Essentials of Paramedic Care Update: Pearson New International Edition

2041 Pages·2013·84.808 MB·English

by  Bryan E. Bledsoe, Robert S. Porter, Richard A. Cherry

Pearson New International Edition

Essentials of Paramedic Care Update
Bryan E. Bledsoe Robert S. Porter
Richard A. Cherry
Second Edition
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ISBN 10: 1-292-03923-X
ISBN 13: 978-1-292-03923-7
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ISBN 10: 1-292-03923-X
ISBN 10: 1-269-37450-8
ISBN 13: 978-1-292-03923-7
ISBN 13: 978-1-269-37450-7
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P E A R S O N C U S T O M L I B R AR Y
Table of Contents
1. Glossary
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1
2. Introduction to Advanced Prehospital Care
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 43
3. Medical/Legal Aspects of Advanced Prehospital Care
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 107
4. Anatomy and Physiology
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 129
5. General Principles of Pathophysiology
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 285
6. Life-Span Development
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 337
7. General Principles of Pharmacology
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 353
8. Intravenous Access and Medication Administration
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 421
9. Airway Management and Ventilation
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 503
10. Therapeutic Communications
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 583
11. History Taking
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 599
12. Physical Exam Techniques
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 619
13. Patient Assessment in the Field
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 707
I
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14. Clinical Decision Making
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 761
15. Communications
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 775
16. Documentation
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 795
17. Trauma and Trauma Systems
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 819
18. Blunt Trauma
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 831
19. Penetrating Trauma
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 865
20. Hemorrhage and Shock
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 885
21. Soft-Tissue Trauma
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 917
22. Burns
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 957
23. Musculoskeletal Trauma
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 991
24. Head, Facial, and Neck Trauma
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1027
25. Spinal Trauma
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1071
26. Thoracic Trauma
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1103
27. Abdominal Trauma
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1135
28. Pulmonology
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1155
29. Cardiology
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1197
30. Neurology
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1319
31. Endocrinology
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1357
II
111111111111111111334444555666788888780378279047502378359339315513771939
32. Allergies and Anaphylaxis
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1373
33. Gastroenterology
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1385
34. Urology and Nephrology
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1409
35. Toxicology and Substance Abuse
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1433
36. Hematology
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1473
37. Environmental Emergencies
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1489
38. Infectious Disease
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1523
39. Psychiatric and Behavioral Disorders
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1571
40. Gynecology
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1595
41. Obstetrics
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1605
42. Neonatology
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1641
43. Pediatrics
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1673
44. Geriatric Emergencies
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1757
45. Abuse and Assault
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1807
46. The Challenged Patient
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1821
47. Acute Interventions for the Chronic-Care Patient
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1839
48. Assessment-Based Management
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1873
49. Operations
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1889
III
122900801755
50. Responding to Terrorist Acts
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 1987
51. Further Reading
Bryan E. Bledsoe/Robert S. Porter/ Richard A. Cherry 2005
Index 2015
IV
W
1
Glossary
10-code radio communications system using codes acquired immunity immunity that develops over
that begin with the word ten. time and results from exposure to an antigen or that
2,3-diphosphoglycerate (2,3-DPG) chemical in the is transferred to the person from an outside source.
red blood cells that affects hemoglobin’s affinity for acquired immunodeficiency syndrome seeAIDS.
oxygen. acrocyanosis cyanosis ofthe extremities.
abandonment termination ofthe paramedic-patient action potential the stimulation ofmyocardial cells,
relationship without assurance that an equal or as evidenced by a change in the membrane electrical
greater level ofcare will continue. charge,that subsequently spreads across the
ABCs airway,breathing,and circulation. myocardium.
abduction movement ofa body part away from the activated charcoal a powder,usually premixed with
midline. water,that will adsorb (bind) some poisons and
aberrant conduction conduction ofthe electrical help prevent them from being absorbed by the body.
impulse through the heart’s conductive system in an active immunity acquired immunity that occurs
abnormal fashion. following exposure to an antigen and results in the
ABO blood groups four blood groups formed by the production ofantibodies specific for the antigen.
presence or absence oftwo antigens known as A and active listening the process ofresponding to a
B.A person may have either (type A or type B),both person’s statements with words or gestures that
(type AB),or neither (type O).An immune demonstrate your understanding.
response will be activated whenever a person active rescue zone area where special rescue teams
receives blood containing A or B antigen ifthis operate;also known as the hot zoneor inner circle.
antigen is not already present in his own blood. active transport movement ofa substance through a
abortion termination ofpregnancy before the 20th cell membrane against the osmotic gradient;that is,
week ofgestation.The term refers to both from an area oflesser concentration to an area of
miscarriage and induced abortion.Commonly, greater concentration,opposite to the normal
abortionis used for elective termination of direction ofdiffusion;requires the use ofenergy to
pregnancy and miscarriagefor the loss ofa fetus by move a substance.
natural means.A miscarriage is sometimes called a actual damages refers to compensable physical,
“spontaneous abortion.” psychological,or financial harm.
abrasion scraping or abrading away ofthe superficial acuity the severity or acuteness ofa patient’s condition.
layers ofthe skin;an open soft-tissue injury. acute arterial occlusion the sudden occlusion of
abruptio placentae a condition in which the placenta arterial blood flow.
separates from the uterine wall. acute coronary syndrome (ACS) a spectrum of
absence seizure type ofgeneralized seizure with disease processes,from myocardial ischemia and
sudden onset,characterized by a briefloss of injury to myocardial infarction.
awareness and rapid recovery. acute effects signs and/or symptoms rapidly
absolute refractory period the period ofthe cardiac displayed on exposure to a toxic substance.
cycle when stimulation will not produce any acute gastroenteritis sudden onset ofinflammation
depolarization whatsoever. ofthe stomach and intestines.
acceleration the rate at which speed or velocity acute myocardial infarction (AMI) seemyocardial
increases. infarction.
acclimatization the reversible changes in body acute pulmonary embolism blockage that occurs
structure and function by which the body becomes when a blood clot or other particle lodges in a
adjusted to a change in environment. pulmonary artery.
acetylcholinesterase (AChE) enzyme that stops the acute renal failure (ARF) the sudden onset of
action ofacetylcholine,a neurotransmitter. severely decreased urine production.
acid a substance that liberates hydrogen ions (H(cid:2)) acute respiratory distress syndrome (ARDS)
when in solution. respiratory insufficiency marked by progressive
acidosis a high concentration ofhydrogen ions;a pH hypoxemia,due to severe inflammatory damage;
below 7.35. also known as adult respiratory distress syndrome.
From the Glossary ofEssentials ofParamedic Care,Second Edition Update.Bryan E.Bledsoe,Robert S.Porter,and Richard A.Cherry.
Copyright © 2011 by Pearson Education,Inc.All rights reserved.
Glossary
acute retinal artery occlusion a nontraumatic aeromedical evacuations transport by helicopter or
occlusion ofthe retinal artery resulting in a sudden, fixed-wing aircraft.
painless loss ofvision in one eye. affect visible indicators ofmood.
acute tubular necrosis a syndrome characterized by affinity force ofattraction between a drug and a
the sudden death ofrenal tubular cells. receptor.
addendum addition or supplement to an original afterbirth the placenta and accompanying
report. membranes that are expelled from the uterus after
addiction compulsive and overwhelming the birth ofa child.
dependence on a drug;an addiction may be a afterload the resistance against which the heart must
physiological dependence,a psychological pump.
dependence,or both. against medical advice (AMA) when a patient
Addison’s disease endocrine disorder characterized refuses care even though he is told he needs it.
by adrenocortical insufficiency.Symptoms may ageism discrimination against aged or elderly people.
include weakness,fatigue,weight loss,and aggregate to cluster or come together.
hyperpigmentation ofskin and mucous agonist drug that binds to a receptor and causes it to
membranes. initiate the expected response.
Addisonian crisis form ofshock associated with agonist-antagonist (partial agonist) drug that binds
adrenocortical insufficiency and characterized by to a receptor and stimulates some ofits effects but
profound hypotension and electrolyte imbalances. blocks others.
adduction movement ofa body part toward the AIDS acronym for acquired immunodeficiency
midline. syndrome,a group ofsigns,symptoms,and
adenosine triphosphate (ATP) a high-energy disorders that often develop as a consequence of
compound present in all cells,especially muscle HIV infection.
cells;when split by enzyme action it yields energy. air embolism air in the vein.
Energy is stored in ATP. airborne transmitted through the air by droplets or
adhesion union ofnormally separate tissue surfaces particles.
by a fibrous band ofnew tissue. air-purifying respirator (APR) system offiltering a
adjunct medication agent that enhances the effects normal environment for a specific chemical
ofother drugs. substance,using filter cartridges.
administration tubing flexible,clear plastic tubing albumin a protein commonly present in plant and
that connects the solution bag to the IV cannula. animal tissues.In the blood,albumin works to
administrative law law that is enacted by maintain blood volume and blood pressure and
governmental agencies at either the federal or state provides colloid osmotic pressure,which prevents
level.Also called regulatory law. plasma loss from the capillaries.
adrenergic pertaining to the neurotransmitter algorithm schematic flow chart that outlines
norepinephrine.See alsosympathomimetic. appropriate care for specific signs and symptoms.
adult respiratory distress syndrome (ARDS) form alimentary canal seedigestive tract.
ofpulmonary edema that is caused by fluid alkali a substance that liberates hydroxyl ions (OH–)
accumulation in the interstitial space within the when in solution;a strong base.
lungs;also known as acute respiratory distress alkalosis a low concentration ofhydrogen ions;a pH
syndrome. above 7.45.
advance directive a document created to ensure that allergen a substance capable ofinducing allergy of
certain treatment choices are honored when a specific hypersensitivity.Allergens may be protein or
patient is unconscious or otherwise unable to non-protein,although most are proteins.
express his choice oftreatment. allergic reaction an exaggerated response by the
advanced life support (ALS) life-support activities immune system to a foreign substance.
that go beyond basic procedures to include allergy exaggerated immune response to an
adjunctive equipment and invasive procedures such environmental antigen.
as intravenous therapy,drug therapy,intubation, allied health professions ancillary health care
and defibrillation. professions,apart from physicians and nurses.
aerobic metabolism the second stage ofmetabolism, alloimmunity seeisoimmunity.
requiring the presence ofoxygen,in which the alveoli microscopic air sacs in the lungs where most
breakdown ofglucose (in a process called the Krebs oxygen and carbon dioxide gas exchanges take place.
or citric acid cycle) yields a high amount ofenergy. Alzheimer’s disease a degenerative brain disorder;
Aerobicmeans “with oxygen.” the most common cause ofdementia in the elderly.
2
Glossary
amnesia seeanterograde amnesia;retrograde amnesia. angiocatheter seeover-the-needle catheter.
amniotic fluid clear,watery fluid that surrounds and angioneurotic edema marked edema ofthe skin that
protects the developing fetus. usually involves the head,neck,face,and upper
amniotic sac the membranes that surround and airway;a common manifestation ofsevere allergic
protect the developing fetus during intrauterine reactions and anaphylaxis.
development. anion ion with a negative charge—so called because
ampere basic unit for measuring the strength ofan it will be attracted to an anode,or positive pole.
electric current. anorexia lack ofappetite.
amphiarthrosis joint that permits a limited amount anorexia nervosa psychological disorder
ofindependent motion. characterized by voluntary refusal to eat.
ampule breakable glass vessel containing liquid anoxia the absence or near absence ofoxygen.
medication. anoxic hypoxemia an oxygen deficiency due to
amputation severance,removal,or detachment, disordered pulmonary mechanisms ofoxygenation.
either partial or complete,ofa body part. antacid alkalotic compound used to increase the
amyotrophic lateral sclerosis (ALS) progressive gastric environment’s pH.
degeneration ofspecific nerve cells that control antagonist drug that binds to a receptor but does not
voluntary movement characterized by weakness, cause it to initiate the expected response.
loss ofmotor control,difficulty speaking,and antepartum before the onset oflabor.
cramping.Also called Lou Gehrig’s disease. anterior cord syndrome condition that is caused
anabolism the constructive or “building up”phase of by bony fragments or pressure compressing the
metabolism in which cells convert nonliving arteries of the anterior spinal cord and resulting
substances into living cytoplasm. in loss of motor function and sensation to pain,
anaerobic able to live without oxygen. light touch,and temperature below the injury
anaerobic metabolism the first stage ofmetabolism, site.
which does not require oxygen,in which the anterior medial fissure deep crease along the ventral
breakdown ofglucose (in a process called glycolysis) surface ofthe spinal cord that divides the cord into
produces pyruvic acid and yields very little energy. right and left halves.
Anaerobicmeans “without oxygen.” anterograde amnesia inability to remember events
analgesia the absence ofthe sensation ofpain. that occurred after the trauma that caused the
analgesic medication that relieves the sensation ofpain. condition.See alsoretrograde amnesia.
anaphylactic shock seeanaphylaxis. antiadrenergic seesympatholytic.
anaphylaxis an unusual or exaggerated allergic antibiotic agent that kills or decreases the growth of
reaction to a foreign protein or other substance;also bacteria.
called anaphylactic shock.Anaphylaxismeans the antibody a substance produced by B lymphocytes in
opposite ofphylaxis,which means “protection.” response to the presence ofa foreign antigen that
anastomosis communication between two or more will combine with and control or destroy the
vessels. antigen,thus preventing infection.See also
anatomy the structure ofan organism;body structure. immunoglobulin (IG).
anchor time set ofhours when a night-shift worker anticholinergic seeparasympatholytic.
can reliably expect to rest without interruption. anticoagulant drug that inhibits blood clotting.
anemia a reduction in red blood cells or in the antidiuresis formation and passage ofa
hemoglobin content within the red blood cells to a concentrated urine,preserving blood volume.
point below that required to meet the oxygen antidote a substance that will neutralize a specific
requirements ofthe body. toxin or counteract its effect on the body.
anesthesia the absence ofall sensations. antidysrhythmic drug used to treat and prevent
anesthetic medication that induces a loss of abnormal cardiac rhythms.
sensation to touch or pain. antiemetic medication used to prevent vomiting.
aneurysm the ballooning ofan arterial wall, antigen a marker on the surface ofa cell that
resulting from a defect or weakness in the wall. identifies it as “self”or “non-self”and that is
anger hostility or rage to compensate for an capable,under appropriate conditions,ofinducing
underlying feeling ofanxiety. a specific immune response.
angina pectoris chest pain that results when the antihistamine medication that arrests the effects of
myocardial demand for oxygen exceeds the heart’s histamine by blocking its receptors.
ability to deliver an adequate supply ofoxygenated antihyperlipidemic drug used to treat high blood
blood to the myocardium. cholesterol.
3