Paramedic Care: Principles and Practice, Volume 5: Special Considerations Operations

by Bledsoe, Bryan E.; Porter, Robert S.; Cherry, Richard A.

• ISBN13: 9780131178410
• ISBN10: 0131178415
• Edition: 2nd
• Format: Hardcover
• Copyright: 2006-01-01
• Publisher: Pearson

Summary

Written by the best-selling author team of Bryan E. Bledsoe D.O., F.A.C.E.P., EMT-P, Robert S. Porter M.A., NREMT-P, and Richard A. Cherry, M.S., NREMT-P, this student-friendly easy to understand series covers the DOT National Standard Curriculum.The fifth of 5 titles in the Brady Paramedic Care Principles and Practice series, Volume 5 - Special Considerations/Operations - contains neonatology, pediatrics, geriatrics, abuse and assault, the challenged patient, chronic-care patient, assessment-based management, operations, incident command, rescue awareness and operations, hazmat, crime scene awareness, rural EMS, and a new chapter on EMS response to WMD.Paramedic Level Emergency Responders or Intermediate level responders training to enter into Paramedic.

Table of Contents

Series Preface	xxv
Preface	xxix
Acknowledgments	xxxiii
About the Authors	xxxix
Neonatology	2	(36)
Introduction	4	(1)
General Pathophysiology, Assessment, and Management	4	(9)
Epidemiology	5	(1)
Pathophysiology	6	(3)
Assessment	9	(1)
Treatment	10	(3)
The Distressed Newborn	13	(12)
Resuscitation	14	(1)
Inverted Pyramid for Resuscitation	14	(9)
Maternal Narcotic Use	23	(1)
Neonatal Transport	23	(2)
Specific Neonatal Situations	25	(13)
Meconium-Stained Amniotic Fluid	26	(1)
Apnea	27	(1)
Diaphragmatic Hernia	27	(1)
Bradycardia	28	(1)
Prematurity	28	(1)
Respiratory Distress/Cyanosis	29	(1)
Hypovolemia	30	(1)
Seizures	30	(1)
Fever	31	(1)
Hypothermia	31	(1)
Hypoglycemia	32	(1)
Vomiting	33	(1)
Diarrhea	33	(1)
Common Birth Injuries	34	(1)
Cardiac Resuscitation, Postresuscitation, and Stabilization	35	(3)
Pediatrics	38	(100)
Introduction	41	(1)
Role of Paramedics in Pediatric Care	41	(2)
Continuing Education and Training	42	(1)
Improved Health Care and Injury Prevention	42	(1)
General Approach to Pediatric Emergencies	43	(11)
Communication and Psychological Support	44	(1)
Growth and Development	45	(4)
Anatomy and Physiology	49	(5)
General Approach to Pediatric Assessment	54	(13)
Basic Considerations	54	(1)
Scene Size-Up	55	(1)
Initial Assessment	55	(7)
Focused History and Physical Exam	62	(5)
Ongoing Assessment	67	(1)
General Management of Pediatric Patients	67	(22)
Basic Airway Management	67	(7)
Advanced Airway and Ventilatory Management	74	(7)
Circulation	81	(5)
C-Spine Immobilization	86	(1)
Transport Guidelines	86	(3)
Specific Medical Emergencies	89	(27)
Infections	89	(1)
Respiratory Emergencies	90	(2)
Specific Respiratory Emergencies	92	(7)
Shock (Hypoperfusion)	99	(9)
Neurologic Emergencies	108	(2)
Gastrointestinal Emergencies	110	(1)
Metabolic Emergencies	111	(3)
Poisoning and Toxic Exposure	114	(2)
Trauma Emergencies	116	(9)
Mechanisms of Injury	116	(3)
Special Considerations	119	(3)
Specific Injuries	122	(3)
Sudden Infant Death Syndrome (SIDS)	125	(1)
Child Abuse and Neglect	126	(4)
Perpetrators of Abuse or Neglect	126	(1)
Types of Abuse	127	(1)
Assessment of the Potentially Abused or Neglected Child	128	(1)
Management of the Potentially Abused or Neglected Child	129	(1)
Resources for Abuse and Neglect	129	(1)
Infants and Children with Special Needs	130	(8)
Common Home-Care Devices	130	(3)
General Assessment and Management Practices	133	(5)
Geriatric Emergencies	138	(66)
Introduction	142	(1)
Epidemiology and Demographics	142	(8)
Population Characteristics	142	(1)
Societal Issues	143	(4)
Financing and Resources For Health Care	147	(3)
General Pathophysiology, Assessment, and Management	150	(11)
Pathophysiology of the Elderly Patient	150	(5)
Assessment Considerations	155	(5)
Management Considerations	160	(1)
System Pathophysiology in the Elderly	161	(7)
Respiratory System	162	(1)
Cardiovascular System	163	(1)
Nervous System	164	(1)
Endocrine System	165	(1)
Gastrointestinal System	165	(1)
Thermoregulatory System	166	(1)
Integumentary System	166	(1)
Musculoskeletal System	166	(1)
Renal System	167	(1)
Genitourinary System	167	(1)
Immune System	167	(1)
Hematology System	168	(1)
Common Medical Problems in the Elderly	168	(28)
Pulmonary/Respiratory Disorders	168	(4)
Cardiovascular Disorders	172	(3)
Neurologic Disorders	175	(5)
Metabolic and Endocrine Disorders	180	(1)
Gastrointestinal Disorders	181	(2)
Skin Disorders	183	(1)
Musculoskeletal Disorders	184	(1)
Renal Disorders	185	(1)
Urinary Disorders	186	(1)
Environmental Emergencies	186	(2)
Toxicological Emergencies	188	(4)
Substance Abuse	192	(2)
Behavioral/Psychological Disorders	194	(2)
Trauma in the Elderly Patient	196	(8)
Contributing Factors	196	(1)
General Assessment	196	(2)
General Management	198	(1)
Specific Injuries	198	(6)
Abuse and Assault	204	(20)
Introduction	206	(1)
Partner Abuse	206	(3)
Reasons for Not Reporting Abuse	206	(1)
Identification of Partner Abuse	207	(1)
Characteristics of Partner Abusers	207	(1)
Characteristics of Abused Partners	208	(1)
Approaching the Battered Patient	209	(1)
Elder Abuse	209	(2)
Identification of Elder Abuse	209	(1)
Theories about Domestic Elder Abuse	210	(1)
Characteristics of Abused Elders	210	(1)
Characteristics of Elder Abusers	211	(1)
Child Abuse	211	(5)
Characteristics of Child Abusers	211	(1)
Characteristics of Abused Children	212	(1)
Identification of the Abused Child	213	(3)
Recording and Reporting Child Abuse	216	(1)
Sexual Assault	216	(8)
Characteristics of Victims of Sexual Assault/Rape	217	(1)
Characteristics of Sexual Assailants	218	(1)
Date Rape Drugs	218	(1)
EMS Responsibilities	219	(1)
Legal Considerations	219	(5)
The Challenged Patient	224	(24)
Introduction	226	(1)
Physical Challenges	226	(9)
Hearing Impairment	226	(3)
Visual Impairments	229	(2)
Speech Impairments	231	(1)
Obesity	232	(2)
Paralysis	234	(1)
Mental Challenges and Emotional Impairments	235	(1)
Developmental Disabilities	235	(2)
Accommodations for Developmental Disabilities	235	(1)
Down Syndrome	236	(1)
Fetal Alcohol Syndrome	237	(1)
Pathological Challenges	237	(6)
Arthritis	237	(1)
Cancer	238	(1)
Cerebral Palsy	239	(1)
Cystic Fibrosis (Mucoviscidosis)	240	(1)
Multiple Sclerosis	240	(1)
Muscular Dystrophy	241	(1)
Poliomyelitis	241	(1)
Previous Head Injuries	242	(1)
Spina Bifida	242	(1)
Myasthenia Gravis	242	(1)
Other Challenges	243	(5)
Culturally Diverse Patients	243	(1)
Terminally Ill Patients	244	(1)
Patients with Communicable Diseases	244	(1)
Patients with Financial Challenges	244	(4)
Acute Interventions for the Chronic Care Patient	248	(44)
Introduction	251	(1)
Epidemiology of Home Care	251	(10)
Patients Receiving Home Care	252	(1)
ALS Response to Home Care Patients	252	(9)
General System Pathophysiology, Assessment, and Management	261	(4)
Assessment	261	(4)
Transport and Management Treatment Plan	265	(1)
Specific Acute Home Health Situations	265	(27)
Respiratory Disorders	266	(10)
Vascular Access Devices	276	(2)
Cardiac Conditions	278	(1)
GI/GU Crisis	279	(3)
Acute Infections	282	(1)
Maternal and Newborn Care	283	(2)
Hospice and Comfort Care	285	(7)
Assessment-Based Management	292	(28)
Introduction	295	(1)
Effective Assessment	296	(5)
Importance of Accurate Information	296	(2)
Factors Affecting Assessment and Decision Making	298	(2)
Assessment/Management Choreography	300	(1)
The Right Equipment	301	(1)
General Approach to the Patient	302	(3)
Scene Size-Up	302	(1)
Initial Assessment	303	(1)
Focused History and Physical Exam	303	(1)
The Ongoing Assessment and the Detailed Physical Exam	304	(1)
Identification of Life-Threatening Problems	305	(1)
Presenting the Patient	305	(3)
Establishing Trust and Credibility	306	(1)
Developing Effective Presentation Skills	307	(1)
Review of Common Complaints	308	(12)
Practice Sessions	308	(1)
Laboratory-Based Simulations	308	(1)
Self-Motivation	308	(12)
Ambulance Operations	320	(24)
Introduction	321	(1)
Ambulance Standards	322	(2)
Ambulance Design	322	(1)
Medical Equipment Standards	323	(1)
Additional Guidelines	324	(1)
Checking Ambulances	324	(2)
Ambulance Deployment and Staffing	326	(1)
Traffic Congestion	326	(1)
Operational Staffing	327	(1)
Safe Ambulance Operations	327	(8)
Educating Providers	328	(1)
Reducing Ambulance Collisions	328	(1)
Standard Operating Procedures	329	(1)
The Due Regard Standard	330	(1)
Lights and Siren: a False Sense of Security	331	(1)
Escorts and Multiple-Vehicle Responses	332	(1)
Parking and Loading the Ambulance	332	(2)
The Deadly Intersection	334	(1)
Utilizing Air Medical Transport	335	(9)
Fixed-Wing Aircraft	335	(1)
Rotorcraft	335	(1)
Advantages and Disadvantages of Air Transport	336	(1)
Activation	337	(1)
Indications for Patient Use	337	(1)
Patient Preparation and Transfer	337	(2)
Scene Safety and the Landing Zone	339	(5)
Medical Incident Management	344	(34)
Introduction	348	(1)
Origins of Emergency Incident Management	349	(3)
Regulations and Standards	349	(2)
A Uniform, Flexible System	351	(1)
Command	352	(5)
Establishing Command	352	(1)
Incident Size-Up	353	(1)
Singular vs. Unified Command	354	(1)
Identifying a Staging Area	355	(1)
Incident Communications	355	(1)
Resource Utilization	356	(1)
Command Procedures	356	(1)
Termination of Command	357	(1)
Support of Incident Command	357	(4)
Command Staff	358	(2)
Finance/Administration	360	(1)
Logistics	360	(1)
Operations	360	(1)
Planning	361	(1)
Division of Operations Functions	361	(1)
Branches	361	(1)
Groups and Divisions	361	(1)
Units	361	(1)
Sectors	361	(1)
Functional Groups With an EMS Branch	362	(9)
Triage	362	(4)
Morgue	366	(1)
Treatment	366	(2)
On-Scene Physicians	368	(1)
Staging	368	(1)
Transport Unit	368	(1)
Extrication/Rescue Unit	369	(1)
Rehabilitation Unit	369	(1)
Communications	370	(1)
Disaster Management	371	(1)
Mitigation	371	(1)
Planning	371	(1)
Response	371	(1)
Recovery	371	(1)
Meeting the Challenge of Multiple-Casualty Incidents	372	(6)
Common Problems	372	(1)
Preplanning, Drills, and Critiques	372	(1)
Disaster Mental Health Services	373	(5)
Rescue Awareness and Operations	378	(46)
Introduction	381	(1)
Role of the Paramedic	381	(1)
Protective Equipment	382	(4)
Rescuer Protection	383	(2)
Patient Protection	385	(1)
Safety Procedures	386	(2)
Rescue SOPs	386	(1)
Crew Assignments	387	(1)
Preplanning	387	(1)
Rescue Operations	388	(8)
Phase 1: Arrival and Size-Up	388	(1)
Phase 2: Hazard Control	389	(1)
Phase 3: Patient Access	390	(1)
Phase 4: Medical Treatment	390	(3)
Phase 5: Disentanglement	393	(1)
Phase 6: Patient Packaging	394	(1)
Phase 7: Removal/Transport	395	(1)
Surface Water Rescues	396	(8)
General Background	396	(1)
Moving Water	397	(3)
Flat Water	400	(4)
Hazardous Atmosphere Rescues	404	(4)
Confined-Space Hazards	405	(2)
Confined-Space Protections in the Workplace	407	(1)
Cave-Ins and Structural Collapses	407	(1)
Highway Operations And Vehicle Rescues	408	(6)
Hazards in Highway Operations	408	(3)
Auto Anatomy	411	(1)
Rescue Strategies	412	(1)
Rescue Skills Practice	413	(1)
Hazardous Terrain Rescues	414	(10)
Types of Hazardous Terrain	414	(1)
Patient Access in Hazardous Terrain	414	(2)
Patient Packaging for Rough Terrain	416	(1)
Patient Removal from Hazardous Terrain	417	(2)
Extended Care Assessment and Environmental Issues	419	(5)
Hazardous Materials Incidents	424	(32)
Introduction	427	(1)
Role of the Paramedic	428	(1)
Requirements and Standards	429	(1)
Levels of Training	429	(1)
Incident Size-Up	429	(9)
IMS and Hazmat Emergencies	429	(1)
Incident Awareness	430	(2)
Recognition of Hazards	432	(3)
Identification of Substances	435	(3)
Hazardous Materials Zones	438	(1)
Specialized Terminology	438	(3)
Terms for Medical Hazmat Operations	439	(1)
Toxicological Terms	440	(1)
Contamination and Toxicology Review	441	(4)
Types of Contamination	442	(1)
Routes of Exposure	442	(1)
Cycles and Actions of Poisons	442	(1)
Treatment of Common Exposures	443	(2)
Approaches to Decontamination	445	(4)
Methods of Decontamination	445	(1)
Decontamination Decision Making	446	(1)
Field Decontamination	447	(2)
Hazmat Protection Equipment	449	(2)
Medical Monitoring and Rehabilitation	451	(1)
Entry Readiness	451	(1)
Post-Exit ``Rehab''	451	(1)
Heat Stress Factors	451	(1)
Importance of Practice	452	(4)
Crime Scene Awareness	456	(22)
Introduction	458	(1)
Approach to the Scene	459	(2)
Possible Scenarios	459	(2)
Specific Dangerous Scenes	461	(5)
Highway Encounters	461	(1)
Violent Street Incidents	462	(2)
Drug-Related Crimes	464	(1)
Clandestine Drug Laboratories	465	(1)
Domestic Violence	466	(1)
Tactical Considerations	466	(5)
Safety Tactics	466	(3)
Tactical Patient Care	469	(2)
EMS at Crime Scenes	471	(7)
EMS and Police Operations	472	(1)
Preserving Evidence	472	(6)
Rural EMS	478	(24)
Introduction	480	(1)
Practicing Rural EMS	480	(6)
Special Problems	481	(2)
Creative Problem-Solving	483	(3)
Typical Rural EMS Situations and Decisions	486	(16)
The Distance Factor	486	(3)
Agricultural Emergencies	489	(7)
Recreational Emergencies	496	(6)
Responding to Terrorist Acts	502	(21)
Introduction	504	(1)
Explosive Agents	505	(1)
Nuclear Detonation	506	(2)
A Nuclear Incident Response	507	(1)
Radioactive Contamination	508	(1)
Chemical Agents	508	(5)
Nerve Agents	509	(1)
Vesicants (Blistering Agents)	510	(1)
Pulmonary Agents	511	(1)
Biotoxins	511	(1)
Incapacitating Agents	512	(1)
Other Hazardous Chemicals	512	(1)
Recognition of a Chemical Agent Release	512	(1)
Management of a Chemical Agent Release	513	(1)
Biological Agents	513	(4)
Pneumonia-like Agents	515	(1)
Encephalitis-like Agents	516	(1)
Other Agents	516	(1)
Protection against Biological Agent Transmission	516	(1)
General Considerations Regarding Terrorist Attacks	517	(6)
Scene Safety	517	(1)
Recognizing a Terrorist Attack	518	(1)
Responding to a Terrorist Attack	518	(5)
Precautions on Bloodborne Pathogens and Infectious Disease	523	(2)
Suggested Responses to ``You Make the Call''	525	(8)
Answers to ``Review Questions''	533	(2)
Glossary	535	(8)
Index	543