Slide 1

Life Span Development

PREHOSPITALEMERGENCY CARECopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedPrehospital Emergency Care, 10th editionMistovich | KarrenTENTH EDITIONPrehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedAdvance PreparationStudent ReadinessAssign the associated section of MyBRADYLab and review student scores.Review the chapter material in the Instructor Resources, which includes Student Handouts, PowerPoint slides, and the MyTest Program.PrepareConsider asking a pediatric nurse or early childhood development specialist from a day care center to be a guest speaker on child development.Bring a bag of cotton balls, cheap pairs of weak reading glasses, some petroleum jelly, gardening gloves, some sewing needles, and thread for a class activity (explained later in the chapter)Plan 60 to 75 minutes for this class as follows:Life Span Development: 60 minutesDescribes characteristics of physical and psychosocial development from infancy through late adulthoodThe total teaching time recommended is only a guideline. Take into consideration factors such as the pace at which students learn, the size of the class, breaks, and classroom activities. The actual time devoted to teaching objectives is the responsibility of the instructor.1Setting the StageOverview of Lesson TopicsLife span developmentNeonates and infantsToddlersPreschool-ageSchool-ageAdolescenceEarly, middle, and late adulthood

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedIntroductionDuring this lesson, students will learn about the stages of life span development and how to apply this knowledge to emergency care.

Case StudyPresent the Case Study Introduction provided in the PowerPoint slide set.Lead a discussion using the case study questions provided.The Case Study with discussion questions continues throughout the PowerPoint presentation.

2IntroductionPeople change physically and psychosocially throughout their lifetimes.EMTs must be able to incorporate knowledge of each stage into patient assessment and management.

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedThe life span is divided into infancy, toddler, preschool-age, school-age, adolescence, and early, middle, and late adulthood.3Table 9-1 Normal Vital Signs Throughout a Life Span

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedAs noted on this slide, vital signs change throughout the life span.4Neonates and InfantsNewborn first few minutes of lifeNeonate birth to 28 days (1 month) of age.Infant 28 days (1 month) to 1 year of age.

During this period, a child undergoes rapid growth and development.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedThe term newborn refers to the related to the first few minutes of life. The term neonate refers to birth to 28 days of life. The term infant is used from 28 days to 1 year of age. During this time, the child undergoes rapid growth and development. 5Newborn/Neonate

continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved12-month-old infant.

continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedNeonates and InfantsNeonatal characteristicsRespiratory rate 4060/min. at birth, decreasing to 3040/min. within minutesTidal volume 68 mL/kgHeart rate 140160/min. at birth, decreasing to 100160/min. in minutesSystolic BP 70 mmHgTemperature 98F to 100Fcontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved8Neonates and InfantsBy age 1 yearRespiratory rate 2030/min.Tidal volume 1015 mL/kgHeart rate 120/min.Systolic BP 90 mmHgTemperature 98F to 100Fcontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved9Neonates and InfantsPhysiological developmentAverage birth weight is 3.03.5 kg.The head accounts for 25% of the body weight.Birth weight drops 510% in the first 2 weeks.Thereafter, the weight continues to increase.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedPoints to Emphasize: Infancy is a time of enormous growth and development. Significant changes occur in the first year of life. Compared to adults, infants rely more upon their noses and diaphragms when they breathe.

10Neonates and InfantsPhysiological developmentPrimarily nose breathers until 4 weeks of ageAirways are easily obstructed.There are fewer alveoli and lung tissue is fragile.The chest wall is soft with weak accessory muscles.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedTalking Points: While the fetus is in the mothers uterus, the lungs do not function, and there is a different pattern of circulation before birth than after. The transition from fetal circulation to pulmonary circulation usually occurs within the first minutes or hours after birth. The infants airway is shorter, narrower, less stable, and more easily obstructed than at any other stage in life. Nasal congestion can cause breathing difficulty. Infants are also diaphragm breathers; you may see more movement in the abdomen than the chest. 11Neonates and InfantsPhysiological developmentFatigue can occur easily from respiratory distress.Observe the abdomen for work of breathing.Increased respirations can lead to dehydration and heat loss.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedWith breathing difficulty, infants fatigue easily because their accessory muscles are less mature and tire easily. 12Neonates and InfantsPhysiological developmentImmune system is immature; immunizations are important.Infants have several important reflexes.Movement of extremities should be symmetrical.Inability to localize paincontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedThe antibodies passed to the infant from the mother help protect the infant until they can produce their own antibodies, either from vaccination or exposure to diseases.

Reflexes:Moro reflex (Startle) Throws arms out, spreads fingers, grabs with fingers and armsPalmar reflex Grasps objects placed in palm (Within a couple of months, this merges with the ability to release an object from the hand.)Sucking reflex Sucks when lips are stroked (This reflex works in conjunction with the rooting reflex.)Rooting reflex Turns toward side of head touched

These movements should be relatively equal on both sides.

13Neonates and InfantsPhysiological developmentPosterior fontanelle closes at 3 months.Anterior fontanelle closes between 9 and 18 months.Examine the fontanelles for assessment of hydration.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedThe bones at the top of the skull are not fused at birth. The soft spot where these bones meet is called a fontanelle. The posterior fontanelle usually closes in 23 months; the anterior fontanelle between 918 months. Looking at the anterior fontanelle gives a good idea of the infants state of hydration. Normally the fontanelle is level with or slightly below the surface of the skull. A sunken fontanelle indicates dehydration. A bulging fontanelle indicates increased pressure inside the skull.14Neonates and Infants2-month milestonesTrack objects with eyes.Focus on objects 812 inches away.Recognize familiar faces.Display primary emotions and facial expressions.Hear and recognize some familiar sounds and voices.Move in response to stimuli. continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved15Neonates and Infants6-month milestonesSit upright in a high chair.Make one-syllable sounds (e.g., ma, mu, da, di).Raise and support upper body when on stomach.Grasp and shake hand toys.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedNeonates and Infants6-month milestonesPush down on legs and feet when held over a firm surface.Follow moving objects with eyes.Recognize familiar objects at a distance.Begin to babble and try to imitate familiar sounds.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedNeonates and Infants12-month milestonesWalk with help.Know own name.Sit without assistance.Crawl and creep on hands and knees.Put objects into containers.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedNeonates and Infants12-month milestonesPoke objects with fingers.Respond to simple requests and "no".Say "mama" or "dada".Imitate some words, gestures, and facial expressions.Begin to use objects like brushes, cups, or phones correctly.Finger feed self.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedNeonates and InfantsPsychosocial changesParents must meet the infant's physical, emotional, and psychological needs for healthy development.Infants do not like to be separated from caregivers.Infants communicate through crying.Can detect and respond to parents' emotions

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedAn infants chief means of expression is crying. Within the first 6 months, infants start displaying the following characteristics: Bonding. This is their sense that their needs will be met. When they are hungry, they are fed. When they need to be held, they are held. Trust vs. mistrust. Infants like orderly, predictable environment. When the environment is disorderly and irregular, infants develop anxiety and insecurity. Scaffolding. Infants learn by building on what they already know. Temperament. This is an infants reaction to the environment.

20Toddlers and Preschoolerscontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved21A toddler

continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedA toddler is 1 to 3 years of age.22ToddlersToddler characteristicsHeart rate 80130/min. Respiratory rate 2030/min. Systolic BP 70100 mmHgTemperature 98.6F99.6Fcontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved23A preschooler

continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedA preschooler 3 to 6 years of age. 24PreschoolersPreschooler characteristicsHeart rate 80120/min. Respiratory rate 2030/min. Systolic BP 80110 mmHgTemperature 98.6F99.6Fcontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedToddlers and PreschoolersPhysiological changesIncreased body mass with decreased body fatPrimary teeth have emergedIncreased number of alveoli in the lungsLoss of passive immunity, but active immunity develops through exposure to pathogenscontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedBody systems continue to grow and refine themselves. Pulmonary system. Terminal airways branch and grow. Alveoli increase in number. Nervous system. Brain is now 90 percent of adult brain weight. Fine motor skills develop. Musculoskeletal system. Muscle mass and bone density increase. Immune system. More susceptible to illness. Develops immunity to pathogens as exposure occurs and through vaccination. Teeth. By 36 months, toddler has all primary teeth.

26Toddlers and PreschoolersPhysiological changesBrain develops quickly, as do motor skills.Toilet training is complete around 28 months.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedThe toddlers mental and social development continues, and the child develops more individuality. This age groups curiosity has led to such terms as curtain climbers or rug rats. Their developing personality is sometimes referred to as the terrible twos. These years can be very rewarding for both toddler and caregivers. By 12 months, toddlers begin to understand that words mean something. They are likely to be toilet trained by 28 months. By ages 34, they have mastered the basics of language.

27Toddlers and Preschoolers3-year milestonesWalk alone and begin to run.Pull or carry several toys when walking.Climb up and down furniture or stairs with minimal support.Scribble and play with toys.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedToddlers and Preschoolers3-year milestonesRecognize names, faces, voices, objects, and body parts.Find hidden objects.Sort objects by shape or color.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedToddlers and Preschoolers5-year milestonesStand on one foot for more than 10 seconds.Hop, jump, swing, climb, and do somersaults.Dress and undress without assistance.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedDuring the preschool years, this age group is typically introduced to social interaction in day care or preschool. Anatomical development continues. Mobility and dexterity increase.30Toddlers and Preschoolers5-year milestonesUse forks, spoons, and sometimes knives appropriately.Count ten or more objects.Trace and draw pictures.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedToddlers and PreschoolersPsychosocial changesLanguage develops.Development of separation anxiety at about 18 monthsPlaytime helps with social skills.Speak at the child's level.Allow him to touch equipment, if appropriate.

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedToddlersBegins to develop magic thinking, imagination, and ability to role play

32School-Age Childrencontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved33A school-age child

continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedA child between 6 and 12 years of age34School-Age ChildrenVital signsHeart rate 70110/min. Respiratory rate 2030/min. Systolic BP 80120 mmHgTemperature 98.6Fcontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedSchool-Age ChildrenPhysiological changesBones increase in density and grow large.Primary teeth are replaced with permanent teeth. Ability to read and writeNocturnal enuresis may continue after the age of 10.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedAnatomical development continues, but school-age children develop most rapidly from a psychosocial standpoint. Socialization and independence from parents create a developmental growth spurt in this time frame. School-age children develop the capabilities of reasoning. EMTs can utilize this capability to assist with assessment and treatment.36School-Age ChildrenPsychosocial changesFriendships are important.Problem-solving skills develop.Self-concept, self-esteem, and morals develop.Increased understanding of pain, illness, injury, and death

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedAdolescentscontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved38Adolescents

continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedAdolescents are between 12 and 18 years old.39AdolescentsVital signsHeart rate 55105/min.Respiratory rate 1220/min.Systolic BP 100120 mmHgTemperature 98.6F continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved40AdolescentsPhysiological changes2- to 3-year growth spurtGirls are done growing by age 16, boys by age 18.Puberty and reproductive maturitycontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedAdolescents experience a rapid 2- to 3-year growth spurt, beginning with enlargement of feet and hands followed by enlargement of arms and legs. Chest and trunk enlarge in the final stage of growth. Girls are usually finished growing by age 16; boys by 18. In late adolescence, the average male is taller and stronger than the average female. Both males and females reach reproductive maturity. Secondary sexual development occurs, with noticeable development of external sexual organs. In females, menstruation begins and breasts develop.

41AdolescentsPsychosocial changesChanges can result in family conflict.Believe they are the focus of others' attention and have a feeling of invulnerabilityDesire to be treated as adults, but legally cannot make medical decisionsPrivacy is important.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedAdolescents want to be treated as adults but are not yet allowed to make their own medical decisions. Adolescence can be a time of serious family conflicts as the adolescent strives for independence and parents strive for continued control. This is a time when eating disorders are common. It also is a time when self-destructive behaviors begin, such as use of tobacco, alcohol, illicit drugs, and unsafe driving. Depression and suicide are alarmingly common in this age group. As adolescents develop their capacity for logical, analytical, and abstract thinking, they begin to develop a personal code of ethics.

42AdolescentsPsychosocial changesExperimentation with alternate identitiesUnderstand there are consequences for actionsMay engage in self-destructive behaviors; depression and suicide increaseConcerned with body imageMay engage in sexual behavior

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedSometimes you must explain the risks of withholding information to them, such as delays in treatment. Its pretty easy to figure the mechanism of injury if they recorded it for YouTube!43Early Adulthoodcontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedAges 20 to 40 years44Early AdulthoodVital signsHeart rate 70/min.Respiratory rate 1620/min.BP 120/80 mmHgTemperature 98.6Fcontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved45Early AdulthoodPhysiological changesOptimum function of body systemsPhysical peak between 19 and 26 yearsAccidents are the leading cause of death.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved46Early AdulthoodPsychosocial changesIncreased responsibility and independenceMay marry and begin familiesBeginning careers, high levels of job stress

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedEarly adulthood sees anatomical development reach full maturity. In many cases, development often reaches peak physical condition. Psychosocial development now introduces new responsibilities and stresses. These stressors play a role in physiological disease and can make assessment and treatment more difficult47Middle AdulthoodThe Sandwich Years

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedAges 40-6048Middle AdulthoodVital signsHeart rate 70/min.Respiratory rate 1620/min.BP 120/80 mmHgTemperature 98.6Fcontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved49Middle AdulthoodPhysiological changesSome decline in body systems and concerns with chronic diseaseWeight gain may occur.Vision changesWomen undergo menopause in their late 40s to 50s.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved50Middle AdulthoodPsychosocial changesProblems seen more as challenges than threats.More developed coping skillsAware of time limitsFocus on others, rather than selfTransitions in parenting

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedThere are no significant changes in vital signs from early adulthood. Adults start to have vision problems and often wear glasses. Cholesterol may be high, and adults are concerned about health problems. For women, menopause commences. Heart disease is the major killer after 40 in all age, sex, and racial groups. Adults become more task oriented as they see the time for accomplishing lifetime goals diminish. They tend to approach problems more as challenges than as threats. With their children starting lives of their own, they are experiencing empty-nest syndrome. This may also be a time of increased freedom and opportunity for self-fulfillment. They are also concerned about their aging parents.

51Late Adulthood

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedAges 61 years and older52Late AdulthoodPhysiological changesMaximum life span is 120 yearsLife expectancy varies with year of birth. Incidence of disease increases.Cardiovascular system changes increase the myocardial workload.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedVital signs will depend on physical and health condition. The cardiovascular system becomes less efficient, and the volume of blood decreases. Adults are less tolerant of tachycardia (fast heart rate). 53Late AdulthoodPhysiological changesRespiratory system changes diminish ability to cough, lung capacity, and gas exchange.The brain becomes smaller, with some neuron loss.There may be memory problems and disruption of sleep cycle.Reaction time slows.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedThe respiratory system deteriorates, making development of respiratory disorders more likely. Changes in the endocrine system result in decreased metabolism. The sleep-wake cycle is disrupted, causing sleep problems. All other body systems are deteriorating. 54Late AdulthoodPhysiological changesDiminished smell, taste, hearing, visionDiminished pain perception and kinesthetic senseProne to fallscontinued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved55Late AdulthoodPhysiological changesProblems with hydration and nutritionChanges in ability to communicateHealth status varies widely.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedHow long can the adult live at home becomes an important question. Is assisted living, or perhaps a nursing home, needed? Though having slowed down, the adult is concerned with producing quality work. With limited income and increasing expenses, financial concerns weigh heavily. The adult sees friends and relatives become ill and die. Concerns about the adults own health condition and mortality often come to mind.56Late AdulthoodPsychosocial changesMay be satisfied with the outcome of life, or regrets can lead to depressionFeelings of isolation may occur.Financial difficulties may occur.Decreased independence can affect feelings of well-being.

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights ReservedLesson SummaryPeople develop and change throughout their life span.Changes are both physical and psychosocial.It is important to know what is normal for each stage.continued on next slide

Prehospital Emergency Care, 10th editionMistovich | KarrenCopyright 2014, 2010, 2008 by Pearson Education, Inc.All Rights Reserved58