Primary Assessment Study Guide for the EMT Test

Page 7

Chief Complaint and Life Threats: Part 4

Medical Emergencies

Paramedics and EMTs usually respond to either medical emergencies or traumas. It’s helpful to understand the difference between the two. Medical emergencies occur due to an illness, such as pneumonia, and diseases, such as heart disease. An example of a medical emergency is an asthma attack or stroke. A trauma is an injury due to force exerted on the body. An example of trauma is a broken leg due to a car accident.

Assessing a medical emergency is different from assessing a trauma patient. The main focus in a medical assessment is the patient’s symptoms and nature of their illness.

There are many types of medical emergencies, and they can be categorized according to what body system they affect. It is important to know the details of each type of emergency, including typical causes, common symptoms, and difficulty of management.

Infectious Diseases

Patients with an infectious disease require special considerations to protect themselves and other people. Understanding the route of transmission and the necessary precautions is an essential part of managing patients with infectious conditions.

Neurologic Emergencies

A neurological emergency involves a condition related to the brain. Some neurological conditions may be life-threatening. Neurological emergencies can occur in both children and adults, but are more common in adults.

Neurological Anatomy and Physiology

The brain is divided into different segments, including the cerebrum, cerebellum, and the brainstem. Each segment controls various functions. Sight, swallowing, speech, movement, and even breathing are controlled by other areas of the brain. The brain also involves a complex network of nerves that carry messages from the brain to various parts of the body.

Neurological Pathophysiology

There are several neurological considerations that range from mild to life-threatening. Neurological emergencies can cause many different symptoms, depending on which part of the brain is affected. Quick recognition of serious neurological emergencies is essential to improve patient outcomes.

Headache

Headaches are a very common neurological condition. Headaches are usually not a sign of a serious condition, but they do sometimes indicate something significant, such as meningitis or a stroke. Pain from a headache is not generated in the brain, since the brain does not have pain receptors. The pain is felt from nearby areas, including the blood vessels, meninges, and scalp.

Stroke

A stroke is a serious medical emergency that can lead to death or permanent brain damage. A stroke occurs due to an interruption of blood flow to the brain, typically because of a clot. When blood flow is interrupted, brain cells can die and temporary or permanent damage can occur. Symptoms include slurred speech, headache, and confusion. Other conditions can mimic a stroke, including hypoglycemia and a postictal state, which occurs after a seizure.

Seizures

A seizure is a misfiring of electrical activity in the brain. It’s often characterized by rigid muscles and uncontrolled muscle activity. In some cases, a loss of consciousness may also develop. Epilepsy is one of the most frequent causes of seizures. Other causes of seizures can include brain tumors, drugs, and injury to the brain from trauma. Airway management is a crucial consideration for patients experiencing a seizure.

Altered Mental Status

Altered mental status involves a patient not thinking clearly. Many conditions can cause altered mental status, including strokes, seizures, alcohol and drug use, brain injury, hyperglycemia, and brain infection. Since various causes of altered mental status are treated differently, it is essential to continue an assessment to determine the probable cause of an altered level of consciousness (ALOC).

Gastrointestinal and Urologic Emergencies

Gastrointestinal and urologic emergencies can involve the stomach, intestines, bladder, gallbladder, and other organs. Since a wide variety of emergencies may occur, narrowing down the problem as soon as possible is critical for appropriate treatment.

Pathophysiology of the Gastrointestinal System

Several conditions can affect the gastrointestinal system, including peritonitis. Peritonitis occurs when any material, such as blood or pus, irritates the peritoneum. An acute abdomen may also be something an EMT frequently encounters. An acute abdomen is a sudden onset of abdominal pain, and it can occur due to many conditions, including appendicitis, gastroenteritis, and diverticulitis.

Endocrine Emergencies

Endocrine emergencies occur when hormone levels in the body become dangerously high or low, disrupting normal bodily function. Conditions such as diabetic emergencies, adrenal crisis, and thyroid storms are the most common seen by EMTs and can rapidly affect metabolism, blood sugar, and vital organ function. Prompt recognition and treatment of these types of emergencies is crucial to prevent serious complications and even death.

Endocrine Anatomy and Physiology

The endocrine system controls several functions. The endocrine system includes various glands, including the pancreas, thyroid, and adrenal glands, that secrete hormones affecting the cells of organs in the body. The endocrine glands may produce too much or too little of a hormone. One of the functions of the endocrine system is to produce adequate amounts of insulin so glucose can enter the cells and provide energy.

Endocrine Pathophysiology

One of the main conditions associated with the endocrine system is diabetes. Diabetes involves impaired glucose metabolism. Glucose production may be impaired or insulin cannot bind to the receptor cells, which prevents glucose from getting into the cell. Diabetes can cause life-threatening symptoms and coma. It can also lead to severe complications, including blindness and kidney disease.

Assessment for Diabetes

Start by making sure the scene is safe. Be aware of needles used for insulin injection, which may be on scene. Breathing can be impaired due to diabetic emergencies and should be assessed immediately during a primary assessment. The patient’s level of consciousness should also be assessed.

Hypoglycemia

Hypoglycemia is low blood glucose. Recognizing hypoglycemia as soon as possible allows for rapid treatment and can be lifesaving. Signs of hypoglycemia include shakiness, blurred vision, confusion, rapid heart rate, and sweating. Seizures, ALOC, and lack of consciousness are additional symptoms when blood glucose levels get extremely low; however, it is important to understand that seizures and an ALOC can have many causes besides hypoglycemia. Getting a history and checking blood sugar levels is a critical part of hypoglycemic care.

Hematologic Emergencies

Hematological emergencies involve treating individuals with various blood disorders, including sickle cell anemia, hemophilia, and thrombophilia. Patients with sickle cell anemia can develop hypoxia, organ damage, and pain crises. Patients with hemophilia have problems with blood clotting and can develop life-threatening internal or external bleeding, even from minor injuries. People who have thrombophilia develop blood clots easily, which can block blood flow to vital organs.

Assessment for Hematological Disorders

When treating a hematological emergency and assessing scene safety, be sure to check for the presence of blood at the scene and use standard contact precautions in addition to eye protection. During the primary assessment, determine the patient’s level of consciousness and if his/her airway is compromised. A history can provide vital information, such as hematological conditions of the patient.

Here are some terms to know:

  • acidosis—a condition in which the blood becomes too acidic; pH drops below 7.35

  • hematology—a branch of medicine and biology that focuses on the study of blood, blood-forming tissues, and blood disorders

  • hemophilia—a genetic disorder in which a person’s blood does not clot properly due to a deficiency of clotting factors

  • thrombophilia—a condition in which a person has an increased tendency to form abnormal blood clots in the veins or arteries

  • sickle cell anemia—genetic blood disorder in which red blood cells become abnormally shaped (crescent), making them less flexible and more prone to blocking blood flow

Immunologic Emergencies

An immunological emergency involves an allergic reaction. Allergic reactions can range from very mild to severe. Since the airway can become blocked, quickly recognizing potential airway compromise is critical.

Anatomy and Physiology

The immune system consists of the lymph nodes, lymph vessels, spleen, and bone marrow. Together, the tissue, cells, and organs of the immune system help the body fight infection. The spleen helps kill bacteria, and the bone marrow produces red and white blood cells, which fight disease. The lymph nodes and vessels trap bacteria in the fluid, which can then be removed by lymphocytes.

Pathophysiology

The immunological emergency that an EMT will treat is an allergic reaction. An allergic reaction occurs when the body responds to a normally harmless substance as if it were dangerous. The immune system overreacts and releases chemicals, including histamine. Histamine triggers allergy symptoms, including sneezing, watery eyes, and hives. The most serious complication of an allergic reaction is anaphylaxis, which involves multiple organs, including the respiratory system.

Allergens

The most common allergens fall into these categories: food, medications, plants, chemicals, and insects. Typical food allergens include peanuts, milk, and shellfish. Penicillin is a common drug allergen. Molds, pollen, ragweed, and oak are common plant allergens. Latex is one of the most common chemical allergens. Bees and wasp bites can also cause severe allergic reactions.

Patient Assessment in Immunologic Emergencies

The airway can become blocked in an immunological emergency. A primary assessment should immediately evaluate airway patency and respiratory status. Getting a history to determine if the patient has noted allergies is critical. The secondary survey should include a quick assessment of vital signs and breath sounds, as well as an oxygen level. Respiratory status can change quickly during an immunological emergency, so reassessment should focus on airway patency, respiratory rate, and level of consciousness.

Poisoning

EMTs and paramedics may encounter patients who have been exposed to, or ingested, a poison. Recognizing the fact that the patient has either been exposed to a toxin or has been poisoned is the first step in treating the problem. Since people who have been poisoned may develop symptoms that also occur in various medical illnesses, it’s essential to assess the patient thoroughly.

Type of Poisons

Poisons and toxins can enter the body in different ways. There are many types of poisons and toxins, including gases, liquids, and solids. Poisons can also enter the body in other ways. For example, poison can be ingested, absorbed, injected, and inhaled. The most frequent route of poisoning is through ingestion.

Specific Poisons

Although they are not thought of as poisons, alcohol and drugs can act as poisons to the body, leading to adverse effects. Opioids and synthetic street drugs can decrease the respiratory system function and lead to respiratory and cardiac arrest. Inhaled chemicals, used to get “high,” such as those contained in paint thinners and cleaning products, are also considered poisonous and can cause cardiac complications.

Food Poisoning

Food poisoning is a common condition you may encounter on the job. Symptoms may include vomiting, stomach cramps, diarrhea, and fever. There are numerous types of bacteria that can cause food poisoning, including Staphylococcus, Escherichia coli, and Salmonella. Symptoms may start anywhere from 2 to 12 hours after eating the contaminated food.

Plant Poisoning

Plant poisoning can occur, especially in children. Many types of household plants are poisonous if they are eaten, and young children often put things in their mouths. Plant poisoning can cause a variety of symptoms, from a skin rash to life-threatening respiratory and circulatory conditions. If possible, try to determine what type of plant the patient may have ingested in order to inform the hospital staff.

Here are some terms to know:

  • Safety Data Sheet—a document that provides detailed information about a hazardous chemical

  • antidote—substance that can counteract or neutralize the effects of a poison or toxic substance

  • hematemesis—vomiting blood

  • toxin—poisonous substance that can cause harm to the body when inhaled, ingested, absorbed through the skin, or injected

  • poison—any substance that can cause harm to the body when swallowed, inhaled, injected, or absorbed, by interfering with normal bodily functions

Assessing the Patient

Assess the scene for safety and make sure toxic substances do not present any danger to you or other personnel. Poisonings can lead to life-threatening situations, so your primary assessment should focus on airway, breathing, and circulation. Taking a history is vital to determine when the poisoning occurred and to rule out other problems. A secondary assessment should include vital signs and a rapid exam to check for non-life-threatening signs of poisoning. Depending on the type of poison, a patient’s condition can change quickly. Reassessment should be ongoing.

Psychiatric Emergencies

Psychiatric emergencies can include life-threatening situations, including suicide attempts. Extreme emotional and behavioral crises can also develop, requiring medical assistance. During your primary assessment, explain everything you will do to avoid agitating the patient.

Mental Illness vs. Emotional Crisis

A mental illness is a condition that affects a person’s thinking, behavior, and mood. Examples of mental illnesses include bipolar disorder and depression. An emotional crisis can involve an intense emotional reaction. The individual may or may not have an underlying mental illness. Both conditions may interfere with a person’s ability to function normally.

Behavioral Crisis

A behavioral crisis involves a person’s reaction to a situation or event. The reaction is so intense that it affects the person’s ability to function normally. A person having a behavioral crisis may exhibit aggression and agitation and may be uncooperative. In some situations, behavior can become bizarre, and they may be a threat to themselves or others.

Acute Psychosis

Acute psychosis is characterized by delusional behavior. A person who has acute psychosis is out of touch with reality. They may see or hear things that are not real. There are different causes of acute psychosis, including drug use, mental illness, such as schizophrenia, and extreme stress.

Excited Delirium

Excited delirium is characterized by impaired cognitive function. Some people may have hallucinations and be disoriented. Since the patient may experience hallucinations, they may become paranoid, which can create a potentially unsafe situation. Physical symptoms may include sweating, increased heart rate, and dilated pupils.

Suicide

Suicide is a possibility when an EMT encounters a person who is having an emotional crisis. If the patient threatens suicide, take it seriously. Signs a person may be suicidal include being tearful and expressing signs of hopelessness. A flat affect and an inability to make eye contact are also signs that the person is experiencing despair. Calmly approach the patient and call law enforcement for backup.

PTSD

Post-traumatic stress disorder (PTSD) can develop after experiencing an extremely stressful situation or event, such as a car accident, assault, or natural disaster. People with PTSD may be unpredictable and can become angry quickly. Signs of PTSD include anxiety, fear, and an exaggerated startle response. When dealing with a patient with PTSD, always explain everything you are going to do in advance. Do not touch the patient without permission and maintain a calm, reassuring manner.

Pathophysiology

Two classifications may be used to describe behavioral crises or psychiatric emergencies: organic and functional. Organic psychiatric conditions have a physical cause. They occur due to a disturbance of brain tissue. A functional disorder occurs when there is a disturbance in a person’s functioning, but a physical cause cannot be identified.

Safe Approach

People who are experiencing a psychiatric emergency can be unpredictable. Using an approach that helps the patient feel safe and not threatened is vital. Start by identifying yourself and being direct. Use precise language and keep a safe distance. Be honest and reassuring to create a calm atmosphere. Do not argue with the patient or take any action that could escalate the situation.

Gynecologic Emergencies

A woman’s anatomy and physiology are complex, and gynecological emergencies can occur in women of all age groups. Disorders that affect the ovaries, fallopian tubes, and uterus can lead to emergencies. During your primary assessment, determine if blood loss has made the patient unstable.

Gynecologic Anatomy and Physiology

The female genitals include the external structures including the labia majora and labia minora. The labia can be injured easily because it is very vascular. Internal structures include the ovaries, uterus, and fallopian tubes. In women of childbearing age, the ovaries release an egg each month in a process called ovulation. The egg travels down the fallopian tubes, where it is available for fertilization. If an egg is fertilized, it is implanted into the wall of the lining of the uterus.

Gynecologic Pathophysiology

There are a number of gynecological conditions that can become emergencies, such as trauma and infections. Common conditions that an EMT might encounter include pelvic inflammatory disease, sexually transmitted diseases, and abnormal vaginal bleeding.

Pregnancy

Pregnancy is the period during which a developing fetus grows inside the uterus, typically lasting about 40 weeks from the mother’s last menstrual period. Throughout pregnancy, a woman’s body undergoes significant physical and hormonal changes to support fetal growth and prepare for childbirth. For EMTs, recognizing normal pregnancy changes and identifying early signs of complications is essential for ensuring the safety of both the mother and the fetus.

Female Reproductive Anatomy and Physiology

Learning the gynecological anatomy discussed in the previous section is helpful to understand the female reproductive system. In women of childbearing age, an egg is released from the ovary and travels down the fallopian tube. If the egg is fertilized, it travels to the uterus where implantation occurs. The fertilized egg develops into an embryo, which continues to grow. The placenta also develops and provides the growing fetus with nutrients and oxygen. The umbilical cord attaches to the fetus and the placenta. The fetus is surrounded by an amniotic sac, which contains fluid to cushion the fetus.

Normal Pregnancy

A normal pregnancy lasts about 40 weeks, but a baby is considered full-term at 39 weeks gestation. Pregnancy is also divided into three equal trimesters. During a normal pregnancy, several changes take place in a woman’s body, including an increase in blood volume. In addition, other changes are common, such as weight gain, slowed digestion, and loose joints due to pregnancy hormones.

Pregnancy Complications

Pregnancy complications can range from minor to life-threatening for both the woman and baby. These can include gestational diabetes, which is diabetes that develops during pregnancy. Uterine bleeding can also occur, for a variety of reasons, including problems with the placenta. Preeclampsia is another pregnancy complication that involves increased blood pressure.

Trauma During Pregnancy

Trauma in pregnancy can cause injuries to both the woman and the baby. Due to the increased blood volume, women may be prone to excess bleeding after sustaining an injury. Special consideration should be given to trauma in the abdominal area. If a woman sustained trauma to the abdomen, vaginal bleeding and abdominal pain may be common complaints. Also, keep in mind that motor vehicle accidents can result in injuries from seat belts worn improperly, so careful assessment is vital when caring for a pregnant woman who has been involved in a car accident.

Cultural Values

Cultural differences affect how a woman deals with pregnancy, and it is important for EMTs and paramedics to respect these differences. For example, in some cultures, women do not want male healthcare providers to treat them. In this situation, if possible, have a female EMT treat the patient.

Pregnant Teens

Although every pregnancy is different, teens may have certain pregnancy complications, such as higher rates of low birth weight. When treating a teen who is pregnant, try to have a parent present. It is also important to be aware of the laws in your state regarding a pregnant teen’s ability to refuse care for themselves. In many states, pregnant teens have the same rights as adults when it comes to medical care.

Obstetrics and Neonatal Care

Obstetrics and neonatal care involve taking care of women before, during, and after pregnancy and giving birth. It’s important to understand that many conditions can affect both the woman and the baby. During a primary assessment, determine if the patient is in active labor. Assess for potentially serious problems, such as breathing difficulties or bleeding.

Head and Spine Injuries

An EMS worker needs to know all of the standards for identification, management, and care of a patient with head and spine injuries. This patient population will benefit from an EMT who is well-versed about the potential impacts from injury to the nervous system, skull, and spinal column.

In the case of a spine injury, special attention should be given to possible compromise of the airway or circulation and the assessment of motor and sensory function, before and after stabilization. Assess the spine for open wounds or lacerations prior to the use of splints, cervical collars, or backboards.

Anatomy and Physiology

The nervous system is the master link to every bodily function. It is made up of two parts: the central and peripheral nervous systems. The skull has two major structures, containing 18 major bones. There are five sections and 33 bones in the spinal column.

  • nervous system—The nervous system’s two parts each have a subset of networks and functions. These systems control all of the body’s movements, whether they are voluntary (such as lifting the arm) or involuntary (such as breathing).

  • skeletal system—The skeletal system is made up of the skull and spinal column. The brain is very well protected and housed in the skull. The skull has two parts: the cranium and the facial bones. The spinal column protects the spinal cord and functions to keep the body aligned and postured to support upright structure and muscles.

Here are some terms to know:

  • parts and functions of the skull, brain, nervous, and skeletal systems—The skull is made up of the cranium, facial bones, and foramen magnum. Its purpose is to protect the brain and support the structures of the face.

The brain is made up of the cerebrum, cerebellum, and brainstem. Its function is to be the control center for the entire body.

The nervous system is composed of the central and peripheral nervous systems, which in turn are divided into the somatic and autonomic systems. The autonomic nervous system is divided into two main systems: the sympathetic and parasympathetic nervous systems. The function of the nervous system is to send and receive messages to control all body functions.

  • meninges—protective layers of tissue that surround and cushion the brain and spinal cord

  • voluntary (somatic) and involuntary (autonomic) activities—functional divisions of the nervous system; somatic controls voluntary skeletal muscle movement, and autonomic controls involuntary organ and other vital functions

  • intervertebral discs—cushion-like pads located between the bones of the spine

Head Injuries

The head is made up of the scalp, skull, and brain. An injury to the head could impact any of these structures. The two basic types of injuries to the head are closed and open. These injuries may be minor (such as a superficial scalp abrasion or bump) or something more serious (such as a laceration, hematoma, concussion, contusion, skull fracture, or brain injury).

  • scalp—An injury to the scalp can be minor or severe. Similar to facial tissue, the scalp tissue has an abundant blood supply and a laceration may present with a significant amount of blood. A not-so-obvious direct impact to the head may complicate the MOI of scalp injuries. The presence of hematomas and bruising may be an indication of more serious injuries.

  • skull—When the skull is injured, a closed or open fracture may be apparent. Types of skull fractures are linear, depressed, basilar, and open. The signs and symptoms may include pain, bruising under the eye or above the ear, or fluid drainage from the nose or ears.

  • traumatic brain injuries—Traumatic brain injuries (TBIs) are the result of an external force that makes a significant impact on the head, resulting in a dysfunction of the brain. There is a broad spectrum of symptoms related to this type of injury, where dysfunction is observed on a cognitive, emotional, and physical level.

  • intracranial pressure—The level of pressure inside the skull is referred to as intracranial pressure. Increased pressure can be caused by blood that pools in the skull or by the brain swelling after trauma to the head. Symptoms of this condition are numerous, and treatment becomes more critical as the pressure increases.

  • concussion—A direct impact to the head or face that causes the brain to shake inside the skull is referred to as a concussion. This type of trauma typically causes the person to have temporary, short-term amnesia and decreased or arrested brain function. It may also include a variety of temporary symptoms, including dizziness, visual changes, vomiting, headache, reduced motor function, slurred speech, apneic episodes, and, in some cases, loss of consciousness, with no apparent brain damage.

  • contusion—The direct impact to the head, which causes brain tissue bruising, bleeding, and/or swelling is referred to as a contusion. This type of trauma is very serious and can cause permanent brain tissue damage because the impact can cause structural injury to the brain. Symptoms are similar and mostly equivalent to those of a patient who has experienced a brain injury.

  • other brain injuries—A number of medical conditions, such as blood clots or hemorrhage, may cause brain injuries. These can be referred to as non-traumatic injuries. The symptoms apparent with these conditions are similar to traumatic brain injuries, but are without an obvious MOI or external evidence of trauma.

Helmet Removal

Helmets are worn for various contact sports and during the riding of recreational vehicles such as three-wheelers, bicycles, motorcycles, and skateboards. If a patient is wearing a helmet at the scene of an emergency, precautions must be taken to avoid complicating the injury and to prevent further damage. Always begin by checking the airway, assessing breathing, and determining central nervous system (CNS) status. The preferred method for helmet removal requires two people, one at the head and one at the shoulder and carefully following the recommended steps. There is an alternative method that the EMT should be aware of for the removal of football and other helmets with face masks, guards, and pads. This alternative method takes a bit longer and requires the removal of straps and screws that secure the pads.

Here is a concept to know:

  • general principles designed to protect and maintain CNS function—Ensure adequate oxygenation, maintain adequate perfusion, prevent further injury to the brain or spine, monitor level of consciousness and neurological status, rapidly recognize and treat CNS emergencies, and minimize secondary injury.
Circulation

When the patient’s airway has been examined and necessary treatment has been provided, circulatory status should be assessed. Circulation assessment is done by feeling for pulses to determine if they are weak, thready, strong, or abnormally fast or slow. The pulse status will help indicate the degree and type of injury.

Here are some terms to know:

  • racoon eyes—dark bruising and discoloration around the eyes that can indicate bleeding under the skin, often caused by basilar skull fracture

  • battle sign—bruising behind the ear, over the mastoid process, indicates a possible basilar skull fracture

  • types of skull fractures—

    • linear—simple crack in the skull without bone displacement

    • depressed—part of the skull is sunken inward toward the brain

    • basilar—a break in the base of the skull

    • open (compound)—the skull is fractured and there is a break in the skin exposing brain tissue or bone

    • closed—the skull is fractured, but the scalp is intact

  • signs and symptoms of increased ICP—These are an altered level of consciousness, headache, nausea and vomiting, Cushing’s triad, pupillary changes, seizures, posturing, and visual disturbances.

  • cerebral edema—This is swelling of the brain tissue caused by the accumulation of fluid.

  • intracranial and subarachnoid hemorrhage—Intracranial hemorrhage is considered to be any bleeding within the brain tissue itself. Subarachnoid hemorrhage indicates bleeding into the space between the brain and the thin tissue covering it (the subarachnoid space).

  • intracerebral, subdural, and epidural hematoma—Intracranial hematoma indicates bleeding within the brain; it is categorized by where specifically within the brain the bleeding is located. Intracerebral indicates it is within the brain tissue. Subdural is between the dura mater and the brain surface. Epidural is between the skull and the dura mater.

  • retrograde and anterograde amnesia—retrograde: loss of memory for events occurring before a traumatic event or injury. Anterograde: inability to form new memories after a traumatic event or injury.

  • signs and symptoms of head and spine injury—altered level of consciousness, headache, nausea and vomiting, bleeding or CSF leakage, pupillary changes, bruising, seizures, posturing, neurological deficits

Spine Injuries

Spinal injuries are multifaceted due to the degree of anatomy and physiology involved with the area. Injuries may include the spinal cord, nerves, discs, ligaments, joints, muscles, or vertebrae. Common complaints include pain and tenderness, as well as loss of muscle control, feeling, or sensation.

Immobilization

Placing all patients with suspected spinal injuries on a long backboard and applying a cervical collar has been standard practice in the past. New and best practice information indicates that these devices must be used according to the patient presentation and assessment. In some cases, their use can cause additional or increased trauma. In some jurisdictions, the EMT is able to use criteria to determine that a backboard or cervical collar is not needed. Other options for immobilization devices include a full-body vacuum mattress and a short board vest.

Here are some concepts to know:

  • axial loading injuries—when force is applied along the long axis of the spine (a fall onto the head, feet, or buttocks; vertical compression)

  • c-spine clearance—The process of determining whether a patient has a cervical spine injury and whether spinal immobilization can be safely removed.

  • time for application of the cervical collar—A cervical collar should be applied as soon as a cervical spine injury is suspected, before any movement of the patient’s head or neck. This is done to prevent further injury.

Genitourinary Injuries

The GU system is made up of both hollow and solid organs. The risk for injury to these areas and their functions is possible through blunt or penetrating trauma. These injuries can often be more extensive, as the kidneys and bladder are contained behind other organs. The genitourinary system and potential injury types differ for men and women, based on external and internal genitalia. Special attention should be given to gender differences and compound impacts, since this system lies beneath other major organs.

Here are some terms to know:

  • parts of male and female GU, genitalia, and reproductive systems—

    • male—penis, scrotum, testes, epididymis, vas deferens, seminal vesicles and prostate gland, urethra

    • female—mons pubis, labia majora and minora, clitoris, urethra, urethral opening, vaginal opening, vagina, perineum, uterus, cervix, fallopian tubes, ovaries

  • potential injuries to these body parts—Injuries can be caused by blunt trauma (straddle injuries, motor vehicle crashes, assaults, falls), penetrating trauma (gunshots, stabbings, impaled objects), sexual assault/genital trauma, and obstetric emergencies.

Genitourinary Anatomy

The GU system is housed behind the digestive tract. It operates the reproductive system and system waste products. The system consists of the kidneys, urinary bladder, ureters, and urethra. This system has control over some of the body’s waste. The kidneys, which are solid organs, filter waste through the blood and are located in the abdominal cavity.

  • The urinary parts of the GU system include the:

    • kidneys—organs that filter blood to remove waste and regulate blood pressure
    • ureters—tubes that carry urine from the kidneys to the bladder
    • bladder—a muscular sac that stores urine until excretion
    • urethra—a tube that carries urine from the bladder to outside the body

  • The male genital/reproductive organs include the:

    • testes—produce sperm and the hormone testosterone
    • epididymis—stores and matures sperm
    • vas deferens—a tube that transports sperm from the testes to the urethra, seminal vesicles
    • prostate gland—produces fluids that mix with sperm to form semen
    • urethra:—carries semen and urine out of the body
    • penis—external organ for urination and reproduction
    • scrotum—a sac that holds and protects the testes and regulates temperature

  • The female genital/reproductive organs include the:

    • ovaries—produce eggs and estrogen/progesterone
    • fallopian tubes—carry eggs from the ovaries to the uterus
    • uterus—a muscular organ where a fertilized egg implants and grows
    • cervix—lower, narrow part of the uterus that opens into the vagina

Rape and Sexual Assault

Rape and sexual assault can occur at any age and to any gender. When handling this emergency, treat any life-threatening injuries and follow any crime and standard evidence procedures for your jurisdiction. This injury is one with both physical and emotional impacts. Provide a same-sex care provider, if available, and approach the victim with patience, care, and empathy.

Here is a concept to know:

  • techniques for preserving evidence—Refrain from removing or changing clothes, do not clean, wipe, or wash areas of assault, and put any items of significance into a paper bag.

Orthopaedic/Musculoskeletal Injuries

Orthopaedic injuries are extremely common. In most cases, they are not life-threatening, but may be painful and might appear massive. These injuries can occur with or without trauma and can include bone fractures and musculoskeletal injuries.

Musculoskeletal Anatomy and Physiology

There are three types of muscle: cardiac, smooth and skeletal. Cardiac muscle supports the functions of the cardiac system. Smooth muscle is found within the blood vessels and intestines. Skeletal muscle makes up the greatest amount of muscle in the body. The skeletal, or striated, muscle is attached to the bones and joints. It functions to support the skeletal system posture and voluntary movements.

Here are some terms to know:

  • striated muscle—a type of muscle tissue with a striped appearance; types are skeletal and cardiac

  • fascia—tough, fibrous connective tissue that surrounds and separates muscles, blood vessels, nerves, and organs

  • tibia—a large weight-bearing bone in the lower leg, located on the inner side

  • fibula—a smaller, thinner bone located on the outer side of the lower leg

  • calcaneus—the heel bone

  • major bones—cranium, facial bones, spine, thorax, upper limbs (humerus, radius, ulna), pelvis, lower limbs (femur, patella, tibia, fibula)

  • skeletal system—provides the body with structure, support, and protection; made up of the axial skeleton (skull, spine, rib cage), appendicular skeleton (shoulders, upper limbs, pelvis, lower extremities, long bones, short bones, flat bones, irregular bones, sesamoid bones, and joints

  • joints—points where bones meet, allowing movement and flexibility; types of joints including fibrous, cartilaginous, and synovial

  • ligaments—tough, fibrous bands of connective tissue that connect bones to other bones at joints

  • articular cartilage—smooth, white tissue that covers the end of bones where they meet to form synovial joints

When dealing with injuries of this nature, you need an understanding of the relationship between and functions of muscles, ligaments, nerves, and joints. It is also important to know the mechanism of injury (MOA) and the five types of musculoskeletal injuries, including the various degrees or types of fractures, dislocations, sprains, strains, and amputations.

Signs and symptoms may include guarding, pain, tenderness, swelling, bruising, crepitus, shortening, deformity, rotation, angulation, exposed fracture, false motion, dislocation, and reduced fracture.

Complications are often related to the impact that caused the injury. The extent of damage can be bone-related and cause bleeding or bone impact to muscle, blood vessels, arteries, and nerves. Additional complications can be seen with open fractures, including deformity and long-term disability.

Here are some concepts to know:

  • four mechanisms of injury—blunt trauma, penetrating trauma, thermal injury, chemical or toxic exposure

  • zone of injury—area of tissue that is damaged during injury

  • two fracture classifications—closed (simple) and open (compound) fractures; closed fractures occur when the bone is broken but skin remains intact, and open fractures occur when the bone pierces through the skin

  • three terms for description of movement—They are:

    • flexion—decreasing the angle between two body parts
    • extension—increasing the angle between two body parts
    • abduction—moving a body part away from the midline

  • the eight types of fractures—hairline, greenstick, closed, open, displaced, nondisplaced, comminuted, spiral

  • false motion—abnormal movement at a site other than a joint

  • exposed fracture—fracture where bone is visible through the skin

  • locked joint—a condition where a joint becomes immobilized and cannot move normally

  • reduced fracture—realigned, stabilized broken bone that’s been restored to proper alignment

Other musculoskeletal injuries that occur with less frequency are injuries to the scapula, clavicle, shoulder, and acromioclavicular (AC) joint. This may include fractures and dislocation injuries. These areas are shielded from frequent injury due to the large muscles surrounding them. Be aware of signs and symptoms if this type of injury is encountered. The humerus, elbow, forearm, wrist, hand, pelvis, hip, patella, foot, ankle, and ligaments are at risk for sprains, strains, fractures, and/or dislocation injuries occurring with falls, trips, sports, motor vehicle accidents, and other activity mishaps.

Here are some terms to know:

  • acromioclavicular (AC) joint—joint at the top of the shoulder

  • sling—device used to support and immobilize injured upper extremities

  • swathe—broad band or strap used in conjunction with a sling to immobilize the arm against the body

  • glenoid fossa—shallow, articular depression on the lateral aspect of the scapula

  • position of function—optimal resting position of limb or joint that minimizes stress, maintains circulation, and preserves function

  • retroperitoneal space—anatomic area in the abdomen located behind the peritoneum

  • sciatic nerve—the largest nerve in the human body, a major nerve of the lower limbs

The chief complaint may or may not be related to the musculoskeletal injury. It is essential to consider further investigation beyond the orthopaedic injury. This will help to ensure there is no more life-threatening injury present. The musculoskeletal injury grading system is a key tool during the patient assessment when dealing with these types of injuries.

Here is a concept to know:

  • musculoskeletal injury grading system—used to classify the severity of injuries to muscles, ligaments, tendons, and sometimes bones; grades range from I (mild) to III (severe)
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