Advanced Medical Life Support : A Practical Approach to Adult Medical Emergencies

by Dalton, Alice; Limmer, Daniel; Mistovich, Joseph J.; Werman, Howard

• ISBN13: 9780835951791
• ISBN10: 0835951790
• Edition: 1st
• Format: Paperback
• Copyright: 1999-01-01
• Publisher: Prentice Hall

Summary

For paramedic, emergency department nursing, and advanced EMS training courses in adult medical emergencies. This ground-breaking book offers a practical approach to adult medical emergencies. It is designed to provide students with pragmatic approaches to applying their knowledge at the scene of commonly encountered medical emergencies.

Author Biography

Alice L. Dalton, RN, MS, NREMT-P: Clinical Educator, Pridemark Paramedic Services, Boulder, Colorado Daniel Limmer, EMT-P: Adjunct Faculty, The George Washington University, Washington, D.C. and Southern Maine Technical College, South Portland Joseph J. Mistovich, M.Ed., NREMT-P: Chairperson, Department of Health Professions; Associate Professor of Health Professions, Youngstown State University, Ohio Howard A. Werman, MD, FACEP: Associate Professor of Clinical Emergency Medicine, The Ohio State University College of Medicine and Public Health

Table of Contents

Preface	xiii	(2)
Acknowledgments	xv	(4)
About the Authors	xix
Chapter 1 Assessment of the Medical Patient	1	(58)
Introduction	2	(2)
Components of the Medical Assessment	4	(1)
Dispatch Information	5	(1)
Scene Size-up	6	(8)
Body Substance Isolation	6	(3)
Scene Safety	9	(2)
Nature of the Illness	11	(1)
Number of Patients	12	(1)
Additional Resources	13	(1)
Entering the Scene	13	(1)
Physiologically Stable or Unstable Criteria	14	(2)
Initial Assessment	16	(13)
Form a General Impression	17	(2)
Assess Mental Status	19	(2)
Assess the Airway	21	(2)
Assess Breathing	23	(1)
Assess Circulation	24	(4)
Establish Patient Priorities	28	(1)
Focused History and Physical Exam	29	(24)
Responsive Patient	31	(9)
Unresponsive or Altered Mental Status Patient	40	(13)
Detailed Physical Exam	53	(1)
Ongoing Assessment	54	(5)
Chapter 2 Airway Management, Ventilation, and Oxygen Therapy	59	(46)
Anatomy and Physiology	60	(6)
Upper Airway Anatomy	60	(2)
Upper Airway Physiology	62	(1)
Lower Airway Anatomy	63	(1)
Respiratory Physiology	63	(3)
Oxygen Supplementation	66	(1)
Airway Management	66	(1)
Ventilation Equipment and Techniques	67	(1)
Endotracheal Intubation	68	(4)
Alternative Methods of Intubation	72	(7)
Nasotracheal Intubation	72	(3)
Digital Intubation	75	(2)
Lighted-Stylet Intubation	77	(2)
Alternative Airway Devices	79	(4)
Pharyngeotracheal Lumen (PtL(R)) Airway	79	(2)
Esophageal-Tracheal Combitube(R) Airway	81	(2)
Surgical Techniques of Airway Control	83	(8)
Percutaneous Transtracheal Jet Ventilation	84	(3)
Retrograde Intubation	87	(2)
Surgical Cricothyroidotomy	89	(2)
Rapid Sequence Intubation	91	(6)
General Procedure	92	(1)
Sedative Agents	93	(2)
Neuromuscular Blockade	95	(2)
Guidelines for Airway and Ventilation Support	97	(8)
Patient Assessment	97	(2)
Patient Monitoring	99	(6)
Chapter 3 IV Access and Medication Administration	105	(24)
Introduction	106	(1)
Medication Administration	106	(1)
Medication Administration Methods	107	(1)
Venous Access	108	(12)
Decision Making	108	(1)
Peripheral and Central Lines	109	(1)
Performing Venipuncture	110	(10)
Delivering Medication by Injection	120	(6)
Intramuscular Injection	120	(1)
Subcutaneous Injection	121	(5)
Other Methods of Medication Administration	126	(3)
Endotracheal Administration	126	(1)
Sublingual Administration	126	(1)
Oral Administration	126	(1)
Rectal Administration	127	(2)
Chapter 4 Hypoperfusion (Shock)	129	(36)
Defining Hypoperfusion and Shock	130	(1)
Anatomy and Physiology of Tissue Perfusion	131	(2)
Heart	131	(1)
Vessels	132	(1)
Blood	133	(1)
Pathophysiology of Shock	133	(4)
The Classic Stages of Shock	134	(3)
Differential Diagnosis	137	(15)
Hypovolemic Shock	138	(5)
Obstructive Shock	143	(3)
Distributive Shock	146	(4)
Cardiogenic Shock	150	(2)
Factors Affecting Shock	152	(1)
Assessment Priorities	152	(7)
Initial Assessment	152	(1)
Focused History and Physical Exam	152	(7)
Management Priorities	159	(6)
Presence of Pulmonary Edema	160	(5)
Chapter 5 Dyspnea	165	(24)
Anatomy and Physiology	166	(2)
Determining the Severity of Respiratory Distress or Failure	168	(5)
Scene Size-up	168	(1)
Initial Assessment	169	(1)
Focused History and Physical Exam	170	(3)
Differential Diagnosis and Management Priorities	173	(16)
Airway Obstruction	174	(1)
Respiratory Diseases	175	(3)
Cardiac Diseases	178	(2)
Neuromuscular Disorders	180	(1)
Other Causes of Dyspnea	180	(9)
Chapter 6 Chest Pain	189	(20)
Introduction	190	(1)
Anatomy and Physiology	190	(1)
Initial Approach to Chest Pain	191	(5)
Immediate Priorities	191	(1)
Focused History and Physical Exam	192	(4)
Differential Diagnosis and Management Priorities	196	(13)
Acute Myocardial Infarction	197	(1)
Unstable Angina	198	(1)
Aortic Dissection	198	(1)
Pulmonary Embolism	199	(1)
Esophageal Disruption	200	(1)
Cardiac Tamponade	200	(1)
Tension Pneumothorax	201	(1)
Pericarditis	201	(1)
Costochondritis	202	(1)
Pleurodynia	203	(1)
Gastrointestinal Diseases	203	(1)
Mitral Valve Prolapse	203	(6)
Chapter 7 Altered Mental Status	209	(86)
Introduction	210	(1)
Terminology and Altered Mental Status	210	(1)
The Pathophysiology of Altered Mental Status	211	(2)
The Cerebrum	211	(1)
The Reticular Activating System	211	(1)
Structural and Metabolic Alterations	212	(1)
General Assessment and Management of Altered Mental Status	213	(9)
Scene Size-up	213	(1)
Initial Assessment	214	(3)
Focused History and Physical Exam	217	(4)
Adjunctive Equipment and Interventions	221	(1)
Ongoing Assessment	221	(1)
Differential Diagnosis: Intracranial Causes of Altered Mental Status	222	(16)
Traumatic Head Injuries	222	(1)
Stroke	223	(7)
Cranial Infection	230	(4)
Seizure Activity	234	(1)
Intracranial Tumor	235	(3)
Differential Diagnosis: Extracranial Causes of Altered Mental Status	238	(57)
Pulmonary Causes	238	(1)
Cardiac Causes	239	(1)
Diabetes Mellitus	240	(7)
Hepatic Encephalopathy	247	(1)
Uremic Encephalopathy	247	(5)
Acidosis and Alkalosis	252	(6)
Electrolyte Imbalances	258	(7)
Thyroid Disorders	265	(5)
Wernicke's Encephalopathy and Korsakoff's Syndrome	270	(3)
Toxic Encephalopathies	273	(9)
Environmental Causes	282	(6)
Shock	288	(7)
Chapter 8 Acute Abdominal Pain	295	(34)
When the Chief Complaint Is Abdominal Pain	296	(1)
Anatomy, Physiology, and Pathophysiology	296	(8)
Anatomy and Physiology of the Abdomen	297	(2)
Pathophysiology of Abdominal Pain	299	(5)
Differential Diagnosis	304	(11)
Right Hypochondriac Region	304	(4)
Epigastric Region	308	(1)
Left Hypochondriac Region	309	(1)
Umbilical and Hypogastric Regions	310	(3)
Right and Left Lumbar Regions	313	(1)
Right Iliac Region	313	(2)
Left Iliac Region	315	(1)
Assessment	315	(8)
Scene Size-up and Initial Assessment	315	(1)
Focused History and Physical Exam	316	(7)
Treatment	323	(6)
Chapter 9 Gastrointestinal Bleeding	329	(10)
Anatomy, Physiology, and Pathophysiology	330	(3)
Characteristics of Blood in the GI Tract	333	(1)
Assessment	334	(1)
Treatment	335	(4)
Chapter 10 Seizures and Seizure Disorders	339	(22)
Anatomy and Physiology of the Brain	340	(3)
Anatomy and Physiology	340	(2)
Consciousness	342	(1)
Updated Classification and Terminology	343	(3)
Generalized Seizures	343	(2)
Partial Seizures	345	(1)
Pathophysiology	346	(1)
Differential Diagnosis	346	(6)
Central Nervous System Injury or Dysfunction	346	(2)
Metabolic Disorders	348	(3)
Infectious Diseases	351	(1)
Assessment and Management Priorities	352	(9)
Scene Size-up	352	(1)
Initial Assessment	352	(1)
Focused History and Physical Exam	353	(4)
Ongoing Assessment	357	(4)
Chapter 11 Syncope	361	(14)
Introduction	362	(1)
Scene Size-up and Initial Assessment	363	(1)
Differential Diagnosis	363	(5)
Vasovagal/Vasodepressor Syncope	363	(2)
Orthostatic Hypotension	365	(1)
Cardiac Syncope	365	(1)
Carotid Sinus Syncope	366	(1)
Other Causes of Syncope	366	(1)
Conditions That Mimic Syncope	367	(1)
Patient Assessment and Treatment	368	(7)
History	368	(1)
Physical Examination	369	(2)
Treatment	371	(4)
Chapter 12 Headache, Nausea, and Vomiting	375	(22)
Introduction	376	(1)
Headache	376	(13)
Anatomy and Physiology	377	(1)
Tension Headache	377	(1)
Migraine	378	(1)
Patient Assessment	378	(5)
Differential Diagnosis	383	(4)
Management Priorities	387	(2)
Nausea and Vomiting	389	(8)
Patient Assessment	389	(2)
Differential Diagnosis	391	(1)
Management Priorities	391	(6)
Chapter 13 Putting It All Together: Case Studies	397	(24)
Introduction	398	(1)
The Case Studies	398	(23)
Case Study 1: Difficulty Breathing	398	(3)
Case Study 2: Difficulty Breathing	401	(2)
Case Study 3: Shock	403	(3)
Case Study 4: Shock	406	(3)
Case Study 5: Abdominal Pain	409	(2)
Case Study 6: Altered Mental Status	411	(4)
Case Study 7: Altered Mental Status	415	(3)
Case Study 8: Chest Pain	418	(3)
Appendix A: Pharmacology Index	421	(32)
Appendix B: Normal Laboratory Values	453	(4)
Appendix C: Anatomy and Physiology Illustrations	457	(13)
Index	470