Lecture #13

2/3

• Liver
• Pancreas
• Kidneys
• Spleen
• adrenal glands
• ovaries

• Stomach
• gallbladder
• duodenum
• large intestine
• small intestine
• urinary bladder
• falopian tubes
• appendix

• liver (mostly all)
• right kidney
• colon
• pancreas (a little bit of it)
• gallbladder

• liver (a little bit of it)
• spleen
• left kidney
• colon
• pancreas (mostly all)
• stomach

• right kidney
• colon
• small intestine
• ureter
• appendix
• fallopian tubes
• ovaries
• uterus

• left kidney
• colon
• small intestine
• ureter
• fallopian tubes
• ovaries
• uterus

• uterus
• ovaries
• fallopian tubes
• cervix
• vagina

• esophagus
• stomach
• small intestine
• large intestine
• rectum

• kidneys
• ureters
• bladder
• urethra

a bulge in the wall of the aorta, possibly causing a rupture which will cause massive bleeding in the abdominal cavity

• some are asymptomatic
• writhing abdominal pain, may radiate to the lower back, hip, or chest
• pulsating mass in the abdomen
• unequal femoral pulses
• if internal bleed is allowed to continue, will cause: hypovolemic shock, hypertension, tachycardia, cyanosis, and altered LOC

implatation of placenta that occurs outside of the uterus (90% being in the fallopian tubes)

• hematemesis (vomiting up blood; from upper GI bleed)
• melena (passing of dark, tarry stools; from lower GI bleed)
• esophageal varices (abnormal, enlarged veins in the lower part of the esophagus) or Mallory-weiss tear (tear occurs in the mucus membrane of the lower part of the esophagus or upper part of the stomach)

• calcium crystals in the kidneys
• hematuria
• writhing pain
• mimics an MI
• pain comes in waves
• diaphretic
• nausea
• vomiting

• triad = female of childbearing age, abdominal pain, s/s of shock
• vaginal spotting, intense painful cramping
• abdominal pain with shoulder pain (indicating severe bleed)
• nausea/vomiting

• upper abdominal pain, age greater than 35
• lower abdominal pain in women age 12-50 with dizziness, snycope, or heavy vaginal bleeding
• abdominal/back pain with syncope/near syncope, age greater than 50
• acutely distended, rigid, or tender abdomen
• unequal or absent femoral pulses

large female reproductive organ in lower abdomen where the fetus grows

lower part of the birth canal

developing unborn baby

fetal organ that provides perfusion from the uterus; filters; feeds the baby

connects fetus to the placenta

sac that surrounds the fetus in utero

skin area between vagina and anus

• emergencies that happen before 36 weeks such as...
• miscarriage/spontaneous abortion
• placenta previa
• placental abruption
• ectopic pregnancy
• preterm bleed
• preeclampsia/eclampsia

• loss of fetus up to 20 weeks (most occuring within 12 wks of pregnancy from a fetal abnormality)
• usually preceded by spotting and intense cramping
• products of conception often naturally expelled and if not, dilation and curettage (D&C) are likely (widening of the cervix and scooping out what was left after the miscarriage)
• fetal loss in the 2nd trimester may occur when the cervix is weak and opens too early

• when the placenta forms over part of or the entire cervix
• bright red bleed in 2nd or 3rd trimester
• always painless

• premature separation of placenta from uterus in the 2nd or 3rd trimester, usually from trauma
• abdominal pain with bleeding that is usually dark red

• last menstral cycle?
• is that length of time normal?

any female of childbearing age with s/s of shock

• general pt care procedures
• place pad between legs (to catch blood and measure the amount)
• do not pack the vagina (....phrasing....)
• do not allow the pt to insert a tampon

• 160/90 (pregnancy induced hypertension)
• lower abdominal pain in women age 12-50 with: dizziness, syncope/near syncope, or heavy vaginal bleeding
• seizures
• s/s of shock
• imminent delivery

when seizures begin

• HCCB...
• history - 36-40wks
• contraction less than 2 mins apart, lasting at least one minute
• crowning
• bowel movement

• gestation of 36 wks or more
• contractions less than 2 mins apart, lasting at least one minute
• crowning is present
• mother feels strong urge to push
• mother feels need to move her bowels

gloves, goggles, splash protection (dexter mask)

• baby's first bowel movement
• if it occurs in utero, baby will aspirate it causing pneumonia

• Do What Probably Seems Simple
• D - dry
• W - warm
• P - position
• S - suction
• S - stimulate

• when the umbilical cord is wrapped around the baby's neck
• pull cord toward baby's face over the top of the head
• if the cord cannot be removed, clamp it and cut in place

• baby gets cholostrom (which contains oxytocen, antigens)
• the oxytocen is a hormone that instigates the contraction of the uterus, causing it to stop bleeding and shrink back down after being stretched from holding the baby

• appearance
• pulse
• grimace
• activity
• respiratory effort

• 1st stage - dilation of cervix to ~10 cm
• 2nd stage - baby!
• 3rd stage - placenta

• do not pull on the umbilical cord in an effort to speed up the delivery of the placenta
• do transport placenta to ED with mom and baby

• 1st treatment - have baby breastfeed
• 2nd treatment - place sanitary napkin in between mom's legs
• 3rd treatment - uterine massage

1-30 days old

perform neonatal resuscitation for 1 minute

perform rescue breathing using a BVM at a rate of 40-60 breaths per minute

• depth of compression - 1/3 depth of chest
• rate of compression - 120/minute
• compression/ventilation ration - 3:1
• rescue breathing rate - 40-60/minute

body part of than head presents in childbirth

• do not attempt to deliver
• ensure cord is not compressed
• place mother in knee-chest position
• transport immediately

• when the cord precedes the baby
• place the mother in knee-chest position
• place a finger on either side of the cord
• transport immediately

• suction the airway before delivery is complete suction the mouth thoroughly before suctioning the nose
• arrange for an ALS rendezvous

the body has lost more heat than gained (e.g. - cold weather, cold floors)

the body has more heat gain than loss (e.g. - hot weather, sickness, firefighting)

• conduction
• convection
• radiation
• evaporation
• respiration

• source of coolness - outside weather, no heat in house, laying on cold floor
• how long is the exposure
• any LOC in pt
• type of injury - general  or localized

a protective state in the body's natural response to hypothermia

• 99-96: shivering - the body's 1st line of defense
• 95-91: intense shivering, difficulty speaking
• 90-86: strong muscle rigidity, lack of muscle coordination, thinking becomes less clear
• 85-81: irrational, stuporous state, vitals low and cardiac arrhythmias begin
• 80-78: LOC, HR decreased, coma, death

• any injuries: fx, burns, head injuries, trauma
• medical hx: diabetes, limited movement
• age: young (no body fat/can't put clothes on) or old (no strengh/medical problem)
• poor: can't afford heat
• drugs/alcohol: vasodilation/affects judgement and body functions

• environmental conditions
• cool/cold skin feel (feel the belly, not the extremities)
• decreased LOC/motor funtion
• stiff/rigid posture
• slow pupil response
• poor judgement (taking off clothes)
• BP low or absent
• in early hypothermia, pulse and breathing are rapid and skin is red
• in late hypothermia, pulse is irregular or absent, breathing is shallow, slow, or absent, and skin is stiff, hard, and cyanotic
• complaints of joint pain

• remove pt from environment
• remove wet clothes and cover body and head
• handle gently to avoid provoking an arrhythmia
• don't allow pt to exert self - carry them
• give O2, preferably warm
• assess pulse for a full minute before CPR and if pulseless confirmed, apply AED and continue with CPR
• turn heat on high in rig
• heat blankets in dryer
• nothing to eat or drink
• don't massage extremities
• check rectal temp
• splint any frostbitten extremities

• if superficial: skin will blanch and color will not return quickly or at all, loss of feeling, skin still soft and flexible, if re-warmed will feel tingly
• if frostbitten: white/waxy appearance of skin, firm to frozen feeling of extremity, swelling present, blisters, if thawed will appear flushed with areas of purple/cyanosis

no, because frozen crystals can cause trauma/lacerations

• cover with dry clothing/dressing
• separate digits
• do not: break blisters, walk on extremity, rub or massage, apply heat, re-warm

• exercize/activity
• age (young - can't remove clothing/poor thermoregulation; old - meds, limited mobility, poor thermoregulation)
• illness - heart disease, obesity, fever, fatigue, diabetes, dehydration

• mild signs - muscle cramps
• moderate signs - heat exhaustion: moist, pale, normal to cool temp, body systems mostly working
• life threatening - heat stroke: hot, dry, red to flushed, rapid HR and unresponsive, mentation will be altered

• remove from environment to cooler area
• remove clothing
• give O2
• cool without inducing shivering
• hydrate with water or sports drink diluted with 50% water if pt is alert with intact airway
• check rectal temp
• if pt is in heat stroke - rapidly cool by placing cold packs on neck and groin

• Type of water? (salt, fresh, stagnant, treated)
• time of immersion?
• diving with partner? where are they?
• use of dive charts, emergency surface?
• depth and duration of dive?
• what kind of gas are they using?

virginia mason and everett naval base

• a dive related injury caused by holding breath and rupturing lung on accent
• rapid onset of blurred vision, chest pain, numbness/tingling extremities, weakness or paralysis, frothy blood from mouth, convulsions, unconscious, respiratory/cardiac arrest

• aka the bends
• build up nitrogen in body due to rapid accent from depth, usually appearing 1-3 hrs after dive
• personality changes, deep pain in joints/muscles, itchy skin, choking paralysis, labored breathing, chest pain, collapse, staggered gait

• ensure ABCs
• give O2 by NRB or BVM
• transport rapidly supine on either side
• prep for suction
• gather info on dive (time, depth, accent)

• ensure ABCs
• consider spinal immobilization
• high flow O2
• prep for suctioning since vomiting is normal
• position on left side
• transport and vitals

• altered or decreased LOC
• rectal temp below 95 or above 105
• pt is very cold (on belly or chest) to touch without shivering

• localized pain at site of bite or sting
• redness/swelling
• weakness
• dizziness
• chills/fever
• nausea/vomiting
• bite marks/stinger

• bite from poisonous snake or reptile
• serious injury to face or neck

• ensure ABCs
• if stinger is still present, scrape with card - do not use tweezers
• remove jewelry
• immobilize affected limbs in position of comfort
• be on the watch for allergic reactions - watch vitals
• DO NOT USE - contricting bands, touniquets or ice