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EMERGENCY MEDICAL TECHNICIAN FINAL REVIEW Barry Barkinsky EMS-I, Paramedic.

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Presentation on theme: "EMERGENCY MEDICAL TECHNICIAN FINAL REVIEW Barry Barkinsky EMS-I, Paramedic."— Presentation transcript:

1 EMERGENCY MEDICAL TECHNICIAN FINAL REVIEW Barry Barkinsky EMS-I, Paramedic

2 Medical Emergencies Respiratory Respiratory Common Problems Common Problems Signs and Symptoms Signs and Symptoms Adequate / Inadequate Adequate / Inadequate Treatment Treatment

3 Obstructive Lung Disease Types Types Emphysema Emphysema Chronic Bronchitis Chronic Bronchitis Asthma Asthma Causes Causes Genetic Disposition Genetic Disposition Smoking & Other Risk Factors Smoking & Other Risk Factors

4 Emphysema Pathophysiology Pathophysiology Exposure to Noxious Substances Exposure to Noxious Substances Exposure results in the destruction of the walls of the alveoli. Exposure results in the destruction of the walls of the alveoli. Weakens the walls of the small bronchioles and results in increase residual volume. Weakens the walls of the small bronchioles and results in increase residual volume. Increased Risk of Infection and Dysrhythmia Increased Risk of Infection and Dysrhythmia

5 Emphysema Assessment Assessment History History Recent weight loss, dyspnea with exertion Recent weight loss, dyspnea with exertion Cigarette and tobacco usage Cigarette and tobacco usage Lack of Cough Lack of Cough

6 Emphysema Assessment Assessment Physical Exam Physical Exam Barrel chest. Barrel chest. Prolonged expiration and rapid rest phase. Prolonged expiration and rapid rest phase. Thin. Thin. Pink skin due to extra red cell production. Pink skin due to extra red cell production. Hypertrophy of accessory muscles. Hypertrophy of accessory muscles. Pink Puffers. Pink Puffers.

7 RESPIRATORY

8 Chronic Bronchitis Pathophysiology Pathophysiology Results from an increase in mucus-secreting cells in the respiratory tree. Results from an increase in mucus-secreting cells in the respiratory tree. Alveoli relatively unaffected. Alveoli relatively unaffected. Decreased alveolar ventilation. Decreased alveolar ventilation. Assessment Assessment History History Frequent respiratory infections. Frequent respiratory infections. Productive cough. Productive cough.

9 Chronic Bronchitis Physical Exam Physical Exam Often overweight. Often overweight. Rhonchi present on auscultation. Rhonchi present on auscultation. Jugular vein distention. Jugular vein distention. Ankle edema. Ankle edema. Hepatic congestion. Hepatic congestion. Blue Bloater. Blue Bloater. Physical Exam Physical Exam Often overweight. Often overweight. Rhonchi present on auscultation. Rhonchi present on auscultation. Jugular vein distention. Jugular vein distention. Ankle edema. Ankle edema. Hepatic congestion. Hepatic congestion. Blue Bloater. Blue Bloater.

10 RESPIRATORY

11 Bronchitis & Emphysema Management Management Maintain airway. Maintain airway. Support breathing. Support breathing. Find position of comfort. Find position of comfort. Monitor oxygen saturation. Monitor oxygen saturation. Be prepared to ventilate. Be prepared to ventilate. Administer medications. Administer medications. Bronchodilators. Bronchodilators.

12 Asthma Pathophysiology Pathophysiology Chronic Inflammatory Disorder Chronic Inflammatory Disorder Results in widespread but variable air flow obstruction. Results in widespread but variable air flow obstruction. The airway becomes hyperresponsive. The airway becomes hyperresponsive. Induced by a trigger, which can vary by individual. Induced by a trigger, which can vary by individual. Trigger causes release of histamine, causing bronchoconstriction and bronchial edema. Trigger causes release of histamine, causing bronchoconstriction and bronchial edema.

13 Asthma Assessment Assessment Identify immediate threats. Identify immediate threats. Obtain history. Obtain history. SAMPLE & OPQRST History SAMPLE & OPQRST History History of asthma-related hospitalization? History of asthma-related hospitalization? History of respiratory failure/ventilator use? History of respiratory failure/ventilator use?

14 Asthma Physical Exam Physical Exam Presenting signs may include dyspnea, wheezing, cough. Presenting signs may include dyspnea, wheezing, cough. Wheezing is not present in all asthmatics. Wheezing is not present in all asthmatics. Speech may be limited to 1–2 consecutive words. Speech may be limited to 1–2 consecutive words. Look for hyperinflation of the chest and accessory muscle use. Look for hyperinflation of the chest and accessory muscle use. Carefully auscultate breath sounds. Carefully auscultate breath sounds.

15 Asthma Management Management Treatment goals: Treatment goals: Correct hypoxia. Correct hypoxia. Reverse bronchospasm. Reverse bronchospasm. Reduce inflammation. Reduce inflammation. Maintain the airway. Maintain the airway. Support breathing. Support breathing. High-flow oxygen or assisted ventilations as indicated. High-flow oxygen or assisted ventilations as indicated.

16 RESPIRATORY (Trauma)

17 Medical Emergencies Cardiac Compromise Cardiac Compromise Cardiac Emergencies Cardiac Emergencies Signs and Symptoms Signs and Symptoms Treatment Treatment

18 Angina Pectoris Angina Pectoris Myocardial Infarction Myocardial Infarction Heart Failure Heart Failure Hypertensive Emergencies Hypertensive Emergencies Cardiogenic Shock Cardiogenic Shock Cardiac Arrest Cardiac Arrest Peripheral Vascular and Other Cardiovascular Emergencies Peripheral Vascular and Other Cardiovascular Emergencies Managing Specific Cardiovascular Emergencies

19 Angina Pectoris Causes of Chest Pain Causes of Chest Pain Cardiovascular, including acute coronary syndrome, or thoracic dissection of the aorta Cardiovascular, including acute coronary syndrome, or thoracic dissection of the aorta Respiratory, including pulmonary embolism, pneumothorax or pneumonia. Respiratory, including pulmonary embolism, pneumothorax or pneumonia. Gastrointestinal, including pancreatitis, hiatal hernia, esophageal disease, gastroesophageal reflux, peptic ulcer disease. Gastrointestinal, including pancreatitis, hiatal hernia, esophageal disease, gastroesophageal reflux, peptic ulcer disease. Musculoskeletal, chest wall trauma. Musculoskeletal, chest wall trauma.

20 Angina Pectoris Field Assessment Field Assessment Signs of Shock Signs of Shock Chest Discomfort Chest Discomfort Typically sudden onset, which may radiate or be localized to the chest. Typically sudden onset, which may radiate or be localized to the chest. Patient often denies chest pain. Patient often denies chest pain. Duration Duration Episodes last 3–5 minutes. Episodes last 3–5 minutes. Pain relieved with rest and/or nitroglycerin. Pain relieved with rest and/or nitroglycerin.

21 Angina Pectoris Breathing Breathing History History Past episodes of angina: Past episodes of angina: Episodes of angina that are increasing in frequency, duration, or severity are significant. Episodes of angina that are increasing in frequency, duration, or severity are significant.

22 Angina Pectoris Management Management Relieve anxiety: Relieve anxiety: Place the patient in a position of physical and emotional comfort. Place the patient in a position of physical and emotional comfort. Administer oxygen. Administer oxygen. Consider medication administration: Consider medication administration: Nitroglycerin tablets or spray Nitroglycerin tablets or spray

23 Angina Pectoris Special Considerations Special Considerations Patients with new-onset often require hospitalization. Patients with new-onset often require hospitalization. Symptoms not relieved by rest, nitroglycerin, and oxygen may indicate an overall worsening of the disease or the early stages of a myocardial infarction. Symptoms not relieved by rest, nitroglycerin, and oxygen may indicate an overall worsening of the disease or the early stages of a myocardial infarction. Patients may refuse transport after pain is relieved, even though the underlying problem is not addressed. Patients may refuse transport after pain is relieved, even though the underlying problem is not addressed.

24 Myocardial Infarction Pathophysiology Pathophysiology Death and necrosis of heart muscle due to inadequate oxygen supply. Death and necrosis of heart muscle due to inadequate oxygen supply. Causes may include occlusion, spasm, acute volume overload, hypotension, acute respiratory failure, and trauma. Causes may include occlusion, spasm, acute volume overload, hypotension, acute respiratory failure, and trauma. Location and size dependent on the vessel involved. Location and size dependent on the vessel involved.

25 Myocardial Infarction Effects of a Myocardial Infarction Effects of a Myocardial Infarction Dysrhythmias Dysrhythmias Heart Failure Heart Failure Goals of Treatment Goals of Treatment Pain Relief Pain Relief Reperfusion Reperfusion

26 Myocardial Infarction Field Assessment Field Assessment Breathing Breathing Signs of Shock Signs of Shock Chief Complaint Chief Complaint Typically related to chest pain. Typically related to chest pain. Evaluate using OPQRST: Evaluate using OPQRST: Discomfort > 30 minutes. Discomfort > 30 minutes. Radiation to arms, neck, back, or epigastric region. Radiation to arms, neck, back, or epigastric region. Patients may minimize symptoms. Patients may minimize symptoms. Feelings of impending doom. Feelings of impending doom.

27 Myocardial Infarction Other Symptoms Other Symptoms Nausea and vomiting Nausea and vomiting Diaphoresis Diaphoresis Myocardial Infarctions & the ECG Myocardial Infarctions & the ECG Dysrhythmias: Dysrhythmias: VF, VT, Asystole, PEA. VF, VT, Asystole, PEA. Dysrhythmias are the leading cause of death in MI. Dysrhythmias are the leading cause of death in MI.

28 Myocardial Infarction Management Management Transport Transport Rapid transport indicated when acute MI suspected Rapid transport indicated when acute MI suspected Prehospital Prehospital Administer oxygen. Administer oxygen. Consider medication administration: Consider medication administration: Aspirin Aspirin Nitroglycerin Nitroglycerin

29 Nitroglycerine Indications Indications Contraindications Contraindications Side effects Side effects Dosage Dosage

30 Heart Failure Left Ventricular Failure Left Ventricular Failure Pathophysiology Pathophysiology Results in increased back pressure into Results in increased back pressure into the pulmonary circulation.

31 Heart Failure Right Ventricular Failure Right Ventricular Failure Pathophysiology Pathophysiology Results in increased back pressure into the systemic venous circulation. Results in increased back pressure into the systemic venous circulation. Pulmonary Embolism Pulmonary Embolism

32 Heart Failure Congestive Heart Failure Congestive Heart Failure Pathophysiology Pathophysiology Reduction in the hearts stroke volume causes fluid overload throughout the bodys other tissues. Reduction in the hearts stroke volume causes fluid overload throughout the bodys other tissues.

33 Heart Failure Field Assessment Field Assessment Pulmonary Edema: Pulmonary Edema: Cough with copious amounts of clear or pink-tinged sputum. Cough with copious amounts of clear or pink-tinged sputum. Labored breathing, especially with exertion. Labored breathing, especially with exertion. Abnormal breath sounds, including rales, rhonchi, and wheezes. Abnormal breath sounds, including rales, rhonchi, and wheezes. Paroxysmal Nocturnal Dyspnea (PND) Paroxysmal Nocturnal Dyspnea (PND) Medications: Medications: Diuretics. Diuretics. Medications to increase cardiac contractile force. Medications to increase cardiac contractile force. Home oxygen. Home oxygen.

34 Heart Failure Mental Status Mental Status Mental status changes indicate impending respiratory failure. Mental status changes indicate impending respiratory failure. Breathing Breathing Signs of labored breathing. Signs of labored breathing. Tripod positioning. Tripod positioning. Number of pillows. Number of pillows. Skin Skin Color changes. Color changes. Peripheral and/or sacral edema. Peripheral and/or sacral edema.

35 Heart Failure Management Management General management: General management: Avoid supine positioning. Avoid supine positioning. Avoid exertion such as standing or walking. Avoid exertion such as standing or walking. Maintain the airway. Maintain the airway. Administer oxygen. Administer oxygen. Avoid patient refusals if at all possible. Avoid patient refusals if at all possible.

36 Hypertensive Emergencies Hypertensive Emergency Hypertensive Emergency Causes Causes Typically occurs only in patients with a history of HTN. Typically occurs only in patients with a history of HTN. Primary cause is noncompliance with prescribed antihypertensive medications. Primary cause is noncompliance with prescribed antihypertensive medications. Also occurs with toxemia of pregnancy. Also occurs with toxemia of pregnancy. Risk Factors Risk Factors Age-related factors Age-related factors Race-related factors Race-related factors

37 Hypertensive Emergencies Field Assessment Field Assessment Initial Assessment Initial Assessment Alterations in mental state Alterations in mental state Signs & Symptoms Signs & Symptoms Headache accompanied by nausea and/or vomiting Headache accompanied by nausea and/or vomiting Blurred vision Blurred vision Shortness of breath Shortness of breath Epistaxis Epistaxis Vertigo Vertigo

38 Hypertensive Emergencies History History Known history of hypertension Known history of hypertension Compliance with medications Compliance with medications Exam Exam BP > 160/90 BP > 160/90 Signs of left ventricular failure Signs of left ventricular failure Strong, bounding pulse Strong, bounding pulse Abnormal skin color, temperature, and condition Abnormal skin color, temperature, and condition Presence of edema Presence of edema

39 Hypertensive Emergencies Management Management Maintain airway. Maintain airway. Administer oxygen. Administer oxygen.

40 Cardiogenic Shock Pathophysiology Pathophysiology General General Inability of the heart to meet the bodys metabolic needs. Inability of the heart to meet the bodys metabolic needs. Often remains after correction of other problems. Often remains after correction of other problems. Severe form of pump failure. Severe form of pump failure. High mortality rate. High mortality rate. Causes Causes Tension pneumothorax and cardiac tamponade. Tension pneumothorax and cardiac tamponade. Impaired ventricular emptying. Impaired ventricular emptying. Impaired myocardial contractility. Impaired myocardial contractility. Trauma. Trauma.

41 Cardiogenic Shock Field Assessment Field Assessment Initial Assessment Initial Assessment Chief Complaint Chief Complaint Chief complaint is typically chest pain, shortness of breath, unconsciousness, or altered mental state. Chief complaint is typically chest pain, shortness of breath, unconsciousness, or altered mental state. Onset may be acute or progressive. Onset may be acute or progressive. History History History of recent MI or chest pain episode. History of recent MI or chest pain episode. Presence of shock in the absence of trauma. Presence of shock in the absence of trauma.

42 Cardiogenic Shock Mental Status Mental Status Restlessness progressing to confusion Restlessness progressing to confusion Airway and Breathing Airway and Breathing Dyspnea, labored breathing, and cough Dyspnea, labored breathing, and cough PND, tripod position, accessory muscle retraction, and adventitious lung sounds PND, tripod position, accessory muscle retraction, and adventitious lung sounds Circulation Circulation Hypotension Hypotension Cool, clammy skin Cool, clammy skin

43 Cardiogenic Shock Management Management Maintain airway. Maintain airway. Administer oxygen Administer oxygen Identify and treat underlying problem. Identify and treat underlying problem.

44 Cardiac Arrest Sudden Death Sudden Death Causes Causes Electrolyte or acid–base imbalances Electrolyte or acid–base imbalances Electrocution Electrocution Drug intoxication Drug intoxication Hypoxia Hypoxia Hypothermia Hypothermia Pulmonary embolism Pulmonary embolism Stroke Stroke Drowning Drowning Trauma Trauma

45 Cardiac Arrest Field Assessment Field Assessment Initial Assessment Initial Assessment Unresponsive, apneic, pulseless patient Unresponsive, apneic, pulseless patient ECG ECG Dysrhythmias Dysrhythmias History History Prearrest events Prearrest events Bystander CPR Bystander CPR Down time Down time

46 Cardiac Arrest Management Management Resuscitation Resuscitation Return of Spontaneous Circulation Return of Spontaneous Circulation Role of Basic Life Support Role of Basic Life Support General Guidelines General Guidelines Manage specific Dysrhythmias. Manage specific Dysrhythmias. AED AED CPR. CPR.

47 AED (Automatic External Defibrillator)

48 Indications

49 Contraindications

50 Joules

51 # of Shocks

52 AED (Automatic External Defibrillator) If NO SHOCK Advised

53 Aneurysm Aneurysm Pathophysiology Pathophysiology Ballooning of an arterial wall, usually the aorta, that results from a weakness or defect in the wall Ballooning of an arterial wall, usually the aorta, that results from a weakness or defect in the wall Types Types Atherosclerotic Atherosclerotic Dissecting Dissecting Traumatic Traumatic Peripheral Vascular and Other Cardiovascular Emergencies

54 Abdominal Aortic Aneurysm Abdominal Aortic Aneurysm Often the result of atherosclerosis Often the result of atherosclerosis Signs and symptoms Signs and symptoms Abdominal pain Abdominal pain Back/flank pain Back/flank pain Hypotension Hypotension Urge to defecate Urge to defecate Peripheral Vascular and Other Cardiovascular Emergencies

55 Dissecting Aortic Aneurysm Dissecting Aortic Aneurysm Caused by degenerative changes in the smooth muscle and elastic tissue. Caused by degenerative changes in the smooth muscle and elastic tissue. Blood gets between and separates the wall of the aorta. Blood gets between and separates the wall of the aorta. Can extend throughout the aorta and into associated vessels. Can extend throughout the aorta and into associated vessels. Peripheral Vascular and Other Cardiovascular Emergencies

56 Acute Pulmonary Embolism Acute Pulmonary Embolism Pathophysiology Pathophysiology Blockage of a pulmonary artery by a blood clot or other particle. Blockage of a pulmonary artery by a blood clot or other particle. The area served by the pulmonary artery fails. The area served by the pulmonary artery fails. Signs and Symptoms Signs and Symptoms Dependent upon size and location of the blockage. Dependent upon size and location of the blockage. Onset of severe, unexplained dyspnea. Onset of severe, unexplained dyspnea. History of recent lengthy immobilization. History of recent lengthy immobilization. Peripheral Vascular and Other Cardiovascular Emergencies

57 Medical Emergencies Altered Mental Status (AMS) Altered Mental Status (AMS) Causes Causes Treatment Treatment

58 Medical Emergencies Diabetes Diabetes Most common cause Most common cause Signs and Symptoms Signs and Symptoms Treatment Treatment

59 Medical Emergencies Seizures

60 Seizures Generalized Seizures Generalized Seizures Tonic-Clonic Tonic-Clonic Aura Aura Loss of Consciousness Loss of Consciousness Tonic Phase Tonic Phase Clonic Phase Clonic Phase Postseizure Postseizure Postictal Postictal

61 Seizures Partial Seizures Partial Seizures Simple Partial Seizures Simple Partial Seizures Involve one body area. Involve one body area. Can progress to generalized seizure. Can progress to generalized seizure. Complex Partial Seizures Complex Partial Seizures Characterized by auras. Characterized by auras. Typically 1–2 minutes in length. Typically 1–2 minutes in length. Loss of contact with surroundings. Loss of contact with surroundings.

62 Seizures Assessment Assessment Differentiating Between Syncope & Seizure Differentiating Between Syncope & Seizure Bystanders frequently confuse syncope and seizure. Bystanders frequently confuse syncope and seizure.

63 Seizures Patient History Patient History History of Seizures History of Seizures History of Head Trauma History of Head Trauma Any Alcohol or Drug Abuse Any Alcohol or Drug Abuse Recent History of Fever, Headache, or Stiff Neck Recent History of Fever, Headache, or Stiff Neck History of Heart Disease, Diabetes, or Stroke History of Heart Disease, Diabetes, or Stroke Current Medications Current Medications Phenytoin (Dilantin), phenobarbitol, valproic acid (Depakote), or carbamazepine (Tegretol) Phenytoin (Dilantin), phenobarbitol, valproic acid (Depakote), or carbamazepine (Tegretol) Physical Exam Physical Exam Signs of head trauma or injury to tongue, alcohol or drug abuse Signs of head trauma or injury to tongue, alcohol or drug abuse

64 Seizures Management Management Scene safety & BSI. Scene safety & BSI. Maintain the airway. Maintain the airway. Administer high-flow oxygen. Administer high-flow oxygen. Treat hypoglycemia if present. Treat hypoglycemia if present. Do not restrain the patient. Do not restrain the patient. Protect the patient from the environment. Protect the patient from the environment. Maintain body temperature. Maintain body temperature.

65 Seizures Management Management Position the patient. Position the patient. Suction if required. Suction if required. Provide a quiet atmosphere. Provide a quiet atmosphere. Transport. Transport.

66 Seizures Status Epilepticus Status Epilepticus Two or More Generalized Seizures Two or More Generalized Seizures Seizures occur without a return of consciousness. Seizures occur without a return of consciousness. Management Management Management of airway and breathing is critical. Management of airway and breathing is critical. Monitor the airway closely. Monitor the airway closely.

67 Medical Emergencies Stroke (CVA)

68 Stroke & Intracranial Hemorrhage Occlusive Strokes Occlusive Strokes Embolic & Thrombotic Strokes Embolic & Thrombotic Strokes Hemorrhagic Strokes Hemorrhagic Strokes Occlusive Strokes Occlusive Strokes Embolic & Thrombotic Strokes Embolic & Thrombotic Strokes Hemorrhagic Strokes Hemorrhagic Strokes

69 Signs Signs Facial Drooping Facial Drooping Headache Headache Aphasia/Dysphasia Aphasia/Dysphasia Hemiparesis Hemiparesis Paresthesia Paresthesia Gait Disturbances Gait Disturbances Incontinence Incontinence Stroke & Intracranial Hemorrhage Symptoms Confusion Agitation Dizziness Vision Problems Symptoms Confusion Agitation Dizziness Vision Problems

70 Transient Ischemic Attacks Transient Ischemic Attacks Indicative of carotid artery disease. Indicative of carotid artery disease. Symptoms of neurological deficit: Symptoms of neurological deficit: Symptoms resolve in less than 24 hours. Symptoms resolve in less than 24 hours. No long-term effects. No long-term effects. Evaluate through history taking: Evaluate through history taking: History of HTN, prior stroke, or TIA. History of HTN, prior stroke, or TIA. Symptoms and their progression. Symptoms and their progression. Stroke & Intracranial Hemorrhage

71 Management Management Scene safety & BSI Scene safety & BSI Maintain the airway. Maintain the airway. Support breathing. Support breathing. Obtain a detailed history. Obtain a detailed history. Position the patient. Position the patient. Protect paralyzed extremities. Protect paralyzed extremities. Stroke & Intracranial Hemorrhage

72 Medical Emergencies Allergic Reaction (Anaphylaxis)

73 Allergies and Anaphylaxis Allergic Reaction Allergic Reaction An exaggerated response by the immune system to a foreign substance An exaggerated response by the immune system to a foreign substance Anaphylaxis Anaphylaxis An unusual or exaggerated allergic reaction An unusual or exaggerated allergic reaction A life-threatening emergency A life-threatening emergency

74 Anaphylaxis Causes Causes

75 Focused History & Physical Exam Focused History & Physical Exam Focused History Focused History SAMPLE & OPQRST History SAMPLE & OPQRST History Rapid onset, usually 30–60 seconds following exposure. Rapid onset, usually 30–60 seconds following exposure. Speed of reaction is indicative of severity. Speed of reaction is indicative of severity. Previous allergies and reactions. Previous allergies and reactions. Physical Exam Physical Exam Presence of severe respiratory difficulty is key to differentiating anaphylaxis from allergic reaction. Presence of severe respiratory difficulty is key to differentiating anaphylaxis from allergic reaction. Assessment Findings in Anaphylaxis

76 Physical Exam Physical Exam Facial or laryngeal edema Facial or laryngeal edema Abnormal breath sounds Abnormal breath sounds Hives and urticaria Hives and urticaria Hyperactive bowel sounds Hyperactive bowel sounds Vital sign deterioration as the reaction progresses Vital sign deterioration as the reaction progresses Assessment Findings in Anaphylaxis

77 Scene safety Scene safety Protect the airway. Protect the airway. Support breathing. Support breathing. Establish IV access. Establish IV access. Administer medications: Administer medications: Epinephrine Epinephrine Management of Allergic Reactions

78 Epi-Auto Injector Indications

79 Contraindications

80 Dosage

81 Actions

82 Side Effects

83 Epi-Auto Injector Administration

84

85 Medical Emergencies Poisons and Overdose Poisons and Overdose How they enter the body How they enter the body Treatment Treatment Environmental Environmental Heat Heat Cold Cold Water Emergencies Water Emergencies

86 Trauma Emergencies Bleeding

87 Bleeding External Types, Treatment ( In order)

88 Hemorrhage Classification Capillary Capillary Slow, even flow Slow, even flow Arterial Spurting blood Pulsating flow Bright red color Arterial Spurting blood Pulsating flow Bright red color Venous Steady, slow flow Dark red Venous Steady, slow flow Dark red

89

90 Bleeding Internal, S/S, Treatment

91 Hemorrhage Control Internal Hemorrhage Internal Hemorrhage Hematoma Hematoma Pocket of blood between muscle and fascia Pocket of blood between muscle and fascia Humerus or Tibia/Fibula fracture: mL Humerus or Tibia/Fibula fracture: mL Femur fracture: 1,500mL Femur fracture: 1,500mL UNEXPLAINED SHOCK is BEST attributed to abdominal trauma UNEXPLAINED SHOCK is BEST attributed to abdominal trauma General Management General Management Immobilization, Stabilization, Elevation Immobilization, Stabilization, Elevation

92 Hemorrhage Control Internal Hemorrhage Internal Hemorrhage Epistaxis: Nose Bleed Epistaxis: Nose Bleed Causes: Trauma, Hypertension Causes: Trauma, Hypertension Treatment: Lean forward, pinch nostrils Treatment: Lean forward, pinch nostrils Hemoptysis Hemoptysis Esophageal Varices Esophageal Varices Chronic Hemorrhage Chronic Hemorrhage Anemia Anemia

93 Trauma Emergencies Shock

94 SHOCK is… INADEQUATE TISSUE PERFUSION In a Nutshell…..

95 Stages of Shock Compensated Shock Compensated Shock Minimal Change Minimal Change Decompensated Shock Decompensated Shock System beginning to fail System beginning to fail Irreversible Shock Irreversible Shock Ischemia and death imminent Ischemia and death imminent

96

97 Etiology of Shock Hypovolemic Shock Hypovolemic Shock Loss of blood volume Loss of blood volume Distributive Shock Distributive Shock Prevent appropriate distribution of nutrients and removal of wastes Prevent appropriate distribution of nutrients and removal of wastes Anaphylactic Anaphylactic Septic Septic Hypoglycemia Hypoglycemia Obstructive Shock Obstructive Shock Interference with the blood flowing through the cardiovascular system Interference with the blood flowing through the cardiovascular system Tension Pneumothorax Tension Pneumothorax Cardiac Tamponade Cardiac Tamponade Pulmonary Emboli Pulmonary Emboli Cardiogenic Shock Pump failure Respiratory Shock Respiratory system not able to bring oxygen into the alveoli Airway obstruction Pneumothorax Neurogenic Shock Loss of nervous control from CNS to peripheral vasculature Cardiogenic Shock Pump failure Respiratory Shock Respiratory system not able to bring oxygen into the alveoli Airway obstruction Pneumothorax Neurogenic Shock Loss of nervous control from CNS to peripheral vasculature

98 Trauma Emergencies Soft Tissue

99 Skin is the largest, most important organ Skin is the largest, most important organ 16% of total body weight 16% of total body weight Function Function Protection Protection Sensation Sensation Temperature Regulation Temperature Regulation AKA: Integumentary System AKA: Integumentary System Introduction to Soft-Tissue Injury

100 Epidemiology Epidemiology Open Wounds Open Wounds Over 10 million wounds present to ED Over 10 million wounds present to ED Most require simple care and some suturing Most require simple care and some suturing Up to 6.5% may become infected Up to 6.5% may become infected Closed Wounds Closed Wounds More Common More Common Contusions, Sprains, Strains Contusions, Sprains, Strains Introduction to Soft-Tissue Injury

101 A&P of Soft Tissue Injuries Skin Layers Skin Layers Epidermis Epidermis Outermost layer Outermost layer Helps prevent infection Helps prevent infection Dermis Dermis Upper Layer (Papillary Layer) Upper Layer (Papillary Layer) Loose connective tissue, capillaries and nerves Loose connective tissue, capillaries and nerves Lower Layer (Reticular Layer) Lower Layer (Reticular Layer) Integrates dermis with SQ layer Integrates dermis with SQ layer Blood vessels, nerve endings, glands Blood vessels, nerve endings, glands Sebaceous & Sudoriferous Glands Sebaceous & Sudoriferous Glands Subcutaneous Subcutaneous Adipose tissue Adipose tissue Heat retention Heat retention

102 Pathophysiology of Soft-Tissue Injury Closed Wounds Closed Wounds Contusions Contusions Ecchymosis Ecchymosis Hematomas Hematomas Crush Injuries Crush Injuries Closed Wounds Closed Wounds Contusions Contusions Ecchymosis Ecchymosis Hematomas Hematomas Crush Injuries Crush Injuries Open Wounds Abrasions Lacerations Incisions Punctures Impaled Objects Avulsions Amputations Open Wounds Abrasions Lacerations Incisions Punctures Impaled Objects Avulsions Amputations

103

104 Trauma Emergencies Penetrating Injuries

105

106 Trauma Emergencies Evisceration

107

108 Impaled Object

109

110 Trauma Emergencies Amputation

111

112 Objectives of Wound Dressing & Bandaging Objectives of Wound Dressing & Bandaging Hemorrhage Control Hemorrhage Control Direct Pressure Direct Pressure Elevation Elevation Pressure Points Pressure Points Consider Consider Ice Ice Constricting Band Constricting Band Tourniquet Tourniquet USE ALL COMPONENTS TOGETHER USE ALL COMPONENTS TOGETHER Management of Soft-Tissue Injury

113 Objectives of Wound Dressing & Bandaging Objectives of Wound Dressing & Bandaging Sterility Sterility Keep the wound as clean as possible Keep the wound as clean as possible If wound is grossly contaminated consider cleansing If wound is grossly contaminated consider cleansing Immobilization Immobilization Prevents movement and aggravation of wound Prevents movement and aggravation of wound Do not use an elastic bandage: TQ effect Do not use an elastic bandage: TQ effect Monitor distal pulse, motor, and sensation Monitor distal pulse, motor, and sensation Management of Soft-Tissue Injury (continued)

114 Pain & Edema Control Pain & Edema Control Cold packs Cold packs Moderate pressure over wound Moderate pressure over wound Management of Soft-Tissue Injury

115 Sterile & Non-sterile Dressings Sterile & Non-sterile Dressings Sterile: Direct wound contact Sterile: Direct wound contact Non-sterile: Bulk dressing above sterile Non-sterile: Bulk dressing above sterile Occlusive/Non-occlusive Dressings Occlusive/Non-occlusive Dressings Adherent/Non-adherent Dressings Adherent/Non-adherent Dressings Adherent: stick to blood or fluid Adherent: stick to blood or fluid Absorbent/Non-absorbent Absorbent/Non-absorbent Absorbent: soak up blood or fluids Absorbent: soak up blood or fluids Wet/Dry Dressings Wet/Dry Dressings Wet: Burns, postoperative wounds (Sterile NS) Wet: Burns, postoperative wounds (Sterile NS) Dry: Most common Dry: Most common Dressing & Bandage Materials

116 Trauma Emergencies Burns Burns Classification Classification Superficial Superficial Partial-Thickness Partial-Thickness Full-Thickness Full-Thickness Severity Severity Depth Depth Body Surface Area (BSA) Body Surface Area (BSA)

117 Burn Depth Superficial Burn: 1st Degree Burn Superficial Burn: 1st Degree Burn Signs & Symptoms Signs & Symptoms Reddened skin Reddened skin Pain at burn site Pain at burn site Involves only epidermis Involves only epidermis

118 Burn Depth Partial-Thickness Burn: 2nd Degree Burn Partial-Thickness Burn: 2nd Degree Burn Signs & Symptoms Signs & Symptoms Intense pain Intense pain White to red skin White to red skin Blisters Blisters Involves epidermis & dermis Involves epidermis & dermis

119 Burn Depth Full-Thickness Burn: 3rd Degree Burn Full-Thickness Burn: 3rd Degree Burn Signs & Symptoms Signs & Symptoms Dry, leathery skin (white, dark brown, or charred) Dry, leathery skin (white, dark brown, or charred) Loss of sensation (little pain) Loss of sensation (little pain) All dermal layers/tissue may be involved All dermal layers/tissue may be involved

120 Trauma Emergencies (Burns) Rule of Nines (Adult) Rule of Nines (Adult) Head and Neck:9 % Head and Neck:9 % Each Upper Ext: 9 % Each Upper Ext: 9 % Anterior Trunk: 18 % Anterior Trunk: 18 % Posterior Trunk: 18 % Posterior Trunk: 18 % Each Lower Ext: 18 % Each Lower Ext: 18 % Genitalia: 1 % Genitalia: 1 %

121 Trauma Emergencies (Burns) Rule of Nines (Child) Rule of Nines (Child) Head and Neck: 18 % Head and Neck: 18 % Each Upper Ext: 9 % Each Upper Ext: 9 % Anterior Trunk: 18 % Anterior Trunk: 18 % Posterior Trunk: 18 % Posterior Trunk: 18 % Each Lower Ext: 14 % Each Lower Ext: 14 % Genitalia: 1 % Genitalia: 1 %

122

123 Trauma Emergencies Burns Burns Rule of Palm Rule of Palm Location Location Preexisting Medical Problems Preexisting Medical Problems Age Age 5 – 55 5 – 55 Source Source Treatment Treatment

124 Rule of Palms A burn equivalent to the size of the patients hand is equal to 1% body surface area (BSA) A burn equivalent to the size of the patients hand is equal to 1% body surface area (BSA)

125 Pathophysiology of Burns Types of Burns Types of Burns Thermal Thermal Electrical Electrical Chemical Chemical Radiation Radiation

126 Thermal Burns Heat changes the molecular structure of tissue Heat changes the molecular structure of tissue Denaturing (of proteins) Denaturing (of proteins) Extent of burn damage depends on Extent of burn damage depends on Temperature of agent Temperature of agent Concentration of heat Concentration of heat Duration of contact Duration of contact

127 Systemic Complications Hypothermia Hypothermia Disruption of skin and its ability to thermoregulate Disruption of skin and its ability to thermoregulate Hypovolemia Hypovolemia Shift in proteins, fluids, and electrolytes to the burned tissue Shift in proteins, fluids, and electrolytes to the burned tissue General electrolyte imbalance General electrolyte imbalance Eschar Eschar Hard, leathery product of a deep full thickness burn Hard, leathery product of a deep full thickness burn Dead and denatured skin Dead and denatured skin

128 Systemic Complications Infection Infection Greatest risk of burn is infection Greatest risk of burn is infection Organ Failure Organ Failure Special Factors Special Factors Age & Health Age & Health Physical Abuse Physical Abuse Elderly, Infirm or Young Elderly, Infirm or Young

129 Pain Pain Changes in skin condition at affected site Changes in skin condition at affected site Adventitious sounds Adventitious sounds Blisters Blisters Sloughing of skin Sloughing of skin Hoarseness Hoarseness Assessment of Thermal Burns General Signs & Symptoms Burnt hair Edema Paresthesia Hemorrhage Other soft tissue injury Musculoskeletal injury Dyspnea Chest pain Burnt hair Edema Paresthesia Hemorrhage Other soft tissue injury Musculoskeletal injury Dyspnea Chest pain

130 Assessment of Thermal Burns Any partial or full thickness burn involving hands, feet, joints, face, or genitalia >30% BSA Partial Thickness Inhalation Injury >10% BSA Full Thickness Critical >2% BSAFull Thickness >50% BSASuperficial <2% BSAFull Thickness <15% BSA Partial Thickness <50% BSASuperficial >15% BSA Partial Thickness Moderate Minor Burn Severity

131 Local & Minor Burns Local & Minor Burns Local cooling Local cooling Partial thickness: <15% of BSA Partial thickness: <15% of BSA Full thickness: <2% BSA Full thickness: <2% BSA Remove clothing Remove clothing Cool or Cold water immersion Cool or Cold water immersion Management of Thermal Burns

132 Moderate to Severe Burns Moderate to Severe Burns Dry sterile dressings Dry sterile dressings Partial thickness: >15% BSA Partial thickness: >15% BSA Full thickness: >5% BSA Full thickness: >5% BSA Maintain warmth Maintain warmth Prevent hypothermia Prevent hypothermia Consider aggressive fluid therapy Consider aggressive fluid therapy Moderate to severe burns Moderate to severe burns Management of Thermal Burns

133 Moderate to Severe Burns Moderate to Severe Burns Caution for fluid overload Caution for fluid overload Frequent auscultation of breath sounds Frequent auscultation of breath sounds Prevent infection Prevent infection Management of Thermal Burns

134 Inhalation Injury Inhalation Injury Provide high-flow O2 by NRB Provide high-flow O2 by NRB Consider intubation if swelling Consider intubation if swelling Consider hyperbaric oxygen therapy Consider hyperbaric oxygen therapy Management of Thermal Burns

135 Electrical Injuries Electrical Injuries Safety Safety Turn off power Turn off power Energized lines act as whips Energized lines act as whips Establish a safety zone Establish a safety zone Lightning Strikes Lightning Strikes High voltage, high current, high energy High voltage, high current, high energy Lasts fraction of a second Lasts fraction of a second No danger of electrical shock to EMS No danger of electrical shock to EMS Assessment & Management of Electrical, Chemical & Radiation Burns

136 Chemical Burns Chemical Burns Scene size-up Scene size-up Hazardous materials team Hazardous materials team Establish hot, warm and cold zones Establish hot, warm and cold zones Prevent personnel exposure from chemical Prevent personnel exposure from chemical Specific Chemicals Specific Chemicals Phenol Phenol Dry Lime Dry Lime Sodium Sodium Riot Control Agents Riot Control Agents Assessment & Management of Electrical, Chemical & Radiation Burns

137 Specific Chemicals Specific Chemicals Phenol Phenol Industrial cleaner Industrial cleaner Alcohol dissolves Phenol Alcohol dissolves Phenol Irrigate with copious amounts of water Irrigate with copious amounts of water Dry Lime Dry Lime Strong corrosive that reacts with water Strong corrosive that reacts with water Brush off dry substance Brush off dry substance Irrigate with copious amounts of cool water Irrigate with copious amounts of cool water Prevents reaction with patient tissues Prevents reaction with patient tissues Assessment & Management of Electrical, Chemical & Radiation Burns

138 Riot Control Agents Riot Control Agents Agents Agents CS, CN (Mace), Oleoresin, Capsicum (OC, pepper spray) CS, CN (Mace), Oleoresin, Capsicum (OC, pepper spray) Irritation of the eyes, mucous membranes, and respiratory tract. Irritation of the eyes, mucous membranes, and respiratory tract. No permanent damage No permanent damage General Signs & Symptoms General Signs & Symptoms Coughing, gagging, and vomiting Coughing, gagging, and vomiting Eye pain, tearing, temporary blindness Eye pain, tearing, temporary blindness Management Management Irrigate eyes with normal saline Irrigate eyes with normal saline Assessment & Management of Electrical, Chemical & Radiation Burns

139 Radiation Burns Radiation Burns Notify Hazardous Materials Team Notify Hazardous Materials Team Establish Safety Zones Establish Safety Zones Hot, Warm, & Cold Hot, Warm, & Cold Personnel positioned Upwind and Uphill Personnel positioned Upwind and Uphill Decontaminate ALL rescuers, equipment and patients Decontaminate ALL rescuers, equipment and patients Assessment & Management of Electrical, Chemical & Radiation Burns

140 Musculoskeleta l System

141 Joint Injury Joint Injury Sprain Sprain Subluxation Subluxation Dislocation Dislocation Bone Injury Bone Injury Open Fracture Open Fracture Closed Fracture Closed Fracture Hairline Fracture Hairline Fracture Impacted Fracture Impacted Fracture Pathophysiology of the Musculoskeletal System

142 Musculoskeletal Ligament

143 Musculoskeletal Tendon

144

145 Pediatric Considerations Pediatric Considerations Flexible nature Flexible nature Geriatric Considerations Geriatric Considerations Osteoporosis Osteoporosis Pathological Fractures Pathological Fractures Pathological diseases Pathological diseases Pathophysiology of the Musculoskeletal System

146 General Considerations with musculoskeletal injuries General Considerations with musculoskeletal injuries Neurological compromise Neurological compromise Decreased stability Decreased stability Muscle spasm Muscle spasm Bone Repair Cycle Bone Repair Cycle Osteocytes produce osteoblasts Osteocytes produce osteoblasts Deposition of salts Deposition of salts Increasing strength of matrix Increasing strength of matrix Pathophysiology of the Musculoskeletal System

147 General Principles General Principles Protecting Open Wounds Protecting Open Wounds Positioning the limb Positioning the limb Immobilizing the injury Immobilizing the injury Checking Neurovascular Function Checking Neurovascular Function Musculoskeletal Injury Management

148 Trauma Emergencies Injuries Injuries Painful, swollen, deformed extremities Painful, swollen, deformed extremities Assessment Assessment Signs and Symptoms Signs and Symptoms Splinting Splinting Upper Extremities Upper Extremities Lower Extremities Lower Extremities Hip / Pelvis Hip / Pelvis

149 Splinting Devices Splinting Devices Rigid splints Rigid splints Formable Splints Formable Splints Soft Splints Soft Splints Traction Splints Traction Splints Other Splinting Aids Other Splinting Aids Vacuum Splints Vacuum Splints Air Sprints Air Sprints Cravats or Velcro Splints Cravats or Velcro Splints Fracture Care Fracture Care Joint Care Joint Care Muscular & Connective Tissue Care Muscular & Connective Tissue Care Musculoskeletal Injury Management

150 Trauma Emergencies Injuries to Head Injuries to Head Nervous System Nervous System Brain Injuries Brain Injuries Direct Direct Indirect Indirect Patient Assessment Patient Assessment Signs and Symptoms Signs and Symptoms Neurological Assessment Neurological Assessment

151 Trauma Emergencies Injuries to Spine Injuries to Spine MOI MOI Assessment Assessment Signs and Symptoms Signs and Symptoms Treatment Treatment Immobilization Immobilization Helmets Helmets Collars Collars LSB LSB Seated Patient Seated Patient

152 Care for Specific Joint Injuries Care for Specific Joint Injuries Hip Hip Knee Knee Ankle Ankle Foot Foot Shoulder Shoulder Elbow Elbow Wrist/Hand Wrist/Hand Finger Finger Musculoskeletal Injury Management Joint Injuries Alert for neurological Compromise

153 Triage

154 Command at Mass-Casualty Incidents

155 Incident Commander (IC) Coordinates all scene activities Coordinates all scene activities Also called Incident Manager (IM) or Also called Incident Manager (IM) or Officer in Charge (OIC)

156 The first on-scene unit must assume command and direct all rescue efforts at a mass-casualty incident (MCI)

157 Singular vs. Unified Command Singular command Singular command One person coordinates the incident. One person coordinates the incident. Most useful in smaller, single-jurisdictional incidents. Most useful in smaller, single-jurisdictional incidents. Unified command Unified command Managers from different jurisdictions share command. Managers from different jurisdictions share command. Fire, EMS, law enforcement Fire, EMS, law enforcement

158 Establishing Command First arriving unit establishes command. First arriving unit establishes command. Assign command early in an incident. Assign command early in an incident. Establish a command post. Establish a command post.

159 EMS Branch Functions Triage Triage Treatment Treatment Transport Transport

160 Triage Sorting of patients based upon the severity of their injuries Sorting of patients based upon the severity of their injuries Primary triage Primary triage Secondary triage Secondary triage

161 Triage Tags Alerts care providers to patient priority Alerts care providers to patient priority Prevents re-triage of the same patient Prevents re-triage of the same patient Serves as a tracking system Serves as a tracking system

162 The METTAG

163 Treatment Red treatment unit Red treatment unit Yellow treatment unit Yellow treatment unit Green treatment unit Green treatment unit

164 Triage Priority 1 (RED)

165 Triage Priority 2 (Yellow)

166 Triage Priority 3 (Green)

167 OB / GYN

168 Labor Labor Bloody Show Bloody Show Crowning Crowning Predelivery Emergencies Predelivery Emergencies

169 Labor Stage One (Dilation) Stage One (Dilation) Stage Two (Expulsion) Stage Two (Expulsion) Stage Three (Placental Stage) Stage Three (Placental Stage)

170 Management of a Patient in Labor Transport the patient in labor unless delivery is imminent. Transport the patient in labor unless delivery is imminent. Maternal urge to push or the presence of crowning indicates imminent delivery. Maternal urge to push or the presence of crowning indicates imminent delivery. Delivery at the scene or in the ambulance will be necessary. Delivery at the scene or in the ambulance will be necessary. Transport the patient in labor unless delivery is imminent. Transport the patient in labor unless delivery is imminent. Maternal urge to push or the presence of crowning indicates imminent delivery. Maternal urge to push or the presence of crowning indicates imminent delivery. Delivery at the scene or in the ambulance will be necessary. Delivery at the scene or in the ambulance will be necessary.

171 Field Delivery Set up delivery area. Set up delivery area. Give oxygen to mother and start Give oxygen to mother and start Drape mother with toweling from OB kit. Drape mother with toweling from OB kit. Monitor fetal heart rate. Monitor fetal heart rate. As head crowns, apply gentle pressure. As head crowns, apply gentle pressure. Suction the mouth and then the nose. Clamp and cut the cord. Dry the infant and keep it warm. Deliver the placenta and save for transport with the mother. Suction the mouth and then the nose. Clamp and cut the cord. Dry the infant and keep it warm. Deliver the placenta and save for transport with the mother.

172 OB / GYN ( Normal Delivery)

173

174

175

176

177

178

179 Apgar Scoring

180 OB / GYN ( Normal Delivery) Care of Newborn

181 OB / GYN (Resuscitation) HR Less than 100

182 OB / GYN (Resuscitation) HR less than 80

183 OB / GYN (Resuscitation) HR less than 60

184 Neonatal Resuscitation If the infants respirations are below 30 per minute and tactile stimulation does not increase rate to normal range, assist ventilations using bag valve mask with high-flow oxygen. If the infants respirations are below 30 per minute and tactile stimulation does not increase rate to normal range, assist ventilations using bag valve mask with high-flow oxygen. If the heart rate is below 80 and does not respond to ventilations, initiate chest compressions. If the heart rate is below 80 and does not respond to ventilations, initiate chest compressions. Transport to a facility with neonatal intensive care capabilities. Transport to a facility with neonatal intensive care capabilities.

185 Causes of Bleeding During Pregnancy Abortion Abortion Ectopic pregnancy Ectopic pregnancy Placenta previa Placenta previa Abruptio placentae Abruptio placentae Abortion Abortion Ectopic pregnancy Ectopic pregnancy Placenta previa Placenta previa Abruptio placentae Abruptio placentae

186 Abortion Termination of pregnancy before the 20th week of gestation. Termination of pregnancy before the 20th week of gestation. Different classifications. Different classifications. Signs and symptoms include cramping, abdominal pain, backache, and vaginal bleeding. Signs and symptoms include cramping, abdominal pain, backache, and vaginal bleeding. Treat for shock. Treat for shock. Provide emotional support. Provide emotional support.

187 Ectopic Pregnancy Assume that any female of childbearing age with lower abdominal pain is experiencing an ectopic pregnancy. Assume that any female of childbearing age with lower abdominal pain is experiencing an ectopic pregnancy. Ectopic pregnancy is life-threatening. Transport the patient immediately. Ectopic pregnancy is life-threatening. Transport the patient immediately.

188 Placenta Previa Usually presents with painless bleeding. Usually presents with painless bleeding. Never attempt vaginal exam. Never attempt vaginal exam. Treat for shock. Treat for shock. Transport immediately treatment is delivery by c-section. Transport immediately treatment is delivery by c-section.

189 Abruptio Placentae Signs and symptoms vary. Signs and symptoms vary. Classified as partial, severe, or complete. Classified as partial, severe, or complete. Life-threatening. Life-threatening. Treat for shock, fluid resuscitation. Treat for shock, fluid resuscitation. Transport left lateral recumbent position. Transport left lateral recumbent position.

190 Abnormal Delivery Situations

191 OB / GYN (Abnormal Deliveries) Breech

192 Breech Presentation The buttocks or both feet present first. The buttocks or both feet present first. If the infant starts to breath with its face pressed against the vaginal wall, form a V and push the vaginal wall away from infants face. Continue during transport. If the infant starts to breath with its face pressed against the vaginal wall, form a V and push the vaginal wall away from infants face. Continue during transport.

193 OB / GYN (Abnormal Deliveries) Prolapsed Cord

194 The umbilical cord precedes the fetal presenting part. The umbilical cord precedes the fetal presenting part. Elevate the hips, administer oxygen, and keep warm. Elevate the hips, administer oxygen, and keep warm. If the umbilical cord is seen in the vagina, insert two gloved fingers to raise the fetus off the cord. Do not push cord back. If the umbilical cord is seen in the vagina, insert two gloved fingers to raise the fetus off the cord. Do not push cord back. Wrap cord in sterile moist towel. Wrap cord in sterile moist towel. Transport immediately; do not attempt delivery. Transport immediately; do not attempt delivery.

195 OB / GYN (Abnormal Deliveries) Limb Presentation

196 Limb Presentation With limb presentation, place the mother in knee–chest position, administer oxygen, and transport immediately. Do not attempt delivery.

197 Other Abnormal Presentations Whenever an abnormal presentation or position of the fetus makes normal delivery impossible, reassure the mother. Whenever an abnormal presentation or position of the fetus makes normal delivery impossible, reassure the mother. Administer oxygen. Administer oxygen. Transport immediately. Transport immediately. Do not attempt field delivery in these circumstances. Do not attempt field delivery in these circumstances. Whenever an abnormal presentation or position of the fetus makes normal delivery impossible, reassure the mother. Whenever an abnormal presentation or position of the fetus makes normal delivery impossible, reassure the mother. Administer oxygen. Administer oxygen. Transport immediately. Transport immediately. Do not attempt field delivery in these circumstances. Do not attempt field delivery in these circumstances.

198 Other Delivery Complications

199 OB / GYN (Abnormal Deliveries) Multiple Births

200 Follow normal guidelines, but have additional personnel and equipment. Follow normal guidelines, but have additional personnel and equipment. In twin births, labor starts earlier and babies are smaller. In twin births, labor starts earlier and babies are smaller. Prevent hypothermia. Prevent hypothermia.

201 OB / GYN (Abnormal Deliveries) Meconium

202 Meconium Staining Fetus passes feces into the amniotic fluid. Fetus passes feces into the amniotic fluid. If meconium is thick, suction the hypopharynx and trachea using an endotracheal tube until all meconium has been cleared from the airway. If meconium is thick, suction the hypopharynx and trachea using an endotracheal tube until all meconium has been cleared from the airway.

203 Maternal Complications of Labor and Delivery

204 Postpartum Hemorrhage Defined as a loss of more than Defined as a loss of more than 500 cc of blood following delivery. Treat for shock as necessary. Treat for shock as necessary. Follow protocols if applying antishock trousers. Follow protocols if applying antishock trousers.

205 Uterine Rupture Tearing, or rupture, of the uterus. Tearing, or rupture, of the uterus. Patient complains of severe abdominal pain and will often be in shock. Abdomen is often tender and rigid. Patient complains of severe abdominal pain and will often be in shock. Abdomen is often tender and rigid. Fetal heart tones are absent. Fetal heart tones are absent. Treat for shock. Treat for shock. Give high-flow oxygen. Give high-flow oxygen. Transport patient rapidly. Transport patient rapidly.

206 Infants and Children Airway Airway Maneuvers Maneuvers FBAO FBAO Adjuncts Adjuncts

207 Infants and Children Trauma Trauma Common Causes Common Causes Types Types Shock Shock Causes Causes Assessment Assessment Treatment Treatment

208 Anatomical and physiological considerations in the infant and child.

209 a. In the supine position, an infants or childs larger head tips forward, causing airway obstruction. b. Placing padding under the patients back and shoulders will bring the airway to a neutral or slightly extended position.

210 General Approach to Pediatric Assessment

211 Basic Considerations Much of the initial patient assessment can be done during visual examination of the scene. Much of the initial patient assessment can be done during visual examination of the scene. Involve the caregiver or parent as much as possible. Involve the caregiver or parent as much as possible. Allow to stay with child during treatment and transport. Allow to stay with child during treatment and transport.

212 Scene Size-Up Conduct a quick scene size-up. Conduct a quick scene size-up. Take BSI precautions. Take BSI precautions. Look for clues to mechanism of injury or nature of illness. Look for clues to mechanism of injury or nature of illness. Allow child time to adjust to you before approaching. Allow child time to adjust to you before approaching. Speak softly, simply, at eye level. Speak softly, simply, at eye level.

213 Suctioning Decrease suction pressure to less than 100 mm/Hg in infants. Decrease suction pressure to less than 100 mm/Hg in infants. Avoid excessive suctioning timeless than 15 seconds per attempt. Avoid excessive suctioning timeless than 15 seconds per attempt. Avoid stimulation of the vagus nerve. Avoid stimulation of the vagus nerve. Check the pulse frequently. Check the pulse frequently.

214 Inserting an oropharyngeal airway in a child with the use of a tongue blade.

215 Ventilation Avoid excessive bag pressure and volume. Avoid excessive bag pressure and volume. Obtain chest rise and fall. Obtain chest rise and fall. Allow time for exhalation. Allow time for exhalation. Flow-restricted, oxygen-powered devices are contraindicated. Flow-restricted, oxygen-powered devices are contraindicated. Do not use BVMs with pop-off valves. Do not use BVMs with pop-off valves. Apply cricoid pressure. Apply cricoid pressure. Avoid hyperextension of the neck. Avoid hyperextension of the neck.

216 Circulation Two problems lead to cardiopulmonary arrest in children: arrest in children: Shock Shock Respiratory failure Respiratory failure

217 Signs and symptoms of shock (hypoperfusion) in a child.

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219 Respiratory Emergencies Infections Infections Upper airway distress Upper airway distress Croup Croup Epiglottitis Epiglottitis Lower airway distress Lower airway distress Asthma Asthma Bronchiolitis Bronchiolitis

220

221 a. Croup and b. Epiglottitis

222 Positioning of the child with epiglottitis. Often there will be excessive drooling.

223 The child with epiglottitis should be administered humidified oxygen and transported in a comfortable position.

224 Poisoning and Toxic Exposure Accidental poisoning is a common childhood emergency. Accidental poisoning is a common childhood emergency. Leading cause of preventable death in children. Leading cause of preventable death in children.

225 Medical Emergencies Seizures

226 Trauma Emergencies Falls Falls Motor vehicle crashes Motor vehicle crashes Car vs. pedestrian injuries Car vs. pedestrian injuries Drowning and near drowning Drowning and near drowning Penetrating injuries Penetrating injuries Burns Burns Physical abuse Physical abuse

227 Falls are the most common cause of injury in young children.

228 A deploying airbag can propel a child safety seat back into the vehicles seat, seriously injuring the child secured in it.

229 Medical Emergencies SIDS

230 Sudden Infant Death Syndrome (SIDS) SIDS is the sudden death of an infant during the first year of life from an illness of unknown etiology.

231 Child Abuse and Neglect

232 The stigmata of child abuse.

233 Infants and Children with Special Needs Common home-care devices Common home-care devices Tracheostomy tubes Tracheostomy tubes Apnea monitors Apnea monitors Home artificial ventilators Home artificial ventilators Central intravenous lines Central intravenous lines Gastric feeding and gastrostomy tubes Gastric feeding and gastrostomy tubes Shunts Shunts

234 Medical Emergencies Meningitis

235 Summary Questions ?


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