Paramedic Care: Principles and Practices, Volume 3: Medical Emergencies

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

• ISBN13: 9780131178342
• ISBN10: 0131178342
• 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 third of 5 titles in the Brady Paramedic Care Principles and Practice series, Volume 3 - Medical Emergencies - covers pulmonology, cardiology, neurology, endocrinology, allergies and anaphylaxis, gastroenterology, urology and nephrology, toxicology and substance abuse, hematology, environmental emergencies, infectious diseases, psychiatric and behavorial emergencies, gynecology, and obstetrics. Paramedic Level Emergency Responders or Intermediate level responders training to enter into Paramedic.

Author Biography

Richard Cherry is Clinical Assistant Professor of Emergency Medicine and Assistant Residency Director at Upstate Medical University in Syracuse, New York. Robert Porter serves as the Senior Advanced Life Support Educator for Madison County, New York, and as a Flight Paramedic with the Onondaga, New York, County Sheriff's Department helicopter service, AirOne. Bryan Bledsoe is an Adjunct Associate Professor of Emergency Medicine at The George Washington University Medical Center in Washington, DC.

Table of Contents

Series Preface	xxvii
Preface	xxxi
Acknowledgments	xxxiii
About the Authors	xxxix
Pulmonology	2	(62)
Introduction	4	(1)
Review of Respiratory Anatomy and Physiology	5	(13)
Upper Airway Anatomy	6	(2)
Lower Airway Anatomy	8	(3)
Physiological Processes	11	(7)
Pathophysiology	18	(3)
Disruption in Ventilation	18	(2)
Disruption in Diffusion	20	(1)
Disruption in Perfusion	20	(1)
Assessment of the Respiratory System	21	(14)
Scene Size-up	21	(1)
Initial Assessment	21	(3)
Focused History and Physical Examination	24	(11)
Management of Respiratory Disorders	35	(1)
Management Principles	35	(1)
Specific Respiratory Diseases	35	(29)
Upper Airway Obstruction	35	(2)
Noncardiogenic Pulmonary Edema/Adult Respiratory Distress Syndrome	37	(2)
Obstructive Lung Disease	39	(1)
Emphysema	40	(2)
Chronic Bronchitis	42	(1)
Asthma	43	(3)
Upper Respiratory Infection	46	(4)
Pneumonia	50	(1)
Severe Acute Respiratory Syndrome (SARS)	51	(2)
Lung Cancer	53	(1)
Toxic Inhalation	54	(1)
Carbon Monoxide Inhalation	55	(1)
Pulmonary Embolism	56	(1)
Spontaneous Pneumothorax	57	(1)
Hyperventilation Syndrome	58	(1)
Central Nervous System Dysfunction	59	(1)
Dysfunction of the Spinal Cord, Nerves, or Respiratory Muscles	60	(4)
Cardiology	64	(9)
Introduction	71	(2)
Part 1: Cardiovascular Anatomy and Physiology, ECG Monitoring, and Dysrhythmia Analysis	73	(69)
Cardiovascular Anatomy	73	(6)
Anatomy of the Heart	73	(5)
Anatomy of the Peripheral Circulation	78	(1)
Cardiac Physiology	79	(7)
The Cardiac Cycle	79	(1)
Nervous Control of the Heart	80	(2)
Electrophysiology	82	(4)
Electrocardiographic Monitoring	86	(12)
The Electrocardiogram	86	(1)
ECG Leads	86	(4)
Relationship of the ECG to Electrical Events in the Heart	90	(6)
Interpretation of Rhythm Strips	96	(2)
Dysrhythmias	98	(44)
Mechanism of Impulse Formation	99	(1)
Classification of Dysrhythmias	99	(1)
Dysrhythmias Originating in the SA Node	100	(5)
Dysrhythmias Originating in the Atria	105	(10)
Dysrhythmias Originating Within the AV Junction (AV Blocks)	115	(6)
Dysrhythmias Sustained or Originating in the AV Junction	121	(6)
Dysrhythmias Originating in the Ventricles	127	(12)
Pulseless Electrical Activity	139	(1)
Dysrhythmias Resulting from Disorders of Conduction	139	(3)
ECG Changes due to Electrolyte Abnormalities and Hypothermia	142	(1)
Part 2: Assessment and Management of the Cardiovascular Patient	142	(61)
Assessment of the Cardiovascular Patient	142	(9)
Scene Size-up and Initial Assessment	143	(1)
Focused History	144	(4)
Physical Examination	148	(3)
Management of Cardiovascular Emergencies	151	(23)
Basic Life Support	152	(1)
Advanced Life Support	152	(1)
Monitoring ECG in the Field	152	(4)
Vagal Maneuvers	156	(1)
Precordial Thump	156	(1)
Pharmacological Management	156	(6)
Defibrillation	162	(2)
Emergency Synchronized Cardioversion	164	(3)
Transcutaneous Cardiac Pacing	167	(4)
Carotid Sinus Massage	171	(1)
Support and Communication	171	(3)
Managing Specific Cardiovascular Emergencies	174	(29)
Angina Pectoris	174	(3)
Myocardial Infarction	177	(6)
Heart Failure	183	(5)
Cardiac Tamponade	188	(2)
Hypertensive Emergencies	190	(1)
Cardiogenic Shock	191	(3)
Cardiac Arrest	194	(4)
Peripheral Vascular and Other Cardiovascular Emergencies	198	(5)
Reviewing the Cardiac Conductive System	203	(1)
Part 3: 12-Lead ECG Monitoring and Interpretation	203	(484)
ECG Recording	204	(1)
ECG Leads	204	(5)
Bipolar Limb Leads	205	(1)
Unipolar or Augmented Limb Leads	206	(3)
Precordial Leads	209	(1)
Mean QRS Axis Determination	209	(1)
Axis Deviation	210	(2)
The Normal 12-Lead ECG	212	(2)
Disease Findings	214	(12)
Evolution of Acute Coronary Syndrome	215	(3)
Localization of Acute Myocardial Infarction	218	(8)
Conduction Abnormalities	226	(6)
AV Blocks	226	(1)
Bundle Branch Blocks	227	(4)
Chamber Enlargement	231	(1)
Prehospital ECG Monitoring	232	(14)
Prehospital 12-Lead ECG Monitoring	237	(9)
Neurology	246	(54)
Introduction	248	(1)
Anatomy and Physiology	249	(12)
The Central Nervous System	249	(10)
The Peripheral Nervous System	259	(2)
The Autonomic Nervous System	261	(1)
Pathophysiology	261	(2)
Alteration in Cognitive Systems	261	(1)
Central Nervous System Disorders	261	(1)
Cerebral Homeostasis	262	(1)
Peripheral Nervous System Disorders	263	(1)
General Assessment Findings	263	(9)
Scene Size-Up and Initial Assessment	263	(2)
Focused History and Physical Exam	265	(7)
Ongoing Assessment	272	(1)
Management of Specific Nervous System Emergencies	272	(28)
Altered Mental Status	273	(2)
Stroke and Intracranial Hemorrhage	275	(6)
Seizures and Epilepsy	281	(4)
Syncope	285	(1)
Headache	286	(2)
``Weak and Dizzy''	288	(1)
Neoplasms	288	(2)
Brain Abscess	290	(1)
Degenerative Neurological Disorders	290	(4)
Back Pain and Nontraumatic Spinal Disorders	294	(6)
Endocrinology	300	(32)
Introduction	303	(1)
Anatomy and Physiology	304	(9)
Hypothalamus	304	(3)
Pituitary Gland	307	(2)
Thyroid Gland	309	(1)
Parathyroid Glands	309	(1)
Thymus Gland	310	(1)
Pancreas	310	(2)
Adrenal Glands	312	(1)
Gonads	312	(1)
Pineal Gland	313	(1)
Other Organs with Endocrine Activity	313	(1)
Endocrine Disorders and Emergencies	313	(19)
Disorders of the Pancreas	314	(10)
Disorders of the Thyroid Gland	324	(3)
Disorders of the Adrenal Glands	327	(5)
Allergies and Anaphylaxis	332	(16)
Introduction	334	(1)
Pathophysiology	334	(5)
The Immune System	335	(1)
Allergies	336	(2)
Anaphylaxis	338	(1)
Assessment Findings in Anaphylaxis	339	(2)
Management of Anaphylaxis	341	(2)
Protect the Airway	341	(1)
Administer Medications	342	(1)
Offer Psychological Support	343	(1)
Assessment Findings in Allergic Reaction	343	(1)
Management of Allergic Reactions	343	(2)
Patient Education	345	(3)
Gastroenterology	348	(32)
Introduction	351	(1)
General Pathophysiology, Assessment, and Treatment	351	(5)
General Pathophysiology	351	(2)
General Assessment	353	(2)
General Treatment	355	(1)
Specific Illnesses	356	(24)
Upper Gastrointestinal Diseases	356	(8)
Lower Gastrointestinal Diseases	364	(7)
Accessory Organ Diseases	371	(9)
Urology and Nephrology	380	(34)
Introduction	383	(1)
Anatomy and Physiology	384	(7)
Kidneys	384	(5)
Ureters	389	(1)
Urinary Bladder	389	(1)
Urethra	389	(1)
Testes	389	(1)
Epididymis and Vas Deferens	390	(1)
Prostate Gland	390	(1)
Penis	390	(1)
General Mechanisms of Nontraumatic Tissue Problems	391	(1)
General Pathophysiology, Assessment, and Management	391	(5)
Pathophysiologic Basis of Pain	391	(1)
Assessment and Management	392	(4)
Renal and Urologic Emergencies	396	(18)
Acute Renal Failure	396	(4)
Chronic Renal Failure	400	(5)
Renal Calculi	405	(3)
Priapism	408	(1)
Urinary Tract Infection	408	(6)
Toxicology and Substance Abuse	414	(44)
Introduction	416	(1)
Epidemiology	417	(1)
Poison Control Centers	417	(1)
Routes of Toxic Exposure	418	(1)
Ingestion	418	(1)
Inhalation	418	(1)
Surface Absorption	419	(1)
Injection	419	(1)
General Principles of Toxicologic Assessment and Management	419	(3)
Scene Size-up	419	(1)
Initial Assessment	420	(1)
History, Physical Exam, and Ongoing Assessment	420	(1)
Treatment	420	(1)
Suicidal Patients and Protective Custody	421	(1)
Ingested Toxins	422	(2)
Inhaled Toxins	424	(1)
Surface-Absorbed Toxins	425	(1)
Specific Toxins	425	(15)
Cyanide	428	(1)
Carbon Monoxide	428	(1)
Cardiac Medications	429	(1)
Caustic Substances	430	(1)
Hydrofluoric Acid	431	(1)
Alcohol	432	(1)
Hydrocarbons	432	(1)
Tricyclic Antidepressants	432	(1)
MAO Inhibitors	433	(1)
Newer Antidepressants	434	(1)
Lithium	435	(1)
Salicylates	435	(1)
Acetaminophen	436	(1)
Other Nonprescription Pain Medications	436	(1)
Theophylline	437	(1)
Metals	437	(1)
Contaminated Food	438	(1)
Poisonous Plants and Mushrooms	439	(1)
Injected Toxins	440	(8)
General Principles of Management	440	(1)
Insect Bites and Stings	441	(3)
Snakebites	444	(3)
Marine Animal Injection	447	(1)
Substance Abuse and Overdose	448	(4)
Drugs of Abuse	449	(3)
Alcohol Abuse	452	(6)
Physiological Effects	452	(1)
General Alcoholic Profile	453	(1)
Consequences of Chronic Alcohol Ingestion	453	(5)
Hematology	458	(32)
Introduction	460	(1)
Anatomy, Physiology, and Pathophysiology	461	(12)
Components of Blood	461	(8)
Hemostasis	469	(2)
Blood Products and Blood Typing	471	(1)
Transfusion Reactions	472	(1)
General Assessment and Management	473	(5)
Scene Size-Up	474	(1)
Initial Assessment	474	(1)
Focused History and Physical Exam	474	(4)
General Management of Hematopoietic Emergencies	478	(1)
Managing Specific Patient Problems	478	(12)
Diseases of the Red Blood Cells	479	(3)
Diseases of the White Blood Cells	482	(2)
Diseases of the Platelets/Blood Clotting Abnormalities	484	(1)
Other Hematopoietic Disorders	485	(5)
Environmental Emergencies	490	(44)
Introduction	493	(1)
Homeostasis	494	(1)
Pathophysiology of Heat and Cold Disorders	494	(3)
Mechanisms of Heat Gain and Loss	494	(1)
Thermogenesis (Heat Generation)	494	(1)
Thermolysis (Heat Loss)	494	(1)
Thermoregulation	495	(2)
Heat Disorders	497	(7)
Hyperthermia	497	(1)
Predisposing Factors	498	(1)
Preventive Measures	498	(1)
Specific Heat Disorders	499	(4)
Role of Dehydration in Heat Disorders	503	(1)
Fever (Pyrexia)	503	(1)
Cold Disorders	504	(8)
Hypothermia	504	(1)
Mechanisms of Heat Conservation and Loss	504	(1)
Predisposing Factors	504	(1)
Preventive Measures	505	(1)
Degrees of Hypothermia	505	(2)
Assessment and Management of Hypothermia	507	(4)
Frostbite	511	(1)
Trench Foot	512	(1)
Near-Drowning and Drowning	512	(4)
Pathophysiology of Drowning and Near-Drowning	513	(2)
Treatment for Near-Drowning	515	(1)
Diving Emergencies	516	(7)
The Effects of Air Pressure on Gases	516	(1)
Pathophysiology of Diving Emergencies	517	(1)
Classification of Diving Injuries	517	(1)
General Assessment of Diving Emergencies	518	(1)
Pressure Disorders	519	(3)
Other Diving-Related Illnesses	522	(1)
Divers Alert Network	523	(1)
High Altitude Illness	523	(3)
Prevention	523	(2)
Types of High Altitude Illness	525	(1)
Nuclear Radiation	526	(8)
Basic Nuclear Physics	526	(1)
Effects of Radiation on the Body	527	(1)
Principles of Safety	528	(2)
Management	530	(4)
Infectious Disease	534	(62)
Introduction	537	(1)
Public Health Principles	538	(1)
Public Health Agencies	539	(1)
Microorganisms	539	(5)
Bacteria	540	(1)
Viruses	541	(1)
Other Microorganisms	542	(2)
Contraction, Transmission, and Stages of Disease	544	(2)
Phases of the Infectious Process	546	(1)
The Body's Defenses Against Disease	546	(3)
The Immune System	546	(2)
The Complement System	548	(1)
The Lymphatic System	548	(1)
Individual Host Immunity	548	(1)
Infection Control in Prehospital Care	549	(7)
Preparation for Response	549	(2)
Response	551	(1)
Patient Contact	551	(1)
Recovery	552	(3)
Infectious Disease Exposures	555	(1)
Assessment of the Patient with Infectious Disease	556	(2)
Past Medical History	556	(1)
The Physical Examination	557	(1)
Selected Infectious Diseases	558	(32)
Diseases of Immediate Concern to EMS Providers	558	(19)
Other Infectious Conditions of the Respiratory System	577	(2)
GI System Infections	579	(2)
Nervous System Infections	581	(3)
Sexually Transmitted Diseases	584	(4)
Diseases of the Skin	588	(2)
Nosocomial Infections	590	(1)
Patient Education	590	(1)
Preventing Disease Transmission	591	(5)
Psychiatric and Behavioral Disorders	596	(28)
Introduction	598	(1)
Behavioral Emergencies	598	(1)
Pathophysiology of Psychiatric Disorders	599	(2)
Biological	599	(1)
Psychosocial	600	(1)
Sociocultural	600	(1)
Assessment of Behavioral Emergency Patients	601	(3)
Scene Size-Up	601	(1)
Initial Assessment	601	(1)
Focused History and Physical Examination	602	(1)
Mental Status Examination	603	(1)
Psychiatric Medications	604	(1)
Specific Psychiatric Disorders	604	(11)
Cognitive Disorders	605	(1)
Schizophrenia	605	(1)
Anxiety and Related Disorders	606	(2)
Mood Disorders	608	(2)
Substance-Related Disorders	610	(1)
Somatoform Disorders	610	(1)
Factitious Disorders	610	(1)
Dissociative Disorders	611	(1)
Eating Disorders	611	(1)
Personality Disorders	612	(1)
Impulse Control Disorders	613	(1)
Suicide	613	(1)
Age-Related Conditions	614	(1)
Management of Behavioral Emergencies	615	(2)
Medical	615	(1)
Psychological	616	(1)
Violent Patients and Restraint	617	(7)
Methods of Restraint	618	(6)
Gynecology	624	(20)
Introduction	626	(1)
Anatomy and Physiology	626	(5)
Female Reproductive Organs	627	(4)
The Menstrual Cycle	631	(1)
The Proliferative Phase	631	(1)
The Secretory Phase	631	(1)
The Ischemic Phase	632	(1)
The Menstrual Phase	632	(1)
Assessment of the Gynecological Patient	632	(3)
History	633	(1)
Physical Exam	634	(1)
Management of Gynecological Emergencies	635	(1)
Specific Gynecological Emergencies	636	(8)
Medical Gynecological Emergencies	636	(3)
Traumatic Gynecological Emergencies	639	(5)
Obstetrics	644	(43)
Introduction	646	(1)
The Prenatal Period	646	(7)
Anatomy and Physiology of the Obstetric Patient	646	(4)
Fetal Development	650	(2)
Fetal Circulation	652	(1)
General Assessment of the Obstetric Patient	653	(3)
Initial Assessment	653	(1)
History	653	(2)
Physical Examination	655	(1)
General Management of the Obstetric Patient	656	(1)
Complications of Pregnancy	656	(12)
Trauma	657	(1)
Medical Conditions	657	(1)
Bleeding in Pregnancy	658	(4)
Medical Complications of Pregnancy	662	(4)
Braxton-Hicks Contractions	666	(1)
Pretern Labor	666	(2)
The Puerperium	668	(9)
Labor	668	(2)
Management of a Patient in Labor	670	(1)
Field Delivery	671	(3)
Neonatal Care	674	(3)
Abnormal Delivery Situations	677	(3)
Other Delivery Complications	680	(1)
Maternal Complications of Labor and Delivery	681	(6)
Precautions on Bloodborne Pathogens and Infectious Disease	687	(2)
Suggested Responses to ``You Make the Call''	689	(8)
Answers to ``Review Questions''	697	(2)
Glossary	699	(16)
Index	715