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Presentation on theme: "EMERGENCY MEDICAL TECHNICIAN"— Presentation transcript:

FINAL REVIEW Barry Barkinsky EMS-I, Paramedic

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

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

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

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

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


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

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


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

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

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

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

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


17 Medical Emergencies Cardiac Compromise Cardiac Emergencies
Signs and Symptoms Treatment

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

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

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

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

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

23 Angina Pectoris Special Considerations
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. Patients may refuse transport after pain is relieved, even though the underlying problem is not addressed.

24 Myocardial Infarction
Pathophysiology 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. Location and size dependent on the vessel involved.

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

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

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

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

29 Nitroglycerine Indications Contraindications Side effects Dosage

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

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

32 Heart Failure Congestive Heart Failure Pathophysiology
Reduction in the heart’s stroke volume causes fluid overload throughout the body’s other tissues.

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

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

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

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

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

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

39 Hypertensive Emergencies
Management Maintain airway. Administer oxygen.

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

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

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

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

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

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

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

47 AED (Automatic External Defibrillator)

48 AED (Automatic External Defibrillator)

49 AED (Automatic External Defibrillator)

50 AED (Automatic External Defibrillator)

51 AED (Automatic External Defibrillator)
# of Shocks

52 AED (Automatic External Defibrillator)
If NO SHOCK Advised

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

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

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

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

57 Medical Emergencies Altered Mental Status (AMS) Causes Treatment

58 Medical Emergencies Diabetes Most common cause Signs and Symptoms

59 Medical Emergencies Seizures

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

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

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

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

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

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

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

67 Medical Emergencies Stroke (CVA)

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

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

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

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

72 Allergic Reaction (Anaphylaxis)
Medical Emergencies Allergic Reaction (Anaphylaxis)

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

74 Anaphylaxis Causes

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

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

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

78 Epi-Auto Injector Indications

79 Epi-Auto Injector Contraindications

80 Epi-Auto Injector Dosage

81 Epi-Auto Injector Actions

82 Epi-Auto Injector Side Effects

83 Epi-Auto Injector Administration


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

86 Trauma Emergencies Bleeding

87 External Types, Treatment ( In order)
Bleeding External Types, Treatment ( In order)

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


90 Internal, S/S, Treatment
Bleeding Internal, S/S, Treatment

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

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

93 Trauma Emergencies Shock


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


97 Etiology of Shock Hypovolemic Shock Cardiogenic Shock
Loss of blood volume Distributive Shock Prevent appropriate distribution of nutrients and removal of wastes Anaphylactic Septic Hypoglycemia Obstructive Shock Interference with the blood flowing through the cardiovascular system Tension Pneumothorax Cardiac Tamponade 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

98 Trauma Emergencies Soft Tissue

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

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

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

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


104 Trauma Emergencies Penetrating Injuries


106 Trauma Emergencies Evisceration


108 Trauma Emergencies Impaled Object


110 Trauma Emergencies Amputation


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

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

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

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

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

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

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

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

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

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


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

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

125 Pathophysiology of Burns
Types of Burns Thermal Electrical Chemical Radiation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

140 Musculoskeletal System

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

142 Musculoskeletal Ligament

143 Musculoskeletal Tendon


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

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

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

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

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

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

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

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

153 Triage

154 Command at Mass-Casualty Incidents

155 Incident Commander (IC)
Coordinates all scene activities 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 One person coordinates the incident. Most useful in smaller, single-jurisdictional incidents. Unified command Managers from different jurisdictions share command. Fire, EMS, law enforcement

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

159 EMS Branch Functions Triage Treatment Transport

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

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

162 The METTAG

163 Treatment Red treatment unit Yellow treatment unit
Green treatment unit

164 Triage Priority 1 (RED)

165 Triage Priority 2 (Yellow)

166 Triage Priority 3 (Green)

167 OB / GYN

168 OB / GYN Labor Bloody Show Crowning Predelivery Emergencies

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

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

171 Field Delivery Set up delivery area.
Give oxygen to mother and start Drape mother with toweling from OB kit. Monitor fetal heart rate. 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.

172 OB / GYN ( Normal Delivery)

173 OB / GYN ( Normal Delivery)

174 OB / GYN ( Normal Delivery)


176 OB / GYN ( Normal Delivery)

177 OB / GYN ( Normal Delivery)

178 OB / GYN ( Normal Delivery)

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 infant’s 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. Transport to a facility with neonatal intensive care capabilities.

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

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

187 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.

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

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

190 Abnormal Delivery Situations

191 OB / GYN (Abnormal Deliveries)

192 Breech Presentation 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 infant’s face. Continue during transport.

193 OB / GYN (Abnormal Deliveries)
Prolapsed Cord

194 Prolapsed Cord The umbilical cord precedes the fetal presenting part.
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. Wrap cord in sterile moist towel. 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. Administer oxygen. Transport immediately. Do not attempt field delivery in these circumstances.

198 Other Delivery Complications

199 OB / GYN (Abnormal Deliveries)
Multiple Births

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

201 OB / GYN (Abnormal Deliveries)

202 Meconium Staining 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.

203 Maternal Complications of Labor and Delivery

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

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

206 Infants and Children Airway Maneuvers FBAO Adjuncts

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

208 Anatomical and physiological considerations in the infant and child.

209 a. In the supine position, an infant’s or child’s larger head tips forward, causing airway obstruction. b. Placing padding under the patient’s 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. Involve the caregiver or parent as much as possible. Allow to stay with child during treatment and transport.

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

213 Suctioning Decrease suction pressure to less than 100 mm/Hg in infants. Avoid excessive suctioning time—less than 15 seconds per attempt. Avoid stimulation of the vagus nerve. 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.
Obtain chest rise and fall. Allow time for exhalation. Flow-restricted, oxygen-powered devices are contraindicated. Do not use BVMs with pop-off valves. Apply cricoid pressure. Avoid hyperextension of the neck.

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

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


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


221 a. Croup and b. Epiglottitis

222 Positioning of the child with epiglottitis
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. Leading cause of preventable death in children.

225 Medical Emergencies Seizures

226 Trauma Emergencies Falls Motor vehicle crashes
Car vs. pedestrian injuries Drowning and near drowning Penetrating injuries Burns 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 vehicle’s 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 Tracheostomy tubes Apnea monitors Home artificial ventilators Central intravenous lines Gastric feeding and gastrostomy tubes Shunts

234 Medical Emergencies Meningitis

235 Summary Questions ?


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