EMT Exam 3 Flashcards
(426 cards)
1
Q
Perfusion
A
The supply of oxygen to and removal of wastes from the body’s cells and tissues as a result of the flow of blood through the capillaries
2
Q
Hypoperfusion
A
The body’s inability to adequately circulate blood to the body’s cells to supply them with oxygen and nutrients
3
Q
Shock
A
The body’s inability to adequately circulate blood to the body’s cells to supply them with oxygen and nutrients, which is a life-threatening condition
4
Q
What is shock a state of
A
Hypoperfusion
5
Q
True or false: respiration and perfusion is the same
A
True
6
Q
What can be the cause of shock/hypoperfusion
A
The malfunctioning of:
- The heart (pump)
- The vessels (pipes)
- Blood (fluid)
7
Q
Types of shock
A
- Hypovolemic
- Cardiogenic
- Neurogenic
- Anaphylactic
- Septic
- Obstructive
8
Q
Hypovolemic Shock
A
- One of the 6 types of shock
- “Fluid” problem
- Results from a decreased volume of circulating blood and plasma
- Often called hemorrhagic shock if caused by uncontrolled bleeding (internal or external)
9
Q
Cardiogenic Shock
A
- One of the 6 types of shock
- Results from inadequate perfusion to heart, decreasing strength of contractions
- Heart’s electrical system may malfunction, causing heartbeat that is too slow, too fast, or irregular
10
Q
Who do you often see cardiogenic shock in
A
MI patients
11
Q
Neurogenic Shock
A
- One of the 6 types of shock
- “Pipe” problem
- Results from inability to control dilation of blood vessels because of nerve paralysis from spinal cord injuries
- No blood loss, but vessels dilated so much that blood volume can’t fill them
12
Q
Anaphylactic Shock
A
- One of the 6 types of shock
- “Pipe” problem
- Results from histamine release by severe allergic reaction
- No blood loss, but vessles dilated so much that blood volume can’t fill them
- Bronchioles constrict, reducing the amount of air entering lungs
13
Q
What can hypovolemic shock be caused by
A
Can be caused by burns or crush injuries
14
Q
Septic Shock
A
- One of the 6 types of shock
- “Pipe” problem
- Results from systemic infection
- Immune and inflammatory response in addition to actual infection release a multitude of toxins, proteins, hormones, etc; these cause vasodilation and impaired ability for cells to absorb oxygen
- Requires aggressive fluid and antibiotic treatments
15
Q
Obstructive Shock
A
- One of the 6 types of shock
- Blood flow is blocked
16
Q
Severity of Shock
A
- Compensated: Body shunts blood where needed
- Decompensated: Blood pressure falls as body can’t handle loos of volume
- Irreversible: Cell damage occurring; causes rapid death
17
Q
What can obstructive shock be caused by
A
Caused by conditions such as pulmonary embolism, cardiac tamponade (trauma to chest causing bleeding), tension pneumothorax (collapsed lung leads to build up leading to pushed organs)
18
Q
Signs and symptoms of shock
A
- AMS
- Pale, cool, clammy skin
- N/V
- Vital signs changes
19
Q
Infants/children have efficient compensating mechanisms that maintain their blood pressure until
A
Half of their volume is depleted (children are good at compensating); potential for shock must be recognized and treated before tell-tale signs appear
20
Q
Care for shock
A
- Aggressive airway maintenance (administer high-concentration oxygen)
- Keep the patient warm with blankets and move to ambulance
- Place supine
- Rapid transport to trauma center within “golden hour”
- Attempt to stop cause of shock
21
Q
Deadly triad of trauma
A
- Acidosis
- Hypothermia
- Coagulopathy
22
Q
Types of bleeding
A
- Hemorrhage is severe bleeding; major cause of shock in trauma
- External
- Internal
23
Q
External bleeding- arteries
A
- Spurting blood
- Pulsating flow
- Bright red color
24
Q
External bleeding- veins
A
- Steady, slow flow
- Dark red color
- Use occlusive dressing because prevents air from getting in (and therefore embolism)
25
External bleeding- capillaries
- Slow, even flow
26
External bleeding
- Occurs outside of body after force penetrates skin and lacerates or destroys underlying blood vessels
- Typically visible on surface of the skin
27
What is how much a person bleeds determined ny
- Size and severity of wound
- Size and pressure of ruptured vessel
- Individual's ability to clot
28
How fast can someone who is bleeding from an artery die
They can die in 3 minutes
29
What is the most frequent cause of preventable death from injury
Serious bleeding from an extremity
30
Methods of controlling external bleeding
- Direct pressure
- Hemostatic agents
- Wound packing
- Tourniquet use on extremities
- Specialized compression devices for junctional bleeding
31
How to apply direct pressure to bleeding
- Apply firm pressure to would with gloved hand and/or gauze
- Hold pressure until bleeding is controlled
- If necessary, add dressing when lower ones are saturated
- Never remove bandages
32
Hemostatic agents
- Dressing containing substance that absorbs and traps RBCs
- Can be wadded up and inserted into wound
- May be a power poured directly into the wound
- Manual pressure is always necessary
33
How to do a wound packing
- Open clothing around the wound
- Locate the source of the most active bleeding
- Pack hemostatic dressing or gauze roll tightly into wound and directly onto the source of bleeding
- Compress firmly
34
What to do if wound packing is reassessed and it fails
Pack a second gauze on top of the first and reapply pressure
35
Tourniquet
- Use if bleeding is uncontrollable via direct pressure
- If applied correctly, a tourniquet stops arterial blood flow into the extremity and from the wound
36
Where do you place tourniquets
Above the bleeding site
37
What to do if bleeding is not controlled by applying initial tourniquet
Apply a second one jut about the first
38
Other ways to stop bleeding
- Splinting: Helps realign bones; decrease bleeding
- Cold application
- Elevation
39
Bleeding from ears
- Usually from head injury
- From increased intracranial pressure not direct trauma
40
What to do with a nosebleed patient
- Have patient sit and lean forward
- Apply direct pressure to fleshy portion of nostrils
- Keep patient calm and quiet
41
Epistaxis
Nosebleed
42
Internal bleeding
- Damage to internal organs and large blood vessels can result in loss of a large quantity of blood in short time
- Blood loss commonly cannot be seen
43
Signs of internal bleeding
- Injuries to surface of body
- Bruising, swelling, or pain over vital organs
- Painful, swollen, or deformed extremities
- Bleeding from mouth, rectum, or vagina
- Tender, rigid, or distended abdomen
- Vomiting coffee-round or bright-red material
44
Blood loss of single rib fracture
125 mL
45
Blood loss of radius or ulna fracture
250-500 ml
46
Blood loss of humerus fracture
750 ml
47
Blood loss of tibia or fibula fracture
500-1000 ml
48
Blood loss of femur fracture
1000-2000
49
Blood loss of pelvis fracture
Massive
50
Blunt force trauma
Leading cause of internal bleeding; can be caused by falls, MVCs, automobile-pedestrians collisions, blast injuries
51
Common penetrating traumas
- GSWs
- Stab wounds
- Impaled objects
52
What do soft tissues include
- Skin
- Fatty tissues
- Muscles
- Blood vessels
- Fibrous tissues
- Membranes
- Glands
- Nerves
53
Functions of skin
- Protection
- Water balance
- Temp regulation
- Excretion
- Shock absorption
54
True or false: soft tissue injuries often appear worse than they are
True; after cleaning up blood looks much better
55
Types of closed wounds
- Contusion
- Hematoma
- Closed crush injury
56
Contusion
- Type of closed wound
- A bruise
- Pain, swelling, discoloration at site
- May be immediate or delayed
57
Hematoma
- Type of closed wound
- Similar to contusion but with more tissue damage and involves larger blood vessels
- "Pocket" of blood
58
Closed crush injury
- Type of closed wound
- Excessive force transmitted from the body's exterior to it's internal structures
- Often crushes or ruptures internal organs
59
Assessment for closed wounds
- Bruising may be internal injury or bleeding
- Consider MOI
- Crush injuries are difficult to identify
60
Treatment for closed wounds
- Manage ABC's
- Always manage shock
- Splint extremities that are painful, swollen, or deformed
- Stay alert for vomiting
- Continuously monitor
61
Types of open wounds
- Abrasion
- Laceration
- Puncture
- Avulsion (peeled skin)
- Amputation
- Crush injury
- Blast injury
62
General treatment strategy for open wounds
- Expose wound
- Clean surface of wound
- Control bleeding
- Provide care for shock
- Prevent further contamination
- Bandage dressing in place after bleeding is controlled
- Keep patient still
- Reassure patient
63
Dressing
Any material applied to wound to control bleeding and preventing contamination (eg MIDDLE of bandage)
64
Bandage
Any material used to hold dressing in place (adhesive part of bandage)
65
How to care for abrasions and lacerations
- Reduce wound contamination
- Hold direct pressure
- Always check pulse, motor, and sensory function distal to injury to assure function
- Never open edges of laceration to see inside or further clean wound
66
Penetrating and puncture wounds
An open wound that tears through the skin and destroys underlying tissues
67
Concerns for puncture wounds
- Objects may be embedded deeper than they appear
- Check for exit wounds; may require immediate care
- Bullets can fracture bones as they enter
- Stab wounds are considered serious if in a vital area of body
68
Treatment for puncture wounds
- Search for exit wound
- Assess need for shock care
- Follow spinal immobilization protocols
69
Avulsion
Flaps of skin or tissue are torn loose or pulled completely off
70
Degloving
The skin is removed like a glove
71
Treatment for avulsions
- Clean the wound surface
- Fold the skin back, if possible; will help the flap continue to profuse and not die
- Control bleeding and dress with bulky dressings
72
What are skin tears considered
Avulsions
73
Amputation
The traumatic severing of a body part, usually an extremity
74
Treatment of amputations
- Control bleeding (apply pressure dressing over stump/apply tourniquet)
- DON'T COMPLETE AMPUTATION
- Wrap amputated part in sterile wet dressing and place in plastic bag; put bag in pan with water and cold packs
75
Open crush injury
- Crush injuries can also be open if bones are fractured as a result of the heavy force and those bone ends break the skin
- Treat any open injuries with basic strategies and expect massive internal injuries
76
Blast injury
Several waves:
- Pressure wave/primary injuries
- Blast wave (things flying at you)/secondary injury
- Patient displacement/tertiary injury
- Hazmat or structural collapse/quaternary injury
- May have a combination of all open and closed injuries
77
What is at risk during blast injuries
Hollow organs
78
Evisceration
Abdominal organs protruding through an open wound
79
How to treat evisceration
- Don't touch or try to replace the exposed organ
- Cover exposed organs and wound with a sterile WET dressing, moistened with sterile water/saline, and secure in place
- Flex the patient's hips and knees if uninjured to relieve pressure
80
Treatment for impaled objects
- Don't remove object; may cause severe bleeding
- Expose wound area
- Control profuse bleeding by direct pressure
- Apply several layers of bulky dressing to "splint" object in place
- Treat for shock
- Provide rapid transport
81
Impaled object in cheek
- Take care that object does not enter oral cavity, causing airway obstruction
- If cheek wall is perforated, profuse bleeding into mouth and throat can cause N/V
- External wound care will not stop flow of blood into the mouth
82
Treatment for impaled object in cheek
- Examine wound site, both inside and outside mouth
- If you find the perforation and can see both ends, remove the object (only if its impaling only the cheek)
- If object is impaled into another structure, stabilize in place
83
Treatment for impaled object in eye
- Stabilize the object in place
- Cover the other eye
- Secure both in place
- Reassure patient
84
Treatment for genital injuries
- Control bleeding
- Preserve avulsed parts
- Consider if injury suggest a more serious injury
- Maintain patient's dignity
- Dress and bandage wound
85
Burns
- May involve more than just skin-level structures
- If respiratory structures are affected, swelling (of airway) may occur, causing life-threatening obstruction
- Don't let burn distract from spinal damage or fractures
86
Assessment of burns
- Agent and source
- Depth
- Severity
87
Depth of burns: 1st degree
- AKA superficial burn
- Involves only epidermis
- Reddening with minor swelling
88
Depth of burns: 2nd degree
- AKA partial thickness burn
- Epidermis burned through, dermis damaged
- Deep, intense pain
- Blisters and mottling
89
Depth of burns: 3rd degree
- AKA full thickness burn
- All layers of skin burned
- Blackened areas surrounded by dry and white patches
- Often doesn't feel pain because lack of functioning nerves
90
How to measure the percent of skin burned
- Rule of 9's
- Palmar method (hand is 1% of skin)
91
True or false: a minor burn area in a young adult can be fatal to a geriatric adult
True
92
True or false: infants and children have a much greater relationship of body surface area to total body size, resulting in greater body fluid and heat loss from burned skin
True
93
What are thermal burns caused by
Flame, radiation, excessive heat from fire, steam, hot liquids, and hot objects
94
How to treat (and not treat) thermal burns
- Use dry, sterile dressings
- Never apply ointments, sprays, or butters
- Don't break blisters (the blister keeps fluid away from healing skin)
95
What are chemical burns caused by
Various acids, bases, and caustic substances
96
Treatment for chemical burns
- Wash with lots of flowing water
- If dry chemical, brush away, then flush with water
- Remove contaminated clothing
- Apply sterile dressings
97
Electrical Injuries
Severe damage through body by disrupting nerve pathways
98
What can be caused by electrical injuries
- Entry and exit burns
- Respiratory/cardiac arrest
- Bones may fracture from violent muscle contractions
- Cardiac rhythm changes (be ready to defibrillate)
99
How to treat electrical injuries
- Cool burning areas and apply sterile dressings
- Treat for shock and provide oxygen
100
Blunt Trauma
A mechanism of chest injury; can fracture ribs, sternum, and costal (rib) cartilages
101
Compression
A mechanism of chest injury; occurs when severe blunt trauma causes the chest to rapidly compress
102
Penetrating Objects
A mechanism of chest injuries; bullets, knives, pieces of metal or glass, steel rods, pipes, etc; can damage internal organs and impair respiration
103
Flail Chest
- A fracture or two or more consecutive ribs in two or more places
- Paradoxical motion occurs when a flail segment moves in the opposite direction of the chest during respiration
104
Assessment for flail chest
- MOI
- Difficulty breathing/hypoxia
- Chest wall muscle contraction/paradoxical movement
105
Treatment for flail chest
- Administer oxygen
- Use bulky dressing to stabilize flail segment
- Monitor patient for respiratory rate and depth; assist ventilations if too shallow
106
Open chest injuries
- Difficult to tell what is injured from entrance wound
- Assume all wounds are life-threatening
- Open wounds allow air into chest which sets pressure imbalance and causes lung to collapse
107
Assessment for open chest wound
- Sucking chest wound
- Direct entrance wound to chest
- May or may not be sucking sound
- May be gasping for air
108
Treatment for open chest wounds
- Maintain open airway
- Seal wound
- OCCLUSIVE DRESSING
- Administer oxygen
- Treat for shock
- Immediate transport
- Consider ALS
109
In how many places do you tape an occlusive wound for a one sided open chest wound
Three; allows air to escape but still keeps air out (flutter valve)
110
What to do if there is an entrance and exit open chest wound
Tape occlusive dressing on four sides to the back exit wound, tape on three sides to chest open wound
111
Pneumothorax
Air in pleural cavity of lung which causes excessive pressure on lungs; can cause lung to collapse
112
Tension pneumothorax
Pneumothorax causes the heart to be pushed to one side; causes drop in blood pressure and tracheal deviation
113
Hemothorax
Blood in pleural cavity of lung which causes excessive pressure on lungs; can cause lung to collapse
114
Hemopneumothorax
Blood and air in pleural cavity of lung which causes excessive pressure on lungs; can cause lung to collapse
115
Traumatic Asphyxia
- Sudden compression of chest
- Sternum and ribs exert pressure on hearts and lungs
- Blood forced out of right atrium and up into jugular veins
- Causes ruptured blood vessels and extensive neck/facial bruising
116
What can cause traumatic asphyxia
People get stuck between heavy objects/machinery
117
Cardiac Tamponade
- Direct injury to heart causing blood to flow into the pericardial sac around the heart
- Pericardium is a tough sac that rarely leaks
- Increased pressure on heart so chambers cannot fill causing blood to back up into veins
118
What causes cardiac tamponade
Usually a result of penetrating trauma
119
Beck's Traid for cardiac tamponade
- JVD
- Muffled heart sounds
- Narrowing pulse pressure
120
What is the largest blood vessel in the body
The aorta
121
What can be caused by damage from the aorta
High-pressure bleeding that is often fatal
122
Types of trauma to the aorta
- Penetrating trauma can cause direct damage
- Blunt trauma can sever or tear the aorta
123
Signs and symptoms of aortic injury
- Patient complains of pain in chest, abdomen, or back
- Signs of shock
- Differences in blood pressure between right and left arms
124
Commotio Cordis
- Trauma to chest when heart is vulnerable
- Causes ventricular fibrillation
125
Treatment for commotio cordis
CPR, defibrillation
126
Abdominal injuries
- Can be open or closed
- Internal bleeding if organs or blood vessels are lacerated or ruptured
- Serious, painful reactions if hollow organs rupture
- Evisceration may occur
127
Assessment for abdominal injuries
- Pain
- Nausea
- Weakness
- Thirst
- Indications of blunt trauma to chest, abdomen, or pelvis
- Coughing up or vomiting blood
- Rigid and/or distended abdomen
128
Treatment for abdominal injuries
- Carefully monitor airway in presence of vomiting
- Position of comfort
- Place patient on back with knees flexed
- Treat for shock
129
Treatment for evisceration
- Don't touch or replace organs
- Apply sterile dressing moistened with sterile saline over wound site
- For large evisceration, maintain warmth by placing laters of bulky dressing over occlusive dressing
130
How many ribs are in the thoracic cavity
12 pairs
131
How many ribs are floating in the thoracic cavity
2 pairs; they are not attached to the sternum or anterior ribs
132
Striated Muscle
AKA voluntary muscle
133
Smooth Muscle
AKA Involuntary muscle
134
Bones physiology
Framework
135
Joints physiology
Bending
136
Muscles physiology
Movement
137
Cartilage physiology
Flexibility
138
Ligaments physiology
Connect bone to bone
139
Tendons physiology
Connects muscles to bone
140
What are bones made of
Formed of dense connective tissue
141
Why are bones susceptible to bleeding on injury
They are vascular
142
Self-healing nature of bone
- Break causes soft tissue swelling and a blood blot in the fracture area
- Interruption of blood supply causes the bone section to die
- Cells further from fracture divide rapidly forming tissue that heals the fracture and develops into new bone
143
Mechanisms of musculoskeletal injruy
- Direct force
- Indirect force
- Twisting (rotational) force
144
Fracture
Any break in a bone (open or closed); can be comminuted, greenstick, angulated
145
Comminuted Fracture
Broken in several places
146
Greenstick Fracture
Incomplete break
147
Angulated Fracture
Bent at an angle
148
Dislocation
"Coming apart" of a joint
149
Sprain
Stretching and tearing of ligaments
150
Strain
Overstretching of muscle
151
Splinting of fractured extremity
Splinting of an extremity with a suspected fracture helps prevent blood loss from bone tissues
152
Assessment for musculoskeletal injuries
- Treat life-threatening conditions
- Be alert for injuries besides grotesque wound
- Pain and tenderness
- Deformity and angulation
- Grating (crepitus)
- Swelling
- Brusing
- Exposed bone ends
- Nerve/blood vessel compromise (decreased CMS)
- Compartment syndrome
153
Compartment Syndrome
Painful conditions that occurs when pressure within the muscles builds to dangerous levels; this pressure can decrease blood flow
154
Six P's of musculoskeletal assessment
- Pain or tenderness
- Pallor (pale skin)
- Parasthesia (pins and needles)
- Pulses diminished or absent
- Paralysis
- Pressure
155
Advantages of splinting
- Minimizes movement of disrupted joints and broken bone ends
- Prevents additional injury to soft tissues (nerves, arteries, veins, muscles)
- Decreases pain
- Minimizes blood loss
- Can prevent a closed fracture from becoming an open fracture
156
Principles of splinting
- Expose injury site
- Assess distal CSM
- Align long-bone injuries to anatomical position
- Don't push protruding bones back into place
- Immobilize both injury site and adjacent joints/bones
- Apply splint before moving patient to stretcher
- Pad voids (prevents hunchback)
157
Realigning deformed extremity
- Assists in restoring effective circulation to extremity and to fit it to splint
- If not realigned, splint may be ineffective, causing increased pain and possible further injury
- ONE TRY TO REALIGN, then just splint
158
Hazards of splinting
- "Splinting patient to death"- splinting patient before life-threatening conditions are addressed
- Not ensuring ABC's
- Too tight- compresses soft tissues
- Too loose- allows too much movement
- Splinting in deformed position
159
Assessment for shoulder girdle injuries
- Pain in shoulder
- Dropped shoulder
- Severe blow to back over scapula
160
Treatment for shoulder girdle injuries/Humerus, Elbow, Radius
- Assess distal CSM
- Use sling and swathe
- Don't attempt to straighten or reduce
- Reassess distal CSM
161
Assessment for pelvic injuries
- Pain in pelvis, hips or groin
- Pain when pressure applied
- Can't life legs
- Lateral rotation of foot
- Unexplained pressure in bladder
162
Treatment for pelvic injuries
- Minimize movement
- Check distal CSM
- Anatomical position
- Stabilize lower limbs
- Treat for shock
163
Assessment for hip dislocation/fracture
- Anterior hip dislocation
- Posterior hip dislocation (rotation of leg and foot; shortening)
- Pain and unable to stand
164
Treatment for hip dislocation or fracture
- Assess distal CSM
- Move patient onto spine board
- Immobilize limb with pillows and blankets
- Secure patient to spine board
- Reassess distal CSM
165
Assessment for femoral shaft fracture
- Intense pain
- Possibly open fracture
- Injured limb may be shortened
166
Treatment for shaft fracture
- Control bleeding
- Assess distal CSM
- Apply traction splint
- Reassess distal CSM
- Treat for shock
167
Assessment for knee injury
- Pain and tenderness
- Swelling
- Deformity with swelling
168
Treatment for knee injury
- Assess distal CSM
- Immobilize in current position
- Reassess distal CSM
169
Assessment for Tib/Fib injury
- Pain and tenderness
- Swelling
- Possible deformity
170
Treatment for Tib/Fib Injury
- Air inflated splint
- Two-splint method
- Single splint with ankle hitch
171
Treatment for ankle/foot injury
- Assess distal CSM
- Stabilize limb
- Lift limb
- Place cravats under ankle
- Lower limb into pillow
- Tie pillow around ankle
- Apply ice pack as needed
172
Disability
Condition interfering with the ability to engage in ADLs
173
Terminal Illness
- May depend on tech to sustain life or relieve pain
- Advance directives
- Special emoitonal needs
174
Obesity
- Increases risk of multiple diseases
- Special measures to care for obese patient
- Allow patient to assume comfortable position for breathing
- Have enough assistance when lifting/moving patient
175
Serious health problems related to homeless and poverty
- Mental health issues
- Malnutrition
- Substance abuse problems
- HIV/AIDS
- Tuberculosis
- Pneumonia
176
How many children does autism effect
1 in 91 children
177
What does autism effect
Ability to communicate; may need to modify assessment techniques and treatment protocols
178
ABCS of dealing with autistic patients
- Awareness
- Basic
- Calm
- Safe
179
(A)wareness of ABCS of dealing with autistic patients
- EMT must adapt
- Disruption of routine not well tolerated by patient
- May have meltdown
180
(B)asic of ABCS of dealing with autistic patients
- Keep instructions simple
- Keep questions short and close-ended
- Keep equipment at a minimum as to not overstimulate patient
- Defer interventions that are not precautions vs necessary
181
(C)alm of ABCS of dealing with autistic patients
- Calm creates calm
- Start with one-to-one contact
- Clear, controlled voice
- Empathy and compassion
- Take extra time to follow patient's timeline unless emergency
182
(S)afe of ABCS of dealing with autistic patients
- Begin treatment where patient is found
- Remove things that may aggravate child
- Do toe-to-head survey, one step at a time
- Consider taking breaks during exam
- Let patient tell you when they are ready for next step
183
Congenital Disease
- Type of disease
- Birth defect
- Congenital heart disease, cleft palate, congenital deafness
184
Acquired Disease
- Type of disease
- COPD, AIDS, traumatic spinal cord injury, deafness
185
Respiratory Devices
- CPAP
- Tracheostomy tubes
- Home ventilators
186
EMT Assessment and Transport for home CPAP device
- The problems are not usually related to the machine
- If patient wishes to bring it to hospital, alert ER staff of use in radio report
187
Tracheostomy Tubes
Respiratory device; surgical opening through neck into trachea in which breathing tube is placed
188
What fits on the end of a tracheostomy tube
BVM
189
Assessment for tracheostomy tube
- If tube is clogged with mucus, clear using whistle tip catheter
- Patient may buck during suction (gag and lurch forward)
- May need to ventilate with BVM
190
Transport for tracheostomy tube
- During transport, elevate patient's head to allow drainage
191
EMT Assessment and transport for home ventilators
- Make sure vent tube has no mucus
- Assure that BVM is attached to oxygen
- Secure ventilator if transporting
192
Cardiac Devices
- Implanted pacemaker
- Automatic implanted cardiac defibrillator (AICD)
- Left ventricular assist device (LVAD)
193
AICD
- Detects life-threatening cardiac rhythms
- Delivers shock to correct dysrhythmia
- Shock is very painful to patient but can't be felt by caregivers
194
Where is the AICD implanted
Upper left chest or upper left abdominal quadrant
195
Assessment for AICD
- Treat as high-risk cardiac patient
- If cardiac arrest, use CPR and AED
196
Left Ventricular Assist Device
Surgically implanted pump used for end-stage heart failure pump; helps heart pump blood effectively through continuous flow of blood SO NO PULSE
197
Assessment for LVAD
- Battery failure: plug into AC source
- Pump failure: use hand or foot pump
- Battery should be secured as not to pull tubing
198
Gastrourinary Devices
- Feeding tubes
- Urinary catheters
- Ostomy bag
199
Assessment and Transport for feeding tube
- Secure tubes to patient with tape before transport
- Keep nutrients higher than tube
- Put protective cap in place to prevent leakage
200
Assessment and transport for urinary catheters
- During transport, keep catheter bag lower than patient but not on floor
- Empty bag if one-third to one-half full
201
What to document during assessment/transport of urinary catheter patients
Urine discoloration, odor, amount emptied
202
Ostomy Bags
Connected to site of colostomy or ileostomy to collect feces
203
Are ostomy bags visible through clothing
No
204
Common problems with ostomy bags
- Infection at stoma site
- Blockage
- Dislodgement
205
Hemodialysis
- Usually at dialysis center
- Performed by attaching patient to dialyzer
- Large needles and tubing removes and returns blood to filter
206
Complication with hemodialysis
- Bleeding from A-V fistula
- Infection
207
Peritoneal Dialysis
- Permanent catheter implanted through abdominal wall into peritoneal cavity
- Dialysis solution runs into abdominal cavity and its absorbed by intestines
208
Complications from peritoneal dialysis
- Dislodging of catheter
- Infection (peritonitis)
209
Assessment for dialysis
- Don't take blood pressure on any arm with shunt, fistula, or graft
- Rupture of shunt, fistula, or graft causes fast, significant blood loss
- Direct pressure to control bleeding
210
Central IV Catheters
- Surgically inserted for long-term delivery of meds or fluids
- May have infection
211
Vulnerable Population
- Patients dependent on others
- More vulnerable to physical/sexual abuse, exploitation, neglect
212
What to look for when dealing with vulnerable population
- Stories that are inconsistent with injuries
- Multiple injuries in various stages of healing
- Repeated injuries
- Caregiver's indifference to patient
213
What to do when dealing with vulnerable populations
- Don't make accusations
- Do best to get patient out of environment
- Report suspicions according to requirements of jurisdiction
214
Central nervous system parts
- Brain
- Spinal Cord
215
Peripheral nervous system
- Vertebral nerves
- Cranial nerves
- Body's motor and sensory nerves
216
How many facial bones are there
14
217
Injuries to scalp
Lots of blood vessels; profuse bleeding
218
Skull injuries
- Open head injury
- Closed head injury (SKULL is in tact)
218
True or false: until proven otherwise, breakages are considered open
True
219
Traumatic Brain Injuries (TBI)
- Concussion
- Contusion (coup, contrecoup)
220
Subdural Hematoma
Hematoma between dura mater and brain
221
Epidural Hematoma
Hematoma between skull and dura mater
222
Intracerebral Hematoma
- Hematoma in the brain
- Patient experiences severe headache
223
Intracranial Pressure
As pressure inside the skull increases the brain is compressed against the skull and this pressure reduces perfusion to vial brain structures
224
Is ICP a closed or open head injury
Closed
225
Cushing's Triad
- For ICP
- Increase in blood pressure
- Decrease in pulse
- Irregular breathing rate
226
Ataxic Respirations (slide 14 of brain)
227
Central Neurogenic Hyperventilation
228
Cheynes-Stokes Breathing
Fast shallow breathing followed by slow heavier breathing
229
Racoon Eyes
230
Battle Signs
231
Signs and symptoms of brain injuries
- AMS
- Laceration, contusion, hematoma to head
- Depressions or deformities in the skill
- Battle signs/raccoon eyes
- One eye appears sunken
- Bleeding/clear fluid from ears or nose
- Change from irritable to irrational behavior
- Hypertension, bradycardia, and irregular respirations
232
What to do with cranial injuries with impaled objects
Stabilize object in place
233
What is the primary concern for injuries to the face and jaw
Airway; when possible, position to allow for drainage
234
Signs and symptoms for nontraumatic brain injuries
Signs are the same as for traumatic injury, except no evidence of trauma and no MOI
235
What is Glasgow Coma Scale Used (GCS) for
May use GCS in addition to AVPU for ongoing neurological assessment
236
Considerations for use of GCS
- Eye opening
- Verbal response
- Motor response
237
Should you spend extra time at the scene calculating GCS?
No
238
KNOW GCS CHART
239
Is the pressure in the large vein in neck higher or lower than atmosphere
Lower
240
Why do wounds to the neck create potential for serious bleeding
Large, major vessels close to surface
241
What is there a great possibility of with wounds to the neck besides bleeding
Air embolus being sucked through
242
Treatment for neck injury
- Stop bleeding (direct pressure)
- Prevent air embolism with 4- side taped occlusive dressing
243
Treatment for open neck wound
- Ensure open airway
- Placed glove hand over wound
- Apply occlusive dressing
- Apply pressure
- Bandage dressing in place
- Immobilize spine if MOI suggest c-spine injury
244
Neurogenic shock
Form of shock resulting from nerve paralysis; causes uncontrolled dilation of blood vessels
245
Assessment for spinal injuries
- Paralysis of extremities
- Pain with or without movement
- Tenderness anywhere along spine
- Impaired breathing
- Deformity
- Priapism
- Loss of bowel or bladder control
246
Treatment for spinal injury
- Provide manual in-line stabilization
- Assess ABC's
- Rapidly assess for sensory and motor function (mark with pen)
- Apply appropriate c-spine
- Reassess sensory and motor function
247
How many spinal cord injuries to males account for
80%
248
How many people are living with SCI in the US
200,000
249
How many new SCI cases a year
12,000 to 20,000 (15 to 40 new cases per million people a year)
250
True or false: C-spine collar used in conjunction with long backboard
True
251
Stabilizing a seated patient: low priority
Use a short board or vest-immobilization device
252
Stabilizing a seated patient: high priority
Maintain manual stabilization while moving patient
253
Applying a long backboard
- Log roll patient
- Pad voids between board and head/torso
- Secure head last
- If pregnant, tilt board to left after immobilizing
254
When to leave helmet in place
- Fits snugly, allowing no movement
- Absolutely no impending airway or breathing issues
- Removal would cause further injury
- Proper spinal immobilization can be done with helmet in place
255
When to remove helmet
- Interferes with access to manage airway
- Improperly fitted
- Interferes with immobilization
- Cardiac arrest
256
Multiple trauma patient
More than one serious injury
257
Multisystem trauma patient
Patient with one or more injuries serious enough to affect more than one body system
258
Determining patient severity
- Physiologic criteria = function
- Anatomic criteria = structure/location
- MOI (unreliable by itself)
259
Physiologic Criteria for determining patient severity
- AMS (GCS<14): head injury
- Hypotension (systolic <90mmHg): shock, internal bleeding
- Abnormally slow respiratory rate: head injury, later stages of shock
- Abnormally high respiratory rate: shock
260
Anatomic Criteria for determining patient severity
- Injury to specific body part/area requiring immediate surgical intervention
- Injuries to head and chest
- Multiple musculoskeletal injuries
- Amputations
- Severely mangled extremities
- Pelvic injuries
261
MOI for determining patient severity
- In absence of anatomic or physiological signs, MOI is considered if severe
- Fall
- High risk auto crash
- Automobile-pedestrian crash
- Motorcycle crash
262
How to prepare for multisystem trauma patients
Determine crew roles
263
Treating multisystem trauma
- Follow priorities determined by primary assessment
- Attend to life threats
- Reassess what to treat on scene and what needs definitive care
- Call hospital so they can prepare
- POSTPONE VITALS; SURGERY IMPORTANT
264
Trauma scoring
- Numerical rating system for trauma
- Assigns number to certain patient characteristics to create a score
- Objectively describes severity
- Helps determine transport to trauma vs local hospital
- Helps trauma centers
265
Revised Trauma Score (RTS)
- Components are GCS, systolic blood pressure, respiratory rate
- Follow local protocol for use of scoring system
- Don't let it interfere with patient care/transport
266
How the body loses heat
- Conduction
- Convection
- Radiation
- Evaporation
- Respiration
267
Generalized hypothermia
The body is unable to maintain proper core temperature
268
Predisposing factors of hypothermia
- Injury
- Chronic illness
- Geriatric/pediatric
269
Why are geriatrics at risk for hypothermia
Older citizens live in unheated rooms; the environment, slowing body systems, and lack of activity can lead to hypothermia
270
Why are pediatrics at risk for hypothermia
They have larger skin surface areas in relation to their total body mass, little body fat, and smaller muscle mass which makes them unable to shiver
271
Assessment for hypothermia
- Shivering, in early stages
- Numbness
- Stiff/rigid posture
- Drowsiness
- Rapid breathing/pulse
- Loss of motor coordination
- Joint/muscle stiffness
- Unconsciousness
- Cool abdominal skin temperature
272
Passive vs active rewarming
- Passive: Cover patient, remove wet clothing
- Active: Apply external heat source
273
True or false: The more severe the hypothermia, the less aggressive rewarming
TRUE
274
When is a patient considered to have extreme hypothermira
- Patient is unconscious, with no discernible vital signs
- Heart rate can slow to 10 bpm
- Very cold
275
What are the most commonly affected areas for localized cold injuries
- Ears
- Nose
- Face
- Feet
276
What happens with localized cold injuries
- Blood flow limited by constriction of blood vessels
- Tissues freeze, may form ice crystals
277
What to do with patient in early/superficial phase of cold injury (frostnip)
Remove from cold and cover
278
What to do with patient in late/deep phase of cold injury (frostbite)
Cover and immobilize gently (immobilize because affected areas can snap off)
279
Dos for frostbite
- Transport, keeping patient warm
- Perform ongoing assessment
280
Do not do for frostbite
- Rub affect areas
- Break blisters
- Expose affected area to dry heat
- Immerse affected area in snow or hot water
- Allow affected part to thaw if it may refreeze before transport is complete
281
How is hyperthermia caused
When heat that isn't needed for temperature maintenance and isn't lost creates hyperthermia
282
True or false: unchecked hyperthermia can lead to death
True
283
Predisposing factors of hyperthermia
- Peds/geri
- Chronic illness
- Obesity
- Exercise for health individuals
284
Signs and symptoms for heat exhaustion
- Muscular cramps
- Weakness or exhaustion
- Rapid, shallow breathing
- Weak pulse
- Heavy perspiration
- Loss of consciousness
285
Treatment for heat exhaustion
- Remove from hot environment
- Administer oxygen
- Loosen/remove clothing
- Position supine
- Small sips of water
- Transport
286
Signs and symptoms of heat stroke
- Rapid, shallow breathing
- Full, rapid pulse
- Generalized weakness
- Little or no perspiration
- AMS
- Dilated pupils
- Seizures
287
Treatment for heat stroke
- Remove from hot environment
- Remove clothing
- Apply cool packs to neck, groin, and armpits
- Administer oxygen
- Transport immediately
288
PA state protocols for heat cramps
Moist, pale, normal to cool skin
289
PA state protocols for heat exhaustion
Moist, pale, normal to cool skin (do passive cooling)
290
PA state protocols for heat stroke
Hot, dry, or possibly moist skin (active cooling)
291
Heat cramps (according to pa state protocols)
Painful muscle spasms of the skeletal muscles that occur following heavy work or strenuous exercise in hot environments; thought to be caused by rapid changes in extracellular fluid osmolarity resulting from fluid and sodium loss
292
Signs and symptoms of heat cramps (pa state protocols)
- Alert
- Muscle cramps (normally in most recently exercised muscle)
- Hot, diaphoretic skin
- Tachycardia
- Normotensive
293
Heat exhaustion (according to PA state protocols)
Patient presents with dizziness, nausea, headache, tachycardia, and possibly syncope. Usually from exposure to high ambient temperatures accompanied by
dehydration due to poor fluid intake. Temperature is less than
103° F. Rapid recovery generally follows saline administration.
294
When should patient be treated as if they have heat stroke (according to pa state protocols)
- Exposure to hot environment
- Hot skin
- AMS
(all three)
295
Treatment for drowning
- Begin rescue breathing without delay
- ABC vs CAB
- May encounter airway resistance
- Don't delay transport
296
Arterial gas embolism
- Common in scuba diving accidents
- Gas bubbles in bloodstream (diver holding breath)
- May be due to inadequate training, equipment failure, underwater emergency, or trying to conserve air
297
Decompression sickness
- Common in scuba diving accidents
- Diver surfacing too quickly from deep, prolonged dive
- Takes 1-48 hours to appear
298
Water Rescue
- Reach: Hold object for patient to grab
- Throw: Throw object that will float
- Row: Row boat to patient
- Go: Swim to patient (last resort)
299
Ice Rescue
- Throw flotation device to patient
- Toss rope with loop
- Push out flat bottomed aluminum boat
- Lay ladder flat on ice to distribute weight of rescuer
- Treat patient for hypothermia
- Always transport
300
Differences at higher altitudes
- Less air to breathe
- Decreased air pressure
301
True or false: Normal, healthy people who have adjusted to high altitudes have a lower oxygen saturation than do those at sea level because there is less oxygen to breathe
True
302
Acute Mountain Sickness
- Type of high-altitude sickness
- Less serious case of a person experiencing problems adjusting to thinner air
- In mild cases, all that may be needed to overcome acute mountain sickness is rest and rehydration at altitude
- In more severe cases, supplemental oxygen and immediate descent should lead to improvement
303
High-altitude cerebral edema (HACE)
- The worst form of acute mountain sickness
304
Signs and symptoms for HACE
- Headache that gets worse
- Loss of coordination
- Severe fatigue
- Seizure
- AMS
- LOC
305
Patient care for HACE
- Arrange for immediate descent (always first)
- Oxygen
- Provide supportive treatment
306
Which is more serious: HAPE or HACE
HACE
307
Signs and symptoms of High Altitude Pulmonary Edema (HAPE)
- Shortness of breath
- Dry cough that progresses to coughing up blood
- Tachypnea and tachycardia
- Mild fever up to 100.4 DF
- Ox sat lower
- Respiratory failure and arrest
308
Patient care for HAPE
- Arrange for immediate descent
- Administer high-concentration oxygen
- Minimize physical activity
- Provide supportive treatment
309
True or false: insect stings and bites are rarely dangerous
True
310
What can be a concern with spider/insect bites/stings
Anaphylactic shock
311
True or false: you must remove stingers quickly
True
312
Snakebites
- Requires special care but are not usually life-threatening
- Death is not sudden unless anaphylactic shock develops
- Stay calm, keep patient calm and at rest
313
True or false: you should not suck on bites
True
314
How can marine life poisoning happen
- Eating improperly prepared seafood or poisonous organisms
- Stings and punctures
315
What can activate toxins on skin, increasing pain related to marine life poisoning
Fresh water
316
How to treat marine life poisoning
Use salt water to rinse affected area (vinegar also works)
317
Poisonous vs venomous
Poisonous: You ingest something
Venomous: Something bites/stings you
318
What is menstruation stimulated by
Estrogen and progestrone
319
What happens during menstruation
- Ovaries release ovum
- Uterus walls thicken
- Fallopian tubes moves eggs (peristalsis)
- Uterus walls expel; bleeding 3-5 days
320
What happens during fertilization
- Sperm reaches ovum
- Ovum becomes embryo
- Embryo implants in uterus
- Fetal stage begins
321
Supine hypotensive syndrome
- Placenta, infant, and amniotic fluid totals 20-24 lbs; when mother is supine, that mass compresses inferior vena cava
- Cardiac output decreases
- Dizziness and drop in blood pressure
322
Physiological changes to respiratory system during pregnancy
- Maternal oxygen demand increases
- Changing diaphragm shape
323
Physiological changes to cardiovascular system during pregnancy
- Cardiac output increases
- Maternal blood volume increases
- HR, BP changes (faster pulse)
324
Physiological changes to GI system during pregnancy
- Morning sickness
- Slowed peristalsis
325
Physiological changes to urinary system during pregnancy
- Changes in urinary frequency
326
Physiological changes to musculoskeletal system during pregnancy
- Shuffled gait
- Center of gravity changes
327
GPA Shorthand
Obstetric history
328
History to ask for OB emergency
- When is your EDD (Expected Due Date)
- How far along are you? (Weeks)
- How many are you expecting?
- Contractions, Period and Frequency
- Water broken or any vaginal discharge?
- Have you been receiving pre-natal care?
- If so, when was the last time?
- Are you a “high risk” pregnancy, what for?
- OB History (GPA)
- Any complications or issues with previous pregnancies/deliveries?
- Have you had now, or in any previous pregnancy had Gestational DM, Pre-Eclampisa,
Eclampsia, c-section
- Social Hx (Smoker, drinker, Drugs
329
When does the first stage of childbirth start/end
- Begins: Regular contractions
- Ends: When the cervix is fully dilated
330
Braxton-Hicks Contractions
Irregular, not sustained, and not indicative of impending delivery
331
Lightening in childbirth
Fetus's movement from high in the abdomen down toward birth canal
332
Breach
Baby's rear end comes out first during child birth (usually head first)
333
When does the second stage of childbirth begin/end
- Begins: When the cervix is fully dilated
- Ends: When the baby is born
334
Second stage of childbirth
- Full dilated of cervix
- Contractions increasingly frequent
- Labor pain is severe
- Mother feels urge to push or move bowels
- EMT will have to decide whether to transport the patient, or keep her where she is and prepare to assist with delivery
335
When does the third stage of pregnancy begin/end
- Begins: After the baby is born
- Ends: After the placenta is delivered
336
Imminent Delivery
- Control scene
- Proper PPE
- Place mother on bed, floor, or ambulance stretcher
- Remove clothing obstructing vagina
- Position assistant and OB kit
337
Off-Duty Delivery Supplies
- Clean sheets and towels
- Heavy, flat twine or new shoelaces
- Towel or plastic bag for placenta
- Clean, unused rubber gloves and eye protection
338
How to deal with fluid in newborns airways
Suctioning mouth right after its born
339
Neonate
Birth to one month old
340
APGAR Score
- Activity (muscle tone), Pulse, Grimace, Appearance (skin color), Respiration
- 0-10 points, 10 is best
- Should be done at 1 and 5 minute
- By 5 minute mark, should be 7-10
341
Severely depressed AGPAR score
0-3
342
Moderately depressed AGPAR Score
4-6
343
Excellent condition AGPAR score
7-10
344
How to keep new born warm
- Heat retention is high priority
- Dry baby
- Discard wet blankets
- Wrap baby in dry blanket
- Cover head
345
Basic neonatal resucitation
- Drying, warming, positioning, suction, tactile, simulation
- Oxygen
- Bag-Mask
- Chest compressions
346
Advanced neonatal resucitation
- Intubation
- Medications
347
Placenta previa
Placenta is in way of baby coming out; tell mother to stop pushing; c-section needed
348
Neonatal resuscitation rules
- Pulse greater than 100: Reassess and warm (this is normal)
- Pulse lower than 100 but greater than 60: Ventilate 40-60
- Pulse lower than 60: Ventilate and chest compressions 3:1
349
How to control vaginal bleeding
- Pad vagina (not pack)
- Vaginal massage (painful)
350
What does placenta delivery start with
Labor pains
351
How long does it take for placenta to come out
30 minutes or longer
352
When to begin transport after birth
10 minute after birth (do not wait to deliver placenta)
353
Providing comfort to mother after childbirth
- Take vitals signs frequently
- Acts of kindness
- Wipe face and hands with damp washcloth
- Replace blood-soaked sheets and blankets
354
What to do when delivery baby i breeched position
- Try to tell mother to not push
- If not, insert fingers near baby's mouth to protect airway
355
Limb presentation during childbirth
Limb comes out first
356
What to do during limb presentation birth
Put mother in head down position, give oxygen, tell mother not to push, rapid transportation
357
Prolapsed Umbilical Cord
Cord sticks out before baby
358
What to do during prolapsed umbilical cord
Push fingers into vagina, lift upwards to relive pressure, rapid transport
359
What to do for multiple birth
- Have appropriate resources (multiple ambulances)
- Clamp or tie cord of first baby
- Assist with second delivery
- Still only one placenta and cord per birth
- Keep babies and mother warm
360
What to do for premature birth
- Keep baby warm
- Keep airway clear
- Provide ventilations and chest compressions
- Watch umbilical cord for bleeding
- Oxygen (blow by)
- Call ahead to emergency department
361
Meconium
- Newborn's first bowel movement
- Don't stimulate infant before suctioning
- Suction MOUTH FIRST, then nose
- Maintain open airway
- Provide ventilations and/or chest compressions
362
Emergencies in pregnancy
- Excessive prebirth bleeding
- Ectopic pregnancy (embryo in fallopian tube)
- Pre-eclampsia and eclampsia (sign is seizure)
- Miscarriage and abortion
- Trauma in pregnancy
- Still births
- Accidental death of pregnant woman
363
Signs of excessive prebirth bleeding
- Main sign is usually profuse bleeding
- Abdominal pain may or may not be felt
364
What to do for excessive prebirth bleeding
- Assess for signs of shock
- High-concentration oxygen and transport
- Pace sanitary napkin over vagina
365
Sign of ectopic pregnancy
- Pain on one side of mother
366
Pre-eclampsia and eclampsia signs and symptoms
- Elevated blood pressure
- Excessive weight gain
- Excessive swelling to face, ankles, hands, and feet
- AMS or headache
- Eclampsia is most severe form, when seizures occur
367
Miscarriage signs snd symptoms
- Cramping, abdominal pains
- Bleeding: moderate to severe
- Discharge of tissue and blood from vagina
368
Trauma in pregnancy
- Pulse 10-15 beats faster than non-pregnant women
- Blood loss may be 30% to 35% before symptoms appear
- Ask patient is she received blows to abdomen
369
What to do for stillbirth
- Do not resuscitate if it is obvious that the baby died some time before birth
- Resuscitate if baby is born in cardiac/respiratory arrest
- Prepare to provide life support
- Age of viability
370
What to do during accidental death of pregnant woman
- Chance to save unborn baby
- Being CPR on mother immediately
- Continue CPR until emergency c-section can be performed or until we are relieved
371
What to do for vaginal bleeding
- Treat as potential life threat
- Check for associated abdominal pain
- Monitor for hypovolemic shock
372
What to do for trauma to external genitalia
- Observe MOI
- Look for signs of severe blood loss and shock
- Consider additional internal injuries
373
What to do in cases of sexual assault
- Treat immediate life threats
- Do not disturb potential evidence
- Examine genitals only if severe bleeding is present
- Discourage bathing, voiding, or cleansing
- Fulfill mandated reporting
374
The Bradley Method
- An alternate birthing method
- All natural, no epidural
375
Hypnobirth
- An alternate birthing method
- Relaxed state
376
Lamaze
- An alternate birthing method
- Breathing exercises
377
Home Birth
- An alternate birthing method
- Not recommended for high risk
378
Water Delivery
- An alternate birthing method
- Not recommended for high risk
379
Name of normal headfirst birth
Cephalic
380
What is the average weight of an infant at birth
6.6-7.7lbs or 3.0-3.5 kg
381
Weight gain of average infant
Weight doubles by six months and triples by twelve months
382
What percent of an infant's total body weight is made up by their head
25%
383
Airway/breathing for infants
- Airway is narrow, short, and easily obstructed
- Nose and diaphragm are used for breathing vs adults who mainly use their nose/mouth
384
How are antibodies passed to infants
They are passed from the mother to the child during pregnancy and also passed through breastfeeding
385
Moro reflex (startle)
- An infant reflex
- Throws arms out, spreads fingers, and then grabs with fingers and arms
386
Palmar Reflex
- An infant reflex
- Grasps objects placed in palm
387
Rooting Reflex
- An infant reflex, usually indicating hunger
- Turns head to the side when cheek is touched
388
Sucking Reflex
- An infant reflex
- Sucks when lips are stroked
389
Sleep patterns for infants
- Initially sleeps 16-8 hours throughout the day and night
- Soon changes to 4-6 hours during the day and 9-10 hours at night
- By 2-4 months, will sleep through the night
390
Fontanelles
"Soft spot" of newborn's skull
391
When do fontanelles close
- Posterior fontanelle closes in 2-3 months
- Anterior fontanelle closes in 9-18 months
392
What do sunken fontanelles indicate
Dehydration
393
What do bulging fontanelles indictae
Without crying, they indicate increased pressure inside the skull
394
Psychosocial aspects of infancy
- Bonding: The sense that needs will be met
- Desire for an orderly predictable environment
- Scaffolding: Learning by building on what is already known
- Temperament: Reaction to environment
395
Body temperature range for toddler phase
98.6-99.6 deg F or 36-37.5 deg C
396
About how weight does a toddler gain per year
4.4 lb or 2.0 kg
397
True or false: body systems improve in efficiency during the toddler phase
True
398
Pulmonary system during toddler phase
- Terminal airways branch and grow
- Alveoli increase in number
399
Nervous system during toddler phase
- Brain is 90% of adult brain weight
- Fine-motor skills develop
400
Musculoskeletal system during toddler phase
- Muscle mass and bone density increase
401
Immune system during toddler phase
- More susceptible to illness
- Immunity develops through exposure and vaccination
402
When do all primary teeth come in by
36 months
403
When is toilet training physically possible vs psychologically possible
- Physically: 12-15 months
- Psychologically: 18-30 months
404
Psychosocial aspects of toddler phase
- Begins to understand that words have meaning
- Begins to understand cause and effect
- Develops separation anxiety
- Begins to develop "magic thinking" and engages in play-acting
- Masters language basics that are refined through childhood
405
What are considered preschool years
3-5 years old
406
Physiologic aspect of preschool years
Body systems continue to develop
407
Psychosocial aspects of preschool years
- Interactive and social skills develop
- Peer groups provide information about other families and the outside world
- Peer interaction offers opportunity for learning, making comparisons and being part of a group
408
What is considered school age
6-12 years old
409
About how weight is gained each year during the school age phase
6.6 lbs or 3.0 kg
410
Much much do school age children grow a year
2.4 inches or 6 cm
411
Teeth during school age years
Primary teeth will be shed and replaced with permanent teeth
412
Psychosocial aspects of school age years
- Parents spend less time with child and provide general supervision
- Decision-making skills develop
- Self-esteem develop and is affected by popularity, support, etc
- Moral development begins based on rewards and punishments for behaviors
- Moral reasoning appears and control of behavior shifts to internal sources
413
What are considered adolescence years
13-18 years
414
Physiological aspects of adolescence
- A rapid 2-3 year growth spurt begins with growth of feet and hands, then arms and legs
- Sexual maturity is reached and secondary sexual development occurs
415
Psychosocial aspects of adolescence
- Strives for independence and individual identity
- Interest in sex develops
- Body image becomes a concern
- May be prone to self-destructive behaviors
- Personal code of ethics develops
416
What is considered early adulthood
19-40 years old
417
Physiological aspects of early adulthood
- Lifelong habits and formed
- Peak physical condition occurs between 19 and 26 years of age
418
Psychosocial aspects of early adulthood
- Job and family stress levels are high
- Marriage, childbirth, and child rearing often occur
- Accidents are the leading cause of death
419
What is considered middle adulthood
41-60 years old
420
Physiological aspects of middle adulthood
- No significant changes occur in vital signs
- Vision correction may be needed
- Cancer, high cholesterol, and heart disease often develop
- Weight control becomes more difficult
- Menopause may begin for women
421
Psychosocial aspects of middle adulthood
- Task orientation increases
- Problems are viewed as challenges rather than threats
- Empty-nest syndrome can occur
- Is concerned about both adult children and elderly parents
422
What is considered late adulthood
61+ years
423
Physiological aspects of late adulthood
- Vital signs depend on health and physical condition
- Cardiovascular system is less efficient and blood volume decreases
- Respiratory system deteriorates and increases the likelihood of respiratory disorders
- Endocrine changes decrease metabolism
- Sleep-wake cycle is disrupted
- Other body systems deteriorate
424
Psychosocial aspects of late adulthood
- Face challenges regarding living environment, self-worth, financial burden, and death
- Motivation, personal interests, and activity level can enhance late adulthood
425
