Section 2: The Human Body and Human Systems 227
Secondary Assessment of Trauma Patients 589
Recording Secondary Assessment Findings 589
Limits of the Secondary Assessment ............. 590
Monitoring Devices .......................... 590
Reassessment .................................. 593
Reassessment of the Primary Survey ............. 593
Reassessment of Patient Care and Transport Priorities 594
CHAPTER 12 Critical Thinking and Clinical
1. Read the Scene 611
2. Read the Patient 612
3. React 613
4. Reevaluate 614
5. Revise the Treatment Plan 614
6. Review Performance 614 Prep Kit 617
Section 4: Pharmacology 619
CHAPTER 13
of
Medication
Medication
Intradermal Medication Administration 737
Subcutaneous Medication Administration 737
Intramuscular Medication Administration 738
IV Bolus Medication Administration 740 IO Medication Administration 749
Percutaneous Medication Administration 749
Medications Administered by the Inhalation Route 753
Nebulizer and Metered-Dose Inhaler 753
Endotracheal Medication Administration 755
of Medication Absorption 761
Laryngectomy, Tracheostomy, Stoma, and Tracheostomy Tubes 823
Dental Appliances 827
Facial Trauma 828
Advanced Airway Management 829
Predicting the Difficult Airway ................. 829
Endotracheal Intubation ...................... 831
Orotracheal Intubation by Direct Laryngoscopy .................. 833
Orotracheal Intubation by Video Laryngoscopy 843
Nasotracheal Intubation 846
Technique for Nasotracheal Intubation 848
Digital Intubation 849
Transillumination Techniques for Intubation 852
Retrograde Intubation 853
Face-to-Face Intubation 855
Failed Intubation 858
Field Extubation 859
Pharmacologic Adjuncts to Airway Management and Ventilation 861
Sedation in Emergency Intubation 861
Neuromuscular Blockade in Emergency Intubation 862
Pharmacology of Neuromuscular Blocking Agents ........................ 863
Depolarizing Neuromuscular Blocking Agent ................................ 863
Rapid Sequence Intubation .................... 864
Alternative Advanced Airway Devices 866
Supraglottic Airway Devices 866
Multilumen Airways 875
Surgical and Nonsurgical Cricothyrotomy 877
Open Cricothyrotomy 878
Needle Cricothyrotomy 880 Prep Kit 890
Section 6: Medical 901
Mechanisms of Respiratory Control 907
Tamponade 1055
Cardiogenic Shock 1056
Hypertensive Emergencies 1057
Infectious Diseases of the Heart 1060
Vascular Disorders 1062 Prep Kit 1068
and Physiology Review 1081
Standard Care Guideline for the Neurologic Patient 1097 Administration of Dextrose 1097 Administration of Naloxone 1099
Interventions for Increased Intracranial Pressure 1099
Pathophysiology, Assessment, and Management of Common Neurologic Emergencies 1099
Pathophysiology, Assessment, and Management of Demyelinating, Degenerating, and Motor
Disease 1123 Amyotrophic Lateral Sclerosis 1123 Cranial Nerve Disorders 1124 Dystonia 1126 Central Nervous System Infections and Inflammation 1127 Abscesses 1129
Lower Gastrointestinal Bleeding:
Anal Fissures 1187
Pathophysiology, Assessment, and Management of Esophageal Pathologies 1187
Esophagitis 1187
Tracheoesophageal Fistula.................... 1188
Esophageal Stricture or Stenosis ............... 1188
Pathophysiology, Assessment, and Management of Acute Inflammatory Conditions ............. 1189
Peritonitis 1189
Cholecystitis and Biliary Tract Disorders 1190
Appendicitis 1191
Diverticulitis 1192
Pancreatitis 1193
Pathophysiology, Assessment, and Management of Chronic Inflammatory Conditions 1194
Ulcerative Colitis 1194
Crohn Disease 1194
Irritable Bowel Syndrome 1195
Pathophysiology, Assessment, and Management of Acute Infectious Conditions 1195
Acute Gastroenteritis 1196
Rectal Abscess 1197
Liver Disease: Cirrhosis 1197
Liver Disease: Hepatic Encephalopathy ......... 1198
Pathophysiology, Assessment, and Management of Obstructive Conditions ........ 1198
Pathophysiology, Assessment, and Management of Ischemic and Neoplastic Disorders 1202 Mesenteric Ischemia 1202 Neoplasms 1203
Tumors of the Colon 1203 Pancreatic Tumors 1203 Hepatic Tumors 1203 Prevention Strategies 1204 Prep Kit 1207
Pathophysiology, Assessment, and Management of Specific Emergencies 1220
Urinary Tract Infections 1220
Urinary Catheters 1221
Panhypopituitarism 1283 Diabetes Insipidus and SIADH 1284 Prep Kit 1287
CHAPTER
Human Immunodeficiency Virus Infection and Acquired Immunodeficiency
1372
1372
1374
........................... 1374
................................ 1374
1375
Pathophysiology, Assessment, and Management of Enteric (Intestinal) Diseases 1375
Norovirus Infection 1375
Pathophysiology, Assessment, and Management of Non-Bloodborne Hepatitis Viruses 1375
Hepatitis A Virus Infection 1375
Hepatitis E Virus Infection 1376
Pathophysiology, Assessment, and Management of Vector-borne and Zoonotic (Animal-borne) Diseases 1377
Introduction 1377
Mosquito-Borne Diseases 1377
Tick-borne Diseases 1378
Hantavirus Infection 1379 Rabies 1380 Middle East Respiratory Syndrome ............. 1380 Tetanus ................................... 1381
Pathophysiology, Assessment, and Management of Infection With Antibiotic-Resistant Organisms and Multidrug-Resistant Organisms 1381
Methicillin-Resistant Staphylococcus aureus 1381
Vancomycin-Resistant Staphylococcus aureus 1382
Vancomycin-Resistant Enterococci 1383
Clostridium difficile 1383
Carbapenem-Resistant Enterobacteriaceae 1384
Pathophysiology, Assessment, and Management of Newly Recognized Diseases 1384
Severe Acute Respiratory Syndrome 1384 Avian Flu 1385
Prep Kit 1387 CHAPTER 27 Toxicology 1397 Introduction 1398 Types of Toxicologic Emergencies 1399
Centers 1400
1400 Routes of Entry 1400
and Using Toxidromes .......... 1403 Overview of Substance Abuse ................. 1403 Patient Assessment ............................ 1406 Scene Size-up .............................. 1406
Survey 1407
Taking 1407
Assessment 1408
1409 Emergency Medical Care 1409
Pathophysiology, Assessment, and Management of Abuse of and Overdose With Specific Substances 1409 Alcohol 1409
1564
1564
1566 Secondary Assessment 1566
Reassessment 1567
Trauma Score 1568
Revised Trauma Score 1568
Management of Trauma 1568
Trauma Lethal Triad 1569
Criteria for Referral to a Trauma Center ......... 1569 Mode of Transport .......................... 1573 Research and Trauma Care ................... 1573 Prep Kit ..................................... 1576 CHAPTER 30 Bleeding 1581
1582 Anatomy and Physiology Review 1582 The Cardiac Cycle 1583 Blood and Its Components 1584
Blood Circulation and Perfusion 1584
Pathophysiology of Hemorrhage 1585
External Hemorrhage 1586
Internal Hemorrhage 1586
The Significance of Hemorrhage 1586
Physiologic Response to Hemorrhage 1586 Shock 1587
Hemorrhagic Shock 1588
Patient Assessment 1590
Scene Size-up 1590
Primary Survey 1590
History Taking 1592
Pathophysiology, Assessment, and Management of Myocardial Injuries 1806
Cardiac Tamponade 1806
Myocardial Contusion 1808
Myocardial Rupture 1808
Commotio Cordis 1809
Pathophysiology, Assessment, and Management of Vascular Injuries.
1809 Traumatic Aortic Disruption .................. 1809 Great Vessel Injury .......................... 1810
Pathophysiology, Assessment, and Management of Other Thoracic Injuries 1811
Diaphragmatic Injuries 1811
Esophageal Injuries 1812
Tracheobronchial Injuries 1812 Traumatic Asphyxia 1812 Prep Kit 1815
CHAPTER 36 Abdominal and Genitourinary Trauma 1819
Splinting 1858
Pathophysiology, Assessment, and Management of Complications of Musculoskeletal Injuries
Disease .................... 1865
Pathophysiology, Assessment, and Management of Specific Fractures 1866
Shoulder Girdle Fracture 1866
Midshaft Humerus Fractures 1866
Elbow Fractures 1867
Forearm Fractures 1867
Wrist and Hand Fractures 1867
Pelvis Fractures 1868
Hip 1871
Femoral Shaft 1872
Knee 1872
Tibia and Fibula 1873
Ankle 1873
Calcaneus 1874
Pathophysiology, Assessment, and Management of Ligament Injuries and Dislocations 1874
Shoulder Girdle Injuries and Dislocations ....... 1874
Elbow Dislocation .......................... 1875
Wrist and Hand Dislocation .................. 1875
Finger Dislocation .......................... 1876
Hip Dislocation 1876
Knee Dislocation 1876
Tendon/Ligament Lacerations, Transections, and Ruptures 1877
Achilles Tendon Rupture 1877
Pathophysiology, Assessment, and Management of Nontraumatic Musculoskeletal Disorders 1878
Bony Abnormalities 1878
Joint Abnormalities: Arthritis 1878
Muscle Disorders 1879
Overuse Syndromes 1879
Prep Kit 1882
CHAPTER 38 Environmental Emergencies 1887
Introduction 1888
Anatomy and Physiology Review 1889
Homeostasis and Body Temperature 1889
Thermoregulatory Mechanisms 1890
Physiologic Responses to Heat and Cold 1891
Pathophysiology, Assessment, and Management of Heat Illness ............................. 1892
Risk Factors for Heat Illness .................. 1892
Heat Cramps .............................. 1893
Heat Syncope 1895 Heat Exhaustion 1895
Heatstroke 1896
Pathophysiology, Assessment, and Management of Cold Injuries 1899
Local Cold Injury/Frostbite 1899
Trench Foot and Chilblains 1901
Hypothermia 1902
Assessment, and Management of
Post-Term Pregnancy 2051 Meconium Staining 2052
Fetal Macrosomia 2052
Multiple Gestation 2052
Intrauterine Fetal Death 2052
Amniotic Fluid Embolism .................... 2053
Hydramnios ............................... 2053
Cephalopelvic Disproportion ................. 2053
Pathophysiology, Assessment, and Management of Complications of Delivery 2053
Cephalic Presentation 2053
Breech Presentations 2054
Shoulder Dystocia 2054
Nuchal Cord 2055
Prolapsed Umbilical Cord 2055
Pathophysiology, Assessment, and Management of Postpartum Complications 2056
Uterine Inversion 2056
Postpartum Hemorrhage 2056
Pulmonary Embolism 2057
Postpartum Depression 2057
Trauma and Pregnancy 2057
Pathophysiology and Assessment Considerations 2057
Considerations for the Fetus Related to Trauma ............................ 2058
Management of the Pregnant Patient With Trauma ......................... 2059
Prep Kit ..................................... 2062
CHAPTER 42 Neonatal Care 2069
Introduction 2070
General Pathophysiology and Assessment 2070
Transition From Fetus to Newborn 2071
Arrival of the Newborn 2071
The Apgar Score 2075
Algorithm for Neonatal Resuscitation 2075
Specific Intervention and Resuscitation Steps 2077
Drying and Stimulation 2077
Airway Management 2078
Circulation 2083
Pharmacologic Interventions 2085
Family and Transport Considerations ............. 2086
Pathophysiology, Assessment, and Management of Specific Conditions ....................... 2086
Apnea .................................... 2086
Bradycardia 2087
Acidosis 2087
Pneumothorax Decompression 2087
Meconium-Stained Amniotic Fluid 2088
Low Blood Volume 2088
Diaphragmatic Hernia 2089
Respiratory Distress and Cyanosis 2089
Respiratory Depression Secondary to Narcotics 2090
Premature and Low Birth Weight Infants 2090
Seizures in the Newborn 2091
Hypoglycemia 2093
Vomiting 2094
Pyloric Stenosis and Malrotation With Volvulus 2173
General Assessment and Management of Gastrointestinal Emergencies 2173
and
Adrenal Hyperplasia ............... 2176
Panhypopituitarism ......................... 2176
Inborn Errors of Metabolism ................. 2176
Pathophysiology, Assessment, and Management of Hematologic, Oncologic, and Immunologic Emergencies 2177
Sickle Cell Disease 2178 Bleeding Disorders 2178
Leukemia/Lymphoma 2179
Pathophysiology, Assessment, and Management of Toxicologic Emergencies 2179
Assessment of Toxicologic Emergencies 2179 Management of Toxicologic Emergencies 2180
Pathophysiology, Assessment, and Management of Psychiatric and Behavioral Emergencies 2181 Safety 2182
Assessment and Management of Psychiatric and Behavioral Emergencies 2182
Pathophysiology, Assessment, and Management of Fever Emergencies 2182
Child Abuse and Neglect ....................... 2183
Risk Factors for Abuse ....................... 2184
Suspecting Abuse or Neglect .................. 2184
Assessment and Management of Abuse and Neglect 2184
Sudden Infant Death Syndrome 2186
Assessment and Management of SIDS 2186
Brief Resolved Unexplained Event 2187
Pathophysiology, Assessment, and Management of Pediatric Trauma Emergencies 2187
Pathophysiology of Traumatic Injuries 2187
Assessment and Management of Traumatic Injuries 2188
Pathophysiology,
Operations
........................ 2310
2310 Traffic Control ............................. 2310
Safe Patient Transport 2310
Postrun Activities: Restocking, Cleaning, and Disinfection 2311 Defensive Emergency Vehicle Driving Techniques 2312 Driver Characteristics 2312 Safe Driving Practices 2313 Emergency Vehicle Control
Skill Drills
VOLUME 1
Skill Drill 11-1 Performing a Rapid Full-Body Scan ............................ 542
Skill Drill 11-2 Performing Percussion .......... 544
Skill Drill 11-3 Performing the Full-Body Exam .. 549
Skill Drill 11-4 Using a Glucometer to Assess Blood Glucose Level ....................... 553
Skill Drill 11-5 Assessing the Head............. 557
Skill Drill 11-6 Examining the Eye ............. 559
Skill Drill 11-7 Examining the Neck 562
Skill Drill 11-8 Examining the Chest 564
Skill Drill 11-9 Examining the Abdomen 572
Skill Drill 11-10 Examining the Musculoskeletal System 576
Skill Drill 11-11 Examining the Peripheral Vascular System ........................... 580
Skill Drill 11-12 Examining the Spine 583
Skill Drill 11-13 Examining the Nervous System .................................. 587
Skill Drill 11-14 Evaluating Deep Tendon Reflexes 588
Skill Drill 14-1 Spiking the Bag ............... 696
Skill Drill 14-2 Obtaining Vascular Access ....... 702
Skill Drill 14-3 Gaining Intraosseous Access With an EZ-IO Device 717
Skill Drill 14-4 Administering Medication via a Nasogastric Tube 731
Skill Drill 14-5 Drawing Medication From an Ampule 733
Skill Drill 14-6 Drawing Medication From a Vial 735
Skill Drill 14-7 Administering Medication via the Subcutaneous Route ................. 738
Skill Drill 14-8 Administering Medication via the Intramuscular Route 741
Skill Drill 14-9 Administering Medication via the Intravenous Bolus Route 742
Skill Drill 14-10 Administering a Medication via Intravenous Piggyback Infusion 744
Skill Drill 14-11 Administering Medication via the Intraosseous Route .................. 750
Skill Drill 14-12 Administering Medication via the Sublingual Route .................... 752
Skill Drill 14-13 Administering Medication via the Intranasal Route 754
Skill Drill 14-14 Assisting a Patient With a Metered-Dose Inhaler 756
Skill Drill 14-15 Administering a Medication via a Small-Volume Nebulizer 758
Skill Drill 14-16 Accessing a Tunneling Device 759
Skill Drill 15-1 Removing an Upper Airway Obstruction With Magill Forceps 805
Skill Drill 15-2 Using CPAP 819
Skill Drill 15-3 Inserting a Nasogastric Tube in a Responsive Patient ..................... 821
Skill Drill 15-4 Inserting an Orogastric Tube in an Unresponsive Patient .................. 823
Skill Drill 15-5 Suctioning of a Stoma .......... 825
Skill Drill 15-6 Ventilating Through a Stoma Using a Resuscitation Mask 826
Skill Drill 15-7 Ventilating a Stoma With a Bag-Mask Device 827
Skill Drill 15-8 Replacing a Dislodged Tracheostomy Tube With a Temporary ET Tube ................................. 828
Skill Drill 15-9 Performing Orotracheal Intubation Using Direct Laryngoscopy ........ 841
Skill Drill 15-10 Performing Orotracheal Intubation Using Video Laryngoscopy 845
Skill Drill 15-11 Performing Nasotracheal Intubation 849
Skill Drill 15-12 Performing Transillumination Intubation 854
Skill Drill 15-13 Performing Retrograde Intubation ............................... 856
Skill Drill 15-14 Performing Tracheobronchial Suctioning ............................... 860
Skill Drill 15-15 Inserting a King LT Airway ..... 868
Skill Drill 15-16 Inserting an LMA ............. 871
Skill Drill 15-17 Inserting an i-gel Supraglottic Airway ........................ 873
Skill Drill 15-18 Performing an Open Cricothyrotomy 881
Skill Drill 15-19 Performing Needle Cricothyrotomy and Translaryngeal Catheter Ventilation ....................... 884
Skill Drill 17-1 Performing Cardiac Monitoring ............................... 976
Skill Drill 17-2 Performing Transcutaneous Pacing 990
Skill Drill 17-3 Performing Synchronized Cardioversion ............................ 998
Skill Drill 17-4 Performing Manual Defibrillation ............................ 1010
Skill Drill 17-5 Performing Defibrillation With an AED 1012
Skill Drill 17-6 Acquiring a 12-lead ECG 1024
Skill Drill 19-1 Examining the Eye With an Ophthalmoscope 1145
Skill Drill 19-2 Examining the Ear With an Otoscope 1151
Skill Drill 28-1 Restraining a Patient 1465
VOLUME 2
Skill Drill 30-1 Managing External Hemorrhage 1594
Skill Drill 30-2 Applying a Commercial Tourniquet (Combat Application Tourniquet) ............................. 1597
Skill Drill 30-3 Managing Internal Hemorrhage 1601
Skill Drill 34-1 Performing Spinal Immobilization of a Supine Adult Patient 1759
Skill Drill 34-2 Using a Scoop Stretcher 1764
Skill Drill 34-3 Performing Spinal Immobilization of a Seated Adult Patient ..... 1765
Skill Drill 35-1 Needle Decompression (Thoracentesis) of a Tension Pneumothorax 1802
Skill Drill 37-1 Performing a Motor Function and Sensory Exam 1855
Skill Drill 39-1 Performing Two-Rescuer Adult CPR 1952
Skill Drill 39-2 Performing CPR on a Child .... 1955
Skill Drill 39-3 Infant CPR .................. 1956
Skill Drill 42-1 Intubating a Newborn ......... 2082
Skill Drill 42-2 Inserting an Orogastric Tube in the Newborn .......................... 2083
Skill Drill 43-1 Inserting an Oropharyngeal Airway in a Pediatric Patient 2146
Skill Drill 43-2 Inserting a Nasopharyngeal Airway in a Pediatric Patient 2147
Skill Drill 43-3 Performing One-Person Bag-Mask Ventilation on a Pediatric
Skill Drill 43-4 Performing Pediatric Endotracheal Intubation
Skill Drill 43-5 Performing Pediatric IO Infusion 2158
Skill Drill 43-6 Immobilizing a Child 2190
Skill Drill 43-7 Immobilizing an Infant 2190
Skill Drill 45-1 Cleaning a Tracheostomy Tube .. 2263
Skill Drill 45-2 Replacing an Ostomy
Skill
Skill Drill 48-1 Breaking Tempered Glass Using a Spring-Loaded Center Punch ........ 2375
Skill Drill 48-2 Stabilizing a Suspected
