Principles of ALS Care (AAOS)

378 Pages·2009·9.24 MB·English

by  Nicholle Brock

AAOS
Principles of
Author:
Nicholle Brock
Fire Fighter/Paramedic
MedicsPrep
Atlanta, Georgia

Contributing Author:
Brian J. Williams, BS, NREMT-P, CCEMT-P
EMS Chief
Pembina Ambulance
Pembina, North Dakota
Medical Editor:
Benjamin Gulli, MD
Northwest Orthopedic Surgeons
Minneapolis, Minnesota
6655881111__FFMM0000__PPrriinntteerr..iinndddd ii 1111//2244//0099 1100::0011::2211 AAMM
World Headquarters Editorial Credits
Jones and Bartlett Publishers Chief Education Offi cer: Mark W. Wieting
40 Tall Pine Drive Director, Department of Publications: Marilyn L. Fox, PhD
Sudbury, MA 01776 Managing Editor: Barbara A. Scotese
978-443-5000 Associate Senior Editor: Gayle Murray
[email protected] AAOS Board of Directors, 2009-2010
www.jbpub.com
Joseph D. Zuckerman, MD
Jones and Bartlett Publishers Canada President
6339 Ormindale Way John J. Callaghan, MD
Mississauga, Ontario L5V 1J2 First Vice President
Canada
Daniel J. Berry, MD
Jones and Bartlett Publishers International Second Vice President
Barb House, Barb Mews Frederick M. Azar, MD
London W6 7PA Treasurer
United Kingdom
Thomas C. Barber, MD
Jones and Bartlett’s books and products are available through most Richard J. Barry, MD
bookstores and online booksellers. To contact Jones and Bartlett Leesa M. Galatz, MD
Publishers directly, call 800-832-0034, fax [phone], or visit our M. Bradford Henley, MD, MBA
website, www.jbpub.com. Michael L. Parks, MD
E. Anthony Rankin, MD
Substantial discounts on bulk quantities of Jones and Bartlett’s William J. Robb, III, MD
publications are available to corporations, professional associations, Michael F. Schafer, MD
and other qualifi ed organizations. For details and specifi c discount David D. Teuscher, MD
information, contact the special sales department at Jones and Paul Tornetta III, MD
Bartlett via the above contact information or send an email to G. Zachary Wilhoit, MS, MBA
[email protected]. Karen L. Hackett, FACHE, CAE (E x-Offi cio )
Production Credits
C hief Executive Offi cer: Clayton Jones Associate Production Editor: Sarah Bayle
Chief Operating Offi cer: Don W. Jones, Jr. Director of Marketing: Alisha Weisman
President, Higher Education and Professional Director, Public Safety Group Sales—Matthew Maniscalco
Publishing: Robert W. Holland, Jr. Cover Design: Kristin E. Parker
V.P., Design and Production: Anne Spencer Interior Design: Anne Spencer
V.P., Manufacturing and Inventory Control: Therese Connell Senior Photo Researcher and
Publisher: Kimberly Brophy Photographer: Christine Myaskovsky
Acquisitions Editor—EMS: Christine Emerton Composition: diacritech
Managing Editor: Carol B. Guerrero Printing and Binding: Courier Companies
Associate Editor: Karen Greene Cover Printing: Courier Companies
Production Manager: Jenny L. Corriveau
Copyright © 2011 by Jones and Bartlett Publishers, LLC
All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical,
including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.
The procedures and protocols in this book are based on the most current recommendations of responsible medical sources. The American Academy
of Orthopaedic Surgeons and the publisher, however, make no guarantee as to, and assume no responsibility for, the correctness, suffi ciency, or
completeness of such information or recommendations. Other or additional safety measures may be required under particular circumstances.
Additional illustration and photographic credits appear on page 370, which constitutes a continuation of the copyright page.
Library of Congress Cataloging-in-Publication Data
Brock, Nicholle.
Principles of ALS care / Nicholle Brock ; contributing author, Brian J. Williams.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7637-6581-1 (pbk.)
ISBN-10: 0-7637-6581-3 (pbk.)
1. Emergency medicine. I. Williams, Brian J. (Brian Jeremy), 1976- II. American Academy of Orthopaedic Surgeons. III. Title.
[DNLM: 1. Emergencies. 2. Emergency Treatment—methods. 3. Wounds and Injuries—physiopathology. 4. Wounds and
Injuries—therapy. WB 105 V773p 2010]
RC86.7.V56 2010
616.02'5—dc22
2009014469
6048
Printed in the United States of America
13 12 11 10 09 10 9 8 7 6 5 4 3 2 1
6655881111__FFMM0000__PPrriinntteerr..iinndddd iiii 1111//2244//0099 1100::0011::2222 AAMM
Contents
SECTION 1 Preparatory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Chapter 1 The Cellular Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Chapter 2 Assessment and Documentation . . . . . . . . . . . . . . . . . . . . . . . . . .12
Chapter 3 Pharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
SECTION 2 Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Chapter 4 Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Chapter 5 Bleeding and Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Chapter 6 Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
SECTION 3 Medical Emergencies . . . . . . . . . . . . . . . . . . . . . . . . 97
Chapter 7 Airway Management and Respiratory Emergencies. . . . . . . . . 98
Chapter 8 Cardiovascular Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . .124
Chapter 9 Neurologic Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Chapter 10 Endocrine Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199
Chapter 11 Medical Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214
Chapter 12 Gastrointestinal Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . 230
Chapter 13 Toxicology: Poisoning and Substance Abuse . . . . . . . . . . . . . . .241
Chapter 14 Hematology and the Immune System . . . . . . . . . . . . . . . . . . . 252
Chapter 15 Environmental Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Chapter 16 Obstetric and Gynecologic Emergencies . . . . . . . . . . . . . . . . . 282
SECTION 4 Special Populations . . . . . . . . . . . . . . . . . . . . . . . . . 301
Chapter 17 Pediatric Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
Chapter 18 Geriatric Considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .351
Photo Credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370
iii
6655881111__FFMM0000__PPrriinntteerr..iinndddd iiiiii 1111//2244//0099 1100::0011::2222 AAMM
Acknowledgments
Jones and Bartlett Publishers would like to thank the following individuals for their review of
the manuscript:
Rick Barton, BS, CCEMT-P, NREMT-P David Brian Jones, MSN, ACNP, BC, EMT-P
Gundersen Lutheran Medical Center Macungie, Pennsylvania
La Crosse, Wisconsin
Daniel Kane, MEd, BSN, RN, CEN, CCRN,
Brandon R. Beck, AS, NREMT-P CFRN, EMT-P
Gadsden State Community College Massachusetts General Hospital—Institute
Gadsden, Alabama of Health Professions
Billerica, Massachusetts
J. R. Behan, MICT, CCEMT-P
Supervisor Judy Larsen, RN, EMT-P
Finney County Emergency Medical Service City of Brookfi eld Paramedic Training
Garden City, Kansas Center
Brookfi eld, Wisconsin
Mark Bird, RN, BSN, CCRN, EMT-P
Manatee Technical Institute Thomas T. Levins, BSN, RN, CCRN, CFRN
St. Petersburg, Florida University of Pennsylvania Health System
PennSTAR Flight
Bradley Dean, BBA, NREMT-P Blue Bell, Pennsylvania
Davidson County Emergency Services
Lexington, North Carolina Jim Mobley, RN, BSN, CEN, CFRN, NREMT-P, FP-C
Wake Forest University Baptist Medical Program Director, Regional One Air
Center—Trauma Department Medical Service
Winston-Salem, North Carolina Spartanburg, South Carolina
Randolph Community College
Asheboro, North Carolina Tina Nuckols, BSN, RN, CEN, CCEMT-P
Alamance Community College Aiken, South Carolina
Graham, North Carolina
Jeffrey Rockett, AA, AS, EMT-P
Robert M. Hawkes, MS, PA-C, NREMT-P Nature Coast EMS
Southern Maine Community College Inverness, Florida
South Portland, Maine
Joshua Tanner, FF/NREMT-P
Jeremy H. Huffman, AAS, EMT-P EMS Coordinator
Southwestern Community College ALERT Academy
Asheville, North Carolina Big Sandy, Texas
iv
6655881111__FFMM0000__PPrriinntteerr..iinndddd iivv 1111//2244//0099 1100::0011::2233 AAMM
Timothy Whitaker, NREMT-P, FP-C, CMTE Brian J. Williams, BS, NREMT-P, CCEMT-P
Allen Medical Center EMS Chief
Stark State College Pembina Ambulance
Oberlin, Ohio Pembina, North Dakota
The author would like to thank the following individuals for sharing their wisdom and
experience and helping to make this book a success:
James Augustine, MD James Potts, MD
Washington, District of Columbia Meharry Medical College
Nashville, Tennessee
Regina V. Clark, EdD
Kennesaw State University Brandy Slade, RN
Atlanta, Georgia Savannah, Georgia

Gwinnett Ladsen, MD
Meharry Medical College
Nashville, Tennessee
Acknowledgments v
6655881111__FFMM0000__PPrriinntteerr..iinndddd vv 1111//2244//0099 1100::0011::2244 AAMM
6655881111__FFMM0000__PPrriinntteerr..iinndddd vvii 1111//2244//0099 1100::0011::2244 AAMM
Preparatory
6655881111__CCHH0011__PPrriinntteerr..iinndddd 11 1111//2200//0099 1100::5599::2277 PPMM
SECTION 1
Preparatory
The Cellular
Environment
It is important to remember when treating your patients that at the cellular level you are
trying to aid the body in maintaining homeostasis (stability, equilibrium) or return it to a
homeostatic state. An understanding of basic cellular structure and function—as well as of
the cellular environment and how alterations in that environment can lead to disease—is
critical in restoring homeostasis.
The Cell
Cells are the basic structural and functional units of the human body. There are many
different types of cells, such as muscle cells, nerve cells, and blood cells. This basic unit of life
consists of protoplasm , a fl uid made up of many compounds, such as water, proteins, lipids,
ions, and amino acids. The protoplasm of a cell is composed of three vital parts:
(cid:129) A nucleus
(cid:129) Cytoplasm
(cid:129) The cell surface membrane
The parts of the cell are illustrated in F igure 1-1 and discussed in the next sections.
Components of the Cell
Nucleus
The nucleus controls all normal cell activities, such as growth and metabolism. It contains
the following:
(cid:129) Chromatin: Genetic material and chromosomes, which make up proteins
(cid:129) Nucleoli: Spherical structures that play a part in the building of ribonucleic
acid (RNA)
Cytoplasm
The protoplasm that surrounds the nucleus is called the cytoplasm . It plays a part in cell
division and forms the larger part of the human cell. It fi lls the cell, giving it shape, and
contains organelles . Organelles are specialized structures that perform specifi c functions. In
addition to the nucleus, the cell’s organelles include:
(cid:129) Centrioles
– Paired cylindrical structures located near the nucleus
– Job description: Play an important role in cell division
(cid:129) Endoplasmic reticulum (ER)
– Two forms: Rough ER and smooth ER. The surface of rough ER is coated with
ribosomes; the surface of smooth ER is not.
– Job description: Rough ER—building of proteins; smooth ER—building of lipids.
(cid:129) Golgi complex
– Membrane-bound, stacked structures located near the nucleus
– Job description: Packages and processes proteins and lipids (fats) synthesized by
the cell, synthesis (of substances such as phospholipids), packages materials for
transport (in vesicles), produces lysosomes
2
6655881111__CCHH0011__PPrriinntteerr..iinndddd 22 1111//2200//0099 1100::5599::5577 PPMM
Nuclear envelope
Centriole Lysosome Nucleolus
Nucleus
Chromatin
Mitochondrion Vacuole
Nuclear pore
Plasma
membrane
Ribosomes
Cytoplasm Golgi complex
Smooth Microfilaments
endoplasmic
reticulum Microtubule
Rough
endoplasmic
reticulum
Figure 1-1 The structure of a cell. The cell is divided into nuclear and cytoplasmic compartments. The
cytoplasm is packed with organelles, the specifi c structures in the cell that carry out a variety of
functions.
(cid:129) Lysosomes
– Vesicles containing digestive enzymes
– Job description: Destruction of damaged cells and degradation of bacteria
(cid:129) Mitochondria
– Small, rodlike structures
– Job description: Contain enzymes that form adenosine triphosphate (ATP), the
energy source of the body
(cid:129) Ribosomes
– Composed of ribosomal RNA and protein
– Often linked together in chains called polyribosomes or polysomes
– May be dispersed randomly throughout the cytoplasm or attached to the surface
of rough ER
– Job description: Create proteins
(cid:129) Vacuoles: Contain water and food substances
Cell Surface Membrane
The cell surface membrane, also called the plasma membrane, is a semipermeable membrane
that surrounds the cell and protects the components within the cytoplasm. It controls which
substances enter and leave the cell.
Structures of the cell membrane include the following:
(cid:129) Flagella and cilia
– Hairlike projections from some human cells
– Cilia are relatively short and numerous
– The fl agellum is relatively long and there is typically only one
– Job description: Varies depending on the type of cell. For example, cells of the tra-
chea contain cilia to move dust particles, and a sperm cell contains a fl agellum that
helps propel it in its search for the egg.
CHAPTER 1 The Cellular Environment 3
6655881111__CCHH0011__PPrriinntteerr..iinndddd 33 1111//2200//0099 1111::0000::0011 PPMM