general2.txt

<35°

<32°

• Muscle activity decreases
• Shivering stops
• Coordinated finger movement stops

• Lose interest in keeping warm
• Removal of clothes
• LOC drops
• Rigid limbs

• Vitals drop
• Pulse drops
• Arrhythmia
• BP drops

• Cardiorespiratory activity ceases
• NOT dead!

30-45 seconds

• Be gentle!
• Don’t over stimulate the heart!

• Remove pt. from cold enviro
• Remove wet clothes
• Prevent conductive heat loss (cold floors etc)
• Prevent convective heat loss (wind)
• Insulate cold bits of body
• Handle gently
• Provide O2

• Gangrene: death of the tissue in considerable mass, usually associated with loss of vascular (nutritive) supply and followed by bacterial invasion and putrefaction.
• Infarction: development or presence of an infarct (a localized area of ischemic necrosis produced by occlusion of the arterial supply or venous drainage of the part)

• DO NOT: Rub
• DO NOT: apply heat
• DO NOT: allow them to walk on frostbitten feet.
• Splint
• Cover with sterile dressing
• Remove jewelry

>38.3°

muscle spasms => loss of large amount of salt and water through exercise. Heat cramps are associated with cramping in the abdomen, arms and calves

• Remove pt. from enviro
• Rest muscles
• Provide fluids (50/50 water & Gatorade would be good)

• Remove excess clothes
• Remove pt. from enviro
• O2
• Pt. lies down
• Iff pt. alert: drink water
• If N/V: no water + LLR or RLR
• Cover with wet sheets
• Fan the pt.

body temperature of greater than 41 °C

In lightning strikes: treat those whom appear dead 1st

• Reassure Pt.
• Supine position
• Clean bite area (no ice): treat as puncture wound
• Splint if limb
• Watch for N/V
• Nil by mouth
• Monitor Vx
• Mark swelling with a pen to assess spread
• Tx for shock
• Bring dead snake

• Dose in vinegar/isopro alcohol
• Scrape with CCard
• Soak in hot water

• Hypovolemic shock => of dehydration
• Cold clammy skin
• Weakness
• Confusion
• Headache
• Rapid pulse

Pulse drops => of submersion in cold water

• Do they have any vacation plans? Suicidal pt.s don’t look to the future.
• Also, ask to borrow some money.

Depression

LLR: helps to drain upper airway

36-40 wks

• Gravida: Total # of pregnancies
• Para: Total # of live births

• BHC: irregular with no increase of frequency or intensity
• REAL: regular + ^ of freq & intensity
• ---
• BHC: Pain in lower abdomen & contractions stay there
• REAL: Pain in lower back that wraps around to lower abdomen
• ---
• BHC: if bloody show; brown
• REAL: if bloody show; pink/red
• ---
• BHC: Moving Pt. position helps
• REAL: Moving Pt. position doesn’t help
• ---
• BHC: If fluids, usually urine
• REAL: If fluids, usually sweet smell + continuous

Pregnancy induced hypertension

Seizures => of Pregnancy induced hypertension

LLR

• Foetus compresses inferior Vena Cava
• Tx: LLR
• Iff supine on back board: Towels under right side of board

Load ‘n’ go, unless baby crowning and coming out, or ass-out breech

• Appearance: pink not cyanotic
• Pulse: has one
• Grimacing: Grumpy is good
• Activity or Muscle Tone: not floppy
• Respirations: regular & Rapid
• ---
• Scoring: 2 for perfect, 1 for medium, 0 for absent

Pt. Care report

• Clinical: Absence of respiratory or circulatory function in unresponsive pt.
• Biological: Absence of brain activity

• Decapitation
• Rigor Mortis
• Icinerated
• Eviserated (of Heart/Brain etc)
• Decomposing

• DABDA
• Denial
• Anger
• Bargaining
• Depression
• Acceptance

• Airway size
• Blood loss coping
• Kids more prone to head injuries

• Alarm response
• Reaction & Resistance
• Recovery OR Exhaustion

Critical Incident Stress Management

• RED
• Rest
• Elevate
• Direct Pressure

• Adult: 4-5 cm
• Child/Infant: 1/2 to 1/3 chest

2 fingers place 1 finger below nipple line

• Encourage coughing
• NRB @15 Lpm
• Transport

• 5 J-Thrusts
• Ensure proper landmarking
• Repeat another set of 5 J-Thrusts
• GOTO 1

Chest thrusts until object free or Pt. collapses

• 30 Compressions: as per CPR
• Check airway for obstruction: and remove with cross finger technique or sweeps (no blind finger sweeps)
• Ventilate: 2 PPVs. If 1st unsuccessful, reposition head.
• Repeat CPR prn

• Hold sandwiched face down
• 5 back blows
• Switch infant face up resting on your thigh
• 5 CPR compressions
• Repeat prn

• PP: A finding (sign or symptom) that you would expect to find in a patient with this condition
• Example: substernal crushing chest pain in a patient suspected of having a heart attack
• PN: A finding (sign or symptom) that you would expect to find in a patient with a condition that is not present
• Example: no half-paralysis of a patient suspected of having a stroke

Adventitious Breath Sounds

• Apices: one inch below the mid-clavicle
• Bases: at the mid-axillary line lateral to the xiphoid process

• >30: BVM if tolerated.
• If not tolerated: NRB & coached down
• <10: BVM if tolerated.
• If not tolerated: NRB & NO coaching

Inward NOT down

• 0-1 min: cardiac irritability
• 0-4 min: brain damage not likely
• 4-6 min: brain damage possible
• 6-10 min: brain damage very likely
• 10+ min: brain damage irrepressible

• Not used much anymore
• 6-10 Lpm
• 35-60% inspired O2

• 200 PSI: empty
• <500 PSI: not suitable in ambulance

• D: 350L – factor 0.16
• E: 635L – factor 0.28
• M: 3000L – factor 1.56

(Tank Pressure – 200)(factor/flow rate)

• pt’s head is elevated...
• Low: 15-30 degrees
• Semi: 30-45 degrees
• Standard: 45-60 degrees.
• High: 80-90 degrees

Skin

• Epidermis
• Dermis
• Subcutaneous

• Axial: Cranium, spine ribs
• Appendicular: everything else

• Total: 33
• Cervical: 7
• Thoracic: 12
• Lumbar: 5
• Sacrum: 5 fused
• Coccyx: 4 fused

Jugular notch

Costal arch

• Tarsals
• Metatarsals
• Phalanges

• Carpals
• Metacarpals
• Phalanges

• Medication Assessment
• Neurologic Assessment
• GI/GU Assessment
• Poisoning / OD Assessment
• OB/GYN Assessment

• Central NS: Brain & Spinal cord
• Peripheral NS: Somatic & Autonomic
• Somatic: voluntary
• Autonomic: involuntary
• Autonomic: Sympathetic & Parasympathetic
• Sympathetic: Adrenogenic (Alpha & Beta receptors)
• Parasympathetic: Cholinergic

• Sympathetic Nervous System
• Prepares your body for stressful events
• --- ^HR
• --- ^Resps
• --- Dilates pupils
• --- Constricts peripheral blood vessels
• --- Dilates coronary and skeletal muscle blood vessels
• --- ileus

• Parasympathetic Nervous System
• Returns the body to normal (or the reverse of above effects if over-stimulated)

• Dura Mater
• Arachnoid Layer
• Pia Mater

Produces numerous hormones to control and regulate other glands

• Produces thyroxin
• Regulates growth and metabolism

Produces parathormone which regulates serum calcium

• Located in the abdominal cavity and retroperitoneal cavity
• Produces insulin (via beta cells) and glucagon (alpha cells)
• Regulates blood sugar levels

• Top of the kidneys
• Produce adrenalin which regulates the stimulation of the SNS

• +ve is least common type: causes itself to produce more and more of the effect until the stimulus is stopped
• Examples: clotting, childbirth (uterine contractions)
• -ve is the most common type: loop continues to produce the hormone until the stimulus is gone (fear factor return to zero)
• Examples: “adrenalin rush”

• SA: SinoAtrial Node
• AV: AtroVentricular Node
• Purkinje fibres: nice

RBC vs white BC

Erythrocyte vs leukocyte

• Enteral: via intestines
• Parenteral: any other way

Eye drops

• OR: Orogastic
• NG: Nasogastic
• Both: not in EMR scope

• Right: 3 lobes
• Left: 2 lobes

• Thrombus: clot which has formed at a specific location
• Embolus: A thrombus that has broken loose and is travelling through the vascular system

• the lack of gas exchange within alveoli, due to alveolar collapse or fluid consolidation. It may affect part or all of one lung.
• It is a condition where the alveoli are deflated.

• Acute respiratory distress syndrome: life-threatening lung condition that prevents enough oxygen from getting into the blood.
• Severe lung disease caused by a variety of direct and indirect issues.
• Very similar to pulmonary edema

• Pink: Emphysema => more RBCs as compensation
• Blue: Cyanosis + barrel chestedness

• Respiratory Syncytial Virus: A virus which causes lower airway illnesses like bronchiolitis or
• pneumonia and possibly respiratory failure
• Highly contagious!

Acute Stress reaction: hyperventilation freak out

• Hemiparesis: Weakness on one side
• Hemiplegia: Paralysis on one side

• Tonic: Sustained muscle contractions
• Clonic: Jerky violent movement

• Jacksonian: involve a progression of the location of the seizure in the brain, which leads to a "march" of the motor presentation of symptoms often beginning in the fingers moving proximally
• Focal Motor: seizure of hands and face

• BVM 15 Lpm 1:3
• Head raised 15°-20°

Vomit

Blood in vomit

• Hematemesis: Blood in vomit
• Hemoptysis: coughing up blood

Blood in urine

• Black tarry stool
• Blood has run most of GI tract

Red runny stool

• Abdominal Aortic Aneurysm
• Pathophysiology: The descending aorta ruptures due to a weakening in the aortic wall, usually due to atherosclerosis or congenital precondition
• Blood leaking from the aorta pools around the peritoneum

• Histamines: trigger the inflammatory response & increas the permeability of the capillaries to white blood cells and some proteins, to allow them to engage pathogens
• Leukotrienes: sustain inflammatory reactions & trigger contractions in the smooth muscles lining the trachea

• Insect stings, bites & animals
• Meds
• Plants
• Food
• Chemicals

• Opiate
• Analgesic - mild to moderate pain
• Relieves coughs
• Antidiarrheal

• “China White”
• Opioid
• Analgesic - for chronic pain
• 100 times more potent than morphine
• rapid onset and short duration of action

• Opiate: derived from poppy
• Opioid: synthetic & binds to opiod receptors

Opiate

• “Smack”
• semi-synthetic opioid drug synthesized from morphine

brand of a time-released formulation of morphine sulfate

• Analgesic - for acute & chronic pain
• Opiate

• opioid analgesic medication
• Analgesic - moderate to moderately severe acute or chronic pain

brand name of a time-release formula of oxycodone

• e.g.: Organophosphates
• SLUDGE
• Salivation
• Lacrimation (tears)
• Urination
• Defecation
• GI irritant
• Emesis

• Delirium: rapid onset, temp change of cog status => of an outside factor (eg booze)
• Dementia: progressive change in Mental Status over years

Mental Health Act: laws relating to consent from a crazy person

Only zap once!

• Premature separation of placenta from uterine wall
• s/s: bleeding & Pain

• Placenta partially or fully covers the cervix
• s/s: bleeding & NO Pain

• 1st: Dilation of cervix
• 2nd: Baby coming out
• 3rd: Delivery of placenta

• 15 foot
• 3x body height

250lbs

Spinal motion restriction

• ABCS
• CMS

• Spinal shock
• Damage to nerves affects control of muscle tone & therefore blood vessels too

• Neurogenic shock
• Damage to nerves affects control of muscle tone & therefore blood vessels too

• Severe chest injury / airway obstruction
• => Hypoxia

• Pt. freaks out causing generalized vascular dilation
• => Syncope

Electrolyte imbalance causes arrhythmia & neuro disfunction

• Compensated
• Decompensated
• Irreversible

• Greenstick: fracture in a young, soft bone in which the bone bends and partially breaks.
• Comminuted: broken into 2 or more pieces
• Pathological: => of weakened / diseased bone (eg: osteoporosis)
• Epiphysial: occurs during bone growth in a child

• compression of nerves, blood vessels, and muscle inside a closed space (compartment) within the body.
• leads to tissue death from lack of oxygenation due to the blood vessels being compressed by the raised pressure within the compartment.
• Because the connective tissue that defines the compartment does not stretch, a small amount of bleeding into the compartment, or swelling of the muscles within the compartment, can cause the pressure to rise greatly.

purple discoloration of the skin => of a bruise

• RICE
• Rest
• Immobilize
• Cold
• Elevate

• Inflammation of paranasal sinuses (above & around ears & nose)
• s/s: Headache / tenderness of upper jaw & teeth / Ear ache

Nose bleed

Separating various layers of soft tissue

• Pool of blood under damaged tissue
• Big ass bruise

• Superficial: (1st) only epidermis
• Partial thickness: (2nd) epidermis & Dermis. Super ouchy.
• Full thickness: (3rd) no pain @ 3rd, plenty @ 2nd
• Chemical: wet / dry
• Electrical: bzzzt

• FT: to hands
• FT: to feet
• FT: to face
• FT: to airway
• FT: to genitals
• FT: >10% of body area
• PT: >30% of body area
• Burns: with respiratory emergencies

• FT: >2% of body area
• PT: 15% to 30% of body area
• SF: >50% of body area

• FT: <2% of body area
• PT: <15% of body area

• Immerse or run under cool sterile water / saline
• <20% BSA = Wet Dressing
• >20% BSA = Dry Dressing
• Blanket
• Shock Tx

• Anterograde amnesia: loss of the ability to create new memories after the event
• Retrograde amnesia: loss of memories created prior to the event

Bleeding in anterior chamber of the eye

fracture of the walls or floor of the eye orbit: Intraorbital material may be pushed out into one of the paranasal sinuses.

One lung collapses & compresses heart and other lung

• Traumatic Asphyxia: sudden, severe compression of the chest causing a massive increase in intrathoracic pressure resulting in a reversal of blood flow through the circulatory system (possibly damaging heart valves)
• Often caused by holding your breath before impact

• Pericardial Tamponade
• -> JVD
• -> Narrowing pulse pressures
• -> Muffled heart sounds

Membranous folds attaching intestines to the body cavity

Respiratory Syncytial Virus: lower airway illness

• Rash
• Stiff neck

• Hypoventilation: respiratory acidosis & < hemoglobin affinity to O2
• Hyperventilation: respiratory alkalosis & ^ hemoglobin affinity to O2

Excess CO2 in blood

• OPA: corner of mouth to earlobe
• NPA: tip of nose to tragus, diameter bit smaller than pinky finger of pt, right nostril

Tongue

>95%

• >95%: OK
• 91%-94%: NC
• 86%-91%: NRB
• <85%: BVM

recommend reductions in both volume and speed at which rescuers provide ventilations, but only if supplemental oxygen is provided.

It’s stiffness or flexibility

Low blood pressure & poor perfusion