HM Advancement Study Guide DIET and NUTRITION Gain/Lose 1 pound 3,500 extra calories Proteins - building blocks of body

needed for growth, maintenance, and replacement of body cells, form hormones/enzymes used to regulate body. Normal daily protein 0.8 gram/kg. Deficiency may stunt growth, promote a secondary anemia, or induce nutritional edema. Fats supply energy / transport vitamins Carbohydrates most efficient source of energy, should be 50% of calorie intake Minerals integral part of cell structure/circulate in fluids Vitamins act as catalysts in chemical reaction needed for metabolic functions Vitamin Vitamin Name Condition: A Retinol Vision Problems Very B1 Thiamine Beri beri Big B2 Riboflavin Pellagra People B6 Pyridoxine Neuritis (INH Therapy) B12 Prime C Steak D Real K Cyanoclabin Ascorbic Acid Sunshine Vitamin Mendinone Pernicious Anemia Scurvy Rickets Blood Clot

Really Thin Recruits Prefer Need Carrots And Spaghetti Meatballs Bad

Rules of 9

Finger Puncture (1) Milk finger (2) Cleanse fingertip (3) Lance fingertip (4) Wipe away 1st drop (5) Collect specimen Phases of Rescue Operations 1st Phase- Remove pinned casualties 2nd Phase- Trapped in more difficult places can be rescued with equip 3rd Phase- Extrication is extremely difficult/time consuming Stages of Extrication 1 Stage Gaining Access 2nd Stage Lifesaving Care 3rd Stage Disentanglement 4th Stage Preparing the victim for removal Final Stage Removing the Victim from area, Transport
st

The Cell Protoplasm- Viscid jelly like substance secret of life Plasma Membrane Selectively permeable membrane surrounding cell. Nucleus Small, dense, usually spherical body controls chemical reactions Nucleoplasm Contained in nucleus, important I cells reproduction Cytoplasm- water-to-gelatinous substance surrounding nucleus

The Neuron Neuron structure/functional unit of the nervous system Dendrites Thin receptive branches, vary greatly size Cyton Cell body containing the nucleus Axon Single, thin extension of the cell outward from cyton Synapse Space between axon of the activated nerve and the dendrite receptors of another neuron. Eye Outer layer of the eye Sclera outer layer though fibrous, protective portion of globe AKA white of eye Cornea window of the eye, permits light to enter globe Middle Layer Choroid middle layer, highly vascular pigmented tissue, nourishes Iris circular, pigmented muscular structure gives color to eye Pupil opening of iris Lens Transparent biconvex structure behind iris Vitreous Humor Jellylike substance maintains shape of eye Inner Layer Retina Inner layer of eye carries visual impulses Rods Respond to low light Cones Respond to higher light Hearing External Ear Auricle Pinna, Cartilaginous Structure located on each side of head External Auditory Canal Sound waves travel through Tympanic Membrane eardrum Middle Ear Malleus Hammer Incus Anvil Stapes Stirrup Inner Ear Organ of Corti hearing organ Semicircular Canals Round Window (fenestra rotunda) membrane covered opening of the inner ear Stomach Superior End esophagus Inferior End duodenum Sphincters Esophageal End Cardiac Sphincter Duodenal End Pyloric Sphincter Small Intestine Duodenum, Jejunum, Ileum Large Intestine Cecum, Colon, Rectum, Anus, Anal Sphincter

Planes of the Body Median (Midsagital) Plane Divides body into R and L halves on vertical axis Sagittal Plane Plane parallel to median plane Frontal (Coronal) Planes Drawn perpendicular to sagittal lines and divide the body into anterior/posterior sections Horizontal (Transverse) Plane Drawn at R angles to both sagittal and frontal

Cranial Nerves Olfactory sense of smell Optic Sensation of sight Oculomotor Controls muscles that move eyeball Trochlear Moves eyeball down and to the side Trigeminal 3 branches ophthalmic, maxillary, mandibular Abducens turns eye outward Facial Controls muscles of face, scalp, ears Acoustic Nerve of hearing and equilibrium Glossopharyngeal Carries sensation from pharynx to tongue Vagus Composed of motor fibers, extends through neck, pharynx, larynx Accessory Supplies nerves to muscles of neck, trapezius, pharyngeal Hypoglossal Controls muscles of the tongue

Shock Chart mL Decrease in Blood % Degree Signs

0-500 500-1200

0-10 10-25

None Mild

1200-1800

25-35

Moderate

1800-2500

35-50

Severe

None Slight tachycardia, BP decreased, Mild vasoconstriction Thready Pulse 100-120, BP 90100, Diaphoresis, Decreased Urine, Marked vasoconstriction, Anxiety Thready Pulse > 120, Systolic BP < 60, Diaphoresis, Obtundation, No urine output

Poisonings Corrosives TX for Acids Milk of Magnesia following Dilution * DO NOT USE CARBONATES* TX for Alkaline Dilute with vinegar in water * TRANSPORT ASAP* Petroleum Distillates S/S Abd. Pain, choking, gasping, vomiting, and fever TX *DO NOT INDUCE VOMITING* If physician can not be reached, give 30-60mL of vegetable oil TRANSPORT ASAP Poisonous Fish Puffer, Filefish, Triggerfish, Surmullet/Goatfish, Parrot Fish, Surgeon Fish, Porcupine Fish TX Inhalation Poisoning Remove victim from environment, BLS, Remove/Decon clothing, Treat shock/O2, Transport Scorpion Stings Centruroudes Sculturatus S/S severe pain/weakness localized, vomiting, visual disturbances, circulatory/ respiratory depression, muscle spasms TX Ice over sting site, Morphine/Meperidine Hydrochloride contraindicated, Calcium Gluconate 10% muscle spasms, Valiumconvulsions, Antivenom is available for Centruroides Sculpturatus, TX symptomatically

Spider Bites Female Black Widow hourglass-shaped red spot on its belly pain to muscles of torso, board like rigidity S/S N/V, HA, Dizziness, SOB, Edema, Rash, Increase BP, Anxiety TX Ice, Hospitalize victims >16<65 for observation, Give antivenin Brown Recluse- violin shaped marking S/S skin rash, fever/chills, N/V, pain TX MO excise/start corticosteroid therapy, debride lesion, and cleanse with peroxide, soaked with Burows solution, Apply polymyxin- bacitracinneomycin ointment LAB Microscope Base Microscope rests on Arm structure which supports magnification/adjustment system Stage platform specimen is placed on Mechanical Stage means by which preparation can be moved on Mirror usually double, a flat surface on one side Internal light source built into base Condenser composed of a compact lens system between mirror and stage Iris diaphragm controls amount of light reaching condenser Resolving Nosepiece contains openings for objective lenses to be fitted; bring object to desired position Objective Lenses set of 3 power lens Body Tube Through which light passes from objective to ocular lens Blood Test uses WBC RBC Detailed Blood Ocular Lenses Color Green Yellow Red Total Magnification 100x low power 450x- High power 1000x- Oil Immersion

Adjustment System Raise/Lower body tube Coarse Adjustment Larger/inner most knob Fine Adjustment Smaller/outermost knobs Women Men Infants CBC Hemoglobin 12.5-15 g/mL 14-17 17-23 Percent 83-110 97-124 97-138

-Total RBC -Hemoglobin -Hematocrit Adult Male Adult Female Newborn

-Total WBC -Differential WBC Normal RBC Count ? Check this 5.4-+ .8 million/mm3 4.6 6.0 + 3 4.8 - .6 million/mm 3.6 - 5.6 5.1+- .9 million/mm3 5.0 - 6.5

Manual Sahli Pipette Manual RBC count *DO NOT SHAKE IN DIRECTION OF LONG AXIS* Multiply by 10,000 for RBCs per cubic millimeter Sahli- Hellise Test Hemoglobin Test Hematocrit (Packed Cell Volume) Determination Normal Values Male - 42-52% Female- 37-47 % Newborns 53-65% WBC Normal 4.500 -11,000 Pneumonia 20,000-30,000 Meningitis 20,000-30,000 Appendicitis- 10,000 30,000 Counts as high 15,000 -Newborn -Pregnancy/Labor -Severe Pain -After exercise/meals -Cold baths -Emotional Upset Differential WBC Normal Ranges Easinophils 2-4% Basophils 0-2% Lymphocytes 20-30% Monocytes 2-6% Metamyelocytes 0% Bands or Stab forms 2-6% Segmented 55-75% Recovery Falling WBC, # of mature neutrophils progressing normal Poor Prognosis Shift to Left, falling WBC TB Increase number of monocytes Healing Increase number of Lymphocytes Increase in Easinophils Parasitic infections/ allergic conditions CELLS

Cytoplasm of Easinophil Coarse, reddish-orange granules Basophil Dark-blue granules, darker than nucleus/ they keep blood from clotting in tissue Lymphocyte Clear sky, blue, scanty/ they destroy protein metabolism Monocyte Largest WBC, Muddy-gray blue/ they destroy bacteria protozoa Neutrophil numerous fine lilac-colored granules/ they ingest bacteria Metamyelocyte (Juvenille) Shaped like a cashew nut Band (Stab) Older or intermediate neutrophil Segmented Separated into 2, 3, 4, or 5 segments Hypersegmented Divided into 6 or more segments Alpha Hemolysin produce partial hemolysis changes medium to green color Beta Hemolysin completely lyses the RBC, leaving clear zone of hemolysis Endotoxin Comprises part of the cell wall, released as bacterial cell Exotoxin Derives from the bacteria during growth found outside cell Serology Procedures by which antigens and reacting serum globulin antibodies may be measured qualitatively and quantitatively Antigen Substance when introduced into an individual who does not already possess that substance may stimulate specific antibodies Fungus Test - Fungi that reproduce by spores that germinate into long filaments Hyphae Potassium Hydroxide (KOH) Preparation used to detect fungi URINALYSIS Toluene spread a thin form of film on surface, prevents air from leaching urine - False positive are seldom encountered Thymol Preserves urine for several days * Produces false + for albumin Normal Daily Urine Output 800-2000mL/average 1500mL Ph 4.6 to 8.0 Specific Gravity 1.015-1.030 Leukocytes 0-3 seen per high power field Erythrocytes Not normally present in urine *1 drop of 5% acetic acid disintegrate RBCs*

Casts Urinary sediments are formed by coagulation of albuminous material in the kidney tubules Casts containing Organized Structures -RBC Casts Indicate renal hematuria -WBC Casts Present in Renal Infection -Epithelial Casts Rarely seen in urine/ Parallel Rows Type of Casts -Hyaline Most frequent in urine -Waxy Result from degeneration of granular casts -Granular indicate Renal Disease -Fatty lupus/Toxic Renal Poisoning CBR Nerve Agents Types Tabun (GA) Sarin (GB) Soman (GD) VX (TSSV) S/S Pinpoint pupils, muscle twitching, Rhinorrhea, Dysphea, Diarrhea, Vomiting, Convulsion, Hypersalivation, Drowsiness, Coma, Uncon. **Odorless / Colorless Vesicants/Blister Agents Types Mustard (HD) Nitrogen Mustard (HN) Lewisite (L) Odor/Color Garlic/horseradis h colorless to pale yellow Fruity/Geranium Light to Dark brown S/S Attack eyes and Resp. Tract TX M291 Skin Decon Kit Decon eyes with H2O. Sodium Sulfacetomide 30% for eye infections TX Issued 3 (2mg) atropine injectors; 2 PAM Cl given at 10-15 min intervals; Medical unrestricted use until mild atropization

*BRITISH ANTI-LEWISTE (BAL), DIMERCAPROL, AVAILABLE FOR INJECTION FOR SYSTEMIC INVOLVEMENT* Blood Agents Types Odor S/S TX

Increase depth of Amyl Nitrate respirations, (Max 8 Ampules), violent Sodium convulsions, Thiosulfate resp/heart failure BLOOD AGENTS HAVE A RAPID RATE OF ACTION* Choking/Lung Agents Types Phosgene (CG) S/S TX Rapid/Shallow No specific breathing, frothy treatment, treat sputum, clammy symptomatically Chlorine (CL) skin, rapid, feeble pulse, decrease BP, shock, death *CAUSE DAMAGE TO LUNG TISSUE PULMONARY EDEMA* Psychochemical Agents Buzz Gas (BZ) Temporarily incapacitated S/S appear in 30 minutes to hours may persist for days; increase HR, increase pupil size, increase skin temperature, decreased alertness TX Prevent them from injuring themselves Lacrimators (Irritants) Types Chloracetophenone (CN) Orthochlorobenzilidin e Malanonitrite (CS) S/S Excessive tearing seldom lasts over 2 hours *Instant Rate of Action* Vomiting Agents Types Diphenylaminochloroarsin e (Adamsite DM) Diphenychloroarsine (DA) Diphenylcyanoarsine (DC) Odor/Color Burning fireworks odor Yellow/White Gas S/S Pepperlike irritation cause uncontrollable, sneezing, coughing N/V, Malaise TX Wear mask Carry on vigorously, Wash skin, rinse eyes, spontaneous recovery 1-3 hrs Odor Pepperlike TX Fresh Air Odor New Mown Hay Odor

Hydrocyanic Acid (AC) Cyanogen Chloride (CK)

Faint bitter almond odor

White Phosphorus TX cover particles with wet cloth, mud, 0.5% copper sulfate, surgically removal particles Nuclear Blindness persists for 20-30 minutes Alpha particles- stopped absorbed by a few inches of air, A Sheet of paper, superficial layers of skin. Beta particles- only penetrates a few millimeters of tissue, shielded by most clothing Gamma rays- most penetrating TX- triples doses of antibiotics Lifesaving procedures done before decon PHARM/TOX United States pharmacopeia and national formularyStandards for drugs of therapeutic usefulness and pharmaceutical necessity Physicians desk referenceMultiple index of commercially available drugs and is used as an advertising outlet for various drug manufacturers Remingtons pharmaceutical sciencesProbably the most widely used text/references in American pharmacy Pharmaceutical basis of therapeuticsKnown as the BLUE BIBLE

CLARKS RULE-

WIEGHT OF CHILD X ADULTS DOSE = CHILDS DOSE 150LBS AGE IN YEARS X ADULT DOSE = CHILDS DOSE AGE+12

YOUNGS RULE-

Chemical name- tells the chemical and molecular structure Generic name- derived from chemical name common name of drug Trade name- name given by manufacturer and is a proprietary name aka BRAND NAME Comprehensive drug abuse prevention and controlled act of 1970 Schedule 1 maximum abuse potential with little or no accepted medical usefulness (heroin, marijuana, LSD) NO REFILLS Schedule 2- high abuse potential and accepted medical usefulness; abuse leads to psychological / physical dependence. (Morphine, meperidine, amphetamines, pentobarbital NO REFILLS Schedule 3- lesser degree of abuse potential with accepted medical usefulness, abuse leads to moderate dependence ( paregoric, some barbiturates, T3, fiorinal) refills 5x in 6 months Schedule 4- low abuse potential with medical usefulness; limited dependence problems (diazepam, pentazocaine, Phenobarbital, chlordiazepoxide, flurazepam) refills 5x in 6 months Schedule 5- low abuse potential accepted medical usefulness limited dependence factors ( lomitil,etho with codine) refills 5x in 6 months

CONVERSION TEMPERATURES F= (C X 1.8) + 32 C= (F- 32) / 1.8 Comminution- process of physical reduction of a substance into fine particle size Tituration- process of reducing a solid to very fine powder Levigation- solids ground to even finer, using liquid

Class A balance- 120mg to 120g Class B balance- 648mg and up ANTACIDS Counteract hyperacidity in stomach - magnesium hydroxide ( milk of magnesia usp) - aluminum hydroxide gel ( ampho jel) - alumina and magnesia oral suspension (Maalox) - alumina, magnesia and simethicone oral suspension ( Mylanta, gelusil) - magaldrate (riopan) ASTRINGENTS Cause shrinkage of mucus/skin membranes - aluminum acetate topical solution ( burrows solution) - calamine lotion ABSORBENTS Drugs which attach another substance to its surface - Activated Charcoal USP EmollientsBland/fatty substances applied to skin to make pliable -Cocoa Butter (Theobroma Oil) -Hydrous wool fat (Lanolin) -Petrolatum (Petroleum Jelly) -Zinc Oxide Ointment Autonomic Drugs Controls autonomic functions of the body -Parasym pathiec drugs -Neostigmine Methyl sulfate (Prostigmin) -Bethanechol Chloride (Urecholine Duviod) -Atropine Sulfate (Obtained from Belladonna) OxytocicsProduce rhythmic contraction of uterus -Ergo ovine Maleate (Ergotrate) -Oxytocin (Pitocin) AntihistaminesFights histamine found in tissue -Diphenhydramine HCL (Bendryal) -Chlorpheniamine Maleate (Chlor-Trimeton)

-Meclizine HCL (Andivet-Bonine) -Dimenhydrinate (Dramamine) Histamine H, Receptor Antagonists-Cimetidine (Tagament) -Ranitidine (Zantac) Cold relief preparations -Pseudoephedrine HCL (Sudafed) -Pseudoephendrine HCL and Triprolidine HCL (Actifed) -Phenypropanolamine/Gusifensin (Entex-LA)

Vasodilators -Amyl Nitrite -Nitroglycerin (Nitrostat, Nitro-Bid) -Isosorbide Sinitrate (Isordil, Sorbitride) -Pyridamole (Pergantine) -Procainamide HCL(Pronestyl Procan SR) Vasoconstrictors Constriction of vessels, increase B/P -Epinephrine (Adrenalin, Sus-phrine) -Tetrahydrozaline HCL (Visine) -Phenlyephrine HCL ( Neo- Synephrine) -Oxymetazoline HCL (Afrin) HemostaticsControl external bleeding by forming a clot. -Absorbable Gelatin Sponge AnticoagulantDelay or prevent blood clotting -Heparin Soduim -Warfarin Sodium (Coumdin) Anesthetics Produce insensibility of pain -Gen Anesthesia -Dibucaine HCL(Nupercaine) -Nitrous Oxide (Laughing Gas) -Proparacine (Ophtestic & Opthaine) -Halothane (Fluothane) -Keatmine HCL (Ketalar) -Fentanyl and Droperidal (Inrovor) -Lidocaine HCL(Xylocaine) Opium and Alkaloids- Morphine/Codeine

-Paregoric (Comphorated Opium Tincture) -Morphine Sulfate -Codeine Sulfate -Meperidine HCL (Demerol) Psychotherapeutic Agents Tranquilizers/Mood Modifiers -Chlorpromazine HCL (Thorazine) -Thioridazine (Mellaril) -Prochlorperiznine (Compazine) -Haloperidol (Haldol) -Lithium (Eskalith, Lithune) -Amitriptyline HCL (Elavil) -Chlordiazapoxide HCL (Librium) -Hydro Xizine HCL (Vistrail) -Diazepam (Valium) -Flurazepam )(Dalmine) Skeletal Muscle Relaxants relax during surgical anesthesia -Methacarbonal (Robaxin) -Cyclobenzaprine HCL (Flexiril) -Chlorzoxozone and Acetaminophen (Parafon Forte) -Orphenadrine, ASA, Caffeine (Norgesic) Cardiovascular Agents- Affect circulatory System -Digitoxin (Crystodigin) -Digoxin (Lanoxin) -Quinidine Sulfate. Expectorants/Antitussives- Assist in removal of secretions/inhibit or suppress coughing. -Guaifenesin (Robtussin) -Dextromethorphan (DM) -Benzonatate (Tessalon Perles) -Terpin Hydrate Elixir w/Codeine (ETH w/ Codeine) Antiseptics- Suppress the growth of microorganisms Disinfectants- Agents used in inanimate objects

GermicidesKill susceptible organisms. -Phenol (Carbonic Acid) -Povidone-Iodine (Betadine) -Isopropyl Alcohol- (Isopropanol) -Hexachlorophene (phishex)

-Silver Nitrate -Benzalkonim Chloride (Zaphiran Chloride) -Glutaraldehyde (Cidex) -Thimersol (Merthiolate) -Hydrogen Peroxide Antifectives -Antibacterial SulfonamidesEffective gram +/- organisms synthetically produced -Suldifoxazole (Cantrisin) -Trimethoprim &Sulfamethoxazole (Bactrim Septra) -Sulfacetamide (Sulamyol) -Silver Sulfadiazine (Sivadene) DiureticsIncrease urine formation TX -> increase B/P, edematous conditions, -Hydrochlorothiazide (EsidlixOretic, Hydrodiuril) -Chlorthalidone (Hygroton) -Furosemide (Lasix) -Aetazolmide (Diamox) -Triametrene &Hydrochlorothiazide (Dyazide) CNS Stimulants- stimulate activity of various portions of CNS -Methylphenidate Hydrochloride (Ritalin) -Dextroampetmine Sulfate (Dexedrine) CNS Depressants- mild sedation -Phenobarbital (Luminal) -Pentobarbital (Nembutal) -Secobarbital (Seconal) -Phenyfoil Sodium (Dilantin) -Alcohol (Ethyl ETOH, ETHANOL) Anti-parasiticParasitic infections or infestations account for largest # of chronic disabling diseases known -Lindane (Kwell) -Cromamiton (Eurax) -Metonidazole (Flagyl) -Chloroquine Phospahate (Aralen) -Primaquine Phosphate -Fansidar (Sulfadoxine & Pyrimethine) -Mebendazole (Vermox) -Pyrantel Pamate (Antineth)

-Thiabendazone (Mintezol) -Pyrvinuim Pomoate (Povan) LaxativesFacilitate passage /elimination of feces. - Mineral oil - Glycerin Suppositories MF - Bisacodyl (Ducolax) - Magnesium Citrate (Citrate of Magnesia) - Psyillium Hydrophilic Micillioid (Metaucil) - Ducosate Calcium (Surfak) - Ducostae sodium (Colace) Antidiarrheals-Kaolin mixture w/ pectin (Kaopectate) -Diphenoxylate HCL (Lomotil)

MacrolidesInhibits protein synthesis effective against gram + cocci, neisseria , hemphilus, myobacteria -Erythromycin (Ilotycin, Erythrocin, E-mycin) - Clindamycin HCL (Cleocin) - Vancomycin HCL (VANOCIN) Misc Antibiotics -Rifampin (Rifadin) -Isoniazid (INH) -Chloramphenicaol sodium saccinate (Cloromycetin) -Polymixin B sulfate (Aeroporinl Polymxin E sulfate (Coly mycins) - Spectinomycin HCL (Trobicin) - Nirtofurantion (Furadantin, Macrodantin) -Phenazopyridine (Pyridium) -Bacitricin AntifungalInhibit or suppress of fungi, dermatophytes or candida -Mystain (Mycostain) -Griseofulvin (Gris-Peg, Pulvicin) -Miconazole Nitrate (Monistat) -Undecylenic Acid (Desenex) -Tolnaflate (Tinactin, Afltate) -Clotrimazole (Lotrimin, Mycelex)

PenicillinDerived from pencillium molds, inhibit cell wall synthesis -PCN G (AQUEOUS) -PCN G procaine Aqueous (Wycillin) -PCN G Benzathine (Bicillin) -PCN V Potassium (Phenonxymenthyl PCN) -Dicloxicillin (Dynapen) -Ampicillin (Polycillin, Onipen, Totacillin) -Methicillin sodium (Staphcillin) -Nafcillin (Nafcil, Unipen) CephalosporinsAntimicrobial agents of fungal origin -Cefazolin (Ancef, Kefzol) -Cephadrine, Anspor, Velosef) -Cefoxitin (Mefoxin) -Cephalexin (Keflex) -Cephalothin (Keflin) TetracyclineBlocking formation of polypeptides used in protein synthesis -Tetracycline HCL (Achromycin) -Doxycycline Hydrate (Vibramycin) -Minocycline HCL (Minocin) AminoglycosidesEffective against most grams +/- share chemical, antimicrobial, pharmacologic toxic characteristics -Streptomycin sulfate -Neomycin Sulfate -Gentamycin Sulfate (Garmycin)

PMR Amebiasis- Intestinal infection maybe asymptomatic s/s- diarrhea w/ blood or mucous, abscesses of liver, lung, or brain Spread by intestinal parasite (Entamoeba histolytic) Botulism- serious condition caused by poisoning from bacteria produced toxins s/s- drooping eyelids, blurred or double vision Toxin produced by Clostridium Botulinum Chickenpox-Herpes Zoster- Acute generalized viral disease w/ sudden onset.

s/s- begins w/ maculopapular rash and rapidly progress to characteristic vesicles Direct contact spreading Cholera- Acute bacteria intestinal infection s/s- sudden vomiting, watery stools, dehydration Transmitted by contaminated water w/ excretions of patients Dengue Fever-(Break bone Fever) s/s- sudden fever, H/A, pain behind eyes, muscle pain, rash, small discolored raised spots or closely aggravated bright spotsTransmitted by Aedes mosquito Dengue Hemorrhagic Fever- s/s circulatory shock, increased fever, loss of appetite, abd pain, excessive bleeding at veinpuncture sites, nose, and gums. Transmitted by Aded Aegypti Mosquito Giardiasis- parasitic infection of small intestine s/s- chronic diarrhea, fat in stools, loose pale stools. HEP A- fever, malaise, loss of appetite, nausea, abd discomfort, few days later jaundice, fecal/oral route HEP B-onset progresses gradually, s/s- loss of appetite, slight abdomen discomfort, n/v, jaundice Incubation period 60-90 days Transmitted thru serum Influenza- Acute viral disease involving thru UR tract s/s fever, chills, H/A, muscular pain, exhaustion, acute rhinitis, sore throat, cough Recovery 2-7 days Transmitted airborne route. Malaria- 4 types, Falciparum malaria most serious s/s- jaundice, blood coagulation defects, shock, renal failure, liver failure and disorientation, delirium Transmitted by female anopheles mosquito Measles-Acute viral disease s/s- small irregular bright red spots with bluish white center (Kopliks spots) located inside cheeks. Transmitted thru throat secretions. Meningitis- bacterial disease s/s-stiff neck often pinpoint red rash Transmitted by direct contact Mumps- viral disease s/s fever, swelling, tenderness of 1 or more salivary glands Pediculosis-infestation of lice on the body and clothing. Lice and eggs found in body hair or inside seams of clothing Tx- 1% gamma benzene hexachloride lotions Plague- disease of animals and man transmitted by a flea bite from infected rodents. 1st sign- inflammation of lymph nodes, septicemia may develop. Poliomyelitis Acute- serious viral disease

s/s-severe pain in muscles and spasms stiff neck/back, paralysis characteristic of disease. Transmitted by fecal/oral modes Rabies- Acute viral disease of CNS, essentially 100% fatal, s/s-malaise, fever, H/A sensory changes, paralysis, spasm, hydrophobia Rubella- Mild viral infectionous disease s/s- conjunctivitis, HA, fever, minimal resp symptoms, rash consists of pink eruptions STDs Chlamydia- urethritis in males/cervicitis in females. s/s-opaque discharge urethral burning/itching TX- PCN, Doxycline, E-Mycin Gonorrhea- Male- purulent discharge, dysuria/females urethritis or cervicitis Tx-procaine PCN G, Ampicillin, Amoxicillin, TCN Herpes Simplex- woman- lesions on cervix, lesions on penis/pubic area Tx- Acyclovir Syphilis- Treponemal disease, rash on skin and mucous membranes, lesions of cardiovascular system, CNS, viscera, bone, skin.

PMR (CONT) Best water fountain- angle jet How often fountains/showers/urinals cleaned- at least once daily OBT- Etoh-glass thermometer bulb shielded kept dry WBT- wet wick is fitted over bulb Absolute Humidity- Mass of water present per unit volume of air Relative Humidity- Ratio of actual amount of H20 in air to max quantity H20 air can hold at that temp. Dew Point- Temp absolute humidity reaches max air becomes saturated w/ H20 vapor Psychometer- Instrument for measuring atmospheric humidity using 2 thermometers Radinet Heat- Transfer of thermal energy by wave motion from/ object to another Globe thermometer- consists of a 6 inch hollow sphere Effective Temp-index combining into single wave. The effects of temp, humidity. Outside temps heated to what avoid condensation 42-50 degrees OBT. Zone Temp berthing medical messing 70 degrees OBT.

Criteria Meats- NAVSUP Manual or NAVSUP 421 Fresh fish- bright red gills and clear eyes, firm elastic flesh 3 areas to check cansLabels Exterior Contents Molasses-not contaminated do to swelling Flipper- flat ends, 1 maybe in convex, other brought down on flat surface. Springer- 1 or both ends slightly bulge yielding finger pressure. Sweller Both ends bulge remain that way- advanced detioriation Fresh eggs (less than 30 days) 32 degree F Helps shrinkage due to evaporation dip eggs in mineral oil at 100-110 degree F. Allergy to Eggs/Fowl T Typhus I Influenza M Measles Y Yellow Fever Quarantinable P Plague S Smallpox Y Yellow Fever C Cholera

DENTAL Dental Caries- result of localized decay of calcified tissues of teeth Actute Pulpitis severe inflammation of tooth pulp Periapical Abscess-Infection of tooth pulp, result of unchecked pulpitis Gingivitis-Inflammation of gingival tissue- poor hygiene NUG-Trench mouth- severe inflammation of gingival tissue Periodontitis- inflammatory condition that involve gingivae Periodontal abscess- caused by an infection in periodontal tissues. Pericoronitis-inflammation of gingival around partially erupted tooth. Stomatitis-inflammation of the oral mucosa Recurrent labial herpes-infection that produces a fever blister/cold sore Alveolar Ostetitis (Dry socket) - normal clot fails to form in socket. Enamel- translucent-yellow gray covers crown protects dentin/hardest tissue in body Dentin- light yellow substance, very porous/largest portion of tooth/living tissue Cementum-bonelike tissue covers roots of the teeth/anchor teeth to bony walls. Dental Pulp- soft tissue of tooth/blood vessels/nerves. Incisors-Incise food Cuspids- Canines angles of mouth Bicuspids-Premolars 2 cusps of cutting/tearing Molars back of mouth 4-5 cusps for grinding/chewing

1st set 20 teeth- 2nd set 32 teeth Fx teeth Type 1- enamel fx- slight chip/fx of enamel Type 2- enamel/dentin fx-no pulp exposure Type 3- enamel/dentin fx-w/ pulp exposure Type 4- Root fx

ADMINISTRATION Naval Letter From To Via Subject (all CAPS) Reference (Inst or USMJ) Enclosure (going along with letter) Signature (4 line to last line / centered) Types of Correspondence 1) Standard Letter 2) Joint from several people 3) Mult Address several people addressed 4) Endorsement CO endorsing letter 5) Speed Letter short message 6) Memo Type a. Plain Paper no letterhead b. Printed c. Letterhead going outside unit d. Memo For most formal Administration MANMED Ch 23 SECNAV sets guidance OPNAV puts guidance in effect BUPERS orders/manning BUMED med/dentistry SECNAVINST 5212.5 Series Medical Dept Journal - As aspects of Dept; signed by SMO/SMDR SECNAVINST 5216.5 Series Dept of Navy Correspondence Manual

Binnacle List NAVMED 6320/18 excuse from duty < 24hr - CO by 0930 daily NAVMED 6320/19 Morning Report of Sick excuse from duty > 24hr - CO by 1000 daily 3 Types of Directives Directives prescribe or establish policy Instruction directive containing authority or information having continuing, reference Value or action - Remains in effect to superseded or cancelled Notice brief period of time, 6 mos or less / self-cancelling Change Transmittal changes in instruction / notice / manuals, publications File # - 4 to 5 digit # which represents a letters subject Originators Code serves as basic ID symbol appears on all outgoing correspondence Serial # - classified correspondence must contain serial #. Tickler Files required for personnel requiring immunizations, physical examinations, program evaluation SECNAVINST 5210.11 SSIC Codes

SSIC CODES 1000 Military Personnel 2000 Telecommunications 3000 Operations/Readiness 400 Logistics 5000 Admin/Management 6000 Medical/Dental 7000 Financial Management

PUT THOSE OPEN LEGS AROUND MY FACE

8000 9000 10000 11000 12000 13000 16000 SUPPLY

Ordinance Material OR Ships Design SEND General Material MY Facilities/Activities Ashore FREAKIN Civilian Personnel CHECK Aeronautical ATTENTION Coast Guard COAST GUARD

6505 Drugs, Biological, and Official Reagents During 6808 Medicated Cosmetics/Toiletries Chilly 6510 Surgical Dressing Materials December 6515 Medical/Surgical Instruments, Equipment, Supplies I 6520 Dental Instruments Deliver 6525 X-ray Equipment Xmas 6530 Hospital Furniture Fruit 6532 Hospital/Surgical Clothing Cake 6540 Opticians Instruments On 6545 Medical Sets, Kits, Outfits Kings 6550 Invitro Diagnostic Substances Island PATIENT CARE OR - 55 TO 60% Humidity - 65 to 740F - O2 Marked with DD Form 1191 Autoclave doesnt begin until it is above 2450 F 3 min 2700 F Flash 8 min 2570 F 18 min 2450 F Dry Heat Sterilization 3200 F for 2 hrs Chemical Glutaraldehyde 10 hrs ETO Gas 3-7 hrs air out Anesthesia Stage 1 Analgesia or Induction, senses Stage 2 Excitement Respond violently to little stimulation Stage 3 Surgical/Operation 4 levels to con. ????

surgical stainless steel only exception to suture material that is sterilized scrub hands to 2 above elbows 30 strokes across fingertips

OR Floor cleaned using wet vacuum method mop least desired 4 Parts of Communication 1) Sender 3) Receiver 2) Message 4) Feedback Barriers to Effective Comm 1) Physical 2) Physiological 3) Psychosocial

BMR Material Conditions or Readiness X-ray least watertight integrity/greatest ease of access. Yoke - greater than x-ray < max condition Zebra greatest degree of subdivision and watertight integrity Circle X-ray/Yoke access fitting to battle stations/compartments Circle Zebra - closed when zebras set, only opened by CO Dog Zebra - Darken Ship William Fittings are vital sea suctions, ventilation Circle William Secured during CBR attacks, ventilation to outside of ship Emergency Escape Breathing Device (EEBD) 13 min air Supplemental Emergency Egress Device (SEED)

FIRES Class A B C D FLAGS Material Wood/Wood products Flammable Liquids Energized Electrical Fires Combustible Metals Extinguisher Water AFFF AFF Halon 1211/1301, PKP CO2, Halon 1211, Water Spray H20 in fog patterns

Code Alpha Divers are down Mike Medical Guard Oscar Man Overboard Papa General Recall Quebec Boat Recall Yankee Visual Communication Duty Union Jack In Port flown from jack staff from 0800 to sunset National Ensign In Port flown from flagstaff at stern from 0800 to sunset Underway flown from gaff Navy Bday Oct 13, 1775 John Paul Jones Struck Sir?, I have not yet begun to fight. Capt Oliver Perry fought on Lake Erie TERMS Lengthwise direction is fore/aft Crosswise arthwartships Bow front of ship Stern rear of ship Centerline divides ship into port/starboard Port - L side Starboard R side Amidships - Section around midpoint area Hull supporting body of the ship Keel backbone of the ship Strakes plates that forms the ships hull Waterline water level along hull of ship afloat Freeboard distance from waterline to main deck Ch 6 Naval Organization - 1947 DOD was created Included by Chairman and military head from each branch (Army, Navy, Air Force, Marine Corps)

Mission 1) Support/Defend Constitution 2) Ensure US Security 3) Uphold/Advance National Policies 4) Safeguard Internal Security of US

Dept of the Navy Objectives 1) Organize, train, equip, prepare, and maintain readiness of USN/USMC to perform military missions. 2) Support USN/USMC Forces as well as other forces. SECNAV Responsibilities 1) Conduct recruiting, organizing, supplying, equipping, training, mobilizing, demobilizing. 2) Oversee construction, outfitting repair USN ships/facilities. 3) Formulate/Implement policy. - Navy founded Oct 13, 1775 - Dept of Navy established Apr 30, 1798 Dept of Navy Principal Components 1) navy Dept including executive offices in DC 2) Operating USN/USMC forces 3) Shore establishment Guide for Unit Organization OPNAVINST 3120.32 - Standard Organizational & Regulations of the USN 2 Elements of Ships Organization - Battle Organization - Admin Organization Ship divided into 5 dept 1) Navigation 2) Engineering 3) Operations 4) Supply 5) Weapons/Deck

Dept Head Div Officer Sections

Senior PO Commanding Officer - Safe navigation, condition/appearance of material/personnel - Prepare ship for battle - Maintain command in state of max readiness - Issues necessary directions to XO - During combat CO directs battle - According to UCMJ CO has power to impose limited punishment - Given advice by Senior Enlisted

Rescue Operations 1st Phase remove lightly pinned 2nd Phase remove more difficult trapped 3rd Phase extreme difficult Last Phase dead bodies Stages of Extrication 1st gaining access 2nd lifesaving care 3rd disentanglement 4th prepare victim for removal 5th remove/transport. SUPPLY NAVSUP Manual Vol I Introduction to Supply Vol II Supply Ashore Vol III Retail Clothing Stores/Commissary Stores Vol IV Transportation of Property NAVSUP P-437 Operating Procedures Manual for Military Standard Requisitioning and Issue Procedures Appropriations Annual generally cover expenses of Navy by fiscal years Continuing available for incurring obligations until funds are exhausted

Multiple-year Appropriations long lead time, only for specified period of time AMAL minimum amount of medical material to be maintained Tycom first aid gun bags, airways, litters, battle dressing supplies Federal Supply Classifications system designed to permit the classification of all items. - classified by 4-digit #: 1st 2 digits major group/ 2nd 2 digits class of commodities National Stock # (NSN) 4 digit classification code National Item Id # (NIIN) 9 digits, identifies item Navy Item Control # - identifies items of material that are not in FSC but are stocked in the Navy Supply System.