EMT Basic

Paramedic

EMS practitioner who provides the highest level of prehospital care

Early Signs and Symptoms of Shock

- Altered level of consciousness - restlessness, anxiety, irritability - Tachycardia - Pale, cool skin due to increased peripheral vasoconstriction - Week peripheral pulses due to increased peripheral vasoconstriction - Increased respiratory rate - Thirst - Delayed capillary refill in kids

Cardiogenic Shock

- Cardiogenic shock is a pump problem. - The heart muscle cannot pump effectively, causing a backup of fluid, pulmonary edema, and hypotension. - Pulmonary edema: accumulation of fluid in the lungs - Caused by low cardiac output due to reduced preload, high afterload, or poor myocardial contractility - Altered level of consciousness

Managing Shock

- Control bleeding - Place patient in Trendelenburg position - Keep warm - Rapid transport - Platinum 10 minutes

Late Signs and Symptoms of Shock

- Falling blood pressure - Irregular breathing - Mottling or cyanosis - Absent peripheral pulses

Hypovolemic Shock

- Fluid problem - Trauma shock - Dehydration due to diarrhea, burns, vomiting, excessive urination, cholera - Hemorrhagic Hypovolemic Shock - loss of whole blood from intravascular space - Non-hemorrhagic Hypovolemic Shock from burns, loss of body fluids, abrasions

Anaphylactic Shock - Anaphylaxis

- Life threatening form of severe allergic reaction with 1 or more of the following: 1 - Anxiety or loss of consciousness 2 - Low blood pressure - hypotension 3 - Respiratory difficulty - shortness of breath, wheezing - Distributive shock component - Massive vasodilation - Widespread vessel permeability (fluid leakage) - Bronchoconstriction - Skin flushed or cyanotic

Obstructive Shock - Tension Pneumothorax

- Lining of lungs separates and air enters the chest cavity due to lung injury or sucking chest wound. Accumulating pressure compresses the lungs and great vessels - JVD - Respiratory distress - Diminished lung sounds - Poor compliance during artificial ventilations with BVM - Trachael deviation towards unaffected side (late sign) - Apply bandage tape on three sides

Neurogenic Shock

- Neurogenic shock is a pipe problem - Distributive shock - Caused by spinal cord damage, typically in cervical region - Interrupts normal communication pathways between central nervous system and peripheral nervous system. - Interferes with body's normal compensatory mechanisms - Low blood pressure, Low heart rate, Low respiratory rate - Skin is warm, pink and dry - Smooth muscle relaxes causing vasodilation - Priapism

Obstructive Shock

- Obstructive shock is a pump problem caused by mechanical obstruction of the heart muscle

Metabolic Shock

- Preeclampsia - Diabetes - Respiratory acidosis.

Obstructive Shock - Pulmonary Embolism

- Pulmonary embolism is a pump problem - Traveling clot gets caught in the lungs

Psychogenic Shock

- Self-Reversing shock - Sudden, temporary neurogenic shock causing vasodilation that interrupts blood flow to the brain

Septic Shock

- Septic shock is a pipe problem - Caused by severe infection which damages blood vessels and increases plasma loss out of the vascular space - Distributive component - vasodilation leads to hypovolemia due to vessel permeability, fever, increased respiratory rate - tachycardia, hypotension, pale, cool skin, weak peripheral pulses, altered level of consciousness

Respiratory Shock

- Trauma Shock resulting from failure of the respiratory system to supply oxygen to the alveoli or remove CO2 from them. - Lungs are unable to supply enough Oxygen to the circulating blood - Asthma

Compensation Mechanisms

1. Tachycardia - If loss of circulating blood volume, increased heart rate and force of contraction. 2. Peripheral vasoconstriction - Body will constrict peripheral blood vessels to try and increase blood pressure and increase perfusion to vital organs 3. Body will increase respiratory rate to improve oxygenation 4. Falling blood pressure is a late sign of shock. It indicates the body's defense mechanisms are no longer working. - Assume any patient with suspected shock and hypotension is in decompensated shock. Treat as a high transport priority

Burnout

A condition resulting from chronic job stress, characterized by a state of irritability and fatigue that can markedly decrease effectiveness

Americans with Disabilities Act (ADA)

A federal law passed in 1990 that protects individuals with a documented disability from being denied initial or continued employment based on their disability

Standard Precautions

A method of preventing infection based on the concept that all blood and body fluids are infectious

Critical Incident Stress Debriefing (CISD)

A session where counselors help emergency personnel process emotions from a critical incident

Quality Improvement (QI)

A system of internal and external reviews and audits of an EMS system to ensure a high quality of care

Purified Protein Derivative (PPD) Tuberculin

A test to determine the presence of a tuberculous infection based on a person's positive reaction to tuberculin, a substance prepared from the tubercle bacillus

Emergency Medical Responder (EMR)

EMS practitoner likely to be the first person on the scene with emergency care training

Defusing

An opportunity to vent emotions and get information before the CISD

Critical Incident

Any situation that causes unusually strong emotions that interfere with the ability to function

Emergency Medical Technician (EMT)

EMS practitioner who provides basic emergency medical care

Advanced Emergency Medical Technician (AEMT)

EMT with some additional qualifications for advanced care, the level of EMS practitioner who performs the responsibilities of an EMT with the addition of the use of advanced airway devices, monitoring of blood glucose levels, initiation of intravenous and intraossseous infusions, and administration of a select number of medications

Prehospital Care

Emergency medical treatment given to patients before they are transported to a hospital or other facility

Personal Protective Equipment (PPE)

Equipment worn to protect against injury and against spreading infectious disease

Irreversible Shock

Final stage of shock. The body has lost the battle to maintain perfusion to vital organs. Even if adequate vital signs return, the patient may die days later due to organ failure. - Profound hypotension - Skin cool, pale, and clammy

Obstructive Shock - Pericardial Tamponade

Fluid accumulates within the pericardial sac and compresses the heart. Also called Cardial tamponade - JVD - Jugular venous distention - filling of jugular veins - Narrowing pulse pressure - systolic and diastolic moving closer together - Hypotension

Shock or Hypoperfusion

Inadequate tissue perfusion. The cells of the body do not get oxygen and nutrients they need from the circulatory System

Decompensated Shock

Late or "progressive" shock. The body can no longer compensate for the hypovolemic state due to low blood volume and lack of perfusion. - Decreasing blood pressure

Pathogens

Microorganisms such as bacteria and viruses that cause disease.

Perfusion

Perfusion is the adequate circulation of oxygenated blood throughout the body. Adequate perfusion is necessary to maintain homeostasis

Medical Director

Physician who is legally responsible for medical oversight of an EMS system.

Medical Direction

Policies, procedures, and practices available either off-line (as protocols or standard orders) or on-line (by phone or radio)

Evidence-Based Medicine

Practice based on evidence that procedures, medications, and equipment improve patient outcome

Three Primary Causes of Shock

Pump (heart) problems Pipe (blood vessel) problems Fluid (blood volume) problems

Sterilization

Subjecting an object to chemical or physical substances (typically, superheated steam in an autoclave) that kill all microorganisms

Compensated Shock

The early stage of shock. The body is still able to compensate for the hypovolemic state through defense mechanisms, such as: - Increased heart rate - Peripheral vasoconstriction

Cleaning

The process of washing a soiled object with soap and water

Disinfecting

Using a disinfectant such as alcohol or bleach to kill microorganisms