EMS FINAL

Pulmonary circulation (lungs)

Carries oxygen-poor blood from the right ventricle through the lungs and back to the left atrium

Systole

Contraction of the heart

Before inserting any catheter, measure for the proper size

Ear to corner of mouth

Enternal Medications

Medications that enter the body through the digestive system.

Middle adults are ages 41 to 60 years.

Middle adults may find themselves caring for children leaving for college and caring for their aging parents as well.

cardiac muscle

Muscle of the heart

Back-boarding Pediatrics

Same as adult, just strap the torso first.

Stroke Volume (SV)

The amount of blood pumped out of the heart with each contraction.

Adsorption

The process of binding or sticking to a surface.

Amlodipine

Treat high blood pressure and chest pain (angina)

Systemic circulation (body)

a. Carries oxygen-rich blood from the left ventricle through the body and back to the right atrium

mild airway obstruction

a. Patient is able to exchange adequate amounts of air but still has signs of respiratory distress b. Leave these patients alone.

Complications in cpr

a.​Fractured ribs b.​Lacerated liver c.​Fractured sternum

Aspirin

b.​Inhibits platelet aggregation (clumping), which is useful during a potential heart attack c.​Contraindications i.​Hypersensitivity to aspirin ii.​Preexisting liver damage, bleeding disorders, and asthma iii.​Should not be given to children

dys-

bad, painful, difficult

-ia

condition of

The mediastinum is the area between the lungs, which contains:

i. Heart ii. Great vessels iii. Esophagus iv. Trachea v. Major bronchi vi. Many nerves

edema

swelling

decompensated shock

when the body can no longer compensate for low blood volume or lack of perfusion. Late signs such as decreasing blood pressure become evident

In patients who have signs and symptoms of an airway infection, do not waste time trying to dislodge a foreign body.

​Administer supplemental oxygen if needed and immediately transport the child to the ED.

Tracheostomy masks

1.​Patients with tracheostomies do not breathe through their mouth and nose. 2.​Tracheostomy masks cover the tracheostomy hole and have a strap that goes around the neck.

rapid scan to identify life threats

60-90 seconds

Compression to Ventilation ratio for Adults, Children, and Infants

Adults: 30:2 1 or 2 rescuers Children/Infants: 30:2 Single rescuer 15:2 2 rescuers

A patient may appear to be breathing after the heart has stopped.

Agonal gasps

Assess circulation.

Circulation is evaluated by assessing the patient's mental status, pulse, and skin condition

Sepsis

Dangerous infection of the blood

-pathy

Disease

Hours of different levels of EMS

EMT 150 hours AEMT 200-400 PARAMEDIC 1,000-1300

Compensating shock

Early signs of shock body can still compensate for blood

Traumatic DOA

Have partner confirm dead

Chest compressions on a child

Heel of hand in between nipples Compress 1/3 of anterior diameter 100-120 times per min 30:2 Pause for two ventilations Reasses pulse after 2 minutes Non pulse= AED Reagan pulse greater than 60 bpm put in position of comfort

Respiratory distress

Increased effort and rate

Infants are often nose breathers

Newborns are "obligate nose breathers." This means they can't breathe through their mouths in the first few months of life. Because babies have small nasal passages, they sound stuffy when they breathe.

Pt states drinking alcohol and asks you not to tell

Only tell those in line of hospital care

obstructive shock

Shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body's tissues.

MDI

Stimulates nervous system causing bronchodilation Asthma Hypersensitivity tachycardia hypertension 1-2

Oxygenation

The process of delivering oxygen to the blood by diffusion from the alveoli following inhalation into the lungs.

-oma

Tumor

Medical examiner called on

a. A patient who is dead on arrival (DOA) (sometimes called dead on scene [DOS]) b. Death without previous medical care, or when the physician is unable to state the cause of death. c. Suicide (self-destruction) d. Violent death e. Poisoning, known or suspected f. Death from accidents g. Suspicion of a criminal act h. Infant and child deaths

EPCR

a. Information is filled in using a computer or tablet device that uploads data over a secure Internet connection. b. ePCRs allow patient information to be transmitted directly to hospital computers.

Adolescents 12-18

a. Pulse rate is 60 to 100 beats/min. b. Respiratory rate is 12 to 20 breaths/min. c. Systolic blood pressure is between 90 and 110 mm Hg.

backboard should be used for a patient

a. Who is unresponsive b. Who must be moved in supine position c. Who must be immobilized

Signs and symptoms of inadequate ventilation

a.​Altered mental status b.​Inadequate minute volume c.​Excessive accessory muscle use and fatigue

Removal of foreign objects

a.​Remove the catheter from the patient's mouth. b.​Log roll the patient to the side. c.​Clear the mouth carefully with a gloved finger.

AAA

abdominal aortic aneurysm

-algia

pain

-al or -ic

pertaining to

Tensionpneumothorax

Air flows into pleural cavity and is trapped

General Adaptation Syndrome

1. Alarm response to stress 2. Reaction and resistance to stress 3. Recovery—or exhaustion from stress

communicable disease

1. From person to person 2. From one species to another C. Infection risk can be minimized by: 1. Immunizations 2. Protective techniques 3. Handwashing

body drag

1. Keep your back locked in a slight curve created by tightening your abdominal muscles. 2. Kneel to minimize the distance you will have to lean over. 3. Extend arms no more than 15-20 inches in front of you. 4. When you can pull no farther because your hands have reached the front of your torso, stop and move back another 15-20 inches. 5. Alternate between pulling the patient by slowly flexing your arms and repositioning yourself.

Mobile integrated health care

1. Mobile integrated health care (MIH) is a new method of delivering health care paramedics receive advanced training to equip them to provide services within a community.

Spleen

1. Solid organ located under the rib cage in left upper part of abdomen 2. Filters worn-out blood cells, foreign substances, and bacteria from the blood 3. Highly vascular and is particularly susceptible to injury from blunt trauma a. Can lead to severe internal bleeding

What does the lymphatic system do?

1. removes excess fluids and waste products from the body's tissues 2. helps the immune system fight infection

AED use in children

1.​Apply after the first five cycles of CPR. ​2.​For children 1 month to 1 year of age, a manual defibrillator is preferred; if this is not available, use pediatric-sized pads and dose-attenuating system. If neither is available, then use an AED with adult-sized pads with anterior-posterior placement.

Pump failure

1.​Causes: heart attack, trauma to heart, obstructive causes 2.​Types of shock a. ​Cardiogenic shock b. ​Obstructive shock i. Tension pneumothorax ii. Cardiac tamponade iii. Pulmonary embolism

Distributive shock

1.​Distributive shock results when there is widespread dilation of small arterioles, small venules, or both. 2.​The circulating blood volume pools in the expanded vascular beds and tissue perfusion decreases.

Nasopharyngeal airways

1.​Indications: a.​Patient who is unresponsive or has an altered level of consciousness b.​Patient who has an intact gag reflex c.​Patient who is unable to maintain his or her own airway spontaneously 2.​Patients with an altered mental status or who have just had a seizure may benefit from this type of airway. 3.​Consult medical control before inserting a nasopharyngeal airway in a patient who has sustained severe trauma to the head or face. a.​It may penetrate into the brain. 4.​A nasopharyngeal airway is usually better tolerated by patients who have an intact gag reflex. a.​Less likely to cause vomiting compared to the oropharyngeal airway 5.​Indications: a.​Semiconscious or unconscious patients with an intact gag reflex b.​Patients who otherwise will not tolerate an oropharyngeal airway 6.​Contraindications: a.​Severe head injury with blood draining from the nose b.​History of fractured nasal bone

Oropharyngeal airways

1.​Keep the tongue from blocking the upper airway 2.​Make it easier to suction the oropharynx if necessary a.​Suctioning is possible through an opening down the center or along either side of the oropharyngeal airway. 3.​Indications: a.​Unresponsive pat

BVM

15 L/min nearly 100%

Effectiveness of mouth to mask ventlation

16% 55% with high flow o2 at 15/l min

SAMPLE history

A brief history of a patient's condition to determine signs and symptoms, allergies, medications, pertinent past history, last oral intake, and events leading to the injury or illness.

Hemophilia

A hereditary disease where blood does not coagulate to stop bleeding

Venturi masks

A number of attachments can vary the percentage of oxygen while a constant flow is maintained from the regulator.

Oral Glucose

Cheek and gums Hypoglycemia Contraindicated decreased loc 1/2 to 1 tube

Forcible restraint

Consult medical control for authorization

If the secondary assessment is not performed at the scene, it is performed in the back of the ambulance en route to the hospital.

However, there will be situations where you may not have time to perform the secondary assessment. 1. You may have to continue to manage life threats identified during the primary assessment en route to the hospital.

terminal drop hypothesis

In the 5 years preceding death, mental function is presumed to decline

medication error

Inappropriate use of a medication that could lead to patient harm.

Patient Refusal

Involve online medical control and document this consultation

fallopian tubes function

Moves ova by peristalsis down the fallopian tube to the uterus. Fertilization of the ova normally occurs in the fallopian tube.

Pace makers and implanted defibrillator

Place electrodes at least 1 inch (2.5 cm) away from the device.

Children learn various types of reasoning.

Preconventional reasoning: children act almost purely to avoid punishment and get what they want. b. Conventional reasoning: children look for approval from their peers and society. c. Postconventional reasoning: children make decisions guided by their conscience.

Instead of the abdominal-thrust maneuver, use chest thrusts for the following responsive patients:

Prenant and obese

Diastole

Relaxation of the heart

Veins

Return oxygen-depleted blood to the heart

Oxygen

Reverse hypoxia Contraindications copd

Epinephrine

Stimulated nervous system causing bronchodilation Anaphylactic shock Contraindications: chest pain hypothermia hypertension 0.3 mg adult half for kid (depends on weight)

Approaching someone from the side

Straight from the head

Moving unresponsive and unconscious pt down stairs

Strap in to back board, carry the pt downstairs with the foot end first always keeping head elevated, and have a stretcher prepared down the stairs

extremity

Used for patients with no suspected extremity or spinal injury who are supine or in a sitting position b. May be helpful when the patient is in a small space because it does not require EMTs to stand side by side c. One EMT is positioned at the patient's head and the other EMT is positioned at the patient's feet. d. Coordinate your movements using direct verbal commands.

Urgent movement/lifting is:

Used for pts with AMS, inadequate ventilations, or shock.

An-

Without

Early adults 19-40

a. Pulse rate will average around 70 beats/min and range between 60 and 100 beats/min. b. Respiratory rate will stay in the range of 12 to 20 breaths/min. c. Systolic blood pressure will be between 90 and 140 mm Hg.

To assist a patient with ventilations using a BVM

a.​Explain the procedure to the patient. b.​Place the mask over the patient's nose and mouth. c.​Squeeze the bag each time the patient breathes, maintaining the same rate as the patient. d.​After the initial 5 to 10 breaths, slowly adjust the rate and deliver an appropriate tidal volume. e.​Adjust the rate and tidal volume to maintain an adequate minute volume.

Compensated shock stages

a.​In early stages of shock, the body can still compensate for blood loss. b.​Signs and symptoms: i.​Agitation ii.​Anxiety iii.​Restlessness iv.​Feeling of impending doom v.​Altered mental status vi.​Weak, rapid (thready), or absent pulse vii.​Clammy (pale, cool, moist) skin viii. Pallor, with cyanosis about the lips ix.​Shallow, rapid breathing x.​Air hunger (shortness of breath), especially if there is a chest injury xi.​Nausea or vomiting xii.​Capillary refill of longer than 2 seconds in infants and children xiii. Marked thirst xiv.​Narrowing pulse pressure

​Pulse pressure

difference between the systolic and diastolic pressures (systolic - diastolic = pulse pressure). a. ​It signifies the amount of force the heart generates with each contraction. b. ​A pulse pressure less than 25 mm Hg may be seen in patients with shock.

nephropathy

disease of the kidney

Pathogen

microorganism that is capable of causing disease

Naloxone (Narcan)

opioid antagonist Contraindications of hypersensitivity 0.4-2mg

blood pressure

the pressure that is exerted by the blood against the walls of blood vessels

If the patient is in cardiac arrest

then a CAB sequence (compressions, airway, breathing) is used because chest compressions are essential and must be started as quickly as possible.

Signs and symptoms of repository failure

• Subjective complaint of shortness of breath • Restlessness • Increased (early distress) or decreased (late distress) pulse rate • Changes to the rate or depth of breathing • Skin color changes • Abnormal breathing, lung, or airway sounds • Difficulty or inability to speak • Muscle retractions (suprasternal, supraclavicular, sub- clavicular, intercostal) • Altered mental status • Abdominal breathing (excessive use of abdominal muscles) • Excessive coughing (with or without expectorating material) • Tripod positioning • Decrease in pulse oximetry (blood o

sternum

(1) Manubrium (upper section) (2) Body (3) Xiphoid process (narrow, cartilaginous tip)

upper airway

(Nose, mouth, pharynx, larynx)FUNCTION:*Conducts air to lower airway *Protects lower airways *Warms, filters & humidifies air

Atrovastatin (Lipitor)

- Lipid Lowering Drug - Causes serious muscle problems that lead to kidney failure.

Factors that may cause inaccurate pulse oximetry readings

. Hypovolemia ii. Severe peripheral vasoconstriction (chronic hypoxia, smoking, or hypothermia) iii. Time delay in detecting respiratory insufficiency iv. Dark or metallic nail polish v. Dirty fingers vi. Carbon monoxide poisoning

nasal canual

1-6 l/min 24-44 percent

Medical direction

1. A physician medical director authorizes EMTs to provide medical care in the field . 2. Appropriate care is described in standing orders and protocols. a. Protocols are described in a comprehensive guide delineating the EMT's scope of practice. b. Standing orders are part of protocols and designate what the EMT is required to do for a specific complaint or condition. 3. Providers are not required to consult medical direction before implementing standing orders. 4. The medical director is the ongoing working liaison between the medical community, hospitals, and the EMTs in the service. 5. Medical control can be off-line or online. a. Off-line (indirect) i. Standing orders, training, supervision b. Online (direct) i. Physician directions given over the phone or radio

grieving process

1. Denial 2. Anger, hostility 3. Bargaining 4. Depression 5. Acceptance

Responsive patients who become unresponsive

1. Lower the patient to the ground and call for help (or send someone for help). 2. Perform 30 chest compressions. a. Do not check for a pulse before beginning chest compressions. 3. Open the airway and look in the mouth. a. If you see an object that can be easily removed, remove it with your fingers and attempt to ventilate. b. If you do not see any object, resume chest compressions. 4. Repeat steps 2 and 3 until the obstruction is relieved or ALS providers take over.

Removing an unconscious patient from a vehicle alone

1. Move the patient's legs clear of the pedals. 2. Rotate the patient so that his or her back is toward the open car door. 3. Place your arms under the patient's shoulders and through the patient's armpits, and support the patient's head against your body. 4. If the legs and feet clear the car, rapidly drag the patient from the seat to a safe location. a. If the legs and feet do not clear the car, lower the patient to the ground until the patient is on his or her back, clear the legs from the vehicle, and drag the patient to a safe location.

Definitive signs of death

1. Obvious mortal damage (decapitation) 2. Dependent lividity, which refers to blood settling to the lowest point of the body, causing discoloration of the skin 3. Rigor mortis, which is the stiffening of body muscles caused by chemical changes within muscle tissue a. Occurs between 2 and 12 hours after death 4. Putrefaction (or decomposition) of body tissues, which (depending on temperature conditions) occurs between 40 and 96 hours after death

Narcan (naloxone)

1. Opioid antagonist that reverses the effects of opioid drugs

A lack of oxygen (hypoxia), combined with too much carbon dioxide in the blood (hypercarbia), is lethal.

1. Provide slow, deliberate ventilations that last 1 second.​

Nervous system control of the cardiovascular system

1. The sympathetic nervous system is responsible for the fight-or-flight response. a. Sends commands to adrenal glands b. Epinephrine and norepinephrine are secreted to stimulate heart and blood vessels. i. The popular names of these hormones are adrenaline and noradrenaline. (a) Blood vessels have alpha-adrenergic receptors. (1) When stimulated, blood vessels constrict, increasing blood pressure. (b) The heart and lungs have beta-adrenergic receptors. (1) When stimulated, heart rate increases. (2) Bronchi in the lungs dilate, allowing more air to be inhaled and exhaled. 2. The parasympathetic nervous system addresses actions that do not require an immediate response. a. When stimulated, this system causes the heart to slow and beat more weakly. 3. The opposition between the sympathetic and parasympathetic nervous systems allows the body to respond appropriately.

Investigate the chief complaint (history of present illness)

1. To investigate the chief complaint, begin by making introductions, make the patient feel comfortable, and obtain permission to treat. 2. If the patient is unresponsive, gather information from people present on-scene or clues from the patient's surroundings. 3. Use the OPQRST mnemonic for gathering additional information about the patient's present illness and current symptoms. 4. Identify pertinent negatives.

Hepatitis

1. ​Inflammation (and often infection) of the liver 2. ​Can be caused by a number of different viruses and toxins 3.​Early signs include: a. ​Loss of appetite b. ​Vomiting c. ​Fever d. ​Fatigue e. ​Sore throat f.​Cough g.​Muscle and joint pain 4.​Signs that appear several weeks later include: a. ​Jaundice b. ​Right upper quadrant abdominal pain 5. ​Toxin-induced hepatitis is not contagious. ​a. ​There is no sure way to tell which hepatitis patients are contagious. 6.​Hepatitis A can be transmitted only from a patient who has an acute infection, whereas hepatitis B and hepatitis C can be transmitted from long-term carriers who have no signs of illness. a.​A carrier is a person (or animal) in whom an infectious organism has taken up permanent residence and may or may not cause an active disease. ​b.​Hepatitis A is transmitted orally through oral or fecal contamination. ​c.​Hepatitis B is far more contagious than HIV. d. ​Vaccination with hepatitis B vaccine is highly recommended for EMTs.

Meningitis

1. ​Inflammation of the meningeal coverings of the brain and spinal cord 2.​Signs and symptoms include: a.​Fever b.​Headache c.​Stiff neck d.​Altered mental status 3. ​Most forms of meningitis are not contagious. a.​However, one form, meningococcal meningitis, is highly contagious. 4. ​Take standard precautions. a.​Gloves and a mask will go a long way to prevent the patient's secretions from getting into your nose and mouth. b.​Vaccines are rarely used. c.​Meningitis can be treated at the ED with antibiotics. 5. ​After treating a patient with meningitis, contact your employer health representative.

Methicillin-resistant Staphylococcus aureus (MRSA)

1. ​MRSA is a bacterium that causes infections. 2. ​It is resistant to many antibiotics. 3. ​In health care settings, MRSA is transmitted from patient to patient by the unwashed hands of health care providers. a.​Studies have shown that 5% to 15% of health care providers carry MRSA in their nares (can be transferred to skin and other areas of the body through a break in the skin). 4.​Factors that increase the risk for developing MRSA include: a.​Antibiotic therapy b.​Prolonged hospital stays c.​A stay in an intensive care or burn unit d.​Exposure to an infected patient 5.​The incubation period for MRSA appears to be between 5 and 45 days. 6.​MRSA results in soft-tissue infections. ​a. ​Signs and symptoms: localized skin abscesses and sepsis in older patients

herpes simplex

1. ​This is a common virus strain carried by humans. 2. ​Of individuals carrying the virus, 80% are asymptomatic. 3. ​Symptomatic infections cause eruptions of tiny fluid filled blisters called vesicles that appear on the lips or genitals. 4.​Can cause more serious illnesses like pneumonia and meningitis in the very young, very old, and immunocompromised patients. 5. ​The primary mode of infection is through close personal contact, so standard precautions are generally sufficient to prevent spread to or from health care workers.

Perfusion Triangle

1.​A pump (the heart) 2.​A set of pipes (blood vessels or arteries that act as the container) 3.​The contents of the container (the blood)

​As long as the patient can breathe, cough, or talk, do not interfere with his or her attempts to expel the foreign body.

1.​Administer supplemental oxygen if needed (and tolerated) and provide transport to the ED.

​Cardiogenic shock

1.​Cardiogenic shock is caused by inadequate function of the heart, or pump failure. 2.​A major effect is the backup of blood into the lungs. 3.​The resulting buildup of pulmonary fluid is called pulmonary edema. a. ​Edema is the presence of abnormally large amounts of fluid between the cells in body tissues, causing swelling of the affected area. b.​Pulmonary edema leads to impaired respiration, which may be manifested by: i. ​An increased respiratory rate ii. ​Abnormal lung sounds 4.​Cardiogenic shock develops when the heart cannot maintain sufficient output to meet the demands of the body. a.​Cardiac output is the volume of blood that the heart can pump per minute, and it is dependent upon several factors. i.​The heart must have adequate strength, which is largely determined by the ability of the heart muscle to contract (myocardial contractility). ii.​The heart must receive adequate blood to pump.

Poor vessel function

1.​Causes: infection, drug overdose (narcotic), spinal cord injury, anaphylaxis 2.​Types of shock a. ​Distributive shock i. ​Septic shock ii. ​Neurogenic shock iii. ​Anaphylactic shock iv. ​Psychogenic shock

Unresponsive patients

1.​Determine unresponsiveness. ​2.​Check for breathing and a pulse. ​3.​If pulse is present but breathing is absent, then open the airway and attempt to ventilate. ​​a. If the first ventilation does not produce visible chest rise, then reposition the airway and reattempt to ventilate. ​4.​If both ventilation attempts do not produce visible chest rise, then perform 30 compressions, open the airway, and look in the mouth. a.​Attempt to carefully remove any visible object.

Infants airway obstruction

1.​Do not use abdominal thrusts responsive infants. ​2.​Instead, perform back slaps and chest thrusts (compressions). In unresponsive infants, begin CPR beginning with chest compressions. ​1.​Do not check for a pulse before starting compressions. ​2.​Open the airway and look in the mouth. ​​a. If you see an object that can be easily removed, then remove it with your finger and attempt to ventilate. ​​b. If you do not see an object, then resume chest compressions. ​3.​Continue the sequence of chest compressions, opening the airway, and looking inside the mouth until the obstruction is relieved or ALS providers take over.

Shock can occur because of medical or traumatic events

1.​Heart attack 2.​Severe allergic reaction 3.​Motor vehicle crash 4.​Gunshot wound

hypovolemic shock

1.​Hypovolemic shock is the result of an inadequate amount of fluid or volume in the circulatory system. a. ​There are hemorrhagic causes and nonhemorrhagic causes. b. ​Injuries involving bleeding may result in hemorrhagic shock, while vomiting and diarrhea may result in nonhemorrhagic hypovolemic shock. 2.​Hypovolemic shock also occurs with severe thermal burns. a.​Intravascular plasma is lost. b.​Plasma leaks from the circulatory system into the burned tissues that lie adjacent to the injury. 3.​Dehydration, the loss of water or fluid from body tissues, can cause or aggravate shock. a.​Fluid loss may be a result of severe vomiting and/or diarrhea.

Three general rules regarding when not to start CPR:

1.​If the scene is unsafe ​2.​If the patient has obvious signs of death, which include an absence of pulse and breathing, along with any one of the following findings: a.​Rigor mortis—stiffening of the body after death b.​Dependent lividity (livor mortis)—discoloration of the skin caused by pooling of blood c.​Putrefaction—decomposition of the body d.​Evidence of nonsurvivable injury—eg, decapitation, dismemberment, or burned beyond recognition ​3.​If the patient and physician have previously agreed on do not resuscitate (DNR) orders a.​Usually only applies when patient is in the terminal stage of an incurable disease b.​Can be a complicated issue c.​Advanced directives expressing patient's wishes may be hard to find. d.​When in doubt, begin CPR. e.​Very important to know local protocol

Influenza

1.​Influenza (flu): an animal respiratory disease that has mutated to infect humans. 2.​Those with chronic medical conditions, compromised immune systems, and the very young and the very old are most susceptible to complications of influenza. 3.​Transmitted by direct contact with nasal secretions and aerosolized droplets from coughing and sneezing by infected people

Attributes of a emt

1.​Integrity: acting consistently; maintaining a firm adherence to a code of honest behavior 2.​Empathy: being aware of and thoughtful toward the needs of others 3.​Self-motivation: discovering problems and solving them without someone directing you 4.​Appearance and hygiene: using your persona to project a sense of trust, professionalism, knowledge, and compassion 5.​Self-confidence: knowing what you know and knowing what you do not know; being able to ask for help 6.​Time management: performing or delegating multiple tasks while ensuring efficiency and safety 7.​Communications: understanding others and making yourself understood to others 8.​Teamwork and diplomacy: being able to work with others; knowing your place within a team; communicating while giving respect to the listener 9.​Respect: holding others in high regard or importance; understanding that others are more important than you 10.​Patient advocacy: constantly keeping the needs of the patient at the center of care 11.​Careful delivery of care: paying attention to details; making sure that what is being done for the patient is done as safely as possible

CPR skills can deteriorate over time

1.​Practice often using manikin-based training. ​2.​CPR self-instruction through a video and/or computer-based modules with hands-on practice may be a reasonable alternative to instructor-led courses.

Cardiac arrest in pregnancy

1.​Priorities are to provide high-quality CPR and relieve pressure off the aorta and vena cava ​2.​If the pregnant patient is not in cardiac arrest, then position her on her left side to relieve pressure on the great vessels. ​3.​If she is in cardiac arrest, and the top of the patient's uterus can be felt at or above the level of the umbilicus, perform manual displacement of the uterus to the patient's left to relieve aortocaval compression while CPR is being performed.

Follow the "six rights." administration medication

1.​Right patient: Ensure that the patient who needs the medication is the person who receives the medication. 2.​Right medication: Verify the proper medication and prescription. 3.​Right dose: Verify the form and dose of the medication. 4.​Right route: Verify the route of the medication. 5.​Right time: Check the expiration date and condition of the medication. 6.​Right documentation: Document your actions and the patient's response.

Once you begin CPR, continue until one of the following occur (using the mnemonic STOP):

1.​S—Patient Starts breathing and has a pulse ​2.​T—Patient is Transferred to another provider of equal or higher-level training ​3.​O—You are Out of strength ​4.​P—Physician directs you to discontinue

Primary assessment for shock

1.​The primary assessment for a patient with suspected shock should include a rapid exam to: a.​Determine level of consciousness b.​Identify and manage life-threatening concerns as they are found c.​Determine priority of the patient and transport i. ​A patient with massive hemorrhage may require a tourniquet (or direct pressure dressings when tourniquets are not feasible or available) before the airway is opened. ii. ​If the patient has life-threatening external bleeding, it should be addressed first (even before airway and breathing), then the ABCs can be assessed and treated, and treatments for shock provided. 2.​Provide high-flow oxygen to assist in perfusion of damaged tissues. a.​If the patient has signs of hypoperfusion, treat aggressively and provide rapid transport to the hospital. b.​Request advanced life support (ALS) as necessary to assist with more aggressive shock management. 3. ​Form a general impression. a.​This will help you develop an early sense of urgency for care of a patient who appears "sick." b.​Determine the need for manual spinal stabilization and assess the patient's level of consciousness using the AVPU scale. c. ​A patient who has an altered level of consciousness (LOC) may need emergency airway management. d.​If the patient is awake and alert, determine a chief complaint. 4. ​Airway and breathing a. ​Assess the airway to ensure it is patent. b. ​Quickly assess breathing. i.​Observe the patient for signs of accessory muscle use such as the muscles of the neck, intercostal retractions, or abnormal use of the abdominal muscles. ii.​An increased respiratory rate is often an early sign of impending shock. iii.​Assess for wheezes or other abnormal breath sounds. c. ​Administer high-flow oxygen or, if needed, assist respirations with a BVM. 5. ​Circulation a. ​Assessing the patient's circulatory status can reveal important clues regarding the presence of shock. b. ​Check for a distal pulse. c. ​If there is none, check for a central pulse. d. ​Determine if the pulse is fast, slow, weak, strong, or altogether absent. i.​A rapid pulse suggests compensated shock. ii.​In shock or compensated shock, the skin may be cool, clammy, or ashen. e.​If the patient has no pulse and is not breathing, immediately begin cardiopulmonary resuscitation (CPR). 6. ​Transport decision a. ​Assess for and identify any life-threatening bleeding in trauma patients; if serious bleeding is discovered, treat it at once. b. ​You must also quickly assess skin temperature, condition, and color, and check for capillary refill time. c.​Determine whether the patient should be treated as high priority, whether ALS is needed, and which facility to transport to. d.​Trauma patients with shock, or a suspicious MOI, generally should go to a trauma center.

capillary sphincters

1.​These sphincters are under the control of the autonomic nervous system, which regulates involuntary functions such as sweating and digestion. 2.​Capillary sphincters also respond to other stimuli, such as: a.​Heat b.​Cold c.​The need for oxygen d.​The need for waste removal 3. ​Keep in mind that, under normal circumstances, not all cells have the same needs at the same time (eg, the stomach and intestines have a high need for blood flow during digestion).

nonrebreather mask

10-15 L/min 95 percent

Mouth to mask

15 L/min and 55%

Anatomy of lower airway

2. Elements of the lower airway (a) Lung tissue is covered with the visceral pleura, a slippery outer membrane. (b) The parietal pleura lines the inside of the thoracic cavity. capillaries. to the rest of the body. where it is exhaled and removed from the body. a. Trachea (windpipe) i. Conduit for air entry into the lungs ii. Begins directly below the cricoid cartilage iii. Descends anteriorly down the midline of the neck into the thoracic cavity b. In the thoracic cavity, the trachea divides at the carina into two main stem bronchi, right and left. i. The bronchi are supported by cartilage. ii. They distribute oxygen to the two lungs. iii. On entering the lungs, each bronchus divides into ever-smaller bronchi, which divide into bronchioles. iv. Bronchioles are made of smooth muscle; they dilate and constrict as oxygen passes through them. v. Smaller bronchioles connect to alveoli. (a) Oxygen and carbon dioxide are exchanged here. (b) Alveoli are millions of thin-walled, balloon-like sacs. (c) Alveoli are surrounded by blood vessels (pulmonary capillaries). (d) Oxygen diffuses across the alveolar membrane into the pulmonary vi. Oxygen in pulmonary capillaries is transported back to the heart and distributed vii. Carbon dioxide (waste) diffuses from the pulmonary capillaries into the alveoli,

diamond carry

A carrying technique in which one EMT is located at the head end of the stretcher or backboard, one at the foot end, and one at each side of the patient; each of the two EMTs at the sides uses one hand to support the stretcher/backboard so that all are able to face forward as they walk.

Ebola

A contagious viral disease originating in Africa. It is transmitted by blood and body fluids and causes body organs and vessels to leak blood, usually resulting in death. i.​Watery diarrhea ii.​Vomiting iii.​Fever iv.​Body aches v.​Bleeding

direct ground lift

A method of lifting and carrying a patient from ground level to a stretcher in which two or more rescuers kneel, curl the patient to their chests, stand, then reverse the process to lower the patient to the stretcher

cardiogenic shock

A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions.

rapid extrication technique

A technique to move a patient from a sitting position inside a vehicle to supine on a backboard in less than 1 minute when conditions do not allow for standard immobilization.

impedance threshold device (ITD)

A valve place between the endotracheal tube and a bag-mask device to limit the amount of air entering the lungs during the recoil phase between chest compressions.

Pathophysiology of Respiration

A. Factors in the nervous system 1. Chemoreceptors monitor levels of oxygen, carbon dioxide, hydrogen ions, and the pH of cerebrospinal fluid and provide feedback to the respiratory centers. B. Ventilation/perfusion ratio and mismatch 1. Air and blood flow must be directed to the same place at the same time. a. Ventilation and perfusion must be matched. 2. A failure to match ventilation and perfusion is the cause of most abnormalities of oxygen and carbon dioxide exchange. 3. When ventilation is compromised but perfusion continues, blood passes over some alveolar membranes without gas exchange taking place. a. Results in a lack of oxygen diffusing across the membrane and into blood circulation b. Carbon dioxide is not able to diffuse across the membrane into the lungs and instead is recirculated within the bloodstream, which can lead to severe hypoxemia. 4. Similar problems can occur when perfusion across the alveolar membrane is disrupted.

scope of practice

A. Outlines the care you are able to provide B. Usually defined by state law C. The medical director further defines scope of practice by developing: 1. Protocols 2. Standing orders D. Authorization to provide care is given by medical director via: 1. Telephone or radio (online) 2. Standing orders or protocols (off-line) E. Carrying out procedures outside the scope of practice may be considered: 1. Negligence 2. Criminal offense F. Do not confuse scope of practice with standards of care, which are what a reasonable EMT in a similar situation would do.

Acitated charcol

Absorb toxic substance in digestive tract Most oral poisoning OD Contraindications: decreased loc od of corrosives caustic or petroleum 1-2 kg

Special Mandatory Reporting Requirements

Abuse a. Children b. Older people c. "At-risk" adults 2. Injury during commission of a felony 3. Drug-related injuries 4. Childbirth 5. Attempted suicides 6. Dog bites 7. Certain communicable diseases 8. Assaults 9. Domestic violence 10. Sexual assault or rape 11. Exposures to infectious disease 12. Transport of patients in restraints 13. Scene of a crime 14. The deceased

Stress reactions

Acute stress reactions a. Occur during a stressful situation 2. Delayed stress reactions a. Manifest after stressful event 3. Cumulative stress reactions a. Prolonged or excessive stress 4. PTSD can develop. a. Characterized by reexperiencing the event and overresponding to the stimuli that recall the event b. Critical incident stress management was developed to decrease the likelihood of PTSD.

Ventalation rate

Adult 1 breath every 5-6 seconds Child 1 breath every 3-5

Volume Capabilities of the BVM:

Adult: 1,200-1,600 mL Child: 500-700 mL Infant: 150-240 mL

Bleeding is more common in geriatric pt head why?

Age-related shrinkage creates a void between the brain and outermost layer of meanings which creates room for brain to move when stressed. Bridging viens can tear when stressed.

Physiology of Breathing

Air enters the body through the oral and nasal cavities and travels into the larynogopharynx. It passes through the vocal cords, into the glottis, and down the trachea, where it is distributed into the mainstem bronchi into the bronchioles of the lungs. Eventually the air reaches the alveolar sacs, where oxygen is diffused across the alveolar membrane into the pulmonary capillaries. At the same time carbon dioxide is diffused across this membrane and is exhaled from the body. The oxygen in the pulmonary capillaries is transported back , where it is distributed to the rest of the body.

Asprin

Anti-inflammatory & anti fever prevents platelet from clumping Relief of mild pain, headache, muscle ache, chest pain of cardiac origin Contraindications hypersensitivity or recent bleeding 160-325 mg

Infants develop relationships with their parents or caregivers at different rates.

Anxious-avoidant attachment is found in infants who are repeatedly rejected. a. Children show little emotional response to their parents or caregivers and treat them as they would strangers. 5. Separation anxiety is common in older infants. a. It involves clingy behavior and fear of unfamiliar places and people. 6. Trust and mistrust refers to a stage of development from birth to about 18 months, which involves an infant's needs being met by his or her parents or caregivers. a. If the environment is not perceived as secure by the infant, a sense of mistrust will develop.

Different cleaning types in ambulance

Bleach 10:1 ratio

Cheyne-Stokes respirations are often seen in patients with stroke or head injury

Breathing with increasing rate and depth of respirations followed by apnea (or lack of spontaneous breathing)

Nasal cannulas

Can provide 24% to 44% inspired oxygen when the flowmeter is set at 1-6 L/min a.​For patient comfort, flow rates above 6 L/min are not recommended. 3.​When you anticipate a long transport time, consider using humidification. a.​Over a prolonged period, a nasal cannula can dry or irritate the mucous membrane lining of the nose.

The EMT must regulate the rate and volume of artificial ventilations to help prevent the drop in cardiac output.

Cardiac output = stroke volume × heart rate

Low fluid volume

Causes: trauma to vessels or tissues, fluid loss from GI tract (vomiting/diarrhea can also lower the fluid component of the blood) 2.​Types of shock a. ​Hypovolemic shock i. ​Hemorrhagic shock ii. ​Nonhemorrhagic shock

Fire

Common hazards: i. Smoke ii. Oxygen deficiency iii. High ambient temperatures iv. Toxic gases v. Building collapse vi. Equipment vii. Explosions

gross negligence

Conduct that constitutes a willful or reckless disregard for a duty or standard of care.

Geriatric spine curvature

Consider geriatric-specific immobilization devices, such as a vacuum mattress.

If a patient seems to develop difficulty breathing after your primary assessment, you should immediately reevaluate the airway.

Consider providing positive-pressure ventilations with an airway adjunct when: i. Respirations exceed 28 breaths/min ii. Respirations are fewer than 8 breaths/min iii. Respirations too shallow to provide adequate air exchange

Medication as a NREMT

Contact with Medical Command is generally required prior to administration with the following exceptions: If contact with Medical Command is not possible, the following specific medications may be administered within protocol guidelines to save life or reduce morbidity: Aspirin Epinephrine 1:1,000 via EpiPen® or vial Oral glucose gel Oxygen

-megaly

Enlargement

Respiratory system assessment

Expose the patient's chest. b. Look again for signs of airway obstruction, as well as trauma to the neck and/or chest 5. Cardiovascular system a. Look for trauma to the chest, and listen for breath sounds. b. Consider the pulse and respiratory rate and the blood pressure. c. Pay particular attention to rate, quality, and rhythm. Inspect the chest for overall symmetry. d. Listen carefully to breath sounds, noting abnormalities. e. Measure the respiratory rate, chest rise and fall (for tidal volume), and effort. f. Look for retractions. g. Look for increased work of breathing. h. Assess the patient's breathing

Glasgow Coma Scale (GCS)

Eye Opening (E) 4 = spontaneous 3 = to sound 2 = to pressure 1 = none NT = not testable Verbal Response (V) 5 = orientated 4 = confused 3 = words, but not coherent 2 = sounds, but no words 1 = none NT = not testable Motor Response (M) 6 = obeys command 5 = localizing 4 = normal flexion 3 = abnormal flexion 2 = extension 1 = none NT = not testable Severe: GCS 8 or less Moderate: GCS 9-12 Mild: GCS 13-15

List the 3 possible signs of a newly diagnosed diabetic

Hunger and fatigue. Your body converts the food you eat into glucose that your cells use for energy. But your cells need insulin to take in glucose. If your body doesn't make enough or any insulin, or if your cells resist the insulin your body makes, the glucose can't get into them and you have no energy. This can make you hungrier and more tired than usual. Peeing more often and being thirstier. The average person usually has to pee between four and seven times in 24 hours, but people with diabetes may go a lot more. Why? Normally, your body reabsorbs glucose as it passes through your kidneys. But when diabetes pushes your blood sugar up, your kidneys may not be able to bring it all back in. This causes the body to make more urine, and that takes fluids. The result: You'll have to go more often. You might pee out more, too. Because you're peeing so much, you can get very thirsty. When you drink more, you'll also pee more. Dry mouth and itchy skin. Because your body is using fluids to make pee, there's less moisture for other things. You could get dehydrated, and your mouth may feel dry. Dry skin can make you itchy. Blurred vision. Changing fluid levels in your body could make the lenses in your eyes swell up. They change shape and can't focus

pupils equal, round, reactive to light

If not: Become fixed with no light reaction Dilate with no light Sluggish Unequal in size Injury to brain or drugs

To determine if a pulse is present, you will need to palpate

In responsive patients who are older than 1 year, you should palpate the radial pulse at the wrist. ii. In unresponsive patients older than 1 year, you should palpate the carotid pulse in the neck. iii. Palpate the brachial pulse, located at the medial area (inside) of the upper arm, in children younger than 1 year. b. If you cannot palpate a pulse in an unresponsive patient, begin CPR.

Intrinsic factors that can cause airway obstruction:

Infections b. Allergic reactions c. Unresponsiveness (eg, tongue obstruction)

-itis

Inflamation

Respiration

Inhalation and exhalation of air.

smooth muscle

Involuntary muscle found inside many internal organs of the body

Pale Skin (shock category)

It means the body is not allowing blood to flow all the way to the skin. This happens because there isn't enough blood or water in the system and to conserve it, the body is shunting it toward the core and away from the surface.

Position for pregnant women

Left side if uncomfortable or hypotensive in supine

parenteral medications

Medications that enter the body by a route other than the digestive tract, skin, or mucous membranes.

Neonates reflexes

Moro reflex (startle reflex): when a neonate is caught off guard, it opens its arms wide, spreads its fingers, and seems to grab at things. ii. Palmar grasp: occurs when an object is placed into the neonate's palm iii. Rooting reflex: when something touches a neonate's cheek, it will turn its head toward the touch. iv. Sucking reflex: occurs when a neonate's lips are stroked

Emergency movement/lifting is:

Moving a pt before initial assessment. *Clothes drag, blanket, arm and arm-to-arm drag

LOC altered but need patent airway

Nasopharyngeal due to gag reeflex

When not to use recover position

Never place a patient with a potential head, spinal, hip, or pelvic injury in the recovery position.

Medications at a national level a EMt can use

O2 Activated charcol Oral glucose Asprin Epinephrine MDI Nitroglycerin Naloxone

Depositions

Oral questions asked of parties and witnesses under oath.

If you see a hand gun on the table

Our yourself between pt and gun

DNR types

POLST

CPR

Perform 30 high-quality compressions to a depth of 2 inches to 2.4 inches (5 cm to 6 cm) in an adult at the rate of 100 to 120 per minute. b.​Open the airway. c.​Restore breathing by providing rescue breathing. ​i. Administer 2 breaths, each over 1 second, while visualizing for chest rise.

Moro reflex

Reflex in which a newborn strectches out the arms and legs and cries in response to a loud noise or an abrupt change in the environment

Quadrants are easiest way to identify areas.

Right upper (RUQ): contains the liver, gallbladder, and a portion of the colon ii. Left upper (LUQ): contains the stomach, spleen, and a portion of the colon posterior is pancreas iii. Right lower (RLQ): contains two portions of the large intestine (cecum and ascending colon) (a) The appendix is attached to the lower cecum. (LLQ): contains the descending and sigmoid portions of the colon

Bvm for tracheostomy

Seal pt move and nose with one hand Unable to generate use French tip catheter to function If you seal stoma mouth to mouth ability to ventilate the pt may be improved or clear obstruction

endocrine system function

Secretes hormones that regulate processes such as growth, reproduction, and metabolism by body cells

Female and make reproductive system

See picture.

septic shock

Septic shock occurs as result of severe infections, usually bacterial, in which toxins are generated by the bacteria or by infected body tissues. i.​The toxins damage the vessel walls, causing increased cellular permeability. ii.​The vessel walls leak and are unable to contract well. iii.​Widespread dilation of vessels, in combination with plasma loss through the injured vessel walls, results in shock. b.​Septic shock is a complex problem. i.​There is an insufficient volume of fluid in the container, because much of the plasma has leaked out of the vascular system (hypovolemia). ii.​The fluid that has leaked out often collects in the respiratory system, interfering with respiration. iii.​The vasodilation leads to a larger-than-normal vascular bed to contain the smaller-than-normal volume of intravascular fluid.

Partial rebreathing masks

Similar to nonrebreathing masks, except there is no one-way valve between the mask and the reservoir 2.​Patients rebreathe a small amount of their exhaled air. a.​This is advantageous if the patient is hyperventilating. 3.​The oxygen enriches the air mixture so that patients receive 80% to 90% oxygen. 4.​To convert a nonrebreathing mask to a partial rebreathing mask, remove the one-way valve between the mask and the reservoir bag.

Patient advocacy is:

Speak up for your pt

Backboarding Standing Victim on Land

Stabilize Head, Secure body to board, stabilize head in device

The mnemonic TACOS can be helpful in identifying conditions that may be complicating a patient's chief complaint or affecting medications.

T Tobacco ​A Alcohol ​C Caffeine ​O Over-the-counter medications/herbal supplements ​S Sexual and street drugs

abdominal muscles location

The abdominal muscles are located between the ribs and the pelvis on the front of the body. The abdominal muscles support the trunk, allow movement and hold organs in place by regulating internal abdominal pressure.

PSA

The designated area in which the EMS service is responsible for the provision of prehospital emergency care and transportation to the hospital.

The medulla oblongata senses pH changes in the cerebrospinal fluid and signals the diaphragm.

The medulla keeps us breathing so we do not have to think about it. i. Initiates the ventilation cycles ii. Stimulated by high carbon dioxide levels iii. Sets the base pattern for respirations

Abnormal pupillary response can indicate altered brain function.

The mnemonic PEARRL is a useful assessment guide: (a) Pupils (b) Equal (c) And (d) Round (e) Regular in size (f) React to Light

Nonrebreathing masks

The preferred way to give oxygen in prehospital setting to patients who are breathing adequately but are suspected of having or showing signs of hypoxia a.​With a good mask-to-face seal, such a mask is capable of providing up to 90% inspired oxygen. a.​Usually 10-15 L/min b.​If the bag does collapse, increase the flow rate.

Reason for protocols

The purpose of EMS protocols is to standardize medical procedures for all emergency medical services and thus provide the highest level of care for patients. Protocols also provide a framework to help EMTs make decisions when assessing and treating a patient. All EMTs and paramedics must follow the protocols or document on the ePCR their rationale for deviating from a protocol. Depending on the jurisdiction the EMT or paramedic may be required to use online medical direction, which is assistance from a higher medical authority, such as a physician or the EMS worker's medical director, before deviating from a protocol or even to receive permission to perform a specific procedure ina protocol.

It is this response that causes all the signs and symptoms of shock in a patient.

These mechanisms include the autonomic nervous system and hormones

None breathing mask and nasal canulas

To patients who are breathing adequately but are suspected of having hypoxia is to fix an oxygenation problem, i.e. they are getting air in and out ok-ish but we want to increase the concentration of O2 they're breathing. as long as they're breathing adequately (12-20/min) you can apply it, especially if their SPO2 is below 98 or so.

Extrinsic factors that can cause airway obstruction

Trauma b. Foreign body airway obstruction

Metered-dose inhalers and nebulizers

Used to administer liquid medications that have been turned into a fine mist by a flow of air or oxygen b.​Medication is atomized, breathed into the lungs, and delivered to the alveoli

Ventilation

Ventilation: simple movement of air into and out of the lungs b. Requires chest rise and fall c. You provide ventilation when you assist a patient with a bag-valve mask. d. Tidal volume: the amount of air that is moved into or out of the lungs during a single breath e. Inspiratory reserve volume: the deepest breath you can take after a normal breath f. Expiratory reserve volume: the maximum amount of air you can forcibly breathe out after a normal breath g. Residual volume: the gas that remains in the lungs to keep the lungs open h. Dead space: the portion of the respiratory system that has no alveoli and, therefore, where little or no exchange of gas between air and blood occurs i. Minute volume: the amount of air that moves in and out of the lungs in 1 minute minus the dead space j. Respiratory rate × tidal volume = minute volume

H1N1 (swine flu)

Virus that attacks respiratory system that originated in pigs and mutated to humans that causes coughing, body aches, fever, loss of appetite, and diarrhea.

Bariatic Stretchers

Wider pt surface area for comfort and dignity Wider wheelbase for increase stablity

Ur

Word root for urine

when to use recovery position

a person is unconscious but is breathing and has no other life-threatening conditions, they should be placed in the recovery position.

Recognizing adequate breathing

a. 12-20 breaths/min b. Regular pattern of inhalation and exhalation c. Bilateral clear and equal lung sounds d. Regular, equal chest rise and fall e. Adequate depth (tidal volume)

Cold-weather clothing consists of three layers

a. A thin inner layer that pulls moisture away from the skin b. A thermal middle layer that serves as insulation c. An outer layer that resists wind, rain, sleet, and snow

External respiration

a. Brings fresh air into the respiratory system b. Exchanges oxygen and carbon dioxide between the alveoli and blood in the pulmonary capillaries i. Surfactant keeps alveoli expanded, making it easier for gas exchange.

The PCR serves six functions

a. Continuity of care b. Legal documentation c. Education d. Administrative information e. Essential research record f. Evaluation and continuous quality improvement

Whereas the majority of oxygen is carried to the tissues attached to hemoglobin, carbon dioxide can be transported in the blood from tissues back to the lungs in three ways:

a. Dissolved in the plasma b. Combined with water in the form of bicarbonate c. Attached to hemoglobin

internal respiration

a. Exchange of oxygen and carbon dioxide between the systemic circulatory system and the cells of the body b. Oxygen passes from blood in capillaries to tissue cells. c. Carbon dioxide and cell wastes pass from the cells into the capillaries, where they are then transported in the venous system back to the lungs. d. All cells need a constant supply of oxygen to survive. e. Time is critical! Without oxygen: i. 0-1 minute: Cardiac irritability occurs. ii. 0-4 minutes: Brain damage is not likely. iii. 4-6 minutes: Brain damage is possible. iv. 6-10 minutes: Brain damage is very likely. f. When there is enough oxygen, cells convert glucose into energy through aerobic metabolism. g. Without adequate oxygen, anaerobic metabolism takes place, which cannot meet the metabolic demands of the cell. h. If this process is not corrected, the cells will eventually die.

Guidelines on how and what to assess during a physical examination

a. Inspection—Look at the patient for abnormalities. b. Palpation—Touch or feel the patient for abnormalities. c. Auscultation—Listen to the sounds a body makes by using a stethoscope. The mnemonic DCAP-BTLS reminds you what to look for when inspecting and palpating various body regions.

Skin condition

a. Perfusion is assessed by evaluating a patient's skin color, temperature, moisture, and capillary refill. b. Skin color i. Poor peripheral circulation will cause the skin to appear pale, white, ashen, or gray. ii. High blood pressure may cause the skin to be abnormally flushed and red. iii. When the blood is not properly saturated with oxygen, it appears blue. c. Skin temperature i. Normal skin temperature will be warm to the touch ii. Abnormal skin temperatures are hot, cool, cold, and clammy. d. Skin moisture i. Dry skin is normal. ii. Skin that is wet, moist (often called diaphoretic), or excessively dry and hot suggests a problem. e. Capillary refill i. Capillary refill is often evaluated in pediatric patients to assess the ability of the circulatory system to perfuse the capillary system in the fingers and toes. (a) Place your thumb on the patient's fingernail with your fingers on the underside of the patient's finger and gently compress. (b) Remove the pressure. (c )With adequate perfusion, the color in the infant or child's nail bed should be restored to its normal pink color within 2 seconds.

Observe how much effort is required for the patient to breathe

a. Presence of retractions b. Use of accessory muscles c. Nasal flaring d. Two-to-three-word dyspnea e. Tripod position f. Sniffing position g. Labored breathing

EMS works with public health agencies in two ways

a. Primary prevention focuses on strategies that will prevent the event from ever happening—for example, educating the community on pool safety and car seat installation. b. Secondary prevention occurs after the event has already happened. The question then is, How can we decrease the effects of the event? Helmets and seat belts are examples of secondary prevention.

General Postexposure Management

a. Turn over patient care to another EMS provider. b. Clean the exposed area with soap and water. c. If your eyes were exposed, rinse your eyes for 20 minutes. d. Activate your department's infection control plan. 2. You will have to complete an exposure report. 3. Time is important! Some diseases will act quickly, whereas others will remaindormant. 4. Early activation of a plan is critical.

A portable or fixed unit should be fitted with the following

a. Wide-bore, thick-walled, nonkinking tubing b. Plastic, rigid pharyngeal suction tips, called tonsil tips or Yankauer tips c. Nonrigid plastic catheters, called French or whistle-tip catheters d. A nonbreakable, disposable collection bottle e. Water supply for rinsing the tips

Psychogenic shock

a.​A patient in psychogenic shock has had a sudden reaction of the nervous system that produces a temporary, generalized vascular dilation, resulting in fainting, or syncope. b. ​The fainting episode is temporary, and the patient rouses soon after. c.​Syncope occurs when blood pools in the dilated vessels, reducing the blood supply to the brain. i.​As a result, the brain ceases to function normally, and the patient faints. d. ​It is important to realize that some of the causes of syncope are of a serious nature, but others are not. e. ​Life-threatening causes include irregular heartbeat and brain aneurysm. f. ​Non-life-threatening events may include receipt of bad news or experiencing fear or unpleasant sights (like the sight of blood).

MERS-CoV

a.​A virus found in animals in the Middle East b.​First human case of MERS-CoV discovered in 2012 in Saudi Arabia i.​Most human infections found in the Middle East ii.​Cases of MERS-CoV have been found in Europe and the United States. c.​Common patient symptoms include: i.​High fever ii.​Cough iii.​Muscle aches iv.​Vomiting v.​Diarrhea vi.​In some cases, renal failure, respiratory failure, and death d.​No cure or vaccines for this virus at present e.​If you suspect MERS-CoV, place a surgical mask on the patient and notify the receiving facility.

For diseases that can be passed by the respiratory route:

a.​Always wear PPE (gloves, eye protection, and a HEPA respirator) b.​Wash hands frequently c.​Place a surgical mask on patients with suspected or confirmed respiratory disease d.​Wear HEPA respirator during aerosol-generating procedures, such as suctioning

Normal ventilation versus positive-pressure ventilation

a.​Artificial ventilations are necessary to sustain life, but are not the same as normal breathing. i.​In normal breathing, the diaphragm contracts and negative pressure is generated in the chest cavity, which sucks air into the chest. ii.​Positive-pressure ventilation generated by a device forces air into the chest cavity. b.​With positive-pressure ventilation: i.​Increased intrathoracic pressure causes compression of the vena cava and reduces blood return to the heart, which reduces the amount of blood pumped by the heart. ii.​More volume is required to have the same effects as normal breathing, which pushes the airway walls out of their normal anatomic shape. iii.​Air is forced into the stomach, causing gastric distention that could result in vomiting and aspiration.

Many older patients take numerous medications that could either mask or mimic signs of shock

a.​Keep in mind the following signs of the normal aging process when managing geriatric patients: i.​The central nervous system often has a delayed response. ii.​The cardiovascular system has a variety of changes that result in a decrease in the efficiency of the system. On assessment, be alert for higher resting heart rates and irregular pulse rates. iii.​The respiratory system undergoes significant changes as the elasticity of the lungs and their size and strength decrease. On assessment, be alert for higher respiratory rates, lower tidal volume, and a decreased gag reflex. In addition, remember that cervical arthritis may be present and that dentures may cause an airway obstruction. iv.​The skin becomes thinner, drier, less elastic, and more fragile, thus providing less protection and thermal regulation (cold and hot). v.​The renal system decreases in function and may not respond well to unusual demands such as illness or dehydration. vi.​The gastrointestinal system sustains changes in gastric motility that may lead to slower gastric emptying.

Nitroglycerin

a.​Many cardiac patients carry fast-acting nitroglycerin to relieve angina pain. b.​Nitroglycerin increases blood flow by relieving the spasms and causes arteries to dilate by relaxing muscles of the coronary arteries and veins. c.​Also relaxes veins throughout the body so that less blood is returned to the heart, decreasing workload and blood pressure d.​Before administration i.​Check the patient's blood pressure before administering nitroglycerin. (a)​If the systolic blood pressure is less than 100 mm Hg, nitroglycerin may have a harmful effect. (b)​Even a patient who has adequate blood pressure should sit or lie down with the head elevated before taking this medication (to avoid fainting). (c)​If a significant drop in blood pressure occurs and the patient feels dizzy or sick, have the patient lie down. ii.​Obtain a medical order or follow local protocols to administer nitroglycerin. e.​Can have potentially fatal interactions with erectile dysfunction (ED) medications taken within the past 24 hours: i.​Sildenafil (Viagra) ii.​Tadalafil (Cialis) iii.​Vardenafil (Levitra) iv.​Erectile dysfunction drugs may be used by both men and women. f.​Administration by tablet i.​Place the tablet under tongue, where it dissolves. ii.​The patient should experience a slight tingling or burning sensation. iii.​Should be stored in its original glass container with the cap screwed on tightly g.​Administration by metered-dose spray i.​Deposits medication on or under the tongue ii.​One spray equals one tablet. h.​Know and follow your local protocols.

neurogenic shock

a.​Neurogenic shock is usually the result of high spinal-cord injury. b.​Causes include: ​i.​Brain conditions ii.​Tumors iii.​Pressure on the spinal cord iv.​Spina bifida c.​In neurogenic shock, the muscles in the walls of the blood vessels are cut off from the sympathetic nervous system and nerve impulses that cause them to contract. i.​All vessels below the level of the spinal injury dilate widely, increasing the size and capacity of the vascular system and causing blood to pool. ii.​The available 6 L of blood in the body can no longer fill the enlarged vascular system. iii.​Even if there is no blood or fluid loss, perfusion of organs and tissues becomes inadequate, and shock occurs. iv. ​Signs of this type of shock are the absence of sweating below the level of injury; normal and low heart rate in the presence of hypotension; and normal, warm skin.

The recovery position is used to help maintain a clear airway in an unconscious patient who is not injured and is breathing on his or her own with a normal respiratory rate and adequate tidal volume (depth of breathing).

a.​Roll the patient onto either side so that the head, shoulders, and torso move at the same time without twisting. b.​Extend the patient's lower arm and place the upper hand under his or her cheek. 2.​For patients who have resumed spontaneous breathing after being resuscitated, the recovery position will prevent aspiration of vomitus. 3.​The position is not appropriate for patients with suspected spinal, hip, or pelvic injuries who are unconscious and require ventilatory assistance. a.​Reposition such patients to provide adequate airway access while maintaining appropriate spinal immobilization.

If a patient who requires assisted ventilations produces frothy secretions as quickly as you can suction them:

a.​Suction the airway for 15 seconds (less in infants and children). b.​Ventilate for 2 minutes. c.​Continue this alternating pattern of suctioning and ventilating until all secretions have been cleared from the airway. d. ​Continuous ventilation is not appropriate if vomitus or other particles are present in the airway.

Decompensated shock irreversable

a.​The late stage, when blood pressure is falling b.​Signs and symptoms: i.​Falling blood pressure (systolic blood pressure of 90 mm Hg or lower in an adult) ii.​Labored or irregular breathing iii.​Ashen, mottled, or cyanotic skin iv.​Thready or absent peripheral pulses v.​Dull eyes, dilated pupils vi.​Poor urinary output

Bag-valve mask

a.​The most common method used to ventilate patients in the field b.​With an oxygen flow rate of 15 L/min, a BVM can deliver nearly 100% oxygen. i.​It can deliver only as much volume as you can squeeze by hand.

French Tip catheter

a.​They are used to suction the nose and liquid secretions in the back of the mouth and in situations when you cannot use a rigid catheter: i.​A patient who has a stoma ii.​A patient with clenched teeth iii.​If suctioning the nose is necessary

Post exposure management

a.​Turn over patient care to another EMS provider. b.​Clean the exposed area with soap and water. c.​If your eyes were exposed, rinse your eyes for 20 minutes. d.​Activate your department's infection control plan. 2.​You will have to complete an exposure report.

Check for Breathing and Pulse

a.​Visualize the chest for signs of breathing. b.​Palpate for a carotid pulse.

Anemia

abnormally low number of red blood cells. a.​Anemia may be the result of either chronic or acute bleeding, a deficiency in certain vitamins or minerals, or an underlying disease process. b. ​Tissues may become hypoxic because the blood is unable to deliver adequate amounts of oxygen to the tissues, even though the available hemoglobin is fully saturated with oxygen and the lungs are delivering enough oxygen to the blood.

whooping cough (pertussis)

airborne disease caused by bacteria that mostly affects children younger than 6 years. 2. ​Symptoms include fever and a "whoop" sound that occurs when inhaling after a coughing attack. 3. ​The best way to prevent exposure is to be vaccinated with the DPT or TDaP; you can also place a mask on the patient and yourself.

peri-

around

Para-

beside, near

Abnormal breathing patterns

c. Irregular rhythm d. Diminished, absent, or noisy auscultated breath sounds e. Reduced flow of expired air at nose and mouth f. Unequal or inadequate chest expansion, resulting in reduced tidal volume g. Increased effort of breathing—use of accessory muscles h. Shallow depth (reduced tidal volume) i. Skin that is pale, cyanotic (blue), cool, or moist (clammy) j. Skin pulling in around ribs or above clavicles during inspiration (retractions)

Snoring respirations are most rapidly managed by

correctly positioning the head

Kussmaul respirations metabolic or toxic disorder

deep, rapid respirations

V/Q

describes how much gas is being moved effectively through the lungs and how much blood is flowing around the alveoli where gas exchange ( perfusion occurs).

The signs of a severe airway obstruction may include:

difficulty breathing, weak and ineffective cough, and inability to speak or breathe cyanosis

varic/o

dilated vein

Nitroglycerin

dilates blood vessels Chest pain of cardiac origin Contraindications hypotension use of slidenafil viagra with 24 hrs head injury 0.4mg

syncope

fainting

BVM

fixes a ventilation problem, i.e. they are not getting enough air in/out rapid, shallow, slow or agonal respirations. apnea or hypoventilation Below 8 breaths Above 24 breaths

MVA accident pt with tachycardia, tachypnea and shallow breathing think of what possible pathology?

flail chest Look for head trauma spinal trauma

-rrhage, -rrhagia, -rrhea

flow

A suction catheter

hollow, cylindrical device used to remove fluids from the airway.

Emphysema

hyperinflation of air sacs with destruction of alveolar walls

Late signs of hypoxia

i. Mental status changes ii. Weak (thready) pulse iii. Cyanosis iv. Conscious patients will complain of shortness of breath (dyspnea). g. The best time to give a patient oxygen is before signs and symptoms of hypoxia appear.

pulmonary embolism

i. ​A blood clot that occurs in the pulmonary circulation that blocks the flow of blood through the pulmonary vessels. ii. ​When a massive pulmonary embolism occurs, it can prevent blood from being pumped from the right side of the heart to the left, resulting in complete backup of blood in the right ventricle and leading to catastrophic obstructive shock and complete pump failure.

Total volume

i.​Adult: 1,200-1,600 mL ii.​Pediatric: 500-700 mL iii.​Infant: 150-240 mL

​If the patient's condition warrants the secondary assessment:

i.​Examine the head, scalp, and face. ​​(a) For possible trauma ​​(b) Check eyes, ears, nose, and mouth ​ii.​Examine the neck closely. (a) Look for evidence of accessory muscle use. (b) Check for jugular vein distention, a tracheostomy, or a stoma. ​iii.​Assess the chest and abdomen. (a) Check breath sounds. (b) Palpate the chest and abdomen. (c) Check for medication patches, rigidity or distension, and scars. (d) Check the pelvis and genital area. ​iv.​Palpate the legs and arms. (a) Look for swelling and abnormalities. (b) Check for distal motion, sensation, and circulation. ​v.​Examine the patient's back.

tension pneumothorax

i.​It is caused by damage to lung tissue. ii.​The damage allows air normally held within the lung to escape into the chest cavity. iii.​The lung collapses, and if the pneumothorax is left untreated, air will accumulate in the chest cavity and apply pressure to the organs, including the heart and great vessels.

Signs of adequate ventilations

i.​Patient's color improves ii.​Chest rises adequately iii.​No resistance when ventilating iv.​You hear and feel air escape as the patient exhales.

Treating a pediatric or geriatric patient in shock is no different than treating any other shock patient:

i.​Provide in-line spinal stabilization if indicated. If spinal immobilization is not indicated, maintain the patient in a position of comfort. ii. ​Control life-threatening hemorrhage immediately with direct pressure or tourniquet application when appropriate. iii.​Suction as necessary and provide high-flow oxygen via a nonrebreathing mask. iv.​Maintain body temperature. v.​Provide rapid transport.

Epinephrine

ii.​Constricts blood vessels, causing increased blood pressure iii.​Dilates passages in the lungs

Ataxic respirations

irregular or unidentifiable pattern and may follow serious head injuries.

pericardiocentesis

is the puncture of the pericardial sac for the purpose of removing fluid

nephr/o

kidney

Oxygen saturation (Spo2)

measure of the percentage of hemoglobin molecules that are bound in arterial blood.

Suspension

mixture of finely ground particles that are distributed evenly throughout a liquid by shaking or stirring but do not dissolve

Ventalation

movement of air in and out of the lungs

Durable powers of attorney for health care Also known as health care proxies

named surrogates to make decisions for them when they can no longer make their own.

anaphylactic shock

occurs when a person reacts violently to a substance to which he or she has been sensitized. i.​Sensitization means becoming sensitive to a substance that did not initially cause a reaction. ii.​Each subsequent exposure after sensitization tends to produce a more severe reaction. b.​Four categories of exposure include: i.​Injections (tetanus antitoxin, penicillin) ii.​Stings (wasps, bees, hornets, ants) iii.​Ingestion (fish, shellfish, nuts, eggs, medication) iv.​Inhalation (dust, pollen, mold) c.​Anaphylactic reactions can develop within minutes or even seconds after contact with the substance. d. ​There may also be a second phase reaction that occurs 1 to 8 hours after the initial reaction. Cyanosis is a late sign

cirrh/o

orange-yellow

Patient autonomy

patient's right to make decisions about his or her health.

The purpose of a secondary assessment is to...

perform a systematic physical examination of the patient The physical examination may be a systematic head-to-toe, secondary assessment or an assessment that focuses on a certain area or system of the body, often determined through the chief complaint (a focused assessment).

cardiac tamponade

pressure on the heart caused by fluid in the pericardial space If the effusion becomes large enough, it can prevent the ventricles from filling with blood It is caused by blunt or penetrating trauma that causes hemorrhage around the heart. iii.​Cardiac tamponade occurs when blood leaks into the space between the tough fibrous membrane known as the pericardium and the outer walls of the heart, an area called the pericardial sac. iv.​As more blood or fluid accumulates in this confined space, the outer walls of the heart become compressed. v.​The accumulated blood or fluid in the pericardial space eventually exerts pressure back onto the outer walls of the heart, compressing the walls of the heart and preventing the heart from completely refilling with blood. vi.​Continued pressure within the pericardial sac obstructs the flow of blood into the heart, resulting in decreased outflow from the heart.

capnography

procedure to record carbon dioxide levels

ADA

prohibits discrimination based on disability

NREMT function

provide a valid, uniform process to assess the knowledge and skills required for competent practice by EMS professionals throughout their careers, and to maintain a registry of certification status.

droplet nuclei

residue of evaporated droplets emitted by an infected host, such as someone with tuberculosis, that can remain in the air for long periods of time. N95 or HEPA masks are required to stop droplet nuclei.

Early signs of hypoxia

restlessness, irritability, apprehension, tachycardia, anxiety

List muscle types and function

skeletal, cardiac, and smooth. Each type of muscle tissue in the human body has a unique structure and a specific role. Skeletal muscle moves bones and other structures. Cardiac muscle contracts the heart to pump blood. The smooth muscle tissue that forms organs like the stomach and bladder changes shape to facilitate bodily functions.

signs and symptoms of upper airway obstruction

stridor, poor chest rise on inspiration, and nasal flaring.

central nervous system

the brain and spinal cord a. The brain is the controlling organ of the body. b. Major subdivisions of the brain i. Cerebrum (a) Largest part of the brain (b) Four lobes (frontal, parietal, temporal, and occipital), each responsible for a specific function such as sight, hearing, balance, and speech (c) Controls activities on the opposite side of the body ii. Cerebellum (a) Coordinates body movements iii. Brain stem (a) Controls body functions necessary for life, including cardiac and respiratory functions and regulation of consciousness (b) Three areas: (1) Midbrain (2) Pons 3 medulla oblongata

Primary Assessment

the first element in a patient's assessment; steps taken for the purpose of discovering and dealing with any life-threatening problems. the six parts of primary assessment are: forming a general impression, assessing LOC (AVPU), assessing airway, assessing breathing, assessing circulation, and determining the priority of the patient for treatment and transport to the hospital.

Beck triad (cardiac tamponade)

the presence of jugular vein distention, muffled heart sounds, and a narrowing pulse pressure where the systolic and diastolic blood pressures start to merge.

poor perfusion

the transportation of carbon dioxide out of the tissues will become impaired, resulting in a dangerous buildup of waste products, which may cause cellular damage.

Implied consent

to patients who are: a. Unconscious b. Otherwise incapable of making a rational, informed decision about care 2. Implied consent applies only when a serious medical condition exists and should never be used unless there is a threat to life or limb. 3. The principle of implied consent is known as the emergency doctrine.

lower airway

trachea, bronchi, bronchioles, and aveoli (gasses travel through the structers to and from the blood)

-emesis

vomiting

Interrogatories

written questions for which written answers are prepared and then signed under oath

Continuous positive airway pressure (CPAP) is noninvasive ventilatory support for patients experiencing respiratory distress.

​The therapy is typically delivered through a face mask held to the head with a strapping system. a.​A good seal with minimal leakage between the face and mask is essential. 3.​Many CPAP systems use oxygen as the driving force to deliver the positive ventilatory pressure to the patient. 4.​Use caution with patients with potentially low blood pressure, because CPAP causes a drop in cardiac output. C.​Indications 1.​The patient is alert and able to follow commands. 2.​The patient displays obvious signs of moderate to severe respiratory distress from a condition such as pulmonary edema or obstructive pulmonary disease (ie, COPD). 3.​The patient is breathing rapidly, such that it affects overall minute volume (greater than 26 breaths/min). 4.​The pulse oximetry reading is less than 90%. D.​Contraindications 1.​Patient in respiratory arrest 2.​Signs and symptoms of pneumothorax or chest trauma 3.​Patient who has a tracheostomy 4.​Active gastrointestinal bleeding or vomiting 5.​Patient who is unable to follow verbal commands 6.​Always reassess the patient for signs of deterioration and/or respiratory failure. E.​Application 1.​Components of a CPAP unit: a.​Generator b.​Mask c.​Circuit containing corrugated tubing d.​Bacteria filter e.​One-way valve 2. ​The CPAP generator creates resistance throughout the respiratory cycle. a. ​This resistance creates a back pressure into the airways that pushes open the smaller airway structures, such as bronchioles and alveoli, as the patient exhales. b. ​The amount of pressure can be determined by adjusting a valve within the CPAP system or with a separate valve that can be attached. c.​A pressure of 7.0 to 10.0 cm H2O is generally an acceptable therapeutic range. 3.​Most CPAP units are powered by oxygen, so it is important to have a full cylinder of oxygen when using CPAP. 4. ​Disposable CPAP devices are lightweight and relatively easy to operate

The following patients should be considered in serious condition and in need of rapid transport:

​i.​Patients who are unconscious or who have an altered mental status ​ii.​Patients with airway or breathing problems ​iii.​Patients with obvious circulation problems such as severe bleeding or signs of shock

DNR

"Do not resuscitate" does not mean "do not treat." Even in the presence of a DNR order, you are still obligated to provide supportive measures (oxygen, pain relief, and comfort) to a patient who is not in cardiac arrest, whenever possible. 1. Clear statement of the patient's medical problem(s) 2. Signature of the patient or legal guardian 3. Signature of one or more physicians or other licensed health care providers 4. DNR orders with expiration dates must be dated in the preceding 12 months to be valid.

Main functions of the urinary system

1. Control fluid balance in the body 2. Filter and eliminate wastes 3. Control pH balance C. The body has two kidneys that lie in the retroperitoneal space. 1. Kidneys rid the blood of toxic waste products and control the balance of water and salt. 2. Waste products and water are constantly filtered from the blood to form urine. The kidneys concentrate this filtered urine by reabsorbing the water as it passes through a system of specialized tubes. 3. A ureter passes from each kidney to drain into the urinary bladder. D. The urinary bladder is located immediately behind the pubic symphysis in the pelvic cavity. 1. The bladder empties to the outside of the body through the urethra.

Team leader

1. Indicates where each team member should be 2. Rapidly describes the sequence of steps to perform before lifting

Restraint requires a minimum of five personnel.

1. One for each extremity of the patient, and one for his or her head 2. One EMT should be the established team leader. 3. Develop a plan to restrain the patient together. 4. A patient who is caught off guard is less likely to cause injury to responders.

The assessment process is divided into five main parts

1. Scene size-up 2. Primary assessment 3. History taking 4. Secondary assessment 5. Reassessment

appendicular skeleton

arms, legs, their connection points, and pelvis

pulmonary artery

artery carrying oxygen-poor blood from the heart to the lungs

Involuntary Consent

consent that is assumed when the patient is either mentally incompetent or legally not permitted to make his own medical decisions

The female reproductive system consists of

ovaries, fallopian tubes, uterus, cervix, and vagina. 1. Contained entirely within the pelvic cavity (except the clitoris and labia) 2. Produces egg cells (ovum) and sex hormones

power lift

A lifting technique in which the EMT's back is held upright, with legs bent, and the patient is lifted when the EMT straightens the legs to raise the upper body and arms.

Transfer moves

1. Direct carry a. With two or more rescuers, move the supine patient from the bed to stretcher using a direct carry method (Skill Drill 8-10). 2. Draw sheet method a. With two or more rescuers, move the patient from the bed to the stretcher using a sheet or blanket. b. Place the stretcher next to the bed, making sure it is at the same height or slightly lower, the rails are lowered, and straps are unbuckled. Hold or secure the stretcher to keep it from moving. Loosen the bottom sheet underneath the patient, or log roll the patient onto a blanket. Reach across the stretcher, and grasp the sheet or blanket firmly at the patient's head, chest, hips, and knees. Gently slide the patient onto the stretcher. c. Center the patient on the sheet and tightly roll up the excess fabric on each side. This produces a cylindrical handle that provides a strong, secure way to grasp the fabric. 3. Using a scoop stretcher (Skill Drill 8-11) a. Insert the halves of the scoop stretcher under each side of the patient. b. Fasten the sides together. c. With two or more rescuers, move the patient to a nearby stretcher. 4. Other carries a. Place a backboard next to the patient, log roll or slide to move the patient onto the backboard, secure the patient, and lift and carry the backboard to the nearby prepared stretcher. b. Assist the patient to the edge of the bed, and place the patient's legs over the side, helping the patient to sit up. Move the stretcher so that its foot end touches the bed near the patient. Help the patient to stand and rotate so that he or she can sit down on the center of the stretcher. Lift the patient's legs, and rotate them onto the stretcher while your partner lowers the patient's torso onto the stretcher. F. If the patient is in a chair and cannot assist you, transfer the patient from the chair to a stair chair.

Elements of lymphatic system

1. Spleen 2. Lymph nodes 3. Lymph 4. Lymph vessels 5. Thymus gland 6. Other components B. Supports the circulatory system and immune system C. Lymph is a thin, straw-colored fluid that carries oxygen, nutrients, and hormones to the cells and waste products of metabolism away from the cells to be excreted. 1. Lymph vessels form a network throughout the body that serves as an auxiliary to the circulatory system. 2. Relies on muscle contractions and movements of the body for lymph to flow 3. Lymph nodes are tiny, oval-shaped structures that filter lymph. D. Helps to rid the body of toxins and other harmful materials

Cardiac Output (CO)

Amount of blood pumped in 1 minute (~5 L) CO = HR × SV

Moving a patient on stairs with a stretcher

Carry the patient on the backboard down the stairs to the prepared stretcher. a. Place the strongest EMTs at the head and foot ends of the board. b. The taller person should be at the foot end. 3. Once you reach the stretcher, place both the backboard and the patient on the stretcher; secure both to the stretcher with additional straps.

patient must be properly positioned based on the chief complaint.

Certain patient conditions, such as head injury, shock, spinal injury, pregnancy, and obese patients, call for special lifting and moving techniques. 2. A patient with no suspected injury reporting chest pain or respiratory distress should be placed in a position of comfort—typically a Fowler or semi-Fowler position. 3. Patients who are in shock should be packaged and placed in a supine position. 4. Patients in late stages of pregnancy should be positioned and transported on their left side if they are uncomfortable or hypotensive when supine. 5. An unresponsive patient with no suspected spinal, hip, or pelvic injury should be placed in the recovery position. 6. A patient who is nauseated or vomiting should be transported in a position of comfort.

School Age (6-12 years)

From ages 6 to 12 years, a school-age child's vital signs and body gradually approach those observed in adulthood. a. Pulse rate is approximately 70 to 120 beats/min. b. Respiratory rate is 15 to 20 breaths/min. c. Blood pressure is 80 to 110 mm Hg. 2. Obvious physical traits and body function changes become apparent. a. Growth of 4 lb (2 kg) and 2.5" (6 cm) each year

HIPPA

HIPAA considers all patient information you obtain in the course of providing medical treatment to a patient to be protected health information (PHI). a. PHI includes medical information. b. PHI includes any information that can be used to identify the patient. Only share information in line of medical care

Emancpated minor

a person who is under the legal age in a given state but, because of other circumstances, is legally considered an adult. i. Many states consider minors to be emancipated if they are married, if they are members of the armed services, or if they are parents.

Preschoolers 3-6

Pulse rate is 80 to 140 beats/min. b. Respiratory rate is 20 to 25 breaths/min. c. Systolic blood pressure is 80 to 100 mm Hg. d. Weight gain should level off. e. Although toddlers and preschoolers have more lung tissue, they do not have well- developed lung musculature. i. Prevents them from sustaining deep or rapid respirations for an extended period of time

in loco parentis

Refers to the legal responsibility of a person or organization to take on some of the functions and responsibilities of a parent.

EMS research

Research helps to determine the shape and impact of EMS on the community. a. For example, in the early days of EMS, patients with major trauma were stabilized on the scene before they were transported. After compiling prehospital EMS research, it was determined that patients with major trauma should be transported immediately; these patients need an operating room more than they need an IV. EMS now provides rapid transport for patients with major trauma. 2. The application of evidence-based practice is becoming an integral part of functioning as an EMS provider. Patient care should be focused on procedures that have proved useful in improving patient outcomes. All aspects of the EMT role are currently being researched. 3. EMTs may be involved in research through gathering data. a. Examples: How much oxygen should be given to patients with shortness of breath? How much time does it take to get patients with serious trauma to the emergency department? Record all of the information so it can be analyzed by others. 4. The results could then be shared with the rest of the EMS community. 5. Evidence-based decision making is based on research. 6. It is important for EMS providers to stay current on the latest advances in health care.

Perfusion

The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries.

skeletal muscle

a muscle that is connected to the skeleton to form part of the mechanical system that moves the limbs and other parts of the body.

impairment of cellular metabolism

When there is inadequate oxygen, cells will create energy through anaerobic metabolism. a. Serves as a temporary backup system b. Can result in metabolic acidosis c. Requires more energy than when using glucose for fuel i. More wastes to remove from the body ii. Body must work harder d. Decreased ability of the blood to effectively carry oxygen to the cells e. Overall decreased functioning of oxygen within the cell f. Brain cells cannot use alternative fuels. i. Rely on a constant supply of glucose to function ii. If the supply of available glucose is dramatically decreased, brain cells will quickly become damaged or die. g. Cellular injury, up to a point, may be repairable if normal tissue perfusion is restored.

Routes of transmission

a. Direct contact (eg, blood-borne pathogens) b. Indirect contact (eg, needlesticks) c. Airborne transmission (eg, sneezing) d. Foodborne transmission (eg, contaminated food) e. Vector-borne transmission (eg, fleas)

Role of medical control

a. Medical control is either off-line (indirect) or online (direct). b. Depending on how the protocols are written, you may need to call medical control for direct orders (permission) to conduct certain tasks: i. Administering certain treatments ii. Determining the transport destination of patients iii. Stopping treatment and/or not transporting a patient c. In most areas, medical control is provided by the physicians working at the receiving hospital. d. Many variations have developed across the country. e. The link to medical control is vital to maintain a high quality of care.

Toddlers 1-3

a. Pulse rate is normally 90 to 150 beats/min. b. Respiratory rate is 20 to 30 breaths/min. c. Systolic blood pressure is 80 to 100 mm Hg. d. Average temperature is 96.8°F (36° C) to 99.6°F (38° C). e. A toddler's lungs continue to develop more terminal bronchioles and alveoli.

EMS systems may use a variety of two-way radio hardware

a. Simplex is push to talk, release to listen. b. Duplex is simultaneous talk-listen. c. Multiplex utilizes two or more frequencies, which enables more than one transmission to occur simultaneously.

Baroreceptors and chemoreceptors

controls our respiratory rate that are sensors located in our blood vessels.

Older adults include those ages 61 years and up.

i. Cholesterol and calcium build up inside the walls of blood vessels, forming plaque. ii. Accumulation of plaque eventually leads to partial or complete blockage of blood flow. iii. More than 60% of people older than 65 years have atherosclerotic disease. b. Heart rate and cardiac output decrease. i. Cardiac output can no longer meet the demands of the body.y c. The vascular system becomes stiff. i. Diastolic blood pressure increases with age. ii. The heart must work harder to move the blood effectively. d. The ability to produce replacement blood cells declines, as does the blood volume. 5. Respiratory system a. The size of the airway increases and the surface area of the alveoli decreases. b. The natural elasticity of the lungs also decreases. i. Intercostal muscles are used more to breathe. ii. Breathing becomes more labor intensive. c. The changes in the respiratory system are often gradual and go unnoticed until a severe, life-threatening condition occurs. d. Within the mouth and nose, there is a gradual loss of the mechanisms that protect the upper airway. i. This leads to a decreased ability to clear secretions as well as decreased cough and gag reflexes. ii. Aspiration and obstruction become more likely. e. As the smooth muscles of the lower airway weaken with age, strong inhalation can make the walls of the airway collapse inward and cause inspiratory wheezing. i. The cells of the immune system are less functional. f. By age 75 years, the vital capacity may amount to only 50% of the vital capacity of a young adult. Factors include: i. Loss of respiratory muscle mass ii. Increased stiffness of the thoracic cage iii. Decreased surface area available for the exchange of air g. Residual volume increases with age. i. A lifetime of breathing, especially breathing air with high levels of pollution, causes the accumulation of pollutants in the lungs. Insulin production drops off and metabolism decreases. Rising costs of health care, mortality, death of friends and loved ones, isolation, depression

Pancreas

i. Exocrine portion secretes pancreatic juice containing enzymes that aid in digestion of fat, starch, and protein. ii. Endocrine portion (islets of Langerhans) produces insulin and glucagon.

Evaluates a patient's ability to remember

i. Person—remembers his or her name ii. Place—identifies the current location iii. Time—the current year, month, and approximate date iv. Event—describes what happened

scene size-up

steps taken when approaching the scene of an emergency call: checking scene safety, taking Standard Precautions, noting the mechanism of injury or nature of the patient's illness, determining the number of patients, and deciding what, if any, additional resources to call for.

The male reproductive system consists of

testicles, epididymis, vasa deferentia, prostate gland, seminal vesicles, and penis. Produces sperm and sex hormones. Penis is also part of the urinary system (contains the urethra)