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ems term #927

laceration - an open injury whose edges may be linear (smooth and regular) or stelate (jagged and irregular); a wound that penetrates the brain.

ems assessment tip #997

if the foot or ankle is injured, having the patient push down or pull back with the big toe will give you the same result as if the entire foot were tested.

ems term #929

abrasion - an open injury to the epidermis caused by a scrapong away, rubbing or shearing away of tissue.

ems assessment tip #988

the severe pain associated with a fracture to an extemity may distract the pafient from complaining of other more significant pain, such as abdominal pain or spinal pain. for this reason, fractures maybe referred to as distracting injuries.

ems term #925

hematoma - a closed injury characterized by a mass of blood beneath the epidermis.

ems assessment tip #1028

to distinguish a clear fluid leaking from the ears or nose from tears or nasal secretions, check the fluid for glucose. cerebrospinal fluid contains glucose, tears and nasal secretions do not.  glucose reading in cerebrospinal fluid will be about half of the blood glucose reading. note, however, that any discharge from the ears or nose must be taken seriously.

ems term #926

crush injury - an open or closed injury in which high-pressure forces cause serious damage to underlying soft tissue with internal bleeding, resulting in possible hemorrhagic shock.

ems assessment tip #1029

there is very little room for bleeding into the brain. so in the patient with trauma to the head, if the blood pressure is decreasing, the pulse pressure is narrow, the heart rate is elevated, and the respiratory rate is increased, suspect shock, but look for evidence of bleeding in an area of the body other than the brain.

ems term #924

ecchymosis - black and blue discoloration.

ems assessment tip #1027

in a brain injury, the affected pupil is usually on the same side as the injury.

ems assessment tip #990

suspect a dislocation when deformity and pain are found at a joint.

ems term #923

contusion - a closed injury to the tissue and blood vessels within the dermis characterized by discoloration, swelling, and pain; a bruise; bruising or swelling of the brain.

ems term #924

closed injury - any injury in which there is no break in the skin.

ems assessment tip #964

the determination of an accurate body surface area (BSA) burned can be delayed until the physical exam is completed. prior to this you should focus on establishing and maintaining the airway, breathing, oxygenation, and circulation.

ems term #897

fragmentation - the breaking up of a bullet into small pieces on impact.

ems assessment tip #962

the head of the infant or child accounts for more of the total body surface area (BSA) than it does in the adult. this is because the head is proportionally larger in younger patients.

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ems term #896

cavitation - a cavity formed by a pressure wave resulting from the kinetic energy of a bullet traveling through body tissue.

ems assessment tip #931

a tension pneumothorax will present with signs and symptoms of severe respiratory distress and cardiovascular compromise as evidenced by hypotension, narrow pulse pressure, increasing heart rate, and pale, cool, and clammy skin.

ems term #899

drag: the factors that slow a projectile.

ems assessment tip #924

hematomas that occur in The elderly with fragile soft tissue could bleed excessively and become extremely large.

ems term #898

dissipation of energy - how energy is transferred to the human body by the forces acting on it.

ems assessment tip #916

it may take up to 2 liters of blood to distend the abdominal girth by 1 inch.

ems term #896

trajectory - the path of a projectile during its travel, a trajectory  may be flat or curved. 

ems assessment tip #914

the initial complaint of some patients with epistaxis.may be throwing up blood, because the blood will irritate the gastric mucous lining when swallowed and cause the patient to vomit. in this case, recognize that the bleeding is not From the stomach but from the nasopharynx.

ems term #686

kinetic energy - the energy contained by an object in motion.

ems assessments tip #909

the best way to estimate the amount of blood loss is not to look on the ground or at the clothing of the patient but rather to perform an assessment and determine the severity of the signs and symptoms.

ems term #385

kinetics - the branch of mechanics dealing with the motions of material bodies.

ems assessment tip #889

"spider web" or other impact marks to the windshield would heighten your suspicion of a potential head injury. be aware that the impact mark on the windshield can also be made by an air bag that as deployed during the crash.

ems term #884

kinetics of trauma - the science of analyzing mechanism of injury.

ems assessment tip #886

be sure to lift a deflated, deployed air bag to assess for deformity of the steering wheel.

ems term #658

syncope: a brief period of unresponsiveness caused by a lack of blood flow to the brain; fainting.

ems term #655

diabetes mellitus - a disease of altered relationships between glucose and insulin

ems assessment tip #650

a typical faint or syncopal episode may be preceded by the patient yawning, sweating,  and complaining of dizziness and nausea. if the patient was a sudden syncopal episode during exertion, it may be an indication that a cardiac rhythm disturbance caused the syncope and not a more typical mechanism for fainting.

ems assessment tip #650

the teem "complex" with regard to partial seizures typically refers to that which results in an alteration in mental status.

ems term #649

postictal state - the recovery period that follows the clonic phase of a generalized seizure. in a postictal state the patient commonly appears weak, exhausted, and disoriented and progressively improves.

ems assessment tip #649

the term "simple" with regard to partial seizures typically refers to a seizure during which the patient retains consciousness.

ems term #627

ischemic stroke - a stroke caused by obstruction to a vessel in the brain, calleed a thrombotic stroke if caused by a clot or an embolic stoke if called by plaque or other material carried to the brain.

ems assessment tip #626

the time of onset of a stroke is commonly defined as the last rime the patient was seen neurologically intact, meaning without any neurological deficit such as numbness, weakness, paralysis, slurred or stuttering speech, or cognitive problems.

ems term #624

coma - an unconscious state in which a person does not respond to any stimulus, including pain.

ems assessment tip #623

even though the patient may still have a gag or cough reflex, he may not be able to maintain his own airway if he has an altered mental status.

ems term #623

reticular activating system - nerve cells within the brainstem that control consciousness.

ems assessment tip #611

an increased respiratory rate and heart rate in the acute coronary syndrome patient may be an indication of hypoxia or may be only a response to the chest pain or discomfort.

ems term #594

cardiac compromise - reduced heart function caused by any condition, disease, or injury affecting the heart.

ems assessment tip #604

a systolic blood pressure of 90 mmHg or a systolic pressure that is 30 mmHg less than the patient's baseline systolic pressure is a contraindication to the administration of any additional nitroglycerin.

ems term #585

automaticity - the ability of cells within the cardiac conduction system to generate a cardiac impulse on their own.

ems assessment tip #570

the severity of shortness of breath does not directly correlate with the level of hypoxia. a severely hypoxic patient may not complain of extreme shortness of breath. pay close attention to your assessment findings.

ems term #586

cardiac conduction system - contractile and conductive tissue of the heart that generates electrical impulses and causes the heart to beat.

ems assessment tip #559

respiratory distress may be produced by both medical illness and traumatic injuries. do not assume that a patient in respiratory distress is usffering a medical illness, but expose the patient and inspect for any evidence of traumatic injuries, especially in the patient with a sudden onset of symptoms.

ems term #569

pulsus paradoxus - a drop in blood pressure of more than 10 mmHg during inhalation resulting from increased pressure within the chest that suppresses the filing of the ventricles of the heart with blood.

ems assessment tip #568

subcutaneous emphysema can be felt much more easily than it can be seen on inspection..

ems term #564

tripod position - a position in which the patient sits upright, leans slightly forward, and supports the body with the arms in front and elbows locked. this is a position commonly found in respiratory distress.

ems assessment tip #550

inspiratory stridor is an indication of an almost completely occluded airway. it is created when the patient breathes in sharply in order to draw air past the airway obstruction. as air passes through the narrowed glotic opening, airflow becomes turbulent and it creates the high pitched sound. if the inspiratory stridor disappears and your patient's mental status continues to deteriorate, it probably means that total airway occlusion has occurred.

ems term #555

small-volume nebulizer - a device that uses compressed air or oxygen to nebulize a liquid medication into a mist that a patient can inhale.

ems assessment tip #547

crackles (or rales)  are a sign of pulmonary edema. be sure to auscaltate the posterior lower lobes of the lungs to pick up early indications of crackles and pulmonary edema. if you only auscaltate the upper lobes, you may easily miss the condition, since gravity pulls the fluid downward into the lower portions of the lungs.

ems term #21

acute coronary syndrome - a group of signs and symtomss resulting from a variety of conditions that can affect the heart, in which the coronary arteries are narrowed or occluded by fat deposits, clots, or spasm.

ems assessment tip #485

once a medication has been administered, it is important to reassess the patient to determine if there is any change in the condition. aspirin and activated charcoal may not produce obvious changes in the patient's condition.

ems term #16

acromion - the lateral triangular projection of the scapula that forms the point of the shoulder.

ems assessment tip #446

pain is typically produced by ischemia (tissue that is hypoxic), inflammation, infection, or obstruction.

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ems term #1263

neglect - the provision of insufficient attension or respect to someone who has a claim to that attention.

ems assessment tip #444

abdominal respiratory patterns typically do not allow for adequate breathing. assess the patient carefully to ensure the respiratory rate and tidal volume are adequate.

ems term #965

pathologic fracture - a broken bone resulting from a disease that causes bone degeneration.

ems assessment tip #443

in a medical patient who complains of a sudden onset of shortness of breath, assess the lower extremities for pain, redness, or swelling to one calf. the patient may also have pain in his calf when pullling his foot backward toward his head. this may be an indication of a blood clot in a deep vein of the lower leg that has broken off and traveled to the lungs.

ems term #764

parietal pain - localizrd, intense, sharp, constant pain associated with irritation of the peritoneum.

ems assessment tip #442

an extremely distended abdomen in the medical patient may be the result of a larger amount of fluid, not blood, in the abdomen. this could still lead to hypoperfusion from fluid loss and respiratory compromise from upward pressure to the diaphragm.

ems term #476

metered-dose inhaled - a device consisting of a plastic container and a canister of medication used to inhale an aerosolized medication.

ems assessment tip #440

a pale oral mucosa inside the mouth may indicate that the medical patient has been losing blood over a long period of time.

ems term #540

bronchoconstriction - constriction of the smooth muscle of the bronchi and bronchioles.

ems assessment tip #438

a responsive medical patient is one who not only responds to your questions and commands but responds appropriately. if the patient responds, but not appropriately, consider the patient's responses to be unreliable and conduct a rapid secondary assessment.

ems term #941

hypercarbia - increased carbon dioxide levels in the blood. also called hypercapnia.

ems assessment tip #432

if a patient is taking a beta blocker or calcium channel blocker drug, the heart rate may ramain slower than expected in some conditions, such as shock. therefore, the one significant sign of shock that might not be seen in this patient is tachycardia, because of the effects of the drugs.

ems term #990

crepitus - the sound or feel of broken fragments of bone grinding against each other.

ems assessment tip #433

a normal blood glucose level in a nondiabetic patient who has nothing to eat or has had no drink containing sugar or other carbohydrates for 8-12 hours is on average, 80-90 mg/dL it may range from 70-100 mg/dL. shortly after a meal and for an hour or so, the nondiabetic BGL is usually 120-140 mg/dL.

ems term #797

convection - loss of body heat to the atmosphere when air passes over the body.

ems assessment tip #430

a palpated systolic blood pressure is an average of 7 mmHg lower than an auscultated systolic blood pressure.

ems term #15

acetylcholinesterase - an enzyme that breaks down the neurotransmitter acetylcholine. nerve agents inhibit the action of the enzyme, allowing acetylcholine to accumulate

ems assessment tip #429

a pulse that becomes very weak or disappears only when the patient inhales may indicate shock from blood loss, a tension pneumothorax, or pericardial tamponade.

ems term #14

acetylcholine - a neurotransmitter that is distributed throughout the body and is necessary for normal function of the parasympathetic nervous system.

ems assessment tip #427

a pelvic fracture can be associated with severe bleeding. be prepared to treat hemorrhagic shock in a patient with a pelvic fracture.

ems term #765

peritonitis - irritation and inflammation of the peritoneum.

ems assessment tip #423

a patient who is hoarse or cannot speak and who has evidence of trauma to the neck may have an injury to the larynx.

ems term #13

acetabulum - the rounded cavity or socket on the external surface of the pelvis that receives the head of the femur.

ems assessment tip #422

 if the patient exhibits the signs and symptoms of shock or hypoperfusion and you find jugular vein distension on inspection of the neck, look for a cause of poor perfusion other than blood loss.

ems term #12

acceleration/deceleration injury- a head injury typical of a vehicle crash in which the head comes to a sudden stop, but the brain continues to move back and forth inside the skull, resulting in bruising to the brain.

ems assessment tip #421

some patients take medicated eye drops that cause the pupils to dialate. also, patients who have had their eyes examined that day may have dialated pupils. the pupils will continue to respond to light changes, but very slightly.

ems term #420

aspiration - breathing a foreign substance into the lungs.

ems assessment tip #420-2

you may meet more resistance when ventilating a patient with stridor because of the increase in resistance to airflow through the swollen larynx. if you feel resistance, however, make sure it is not from a poorly established head-tilt, chin-lift maneuver or jaw-thrust maneuver.

ems term #419

brain herniatiion - a protrusion or pushing of a portion of the brain through the cranial wall.

ems assessment tip #415

the mental status of a patient with a brain injury will continue to deteriorate or will not improve if it is already altered.

ems term #441

orthopnea - shortness of breathe while lying flat.

ems assessment tip #420

bradycardia in a patient with a suspected head injury is a very serious sign of brain injury.

ems term #8

abruptio placenta - the premature separation of the placenta from the uterine wall.

ems assessment tip #414

if the patient -adult or child -has not suffered a significant mechanism of injury (moi) but is exhibiting signs and symptoms of shock or a severe injury, assume the patient is injured and provide immediate emergency care based on the clinical findings and not the moi.

ems term #4

abdominal cavity - the space locatebelow the diaphragm. that extends to the pelvis.

ems assessment #407:

if the scrotum is swollen and red in a male patient with trauma to the pelvis,  suspect a possible pelvic fracture with internal bleeding.

ems terms #3:

ems terms #3: abdominal aortic aneurysm - a weakened, ballooned, and enlarged area of the wall of the abdominal aorta

ems assessment tip #405:

a patient with severe abdominal pain will often lie extremely still, draw his knees up froward the chest, and breathe fast and shallowly to reduce the movement of the diaphragm. the condition usually involves irritation of the peritoneum (lining of the abdominal). a patient who is complaining of pain but feels better if he is up and walking may be suffering from a bowel obstruction.

ems teem #2

abdominal aorta -the portion of the depending aorta that extends from  the thoracic portion of the aorta proximally to the distal point where the aorta divides into the Iliad arteries.  arteries branching from the abdominal aorta supply the abdominal organs.

ems assessment tip #404

a patient with a simple rib fracture may breathe very shallowly and rapidly because of the pain associated with deeper breathibg. By intentionally breathing shallowly, the parient is lowering the tidal volume ans making. The ventilation inadequate.this canlead to hypoxia in the parient with a rib fracture,particularly in the elderly and those with underlying lung disease.

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ems fact #203

partial pressure of gases in ambient atmosphere at sea level

gas - % - partial pressure
oxygen - 21% - 159 mmHg
nitrogen -79% - 597 mmHg
argon - 0.9% - 7 mmHg
carbon dioxide - 0.03% - 0.3 Knuth

ems term #1

abandonment - the act of discontinuing emergency care without ensuring that health care professional with equivalent or better training will take over.

ems assessment tip #395

a parient with anemia, who has a low number of red blood cells or low hemoglobin content to start with, may take longer do become cyanotic when hypoxic.

ems term #365

mechanism of injury - the factors and forces that cause traumatic injury.

ems assessment tip #342

when patients are asked about their last meal, they often interpret this as breakfast, lunch, pr dinner, which may have been several hours from the time of the call, and not provide information about smacks between meals, which may have occurred very close to the time of the call. that is why you should ask about their last oral intake and not the last meal.

ems documentation method - CHART

C - chief complaint of the patient
H - history of the patient (including the SAMPLE histrory)
A - assessment findings gathered in the primary assessment, secondary assessment, detailed physical exam, and ongoing assessment.
R - Rx for treatment that was provided to the patient
T - transport - any change in the patient's condition enroute to the hospital and the type of transport.

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ems term #405

paradoxical movement - a section of the chest that moves in the opposite direction to the rest of the chest during the phases of respiration. typically seen with a flail segment.

ems teem #420

aspiration - breathing a foreign substance into the lungs.

ems assessment tip #394.2

capillary refill alone cannot provide an accurate assessment of perfusion in infants, children or adults. you must also assess the mental status, heart rate, peripheral and central pulsses, skin signs, and bloood pressure to determine the perfusion status of the patient.

ems formula #209

alveolar ventilation = (tidal volume - dead air space) x frequency of ventilation / minute

alveolar ventilation - the amount of air that enters the alveoli for gas exchange
tidal volume - the volume of air in each breath
dead air space - anatomical areas in the respiratory tract where no gas exchange occurs but air collects during inhalation.

ems term #391

apnea - absense of breathing; respiratory arrest.

ems assessment tip #390

because brain cells require a constant supply of oxygen, an altered mental status may be an early sign of hypoxia.

ems fact #217

blood is distributed in the various components of the cardiovascular system as follows;
venous - 84%
arterial - 13%
pulmonary vessels - 9%
capillaries - 7%
heart - 7%

ems term #326

pulsus paradoxus - a decrease in pulse strength during inhalation.

ems assessment tip #334

when you take orthostatic vital signs, moving the patient from a supine to a standing position provides the best results. a supine-to-seated position will provide orthostatic vital signs if they are present but is not as accurate.

ems terms #331

pulse pressure - the difference between the systolic blood pressure and the diastolic blood pressure.

ems assessment tip #330

when assessing for pupillary reaction, use only a penlight with a regular bulb, not an LED. also do not use a flashlight with a bright light. these could be uncomfortable for the patient to look at.

ems term #268

residual volume - the air remaining in the lungs after a maximal exhalation.

ems assessment tip #267

prior to suctioning, to avoid inserting the catheter too far into the oropharynx, the hard suction catheter can be measured with the tip placed at the angle of the jaw and a landmark established at the corner of the mouth.

ems term #75

minimum data set - the minimum information the u.s. department of transportation has determined should be included on all prehospital care reports.

ems assessment tip #156

damage to the spinal cord will typically produce a loss of sensation or movement distal to the injury, whereas an injury for the spirit al column (vertebrae) will usually produce only pain.

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ems term #96

SBAR - situation, background, assessment, and recommendation; a method of organizing communications about a patient.

ems assessment tip #165 - medical

the immature respiratory chest muscles of the infant  and young child often mean they need to use their abdominal muscles more during breathing; thus, you would expect to see more exaggerated abdominal movement during normal breathing.

ems term #381

penetrating trauma - a force that pierces the skin and body tissues, for example, a knife or gunshot woumd.

ems assessment tip #392 - medical

the patient with an SpO2 reading of 95% or 96% who has been receiving oxygen by nonrebreather  mask at 15 lpm for a period of time will likely become hypoxemic upon removal of the oxygen.

ems term #391-2

dyspnea - shortness of breath or perceived difficulty in breathing

ems assessment tip #443-1 - medical

in a medical patient who complains of a sudden onset of shortness of breath, assess the lower extremetities for pain, redness, or swelling to one calf. the patient may also have pain in the calf when pulling his foot backward toward his head. this may be an indication of a blood clot in a deep vein of the lower leg that has broken off and traveled to the lungs.

ems term #648-2

aura - an unusual sensory sensation that may precede a seizure episode by hours or only a few seconds.

ems assessment tip #653 - medical

paralysis to one area of the bodt may occur following a generalized seizure and may last up to 24 hours. this is referred to as Todd paralysis. it may also indicate a space-occupying problem in the brain is causing the ssizure.

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ems term #997

parentheses - a prickling or tingling feeling that indicates some loss of sensation.

ems assessment tip #997 - trauma

if the foot or ankle is injured, having the patient push down or pull back with the great (big) toe will give you the same results as if the entire foot were tested.

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ems term #764-2: referred pain

pain that is felt in a body part removed from the point of origin of the pain.

ems assessment tip #775 - medical

inspect inside the mouth of the patient complaining of acute abdominal pain. if the oral mucosa is pale, it may be an indication that the patient has been bleeding over a long eriod of time.

ems terms #670

diabetic ketoacidosis (DKA)  hyperglycemia with low to absent insulin level, resulting in dehydration and a buildup of acid.

ems assessment tip #676 - medical

many people are unable to smell acetone: thus you may not be able smell the fruity odor on the DKA patient's breath.

ems assessment tip #698 - medical

medical: what appears to be a mild allergic reaction can progress to a severe, life-threatening anaphylactic reaction within minutes.

ems assessment tip #394 - trauma:

if the patient has lost a significant amount of blood, the arterial bleeding may not be spurting by the time tou reach the scene. the loss of blood volume will reduce the pressure to the point that it is no longer great enough to make the blood spurt, instead, the bleeding will be a steady flow.