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How does the body loose heat?
Conduction - direct physical touch
Radiation - to atmosphere or nerby objects without touching them
Evaporation - Perspiration or wet skin, when liquid evaportes
Respiration - exhalation of warm air and inhalation of cold air
Convection - lost to surrounding air, which becomes warmer, rises, and is replaced with cooler air.
Passive and Active Rewarming
Passive - Taking measures to prevent further heat loss and giving the body the chance to rewarm itself

Active - aggressively applying heat to warm the body. ex, blankets heat packs
Why are elderly Patients vulnerable to temperature extremes?
Cold - Less body fat, diminished metabolism, impaired recognition, diminished basal metabolism, poor contriction of blood vessels in the extremeties. 

Heat - take medications that increase risk of heat injury, may lack the mobility to escape a hot envirnment, poor ability to regulate body temp
How to treat unconscious patient with heat related problems?
Remove from hot envirnment and remove clothing. Airwyay (npa or opa). Suction. Breathing. Give oxygen. air conditioner.
Skin is cool, moist and pale (heat exhaustion) cool by applying cold and fan lightly
Skin is hot and dry or mosit (heat stroke) pour cool water, place cold backs in armpits, fan, if shivers slow down, prepare for seizures.
Transport Reasse
How to treat hypothermia?
1 prevent further heat loss
2 rewarm patient quickly and safely
3 stay alert for complications
Order of how to rescue a patient that is drowning
If responsive and close to sure: Reach, Throw, Row, Go strategy

1 remove from water. if spine injury, place in backboard before removing from water
2 If no spine injury, place on left side
3 suction
4 ventilation and bag valve
5 if pulseless do CPR and use AED
6 do not apply heimlich. may suffer from severe gastric distention where stomach has water
7 manage other medical or trauma conditions
8 transport
How to treat local cold injuries?
1 remove from cold envirnoment
2 never thaw if there is any dange of refreezing
3 breathing and oxygen
4 prevent furthur injury to injured part - remove wet clothes, cover skin.
Rewarm skin
1 warm water bath
2 monitor water so it stays same temp
3 stir and evenly distribute around frozen extremity
4 keep tissue in warm water until its soft and color and sensation return
5 dress with dry sterile dressing
6 elevate extremety
7 protect against refreezing
8 transport
heat cramps VS heat exhaustion Vs heat stroke
heat cramp - least serious, cramps worse when not enough salt is taken into body
heat exhaustion - skin is normal to cool, pale or gray, and sweaty
heat stroke -  life threatening, 20-80% mortality, Unresponsive, skin hot and red, moist or dry, stop sweating
How to treat suicidal patients per NM protocols?
1 Your safety
2 Asses for trauma or medical
3 Calm patient and stay with them
4 Restrain if needed
5 Transport
Acceptable methods of patient restraint
Use humane restraints. 4 rescuers at least for each limb. Secure to strecher in SUSPINE position with multiple straps.
Behavior Emergency
When a person exhibits ABNORMAL behavior, that is unacceptable or intolerable to the patient, family or community.
Organs of the Abdominal Cavity (10)
Stomach
Duodenum
Small intestine
Large intestine
Liver
Gallbladder
Spleen
Pancreas
Kidneys
Urinary Bladder
Referred Pain
Visceral pain (pain from the organ itself) that is felt elsewhere in the body.
Hernias
A protrusion or thrusting forward of a portion of the intestine through an opening or weakness in the abdominal wall.

Signs and symptoms: Sudden onsent of abdominal pain usually after heavy lifting or straining. Fever. Rapid pulse. Tender mass at point of hernia. Others similar to intestinal obstruction such as vomiting, costibation, abnormal bowl sounds, distention and tenderness
How to treat Abdominal Pain per NM protocols
1 Airway
2 Place in position of confort
3 Oxygen
4 NEVER GIVE ANYTHING BY MOUTH
5 Calm and reassure patient
6 If hypoperfusion, treat for shock
7 Transport
Gall Stones
Hard, pebble like deposits that form in gallbladder. Most common made of cholesteral. Also made of bilirubin.
Pancreatitis
Inflammation of the pancreas, may cause severe pain in the MUQ. May radiate to back. Caused by drinking alcohol, gallstones, or infections.

Signs and symptoms: Abdominal pain, nausea, vomitting, tenderness and distention, mild jaundice, severe pain, fever, rapid pulse, and signs of shock
What type of injuries to expect in diving emergencies
Possible spine injury, may be struck by a boat or other object. Decompression sickness possible.
Arterial Gas Embolism signs and symptoms
The blocking of blood vessels by ain air bubble or clusters of air bubbles during a water dive if the diver assends too rapdily

Itchy, blotchy, or mottled skin. Difficulty breathing. Dizzy. Chest pain. Pain in muscles, joints and tendons. Blurred vision, partial deafness, poor senses, nausea, vomiting, numb, paralysis, weakness on one side of body, lack of coordination, frothy blood in the nose and mouth, swelling of neck, loss of memory, coma, cardiac or respiratory arrest, behavioral changes.
Decompression Sickness signs and symptoms last for how long?
24 HOURS for Test

Type 1 Mild - onset upto 72 hours - feels like pulled muscle
Type 2 Serious - onset could be immediate but could take up to 12, 36, or 72 hours and may last for 12-48 hours.
Arterial gas embolism - apear withing 15 min
How to cut an umbilical cord per NM protocol
Place first clamp about 4 figer widths or 6 - 9 inches from the infant's abdoman. Then place 2nd clamp 2 - 3 inches after that.  Cut between the clamps. Chekck ends or cords for bleeding and place another clamp if any bleeds.
How to deliver oxygen to a premature baby
Blow-by oxygen 1 inch away with 5 lpm or bag-valve mask ventillation with rate of 40-60 a min.

Few will need chest compressions, fewer will need medications or incubators.
Meconium straining and the risks associated
Passing of a bowel movement in the amniotic fluid, causes clear fluid to turn greenish or brownish yellow.

Risk of infant it into infant's lungs and can cause infections and aspiration pheumonia. Use aggressive suction of the airway.
Signs of imminent delivery and your actions
Crowning. Contractions are 2 min apart or closer and are intesne lasting from 60 to 90 seconds. Patient feels the infant's head moving down the birth canal. Patient has strong urge to push. Patient's abdomen is very hard.

Contact medical direction. If no deliver in 10 min contact and see if you can transport.
To Deliver:
1 Position patient
2 Create sterile field
3 Monitor for vomitting
4 Asses for crowning
5 Place fingers on bony part of infants skull
6 Tear amniotic saf if not ruptured
7 Determine position of umbilical cord
8 Suction fluids from infants airway
9 As torso comes out support with both hands
10 Grasp Feet
11 Clean baby's mouth and nose
12 Dry, wrap, warm and position baby
13 Assign partner to moniter and complete initial care of baby
14 Clamp, tie and cut umbilical cord as pulsations cease
15 Observe for delivery o f placenta
16 Bag and transport delivered placenta
17 Place one or two sanity pads over vaginal opening
18 Record time of delivery and transport
A strong indicator of hypoperfusion in children is
Prolonged capillary refil, weak or absent pulse, rapid respiratory rate, pale cool clammy skin, motting, decreased mental status.

Also include diarrhea, dehydration, trauma, vomitting, blood loss, infection and abdominal injuries
Most common injury in children
Blunt Traum

Most common cause of a seizure in children
FEVER
Also caused by epilepsy, head injury, meningitis, oxygen deficiency, drug overdose, electrolyte abnormality, brain tumor and low blood surgar.
Cardiovascular changes that result from aging
Stenosis or narrowing of the valve opening which restrics blood flow to heart.
Cardiac hypertrophy, thickening of the heart walls which causes decrease in stroke volume of heart.
Dysrhythmias, irregular contractions of the myocardium
Arterioscloeris when the arteries harden. Arteries lose elasticisy.

Summay, again hart grows weaker, has to pump thru harder resistance
Tolerance of heat and cold in the elderly
Heat and cold sensors diminish.
***Belive they are less tolerant****
Temporary organ of pregranacy
PLACENTA: disk shaped inner lining of the uterus which the fetas exchanges nourishment and waste products during pregnancy
The Function of the Amnionic Sac
Bag of waters, fluid in which the infant floats, insulating, and protecting it. Helps to lubricate birth canal and remove any bacteria.
How to treat Delivery Emergencies
Medical direction and if possible treat as normal delivery

Emergencies: Any fetal presentation other than normal crowning, abnormal color or smell of amniotic fluid, labor before 38 weeks, recurrence of ctractions after first infanct is born which indicates multiple births

Manage with hands and by reposittioning mom.
Types of respiratory diseases that children can experience
Croup - infection
Epiglottitis - swelling of epiglottis
Asthma
Bronchiolitis - bronchioles in lungs become inflamed by viral infection
Pneumonia - bacterial infection in lungs
Shock
Congenital Heart Disease
Cardiac Arrest
Decompenstated respiratory failure - unable to maintain adequate breathing
Respiratory Arrest - when breathing starts to fail
Airway obstruction
Know about Child Abuse and how to treat it
Physical abuse and neglect.
Treatment:
Gaining entry, dealing with child, examing, dealing with caregivers, trasport, provide documentation.
How to deliver the placenta
When the placenta appers at the vagina, grasp it gently. Never pull. Slowly guide it and the attached membranes from the vagina. Place in plastic bag and transport it.
What is crowning?
When the infant's head appears at the opening of the birth canal
What to do if the amnionic sac is still in tact?
Tear the amnionic sac by using your fingers to rupture the sac, then push it away from the infants head
How to handle post delivery bleeding for the mother
Place sanitary pads over vaginal opening. Inspect the perineum, space under vagina, since it may be torn. If bleeding apply sterile dressings and direct pressure to control bleeding. Lower patients legs to hold down. elevate feet if needed.

Postpartum Hemorrhage: Loss of more than 500mL of Blood. Oxygen therapy, fundal masage, and immediate, transport
Know about SIDS and how to treat
"crib death" When autopsy fails to determine cause of death.

1 Try to resuscitat
2 Encourage the caregivers to talk and tell their story
3 Do not provide false assurances
4 Trasnport and deliver
Congestive heart failure in the geriatric patient
Heart becomes wakened by again, can cause hypertension, arteriorscloerotic disease, dysrhthmias, and heart valve damage.
Common causes of altered mental status in the elderly
Stroke
transient ischemic attack or mini stroke
seizure
syncope or fainting
hyperosmolar hyperglycemic nonketic syndrom
drug toxity
dementia - malfunctioning brain
delirium- more abrupt usualy goes away
alzheimer disease -
How to treat respiratory distress in children
Provide oxygen and transport. May need bag valve mask or other ventillation. May  have airway obstruction. Use suction if needed.
Skin tears in elderly
Skin becomes thinner and is much more prone to injury. Replacement cells are slower so wounds heal slowly. Touch sense is dilluted. Skin is normally dry and less elastic.
The diseases processes that obese people are most prone to
Coronay heart disease, type 2 diabetis, immobility, sleep apnea, and hypertension. depression, liver disease, stroke
How to treat patients with tracheostomy tubes
Used when necessary to open airway. Opening is called a stoma.

CPAP  and BiPap may be needed or used with negative or positive pressure. For ventallation conect to stoma.
Know the causes of mechanical ventilator failure
High Pressure Alarm - pressure to inflate lung is too high
Low Pressure alarm - tidal volume is too low
Apnea Alarm - when patient stops breathing
Low Fi02 - when oxygen source is empty or depleted
Stomach
Pouch that receives food from the esophagus. Enables digestion by secreting a fluid to aid in the breakdown and absoption of food.
Duodenum
The first part of the small intestine that connects to the stomach
Small intestine
To absob nutrients from the intestinal contents
Large intestine
Reabsorbs fluid from intestinal contents, enabling the excretion of solid waste from the body
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