Subject
Topic
Meaning
Additional Info
Additional Info
Additional Info
Chapters 37-46
Anatomy and
Physiology
Physiological
Changes
Cervix - the neck of the uterus, contains a mucus plug
(protects the fetus) that seals the uterine opening
during pregnancy
Bloody show - the mucus and blood that are expelled
as labor begins
Placenta - the fetal organ through which the fetus
exchanges nourishment and waste products during
pregnancy
Umbilical cord - an extension of the placenta
through which the fetus receives nourishment
while in the uterus
Amniotic sac - a thin, transparent membrane that
forms the sac that holds the fetus suspended in
amniotic fluid, also called the bag of waters
Parts of the uterus
Fundus
Body
Cervix
Maternal blood volume increases by 45%
Maternal heart rate increases by 10 to 15 bpm
Bp decreases slightly during the first and second
trimester and returns to normal during the third trimester
Urinary bladder is displaced superiorily and
anteriorily.
Veins carry oxygen and nutrients and arteries carry deoxygenated
blood from the fetus to the placenta.
Signs and Symptoms
Cramplike lower abdominal pain
Moderate to severe bleeding
Passage of tissue or blood clots
Placenta previa - abnormal implantation of the
placenta near or over the cervix. Excessive
bleeding can occur as the cervix begins to dilate.
The bleeding is painless (separates placenta
previa from abruptio placentae)
Abruptio placentae - abnormal separation of the placenta from the
uterine wall prior to birth of the baby..
Bleeding with pain
Ruptured uterus - thinned uterine wall can rupture, releasing the fetus into the
abdominal cavity.
Approximately 5-20% chance of maternal death, with infant mortality over
50%.
Ectopic pregnancy - the egg is implanted outside of the
uterus, 90% of ectopic pregnancies occur in the fallopian
tubes.
Kehr sign (referred shoulder pain from abdominal pain)
Tender, bloated abdomen, palpable mass
Signs of shock
Discoloration around the naval
Preeclampsia - characterized by high blood
pressure, swelling, headaches, and visual
disturbances
Often occurs in around 20 year old females, first
time pregnancies.
Stages of delivery
Dilation
Expulsion
Delivery of the placenta
During the expulsion stage, contractions will be around
2-3 minutes apart, and last for 60-90 seconds each.
It won't be possible to differentiate Braxton-Hicks
During this, the perineum bulgse, and the infant crowns, contractions from real contractions.
and the rest of the body is delivered.
Infants have "soft spots" on their heads known as fontanelles which close
between 12 and 18 months, the posterior fontanelle closes by 2 months of
age. This is a key indicator in telling if an infant is dehydrated because the
fontanelles will be sunken in.
The child's chest wall is much more pliabe than the
adult's, which means the rib cage cannot protect the
internal organs as effectively.
Ovaries - female sex glands
Fallopian tubes - thin, flexible structures that extend from the uterus to the
ovaries
Uterus - pear-shaped organ that contains the developing fetus (baby)
approximately 2500 ml of blood can be concealed in the uterus
At the end of pregnancy, the uterus weighs more than 2 pounds and holds
5000ml.
The pregnant uterus is extremely vascular and contains about one-sixth of the
total blood volume of the mother
Spontaneous abortion - without apparent cause, the termination of pregnancy
before the fetus reaches the stage of viability, generally before the 20th week of
pregnancy.
Occurs in 15-20% of all recognized pregnancies
May occur around the 12th week
Obstetrics and Care
of the Newborn
Predelivery
Emergencies
Anatomy and
Physiology
Bradycardia is a late sign of hypoxia in infants and children but an early sign in Hypotension does not develop until more than 30% of
newborns.
the blood volume is lost.
Pediatric
Assessment
Triangle
SIDS
Eclampsia - life-threatening, seizures and coma
Prolapsed cord - don't push, moist towel, O2, push baby's head off of
the cord. Drive fast.
Nuchal cord - slip the cord over the baby's shoulder, or if it can't be
moved, clamp and cut.
The child's tongue is also proportionally
Their metabolic rate is also much faster. Their cells use more oxygen
bigger than the adult's tongue and their airway and glucose.
is smaller in diameter..
Less oxygen reserves, can lead to hypoglycemia faster.
Head bobbing is indication that a child is in
respiratory failure.
Children can compensate well but fall off relatively fast.
Appearance
Tone
Interactivity and irritability
Consolability
Look or gaze
Speech or cry
Work of breathing
Abnormal sounds
Abnormal posture or position
Retractions
Nasal flaring
Head bobbing
Circulation to skin
Pallor
Mottling
Cyanosis
Petechiae
Since the child can compensate well in the beginning for most problems (shock
and others), they can lead from respiratory distress to failure within minutes.
Respiratory distress
Increased respiratory rate
Nasal flaring
Intercostal retractions
Supraclavicular and subcostal retractions
Neck muscle use
Seesaw respirations
Respiratory failure
Respiratory rate over 60 /min
Cyanosis
Decreased muscle tone
Accessory muscle use
Poor peripheral perfusion
Head bobbing
Respiratory arrest
Respiratory rate less than 10 / min
Irregular or gasping respirations
Unresponsiveness
Bradycardia
Weak or absent peripheral pulses
Hypotension
Sudden Infant Death Syndrome - the sudden and unexpected death of an
infant or young child in which an autopsy fails to identify the cause of death.
SIDS typically occurs while the infant is asleep. Under 1 year of age.
Attempt resuscitation if any chance of survival exists,
but if signs of death exist, turn treatment to emotional
support for the parents or caregivers.
Causes of death that may be mistaken for SIDS
includes
Meningitis
Severe infection
Most common in ages 2-4 months.
Child abuse
The PAT assesses appearance, work of breathing, and circulation to skin.
When assessing a child, use a toe-to-head approach.
Pediatrics
Respiratory
Problems
Supine hypotensive syndrome - typically a third-trimester complication
that occurs when the weight of the fetus compresses the inferior vena
cava when the patient is in a supine position.
NOT hyperglycemia
Cardiovascular
System
and Respiratory
System
Geriatrics
Patients with Special
Challenges
Stenosis - constriction or narrowing of a passage or opening, the valves of the
heart for example
Cardiac hypertrophy - an increase in size of the heart from a thickening of the
heart wall, without a parallel increase in the size of the cavity
Arteriorsclerosis - disease process that causes the loss of elasticity in the
vascular walls from thickening and hardening of the vessels
MI may present as a "silent heart attack."
Geriatric population cannot compensate well, because
of their degenerative processes affecting their bodies.
Geriatrics > 65 years old
Geriatric patients have a weakened cough reflex,
and decreased number and function of cilia.
Decreased cough reflex results in decreased
Orthopnea - difficulty breathing when laying flat
ability to clear secretions whereas a decreased
number and fucntion of cilia increases the risk of
infection
Dementia and
Delirum
Dementia - chronic condition resuling in malfunctioning of normal cerebral
Alzheimer's disease - disease characterized by
processes.
cerebral function loss as seen with diseases that affect
Delirium - sudden-onset AMS that may involve illusions, disjointed thought
the brain.
processes, incoherent speech, and increased or decreased psychomotor activity.
Signs and Symptoms
Confusion
Emotional depression
Irritability
Violence between lucid intervals
Eventually not recognizing people
Vision Impairment,
Speech
Impairment, and
Obesity
Glaucoma - an abnormal increase in intraocular pressure that damages the optic
nerve resuling in peripheral vision loss and eventual blindness.
Diabetic retinopathy - damage to the small blood vessels of the eye from the
Dysarthria - defective speech caused by impairment of
long-term effects of diabetes mellitus
the tongue or other muscles necessary for speech
Cataracts - clouding of the lens of the eye from pathologic changes within the
lens
20% over ideal weight is considered obese
50% - 100% over ideal weight is considered
morbidly obsese
Patients with Special
Challenges
Airway and
Respiratory
Devices
Implanted Ports
Tracheostomy - a surgical opening in the trachea, necessary in patients with
medical or trauma conditions
If a permanent opening is necessary, a stoma will result
Use a soft suction catheter to clear blood or secretions
from the tracheostomy tube
Try to use sterile gloves as the trachea is to be
Do not suction for more than 15 seconds in adults
considered a sterile field.
and more than 5 in children
Totally Implantable Venous Access System (TIVAS) - medication
administration devices that are surgically placed beneath the skin outside of the
rib cage
Embolism formation is a problem with these devices, if
the patient complains of dyspnea with clear lung sounds,
severe headache, sudden, sharp chest pain, or AMS,
suspect an accidental air embolism.
PTSD (Post-Traumatic Stress Disorder) - a severe anxiety disorder caused
when an individual is exposed to traumatic events that threaten actual or
perceived immediate death, serious injury, or horrific trauma. The symptoms are
frequently delayed and may occur years or decades after the traumatic event
itself.
Signs and Symptoms
Guilt
Depression or Paranoia
Agitation
Anger
Alcohol and drug abuse
TBI (Traumatic Brain Injury) - an alteration in brain function, or other evidence
of brain pathology, caused by an external force, such as concussion, whose
signs and symptoms may emerge over time
Signs and Symptoms of TBI
Numbness
Impulsive
Lack of focus
TBI increases the likelihood of developing PTSD.
Signs and symptoms of both PTSD and TBI overlap, but Clumsy
it is not the responsibility of the EMT to diagnose either. Trouble swallowing
Confusion
Trouble hearing
Loss of sense of smell
Overlapping signs and symtpoms of TBI and PTSD
Severe headaches
Drug and alcohol abuse
Sleep disturbance
Depression
Anxiety
Anger
Memory problems
Easily frustrated
Relationship problems
Traumatic event
Easily fatigued
Botherd by certain smells
Automatic actions
You must exercise due regard for the safety of others
Some state statutes grant certain privilages when driving an ambulance such as
Exceeding the speed limit
Parking anywhere as long as you are not endangering the lives of others
Driving the wrong way down a one-way street or drive down the opposite side of
the road
Pass other vehicles in a no-passing zone
Always enter from the outside of a curve, breaking
beforehand, and turning as early as possible
Use a lower gear when going downhill
Hydroplaning can begin at 35mph
At 55 mph it takes about 4.5 seconds to cover
350 feet, so control your speed at night
Chains are the best protection against skidding
Park infront of the vehicles if another EMS unit is on
scene, whether it be, PD, fire, or an ambulance.
If you are the first unit on scene, park behind the
vehicles
Always approach from uphill and upwind in
case of any leaking hazardous materials
The Combat Veteran Psychophysiology
Driving the
Ambulance
Ambulance
Operations and Air
Medical Response
Always perform a 360-degree scene survey, looking up and down, side to side
1/2 of vehicle fatalities occur at night
Create a physical barrier between traffic and the
scene if you are first to arrive
Personnel Safety
Gaining Access
Always approach air medical from downhill,
never uphill.
Sterilize any equipment that will be used invasively
Throw all soiled linens in a dirty linen bag at the end of a call
1:100 bleach solution is a low-level disenfectant
1:10 bleach solution on surfaces that come into contact with the skin,
such as stethoscopes, blood pressure cuffs, or splints
Minimizing the possibility of carbon monoxide poisoning
Prevent carbon monoxide poisoning by keeping the heater or air conditioner on
Patients in cardiac arrest are not candidates
by having an exhaust system that exits beyond the side
in the ambulance
for medical helicopter transportation
of the vehicle
Use high level disenfectants such as hot water pasteurization (80-100
degrees celsius for 30 minutes) or immerse in an EPA-registered
chemical sterilant for 10-45 minutes for reusable instruments that come
into contact with mucous membranes, such as laryngoscopes, blades,
and handles
Simple access - a way to gain access to a patient that does not require tools or
specialized equipment
Complex access - a way to gain access to a patient that requires the use of
tools and specialized equipment
Freeing a patient from a wreckage is known as disentanglement
For simple access, try to simply just open the door
before trying to show off how cool you are and break a
window
Easiest and less costly version of complex access is breaking a window
Use a spring-loaded center punch
Gaining Access and
Patient Extrication
PTSD has the consequence of "making young
bodies look old."
The EMT's primary role is patient care! Explain
to the patient everything you are doing
regardless if they ask
Make sure to tell the patient not to move their heads, and if need be,
Maintain manual spinal stabilization at all times
break the window farthest from the patient
during the extrication process (first step in "rip
and blitz" disentanglement)
Vehicle
Stabilization
Upright vehicles
First step is to position plastic step chocks under the vehicle parallel to each
wheel
Vehicles on its side
Using a chain or cable to secure the vehicle to an
immovable object
Vehicles on its roof
Use airbags or block cribbing to remove the weight
Turn off the car, then cut the battery by cutting the negative cable first
of the vehicle from the roof posts sinces roof posts
and then the positive cable
are not designed to support the weight of the
vehicle
Identifying
Hazardous
Materials
Hazardous material - material that in any quantity poses a threat or
unreasonable risk to life, health, or property if not properly controlled during
manufacture, processing, packaging, handling, storage, transportation, use, and
disposal
Types of Damage from Hazardous Materials
T - Thermal
R - Radiological
A - Asphyxiation
C - Chemical
E - Etiological (Biological Hazards)
M - Mechanical (Trauma from bullets)
A warning placard which is diamond-shaped and
divided into four smaller diamonds is known as a
NFPA 704 system
Left - health hazard
Upper middle - flammability
Right - stability
Bottom - additional hazards (reacts with water,
etc...)
Protect the safety of all rescuers and patients
Provide patient care
Decontaminate clothing, equipment, and the vehicle
First Responder Operations - those who initially
respond to hazardous materials emergencies to protect
people, property, and the environment. Trained in the
use of specialized personal protective equipment and
help to stop the emergency from spreading
Hazardous Materials Technician - rescuers who
actually plug, path, or stop the release of
hazardous material
Hazardous Materials Specialist - provide command and support
activities at the site of a hazardous materials emergency
Hot (Contamination) Zone - contamination is actually
present, personnel must wear appropriate protective
gear, number of rescuers is limited to those absolutely
necessary, bystanders never allowed
Warm (Control) Zone - area surrounding the
contamination zone, vital to preventing the spread
of contamination, personnel must wear protective
gear, lifesaving emergency care is performed
Cold (Safe) Zone - normal triage, stabilization, and treatment
performed, rescuers must shed contaminated gear before entering the
cold zone
Hazardous Materials
First Responder Awareness - those who are likely to witness or discover a
Levels of Training hazardous materials emergency, such as an EMT. Only expected to call for
proper resources and prevent others from entering the scene
Awareness
R - Recognize
A - Avoid
I - Isolate
N - Notify
National Incident
Management
System
Multiple-Casualty
Incidents and
Incident
Management
Triage
JumpSTART
Weapons of Mass
Destruction
EMS Response to
Terrorism Involving
Weapons of Mass
Destruction
NIMS - a system administered by the U.S. Secretary of Homeland Security to
provide a consistent approach to disaster management by all local, state, and
federal employees who respond to such incidents
The 2 main components that make this beneficial are flexibility and
standardization
Incident Command System (ICS) - the standardized
management concept that has become the standard for
on-scene management of disasters and multiple-casualty
incidents
Purpose of such system is
The safety of the emergency responders and others
The achievement of tactical objectives
The efficient use of resources
Triage - the process of sorting patients to determine the order in which they will
receive care or transportation to definitive care
Primary triage - evaluation of patients that occurs
immediately upon arrival of the first EMS crew at the
actual site of the incident to quickly categorize the
severity of a patient's condition and priority for treatment
and transport
System for Triaging
Walking wounded - Green
Respirations - (Yes - down, No - next box)
Under 30/Min - (Yes - down, No - Red)
Perfusion - (Radial Pulse Present + Cap Refill < 2 sec - down, Absent Radial
Pulse or Cap Refill > 2 sec - Red + Control Bleeding)
Mental Status - (Follows Commands - Yellow, Cannot Follow Commands - Red)
If the patient is not breathing, open the airway (Breathing now - Red, No breathing - Black)
System for Triaging Pediatrics
Walking wounded - Green
Breathing - (Yes - down, No - next box)
Respirations - (Between 15-45 - down, < 15 or > 45 - Red)
Palpable Pulse - (Yes - down, No - Red)
AVPU - (A, V, P - Yellow, Inappropriate Posturing or U - Red)
If the patient is not breathing, open the airway (Breathing now - Red, No breathing - down)
Palpable Pulse - (Yes - down, No - Black)
5 Rescue Breaths - (Yes - Red, No - Black)
WMD - weapons intended to cause widespread and indiscriminate death and
destruction
Primary effect - the blast of an explosion
Secondary effect - effects from flying debris, shrapnel,
and other projectiles causing penetrating injuries or blunt
trauma
Tertiary effect - when a person is propelled by a blast or
shock wave and strikes the ground or other objects
Volatility - the tendency of a chemical agent to evaporate. A volatile liquid
evaporates easily and creates a dangerous, breathable vapor
Chemical Agents
Persistence - a characteristic of agents that do not evaporate quickly and tend
to remain as a puddle for long periods of time
Six major types of chemical agents
Nerve agents
Vesicants
Cyanide
Pulmonary agents
Riot-control agents
Toxic industrial chemicals
Secondary triage - reeavulation that takes place
in the triage unit of the severity of a patient's
condition and priority for treatment and transport
Incendiary devices - devices using agents such
as napalm, thermite, magnesium, and white
phosphorous to cause injury by burning at high
temperatures
Nerve agents - agents that block the action of
acetylcholinesterase (AChE) in the plasma of the
blood, red blood cells, and nervous tissue. The
most severe effects are those to the nervous
tissue
Most deadly known chemical
Signs and symptoms (vapor)
Runny nose, mild dyspnea, pupillary constriction
Sudden onset of unresponsiveness, seizures,
apnea, copious secretions
Signs and symptoms (liquid)
Localized sweating, nausea, vomiting, fatigue
Sudden onset of unresponsiveness, seizures,
apnea, paralysis, copious secretions
Biological Agents
Biological agents - agents that are made up of living organisms or the toxins
produced by the living organisms that are used as weapons of mass destruction
to cause disease in a target population
Biological toxins are not living, but products of living
organisms, cannot be transmitted from person to
person
Nuclear Weapons
and Radiation
Nuclear radiation - energy released when an unstable atom breaks apart
Primary exposure - primary radiation injury that occurs
during or shortly after a radioactive detonation
Fallout - radioactive dust and particles that may be lifethreatening to people far from the epicenter of a
radioactive detonation
Acetylcholinesterase - an enzyme that breaks down the
neurotransmitter acetylcholine. Nerve agents inhibit the action of this
enzyme, allowing acetylcholine to accumulate
Acetylcholine - a neurotransmitter that is distributed throughout the
body and is necessary for normal function of the parasympathetic
nervous system