lesson 10

Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

Lesson 10Lesson 10

Special PopulationsSpecial Populations

Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2

ObjectivesObjectives

As a result of active participation in this As a result of active participation in this lesson you should be able to:lesson you should be able to: Consider the interaction of age and health with Consider the interaction of age and health with

kinematics to modify the index of suspicion for kinematics to modify the index of suspicion for injuryinjury

Modify assessment and management of the Modify assessment and management of the trauma patient based on age and health statustrauma patient based on age and health status

Relate the anatomic and physiologicRelate the anatomic and physiologicchanges associated with pregnancy to thechanges associated with pregnancy to thepathophysiology and management of traumapathophysiology and management of trauma


ScenarioScenario

You respond to a motor vehicle crash on a rainy You respond to a motor vehicle crash on a rainy afternoon. Upon arrival, you find a 70-year-old afternoon. Upon arrival, you find a 70-year-old conscious, unrestrained female driver and a 4-conscious, unrestrained female driver and a 4-year-old unrestrained male in the front seat of a year-old unrestrained male in the front seat of a vehicle. The auto has moderate damage to the vehicle. The auto has moderate damage to the front end caused by striking a telephone pole. front end caused by striking a telephone pole. Witnesses state the vehicle was moving Witnesses state the vehicle was moving approximately 25 mph (kph) when the driver approximately 25 mph (kph) when the driver skidded and struck the pole.skidded and struck the pole.


OverviewOverview

Injury is the most common cause of death of Injury is the most common cause of death of American childrenAmerican children 80% of these deaths may be preventable80% of these deaths may be preventable

Elderly represent the fastest growing age group Elderly represent the fastest growing age group in the nationin the nation ““Elderly” is divided into three categoriesElderly” is divided into three categories

• Middle age: 50-64 yearsMiddle age: 50-64 years

• Late age: 65-79 yearsLate age: 65-79 years

• Older age: 80 years and olderOlder age: 80 years and older


Comparing Young and OldComparing Young and Old

Our bodies and body systems Our bodies and body systems grow and develop throughout grow and develop throughout our lifetimeour lifetime

In the young, the systems In the young, the systems develop and maturedevelop and mature

In the elderly, body systems In the elderly, body systems begin to show the effects of begin to show the effects of agingaging


Primary SurveyPrimary Survey

Airway and breathingAirway and breathing Anatomic differences in pediatric patientsAnatomic differences in pediatric patients Respiratory complications in elderly patientsRespiratory complications in elderly patients Decreased lung volume in elderly patientsDecreased lung volume in elderly patients

CirculationCirculation Pediatric patientPediatric patient——compensates well but deteriorates compensates well but deteriorates

rapidlyrapidly Elderly patientElderly patient——poor compensationpoor compensation


Anatomy and Physiology: ChildrenAnatomy and Physiology: Children

Less body fat, increased elasticity of connective Less body fat, increased elasticity of connective tissue, and close proximity of organstissue, and close proximity of organs Forces are not dissipated as wellForces are not dissipated as well

Skeleton is incompletely calcified and has active Skeleton is incompletely calcified and has active growth centersgrowth centers More resilientMore resilient Less able to absorb force; therefore trauma results in Less able to absorb force; therefore trauma results in

more damage to underlying organsmore damage to underlying organs



Injured children can Injured children can rapidly deteriorate from rapidly deteriorate from labored breathing, to labored breathing, to tachypnea, tachypnea, to a state of total to a state of total exhaustion and apneaexhaustion and apnea


Anatomy and Physiology: ChildrenAnatomy and Physiology: Children Larger head and tongueLarger head and tongue

Larger occiput is difficult to positionLarger occiput is difficult to position Trachea is shorterTrachea is shorter

Main stem intubation is more likely to occurMain stem intubation is more likely to occur Hypoventilation and hypoxia are more common Hypoventilation and hypoxia are more common

than hypovolemia and hypotensionthan hypovolemia and hypotension



Most pediatric injuries do not cause Most pediatric injuries do not cause immediate exsanguinationimmediate exsanguination

Blood pressure alone is poor indicator of Blood pressure alone is poor indicator of peripheral perfusionperipheral perfusion

Children compensate for hemorrhage by Children compensate for hemorrhage by increasing systemic vascular resistance at increasing systemic vascular resistance at the expense of peripheral perfusionthe expense of peripheral perfusion



Organ function is a better indicator of Organ function is a better indicator of perfusionperfusion Brain: confusionBrain: confusion Skin: delayed capillary refillSkin: delayed capillary refill Kidney: oliguriaKidney: oliguria


Considerations in the Management Considerations in the Management of the Pediatric Patientof the Pediatric Patient

Airway and breathingAirway and breathing Always the priority; provide supplemental oxygen to Always the priority; provide supplemental oxygen to

maintain SpOmaintain SpO22 at 95% or greater at 95% or greater

Management with BVM may be adequate; reserve Management with BVM may be adequate; reserve intubation for situations when BVM intubation for situations when BVM is ineffectiveis ineffective

Tachypnea and signs of increased effort may be first Tachypnea and signs of increased effort may be first signs of respiratory distress or shocksigns of respiratory distress or shock

Watch for signs of increasing respiratory fatigueWatch for signs of increasing respiratory fatigue



CirculationCirculation Evaluate skin color, temperature, peripheral perfusionEvaluate skin color, temperature, peripheral perfusion Children compensate well; don’t show signs of Children compensate well; don’t show signs of

hypotension until loss of 30% of volume, then hypotension until loss of 30% of volume, then decompensate quicklydecompensate quickly

Limit attempts at peripheral line placement to 2, then Limit attempts at peripheral line placement to 2, then IO access should be considered in critical patientsIO access should be considered in critical patients

Fluid replacement: attempt 20 mL/kg bolusFluid replacement: attempt 20 mL/kg bolus With minimal bleeding and normal vital signs,With minimal bleeding and normal vital signs,

limit to 1-2 fluid boluseslimit to 1-2 fluid boluses Child requiring more than one bolus may be Child requiring more than one bolus may be

deterioratingdeteriorating



DisabilityDisability A child can be deeply obtunded but have excellent A child can be deeply obtunded but have excellent

recovery if cerebral hypoxia is avoidedrecovery if cerebral hypoxia is avoided Baseline neurological evaluation includes Baseline neurological evaluation includes

• GCS/pupillary reactionGCS/pupillary reaction

• Response to sensory stimulation/motor functionResponse to sensory stimulation/motor function

LOC is most important factor in initial assessment LOC is most important factor in initial assessment of CNSof CNS



Use appropriately sized equipmentUse appropriately sized equipment Preserve body heat!Preserve body heat! Use modified GCS for children under 4Use modified GCS for children under 4 Regardless of size, a child with BP below 50 mm Hg is in Regardless of size, a child with BP below 50 mm Hg is in

jeopardyjeopardy Closely monitor vital signsClosely monitor vital signs Modify immobilization to ensure proper alignment of entire Modify immobilization to ensure proper alignment of entire

spine and limit lateral movement of body spine and limit lateral movement of body Transport to a pediatric facility when possibleTransport to a pediatric facility when possible


Anatomy and Physiology: ElderlyAnatomy and Physiology: Elderly

Body gradually loses its ability to maintain Body gradually loses its ability to maintain homeostasishomeostasis

Due to preexisting physical conditions, elderly Due to preexisting physical conditions, elderly die from less severe injuries and die sooner than die from less severe injuries and die sooner than younger patients wouldyounger patients would

““Old age” is generally characterized by frailty, Old age” is generally characterized by frailty, slower cognitive processes, diminished energy, slower cognitive processes, diminished energy, degenerative diseases, and decline in sensory degenerative diseases, and decline in sensory acuityacuity



Musculoskeletal systemMusculoskeletal system Height loss due to dehydration of vertebral discsHeight loss due to dehydration of vertebral discs KyphosisKyphosis Bones more porous, fragile, brittleBones more porous, fragile, brittle Weakening muscles fatigue more easilyWeakening muscles fatigue more easily Changes in vertebral column result in decreased Changes in vertebral column result in decreased

range of motion, narrowing canal, and increased range of motion, narrowing canal, and increased chance of cord compressionchance of cord compression



Ventilatory function declinesVentilatory function declines Increased stiffness in chest wallIncreased stiffness in chest wall

Alveolar surface decreasesAlveolar surface decreases

Body loses ability to saturate hemoglobin with oxygenBody loses ability to saturate hemoglobin with oxygen

Preexisting cardiovascular diseasesPreexisting cardiovascular diseases Reduced circulation contributes to cellular hypoxiaReduced circulation contributes to cellular hypoxia

Fluid resuscitation should be carefullyFluid resuscitation should be carefullymonitored to prevent volume overloadmonitored to prevent volume overload



Nervous systemNervous system Cerebral atrophy/increased cerebrospinal fluidCerebral atrophy/increased cerebrospinal fluid Nerve impulse conduction slowedNerve impulse conduction slowed Mental and psychomotor activity declinesMental and psychomotor activity declines

Sensory changesSensory changes 28% have hearing impairment28% have hearing impairment 13% have visual impairment13% have visual impairment Temperature regulation and pain perception Temperature regulation and pain perception

are alteredare altered


Considerations in the Management Considerations in the Management of the Elderly Patientof the Elderly Patient

Airway and ventilatory management issuesAirway and ventilatory management issues Diminished surface for gas exchangeDiminished surface for gas exchange

• Patient is less able to compensate for traumaPatient is less able to compensate for trauma Facial structure changes Facial structure changes

• Impair BVM sealImpair BVM seal• May make intubation more difficultMay make intubation more difficult

Impaired cough/gag reflexes and diminished Impaired cough/gag reflexes and diminished esophageal sphincter tone esophageal sphincter tone • Increases risk for aspirationIncreases risk for aspiration

Increased reliance on diaphragm Increased reliance on diaphragm • Sensitivity to intraabdominal pressure changesSensitivity to intraabdominal pressure changes• Difficulty lying flat/immobilizedDifficulty lying flat/immobilized



Circulation management issuesCirculation management issues Many causes of delayed capillary refill in elderlyMany causes of delayed capillary refill in elderly

• Finding is poor indicator of statusFinding is poor indicator of status Many elderly patients have preexisting cardiovascular Many elderly patients have preexisting cardiovascular

disease/taking medicationsdisease/taking medications• Some medications may directly effect clotting abilitySome medications may directly effect clotting ability

Heart rate may be unreliable findingHeart rate may be unreliable finding • Effects of prescription medicationEffects of prescription medication• Poor response to circulating catecholaminesPoor response to circulating catecholamines

Blood pressure may be unreliable findingBlood pressure may be unreliable finding• Baseline pressure may be high due to chronic hypertension Baseline pressure may be high due to chronic hypertension

May have a drop in pressure that initially goes unnoticed May have a drop in pressure that initially goes unnoticed



Wide differences in mentation, memory, and Wide differences in mentation, memory, and orientation exist in the elderlyorientation exist in the elderly

Decrease in pain/temperature sensation may Decrease in pain/temperature sensation may result in poor awareness of environment or result in poor awareness of environment or injuryinjury

Many elderly patients are malnourished, Many elderly patients are malnourished, which may effect response to treatmentwhich may effect response to treatment

Changes in body structure require Changes in body structure require modifications in packaging andmodifications in packaging andimmobilizationimmobilization


ScenarioScenario

The scene is safe and traffic is being directed by law The scene is safe and traffic is being directed by law enforcement personnel. The driver is confused, pale, enforcement personnel. The driver is confused, pale, anxious, and complaining of dyspnea and knee pain. anxious, and complaining of dyspnea and knee pain. The child is alert and crying, with minor bleeding and The child is alert and crying, with minor bleeding and a deformity noted to his nose from striking the a deformity noted to his nose from striking the dashboard. He also has a laceration and swelling dashboard. He also has a laceration and swelling noted to his lower lip.noted to his lower lip.


Scenario:Scenario:Assessment of AirwayAssessment of Airway

What is the status of the What is the status of the airway forairway for The elderly patient?The elderly patient? The child?The child?

What precautions should be What precautions should be taken while assessing the taken while assessing the airway of each patient?airway of each patient?

What indications are present What indications are present that cervical injury may be that cervical injury may be possible?possible?


Scenario:Scenario:Breathing and CirculationBreathing and Circulation

The elderly patient has rapid, shallow The elderly patient has rapid, shallow respirations, is cool and dry to touch, has respirations, is cool and dry to touch, has delayed capillary refill, and a weak radial pulsedelayed capillary refill, and a weak radial pulseof 78of 78

The pediatric patient has crying respirations of The pediatric patient has crying respirations of 28, warm and dry to touch, and an easily 28, warm and dry to touch, and an easily palpable pulse of 132palpable pulse of 132


Scenario:Scenario:Physical Exam FindingsPhysical Exam Findings

Elderly patientElderly patient Trachea midline with significant JVD notedTrachea midline with significant JVD noted Tenderness and diminished breath sounds over Tenderness and diminished breath sounds over

left lateral chestleft lateral chest Increasing dyspnea and confusionIncreasing dyspnea and confusion

ChildChild Trachea midline, no JVD notedTrachea midline, no JVD noted Equal breath sounds Equal breath sounds No injuries or deformities notedNo injuries or deformities noted Crying subsiding with no apparent dyspneaCrying subsiding with no apparent dyspnea


ScenarioScenario

What are the primary concerns regarding the What are the primary concerns regarding the management of the elderly patient?management of the elderly patient?

Based on the assessment findings so far, Based on the assessment findings so far, what decisions should be made regarding the what decisions should be made regarding the transport of the elderly patient?transport of the elderly patient?

What are the primary concerns regarding the What are the primary concerns regarding the management of the pediatric patient?management of the pediatric patient?


Scenario: Elderly PatientScenario: Elderly PatientAssessment of DisabilityAssessment of Disability

Elderly patient confused and unable to answer Elderly patient confused and unable to answer questions appropriatelyquestions appropriately

Opens eyes to speechOpens eyes to speech Pupils are sluggish, but equalPupils are sluggish, but equal Localizes to painful stimulusLocalizes to painful stimulus

What is the Glasgow Coma Score?What is the Glasgow Coma Score?


Scenario: Pediatric PatientScenario: Pediatric PatientAssessment of DisabilityAssessment of Disability

Child is alert, consolable, and asking about his Child is alert, consolable, and asking about his grandmothergrandmother

Eyes open Eyes open Pupils equal and reactivePupils equal and reactive Complains that his nose hurts and is concerned Complains that his nose hurts and is concerned

about his lipabout his lip Follows simple commandsFollows simple commands

What is the Glasgow Coma Score?What is the Glasgow Coma Score?


Scenario:Scenario:Expose/EnvironmentExpose/Environment

After exposing and evaluating the elderly After exposing and evaluating the elderly patient, you discoverpatient, you discover Abdomen is softAbdomen is soft Pelvis is stablePelvis is stable Abrasion and deformity to left kneeAbrasion and deformity to left knee

After evaluating the child, you findAfter evaluating the child, you find Abdomen is softAbdomen is soft Pelvis is stablePelvis is stable No injuries noted and good movement of No injuries noted and good movement of

extremitiesextremities


Scenario: Resuscitation, Scenario: Resuscitation, Treatment, and TransportTreatment, and Transport

You are approximately 8 minutes by ground You are approximately 8 minutes by ground transport from a trauma center. A second unit transport from a trauma center. A second unit has arrived to assist and has brought the has arrived to assist and has brought the necessary packaging and immobilization necessary packaging and immobilization equipment to your side. The second unit has equipment to your side. The second unit has agreed to take responsibility for the pediatric agreed to take responsibility for the pediatric patient.patient.


Packaging and Transportation Packaging and Transportation of the Elderly Patientof the Elderly Patient

How should the How should the elderly patient elderly patient be packaged?be packaged?


Scenario: Elderly PatientScenario: Elderly PatientResuscitation, Treatment, TransportResuscitation, Treatment, Transport

The elderly patient’s vital signs are:The elderly patient’s vital signs are: V = 32 and shallowV = 32 and shallow P = 78 and irregularP = 78 and irregular B/P = 104/66B/P = 104/66

Where should the patient be transported?Where should the patient be transported? What interventions should be takenWhat interventions should be taken

On scene?On scene? En route?En route?


Scenario: Elderly PatientScenario: Elderly PatientResuscitation, Treatment, TransportResuscitation, Treatment, Transport Is the elderly patient a critical patient?Is the elderly patient a critical patient? Why?Why?


Scenario: Pediatric PatientScenario: Pediatric PatientResuscitation, Treatment, TransportResuscitation, Treatment, TransportThe child’s vital signs are:The child’s vital signs are:

V = 26 and nonlaboredV = 26 and nonlabored P = 122 and regularP = 122 and regular B/P = 100/60B/P = 100/60

Is the pediatric patient critical?Is the pediatric patient critical?Why?Why?How should the patient be packaged?How should the patient be packaged?Where should the patient be transported?Where should the patient be transported?What interventions should be made onWhat interventions should be made on

scene? En route?scene? En route?


Scenario: Elderly PatientScenario: Elderly PatientOn-Going AssessmentOn-Going Assessment

En route to the hospital, the elderly patient is En route to the hospital, the elderly patient is reassessedreassessed Continues to be confused and disorientedContinues to be confused and disoriented Breath sounds diminished on right side but no notable Breath sounds diminished on right side but no notable

change from initial assessmentchange from initial assessment Respiratory rate of 34 and shallowRespiratory rate of 34 and shallow SaOSaO22 92% 92%

Pulse rate is 74 and irregularPulse rate is 74 and irregular Blood pressure is 100/58 Blood pressure is 100/58


Elderly PatientElderly PatientArrival at Trauma CenterArrival at Trauma Center

The elderly patient is The elderly patient is delivered to the trauma delivered to the trauma center after a 7-minute center after a 7-minute transport from the scenetransport from the scene

The trauma team had The trauma team had been alerted and is been alerted and is awaiting her arrivalawaiting her arrival


Transport of Pediatric PatientTransport of Pediatric Patient

En route to a pediatric hospital, the child is En route to a pediatric hospital, the child is reassessedreassessed Continues to be alert, cries periodically due to Continues to be alert, cries periodically due to

discomfort of immobilizationdiscomfort of immobilization Breath sounds are clear and equal with a respiratory Breath sounds are clear and equal with a respiratory

rate of 26 and nonlabored with an SaOrate of 26 and nonlabored with an SaO22 of 100% of 100%

Pulse rate is now 114Pulse rate is now 114 Blood pressure remains stable at 100/60Blood pressure remains stable at 100/60


Arrival at Pediatric FacilityArrival at Pediatric Facility

The child is delivered to a pediatric facility after a The child is delivered to a pediatric facility after a 14-minute transport from the scene14-minute transport from the scene

The child began crying and requesting to “get The child began crying and requesting to “get up” after seeing his father in the emergency up” after seeing his father in the emergency departmentdepartment

After a brief stay in the ED, the child was After a brief stay in the ED, the child was discharged to homedischarged to home


Trauma In PregnancyTrauma In Pregnancy

Pregnancy causes both anatomic and Pregnancy causes both anatomic and physiologic changes to the body’s systemphysiologic changes to the body’s system Uterus grows out of pelvis by 12th weekUterus grows out of pelvis by 12th week

Heart rate increases 15-20 beats/min by 3rd trimesterHeart rate increases 15-20 beats/min by 3rd trimester

Blood pressure drops slightly in 2nd trimester, but is Blood pressure drops slightly in 2nd trimester, but is normal at termnormal at term

Cardiac output increases; blood volume increases by Cardiac output increases; blood volume increases by as much as 48%as much as 48%

Gastric emptying slowsGastric emptying slows


Scenario: InjuredScenario: Injured Pregnant Patient and Child Pregnant Patient and Child

You are the first EMS unit to arrive at a domestic You are the first EMS unit to arrive at a domestic violence scene in a rural setting in which a violence scene in a rural setting in which a pregnant female and her 7-year-old daughter have pregnant female and her 7-year-old daughter have both been assaulted by the child’s father. Law both been assaulted by the child’s father. Law enforcement has secured the scene, and it is safe enforcement has secured the scene, and it is safe for you and your partner to enter. You see a for you and your partner to enter. You see a conscious, alert female who appears to be in her conscious, alert female who appears to be in her third trimester holding a child and asking for help. third trimester holding a child and asking for help. An additional EMS unit is en route to assist andAn additional EMS unit is en route to assist andhas an ETA of 20 minutes.has an ETA of 20 minutes.


Scenario:Scenario:Injured Pregnant PatientInjured Pregnant Patient

You take responsibility for the adult and your You take responsibility for the adult and your partner takes the child. The adult is alert, anxious, partner takes the child. The adult is alert, anxious, and moving around with fast, labored breathing. and moving around with fast, labored breathing. She states she was stabbed in the arm. She has She states she was stabbed in the arm. She has bilateral fast, palpable radial pulses and a wound bilateral fast, palpable radial pulses and a wound noted to the left upper arm with significant bleeding. noted to the left upper arm with significant bleeding. She is holding her abdomen and states she is She is holding her abdomen and states she is worried about the unborn child. She indicatesworried about the unborn child. She indicatesthat the assailant kicked her 7-year-oldthat the assailant kicked her 7-year-olddaughter in the abdomen and legs.daughter in the abdomen and legs.


Scenario: Injured Pregnant Scenario: Injured Pregnant Patient Primary AssessmentPatient Primary Assessment

What is the mom’s airway status? What is the mom’s airway status? How should her airway and breathing be managed at this How should her airway and breathing be managed at this

point? point? Are there indications for cervical stabilization?Are there indications for cervical stabilization?

What is her circulatory status?What is her circulatory status? What should be done for the bleeding? What should be done for the bleeding?

What is the moms’ GCS?What is the moms’ GCS? Additional assessment findings include:Additional assessment findings include:

Trachea midline, no JVD notedTrachea midline, no JVD noted No indications of blunt or penetrating trauma noted toNo indications of blunt or penetrating trauma noted to

chest; clear and equal breath soundschest; clear and equal breath sounds No blunt or penetrating trauma noted to abdomen;No blunt or penetrating trauma noted to abdomen;

patient denies being hit or stabbed in the bellypatient denies being hit or stabbed in the belly


Scenario:Scenario:Injured ChildInjured Child

Your partner has begun assessing the child. Your partner has begun assessing the child. She is responsive to verbal stimuli, has rapid, She is responsive to verbal stimuli, has rapid, shallow respirations and is pale and cool to shallow respirations and is pale and cool to touch. She has a very fast carotid pulse, but no touch. She has a very fast carotid pulse, but no visible wounds noted. Opens eyes to loud visible wounds noted. Opens eyes to loud speech. Localized to painful stimuli.speech. Localized to painful stimuli.

What is the Glasgow Coma Score?


Scenario: Injured Child Scenario: Injured Child Primary AssessmentPrimary Assessment

What is status of the child’s airway? What is status of the child’s airway? How should her airway and breathing be managed at How should her airway and breathing be managed at

this point?this point? Is there indication for cervical stabilization?Is there indication for cervical stabilization?

Additional assessment findings include:Additional assessment findings include: Trachea midline, no JVD notedTrachea midline, no JVD noted No indications of blunt or penetrating trauma notedNo indications of blunt or penetrating trauma noted

to the chest; clear and equal breath sounds with to the chest; clear and equal breath sounds with ventilatory rate of 38 and shallowventilatory rate of 38 and shallow

Obvious bruising and distention noted toObvious bruising and distention noted toabdomen; imprint of tread of tennis shoeabdomen; imprint of tread of tennis shoenoted to RUQnoted to RUQ


Scenario: SituationScenario: Situation

Your back-up unit is 20 minutes away.Your back-up unit is 20 minutes away. You are 2 hours away from the closest Level I You are 2 hours away from the closest Level I

Trauma Center. Your service transports to a Trauma Center. Your service transports to a Level III Trauma Center that is 12 minutes from Level III Trauma Center that is 12 minutes from your location.your location.

Do you wait on your back-up unit?Do you wait on your back-up unit? Do you activate air transport to transfer the Do you activate air transport to transfer the

patient to the Level I facility?patient to the Level I facility? Which patient takes priority?Which patient takes priority? What decisions do you make at this point?What decisions do you make at this point?


Scenario: Injured ChildScenario: Injured ChildResuscitation, Treatment, TransportResuscitation, Treatment, Transport

What interventions should be done on scene What interventions should be done on scene for the child?for the child?

What interventions should be done en route?What interventions should be done en route? First full set of vital signs are:First full set of vital signs are:

V = 34 and shallowV = 34 and shallow Pulse = 138 and regularPulse = 138 and regular BP = 90/56BP = 90/56


Scenario: Pregnant PatientScenario: Pregnant PatientResuscitation, Treatment, TransportResuscitation, Treatment, Transport

What interventions should be done on scene What interventions should be done on scene for the pregnant patient?for the pregnant patient?

What should be done en route?What should be done en route? First full set of vital signs are:First full set of vital signs are:

V = 22 and non-laboredV = 22 and non-labored Pulse = 116 and regularPulse = 116 and regular BP = 108/68BP = 108/68


SummarySummaryPrimary survey remains unchangedPrimary survey remains unchangedWhen making assessments, consider the patient’s age When making assessments, consider the patient’s age

as a complicating factoras a complicating factorPotential for rapid deterioration mandates frequent Potential for rapid deterioration mandates frequent

reassessmentreassessmentPhysiologic changes that occur during pregnancy Physiologic changes that occur during pregnancy

should be noted during evaluationshould be noted during evaluationSurvival of the fetus depends on aggressive Survival of the fetus depends on aggressive

assessment and management of the motherassessment and management of the motherModifications may be necessary duringModifications may be necessary during

packaging and immobilization of thesepackaging and immobilization of thesepatientspatients


QUESTIONS?QUESTIONS?

lesson 10

Education

elderly body

elderly die

pediatric patient circulation

pediatric patient airway

pediatric patient use

nation elderly

preventable elderly

elderly ventilato