Jones & Bartlett Learning 2012 Nancy Caroline's Emergency Care in the Streets, Seventh Ed. Catalog

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NANCY CAROLINE’S Emergency Care in the Streets, Seventh Edition

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Edition

SourceCode: CCIV_AW

Request your complimentary review copy today.

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THE COMPLETE 2-VOLUME SET This convenient 2-volume set features comprehensive coverage of every paramedic-level competency statement in the National Emergency Medical Services Education Standards. Working together, these dynamic and engaging volumes prepare the premier paramedics of tomorrow, today.

Volume 1:

Volume 2:

Chapters 1-28 Preparatory Human Body and Human Systems Pharmacology Patient Assessment Airway Management Medical

Chapters 29-52 Trauma Shock and Resuscitation Special Patient Populations Operations

*Instructor and student resources cover both volumes.

The Seventh Edition is the next step in the evolution of the premier paramedic education program.

American Academy of Orthopaedic Surgeons ISBN- 13: 978-1-4496-4586-1 Hardcover • 2200 Pages • © 2013 Chapter 17

Up Sloping

New Chapters Anatomy and Physiology Emergency Medications Diseases of the Eyes, Ears, Nose, and Throat Managing the Field Code Management and Resuscitation of the Critical Patient Patients With Special Challenges Disaster Response

Horizontal

Peaked / tented – the apex of the T wave elevates and forms a “peaked” appearance

Hyperacute – the height of the T wave exceeds ½ the overall height of the QRS

Symmetry – the T wave becomes symmetrical with respect to the Y axis

Broad base – the base of the T wave elongates during ischemia

With ST-segment depression Without ST-segment depression

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alleviated by sitting forward), shortness of breath, and history of recent infection or fever. The condition is characterized by diffuse ST-segment elevation (not exceeding 5 mm) and . The PR a depressed or down-sloping PR segment segment is elevated or up-sloping in lead aVR. The ST segment is concave in pericarditis, and reciprocal ST-segment depression is never seen.

Noncardiac Causes of ECG Abnormalities The remaining ECG abnormalities to be discussed are noncardiac causes, including genetic disorders that affect the size or function of the heart.

Seventh Edition highlights include: • Strong cardiovascular emergencies, pathophysiology, and pharmacology focus • Stresses clinical decision making and scene leadership • A new chapter on Disaster Response that covers mass-fatality situations and natural disasters • Updated progressive case studies with complete patient care reports • Focus on differential diagnosis • Emphasis on affective behavior and professionalism • Retains Dr. Caroline’s engaging tone, creative teaching style, and street wisdom

Cardiovascular Emergencies

Down Sloping

(V4 to V6) and/or the inferior leads. Reciprocal changes are never seen in benign early repolarization.

Pericarditis is the inflammation of the pericardial sac as a result of an infection (bacterial, viral, or fungal) or trauma. Patients can present with positional chest pain (often

Pulmonary Embolism A pulmonary embolism may also be identified on a 12-lead ECG. The criteria for suspecting this include the presence of an S1Q3T3 pattern,, new RBBB, and ST-segment . The pattern refers to depression in leads V1 to V3 a deep S wave in lead I, a deep, narrow Q wave in lead III, and T-wave inversion in lead III. This is also sometimes written as

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Section 8

23/11/11 12:17 PM

Shock and Resuscitation

Anatomy and Physiology of Perfusion

Perfusion is the circulation of blood within an organ or tissue in adequate amounts to meet the cells’ current needs for oxygen, nutrients, and waste removal. Perfusion requires having a working cardiovascular system. It also requires adequate gas exchange in the lungs, adequate nutrients in the form of glucose in the blood, and adequate waste removal, primarily through the lungs. Because tissue perfusion is primarily a function of the cardiovascular system, an examination of that system is important in understanding shock, or hypoperfusion.

To keep the blood moving continuously through the body, the : cardiovascular system requires three intact components � � �

A functioning pump: the heart Adequate fluid volume: the blood and body fluids An intact system of tubing capable of reflex adjustments (constriction and dilation) in response to changes in pump output and fluid volume: the blood vessels

re tthe he M Medic edic YOU Y OU aare

The heart’s contractility allows it to increase or decrease the volume of blood it pumps with each contraction, also known as the stroke volume (SV). The heart can also vary the speed at which it contracts by raising or lowering the pulse rate. Cardiac output (CO) is the volume of blood that the heart can pump per minute, and it is dependent on several factors. First, the heart must have adequate strength, which is largely determined by the ability of the heart muscle to contract. This ability to contract is referred to as myocardial contractility. Second, the heart must receive adequate blood to pump. As the volume of blood flowing to the heart increases, the precontraction pressure in the heart builds up. This precontraction pressure is known as preload.

The preload is the initial stretching of the cardiac muscles prior to contraction. It is related to the chamber volume of blood just prior to contraction. As preload increases, the volume of blood within the ventricles increases, which causes the heart muscle to stretch. When the muscle is stretched, myocardial contractility increases, leading to greater force of contraction and increased cardiac output. Lastly, the resistance to flow in the peripheral

PART 2

Your partner attempts to open the patient’s airway with a head tilt–chin lift maneuver. On the basis of your scene assessment, there is no indication that Mr. Oliver has fallen or sustained trauma that would necessitate taking spinal precautions. You suction the airway and remove loose but thick, light brown secretions. You note this stimulates his gag reflex and induces coughing. You assess your patient’s breathing, and it is slightly labored with a respiratory rate of 24 breaths/min.

Chest rise is equal bilaterally. Auscultation reveals scattered rales and rhonchi in all lung fields. You assess for a radial pulse and detect one that is weak with a rate of 120 beats/min. Your impression of his skin is that it is pale, mottled, cool, and clammy to touch. The patient appears to be critical, and a rapid assessment is indicated before initiating transport. Because the patient is nonverbal and unable to respond to your questions, you look to his home health aide for assistance. Your paramedic partner is assisting the patient’s ventilations with a bag-mask device and supplemental oxygen at 15 L/min.

You obtain a limited SAMPLE history from his aide. She tells you that Mr. Oliver had a terrible cough 3 days ago and a temperature of 101°F. She said he also reported pain when he took a deep breath. She told him she was concerned he may have pneumonia and should call his doctor. She knows he has an allergy to shellfish. His medications are in the kitchen, and she tells you he took them regularly as far as she knows. She hands you her information sheet on Mr. Oliver’s medical history. You note he has a history of hypertension, chronic bronchitis, and had a myocardial infarction approximately 5 years ago. The aide is unsure as to when he last ate but tells you he refused lunch during her last visit when he said he had no appetite. She is not sure how long he has been like this or when his condition changed, but he normally walked daily around 8:00 AM. You recall the security officer telling you he did not see Mr. Oliver for his last two shifts.

3. Describe what contributing factors would lead you to label this patient as critical.

4. Discuss pathophysiologic changes associated with septic shock.

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03/08/12 9:29 PM

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A Teaching and Learning System Like No Other Nancy Caroline’s Emergency Care in the Streets, Seventh Edition is accompanied by the most robust set of student and instructor support resources on the market, including: • E xpanded Instructor’s • Instructor’s Test Bank • Robust Student ToolKit DVD with CD-ROM with pageWorkbook that thorough PowerPoint referenced questions includes a variety of presentations, lecture that are organized into activities, including ECG outlines with highlighted general knowledge and interpretation exercises, cultural considerations critical thinking categories, “What Would You Do” and teaching tips, valuable enabling instructors to pull scenarios, Skill Drills, Fill in skill evaluation sheets, and a multiple-choice quiz or the Patient Care Report, much, much more. final exam of all case-based medical terminology ISBN-13: 978-1-4496-3609-8 critical thinking questions. exercises, and many more.

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