EMR First on Scene 3

hypoglycemia

Low blood glucose (sugar) levels and can cause altered mental status, lethargy, unconsciousness and seizures.

What are the limitations of monitoring devices?

Monitoring devices are tools to suppliment traditional examination skills and can provide faulty readings based on various situations such as poor calibration, improper use, etc... ALWAYS remember to treat the patient NOT the monitor-(re-verify the information).

When lifting a patient your feet should be placed:

a comfortable distance apart.

Pale skin color is...

a result of constricted blood vessels possibly resulting from blood loss, shock, decreased blood pressure, emotional distress.

Cold, dry skin temp is...

a sign of exposure to cold, diabetic emergency.

Hot, dry skin temp is...

a sign of high fever, heat emergency, spine injury.

Jaundiced (yellow) skin color is....

a sign of liver abnormalities.

Hot, moist skin temp is...

a sign of possible high fever, heat emergency, diabetic emergency.

What device would be best suited to carry a responsive patient w/ no suspected spine injury down a flight of stairs.

a stair chair.

Which 1 of the following patients would best be served by being placed in the recovery position? a) an unresponsive child following a seizure. b) an adult in cardiac arrest & in need of CPR. c) an unresponsive child who is face down in a pool. d) an adult victom of a MVA

a) an unresponsive child following a seizure.

Before restraining a combative patient, the EMR should obtain ________ approval.

a) law enforcement (page 627) personally if law inforcement is there to gain approval from I'd let them do it.

All of the following are goals of therapeutic communication, EXCEPT: a) pain management b) collecting information c) assessing behavior d) providing education

a) pain management

An EMR should immediately move a patient EXCEPT when the patient: a) has a blocked airway. b)is bleeding severly. c) has mild shortness of breath. d) is in cardiac arrest.

c) has mild shortness of breath

Which one of the following is most accurate when describing a palpated blood pressure? a) It provides only the diastolic pressure b) It must be taken on a responsive patient c) It can be obtained w/o a stethoscope d) It can be obtained w/o a BP cuff

c) it can be obtained with out an stethoscope

An absence of a pulse indicates

cardiac arrest (clinial death)

What are the two pulse points that are referred to as central pulses?

carotid and femoral

The most approprate location to obtain a pulse for an unresponsive adult is the ...

carotid artery

Constricted, nonreactive pupils indicate possible ....

central nervous system damage, certain medications.

P E R L is an acronym used for ....

characteristics of pupils Pupils, Equal, Reactive, Light.

Cyanotic (blue) skin color is.....

due to a lack of oxygen in blood cells and tissues resulting from inadequate breathing or heart function.

O P Q R S T is an mnemonic used.....

during a secondary assessment to help assess pain, they stand for Onset, Provocation, Quality, Region/Radiate, Severity, Time began/How long

When assessing a patient's respirations, you must determine rate, depth and

ease

diaphoretic

excessive seating; commonly caused by exertion or some medical problem, such as heart attack and shock

A rapid pulse may result from:

exertion, anxiety, pain, fever, dehydration, blood loss, shock.

The four types of body language are...

verbal, nonverbal, written, and visual.

Describe strategies for successful interviewing...

*Introduce yourself immediately, *Obtain the patient's name and use it frequently, *Position yourself at or below the patient's eye level whenever possible, *Ask one question at a time allowing the patient ample time to respond, *Listen carefully to everything the patient tells you, *Restate the patient's answer when necessary.

A good transfer of care should contain.....

*Patient's name and age, *Chief complaint, *Brief account of the patient's current condition, *Past pertinent medical history, *Vital signs, *Pertinent findings from the physical exam, *Overview of care provided and patients response to that care.

A respiratory rate that is less than _____ for an adult should be considered inadequate.

10

This is used for wilderness or cliff rescue situations.

A basket stretcher, it is sometimes referred to as a Stokes basket.

stethoscope

A device used to auscultate sounds within the body; most commonly used to obtain blood pressure.

end-tidal CO2 detector

A device used to detect the presence of CO2 in the exhaled breath of a patient.

cardiac monitor

A device used to display the electrical activity of the heart.

glucometer

A device used to measure and display the amount of glucose in a given sample of blood.

pulse oximeter

A device used to measure and display the percentage of hemoglobin in the blood that is saturated with oxygen.

patient care report (PCR)

A document that provides details about a patient's condition, history, and care as well as information about the event that caused the illness or injury.

This type of device requires a second person to lift the undercarraige prior to pushing it into the ambulance.

A dual-operator stretcher.

repeater

A fixed antenna that is used to boost a radio signal.

interpersonal communication

A form of communication where the participants are dependent on one another and have a shared history.

portable radio

A handheld device used to transmit and receive verbal communication.

base station radio

A high-powered two-way radio located at a dispatch center or hospital.

blanket drag

A method used to move a patient by placing him on a blanket or sheet and pulling it across the floor or ground.

log roll

A method used to move a patient with a suspected spine injury from the prone position to the supine position. (instructor said minimun of 3 people is required to do this effectivly; 4 if spine is compromised to stabilize head during movement. Always inspect back, buttox, & legs. If you are a single rescuer and MUST preform this move , grasp the shoulder and hips and roll the patient toward you.)

firefighter's carry

A method used to walk to safety with a patient securely placed over one shoulder.

extremity lift

A move performed by two rescuers, one lifting the patient's arms and one lifting the patient's legs. (The instructor said this is not a preferred method, but sometimes is the only option)

What are normal and abnormal values displayed by an end-tidal CO2 detector?

A normal ETCO2 level is 35-45 mmHg.

Differentiate normal and abnormal values displayed by the pulse oximeter.

A normal saturation level is above 97%. Saturation levels below 90% are NEVER normal and should be corrected quickly with supplemental oxygen. Levels as low as 90% could be normal for a patient w/ chronic lung disease such as COPD.

emergency move

A patient move that is carried out quickly when the scene is hazardous, care of the patient requires immediate repositioning, or you must reach another patient who needs lifesaving care.

This device is light, folds or collapses, is typically canvas and aluminum and makes moving a patient down stairs or out of tigh spaces easier to do.

A portable stretcher.

Fowler's position

A position in which a patient is places fully upright in a seated position, creating a 90-degree angle. Breathing can often be aided by placing a patient in this position.

Trendelenburg position

A position in which the patient is placed flat on his back with his legs and feet raised. Used for patients who suspect may be suffering from shock. (Place the patient supine on a long spineboard or stretcher with the foot of the device raised 12-18".

contraindication

A reason that a medication should not be administered to a patient because of the potential for harmful effect.

This is typically made of hard plastic or aluminum and splits vertically into two pieces. It is commonly used for picking up and moving a patient w hip injuries or multiple injuries rather than for spine injuries. It can also be used to transfer patients from a bed or the floor to a wheeled stretcher or from a wheeled stretcher to a hospital bed.

A scoop stretcher.

This device is used for a patient that is found either lying down or standing and have suspected spine injuries.

A spine board also know as a back board.

This device assists in moving a medical patient down stairways and through tight places. It has a sturdy folding frame with wheels making it easy to store and be rolled over flat surfaces.

A stair chair.

direct ground lift

A standard lift in which three rescuers move a patient from the groung to a bed or stretcher. (Use splint, slide board, rug etc... to lift patient w)

power lift

A technique used to life a patient who is on a stretcher or cot.

autoinjector

A type of device used to self-administer some medications by way of needle injection.

A common tool used in EMS to classify a person's mental status is the ______ scale.

AVPU scale. Alert Verbal Pain Unresponsive

firefighter's drag

Aa move in which the rescuer straddles the supine patient, secures the patient's hands behind the rescuer's neck, and then crawls to safety while dragging the patient underneath him.

Describe the indications, contraindications, actions, and side effects of activated charcoal.

Activated charcoal is administered to patients who have ingested a poison or who took an overdose of oral drugs or medications. It binds w/ the poisonous substance & also helps prevent it from being absorbed by the body. Do not give to anyone w/ an altered mental status, is unable to swallow, or whose injested acids or alkalis. Side effects are black stools and possible vomiting. It a patient vomits, repeat the dose once.

normal respiration rate for adult, adolescent,school age, preschooler, toddler, infant, & newborn

Adult & Adolescent 12-20; School age (6-10 yrs) 15-30; Preschooler-Infant (5yrs-1 month) 20-30; Newborn 30-50

Normal Bp for an Adult

Adult 120/80;

Normal pulse for an Adult, Adolescent, School age, Preschooler, Toddler, Infant 6-12 mos, Infant 0-5 mos, newborn

Adult 60-100; Adolescent 60-105, School age 70-110, Preschooler 80-120, Toddler 80-130, Infant 6-12 mos 80-140, Infant 0-5 mos 90-140, newborn 120-160 *In infants and children , a high pulse is not as great a concern as a low pulse. A low pulse may indicate imminent cardiac arrest.

Proper dragging technique

Always pull in the direction of the long axis of the patient's body. Do not pull a patient sideways, avoid bending or twisting the patients trunk.

Explain the role of the EMR when assisting a patient w administration of medication.

An EMR may only administer or assist with specific medications and then only with medical direction and you must check the 5 rights by asking the proper questions prior to assisting or administering any medications.

side effect

An action of a medication that is not desired.

This device is equipped with a pneumatic or electronic mechanism that will lift and lower at the touch of a button.

An electric/pneumatic-lift stretcher; this stretcher minimizes the need for rescuers to lift a stretcher w a patient on it, thus reducing back injury.

clothing drag

An emergency move in which a rescuer grabs the patient's clothing near the shoulders and pulls him to safety.

body language

Communication using the movements and attitudes of the body.

positional asphyxia

Death resulting from securing a person in the prone position, limiting his ability to breathe adequately. Also called restraint asphxia.

shock position

Elevation of the feet of a supine patient 6-12". Recommended for shock that is not caused by injury. This position should ONLY be used for a patient exibiting signs of shock AND have NO evidence of trauma or other injury.

In a SAMPLE history E represents

Events leading to illness or injury

continuity of care

How each new provider, who is assuming care for a patient, is properly informed of the patient's progression, so he can watch for trends and continue effective treatments.

Describe the indications, contraindications, actions, and side effects of oral glucose.

Indications: Patient has altered mental status w/ a known history of diabetes, patient has taken insulin but no food recently and may have been very physically active. Actions: Increases blood sugar levels. Side Effects: None when given properly. Contraindications: Unresponsiveness or unable to swallow or otherwise manage own airway, Known diabetic who has not taken insulen for days.

Describe the indications, contraindications, actions, and side effects of metered-dose inhalers.

Indications: must meet all of the following criteria: Patient exhibits signs and symptoms of respiratory difficulty; has a physician-prescribed inhaler; Medical direction gives EMR specific authorization to use. Contraindications: Altered mental status (such as the patient is unable to use the device properly), No permission has been given by medical direction, Patient has already taken the maximum prescribed does prior to rescuer's arrival. Actions: dilates bronchioles,reducing airway resistance. Side effects: Increased pulse rate, anxiety, nervousness.

Describe the indications, contraindications, actions, and side effects of nitroglycerine.

Indications: patient complains of chest pain, has a history of cardiac problems, has a Rx for nitroglycerine, systolic Bp is greater than 100, Medical direction authorizes administration of the medication. Actions: Dilates blood vessels, decreases workload if the heart. Contraindications: Systolic Bp <100, head injury,maxium prescribed dose already taken, is expired. Side Effects: Hypotension (lowers Bp), headache, changes pulse rate, dizziness, lightheadedness.

run data

Information about the call itself: names of the EMR responding, the organization they work for, date and time of incident, certification levels of those providing patient care, final outcome of the call, patient's refusal to be treated or the name of the person who assumed care from you.

Describe the procedure for appropriately attaching cardiac electrode pads to a patient.

Most monitors have labels on the end of each cable indicating where on the body they should be placed, such as LL for left leg RA for right arm. Some use a color code system in which case the black lead is for the upper left extremity or chest, the red lead is for the lower left extremity or chest and the white lead is for the right upper extremity or chest. As a general rule, electrodes should always be placed over muscle or fat tissue, not boney areas.

What factors might cause a pulse oximeter to provide inaccurate readings?

Nail polish, hypothermia, carbon monoxide poisoning.

7 routes for administering medications are ...

Oral or swallowed; Intramuscular; Sublingual; Inhaled; Endotracheal or sprayed into a tube inserted into the trachea; Transdermal patches or transdermal infusion systems; Intranasal. See page 612 for explaination of each route

Describe the indications, contraindications, actions, and side effects of as epinephrine autoinjector.

Patients MUST meet the following 3 criteria: Exhibits signs of a severe allergic reaction, including respiratory distress or shock; Medication is prescribed for this patient by a physician; & Medical direction authorizes use for this patient. There are NO contraindications when used in a life-threatening situation. Epinephrine dialates the broncholes and constricts blood vessels. Side effects: increased heart rate, dizziness, chest pain, headache, nausea, vomiting,excitability,anxiety,pale skin.

This immobilization device is used for infants and children.

Pedi-board

List the 7 common barriers to effective communication...

Physical, Perceptual, Emotional, Cultural, Language, Gender, & Interpersonal. pg 118- to know what these mean.

Describe the characteristics of proper body mechanics.

Position feet properly; lift w/ legs, keeping back straight; avoid leaning to either side; minimize twisting; keep weight as close to your body as possible; communicate clearly with those assisting you; on stairways use stair chair and have a "spotter" walk behind you guiding you as you walk backwards.

What is the purpose of an end-tidal CO2 detector (ETCO2)?

Primarily to verify proper placement of an endotrachael tube following intubation. If the tube is misplaced, such as in the stomach, then no CO2 will be returned or detected by the device.

List the 5 "rights" of medication administration.

Right patient, Right medication, Right dose, Right route, Right time

semi-Fowler's position

Semi-seated position in which the patient reclines at a 45-degree angle. Breathing can often be aided by placing a patient in this position.

sign

Something that can be observed or measured when assessing a patient.

symptom

Something that the patient complains of or describes during the secondary assessment.

medications

Something that treats, prevents, or minimizes the symptoms of disease.

What type of move is used when there is no immediate threat to the patient's life?

Standard

What is the difference between a standard move and an emergency move and when would each be used?

Standard moves are lifting and moving of patients for non-emergent reasons such as comfort or preparation for transport. Emergency moves are when a patient must be moved immediately. ie immediate danger, the inability to access and care for ABC's,to gain access to other patients needing lifesaving care. Lifesaving care outweighs the risks associated with moving patients quickly.

electronic documentation

Technology such as computers, PDA's, and cell phones and their use to document condition and care .

respiration

The act of breathing in and out; also, the exchange of oxygen and carbon dioxide within the cells.

trending

The act of comparing multiple sets of signs and symptoms over time to determine patient condition.

auscultation

The act of listening to internal sounds of the body, typically with a stethoscope.

palpation

The act of using one's hands to touch or feel the body

communication

The activity of conveying information.

cyanotic

The bluish coloration of the skin caused by an inadequate supply of oxygen; typically seen at the mucous membranes and nail beds

work of breathing

The effort that a patient must exert to breath.

minimum data set

The essential information that MUST be gathered and documented on every patient care report: Time the incident was reported to 911, Time of dispatch, Time of arrival at patient's location, Time the patient was transported from the incident location, Time the patient arrives at the destination, Time patient care was transferred to more advanced providers, Patient's chief complaint, Vital signs, Demographics (age,gender,race,weight)

therapeutic communication

The face-to-face communication process that focuses on advancing the physical and emotional well-being of a patient.

This device is made of rubberized canvas with wooden slats sewn into pockets, has 3 carrying handles on each side and can be useful in restricted areas or narrow hallways.

The flexible stretcher.

This is a full body vaccume splint. It consists of large airtight bad filled w/ tiny beads, which mold to fit the shape and contours of the patient's body. Once in place the air is removed and becomes a hard cast like splint that immobilizes the patient.

The full-body immobilization device.

actions

The intended effect of a drug on the body.

blood glucose

The level of glucose in the bloodstream at any given time.

Explain the purpose of a cardiac monitor.

The main purpose is to allow EMS provider to easily monitor the heart rate and the rhythm.

Explain the two values that a pulse oximeter monitors.

The percentage of oxygen saturation and the heart rate.

receiver

The person for whom the message is intended.

sender

The person introducing a new thought, concept or iniating the communication process.

transfer of care

The physical and verbal handing off of care from one health-care provider to another.

recovery position

The position in which a patient with no suspected spine injuries may be placed, usually on the left side. Also called lateral recumbent position.

standard move

The preferred choice when the situation is not urgent, the patient is stable, and you have adequate time and personnel for a move.

diastolic

The pressure that remains in the arteries when the heart is at rest; the resting phase of the heart.

systolic

The pressure within the arteries when the heart beats; the contraction phase of the heart.

pulse

The pulsation of the arteries that is felt with each beat.

indication

The reason a medication should be administered.

What is the name of the device that allows a single operator to load a patient into an ambulance?

The single-oporator stretcher. It's undercarraige is designed to collapse and fold up as the stretcher is pushed into the ambulance.

message

The thought, concept, or idea that is being transmitted.

body mechanics

The use of the body to facilitate lifting & moving to minimize injury.

This type of device is used to help immobilize and remove patients found in a seated position in a vehicle.

The vest-type extrication device. This wraps around the patients torso to stabilize the spine and has an extended section above the vest with side flaps for stabilixing the head and neck. The vest-type extrication device is commonly replacing the short spine board.

restraint

Tthe process of securing a combative patient's body and extremities to prevent injury to himself or others. ( Must justify why restraints were used and clearly document EVERYTHING. Leather, fabric,cloth straps, gauze,sheets, clothing, cravats are types of soft restraints that will not harm patients and ONLY ALLOWED when necessary AND with DR's ORDERS used as the last resort. Use tactical retreat and reassess the situation before requesting permission to use restraints.)

baseline vital signs

Tthe very first set of vital signs obtained on a patient.

The words and sounds that make up a language is a description of what type of communication?

Verbal

Name the various carrying and "packaging" devices used by EMS personnel.

Wheeled stretchers are known commonly referred to as a gurney, stretcher, cot, or pram; these are used to transport the patient from a scene to the ambulance to the hospital bed. Other stretchers: scoop, portable, flexible, basket. Other devices: spine boards, extrication vests, full body immobilization device, pedi-board.

Communication is best defined as:

an interchange of ideas or information.

The load on your back is minimized if you can keep the weight you are carrying...

as close to your body as possible.

Patient care reports are used for all of the following EXCEPT: a) billing b) press releases c) quality improvement d) lawsuits

b) press releases

The first set of vital signs obtained on any patient is referred to as the

basseline set.

Nonverbal communication is best characterized by:

body language

The majority of a message is delivered by way of:

body language.

Goose bumps accompanied by shivering, chattering teeth, blue lips and pale skin indicate possible....

chills, communicable disease, exposure to cold, pain or fear.

You are writing the patient's history on a PCR and inadvertently document an incorrect medication. You should...

correct the error with a single, initialed line.

Skin that is bluish in color is called:

cyanotic

All of the following are components of the communication process, EXCEPT: a) sender b)receiver c) idea (message) d) frequency

d) frequency

Which one of the following would be the best choice for a stable patient w a suspected spine injury? a) 1-rescuer assist . b) cradle carry. c) 2-rescuer assist. d) shoulder drag

d) the shoulder drag

As blood pressure drops, perfusion is most likely to:

decrease

When going from a well lit room to a dark one, you would expect the normal pupil to:

dilate

A slow pulse may result from:

head injury, drugs, some poisons, some heart problems, lack of oxygen in children

Flushed (red) skin color is....

heat exposure, high blood pressure, emotional excitement; cherry red indicates late stages of carbon monoxide poisoning.

What type of communication most often occures between three or fewer participants who are in close proximity to one another?

interpersonal pg 118

A V P U scale is used to evaluate....

mental status or LOC (level of consciousness) Alert, Verbal, Pain, Unresponsive

Pink skin color is ....

normal in light-skinned patients, normal in inner eyelids, lips, and nail beds of dark-skinned patients.

S A M P L E is an acronym used to......

obtain a patient history during the secondary assessment and stands for: Signs/Symptoms Allergies Medications Past pertinent medical history Last oral intake Events leading to the illness or injury

The adequate flow of oxygenated blood to all cells of the body is called:

perfusion

The distance that exists between two parties that are communicating by radio is an example of what type of barrier?

physical

An irregular pulse may indicate...

possible abnormal electrical heart activity (arrhythmia)

Clammy (moist), cool skin temp is...

possibly shock, heart attack, anxiety.

medical history

previous medical conditions and events for a patient

Proper body mechanics is best defined as:

properly using your body to facilitate a lift or move.

The five most inportant vital signs are

pulse, respirations, blood pressure, pupils, and skin signs.

Characteristics of a pulse include:

rate, strength, and rhythm.

What can be assessed by watching and feeling the chest and abdomen move during breathing?

respiratory rate

Mottling (blotchiness) of the skin is...

seen occasionally in patients in shock.

Dilated, nonreactive pupils indicate possible...

shock, cardiac arrest, bleeding, certain medications, head injury.

A ______ is something the EMR can see or measure during the patient assessment.

sign

The term diaphoretic refers to:

skin moisture

Good body mechanics means keeping your back ____ and bending at the knees when lifting a patient or large object.

straight

Unequal pupils indicate possible....

stroke or head injury.

"The patient complained of ches pain, but I believe that he was just trying to avoid getting a speeding ticket," is an example of a(n) _____ statement.

subjective

The pressure inside the arteries each time the heart contracts is referred to as the ________ pressure.

systolic

vital signs

the 5 most common signs used to evaluate a patients condition (respirations, pulse, blood pressure, skin and pupils)

The term trending is best defined as the

the ability to spot changes in a patient's condition over time.

mental status

the general conditionof a patient's level of consciousness and awareness

chief complaint

the main medical complaint as described by the patient

blood pressure is

the measurement of the pressure inside the arteries, both during contractions of the heart and between contractions.

Continuity of care is best described as:

the process where each new car provider is properly updated about the patient's progress.

When assessing circulation for a responsive adult patient, you should assess:

the radial pulse on one side.

capillary refill is

the time it takes for the capillaries to refill after being blanched; normal capillary refill time is 2 seconds or less.

The purpose of a blood glucometer is ...

to measure a person's glucose (sugar) level. Normal blood glucose levels range from 80-120.

100% oxygen is a drug used to ...

treat patients who have low oxygen levels in their blood because of medical or traumatic conditions.