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Airway and ventilatory support Oxygen (1) (2) Positioning (3) Suction (4) Assisted ventilation (5) Suction (6) Advanced airway devices b treatments for depression safe detrol 2mg. Pharmacological interventions (1) Rehydration (2) Bicarbonate (3) Potassium Insulin (4) medicine recall discount 4mg detrol visa. Transport considerations (1) Appropriate mode (2) Appropriate facility Thyrotoxicosis (thyroid storm) 1 symptoms vaginal yeast infection discount 4 mg detrol fast delivery. Excessive circulating level of thyroxine and triiodothyronine (1) Regulate metabolism (2) Regulate growth and development 3 treatment lichen sclerosis order 4 mg detrol with visa. Pharmacological interventions (1) Anti-thyroid drugs - in hospital management (2) Beta adrenergic receptor blockers d. Signs and symptoms (1) Edematous face (2) Periorbital edema (3) Mask-like effect (4) Impaired memory (5) Slowed speech (6) Decreased initiative (7) Somnolence (8) Cold intolerance (9) Dry, coarse skin (10) Muscle weakness and swelling (11) Constipation (12) Weight gain (13) Hair loss (14) Hoarseness 4. A spectrum of clinical abnormalities caused by an excess of corticosteroids, especially glucocorticoids 2. Adrenal steroids are reduced Glucocorticoids (1) (2) Mineralocorticoids (3) Androgens 2. Less common caused include hemorrhage, infarctions, fungal infections and acquired United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 12 Medical: 5 Endocrinology: 4 C. Skin hyperpigmentation (1) Areas exposed to the sun (2) Areas exposed to pressure points (3) Joints and creases. United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 2 Medical: 5 Allergies and Anaphylaxis: 5 2. Somatic pain (1) Appendicitis (2) Pancreatitis (3) Perforated viscus (a) Gallbladder (b) Ulcer (c) Intestine b. Visceral pain (1) Appendicitis (2) Pancreatitis Cholecystitis (3) (4) Obstruction of hollow viscera (a) Intestines (b) Biliary tree c. General impression (1) Trauma (a) Responsive (b) Unresponsive Medical (2) (a) Responsive (b) Unresponsive 2. Pathophysiology (1) Lesions (2) Peptic ulceration (3) Erosive gastritis (4) Esophagogastric varices 2. Physical (1) Altered level of consciousness (2) Skin (a) Pale (b) Cool (c) Moist (3) Inspect abdomen (a) Scars (b) Ecchymosis (c) Contour i) Bulges ii) Symmetry Auscultate (4) (a) Bowel sounds (5) Percuss (6) Palpate c. Pathophysiology (1) Lesions (2) Anal and rectal lesions (a) Hemorrhoids (b) Anal fissures Fistulas (c) (3) Colonic lesions (a) Carcinoma Polyps (b) (4) Diverticula 2. Physical (1) Altered level of consciousness (2) Skin (a) Pale (b) Cool (c) Moist Inspect abdomen (3) (a) Scars (b) Ecchymosis (c) Contour i) Bulges ii) Symmetry Auscultate (4) (5) Percuss (6) Palpate c. History (1) Quality of pain (2) Onset of pain (3) Location of pain Blood in the stool (4) (5) Epigastric pain (6) Nausea Vomiting (7) b. Physical (1) Restless (2) Skin Pale (a) (b) Cool (c) Moist Vital Signs (3) (a) Hypotension Abdominal Exam (4) (a) Inspect i) Contour Bulges a) b) Symmetry Auscultate (b) (c) Percuss (d) Palpate Management (1) Positioning (2) Airway and ventilatory support Oxygen (a) Circulatory support (3) (a) Fluid bolus (4) Pharmacological interventions Non-pharmacological interventions (5) Transport consideration (6) Epidemiology a. Anatomy and physiology review Pathophysiology (1) inflammatory bowel disease (2) inflammatory action of colonic mucosa 2. History (1) Quality of pain Onset of pain (2) (3) Location of pain (4) Bloody diarrhea (5) Fever (6) Weight loss b. Physical (1) Restless (2) Skin (a) Pale (b) Cool (c) Moist (d) Warm (3) Fever Vital signs (4) (a) Hypotension (5) Abdominal exam (a) Inspect i) Contour Bulges a) b) Symmetry (b) Auscultate (c) Percuss i) Dull over bladder (d) Palpate 3. Management Positioning (1) Airway and ventilatory support (2) (a) Oxygen Circulatory support (3) Fluid bolus (a) Pharmacological interventions (4) Non-pharmacological interventions (5) Transport consideration (6) Gastroenteritis 1. Populations in disaster areas, where water supplies are contaminated, are susceptible c. Signs and symptoms - nausea, vomiting, fever, abdominal pain and cramping, anorexia, lassitude, and frank shock a. Diarrhea of enteric bacteria - different clinical pictures depending on the degree of intestinal invasion b. Chronic gastritis and ulcers with abdominal pain, nausea, and "heartburn" are caused by infection 7.

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When a patient refuses medical care medicine game best 4mg detrol, the paramedic must show in the report the process undergone to come to that conclusion treatment quality assurance unit purchase genuine detrol on-line, including a oxygenating treatment purchase genuine detrol online. In unusual circumstances symptoms your period is coming purchase detrol 4mg with amex, comprehensive documentation has to wait until after mass casualties are triaged and transported 2. The paramedic should know and follow local procedures for documentation of mass casualty situations Document revision/ correction A. Note the purpose of the revision, and why the information did not appear on the original document 3. Written narrative is appropriate, on a new report form which is then attached to the original 2. An incomplete, inaccurate, or illegible report may cause subsequent care givers to provide inappropriate care to a patient B. United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 4 Patient Assessment: 3 Documentation: 6 C. A lawyer considering the merits of an impending lawsuit can be dissuaded from a case when the documentation is done correctly 2. The paramedic shall assume responsibility for self-assessment of all documentation B. P Peer advocacy of proper appreciation for the importance of good documentation 1. Complete and accurate history of incident will identify possibility for 95% of the injuries present 2. Ground transport (1) If appropriate facility can be reached within reasonable time (2) To a more accessible landing zone for air medical transport b. A body at rest or a body in motion will remain in that state until acted upon by an outside force b. When the car stops, the occupant continues to travel at 50 mph until some force acts on the occupant 2. Simply put, to accelerate a bullet from a the muzzle of a weapon requires the force from the explosion of the gunpowder; once the bullet is set in motion by this explosion, an equal amount of tissue destruction must occur inside the body to stop it as was used to start it 5. Temporary cavity (1) Short lived (2) Produced by stretching (3) Dependent on the elasticity of the object involved (4) Produces particle compression at the limits of the cavity c. Permanent cavity Visible when the energy exchange has been completed (1) (2) Produced by compression and destruction 2. At least one must be in motion United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 3 Trauma: 4 Trauma Systems and Mechanism of Injury: 1 3. Both can be in motion Dependent on number of particles involved in the interface of the interaction a. Density of the interacting bodies (1) Air density (few particles) (a) Lung (b) Intestinal tract (2) Water density (more particles) Vascular system (a) (b) Liver Spleen (c) (d) Muscle Solid density (thick particles) (3) (a) Bone (b) Asphalt (c) Steel b. Area on interaction (1) Shape of object (2) Position of object (3) Fragmentation of object Types on trauma based on ingress 1. Down and under (1) Feet impact floor pan (2) Knees impact dash (a) Tibia impact i) Knee dislocation ii) Popliteal artery disruption iii) Knee support disruption United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 4 Trauma: 4 Trauma Systems and Mechanism of Injury: 1 C. Femur impact i) Femur fracture ii) Acetabular posterior fracture dislocation (3) Torso rotates (a) Steering column (b) Dash (c) Windshield b. Up and over (1) Head impact Windshield (a) (b) Roof (c) Mirror (2) Chest impact (a) Steering column (b) Dash (3) Abdominal impact (a) Steering column (b) Dash 2. Vehicle moves into and impacts body (1) Chest (2) Pelvis (3) Body moves laterally (a) Neck i) Rotates ii) Lateral flexion iii) Combination 3. Vehicle seat pushes body All body parts in contact with seat move (1) (2) Body parts not in contact dragged along with torso b. Change in velocity (1) Acceleration (a) Shear Avulsion (b) (b) United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 5 Trauma: 4 Trauma Systems and Mechanism of Injury: 1 2. Deceleration (a) Shear (b) Avulsion Organ collisions with different vehicular collisions a. Frontal impacts (1) Head (a) Compression Skull fractures i) ii) Cerebral contusion Deceleration (b) i) Opposite end separation ii) Hemorrhage iii) Brain stem stretch (2) Neck (a) Compression i) Vertebral body a) Compression fracture b) Hyperextension injury Posterior element compression Anterior body separation c) Hyperflexion injury Anterior body compression Posterior element separation Shear (b) i) Not significant (3) Thorax (a) Chest wall i) Compression a) Fracture rib(s) - producing single rib fractures, flail chest, and/or pneumothorax ii) Shear a) Fracture thoracic spine (b) Heart i) Compression a) Contusion b) Rupture ii) Shear a) Not significant Aorta (c) i) Compression a) Not significant ii) Shear a) Junction arch and descending portions b) Aortic origin at the aortic valve (2) United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 6 Trauma: 4 Trauma Systems and Mechanism of Injury: 1 c) (d) Lung i) A t the diaphragm ii) (4) Compression a) Pneumothorax b) Rib fracture and penetration Shear a) Not significant b. Abdomen (a) Abdominal cavity i) Diaphragm a) Compression tears Shear - not significant b) ii) Abdominal wall a) Compression tears b) Shear - not significant Liver (b) i) Compression a) Burst type injuries ii) Shear a) Tears from Ligamentum Teres b) Avulsion of liver from inferior vena cava at the hepatic veins Spleen (c) i) Compression a) Burst Shear ii) a) Avulsion of pedicle (d) Gastrointestines i) Compression a) Rupture ii) Shear a) Avulsion of mesenteric vessels from aorta or vena cava b) Tears along mesenteric vessels c) Avulsion of vessels from intestine Gall bladder (e) i) Compression a) Rupture Shear ii) a) Avulsion from liver b) Avulsion of cystic duct Lateral impacts (1) Head (a) Compression i) Similar to frontal except lateral head and on the United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 7 Trauma: 4 Trauma Systems and Mechanism of Injury: 1 side of the impact to the vehicle (b) Shear i) Shear of brain and vessels opposite side of the impact (2) (3) Cervical spine (a) Compression i) Minimal unless head hits the top of the passenger compartment or the support for the windows (b) Shear i) Two fold mechanism ii) Rotation a) Center of gravity of the head is anterior to the pivot point of the head and the spine at the odontoid process; as lateral impact occurs the torso and then the Cspine is pushed under the head; the head rotates in relative position to the body, toward the impact b) the center of gravity of the head is also cephalad to the point of support at the cervical spine; as the lateral forces push the torso away from the point of impact the motion of the head produces lateral flexion of the head c) the combination of these two forces is lateral flexion of the neck opening the facets opposite the side of impact and rotation of the vertebral bodies in relation to each other; the result is jumped facets and if the force is great enough significant torsion of the spinal cord Thorax Compression (a) i) Impact of the door into the thorax a) Lateral ribs - fractures and flail chest b) Lung - pneumothorax c) Spleen or liver - lacerations and hemorrhage (b) Shear i) Lateral motion of the thoracic spine as the torso is pushed away from the impact ii) Thoracic aorta moves with the spine iii) Arch and heart do not move until traction on the arch United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 8 Trauma: 4 Trauma Systems and Mechanism of Injury: 1 iv) Shear forces tear the aorta at the junction of the movable arch and the descending aorta that is attached to the thoracic spine (4) c.