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TermDefinition
Periotoneal membrane that forms the lining of the abdominal cavity. produces somatic/ parietal pain - sharp and easily localized
Somatic/ Parietal Pain Sharp / Easily localized pain
Visceral Pain Dul, poorly localized
Hematoma a solid swelling of clotted blood within the tissues
Amputated Parts should be protected and transported in dry cool setting. Putting directly on cold pack could freeze the part
Beta- Blockers Prevent heart from speeding up, or beating harder, - used for the management of cardiac arrhythmias, protecting the heart from a second heart attack MI after a first heart attack, used to be used for high blood pressure
APGAR
Appendicitis – Inflammacion of the appendix • Life threatening infection and septic shock • S+S o Nausea, vomiting, diarrhea, loss of appetite, fever o Pain begin as diffuse Pain starts periumbilical and the moves to RLQ
Upper Airway Issue Stridor
Adventitious Breath Sounds are abnormal sounds that are heard over a patient's lungs and airways. These sounds include abnormal sounds such as fine and coarse crackles (crackles are also called rales), wheezes (sometimes called rhonchi), pleural rubs and stridor.
Lower Airway Issue Rales, rhonchi and wheezes
Fowlers Sitting - The upper half of the patient's body is between 60 degrees and 90 degrees in relation to the lower half of their body.
Semi Fowlers position of a patient who is lying in bed in a supine position with the head of the bed at approximately 30 to 45 degrees. Upright at 90 degrees is full or high Fowler's position.
Supine face upward
Prone lying flat face downward
Left Lateral Recumbant
Tredelenburg Back Flat - Feet Up
Epistaxis Bleeding from the nose
SLUDGEM drug overdose, nerve gas pathological effects indicative of massive discharge of the parasympathetic nervous system - Salivation, Lacrimation(tearing), Urination, Defecation Gastrointestinal upset, Emesis (Vomiting) Miosis pupillary constriction
CO2 Poisoning Leading cause of death due to fires, home heating devices and vehicle exhaust -Inhibits bodys ability to transport and use O2 - greater risk in confined space – tasteless, colorless, odorless non irritating Headache, nausea, vertigo weakness
DCAP - BTLS rapid trauma assessment - soft tissue injuries - Deformities & Discolorations Crepitus & Contusions Abrasion & Avulsion Penetrations & Punctures Burns Tenderness Lacerations Swelling & Symmetry
Cardiogenic shock pump problem – backup of fluid, pulmonary edema and hypotension – caused by reduced preload, high afterload or poor myocardial contracality S+S hypotension, cardiac hx, chest pain, respiratory distress, pulmonary edema, altered LOC
Obstructive Shock – pump problem caused by mechanical obstruction of the heart muscle - cardiac tamponade and tension pneumothorax
cardiac tamponade fluid accumulates within the pericardial sac and compresses the heart S+S (JVD, narrowing pulse pressure, hypotension)
Tension pneumothorax air enters chest cavity due to lung injury - pressure compresses lungs and great vessels – S+S include JVD, resp. distress, diminished absent lung sounds, poor BVM compliance, tracheal deviation toward unaffected side
Distributive shock – pipe (blood vessel) problem – widespread vasodilation - causes blood pooling or relative hypovolemia – Analphylactic shock, neurogenic, septic, psychogenic
Anaphylactic Shock allergic reaction – vasodilation, widespread (fluid leakage), bronchoconstriction – causes meds, foods bites stings enviro allergens skin:hives, swelling, itching flushed or cyanotic, cardio:weak pulse, low bp resp:severe dyspnea, wheezing, failure
Neurogenic Shock – spinal cord damage, typically in cervical region – interrupts normal communication pathways between nervous systems – S+S – MOI:c-spine, hypotension, warm, normal skin, HR NOT tachycardic, Paralysis +resp paralysis
Septic Shock infection- damages blood vessels and increases plasma loss out of vascular space - fever, chills, weakness, recent illness infection or surgery, altered LOC, increased RR, tachycardia, low bp, pale cool skin, weak peripheral pulses, no appetite
Psychogenic Shock – sudden temoporary vasodilation that leads to syncope (fainting) – doenst present a sustained problem – sudden vasodilation intterrups blood flow to brain leading to syncopal episode
Hypovolemic Shock fluid problem-Loss off blood, Dehydration from vomiting, diarrhea or burns- Common pedi and geriatric pts- S&Sx - Trauma, blunt or penetration - Bleeding, change LOC, nausea, vomit, diarrhea, Tachycardia pale cool skin, Week peripheral pulse, hypotension
CPR Emphasis on high quality compressions -Rate at least 100/ min Depth - 2 in for adults - At least 1/3 of chest for infants and pedis - 2 in for pedis - 1.5 inches for infants Minimum interruptions - Max is 10 sec 30 COMPRESSIONs: 2 BREATHS — Always
Nitro
Aspirin Class: anti-inflammatory, anti-platelet aggregate, antipyretic 3. Mechanism of action: reduces inflammation, decreases platelet aggregation, reduces fever
Normal Respiratory Rate & Rhythm Adults - 12 to 20 BPM Children - 15 to 30 BPM Infants - 25 to 50 BPM
Oropharyngeal Airway Indications: Unresposive pts without gag reflex Contraindications: Consious pts or any pt with gag reflec Sizing - mouth to earlob
Nasopharyngeal Airway Indications - Unresponsive pt without gag reflex or pts with decreased level of conciousness but with intact gag Contraindications - concious pts who can protect their own airway - head or facial trauma - resistance to insertion - pts less then 1 year
Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure.
PT Assessment SCENE SIZE UP • Scene Satey – Precautions (BSI) • Determine # of pts and need for additional resources • Consider MOI or NOI PRIMARY ASSESSMENT • Assess and manage ABCs (CABs if pt is unresponsive) • Simultaneious manual c-spine if precautions are
Asthma acute condition caused by bronchoconstriction & Excess mucus production – triggered by exercise. Allergic response and illness – wheezing on exhalation, abselt lung sounds in severe cases and coughing
Chronic Obstructive pulmonary Disease (COPD) Slow chromic disease that obstructs and damages the lower airways and alveoli – COPD includes chronic bronchitis and emphysema Largely due to cigarette smoking – often on home or portable Ox
Congestive Heart Failure heart doesn’t pump effectively and leads to back up of fluid and pulmonary edema
Croup (laryngotracheobronchitis) – inflammation of the pharynx, larynx and trachea - hignly infectious and occurs in children of up to 3 years of age S&Sx Ususally proceeded by a cold and occurs in winter “barking” cough Presents with stridor a high-pitche
Cystic Fibrosis (CF) Genetic disorder leading to thick mucus production and chronic lung infections - often causes death prior to entering adulthood S&Sx – asthmalike symptoms and gastrointestinal problems
Flail Chest
Pneumonia Infection in the lungs – leading cause of pedi deaths worldwide – concern for any patient that aspirates S&Sx History of chronic or termina illness, productive cough, weekness, chest pain, fever, low pulse ox reading
Pneoumothorax Accumulation of air in the pleural space Occurs spontaneously or as a result of trauma Astham patients are at a high risk of spontaneous pnt S&Sx Hx of respiratory problems or thoracic trauma Diminished or absent lung sounds in affected area
Pulmonary Edema – accumularion of fluid in the lungs Causes – CHF, toxic inhalation, disease trauma S&Sx – cardiac hx, rales, pedal edema, orthopnea (dificulyry brearhing while lying down
Respiratory Syncytial Virus (RSV) – respiratory infection commin in infants and children – extremely contagious S&Sx coldlike symptoms, poor fluid intake, signs of dehydration
Hyperventilation Syndrome – rapid breathing and often associated with distraught patients Can be sign of serious underlying medical problems Attempt to calm patient and move from stressful situation Never have a patient breathe in to a paper bag or O2 mask without O2
Acute Coronary Syndrome (ACC) • Myocardial ischemia • Angina pectoris and acute MI
Angina Pectoris - Transient Chest pain caused by a lack of 02 to the hearth muscle • Usually caused by atherosclerosis ( buildup of plaque in a blood vessel that restricts or obstructs flow) in the coronary arteries • Usually occurs during physical activity or stress a
Acute Myocardial Infarction (AMI or MI) death to an area of the myocardial muscle due to lack of oxygenated blood flow through the coronary arteries - dead myocardial tissue becomes scar tissue and cant contribute to cardiac contraction. Time is criritcal to restore blood flow and minimize car
Atypical Presentations of MI o Not all pts have chest pain – silent MI o Some complain of epigastic pain or indigestion o Pt groups who experience atypical MI presentations • Geriatiric • Women • Diabetic
Congestive Heart Failure (CHF) – when ventricles aren’t able to keep up with the flow of blood coming to them • RIGHT VENTRICLE - if pumps ineffectively blood backs up in the venous system that feeds the right heart o Signs – JVD and Pedal Edema • LEFT VENTRICLE – backs up the lun
Hypertension (High BP) – systolic greater then 140 mmHG and a Diastoluc above 90 mmHG • Hypertensive Crisis – Systolic over 160 and diastolic over 94 o Pt might have associated symptoms or asymptomatic o Asymptomatic pts should be evaluated by a physician • S+Sx:Headache,
Assessment and Management Cardiogenic SHock • Chest pain or other symptoms cardiac emergency should be high transport priority • Consider nitroglycerin and aspirin • Consider CPAPC or BiPAP for CHF
Stroke - death to brain tissue due to interruption in blood flow - Cerebrovascular Accident CVA - Ischemic, Hemorrhagic S+Sx - Severe headache, slurred speech, Facial Droop, drooling, Unilateral numbness, weakness, paralysis, Altered LOC, Vision Problems
Risk Factors CVA • Nonmodifiable – RASH Races, Age, Sex Heredity • Modifiable - SHEDS Smoking Hypertension Exercise Diet and Diabetes, Stress
Ischemic Strokes – bloodflow is compromised due to blockage • Due to atherosclerosis (build up of plaque) • Most strokes are ischemic
Hemorrhagic Stroke – bleeding within the brain • Bleeding robs brain of O2 and can ply pressure to surrpinding brain tissue – further limiting O2 • Limited options for interventions – prevention through modification of risk factors is key
Cincinnati Prehospital Stroke Scale • Facial Droop – ask pt to smile • Arm drift – close eyes while holding arms out front palms up (one arm will drift) • Speech - ask pt. to repeat a given sentence - speech is slurred, pt unable to speak
Transient Ischemic Attack • TIAs have same signs and symptoms as CVA but signs and symptoms self-correct within 24 hours - no permanent brain damage o Mini strokes – warning sign for impending CVA
Seizures Causes by disorganized electrical activity in the brain- Phases – varies for pt- Aura phase – warning – pt may sense seizure - Tonic – muscle rigidity – incontinence - Tonic-clonic – uncontrolled muscle contraction and relaxation (pt. may be apneic) - Po
Generalized Seizures – Grand Mal o Pt unresponsive and experiences full-body convulsions
Absence Seizures – petit mal seixures o PT doesn’t interact with environment
Partial Seizures o No change in LOC, possible twitching/ sensory changes (no ful body convulsions o Complex Partial Seizures – altered LOC, isolated twitching and sensory changes possible
Status epilepticus o Prolonged (30 min) or recurring without pt. regaining consciousness in between o Dangerous – lead to permanent brain damage or death
Cause Seizures Congenital problems, trauma, med conditions, alchoho, brain injury, tumor, diabetic emergency, epilepsy, fever, infection, insulin, poisoning/toxic exp., stroke, bio/chem weapons - Febrile seizures common in pedi pts. – typically do not present significa
Syncope – fainting – temporary loss of blood to brain • Cardiac Emgr, hypotentsion, neuro problems, stress, diabetes, pregnancy, anemia, meds or toxic exposure • Pts regain consciousness when they are supine and blood flow returns to brain Assessment and Manag
Insulin pancreatic hormone – move glucose out of bloodstream and into cells - W/out insulin glucose can’t enter cells - cells starve look for other fuel – brain cells cant -Brain cells starve if no glucose/not starve if glucose is present regardless of insulin
Glucagon - pancreatic hormone works opposite of insulin – increases blood glucose
Regulation of Sugar • Food consumed – glucose increases • Insulin released – glucose goes into cells • Blood sugar levels fall – glucagon is released • Glucagon temporarily maintains sugar levels • Etc
Glucose Levels • - Normal 80 – 120 • After eating 120-140 • Hypoglycemia – less then 60 • Hyperglycemia - > 120
Type 1 - Insulin Dependent Diabetes Mellitus (IDDM) Must (inject) supplemental insulin - Develops in pedis -genetic in most cases- present with the three Ps and high glucose levels • Type 1 are high risk for diabetic ketoacidosis (DKA) if untreated • High risk for insulin shock due to overdose
Type 2 – non insulin dependent diabeties mellitus • Don’t typically require supplemental insulin • Combo of lifestyle and genetics
3 Ps of Diabetes • Polyuria – excessive urination due to excess glucose in the urine • Polydipsia – excessive thirst due to dehydration • Polyphagia – excessive hunger due to cell starvation
Insulin Shock Rapid - brain damage can occur rapidly - treatment must be rapidl - Low BG - Altered LOC – confusion, irritability - Seizures and coma - Restless, anxious - Diaphoresis, tachycardia -Pale, cool skin tremors misdiagnosed intox or behavioral EMRG
Diabetic Ketoacidosis (DKA_ Occurs with type 1- BG is> 350 mg - Brain cells use glucpse rest of the bodys cells starve -spills glucose into urine - dehydration - Use of alternate fuel sources - anaerobic metabolism production of ketones and acidosis -Acidosis threatens brain
Signs and Symptoms of Diabetic Ketoacidosis high blood glucose above 350 - Deep Rapid Breaths -Kussmauls - The 3 Ps - Polydipsia – excessive thirst - Polyphagia – excessive hunger - Polyuria – excessive urination - Unusual odor on breath – fruity or acetonelike - Incontience - Tachycardia -Coma
Hyperflycemic Hyperosmolar Nonketotic Syndrome • Similar to DKA but without the build up of ket0nes • Occurs more frequently with type 2
Sedatives Narcotics Barbiturates o Decreased LOC, respiratory depression o Pupillary constriction o Respiratory arrest seizures coma and death
Specific Interventions for Ingested Toxins • Activated charcoal • Contact med direction or a positon control center
Narcotics - opiods - widely abused - ingested or injected - Morphine, codeine, heroin, oxycodone, -CNS depressants - Bradypnea,shallow respirations, and pinpoint pupils - case coma and severe respiratory depression • ALS providers able to administer Narcan
Sedative Hypnotic Drugs • Sedative Hypnotics are CNS depressants • Calming effect and induce sleep – taken orally but can be injected • Barbiturates – amytal seconal and luminal • Benzodiazepines – valium, Xanax and Rphypnol
Acids and Alkalis Caustic substances • Acids – low pJ and burn on contact • Alkalis have a very high pH and tent to burn deeper the acids – pain may be delayed - Activated charcoal is contraindicated with caustic or hydrocarbon ingestion.
Emergency Response Guide
Primary Assessment Determine the transport priority.
chest compressions, is indicated for unresponsive children with a pulse rate below 60
Rapid Scan part of the primary assessment - meant to identify any lift-threatening conditions - not used to identify low priority injuries - pt with the potential for life threatening conditions, conscious or unconscious, receive a rapid scan.
The foramen magnum is a large opening at the base of the skull that allows the brain and spinal cord to connect.
inhalation the diaphragm and intercostal muscles are contracting. There is a drop in pressure within the thorax and air is pulled in, not pushed. the diaphragm and intercostal muscles are contracting. There is a drop in pressure within the thorax and air is pulled in, not pushed.
Left Heart Failure Pulmonary edema
Right Heart Failure JVD and Pedal Edema
parasympathetic nervous system exerts control over digestive functions
sympathetic nervous system Dilated pupils, dry mouth, and hypertension, increased cardiac output, increased respirations, peripheral vasoconstriction, and decreased blood flow to the GI tract
chemical agents Nerve agents and choking agents are examples of chemical agents
Biological agents are intended to cause disease
Nuclear and radiological agents are intended to cause injury by blast, radiation, or thermal burns
ABC Responsive Pts. - AIRWAY - Manual airway maneuvers, suction, mechanical adjuncts BREATHING - Assess respiratory rate, quality, and auscultate lung sounds. Give O2 or ventilations CIRCULATION - Pulses, bleeding, and skin condition
CAB Unresponsive Pts
A nonrebreather mask is indicated for spontaneously breathing patients with adequate ventilations and signs of hypoxia
Ventilation Patients with inadequate, slow, or shallow ventilations should be ventilated
SVN machine is used to nebulize bronchodilator medications
Primary Assesment - Assess and manage ABCs (CABs if pt is unresponsive)- manual c-spine if precautions are needed - Administer 02 and ventilate if needed - Rapid Scan – less then 90 seconds (inspection, palpation and auscultation as needed) - Determine Tranpsort priority
AVPU Alert/Awake, Verbal, Pain, Unresponsive
CO2 Drive Primary regulation of Breathing in our bodies - Monitors C02 levels in our bodies
The hypoxic drive is the body’s backup system to the CO2 drive. It monitors oxygen levels in the blood
Supine hypotensive syndrome occurs when the weight of the fetus and uterus compresses the inferior vena cava.This reduces the return of blood to the heart, reducing cardiac output and blood pressure.
Cincinnati Prehospital Stroke Scale acial droop, slurred speech, and arm drift
Scene Size Up • Scene Satey – Precautions (BSI) • Determine # of pts and need for additional resources • Consider MOI or NOI
Secondary Assessment • Head to Toe • SAMPLE / OPGRST • Vitals
Peritonitis • Caused by inflammation of the peritoneum (membrane lining the abdominal organs and cavity) • S+S o Nausea vomiting, loss of appetite, diarrhea, fever
Cholecytitis Inflammation of the gall bladder often due to gallstones - Females 30-50 S+S - Right upper quadrant pain - Increased pain at night - Increased pain after eating fatty foods - Referred pain in the shoulder is common - Nausea and vomiting
RUQ Cholecytitis
LUG
RLQ Appendix - late
LLQ
Diverticulitis Develops when small pouches (fiverticula) along the wall of the intetestine fill with feces abd become inflamed/ infected over 40 and low fiber diet - S+S - Abdo pain in the lower left quadrant, Fever, Weakness, Nausea, vomiting, Bleeding not common
GI Bleeding Often middle age pts, Most often fatal in geriatric pts •Upper GI bleeds – ulcers •Lower Gi Bleeds – due to diverticulitis • S+S vomiting blood, bloody stool o Dark Tarry Stool o Signs and symptoms of hypovolemic shock
Hematemesis – vomiting blood
Hematochezia – bloody stool
Gastroenteritis • Infection with associated diarrhea, nausea and vomiting • Due to contaminated food or water – not contagios • Prolonged vomiting and diarrhea can lead to hypovolemic shock • Common cause of shock in children
Espophageal Varices • Weakening of the blood vessels lining the esophagus • Frequently addociated with alcoholism • S+S o Vomiting large amounts of bright red blood o Hx of alcohol abuse or liver disease o S+S of hypovolemic shock
Ulcers • Open wounds along the digestive tract – often the stomach • S+S o History of ulcers o Abdominal pain in the left upper quadrant o Nausea and vomiting o Elicits increase in pain before meals and during stress
Abdominal Aortic Aneurysm (AAA) • Weakening of the wall of the aorta in the abdominal region, prone to rupture - will cause rapid fatal bleeding - S+S, common in geriatric Males, Tearing back pain, S+S of hypovolemic shock, pulsating abdominal mass o Transported without delay
Pelvic Inflammatory Disease (PID) • Painful and requires treatment – non emergency transport is recommended • S+S o Abdominal pain o Fever o Pain during urination o Increased pain while walking • Vaginal Bleeding o Causes – spontaneous abortion, PID, STDS
UTI – Urinary Tract Infection • Signs and Symptoms o Abdo pain o Hematuria – blood in urine o Painful or frequent urination o Fever, nausea, vomiting
Kidney Stones • Crystals formed in the kidneys that cause an obstruction in the urinary tract causing severe pain • Males more likely to develop • Signs and Symptoms o Severe abdo pain, groin pain o Pain urination, fever, nausea and vomiting
Head on Motor Vehicle Collisions (MVC) up and over or down and under the dash – head, spinal chest, abdo, hip and lower extremity injuries – unrestrained pts are ejected
Rear- Impact Motor Vehicle Collisions (MVC) C-spine injury due to hyperextension is common
Lateral Impact (T-bone) Motor Vehicle Collisions (MVC) –injuries along the side of impact are common
Rollover MVC - injury patterns are difficult to predict – high risk of ejection
Rotational Spins – increase risk of c-spine injury
Coup Contrecoup brain insjury on the opposite side of the impact
Falls MOI o >10 ft by pedi or any fall with loss of conciousness o greater then 15 ft or three times patient’s height is significant o Surface Struck o Body part landed on
Blast Injuries Primary – injuries dues to pressure wave of blast - Secondary – injuries due to flying debris - Tertiary – injuries from being thrown against stationary object - Miscellaneous – burns, inhalation etc
Glasgow Coma Scale Eye opening - Spontaneous 4,speech3,pain 2,None 1 Verbal - A&O 5, Confused 4, Inappropriate 3, Incomprehensible 2, None 1 Motor - Obeys 6, Localizes Pain 5, Withdraws from pain 4, Abnormal Flexion – 3, Abnormal Extension – 2, None 1Total – min3 max – 15
Control External Hemmorrhage 1 Method - Direct pressure with dry, sterile dressing, Elevate extremity above heart if possible, apply pressure dressing if bleeding is controlled 2nd - Direct pressure does not control bleeding – apply a tourniquet proximal to the source of blood
• Abrasion scrape to the skin due to surface friction
• Laceration – jagged cut
• Incission – sharp, clean cut
• Avulsion flap of skin being torn partially or completely loose
• RICES o Rest, Ice, Compression, Elevation Splinting
Evisceration open abdo injury with externam organs (ususally intestines) protruding • Cover with moist sterile dressing • Cover that dressing with an occlusive dressing • Flex legs to reduce abdominal contraction • Treat for Shock • High Priority Transport
Impaled Object • Should be stabilized • Indications for removal o Object creates airway obstruction or inability to manage airway (cheek) o Object is in the chest and prevents CPR for pt in cardiac arrest
Open Neck Injury cover open neck wounds with an occlusive dressing to prevent air embolism
Five Factors of Burn Severity • Depth, • Amount of body surface area burned • Burns to critical areas• Associated trauma or preexisting medical conditions, poor health and certain meds complicate bodies ability to handle a burn injury • Age
Superficial Burn • Epidermal damage only • Painful, red, no blisters
Partial thickness (second-degree) burn • Epidermal and partial dermal injury • Paintful blisters present
Full thickness (third degree burn) • Injury completely through dermal layer • Dry Leathery Skin – no pain
Severe Burn Injuries compromise respiratory, 3rd circumferential burns 2nd covering > 30% 3rd covering> 10% Burns with associated trauma Full thickness burns to airway, hands, face, feet or genitalia A moderate burn criteria for pts under 5 and over 55
Moderate Burn Injuries • Full thickness burns covering 2 to 10% o • Partial thickness nurns covering 15 to 30% • Superficial Burns covering more than 50%
Minor Burn Injuries • Full thickness burns covering less than 2% • Partial Thickness burns covering less than 15% • Superficial Burns covering less than 50%
Thermal Burns heat from water, steam or fire - Stop burning with moist sterile burn sheet until skin is no longer hot to touch - Replace with dry sterile burn sheet reduce risk of hypothermia infection, Remove clothing that trap heat +Jewelry – massive swelling
Inhalation Injury – chemical inhalation or inhales hot gases due to fire in a confined space • S+S include stridor, dyspnea, coughing, wheezing, facial burns, hoarse voice, airway edema, singed facial hair or soot in mouth or nose
Electrical Burns scene safety – don’t remove pt without proper training -Significant unseen injury have occurred entrance and exit points on body - Electrical burn pts are high risk of respiratory and cardiac arrest -All pts require transport and evaluation by physician
Chemical Burns Eyes and respiratory system are at high risk - scene safety first – Remove contaminated clothing, jewelry - Brush off any dry chemical on skin - Irrigate f water o Avoid contaminating unaffected areas with runoff • Treat as thermal burn
Strain – stretching injury to a muscle or tenden • S+S pain and tenderness • Usually little bleeding with a strain so swelling and discoloration will likely be minimal
Sprain – injury to a ligament • Involve shoulder, knee or ankle joints • S+S o Pain and tenderness – immediately o Swelling and discoloration – delayed
• Pelvic Fracture 1 in 5 hip fx pts dies within one year Risk of hypovolemic shock, embolism, pneumonia and sepsis Most hip fractures occur in geriatric pts Pelvic binders are commercial splints used in some EMS systems to stabilize pelvic fx and reduce bleeding
• Femur Fx o Single femur fx can cause hipvolemic shock o Increased risk of embolism o Fxs to multiple smaller long bones can combine to cause hypovolemic shock
Skull fx • S+S o Battle’s Sign - bruising behind the ears o Raccoon Eyes – bruising under the eyes
Linear skull fx – most skull fxs – don’t present deformity or depression
• Depressed – may be noticeable on palpation - increased risk of brain injury due to bone displaced from tissue
• Basal Skull Fx - occur base of skull - fluid may leak from nose or ears
Cerebral Contusion - accompanied by edema and/or concussion injury • S+S o Signs of concussion o AND decreased mental status, unresponsive, pupillary changes, changes in vital signs, obvious behavioral abnormalities
Epidural Hematoma bleeding beneath skull but above the dura mater - significant arterial bleeding -dangerous increase in intercranial - Brief loss of consciousness Worsening LOC, headache, seizures, vomiting, posturing, hypertension, bradycardia, pupillary changes
Intercranial pressure rise in systolic blood pressure, widened pulse pressures, bradycardia, irregular breathing, heart rate increase, breathing shallow, apnea will occur, and blood pressure will begin to fall. agonal rhythm followed by respiratory arrest and cardiac arrest.
Subdural Hematoma – bleeding above the brain (beneath the dura mater and above the arachnoid meningeal layer) - caused by venous bleeding following cerebral contusion Vomiting, decrease LOC, pupillary changes, unilateral weakness or paralysis, hypertension, changes in resp
Subarachnoid Hemorrhage - bleeding in subarachnoid space • Allows blood to enter cerebrospinal fluid (CSF) • Due to trauma or a ruptured aneurysm • S+S o Headache, stiff neck o Neuro impairment, decreased LOC and seizures
Intracerebral Hemorrhage • Bleeding within brain tissue • Pts can deteriorate rapidly • High mortality rate
Herniation Syndrome • brain is compressed due to excessive ICP - Will force brain down toward foramen mangnum o Cushings response/ reflex – hypertension, bradycardia, altered respiratory patern -Mortality rates high – attempt to reduce dangerously high ICP higher ventilation
Cushings Triad hypertension, bradycardia and apnea.
Flexion – extreme forward (chin to chest) movement of head
Extension – extreme backward movement of head (eg rear impract accident)
Compression –Compression of head against body (diving injury)
Rotation – extreme lateral (side to side) movement
Distraction – stretching of spinal column (hanging)
Lateral bending – (extreme bending of head to side (ear to shoulder)
Transected Severed Cord Paralysis below injury, Loss of bladder/ bowel control, Respiratory arrest if high cervical injury – C5 +, Neurogenic shock ,Hypotension without tachycardia, Priapism (involuntary penile erection – spinal shock can present but resolves with 24 hours
Corneal Abrasion • Caused by Direct trauma and foreign objects • Cornea transparent covering over the iris and pupil • S+S – pain, tearing, sensation of something in eye
Orbital Fx • Signifcant MOI – consider spinal trauma • S+S o Visual disturbances, double vision o Deformity around the orbit o Loss of sensation around the orbit o Inability to move eye in upward gaze
Chemical Burns • Chemicals require immediate and continuous irrigation • Avoid moving from one eye to the other
Impaled Objects • Don’t remove from eye • Stabilize in place • Keep both eyes closed to prevent passive movement of impaled object
Conduction direct transfer of heat through contact with colder structure
Convection – loss of heat to passing air
Evaporation – loss of heat through evaporation of water from the skin
Respiration – loosing heat from your breath
Radiation - transfer from radiant heat
Heath Cramps – local emergency • Occur during prolonged exertion and are likely caused by electrolyte imbalance and dehydration • Management – rest, rehydrate, restore electrolytes
Heat Exhaustion • Systemic heat emrg • Combo of heat exposure and hypovolemia • S+S o Hx of exertion in warm environment o Dizziness, weakness o Nausea vomiting o Headache o Muscle and abdo cramps o Thirst o Tachycardia o Changes in orthostatic vitals
Heatstroke Body looses ability to regulate heat lead to death if untreated Altered LOC,Skin hot and dry or wet, Seizures, Move cool enviro, If alert water can be administered, Expose pt – cool with water, wet towels cold packs in groin, neck and armpit, transport
Plancenta Prvia • third trimester – placenta attaches to the uterus over the cervical opening • cervix dilates - placenta is torn and bleeds • Classic presentation – painless vaginal bleeding third trimester • Asses for S+S of shock
Abruptio Placenta Premature separation of placenta from the uterine wall O2 and nutrients to fetus is compromised Maternal blood loss can be severe Fetus will not survive a complete abruption Painful vaginal bleeding in 3rd trimester Assess S+S of shock
Ectopic Pregnancy • Egg is implanted outside of the uterus – usually fallopian tube • Can lead to rupture and severe bleeding • Classic Presentation – severe abdo pain without vaginal bleeding • Assess S&S of shock
Uterine Rupture • Thins as it grows – increasing risk for rupture • Danger to mother and fetus • Classic presentation – abdo pain and vaginal bleeding
Spontaneous Abortion • Prior to the 20th and 22nd week of pregnancy • Classic presentation - cramping, lower abdo pain, vaginal bleeding, passage of tissue or clots • Assess s+s of shock
Preeclampsia – toxemia of pregnancy • Occurs 3rd trimester • Cause not completely understood • S+S – sudden weight gain, visual disturbances, sudden swelling in face, hands, feet, headache, hypertension
Eclampsia • When mother seizes following preeclampsia • Life threatening
Supine Hypotensive Syndrome Fetus compresses inferior vena cava – cause severe drop in blood pressure, Occurs later stages when mother is supine- Dizziness, hypotension, pale skin, altered LOC- keep fetus off of vena cava Put pt in seated position, left or right side, if pt is supin
Prolapsed Cord - When the cord is presenting in the birth canal • Can become compressed and cut of 02 • Instruct Mother not to push – decrease pressure • Place mother in knee to chest position • Push presenting part of baby away from cord • Transport Immediately
Breech • Buttocks or legs are presenting • Transport Immediately – if delivery occurs high risk head will become stuck in birth canal • If the head is tick use fingers to form a V along the vaginal wall to create space to allow the baby to breath
TICLS – abnormal findings indicate neuro problem, Tone – movement, muscle tone, listlessness, Interactivity – alertness, reactivity to stimulus, interaction with enivro, Consolability – can be consoled Look – able to fixi gaze Speech or cry – assess
Pedi Assessment Triangle Appearance, Breathing, Circulation
Deep Vein Thrombosis (DVT) • Blood clot in a large vein usually the leg • Loose clot can cause pulmonary embolism • Long term immobility (travel, hospitalization, sedentary lifestyle) increase risk
Diamond Placards Blue – health hazard 4 deadly, 0 normal material Red – fire hazard – flash points – 4 below 73F – 0 will not burn Yellow – Reacticity – 4 may detonate – 0 Stable Whitel specific hazard