaf like structure that covers the trachea and makes sure food doesn’t get into it

Right atrium of the heart
Revives blood from
The superior vena cava and inferior vena cava and pumps it to the right ventricle

Right ventricle of the heart
Recives low oxygen blood from the right atrium and pumps it to the lungs through the pulmonary arteries.

Left atrium of the heart
Recives oxygen rich blood from the lungs and pumps it to the left ventricle

Left ventricle of the heart
Recives oxygen righ blood from the left atrium and pumps it to the aorta which distributes it through the body. Stronges chamber of the heart

Coronary arteries
Arteries that branch off of the aorta and supply the heart with blood

Aorta
Largest artery in the body begins at the left ventricle and distributes blood through the body

Pulmonary artery
Begins at the right ventricle and carries oxygen poor blood to the lungs

Carotid artery
Major artery of the neck and supplies blood to the brain

Femoral artery
The major artery of the thigh.major source of blood supply for the thigh and leg

Brachial artery
Felt in the elbow

Radial artery
Felt at the wrist provide the hand and forearm with blood

Posterior tibial artery
Often used in determining the circulatory status of the lower extremities, may be palpated on the posterior aspect of the malleolus

Dorsal pedal artery
Lies on top of the dorsal portion of the foot, lateral of the large tendon of the big toe

Pulmonary vein
Carries oxygenated blood from the lungs to the left atrium of the heart, exception to the rule that veins carry oxygen poor blood and arteries carry oxygen rich blood

Loss of tone in blood vessels
When the blood vessels are no longer able to control their diameter

Stroke volume
The amount of blood moved with one squeeze of the heart

Cardiac output
Per minute measurement of cardiac output, calculated by multiplying stroke volume by heart rate

Hypovolemic shock
A type of shock that is caused by low blood volume, and happens when someone is bleeding profusely

Disruptive shock
A type of shock that happens when when the blood vessel tone is lost and the blood vessels dilate drooping the blood pressure. Some causes can be anaphylaxis or sepsis, pressure within the system drops

Cardiogenic shock
A type of shock that is caused by the heart failing in its ability to pump blood. Therefore cardiac output suffers

Obstructive shock
Caused when blood is physically being prevented from flowing

Vital signs infant
( birth through 1 year)
Heart rate: 140-160
Respiratory rate: 40-60 at birth and drops to 30-40 shortly after birth
Systolic blood pressure: 70mmHg at birth to 90mmHg at one year

Vital signs of a toddler
( 1 year through 3 years)
Heart rate: 80- 130
Respiratory rate: 20-30
Systolic blood pressure: 70-100 mmHg

Vital sights of a school age kid
( 6-12 years)
Heart rate: 70-110
Respiratory rate: 20-30
Systolic blood pressure: 80-120 mmHg

Vital signs of an adolescent
13-18 years
Heat rate: 55-105
Respiratory rate: 12-20
Systolic blood pressure:80-120 mmHg

Vital signs of early adults
19-40
Heart rate: average 70
Respiratory rate: 16-20
Systolic blood pressure: 120/80 mmHg

Diffusion
The movement of gasses from an area of high concentration to an area of low concentration

Pulmonary respiration
The diffusion of oxygen and carbon dioxide between the cells and the circulating blood

Oxygen cylinder size D
350 litters of oxygen

Oxygen cylinder size E
625 liters of oxygen

Oxygen cylinder size M
3,000 liters of oxygen

Oxygen cylinder size G
5,300 liters of oxygen

Oxygen cylinder size H
6,900 liters of oxygen

Non rebreather mask flow rates and oxygen concentration
12-15 liters per minute and 80-90 precent oxygen

Nasal cannula flow rates and oxygen concentration
1-6 litters per minute and 24-44 precent oxygen

Tracheostomy mask flow rates and oxygen concentration
8-10 lpm and can be set to deliver barring oxygen percentages

O
P
Q
R
S
T
Onset
Provocation
Quality
Radiation/ region/ relief
Severity
Time

D
C
A
P
B
T
L
S
Deformities
Contusions & crepitus
Abrasions
Penetration
Burns& bruising
Tenderness
Lacerations
Swelling

S
A
M
P
L
E

History

H
A
M

History

Signs and symptoms
Allergies
Medications
Pertinent past medical history
Last oral intake
Events

History
Allergies
Medications

What are the six vital signs?
Pulse- presence, regularity, strength
Blood pressure- systolic/ diastolic
Respiratory- rate, depth, lung sounds
Skin- color, tempture, condition
Pulse oximetry
Pupils- size, reactivity, pearl

Pulse quality
Determined by strange and rhythm

Sphygmomanometer
Blood pressure cuff

Medications EMT’s can administer
ON THE AMBULANCE
– asprin
– oral glucose
– oxygen
– activated charcoal
PRESCRIBED MEDICATIONS
– bronchodilator inhalers
– nitroglycerin
– epinephrine auto injector

Aspirin
Administered to patients experiencing chest pain with a suspicion of cardiac origin. It reduces the bloods ability to clot and works to prevent a clot from forming which could cause damage to the heart
CONTRAINDICATIONS
– patient allergic to aspirin
– gastrointestinal bleeding
– patient cant control own airway
– history of asthma
– patient has gastrointestinal ulcers
-known bleeding disorder

Oral glucose
Glucose is a type of sugar. Oral glucose is a type of glucose that can be taken by mouth by a concours patient. Used to treat low blood sugar
CONTRAINDICATIONS
– unconscious patient
– unable to swallow
– known diabetic who has not taken their insulin for days

Oxygen
Used to treat any medical or traumatic condition that results in hypoxia or in danger of becoming hypoxic.

Activated charcoal
A powder prepared from charred wood and mixed with water and turned into slurry for use in the field.used to treat poisonings and overdoses by binding them to the surface of the charcoal to prevent them from being absorbed by the body.
CONTRAINDICATIONS
– altered mental status
– ingestion of acids or alkalis
– inability to swallow

Bronchodilator inhalers
Used to treat diseased that offer trouble breathing such as asthma, emphysema, and chronic bronchitis. Usually albuterol. Common side affect or increased heart rate and jitteriness. and make sure u have permission to administer form medical direction.

5 rights of giving prescribed medication
– do i have the right patient
– is it the right time to administer this medication
– is this the right medication
– is this the right dose
– am i giving this medication by the right route of administration

Nitroglycerin
Used to treat chest pain of cardiac origin. It comes in either tablets or spray and is administered sublingual. It works by displaying the coronary vessels that supply the heart with blood so it can bet more blood. It can drop blood pressure. And only 3 maximum should be taken.
CONTRAINDICATIONS
– blood pressure bellow 90
– taken more then 3
– has taken erectile disfunction medication recently
– head injury
– infant or child

Epinephrine auto injector
Used to treat allergic reactions. Increased heart rate and blood pressure are common side effects. Always get permission from medical direction to administer online of offline

Abnormal breath sounds
– wheezing
– crackles
-ronchi
-stridor
– gurgling
– snoring
– crowing

Chronic obstructive pulmonary disease ( copd)
A result of many respiratory diseases such as EMPHYSEMA, CHRONIC BRONCHITIS, BLACK LUNG, and many other respiratory illnesses that cause problems like emphysema. mostly affects middle age and older patient because the disease takes time to develoup. Most cases of COPD are caused by many years of heavy smoking but it can also be cause by exposure to other irritants such as chemicals, air pollutants, or repeat infections. Many of the COPD patients are connected to home oxygen.

Chronic bronchitis
The alveoli remain unaffected by the disease butt inflamed and swollen bronchioles and thick mucus restrict the airflow to the alveoli so that they do not expand fully.the major problem with chronic bronchitis is the swelling and thickening of the lining of the where airway and an increase in mucus production

Chronic bronchitis signs and symptoms
– typically overweight
– chronic cyanotic complexion
– difficulty in breathing
– vigorous productive cough with sputum
– coarse rhonchi usually heard upon auscultation of the lungs
– wheezes and possible crackles at the base of the lungs
– respiratory infections that lead to more acute episodes

Treatment for chronic bronchitis
– high flow o2 15lpm by non rebreather mask
– placing patient in position of comfort when appropriate
– always upgrade als
– vitals every 3-5min

Emphysema
Lung tissue looses its elasticity, the alveoli become distended with trapped air, and the walls of the alveoli are destroyed. Loss of the alveolar wall reduces the surface area in contact with the pulmonary capillaries. Therefore a drastic disruption in gas exchange occurs, and the patient becomes hypoxic and begins to retain carbon dioxide. The loss of the lung elasticity and the trapping of air cause the chest to increase in diameter, producing the barrel chest appearance

Emphysema signs and symptoms
– pursed lip breathing
– extreme difficulty breathing on minimum exertion
– pink complexion
– tachypnea ( breathing rate usually greater then 20 per min at rest)
– tachycardia
– tripod position
– accessory muscle use
– may be on home oxygen
– low spo2

Emphysema treatment
– high flow o2 15 lpm by non rebreather mask
– pacing patient in position of comfort when appropriate
– always upgrade als
– vitals every 3-5 min

Asthma
The following condition in the asthma patient contribute to the increasing resistance to airflow and difficulty breathing, bronchospasm, edema, and increased secretion of mucus that causes plugging of the smaller airways. Asthma patients usually suffer acute, irregular, periodic attacks but between the attacks usually have either no or very few symptoms. Status asthmatics is a prolonged life threatening attack producing inadequate breathing and sever signs and symptoms. It does not respond to either oxygen or medication and requires immediate and rapid transport to the hospital

Asthma signs and symptoms
– dyspnea that may progressively worsen
– nonproductive cough
– wheezing on auscultation
– tachypnea
– tachycardia
– anxiety and apprehension
– typical allergic signs and symptoms
– accessory muscle use
– spo2 less then 95%

Treatment for asthma
– high flow o2 15 lpm by non rebreather mask
– pace patient in position of comfort when appropriate
– upgrade to als
– check vitals every 3-5 min

Pulmonary edema
Cariogenic pulmonary edema is typically related to an inadequate pumping function of the heart that drastically increases pressure in the pulmonary capillaries. This forces fluid to leak into the space between the alveoli and capillaries and , eventually into the alveoli themselves. Congestive heart failure causes pulmonary edema primarily. The previous respiratory diseases are not due to a failing heart. You may also see acute pulmonary edema with submersion events ( drowning) or aspiration of emesis.

Pulmonary edema signs and symptoms
– dyspnea, especially on exertion
– difficulty breathing when laying flat
– frothy sputum
– tachycardia
– anxiety, apprehension, combativeness, confusion due to hypoxia
– tripod position
– fatigue
– crackles and possibly wheezing upon auscultation
– cyanosis or dusty skin color
– pale, most skin
– distended neck veins
– swollen lower extremities
– symptoms of cardiac compromise
– low spo2

Treatment for pulmonary edema
– high flow o2 15 lpm by non rebreather mask
– pacing patient in high flowers position
– have suction unit ready
– upgrade als
– get vitals every 3-5 min

Pneumonia
An infection of the lungs caused by either bacteria, viruses, or fungi. It results from the inhalation of certain microbes that grow in the lungs causing inflammation. People with COPD or other respiratory diseases are more likely to get pneumonia, along with people with chronic health problems.

Signs and symptoms of pneumonia
– coughing mucus can be greenish, yellow or occasionally bloody
-fever
– chest pain
– sever chills
Most patients complain of
– shortness of breath with or without exertion
– chest pain that is sharp and worsens on inhalation
– headache
– pale sweaty skin
– fatigue and confusion

Treatment of pneumonia
Supportive treatment that u would administer to any patient with difficulty breathing

Spontaneous pneumothorax ( pg 480
When a lung collapses without injury or other obvious causes.

Signs and symptoms of spontaneous pneumothorax
– sharp pleuritic chest pain
– shortness of breath
– easily tired
– tachycardia
– breathe fast
– low o2 saturation
– cyanosis

Treatment for spontaneous pneumothorax
Treat as u would any other patient with difficulty breathing

Cystic fibrosis (481
A genetic disease that typically appears in childhood, causes thick sticky,mucus that accumulates in the lungs and digestive system.

Signs and symptoms of cystic fibrosis
– coughing with large amount of mucus from the lungs
– fatigue
– frequent occurrence of pneumonia
– abdominal pain and distention
– coughing up blood
– nausea
– weight loss

Acute coronary syndrome ( cardiac compromise )
A blanket term for any time the heart isn’t getting enough oxygen

Aneurism
Occurs when a weakened section of the aortic wall, begins to dilate or bloom outwards from the pressure exerted from the blood flowing through the vessels.

Signs and symptoms of aneurism
– chest pain
– tearing sensation radiating to back
– pulsating mass ( late stage)
– severely agitated patient
– pale, cool, diaphoretic skin
– hypertensive at first then hypotension after significant blood loss
– decreased loc

Treatment of an aneurism
– high flow o2
– place patient in position of comfort when appropriate
– immediately upgrade to als!!! Identify when vitas are abnormal, decreased loc , etc

Angina pectoris
A symptom of inadequate oxygen supply to the heart muscle. It is often caused by blockage of the coronary arteries

Signs and symptoms of angina pectoris
– steady chest discomfort
– chest pain that is relived with rest or nitroglycerin
– pale, cool, diaphoretic skin
– may or may not have nausea and vomiting
– rapid onset brought on with stress or physical activity
– may or may not have shortness of breath

Treatment of angina pectoris
– high flow o2
-place patient in position of comfort when appropriate
– upgrade als
– vitals every 3-5 min
– obtain opqrst
– obtain sample history
– may administer patients nitroglycerin and aspirin

Acute myocardial infarction ( 502
Sever narrowing or complete obstruction of the coronary arteries results in death of myocardial cells if the blockage is not quickly reversed.

Signs and symptoms of an acute myocardial infarction
– chest discomfort radiating to the jaw, arms, shoulders, or back
– anxiety
– diaphoresis
– dyspnea
– sense of impending doom
– weakness
– pain is not relieved with rest or decrease in physical activity

Treatment of an acute myocardial infarction
– high flow o2
– placing patient in position of comfort when appropriate
– always upgrade to als
– vitals every 3-5 min
– obtain an opqrst
– obtain a sample history
– may administer a patients nitroglycerin and aspirin

Congestive heart failure
Is a condition of excessive fluid buildup in the lungs/ and or other organs and body parts due to inadequate pumping of the heart.

Signs and symptoms of congestive hear failure
– tachycardia
– dyspnea
– normal or elevated blood pressure
– cyanosis
– profuse sweating, cool, clammy skin
– pulmonary edema, sometimes coughing up frothy white or pink sputum
– anxiety or confusion do to hypoxia
– pedal edema
– encouraged, pulsating neck veins ( late signs)
– enlarged liver

Reticular activating system
The numerological circuits in the brain responsible for staying awake, paying attention, and sleeping

AVPU
A system used to test the responsiveness and level of conciseness of a patient

Alert
Verbal
Pain
unresponsive

Glucose
A form of sugar that is the body’s basic source of energy

Diabetes
The body’s underproduction of insulin or its inability to use it

Type 1 diabities
Body doesn’t make enough insulin

Type 2 diabetes
Body doesn’t use insulin properly

Hypoglycemia vs hyperglycemia
ONSET- hyperglycemia is usually a slow onset where as hypoglycemia is a sudden onset
SKIN- hyperglycemia patients often have warm, red, dry skin. Hypoglycemia patients have cool pale, moist skin
BREATH- hyperglycemia patients have breath that smells like acetone where as hypoglycemia patients do not

Sepsis
A sever system wide response to an infection

Treatment of sepsis
– treat shock
– o2 if hypoxic
– upgrade to als

Signs and symptoms of sepsis
– altered mental status
– increased heart rate
– increased respiratory rate
– low blood pressure
– high blood glucose levels
– decreased cap refill

Causes of seizures
– hypoxia
– stroke
– traumatic brain injury
– toxins
– hypoglycemia
– brain tumor
– congenital brain defects
– infections
– metabolic- seizures can be caused by irregularities in the patients body chemistry
– idiopathic- occurring spontaneously

Stroke (548-52
Death of brain tissue that is deprived of oxygen. This can be caused by blockage of an artery that supply’s blood to part of the brain or bleeding from a ruptured blood vessels in the brain.

Signs and symptoms of a stroke
– confusion
– dizziness
– numbness
– weakness or paralysis ( usually on one side of the body)
– loss of bowel and or bladder control
– Impaired vision
– high blood pressure
– difficult respiration or snoring
– nausea or vomiting
– seizures
– unequal pupils
– headache
– loss of vision in one eye
– unconcisness
– facial droop
– slurred speech

Cincinnati prehospital stroke scale
– test for facial droop- have them smile
– assess for speech difficulties- have them say a simple sentence
– check for arm drift – have patient close eyes and put arms up at shoulder level with palms up and see if they drift

Treatment of a stroke
– control airway
– administer oxygen

Transient ischemic attack ( 549
A small clot is blocking one of the blood vessels to the brain

Signs and symptoms of a transient ischemic attack
Signs and symptoms of a stroke that may or may not go away before u get there

Anaphylaxis
A sever allergic reaction that shows signs of either respiratory distress of shock

Peritoneum
Double-layered membrane surrounding the abdominal organs. It surrounds the stomach, liver, spleen, appendix, small and large colon and in women the uterus , fallopen tubes and ovaries. The peritoneum splits into two parts , the visceral peritoneum which covers the organs and the parietal peritoneum which is attached to the abdominal wall.

What organs are the organs located inside the peritoneum
Stomach, liver, spleen, appendix, small and large colon, in women it also surrounds the uterus, Fallopian tubes, and the ovaries

What organs are located in the retro-peritoneal space
Kidneys, pancreas, aorta

Visceral pain
Pain that originates within the organs and is often described as dull, achy , or intermittent, and it may be diffuse and hard to locate

Parietal pain
Pain caused by direct irritation to the parietal peritoneum. Many things could cause this such as internal bleeding, infection/ inflammation. Often described as sharp or constant and localized to a peticular area

Tearing pain
A type of pain that is only felt in the aorta and the stomach, often felt in a AAA, and stomach ulcers.

Referred pain
Pain that is felt in an area other then where the pain originates

Appendicitis (606
An infection of the appendix

Signs and symptoms of appendicitis
– nausea and sometimes vomiting
– pain in the area of the umbilicus initially and followed by persistent pain in the right lower quadrant

Peritonitis (606
When foreign substances from the body get released into the peritoneum space

Signs and symptoms of peritonitis
– the abdomen becomes rigid and distended
– the abdomen is tender and painful
– reaver and other signs of infection

Cholecystitis/gallstones (606
Inflammation of the gallbladder often caused by kidney stones

Signs and symptoms of cholecystitis/ gallstones
– Sever and sometimes sudden pain in the right upper quadrant ore epigastric pain that radiates to the shoulder

Pancreatitis
The inflammation of the pancreas and is common in patients with chronic alcohol problems

Signs and symptoms of pancreatitis
– pain that radiates to the back and or shoulders.

Gastrointestinal bleeding
Bleeding in the gastrointestinal system. Anywhere from the esophagus to the rectum

Sings and symptoms of gastrointestinal bleeding
-Coffee ground like vomit or bright red vomit
– dark tarry stools or red stools

Hernia
protrusion of an organ or part through the tissues and muscles normally containing it

Signs and symptoms of a hernia
– sudden onset of pain
– can be palpated as a abnormal lump

history specific to women
– where are u in your menstrual cycle
– do u have bleeding now that is not menstrual bleeding
– if u are menstruating is the flow normal
– have u had this pain before

Purpose of blood
– control of bleeding by clotting
– delivery of oxygen to the cells
– removal of co2 from the cells
– removal and delivery of other waste products to organs that provide filtration and removal such as kidneys and liver

Coagulopathy
The loss of normal ability of form a blood clot with internal or external bleeding

Anemia
Lack of a normal number of red blood cells in circulation around the body. Some causes of anemia are trauma or sudden massive GI bleed

sickle cell anemia
An inherited disease in which a genetic defect in the hemoglobin results in abnormal structure of the red blood cells.

Purpose of blood
– control of bleeding by clotting
– delivery of oxygen to the cells
– removal of co2 from the cells
– removal and delivery of other waste products to organs that provide filtration and removal such as kidneys and liver

Anemia
Lack of a normal number of red blood cells in circulation around the body. Some causes of anemia are trauma or sudden massive GI bleed

Coagulopathy
The loss of normal ability of form a blood clot with internal or external bleeding

Purpose of blood
– control of bleeding by clotting
– delivery of oxygen to the cells
– removal of co2 from the cells
– removal and delivery of other waste products to organs that provide filtration and removal such as kidneys and liver

sickle cell anemia
An inherited disease in which a genetic defect in the hemoglobin results in abnormal structure of the red blood cells.

Urinary tract infection
Infection of the urinary tract that is caused by bacteria

Signs and symptoms of a urinary tract infection
– painful and frequent urination

Kidney stones
A little buildup of calcium made in the kidney

Signs and symptoms of kidney stones
– sever unilateral flank pain
– nausea and vomiting

Hemodialysis
The most common for of dialysis, a patient is connected to a dialysis machine that pumps his blood through spec lined filters to remove toxins and excess fluid.

Peritoneal dialysis
Uses the peritoneal in the abdomen as a way to remove toxins from the body.people on peritoneal dialysis have a percent catheter implanted in their abdominal wall and into their a-retinal cavity. Several liters of formulated dialysis soluation are ran into the abdominal cavity and left there for several hours, where it absorbs waste materials and excess fluids, then the fluid is drained back out into the bag and digarded

Signs of internal bleeding
– injuries to the surface of the body that could suggest underlying issues
– bruising, swelling , tenderness over vital organs
– painful, swollen, or deformed extremities
– bleeding from the mouth, rectum,vagina, or any other body orifice
– a tender rigid or distended abdomen
– vomiting a coffee ground like substance or bright red vomit
-dark tarry stools or bright red stools
– signs and symptoms of shock

Treatment of internal bleeding
Based on the prevention and treatment of hypo-perfusion

Contusion
A bruise

Hematoma
A swelling caused by the collection of blood under the skin or in damaged tissue as a result of an injured or broken blood vessel. Different from a contusion because it involves more tissue damage and bleeding

Closed crush injuries
An injury caused when force is transmitted from the body’s exterior to its internal structures. Bones can be broken, muscles, nerves, and tissues damaged; and internal organs ruptured, causing internal bleeding

Abrasions
Simple scrapes and scratches of the outer layer of skin ( kid falling and skinning his knee )

Lacerations
A cut

Penetrating trauma and punctures
An open wound that tears through the skin and destroys underlying tissue. A penetrating puncture can be shallow or deep. A perforating puncture wound has an entrance wound and an exit wound

Avulsion
The tearing away or the tearing off of a piece or flap of skin or other soft tissue. This term also may be used for an eye pulled out of its socket or a tooth dislodged from its socket.

Amputation
The surgical removal or traumatic severing of a body part.

Superficial burn
Involves only the epidermis and is characterized by reddening of the skin and perhaps some swelling

Partial thickness burn
A burn in which the epidermis is burned through and the dermis is damaged. Burns of this type are characterized by blistering, reddening, and a molting appearance

Full thickness burn
A burn in which all the layers of skin are damaged. There are usually areas that are charged black or areas that are dry and white. Also called a third degree burn

Rule of nenes for adults when calculating burn area
Head and neck- 9%
Each upper extremity -9%
Chest- 9%
Abdomen – 9%
Upper back- 9%
Lower back and buttocks- 9%
The front of each owner extremity – 9%
The back of each lower extremity-9%
Groin- 1%

Rule of nines for children
Head and neck-18%
Each upper extremity-9%
Chest and abdomen- 18%
The entire back- 18%
Each lower extremity- 14%
Genital region- 1%

Classifying minor burns- adults
– full thickness burns of less then 2%of the body surface, excluding the face, hands, feet, genitalia, or respiratory tract
– partial thickness burns to less then 15% of the body’s surface
– superficial burns of 50% of the body surface or less

Classifying moderate burns – adults
-Full thickness burns of 2 to 10% of the body’s surface excluding the face, hands, feet, genitalia, or respiratory tract
– partial thickness burns of 15-30% of the body’s surface
– superficial burns that involve mor then 50% of the body’s surface

Classifying critical burns- adults
– all burns complicated by injuries of the respiratory tract, other soft tissue injuries , and injuries of the bones
– partial thickness or full thickness burns involving the face, hands, feet, genitalia, or respiratory tract
– full thickness burns of more then 10%
– partial thickness burns of more then 30%
– burns complicated by musculoskeletal injuries
– circumferential burns

Flail Chest
Fracture of two or more consecutive ribs in two or more places

Pneumothorax
Occurs when air enters the chest cavity, possibly causing the collapse of the lungs.

tension pneumothorax
Most often in a closed Chest injury. Happens when air escapes into the chest cavity and cant escape. Often happens when a broken rib punctures a lung

Hemopneumothorax
The chest cavity fills with both blood and air

Hemothorax
A condition in which the chest cavity fills with blood

cardiac tamponade
When an injury to the heart causes blood to flow into the surrounding pericardial sac. What happens is the blood fills the hears unyielding sac and compresses the hearts chambers until they don’t get to fill adequately

Signs and symptoms of cardiac tamponade
– distended neck veins
– very weak pulse
– low blood pressure
– steadily decreasing pulse pressure
– tearing chest pain radiating to the back
– differences between pulse or blood pressure between the left and right extremities
– palpable pulsating mass ( if the aorta is involved)
– cardiac arrest

Dislocations
The disruption or coming apart of a joint

Sprain
The stretching and tearing of a ligament

Strain
A muscle injury caused by the overexertion or overstretching of a muscle

Intacerebral
Inside the brain

Subdural
Inside the dura

Epidural
Outside the dura

Glasgow coma scale
A system used to calculate level of conciseness

EYE OPENING
Spontaneous -4
To voice-3
To pain – 2
None- 0
VERBAL RESPONSE
Orientated- 5
Confused- 4
Inappropriate words- 3
Incomprehensible sounds-2
None-1
MOTOR RESPONSE
Obeys commands-6
Localizes pain- 5
Withdraws (pain)- 4
Flexion (pain)- 3
Extension (pain)- 2
None- 1

Tearing pain
A type of pain that is only felt in the aorta and the stomach, often felt in a AAA, and stomach ulcers.

Air embolism
Air bubble in the arteries and blood vessels of the neck. Can be carried to the lungs and interfere with the pulmonary circulation and the body’s ability to exchange oxygen and carbon dioxide.

pulmonary embolism
When a air embolism reaches the lungs.

Multisystem trauma
Patient has one or more injuries that affect more then one body system.

Hypothermia
When cooling affects the whole body.

Hypothermia sighs and symptoms
Shivering
Difficulty speaking
Strong muscular rigidity
Muscle coordination is affected
Erratic or jerky movements
Altered mental status

Passive warming
Allowing the body to warm itself. My involve removing wet clothing or covering the patient, and preventing further heat loss

Active warming
The application of an external heat source to the body.

Extreme hypothermia
NEVER CONSIDER A PATIENT DEAD UNTIL THEY ARE WARM AND DEAD!!!!!!! Assess cardioid pulse for 30 second if not found start cpr and apply and aed.

Local cooling signs and symptoms
– skin discoloration
– gray or white blotchy appearance of skin
– exposed skin becomes numb and if freezing process continues all feeing is lost
– skin becomes dead white

Early or superficial local cold injuries
Brought about by direct contact with a cold object or exposure to cold air. Wind chill and water chill can also be a major factor. Tissue damage is minor and response to treatment is good.

Early or superficial local cold injuries signs and symptoms
– skin in affected area changes color ( light skin people skin reddens in dark sin it becomes lighter) then in both the skin beaches
– affected area feels numb

Treatment for superficial or early local cold injuries
– get patient out of the cold environment
– warn the affected area
– if the injury is to an extremity splint and cover it

Late or deep local cold injuries
Devolution as a early or superficial local cold injury goes untreated

Signs and symptoms of late or deep local cold injuries
– affected skin appears white and waxy .when the condition progresses to actual freezing the skin turns white and molted or blotchy, and the color turns from white to grayish yellow and finally to a grayish blue. Swelling and blistering may also occur

Treatment of deep or late local cold injuries
-If there are signs of hypoxia, or the patient vital signs indicate or suggest the potential for shock administer oxygen
– transport to a medical facility without delay, cover and treat frozen part as gently as possible

Hyperthermia
Body tempture that is to high

Heat emergency patient with moist, pale, and normal or cool skin
– muscular cramps
– weakness or exhaustion and sometimes dizziness or periods of faintness
– rapid, shallow breathing
– weak pulse
– heavy perspiration
– loss of conciseness is possible but usually brief if it occurs

Treatment of a heat emergency patient with moist,pale,and normal or cool skin
– remove patient from hot environment
– if there are signs of hypoxia or vital signs indicate shock administer oxygen
– loosen or remove clothing to cool the patient by fanning them without chilling them
– put the patient in a supine position
– if patient is alert and orientated and not nauseated have them take small drinks of water
– if patient experiences muscle cramps, apply moist towels over the cramped muscles

Drowning
The process of experiencing respiratory impairment from submersion/ immersion in liquid

Air embolism (scuba diver related )
Results from air leaving a damaged lung and entering the blood stream

Air embolism ( scuba diver related) signs and symptoms
– blurred vision
– numbness and tingling sensation in the extremities
– chest pains
– generalized or specific weakness, possibly paralysis
– frothy blood in mouth or nose
– convulsions
– rapid lapse into unconsciousness
-respiratory arrest and cardiac arrest

Decompression sickness
Usually happens when a diver comes up from a deep prolonged dive. The quick scent traps nitrogen in the body’s tissue and then into the bloodstream. It can take from one to 48 hours for decompensation sickness to set in.

Decompression sickness signs and symptoms
-personality changes
– fatigue
– deep pain to the muscles and joints
– itchy blotching or molting of the skin
– numbness or paralysis
-choking
– coughing
– labored breathing
– behavior similar to intoxication
-chest pains
– collapse leading to unconsciousness

Treatment for decompression sickness and air embolism
– maintain an open airway
– administer the highest concentration possible by non rebreather mask
– rapidly transport
-. Contact medical direction on where to take the patient
– keep patient warm
– position patient supine or in lateral recurbnat positon

Signs and symptoms of injected venom ( usually from snake or spiders)
– altered states of awareness
– noticeable stings or bites on the skin
– puncture marks
– blotchy ( molted skin)
– localized pain or itching
– numbness in a limb or body part
– burning sensation at the site followed by pain spreading through the limb
– redness
– swelling or blistering at the site
– weakness or collapse
– difficulty breathing and abnormal pulse rate
-headache or dizziness
– chills
– fever
– nausea and vomiting
– muscle cramping, chest tightness, joint pains
– excess saliva formation, profuse sweating
– anaphylaxis

Treating insect nights and stings
– treat for shock even if vitals do indicate it
– call medical direction ( skip only if the organism is known
– remove stinger or venom sac
– remove jewelry from patients affected limb in case of swelling
– if local protocol permits it and if the wound is on an extremity place constricting bands above and below the site
-immobilize the limb

Women’s external genitalia (diagram on page 884)
Labia- consist of soft tissue that protect the entrance to the birth canal
Perineum- the soft tissue and muscle found between the vaginal opening and the anus
Mons pubis- a layer of soft tissue that covers and protects the public symphysis. It is the area where hair grows when a women reaches puberty

Women’s internal genitalia
– vagina- is the birth canal
– ovaries- small round organs that are located on either side of the women’s lower abdominal quadrants. These organs are responsible for producing eggs for conception
– Fallopian tubes- the passage way from the ovaries to the uterus
– uterus – is a muscular, hollow organ located along the midline in most women’s lower abdominal quadrants. This organ is the intended site for fertilized egg to implant and devolution into a fetus

First stage of labor
This stage starts with regular contractions and the thinning and gradual dilation of the cervix and ends when the cervix is fully dilated

Second stage of labor
This stage is the time from when the baby enters the birth canal until the time he is born

Third stage of labor
This stage begins after the baby is born until the after birth is delivered

Assessment of women in labor
– ask her name, age, and approximate due date
– ask if this is her first pregnancy- delivery is typically shorter in women who have had babies before
-ask if she has seen a doctor regarding her pregnancy – important in knowing known problems with the pregnancy
– ask he when her labor pains started and how often she is having them. Ask he if her water has broken and if she has had any bleeding or bloody show
– ask her if she feels the urge to push or she feels like she needs to move her bowls- if she says yes it usually means that the baby has moved into the birth canal and is pushing on the rectum. It means the baby might come very soon
– examine the mother for crowning- if visible birth is imminent
– feel for uterine contractions
– take vital signs

Delivering a baby
1) keep someone at the head of the mother to provide support, monster vitals, and to be alert of vomiting
2) position your hand gently on the baby’s head as it bulges out of the vagina to prevent a sudden uncontrolled expulsion of the newborn. ( do not touch the are around the vagina except to assist with delivery) ( for legal reasons it is always preferable to have your partner present at all times when u are touching a women’s vaginal area)
3) pace one hand bellow the baby’s head as it delivers. Spread your fingers evenly supporting the baby’s head. A slight well distributed pressure may help prevent n explosive delivery. Keeping one hand on the baby’s head and using the other hand to hold a sterile towel to support the tissue between the mothers vagina and anus can help prevent tearing of this tissue during the delivery of the head.
4) if the amniotic sack has not broken by the time the baby dead is delivered use your finger to puncture the membrane and pull it away from the baby’s mouth and nose. If the amniotic fluid is meconium stained ( poop in the fluid) u must suction the baby’s mouth and nose immediately or it may be inhaled and cause more complications for the baby
5) once the baby’s head is delivered check to see if the umbilical cord is wrapped around the babys neck. Ask the mother to not push while u check. It it is try and Bentley sip it off of the baby’s neck. If u cant clamp the cord in two places and cut the cord in the middle of the 2 clamps and then unwrap it from the babies neck, then resume delivery
6) help deliver the shoulders.
7) support the baby through the rest of the delivery. Once the feet are delivered lay the baby on his side with his head slightly lower then his body. This is done to allow blood fluids and mucus to rain form the mouth and nose. Keep the baby on the same level as the mom until the umbilical cord stops pulsating. Then cut the cord
8) assess the airway. If the baby is not moving or not breathing suction the airway, or if the airway is at a Tehran of being obstructed.
9) note the exact time of birth. Write the mothers last name ad time of delivery on a price of tape and fold it so the adhesive side is not touching the baby’s skin and place it around the baby’s wrist

APGAR SCORE
APPEARANCE
Blue or pale all over – 0
Extremities blue, trunk pink- 1
Pink all over- 2
PULSE
0-0
< 100- 1 > 100- 2
GRIMANCE( REACTION TO SUCTIONING OR STIMULATION)
No reaction- 0
Facial grimace – 1
Sneeze cough or cry-2
ACTIVITY
No movement – 0
Only slight activity -1
Moving around normally – 2

RESPIRATORY EFORT
NONE -0
Slow or irregular breathing, weak cry- 1
Good breathing, strong cry- 2

APGAR scores should be taken 1 minute after birth and 5 min after birth

Cutting the umbilical cord
– wait for the umbilical cord to stop pulsating
– place one clamp about 10 inches away from the baby and place the second clamp about 7 inches away from the baby
– cut the cord in the middle of the two clamps

Breach presentation in child birth
When the child presents feet or but first

How to treat breach presentation
– imitate rapid transport upon recognition of breach presentation
– provide high concentration oxygen
– place mother in a head down position with pelvis elevated
-if the body delivers support it and prevent an explosive delivery of the head. Then insert your middle and index finger inside the vagina and form a V on either side of the patients nose and lift it off the vaginal wall in case it spontaneously starts breathing

Limb presentation in child birth
When a limb of an infant protrudes from the vagina

How to treat limb presentation
– If there is a prolapsed cord follow the normal procedure u would for a prolapsed cord
– transport the mother immodestly to a medical facility
-place the mother in a head Down position with the pelvis elevated
-administer high concentration oxygen with Ann rebreather mask

Prolapsed umbilical cord
When the umbilical cord presents first. The head will cut of the circulation as it delivers causing the baby to die

How to treat prolapsed umbilical cord
– position the mother with her head down and pelvis raised with a blanket or pillow, using gravity to lessen the pressure on the birth canal
– provide the mother with high concentration oxygen by non rebreather mask
– check the cord for pulses and wrap the exposed cord.
– insert several fingers of your gloved hand into the vagina so u can Bentley push the baby to keep pressure off the cord and continue until relived by a physician
– rapid transport and have your partner get vitals

Premature birth
A baby that weighs less then 5 1/2 pounds or one who is born before the thirty seventh week of pregnancy

Treatment off premature birth
– keep baby warm
– keep the airway clear ( suction if necessary)
– provide rescue breathe/ chest compressions based on pulse and respiratory effort
-watch the umbilical cord for bleeding
-avoid contamination ( keep them away from people and do not breath on their face)
-transport infant in warm ambulance ( ideal temperature is between 90 degrees and 100 degrees F

placenta previa
The placenta devolution in an abnormal location that does not allow for proper delivery of the placenta. The cervix dilates and the placenta tears

abruptio placentae
When the placenta separates from the uterine wall before delivery ( often due to trauma)

Ectopic pregnancy
When the egg implants outside the uterus.

Ectopic pregnancy sighs and symptoms
– acute abdominal pain, often starting on one side or the other
– vaginal bleeding
– rapid and weak pulse ( a later sign)
– low blood pressure ( a very late sign)
– absent menstrual period used to indicate possible pregnancy

Treatment for ectopic pregnancy
– consider the need for immediate transport
– position the patient for shock
– care for shock
– administer oxygen if signs and symptoms of shock are present
– do not give the patient anything by mouth

Fever
Above normal body temperature

Meningitis
A potentially life threatening infection of the lining of the brain and spinal cord. Usually occurs between the ages of one month to 5 years however it is not uncommon to find meningitis in adelosents

Signs and symptoms of meningitis
– high fever
– stiff neck
– lethargy
– irritability
– headache
– sensitivity to light
– in infants bulging fontanelles unless infant is dehydrated
– pain full movement during which the child does not want to be touched or held
– seizures
– a rash if the infection is bacterial

Treatment of meningitis
– monster the patients ABC’s and vitals
– provide high concentration o2 by non rebreather mask
– provide cpr if necessary
– be aware of seizures
– transport immediately

Diarrhea and vomiting
Are common in childhood illnesses. Either one could easily cause dehydration that worsens whatever other conditions the child may have.

Treatment of diarrhea and vomiting
– monster airway and be prepared to provide suction
– provide o2 if respirations are compromised or if there are signs of shock
– if signs of shock are present contact medical direction and transport immediately
– if your protocols or medical direction permits, offer the child sips of clear liquids or chipped ice if only diarrhea is present
– some systems recommend that u save a sample of vomitis and rectal discharge

Seizures
Fever is the most common cause of seizures in infants and children. Epilepsy, infection, poisoning, hypoglycemia, trauma, or decreased levels of oxygen can also bring on seizures

Treatment of seizures
-Maintain an open airway
– position the patient on his side if there is no possibility of spinal injury
– be alert of vomiting ( suction as needed)
– provide oxygen and if they are in cardiac arrest provide artificial ventilations with connected oxygen
– transport