Lecture #13

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jessjohnson0617
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216211
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Lecture #13
Updated:
2013-04-28 02:03:30
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Thurston County EMT
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Description:
Abdominal Pain, Environmental Emergencies, OB-GYN
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  1. _____ of the blood is found in the venous system.
    2/3
  2. List the solid organs.
    • Liver
    • Pancreas
    • Kidneys
    • Spleen
    • adrenal glands
    • ovaries
  3. List the hollow organs
    • Stomach
    • gallbladder
    • duodenum
    • large intestine
    • small intestine
    • urinary bladder
    • falopian tubes
    • appendix
  4. List the organs in the right upper quadrant
    • liver (mostly all)
    • right kidney
    • colon
    • pancreas (a little bit of it)
    • gallbladder
  5. List the organs in the left upper quadrant
    • liver (a little bit of it)
    • spleen
    • left kidney
    • colon
    • pancreas (mostly all)
    • stomach
  6. List the organs in the left lower quadrant
    • right kidney
    • colon
    • small intestine
    • ureter
    • appendix
    • fallopian tubes
    • ovaries
    • uterus
  7. List the organs in the right lower quadrant
    • left kidney
    • colon
    • small intestine
    • ureter
    • fallopian tubes
    • ovaries
    • uterus
  8. List all the female organs
    • uterus
    • ovaries
    • fallopian tubes
    • cervix
    • vagina
  9. List the components of the GI tract
    • esophagus
    • stomach
    • small intestine
    • large intestine
    • rectum
  10. List the components of the genitourinary system
    • kidneys
    • ureters
    • bladder
    • urethra
  11. Define a abdominal aortic aneurysm
    a bulge in the wall of the aorta, possibly causing a rupture which will cause massive bleeding in the abdominal cavity
  12. List the s/s of an abdominal aortic aneurysm
    • 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
  13. Define an ectopic pregnancy
    implatation of placenta that occurs outside of the uterus (90% being in the fallopian tubes)
  14. List the s/s of a GI bleed
    • 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)
  15. Define and list the s/s of kidney stones
    • calcium crystals in the kidneys
    • hematuria
    • writhing pain
    • mimics an MI
    • pain comes in waves
    • diaphretic
    • nausea
    • vomiting
  16. List the s/s of an ectopic pregnancy
    • 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
  17. What are the ALS upgrades for abdominal/back pain?
    • 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
  18. What is the uterus?
    large female reproductive organ in lower abdomen where the fetus grows
  19. What is the vagina?
    lower part of the birth canal
  20. What is a fetus?
    developing unborn baby
  21. What is a placenta?
    fetal organ that provides perfusion from the uterus; filters; feeds the baby
  22. What is the umbilical chord?
    connects fetus to the placenta
  23. What is the amniotic sac?
    sac that surrounds the fetus in utero
  24. What is the perineum?
    skin area between vagina and anus
  25. What are the preterm emergencies?
    • emergencies that happen before 36 weeks such as...
    • miscarriage/spontaneous abortion
    • placenta previa
    • placental abruption
    • ectopic pregnancy
    • preterm bleed
    • preeclampsia/eclampsia
  26. Define and list s/s of a miscarriage
    • 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
  27. Define and list the s/s of placenta previa
    • when the placenta forms over part of or the entire cervix
    • bright red bleed in 2nd or 3rd trimester
    • always painless
  28. Define and list s/s of placental abruption
    • premature separation of placenta from uterus in the 2nd or 3rd trimester, usually from trauma
    • abdominal pain with bleeding that is usually dark red
  29. If ectopic pregnancy is high on your index of suspicion, what are the questions you should ask?
    • last menstral cycle?
    • is that length of time normal?
  30. Until proven otherwise, an ectopic pregnancy should be assumed in who?
    any female of childbearing age with s/s of shock
  31. What is the treatment for a preterm bleed?
    • 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
  32. What are the ALS upgrades in pregnancy?
    • 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
  33. At what point does preeclampsia become eclampsia?
    when seizures begin
  34. When deciding to do an vaginal exam, what are the 4 things you should consider?
    • HCCB...
    • history - 36-40wks
    • contraction less than 2 mins apart, lasting at least one minute
    • crowning
    • bowel movement
  35. What are the signs of imminent delivery?
    • 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
  36. What is the minimum BSI needed for child birth?
    gloves, goggles, splash protection (dexter mask)
  37. What is meconium and why can it be a cause for concern?
    • baby's first bowel movement
    • if it occurs in utero, baby will aspirate it causing pneumonia
  38. Once the umbilical cord is cut, what should you do next?
    • Do What Probably Seems Simple
    • D - dry
    • W - warm
    • P - position
    • S - suction
    • S - stimulate
  39. What is a nuchal cord and how do you remedy it?
    • 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
  40. Why is it best for mom to start breastfeeding right after delivery?
    • 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
  41. What does APGAR stand for?
    • appearance
    • pulse
    • grimace
    • activity
    • respiratory effort
  42. What do the three stages of labor consist of?
    • 1st stage - dilation of cervix to ~10 cm
    • 2nd stage - baby!
    • 3rd stage - placenta
  43. What should you do/not do in regards to the delivery of the 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
  44. What are the three steps to control postpartum hemorrhage?
    • 1st treatment - have baby breastfeed
    • 2nd treatment - place sanitary napkin in between mom's legs
    • 3rd treatment - uterine massage
  45. What is the definition of a neonate?
    1-30 days old
  46. If the neonate's HR is 0-59 beats per minute, the EMT should...
    perform neonatal resuscitation for 1 minute
  47. If the neonate's HR is 60-99 beats per minute, the EMT should...
    perform rescue breathing using a BVM at a rate of 40-60 breaths per minute
  48. How do you give neonatal resuscitation?
    • depth of compression - 1/3 depth of chest
    • rate of compression - 120/minute
    • compression/ventilation ration - 3:1
    • rescue breathing rate - 40-60/minute
  49. Define breech
    body part of than head presents in childbirth
  50. What should the EMT do if breech is present?
    • do not attempt to deliver
    • ensure cord is not compressed
    • place mother in knee-chest position
    • transport immediately
  51. What is a prolapsed cord and what should the EMT do if it is found?
    • when the cord precedes the baby
    • place the mother in knee-chest position
    • place a finger on either side of the cord
    • transport immediately
  52. If you notice meconium staining in the amniotic fluid, what should you do?
    • suction the airway before delivery is complete suction the mouth thoroughly before suctioning the nose
    • arrange for an ALS rendezvous
  53. What is the definition of hypothermia?
    the body has lost more heat than gained (e.g. - cold weather, cold floors)
  54. What is the definition of hyperthermia?
    the body has more heat gain than loss (e.g. - hot weather, sickness, firefighting)
  55. What are the types of heat loss?
    • conduction
    • convection
    • radiation
    • evaporation
    • respiration
  56. What are the questions the EMT should ask a hypothermic patient?
    • 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 - generalĀ  or localized
  57. What is the mamallian dive reflex?
    a protective state in the body's natural response to hypothermia
  58. What are the stages of 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
  59. What are the factors affecting hypothermia?
    • 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
  60. What are the s/s of generalized (whole body) hypothermia?
    • 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
  61. What is the care for hypothermia?
    • 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
  62. What are the s/s of localized cold injuries?
    • 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
  63. Should you move a frostbitten extremity? Why/why not?
    no, because frozen crystals can cause trauma/lacerations
  64. In addition to care for generalized hypothermia, care for frostbite should include...
    • cover with dry clothing/dressing
    • separate digits
    • do not: break blisters, walk on extremity, rub or massage, apply heat, re-warm
  65. What are the predisposing factors for hyperthermia?
    • exercize/activity
    • age (young - can't remove clothing/poor thermoregulation; old - meds, limited mobility, poor thermoregulation)
    • illness - heart disease, obesity, fever, fatigue, diabetes, dehydration
  66. What are the s/s of a heat injuries?
    • 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
  67. What is the care for hyperthermia?
    • 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
  68. What are the questions an EMT should ask in dive related injuries?
    • 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?
  69. Where is the nearest hyperbaric chamber?
    virginia mason and everett naval base
  70. What is an air embolism and what are the s/s?
    • 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
  71. What is a decompression injury and what are the s/s?
    • 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
  72. What is the care for dive related injuries?
    • ensure ABCs
    • give O2 by NRB or BVM
    • transport rapidly supine on either side
    • prep for suction
    • gather info on dive (time, depth, accent)
  73. What is the care for a near drowning?
    • ensure ABCs
    • consider spinal immobilization
    • high flow O2
    • prep for suctioning since vomiting is normal
    • position on left side
    • transport and vitals
  74. What are the ALS upgrades for environmental emergencies?
    • altered or decreased LOC
    • rectal temp below 95 or above 105
    • pt is very cold (on belly or chest) to touch without shivering
  75. What are the s/s of bites and stings?
    • localized pain at site of bite or sting
    • redness/swelling
    • weakness
    • dizziness
    • chills/fever
    • nausea/vomiting
    • bite marks/stinger
  76. What are the bite/sting ALS upgrades?
    • bite from poisonous snake or reptile
    • serious injury to face or neck
  77. What is the care of bite/sting injuries?
    • 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

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