1. Division 4 Medical Emergencies
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

2. Chapter 35 Hematology
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

3. Topics Anatomy, Physiology, and Pathophysiology
General Assessment and Management
Managing Specific Patient Problems
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

4. Hematology The study of blood and blood-forming organs
Includes study of blood disorders:
Red blood cell disorders
White blood cell disorders
Platelet disorders
Coagulation problems
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

5. Anatomy, Physiology, and Pathophysiology
Components
Blood, bone marrow, liver, spleen, kidneys
Hematopoiesis
Pluripotent stem cell
Erythropoietin
Blood volume
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

6. Components of Blood (1 of 6)
Plasma
Water
90–92% by volume
Proteins
6–7% by volume
Other
2–3% by volume
Fats, carbohydrates, electrolytes, gases, and chemical messengers
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

7. Components of Blood (2 of 6)
Red blood cells
Hemoglobin
Oxygen transport
Bohr effect
2,3 DPG
Oxygen-hemoglobin dissociation curve
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

8. Components of Blood (3 of 6)
Red blood cells
Production
Erythropoiesis
Hemolysis
Sequestration
Laboratory analysis of red blood cells
Red blood cell count
Hematocrit
Hemoglobin
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

9. Components of Blood (4 of 6)
White blood cells
Margination
Phagocytosis
White blood cell count
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

10. Components of Blood (5 of 6)
White blood cells
Leukopoiesis
Granulocytes
Neutrophil
Basophil
Eosinophil
Lymphocytes
Monocytes
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

11. Components of Blood (6 of 6)
White blood cells
Immunity
Subpopulation of lymphocytes known as T cells and B cells
T cells develop cellular immunity.
B cells produce humoral immunity.
Autoimmune disease
Alterations in the immune process
Inflammatory process
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

12. Immune Response
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

13. Components of Blood Platelets Megakaryocytes Thrombocytopenia
Thrombocytosis
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

14. Hemostasis (1 of 3) Controlling blood loss Vascular spasms
Platelet plugs
Stable fibrin blood clots
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

15. Hemostasis (2 of 3)
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

16. Hemostasis (3 of 3) Fibrinolysis Thrombosis Fibrinolytics
Medications affecting clot formation
Alter the enzyme on the platelet
Affect the coagulation cascade
Enhance clotting
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

17. Blood Products and Blood Typing (1 of 2)
Blood types
Antigens
A, B, AB, O
Universal donors
Rh factor
© Gaillard/Jerrican/Photo Researchers, Inc.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

18. Blood Products and Blood Typing (2 of 2)
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

19. Transfusion Reactions (1 of 2)
Hemolytic reactions
Signs and symptoms
Facial flushing, hyperventilation, tachycardia, hives, chest pain, wheezing, fever, chills, and cyanosis
Treatment
Stop transfusion, change all IV tubing, and initiate IV therapy with normal saline or lactated Ringer’s.
Consider furosemide, dopamine, and diphenhydramine.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

20. Transfusion Reactions (2 of 2)
Febrile nonhemolytic reactions
Signs and symptoms
Headache, fever, and chills
Treatment
Stop transfusion, change all IV tubing, and initiate IV therapy with normal saline or lactated Ringer’s.
Consider diphenhydramine and an antipyretic.
Observe closely to ensure reaction is nonhemolytic.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

21. General Assessment and Management (1 of 3)
Scene size-up
Initial assessment
Focused history and physical exam
SAMPLE history
Hematological disorders are rarely the chief complaint.
Physical exam
Evaluate nervous system function.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

22. General Assessment and Management (2 of 3)
Physical exam
Skin signs
Lymphatic signs
Gastrointestinal signs
Musculoskeletal signs
Cardiorespiratory signs
Genitourinary signs
John Callan/Shout Picture Library
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

23. General Assessment and Management (3 of 3)
General treatment guidelines
Maintain ABCs.
Provide high-flow, high-concentration oxygen or assist ventilations as indicated.
Consider volume replacement.
Monitor cardiac rhythm and vital signs.
Treat rhythm disturbances.
Provide reassurance, comfort care, and transport.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

24. Managing Specific Patient Problems
Diseases of the red blood cells
Diseases of the white blood cells
Diseases of the platelets/blood clotting abnormalities
Other hematopoietic disorders
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

25. Diseases of the Red Blood Cells (1 of 4)
Anemias
Anemia is a sign, not a separate disease process.
Signs and symptoms may not be present until the body is stressed.
Differentiate chronic anemia from acute episode.
Treat signs and symptoms.
Maximize oxygenation and limit blood loss.
Establish IV therapy if indicated.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

26. Diseases of the Red Blood Cells (2 of 4)
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

27. Diseases of the Red Blood Cells (3 of 4)
Sickle cell disease
Sickle cell crises
Vaso-occlusive
Hematological
Infectious
Management
Follow general treatment guidelines.
Consider analgesics.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

28. Diseases of the Red Blood Cells (4 of 4)
Polycythemia
Overproduction of erythrocytes
Occurs in patients >50 years old or with secondary dehydration
Results in bleeding abnormalities
Epistaxis, spontaneous bruising, GI bleeding
Management
Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

29. Diseases of the White Blood Cells (1 of 3)
Leukopenia/neutropenia
Too few white blood cells or neutrophils
Follow general treatment guidelines and provide supportive care.
Leukocytosis
An increase in the number of circulating white blood cells, often due to infection
Leukemoid reaction
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

30. Diseases of the White Blood Cells (2 of 3)
Leukemia
Cancer of hematopoietic cells
Initial presentation
Acutely ill, fatigued, febrile and weak, anemic
Often have a secondary infection
Management
Follow general treatment guidelines.
Utilize isolation techniques to limit risk of infection.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

31. Diseases of the White Blood Cells (3 of 3)
Lymphomas
Cancers of the lymphatic system
Presentation
Swelling of the lymph nodes
Fever, night sweats, anorexia, weight loss, fatigue, and pruritis
Management
Follow general treatment guidelines.
Utilize isolation techniques to limit risk of infection.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

32. Diseases of the Platelets
Thrombocytosis and Thrombocytopenia
Thrombocytosis
An abnormal increase in the number of platelets
Thrombocytopenia
An abnormal decrease in the number of platelets
Management
Provide supportive care and follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

33. Blood Clotting Abnormalities (1 of 2)
Hemophilia
Deficiency or absence of a blood clotting factor
Deficiency of factor VIII causes hemophilia A.
Deficiency of factor IX causes hemophilia B.
Deficiency is a sex-linked, inherited disorder.
Defective gene is carried on the X chromosome.
Signs and symptoms
Numerous bruises, deep muscle bleeding, and joint bleeding
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

34. Blood Clotting Abnormalities (2 of 2)
Hemophilia
Management
Treat the patient similarly to others.
Administer supplemental oxygen.
Establish IV access.
Be alert for recurrent or prolonged bleeding, and prevent additional trauma.
Von Willebrand’s disease
Deficient component of factor VIII
Generally results in excessive bleeding
Generally is not serious; provide supportive care
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

35. Other Hematopoietic Disorders
Disseminated intravascular coagulation
System activation of coagulation cascade
Results from sepsis, hypotension, OB complications, severe tissue or brain injury, cancer, and major hemolytic reactions
Multiple myeloma
Cancerous disorder of plasma cells
Pathologic fractures common
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

36. Summary Anatomy, Physiology, and Pathophysiology
General Assessment and Management
Managing Specific Patient Problems
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ