Zack EMT-B Test 6

Lack of O2 and/or glucose leads to cellular dysfunction to cellular chaos to cellular death to tissue failure to organ failure to system failure to organism death

• Burns
• Vomiting
• Diarrhea
• Blood loss
• DKA

• Anaphylaxis
• Spinal cord injury
• Septic shock

• Myocardial Infarction
• CHF
• Cardiac trauma
• Infection

• Pallor
• Diaphoresis
• Tachycardia
• Tachypnea
• Altered LOC
• Weak peripheral pulses
• Delayed capillary refill
• Prostration
• Decreased LOC
• Hypotension
• Decreased urine output
• Bradycardia (late sign)

• Stop bleeds
• High flow O2
• Keep warm
• Keep calm
• Trendelenburg position
• ALS rendezvous
• Rapid transport
• Maintain ABC’s

• Hypovolemic
• Distributive
• Cardiogenic
• Obstructive

• Cardiogenic
• Anaphylactic
• Neurogenic
• Septic
• Hypovolemic
• Respiratory
• Metabolic
• Psychogenic

• Pulmonary Embolism
• Pericardial Tamponade
• Tension Pneumothorax

• Hypovolemic - Volume deficit
• Distribtive - Vasodilation
• Cardiogenic - Pump failure
• Obstructive - Decreased preload

• Comminuted
• Colles
• Linear
• Piral
• Transverse
• Oblique
• Open

A break in the continuity of bone

The end of a bone being displaced from its normal place in a joint

A tearing or stretching of a ligament or a tendon

A stretching or tearing of a muscle

• Rest
• Ice
• Compress
• Elevation
• Splint

• To limit the motion of bone fragments, bone ends, or dislocated joints
• To lessen damage to muscles, nerves, or blood vessels
• To help prevent a closed injury from becoming an open injury
• To lessen the restriction of blood flow caused by bone ends or dislocations compressing blood vessels
• To reduce bleeding
• To reduce pain
• To reduce the risk of paralysis caused by a damaged spine

• Compression of nerves, tissues, and blood vessels
• Transport delay
• Reduced distal circulation from a splint that is too tight
• Aggravation of the musculoskeletal injury
• Causing or worsening tissue, nerve, vessel, or muscle damage

• Take BSI precautions and wear appropriate PPE
• Remove or cut away clothing to expose the injury
• Remove jewelry from the injured area
• Assess pulses, movement, and sensation distal to the injury before and after splinting
• Cover open wounds with a sterile dressing
• Pad a rigid or a semi-rigid splint
• Splint the area above and below the injury
• Splint joints above and below the injured bone
• Splint bones above and below the injured joint

• Traction
• Wire
• Cardboard
• SAM
• Pillow
• Blanket
• Sling and swathe
• Pneumatic Anti-Schock Garments (PASG)

• Compression
• Extension
• Flexion
• Rotation
• Lateral
• Distraction

• Paraplegia - Loss of movement and sensation in the body from the waist down. Results from spinal cord injury at the level of the thoracic or lumbar vertebrae
• Quadriplegia - Loss of movement and sensation in both arms, both legs, and parts of the body below an area of injury to the spinal cord. Results from a spinal cord injury at the level of the cervical vertebrae

• Tenderness in the injured area
• Pain associated with movement
• Pain independent of movement or palpation along the spinal column
• Pain down the lower legs or into the rib cage
• Pain that comes and goes, usually along the spine and/or lower legs
• Soft-tissue injuries associated with trauma to the head and neck
• Numbness, weakness, or tingling in the limbs
• Loss of sensation or paralysis below the site of injury
• Loss of sensation or paralysis in the upper or lower limbs
• Difficulty breathing
• Loss of bladder or bowel control
• Inability to walk, move limbs, or feel sensation
• Deformity or muscle spasm along the spinal column

• Assess pt
• Apply manual stabilization
• Fit and apply c-collar
• Log roll pt assess back (person at head is in control of move)
• Roll pt onto backboard (work in unison, minimize movement)
• Secure the chest and pelvis first
• Secure the extremities
• Secure the head last with towel rolls and tape
• Reassess the pt CSM

Check CSM

• Bruises or cuts to the scalp
• Deformity to the skull
• Discoloration around the eyes (raccoon eyes)
• Discoloration behind the ears (Battle’s sign)
• Loss of consciousness
• Confusion
• Convulsions
• Restlessness
• Irritability
• Drowsiness
• Blood or clear watery fluid (cerebrospinal fluid) leaking from the ears or nose
• Visual disturbances
• Changes in pupils
• Slurred speech
• Difficulties with balance
• Stiff neck
• Vomiting

• Concussion
• Contusion
• Subdural hematoma
• Epidural hematoma
• Intercerebral hematoma

• Slow bounding pulse
• Hypertension with widening pulse pressures
• Erratic respirations
• It is a sign of severe head trauma and requires rapid transport and tertiary intervention
• Cushing's triad is the triad of widening pulse pressure (rising systolic, declining diastolic), change in respiratory pattern (irregular respirations), and bradycardia
• It is sign of increased intracranial pressure, and it occurs as a result of the Cushing reflex
• Cushing triad is hypertension (systolic), bradycardia and respiratory depression
• Widened pulse pressure is not a separate component of the triad as it is a result of the elevated systolic blood pressure.

• Subdural - venous bleed, usually a longer onset;
• Epidural - arterial bleed, rapid onset; lucid interval (they are unconscious, regain consciousness and then deteriorate back into unconsciousness)

• Assessment
• Maintain C-spine
• Control bleeding (minimal pressure if skull fracture noted)
• Do not attempt to stop flow of blood or CSF from the ears or nose (check bullseye test)
• Do not remove a penetrating object; Stabilize it in place
• If bleeding from open head wound - Apply firm pressure with a clean cloth to control blood loss over a broad area
• Treat for shock if present
• Dress and bandage wounds
• Transport

• Tension pneumothorax
• Open pneumothorax
• Massive hemothorax
• Cardiac tamponade
• Flail chest
• Pulmonary contusion
• Myocardial contusion

4 through 9

• Localized pain at the fracture site
• Self-splinting of the injury
• Pain on inspiration
• Shallow breathing
• Tenderness on palpation
• Chest wall deformity
• Crepitus
• Swelling and/or bruising at fracture site
• Possible subcutaneous emphysema

• Spinal stabilization if spinal injury suspected
• Establish and maintain an open airway
• Give oxygen
• Encourage patient to breathe deeply
• Do not apply tape or straps to the ribs or chest wall
• Allow patient to self-splint
• Perform ongoing assessments

• Fracture of two or more ribs in two or more places. A flail chest is a life-threatening medical condition that occurs when a segment of the chest wall bones breaks under extreme stress and becomes detached from the rest of the chest wall.
• Paradoxical respiration

• Pallor
• Diaphoresis
• Cyanosis
• Tachycardia
• JVD
• Hypotension
• Respiratory distress
• Agitation
• Restlessness
• Bulging of intercostal muscles on the affected side
• Decreased or absent breath sounds on the affected side
• Possible subcutaneous emphysema
• Tracheal deviation toward the unaffected side (late sign)

• Keep on scene time to a minimum
• Request an early response of ALS personnel
• Spinal stabilization if suspected spinal injury
• Establish and maintain an open airway
• High flow oxygen
• If an open chest wound was bandaged with an occlusive dressing, release the dressing
• Treat for shock if indicated
• Transport
• Reassess often

• Accumulation of blood in the potential space due to a traumatic chest injury
• Diaphoresis
• Weak, rapid pulse
• Restlessness
• Agitation
• Anxiety
• Coughing up blood (hemoptysis) (may not occur)
• Tachypnea
• Flat neck veins (caused by hypovolemia)
• Hypotension
• Decreased or absent breath sounds on the affected side

• Accumulation of blood in the pericardial sac
• Diaphoresis
• Normal breath sounds
• Narrowing pulse pressure
• Trachea in the midline position
• Tachycardia
• Cyanosis of the head, neck, and upper extremities
• Muffled heart sounds (often difficult to assess in the field)
• Distended neck veins (may not be present in hypovolemia)

• Keep on scene time to a minimum
• Request an early response of ALS personnel
• Spinal stabilization if suspected spinal injury
• Establish and maintain an open airway
• High flow oxygen
• Treat for shock if indicated
• Transport
• Reassess often

• Severe compression of the chest causing complete disruption to the resp and circulatory systems
• JVD
• Swelling of the tongue and lips
• Eyes that appear bloodshot and bulging
• Deep red, purple, or blue discoloration of the head and neck (“hooding”)
• Low blood pressure when compression is released
• Normal-looking skin below the level of the crush injury (unless other injuries are present)

• Solid - pancreas, kidney; ovaries; spleen; liver
• Hollow - stomach; intestines; gallbladder; bladder; ureters; appendix;

• Patient who lies still, usually in fetal position
• Nausea
• Vomiting blood (hematemesis)
• Possible blood in the urine (hematuria)
• Possible skin wounds and penetrations
• Abdominal pain
• Rigid abdominal muscles
• Distended abdomen
• Rapid, shallow breathing
• Signs of shock
• Protruding organs (evisceration)

• Keep on scene time to a minimum
• Spinal stabilization if indicated
• Establish and maintain an open airway
• High flow oxygen
• Control any external bleeding
• Stabilize a penetrating object in place
• Apply moistened sterile dressing to protruding organs
• Treat for shock if indicated

• Burns
• Vomiting
• Diarrhea
• Blood loss
• DKA

• Direct pressure
• Pressure points
• Pressure dressing
• Splinting
• Tourniquet
• Pneumatic Anti-Schock Garments (PASG)

• Epidermis
• Dermis
• Subcutaneous tissue

• Protection
• Sense organ
• Pigmentation
• Homeostasis
• Temperature control
• Fluid regulation
• Reservoir

• Capillary – slow ooze, red
• Venous – steady flow, dark red
• Arterial – spurting , bright red

• Puncture
• Penetration
• Avulsion
• Abrasion
• Amputation
• Incision
• Laceration

• Direct pressure
• Pressure point
• Elevation
• Cold
• Pressure dressing
• Tourniquet
• Pneumatic Anti-Schock Garments (PASG)

• 1st degree – red, painful, edema, small blisters, epidermis
• Partial thickness – red, painful, blisters, weeping, into dermis,
• 3rd degree – white waxy , black-charred, less painful, tissue sloughing, full thickness

• Remove from source
• Wet dressing < 10% TBS
• Dry dressing > 10% TBS
• Remove jewelry
• Remove non adhering clothing
• High flow O2
• Keep patient warm
• Do not break intact blisters

• Lower leg x 2 circumferential 9%
• Upper leg x 2 circumferential 9%
• Arm x 2 circumferential 9%
• Anterior abdomen 9%
• Anterior chest 9%
• Posterior abdomen 9%
• Posterior chest 9%
• Head circumferential 9%
• Perineum 1%

• Lower leg x 2 circumferential 13.5%
• Arm x 2 circumferential 9%
• Anterior abdomen 9%
• Anterior chest 9%
• Posterior abdomen 9%
• Posterior chest 9%
• Head circumferential 18%
• Perineum 1%

• Hemothorax is a collection of blood in the space between the chest wall and the lung (the pleural cavity)
• A massive hemothorax is the loss of 1.5L of blood.

• A pneumothorax (a term for collapsed lung) occurs when air leaks into the space between your lungs and chest wall, creating pressure against the lung
• Depending on the cause of the pneumothorax, your lung may only partially collapse, or it may collapse completely

• The most serious type of pneumothorax, this occurs when the pressure in the pleural space is greater than the atmospheric pressure, either because air becomes trapped in the pleural space or because the entering air is from a positive-pressure mechanical ventilator
• The force of the air can cause the affected lung to collapse completely
• It can also push the heart toward the uncollapsed lung, compressing both it and the heart
• Tension pneumothorax comes on suddenly, progresses rapidly and is fatal if not treated quickly.

A pneumotharax caused by an open wound in the chest wall.

• A subdural hematoma is a collection of blood on the surface of the brain.
• Subdural hematomas are usually the result of a serious head injury
• When one occurs in this way, it is called an "acute" subdural hematoma
• Acute subdural hematomas are among the deadliest of all head injuries
• The bleeding fills the brain area very rapidly, compressing brain tissue
• This often results in brain injury.

• An epidural hematoma is bleeding between the inside of the skull and the outer covering of the brain (called the "dura")
• An extradural hemorrhage occurs when there is a rupture of a blood vessel, usually an artery, which then bleeds into the space between the "dura mater" and the skull
• The affected vessels are often torn by skull fractures

• Subcutaneous emphysema occurs when air gets into tissues under the skin covering the chest wall or neck.
• Subcutaneous emphysema can often be seen as a smooth bulging of the skin
• When a health care provider feels (palpates) the skin, it produces an unusual crackling sensation as the gas is pushed through the tissue