EMS-111 Final Review

Effects of anaerobic metabolism

Byproducts are lactic acid and small amounts of ATP Creates acidotic state, leading to cell death Cell has little energy to perform normal function Inadequate delivery of oxygen and glucose to cells

Integumentary system: basic anatomy of layers and overall function of the system

Has three layers Epidermis Outermost layer Composed of 4 layers of cells, two living and two dead Melanin resides in the deepest layer Dermis Second layer of the skin is the thickest Contains a vast network of blood vessels, hair follicles, sweat glands, oil glands, and sensory nerves subcutaneous

HIPPA - EMT practice policies and behaviors

NA

Specific fractures - pelvis and femur

Pelvis Femur

Causes of cellular hypoxia

Perfusion disturbance Blood loss reduced the amount of blood flow through pulmonary capillaries Not enough blood to pick up the oxygen available in the alveoli Ventilatory disturbance Less oxygenated air to be available in the alveoli for blood flowing through pulmonary capillaries Less oxygen saturating the blood less oxygen delivered to cells

When orthostatic BOP is taken, what it indicates

Pt with suspected volume loss Increased heart rate between vital sets also shows volume loss

Ground rules for radio communication

Reduce background noise Use the proper frequency Be sure no one is on the channel transmitting (listen before speaking) Wait 1 second after pushing PPT (press to talk button) to engage repeaters Keep lips 2-3 inches from microphone and speak clearly and slowly First address unit being called, then your unit designation Wait for a verbal signal from the receiving party before initiating transmission Keep transmissions brief Use a logical organized order when communicating large amounts of information If using numbers say the number then break it down Say thirteen, then say one-three All information should be impartial and objective, followed by subjective statement form the patient Objective - measurable (vital signs) Subjective - what the patient tells you (symptoms)

How to estimate a child's (1-10 years old) systolic BP

(2 x years in age) + 70 = lower limit of a normal systolic blood pressure

Differentiating objective and subjective information

-measurable or verifiable: a sign is a(n) ____ observation -based on an individual's perceptions or interpretations

Effects of sympathetic nervous system stimulation

Activation of the four effects by the hormones Alpha1 Causes vessels to constrict Causes skin to become cool, pale and clammy Alpha2 Regulate the release of Alpha1 Beta1 Increase heart rate Increases the force of cardiac contraction Speed up the electrical impulse traveling down Beta2 Causes smooth muscle to dilate

Types of stress reactions

Acute stress Immediate onset Cognitive Physical Behavioral Psychological symptoms Chest pain Shortness of breath Delayed stress PTSD is most common form Symptoms do not develop for days, months or even years Nightmares Irritability Insomnia Difficulty concentrating Flashbacks Increased in interpersonal conflicts Cumulative stress Constant exposure to situations that build up over time Common cause of EMS burnout Increased anxiety and irritability Emotional state of exhaustion

Components needed for adequate ATP production

Adequate oxygen and glucose are required for production of ___

Identify life threats found during the primary assessment

Airway compromise Respiratory insufficiency Cardiac arrest Severe bleeding

Determine if a patient can refuse treatment and transportation

All competent medically informed patients have a right to refuse treatment or transport by EMS personnel

Legal concerns: confidentiality, distribution, refusal of treatment, falsification, correcting errors

All competent medically informed patients have a right to refuse treatment or transport by EMS personnel Explain medical care given Consequences of failing to accept care/transport including the potential for death Circumstances when the patient refused to allow complete assessment or the patient refused all emergency care Patient was alert and oriented to time, place and person There was no question, the patient understood the information and instructions given Patient was not under the influence of drugs or alcohol and was not mentally incapacitated The patient was not suffering from any type of distracting injury The patient may then sign the refusal form Falsification Most common are vital signs Treatment performed or not performed Falsifying a PCR may lead to suspension or revocation of EMT certification or licensure Also compromises patient care and gives other healthcare providers an incorrect impression of the patient's condition from false assessment correcting errors Draw a single horizontal line through the error and initial the error on PCR Write correct information directly next to it Do not try to erase or write over errors on a written report Looks like EMT was trying to cover up a mistake If error is discovered after report is submitted, use a different colored ink to draw a single horizontal line through the error, correct it, initial and date the correct response If information was omitted, an EMT should add a note with the correct information, the date and EMT's initials

Dealing with family members at a crime scene

Allow them to show emotion (yelling or crying) Listen empathetically Do not give false assurances Use a gentle tone of voice Allow family to touch or hold the patient after death

Function of arteries, veins and capillaries - central, coronary and peripheral

Arteries Carry blood away from the heart to the body All arteries carry oxygen rich blood except the pulmonary artery Veins Carry blood towards the heart Carry oxygen depleted blood except the pulmonary vein Capillaries Tiny blood vessels which connect arterioles to values and have semi-permeable walls to allow the exchange of gasses nutrients and wastes at the cellular level Occurs throughout the entire body

Sequencing of care while on a crime scene

Assure personal safety first, crew safety second, then patient care

Specific function of each heart chamber

Atria Receive blood from veins Right atrium receives oxygen-depleted blood from the veins of the body Left atrium receives oxygen-rich blood from the pulmonary veins from lungs Ventricles Pump blood out to the arteries Right ventricle pumps oxygen-depleted blood to the pulmonary arteries Transport the blood to the lungs where it will be oxygenated Left ventricle pumps oxygen-rich blood to the major artery from the heart

Purpose of systolic and diastolic blood pressures

Blood pressure is the force exerted by the blood on the interior walls of the arteries Systolic blood pressure Exerted against the walls of the arteries when the left ventricle contracts Measures effectiveness of the pumping function of the left ventricle Diastolic blood pressure Exerted against the walls of the arteries when the left ventricle is at rest, or between contractions Measures the resistance in the arteries between contractions Related to vessel diameter

Respiratory compromise and mechanics of ventilation: Boyle's law, compliance and airway resistance issues

Boyle's law Increase in pressure will decrease the volume of gas Decrease in pressure will increase the volume of gas Accessory muscles Help increase the chest size in order to draw more air into chest and lungs Help decrease the chest size to force air out of the lungs and chest Requires energy Adequate amounts of oxygen must be constantly delivered to the cells to produce energy Compliance Measure of the ability of the chest wall and lungs to stretch, distend and expand Decrease in compliance makes it more difficult for the pt to move air in and out of the lungs, Alose more difficult for EMT to ventilate for pt artificially Airway resistance Related to the ease of airflow down the conduit of airway structures leading to the alveoli Higher resistance makes it more difficult to move air through airways Makes pt work harder to breath, expending more energy and possibly using accessory muscles Accelerate respiratory muscle fatigue

Components of the central nervous system

Brain Spinal cord Cerebrum Cerebellum Brainstem

Differences between spontaneous breathing and PPV: cardiac considerations, rate of PPV for adults, indications of using PPV vs oxygen delivery devices, method of delivery PPV via BVM

Breathing spontaneously is the patient doing it on their own Air movement Negative pressure created Airway wall pressure is not affected Esophageal opening pressure Remains collapsed and has no air moving into it Cardiac output Does not affect the cardiac output or blood pressure Negative pressure generated in the thorax acts like a vacuum and sucks the venous blood into the inferior vena cava Adequate preload contributes to an adequate stroke volume, cardiac output and blood pressure Cardiothoracic pump effect PPV Air movement is forcing air into the lungs regardless of the pressure changes in the thorax Airway wall pressure are pushed outwards to create larger space Higher volumes to fill the larger space to ventilate properly Esophageal opening pressure is overcome to allow air to enter the esophagus and filling the stomach Leads to gastric distention Cardiac output Thorax becomes positive during inhalation phase Loss of negative pressure rids of the vacuum effect for venous return Decreases preload, reduces stroke volume, cardiac output, blood pressure and perfusion Methods of artificial ventilation Mouth to mask Bag valve mask operated by two people flow-restricted , oxygen-powered ventilation device Bag-valve mask operated by one person

Critical incident stress management techniques

CISD (critical incident stress debriefing) 24-72 hours after a high-stress incident Allows participants to review facts of incident Identify how they are feeling about the incident Receive suggestions from peers Defusing 1-4 hours following a critical incident Used for those most directly involved in the incident Only lasts 30-45 minutes Allows for smaller groups to meet before debriefing

Regulation of normal ventlation

Chemoreceptors Central chemoreceptors are located in the brain Peripheral located in the aortic arch and carotid bodies in the neck Increased CO2 = increased acid pH This stimulates the chemoreceptors to increase ventilatory depth and rate to blow off excess CO2 Primary impetus to breathe is and increase arterial CO2 as monitored by central chemoreceptors

Necessary data included in a valid PCR

Chief complaint Level of responsiveness-mental status Blood pressure for patients older than three years old Skin perfusion (capillary refill) for patients less than 6 years old Skin color, temperature and moisture Pulse rate Respiratory (ventilatory rate), effort and tidal volume Patient demographics (age, sex, race, weight) Administrative information Time the incident was reported Time the unity was notified (dispatch time) Time unit arrives on the scene Time patient access is obtained Time the unit left the scene Time the unit arrives at its destination-hospital Time care is transferred

Mandatory reporting obligations

Child abuse Elder abuse Spousal abuse Dog bites Sexual assault Gunshot wounds Suspicious burns and poisonings Drug use injuries Suspected infectious disease exposure Attempted suicide Use of restraints

Causes of auscultated lower airway sounds

Constriction and inflammation of the bronchioles Fluid surrounding and filling the alveoli Mucus blocking the larger bronchioles

Components needed for adequate alveolar ventilation

Contains the dead space Areas of the respiratory tract where there is no exchange of oxygen and carbon dioxide (tidal volume - dead air space) x frequency of ventilation/minute (respiratory rate) Regular tidal volume Average ventilatory rate

Communicating with Medical Direction

Could suggest procedures that you should follow with a patient or tell you not to perform other procedures Organized, concise and pertinent Provide the following information to medical direction Your unit's identification and its level of service Patients age and sex Pt chief complaint brief , pertinent history of the present illness Major past illnesses Pt mental status Pt baseline vitals Pertinent findings on the physical exam Description of medical care given to pt Patients response to emergency medical care Patients current condition Request for further actions and interventions at the receiving facility Estimated time of arrival

Specific conditions suspected by assessment of pupils

Dilated Cardiac arrest (pupils will be fixed) Drug use (LSD, amphetamines, cocaine) Constricted Central nervous system disorder Narcotics use Unequal Stroke Head injury Artificial eye Eye drops Eye trauma Nonreactive Cardiac arrest Brain injury Eyedrops Drug intoxication or overdose

Geriatric response to decreased tidal volume

Due to decreased tidal volume, an increase in respiratory rate is seen 12-20 is average for adults, but not uncommon for geriatric to be on higher end of scale

EMS legal duties and protections

Duty to act Legal obligation to provide care If you begin patient care, you must follow through or charged with abandonment Duty to self Maintain education and credentialing Duty to patient Respect rights act as an advocate (HIPPA) Legal breeches (Torts) A breech of legal duty is known as a "liability" Civil liability - an individual sues for damages Criminal liability - a law is broken and the government brings legal action Plaintiff - individual filing the civil lawsuit Defendant - individual accused of committing a "tort" (wrongful act causing injury or damage) Torts include: Negligence - a breach of duty to act, or an act of omission which results in injury or harm to the patient. The EMT did not intentionally try to injure the plaintiff. EMT failed to meet the Standard of Care Gross negligence - results from willful, wanton, extremely reckless patient care far beyond being negligent or careless Proximate cause - injuries suffered by the patient were a direct result of the EMT's negligence Contributory negligence - this protects the EMT when it is discovered the patient, through their own negligence, caused or contributed to the damage which occurred to them Health information protected by HIPPA Gives patient control of how information is distributed and used All patients will sign HIPPA form with each documented call Acceptable release of information by an EMT to another party includes Another healthcare provider to continue care Mandatory release to public health official Request by police for potential crime investigation Third party billing Legal supoena COBRA Consolidated omnibus budget reconciliation act Prohibits discrimination in providing health plans for preexisting conditions EMTALA Emergency medical treatment and active labor law Provides all patients the ability to receive emergency care regardless of ability to pay Advance directives POLST-DNR Must determine validity Living Will Addresses long term life support equipment Healthcare durable power of attorney Person designated by the patient to make decisions regarding healthcare Good samaritan law Person who is not being paid but stops to render emergency care If the person acts in good faith and does not commit an act of gross negligence Does not protect a person from being sued Sovereign Immunity Governmental immunity - prevents people from suing the government for cibil liability when treated by governmental EMS

Intentional torts: abandonment, assault, battery, slander, libel; false imprisonment

EMT knowingly committed - legally considered civil wrongdoing Abandonment - leaving the patient with a lesser qualified individual Assault - willful, threat to inflict harm Battery - unlawfully touching a person without consent False imprisonment - intentionally transporting a patient without consent Defamation - release of written or spoken information to the public which damages the person's reputation or standing within the community Slander - spoken form of defamation Libel - written form of defamation

Differentiating emergency moves, urgent moves, nonurgent moves

Emergency - immediate life threat Dangerous to pt or rescuer Spinal injury to pt is primary danger Types of emergency moves Armpit-forearm drag Shirt drag Blanket drag Circumstances for emergency moves Fire, danger of fire or explosion Inability to protect yourself or pt from scene hazards Need to access more critically injured pt Inability to perform care where pt is located Attempt to keep pt head and eyes forward in neutral position Apply cervical collar as indicated as soon as possible Urgent - rapid extrication Indications for rapid extrication Altered mental status Inadequate respiratory rate or tidal volume Shock parameters Skin signs Tachycardia Tachypnea Bilateral femur fracture Major bleeding Used when removing a pt when it is deemed too time consuming to apply a vest type spine immobilization device Nonurgent - no immediate life threats suspected Types of nonurgent moves Direct ground lift Not recommended for heavier pt Used when a backboard cannot be used Extremity lift Used to move pt from ground to conveyance device Not to be used if pt has suspected spinal injury Direct carry method Used to move supine pt from a bed to a stretcher Draw sheet Move pt from supid to stretcher Most common carry pt in a bed

Endocrine system: glands and functions

Endocrine system is made up of ductless glands Release hormone: chemical substances that have effects on the activity of certain organs Pineal gland Located superior and posterior to the thalamus Produces melatonin Inhibits the functions of the reproductive system Regulates circadian rhythm Thyroid gland Anterior neck Regulates metabolism, growth and development Parathyroid glands Located behind the thyroid Produce hormone necessary for the metabolism of calcium and phosphorus in the bones Adrenal glands Sits on top of the kidney Secretes epinephrine (adrenaline) and norepinephrine Postpone muscle fatigue Increase the storage of sugar Control kidney function Regulate the metabolism of sal and water Gonads (ovaries and testes) Produce hormones for reproduction and sex characteristics Islets of langerhans Located in the pancreas Make insulin Allows glucose to enter cells and produce glucagon Hormone that raises the glucose level in the blood Pituitary gland Located at the base of the brain Master gland Regulates growth, thyroid and parathyroid, the pancreas, gonads, metabolism, blood sugar reactions and urinary excretion Thymus gland Located in the neck, superior to the heart Secretes thymosin Influences the development and maturation of the immune system

EtCO2 use, measurement and indications during CPR

EtCO2 represents the measurement of CO2 concentration at the end of expiration Correlates the maximum CO2 content in the exhaled gas Normal physiological range for EtCO2 is about 35-45 mmHg Used to monitor the effectiveness of chest compressions A decrease in the EtCO2 level and reading usually indicates compressor fatigue Produces ineffective chest compressions and poor cerebral and coronary artery perfusion pressures

SpO2 use and limitations

Found through use of a pulse oximeter Percent of hemoglobin saturated with oxygen Used in any situation where the pt's oxygen status is a concern or when hypoxia is even remotely suspected Used as a vital sign Conditions which would produce no reading or inaccurate reading Hypoperfusion of blood loss or poor perfusion Hypothermia reduces peripheral perfusion and limit blood available in capillaries Excessive movement of the pt Nail polish on the figer the probe is attached to Carbon monoxide will give abnormally high reading Cigarette smokers have falsely high SpO2 readings Anemia produce erroneously high readings

Skeletal system: physiological functions

Giving the body its shape Protecting the vital internal organs Allowing for movement Storing minerals and producing blood cells

Infection control practices

Handwashing Personal protective equipment Eye protection Protective gloves Gowns Masks Immunization Disposable equipment when possible Cleaning, disinfecting and sterilization Report exposure

Methods to open the airway and indications for each: head- tilt chin- lift, jaw thrust, adult and pediatric

Head-tilt-chin lift No suspected spinal injury Supplemented with a mechanical airway device if airway cannot be adequately maintained Unresponsive pt with no suspicion of spinal trauma Pt with cardiac arrest not due to trauma Apneic pt with no signs of trauma Head-tilt-chin lift in infants and children Preferred method of opening an airway Head should be tilted back gently into a sniffing or neutral position Opening to the ear is lined up horizontally with the sternal notch Place a pad behind the shoulders to keep airway open Jaw thrust maneuver Open an airway in suspected spinal injury pt Neck maintained in neutral, in-line position Used in unresponsive pt Jaw thrust in infants and children Same basic procedure as adults

Pathophysiology of reduced cardiac output

Heart rate (HR) x Stroke volume (SV) = Cardiac Output (CO) If either factor has a decrease, cardiac output will also decrease A decrease in the CO would ultimately show a decrease in blood pressure as well as perfusion Leads to poor oxygen rich blood to the cells Causing hypoxia

Infectious diseases of concern

Hepatitis B: directly affects the liver, is possible to show no symptoms Fatigue Nausea / anorexia Abdominal pain Headache Fever Jaundice Dark urne Hepatitis C: most common blood-born infection, 80% of patients have no S&S Jaundice Fatigue Abdominal pain Nausea / anorexia Dark urine Tuberculosis: new drug-resistant strains, pathogen found in the lungs, airborne Fever Cough Night sweats Weight loss AIDS (acquired immune deficiency syndrome): syndrome of HIV, spread through sexual contact of blood, semen or secretions, infected needles and invetero fetus Persistent low-grade fever Swollen lymph glands Nausea Fatigue Weight loss Shortness of breath SARS (severe acute respiratory syndrome): respiratory virus High fever Headache and body ache Malaise (general feeling of discomfort) Respiratory symptoms Diarrhea Dry cough Meningitis (bacterial or viral): bacterial can be treated with antibiotics, viral is a major airborne disease Fever Headache and body ache Skin rash Swollen lymph glands Confusion and disorientation Seizures Paralysis Vision loss West Nile Virus: 80% of patients show no symptoms Multidrug-resistant organisms: pathogens that resist standard antimicrobial drug therapy Patients with chronic wounds or frequently visit healthcare facilities Ebola Virus: viral hemorrhagic fever S&S start 2-21 days after exposure High fever Severe headache Muscle pain and weakness Severe vomiting and diarrhea Severe bleeding Zika virus: could be sexually transmissible, can spread from pregnant mother to baby Fever Rash Joint and muscle pain Headache Conjunctivitis

Indications and contraindications of CPAP

Indications Awake, alert and oriented Able to maintain his own airway Able to breathe on his own and has a respiratory rate Relative hemodynamic stability Signs and symptoms of moderate to severe respiratory distress or early respiratory failure Presenting with increased EtCO2 able to wear a face mask Contraindications Apnea, respiratory arrest or agonal respirations Inability to understand or obey commands Inability to maintain his own airway Unresponsiveness Shock associated with cardiac insufficiency Cardiac arrest Active vomiting Upper gastrointestinal bleeding Pneumothorax or trauma to the best Tracheotomy Facial trauma Increased intrathoracic pressure causing hypotension

Indications for oropharyngeal suctioning and complications of suctioning

Indications Necessary to remove blood, vomitus secretions or food particles from the mouth and airway Gurgling sound heard while assessing ventilation Complications Residual volume of air in the lungs is removed Residual volume is the air remaining in the lungs after maximal exhalation Decrease in blood oxygen levels Rapid heart rate, slowed heart rate or irregular heart rate may occur Stop suctioning and return to positive pressure ventilation Suction no more than 15 seconds at a time

Consent: Identify type based on scenario

Informed EMT has informed the patient of the impending care and associated risks of treatment or lack of treatment Expressed Consent must be obtained from every conscious and mentally competent adult before treatment begins Patient must be of legal age and reliable Competency is determined by the ability to comprehend place, time, person and event which occurred Alcohol, drugs and mental incapacity must be factored into competency Implied Assume that an unresponsive, incompetent patient, or one who cannot make a rational decision, would want to have treatment performed Consent to treat a minor Under the age of 18 Consent must be obtained from the patient's parent, guardian or other person who has been granted the right to make healthcare decisions for the minor If the parent cannot be reached, implied consent is used for treatment Emancipated minor Legally able to make their own healthcare decisions without a parent or guardian's approval Married Pregnant A parent Member of the armed forces Financially independent and living away from parent's home Minor declared emancipation by court decree

Mechanics and control of ventilation

Inhalation Diaphragm and external intercostal muscles contract Diaphragm moves down rib cage moves up and outward Increase size of chest cavity resulting in negative pressure Draws air by way of nose, mouth, trachea and bronchi into the lungs Active process because it requires energy to contract the muscles Exhalation Diaphragm and external intercostals relax, returning chest cavity to normal position Elastic lung tissue recoils Pressure in the cavity becomes negative Forces a volume of air out of the lungs Little energy is expended Passive process Control of respiration Respirations are controlled by the nervous system Dorsal respiratory group (DRG) Ventral respiratory group (VRG) Pontine respiratory central (pneumotaxic center) These control the impulses being sent to the respiratory muscles Chemoreceptors monitor levels of oxygen, carbon dioxide and pH in the arterial blood Stimulate an increase or decrease in impulses from the respiratory rhythm centers

Types and recognition of various therapeutic communication techniques

Introduce yourself and partners Gain patient consent Mention you are there to help them Body position Posture is a form of nonverbal communication Eye level if possible Use communication skills Maintain eye contact Speak calmly and deliberately Actively listen Be courteous Resist yielding to similar stressors as patient or family members Remain calm Use touch when appropriate Powerful comfort when dealing with patients Must be sincere in your gestures Active listening techniques Facilitation Reflection Clarification Empathetic response Confrontation Interpretation

Complications of hypoxemia

Low oxygen content in the arterial blood Ventilation-perfusion mismatch Lack of available oxygenated air in the alveoli even though perfusion to the alveoli is adequate Alveoli are adequately oxygenated by perfusion to the alveoli is poor Inadequate ventilatory drive Anemia Carbon monoxide poisoning

Roles & responsibilities of an EMT

Maintain vehicle and equipment readiness Ensure safety of EMS crew, patient and bystanders Provide emergency care Safely lift and move the patient Prepare oral and written reports Transfer patient care Perform record keeping and data collection Serve as patient advocate Integrate EMS and other healthcare fields for patient necessities Develop and maintain community relations

Permission to assist or administer medications

Medication administration All necessary medication is on the EMS unit EMT carries out steps necessary to give the pt the medication via: Oral, injection, inhalation or intranasal route Patient-assisted medication administration EMT prepares the medication and hands it to the patient who will proceed with taking the medication

Function and control centers of the brainstem, RAS and cerebral hemispheres

Medulla consists of three major control centers Respiratory center: controls rate and depth of respiration Cardiac center: responsible for regulating the heart rate and force of contraction of the ventricles Vasomotor center: controls blood pressure, produces vasoconstriction and dilation RAS (reticular activating system) Group of nerves found in the brainstem "wake/sleep center" Determines whether the patient remains awake and aware of his surrounds Continuously transmitting impulse regarding pt surroundings for constant stimulation and response Cerebral hemispheres Left and right sides of the cerebrum

Necessary elements of aerobic metabolism and consequences of anaerobic metabolism

Metabolism: breakdown of glucose inside the cell to provide energy for the cell aerobic metabolism Process of metabolism in the presence of oxygen Anaerobic metabolism Without oxygen If there is no oxygen benign delivered to the cells, little energy is being produced

Capillary refill age parameters and findings

Most reliable in infants and younger children Adults have preexisting conditions that may affect the perfusion of the capillaries The time it takes or compressed capillaries to fill up again Longer time to refill indicates poor circulation of blood through capillaries Suffering from hypoperfusion

Airway anatomy in infants and children: causes of cardiac arrest, alignment for opening airway, differences in chest wall and diaphragm

Mouth and nose are smaller than adults More easily obstructed by foreign bodies, swelling, blood, mucus and secretions Infants are obligate nose breathers Pharynx Tongue is relatively large in proportion to the size of the mouth More prone to obstruction of airway from displacement of the tongue Trachea and lower airway Narrower, softer, and more flexible Kinking of the trachea with flexion or extension Small reductions in diameter cause serious resistance effects Padding under neck and shoulders achieves proper neutral alignment Chest wall and diaphragm Softer and more pliable Greater compliance during ventilation Rely on diaphragm to breathe Chest should rise easily during artificial ventilation Oxygen reserves Less oxygen in the lungs available during periods of inadequate breathing or apnea Twice the metabolic rates of adult causing them to use oxygen at a faster rate Hypoxia is the most cause of cardiac arrest

Specific differences when observing breathing in an infant

Mouth and nose are smaller, more easily obstructed Infants are nose breathers Tongue takes up more space in the pharynx and can block airway Narrow tracheas that may be obstructed by swelling or foreigh bodies Cricoid cartilage is less developed, so not as rigid Because chest wall is softer, they rely on the diaphragm for breathing See-saw breathing

EMS documents defining education and skill set - types of services / levels of training

National Scope of Practice Model EMR (emergency medical responder) Provides basic airway and oxygen therapy Provide stabilization of spine and extremity injuries Eye irrigation Bleeding control Emergency moves CPR and AED use Emergency childbirth EMT (emergency medical technician) Continued list of EMR duties Provide advanced oxygen therapy Pulse oximetry Automatic blood pressure monitoring Limited medication administration AEMT (advanced emergency medical technician) Continued list of EMT duties Advanced airway devices Monitoring blood glucose levels Initiation of IV and IO infusion Administration of additional medications Paramedic Continued list of AEMT Perform more advanced patient assessment Form a field impression Provide invasive drug interventions

Pathophysiology of a failed sodium potassium pump

Need ATP to function Sodium (Na) found extracellular, Potassium (K) found intracellular Concentration gradient, sodium moves into the cell and have to be actively pumped out, requires ATP Water follows sodium Cell swells and eventually ruptures, showing cell death

Given a description decide the component of OPQRST being assessed

Onset When and how did the symptom begin? provocation/palliation/position What makes the symptom worse? What makes the symptom better? In what position was the patient found? Quality How would you describe the pain? Radiation Where do you feel the pain? Where does the pain go? Severity How bad is the symptom? Time How long have you had the symptom?

Asking questions during pt. history - Open vs closed

Open-ended questions Patient is able to give a detailed response "How are you feeling?" Closed-ended questions Direct questions "What medications do you take on a regular basis?"

Airway adjuncts and sizing: oropharyngeal airway, nasopharyngeal airway

Oropharyngeal airway Holds the tongue away from the back of the airway Allows for suctioning of secretions Pt must be completely unresponsive and have no gag reflex Properly size Front teeth or angle of the jaw Use a tongue depressor Nasopharyngeal airway Use on pt who the oral airway cannot be inserted because of clenched teeth, biting or injuries to the maxilla or face Can be used on a pt who is not fully responsive and needs to maintain an open airway Pt may still have a slight gag reflex

Medications used for various conditions including: hypoxia, hypoglycemia, ingested poisons, acute coronary syndrome, asthma attack, anaphylaxis, opioid overdose

Oxygen Used for hypoxia Delivered via cannula, nonrebreather mask (NRB) and bag valve mask (BVM) Oral glucose Treating hypoglycemia (low blood sugar) Activated charcoal For ingested poisons Aspirin Reduction of platelet aggregation during acute coronary syndrome (ACS) Used for pt with chest pain Nitroglycerin Angina, ACS Vasodilator Reduces preload, reduction in myocardial oxygen consumption Epinephrine Treatment of anaphylaxis Auto-injector administration Constriction of vessels, increase in BP, dilation of the bronchioles Beta2 agonist Inhaled bronchodilator albuterol Via metered dose inhaler (MDI) or small volume nebulizer (SVM) to treat asthma Naloxone hydrochloride (Narcan) Opioid antagonist Binds to opioid receptor sites and reverses opioid respiratory depression and also prevents rebinding of circulating opioid still in the system Given intranasal via mucosal atomizing device (MAD), intramuscular, subcutaneous, ALS can give IV, IO or down an endotracheal tube

Physiology of respiration: bronchoconstriction / dilation - function of the diaphragm

Oxygen and carbon dioxide are exchanged through alveoli and capillaries bronchoconstriction/dilation Bronchioles are lined with smooth muscle and react to certain stimuli Bronchoconstriction increases the resistance making it more difficult to move air In bronchodilation the smooth muscle relaxes, decreasing the resistance Function of the diaphragm Powerful dome shaped muscle essential for adequate ventilation 70% of breathing is a direct response to movement Separates the thoracic cavity from the abdominal cavity

Advance directives, EMT actions to be taken with or without POLST documentation

POLST/DNR Must determine validity Living Will Addresses long term life support equipment healthcare durable power of attorney Person designated by the patient to make decisions regarding healthcare

What conditions skin color, temperature and moisture indicates

Paleness or pallor Sign of extreme vasoconstriction or blood loss Shock (hypoperfusion) Heart attack Freight Anemia Fainting Emotional distress Inadequate oxygenation Hypoxia Hypoxemia Blue-gray color or cyanosis Inadequate oxygenation or poor perfusion Suffocation Inadequate respirations Hypoxia Hypoxemia Heart attack Poisoning Red color or flushing Heat exposure Peripheral vasodilation Late finding of carbon monoxide poisoning Yellow color or jaundice Liver disease Mottling Shock Blood pooling in the extremities Hot temperature Fever Exposure to heat Cool temperature Inadequate circulation Shock Exposure to cold Cold temperature Exposed to cold Clammy skin Wet or moist Shock (hypoperfusion) Poisoning Cardiac emergency Diaphoresis Profuse sweating Abnormally dry skin Spinal injury Severe dehydration

Refusal of service policy/procedure

Patient must have the capacity to refuse care and informed of all risks with refusal, up to death They must completely understand a refusal might worsen the condition EMT should make at least two attempts to transport patient before accepting refusal Persistent refusal must be documented well If the patient refuses to sign the form, a refusal to sign refusal must be done All refusals need to be witnessed by the EMT completing the form and at least one other witness Competence A legal definition by a court Capacity Determined by a medical authority (including EMTs) Make a rational decision based on full disclosure and full understanding of the current situation and risks involved with refusing treatment De facto incompetent Person who is in fact incompetent although not determined to be through a court of law Capacity factors Orientation to a person, place and time - conscious alert and oriented x 3 Conscious alert and oriented x 4 Orientation leading to to illness or injury Patients without capacity to decide include - Under the influence of ethyl alcohol or medications/illicit drugs Due to medical condition or injury Mentally or behaviorally disabled Unable to understand the condition or risk of refusal

Method of auscultating a BP

Properly fit the blood pressure cuff, lining up the bold indication arrow with the brachial artery Position arm so brachial artery of the antecubital fossa is at the level of the heart Palpate the radial pulse and inflate rapidly to 70 mmHg then increase by 10 mmHg increments until the radial pulse is no longer felt Note the number on the cuff Place the stethoscope in your ears, locate brachial artery @ antecubital fossa and place stethoscope over that area Close the thumb valve and squeeze the bulb, inflate the cuff 30 mmHg above Slowly turn the thumb valve counterclockwise at a rate of 2mmHg per second As soon as you hear the first sound, record This is systolic blood pressure Continue to release until you no longer hear a pulse, record This is the diastolic blood pressure

Functions of the skin

Protecting the body from the environment, bacteria and other foreign organisms Regulate the temperature of the body Serving as a receptor for heat, cold, touch, pain and pressure Aiding in the regulation of water and electrolytes

Process of a narrowing pulse pressure and what it indicates

Pulse pressure is the difference between the systolic and diastolic blood pressure Narrow pulse pressure is defined as being less than 25% of the systolic blood pressure reading Indicates dropping cardiac output from blood or fluid loss and rising systemic vascular resistance to attempt to compensate decreasing pressure

Differentiate S & S of inadequate breathing

Rates either too slow or too fast compared to what is normal for pt Irregular pattern of breathing Diminished or absent breath sounds Unequal chest expansion Pale or bluish mucous membrane or skin Use of accessory muscles Nasal flaring Head bobbing Agonal respirations Grunting If either rate or tidal volume are deemed inadequate, so is the breathing

Differentiating signs and symptoms

Signs Objective physical evidence of medical or trauma conditions you can: See Hear Feel Smell Symptoms Conditions that cannot be observed and must be described by the patient Pain Sensation

Function of smooth, skeletal and cardiac muscle

Skeletal Under control of the brain and nervous system Aka voluntary muscle Major muscle mass of the body Striated muscles Smooth Involuntary muscle Automatic muscles control function Non-striated muscle Cardiac Automaticity: can generate an impulse of its own when disconnected from the central nervous system Has own blood supply furnished by the coronary arteries Cannot tolerate interruption of the blood supply

Functions of individual organs, solid vs hollow organ trauma

Stomach Hollow organ Main organ of the digestive system Gastric juices secreted to convert food to absorbable content Pancreas Solid organ Secretes pancreatic juices that aid in the digestion of fats, starches and proteins Islet of langerhans located in the pancreas produces insulin to regulate sugar in the bloodstream Liver Largest solid organ Produces bile which aid in digestion of fat Stores sugars Spleen Solid organ Blood filtration Blood reservoir Gallbladder Hollow pouch Reservoir for bile via the bile duct Small intestine Duodenum, jejunum and ileum Receives food from stomach and secretions from pancreas and liver Food is completely broken down into usable form Absorption of nutrients through intestinal walls to circulate throughout the bloodstream Large intestine Aka colon Parts of food which cannot be absorbed are passed as waste products to be eliminated Water is extracted from waste products, remaining solid gets passed through the rectum and anus

Suspected conditions indicated by a weak, strong, bounding, peripheral or central pulse

Strong pulse Full and normal Bounding pulse Abnormally strong Weak pulse Doesn't feel full may be difficult to find and palpate Could be rapid Thready pulse Weak and fast Regular pulse Normal pulse occurring at regular intervals with a smooth rhythm Irregular pulse Pulse occurs at irregular intervals Indicates cardiac disease Regularly irregular pulse Irregular beat occurs at a regular interval Irregularly irregular pulse No predictable pattern and presents as a chaotic rhythm

Differentiate the function of the sympathetic and parasympathetic nervous systems

Sympathetic nervous system Activated when the body is challenged by stressors (trauma, blood loss, fright) Fight or flight response Parasympathetic nervous system Returns body processes to normal or depresses body function

Role of systemic vascular resistance and preload

Systemic vascular resistance Resistance offered to blood flow through a vessel Vasoconstriction increases blood pressure Vasodilation decreases blood pressure Influenced by the autonomic nervous system Stimulation of the sympathetic nervous system to constrict Alpha1 Stimulation of parasympathetic nervous system to dilate Preload Pressure generated in the left ventricle at the end of diastole

What systolic and diastolic BP indicates

Systolic blood pressure is a relative indicator of cardiac output Diastolic blood pressure measures the systemic vascular resistance Increase in the systemic vascular resistance increase diastolic blood pressure And opposite for decrease

Signs of severe hypoxia

Tachypnea Dyspnea Cyanosis Tachycardia leading to dysrhythmias Severe confusion Loss of coordination Sleep appearance Head bobbing with ventilation Slow reaction time Altered mental status Seizure

Advantages of the power lift

Technique that offers you the best defense against injury and protects the patient with a safe and stable move Useful technique for rescuers with weak knees or thighs

Obtaining a chief complaint

The reason why the EMS crew was called to the scene Process must remain dynamic to allow EMT to pursue pieces of information provided by the patient

Relationship and assessment of tidal volume including respiratory rate effect on tidal volume

Tidal volume is the amount of air moved into the lungs Faster breathing causes a decrease in tidal volume Less air making it to the bottom of the lungs Hyperventilating Look for chest rise Expansion and retraction Listen Feel the volume of air escaping Auscultate bilaterally

Recognizing death in the field - obvious vs presumptive

Treatment may be withheld or terminated if a patient has a valid POLST/DNR Presumptive signs of death requiring treatment unless a valid POLST/DNR on scene Absence of pulse, breathing or breath sounds Complete unresponsiveness to any stimuli No eye movement or pupil reflex Absence of a blood pressure No reflexes Obvious signs of death when resuscitative treatment may be withheld despite no DNR Decapitation Rigor mortis (2-12 hour onset) Decomposition of the body Dependent lividity

Multiple casualty incidents

Triage Tag: Chief complaint Vital signs Treatment provided

Function of the heart valves

Tricuspid - between right atrium and ventricle Pulmonary - base of the pulmonary artery in the right ventricle Mitral - (bicuspid) between left atrium and ventricle Aortic - base of aortic artery in the left ventricle

Anatomy of the airway

Upper airway Nose and mouth Pharynx Nasopharynx Oropharynx Esophagus Epiglottis Larynx Lower airway Trachea Carina Bronchi and bronchioles Lungs Alveoli diaphragm

Hazardous materials resources

Use binoculars to try and identify materials before approaching the scene Use Emergency Response Guidebook (ERG) Identify placards and signs to identify hazardous materials in facility Call a specialized hazmat team to control the scene Only rescuers trained in managing Haz Mat should enter EMTs should provide emergency care only after the scene is safe

Results of a lack of venous blood return to the heart

VR must equal CO

Process of vasoconstriction and vasodilation

Vasoconstriction Decreasing the diameter of the vessel Controlled by smooth muscle Vasodilation Increasing the diameter of the vessel Controlled by smooth muscle

Differentiate ventilation, respiration and oxygenation

Ventilation Mechanical process by which air is moved in and out of the lungs Oxygenation Form of respiration in which oxygen molecules move across a membrane from an area of high concentration to an area of low concentration Respiration The process of moving oxygen and carbon dioxide across membranes in and out of the alveoli, capillaries and cells Defines the actual gas exchange process

Recognition of and treatment for tachypnea

Ventilatory rate greater than 25 breaths per minute Decreased tidal volume Apply positive pressure ventilation

Identify the life span developmental stage based on psychosocial or physiologic changes/patterns

Vital Signs Neonate HR: 100-205 bpm Breathing rate: 40-60 breaths/min Systolic BP: 67-84 mmHg Diastolic BP: 35-53 mmHg Infant HR: 100-180 bpm Breathing rate: 30-53 breaths/min Systolic BP: 72-104 mmHg Diastolic BP: 37-56 mmHg Toddler HR: 98-140 bpm Breathing rate: 22-37 breaths/min Systolic BP: 86-106 mmHg Diastolic BP: 42-63 mmHg Preschooler HR: 80-120 bpm Breathing rate: 20-28 breaths/min Systolic BP: 89-112 mmHg Diastolic BP: 46-72 mmHg School-aged HR: 75-118 bpm Breathing rate: 18-25 breaths/min Systolic BP: 97-115 mmHg Diastolic BP: 57-76 mmHg Preadolescent HR: 70-100 bpm Breathing rate: 15-20 breaths/min Systolic BP: 100-120 mmHg Diastolic BP: 61-80 mmHg Adolescent HR: 60-100 bpm Breathing rate: 12-20 breaths/min Systolic BP: 110-131 mmHg Diastolic BP: 64- 83 mmHg Adult HR: 60-100 bpm Breathing rate: 12-20 breaths/min Systolic BP: 120 or less mmHg Diastolic BP: 80 or less mmHg Psychosocial Neonate and infants Established connection with caretaker Crying as form of communication Different sounds for basic need, anger or pain Ability to recognize familiar faces and objects Toddlers and preschool-age children Language replaces crying as sole form of communication Separation anxiety Use play to explore new objects and locations Take communication literally School-age children Form friendships Develop self-concept Understand rules to avoid punishment Recognize EMS as people who can help in crisis Adolescence More argumentative Participate in risky behavior Desire to be treated as adults Develop their identity Peer pressure increases self-conscious ness increases Depression and suicide are most ommon at this age Body image issues Eating disorders develop Interest in opposite sex adult Take more responsibility Become independent Develop romantic and affectionate relationships Many get married and start families Core capable of coping with stress Mid life crisis hits Begin questioning if you've accomplished your goals Formulate new goals Empty nest syndrome Feeling of isolation Worthlessness Feeling ashamed asking for help

Methods and terminology when taking a pulse

Waves created by the contraction of the left ventricle correlates to the relative strength of left ventricular contraction, as well as volume of ejected blood from the left ventricle (stroke volume) Rate Fast or slow Strength Strong or weak Rhythm Regular Irregular Irregularly irregular Central pulse points Carotid artery Bilateral neck Femoral artery Crease between lower abdomen and upper thigh Peripheral pulse points Radial artery Proximal to the thumb Brachial artery Medial aspect of arm Popliteal artery Crease behind the knee Posterior tibial artery Behind the medial malleolus Dorsalis pedis artery Top of food on the great toe side

Sequence the priorities of personal safety

Wear personal protective gear Gloves Eye protection Mask Gown Avoid hazardous sites Gasoline leaks Fires Chemical spills Radiation leaks Do not enter volatile crowd without law enforcement Take extra precautions if patient is under influence of drugs, alcohol or behavioral condition Follow directions given by police, fire and utility Wear reflective clothing at night Wear a helmet, outerwear and leather gloves to protect from jagged scenes Prevent injury with proper body mechanics Determine which facility will be most appropriate based on pt needs

Equipment uses: wheeled stretcher, bariatric stretcher, portable stretcher, stair chair, backboard, scoop stretcher, basket stretcher, flexible stretcher

Wheeled stretcher (aka cot or gurney) Lift in type Roll in type - reduces injury to operators Battery Hydraulic Pneumatic Bariatric - used for morbidly obese pts up to 1600 lbs Portable stretcher Types Basic Basic with wheels and posts Breakaway Lightweight and hold up to 350 lbs, used in mass casualty triage Usually must be carried rather than rolled (except one with wheels) Easily cleaned, usually vinyl Cannot be used in conjunction with spinal immobilization Stair chair Used w/ pt. In a seated position to move up or down stairs or in narrow hallways Two team members are needed to use the chair in ascent or descent situations - one at the head and another at the feet Conditions where a stair chair should not be used: Altered mental status Suspected spinal injury Injuries to the lower extremities Backboards Used to move supine pts. with suspected spinal injuries Can move pt from cramped location into a more open area Usually made from plastic or composite material Have handholds built into the sides Vest-type/corset type immobilization device Used only for noncritical seated pts. When an urgent move is not needed Best known is the KED (kendrick extrication device) Rigid flat stabilizers sown vertically into the back of the best to bilaterally limit spinal column motion After the vest is 'set' on the pt they should be placed onto a long backboard to complete spine motion restriction Scoop stretcher Designed for weights up to 300 lbs Can be adjusted to pt. Height Can be assembled and disassembled around the pt Fits well in confined areas Can be used when packaging pts with pelvic fractures or unilateral/bilateral femur fractures Not recommended for spinal injuries Basket stretcher (Stokes basket) Can place a long backboard within the stretcher Can be used for vertical extrication to raise or lower the pt Helpful for transporting in rough terrain

Identify the functions of quality improvement

determine the overall effectiveness of the prehospital emergency medical system and what improvements can be made for better care

Legal elements of a refusal of service and required form

signed refusal form

Understand pertinent negatives

signs and symptoms that might be expected based on the chief complaint but the patient denies having It is extremely important to list in the PCR because this verifies that the EMS were thorough in the assessment of the patient's nature of illness or mechanism of injury

Recognize negligence given a scenario

the act of deviating from an accepted standard of care through carelessness, inattention, disregard, inadvertence, or oversights, which results in further injury to the patient

Main purpose of documentation

to report accurate data obtained during time with a patient to ensure continuity of care