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Prehospital Physical Assessment and Critical Interpretation of Vital Signs

Questions and Answers 1 Why is it important to have a systematic approach to the evaluation of a seriously ill or injured child? It is important because it will help the provider quickly recognize clear signs of respiratory distress, respiratory failure, and shock, as well as immediately provide lifesaving procedures once these signs are identified. 2 According to the American Heart Association (AHA) Pediatric Advanced Life…

Care of the Entrapped Patient Including Crush Injuries

Questions and Answers 1 Why is scene safety so important? There are a variety of scenarios to which EMS providers will be called. When discussing patient extrications, the majority will be from severe motor vehicle accidents. There are also many possible industrial and agricultural accidents, as well as the rare but catastrophic natural disasters and acts of terrorism. Extreme caution must be used to avoid secondary…

Thermal Burns and Inhalational Injuries

Questions and Answers 1 What characteristics describe the various degrees of burns? The historical classification of burns was first established almost 200 years ago and was based on the depth of the burn and is still utilized today. First-degree burns are superficial. Second-degree burns are partial-thickness. Third-degree burns are full-thickness. Although less frequently utilized, higher-grade burn descriptions also exist. Fourth-degree burns extend into the underlying soft tissue.…

Extremity Injuries

Questions and Answers 1 You are called to the scene of a 78-year-old male who was involved in a motor vehicle collision after he ran a red light. He is reporting pain in his right wrist and left leg. Describe the initial evaluation of the patient’s extremities after completion of the initial Basic Life Support (BLS) assessment. Once basic life support has been completed, a secondary…

Chest, Abdominal, and Pelvic Injuries

Questions and Answers 1 How should chest trauma be evaluated? Patients suffering from significant chest trauma may complain of chest pain, shortness of breath, back or flank discomfort, or abdominal pain. Significant injuries may be accompanied by tachycardia, tachypnea, hypotension, and hypoxia. The first step is visual inspection of the patient. How is the work of breathing—is there any splinting or flail chest? Further inspection should…

Cervical Spine and Spinal Cord Injuries

Questions and Answers 1 How common are traumatic spine injuries (TSIs)? There are an estimated 12,000 injuries per year in the United States, with the majority occurring as a result of motor vehicle crashes and falls. 2 Why is this subject important? The morbidity associated with severe TSI results in significant change in quality of life and financial costs. Patients with severe TSI have significant reductions…

Head Injuries and Facial Trauma

Questions and Answers 1 What is the anatomy of the brain and pathophysiology of injury? Familiarity with the anatomy leads to an understanding of the pathophysiology of traumatic brain injury. The skull is a hard area with a fixed volume. Contact of the brain against the bone of the skull can cause primary injury. The fixed volume of the skull allows for little room for any…

General Adult Trauma Principles and Triage

Questions and Answers 1 What is a traumatic injury? A traumatic injury is a term that refers to physical injuries of sudden and onset severity. These injuries require immediate medical attention as they can sometimes be life-threatening. Trauma makes up a significant percentage of the calls to which prehospital personnel respond and is the leading cause of death for those between the ages of 1 and…

Syncope

Questions and Answers 1 What is syncope? Syncope, commonly known as fainting, is a sudden and self-limited loss of consciousness with loss of postural tone. It is a symptom, not a diagnosis. Following an episode of syncope, patients should also experience a rapid and complete return to baseline. 2 What mechanism causes syncope? Syncope is due to a temporary episode of insufficient blood flow to the…

Stroke and Transient Ischemic Attack

Questions and answers 1 What is a stroke? A stroke, more formally termed a cerebrovascular accident (CVA), is any event that disrupts blood supply to the brain and causes neurologic compromise. It is important to diagnose and treat early as lack of blood supply to the brain equates to lack of oxygen and nutrients thus leading to irreversible cell death. 2 What is a transient ischemic…

Seizures

Questions and answers 1 What is a seizure? A seizure occurs when there is an abnormal surge of coordinated electrical impulses in the brain. It can have many different objective appearances such as shaking of the whole body, part of the body, or staring off. Seizures themselves are not a disease, but rather they are a symptom of several different disorders. 2 What types of seizures…

Dyspnea

Questions and Answers 1 What is dyspnea? The word stem dys- means difficult and -pnea means breath. Combined, the word dyspnea means difficult breath. The symptom of dyspnea or shortness of breath is very subjective and is included in the patient’s history. 2 How is respiratory distress described and documented? General inspection: While collecting the history, you will already have begun a general examination of the…

Obstetric and Gynecologic Emergencies

Questions and Answers Obstetrical and Gynecologic Emergencies 1 What are the typical expected physiologic/anatomic changes in pregnancy? A number of changes occur. Average weight gain is 25–35 lbs (11.5–16 kg). Most weight gain is from the enlarged uterus/fetus, blood volume, breast tissue, and extracellular fluid. Physiologic changes include 1500 mL increase in blood volume, heart rate increases of 15 to 20 bpm, increased cardiac output (30%–50% above baseline), and…

Sepsis

Questions and Answers 1 What is sepsis and why is it important? Describing sepsis, Sir William Osler wrote: “Except on few occasions, the patient appears to die from the body’s response to infection rather than from (the infection itself).” Simply put, sepsis is a dysregulated exaggeration of the normal immune mechanisms set in place to fight infection. Sepsis may be caused by any infection, including bacterial,…

Diabetic Emergencies

Questions and Answers Case: A neighbor calls 911 for someone continuously pounding trying to enter the apartment next door. They are worried that the person knocking is high on drugs. Police arrive to a confused male in his 20s and recognize a medical emergency. EMS is called. Meanwhile, the pale, diaphoretic male passes out across the doorway. With the noise of the sirens, the patient’s girlfriend…

Gastrointestinal Emergencies

Questions and answers 1 What elements of history are helpful to elicit from a patient with abdominal pain? Establish the location, severity, duration, and a description of the pain. Any associated symptoms, such as fevers, vomiting, diarrhea, dysuria, hematuria, or passing out, should be noted. Identify factors that improve or worsen the pain, such as movement or eating. Ask about any recent trauma. Women of childbearing…

Cardiac Device Emergencies

Questions and answers Case: You arrive on scene to find a 69-year-old female with a past medical history of atrial fibrillation, hypertension, and heart failure and an implantable defibrillator with a pacemaker. She called because her defibrillator shocked her. 1 What are the types of implantable devices and their purposes? An implantable pacemaker is used to ensure that the heart rate is adequate when the native…

Cardiac Emergencies—Chest Pain, Stemi, ACS, CHF

Chest Pain 1 Name some life-threatening causes of chest pain. Chest pain can be due to a variety of causes. In the prehospital setting, it is always important to consider some of the more life-threatening etiologies to chest pain. Listed here are the “serious 6” concerning etiologies for chest pain: Tension pneumothorax Pulmonary embolism (PE) Ruptured esophagus Cardiac tamponade Aortic dissection Acute coronary syndrome (ACS) 2…

Arrhythmias and Electrocardiogram Interpretation

Questions and Answers 1 What is an EKG? An electrocardiogram (EKG/ECG) is a graphic recording of electrical potentials produced by the cardiac tissue and measured by electrodes placed at different sites on the body. 2 How does electrical activity travel through the heart? Cardiac conduction typically starts at the sinoatrial (SA) node near the top of the right atrium ( Fig. 14.1 ). This impulse carries across…

Altered Mental Status

Questions and Answers 1 What does altered mental status mean? Altered mental status is a disorder of consciousness; disorders of consciousness are divided into issues of arousal, thought content, or some combination of both. Dementia is more progressive in nature. Coma can be acute or progressive. Delirium is typically more abrupt in onset, over hours or days. Both coma and delirium can fall under the category…