Critical Care Paramedic

by Bledsoe, Bryan E.; Benner, Randall W.

• ISBN13: 9780131192713
• ISBN10: 013119271X
• Edition: 1st
• Format: Hardcover
• Copyright: 2005-12-19
• Publisher: Prentice Hall

Summary

Critical Care Paramedicis the first and only book written for the expanding field of critical care transport. Utilizing the successful format of Bradyrs"s best-sellingParamedic Care: Principles & Practice, this book is both written and extensively reviewed by leading experts in the field.This comprehensive book addresses all aspects of critical care transport including: operations, safety, advanced pharmacodynamics, advanced physiologic monitoring, advanced airway management, medical emergencies, trauma emergencies, organ donation, and other important areas of critical care.Critical Care Paramedicwill be the industry standard for critical care paramedic education and available only from Brady.

Author Biography

Dr. Bryan Bledsoe is an emergency physician with a special interest in prehospital care. He received his B.S. degree from the University of Texas at Arlington and his medical degree from the University of North Texas Health Sciences Center/Texas College of Osteopathic Medicine.  He completed his internship at Texas Tech University and residency training at Scott and White Memorial Hospital/Texas A&M College of Medicine. Dr. Bledsoe is board certified in emergency medicine and is an Adjunct Associate Professor of Emergency Medicine at The George Washington University Medical Center in Washington, D.C.

Table of Contents

Preface	xxxiii
Acknowledgments	xxxv
About the Authors	xliii
Introduction to Critical Care Transport	1	(14)
Introduction	3	(1)
History of Ambulance Transport	4	(1)
History of Air Transport	4	(2)
History of Critical Care Medicine	6	(1)
History of Prehospital Critical Care	7	(1)
Role of the Critical Care Paramedic	8	(3)
The Critical Care Paramedic in the Hospital Setting	11	(1)
Professionalism	11	(1)
Professional Ethics	12	(1)
Post-Graduate Responsibilities	12	(1)
Continuing Education	13	(1)
Professional Organizations	13	(2)
Critical Care Ground Transport	15	(10)
Introduction	17	(1)
History	18	(1)
System Design	19	(1)
System Financing	19	(1)
Staffing	20	(1)
Equipment	21	(4)
Critical Care Aerial Transport	25	(23)
Introduction	27	(1)
The Air Medical Administrative Team	27	(1)
Medical Crew Configuration	28	(1)
Communication Center	29	(1)
Fixed-Wing Transport	29	(1)
Rotor-Wing Transport	30	(1)
Rotorcraft Airframes	31	(5)
VFR vs. IFR	36	(4)
Indications for Air Medical Transport	40	(5)
Advantages and Disadvantages of Air Medical Transport	45	(1)
Patient Packaging for Transport	46	(1)
Special Considerations	46	(2)
Altitude Physiology	48	(27)
Introduction	50	(1)
The Atmosphere	50	(1)
Physiological Zone	51	(1)
Physiologically Deficient Zone	51	(1)
Space-Equivalent Zone	51	(1)
Gas Physics and Physiology	51	(9)
Pressure	51	(2)
Gas Mixtures	53	(1)
Dalton's Law	53	(1)
Boyle's Law	53	(2)
Charles'Law	55	(1)
Gay-Lussac's Law	56	(1)
Henry's Law	57	(1)
Graham's Law	57	(1)
Fick's Law	58	(1)
Avogadro's Law	58	(1)
Ideal Gas Law	59	(1)
Stressors of Altitude and Flight	60	(8)
Hypoxia	60	(2)
Barometric Pressure	62	(1)
Fatigue	63	(1)
Thermal	63	(1)
Dehydration	63	(1)
Noise	64	(1)
Vibration	64	(1)
Gravitational Forces	64	(2)
Third Spacing	66	(1)
Spatial Disorientation	67	(1)
Vertigo	67	(1)
Problems Related to Altitude	68	(5)
High-Altitude Pulmonary Edema (HAPE)	68	(1)
High-Altitude Cerebral Edema (HACE)	69	(1)
Rapid Decompression	69	(2)
Decompression Sickness	71	(1)
Hypothermia	71	(1)
Trapped Gas Emergencies	71	(2)
Preventive Measures	73	(2)
Flight Safety and Survival	75	(28)
Introduction	78	(1)
Becoming Safety Conscious	78	(2)
Defining Flight Safety	79	(1)
Flight Safety Awareness Program	79	(1)
Safety Consciousness	79	(1)
Types of Aircraft	80	(2)
Single-Engine Helicopters	81	(1)
Dual-Engine Helicopters	81	(1)
Fixed-Wing Aircraft	81	(1)
Helicopter Specifics and Operations	82	(6)
Aircraft Components	82	(3)
Aircraft Controls	85	(1)
Helicopter Controls	85	(2)
Aircraft Aerodynamics (Weights and Balances)	87	(1)
Safety Training and Communication	88	(2)
Crew Resource Management (CRM)	88	(1)
Pilot Safety Brief	88	(1)
Comfort of Flight	88	(1)
Annual Safety Training	89	(1)
Safe Operations in Helicopter Environments	89	(1)
Personal Safety (Fitness Standards)	90	(1)
Personal Protective Equipment	91	(1)
Crew Member Responsibilities	91	(6)
Preflight Procedures and Safety Issues	92	(2)
In-Flight Procedures and Safety Issues	94	(1)
Post-Flight Procedures and Safety Issues	95	(1)
In-Flight Emergencies	95	(2)
In-Flight Emergency Procedures and Safety Issues	97	(1)
Emergency Egress Procedures and Safety Issues	97	(6)
Post-Accident Duties and Safety Issues	98	(1)
Survival Principles and Safety Issues	99	(2)
Environmental Considerations for Survival	101	(1)
Rescue Extrication and Safety Issues	101	(2)
Patient Assessment and Preparation for Transport	103	(21)
Introduction	106	(1)
Patient Assessment	106	(1)
Prearrival Information and Its Relation to the Assessment	107	(1)
Reason for Transport	107	(2)
History of the Current Illness	109	(1)
Current Interventions and Medications Administered	109	(1)
Responses to Interventions and Medications	109	(1)
Expected and Anticipated Interventions During Transport	110	(1)
Current Physiologic Status of the Patient	110	(1)
Diagnostics	110	(1)
Assessment of the Body Systems on Arrival	111	(1)
Scene Size-Up	111	(1)
Initial Assessment	112	(3)
Forming a General Impression	112	(1)
Mental Status Assessment	113	(1)
Airway Assessment	113	(1)
Breathing Adequacy	113	(1)
Circulatory Assessment	114	(1)
Determination of Patient Priority Status	115	(1)
Rapid Physical Exam	115	(1)
Detailed Physical Exam	116	(2)
Head and Airway	116	(1)
Neck	117	(1)
Chest	117	(1)
Abdomen	117	(1)
Pelvis/Genitourinary	118	(1)
Extremities and the Posterior Surface	118	(1)
Review and Integration of Previous Assessments, Diagnostic Studies, and Current Patient Status	118	(2)
Current Interventions for Patient Care	119	(1)
Preparation of the Patient for Transport	120	(1)
Documentation, Emtala/Cobra, and Critical Care Transport	120	(4)
Patient Packaging for Transport	121	(1)
Discussion of Patient Condition with Family	121	(3)
Airway Management and Ventilation	124	(61)
Introduction	127	(1)
Advanced Airway Management Techniques	128	(1)
Specialized Laryngoscope Blades	129	(1)
Intubation Adjuncts	129	(4)
Gum Elastic Bougie	129	(2)
Nasotracheal Tube Auscultation Device	131	(1)
Beck Airway Airflow Monitor	132	(1)
Special Airway Management Techniques	133	(9)
BURP Maneuver	133	(1)
Digital Intubation	133	(2)
Sky Hook Technique	135	(2)
Lighted Stylet	137	(3)
Retrograde Intubation	140	(2)
Rapid-Sequence Induction/Intubation	142	(1)
RSI Pharmacology	142	(1)
Induction Agents	142	(7)
Premedication	145	(1)
Neuromuscular Blocking Agents	145	(1)
Depolarizing Blocking Agents	146	(1)
Nondepolarizing Blocking Agents	146	(1)
Critical Care Transport Use of Neuromuscular Blockers	147	(2)
Maintenance Medications	149	(2)
Reversal Agents	149	(1)
Rapid-Sequence Intubation Procedure	149	(2)
Alternative (Rescue) Airways	151	(9)
Endotracheal CombiTube (ETC)	151	(2)
Pharyngotracheal Lumen Airway	153	(7)
Surgical Airways	160	(1)
Needle Cricothyrotomy	160	(4)
Needle Cricothyrotomy Complications	161	(1)
Needle Cricothyrotomy Technique	161	(3)
Open Cricothyrotomy	164	(3)
Cricothyrotomy Complications	164	(1)
Open Cricothyrotomy Technique	164	(3)
Approach to the Difficult Airway	167	(4)
Historical Factors	168	(1)
Anatomical Factors	168	(3)
Poor Technique	171	(1)
Noninvasive Respiratory Monitoring	171	(4)
Pulse Oximetry	171	(1)
Capnography	172	(1)
Electronic Devices	173	(1)
Capnogram	174	(1)
Clinical Applications	174	(1)
Ventilation	175	(7)
Automatic Transport Ventilator	176	(1)
Types of Ventilators	176	(2)
Ventilator Modes	178	(1)
Mechanical Ventilation Parameters	179	(1)
Ventilator Alarms	180	(2)
Documentation	182	(3)
The Shock Patient: Assessment and Management	185	(19)
Introduction	187	(1)
Prerequisites	187	(1)
Defining Shock	188	(1)
Pathophysiology	188	(5)
The Cell In Shock	188	(5)
Organ Systems in Shock	193	(1)
Neurohumoral Responses in Shock States	193	(1)
Stages of Shock	193	(1)
General Management	194	(2)
Initial Assessment and Management	195	(1)
Detailed Exam/History	196	(1)
Patient History	196	(1)
Performing the Detailed Exam	197	(1)
Management and Further Evaluation of the Shock Patient	197	(3)
General Treatment Considerations	197	(1)
Fluid Resuscitation	198	(1)
Hemoglobin-Based Oxygen-Carrying Solutions (HBOCs)	198	(1)
Other Fluids	198	(1)
Hemodynamic Monitoring	199	(1)
Additional Management (Diagnostic Tests)	199	(1)
Classification of Shock	200	(4)
Hypovolemic Shock	201	(1)
Obstructive Shock	201	(1)
Distributive Shock	201	(1)
Cardiogenic Shock	202	(2)
Cardiac and Hemodynamic Monitoring	204	(121)
Introduction	206	(1)
Electrocardiographic Monitoring	207	(1)
12-Lead ECG Monitoring in Critical Care	207	(2)
Arterial Blood Pressure	209	(1)
Indirect (Noninvasive) Pressure Monitoring	209	(1)
Direct (Invasive) Pressure Monitoring	209	(2)
Placement of the Arterial Catheter	211	(4)
Indications	211	(1)
Insertion of the Arterial Catheter	211	(2)
Complications	213	(1)
Check the Arterial Catheter Waveform	214	(1)
Central Circulation Monitors	215	(15)
Central Venous Pressure Monitor	215	(1)
Placement of a Central Venous Catheter	216	(6)
Pulmonary Artery Pressure Monitoring	222	(8)
Cardiac Output Determination	230	(74)
Hemodynamic Parameters	231	(2)
Systemic Oxygen Transport	233	(71)
Sympathomimetic Aerosols	304	(1)
Albuterol (Proventil, Ventolin)	304	(1)
Ipratropium Bromide (Atrovent)	304	(1)
Levalbuterol Hydrochloride (Xopenex)	305	(1)
Sympathomimetics (Injection)	305	(1)
Terbutaline (Brethaire, Brethine, Bricanyl)	305	(1)
Corticosteriods	306	(1)
Hydrocortisone Sodium (A-Hydrocort, Solu-Cortef)	306	(1)
Neuromuscular Blockers	306	(3)
Succinylcholine Chloride (Anectine, Quelicin, Sucostrin)	306	(1)
Vecuronium (Norcuron)	307	(1)
Pancuronium Bromide (Pavulon)	307	(1)
Rocuronium Bromide (Zemuron)	308	(1)
Cisatracurium Besylate (Nimbex)	308	(1)
Analgesics	309	(1)
Narcotic Analgesics	309	(2)
Hydromorphone Hydrochloride (Dilaudid, Dilaudid-HP)	309	(1)
Morphine Sulfate (Duramorph, MS Contin)	310	(1)
Meperidine Hydrochloride (Demerol)	310	(1)
Fentanyl Citrate (Sublimaze, Duragesic)	311	(1)
Narcotic Agonists-Antagonists	311	(1)
Nalbuphine Hydrochloride (Nubain)	311	(1)
Non-Steroidal Anti-Inflammatory Agents	312	(1)
Ketorolac Tromethamine (Toradol, Acular)	312	(1)
Sedatives and Hypnotics	312	(1)
Benzodiazepines	312	(2)
Midazolam Hydrochloride (Versed)	312	(1)
Diazepam (Valium)	313	(1)
Lorazepam (Ativan)	313	(1)
Hypnotics	314	(1)
Propofol (Diprivan)	314	(1)
Nonbarbiturate Hypnotic	314	(1)
Etomidate (Amidate)	314	(1)
Narcotic/Benzodiazepine Antagonists	315	(1)
Naloxone Hydrochloride (Narcan)	315	(1)
Flumazenil (Mazicon, Romazicon)	315	(1)
Antibiotics and Antifungals	316	(3)
Cefazolin Sodium (Ancef, Kefzol, Zolicef)	316	(1)
Ceftriaxone Sodium (Rocephin)	316	(1)
Imipenem-Cilastatin Sodium (Primaxin)	317	(1)
Vancomycin Hydrochloride (Vanocin)	317	(1)
Gentamicin Sulfate (Garamycin)	317	(1)
Clindamycin Hydrochloride (Cleocin, Dalacin)	318	(1)
Ampicillin/Sulbactam Sodium (Unasyn)	318	(1)
Fluconazole (Diflucan)	318	(1)
Diuretics	319	(1)
Furosemide (Lasix)	319	(1)
Bumetanide (Bumex)	319	(1)
H2 Blockers/Proton Pump Inhibitors	320	(1)
Ranitidine Hydrochloride (Zantac)	320	(1)
Cimetidine (Tagamet)	320	(1)
Famotidine (Pepcid)	320	(1)
Antiemetics	321	(1)
Promethazine Hydrochloride (Phenergan, Histantil, Phenazine, Phencen)	321	(1)
Prochlorperazine (Compazine)	321	(1)
Ondansetron Hydrochloride (Zofran)	322	(1)
Miscellaneous Pharmacologic Agents	322	(3)
Drotrecogin Alfa (Xigris)	322	(3)
Interpretation of Lab and Basic Diagnostic Tests	325	(30)
Introduction	328	(1)
Laboratory Tests	328	(1)
Laboratory Values	328	(3)
Hematology	331	(3)
Coagulation Tests	334	(2)
Chemistries	336	(4)
Electrolytes	336	(1)
Renal Function Tests	337	(3)
Tests of Glucose Metabolism	340	(1)
Tests of Lipid Metabolism	340	(2)
Cardiac Enzymes and Markers	342	(2)
Tests of Liver Function	344	(1)
Serologic Testing	344	(2)
Blood Banking	345	(1)
Microbiological Serologic Tests	346	(1)
Endocrine Tests	346	(1)
Microbiology	346	(1)
Urinalysis	347	(1)
Toxicology	347	(1)
Imaging	348	(1)
Physiological Tests	349	(6)
Introduction to Trauma	355	(17)
Introduction	358	(1)
Epidemiology and Cost of Trauma	359	(2)
History and Overview of Trauma Systems	361	(1)
Components of a State or Regional Trauma System	362	(1)
Injury Prevention	363	(1)
Triage and Trauma Scoring Systems	364	(3)
Research in Trauma Management	367	(1)
Biomechanics of Trauma and Mechanism of Injury	367	(1)
General Approach to the Trauma Patient	368	(4)
Neurologic Trauma	372	(28)
Introduction	374	(1)
Diagnosis of CNS Trauma	374	(2)
The Clinical Exam	374	(1)
Detailed Neuro Assessment	375	(1)
Diagnostic Imaging and Procedures	376	(1)
X-Rays	376	(1)
Computed Tomography (CT) Scan	377	(1)
Magnetic Resonance Imaging (MRI)	377	(1)
Lumbar Puncture	377	(1)
Electroencephalogram (EEG)	377	(1)
Head Trauma	377	(7)
Tentorial (Uncal) Herniation	382	(1)
Central Tentorial Herniation	382	(1)
Subfalcine Herniation	382	(1)
Tonsillar Herniation	383	(1)
Intracranial Pressure Monitoring	384	(3)
Ventriculostomy and Extraventricular Drain (EVD)	384	(1)
Fiber-Optic Bolt	385	(1)
Subarachnoid Screw	385	(1)
The ICP Waveform	385	(1)
The Extraventricular Drain	385	(2)
Procedures	387	(2)
Opening and Closing the Drainage System	387	(1)
Balancing the Transducer	387	(1)
Zeroing the Monitor	388	(1)
Emptying the Collection Burette	388	(1)
Emptying the Collection Bag	388	(1)
Flushing the Collection System	388	(1)
Troubleshooting the EVD	389	(1)
Cessation of Drainage	389	(1)
Absence of Waveform	389	(1)
Grossly Abnormal Or Negative ICP Values	389	(1)
Abnormal Waveform	389	(1)
Troubleshooting the Fiber-Optic Bolt	389	(1)
Additional Monitoring Devices	390	(1)
Surgical Management of Head Trauma	390	(1)
Bedside Management of Intracranial Hypertension	391	(1)
Hypothermia	392	(1)
Pharmacologic Intervention for Head Trauma	392	(2)
Mannitol	393	(1)
Hypertonic Saline	393	(1)
Barbiturate Coma	393	(1)
Acute Spinal Cord Injuries	394	(6)
Anterior Cord Syndrome	394	(1)
Central Cord Syndrome	394	(1)
Brown-Sequard Syndrome	395	(1)
Spinal Shock	395	(1)
Neurogenic Shock	395	(1)
Autonomic Dysreflexia (AD)	395	(1)
Diagnosis of SCI	395	(1)
Pharmacologic Management of SCI	396	(4)
Thoracic Trauma: Assessment and Management	400	(20)
Introduction	402	(1)
Pathophysiology	402	(1)
General Management	403	(1)
Initial Assessment and Management	403	(1)
Detailed Exam/History	403	(1)
Patient History	404	(1)
Management of Life-Threatening Injuries	404	(12)
Tension Pneumothorax	404	(1)
Massive Hemothorax	405	(5)
Open Pneumothorax (Sucking Chest Wound)	410	(1)
Flail Chest	411	(2)
Pericardial Tamponade	413	(2)
Aortic Rupture	415	(1)
Myocardial Rupture	415	(1)
Management of Potentially Life-Threatening Injuries	416	(4)
Myocardial Contusion	416	(1)
Pulmonary Contusions	416	(1)
Diaphragmatic Rupture	417	(1)
Tracheobronchial Disruption	417	(1)
Esophageal Perforation	418	(2)
Abdominal and Genitourinary Trauma	420	(30)
Introduction	422	(1)
Abdominal Trauma	423	(1)
Anatomy and Physiology	423	(5)
Digestive Tract	424	(2)
Accessory Organs	426	(1)
Other Abdominal Structures	426	(2)
Pathophysiology	428	(1)
Specific Abdominal Organ Injuries	429	(2)
Liver	429	(1)
Gallbladder	429	(1)
Spleen	429	(1)
Stomach	430	(1)
Duodenum	430	(1)
Jejunum and Ileum	430	(1)
Pancreas	430	(1)
Large Intestine	431	(1)
Vascular Injuries	431	(1)
Assessment of the Abdominal Injury	431	(1)
Screening Exams for Abdominal Injury: Imaging Studies	432	(9)
Laparotomy	432	(1)
Diagnostic Peritoneal Lavage	433	(1)
Sonography	434	(3)
Computed Tomography	437	(1)
Radiography	438	(1)
Pertinent Lab Values	438	(2)
Management	440	(1)
Genitourinary Trauma	441	(1)
Anatomy and Physiology	441	(6)
Urinary System	441	(1)
Reproductive System: Genitalia	441	(2)
Pathophysiology	443	(2)
Renal System	445	(1)
Kidney	445	(1)
Ureter	445	(1)
Bladder	445	(1)
Urethra	446	(1)
Reproductive	446	(1)
GU Assessment	446	(1)
Screening Exams for Genitourinary Injury: Imaging Studies	447	(3)
Cystography	447	(1)
Computed Tomography	447	(1)
Sonography	447	(1)
Pertinent Laboratory Values	447	(1)
Management	448	(2)
Face/Ear/Ocular/Neck Trauma	450	(35)
Introduction	453	(1)
Anatomy and Physiology	453	(14)
Soft Tissue of the Face	453	(1)
Bones of the Face	454	(4)
The Ear and Auditory Function	458	(1)
The Eye	459	(1)
The Cranial Nerves	460	(3)
The Pharynx	463	(1)
The Oral Cavity and Dentition	463	(1)
The Neck	463	(4)
Pathophysiology of Facial Injuries	467	(3)
Soft-Tissue Injuries	467	(1)
Facial Fractures	468	(2)
Pathophysiology of the Ear and Auditory Injuries	470	(2)
External Ear Injury	470	(1)
Ruptured Tympanic Membrane	471	(1)
Auditory Trauma	472	(1)
Pathophysiology of Ocular Injuries	472	(3)
Eyelid Lacerations	472	(1)
Conjunctival Injuries	473	(1)
Corneal Injuries	473	(1)
Hyphema	473	(1)
Ocular Globe Rupture	474	(1)
Ocular Avulsion	475	(1)
Traumatic Retinal Detachment	475	(1)
Pathophysiology of Neck Injuries	475	(2)
Vascular Neck Injuries	476	(1)
Laryngotracheal Injuries	476	(1)
Neurologic Injuries	477	(1)
Thyroid Injuries	477	(1)
Pharynx and Esophagus Injuries	477	(1)
Assessment Findings and Interpretation	477	(8)
Primary Assessment	477	(1)
Maxillofacial Assessment	477	(1)
Ocular Assessment	478	(1)
Ocular Motility	478	(1)
Fundoscopic Examination	478	(1)
Examination of the Neck	478	(1)
Management	479	(1)
Airway	480	(1)
Hemorrhage Control	481	(1)
Impaled Objects	481	(1)
Facial Fractures	481	(1)
Ocular Injuries	481	(1)
Contact Lens Removal	482	(1)
Auditory Injuries	482	(1)
Mandibular Dislocation	482	(1)
Dental Avulsions	483	(2)
Burns and Electrical Injuries	485	(36)
Introduction	488	(1)
Epidemiology	488	(1)
Types and Effects of Burns	489	(1)
Thermal Burns	490	(3)
Initial Assessment and Management	493	(9)
Airway	493	(1)
Breathing and Ventilation	494	(1)
Circulation	494	(1)
Disability and Neurologic Deficit	494	(1)
Examine/Exposure	494	(1)
Detailed Exam	495	(1)
Patient History	495	(1)
Medical History Taking	496	(5)
Management and Further Evaluation of the Burn Patient	501	(1)
General Treatment Considerations	502	(4)
Fluid Resuscitation	503	(2)
Pain Management	505	(1)
Wound Care	505	(1)
Tetanus Immunization	506	(1)
Management of Specific Injuries	506	(4)
Inhalation Injuries	507	(2)
Inhalation Injury and the Pediatric Patient	509	(1)
Facial Burns	509	(1)
Burns to the Eyes	509	(1)
Burns to the Ears	509	(1)
Burns to the Hands	509	(1)
Burns to the Feet	510	(1)
Burns to the Genitalia and Perineum	510	(1)
Electrical Burns	510	(3)
Specific Mechanisms of Electrical Burn Injuries	511	(1)
Management of Electrical Burn Injuries	512	(1)
Electrical Burns in Pediatric Patients	512	(1)
Chemical Burns	513	(3)
Management of Specific Chemical Burns	514	(2)
Radiation Injury	516	(1)
Management of Associated Nonburn Injuries	517	(1)
Criteria for Burn Center Referral	517	(1)
Additional Management (Diagnostic Tests)	518	(1)
Preparing the Patient for Transport	519	(2)
Principles of Orthopedic Care	521	(22)
Introduction	522	(1)
Incidence	523	(1)
Skeletal Anatomy and Physiology	523	(1)
Types of Injuries	524	(2)
Pathophysiology	526	(1)
Assessment of the Skeletal System	527	(1)
Special Patients: Pediatric Fractures	528	(2)
Treatment	530	(2)
Splint	530	(1)
Casting	530	(1)
Reduction/Realignment	530	(1)
External Fixation	530	(1)
Internal Fixation	531	(1)
Amputation	531	(1)
Critical Fractures and Injuries	532	(6)
Pelvic Fractures	532	(1)
Femur Fractures	532	(2)
Vertebral Fractures	534	(1)
Cervical Fractures	534	(1)
Thoracic Fractures	535	(1)
Lumbar Spine Fractures	535	(1)
Humerus Fractures	536	(1)
Rib Fractures	536	(1)
Amputations	537	(1)
Pulseless Extremity	537	(1)
Compartment Syndrome	538	(1)
Pharmacology	538	(2)
NSAIDs	538	(1)
Opiate Analgesics	539	(1)
Antibiotics	539	(1)
Muscle Relaxants	539	(1)
Anticoagulants	540	(1)
Roentgenogram/X-Ray Evaluation	540	(3)
Special Patients: Pediatric, Geriatric, and Obstetrical Trauma	543	(2)
Introduction	545	(1)
Part 1: Pediatric Trauma	545	(518)
Introduction	545	(1)
Epidemiology of Pediatric Trauma	545	(2)
Falls	546	(1)
Motor Vehicle Collisions	546	(1)
Drowning and Near-Drowning	546	(1)
Penetrating Injuries	546	(1)
Burns	547	(1)
Physical Abuse	547	(1)
General Approach to Pediatric Trauma	547	(2)
Communication and Psychological Support	547	(1)
Responding to Patient Needs	548	(1)
Responding to Parents or Caregivers	548	(1)
Growth and Development	549	(3)
Newborns (First Hours after Birth)	549	(1)
Neonates (Ages Birth to 1 Month)	549	(1)
Infants (Ages 1 to 5 Months)	550	(1)
Infants (Ages 6 to 12 Months)	550	(1)
Toddlers (Ages 1 to 3 Years)	550	(1)
Preschoolers (Ages 3 to 5 Years)	551	(1)
School-Age Children (Ages 6 to 12 Years)	551	(1)
Adolescents (Ages 13 to 18 Years)	551	(1)
Facility Arrival and Initial Trauma Assessment	552	(9)
Vital Functions	554	(1)
Level of Consciousness	554	(1)
Airway	554	(1)
Breathing	554	(1)
Oxygenation	555	(1)
Ventilation	555	(1)
Circulation	556	(1)
Physical Exam	557	(1)
Specific Injuries	557	(1)
Head Trauma and Neurologic Status	558	(1)
Chest	559	(1)
Abdomen	559	(1)
Shock	559	(2)
Transport Considerations and Management	561	(3)
Chest Tubes	562	(1)
Noninvasive Monitoring	563	(1)
Invasive Monitoring	564	(1)
Mechanical Ventilation	564	(1)
Definitive Management of Pediatric Trauma	564	(1)
Summary	565	(1)
Part 2: Geriatric Trauma	565	(1)
Introduction	565	(1)
Epidemiology of the Geriatric Population	565	(1)
System Pathophysiology and Organ System Decline	566	(2)
Respiratory System	566	(1)
Cardiovascular System	567	(1)
Renal System	568	(1)
Nervous System	568	(1)
Musculoskeletal System	568	(1)
Trauma in the Elderly	568	(1)
Facility Arrival and Initial Trauma Assessment	569	(2)
Transport Considerations and Management	571	(1)
Cardiovascular Considerations	571	(1)
Respiratory Considerations	571	(1)
Renal Considerations	571	(1)
Transport	571	(1)
Hospice	572	(1)
Summary	572	(1)
Part 3: Obstetrical Trauma	572	(1)
Introduction	572	(1)
Epidemiology of Obstetrical Trauma	572	(1)
General Approach to Obstetrical Trauma	573	(1)
Physiological Changes During Pregnancy	573	(1)
Facility Arrival and Initial Trauma Assessment	574	(4)
Fetal Assessment	575	(1)
Transport Considerations and Management	575	(3)
Pulmonary Emergencies	578	(42)
Introduction	580	(1)
Anatomy and Physiology	580	(1)
The Upper Airway	581	(1)
Respiratory Epithelium	581	(1)
Nasal Cavity	581	(1)
Pharynx	582	(1)
The Lower Airway	582	(6)
Larynx	582	(2)
Trachea and Primary Bronchi	584	(1)
Bronchial Tree	585	(1)
Alveoli	586	(1)
Lungs	586	(1)
Blood Supply to the Lungs	586	(2)
Pathophysiology, Assessment, and Management	588	(3)
Acute Respiratory Failure	588	(1)
Oxygenation Failure	588	(2)
Ventilation Failure	590	(1)
Assessment of the Pulmonary Patient	591	(6)
Inspection	591	(1)
Palpation	592	(1)
Percussion	592	(1)
Auscultation	593	(1)
Arterial Blood Gas	594	(1)
Pulse Oximetry	594	(1)
End-Tidal Capnography	595	(1)
Management	596	(1)
Capnography	597	(1)
Asthma	597	(8)
Epidemiology	597	(1)
Pathophysiology	597	(1)
Signs and Symptoms	598	(1)
Diagnosis	598	(3)
Management	601	(4)
Chronic Obstructive Pulmonary Disease	605	(4)
Epidemiology	605	(1)
Pathophysiology	606	(1)
Signs and Symptoms	606	(1)
Diagnosis	607	(1)
Management	608	(1)
Acute Respiratory Distress Syndrome	609	(3)
Epidemiology	609	(1)
Pathophysiology	609	(1)
Signs and Symptoms	610	(1)
Diagnosis	610	(1)
Management	610	(2)
Pneumonia	612	(2)
Epidemiology	612	(1)
Pathophysiology	612	(1)
Nosocomial Pneumonia	612	(1)
Signs and Symptoms	613	(1)
Diagnosis	613	(1)
Management	613	(1)
Spontaneous and Iatrogenic Pneumothorax	614	(6)
Epidemiology	614	(1)
Pathophysiology	614	(1)
Signs and Symptoms	615	(1)
Diagnosis	615	(1)
Management	616	(4)
Cardiovascular Emergencies	620	(57)
Introduction	622	(1)
Anatomy and Physiology of the Heart	623	(8)
Location	623	(1)
Physiology	623	(1)
Cardiac Conduction	623	(1)
Coronary Perfusion	624	(1)
Cardiac Auscultation	624	(1)
Heart Sounds	624	(5)
Heart Murmurs	629	(2)
Acute Coronary Syndrome	631	(8)
Pathophysiology	631	(1)
Clinical Manifestations	632	(1)
Diagnostics	633	(1)
General Management	634	(1)
Right Ventricular Myocardial Infarctions	635	(1)
Analgesics	635	(1)
Antiplatelets/Anticoagulants	636	(1)
Nitrates	636	(1)
Heart Rate and Rhythm Control	636	(1)
Beta-Blockers	637	(1)
Calcium Channel Blockers	637	(1)
Fibrinolytics	638	(1)
Mechanical Reperfusion	638	(1)
Surgical Reperfusion	639	(1)
Aortic Aneurysm	639	(2)
Pathophysiology	639	(1)
Clinical Manifestation	640	(1)
Diagnostics	640	(1)
Management	640	(1)
Aortic Dissection	641	(2)
Pathophysiology	641	(1)
Clinical Manifestations	642	(1)
Diagnostics	643	(1)
Management	643	(1)
Postoperative Transport	643	(1)
Cardiogenic Shock	643	(4)
Pathophysiology	644	(1)
Clinical Manifestations	644	(1)
Diagnostics	644	(1)
Management	644	(1)
Intra-Aortic Balloon Pump	645	(1)
Left Ventricular Assist Devices	645	(2)
Air Medical Transport Special Considerations	647	(1)
Cardiomyopathy	647	(2)
Dilated Cardiomyopathy	647	(1)
Hypertrophic Cardiomyopathy	648	(1)
Restrictive Cardiomyopathy	648	(1)
Cardiopulmonary Arrest	649	(2)
Pathophysiology	649	(1)
Clinical Manifestations	649	(1)
Diagnostics	650	(1)
Management	650	(1)
Congestive Heart Failure	651	(1)
Pathophysiology	651	(1)
Clinical Manifestations	651	(1)
Diagnostics	652	(1)
Management	652	(1)
Hypertensive Emergencies	652	(4)
Pathophysiology	653	(1)
Clinical Manifestations	653	(1)
Diagnosis	654	(1)
Management	655	(1)
Pericarditis, Pericardial Effusion, and Cardiac Tamponade	656	(2)
Pericarditis	656	(1)
Pericardial Effusion	657	(1)
Cardiac Tamponade	657	(1)
Management	658	(1)
Valvular Dysfunction	658	(1)
Disorders of the Aortic Valve	659	(1)
Aortic Stenosis	659	(1)
Aortic Regurgitation	660	(1)
Disorders of the Mitral Valve	660	(2)
Mitral Stenosis	660	(1)
Mitral Regurgitation	661	(1)
Disorders of the Tricuspid and Pulmonary Valves	662	(1)
Critical Care Procedures for Cardiovascular Emergencies	662	(11)
Arterial Line	662	(2)
Subclavian Vein	664	(2)
Femoral Vein	666	(1)
Internal Jugular Vein	667	(2)
Vascular Access Device	669	(2)
Intra-Aortic Balloon Pump Management	671	(1)
Pericardiocentesis	672	(1)
Ground and Air Transport Considerations for the Cardiac Patient	673	(1)
Special Considerations for Interfacility Transport	673	(1)
Special Considerations for Air Transport	674	(1)
Preparation for Transport and Flight	674	(1)
Alterations in Cardiovascular Physiology at Altitude	674	(1)
Cardiovascular Emergencies at Altitude	674	(3)
Flight Cardiopulmonary Arrest	674	(3)
Neurologic Emergencies	677	(40)
Introduction	679	(1)
Neuroanatomy and Physiology	679	(1)
The Brain	679	(2)
Cerebrum	679	(1)
Cerebellum	680	(1)
Diencephalon	680	(1)
Brainstem	680	(1)
Ventricular System	680	(1)
The Meninges	681	(1)
The Spine	681	(1)
Cerebral Vasculature	682	(2)
Arterial System	682	(2)
Venous System	684	(1)
Functional Systems of the CNS	684	(4)
Voluntary Motor Control	684	(2)
Extrapyramidal Motor System	686	(1)
Sensation	686	(1)
Vision	686	(1)
Hearing	687	(1)
Smell and Taste	687	(1)
Autonomic Regulation	687	(1)
Thought, Emotion, and Memory	687	(1)
Diagnosis of Neurologic Emergencies	688	(1)
Detailed Neurologic Assessment	688	(1)
The Conscious Patient	688	(1)
The Unresponsive Patient	689	(1)
Diagnostic Imaging	689	(1)
Computed Tomography (CT) Scan	690	(1)
Magnetic Resonance Imaging (MRI)	690	(1)
Cerebral Angiography	690	(1)
Transcranial Doppler Ultrasound	690	(1)
Electroencephalogram (EEG)	690	(1)
Lumbar Puncture	690	(1)
Other Studies	690	(1)
Secondary Injury in the Neurologic Patient	690	(1)
Cerebrovascular Disorders	691	(10)
Acute Ischemic Stroke	691	(3)
Middle Cerebral Artery (MCA)	694	(1)
Anterior Cerebral Artery (ACA)	694	(1)
Posterior Cerebral Artery (PCA)	694	(1)
Vertebral and Basilar Arteries	694	(1)
Cerebellar Arteries	695	(2)
Hemorrhagic Stroke	697	(3)
Intracerebral Hemorrhage	700	(1)
Infectious Processes	701	(1)
Meningitis	701	(1)
Encephalitis	702	(1)
Bacterial Infection of the Brain	702	(1)
CNS Infection in Immunocompromised Patients	702	(1)
CNS Tumors	702	(3)
Brain Tumors	703	(2)
Spinal Tumors	705	(1)
Encephalopathy	705	(1)
AIDS Encephalopathy	705	(1)
Wernicke's Encephalopathy	706	(1)
Hepatic Encephalopathy	706	(1)
Toxin-Induced Encephalopathy	706	(1)
Seizure Disorders	706	(2)
Status Epilepticus	707	(1)
Neurologic Disorders with Systemic Manifestations	708	(1)
Alzheimer's Disease	708	(1)
Parkinson's Disease	709	(1)
Multiple Sclerosis (MS)	710	(1)
Amyotrophic Lateral Sclerosis	710	(2)
Guillain-Barre Syndrome	712	(1)
Myasthenia Gravis	712	(1)
Neuroleptic Malignant Syndrome (NMS)	713	(1)
Malignant Hypertension Syndrome (MHS)	714	(1)
Creutzfeldt-Jakob Disease and Bovine Spongiform Encephalopathy	714	(1)
Neurotoxic Poisoning	714	(1)
Spinal Cord Disorders	714	(3)
Myelomeningocele (Spina Bifida)	715	(2)
Gastrointestinal Emergencies	717	(32)
Introduction	719	(1)
Anatomy and Physiology	720	(8)
Histological Anatomy	720	(1)
Gross Anatomy	721	(4)
Accessory Organs	725	(3)
Pathophysiology, Assessment, and Management of Gastrointestinal Bleeding	728	(1)
Causes of Upper Gastrointestinal Bleeding	729	(2)
Peptic Ulcer Disease	729	(2)
Gastritis	731	(1)
Esophageal and Gastric Varices	731	(1)
Mallory-Weiss Syndrome	731	(1)
Causes of Lower Gastrointestinal Bleeding	731	(4)
Diverticular Disease	732	(1)
Assessment	732	(1)
Laboratory Data	733	(1)
Imaging Studies	734	(1)
Management	735	(1)
Pancreatitis	735	(3)
Signs and Symptoms	736	(1)
Laboratory Data	736	(1)
Imaging Studies	737	(1)
Management	737	(1)
Liver Failure	738	(1)
Pathophysiology	738	(1)
Signs and Symptoms	739	(1)
Laboratory Data	739	(1)
Management	739	(1)
Gastrointestinal Management Devices	739	(10)
Nasogastric Tubes	740	(1)
Nasointestinal Tubes	741	(1)
Transabdominal Feeding Tubes	741	(2)
Nasointestinal Tubes to Correct Bowel Obstruction	743	(1)
T-Tube	743	(1)
Esophageal Tubes	744	(1)
Ostomy Collection Bags	745	(1)
Rectal Tubes	745	(1)
Surgical Wound Drainage Systems	745	(1)
Peritoneal Dialysis Catheters	746	(1)
Tube Checklist	746	(3)
Renal and Acid-Base Emergencies	749	(22)
Introduction	751	(1)
Renal Anatomy	751	(1)
Renal Physiology	752	(3)
Filtration	753	(1)
Reabsorption	753	(1)
Secretion	753	(2)
Emergencies of Renal Failure	755	(3)
Prerenal Failure	755	(1)
Intrarenal Failure	755	(1)
Post-Renal Failure	755	(1)
Acute Emergencies in Chronic Renal Failure	756	(1)
Dialysis	756	(1)
Continuous Veno-Venous Hemofiltration (CVVH)	756	(1)
Dialysis-Related Complications	756	(1)
Diagnostic Findings of Acute Renal Failure	757	(1)
Acid-Base Physiology	758	(2)
Buffering Systems	759	(1)
Respiratory System	759	(1)
Renal System	760	(1)
Acid-Base Imbalances	760	(1)
Metabolic Acidosis	761	(10)
Methanol	761	(2)
Uremia	763	(1)
Diabetic Ketoacidosis	763	(2)
Paraldehyde	765	(1)
Infection	765	(1)
Lactic Acidosis	766	(1)
Ethylene Glycol	767	(1)
Salicylate Poisoning	767	(4)
Infectious Disease Emergencies	771	(39)
Introduction	774	(1)
Infectious Diseases	774	(1)
Classifications of Disease-Causing Agents	774	(1)
How Infectious Diseases Occur	775	(11)
Source-Host-Transmission	775	(1)
Prevention	776	(1)
Standard Precautions	776	(7)
Managing Patients with Infectious Diseases	783	(3)
Commonly Encountered or Epidemiologically Important Infectious Diseases	786	(13)
Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome	786	(1)
Hepatitis	787	(2)
Respiratory Infections	789	(1)
Epiglottitis	789	(1)
Influenza	790	(1)
Pneumonia	790	(1)
Tuberculosis	791	(1)
Severe Acute Respiratory Syndrome (SARS)	792	(2)
Meningitis	794	(1)
Meningococcal Infections	794	(1)
The Childhood Diseases	795	(1)
Gastroenteritis (Bacterial)	796	(1)
Tetanus	796	(1)
Septicemia and Toxic Shock Syndrome	797	(1)
Necrotizing Fasciitis	798	(1)
Antibiotic-Resistant Organisms and Multidrug-Resistant Organisms	798	(1)
Infectious Agents and Bioterrorism	799	(5)
Anthrax	800	(1)
Smallpox	801	(1)
Plague	801	(1)
Botulism	802	(1)
Tularemia	802	(1)
Filoviruses	803	(1)
Arenaviruses	803	(1)
Hantavirus	803	(1)
Cholera	803	(1)
Q Fever	804	(1)
Brucellosis	804	(1)
Toxins	804	(1)
Ricin	804	(1)
Saxitoxin	805	(1)
SEB	805	(1)
Mycotoxins	805	(1)
Information Sources on Biological/Chemical Weapons	805	(5)
Pediatric Medical Emergencies	810	(30)
Introduction	812	(1)
Relative Anatomy and Physiology	813	(5)
Physiology of Metabolism and Thermoregulation	813	(1)
Glucose Requirements	813	(1)
Airway Anatomy and Physiology	814	(2)
Pulmonary Anatomy and Physiology	816	(1)
Cardiovascular Anatomy and Physiology	817	(1)
General Pathophysiology in the Pediatric Patient	818	(2)
Respiratory Distress, Failure, and Arrest	818	(1)
Clinical Presentation of Respiratory Distress and Failure	819	(1)
Pulmonary Disorders	820	(9)
Croup (Laryngotracheobronchitis)	821	(3)
Epiglottitis	824	(1)
Asthma	825	(2)
Bronchiolitis	827	(1)
Foreign Body Airway Obstruction (FBAO)	828	(1)
Hypoperfusion Syndromes	829	(3)
Nondistributive Shock	829	(1)
Distributive Shock	829	(1)
Cardiogenic Shock	830	(1)
Obstructive Shock	830	(1)
Sepsis	830	(2)
Drowning and Near-Drowning	832	(1)
Congenital Heart Disease	832	(2)
General Management Concerns	834	(6)
Airway	834	(2)
Vascular Access	836	(1)
Temperature Regulation	836	(1)
Hypoglycemia	836	(4)
High-Risk Obstetrical/Gynecological Emergencies	840	(33)
Introduction	843	(1)
Anatomy and Physiology	843	(5)
Fertilization and the First Trimester	843	(1)
The Second and Third Trimesters	844	(3)
Changes in Maternal Physiology	847	(1)
General Assessment of the Ob/Gyn Patient	848	(3)
History	848	(1)
Physical Exam	849	(2)
Intrapartum Fetal Heart Rate Monitoring	851	(6)
Baseline Rate	852	(1)
Variability	853	(1)
Periodic Changes in FHR	854	(2)
Changes in Trending Patterns of FHR	856	(1)
Management of Fetal Distress	857	(1)
Pathophysiology, Assessment, and Management of Specific Ob/Gyn Emergencies	857	(3)
Vaginal Hemorrhage during Pregnancy	857	(1)
Abruptio Placentae	858	(1)
Placenta Previa	859	(1)
Complications of Labor and Delivery	860	(7)
Preterm Labor	860	(2)
Breech Presentation	862	(1)
Dystocia	863	(2)
Umbilical Cord Prolapse	865	(1)
Uterine Rupture	865	(1)
Postpartum Hemorrhage	866	(1)
Medical Complications of Pregnancy	867	(6)
Hypertension in Pregnancy	867	(2)
Gestational Diabetes Mellitus	869	(1)
Embolism	870	(3)
Neonatal Emergencies	873	(22)
Introduction	875	(1)
Relative Anatomy and Physiology	876	(1)
Physiology of Thermoregulation	876	(1)
Glucose Requirements	876	(1)
Airway Anatomy and Physiology	876	(1)
Pulmonary Anatomy and Physiology	877	(1)
Cardiovascular Anatomy and Physiology	878	(2)
General Pathophysiology: Pulmonary	880	(4)
Assessment of Respiratory Distress	880	(1)
Respiratory Distress, Failure, and Arrest	880	(1)
Persistent Pulmonary Hypertension of the Newborn	881	(1)
Meconium Aspiration Syndrome	882	(1)
Transient Tachypnea of the Newborn	882	(1)
Neonatal Respiratory Distress Syndrome	882	(2)
Congenital Diaphragmatic Hernia	884	(1)
General Pathophysiology: Cardiovascular	884	(2)
Left-to-Right Shunt Defects	885	(1)
Atrial Septal Defect	885	(1)
Ventricular Septal Defect	885	(1)
Patent Ductus Arteriosus	886	(1)
Obstructive Heart Defects	886	(3)
Aortic and Pulmonary Valve Stenosis	887	(1)
Coarctation of the Aorta	887	(1)
Cyanotic Heart Defects	887	(1)
Complete Transposition of the Great Vessels	888	(1)
Tetralogy of Fallot	888	(1)
Transport Considerations for Congenital Heart Defects	889	(1)
General Pathophysiology: Other Neonatal Emergencies	889	(1)
Necrotizing Enterocolitis	890	(1)
Sepsis	890	(1)
General Neonatal Assessment Findings and Considerations	890	(1)
Skin Color	890	(1)
Vital Signs	891	(1)
General Neonatal Treatment Considerations	891	(4)
Airway	891	(1)
Vascular Access	891	(1)
Temperature Regulation	892	(1)
Hypoglycemia	893	(2)
Environmental Emergencies	895	(21)
Introduction	897	(1)
Pathophysiology	897	(1)
Heat	898	(5)
Heat Production	899	(1)
Heat Loss	899	(1)
Thermoregulation	900	(2)
Mechanisms That Decrease Body Temperature When the Body Is Too Warm	902	(1)
Mechanisms That Increase Body Temperature When the Body Is Too Cold	902	(1)
Hyperthermic Categories	903	(2)
Heat Tetany	903	(1)
Heat Cramps	904	(1)
Heat Syncope	904	(1)
Heat Exhaustion	904	(1)
Heatstroke	905	(1)
Hypothermic Categories	905	(7)
Hypothermia	906	(2)
Stages of Mild Hypothermia	908	(1)
Frostbite	908	(1)
Treatment for Hyperthermic Conditions	909	(1)
Treatment for Hypothermic Conditions	910	(2)
Frostbite	912	(1)
Special Considerations: Drowning and Near-Drowning	912	(4)
Pathophysiology	912	(2)
Treatment	914	(2)
Diving Emergencies	916	(19)
Introduction	918	(1)
History of Diving	918	(1)
Diving Physics	919	(1)
Gases of Diving	920	(1)
Buoyancy	920	(1)
Diving Environments	920	(1)
Diving Equipment	921	(1)
Injuries Associated with Descent	922	(1)
Injuries Associated with Depth and Decompression	923	(3)
Nitrogen Narcosis	923	(1)
Decompression Sickness	923	(2)
High-Pressure Neurologic Syndrome	925	(1)
Hypoxia and Gas Toxicity	926	(1)
Injuries Associated with Ascent	926	(1)
Aquatic Diseases Associated with Diving	927	(1)
Dangerous Marine Animals	927	(3)
Animals that Bite and Cause Trauma	927	(1)
Animals that Bite and Envenomate	928	(1)
Animals that Puncture	928	(1)
Animals that Sting	928	(2)
Aquatic-Life Borne Disease	930	(1)
Other Medical Conditions Associated with Diving	930	(1)
Causes of Death in Divers	930	(1)
Hyperbaric Medicine	931	(1)
Special Considerations for Females in Diving	932	(1)
Role of the Critical Care Provider in Support Situations	933	(2)
Toxicological Emergencies	935	(24)
Introduction	938	(1)
Drug Abuse Defined	938	(1)
Toxidromes	938	(1)
Specific Drugs of Abuse	938	(2)
Specific Prescription Drugs	940	(4)
Cardiac Medications	940	(1)
Psychiatric Medications	941	(1)
Anticonvulsants	942	(1)
Over-the-Counter Medications	943	(1)
Herbal Medications	944	(1)
Caustics	944	(1)
Ethanol and Toxic Alcohols	945	(1)
Industrial Exposures	946	(2)
Warfare Agents	948	(1)
Other Potentially Toxic Agents	949	(1)
Food Poisoning	950	(1)
Plants and Mushrooms	951	(1)
Envenomations and Stings	952	(2)
Snakes	952	(1)
Hymenoptera	952	(1)
Anthropods: Spiders and Scorpions	953	(1)
Marine Animal	954	(1)
Initial Evaluation	955	(1)
Decontamination	955	(1)
Gastric Decontamination	955	(1)
Transportation Issues	956	(3)
Weapons of Mass Destruction	959	(28)
Introduction	962	(1)
Personal Protection	963	(1)
Chemical Agents	964	(1)
Nerve Agents	964	(3)
Pulmonary Agents	967	(1)
Cyanide	967	(1)
Vesicants	968	(2)
Mustard	969	(1)
Lewisite	970	(1)
Phosgene Oxime	970	(1)
Incapacitating and Irritant Agents	970	(1)
Biological Agents	970	(1)
Bacterial Agents	971	(3)
Anthrax	972	(1)
Plague	973	(1)
Tularemia	974	(1)
Viral Agents	974	(3)
Smallpox	975	(1)
Viral Hemorrhagic Fevers	975	(2)
Biological Toxins	977	(1)
Botulinum Toxin	977	(1)
Other Potential Agents	977	(1)
Radiological/Nuclear Concerns	978	(5)
Types of Ionizing Radiation	979	(1)
Exposure and Contamination	979	(1)
Radiation Injury	979	(2)
Management of Radiation Illness	981	(2)
Explosives	983	(1)
Effects of Explosions	983	(1)
Blast Injury Phases	983	(1)
Incendiary Devices	984	(1)
Assessment and Management Considerations	984	(1)
Additional Information Resources	984	(3)
Organ Donation and Retrieval	987	(15)
Introduction	990	(1)
Indications for Organ Donation	991	(1)
Neurologic Death	991	(1)
Determining Neurologic Death	991	(1)
Organ Donors	992	(1)
Consent in Organ Donation	992	(1)
Donated Organ/Organ Recipient Matching	993	(1)
Clinical Management of the Organ Donor	994	(1)
Assessing Organ Viability	995	(1)
Anesthesia Requirements for Organ Recovery	996	(1)
Organ Recovery and Preservation	996	(1)
Tissue Donation	997	(2)
EMS Scene Death Referral Program	999	(3)
Quality Improvement in Critical Care Transport	1002	(27)
Introduction	1003	(3)
Recent Trends in Quality Management	1006	(1)
Quality Assurance versus Quality Improvement	1007	(1)
Measuring Performance and Quality in Critical Care Transport	1007	(1)
Chart Review and Feedback to Clinicians	1007	(1)
Environmental Scanning	1007	(1)
How is the Organization Performing?	1008	(1)
Information and Analysis	1009	(1)
Data Analysis: Common Tools of Quality Improvement	1010	(4)
Flowchart	1011	(1)
Cause-and-Effect Charts	1011	(1)
Run (Trend) Chart	1011	(1)
Histogram	1012	(1)
Scatter Diagram	1012	(1)
Pareto Chart	1013	(1)
Control Chart	1013	(1)
Quality Improvement Sop	1014	(1)
Leadership and Quality Improvement	1015	(2)
Drive Out Fear	1017	(12)
Communications and Documentation	1029	(21)
Introduction	1031	(1)
Communications	1032	(1)
Dispatch Center Considerations	1032	(7)
Planning	1032	(1)
Location	1033	(1)
Personnel	1033	(1)
Console Design	1034	(1)
Ergonomics	1035	(1)
Emergency Electrical Power	1035	(1)
Security	1036	(1)
Equipment	1036	(3)
Backup and Alternative Sites	1039	(1)
Mission Status or Tracking Board	1039	(1)
Aeromedical Pilot Considerations	1039	(2)
Maintenance with FAA Requirements	1040	(1)
Interaction with the Communications Center	1040	(1)
Interaction with Air Traffic Controllers	1041	(1)
Interaction with Emergency Service Agencies	1041	(1)
Critical Care Provider Considerations	1041	(4)
Familiarity with Communications Hardware and Frequency	1042	(1)
Familiarity with Pilot and Communications Center Procedures	1042	(1)
Communication with Other Care Providers	1043	(1)
Communication with Receiving Facilities	1043	(1)
Receiving and Providing Bedside Reports	1044	(1)
Documentation	1045	(5)
Similarities with Prehospital EMS Documentation Practices	1045	(2)
General Considerations for Completing a Patient Care Report	1047	(1)
Modes of Documentation	1048	(1)
Consequences of Poor Documentation Practices	1048	(2)
The Critical Care Paramedic in the Hospital Environment	1050	(13)
Introduction	1052	(1)
Defining the Role of the Critical Care Paramedic in the Hospital	1053	(1)
State Law	1053	(1)
Medical Director	1053	(1)
State Laws Governing Medications and Procedures	1054	(1)
Political Entities Influencing Paramedic Practice in the Hospital	1054	(2)
Hospital Work Environments for the Critical Care Paramedic	1056	(4)
Emergency Department	1056	(3)
Critical Care Units	1059	(1)
Special Procedure Units	1060	(3)
Cardiac Catheterization and Electrophysiology Laboratory	1060	(1)
Diagnostic Noninvasive Cardiology Laboratory	1061	(1)
Interventional Radiology	1061	(2)
Precautions on Bloodborne Pathogens and Infectious Diseases	1063	(2)
Answers to Review Questions	1065	(46)
Glossary	1111	(18)
Index	1129