Emergency Care PDF
Preview Emergency Care
12th Edition This page intentionally left blank 12th Edition DANIEL LIMMER | MICHAEL F. O’KEEFE MEDICAL EDITOR EDWARD T. DICKINSON, MD, FACEP LEGACY AUTHORS Harvey D. Grant | Robert H. Murray, Jr. | J. David Bergeron Bradyis an imprint of Pearson Boston Columbus Indianapolis New York San Francisco Upper Saddle River Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montréal Toronto Delhi Mexico City São Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo Library of Congress Cataloging-in-Publication Data Emergency care.— 12th ed./ Daniel Limmer,Michael F.O’Keefe ;medical editor,Edward T.Dickinson ;legacy authors,Harvey D. Grant,Robert H.Murray,Jr.,J.David Bergeron. p.;cm. Includes index. ISBN-13:978-0-13-254380-4 ISBN-10:0-13-254380-X 1.Emergency medicine.2.First aid in illness and injury.3. Rescue work.4.Emergency medical personnel.I.Limmer,Daniel.II. O’Keefe,Michael F.III.Dickinson,Edward T. [DNLM:1.Emergency Medical Services—methods.2.Emergencies.3. Emergency Medical Technicians.4.Emergency Treatment—methods.WX 215] RC86.7.B68 2012 616.02'5—dc22 2010046129 Publisher:Julie Levin Alexander The material in this textbook contains the most current information available at Publisher’s Assistant:Regina Bruno the time of publication.However,federal,state,and local guidelines concerning Editor-in-Chief:Marlene McHugh Pratt clinical practices,including (without limitation) those governing infection control Acquisitions Editor:Sladjana Repic and universal precautions,change rapidly.The reader should note,therefore,that the Senior Managing Editor for Development:Lois Berlowitz new regulations may require changes in some procedures. Project Manager:Sandra Breuer It is the reader’s responsibility to familiarize himself or herself with the Editorial Assistant:Jonathan Cheung policies and procedures set by federal,state,and local agencies as well as the institution or agency where the reader is employed.The authors and the Director of Marketing:David Gesell publisher of this textbook and the supplements written to accompany it disclaim Executive Marketing Manager:Katrin Beacom any liability,loss,or risk resulting directly or indirectly from the suggested Marketing Manager:Brian Hoehl procedures and theory,from any undetected errors,or from the reader’s Marketing Coordinator:Michael Sirinides misunderstanding of the text.It is the reader’s responsibility to stay informed of Managing Editor for Production:Patrick Walsh any new changes or recommendations made by any federal,state,or local agency Production Liaison:Faye Gemmellaro/Yagnesh Jani as well as by his or her employing institution or agency. Production Editor:Heather Willison,S4Carlisle Publishing Services NOTICE ON GENDER USAGE Manufacturing Manager:Alan Fischer The English language has historically given preference to the male gender. Manager of Design Development:John Christiana Among many words,the pronouns heandhisare commonly used to describe Cover and Interior Design:John Christiana both genders.Society evolves faster than language,and the male pronouns still Cover Photography:foreground image,Michal Heron for predominate in our speech.The authors have made great effort to treat the two Pearson Education;background image,© Daniel Limmer genders equally,recognizing that a significant percentage of EMTs are female. Managing Photography Editor:Michal Heron However,in some instances,male pronouns may be used to describe both males Photographers:Nathan Eldridge,Michael Gallitelli,Michal and females solely for the purpose of brevity.This is not intended to offend any Heron,Ray Kemp/911 Imaging,Richard Logan readers of the female gender. Editorial Media Manager:Amy Peltier Media Project Manager:Lorena Cerisano NOTICE RE “STREET SCENES”AND “SCENARIOS” The names used and situations depicted in the Street Scenes and Scenarios Composition:S4Carlisle Publishing Services throughout this text are fictitious. Printer/Binder:RR Donnelley/Willard Cover Printer:Lehigh-Phoenix Color/Hagerstown NOTICE ON MEDICATIONS The authors and the publisher of this book have taken care to make certain that NOTICE ON CARE PROCEDURES the equipment,doses of drugs,and schedules of treatment are correct and It is the intent of the authors and publisher that this compatible with the standards generally accepted at the time of publication. textbook be used as part of a formal Emergency Medical Nevertheless,as new information becomes available,changes in treatment and in Technician (EMT) education program taught by the use of equipment and drugs become necessary.The reader is advised to qualified instructors and supervised by a licensed carefully consult the instruction and information material included in the page physician.The procedures described in this textbook are insert of each drug or therapeutic agent,piece of equipment,or device before based upon consultation with EMT and medical administration.This advice is especially important when using new or authorities.The authors and publisher have taken care to infrequently used drugs.Prehospital care providers are warned that use of any make certain that these procedures reflect currently drugs or techniques must be authorized by their Medical Director,in accord with accepted clinical practice;however,they cannot be local laws and regulations.The publisher disclaims any liability,loss,injury,or considered absolute recommendations. damage incurred as a consequence,directly or indirectly,of the use and application of any of the contents of this book. Copyright © 2012,2009,2005,2001,1998,1995 by Pearson Education,Inc.,Publishing as Pearson,1 Lake Street,Upper Saddle River,New Jersey,07458. All rights reserved.Manufactured in the United States of America.This publication is protected by Copyright,and permission should be obtained from the publisher prior to any prohibited reproduction,storage in a retrieval system,or transmission in any form or by any means,electronic, mechanical,photocopying,recording,or likewise.For information regarding permission(s),write to:Rights and Permissions Department. Pearson®is a registered trademark of Pearson plc. 10 9 8 7 6 5 4 3 2 1 ISBN-10 0-13-254380-X ISBN-13 978-0-13-254380-4 To the memory of my father, Darwin H. “Punk” Limmer, 1935–2007 D.L. To my parents, Mike and Noreen, my first and best teachers M.O’K. To Debbie, Stephen, and Alex for their endless love and extraordinary patience throughout this and many other projects E.T.D. This page intentionally left blank BRIEF CONTENTS SECTION 1 Foundations 3 Chapter 1• Introduction to Emergency Medical Care 4 Chapter 2• The Well-Being of the EMT 21 Chapter 3• Lifting and Moving Patients 48 Chapter 4• Medical, Legal, and Ethical Issues 74 Chapter 5• Medical Terminology and Anatomy and Physiology 92 Chapter 6• Principles of Pathophysiology 135 Chapter 7• Life Span Development 156 SECTION 2 Airway Management, Respiration, and Artificial Ventilation 171 Chapter 8• Airway Management 172 Chapter 9• Respiration and Artificial Ventilation 196 SECTION 3 Patient Assessment 243 Chapter 10• Scene Size-Up 244 Chapter 11• The Primary Assessment 264 Chapter 12• Vital Signs and Monitoring Devices 289 Chapter 13• Assessment of the Trauma Patient 315 Chapter 14• Assessment of the Medical Patient 350 Chapter 15• Reassessment 371 Chapter 16• Critical Thinking and Decision Making 381 Chapter 17• Communication and Documentation 393 SECTION 4 Medical Emergencies 423 Chapter 18• General Pharmacology 424 Chapter 19• Respiratory Emergencies 443 Chapter 20• Cardiac Emergencies 469 Chapter 21• Diabetic Emergencies and Altered Mental Status 505 Chapter 22• Allergic Reaction 530 Chapter 23• Poisoning and Overdose Emergencies 545 Chapter 24• Abdominal Emergencies 570 Chapter 25• Behavioral and Psychiatric Emergencies and Suicide 587 Chapter 26• Hematologic and Renal Emergencies 601 vii SECTION 5 Trauma Emergencies 615 Chapter 27• Bleeding and Shock 616 Chapter 28• Soft-Tissue Trauma 641 Chapter 29• Chest and Abdominal Trauma 679 Chapter 30• Musculoskeletal Trauma 695 Chapter 31• Trauma to the Head, Neck, and Spine 746 Chapter 32• Multisystem Trauma 791 Chapter 33• Environmental Emergencies 804 SECTION 6 Special Populations 835 Chapter 34• Obstetric and Gynecologic Emergencies 836 Chapter 35• Pediatric Emergencies 876 Chapter 36• Geriatric Emergencies 930 Chapter 37• Emergencies for Patients with Special Challenges 949 SECTION 7 Operations 973 Chapter 38• EMS Operations 974 Chapter 39• Hazardous Materials, Multiple-Casualty Incidents, and Incident Management 1006 Chapter 40• Highway Safety and Vehicle Extrication 1037 Chapter 41• EMS Response to Terrorism 1063 Appendices APPENDIX A • EMT Practice Examination 1098 APPENDIX B •Basic Cardiac Life Support Review 1124 APPENDIX C •Research and EMS 1143 Reference Section Anatomy and Physiology Illustrations 1150 Medical Terminology 1163 Answer Key 1170 Glossary 1239 Index 1255 viii www.bradybooks.com DETAILED CONTENTS SECTION 1 Foundations 3 Chapter 1 • Introduction to Emergency Medical Care 4 The Emergency Medical Services System 5 • Where Will You Become a Provider? 12 • How It Began 5 • National Registry of Emergency Medical • EMS Today 6 Technicians 13 • Quality Improvement 13 Components of the EMS System 7 • Medical Direction 15 • Accessing the EMS System 8 • Research 16 • Levels of EMS Training 8 • The EMS Role in Public Health 17 CRITICAL DECISION MAKING A Key Concept 9 • Special Issues 18 • Roles and Responsibilities of the EMT 10 • Traits of a Good EMT 11 Chapter Review 19 Chapter 2 • The Well-Being of the EMT 21 Well-Being 22 • Causes of Stress 38 • Signs and Symptoms of Stress 38 Personal Protection 23 • Dealing with Stress 39 • Standard Precautions 23 CRITICAL DECISION MAKING Standard Scene Safety 40 Precautions 24 • Hazardous Material Incidents 41 • Personal Protective Equipment 25 • Terrorist Incidents 42 Diseases of Concern 28 • Rescue Operations 42 • Emerging Diseases and Conditions 30 • Violence 42 • Infection Control and the Law 30 Chapter Review 46 • Immunizations 35 Emotion and Stress 35 • Physiologic Aspects of Stress 35 • Types of Stress Reactions 36 Chapter 3 • Lifting and Moving Patients 48 Protecting Yourself: Body Mechanics 49 CRITICAL DECISION MAKING Choosing a Patient-Carrying Device 64 Protecting Your Patient: Emergency, Urgent, and Non-Urgent Moves 51 Chapter Review 71 • Emergency Moves 52 • Urgent Moves 52 • Non-Urgent Moves 56 Chapter 4 • Medical, Legal, and Ethical Issues 74 Scope of Practice 75 • Good Samaritan Laws 83 • Confidentiality 83 Patient Consent and Refusal 76 • Special Situations 85 • Consent 76 • Crime Scenes 87 CRITICAL DECISION MAKING Ethical Dilemmas 76 • Special Reporting Requirements 88 • When a Patient Refuses Care 77 • Do Not Resuscitate Orders 80 Chapter Review 89 Other Legal Issues 81 • Negligence 81 • Duty to Act 83 ix
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