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The Legendary

Paramedic Education

Program is Now

Available in a New

Edition!

Emergency Care in the Streets, Seventh Edition

NANCY CAROLINE’S

SourceCode: CCIV_AW

THE COMPLETE 2-VOLUME SET

The Seventh Edition is the next step in the evolution of the premier paramedic education program.

This convenient 2-volume set features comprehensive coverage of every paramedic-level competency statement in the National Emergency Medical Services Education Standards. Working together, these dynamic and engaging volumes prepare the premier paramedics of tomorrow, today.

American Academy of Orthopaedic SurgeonsISBN- 13: 978-1-4496-4586-1Hardcover • 2200 Pages • © 2013

Seventh Edition highlights include:

• Strongcardiovascularemergencies,pathophysiology, and pharmacology focus

• Stressesclinicaldecisionmakingandsceneleadership

• AnewchapteronDisasterResponsethatcovers mass-fatality situations and natural disasters

• Updatedprogressivecasestudieswithcomplete patient care reports

• Focusondifferentialdiagnosis• Emphasisonaffectivebehaviorand

professionalism • RetainsDr.Caroline’sengagingtone,creative

teaching style, and street wisdom

Volume 1:

Chapters 1-28Preparatory Human Body and

Human Systems Pharmacology Patient Assessment Airway Management Medical

Volume 2:

Chapters 29-52 Trauma Shock and Resuscitation

Special Patient Populations

Operations

*Instructor and student resources cover both volumes.

New Chapters

Anatomy and Physiology Emergency Medications DiseasesoftheEyes,Ears,Nose,andThroatManagingtheFieldCodeManagementandResuscitationofthe Critical Patient Patients With Special Challenges DisasterResponse

The heart’s contractility allows it to increase or decrease the volume of blood it pumps with each contraction, also known as the stroke volume (SV) . The heart can also vary the speed at which it contracts by raising or lowering the pulse rate. Cardiac output (CO) is the volume of blood that the heart can pump per minute, and it is dependent on several factors. First, the heart must have adequate strength, which is largely determined by the ability of the heart muscle to contract. This ability to contract is referred to as myocardial contractility . Second, the heart must receive adequate blood to pump. As the volume of blood fl owing to the heart increases, the precontraction pressure in the heart builds up. This precontraction pressure is known as preload. The preload is the initial stretching of the cardiac muscles prior to contraction. It is related to the chamber volume of blood just prior to contraction. As preload increases, the volume of blood within the ventricles increases, which causes the heart muscle to stretch. When the muscle is stretched, myocardial contractility increases, leading to greater force of contraction and increased cardiac output. Lastly, the resistance to fl ow in the peripheral

6 Anatomy and Physiology of Perfusion

Perfusion is the circulation of blood within an organ or tissue in adequate amounts to meet the cells’ current needs for oxy-gen, nutrients, and waste removal. Perfusion requires having a working cardiovascular system. It also requires adequate gas exchange in the lungs, adequate nutrients in the form of glucose in the blood, and adequate waste removal, primarily through the lungs. Because tissue perfusion is primarily a function of the cardiovascular system, an examination of that system is impor-tant in understanding shock, or hypoperfusion .

To keep the blood moving continuously through the body, the cardiovascular system requires three intact components :

� A functioning pump: the heart � Adequate fl uid volume: the blood and body fl uids � An intact system of tubing capable of refl ex adjustments

(constriction and dilation) in response to changes in pump output and fl uid volume: the blood vessels

Your partner attempts to open the patient’s airway with a head tilt–chin lift maneuver. On the basis of your scene assessment, there is no indication that Mr. Oliver has fallen or sustained trauma that would necessitate taking spinal precau-tions. You suction the airway and remove loose but thick, light brown secretions. You note this stimulates his gag refl ex and induces coughing. You assess your patient’s breathing, and it is slightly labored with a respiratory rate of 24 breaths/min. Chest rise is equal bilaterally. Auscultation reveals scattered rales and rhonchi in all lung fi elds. You assess for a radial pulse and detect one that is weak with a rate of 120 beats/min. Your impression of his skin is that it is pale, mottled, cool, and clammy to touch. The patient appears to be critical, and a rapid assessment is indicated before initiating transport. Because the patient is nonverbal and unable to respond to your questions, you look to his home health aide for assistance. Your paramedic partner is assisting the patient’s ventilations with a bag-mask device and supplemental oxygen at 15 L/min.

You obtain a limited SAMPLE history from his aide. She tells you that Mr. Oliver had a terrible cough 3 days ago and a temperature of 101°F. She said he also reported pain when he took a deep breath. She told him she was concerned he may have pneumonia and should call his doctor. She knows he has an allergy to shellfi sh. His medications are in the kitchen, and she tells you he took them regularly as far as she knows. She hands you her information sheet on Mr. Oliver’s medical his-tory. You note he has a history of hypertension, chronic bronchitis, and had a myocardial infarction approximately 5 years ago. The aide is unsure as to when he last ate but tells you he refused lunch during her last visit when he said he had no appetite. She is not sure how long he has been like this or when his condition changed, but he normally walked daily around 8:00 AM . You recall the security offi cer telling you he did not see Mr. Oliver for his last two shifts.

3. Describe what contributing factors would lead you to label this patient as critical.

4. Discuss pathophysiologic changes associated with septic shock.

Your partner attempts to open the patient’s airway with a head tilt–chin lift maneuver. On the basis of your scene assessment, there is no indication that Mr. Oliver has fallen or sustained trauma that would necessitate taking spinal precau-tions. You suction the airway and remove loose but thick, light brown secretions. You note this stimulates his gag refl ex and induces coughing. You assess your patient’s breathing, and it is slightly labored with a respiratory rate of 24 breaths/min. Chest rise is equal bilaterally. Auscultation reveals scattered rales and rhonchi in all lung fi elds. You assess for a radial pulse and detect one that is weak with a rate of 120 beats/min. Your impression of his skin is that it is pale, mottled, cool, and clammy to touch. The patient appears to be critical, and a rapid assessment is indicated before initiating transport. Because the patient is nonverbal and unable to respond to your questions, you look to his home health aide for assistance. Your paramedic partner is assisting the patient’s ventilations with a bag-mask device and supplemental oxygen at 15 L/min.

You obtain a limited SAMPLE history from his aide. She tells you that Mr. Oliver had a terrible cough 3 days ago and a temperature of 101°F. She said he also reported pain when he took a deep breath. She told him she was concerned he may have pneumonia and should call his doctor. She knows he has an allergy to shellfi sh. His medications are in the kitchen, and she tells you he took them regularly as far as she knows. She hands you her information sheet on Mr. Oliver’s medical his-tory. You note he has a history of hypertension, chronic bronchitis, and had a myocardial infarction approximately 5 years ago. The aide is unsure as to when he last ate but tells you he refused lunch during her last visit when he said he had no appetite. She is not sure how long he has been like this or when his condition changed, but he normally walked daily around8:00 AM . You recall the security offi cer telling you he did not see Mr. Oliver for his last two shifts.

3. Describe what contributing factors would lead you to label this patient as critical.

4. Discuss pathophysiologic changes associated with septic shock.

YOU are the MedicOOOOOOOOOOUUUUUUUUUU YYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU aaaaaaaaaaaaaaarrrrrrrrrrrrrrreeeeeeeeeeeeeee ttttttttttttttthhhhhhhhhhhhhhheeeeeeeeeeeeeee MMMMMMMMMMMMMMMeeeeeeeeeeeeeeedddddddddddddddiiiiiiiiiiiiiiiccccccccccccccc PART 2

1886 Section 8 Shock and Resuscitation

41511_CH40_1880_1917.indd 1886 03/08/12 9:29 PM

Up Sloping Horizontal Down Sloping

Peaked / tented – the apex of the Twave elevates and forms a “peaked”

appearance

Symmetry – the T wave becomessymmetrical with respect to the Y axis

Broad base – the base of the Twave elongates during ischemia

Hyperacute – the height of the Twave exceeds ½ the overall height of

the QRS

Without ST-segment depression

With ST-segment depression

(V 4 to V

6 ) and/or the inferior leads. Reciprocal changes are never

seen in benign early repolarization. Pericarditis is the infl ammation of the pericardial

sac as a result of an infection (bacterial, viral, or fungal) or trauma. Patients can present with positional chest pain (often

alleviated by sitting forward), shortness of breath, and history of recent infection or fever. The condition is characterized by diffuse ST-segment elevation (not exceeding 5 mm) and a depressed or down-sloping PR segment . The PR segment is elevated or up-sloping in lead aVR. The ST seg-ment is concave in pericarditis, and reciprocal ST-segment depression is never seen.

Noncardiac Causes of ECG Abnormalities The remaining ECG abnormalities to be discussed are noncar-diac causes, including genetic disorders that affect the size or function of the heart.

Pulmonary Embolism A pulmonary embolism may also be iden-tifi ed on a 12-lead ECG. The criteria for suspecting this include the presence of an S1Q3T3 pattern, new RBBB, and ST-segment depression in leads V

1 to V

3

,, . The pattern refers to

a deep S wave in lead I, a deep, narrow Q wave in lead III, and T-wave inversion in lead III. This is also sometimes written as

Chapter 17 Cardiovascular Emergencies 983

09221_CH17_Printer.indd 983 23/11/11 12:17 PM

2 5 Wall Street | Burlington, MA | 01803 | 1-800-832-0034 | www.jblearning.com

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4

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