Advanced Medical Life Support

by Dalton, Twink M.; Limmer, Daniel, EMT-P; Mistovich, Joseph J.; Werman, Howard

• ISBN13: 9780131723405
• ISBN10: 0131723405
• Edition: 3rd
• Format: Paperback
• Copyright: 2006-08-04
• Publisher: Prentice Hall

Summary

Going above andbeyondthe new DOT curriculum, this book offers a high levelyet practicalapproach to the assessment, diagnosis and treatment of thefull rangeof adult medical emergencies. Each well-illustrated chapter discusses realistic methods that a seasoned EMS practitioner would usemoving from assessment-based procedures with initial management of the threats, to field diagnosis and management of treatable underlying causes. Includes real-world case studies. Assumes a familiarity with anatomy, physiology, and pathophysiology, and an overall understanding of the nature of medical emergencies.Assessment of the Medical Patient. Airway Management, Ventilation, and Oxygenation Therapy. IV Access and Medication Administration. Hypoperfusion (Shock). Dyspnea. Chest Pain. Altered Mental Status. Acute Abdominal Pain. Gastrointestinal Bleeding. Seizures and Seizure Disorders. Syncope. Headache, Nausea, and Vomiting. Case Studies.For EMTs, paramedics, nurses, and others involved in emergency medical care.

Author Biography

Twink Dalton is a nurse and a paramedic.   She worked as an Emergency Department nurse, worked with EMS training programs, was a trauma coordinator and worked with the Omaha Fire Department and Pridemark Paramedic Services.   She is now the Director of the EMS Division of the Mountain View Fire Protection District.  Twink lectures nationally and is a well known author.

Table of Contents

Preface	xi
Acknowledgments	xiii
Assessment of the Medical Patient	1	(72)
Introduction	2	(2)
Categorize the Patient: Medical versus Trauma	2	(2)
Components of the Medical Assessment	4	(1)
Dispatch Information	5	(1)
Scene Size-Up	6	(10)
Body Substance Isolation	6	(3)
Scene Safety	9	(2)
Nature of the Illness	11	(1)
Number of Patients	12	(1)
Additional Resources	12	(1)
Agents of Terrorism	13	(2)
Entering the Scene	15	(1)
Physiologically Stable or Unstable Criteria	16	(2)
Initial Assessment	18	(15)
Form a General Impression	18	(2)
Assess Mental Status	20	(2)
Assess the Airway	22	(2)
Assess Breathing	24	(3)
Assess Circulation	27	(5)
Establish Patient Priorities	32	(1)
Focused History and Physical Exam	33	(27)
Responsive Patient	34	(12)
Unresponsive or Altered Mental Status Patient	46	(14)
Possibilities to Probabilities: Forming a Differential Field Diagnosis	60	(8)
Detailed Physical Exam	68	(1)
Ongoing Assessment	68	(5)
Airway Management, Ventilation, and Oxygen Therapy	73	(50)
Anatomy and Physiology	74	(5)
Upper Airway Anatomy	74	(1)
Upper Airway Physiology	75	(1)
Lower Airway Anatomy	76	(1)
Respiratory Physiology	77	(2)
Oxygen Supplementation	79	(1)
Airway Management	80	(1)
Ventilation Equipment and Techniques	80	(1)
Tracheal Intubation	81	(5)
Alternative Methods of Intubation	86	(6)
Nasotracheal Intubation	86	(3)
Digital Intubation	89	(1)
Lighted-Stylet Intubation	90	(2)
Alternative Airway Devices	92	(8)
Pharyngeotracheal Lumen Airway	93	(2)
Esophageal-Tracheal Combitube Airway	95	(2)
Laryngeal Mask Airway	97	(3)
Surgical Techniques of Airway Control	100	(9)
Percutaneous Transtracheal Jet Ventilation	103	(2)
Retrograde Intubation	105	(2)
Surgical Cricothyroidotomy	107	(2)
Rapid Sequence Intubation	109	(6)
General Procedure	110	(2)
Sedative Agents	112	(1)
Neuromuscular Blockade	113	(2)
Guidelines for Airway and Ventilation Support	115	(8)
Patient Assessment	115	(2)
Patient Monitoring	117	(6)
Access and Medication Administration	123	(24)
Introduction	124	(1)
Medication Administration	124	(1)
Medication Administration Methods	125	(1)
Venous Access	126	(11)
Decision Making	126	(1)
Peripheral and Central Lines	126	(1)
Performing Venipuncture	127	(10)
Intraosseous Infusion	137	(1)
Delivering Medication by Injection	138	(6)
Intramuscular Injection	139	(3)
Subcutaneous Injection	142	(2)
Other Methods of Medication Administration	144	(3)
Tracheal Administration	144	(1)
Sublingual Administration	144	(1)
Oral Administration	145	(1)
Rectal Administration	145	(2)
Hypoperfusion (Shock)	147	(38)
Defining Hypoperfusion and Shock	148	(1)
Anatomy and Physiology of Tissue Perfusion	149	(2)
Heart	149	(1)
Vessels	150	(1)
Blood	151	(1)
Pathophysiology of Shock	151	(4)
The Classic Stages of Shock	152	(3)
Differential Diagnosis	155	(18)
Hypovolemic Shock	157	(4)
Obstructive Shock	161	(3)
Distributive Shock	164	(7)
Cardiogenic Shock	171	(2)
Factors Affecting Shock	173	(1)
Assessment Priorities	173	(7)
Initial Assessment	173	(1)
Focused History and Physical Exam	173	(7)
Management Priorities	180	(5)
Presence of Pulmonary Edema	181	(4)
Dyspnea, Respiratory Distress, or Respiratory Failure	185	(22)
Anatomy and Physiology	186	(2)
Determining the Severity of Respiratory Distress or Failure	188	(5)
Scene Size-Up	188	(1)
Initial Assessment	189	(1)
Focused History and Physical Exam	190	(3)
Differential Diagnosis and Management Priorities	193	(14)
Airway Obstruction	194	(1)
Respiratory Diseases	195	(4)
Cardiac Diseases	199	(2)
Neuromuscular Disorders	201	(1)
Other Causes of Dyspnea	202	(5)
Chest Discomfort or Pain	207	(22)
Introduction	208	(1)
Anatomy and Physiology	208	(1)
Initial Approach to Chest Discomfort or Pain	209	(5)
Immediate Priorities	209	(1)
Focused History and Physical Exam	210	(4)
Differential Diagnosis and Management Priorities	214	(15)
Acute Myocardial Infarction	215	(2)
Unstable Angina	217	(1)
Aortic Dissection	217	(2)
Pulmonary Embolism	219	(1)
Esophageal Disruption	220	(1)
Cardiac Tamponade	220	(1)
Simple Pneumothorax/Tension Pneumothorax	221	(1)
Pericarditis	222	(1)
Costochondritis	222	(1)
Pleurodynia	223	(1)
Gastrointestinal Diseases	223	(1)
Mitral Valve Prolapse	223	(6)
Altered Mental Status	229	(85)
Introduction	230	(1)
Terminology and Altered Mental Status	230	(1)
The Pathophysiology of Altered Mental Status	231	(2)
The Cerebrum	231	(1)
The Reticular Activating System	232	(1)
Structural and Metabolic Alterations	233	(1)
General Assessment and Management of Altered Mental Status	233	(9)
Scene Size-Up	234	(1)
Initial Assessment	234	(4)
Focused History and Physical Exam	238	(3)
Adjunctive Equipment and Interventions	241	(1)
Ongoing Assessment	241	(1)
Differential Diagnosis: Intracranial Causes of Altered Mental Status	242	(17)
Traumatic Head Injuries	242	(1)
Stroke	243	(9)
Cranial Infection	252	(4)
Seizure Activity	256	(1)
Intracranial Tumor	256	(3)
Differential Diagnosis: Extracranial Causes of Altered Mental Status	259	(55)
Pulmonary Causes	259	(1)
Cardiac Causes	260	(1)
Diabetes Mellitus	261	(8)
Hepatic Encephalopathy	269	(1)
Uremic Encephalopathy	270	(4)
Acidosis and Alkalosis	274	(6)
Electrolyte Imbalances	280	(6)
Thyroid Disorders	286	(5)
Wernicke's Encephalopathy and Korsakoff's Syndrome	291	(3)
Toxic Encephalopathies	294	(8)
Environmental Causes	302	(7)
Shock	309	(5)
Acute Abdominal Pain	314	(31)
When the Chief Complaint Is Abdominal Pain	315	(1)
Anatomy, Physiology, and Pathophysiology	315	(7)
Anatomy and Physiology of the Abdomen	316	(2)
Pathophysiology of Abdominal Pain	318	(4)
Differential Diagnosis	322	(11)
Right Hypochondriac Region	322	(3)
Epigastric Region	325	(2)
Left Hypochondriac Region	327	(1)
Umbilical and Hypogastric Regions	328	(2)
Right and Left Lumbar Regions	330	(1)
Right Iliac Region	331	(1)
Left Iliac Region	332	(1)
Assessment	333	(7)
Scene Size-Up and Initial Assessment	333	(1)
Focused History and Physical Exam	334	(6)
Treatment	340	(5)
Palliation of Pain	342	(3)
Gastrointestinal Bleeding	345	(10)
Anatomy, Physiology, and Pathophysiology	346	(3)
Characteristics of Blood in the GI Tract	349	(1)
Assessment	350	(1)
Treatment	351	(4)
Seizures and Seizure Disorders	355	(22)
Introduction	356	(1)
Anatomy and Physiology of the Brain	356	(3)
Anatomy and Physiology	356	(3)
Consciousness	359	(1)
Classification and Terminology	359	(3)
Generalized Seizures	359	(2)
Partial Seizures	361	(1)
Pathophysiology	362	(1)
Differential Diagnosis	363	(5)
Central Nervous System Injury or Dysfunction	363	(1)
Metabolic Disorders	364	(3)
Infectious Diseases	367	(1)
Assessment and Management Priorities	368	(9)
Scene Size-Up	368	(1)
Initial Assessment	369	(1)
Focused History and Physical Exam	370	(4)
Ongoing Assessment	374	(3)
Syncope	377	(14)
Introduction	378	(1)
Pathophysiology	379	(1)
Mechanisms of Syncope	379	(5)
Cardiocirculatory Syncope	380	(3)
Metabolic Syncope	383	(1)
Neurologic Syncope	383	(1)
Miscellaneous Causes of Syncope	384	(1)
Patient Assessment and Differential Diagnosis	384	(3)
Scene Size-Up and Initial Assessment	384	(1)
Focused History and Physical Exam	385	(2)
Prehospital Management	387	(4)
Headache, Nausea, and Vomiting	391	(28)
Introduction	392	(1)
Headache	392	(17)
Anatomy and Physiology	393	(1)
Tension-Type Headache	394	(2)
Migraine	396	(3)
Patient Assessment	399	(5)
Differential Diagnosis	404	(4)
Management Priorities	408	(1)
Nausea and Vomiting	409	(10)
Cyclic Vomiting Syndrome	410	(2)
Patient Assessment	412	(2)
Differential Diagnosis	414	(1)
Management Priorities	414	(5)
Putting It All Together: Scenarios	419	(25)
Introduction	420	(1)
The Scenarios	420	(24)
Scenario 1: Difficulty Breathing	420	(2)
Scenario 2: Difficulty Breathing	422	(3)
Scenario 3: Shock	425	(3)
Scenario 4: Shock	428	(2)
Scenario 5: Abdominal Pain	430	(2)
Scenario 6: Altered Mental Status	432	(3)
Scenario 7: Altered Mental Status	435	(3)
Scenario 8: Chest Pain	438	(2)
Scenario 9: Sudden-Onset Paraplegia	440	(1)
Scenario 10: Unconscious Woman	441	(3)
Appendix A: Pharmacology Index	444	(37)
Appendix B: Electrocardiographic Interpretation	481	(36)
Appendix C: Anatomy and Physiology Illustrations	517	(13)
Appendix D: Normal Laboratory Values	530	(3)
Index	533