Prehospital Emergency Care 11th Edition by Joseph Mistovich, ISBN-13: 978-0134704456

Prehospital Emergency Care 11th Edition by Joseph Mistovich, ISBN-13: 978-0134704456

[PDF eBook eTextbook]

• Publisher: ‎ Pearson; 11th edition (October 17, 2017)
• Language: ‎ English
• ‎1552 pages (Large File: 40MB)
• ISBN-10: ‎ 0134704452
• ISBN-13: ‎ 978-0134704456

For courses in Prehospital Emergency Care.

The most complete resource for EMT training.

Comprehensive in scope and student-friendly, Prehospital Emergency Care conveys the “WHY” behind the signs and symptoms students observe and the services they provide. Through a solid foundation of pathophysiology, students will learn to quickly identify immediate life threats and deliver excellent emergency care.

The 11th edition continues to meet and exceed the National EMS Education Standards. It has been thoroughly updated to reflect the latest and best practices for emergency medical services in the US, including conforming to the latest American Heart Association guidelines. Spine motion restriction, naloxone administration, sepsis, stroke screening tools, human trafficking, active shooter, domestic violence, and clinical decision-making with regard to oxygen administration are just a few of the updates readers will discover in this hallmark text.

Table of Contents:

Prehospital Emergency Care
Dedication
Detailed Contents
Key Features
EMT Skills
Preface
Be Prepared
It All Makes Sense
Features
In Your EMS Career
Pathophysiology
The Importance of Patient Assessment
Using Medical Terminology
As You Begin Your EMS Career
What’s New in the 11th Edition?
Medical Editor
Contributing Writers
Reviewers
Photo Acknowledgments
Organizations
Photo Coordinators/Subject Matter Experts
Models
About the Authors
Welcome to Prehospital Emergency Care
A Guide to Key Features
A Guide to the Student Workbook
MyLab BRADY
Part 1 Preparatory and Public Health
Chapter 1 Emergency Medical Care Systems, Research, and Public Health
Objectives
Key Terms
The Dispatch
En Route
Upon Arrival
Introduction
The Emergency Medical Services System
A Brief History
Technical Assistance Program Assessment Standards
Access to the EMS System
Types of EMS Services
Levels of Training
The Health Care System
The EMT
Roles and Responsibilities
Personal Safety and the Safety of Others
Patient Assessment and Emergency Care
Safe Lifting and Moving
Transport and Transfer of Care
Record Keeping and Data Collection
Patient Advocacy
Professional Attributes
Appearance
Knowledge and Skills
Physical Demands
Personal Traits
Maintenance of Certification and Licensure
EMS System Organization and Standards
State EMS Agency Role
Medical Oversight of EMS
The Medical Director, Protocols, and Standing Orders
Quality Improvement
Patient Safety
EMS Research
Evidence-Based Guidelines
Public Health
Mobile Integrated Healthcare and Community Paramedicine
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 2 Workforce Safety and Wellness of the EMT
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Emotional Aspects of Emergency Care
Death and Dying
Five Emotional Stages
Dealing with the Dying Patient, Family, and Bystanders
High-Stress Situations
Stress Reactions
Common Signs and Symptoms of Stress Reactions
Stress Management
Make Lifestyle Changes
Keep Balance in Your Life
Recognize the Response of Your Family and Friends
Make Changes in Your Work Environment
Seek Professional Help
Critical Incident Stress Management
Scene Safety
Protecting Yourself from Disease
How Diseases Spread
Standard Precautions
Hand Washing
Personal Protective Equipment
Additional Guidelines
Immunizations
Reporting Exposure
Infectious Diseases of Concern to the EMT
Hepatitis B
Hepatitis C
Tuberculosis
Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS)
Severe Acute Respiratory Syndrome
West Nile Virus
Ebola Virus Disease
Zika Virus Disease
Multidrug-Resistant Organisms
Protecting Yourself from Accidental and Work-Related Injury
Hazardous Materials
Rescue Situations
High-Visibility Vest
Violence and Crime
Wellness Principles
Physical Well-Being
Physical Fitness
Cardiovascular Endurance
Muscle Strength
Muscle Endurance
Muscle Flexibility
Body Composition
Adequate Sleep
Smoking Cessation
Alcohol- and Drug-Related Issues
Mental Well-Being
Chapter Review
Summary
Scene Size-Up
Patient Assessment
Critical Incident Follow-Up
In Review
Critical Thinking
Chapter 3 Medical, Legal, and Ethical Issues
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
The Scope of Practice
Legal Duties
Duty to Act
Good Samaritan Laws
Other Legal Protections
Medical Direction
Ethical Responsibilities
Issues of Patient Consent and Refusal
Types of Consent
Advance Directives
Refusing Treatment
Capacity
Protecting Yourself in Refusal Situations
Other Legal Aspects of Emergency Care
Negligence
Duty to Act
Breach of Duty to Act
Damages
Proximate Cause
Intentional Tort
Abandonment
Assault
Battery
False Imprisonment or Kidnapping
Defamation
Confidentiality
Health Insurance Portability and Accountability Act
COBRA and EMTALA
Protecting Yourself in Transport and Transfer Situations
Special Situations
Donors and Organ Harvesting
Medical Identification Insignia
Medical Alert Tattoo
Recognizing Death in the Field
Crime Scenes
Special Reporting Situations
Baby Safe-Haven Laws
Chapter Review
Summary
Scene Size-Up
Patient Assessment
An Ethical Obligation
In Review
Critical Thinking
Chapter 4 Documentation
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Functions of the Prehospital Care Report
Continuity of Medical Care
Administrative Uses
Legal Document
Educational and Research Uses
Evaluation and Continuous Quality Improvement
Collection of Data in Prehospital Care Reports
PCR Formats
PCR Data
The Minimum Data Set
Administrative Information
Patient Demographics and Other Patient Data
Vital Signs
Patient Narrative
Treatment
Medical Abbreviations
Legal Concerns
Confidentiality
Distribution
Refusal of Treatment
Falsification
Correcting Errors
Transfer-of-Care Report
Multiple-Casualty Incidents
Special Reports
Alternative Documentation Methods
SOAP
CHART
CHEATED
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Documentation
In Review
Critical Thinking
Chapter 5 Communication
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
EMS Communications Systems
Components of an Emergency Communications System
Base Station
Land Mobile Radio Systems
Mobile Radios (Transmitter/Receivers)
Portable Radios (Transmitter/Receivers)
Repeaters
Digital Equipment
Cellular (Wireless) Phones
Telemetry
Land Mobile Satellite Communications
Broadcast Regulations
System Maintenance
Communicating Within the System
Ground Rules for Radio Communication
Phone/Cellular Phone Communication
Communicating with Dispatch
Communicating with Health Care Professionals
Communicating with Medical Direction
Communicating with the Receiving Facility
The Oral Report
Transferring Patient Care to Another EMS Provider
Team Communication and Dynamics
Taking Charge
Radio Codes
Times
Radio Terms
Therapeutic Communication
Principles of Patient Communication
The Communication Process
Communication Responses
Communicating with the Patient
Patient Contact
The Patient Interview
Nonverbal Communication
Asking Questions
Considerations in Interviewing
Special Circumstances
Transcultural Considerations
Considerations for Elderly Patients
Considerations for Children
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 6 Lifting and Moving Patients
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Body Mechanics for Safe Lifting
Four Basic Principles
Posture and Fitness
Communication and Teamwork
General Guidelines for Lifting and Moving
The Power Lift
The Squat Lift
One-Handed Equipment-Carrying Technique
Reaching
Pushing and Pulling
Lifting and Moving Patients
Emergency Moves
The Armpit-Forearm Drag
The Shirt Drag
The Blanket Drag
Urgent Moves
Rapid Extrication
Self-Extrication
Nonurgent Moves
Direct Ground Lift
Extremity Lift
Direct Carry Method
Draw Sheet Method
Packaging For Transportation
Equipment
Wheeled Stretcher
Bariatric Stretchers and Devices
Portable Stretcher
Stair Chair
Tracked Stair Chair.
Backboard
Scoop Stretcher
Basket Stretcher
Flexible Stretcher
Patient Positioning
Packaging Patients for Air Transport
General Guidelines for Carrying a Patient Using a Backboard, Portable Stretcher, or Flexible Stretcher
Two-Person Carry
Four-Person Carry
Carrying a Supine Patient on Stairs
Neonatal Isolette
Chapter Review
Summary
Scene Size-Up
Patient Assessment
Lifting and Moving the Patient
Reassessment
In Review
Critical Thinking
Part 2 Anatomy, Physiology, and Medical Terminology
Chapter 7 Anatomy, Physiology, and Medical Terminology
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Anatomical Terms
Body Systems
The Musculoskeletal System
The Skeletal System
The Skull.
The Spinal Column.
The Thorax.
The Pelvis.
The Lower Extremities.
The Upper Extremities.
The Joints.
Bone Injury
The Muscular System
Skeletal Muscle.
Smooth Muscle.
Cardiac Muscle.
The Respiratory System
Respiratory System Functions
Respiratory System Structures: The Airway
Nose and Mouth.
Pharynx.
Nasopharynx.
Oropharynx.
Laryngopharynx (hypopharynx).
Larynx.
Trachea.
Bronchi.
Lungs.
Diaphragm.
Anatomy in Infants and Children
Mechanics of Ventilation
Physiology of Respiration
Adequate and Inadequate Breathing
The Circulatory System
Basic Anatomy
The Heart.
The Arteries.
The Arterioles.
The Capillaries.
The Venules.
The Veins.
Composition of the Blood
Physiology of Circulation
Transport of Gases in the Blood
Cell Metabolism.
The Nervous System
Structural Divisions of the Nervous System
The Central Nervous System.
The Peripheral Nervous System.
Functional Divisions of the Nervous System
The Voluntary Nervous System.
The Autonomic Nervous System.
Consciousness and Unconsciousness
Consciousness.
Unconsciousness.
The Endocrine System
Epinephrine and Norepinephrine
The Integumentary System (Skin)
The Digestive System
Basic Anatomy
Digestive Process
The Urinary or Renal System
The Reproductive System
Medical Terminology
Medical Words and Word Parts
Chapter Review
Summary
Scene Size-Up
Patient Assessment
Communication and Documentation
In Review
Critical Thinking
Part 3 Pathophysiology
Chapter 8 Pathophysiology
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Cellular Metabolism
Aerobic Metabolism
Anaerobic Metabolism
Sodium/Potassium Pump Failure
Components Necessary for Adequate Perfusion
Composition of Ambient Air
Patency of the Airway
Nasopharynx
Oropharynx
Epiglottis
Larynx
Trachea, Bronchi, and Bronchioles
Respiratory Compromise Associated with Mechanics of Ventilation
Boyle’s Law Applied to Ventilation
Accessory Muscles
Accessory Muscles of Exhalation
Compliance and Airway Resistance
Pleural Space
Minute Ventilation
Alveolar Ventilation
Regulation of Ventilation
Chemoreceptors
Central Chemoreceptors
Peripheral Chemoreceptors
Hypoxic Drive
Lung Receptors
Irritant Receptors
Stretch Receptors
J-Receptors
Respiratory Centers in the Brainstem
Ventilation/Perfusion Ratio
Pressure Imbalances
Ventilatory Disturbances
Perfusion Disturbances
Transport of Oxygen and Carbon Dioxide by the Blood
Oxygen Transport
Carbon Dioxide Transport
Alveolar/Capillary Gas Exchange
Cell/Capillary Gas Exchange
Blood Volume
Composition of Blood
Distribution of Blood
Hydrostatic Pressure
Plasma Oncotic Pressure
Pump Function of the Myocardium
Cardiac Output
Heart Rate
Stroke Volume
Systemic Vascular Resistance (SVR)
Systemic Vascular Resistance Effect on Pulse Pressure
Microcirculation
Blood Pressure
Regulation of Blood Pressure by Baroreceptors
Baroreceptor Response to an Increase in Blood Pressure
Baroreceptor Response to a Decrease in Blood Pressure
Vasomotor Response to a Change in Blood Pressure
Regulation of Blood Pressure by Chemoreceptor Reflexes
Chapter Review
Summary
Scene Size-Up
Patient Assessment
In Review
Critical Thinking
Part 4 Life Span Development
Chapter 9 Life Span Development
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Life Span Development
Neonates and Infants
Vital Signs
Physiologic Changes
Psychosocial Changes
Toddlers and Preschool-Age Children
Vital Signs
Physiologic Changes
Psychosocial Changes
School-Age Children
Vital Signs
Physiologic Changes
Psychosocial Changes
Adolescence
Vital Signs
Physiologic Changes
Psychosocial Changes
Early Adulthood
Vital Signs
Physiologic Changes
Psychosocial Changes
Middle Adulthood
Vital Signs
Physiologic Changes
Psychosocial Changes
Late Adulthood
Vital Signs
Physiologic Changes
Psychosocial Changes
Chapter Review
Summary
Scene Size-Up
Patient Assessment
Transport and Transfer of Care
In Review
Critical Thinking
Part 5 Airway Management, Artificial Ventilation, and Oxygenation
Chapter 10 Airway Management, Artificial Ventilation, and Oxygenation
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Respiration
Respiratory System Review
Anatomy of the Respiratory System
The Upper Airway
Nose and Mouth
Pharynx
Epiglottis
Larynx
The Lower Airway
Trachea
Bronchi and Bronchioles
Lungs
Diaphragm
Mechanics of Ventilation (Pulmonary Ventilation) Review
Respiratory Physiology Review
Hypoxemia
Hypoxia
Alveolar/Capillary Exchange (External Respiration)
Capillary/Cellular Exchange (Internal Respiration)
Pathophysiology of Pulmonary Ventilation and External and Internal Respiration
Airway Anatomy in Infants and Children
Mouth and Nose
Pharynx
Trachea and Lower Airway
Cricoid Cartilage
Chest Wall and Diaphragm
Oxygen Reserves
Airway Assessment
Airway Functions and Considerations
Abnormal Upper Airway Sounds
Opening the Mouth
Opening the Airway
Head-Tilt, Chin-Lift Maneuver
Head-Tilt, Chin-Lift Maneuver in Infants and Children
Jaw-Thrust Maneuver
Jaw-Thrust Maneuver in Infants and Children
Positioning the Patient for Airway Control
Suctioning
Standard Precautions During Suctioning
Suction Equipment
Mounted Suction Devices
Portable Suction Devices
Suction Catheters
Suctioning Technique
Special Considerations When Suctioning
Airway Adjuncts
Oropharyngeal Airway
Inserting the Oropharyngeal Airway
Nasopharyngeal Airway
Inserting the Nasopharyngeal Airway
Assessment of Breathing
Relationship of Volume and Rate in Breathing Assessment
Tidal Volume and Minute Volume
Alveolar Ventilation
Assessing for Adequate Breathing
Adequate Breathing
Inadequate Breathing
Signs of Inadequate Breathing
Deciding Whether or Not to Assist Ventilation
Techniques of Artificial Ventilation
Differences Between Normal Spontaneous Ventilation and Positive Pressure Ventilation
Basic Considerations
Standard Precautions
Adequate Ventilation
Inadequate Ventilation
Cricoid Pressure, BURP, and ELM
Cricoid Pressure
BURP
ELM
Other Basic Ventilation Considerations
Mouth-to-Mouth Ventilation
Mouth-to-Mouth and Mouth-to-Nose Technique
Mouth-to-Mask and Bag-Valve Ventilation: General Considerations
Ventilation Volumes and Duration of Ventilation
Ventilating a Pulseless Patient with an Advanced Airway in Place
Gastric Inflation
Mouth-to-Mask Ventilation
Mouth-to-Mask Technique—No Suspected Spinal Injury
Mouth-to-Mask Technique—Suspected Spinal Injury
Ineffective Ventilation
Bag-Valve-Mask Ventilation
Bag-Valve-Mask Technique—No Suspected Spinal Injury
Two-Person BVM Technique
One-Person BVM Technique
Bag-Valve-Mask Problems
Bag-Valve-Mask Technique—Suspected Spinal Injury
Flow-Restricted, Oxygen-Powered Ventilation Device (FROPVD)
FROPVD Techniques
FROPVD Problems
Automatic Transport Ventilator (ATV)
ATV Recommended Features
ATV Techniques
Ventilation of the Patient Who Is Breathing Spontaneously
Continuous Positive Airway Pressure (CPAP)
How CPAP Improves Ventilation and Oxygenation
CPAP and Children
Criteria and Indications for CPAP
Contraindications for CPAP
CPAP Administration Procedure
Assessing the Patient’s Response to CPAP
BiPAP
Hazards of Overventilation
Special Considerations in Airway Management and Ventilation
A Patient with a Stoma or Tracheostomy Tube
Bag-Valve-Mask-to-Tracheostomy-Tube Ventilation
Bag-Valve-Mask-to-Stoma Ventilation
Mouth-to-Stoma Ventilation
Infants and Children
Patients with Facial Injuries
Foreign Body Airway Obstruction
Dental Appliances
Oxygen Therapy
Oxygen Cylinders
Duration of Flow
Safety Precautions
Pressure Regulators
Oxygen Humidifiers
Clinical Decision Making Regarding Oxygen Administration
Indications for Oxygen Administration
Variations in SpO2 Goals for Medical, Trauma, and Other Special Consideration Patients
Hazards of Oxygen Administration
Oxygen Administration Procedures
Terminating Oxygen Therapy
Transferring the Oxygen Source: Portable to On-Board
Oxygen Delivery Equipment
Nonrebreather Mask
Applying the Nonrebreather Mask
Nasal Cannula
Applying the Nasal Cannula
Other Oxygen Delivery Devices
Simple Face Mask
Partial Rebreather Mask
Venturi Mask
Tracheostomy Mask
Chapter Review
Summary
Scene Size-Up
Patient Assessment
In Review
Critical Thinking
Part 6 Assessment
Chapter 11 Vital Signs, Monitoring Devices, and History Taking
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Gathering Patient Information
Vital Signs
Respiration
Respiratory Rate
Respiratory Quality
Respiratory Rhythm
Pulse
Location of Pulses
Heart Rate
Pulse Quality and Rhythm
Skin
Skin Color
Skin Temperature
Skin Condition
Capillary Refill
Pupils
Blood Pressure
Methods of Measuring Blood Pressure
Testing Orthostatic Vital Signs
Vital Sign Reassessment
Monitoring Equipment
Pulse Oximeter: Oxygen Saturation Assessment
Indications for Pulse Oximetry
Limitations of the Pulse Oximeter
Procedure for Determining the SpO2 Reading
Noninvasive Blood Pressure Monitor
Procedure for Noninvasive Blood Pressure Monitoring
Capnometry (EtCO2 Monitor)
Preparing to Take the History
Gain Control of the Scene
Achieve a Smooth Transition of Care
Reduce the Patient’s Anxiety
Bring Order to the Environment
Introduce Yourself
Gain Patient Consent
Position Yourself
Use Communication Skills
Be Courteous
Use Touch When Appropriate
Maintain Control
Taking the History
Statistical and Demographic Information
Current Health Status
Techniques for Taking a Patient History
Note Taking
Types of Questions
Active Listening Techniques
Standardized Approach to History Taking
The SAMPLE History
Assessing Patient Complaints: OPQRST
Sensitive Topics or Special Challenges
Sensitive Topics
Special Challenges
Chapter Review
Summary
Scene Size-Up
Patient Assessment
In Review
Critical Thinking
Chapter 12 Scene Size-Up
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Violence Toward EMS Personnel
Take the Necessary Standard Precautions and Other Personal Protection Precautions
Determine Scene Safety
Consider Dispatch Information
Consider the Need for Additional or Specialized Resources
Consider Scene Characteristics
Crash Scenes
Protection from Moving Traffic
Other Rescue Scenes
Unstable Surfaces and Slopes
Ice
Water
Toxic Substances and Low-Oxygen Areas
Clandestine Drug Operations
Crime Scenes
Arriving at the Scene
Studying the Crowd
Approaching the Scene
At the Patient’s Side
Barroom Scenes
Car Passengers
Protect the Patient
Protect Bystanders
Control the Scene
Maintain Situation Awareness
Determine the Nature of the Problem
Determine the Mechanism of Injury
Falls
Motor Vehicle Crashes
Motorcycle Crashes
Recreational Vehicle Crashes
Penetrating Trauma
Blast Injuries
Determine the Nature of the Illness
Determine the Number of Patients
Chapter Review
Summary
Scene Size-Up
Patient Assessment
In Review
Critical Thinking
Chapter 13 Patient Assessment
Objectives
Key Terms
Overview
Call One—A Trauma Patient
The Dispatch
Upon Arrival
Call Two—A Medical Patient
The Dispatch
Upon Arrival
Introduction
Form a General Impression of the Patient
Introduction to Spine Motion Restriction
Determine Whether the Patient Is Injured or Ill
Obtain the Chief Complaint
Identify Immediate Life Threats During the General Impression
Perform Spine Motion Restriction
Position the Patient for Assessment
Assess Level of Consciousness (Mental Status)
Assess the Level of Responsiveness
Alertness and Orientation
Responsiveness to Verbal Stimulus
Responsiveness to Painful Stimulus
Problems with Some Types of Painful Stimuli
Unresponsiveness
Document the Level of Responsiveness
Assess the Airway
Determine Airway Status
In the Responsive Patient
In the Unresponsive or Severely Altered Mental Status Patient
Open the Airway
Indications of Partial Airway Occlusion
Snoring
Gurgling
Crowing and Stridor
Assess Breathing
Assess Rate and Quality of Breathing
Look
Listen and Feel
Absent or Inadequate Breathing
Adequate Breathing
Assess Oxygenation
Oxygen Therapy in the Patient with Adequate Breathing
Assess Circulation
Assess the Pulse
Identify Major Bleeding
Assess Perfusion
Skin Color
Skin Temperature
Skin Condition
Capillary Refill
Shock (Hypoperfusion)
Establish Patient Priorities
Overview of Secondary Assessment: Anatomic and Body Systems Approaches, Vital Signs, and History
Performing the Secondary Assessment: An Anatomic Approach
Assess the Head
Ears
Face
Eyes
Nose
Mouth
Assess the Neck
Assess the Chest
Auscultation
Assess the Abdomen
Assess the Pelvis
Assess the Lower Extremities
Pulses
Motor Function
Sensation
Assess the Upper Extremities
Pulses
Motor Function
Sensation
Assess the Posterior Body
Performing the Secondary Assessment: A Body Systems Approach
Assess Vital Signs
Obtain a History
Reevaluate the Mechanism of Injury
Significant Mechanisms of Injury
Special Considerations for Infants and Children
Rapid Secondary Assessment: Trauma Patient with Significant Mechanism of Injury, Altered Mental Status, Multiple Injuries, or Critical Finding (Unstable)
Continue Spine Motion Restriction
Consider an Advanced Life Support Request
Reconsider the Transport Decision
Reassess Mental Status
Perform a Rapid Secondary Assessment
Assess the Head
Scalp and Skull
Face
Ears
Pupils
Nose
Mouth
Assess the Neck
Apply a Cervical Collar
Assess the Chest
Assess the Abdomen
Assess the Pelvis
Assess the Extremities
Assess the Posterior Body
Assess Vital Signs
Blood Glucose Test
Obtain a History
Prepare the Patient for Transport
Provide Emergency Care
Trauma Score
Modified Secondary Assessment: Trauma Patient with no Significant Mechanism of Injury, Altered Mental Status, Multiple Injuries, or Critical Finding (Stable)
Perform a Modified Secondary Assessment
Obtain Vital Signs and History
Perform a Rapid Secondary Assessment if Indicated
Medical Patient Who is not Alert or is Disoriented, is Responding Only to Verbal or Painful Stimuli, or is Unresponsive
Perform a Rapid Secondary Assessment for the Medical Patient
Assess the Head
Assess the Neck
Assess the Chest
Assess the Abdomen
Assess the Pelvic Region
Assess the Extremities
Assess the Posterior Body
Assess Vital Signs
Blood Glucose Test
Position the Patient
Obtain a History
Provide Emergency Care
Make a Transport Decision
Responsive Medical Patient Who is Alert and Oriented
Assess Patient Complaints: OPQRST
Complete the History
Perform a Modified Secondary Assessment
Assess Vital Signs
Provide Emergency Care
Make a Transport Decision
Purposes of the Reassessment
Detect Any Change in Condition
Identify Any Missed Injuries or Conditions
Adjust the Emergency Care
Repeat the Primary Assessment
Reassess Mental Status
Reassess the Airway
Reassess Breathing
Reassess Oxygenation
Reassess Circulation
Reassess Pulse
Reassess Bleeding
Reassess Skin
Reestablish Patient Priorities
Complete the Reassessment
Reassess and Record Vital Signs
Repeat Components of the Secondary Assessment for Other Complaints
Check Interventions
Note Trends in the Patient’s Condition
Chapter Review
Summary
Call One—A Trauma Patient
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
Call Two—A Medical Patient
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Scenario 1
Scenario 2
Part 7 General Pharmacology and Medication Administration
Chapter 14 General Pharmacology and Medication Administration
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Administering Medications
Medications the EMT Commonly Administers
Medications
Oxygen
Precautions with Oxygen Administration
Oxygen Administration Difference in Medical vs. Trauma Patients
Oral Glucose
Activated Charcoal
Aspirin
Inhaled Bronchodilator
Metered-Dose Inhaler
Small-Volume Nebulizer
Nitroglycerin
Epinephrine
Naloxone Hydrochloride
Medication Names
Routes of Administration
Medication Forms
Essential Medication Information
Indications
Contraindications
Dose
Administration
Actions
Side Effects
Key Steps in Administering Medications
Obtain an Order from Medical Direction
Select the Proper Medication
Verify the Patient’s Prescription for Patient-Assisted Administration
Check the Expiration Date
Check for Discoloration or Impurities
Verify the Form, Route, and Dose
Medication Administration: The Five “Rights”
Documentation
Reassessment Following Administration
Sources of Medication Information
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Part 8 Shock and Resuscitation
Chapter 15 Shock and Resuscitation
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Shock
Etiologies of Shock
Categories of Shock
Hypovolemic Shock
Distributive Shock
Cardiogenic Shock
Obstructive Shock
Metabolic or Respiratory Shock
Specific Types of Shock
Hemorrhagic Hypovolemic Shock
Nonhemorrhagic Hypovolemic Shock
Burn Shock
Anaphylactic Shock
Septic Shock
Sepsis
Neurogenic Shock
Cardiogenic Shock
The Body’s Response to Shock
Direct Nerve Stimulation
Release of Hormones
Stages of Shock
Compensatory Shock
Decompensatory Shock
Shock Assessment
History
Physical Exam
Age Considerations in Shock
General Goals of Prehospital Management of Shock
Resuscitation in Cardiac Arrest
Pathophysiology of Cardiac Arrest
Electrical Phase
Circulatory Phase
Metabolic Phase
Terms Related to Out-of-Hospital Cardiac Arrest (OHCA) Resuscitation
Withholding a Resuscitation Attempt
The 2015 AHA Chain of Survival
Automated External Defibrillation and Cardiopulmonary Resuscitation
Types of Defibrillators
Advantages of AEDs
Types of AEDs
Analysis of Cardiac Rhythms
When and When Not to Use the AED
Recognizing and Treating Cardiac Arrest
Assessment-Based Approach: Cardiac Arrest
Scene Size-Up and Primary Assessment
Secondary Assessment
Signs and Symptoms
Emergency Medical Care
Reassessment
Performing Defibrillation
Using an AED
Use of the AED by a Single EMT
Cardiac Arrest in a Pregnant Patient
Transporting the Cardiac Arrest Patient
Transporting a Patient with a Pulse
Transporting a Patient Without a Pulse
Post-Resuscitation Care
Providing for Advanced Cardiac Life Support
Summary: Assessment and Care
Special Considerations for the AED
Safety Considerations
AED Maintenance
Training and Skills Maintenance
Medical Direction and the AED
Cardiac Pacemakers
Automatic Implantable Cardioverter Defibrillators
Automated Chest Compression Devices
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Part 9 Medical
Chapter 16 Respiratory Emergencies
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Respiratory Anatomy, Physiology, and Pathophysiology
Normal Breathing
Abnormal Breathing
Assessing Breath Sounds
Respiratory Distress
Pathophysiology of Conditions That Cause Respiratory Distress
Obstructive Pulmonary Diseases
Emphysema
Pathophysiology
Assessment
Chronic Bronchitis
Pathophysiology
Assessment
Emergency Medical Care for Emphysema and Chronic Bronchitis
Asthma
Pathophysiology
Assessment
Emergency Medical Care
Other Conditions That Cause Respiratory Distress
Pneumonia
Pathophysiology
Assessment
Emergency Medical Care
Pulmonary Embolism
Pathophysiology
Assessment
Emergency Medical Care
Acute Pulmonary Edema
Pathophysiology
Assessment
Emergency Medical Care
Spontaneous Pneumothorax
Pathophysiology
Assessment
Emergency Medical Care
Hyperventilation Syndrome
Pathophysiology
Assessment
Emergency Medical Care
Epiglottitis
Pathophysiology
Assessment
Emergency Medical Care
Pertussis
Pathophysiology
Assessment
Emergency Medical Care
Cystic Fibrosis
Pathophysiology
Assessment
Emergency Medical Care
Poisonous Exposures
Pathophysiology
Assessment
Emergency Medical Care
Viral Respiratory Infections
Pathophysiology
Assessment
Emergency Medical Care
Metered-Dose Inhalers and Small-Volume Nebulizers
Using an MDI
Using an SVN
Advair: Not for Emergency Use
Age-Related Variations: Pediatrics and Geriatrics
Pediatric Patients
Respiratory Distress or Failure in the Pediatric Patient: Assessment and Care
Scene Size-Up and Primary Assessment
Secondary Assessment
Early Signs of Breathing Difficulty (Respiratory Distress) in the Infant or Child
Signs of Inadequate Breathing (Respiratory Failure) in the Infant or Child
Emergency Medical Care
Reassessment
Geriatric Patients
Respiratory Distress or Failure in the Geriatric Patient: Assessment and Care
Scene Size-Up and Primary Assessment
Secondary Assessment
Early Signs of Breathing Difficulty (Respiratory Distress) in the Geriatric Patient
Signs of Inadequate Breathing (Respiratory Failure) in the Geriatric Patient
Emergency Medical Care
Reassessment
Assessment and Care: General Guidelines
Assessment-Based Approach: Respiratory Distress
Scene Size-Up
Primary Assessment
General Impression
Mental Status
Airway
Breathing
Circulation
Priority
Secondary Assessment
History
Physical Exam
Vital Signs
Signs and Symptoms
Emergency Medical Care
Inadequate Breathing (Respiratory Failure or Respiratory Arrest)
Adequate Breathing (Respiratory Distress)
Reassessment
Summary: Assessment and Care
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 17 Cardiovascular Emergencies
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Review of The Circulatory System Anatomy, Physiology, and Pathophysiology
The Circulatory System
The Conduction System
The Heart
The Vessels
Coronary Arteries
The Blood
Cardiac Contraction
The Electrocardiogram
Blood Pressure
Inadequate Circulation
Cardiac Compromise and Acute Coronary Syndrome
Arteriosclerosis and Atherosclerosis
Acute Coronary Syndrome
Angina Pectoris
Pathophysiology
Assessment
Emergency Medical Care
Acute Myocardial Infarction
Pathophysiology
Assessment
Emergency Medical Care
Aortic Aneurysm or Dissection
Acute Coronary Syndrome in Females
The Dangers of Administering Too Much Oxygen in Acute Coronary Syndrome
Other Causes of Cardiac Compromise
Heart Failure
Pathophysiology
Assessment
Emergency Medical Care
Hypertension Associated with Emergency Conditions
Cardiac Arrest
Nitroglycerin
Age-Related Variations: Pediatrics And Geriatrics
Pediatric Considerations
Geriatric Considerations
Assessment and Care: General Guidelines
Assessment-Based Approach: Cardiac Compromise and Acute Coronary Syndrome
Scene Size-Up
Primary Assessment
Secondary Assessment
History
Percutaneous Intervention or Fibrinolytic Therapy and the EMT’s Role
Physical Exam and Vital Signs
Signs and Symptoms
Emergency Medical Care
Reassessment
Summary: Assessment and Care
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 18 Altered Mental Status, Stroke, and Headache
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Altered Mental Status
Assessment-Based Approach: Altered Mental Status
Scene Size-Up
Primary Assessment
Secondary Assessment
History
Physical Exam
Signs and Symptoms
Emergency Medical Care
Reassessment
Stroke
Neurologic Deficit Resulting from Stroke
Acute Stroke
Pathophysiology of a Stroke
Cerebral Circulation and the Ischemic Penumbra
Types of Stroke
Ischemic Strokes
Thrombosis
Embolism
Atrial Fibrillation and Stroke.
Hemorrhagic Strokes
Stroke or Transient Ischemic Attack
Stroke
Signs and Symptoms
Anterior and Posterior Circulation Strokes
Transient Ischemic Attack
Cryptogenic Stroke
Assessment-Based Approach: Stroke and Transient Ischemic Attack
Scene Size-Up
Primary Assessment
Secondary Assessment
Physical Exam
Prehospital Stroke Screening Tools
Cincinnati Prehospital Stroke Scale (CPSS).
Los Angeles Prehospital Stroke Screen (LAPSS).
Miami Emergency Neurologic Deficit (MEND) Scale.
Rapid Arterial Occlusion Evaluation (RACE) Scale and Large Vessel Occlusion (LVO) Stroke.
History
Signs and Symptoms
The Dangers of Administering Too Much Oxygen in a Stroke.
Emergency Medical Care
Reassessment
Summary: Assessment and Care
Headache
Types of Headache
Assessment
Emergency Medical Care
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 19 Seizures and Syncope
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Seizures
Pathophysiology of Seizures
Primary (Unprovoked) Seizures
Secondary (Provoked) Seizures
Status Epilepticus
Types of Seizures
Generalized Seizures
Generalized Tonic-Clonic Seizure.
Emergency Medical Care.
Absence Seizure
Myoclonic Seizure
Tonic Seizure
Atonic Seizure
Febrile Seizure
Partial Seizures
Simple Partial Seizure
Emergency Medical Care.
Complex Partial Seizure
Emergency Medical Care.
Secondarily Generalized Seizure
Assessment-Based Approach to Seizure Activity
Scene Size-Up
Primary Assessment
Secondary Assessment
Signs and Symptoms
Emergency Medical Care
Reassessment
Prehospital Medications Used to Stop Seizures
Summary: Assessment and Care for Seizures
Syncope
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 20 Acute Diabetic Emergencies
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Understanding Diabetes Mellitus
Glucose (Sugar)
Hormones That Control Blood Glucose Levels
Insulin
Glucagon
Other Hormones
Normal Metabolism and Glucose Regulation
Checking the Blood Glucose Level
Testing the Blood Glucose Level with a Glucose Meter
Diabetes Mellitus
Acute Diabetic Emergencies
Hypoglycemia
Pathophysiology of Hypoglycemia
Assessment Findings in Hypoglycemia
Hypoglycemia Unawareness
Emergency Care for Hypoglycemia
Oral Glucose
Intranasal Glucagon
Hyperglycemia
Hyperglycemic Condition: Diabetic Ketoacidosis
Pathophysiology of DKA
Assessment Findings in DKA
Emergency Care for DKA
Hyperglycemic Condition: Hyperglycemic Hyperosmolar Syndrome
Pathophysiology of HHS
Assessment Findings in HHS
Emergency Medical Care for HHS
Assessment-Based Approach: Altered Mental Status in a Diabetic Emergency
Scene Size-Up and Primary Assessment
History and Secondary Assessment
Signs and Symptoms
Emergency Medical Care
Reassessment
Summary: Assessment and Care
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 21 Allergic and Anaphylactic Reactions
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Allergic and Anaphylactic Reactions
Pathophysiology of Allergic Reaction
Pathophysiology of Anaphylactic Reaction
Sensitization
Anaphylactoid (Non-IgE-Mediated) Reaction
Causes of Anaphylactic and Anaphylactoid Reaction
Assessment-Based Approach to Anaphylactic Reaction
Scene Size-Up
Primary Assessment
Secondary Assessment
History
Signs and Symptoms
Physical Exam
Vital Signs
Emergency Medical Care
Reassessment
Biphasic Anaphylactic Reaction
Summary: Assessment and Care
Epinephrine
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 22 Toxicologic Emergencies
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Poisons and Poisonings
Poisons and Routes of Exposure
Managing the Poisoning Patient
Antidotes
Ingested Poisons
Assessment-Based Approach: Ingested Poisons
Scene Size-Up
Primary Assessment
Secondary Assessment
History
Physical Exam
Signs and Symptoms
Emergency Medical Care
Reassessement
Activated Charcoal
Inhaled Poisons
Assessment-Based Approach: Inhaled Poisons
Scene Size-Up
Primary Assessment
Secondary Assessment
History
Physical Exam
Signs and Symptoms
Emergency Medical Care
Reassessment
Injected Poisons
Assessment-Based Approach: Injected Poisons
Scene Size-Up
Primary Assessment
Secondary Assessment
History
Physical Exam
Signs and Symptoms
Emergency Medical Care
Reassessment
Absorbed Poisons
Assessment-Based Approach: Absorbed Poisons
Scene Size-Up
Primary Assessment
Secondary Assessment
History and Physical Exam
Signs and Symptoms
Emergency Medical Care
Reassessment
Summary: Assessment and Care
Specific Types Of Poisoning
Food Poisoning
Signs and Symptoms
Emergency Medical Care
Carbon Monoxide Poisoning
Signs and Symptoms
Emergency Medical Care
Cyanide
Signs and Symptoms
Emergency Medical Care
Acids and Alkalis
Signs and Symptoms
Emergency Medical Care
Hydrocarbons
Signs and Symptoms
Emergency Medical Care
Methanol (Wood Alcohol)
Signs and Symptoms
Emergency Medical Care
Isopropanol (Isopropyl Alcohol)
Signs and Symptoms
Emergency Medical Care
Ethylene Glycol
Signs and Symptoms
Emergency Medical Care
Poisonous Plants
Suicide Bags and Chemical Suicide by Toxic Gas Inhalation
Poison Control Centers
Drug And Alcohol Emergencies
Assessment-Based Approach: Drug and Alcohol Emergencies
Scene Size-Up
Primary Assessment
Secondary Assessment
Physical Exam
History
Signs and Symptoms
Emergency Medical Care
Reassessment
Summary: Assessment and Care
Managing a Violent Drug or Alcohol Abuse Patient
The Talk-Down Technique
Specific Substance Abuse Considerations
Drug Withdrawal
The Alcoholic Syndrome
The Withdrawal Syndrome
Delirium Tremens
Opioids
Signs and Symptoms
Emergency Medical Care
PCP, Cocaine, Amphetamines, Methamphetamines, PABS, and MDMA
PCP
Cocaine
Amphetamines and Methamphetamines
PABS (Bath Salts)
Methylenedioxymethamphetamine (MDMA or Ecstasy)
Signs and Symptoms of PCP, Cocaine, Amphetamines, Methamphetamines, PABS, and MDMA
Emergency Medical Care
Tetrahydrocannabinol
Synthetic Cannabinoids
Cannabinoid Hyperemesis Syndrome
Medication Overdose
Huffing
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 23 Abdominal, Hematologic, Gynecologic, Genitourinary, and Renal Emergencies
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Acute Abdomen
Abdominal Structures and Functions
Abdominal Quadrants and Regions
Types of Abdominal Structures
Abdominal Pain
Pathophysiology of Abdominal Pain
Types of Abdominal Pain
Conditions That Can Cause Acute Abdominal Pain
Peritonitis
The Markle “Heel Drop” or “Heel Jar” Test
Appendicitis
Pancreatitis
Cholecystitis
Gastrointestinal Bleeding
Esophageal Varices
Gastroenteritis
Ulcers
Intestinal Obstruction
Hernia
Abdominal Aortic Aneurysm
Vomiting/Diarrhea/Constipation
Considerations in Special Populations with Abdominal Pain
Pediatrics
Elderly (Geriatric)
Immunocompromised Patients
Bariatric Surgery Patients
Assessment-Based Approach: Acute Abdomen
Scene Size-Up
Primary Assessment
Secondary Assessment
History
Physical Exam
Signs and Symptoms
Emergency Medical Care
Reassessment
Summary: Assessment and Care
Hematologic Emergencies
Common Hematologic Conditions
Anemia
Sickle Cell Anemia
Sickle Cell Crisis
Common Signs and Symptoms of Sickle Cell Crisis.
Emergency Care for Sickle Cell Crisis.
Hemophilia
Thrombophilia and Deep Vein Thrombosis
Gynecologic Emergencies
Female Reproductive Structures and Functions
Gynecologic Conditions
Sexual Assault
Vaginal Bleeding (Nontraumatic)
Menstrual Pain
Ovarian Cyst
Endometritis
Endometriosis
Pelvic Inflammatory Disease
Sexually Transmitted Diseases
Assessment-Based Approach: Gynecologic Emergencies
Scene Size-Up
Primary Assessment
Secondary Assessment
History
Signs and Symptoms
Physical Exam
Emergency Medical Care
Reassessment
Genitourinary/Renal Emergencies
Genitourinary/Renal Structures and Functions
Genitourinary/Renal Conditions
Urinary Tract Infections
Kidney Stones
Kidney Failure
Dialysis
Dialysis Emergency Management
Urinary Catheters
Urinary Catheter Management
Assessment-Based Approach: Genitourinary/Renal Emergencies
Scene Size-Up
Primary Assessment
Secondary Assessment
History
Signs and Symptoms
Physical Exam
Emergency Medical Care
Reassessment
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 24 Environmental Emergencies
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Heat and Cold Emergencies
Regulation of Temperature
When Heat Lost Exceeds Heat Gained
Radiation.
Convection
Conduction
Evaporation
Respiration
When Heat Gained Exceeds Heat Lost
Exposure to Cold
Generalized Hypothermia
Pathophysiology of Generalized Hypothermia
Predisposing Factors
Stages of Hypothermia
Immersion Hypothermia
Cold Shock Response
Cold Incapacitation
Further Considerations with Immersion Hypothermia
Urban Hypothermia
Myxedema Coma
Nonfreezing Cold Injury
Freezing Cold Injury
Pathophysiology of Freezing Cold Injury
Predisposing Factors
Stages of Freezing Cold Injury
Assessment-Based Approach: Cold-Related Emergency
Scene Size-Up
Primary Assessment
Secondary Assessment
Signs and Symptoms of Generalized Hypothermia
Emergency Medical Care for Generalized Hypothermia
Emergency Medical Care for Immersion Hypothermia
Signs and Symptoms of Freezing Cold Injury (Frostbite)
Emergency Medical Care for Freezing Cold Injury
Reassessment
Summary: Assessment and Care—Cold Emergency
Exposure To Heat
Hyperthermia
Pathophysiology of Heat-Related Emergencies
Predisposing Factors
Assessment-Based Approach: Heat-Related Emergency
Scene Size-Up
Primary Assessment
Secondary Assessment
Signs and Symptoms of Generalized Hyperthermia
Emergency Medical Care for a Heat Emergency Patient with Moist, Pale, Normal-to-Cool Skin
Emergency Medical Care for a Heat Emergency Patient with Hot Skin That Is Moist or Dry
Emergency Medical Care for Heat Cramps
Reassessment
Summary: Assessment and Care—Heat Emergency
Exercise-Associated Hyponatremia
Bites and Stings
Snakebite
Insect Bites and Stings
Black Widow Spider
Brown Recluse Spider
Scorpion
Fire Ant
Tick
Assessment-Based Approach: Bites and Stings
Scene Size-Up
Primary Assessment
Secondary Assessment
Signs and Symptoms of Anaphylactic Shock
Emergency Medical Care for Anaphylactic Shock
Signs and Symptoms of a Bite or Sting
Emergency Medical Care for a Bite or Sting
Reassessment
Marine Life Bites and Stings
Emergency Medical Care for Marine Life Poisoning
Lightning Strike Injuries
Pathophysiology of a Lightning Strike Injury
Assessment of the Lightning Strike Patient
Emergency Care for the Lightning Strike Patient
High-Altitude Sickness
Acute Mountain Sickness
Signs and Symptoms of AMS
Emergency Medical Care for AMS
High-Altitude Pulmonary Edema
Signs and Symptoms of HAPE
Emergency Medical Care for HAPE
High-Altitude Cerebral Edema
Signs and Symptoms of HACE
Emergency Medical Care for HACE
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 25 Submersion Incidents: Drowning and Diving Emergencies
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Water-Related Emergencies
Definitions
Incidence of Drowning
Prognostic Predictors
Pathophysiology of Drowning
Diving Emergencies
Safety Measures in Water-Related Emergencies
Possible Spine Injury
Resuscitation
Assessment-Based Approach: Drowning and Water-Related Emergencies
Scene Size-Up
Primary Assessment
Secondary Assessment
Signs and Symptoms
Emergency Medical Care for the Drowning Patient
Reassessment
Summary: Assessment and Care
Scuba or Deepwater Diving Emergencies
Basic Laws of Physics Related to Scuba or Deepwater Diving Emergencies
Decompression Sickness
Pathophysiology
Predisposing Factors of Decompression Sickness
Categories of Decompression Sickness
Type I Decompression Sickness
Type II Decompression Sickness
Arterial Gas Embolism
Barotrauma
Emergency Medical Care for Decompression Sickness, Air Embolism, or Barotrauma
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 26 Psychiatric Emergencies
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Psychiatric Problems and Emergencies
Behavioral Changes: Psychiatric or Physical?
Mental Status Exam
Clues to a Physical Cause
History and Physical Exam
Psychiatric Problems
Anxiety Disorders
Panic Attacks
Phobias
Bipolar Disorder
Depression
Neurocognitive Disorders
Agitated Delirium
Schizophrenia Spectrum and Other Psychotic Disorders
Schizophrenia
Paranoia
Psychosis
Substance Use and Addictive Disorders
Trauma- and Stressor-Related Disorders
Extrapyramidal Symptoms
Violence
Suicide
Violence to Others
Mini Assessment for Common Psychiatric Emergencies
Suicidal Ideation
Homicidal Ideation
The Need for Law Enforcement Involvement
Dealing with Psychiatric Emergencies
Basic Principles
Techniques for Treating Psychiatric Emergency Patients
Assessment-Based Approach: Psychiatric Emergencies
Scene Size-Up
Primary Assessment
Secondary Assessment
Suicidal Patients
Violent Patients
Signs and Symptoms
Emergency Medical Care
Reassessment
Summary: Assessment and Care
Restraining a Patient
Legal Considerations
Consent
Refusal of Care
Using Reasonable Force
Police and Medical Direction
False Accusations
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Part 10 Trauma
Chapter 27 Trauma Overview: The Trauma Patient and the Trauma System
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
The Kinetics of Trauma
Mass and Velocity
Acceleration and Deceleration
Energy Changes Form and Direction
Impacts
Mechanisms of Injury
Vehicle Collisions
Frontal Impact
Abdomen
Chest
Face, Head, and Neck
Rear-End Impact
Lateral Impact
Head and Neck
Chest and Abdomen
Pelvis
Rotational or Rollover Crash
Vehicle-Pedestrian Collision
Restraints: A Cause of Hidden Injuries
Considerations for Infants and Children
Motorcycle Collisions
Head-On Impact
Angular Impact
Ejection
“Laying the Bike Down.”
All-Terrain Vehicles
Penetrating Injuries
Low-Velocity Injuries
Medium- and High-Velocity Injuries
Gunshot Wounds
Head
Chest
Abdomen
Extremities
The Multisystem Trauma Patient
The Golden Period and Platinum 10 Minutes
The Trauma System
Golden Principles of Prehospital Trauma Care
Special Considerations in Trauma Care
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 28 Bleeding and Soft Tissue Trauma
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
External Bleeding
Severity
Types of Bleeding
Methods of Controlling External Bleeding
Direct Pressure
Tourniquets
Splints
Hemostatic Agents
Junctional Bleeding Control
Assessment-Based Approach: External Bleeding
Scene Size-Up, Primary Assessment, and Rapid Secondary Assessment
Emergency Medical Care
Reassessment
Bleeding from the Nose, Ears, or Mouth
Internal Bleeding
Severity
Assessment-Based Approach: Internal Bleeding
Scene Size-Up and Primary Assessment
Secondary Assessment
Signs and Symptoms
Emergency Medical Care
Reassessment
Factors That Increase Bleeding
Hemorrhagic Shock
Assessment-Based Approach: Hemorrhagic Shock
Scene Size-Up and Primary Assessment
Secondary Assessment
Signs and Symptoms
Emergency Medical Care
Remainder of the Assessment and Reassessment
Summary: Assessment and Care
Soft Tissue Trauma
The Skin
Closed Soft Tissue Injuries
Contusions
Hematomas
Crush Injuries
Assessment-Based Approach: Closed Soft Tissue Injuries
Scene Size-Up and Primary Assessment
Secondary Assessment
Signs and Symptoms
Emergency Medical Care
Reassessment
Open Soft Tissue Injuries
Abrasions
Lacerations
Avulsions
Amputations
Penetrations/Punctures
Crush Injuries
Other Soft Tissue Injuries
Bites
Clamping Injuries
Assessment-Based Approach: Open Soft Tissue Injuries
Scene Size-Up and Primary Assessment
Secondary Assessment
Signs and Symptoms
Emergency Medical Care
Reassessment
Special Considerations
Chest Injuries
Abdominal Injuries
Impaled Objects
Amputations
Large Open Neck Injuries
Dressings and Bandages
Dressings
Bandages
Pressure Dressings
General Principles of Dressing and Bandaging
Summary: Assessment and Care
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 29 Burns
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Review of the Anatomy of the Skin
Pathophysiology of Burns
Circulatory System
Respiratory System
Toxin-Induced Lung Injury
Renal System (Kidneys)
Nervous and Musculoskeletal Systems
Gastrointestinal System
Classification of Burns
Classifying Burns by Depth
Superficial Burns
Partial-Thickness Burns
Full-Thickness Burns
Classifying Burns by Severity
Burn Injury Location
Age and Preexisting Medical Conditions
Special Considerations for Infants and ­Children
Classifying Burns by Burn Size (Body Surface Area)
Types of Burns
Causes of Burns
Assessment-Based Approach: Burns
Scene Size-Up
Primary Assessment
Secondary Assessment
Signs and Symptoms
Emergency Medical Care
Special Considerations for Dressing Burns
Reassessment
Chemical Burns
Special Considerations in Treating Chemical Burns
Electrical Burns
Summary: Assessment and Care
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 30 Musculoskeletal Trauma and Nontraumatic Fractures
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Musculoskeletal System Review
The Muscles
Tendons and Ligaments
Cartilage
The Skeletal System
Upper Extremity
Lower Extremity
Injuries To Bones And Joints
Types of Injuries
Fracture
Strain
Sprain
Dislocation
General Injury Considerations
Mechanism of Injury
Direct Force
Indirect Force
Twisting Force
Critical Fractures: The Femur and the Pelvis
Assessment-Based Approach: Bone or Joint Injuries
Scene Size-Up and Primary Assessment
Secondary Assessment
Signs and Symptoms
Emergency Medical Care
Reassessment
Summary: Assessment and Care
Basics of Splinting
General Rules of Splinting
Splinting Equipment
Rigid Splints
Pressure (Air or Pneumatic) Splints
Traction Splints
Formable Splints
Vacuum Splints
Sling and Swathe
Spine Board or Full Body Vacuum Mattress
Vest-Type Immobilization Device
Improvised Splints
Hazards of Improper Splinting
Splinting Long Bone Injuries
Splinting Joint Injuries
Traction Splinting
Splinting Specific Injuries
Pelvic Fracture
Compartment Syndrome
Nontraumatic Fractures
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 31 Head Trauma
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Anatomy of The Skull and Brain
The Skull
The Brain
The Meninges
Parts of the Brain
Head Injury
Scalp Injuries
Skull Injuries
Brain Injuries
Pathophysiology of Traumatic Brain Injury
Primary Brain Injury
Secondary Brain Injury
Seizure Activity.
Brain Herniation
Types of Head and Brain Injuries
Closed and Open Head Injuries
Concussion
Contusion
Subdural Hematoma
Epidural Hematoma
Laceration
Assessment-Based Approach: Head Injury
Scene Size-Up
Primary Assessment
Mental Status
Secondary Assessment
Physical Exam
Vital Signs
History
Signs and Symptoms
Emergency Medical Care
Reassessment
Summary: Assessment and Care
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 32 Spinal Injury and Spine Motion Restriction
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Anatomy And Physiology Of Spinal Injury
The Nervous System
Parts of the Nervous System
The Skeletal System
The Skull
The Spinal Column
Common Mechanisms of Spinal Injury
Spinal Column Injury Versus Spinal Cord Injury
Complete Spinal Cord Injury
Spinal Shock
Neurogenic Hypotension from Spinal Shock
Incomplete Spinal Cord Injury
Central Cord Syndrome
Anterior Cord Syndrome
Brown-Séquard Syndrome
Emergency Care for Suspected Spinal Injury
Assessment-Based Approach: Spinal Injury
Scene Size-Up
Likely Mechanisms of Spinal Injury
Clues to Mechanism of Injury
Primary Assessment
Secondary Assessment
Physical Exam
Vital Signs
History
Signs and Symptoms
Indications for Spine Motion Restriction Based on Assessment Findings
Complications of Spinal Injury
Emergency Medical Care
Reassessment
Summary: Assessment and Care
Guidelines For Spine Motion Restriction
Historical Perspective: Spinal Immobilization Versus Spine Motion Restriction
Spinal Immobilization
Spine Motion Restriction
Indications for Spine Motion Restriction
Spine Motion Restriction Protocols
Tools for SMR
Cervical Collars
A cervical collar should be used any time you suspect injury to the spine. There are several types of cervical collars (EMT Skills 32-3) including rigid and soft collars. The primary purpose of the cervical collar is simply to remind the patient to keep his head and neck in a neutral in-line position and not to move. Because awareness has become the primary purpose and because there are hazards associated with the rigid cervical collar, the use of a soft cervical collar, at one time out of favor, is again recommended
Hazards of Rigid Cervical Collars
Full Body Spinal Restriction Devices
Long Rigid Backboards
Hazards of Long Rigid Backboards
Alternative Long Devices for Spine Motion Restriction
Short Spine Motion Restriction Devices
Other SMR Equipment
Spine Motion Restriction Techniques
The Ambulatory Patient
Self-Restriction and Assessing an Ambulatory Patient
Performing SMR for an Ambulatory Patient
The Patient Found Supine or Prone
SMR for a Supine or Prone Patient to Be Secured to a Long Backboard
SMR for a Supine or Prone Patient with the Backboard as a Movement Device Only
The Patient Seated in a Vehicle
SMR and Self-Extrication from a Vehicle
SMR for a Seated Patient Using a Vest-Type Device
Rapid Extrication (Rapid Rollout)
Special Considerations
Helmets
Helmet Removal
Equipment-Intensive Sports (Football, Hockey, and Lacrosse) Injuries
Removal of the Face Mask
SMR for the Player
SMR in Infants and Children
Extrication from a Car Seat
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 33 Eye, Face, and Neck Trauma
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Anatomy of the Eye, Face, and Neck
The Eye
The Face
The Neck
Eye, Face, and Neck Injuries
Assessment-Based Approach: Eye, Face, and Neck Injuries
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
Specific Injuries Involving the Eye, Face, and Neck
Injuries to the Eye
Assessment and Care Guidelines
Foreign Object in the Eye
Injury to the Orbits
Lid Injury
Injury to the Globe
Corneal Injury
Chemical Burn to the Eye
Impaled Object in the Eye or Extruded Eyeball
Summary: Emergency Care—Eye Injuries
Removing Contact Lenses
Removing Soft Contact Lenses
Removing Hard Contact Lenses
Injuries to the Face
Assessment and Care Guidelines
Avulsed Tooth
Injury to the Midface, Upper Jaw, or Lower Jaw
Object Impaled in the Cheek
Injury to the Nose
Injury to the Ear
Summary: Emergency Care—Facial Injuries
Injuries to the Neck
Summary: Emergency Care—Neck Injuries
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 34 Chest Trauma
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
The Chest
Anatomy of the Chest
General Categories of Chest Injuries
Open Chest Injury
Closed Chest Injury
Specific Chest Injuries
Flail Segment
Pulmonary Contusion
Pneumothorax
Open Pneumothorax
Tension Pneumothorax
Hemothorax
Traumatic Asphyxia
Cardiac Contusion
Commotio Cordis
Pericardial Tamponade
Rib Injury
Assessment-Based Approach: Chest Trauma
Scene Size-Up
Primary Assessment
Secondary Assessment
Signs and Symptoms
General Emergency Medical Care—Chest Trauma
Emergency Medical Care—Open Chest Wound
Emergency Medical Care—Flail Segment
Reassessment
Summary: Assessment and Care—Chest Trauma
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 35 Abdominal and Genitourinary Trauma
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
The Abdomen
Anatomy of the Abdominal Cavity
Types of Abdominal Organs and Structures
Hollow Organs
Solid Organs
Vascular Structures
Additional Structures
The Diaphragm
The Abdominal Wall
Abdominal Injuries
Assessment-Based Approach: Abdominal Trauma
Scene Size-Up
Primary Assessment
Secondary Assessment
Signs and Symptoms
General Emergency Medical Care—Abdominal Trauma
Emergency Medical Care—Abdominal Evisceration
Reassessment
Summary: Assessment and Care—Abdominal Trauma
Genital Trauma
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 36 Multisystem Trauma and Trauma in Special Patient Populations
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Multisystem Trauma
Golden Principles of Prehospital Multisystem Trauma Care
Trauma in Special Patient Populations
Trauma in Pregnant Patients
Anatomic and Physiologic Considerations in the Pregnant Trauma Patient
Assessment Considerations in the Pregnant Trauma Patient
Management Considerations for the Pregnant Trauma Patient
Trauma in Pediatric Patients
Anatomic and Physiologic Considerations in the Pediatric Trauma Patient
Assessment Considerations in the Pediatric Trauma Patient
Management Considerations for the Pediatric Trauma Patient
Trauma in Geriatric Patients
Anatomic and Physiologic Considerations in the Geriatric Trauma Patient
Assessment Considerations in the Geriatric Trauma Patient
Management Considerations for the Geriatric Trauma Patient
Trauma in Cognitively Impaired Patients
Anatomic and Physiologic Considerations in the Cognitively Impaired Trauma Patient
Assessment Considerations in the Cognitively Impaired Trauma Patient
Management Considerations for the Cognitively Impaired Trauma Patient
Assessment-Based Approach: Multisystem Trauma and Trauma in Special Patient Populations
Scene Size-Up
Primary Assessment
Secondary Assessment
Physical Exam
Vital Signs
History
Signs and Symptoms
Emergency Medical Care
Reassessment
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Part 11 Special Patient Populations
Chapter 37 Obstetrics and Care of the Newborn
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Anatomy and Physiology of the obstetric patient
Anatomy of Pregnancy
Menstrual Cycle
Prenatal Period
Physiologic Changes in Pregnancy
Antepartum (Predelivery) Emergencies
Antepartum Condition Causing Severe Vomiting, Dehydration, and Electrolyte Imbalance: Hyperemesis Gravidarum
Antepartum Conditions Causing Hemorrhage
Spontaneous Abortion
Pathophysiology
Assessment
Emergency Medical Care
Ectopic Pregnancy
Pathophysiology
Assessment
Emergency Medical Care
Placenta Previa
Pathophysiology
Assessment
Emergency Medical Care
Abruptio Placentae
Pathophysiology
Assessment
Emergency Medical Care
Ruptured Uterus
Pathophysiology
Assessment
Emergency Medical Care
Antepartum Seizures and Hypertensive Emergencies
Seizures During Pregnancy
Pregnancy-Induced Hypertension
Preeclampsia/Eclampsia
Pathophysiology
Assessment
Emergency Medical Care
Supine Hypotensive Syndrome
Pathophysiology
Assessment
Emergency Medical Care
Assessment-Based Approach: Antepartum (Predelivery) Emergency
Scene Size-Up
Primary Assessment
Secondary Assessment
Signs and Symptoms
Emergency Medical Care
Reassessment
Summary: Assessment and Care—Antepartum (Predelivery) Emergency
Labor And Normal Delivery
Labor
First Stage: Dilation
Braxton-Hicks Contractions
Second Stage: Expulsion
Third Stage: Placental Delivery
Assessment-Based Approach: Active Labor and Normal Delivery
Scene Size-Up, Primary Assessment, and Secondary Assessment
Estimating Gestational Age Based on Fundal Height
Prehospital Delivery
Imminent Delivery
Delivery at the Scene
Reassessment
Abnormal Delivery
Assessment-Based Approach: Active Labor with Abnormal Delivery
Scene Size-Up, Primary Assessment, and Secondary Assessment
Signs and Symptoms
Emergency Medical Care and Reassessment
Intrapartum Emergencies
Prolapsed Cord
Breech Birth
Face, Chin, Brow, Limb, and Compound Presentations
Shoulder Dystocia
Precipitous Delivery
Multiple Births
Meconium
Preterm Labor
Preterm Birth
Postterm Pregnancy
Premature Rupture of Membranes
Summary: Assessment and Care—Active Labor and Delivery
Postpartum Complications
Postpartum Hemorrhage
Embolism
Care of The Newborn
Assessment-Based Approach: Care of the Newborn
Assessment
Signs and Symptoms
Emergency Medical Care
YES Answer to All Three Questions
No Answer to Any of the Three Questions
Interventions
Meconium Present at Birth
Summary: Care of the Newborn
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 38 Pediatrics
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Dealing With Caregivers
Dealing with the Child
Developmental Characteristics
Neonates (Birth to 1 Month of Age)
Infants (1 Month to 1 Year of Age)
Toddlers (1 to 2 Years of Age)
Preschoolers (3 to 5 Years of Age)
School-Age and Preadolescent Children (6 to 12 Years of Age)
Adolescents (12 to 18 Years of Age)
Anatomic and Physiologic Differences
Assessment-Based Approach to Pediatric Emergencies
Scene Size-Up
Primary Assessment
Forming a General Impression Using the Pediatric Assessment Triangle
Appearance
Work of Breathing
Circulation to Skin
PAT Application and Interpretation
Forming a General Impression Using the Pediatric Advanced Life Support Initial Impression
Acting on Life Threats Identified During the General Impression
Assessing the Level of Consciousness
Airway Assessment
Breathing Assessment
Circulatory Assessment
Priority Determination
Secondary Assessment
Special Considerations for the Physical Exam
Pediatric Glasgow Coma Scale
Assessing Lung Sounds
Pulse Oximetry
Other Physical Exam Considerations
Special Considerations for Assessing the Vital Signs
Special Considerations for Taking a History
Reassessment
Airway and Respiratory Problems in Pediatric Patients
Early Respiratory Distress
Decompensated Respiratory Failure
Respiratory Arrest
Airway Obstruction
Signs and Symptoms of a Respiratory Emergency
Emergency Medical Care—Respiratory Emergencies
Emergency Medical Care—Foreign Body Airway Obstruction
Infant or Child with a Mild Foreign Body Airway Obstruction
Infant with a Severe Foreign Body Airway Obstruction
Unresponsive Infant with a Foreign Body Airway Obstruction
Child with a Severe Foreign Body Airway Obstruction
Unresponsive Child with a Foreign Body Airway Obstruction
Specific Pediatric Respiratory and Cardiopulmonary Conditions
Croup
Emergency Medical Care
Epiglottitis
Emergency Medical Care
Asthma
Emergency Medical Care
Bronchiolitis
Emergency Medical Care
Pneumonia
Emergency Medical Care
Congenital Heart Disease (CHD)
Emergency Medical Care
Shock
Emergency Medical Care
Cardiac Arrest
Emergency Medical Care
Summary: Pediatric Respiratory and Cardiopulmonary Emergencies
Other Pediatric Medical Conditions and Emergencies
Seizures
Assessment Considerations
Emergency Medical Care
Altered Mental Status
Assessment Considerations
Emergency Medical Care
Drowning
Assessment Considerations
Emergency Medical Care
Fever
Assessment Considerations
Emergency Medical Care
Meningitis
Assessment Considerations
Emergency Medical Care
Gastrointestinal Disorders
Assessment Considerations
Emergency Medical Care
Poisoning
Assessment Considerations
Emergency Medical Care
Brief Resolved Unexplained Events
Assessment Considerations
Emergency Medical Care
Sudden Infant Death Syndrome
Assessment Considerations
Emergency Medical Care
Aiding Family Members in SIDS Emergencies
Presence of Parents During Pediatric Resuscitation
Pediatric Trauma
Trauma and the Pediatric Anatomy
Assessment Considerations
Head
Chest
Abdomen
Extremities
Burns
Emergency Medical Care—Pediatric Trauma
Infant and Child Car Seats in Trauma
Removing the Infant or Child from a Car Seat
Safe Transport of Children in Ground Ambulances
Four-Point Spine Motion Restriction of an Infant or Child
Injury Prevention
Child Abuse and Neglect
Emergency Medical Care Guidelines for Child Abuse
Special Care Considerations
Emergency Medical Services for Children
Family-Centered Care
Taking Care of Yourself
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 39 Geriatrics
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Effects of Aging on Body Systems
The Cardiovascular System
The Respiratory System
The Neurologic System
The Gastrointestinal System
The Endocrine System
The Musculoskeletal System
The Renal System
The Integumentary System
Special Geriatric Assessment Findings
Assessment Finding: Chest Pain or Absence of Chest Pain
Heart Attack (Myocardial Infarction)
Congestive Heart Failure
Assessment Finding: Shortness of Breath (Dyspnea)
Pulmonary Edema
Pulmonary Embolism
Pneumonia
Chronic Obstructive Pulmonary Disease
Assessment Finding: Altered Mental Status
Cognitive Impairment
Stroke
Transient Ischemic Attack
Seizure
Syncope
Hyperosmolar Hyperglycemic Syndrome
Drug Toxicity
Dementia and Delirium
Alzheimer’s Disease
Assessment Finding: Signs of Trauma or Shock
Assessment Finding: Gastrointestinal Bleeding
Assessment Finding: Environmental Temperature Extremes
Elder/Geriatric Abuse
Assessment-Based Approach: Geriatric Patients
Scene Size-Up
Primary Assessment
Secondary Assessment
For the Geriatric Trauma Patient
For the Geriatric Medical Patient
Emergency Medical Care and Reassessment
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 40 Patients with Special Challenges
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Recognizing the Patient with Special Challenges
Sensory Impairments
Hearing Impairment
Vision Impairment
Speech Impairment
Accommodations for Patients with Sensory Impairments
Cognitive and Emotional Impairments
Mental or Emotional Impairments
Developmental Disabilities
Autism and EMS
Accommodations for Patients with Mental, Emotional, or Developmental Impairments
Brain-Injured Patients
Accommodations for Brain-Injured Patients
Paralysis
Accommodations for Paralyzed Patients
Obesity
Accommodations for Obese Patients
Homelessness and Poverty
Accommodations for Patients Who Are Homeless or Poor
Abuse
Human Trafficking
The Human Trafficking Victim
Common Characteristics of Human Trafficking Victims
Psychological and Behavioral Clues to Help Identify a Human Trafficking Victim
Physical Clues to Help Identify a Human Trafficking Victim
EMS Management for a Suspected Human Trafficking Victim
Domestic Violence
The Domestic Violence Victim
Types of Domestic Abuse
Cycle of Violence
EMS Management for a Victim of Domestic Abuse or Violence
Assessment Findings of Domestic Abuse
Approach to the Scene and Victim of Domestic Violence
Preserving Evidence and Documentation
Technology Dependence
Airway and Respiratory Devices
Medical Oxygen
Apnea Monitors
Pulse Oximetry
Tracheostomy Tubes
CPAP and BiPAP
Home Mechanical Ventilators
Accommodations for Patients with Airway or Respiratory Devices
Vascular Access Devices
Central Intravenous Catheters
Central Venous Lines
Implanted Ports
Accommodations for Patients with Vascular Access Devices
Ventricular Assist Device
Special Assessment Considerations for Patients with an Implanted VAD
Accommodations for Patients with an Implanted VAD
Vagus Nerve Stimulator
Accommodations for Patients with a VNS
Renal Failure and Dialysis
Accommodations for Patients on Dialysis
Gastrointestinal and Genitourinary Devices
Feeding Tubes
Ostomy Bags
Urinary Tract Devices
Accommodations for Patients with Gastrointestinal and Genitourinary Devices
Intraventricular Shunts
Accommodations for Patients with Intraventricular Shunts
Terminally Ill Patients
Accommodations for Terminally Ill Patients
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 41 The Combat Veteran
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
The Psychophysiology of Stress Response
Combat Veterans
The Nature of Ptsd
Associated Signs and Symptoms of PTSD
Alcohol and Drug Use
Danger to Self or Other
Signature Wounds of the Combat Veteran
TBI Versus PTSD: Signs and Symptoms
Assessing and Providing Emergency Care to Combat Veterans: Recommendations for Emts
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Transport and Follow-Up
Reassessment
In Review
Critical Thinking
Part 12 EMS Operations
Chapter 42 Ambulance Operations and Air Medical Response
Objectives
The Dispatch
En Route
Introduction
Culture of Safety in Ems
Crew Resource Management
Driving the Ambulance
Laws, Regulations, and Ordinances
Driving Excellence
Basics of Good Driving
Maintaining Control
Braking
Driver Distractions
Driving Alone
Fatigue
Railroads
School Buses
Bridges and Tunnels
Day of the Week
Time of Day
Road Surface
Backing Up
Higher Speeds
Aggressive Drivers
Escorts
Intersection Collisions
Driving in Inclement Weather
Rainy or Wet Weather
Winter Driving
Fog, Mist, Dust Storms, and Smog
Driving at Night
Warning Devices
Colors and Markings
Warning Lights and Emergency Lights
Using Your Siren
Using Your Air Horn
Roadway Incident Scene Safety
High-Visibility Apparel
Safety Benchmarks
Phases of an Ambulance Call
Daily Prerun Preparation
Ambulance Maintenance
Daily Inspection of Vehicle
Ambulance Equipment
Personnel
Dispatch
En Route to the Scene
At the Scene
En Route to the Receiving Facility
At the Receiving Facility
En Route to the Station or Response Area
Post Run
Infection Control Procedures
Dispose of Sharps
Wash Hands
Clean, Disinfect, or Sterilize Contaminated Equipment
Launder Soiled Clothing and Linens
Dispose of Infectious Wastes
Air Medical Transport
When to Request Air Medical Transport
Requesting Air Medical Transport
Additional Considerations for Air Medical Transport
Setting Up a Landing Zone
Security and Safety
Operational Security Measures
Carbon Monoxide in Ambulances
Chapter Review
Summary
En Route to the Scene
At the Scene
En Route to the Receiving Facility
At the Receiving Facility
En Route to the Station
Post Run
In Review
Critical Thinking
Chapter 43 Gaining Access and Patient Extrication
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Planning Ahead
Dispatch
Location
Motor Vehicle Collisions
Sizing Up the Scene
Perform a 360-Degree Assessment
Evaluate the Need for Additional Resources
Personal Protective Equipment
Scene Safety
Electrical Lines
Control of Traffic Flow
Alternative-Fueled Vehicle Systems
Undeployed Air Bags
Energy-Absorbing Bumpers
Locate All Patients
Vehicle Safety
Gaining Access
Residential Access
Motor Vehicle Access
Simple Access
Complex Access
Extrication
The Role of the EMT
Caring for the Patient
Specialized Stabilization, Extrication, and Disentanglement Techniques
Stabilizing a Vehicle
Upright Vehicle
Vehicle on Its Side
Vehicle on Its Roof
Extricating a Patient
“Rip and Blitz” Disentanglement
Side-Impact or Head Protection Air Bags
Other Methods of Access and Disentanglement
Door Removal
Windshield Removal and Roof Rolling
Special Disentanglement Procedures
Chapter Review
Summary
Scene Size-Up
In Review
Critical Thinking
Chapter 44 Hazardous Materials
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Identifying Hazardous Materials
What Is a Hazardous Material?
Placards and Shipping Papers
Safety Data Sheets
Using Your Senses
Resources
The Emergency Response Guidebook
WISER
Training Required by Law
Guidelines For Hazardous Materials Rescues
General Rules
Decontamination
Incident Management
Preincident Planning
Implementing the Plan
Establishing Safety Zones
Hot Zone
Warm Zone
Cold Zone
Emergency Procedures
Radiation Emergencies
Exposure and Contamination
Guidelines for Radiation Emergencies
Procedures for Radiation Emergencies
Scene Safety
Personal Protection
Patient Care
Personal Decontamination
Vehicle/Equipment Decontamination
Problems Caused by Radiation
Protection from Radiation
Criminal Use of Hazardous Materials
Methamphetamine Clandestine Drug Laboratories
Marijuana Clandestine Drug Laboratories
Terrorist Attacks
Chapter Review
Summary
Scene Size-Up
Primary Assessment
Secondary Assessment
Reassessment
In Review
Critical Thinking
Chapter 45 Multiple-Casualty Incidents and Incident Management
Objectives
Key Terms
The Dispatch
Upon Arrival
Introduction
Multiple-Casualty Incidents
National Incident Management System
Incident Command System
Triage
Primary and Secondary Triage
START Triage System
Ability to Walk (Ambulatory or “Walking Wounded”)
Respirations
Perfusion
Mental Status
JumpSTART Pediatric Triage System
JumpSTART Ambulatory Assessment
JumpSTART Breathing Assessment
JumpSTART Perfusion Assessment
JumpSTART Mental Status Assessment
SALT Triage
Patient Tagging
Treatment
Staging and Transport
Communications
Follow-Through
Reducing Posttraumatic and Cumulative Stress
Disaster Management
Requirements of Effective Disaster Assistance
Warning and Evacuation
Disaster Communications Systems
The Psychological Impact of Disasters
Helping Disaster Patients
Chapter Review
Summary
Scene Size-Up
Triage
Supply and Extrication Units
Triage and Treatment Units
Staging and Transport
In Review
Critical Thinking
Chapter 46 EMS Response to Terrorist Incidents
Objectives
Key Terms
The Dispatch
En Route
Introduction
Weapons of Mass Destruction
Prehospital Response to Terrorism Involving WMD
Supplies and Equipment
Medical Direction
Provider Preparation
Responding to the Scene
Issues of Scene Safety
Role of the EMT at the Terrorist Incident Involving WMD
Conventional Explosives and Incendiary Devices
Explosives
Improvised Explosive Devices
Common Explosive Compounds
Primary, Secondary, Tertiary, Quaternary, and Quinary Effects
Body Position
Types of Injuries
Incendiary Devices
Chemical Agents
Properties of Chemical Weapons
Types of Chemical Agents
Nerve Agents
Signs and Symptoms
Emergency Medical Care
Vesicants
Signs and Symptoms
Emergency Medical Care
Cyanide
Signs and Symptoms
Emergency Medical Care
Pulmonary Agents
Signs and Symptoms
Emergency Medical Care
Riot-Control Agents
Signs and Symptoms
Emergency Medical Care
Toxic Industrial Chemicals
Signs and Symptoms and Emergency Medical Care
Biological Agents
Specific Biological Agents
Pneumonia-Like Agents
Encephalitis-Like Agents
Biological Toxins
Other Biological Agents
Emergency Medical Care for Biological Agents
Nuclear Weapons and Radiation
Radiation
Radiation Exposure
Primary Exposure
Fallout
Blast Injuries
Thermal Burns
Radiological Dispersal Devices/Radiological Exposure Devices
Improvised Nuclear Device
Assessment and Care for Nuclear Detonation and Radiation Injuries
Assessment
Emergency Medical Care
Personal Protection and Patient Decontamination
Active Shooter Incident
Tactical EMS
Cyberterrorism
Chapter Review
Summary
Scene Size-Up
Primary Assessment and Triage
Establishing Sectors
Additional Threats
In Review
Critical Thinking
Appendix 1 ALS-Assist Skills
Assisting in Intravenous Therapy
Intravenous Therapy Equipment
Catheter
Intravenous Tubing
Bag of Fluid
Preparing the Intravenous Setup (“Spiking the Bag”)
Saline Lock or Heparin Lock
ECG Lead Placement
3- or 4-Lead Electrode Placement
12-Lead Electrode Placement
Appendix 2 Advanced Airway Management
Airway and Respiratory Anatomy and Physiology
Airway Anatomy
Nose, Mouth, and Pharynx
Larynx
Trachea, Bronchi, and Bronchioles
Lungs
Airway Anatomy in Infants and Children
Head
Mouth, Nose, and Pharynx
Larynx
Trachea and Bronchi
Chest Wall and Diaphragm
Summary of Pediatric Airway Considerations
Basic Airway Management
Oropharyngeal Suctioning
Orotracheal Intubation
Advantages
Indications
Standard Precautions
Equipment
Laryngoscope
Straight Blade
Curved Blade
Alternative Blades
Assembly
Tracheal Tubes
Stylet
Other Intubation Equipment
Cricoid Pressure, BURP, or ELM
Tracheal Tube Insertion in an Adult
Complications of Orotracheal Intubation
Orotracheal Suctioning
Indications
Suctioning Technique
Complications of Orotracheal Suctioning
Alternative Intubation Methods
Alternative Intubation Equipment
Grandview Intubation Blade
McGrath™-MAC Video Laryngoscope
Eschmann Tracheal Tube Introducer
Alternative Advanced Airway Devices
Dual Lumen Retroglottic Airway Device
Esophageal Tracheal Combitube Airway
Advantages
Disadvantages
Indications
Contraindications
Insertion
Removal
Supraglottic Airway Device
Laryngeal Mask Airway
Insertion
Complications
Single Lumen Retroglottic Airway Device
King LT Airway
Orotracheal Intubation In Infants and Children
Indications in Infants and Children
Anatomic Considerations
Equipment for Infants and Children
Suction Devices
Laryngoscope Handles and Blades
Tracheal Tubes
Tracheal Tube Insertion in an Infant or Child
Nasogastric Insertion in Infants and Children
Indications
Contraindications
Equipment
Insertion
Complications
Appendix 3 Agricultural and Industrial Emergencies
Response to Agricultural and Industrial Emergencies
Assessment-Based Approach: Agricultural and Industrial Emergencies
Scene Size-Up
Primary Assessment
Secondary Assessment
Emergency Medical Care
Reassessment
Characteristics of Agricultural Accidents
Mechanisms of Injury
Stabilizing and Shutting Down Agricultural Equipment
General Guidelines
Tractors
Power Takeoff Shafts
Combines
Corn Pickers
Hay Balers
Agricultural Storage Devices
Grain Tanks
Silos
Manure Storage
Agricultural Chemicals
Injuries from Livestock
Industrial Rescue
Answer Key
Chapter 1 Emergency Medical Care Systems, Research, and Public Health
In Review
Chapter 2 Workforce Safety and Wellness of the EMT
In Review
Chapter 3 Medical, Legal, and Ethical Issues
In Review
Chapter 4 Documentation
In Review
Chapter 5 Communication
In Review
Chapter 6 Lifting and Moving Patients
In Review
Chapter 7 Anatomy, Physiology, and Medical Terminology
In Review
Chapter 8 Pathophysiology
In Review
Chapter 9 Life Span Development
In Review
Chapter 10 Airway Management, Artificial Ventilation, and Oxygenation
In Review
Chapter 11 Vital Signs, Monitoring Devices, and History Taking
In Review
Chapter 12 Scene Size-Up
In Review
Chapter 13 Patient Assessment
In Review
Chapter 14 General Pharmacology and Medication Administration
In Review
Chapter 15 Shock and Resuscitation
In Review
Chapter 16 Respiratory Emergencies
In Review
Chapter 17 Cardiovascular Emergencies
In Review
Chapter 18 Altered Mental Status, Stroke, and Headache
In Review
Chapter 19 Seizures and Syncope
In Review
Chapter 20 Acute Diabetic Emergencies
In Review
Chapter 21 Allergic and Anaphylactic Reactions
In Review
Chapter 22 Toxicologic Emergencies
In Review
Chapter 23 Abdominal, Hematologic, Gynecologic, Genitourinary, and Renal Emergencies
In Review
Chapter 24 Environmental Emergencies
In Review
Chapter 25 Submersion Incidents: Drowning and Diving Emergencies
In Review
Chapter 26 Psychiatric Emergencies
In Review
Chapter 27 Trauma Overview: The Trauma Patient and the Trauma System
In Review
Chapter 28 Bleeding and Soft Tissue Trauma
In Review
Chapter 29 Burns
In Review
Chapter 30 Musculoskeletal Trauma and Nontraumatic Fractures
In Review
Chapter 31 Head Trauma
In Review
Chapter 32 Spinal Trauma and Spine Motion Restriction
In Review
Chapter 33 Eye, Face, and Neck Trauma
In Review
Chapter 34 Chest Trauma
In Review
Chapter 35 Abdominal and Genitourinary Trauma
In Review
Chapter 36 Multisystem Trauma and Trauma in Special Patient Populations
In Review
Chapter 37 Obstetrics and Care of the Newborn
In Review
Chapter 38 Pediatrics
In Review
Chapter 39 Geriatrics
In Review
Chapter 40 Patients with Special Challenges
In Review
Chapter 41 The Combat Veteran
In Review
Chapter 42 Ambulance Operations and Air Medical Response
In Review
Chapter 43 Gaining Access and Patient Extrication
In Review
Chapter 44 Hazardous Materials
In Review
Chapter 45 Multiple-Casualty Incidents and Incident Management
In Review
Chapter 46 EMS Response to Terrorist Incidents
In Review
Glossary
Index

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