EMT SUPER SET (merged)
WARNING
YOU ARE NOT CARRY THESE MEDICATION
brainstem
controls vital functions (Fx necessary for life)
tar burns
cool with water, do not remove tar
PPE
cover everything for ebola
EXTRA: If one of your patient's eye gets jabbed out,
cover the affected eye ONLY in LAC
midaxillary line
cuts body into anterior and posterior
Know Policy 802 difference
!!
START mnemonic
"thirty two can do" thirty: respiratory rate (look at next slide) two: capillary refill can do: command (simple command e.g. can you wiggle your foot)
Injury management [When should you start treating someone who is being crushed by something?]
"treatment in the rubble" 1. ACLS treatment should be stated before pressure is released 2. may be hampered by the multicausaltiy incident and confined space
Questions to ask: abdominal pain
1. OPQRST 2. N/V (nausea/vomiting) 3. Normal pooping and urinating? 4. GI Bleed? 5. FEMALES: pregnant? LMP?
Questions to ask: Assualt
1. safety 2. hit with what? 3. where? 4. # of times? 5. KO?
Vital Signs
BP Pulse Respirations Temperature
Small Pox Cause
- Caused by Variola major - Exposure - inhalation or direct contact - Any confirmed case of smallpox should be considered an international emergency!
Activate of EMS
*ADULTS* 1. Initiate EMS 2. Immediately get AED *Children and Infant* a. WITNESSED 1. initiate immediately 2. get AED b. UNWITNESSED 1. 5 cycles of CPR 2. Initiate EMS 3. Get AED
RATIO of compression to ventilations
*Adult* 30:2 (1 and 2 rescuer) *Child and Infant*: 30:2 (1 rescuer) 15:2 (2 rescuer)
Rescue breathing for...
*Adult* 1:5-6 sec *Child* 1:3-5 sec *Infant* 1:3-5 sec have good seal look at chest rising no resistance
Circulation
*Capillary refill* Good--> check mental status Delayed--> IMMEDIATE *Pulse* Good *radial pulse*: check mental status (command) Absent *radial pulse*: IMMEDIATE
Three Stages of Labor
*First* -onset of labor to *full dilation the cervix* -people have problem dilating to *9cm* -you gotta take baby out because it could be traumatized *Second* -full dilation of the cervix to *delivery of infant* *Third* -delivery of infant to *delivery of placenta*
American Heart Association *Age Classifications*
*Infant*: 0-1 year old *Child*: 1- onset of puberty *Adult*: puberty and on *Male* puberty is armpit hair and *female* puberty is boobs
Standards Imposed by States
*Medical Practices Act* -Exempts EMT-Bs from licensure requirements *Certification* -Process of evaluating and recognizing that EMT-B has met certain predetermined standards
DNR in *Medical Facility* vs *Home or Street*
*Nursing Facilities* +Written order in patient's chart = DNR Verbal order from MD *NOT VALID unless put in writing* *Home or Street* +POLST +LAC "Prehospital DNR" Form +California "Prehospital DNR Form +Medical tag
Pulse
*Rate* -number of breaths in one minute or in 30 seconds multiply by 2 *Strength* -bounding, strong, or weak (thready) *Regularity* -regular or irregular
How to check potency of nitroglycerin
*SPRAY* 1. patient feels headache in 30 sec 2. tongue stings/burn 3. flush feeling *PILL* 1. should look white and clean, NOT fuzzy and whacky 2. flush feeling
Type 1 vs Type 2
*Type 1*: juvenile onset *Type 2*: adult onset
What, When and Who (for Reporting)
*What* 1. verbal report 2. written report *When* 1. within 36 hours *Who* 1. law enforcement 2. protective services
Refusal of treatment
*against medical advice* (AMA) -when a patient refuses care or transport
Fever (Common causes) [What question should you ask?]
*common* 1. infections 2. *neoplasm* (cancer) 3. drug ingestion 4. *collagen vascular disease* (malfunctioning immune system e.g. lupus) 5. high environmental temperatures Question: Did you give tylenol or something?
records and reports
*complete documentation* is a safeguard against legal complications you didn't *document* it then you didn't do it
Critical Incident Stress Managements (CISM)
*composed of trained peers and mental health professionals* -confronts réponses to critical incidents -process designed to help EMS personnel defuse responses to critical incidents
Obviously Dead (policy 814) [I DED + 2 SPECIAL ONES]
*decapitation* *incineration*: burned beyond recognition *decomposition* *evisceration*: of heart, lung, or brain *post mortem lividity*: when blood stops circulating and gravity pulls blood down. *rigor mortis*: stiff FOR *post mortem lividity* and *rigor mortis* you must check *apical pulse* for 60 secs to pronounce dead SPECIAL SITUATION -MVI with limited resources -entrapment
Premature infants [What are the 2 either/or requirements]
*delivery before 8 months or weight less than 5 pounds at birth* 1. keep warm 2. *keep mouth and nose clear or mucus* 3. give low flow oxygen 4. *do not infect the infant* 5. notify hospital
Complications of rescue breathing
*gastric distention*: when air entering the stomach then *vomit* comes out *over ventilating* improper head tilt (no tilt)
How to *Open Airway*
*head tilt chin lift* (except for head injury and infants)
Pediatric safety
*injury due to "accident"* is #1 cause of pediatric death... most r preventable e.g. -seat belts -fire safety -pools -firearms -etc... 1. *Airway problems* are common for choking 2. *Respiratory arrest* that leads to cardiac arrest
ON TEST
*jump bag*/*jump kit*/*trauma kit* You always take it out of ambulance to patient all the stuff you need for first 5-10 minutes of patient care
Signs of physical abuse
*may be obvious or subtle* -obvious signs include bruises, bites, burns, etc -look for injuries to ears -look at rectum and genitals
*Authority* for patient care
*most qualified* at rendering emergency care doctor > paramedic > EMT (Doctor must show proof) *Here's the catch: person CANNOT relinquish care*
uterus [How would you describe this organ?]
*muscular* organ where fetus grows (lower to top) 1. cervix 2. body 3. fundus
Chest Compression essential NUMBERS
*proper speed* 100-120/ min FOR ALL *proper depth* -Adult: 2'' -Child: 2'' -Infant: 1.5'' *proper position* -Above nipple line -OFF the xiphoid process -Adult: 2 hands -Child: 1 hand -Infant: 2 fingers
angina pectoris [What;s the difference between this and AMI in terms of onset? What's Tx?]
*symptoms of a heart attack without a heart attack* 1. decrease blood flow to heart muscle results in ischemia (lack of oxygen) 2. causes mild to moderate pain 3. pain may radiiate 4. usually lasts 3-8 minutes 5. DIFFERENCE TO <3 ATTACK: no permanent damage to heart 6. can be difficult to differentiate from heart attack ________________________________ TX take nitroglycerine to vasodilate
Small Pox
- 1967, health officials undertook a worldwide immunization program to eradicate smallpox - 1971, the western hemisphere achieved elimination of the disease - 1972, routine immunization ended - 1977, last known naturally occurring case was reported in Somalia - 1980, the world is declared free of naturally occurring smallpox
Small Pox S/S
- Severe, flu-like illness with fever and pustular rash a. Rash on face, hands and feet b.Later spreads to torso - Infectious before rash appears and until all scabs are healed - Often fatal, only supportive care available, vaccine must be done during the 1st sign of fever
*1.* scene size-up
-*body substance isolation (BSI)*: e.g. wear gloves before you get out of the ambulance -*safety*: e.g. when you get 5150 you wait till police clear scene first -*mechanism of injury*: (how did patient hurt himself?)e.g. fell down and mess up knee OR -*nature of illness*: chest pain, headache -*# of patients* -*need for additional resources* (police, fire dept, buses [for non serious victims]): e.g. if you have a lot of patients -*need for extrication/ spinal precautions*: extra equipment
APGAR (on test) [Difference between grimace and activity?]
-*done at birth and 5 minutes after birth* -score should improve *Appearance* -0: completely blue -1: pink body but blue limbs -2: completely pink *Pulse* (target: 100bpm) -0: no pulse (do CPR) -1: <100 -2: >100 *Grimace* (it's about crying) -0: no crying or no rxn to stimulus(feet tapping) -1: weak cry in response to stimulus -2: strong cry *Activity* -0: no movement or limp -1: moves weakly -2: actively moving *Respirations* (target: 30) -0: absent -1: <30 -2: >30 Top score: 10 Each category is 0-2
negligence (3 things)
-*failure to apply* standard of care -*failure to provide* the same care that a person with similar training would provide -*act or omission* of an act -*Good Samaritan Act DOES NOT APPLY to on duty personnel*
Scene Safety
-*look for danger*: e.g. swords -*park in a safe area*: face your ambulance the way you want to leave -*speak with law enforcement first if present*: e.g. "what's going on? -*safety of you and your partner comes first*: -*next is safety of patients and bystanders*: -*request additional resources*
Standard of Care
-*minimum level of care* that a person can expect -imposed by local protocol, law, professional or institutional standards
The Well-Being of the EMT-1
-*personal health, safety, and well-being* are vital to an EMS operation -hazards are common -mental and physical stresses are part of the job
abandonment
-*terminate of care without patient's consent* -termination of care without provisions for continued care -cannot relinquish care to a person that is lower trained** **but you can relinquish care if need for care is not required for your ability and can be done by a lower trained personel
When to *Interrupt CPR*
-5-10 seconds for pulse checks -AED rhythm analysis *NEVER STOP FOR MORE THAN 10 SECONDS*
*Elder Abuse* Characteristics
-Any person who takes advantage of person, *property or emotional state* -Victims are often hesitant or unable to report -signs of abuse are often overlooked -Victim often has multiple medical conditions and are dependent on others
Limited Legal Authority
-As an EMT-B, you have *limited legal authority* to require or force a patient to undergo care -police may put a patient in protective custody to allow you to provide care
Temperature
-Axillary (not the most accurate) -Oral (BLUE goes in mouth) -Rectal (RED goes in ass) -Other *NORMAL= 98.6 F*
Airway (3 TYPES)
-Conscious v unconscious 3 types of obstructions 1. anatomical 2. solid 3. liquid
Pulse Points
-Femoral: groin -Apical: with stethoscope -Carotid: neck -Radial: wrist -Branchial: arm -Temporal: head -Dorsalis Pedis: on top of your foot -Popliteal: behind the knee -Posterior Tibialis: Achilles' heel
Prehospital Care Providers
-First Responders -EMT-Basic (EMT-1) -EMT-I -EMT-P -MICN (mobile intensive care nurses) -Physician
Critical Incident Stress Debriefing (CISD)
-Held within 24-72 hours -all information is confidential -CISD leaders offer suggestions for overcoming the stress -It Works - Cerritos vs San Diego (similar plane crashes) San Diego: no support --> a lot of people resigned Cerritos: lost only one paramedic due to resigning
Who may place 5150?
-Law Enforcement (e.g. PCC popo) -PET or PMRT member (these people come to your home to evaluate your health) -County "designated" doctors *NOT EMT *5150 ORGINAL ORDER must be there for the order to take effect*
Glasgow Coma Scare
-More advance LOC indicator -point scale 15 - 3 (15 is the best score; 3 is worst) 1. *eye*: -if they open their eyes spontaneously = 4 -if they open eyes when you talk to them=3 -open eyes to pain= 2 -totally unresponsive= 1 2. *verbal*: -Oriented= 5 -Confused= 4 -Inappropriate words (not making sense; rambling)= 3 -Grunting sounds= 2 -None= 1 3. *motor* (take this with a grain of salt) -obeys commmand= 6 -localizes pain (when you touch their body part they flinch and guard that area)= 5 -withdraw (from pain into fetal position)= 4 -flexion (arms/legs bend as a result of pain)= 3 -extension (flail limbs out as a result of pain)= 2
Critical Incident Stress
-Multi-casualty incidents (MCI) -infant and child trauma -patients that remind us of loved ones -death or injury of a coworkers -extreme circumstances (amputations, abuse)
OPQRST
-Onset: when did the problem first begin -Provoking factors: what caused you to have this symptom -Quality of pain: describe the pain in their own words e.g. sharp; crushing; pressure -Radiation/ Region: Point to the region where it hurts; does it radiate to another area? -Severity (take with a grain of salt): ask them with scale of 1-10 -Time/ Treatment: ask about previous time people had this treatment, what was the outcome?
Specialty Centers
-Trauma -Pediatric -Perinatal (babies) -Burn -STEMI (heart attack)
Shockable Rhythms
-Ventricular Fibrillation (V Fib) -Ventricular Tachycardia (V Tach)
special reporting requirements
-abuse -injury during the commission of a felony -drug-related injury -childbirth -infectious disease exposure (e.g. zika virus) -crime scene (don't touch anything) -deceased (EMT's cannot pronounce death except for those of LAC under policy 814)
Number of patients
1. *# of patients and condition* 2. *additional resources needed* 3. *triage to identify severity of each patient's condition*
Body Substance Isolation
-assume all body fluids present a possible risk of infection -protective equipment 1. gloves 2. eye protection: if fluids are flying around 3. mask 4. gown 5 turnout gear
Dealing With Family Members
-be calm -use a gentle tone of voice -respect the family's wishes -do not create false hope
Why are there age considerations
-chest mus tue large enough for adult pads -pads must be at least 1/2'' apart -children require *lower voltage shock*
Signs and symptoms of PTSD
-depression -startled reactions -flashback phenomena -amnesia of event
negligence determination (4 Steps)
-duty: there was a duty to be completed -breech of duty: duty is ignored -damages: some kind of harm done to patient physically or psychologically -cause
Strategies to Manage Stress
-eliminate stressors -change partners (if you hate your partner) -stop complaining -expand your social support system -deep breath -stretching -exercise -proper nutrition
1. Death and dying
-few people have *witnessed* death -death is something you have to face -think about it ahead of time -REMEBER: hearing is the last sense to go Notes: be desensitized to death but still care
Complications of Compressions
-fractured ribs -lacerated lungs, etc
Causes of Cardiac Arrest
-heart attack (myocardial infarction) or cardiovascular disease -trauma (traumatic cardiac arrest) e.g. fall off a building -drowning (kids can drown easily) -drugs -electrocution
Signs and symptoms of *stroke (CVA)* HHAO
-hemiparesis & hemiparalysis -headache, blurred vision -aphasia (speaking problems) -one side face droop
Duty to Act
-individual's *responsibility* to provide patient care -begins once an ambulance response to a call or treatment is initiated *When you put on that uniform and get on the ambulance then you have the duty to act*
Reporting
-it's a *misdemeanor* to fail to report abuse -report *suspicion* of child abuse, you do not need proof to report an incident
ethical responsibilities
-make physical/emotional needs a priority -practice/maintain skills -critically review performances -attend refresher programs -be honest in reporting
*cardiovascular disease* can lead to (MAS)
-myocardial infarction -stroke: cerebral vascular accident (CVA) [brain attack] number one cause is *hypertension* -aneurysm: weak spot in artery that causes it to explode (esp when in brain)
NON-shockable rhythms
-normal sinus rhythm -flatline -asystole -agonal
pharynx
-oropharynx: throat -nasopharynx: area above roof of mouth -it is where gag reflex for airway protection is located
*Contraindication* for the use of an AED
-patient has a pulse -patient is breathing -patient is under 1 year (because pads touch each other) -patient laying on *metal surfaces and/or water*
Transport when
-patient regains a pulse -6 shocks have been delivered -3 consecutive "no shock messages*
Examples of patients who are more sick than others (slide 26)
-poor general impression -unresponsive with no gag or cough reflexes -responsive but unable to follow commands -difficulty breathing -poor perfusion -complicated birth -uncontrolled breathing etc
What can an EMT-1 do to help with grief
-provide support -make helpful statements -be sincere -understand the grief is a process *NEVER SAY* "Everything will be okay" when the patient is dying *DON'T tell people how they should feel*
Assessment of *Elder Abuse*
-repeat visits to the ER -history of being "accident prone" -soft-tisssue injuries -vague explanation of injuries -psychosomatic complaints (complain about the same things over and over) -chronic pain -self-destructive behavior -eating and sleeping disorder -depression or a lack of energy -substance and/or sexual abuse (rape)
2. Signs of Stress
-sleep problems -headaches -change in appetite -fatigue -irritability -anxiety -mood swings -isolation -substance abuse -*"Normal response to abnormal stress"*
*Cardiovascular disease (CVD)* that you can change
-smoking -high blood pressure -high cholesterol** -lack of exercise **consume in moderation *OTHER FACTORS* diabetes: weaken your blood vessels obesity: pressure on your heart excessive stress: causes high BP
Advance Directives
-specific medical treatments desired if patient is unable to make decisions (-If you don't have advance directive , decision for treatment will go to the next kinship) -Do Not Resuscitate (DNR) orders (it has to carried out in legal ways)
ventricular fibrillation
-sudden death -we can *SHOCK* heart back into normal rhythm
Rapid Physical Exam intro
-takes 60-90 seances -head to toes exam FOR 1. significant *trauma* patient 2. unresponsive medical patients
Blood Pressure
-the pressure of the circulating blood against the walls of the arteries -drop in blood pressure may indicate a. loss of blood b. loss of vascular tone c. cardiac pumping problem -BP should be measured in all patients older than 3 years
*Indication* for use of AED
-unresponsiveness -pulseless -non breathing patient -over 1 y.o.
respirations
0: dead Under 30: check circulation Over 30: immediate
Focused history for pregnancy
1. "What baby is this for you?" (like what number) 2. PARA-GRAVIDA score PARA: how many alive births have you had GRAVIDA: how many times have you gotten pregnant -you want to know what happened to other pregnancies 3. Contractions? 4. How long ago did labor start? 5. Due date? 6. Have you been getting prenatal care? 7. Are you taking your vitamins 8. urge to push? 9. Has water broken?
WBC
1. AKA leukocyte
Lyme [incubation period? Fun fact? end result?]
1. *2nd fastest growing infectious disease next to AIDS* 2. S/S may begin 3 days after bite 3. *bulls eye rash* 4. *painful swelling of joint* (esp at knee) 5. can result in permanent disability if not treated
Airway Obstruction
1. *Croup* -an infection of the airway below the level of the vocal cords, caused by a *virus* 2. *epiglottitis* -infection of the soft tissue in the area above the vocal cords -*drools* because they can't swallow saliva 3. foreign body aspirations
Ways of controlling diabetes [3 ways and in what circumstance do you use it?]
1. *Diet* alone can fix it 2. *oral medications*: use to stimulate pancreas to produce insulin is you are low on insulin 3. *insulin* shot is given if you are producing none Note: We cannot orally eat insulin because HCl digests it
Hypothermia [What is body temperature?]
1. *Lowering of the body temperature below 95 F* 2. Can develop rapidly or gradually 3. weather does not have to be below freezing 4. elderly persons, infants and ill or injured are at high risk
Chief complaint
1. *Most serious problem voiced by the patient*: e.g. patient may think their chronic pain is very serious all of the sudden 2. *May not be the most significant problem present*
Foreign body aspirations [Difference between sounds? Is cyanosis partial or complete blockage?]
1. *Partial blockage* -coughing -accesssory muscle use -nasal falring -*wheezing* 2. *COmplete blockage* -no sound -no cry -*stridor* -loss of consciousness -cyanosisi
Placenta Problems [Which has higher pain? Which has brighter blood?]
1. *Placenta abruptio*: premature separation of the placenta from the uterine wall and causes sharp abdominal pain [Light to heavy bleed; high pain] 2. *Placenta previa*: development of placenta over the cervix [Bright red blood; low pain]
Predelivery Emergencies
1. *Pregnancy induced hypertension* (PIH) -preeclampsia 2. Eclampisa -the full version of preeclampsia 3. *Supine hypotensive syndrome* -low BP form lying supine -fetus putting pressure on IVC
Approach to Assessment [Babies __________ better than adults but ____________ harder]
1. *Q1*: What is normal level activity and how are they acting now? *Q2*: work of breathing? *Q3*: skin color? 2. *capillary refill* (you can do it on their thighs instead of fingers) 3. *ALS backup or immediate transport*? 4. *Compensate* better than adults but also *crash* harder 5. *transport to pediatric facilities ASAP* (there are special pediatric ambulances)
Biological agents
1. *Viruses* - Much smaller than bacteria, structurally different - Reproduce only within specific types of cells - Do not respond to antibiotics, vaccines may prevent or reduce the effects of some viral infections 2. *Types of Viruses* - Smallpox - VHF's - Others
Plague
1. *Yersinia pestis* 2. found in rodents and their fleas 3. 3 TYPES a. bubonic (most common) b. septicemic c. pneumonic 4. depending on circumstances, these forms may occur separately or in combination
Croup [What kind of cough? What 3 sounds?]
1. *barking seal like cough* 2. stridor, wheezing, rales 3. accessory muscle use 4. nasal flaring 5. grunting
kidney stones [AKA? What pain does it induce? (it's a pain specific to kidney problems)]
1. *calculi* in the kidney a. severe flank pain b. maybe colicky c. restlessness d. nausea and vomitting NOTE: person on the ground holding low back
Assessing Mental Status
1. *checking responsiveness*: e.g. pinch on the shoulder A- Alert: V- Verbal P- Pain: does the patient respond to pain? e.g. smelling sulfur U- Unresponsive 2. *check for orientation*: e.g. ask easy things that most people should know Person: who they are Place: where they are Time: night? day? season? Event: how did you get yourself in this situation
pleural effusion (caused by what special type of disease(s)?)
1. *collection of fluid outside lung* (all the weight is going to give your SOB) 2. causes dyspnea 3. caused by irritation, infection, or cancer 4. decreased breath sounds 5. eased if patient is sitting up (high fowler position assists breathing)
Adolescents
1. *concerned about body image* (they are afraid of people seeing them getting wheeled out of the school in a gearney) 2. may have strong feelings about being observed 3. respect their privacy 4. they understand pain 5. explain any procedure
Eye parts
1. *conjunctiva*: delicate membrane that *covers inner surface of eyelid and eyeball* 2. *lacrimal glands*: *produce fluids* that keep conjunctiva moist 3. *Sclera* (white part): tough fibrous tissue that helps to *maintain the shape* of the globe 4. *pupil*: *opening* in the center of the iris 5. *Iris*: *color portion* of the eye; a muscle that creates pupil 6. *cornea*: clear transparent membrane that allows light to enter; *protects eye* 7. *lens*: sit behind iris and allows you to *focus* 8. *retina*: light sensitive area in the back of eye that has *nerve endings* 9. *optic nerve*: *transmits signal* from retina to brain 10. *vitreous humor* (irreplaceable): in posterior chamber 11. *aqueous humor* (replaceable): in anterior chamber; between cornea and lens
Chronic Obstructive Pulmonary Disease (COPD) [What is productive cough a result of? What kind of chest? What sounds?
1. *emphysema* or *chronic bronchitis* (have productive cough) 2. barrel chest: lungs become overinflated all the time 3. labored breathing 4. cyanosis 5. can have sudden onset 6. abnormal breath sounds may be present (Rhonchi, rales, wheezes) Note: comes from smoking
Eye injuries
1. *enucleation*: removal of eyeball from socket 2. *laceration* 3. *foreign object*: e.g. sand 4. *abrasion*: usually from foreign object; scratches conjunctiva 5. *burns*: from heat, chemicals, light, etc
TX(treatment) for pneumonia
1. *higher flow O2* 2. high fowler position 3. rapid transport 4. reassure patient 5. support ventilations PRN (abbreviation as needed)
S/S decompression sickness [How fast is onset? What are 2 other distinct S/S?]
1. *joint pain* 2. *abdominal pain* 3. itching 4. vertigo, nausea, vomiting
Narcotics or Opiates
1. ALC 2. *respiratory depression/hypoventilation* 3.*pinpoint pupils* 4. hypotension 5. N/V *NEED NARCAN*
Anatomical differences
1. *less circulating blood* (go into shock more easily because they can't lose a lot of blood) 2. *loses body heat more easily* (body SA in relation to mass is higher) 3. *bones are more flexible* (e.g. 4 year old girl falls from 4 story building and did not get seriously hurt) 4. *less fat surrounding organs* (could have a lot of internal damage) 5. *could be much internal damage with little external visible trauma* (as a result of less fat surrounding organs
Rare presentation [Paul has only seen it in the hospital not on the field]
1. *limb presentation*: single arm/leg showing -very rare -rapid transport 2. *prolapsed cord*: umbilical cord comes out first? -transport immediately -place fingers into mother's vagina and push head away from the cord -infant's head will compress the cord and cut off circulation
Scorpion sting (bark scorpion is poisonous) [2 distinct S/S]
1. *muscle cramps* 2. *excessive salivation* 3. seizure 4. shock 5. cardiac arrest
Treatment consideration [How to admin. oxygen? Position? main focus?]
1. *oxygen*: treat same as adult; use *blow by* administration if needed 2. *patient position*: same as adult (they need to be in car seat on ambulance[unless if they're in cardiac arrest etc.. Don't let parent hold child.) 3. *airway and breathing* (not CAB, just AB) are main focus
OBSTRUCTIVE SHOCK
1. *physical* obstructive of blood flow -tension pneumothorax -cardiac tamponade -pulmonary embolus -dissecting aortic aneurysm
Rib Fracture [3 symmtoms]
1. *pleuritic chest pain*: pain that worsens when you breath (patients breathing shallowly) 2. a rib may lacerate a lung 3. may have contusion 4. often splinted
Breech delivery [What are the presenting parts? How long does it take?]
1. *presenting part is the buttocks or legs* 2. breech delivery is usually slow so mom has time to go to the hospital 3. support the infant when it comes out 4. insert your gloved fingers into the vagina and make a "V" to protect airway; get the baby's face off of the bottom of birth canal; once you get up in there your hand is going to stay in there [because face is plaster to the birth canal]
Labor duration [Difference between first time mom and veteran mom]
1. *primipara*: first time for mom usually a long time [18-24 hr] 2. *multipara*: mom with more than 1 live birth [7-10 hr] Note: get epidural pain reliever IMMEDIATELY
rabies from dog bites
1. *rabies: an acute viral infection to the CNS* 2. can only be treated with a series of vaccine injections 3. bitten patient can avoid shots only if dog can be identified and tested for rabies
Nature of Illness
1. *search for clues*: e.g. look for needles, medications 2. *This is chief complaint* 3. *Gather information from the patient/bystander*: e.g. people who know them 4. *observe the scene*
Submersion injury (near drown)
1. *second more common cause of unintentional death* 2. CAB 3. may be in respiratory of cardiac arrest 4. C-spine precautions 5. be ready to suction 6. keep warm
S/S Acute Myocardial Infarction [What other condition is it associated with?] {6 HOUR 90% tissue death; 2-4 hr is 50%; 30 min -1 hour begginng of tissue death}
1. *sudden onset of weakness, nausea, and diaphoresis [sweating]* 2. chest pain or discomfort 3. dyspnea 4. irregular pulse 5. pain in lower jaw, arms, or back 6. sudden fainting 7. pulmonary edema 8. sudden death 9. feeling of impending doom
Complication with Normal Vaginal Delivery
1. *unruptured amniotic sac* 2. *umbilical cord around the neck* (nuchal cord) -use your fingers to feel umbilical cord -use free hand and loop up and over baby's head -if that doesn't work then cut it 3. *meconium staining* [cause and effect? how can you tell?] -when baby is mature and poops inside of you -amniotic fluid has color and smells like poo -baby might suck poop in lungs -baby needs to spend time in NICU
Mark I/DuoDote Kit (ON THE TEST)
1. 1 auto injector of 2 PAM chloride (pralidoxime chlorde) (600mg in 2 cc) 2. 1 auto injector of Atropine (2 mg in 0.7 cc)
status epilepticus
1. 1 seizure over 1o minnutes 2. 2 seizures without regaining consciousness 3. 3 seizures within 1 hour
History of Bioterrorism
1. 1984: Rajneeshs Cult- Salmonella sprayed on food at buffet restaurants in Oregon with intent to sway an election, 751 people sick 2. October 2001: Anthrax attack by mail sent to media and government offices in Washington, Florida, and elsewhere; 5 deaths, 23 sick, 17,759 people treated for 60 days 3. October 2003: Two letters containing ricin were sent to Dept of Transportation and the White House, but were safely intercepted
Contents of Spill Kit
1. 2 pairs of gloves-thick (0.007 inch) 2. gown and shoe covers 3. goggles 4. mask 5. disposal bags and equipment
Fun Fact [weight, cardiac output, and glucose usage of the brain]
1. 2% of body is brain 2. 15% of cardiac output is used by brain 3. 25% of glucose is used by brain 4. 400 billion bits of information per second
Chambers of the heart
1. 4 chambers 2. septum divides two sides 3. surrounded by *pericardium* 4. system of one way valves
History of biological warfare
1. 400s BCE- Greeks and Romans polluted water wells, used poison arrows, and hurled venomous snakes at their enemies 2. 1300s- Tartar Army catapulted plague infected corpses at Kaffa 3. 1700s-French and Indian War Native Americans given small pox laden blankets 4. 1900s- WWI German army infected animals in Romania and France with anthrax
Anaphylactic rxn to stings [How many percent of people are allergic? How many deaths a year? When do deaths occur?]
1. 5% of all people are allergic to bee, hornet, yellow jacket and wasp stings 2. about 200 deaths a year 3. death occur within first 30 min
When to ventilate with BVM? [range and 2 other things]
1. <12 2. >60 3. ALOC and/or an inadequate tidal volume
Tx for near drowning [What are you gonna do with the water that might have went in body? Patient feels fine after drowning, should he or she go to hospital?
1. ABC's aggression suctioning, ventilation with 100% oxygen 2. C-spine precautions 3. rapid transport N0te: always insist in transporting even if patient feels fine because you might get water in lungs and get pneumonia
Signs of increasing intracranial pressue [What 5 distinct S/S?]
1. ALOC 2. *vomiting (PROJECTILE)* 3. *unequal pupils* 4. *hypertension & decreasing HR* 5. expanding pulse pressure 6. seizure 7. *abnormal respiratory patterns* 8. *posturing*
No vomit for
1. ALOC 2. Patients at risk for seizures 3. injected caustics/hydrocarbons
depressants
1. ALOC 2. respiratory depression. hypoventilation 3. pupils dilated 4. loss of coordination 5. slurred speech 6. bradycardia and hypotension
killer bees
1. Africanized Honey Bees (AHB) 2. looks identical just meaner 3. very aggressive 4. case up to 0.25 miles contact police and fire
Vital Signs [When to get baseline vital signs? When to reassess?]
1. After rapid assessment, obtain baseline vital signs and a SAMPLE history 2. Vital signs of stable patients should be reassessed every 15 minutes 3. Vital signs of unstable patients should be reassessed every 5 minutes NOTE: if patient is seemingly stable but have spinal fracture, abdominal, chest injuries. heart attack or anaphalyasix then he or she should be checked every 5 minute
Responding
1. Always use maps - BEFORE you begin to move! Note: know how to read thomas guides which are spiral stacked maps 2. The attendant should help with the response (e.g. read map) 3. Make eye contact with other drivers and STILL DON'T TRUST THEM
Category A Agents (bioweapons)
1. Anthrax (Bacillus anthracis) 2. Botulism (Clostridium botulinum toxin) Plague (Yersinia pestis) 3. Small Pox (Variola majo) 4. Tularemia (Francisella tularensis) 5. Viral Hemorrhagic Fevers (filoviruses- Ebola, Marburg; arenaviruses- Lassa, Machupo
Vessels
1. Arteries 2. Arterioles 3. Capillaries (tiny vessels where gas exchange between cell takes place) 4. Venules 5. Veins
Valid AMA (Advance Medical Advice)
1. Ask them: Person Place Time 2. competent (is she confused? intoxicated?) 3. obtain witness signature 4. 18+ *MUST advice patient* 1. of need for treatment 2. of consequences (e.g. you could die) 3. that they can recontact 911
Focused History and Physical Exam (Trauma-no significant mechanism)
1. Assess the chief complaint -chest pain -shortness of breath -abdominal pain (for girls, always go down pregnancy path) -any pain associated with bones or joints -dizziness 2. Obtain baseline vital signs and SAMPLE history
Scope of Practice of EMT
1. Assessment of the sick & injured 2. Render BLS, Rescue, & First Aid 3. Obtain diagnostic signs 4. Perform CPR 5. Oropharyngeal & nasopharyngeal pathways 6. Suction devices (to pump vomit and stuff out of your inside 7. Oxygen delivery devices (it's a drug) 8. Use various types of stretchers 9. Use various body immobilization devices 10. Provide initial prehospital trauma care 11. Extricate entrapped persons 12. Perform field triage (to sort people from most needed to least needed) 13. Use AED
Stages of seizure (4 stages)
1. Aura: prior sensory warning 2. Tonic: cxn phase; when the patient becomes unresponsive; arch back 3. Clonic: alternating movement (muscles alternate cxn and relax; breath becomes shallow NOTE: tonic and clonic phase is sometimes put together 4. Postictal: after seizure a period of ALOC with deep and labored respirations Note: vomiting can occur
adverse effect of epinephrine
1. BP up; HR up
Neisseria Meningitidis Tx
1. BSI 2. CAB 3. protect patient 4. high flow O2 5. passive cooling for fever 6. monitor for shock 7. transport 8. Call ALS backup
Emergency Care for Fever
1. Begin passive cooling -remove clothing/covering -damp towels with luke warm water then touch their foreheads 2. No ice 3. No alcohol 4. No cold water baths
Cardiac Tamponade AKA Pericardial Tamponade [Pulse and BP? How is pulse pressure? Breathing sounds?]
1. Blood in the pericardium -weak pulse -hypotension -narrow pulse pressure -JVD -dyspnea with equal breathing sounds RX: high flow oxygen and rapid transport
Myocardial Contusion`(heart bruise
1. Blunt Myocardial Injury -chest pain -may have contusion over sternum -irregular pulse RX -high flow O2 -rapid transport
Injuries of the Nose
1. Blunt trauma can cause fractures and soft-tissue injuries. 2. CSF/blood 3. Use dry sterile dressing for soft tissue injuries 4. Object inserted in nose can be removed if freely movable 5. Impaled objects get bulky dressing
Pulmonary Contusion (lung bruise) [What fills with blood?]
1. Bruising of the lung 2. develops over hours 3. alveoli fill with blood 4. provide oxygen and ventilatory support
bee sting Tx
1. CAB 2, scrape out stinger (with credit card) 3. monitor and treat for shock PRN 4. Ice is OK 5. transport
Foreign body aspirations Tx
1. CAB 2. High flow O2 3. Position of comfort DON'T visualize the throat DON' put anything in patient's mouth
Rx for dehydration
1. CAB 2. Obtain baseline vital signs 3. ALS backup for IV (probably have to use IO in tib/fib, clavicle, chest, etc) [we don't use this unless if they truly need it] 4. pediatric gatorade, popsicles, etc
Tx for seizures [What is an important question to ask?
1. CAB 2. Protect patient from injuring self 3. oxygen 4. supine or left lateral 5. transport NOTE: *ask what they were doing before seizure. So you can decide if they have trauma injury too*
Brown recluse bite Tx [Same as snake bite! Recall: what not to do?]
1. CAB 2. calm 3. immobilized affect extremity 4. treat for shock PRN 5. transport NO ICE
Tx Febrile Seizure
1. CAB 2. recovery position 3. high flow of O2 4. suction PRN 5. Passive cooling measures 6. transport
Abuse emergency medical care
1. CAB 2. transport if you suspect child abuse 3. do not make accusations 4. EMT-B must report all suspected cases of child abuse
Tx to anaphylactic
1. CAB oxygen 2. administer epic pen if indicated 3. treat for shock 4. reassure 5. rapid transport
Tx Snakebite [What to do around wound? What to do with extremity?]
1. CAB oxygen 2. calm patient 3. *immobilize extremity* 4. treat shock PRN 5. *draw circle around bite and note time* 6. transport Note: If possible safely ID snake
Scorpion sting Tx [same ol']
1. CAB oxygen 2. reassure patient 3. treat shock PRN 4. transport no ice
marine animal sting Tx [What is the alternative to peeing?]
1. CAB oxygen 2. treat for shock 3. limit movement 4. scrape off any remaining tentacles 5. *inactivate with alcohol, meat tenderizer, or talcum powder*
Tx of air embolism and decompression sickness [2 distinct Tx]
1. CAB's 2. high flow oxygen 3. *left lateral trendelenberg* (it keep embolism from vital organs because blood goes down and air goes up) 4. rapid transport 5. transport to *hyperbaric chamber*
Special Considerations for COPD
1. COPD in distress (if they really need O2): high flow of O2 2. COPD in no distress: low flow of O2 -2 LPM (liters per min) via nasal cannula -Due to hypoxic drive (increase CO2 in system causes hyperventilation to blow CO2 off)
Stroke
1. CVA 2. TIA 3. Hemorrhagic stroke 3. ischemic stroke: thrombus or embolus
Duty to Act
1. Cannot deny care to a patient with a suspected communicable disease e.g. AIDS 2. Abandonment / breach of duty /negligence
Anthrax
1. Caused by *Bacillus anthracis* 2. Incubation: 1-7 days 3. Transmission: aerosol, inhalation, ingestion, or cutaneous contact 4. not person to person
Sexual abuse
1. Children of any age or either gender can be victims 2. Limit examination 3. Do not allow child to wash, urinate, or defecate (preserve evidence) 4. Document carefully 5. Transport
Fractures (4 types)
1. Closed fracture: does not break skin 2. Open fracture: external wound 3. nondisplaced fracture: simple crack (need x ray) 4. displaced fracture: deformity; just put some dirt on your arm and sip on a beer. Don't forget to go to el torito's after
(nitroglycerin) Note: [How many types? What adverse effect? WHAT DO YOU DO AFTER ADMIN??]
1. Comes in tablet, spray or skin patch 2. Always check BP after administration *BP should go down* 3. *PUT IN SHOCK POSITION* Don't use if 1. fuzzy
Febrile Seizures [age group? Cause? What kind of seizure? How long?]
1. Common in children 6 months to 6 years 2. just like a seizure but has nothing to do with brain 3. caused by high fever 4. Hx of infection 5. grand mal seizure 6. less than 15 min
Respirations (don't let them know that you're assessing their respiration)
1. Count the number of breaths per minute -but you shorten it to 30 or 15 seconds) 2. Assess Quality (REN) a) Rhythm -regular or irregular) b) Effort -normal breathing is effortless c)Noise -Noises insinuate obstruction 3. Assess *tidal volume* (def: Amt of air that the patient is taking in) -increased (arrow up TV), decreased (arrow down TV), normal (NTV) e.g. deep respiration = increase tidal volume
Blood Agents
1. Cyanides: Hydrogen Cyanide (AC) & Cyanogen Chloride (CK) 2. Works at the cellular level, inhibits the cells ability to use oxygen (venous blood remains bright red) 3. Route of Exposure: Inhalation, Ingestion 4. Signs and Symptoms: - Rapid Onset of increased respirations, gasping for air - Loss of Consciousness - Seizures - Death 5. Treatment - Cyanide Antidote Kit
Assessment of Chest Injuries *5
1. DCAP-BTLS 2. chest wall movement: looking for uneven movement caused by muscle injury -*paradoxical movement*: chest moving like teeter toter 3. hemoptysis: coughing up blood 4. shock: because of insufficient oxygen 5. cyanosis: poor perfusion or ventilation
Questions to ask: ALOC
1. DERM 2. AEIOU TIPS 3. PMSC 4. Sudden or slow? 5. Ask bystanders
Impaled Object [How do you remove it?]
1. DO NOT REMOVE 2. Immobilize object 3. moist sterile dressing over BOTH eyes (for national), 1 eye for (LAC)
Melena [Indicates bleeding where? What color? What further complication does this imply?]
1. Dark, tar-like stools 2. lower GI bleed a. can be only indication of GI bleed b. can represent significant blood loss
Nerve Agents decontamination/Tx
1. Decontamination - remove clothing (80% of contamination) and scrub with soap & water, remember you don't want to become a victim 2. Atropine 2mg until symptoms stop -Blocks the receptor sites for acetylcholine -Has drying effects 3. 2 Pam Chloride -Removes the nerve agent so the acetylcholinesterase enzyme can break the acetylcholine down 4. Diazepam (valium) -Stops the convulsions
Suicide
1. Depression is the single most significant factor 2. an attempted suicide is cry for help 3. immediate intervention is necessary 4. patients will usually exhibit warning signs *5150 immediately*
Dialysis [What are the bulges called?)
1. Dialysis: Pulls blood out of body and cleans it -be careful where you take BP because fistula is fragile 2. shunts/fistulas
Everybody gets triaged
1. Direct patients to treatment areas 2. find and transport all immediate 3. reassess *delayed", anticipate reassignment 4. set up morgue area 5. give triage report to incident command
Routes of Transmission
1. Direct: by bodily fluid 2. Vector-borne: through living body 3. Vehicle(indirect): contact with contaminated object e.g. needle 4. airborne: inhaling dust e.g. coughing in face
Impaled Object
1. Do not attempt to move or remove the object 2. Bulky dressing 3. Shorten object if possible 4. Transport carefully Note: except for CPR interference you don't do anything
Note: [What happens if you inject it to other places?]
1. Dont inject to anywhere else 2. No IV injection; could lead to *MI* or *CVA* 3. Side effect: tachycardia, pallor, dizziness, chest pain, headache, n/v
ASSESSMENT of Dissecting abdominal aortic aneurysm (what 2 acronyms?)
1. OPQRST 2. SAMPLE a. nausea, vomtting, diarrhea b. anorexia c. fever d. weakness or syncope
Anthrax Tx and mortality
1. Duration of illness depends on route and severity of exposure, flu-like symptoms last from a few hours to days and get progressively worse TX -Mechanical ventilation may be needed along with antibiotic therapy: Ciprofloxacin or Doxycycline Mortality - Inhalation 75% despite treatment - Gastrointestinal- 25-60% despite treatment - Cutaneous- 20% without treatment, less than 1% with treatment
Pneumonic (duration, Tx, Mortality)
1. Duration: 2-5 days depending on severity 2. Treatment: - Early antibiotic treatment is essential, must occur within 18 hours of onset (Streptomycin/Gentamicin) 3. Mortality: - 50-90% untreated - 15% with treatment
Septicemic (duration, treatment, mortality)
1. Duration: 2-5 days depending on severity 2. Treatment: - Antibiotic therapy (Streptomycin/Gentamicin) 3. Mortality: - 100% without treatment - 15% with treatment
Signs of Adequate Respirations
1. Effortless 2. NTV 3. Normal rate 4. Regular rhythm 5. Normal LOC 6. Warm skin with normal color 7. Normal breath sounds bilaterally Note: noisy breathing is obstructive breathing
Common terms
1. Exposure: contact with bodily fluid (direct or indirect) 2. universal precautions: prevent workers from exposure with germs 3. BSI: infection control technique based on the assumption that all bodily fluid in infectious 4. Exposure Control Plan
Cincinnati Stroke Scale
1. Face Droop (tell them to smile) 2. Arm drift (tell them to close eyes) 3. Speech (Say "Sky is blue in Cincinnati")
Sympathetic
1. Fight or Flight -pupils dilate -increase CNS stimulation -increased HR and BP -bronchioles dilate -decreased GI activity
START steps
1. First step in triaging is to separate he walking wounded 2. get rid of bystanders during this process 3. designate a collection area for these patients 4. tag them later
Acute Pulmonary Edema [What is the pathophysiology explanation?]
1. Fluid build-up in the lungs 2. Signs and Symptoms -Dyspnea -frothy pink sputum (phlegm) -rales (crackles) 3. Recurrence is HIGH 4. History of chronic congestive heart failure Left ventricle cannot pump blood faster that the right ventricle pumping through the pulmonary circuit
Lobes of the brain
1. Frontal: cognition and motor 2. Parietal: touch and orientation 3. Temporal: speech and hearing 4. Occipital: sight
Anatomy
1. GI system 2. renal or urinary system 3. genitals
MCI
1. GOAL: *planning and organization* 2, often our natural response leads to a bad decision 3. the first consideration is safety, has the *patient generator* stopped? 4. second consideration is planning 5. do windshield assessment 6. OVERESTIMATE
Seizures [What are the 3 types?]
1. Generalized (Grand mal) seizure -unconscious and generalized severe twitching 2. Petit mal seizure -a brief lapse of attention 3. Focal or jacksonian -in one area -severe and bizarre behavior
Circulatory differences [How to compensate for illnesss and injury? How to keep organs nourished? What indicated early perfusion problems?]
1. HR inc. for illness and injury (to compensate for dec. O2) 2. Very effective vasoconstriction keeps vital organs nourished 3. pale, cool, mottle skin, dec. capillary refill are *early signs of perfusion problems*
Basic Realignment Steps
1. Have all equipment ready in place 2. explain procedure to patient 3. in 1 move with gently traction, align extremity in anatomical position 4. use the least amount of force necessary 5. if resistance is met or pain increases, spine in deformed position 6. Reassess distal function (PMSC) (hopefully pulse is restored)
Rx of tension pneumothorax
1. High flow O2 2. Rapid Transport 3. Unseal one side of occlusive dressing
Flail Tx [1 similar Tx to rib fracture; What is the difference Tx?]
1. High flow of O2 2. Immobilize flail segment 3. Supine 4. Rapid Transport 5. Maintain airway 6. Provide respiratory support
Hip Injury [What is the difference between hip fracture and dislocation?
1. Hip fracture: noticeably shortened and externally rotated 2. Hip Dislocation: usually flexed (knee bend) and internally rotated NOTE: for young people it requires significant force
Food poisoning Rx
1. History is important 2. transport promptly 3. bring some of the suspected food to the hospital
Questions to ask: Seizures
1. How long did it last? 2. where were you? did you fall? 3. More than one? 4. How did it start? 5. *status epilepticus*: when you have multiple seizures that last a long time
Questions to ask: Shortness of breath
1. How long? 2. Sudden or slow onset? 3. Chest pain also? 4. Chest auscultation
Field Operations Guide
1. ICS "Bible" 2. Incident Command System Publication 3. FIRESCOPE
Chemical burns [what do you do? For how long? What kind of dressing? (think about why)
1. IRRIGATE-IRRIGATE-IRRIGATE 2. use water or saline soln 3. do it for 20 mins 4. powder or liquid: irrigate 5. dry dressing
ALS considerations
1. IV fluid: (hypovolemic) 2. medications: (cariogenic /distributive) 3. MAST: medical anti shock trousers
Drug Routes
1. IV intravenous 2. SL: sublingual 3. PO: by mouth 4. IM: intramuscular 5. SQ or SC: subcutaneous (e.g. TB test) 6. IO: interosseous (through bone) 7. transcutaneous: absorbed through skin (e.g. patch) 8 IN: inhaled (e.g. mist) 9. PR: per rectum; through the booty
Nuclear/radiological agents
1. Illness - Acute Radiation Syndrome - Sterility (Ovaries and Testes) - Fetal Exposure (defect depends on stage of development) 2. Injuries - Radiation Skin Burns (classified like thermal burns) 3. Long-Term Effects - Cancer (leukemia, breast, stomach, thyroid) - Genetic Effects (mutations)
Question to ask: Chest pain
1. OPQRST 2. shortness of breath also? 3. Medications?
VHF incubation periods and stuff
1. Incubation periods variable 2. Fever, muscle aches, fatigue common a. Typically evolves to shock and bleeding from mucous membranes b. Nervous system and lung involvement frequent c. Kidney or liver failure in some syndromes 3. No licensed vaccines except for yellow fever - Mortality 5-20% (Ebola 50-90%)
Septicemic (incubation, transmission, S/S)
1. Incubation: 2-6 days 2. Transmission: - Plague bacteria multiply in the blood after infection through bite or cut - Can occur by itself or as a complication to pneumonic or bubonic plague - No person to person transmission 3. Symptoms: - Fever, chills, prostration, abdominal pain, shock, and bleeding into skin and other organs
Bubonic (transmission, S/S)
1. Incubation: 2-6Days 2. Transmission: - Infected flea bites a person or when materials contaminated with Y. pestis enter through a break in a person's skin - Bubonic plague does not spread from person to person 3. Symptoms: - Swollen, tender lymph glands (called buboes) and fever, headache, chills, and weakness
Pneumonic (tranmission, S/S)
1. Incubation: 2-6days 2. Transmission: - Breathing in aerosolized bacteria or respiratory droplets from a person with pneumonic plague (person to person transmission) - Bubonic or septicemic may progress to pneumonic plague 3. Symptoms: - Sudden onset of fever, chills, headache, Cough, chest pain, dyspnea, myalgia
Appendicitis (What are the 2 distinct S/S)
1. Inflammation of the appendix a. fever b. anorexia (lack of appetite for food) c. N/V d. RLQ pain e rebound tenderness (when pressure is released on abdomen pain occurs)
Anthrax S/S
1. Inhalation: flu like symptoms, nausea, chest pain, vomiting, abdominal pain, fever, respiratory distress 2. Cutaneous: initial itching papule, 1-3 cm painless ulcer, the necrotic center, fever 3. Gastrointestinal (25% death): Nausea, loss of appetite, vomiting, fever, abdominal pain, vomiting blood, severe diarrhea
Assessing the stroke patient
1. Initial assessment a. CAB b. obtain a history c. High flow of O2 2. Focuses history and physical exam a. GCS b. Cincinnati Stroke Scale (neurologic exam)
Focused Physical Exam
1. Investigate problems associated with chief complaint 2. Examine abnormalities 3. Assess vital signs. -BP -Pulse -Respirations -Temperature -Skins -Chest Auscultation (listening with stethoscope for their lungs) 4. make transportation decision 5. document findings
Ongoing Assessment (on the way to hospital)
1. Is treatment improving the patient's condition? 2. Has a problem gotten better? Worse? 3. Any newly identified problems?
Additives *requiring* an infusion pump [What can we do with these?]
1. KCl 2. Total Parental Nutrition: nutrients that bypass digestive system and go straight to blood stream *These additives may not be transported without an infusion pump* NOTE: we can only *monitor* there infusion pumps that are preset
Incapacitating Agents
1. Mace, Pepper Spray, Tear Gas 2. Route of Exposure: Inhalation, Ingestion, Absorption 3. Signs and Symptoms: - Burning pain of skin, eyes, and mucous membranes - Elevated Blood Pressure - Irregular respirations, may trigger asthma attack in patients 4. Treatment - Symptoms dissipate usually in 15-20 minutes upon removal of victim to fresh air
Patient Controlled Infusion Pumps [Where? Activated by who? What happens during transplant?]
1. May be implanted or external 2. may only be activated by patient or caregiver 3. transport locked e.g. insulin, demerol, morphine
S/S
1. Mechanism 2. Pain: pain upon palpation 3. tachycardia 4. shock 5. bruising 6. distended or rigid abdomen 7. nausea and vomitting
Detection of Biological Attack
1. Most likely a covert attack- look out for suspicious, unusual behavior/activities 2. Increase in unusual/unlikely disease incidence in humans and animals (Anthrax, Flu in Summer) 3. Increased 911, ER and Doctor visits, reports of illness from many people, presenting the same symptoms, and coming from one locality 4. Epidemiology(the art of controlling disease) is key
Significant MOI
1. Motor Vehicle Accidents 2. falls 3. blunt or penetrating trauma 4. hangings 5. recreational accidents
When to expect shock
1. Multiple severe fractures 2. abdominal or chest injuries 3. spinal injuries 4. sever infection 5. major heart attack 6. anaphylaxis
aspirin (a blood thinner) S/S
1. N/V 2. hyperventilation 3. ringing in ears 4. confusion 5. seizures 6. transport promptly
MEDICAL WISDOM
1. NOT DEAD UNTIL WARM AND DEAD
Botulism
1. Neurotoxins produced by Clostridium botulinum 2. Incubation 12-72 hours 3. Transmission via aerosol inhalation and ingestion 4. No person to person transmission S/S Difficulty swallowing Difficulty speaking Symmetric descending weakness Respiratory dysfunction Paralysis No sensory dysfunction No fever
Freeway Response (read this in book)
1. No light bar 2. Forward steady red and Rear flashers only (think CHP) 3. Can use all lights once parked Note: it is not illegal to do code 3 on freeway but it's dangerous
S/S of *Severe hypothermia* (decompensating) [How do pupils look? How do you summarize all the S/S in one sentence?]
1. No more shivering 2. muscular activity decrease 3. lethargy/apathy(tends to make poor decisions) 4. LOC 5. bradycardia and hypotension 6. dilated pupil 7. Eventually, all muscle activity stops (heart stops) *TL;DR: everything thing gradually stops functioning*
Type 2 Diabetes (metabolic disease; insulin resistant) [Tx?]
1. Non-insulin-dependent diabetes 2. Patient produces inadequate amounts of insulin (because body is resistant to insulin) *TX*: diet and oral hypoglycemics
Non-traumatic Brain Injuries [What causes it? What S/S is different?]
1. Not always caused by trauma 2. medical conditionals may cause spontaneous bleeding in the brain 3. S/S are the same -There is no mechanism of injury
Consent
1. Not mentally competent: implied consent 2. not always clear-cut with psychiatric emergencies 3. When in doubt, request law enforcement assistance
Neck injuries [What can be a risk factor? How do we prevent the risk factor?]
1. Open neck injury can be life threatening 2. Air can get into the veins and cause an *air embolism* 3. Cover with *occlusive dressing* 4. Apply manual pressure.
Applying a tourniquet [What are 2 very important things that you do?]
1. Pad skin with dressing 2. Fold a triangular bandage into 4" cravat. 3. Wrap twice loosely 4. Use a wooden dowel as a handle to twist and secure the stick. 5. Write "TK" and time and place on patient.
Botulism
1. Paralysis caused by botulism may last for weeks and gradually improve in the following months, fatigue and shortness of breath may continue for years 2. Treatment: Intensive supportive care possibly including ventilation, administration of antitoxin if diagnosed early, induce vomiting, enemas, surgical excision of bacteria from wounds 3. Mortality rate is high if treatment is not immediate and proper - The disease can be fatal in 5 to 10% of cases
EMT roles [on scene] [What determines scene manager?]
1. Patient contact 2. Scene manager (the highest ranking person e.g. CHP, fire captain)
If the patient Core temp <80 F is he dead? If not, when is a patient dead? (quote Paul Easterling)
1. Patient may *appear dead* 2. Never assume that a cold pulseless patient is dead
Reasons to *Stop CPR*
1. Patient survives 2. Higher trained personnel arrives 3. Doctor tells you to stop 4. Exhaustion
Complications of diabetes
1. Peripheral Vascular disease: damaging blood vessels in lower extremity (that's why you see amputated diabetics) 2. heart disease: from *sticky blood* 3. visual disturbances: e.g. diabetic retinopathy, cataracts 4. renal failure: need dialysis 5. stroke: weakened vessels 6. ulcers 7. seizures: inadequate supply of blood to your brain Note: Happens because of repeat ketoacidosis
Pulmonary (Choking) Agent
1. Phosgene (CG) & Chlorine (H2O reactive) First used in WWI as chemical weapon 2. Route of Exposure: Inhalation 3. Signs and symptoms: - Chlorine - immediate pain - Eye and airway irritation - Dyspnea, Chest tightness, Bronchospasm - Non-Cardiogenic Pulmonary Edema (not treatable with diuretics) 4. Treatment - Aggressive airway management, supportive care for respiratory and circulatory systems
Toxins
1. Poisons produced by living organisms 2. Plants - Ricin 3. Bacteria -Botulinum toxin
Natural Events
1. Remember we are constantly under biological attack. - 1918 - 20 million die throughout the world due to influenza - As many as 20 thousand die due to influenza every year - The next pandemic could occur anytime a. Avian Influenza Virus, Hong Kong, 1997 - At least 30 new diseases recognized in last 25 years - Lyme disease, Lyme, Connecticut, 1982 - HIV, 1983 - Hantavirus pulmonary syndrome, Southwest US, 1993 - Hepatitis C virus, 1989
Vesicants/Blister Agents S/S
1. Route of Exposure: Inhalation, Skin absorption 2. Used in the Gulf War & WWI 3. Signs and Symptoms - Mustard-oily, delayed onset 2-24 hours - Lewisite-immediate pain - Tearing and burning of eyes, runny nose - Sneezing, coughing - Reddening of skin followed by blisters 4. Treatment - Burn and airway management - Lewisite- BAL (British Anti-lewisite)
BSA
1. Rule of Nines: for large area burns 2. patient palm size *(1%)*: for small area burns
Heart Nodes
1. SA node 2. AV node 3. Bundle of His (AV Bundle) 4. Bundle branches 5. purkinje fibers (which stimulates the ventricles to contract)
Laceration of the Great Vessel
1. SVC, IVC, Pulmonary arteries and veins, aorta 2. causes fatal hemorrhaging TX: CPR with BVM transport immediately
Auto vs pedestrian or bike/motorcycle
1. Safety 2. observe/ask questions about mechanism 3. helmet? 4. KO? 5. Injuries more likely to be severe
Types of traction splits
1. Sager: easier 2. Hares: harder
Posturing [sign of what? What are the 2 types?]
1. Severe sign of increased intracranial pressure 2 Types of Posturing a. *decerebrate*: injury of the spinal column at the brain stem; arms and the legs extend b. *decorticate*: brain injury; arms flex across chest, and legs normal
Dyspnea [AKA?]
1. Shortness of breath (SOB) or difficulty breathing 2. Patient may not be alert enough to complain of shortness of breath (this is where good assessment comes into play)
Administering oral glucose [What are precautions for ALOC people? What are the 2 forms that it comes in? When do we use each?]
1. Should be given to a diabetic with decreased LOC 2. DO NOT give glucose to a patient with the inability to swallow or unconscious 3. Liquid or Paste (can make their own liquid like juice + sugar 4. Use liquid only if they are able to hold and drink on their own 5. Paste
the upper extremity [What is the shoulder girdle composed of?]
1. Shoulder girdle: clavicle, scapula and humerus 2. Arm: humerus 3. elbow: olecranon process 4. Forearm: ulna and radius 5. wrist: carpals 6. Fingers: metacarpals and phalanges
S/S abdominal aortic aneurysm (AAA) [4]
1. Signs and symptoms a. "tearing" abdominal or back pain b. pulsating mass in midline of abdomen c. unequal femoral pulses d. syncope
Foreign Objects in the Eye [What to do with small objects? What to never do?]
1. Small foreign objects Soln: irrigate with saline by flushing from nose outwards 2. never attempt to remove an object on the cornea
Spontaneous Pneumothorax (congenital) [How does chest pain come up?]
1. Some people are born with a develop weak areas on the surface of the lungs 2. area can rupture spontaneously 3. suspect in cases of sudden chest pain with no cause
Sprain and strain
1. Sprain: joint injury with tearing of ligaments 2. strain: stretching or tearing of a muscle
AED Operation!!!!!!!
1. Stop CPR if in progress 2. Verify patient is *unresponsive, pulseless and non breathing* 3. Have partner resume CPR 4. Attach, turn on and follow AED
Traumatic Asphyxia
1. Sudden, severe compression of chest 2. Results in JVD, cyanosis, and bleeding into the eyes 3. Provide supplemental oxygen and monitor vital signs 4. Transport immediately
Parameters [5]
1. The 3 medications 2. {patient condition must indicate use 3. Must be prescribed to pateint 4. Must be patient's own medication 5. doses PTA (prior to arrival) count
Pelvic Inflammatory Disease (for woman only)
1. The inflammation of the female pelvic organs (STD) a. dull RLQ or LLQ pain (pain in the fallopian tubes) b. abnormal vaginal discharge c. nausea and vomitting d. fever
Types of VHF's
1. There are many types of VHF's 2. These include Hantavirus Hemorrhagic Fever with renal syndrome (HFRS), Marburg and Ebola HF's, Yellow fever 3. Disease syndrome varies with viral characteristics, route of exposure, dose, and patient 4. Naturally occurring disease restricted to certain geographic areas (usually vector- borne; rodent, mosquito, tick, etc.)
Responsible for Mechanical Check -Driver
1. Tires 2. Gas Level 3. Oil 4. Brakes, etc ETC
Ricin
1. Toxin produced by castor oil bean plant 2. Highly toxic, no known antidote 3. Treatment and symptoms vary by exposure route a. Ingestion b. Injection c. Inhalation
ALOC diabetic patient Treatment [Position? What air should be given? What oral medication? Where they going?]
1. Treat any ALOC diabetic the same a. high flow O2 via mask b. supine or left lateral position c. administer oral glucose d. rapid transport
Epidemiology
1. Unusual illness in age group for season 2. Unusual/ unknown disease/ syndrome in a geographical region 3. Unusually large number of insects/ wrong time of year 4. Deaths/ illness in animals in the area
Preparing for delivery [Who do you call? What kit do you get?]
1. Use proper BSI precautions: this is the right time to put all your gear on 2. be calm and reassuring 3. protect mother's modesty 4. *Contact medical control*: tell the hospital so they can be ready -deliver on scene -transport 5. position mother for delivery 6. *prepare OB kit*
Pediatric Resuscitation Tape Measure (Broslow Tape)
1. Used to determine height, weight (kg), and proper equipment
Scene Approach
1. VIOLENT? Approach slow and silent 2. Consider Staging 1-2 blocks away 3. Beware dead ends and long alleys 4. Park as a *TACTIC*, not as if not as if you were shopping
hemorrhage
1. Vagina bleeding 2. If present in early pregnancy a. spontaneous abortion (miscarriage) b. ectopic pregnancy 3. Later in pregnancy -placenta problem
S/S of Diabetic Ketoacidosis [Conscious or unconscious? What are the 2 distinct S/S? How would you describe Kussmall respirations? (why)]
1. Vomiting 2. Abdominal pain 3. *Kussmaul respirations: Rapid and deep breaths to eliminate ketones via respiratory system (hence the fruity breath)* 4. Fruity odor 5. unconscious Note: they need insulin to break down glucose
Other considerations
1. What is beneath fracture site? 2. Open fracture (infection might set in) 3. joint involved?
EMS response to pediatric emergencies
1. You may experience a wide range of emotions 2. You may feel anxious 3. Practice helps 4. After difficult incidents, a debriefing may be helpful
Delivery without sterile OB kit [What to do with umbilical cord? What level is placenta relative to infant?]
1. You should always have goggles and sterile gloves on you 2. use clean sheet and towel 3. do not cut or clamp the umbilical cord (mom can hold baby while it's still on) 4. keep placenta and infant at same level
aneurysm
1. a *ballooning* out of a weakened section of an artery 2. possibility of rupture -cause threatening internal bleeding
Bowel Obstruction
1. a blockage or the bowel lumen prohibiting the passage of material a. Hx of recent abdominal suergery b. constipation c. colicky abdominal pain d. abdominal distention: belly grows e. nausea/vomitting
embolus
1. a thrombus that breaks off from vessel wall 2. flows through blood vessels 3. may partially or completely occlude smaller atery 4. occlusion will result in decreased oxygen to tissue or tissue death
Respirations [What's one way pediatrics raise their respiration rate that you shouldn't concern about? Less than 3 rpm what should you do?}
1. abnormal respirations are a common sign of illness of injury 2. les than 3, count rise and fall of abdomen 3. note effort of breathing/noises 4. note if they are crying (crying can increase respiration rate so make sure to document everything)
Ingested Poison stat's and Tx
1. accounts for 80% of all poisonings 2. accidental or deliberate 3. activated charcoal -- NOT used by EMT's in LAC 4. CAB's and transport
spontaneous pneumothorax [what is it? What are 2 distinct S/S?]
1. accumulation of air in the pleural space (when vacuum in pleural space is lost then the lungs will collapse) 2. caused by certain medical condition 3. *dyspnea and sharp chest pain* on one side 4. *absent or decreased breath sounds* on one side Note: can happen from coughing, strenuous activities, stab wound in lung
stimulants (sympathomimetics)
1. agitation and anxiety 2. dilated pupils 3. tachycardia 4. hypertension 5. rapid speech 6. seizures
Pneumothorax [What is it? What happens? What is a *sucking chest wound*?]
1. air accumulate in the pleural space 2. air enters through a hole in the chest wall -the lung may collapse in a few seconds or a few hours 3. An open or penetrating wound to the outside chest is called a *sucking chest wound*
Common bronchodilators
1. albuterol 2. proventil etc...
possible causes
1. alcohol and drugs 2. head injury 3. metabolic disorders (diabete, renal) 4. neurological 5. psychiatric illness 6. stress response
review of allergic rxn
1. allergic rxn -exaggerated immune response to any substance 2. histamine and leukotrienes -chemicals released by the immune system
FEMALES
1. always consider a gynecological problem with women having abdominal pain a. preggo? b. LMP? c. Normal? d. Prior gynecological problems?
Dissecting abdominal aortic aneurysm
1. aneurysm develops between aortic aneurysm a. shearing/tearing abdominal pain b. sudden onset c. shock d. unequal femoral pulses
Tips and other stuff [When do we realign fractures? What 2 types of skull fracture and how do we find it?]
1. angulation or angulated extremity: WE ONLY REALIGN IF IT IS PULSELESS 2. Depressed skull fracture: if you feel a little dip then there may be a head injury 3. Basilar skull fracture 4. Flail chest: if your chest is a mush, paradoxical movement, etc
Critical burns
1. any burn involving respiratory tract 2. any electrical burn 3. hands, feet, or genitalia 4. face 5. 2nd degree w/over 30% BSA 6. 3rd degree w/over 10% BSA
Child abuse
1. any improper or excessive action that injures or harms a child or infant 2. physical, sexual, emotional abuse and neglect 3. more than 2 million cases reported annually 4. be aware of signs and report
major arteries and veins
1. aorta 2. pulmonary arteries: unoxy blood from RV to lungs 3. carotid arteries: blood from ascending aorta to supply head or the brain 4. femoral artery: takes blood to lower extremity 5. brachial artery: takes blood to upper extremity 6. radial artery: branches off from brachial artery and supplies blood to distal upper extremities 7. SVC: unoxy blood from head, neck, shoulders, and upper extremities to the right atrium 8. IVC: unoxy blood from abdomen, pelvis, lower extremities, back to right atrium 9. pulmonary vein: oxygenated blood from lungs to LA
Abnormal Respiratory Patterns [4]
1. apnea 2. cheyne-stokes: they are breathing fast then stop breathing for a little then they breathing fast again 3. CNS hyperventilation (unconscious hyperventilation): usually when patient is unconscious; indicate head injury. (similar to Kussmal respirations in a diabetic patient) 4. ataxic: loss control of body movement
Types of bleeding [rate and color for the 3 types]
1. arterial: spurting, lighter 2. venous: flowing, darker 3. capillary: oozing
Develop a general impression
1. as you approach the scene a. assess environment b. patient chief complaint c. presenting signs and symptoms of patient (NOT vitals. only skin signs and cap refill)
Assessing the Responsive Medical Patient
1. ask general questions 2. may not be obvious 3. use patient's own words (quote them) 4. multiple complaints? (if they are unresponsive then their complaint becomes "ALOC")
Tasks at scene of SIDS case
1. assess and manage patient 2. communicate with and support the family (let police handle the family) 3. Assess the scene (How does the house look like? etc) Pro Tip: Always resuscitate even if you know the baby is hopeless
Pediatric Needs (what sign of asthma is a late finding?)
1. asthma is common in childhood 2. cyanosis is a *LATE* finding 3. treatment is same as for an adult
Tourniquet (last resort)
1. at least 2 inches 2. *never over a joint* 3. *never loosen* Note: they are discouraged because they cause tissue and healing problems ALWAYS document time
umbilical cord [How many veins? arteries? what are their functions? from where to where?
1. attach baby to mother 2. becomes belly button 3. has *1 vein and 2 arteries* Vein: carry oxygenated blood and nutrients from placenta to the fetus Arteries: carry deoxygenated blood and waste product back to placenta
UTI [what is called when blood is in your urine? What peeing pattern may patient report?]
1. bacterial infection in the uriinary tract a. lower abdominal pain b. pain and/or burning with urination c. hematuria: blood in urine d. urgency and frequency
Joints
1. ball and socket 2. hinge joint
Radio Requests
1. be composed 2. be brief 3. be specific 4. be structured a. unit to base b. location c. age-sex-weight d. chief complaint e. expanded chief complaint f. LOC g. pupil and skin signs h. vital signs i. Physical exams j. Rx k. destinatopm Note: report this through radio only if patient is really critical 5. state purpose of request
Spontaneous Abortion [Happens when? What 2 complications? How to treat? How to handle fetus and remains?]
1. before 20th week 2. complications: infecting and bleeding 3. treat for shock 4. transport 5. bring any tissue (*POC: product of conception* including blood clots, fetus parts, sanitary pads; to see how much blood and what has come out) that has passed Note: a blessing in disguise because the child may be problematic
School-age child
1. begin to think like adults 2. can be included when taking medical history 3. should be familiar with physical exam 4. allow them to make choices when possible (e.g. do you want to sit up? do you want a blanket?)
Systemic ciruclation
1. begins at left ventricle 2. to aorta 3. Arteries, arterioles, capillaries 4. vena cava (IVC, SVC) 5. right atrium
Hallucinogens
1. blank stare 2. visual hallucinations 3. tachycardia, hypertension 4. anxiety, agitation 5. inappropriate behavior 6. dilated pupils 7. nystagmus (pupils bounce around like basketball) 8. hot flashed (naked people) 9. seizures
Explosive weapon injuries
1. blast force injuries *mostly shrapnel injuries* 2. crush syndrome 3. Potassium affects heart causing VFib 4. Myoglobin clogs the kidneys causing renal failure etc
We don't stop to treat patient unless if
1. bleeding 2. airway is obstructed
anticholinergics
1. block parasympathetic nerves 2. *Hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter* 3. seizure and death within 30mins 4. Have ALS and transport rapidly e.g. jimson weed
pulmonary embolus [What do you cough up? How do you prevent it?]
1. blood clot that winds up in lungs (causes obstruction) -dyspnea -*hemoptysis*: coughing of blood -cyanosis -tachypnea -pleuritic chest pain -one-sided chest pain -can have sudden onset -can have abnormal breath sounds Note: it is important to move
complication of fracture [1 distinct complication]
1. blood vessel and nerve damage 2. *fat embolus*: fat in skin break off and swim in blood vessels 3. disability or deformity
Non trauma related eye injury [What could other causes be?]
1. blurred vision 2. double vision 3. sudden blindness THINK CVA or other neurological
Skeletal Difference
1. bones are prone to fracture with stress (epiphyseal fracture) because they are constantly growing 2. Infants have 2 openings in skull called fontanels. They *close by 18 months*. (Don't touch them!!)
bleeding (internal)
1. bones have a blood supply femur: 1 L pelvis: 1 liter tibia: 500cc
atherosclerosis(plaque build up)/arteriosclerosis (hardening of the wall then it loses it smooth muscle capabilities) [3 effects]
1. build up of fatty deposits and calcium 2. causes narrowing of the lumen (or your arteries) 3. can create rough inner surface that lead to clot
Crushing mechanisms
1. building and structural collapse 2. motor vehicle accidents 3. collapse of Earth 4. industrial accidents 5. farming accidents
respiratory involvement
1. burned face or mouth 2. singed nasal hair 3. sooty sputum 4. voice changes 5. dyspnea 6. enclosed space burns!! (like you're BBQing and something blows up in your face
Pediatric needs
1. burns to children are more serious 2. more surface area relative to body mass 3. many burns result from abuse 4. report all suspected cases of abuse to the authorities
Preschool
1. can understand directions (they know when they are going to doctor) 2. can identify pain 3. fearful of pain 4. allow them to handle equipment (distract them with stethoscope or toy or stickers) 5. explain what you are going to do (be truthful)
Brainstem (controls automatic function of the body) [4 parts]
1. cardiac center: controls heart rate and ventricular cxn 2. respiratory center: controls breathing rate and tidal volume 3. vasomotor center: control constriction and dilation of blood vessels (BP) 4. RAS: controls awareness of your surroundings (LOC, reflexes, behavioral responses)
RBC
1. carry oxygen 2. AKA erythrocyte 3. hemoglobin combines with oxygen in RBC
abrasion [What comes out of the wound?]
1. cause by friction 2. don't bleed a lot they usually ooze Tx: put nice and moist gauze
Other Devices we can transport
1. central lines 2. indwelling vascular access device (IVAD)
MAY NOT TRANSPORT
1. central venous monitoring devices (patient needs to go with higher level of care) (CVMD) 2. Swan Ganz catheters (IV that goes directly into heart 3. arterial lines
Advantages of bioweapons
1. cheap 2. found in nature 3. highly infectious and contagious 4. can be undetectable 5. impossible to trace 6. initial symptom mimic naturally occurring disease 7. long incubation periods
care for penetrating injuries
1. check for exit wounds 2. dry sterile dressing 3. bulky dressing for impaled object
Designer Drugs
1. chemically designed for a special effect a. ecstasy b. GHB Overdose: respiratory arrest, hallucination, ALOC, etc
Transporting infant and children [Should you hold the baby during transport?]
1. children require padding under the torso (or use a car seat) 2. newborns should begin special incubators 3. do not hold child during actual transport (in case if car crash) 4. drive with due care 5. do not allow emotions to take control
Thorax (how many ribs?)
1. clavicle 2. scapula: shoulder blade 3. thoracic cage: rib cage 4. sternum: breath bone a. xiphoid process b. body c. manubrium RIBS (12) 1-10: attached to sternum 11-12: free float
Treatment of wounds [How do we determine level of moisture for different types of wounds?]
1. clean dressing (sterile is not feasible) 2. *dry for bleeding* 3. *wet if wound is drying* 4. secure with bandage
Care for Open Pneumothorax
1. clear and manage the airway 2. provide oxygen 3. seal an open wound with an occlusive dressing 4. tape down all 4 sides and create *flutter valve* (to leave a corner to let air out) If flutter valve is not there it can cause *tension pneumothorax* (deadly)
Soft-tissue injuries [define a burn]
1. closed injuries 2. open injuries 3. burns: when tissue receives more energy than it can absorb
marine animals [2 types; 2 S/S]
1. coelenterates: jellyfish, sea anemone, some coral 2. nematocysts (actual barbs): stinging cells 3. local rxn at site: painful red lesions 4. maybe shock from anaphylaxis
Hemothorax
1. collection of blood in the pleural space -S/S of shock -decreased breath sounds on affected side 2. *hemopneumothorax*: Blood AND air in the pleural space. Like the video we saw of the mexican guy with gunshot wound.
Abdominal pain
1. common 2. CAUSE is difficult to identify 3. life threatening? 4. Sudden onset of abdominal pain indicated peritoneal irritation (PAIN)
CAUSES of seizures
1. congenital (present from birth) 2. high fevers 3. structural problems in the brain (e.g. TUMOR) 4. metabolic disorders (diabetic, alcohol withdraw 5. chemical
What does the NS do? [Controls what two aspects of the body fx?]
1. controls the body's voluntary and involuntary actions 2. somatic NS: controls voluntary actions (e.g. skeletal muscles) 3. autonomic NS: controls smooth, cardiac muscle, and glands
Governor's Office of Emergency Services (OES)
1. coordinate emergency response -between regional operations -federal authorities 2. Six mutual aid regions 3. LAC is in region 1 4. Resources are coordinated within the structure of SEMS 5. Aids in recovery
Absorbed Poisons
1. corrosives will damage the skin 2. treat chemical burns 3. do not irrigate phosphorous or elemental Na 4. CAB, high flow of O2, rapid transport e.g. acid
Signs of Imminent Delivery [3]
1. crowning 2. Urge to bear down or go to the bathroom 3. It's coming 4. contraction of increased frequency and intensity (every 2-3 minutes)
Lacerations [How do you exert pressure? What happens when a part of eye is exposed?]
1. cut to the globe or surround tissue 2. *never exert pressure* on or manipulate eye 3. if part of eyeball is exposed, * a moist, sterile dressing and eye shield*
Communication and support of family
1. death of child is stressful for family 2. parent guilt is overwhelming 3. provide support emotionally 4. not your place to judge 5. use infant's name 6. give family time with the infant
acute myocardial infarction [Leads to death of what? Is it permanent? How long does it last?]
1. decreased flow of blood to the myocardium leading to the death of tissue (scar tissue; they become a burden to the heart) 2. may not be provoked 3. moderate to severe pain 4. can last between 30 minutes and several hours 5. may not go away with rest, O2 or nitroglycerine 6. immediate transport is essential
Heat cramps definition and S/S
1. definition=*depletion of body salts* S/S 1. muscle spasms of leg and abdomen 2. history of exertion with no salt intake
When to consider field delivery
1. delivery is imminent 2. impossible to reach hospital 3. no transportation is available
Burn assessment [4 things you must know]
1. depth of burn 2. extent of burn or BSA (burn surface area) 3. identify critical burn 4. under 5 or over 55?
Medical vs Trauma
1. determination should come after initial assessment is finished 2. Patients may have traumatic injuries caused by a medical reason e.g. walking down the street then having a stroke and falling. This situation is medical situation leading to trauma 3. *Initially assume all patients have both medical and traumatic aspects to their condition*
Physical exam
1. determine type of injury 2. observe for distention 3. palpate (TRPGR) 4. check all 4 quadrants 5. start away from pain
ICS History
1. developed in 70s for wildfire 2. certification and training by the fire departments 3. *counties and cities* are required to use SEMS 4. now being adopted *nationally* NIMS 5. *Hospitals* use HEICS
START history
1. developed in 83' 2. designed for personnel with minimal medical training
diabetes intro
1. diabetes mellitus 2. 6% of the population is diabetic 3. deadly if not treated
DON'T
1. diagnose 2. judge 3. label 4. express accusations and anger
SIDS assessment and Management [When to not resuscitate?]
1. diagnosis of exclusion 2. can be other causes of condition 3. regardless of cause, Tx is the smae 4. infants may have signs of *postmortem changes* 5. it is okay to work up an obviously dead baby 6. *if no postmortem changes, begin CPR immediately* *Potential Causes*: child abuse infect bacterial or viral illness accidental or intentional poisoning Pro Tip: kick parents off of ambulance
Breathing process: inhalation
1. diaphragm and intercostal muscles contract 2. size of thoracic cavity increases 3. pressure in the lungs decreases 4. air travels to the lungs
Breathing process: exhalation
1. diaphragm and intercostal muscles relax 2. all dimensions of the thorax decrease 3. pressure in the lungs increase 4. air flows out of the lungs
Common medications
1. dilantin 2. tegretol 3. phone-barbitol and....
Control of bleeding [What is the last resort for controlling bleeding?]
1. direct pressure 2. elevate extremity 3. Pressure dressing 4. pressure points 5. *tourniquet (last resort)*
California Emergency Medical Authority (EMSA)
1. disaster planning, training and exercise 2. manages the state's medical response to disaster 3. coordinates field deployments for DMAT
Tx of injected caustics/hydro carbons
1. discourage vomiting 2. drink water or milk if available 3. rapid transport
What causes diabetes? [specific something in not produced]
1. disease in which there is inadequate insulin produced by the body
Congestive heart failure CAUSES [just think about what heart is trying to do to compensate, and what the result of compensation is; What disease usually lead to this?]
1. diseased heart valves and damaged ventricles (when muscles cannot contract regularly, the heart tries to COMPENSATE; left ventricle dilates) Note: creates a lot fluid (APE) that the body cannot get rid of it 2. chronic hypertension 3. COPD 4. often a complication of an MI
Decision to Operate CODE 3
1. dispatch decides initially 2. You(EMT) decide how to transport to Hospital
Actions
1. distance and shield (300') 2. Isolate the area and deny entry to unauthorized personnel 3. summon help
sexual assault [When to examine genitalia? What should patient NOT do?]
1. do not examine genitalia unless there is obvious bleeding 2. document and preserve evidence 3. the patient should not wash the area, defecate, eat or drink until examined 4. treat other injuries accordingly 5,. offer to call the local rape crisis center
Stabilization of the cervical spine [this is common sense lol]
1. do not force the head into a neutral, in-line position if: a. muscles spasm b. pain increases, resistance, crepitus c. numbness, tingling, or weakness develop d. there is a compromised airway or breathing
Under 5 or over 55?
1. do not tolerate burns as well 2. more likely to develop shock, hypothermia and experience airway problems 3. may indicate child/elder abuse
Establish Patient Rapport (people skills)
1. do what you can to make the patient comfortable: e.g. get on their level and be calm 2. listen to the patient 3. make eye contact 4. base question on the patient's complaint 5. mentally summarize before starting treatment: based treatment off of summary 6. obtain consent: if they are not disagreeing then they are pretty much consenting
Injuries of the ear (how much does the ear bleed?)
1. doesn't usually bleed much 2. place a dressing between ear and scalp 3. for *avulsion* (when u van gogh your ear), moist sterile dressing 4. do not try to remove a foreign body 5. CSF/blood 6. rupture tympanic membrane (from loud noises)
Hip Injury Tx [How do we straighten leg?]
1. draw sheet method 2. make NO attempt to straighten leg 3. support with rolled blanket (compress hip) 4. prevent hip movement
Types of water incidents
1. drowning(means to die) /near drowns 2. diving injuries 3. air embolism 4. bends or decompression sickness
Dehydration [Cause, S/S,]
1. dry lip and gum 2. few wet diapers 3. sunken eyes 4. *poor skin turgor* (when you take your skin squeeze and pull it, it should be elastic and snap right back) 5. sleepy or irritable 6. sunken fontanels 7. caused by diarrhea, vomtting Note: if they can't keep anything down they need an IV at the bone
S/S Pneumothorax [3 symptoms]
1. dyspnea 2. sharp chest pain 3. unequal breath sounds
Asthma
1. dyspnea 2. wheezing 3. accessory muscle use (you also see sternal retraction) 4. nasal flaring 5. respiratory rate (Observe)
Critical CHF and Pulmonary Edema
1. dyspnea 2. rales & AUDIBLE rales 3. pink sputum 4. tachycardia 5. cyanosis (not perfusing well) 6. anxiety, restlessness
Significant Mechanism of Injury (MOI)
1. ejection from vehicle 2. death in passenger compartment 3. Fall greater than 15-20' 4. Vehicle rollover 5. High speed collision 6. Unresponsive or altered mental status 7. Penetrating trauma to head, chest, or abdomen Note: these are mechanisms that causes you to go to the trauma center regardless if you are not injured
ectopic pregnancy
1. embryo gestation outside uterus a. RLQ or LLQ pain b. late LMP c. may have vaginal bleeding d. shock
EMT-B job description (2 things)
1. emergency *care and transport* of the sick and injured 2. *assist* ALS personnel (paramedic) with patient care
esophageal varices [comes from a history of what?]
1. enlarged blood vessels in the esophagus that can rupture a. marine bright red bleeding (oral) b. shock c. Hx of liver disease or ETOH (alcohol) abuse
GI complaints: hemorrhoid [What is it caused by? hint: enlargement of something]
1. enlarged blood vessels near the anus a. rectal pain b. bleeding
Delivering an infant of an addicting mother
1. ensure proper BSI precautions 2. deliver as normal 3. wach for severe respiratory depression (lung issues) and low birth weight 4. may require immediate care 5. long term effects include learning disabilities, autism, ADHD
ulcer [What is it? What are the 2 S/S? (pain and puke)]
1. erosion of the stomach or intestinal lining a. epigastric(relating to anterior wall of abdomen) or abdominal pain b. *hematemesis*: blood in emesis i. bright red ii. coffee ground color
platelets [AKA what?]
1. essential for blood clot 2. AKA *thrombocyte*
Operating Code 3
1. exempt from most traffic regulations 2. over 10 MPH over the posted speed limit 3. beware intersections
Ear anatomy
1. external ear: pinna, external auditory canal, tympanic membrane 2. middle ear: responds to sounds 3. inner ear: bone chamber filled with fluid for hearing and equilibrium
Other indications
1. fearful, withdrawn, or hostile child 2. refusal to discuss MOI 3. History of "accidents" 4. conflicting stories 5. caregiver lack of concern
Meningitis S/S [2 distinct S/S]
1. fever 2. ALOC 3. Headache 4. Seizure 5. *stiff neck and stiff back* 6. vomiting 7. photophobia 8. irritability 9. *bulging fontanel*
amniotic sac [How much fluid? What nutrient does the baby get from here?]
1. filled with amniotic fluid (500-100mL) 2. embryo is suspended here 3. acts as cushion 4. for hydration
Depth of burn
1. first degree (superficial) -reddened, painful skin e.g. touching a hot pot 2. second degree (partial thickness) -blisters, painful skin 3. Third degrees (full thickness) -charred, leather like skin, white, waxy, painless
peripheral vascular resistance
1. force against which heart has to beat 2. partially determined by the size of blood vessels
thrombus (blood clotting as oppose to the cholesterol and claim clotting from atherosclerosis)
1. formation of clot and debris in vessels from plaque 2. can become large enough to occlude vessel 3. partial bloackage= distal reduction of O2 4. complete blockage= distal tissue death
triage
1. french word meaning "to sort" 2. goal of triage in an MCI event: "the greatest food for the greater number of patients" 3. sorting by severity of injury 4. treatment and transport decisions are based on the result of triage
Communicabel Diseases
1. from one person to another 2. minimize risk with proper protection 3. immunizations
Hazards of improper splinting
1. further damage 2. delay in transport 3. reduction of distal circulation 4. Aggravation of the injury 5. injury to tissue, nerves, blood vessels, or muscle
Components of the EMS system
1. general public 2. dispatchers 3. first responders (cops, firefighters, EMT, etc.) 4. transporting agencies 5. hospital emergency departments 6. specialty centers
Chronic Risks of Exposure
1. genetic damage 2. birth defects (WOMAN IF U PREGGO THEN DON'T EVEN) 3. cancer
Skeletal System [how many bones?]
1. give form to body 2. protect vital organs 3. 206 bones 4. sdannfkvbskf blah blah
Functions of Musculoskeletal system
1. gives the body shape 2. protects internal organs 3. provides for movement 4. consistent of more than *600 muscles*
Types of fracture [6; which of the ones occur in children?]
1. green stick: incomplete fracture that only passes part way through the bone(only half way) (mostly occur in children)(it's like when you try to break a branch but it cracks and it doesn't come off. 2. spiral [AKA torsion]: 3. Transverse: fracture occur straight across the bone 4. Comminuted: bone broken into 2 or more fractures 5. Pathological: diseased bone (e.g. have osteoporosis etc) 6. epiphyseal: occurring in growth section in CHILDREN ONLY
Tx Hypothermia
1. handle gently 2. remove from enviornment 3. high flow oxygen 4. warming measures 5. heat up ambulance 6 *PREVENT FURTHER HEAT LOSS*
Preeclampsia (*toxemia*) [When does it happen? What 5 distinct S/S aside from the obvious ones? How many percent of pop. have this?]
1. happens after 20th week 2. *headache* 3. hypertension 4. *edema and sudden weight gain* 5. *visual problems* 6. *anxiety* STATE: 5-6% have this Note: you shouldn't be working and getting stressed out
diaphragm
1. has characteristics of both voluntary and involuntary muscles 2. Dome-shaped 3. Divides thorax from abdomen 4. Contracts during inspiration (and intercostal muscles) 5. Relaxes during exhalation
Questions for the diabetic (you have to wait until they are alert) [4 questions]
1. have you taken insulin or hypoglycemics 2. have you taken your usual dose today? 3. have you eaten normally today? 4. any illness, unusual activity, or stress today?
CO poisoning
1. headache 2. confusion 3. N/V 4. dyspnea, tachypnea, tachycardia 5. unconsciousness
CHF reasoning
1. heart tries to compensate 2. increase HR 3. enlarged LV 4. heart cannot efficiently pump the amount of fluid in the body and CHF develops 5. fluid backs up into lungs or body as heart fails to pumo
components of the CV system
1. heart: pumps blood 2. Arteries: away 3. Veins: back to heart 4. Blood: carries nutrients
Treatment for Eclampsia [When to use code 3? What position?]
1. high flow of oxygen 2. code 2 unless seizing or coma 3. left lateral position
Treatment of all abdominal injuries
1. high flow of oxygen 2. keep airway clear 3. treat for shock PRN 4. no oral fluids 5. rapid transport 6. supine/shock
Rx for all
1. high flow of oxygen 2. position of comfort 3. rapid transport
hyperglycemia
1. high glucose levels 2. normal 80-120
The lower extremity
1. hip: pelvis 2. thigh: femur 3. knee: patella 4. leg 5. ankle: tarsals 6. foot: metatarsals 7. patella: knee cap 8. Tibula (shin bone) 9. Fibular (lower leg)
pneumonia [History of what? What are two symptoms? How fast is onset?]
1. history of Upper Respiratory Infection (URI) 2. Fever 3. Productive cough 4. Slow onset
Near drowning [1 distinct S/S]
1. history of underwater episode 2. dyspnea 3. tachypnea 4. *laryngospasms*: spasm/seizing of vocal cords that make it difficult to speak or breath 5. ALOC 6. apnea and cyanosis
Insulin [What secrets it? It allows cells to do what?]
1. hormone secreted by pancreas 2. it allows cells to use glucose Note: Without insulin, cells begin to starve
Human bites
1. human bites that penetrate the skin can be serious injuries. 2. immobilize the area 3. Apply a dry, sterile dressing 4. Transport
S/S CVA
1. hypertension 2. altered mental status 3. hemiparesis and hemiparalysis 4. headache blurred vision 5. aphasia 6. one side face droop 7. incontinence: involuntary control over poop and pee ASK: "When was the last person seen normal??"
Altered Mental States (AMS)
1. hypoglycemia 2. hypoxemia 3. intoxication 4. drug overdose 5. unrecognized head injusry 6. poisoning 7. tumor 8. brain infection blasndklanvnsdfvw GOES ON AND ON
Stroke Mimics
1. hypoglycemic people 2. postiytal state 3. subdural or epidural bleeding
4 Categories of shock
1. hypovolemic 2. cardiogenic 3. obstructive 4. distributive
Complications of seizures
1. hypoxia 2. trauma 3. hyperthermia 4. hypoglycemia 5. aspiration 6. dehydration
Terminology for respiratory emergency
1. hypoxia: decreased/low oxygen 2. Anoxia: no oxygen (#3-4 are BIG lung sounds): be familiar with how they sound like 3. Wheezing: whistling sound 4. Rales (usually heard in inspiration): fluid (usually in alveoli) sound (crackles) 5. stridor (usually heard on inspiration; caused by narrowing of upper airway): high pitched sound 6. Rhonchi (usually heard on expiration; caused by mucus; lower pitch than wheezing): coarse gravelly sounds
Shock [What do you do when the patient is in shock?]
1. if patient has S/S of shock look elsewhere for cause!! -abdomen or chest
Post delivery care [How to position? What to suction?]
1. immediately wrap the infant in a towel with the head lower than the body 2. suction the MOUTH then NOSE again 3. clamp and cut the cord 4. do APGAR score
Amputations
1. immobilize partial amputation with bulky dressings and splint 2. wrap severed part in dry* sterile dressing and placed in a plastic bag 3. put bag in a cool container filled with ice 4. transport severed part with patient e.g. chop your finger off
Skin signs
1. important 2. always check capillary refill (to check for early perfusion problems) 3. feel for temperature and moist
Where does fertilization occur
1. in the fallopian tube
ICS personnel (in order)
1. incident commander 2. section chief 3. director 4. unit leader 5. officer 6. worker bees
Electrical system of the heart [Where does it start? What is it called? What is it called when it's beginning at another location?]
1. independent 2. stimulates contractions of heart 3. normally initiated in right atrium (SA node) 4. if initiated from other = abnormal (cardiac disarrythmia)
Basilar skull fracture [What else do you look for when you encounter this?]
1. indicates SIGNIFICANT force 2. CSF fluid in ears and nose 3. "battle" sign 4. "raccoon eyes"
Bright red rectal bleeding [Indicates bleeding where?]
1. indicates bleed close to anus a. obvious sign (not subtle) b. minor bleeds usually hemorrhoid (AKA fisher or a tear)
Breathing differences [Rates? Body part used? What happens during sustained labored breathing?
1. infants breathe faster than children or adults -higher HR -higher respiratory rate -lower BP (we don't care about BP for pediatrics) 2. Infants use the diaphragm when they breathe (anything that blocks abdomen can lead to respiratory failure) 3. Sustained, labored breathing may lead to respiratory failure (because their accessory muscles become fatigue)
Pulse
1. infants: brachial or femoral 2. child: carotid 3. count at least 1 minute 4. note strength
Upper or lower airway infection
1. infection diseases may affect all parts of the airway 2. cause obstruction
Light burns
1. inferred rays, eclipse light, direct sunlight, laser burns 2. welding without protection 3. burns on cornea 4. very painful 5. cover eyes with sterile pad and eye shield 6. transport supine
Meningitis [What is it? Which one is highly contagious? Effects? What is it often mistaken as?]
1. inflammation of meninges 2. bacterial (HIGHLY CONTAGIOUS, if they hack in your face you're done) or viral 3. permanent brain damage/death Note: it looks like a bad flu and it's often misdiagnosed
pyelonephritis
1. inflammation of the kidney a. flank pain b. pain and/or burning with urination c. hematuria d. fever
peritonitis
1. inflammation of the peritoneum a. generalized abdominal pain b. fever c. rigid abdomen d. nausea or vomittting e. *distention*
forms/ devices include [4] [What if EMT is unfamiliar with device?]
1. inhaler 2. inhaler with a spacer 3. nebulizers (there is an exhale pipe) 4. *pulmonaid device* ANS: let patient set it up
Fiver general Allergen categories
1. insect bites and stings 2. medication (prescribed medication e.g. penicillin) 3. plants (poison oak and stuff including seasonal allergies to pollen and dust) 4. food (e.g. gluten, etc) 5. chemicals (e.g. soap, detergent, deodorant, perfume) 6. animals: you are allergic to the dander of animals. (dander is the dried up saliva that gets up into the air when animals clean themselves)
Scene assessment
1. inspect the environment, noting: -signs of illness, including medications -general condition of the house -family interaction -Where was baby discovered?
Common medications
1. insulin needle 2. diabeta 3. orinase 4. diabinese 5. glucagon: raise blood sugar through needle in muscle etc Note: Anything with "Gluco-"
Type 1 diabetes (autoimmune disease) [What cells are being destroyed? Tx?]
1. insulin-dependent diabetes 2. *beta cells* (store and release insulin) in pancreas are gradually killed by the body's immune system 3. no insulin is produced 4. insulin is injected daily
Cardiac muscle
1. involuntary muscle 2. has own blood supply and electrical system 3. can tolerate interruptions of blood supplies briefly
Explosive weapon
1. involved in the majority of terrorist incidents 2. can be used to disperse other agents 3. easily transportable 4. associated injuries
Acute risk of exposure
1. irritation 2. burning 3. tissue destruction
Questions regarding child abuse [look for clues! What is glove distribution?]
1. is injury typical? 2. is reported method of injury consistent with injuries? 3. Is the caregiver behaving appropriately? 4. Is there evidence of drinking or drug abuse? 5. Delay in seeking care? 6. relationship between child and caregiver? (good/bad) 7. Multiple injuries at different stages of healing 8. Any unusual marks or bruises? (cigarette burns, branding injuries, stab marks, etc) 9. Are the several types of injuries 10. any burns on the hands or feet involving a *glove distribution* (when the skin on your hand is peeled off like a glove as a result of contact with hot water) 11. Unexplained decreased LOC 12. If the child clean and appropriate in weight? 13. Any rectal or vaginal bleedings 14. What does the home look like?
Support Groups
1. know your local phone number and referral 2. prepare for proper debriefing
Hyperglycemia [Associated with what 3 P's?]
1. lack of insulin causes glucose to build up in blood 2. kidneys excrete glucose 3. This requires a large amount of water (polyuria, polydipsia[excessive thirst], polyphagia) 4. Without glucose, body uses fat for fuel 5. Ketones (hard to excrete) are byproducts of fat metabolism 6. *diabetics ketoacidosis*: blood became more acidic than it should Note: Ketone causes sticky blood TL;DR: waaaaay too much sugar but not enough insulin to balance it out
Airway differences
1. larger tongue relative to mouth 2. less well-developed rings of cartilage in the trachea (so we don't do overly aggressive head tilt chin lift) 3. Head tilt chin lift may occlude the airway (use jaw thrust)
Medications
1. lasix: its a diuretic; reduced fluid retention 2. digoxin: for disarrythmia 3. lanoxin: for disarrythmia 4. inderal: for hypertension 5. Nitroglycerine (NTG): put underneath tongue to be absorbed by mucus membrane
Nose bleeds [Steps? Does the stomach like blood?]
1. lean forward 2. pinch nostril and hold 3. blood is an irritant to the stomach 4. hypertensive?
Contact lenses [When should an EMT try to remove it? (what situation?) What other 2 ways can be contact be removed?
1. leave in place unless chemical burn 2. trying to remove them can damage cornea 3. If irrigation removes them [OK] 4. If patient removes them [OK] 5. If there is no function in an eye, ask if the patient has an artificial eye
Placenta *previa and abruptio* Tx
1. left lateral position 2. rapid tranport 3. high flow O2
Re-certification Requirements
Every 2 years, complete refresher course OR Obtain 24 hours of approved continuing education
peripheral NS
1. links the organs of the body to the central nervous system 2. *sensory nerves* carry information from the body to the CNS 3. *motor nerves* carry information from the CNS to the muscles of the body
blood
1. liquid portion: plasma 2. Solid is 2. transports nutrients 3. basically a salt soln
description of abdominal pain [LG-RC]
1. local 2. general or diffuse 3. *referred* [ON THE TEST!!!!!] (e.g. it can shoot pain up to your shoulder) 4. colic: cramping, intermitten cramping pain
Mutual Aid Coordination
1. local requests are initiated through the Medical Health Operational Area Coordinator (local health officer) 2. Regional requests are made by the medical health operational area coordinator through the reigonalsmfsala sa Coordinator for region 1
Compartment syndrome [What dies? What is the end result?]
1. local side affect 2. excessive swelling in confined space 3. *ischemia kills muscle cells in 4-12 hours* 4. *permanent disabilities/ amputation* can result if undiagnosed
bee sting
1. local swelling 2. pain 3. edema
Respiratory Center [Where is located? What does it respond to what does it control? The cranial nerve ______ located in _______ controls________]
1. located in brainstem 2. responds to CO2 3. controls rate & tidal volume 4. phrenic nerve makes the diaphragm work (C3-C5 injury can injure this nerve)
The heart
1. located in the thoracic cavity -2nd intercostal space at the right sternal border -5 intercostal space at left midclavicular line 2. About the size of your clenched fist 3. in mediastinum (cavity between your lungs; it contains the pericardium)
Rocky Mountain spotted fever S/S [incubation period?]
1. long incubation period of 7-10 days 2. N/V 3. headache 4. weakness 5. *paralysis* 6. possible cardiorespiratory collapse
hypoglycemia [Most calls are what?]
1. low glucose level 2. normal range 80-120 mg/DL (milligrams/deciliter) 3. Most calls are hypoglycemia
Tx for shock
1. maintain airway 2. control external bleeding 3. shock posoiiotn 4. high flow transport 5. rapid transport 6. keep warm 7. NO FOOD
Rx for head and Spine injury [1 distinct Rx]
1. maintain airway 2. oxygen 3. stabilize C-spine
Rapid Physical Exam pt 1
1. maintain spinal immobilization while checking patient CABs 2. Use DCAP BTLS 3. Assess the neck 4. Apply a cervical spine immobilization collar
Standardized Emergency Management System (SEMS)
1. manage and coordinate emergency responses involving multi-agencies 2. used statewide 3. required use for cost recovery 4. utilizes the incident command system (ICS) 5. Single Point of Contact 24/7
S/S of a dislocation; Tx?
1. marked deformity 2. edema 3. pain 4. tenderness on palpation 5. *complete loss of joint function* 6. distal numbness 7. Tx: RICE
IV monitoring (Under Title 22)[What are the 2 catches? Are there exceptions to LAC EMT?{refer to slide #20}]
1. may monitor, maintain, and adjust a preset rate of flow 2. shut off IV if there are signs of infiltration *NOTE: WE CAN ONLY MONITOR IV's with NO ADDITIVES* *NOTE: WE CANNOT REMOVE OR ADJUST IV*
Identifying C-spine candidates [3 criteria]
1. mechanism of injury 2. pain 3. numbness or tingling in extremities
*3.* Focused History and Physical Exam (medical)
1. medical history 2. baseline vital signs 3. physical exam
Toddler [3 distinct traits? How to get their attention?]
1. mobile (they climb, pull, eat dog food, and pull dog food.) 2. may resist separation (usually like to sit mommy's lap during assessment etc.) 3. don't like being restrained 4. can be distracted (distract them with toy like the stethoscope so they can calm down)
Detailed Physical Exam
1. more in-depth 2. only perform if time allows 3. performed en route to the hospital 4. have system- head to toe 5. practice same way every time 6. always check area before covering 7. for our lab, rapid trauma assessment and detailed physical exam are same
SIDS risk factors
1. mothers <20 2. smoking mothers 3. low birth weight 4. babies sleeping on stomach (cause of death can be suffocation) 5. Siblings of SIDS babies Other considerations: 1. people dont properly place infant in good sleeping position 2. not dressing them well
S/S air embolism [How fast do you see symptom?]
1. mottled skin 2. froth at nose/mouth 3. dizziness, headache 4. confusion or ALOC 5. chest pain, dyspnea 6. pain 7. neuro déficits 8. cardiac arrest note: *SEE symptom IMMEDIATELY*
Vesicants/Blister Agents
1. mustard 2. lewisite 3. phosgene oxime
Drug categories
1. narcotics or opiates (from poppy's) 2. depressants-downers (give ALOC) [e.g. alcohol, THC, barbiturate, roofies] 3. stimulants-uppers [e.g. meth, cocaine, crack, speed] 4. hallucinogens [e.g. LSD, PCP, Jimson weed] 5. Designer: stuff made in a garage or in your lab [e.g. ecstasy] 6. hydrocarbons [glue sniffers, paint sniffers, gas sniffers]
Types of chemical agents
1. nerve agents (pesticide for human most toxic ) 2. vesicants/blister agents 3. blood agents 4. pulmonary (choking) agents 5. incapacitating agents
Cholinergic agents
1. nerve agents for warfare 2. organophosphate insecticide or wild mushrooms 3. overstimulate parasympathetic nerves
Realignment issues (review of previous slides)
1. never realign a joint 2. never realign a injury with good distal function 3. only pulseless, long bone fractures
Tx of tick bite [How to make sure tick is not carrying any disease? How to remove?]
1. no hurry in removing tick 2. use tweezers and pull straight out 3. take tick for ID 4. treat shock PRN 5. position of comfort 6. transport
TX to hyperventilation
1. no paper bags 2. reassure patients 3. *give oxygen* (so they can feel like they are taking in a lot of air each time when they breath to slow down breathing)
Inducing Vomiting
1. not within EMT-B scope of practice to induce vomit 2. But is the indicated treatment for many poisoning/OC
physical exam [What are the 2 distinct assessments? (_______& and palpate ________)
1. observe for distention 2. Palpate for TRPGR Tendernes Ridigity Pulsating Guarding Rebounding tenderness 3. Check all 4 quadrants 4. start away frame pain
2 types of stroke
1. obstructive -ischemic stroke -thrombus or something travels to your brain and blocks your artery -clot can be broken with medication 2. hemorrhagic -caused by bleeding in brain -caused by aneurysm -need IMMEDIATE repair
Eye injuries following a head injury [Haywiring and anatomical issues]
1. one pupil larger than the other 2. eyes not moving together 3. failure of the eyes to follow equally 4. bleeding under conjunctiva (that obscures the sclera) 5. protrusion or bulging of one eye
ONLY 3 treatments during triage
1. open airway insert OPA 2. stop bleeding 3. elevate extremities
lungs
1. organ of respiration where exchange of O2 and CO2 take place 2. Right lung has 3 lobes, left has 2 3. location during *-inspiration: extend to umbilicus -expiration: shrink to intercostal space*
abdominal evisceration
1. organs and fat portrude 2. never try to replace organs 3. cover with moist gauze, then sterile dressing 4. keep organs warm and moist 5. transport promptly
Questions to ask: Syncope (feeling like you're going to faint)
1. out how long? 2. fall? 3. chest pain? 4. irregular heart beat?
Tx (the usual)
1. oxygen 2. position of comfort 3. no oral fluids 4. monitor vitals carefully 5. transport 6. treat for shock PRN
exchange of oxygen and carbon dioxide [How many percent oxygen does exhaled air have?]
1. oxygen-rich air is delivered to alveoli 2. oxygen diffuses into the blood 3. the body does not use all the inhaled oxygen Note: exhaled air contains *16% oxygen* Note: 16% oxygen is not enough, would rather have 100% oxygen
Other considerations for chest pain
1. pacemaker (have defibrillator in them) 2. CABG: coronary artery bypass graft
Open fracture S/S
1. pain 2. deformity 3. break in skin and/or exposed bone Tx: dressing, immobilize, ice and elevate if possible
Closed fracture S/S
1. pain 2. edema 3. possible deformity 4. contusion 5. loss of motion 6. false motion 7. crepitus 8. guarding Tx: RICE
sprain and strain S/S; Tx? [Acronym and 2 E's]
1. pain 2. edema and ecchymosis (discoloration of skin from bleeding underneath) 3. joint instability 4. treatment: Immobilize, ice, and elevate
GI Bleeding [What are the 3 symptoms? <3]
1. pain 2. heartburn 3. signs of shock .....and the following types of bleeding [to the next slides]
Signs and Symptoms of chest injuries [pulse? breathing? skin signs?]
1. pain at site 2. *hyperventilation* 3. dyspnea 4. hemoptysis 5. *rapid weak pulse, low BP* 6. cyanosis (poor perfusion)
S/S spinal injury [What are the 2 distinct S/S]
1. pain, swelling, deformity 2. *tingling in the extremities* 3. paralysis or paresis 4. *incontinence*(cannot hold in poop or pee) 5. injuries to the head
hydrocarbons (abused inhalants)
1. paint residue around mouth and hand 2. smell of paint of glue 3. coughing 4. choking
EMT Roles- Other
1. paperwork 2. Radio reporting 3. Verbal to ER staff The other person should clean up the ambulance and be prepared for the next call
Diabetes and alcohol abuse
1. patients may appear intoxicated (but don't smell alcohol) 2. suspect hypoglycemia with any altered mental status 3. be alert to the similarity in symptoms
Trauma patients
1. patients with significant mechanism of injury (MOI) 2. unresponsive or disoriented 3. extremely intoxicated 4. Patients whose complaint cannot be identified or understood -proceed with rapid trauma assessment -rapid transport -consider ALS backup
S/S of CHF [3 fluid accumulations]=
1. pedal edema 2. JVD 3. *ascites*: accumulation of fluid in the abdominal cavity
Assessing the unresponsive patient (medical)
1. perform a rapid medical assessment 2. obtain baseline vital signs 3. obtain SAMPLE history from family if available 4. provide emergency care and transport 5. document findings Note: checking *blood sugar* may solve a lot of problems because they usually have low blood sugar
placenta [Location? Fx?]
1. placenta(is on uterine wall) connects umbilical cord to uterine wall of the mother 2. acts as filter for blood for baby (also provide nourishment to fetus according to book)
Poisoning
1. positing is common in children 2. ask specific question of caregiver 3. CABs 4. Give O2 5. Poison control CALL THEM 6. transport!!
Dog bites
1. potentially infected wounded 2. may require antibiotics, tetanus, suturing 3. apply dry sterile dressing and transport promptly 4. rabies is major concern
CISM components
1. pre-incident stress education 2. on-scene peer support 3. disaster support services (e.g. American Red Cross) 4. defusing (immediate support; hot washes) 5. CISD (next slide) 6. Follow-up services 7. spouse and family support 8. community outreach 9. talk talk talk
eclampsia [What 2 extra LIFE AND DEATH S/S?]
1. preeclampsia + 2. seizures 3. coma Note: life and death
Ectopic pregnancy [When to suspect? History of what?(3)]
1. pregnancy outside of the uterus 2. Any woman of childbearing age with abdominal pain and missed period 3. History of PID, tubal ligation (equivalent to vasectomy), have previous ectopic pregnancy
Scene Safety and PPE
1. prepare yourself when dispatched (Wear BSI) 2. Inspect surrounding 3. Mark the scene (tell someone through radio) 4. Check vehicle stability (before approaching) 5. Take proper night time precautions
Department of Health Services (DHS)
1. preserve and restore public health in disaster areas 2. coordinate state public health assistance 3. support local public health operations 4. assist EMSA in coordinating medical resources
S/S Tension Pneumothorax (3-5)
1. progressive dyspnea 2. absent/decreased lung sounds on one sound 3. JVD (jugular vein distension) 4. Hypotension 5. Tachycardia
Fx of the EMT
1. prompt & efficient care 2. control of the scene 3. safe transport 4. transfer of patient to staff 5. communications & record keeping 6. care of vehicle & equipment 7. may be employed in a healthcare setting
suicidal patients
1. protect self and others 2. do not leave alone 3. question patient regarding his/her feelings and prior attempts 4. ask open ended Qs 5. keep direct eye contact 6.. If injured or OD: treat appropriately 7. suicidal ideations: incompetent
Skin
1. protection 2. sensation 3. temperature control (by constricting and dilating vessels)
Hernia [What is it? Name the type of hernia that cannot be pushed back in]
1. protrusion of tissue through body wall a. pain b. red or blue skin discoloration c. *incarcerated hernia*: cannot be pushed back into body (compromise blood supply) d. can be serious medical emergency
Causes of poor breathing
1. pulmonary vessels become obstructed (by fluids, infection, collapse air space, etc) 2. alveoli are damaged 3. air passages are obstructed 4. blood flow to the lungs is obstructed (from blood clot etc) 5. pleural space is filled (with air fluid, etc from hole in chest or punctured lungs; lungs can collapse
CARDIOGENIC SHOCK
1. pump failure: heart lacks power to force blood through the circulatory system e.g. basically CHF that is out of control 2. onset may be immediate or not apparent for 24 hours after AMI 3. Can also be caused by dysrhythmias
Snake bite S/S [poisonous vs non poisonous marks! 1 more unique S/S]
1. puncture 2. swelling 3. pain 4. weakness 5. *metallic taste* (some types) (you just get it after you get bit) *Poisonous*: fang marks *Non Poisonous*: horseshoe mark
Ways the body loses heat [5]
1. radiation: heat lost from host to air 2. convection: heat lost through the movement of air 3. conduction: heat lost from host to solid objects (putting hand on colder object) 4. evaporation: heat loss through sweating 5. respiration: loss of heat through breathing (warm air out - cool air in)
Neisseria Meningitidis [Regular meningitideis S/S plus 1 distinct S/S? Onset? Effect?]
1. rapid onset 2. pinpoint cherry-red spot or larger purple/black rash 3. sepsis, shock, and death 4. HIGHLY CONTAGIOUS
S/S Insulin shock (hypoglycemia) insulin>glucose
1. rapid onset ALOC (they may try to fight you) 2. *Cool and clammy* 3. dizziness, headache 4. rapid pulse 5. Fainting, seizure, or coma
AAA Tx
1. rapid transport 2. high flow O2 3. treat for shock
4 types of poisonous snake
1. rattlesnake -they bite you when you intrude them 2. cottonmouth 3. copperhead 4. coral snake
NAERG (Emergency response guide)
1. reference bible 2. updated every 4 years
Identifying Patient Priority (decision point)
1. regardless if trauma or medical 2. is the patient critical? 3. Do they need rapid transport? 4. Do they need ALS?
Why we SPLINT
1. relieve pain 2. reduce tissue/vessel damage during movement
general principle of splinting
1. remove clothing area (even if it's c spine) 2. PMSC 3. dress all wounds 4. *Do not move the patient before splinting* 5. immobilize the joints 6. pad rigid splints 7. maintain manual immobilization 8. realign angulation PRN 9. When in doubt, splint 10. Reassess PMSC 11. Immobilize all suspected spinal injuries in a neutral in line position (pain, resistance, crepitus)
Tx Heat cramps
1. remove fro environment 2. PO isotonic soln
Tx Frostbite
1. remove from cold 2. high flow O2 3. passive rewarming 4. do not massage 5. do not break blister
Tx Heat Exhaustion
1. remove from environment 2. loosen clothing 3. high flow of O2 4. oral fluids (isotonic or water; try this first if it doesn't work then put IV fluid) 5. position of comfort 6. transport
Tx for heat stroke [What liquid do you give?]
1. remove from environment 2. no oral fluids 3. high flow oxygen 4. cooling measures 5. shock position PRN 6. rapid transport
Thermal Burn Rx
1. remove patient from source and stop the burning process 2. assess burn 3. high flow oxygen 4. remove jewelry and clothing 5. cool burn areas 6. cover with clean dressing/sheet 7. be aware of hypothermia 8. transport
Steps of the ongoing assessment
1. repeat the initial assessment 2. reassess vital signs 3. repeat focused assessment 4. check interventions
hyperventilation [Causes toes and fingers to do what?]
1. response to illness 2. response to emotional event 3. anxiety!! 4. dizziness 5. clear lung sounds 6. increased tidal volume (TV) 7. numbers and tingling hands and feel 8. *carpal/pedal spasms* (your fingers and toes curl up)
S/S atherosclerosis/arteriosclerosis
1. restricted blood flow 2. hypertension 3. AMI
Protective Structures
1. rib cage: protects from trauma 2. cilia (hairlike): removes microscopic particles 3. Pleura: reduce friction
Rapid Physical Exam pt 3
1. roll patient (to check back) with spinal precautions 2. assess baseline *vital signs and SAMPLE history*
The Pelvis
1. sacrum 2. 2 pelvic bone a. iliac crest: highest part b. ischial tuberosity: lowest part
Auto vs Auto incidents [What's the special word]
1. safety 2. observe/ask questions about mechanism 3. speed 4. position of patient before accident: backseat? driver? 5. anybody K.O.ed? 6. seatbelt? airbag? 7. *Passenger space intrusion*: e.g. the door dents in and it is now on your lap
chemical burns
1. safety 2. remove chemical from the patient 3. if powder chemical, brush off first 4. remove all contaminated clothing 5. flush with water for 15 to 20 minutes 6. rapid transport
Questions to ask: Shootings AKA gun shot wound GSW
1. safety 2. # of shots heard 3. type of gun (caliber) 4. distance 5. other associated trauma?
Questions to ask: Stabbing
1. safety (scene safety) 2. type of knife? Size? 3. associated trauma?
Food Poisoning
1. salmonella bacterium 2. staphylococcus 3. Botulism
Managing a Disruptive Situation
1. scene safety 2. be prepared to spend extra time 3. have a plan of action 4. reduce distractions 5. take charge 6. do not get too close 7. avoid fighting 8. summon law enforcement prn
electrical burns
1. scene safety 2. can be deceving 3. monitor vitals closely
Patient Assessment
1. scene size-up 2. initial assessment 3. focused history and physical exam 4. ongoing assessment
abdomen
1. second major body cavity 2. contains the major organs of digestion and excretion
General Post Exposure Management
1. see a doc immediately 2. Ryan White Law: by law you have the right to know if you have a communicable disease Ryan White is a hemophilia who needs frequent blood transfusion. He contracted AIDS when he was getting blood transfusion.
More neurological emergencies
1. seizure 2. stroke 3. Altered mental status (AMS)
Rib Fracture Tx
1. self splint 2. high flow oxygen 3. make comfortable
Types of splints
1. self splint 2. pillows, blankets, and items of clothing 3. *sling and swath* (wrap that goes around sling) 4. rigid: cardboard, plastic, ladder 5. air or vacuum 6. traction: FOR FEMUR ONLY
Nasal anatomy
1. septum 2. *turbinates*: layers of bone within each nasal chamber 3. *frontal sinus*: above your nose and between your eyes
Plant poisoning
1. several thousand cases each year a. assess the patient's airway and vital signs b. notify poison control center c. take the plant to the emergency department d. provide prompt transport
anaphylaxis [Hive AKA? skin?]
1. severe allergic reaction (happens fast esp for bee stings) 2. dyspnea, wheezing, stridor 3. urticaria (hives) 4. flushed skin 5. shock 6. respiratory arrest
Epiglottitis [What sound? What swells up causing what? What complication?]
1. severe dyspnea 2. stridor 3. inability to swallow --> DROOLING 4. fever 5. tripod position
S/S of *Mild* hypothermia (compensating) [3 major S/S]
1. shiver 2. rapid pulse and respirations 3. red, pale cyanotic skin (by constricting blood vessels)
S/S eye injuries [What do you call blood in chamber?]
1. signs can be subtle e.g. *hyphema*: blood in anterior chamber
ALOC
1. single most important observation 2. Use AVPU or GCS 3. *repetitive questioning (ask the same questions)* Note: Indication of injury
Type of Muscle
1. skeletal muscle: attached to the bones of the body 2. Smooth muscle: carry out the automatic muscular functions of the body
PCP
1. slow motion man 2. fast if violent 3. increased strength 4. nystagmus 5. rebound dilation (pupils constrict and dilate soon after when you shine light on eye)
S/S of Diabetic Coma (hyperglycemia) [2 distinct S/S; How's water situation going? How does ALOC set on?] glucose>insulin
1. slow onset of ALOC 2. dehydration 3. Kussmaul respirations 4. "Fruity" breath odor
Signs of Respiratory Distress [what's the breath range?]
1. slower than 8 breaths/min or faster than 24 breaths/min 2. Irregular rhythm 3. Quality: labored 4. Accessory muscle use (use of chest and abdominal muscles causing muscle retraction above clavicle between the ribs) 5. Noisy (obstructive) or diminished breath sounds 6. Pale or blue skin (poor perfusion) 7. *Dyspnea*: labored breathing 8. *Conversational dyspnea*: cannot speak in a full sentence without gasping for air 9. tripod position: back arched with hands on knees 10. anxiety
alveoli
1. smallest unit of the respiratory system 2. microscopic sacks surrounded by capillaries 3. gas exchange
Glucose [What is its function in the body?]
1. source of energy required by all cells for normal functioning
acute asthma [What happens to the bronchioles]
1. spasm of the bronchioles -tachypnea -anxiety -wheezing -labored breathing -can have sudden onset Note: albuterol relaxes the airway
tension pneumothorax CAUSES (3)
1. spontaeous pneumothorax 2. pressure in one lung cavity pushes mediastinum into the opposite pleural space. Moves jugular vein and can seal IVC in heart 3. can be caused by ribs puncturing a lung 4. open pneumothorax
Impaled object
1. stabilize with bulk dressings 2. use manual stabilization RN 3. May remove if interfering with CPR
TX atherosclerosis/arteriosclerosis
1. stint 2. bypass surgery
Identification of Haz Mat
1. storage containers 2. placards 3. labels 4. biological indicators
Infant and child considerations [What do children have that is bigger? What are the 2 tell tale signs of respiratory distress in children?]
1. structure of children are less rigid 2. children have bigger tongues in relation to their airway 3. Smaller airway 4. More dependent on diaphragm 5. Nasal flaring and seesaw respirations (a teeter toter: the chest chest goes up the abdominal goes down and vice versa)
Intracranial bleeding [increases what?]
1. subdural *(venous bleed)* between dura mater and brain; venous injury; SLOW developing bleed 2. intracranial: bleed within brain tissue in *cranial vault* 3. epidural *(arterial bleed)*: bleeding of the artery between dura mater and the skull; RAPID bleeding Note: *All bleeds causes increased intracranial pressure & brain damage*
Cerebral Vascular Accident
1. sudden change in neurological status caused by interference with blood supply to brain
radiation burns
1. summon expert assistance 2. contain source of radiation 3. remove patient's clothing 4. follow decontamination procedure
Delivering the infant [What is the suction order?]
1. support the head as it emergees 2. Suction MOUTH first then NOSE 3. Support the head and upper body as he shoulders delivers 4. Handle the infant firmly but gently as the body delivers 5. Make them warm because hypothermia is a big problem
Incident Command System (ICS)
1. system of emergency management 2. made up of policies and procedures 3. specific roles and responsibilities 4. designed to maximize the impact of resources during an emergency TL;DR: unified command
crush syndrome [Understand the mechanism and reasoning. What spills out? What happens when the "crushing object* is removed? ____________ occurs and ____________(spilled stuff) flow to ____________(organ) causing instant _____________]
1. systemic side effect of crush injury 2. cell membrane compromised 3. *acids and potassium spill* into surround tissue when cells rupture -the acid and K collects around the muscle affected. When a person comes and pick up the limb then reperfusion happen in which K and acid goes to the heart and you die instantly 4. on *reperfusion*, acids, and K get back to the heart with often fatal results
Compensatory Mechanisms
1. tachycardia 2. vasoconstriction 3. increased respiratory rate depth: try to bring more oxygen in your blood 4. decreased urine production: to keep volume up
Questions to ask: Diabetes
1. taken your medicine 2. eaten normally 3. slow or fast onset
Delivery of Placenta [How long? How to aid the process? What to do with the placenta? Severe bleeding?]
1. takes 15-30 mins 2. when placenta delivers, wrap it and take it with you 3. massage fundus [do it from the outside] 4. if mother continues to bleed, transport promptly
Concussion [What superficial problem can happen to brain? It is not a problem until what indication?]
1. temporary loss or alteration in brain function 2. brief loss of consciousness 3. brain can sustain bruise *(contusion)* 4. not a problem unless there is bleeding
chemotherapy
1. there are risks 2. exposure can occur from IV leakage or spills Note: BECAREFUL
hazardous materials
1. theres A LOT 2. transportation accidents 3. bulk storage accidents 4. human error! 5. weed labs and meth labs
tick bites [transmit what disease]
1. ticks attach themselves to the skin 2. not painful 3. common carry *rocky mountain spotted fever* or *Lyme disease* Note: lyme saliva transmit disease
Sting ray sting
1. treat by soaking in warm water 2. don't attempt to remove barb because it back hooks you
Questions to ask: Falls
1. trip and fall? or dizzy and fall? 2. how far? 3. how did they land? 4. what did they land on? 5. KO?
Changes in pupil size
1. unequal pupil size may indicated increased pressure on one side of the brain
pulmonary circulation
1. unoxygenated blood is pushed into right ventricle 2. pulmonary artery 3. lung (pulmonary cap) 4. pulmonary veins 5. left atrium
Bright red emesis [Where does it come from? (above where?) What is the complication that leads to this?]
1. upper GI bleed 2. Above stomach a. think *esophageal varices*: enlarged veins in the esophagus b. can be severe
potential violent patients
1. use a list of risk factors to assess the level of danger a. past history b. posture c. scene d. vocal activity e. physical activity
restraints
1. use only in emergency 2. transport without restraints if possible 3. If you must restrain, use reasonable force -law enforcement personnel should be involved
BP [When to start checking BP?]
1. use right size cuff (size precisely) 2. difficult scene? Don't waste time 3. Under 3: no BP
Interossius IV
1. used if traditional IV sites are difficult to assess 2. medication delivered into bone marrow 3. painful Note: use BP cuff to wrap around IV to force fluid down
injected poisons facts and Tx
1. usually OD 2. impossible to remove to dilute 3. can be counteracted (ALS) with narcan 4. CAB, high flow of O2, rapid transport
Twins
1. usually smaller 2. delivery procedures are the same 3. there may be one or two placentas If there are 2 cords and 1 placenta is identical if there are 2 cords and 2 placenta is fraternal
Thermal burns [What to do?]
1. usually to the eyelid e.g. sudden fire flash 2. cover both eyes with a moist, sterile dressing and eye shield 3. transport supine to burn center
Coffee ground emesis [Where is the vomitted substance from? (2 places)]
1. vomitting up partially digested blood a. chronic b. in stomach or duodenum
Assessing ABC (Airway breathing circulation)
1. we know how to assess the unresponsive 2. more evaluation needed in responsive pt. 3. is patient speaking to you? -A and B -FUll sentences -2-3 words 4. Skin signs? Capillary refill? -C -indicate perfusion
Precautions
1. wear protective clothing 2. nursing mothers should not have any contact with patient 3. have a SPILL KIT
Questions to ask: Overdose poisoning
1. what 2. how long ago 3. route 4. any others e.g. when people don't have alcohol or something they drink hairspray
Family Matter
1. when a child is ill or injured, you may have several patients, not just one 2. children mimic caregiver behavior (give baby to the calmer patient so baby doesn't freak out) 3. Be calm, professional, and sensitive
Insulin users [Where is insulin stored?]
1. when you arrive on scene and see a bunch of needles 2. check in the refrigerator to see if insulin is there (because insulin needs to be cold)
Frost bite [What color is skin? What are those big fluid filled sacs called? What complication (learned this in microbiology) does this lead to? What happens to body part after it defrosts?
1. white, cold, hard, waxy skin 2. painful or painless 3. may have *blisters* or swelling 4. *PERMANENT DAMAGE* -when defrosting, *gangrene* sets in then choppy choppy, offy, offy
Inhaled Poisons facts and Tx
1. wide range of effects 2. YOUR safety is 1st 3. move to fresh air immediately 4. provide airway support and rapid transport 5. bring contained agent or label to hospital Note: CO is colorless and odorless
DISTRIBUTIVE SHOCK
1. widespread vasodilation -neurogenic (spinal cord trauma): NS system i) absent of sweating below level of injury -sepsis: *bacterial infection* that generates toxins that damage blood vessel wall. Vessels leak and cause *dehydration* -anaphylaxis: e.g. bee sting cause vasodilation -drugs/overdose -psychogenic: e.g. when you get scared badly
ALWAYS DO.....
1. work within the scope of practice 2. complete required documentation & patient charting
If you administer
1. you must have ALS unit enroute OR the patient must be transported immediately to the nearest hospital 2. NEVER treat and release; this is emergency supportive therapy [You cannot
trimester
12 weeks or so
triage time per patient
15 seconds
Auscultation vs Palpation
2 ways to use a sphygmomanometer *Auscultation* -obtain both systolic & diastolic readings *Palpations* -only systolic reading obtained
5250
2 week hold
Parasympathetic
2. Passive -after eating a big meal -increased GI activity -constricted pupils -sleepy
Infant [Main mean of expressions? Who should hold the baby?]
2. respond physical stimuli 3. crying is main means of expression 4. have caregiver hold patient
The spinal column
33 units Cervical:7 Thoracic: 12 Lumbar: 5 Sacral: 5 Coccyx: 4
full term
36 to 40 weeks
average amount of blood in adult
4-6 liters
ark storm
40-50 days of straight raining
blood supply
=caoritds
chemical agents
A chemical substance...intended for use in military operations to kill, seriously injure, or incapacitate humans (or animals) through its toxicological effects.
Do Not Resuscitate (YOU NEED THE OFFICIAL PAPERWORK)
A.K.A. "No Code" *Supportive measures only- No CPR* HOWEVER family members can request resuscitation
Cricoid Pressure: when you put pressure on cricoid cartilage to show trachea
AKA *Sellicks manuver* -prevent vomiting -assit during endotracheal intubation
Transient Ischemic Attack (like angina attack)
AKA mini stroke can have symptoms of CVA precursor of stroke temporary
Orthostatic vital signs
AKA postural vital signs *assessment for hypovolemia/shock* * blood pressure & pulse* 3 times: supine - sitting - standing 1. Check BP and pulse 2. Let them sit up on their own. If they can't, then they are definitely hypovolemic 3. same for standing 4. wait 1 minute after changing positions !!: Increase in pulse or decrease in blood pressure of 20 points or more equals hypovolemic. Indicates 15% volume loss. !!
PMSC before and after!!!!!!! [REMEMBER THIS DAWG]
AND DOCUMENT
Normal Ranges of BP
Adult 100-140/60-90 Children (systolic) 80-110 Infants (systolic) 60
Normal respiratory rate
Adult 12-20/min Child 18-30/min Infant: 30-60/min
Normal Pulse Values
Adult 60-100 Child 70-120 Toddler 90-150 Newborn 120-160
AEIOU TIPS
Alcohol, apnea (not breathing), arrhythmia (heart issue), anaphylaxis (rxn to sting/bite, etc) Epilepsy (seizure) / environment (hypothermia; heat stroke) Insulin (b/c you is diabetic; low blood sugar) Overdose Uremia (kidney issues) / underdose (mentally ill patients) Trauma Infection Psychogenic (mentally ill) Stroke
Stress Management
Anything that throws off my equilibrium is stress -positive and negative ways to handle it -stress is unavoidable -understand the effects -find the balance in life
Assault and Battery
Assault: unlawfully placing a person *in fear* of immediate bodily harm without consent Battery: unlawfully *touching a person*
Rapid Physical Exam pt 2
Assess... 1. Chest 2. Abdomen 3. Pelvis 4. 4 extremities
Document Properly [4]
Assessment and the following: 1. medicine prescribed by MD 2. medicine is patient's 3. other factors (how was the medicine used) 4. VITALS and REASSESSMENT after treatment
BP= (whats the equation tho)
BP= CO x PVR CO: cardiac output -amount of blood pumped by *left ventricle per minute* PVR: peripheral vascular resistance -amount of blood pumped by *left ventricles per pump*<----
Spinal immobilization
Backboard 1. *Consider early during assessment* 2. *Do not move without immobilization*
Mechanism of injury
Blunt or penetration? 1. *force body was exposed to*: e.g. a car? a door? -is this chief complaint 2. *evaluate* -amount of force applied: e.g. falloff a building or off the curb -length of time applied: e.g. 30 minutes in mangled metal -area involved: e.g. arm
CNS
Brain and spinal cord
*Note for using RICE*
C: compression is only used for bone fractures in musculoskeletal injuries
No matter how bad the fracture is don't forget
CAB
Asthma treatment
CAB O2 high flow position of comfort transport
REMEBER
CAB is the most important
Air embolism (cause by scuba diving)
CAUSE 1. by *holding breath while ascending air bubbles* are forced into blood stream *explanation*: pressure in lung remain high, pressure outside to decrease, then alveoli rupture. Then the air from rupture alveoli act as a "plug" and prevent normal blood flow
Decompression sickness [how fast do you see S/S?]
CAUSE: formation of nitrogen bubbles in blood stream from *ascending too fast in scuba diving* EXPLANATION: When you are breathing under pressure nitrogen is forced into body's tissues when you have a normal slow ascend the nitrogen is released from cell through gas exchange. With rapid exchange the nitrogen leaves the cells too fast and the nitrogen end up in your blood.
Crushing triad
CAUSE: inc. ICP EFFECT: 1. inc. BP 2. dec. HR 3. expanding Pulse Pressure
Signs of *heart attack*
CHEST PAIN Typical: pressure, "tightness" Atypical: indigestion. jaw pain *people can have heart attack and not feel anything at all* *there are more symptoms* shortness of breath irregular heart rate irregular blood pressure
BP=cardiac output
CO x PVR
sudden deafness indicate
CVA (left hemisphere receptive aphasia)
Wisdom
Choose a hospital with NICU next to delivery room Problems that babies have 1. jaundice 2. low blood sugar
CABD of CPR
Circulation Airway Breathing Defibrillation
Skin
Color: pink, pale, blue, flushed, jaundice(liver failure) Temperature (take off glove when you're feeling somebody): warm, hot, or cool Moisture: dry, moist, wet
Terrorism
DEFINITION: The FBI defines terrorism as, "The unlawful use of force against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in the furtherance of political or social objectives." The three elements of this definition are: 1. Terrorist activities are illegal and use force 2. Actions are intended to intimidate or coerce 3. Actions are committed in support of political or social objectives. 4. US Department of Justice 1999
Substance Abuse
DEFINITION: The knowing misuse of any substance to produce a desired effect Characterized by 1. overindulgence 2. dependency
Poison
DEFINITION: any substance whose chemical action can damage body structure or impair body functions 1. Act acutely(cyanide) or chronically (alcohol) 2. Act by destroying and changing normal metabolism of cells
SIDS description
DEFINTION: unexplained death of an apparently healthy infants 1. *7500+* cases per year in US 2. *Leading cause of death in infants <1* 3. *more in winter months*
Shock
Defined in one word: *hypoperfusion* -widespread inadequate tissue perfusion, CAUSE: by the state of collapse and failure of the cardiovascular system
Heat exhaustion definition and S/S [skin color, condition? They need water or nah cuh?] *COLD AND WET*
Definiton: dehydration with loss of salt S/S 1. *cold, moist*, ashen skin 2. thirsty 3. headache and nausea 4. weakness, dizziness, syncope
DCAP-BTLS
Deformities Contusions Abrasions Punctures/Penetrations Burns Tenderness Lacerations Swelling
DERM
Depth of consciousness Eyes: pupillary response Respirations (look for abnormal patterns) Motor function
Documentation
EMS form - Run Sheet - Patient Chart 1. It is a legal document, same as a will, trust deed, arrest record, etc 2. It is a reflection of the care you provide Note: if didn't document it you didn't do it
IV monitoring
EMT can do everything to an IV *EXCEPT* INITIATING IT 1. monitor 2. maintain 3. adjust -peripheral lines only -glucose solutions & balanced salt solutions -no additives (added drugs to IV) *EXCEPTIONS*: LA County EMT-B lets EMT do some other things that we are going to talk about later on in the course e.g. Glucose= Dextrose (5% Dextrose)
Who can deem Competence of Adults?
EMT-1 or EMT-P can deem a patient incompetent
Hospital Diversion Status
ER Saturation (people overflowing) Internal Disaster (e.g. hospital burning down) CT Trauma STEMI (heart)
ALSO... Bleeding from
Ears Penetrating head wounds Rectum Vagin 1. use loose dressing 2. do not stop blood flow 3. do not pack 4. do not apply pressure
implementation
Feb 28, 1997 became policy May 30, 1997 after this date all EMT-1's certified or recertified in LA County must have attended EMR-1 expanded scope practice
Department of Transportation (DOT)
Federal Agency responsible for curriculum development
Viral Hemorrhagic Fevers S/S
Fever with malaise, myalgias, headache, vomiting, diarrhea may occur
scenario
Fever: 104 F all of the sudden goes to 106--> seizure--> goes down to 104
Tularemia
Franciscella tularensis 1. Incubation 3-5 days 2. Transmission via inhalation, ingestion, contact with skin 3. No person to person transmission 4. S/S a. Fever, cough, chest tightness, cutaneous lesions b. Pleuritic pain and hemoptysis rare 5. Duration of illness around 18 days 6. Treatment- antibiotic therapy with Streptomycin or Gentamicin 7. Mortality - Less then 4% with treatment - 33% without treatment
Nerve Agents
GA (tabun) GB (sarin) GD (soman) GF (cyclosarin) VX
Potential Targets
Government Buildings Manufacturing Plant Abortion Clinics Arena/Convention Center Animal Shelter Research Facility Hospitals Schools First Responders! Major Freeways & Railroad Centers
Growth and development
Grouped into stages patient is considered pediatric until the end of 18 years old 1. infant (0-1) 2. toddler (1-3) 3. preschool (3-6) 4. school-age child (6-12) 5. adolescents (12-18)
Diseases of special concern
HIV infection Hepatitis (ABCDE): liver prob Note: Hep A can only be transmitted through patient with acute infection. Hep B, C transmitted by blood. Meningitis: brain infection TB: droplet Nuclei of TB can be alive for 10 years MRSA: flesh eating bacteria (highly resistant to antibiotic) VRE
dehydration
History of 1. nausea 2. vomitting 3. exertion 4. diarrhea SIGNS 1. dry mucus membranes 2. sunken eyes 3. decreased urination 4. *poor skin turgor* (for adults): when you pinch skin and skin doesn't rebound NOTE: for infants check fontanelle
Chain of Survival
If one of these pieces is missing the chances of them living is low TL;DR Dont break the chain 1. early access 2. early CPR 3. early defibrillation (AED's) 4. early ACLS (Advance Cardiac Life Support) 5. Post cardiac arrest treatment
Rule of Nines (ON THE TEST)
If patient has burn on his anterior chest= 9% If anterior arm is burn= 4.5%
Late signs of shock (decompensated
In addition to early signs.... 1. hypotension 2. labored irregular breathing 3. ashen, mottled, cyanotic skin 4. Tready or absent peripheral pulses 5. dilated pupils 6. poor urinary output
Nitroglycerin [IRRC]
Indication: chest pain Route: sub lingual Repeat: MAX 3 doses Contraindication: 1. BP <100 2. Viagara in 24 hours 3. 3 doses PTA 4 Head injury
Bronchodilators [When does it not work?]
Indication: dyspnea, bronchospasm associated Route: IN Repeat: as prescribed Contraindication: patient unable to use device; max doses taken PTA Note: doesn't work when it's cold
epinephrine auto injector
Indication: severe allergic rxn Repeat: as prescribed Route: IM Site: upper outer thigh only
Nerve Agents
Inhibits Acetylcholine uptake 1. Signs & Symptoms...*Remember SLUDGEM* - Salivation - Lacrimation - Urination - Diarrhea - GI Upset - Emesis - Miosis
respiratory system
KEY component in patient care (b/c it can cause cardiac arrest) If you have airway but no breathing then nothing matters
Monitor IV with additives (under policy 802, LAC EMT can do this)
LAC EMT can carry the following 1. Folic acid - 1mg / 1000ml max 2. Multivitamins - 1 vial /1000ml max 3. Magnesium Sulfate - 2grams/1000ml (in conjunction w/MVI 4. Thiamin - 100mg / 1000ml max Note: monitor, maintain, & adjust a TKO rate of flow. this is NOT for EMT but for IFT
Assist with MEDS
LAC EMT's can give 1. nitroglycerin 2. epinephrine 3. bronchodilator inhalers
LA County Expanded Scope
LAC ONLY!!! Policy 802
S/S of stroke [Left hemisphere? Right hemisphere?]
Left hemisphere 1. aphasia: inability to produce or understand speech 2. receptive aphasia: ability to speak clearly but inability to understand speech 3. expressive aphasia: u already kno boiiiii Right Hemisphere 1. Dysarthria: slurred speech
Levels of protection
Level A: with full hood mask [kraken is released; eye and skin protection is needed] Level B: has respirator, googles, and air tight [lesser level of skin and eye protection is needed] Level C: suit with respirator NOT hooked up to air and skin is also exposed [When there is airborne stuff] Level D: your clothing
MCI terminology
M.C.I. -- Mass Casualty Incident M.V.I. - Multi-victim Incident Disaster - Overwhelming M.O.I. -- Mechanism of Injury M.V.A. -- Motor Vehicle Accident Definitions vary slightly, planning becomes the goal
Breathing vs Respiration
NOT THE SAME Breathing: moving air in and moving air out Respiration: supplies cells with O2 and removes CO2- exchange at the cellular level
Transport with
Nasogastric tubes gastrointestinal tubes
Documentation
Note: they are usually check boxes so it is hard to miss 1. skin color, temperature, and moisture 2. initial assessment findings 3. baseline and subsequent vital signs and SAMPLE history 4. Circulation, sensation and movement in all extremities 5. Breath sounds
Injuries to the chest
Open Chest Injuries: caused by penetration Closed chest injury: blunt
Pregnancy protocol (0ver 20 weeks?)
Over 20 weeks call -goes straight to delivering clinic
How to check eye? [acronym]
PEARRL
Assessment of injured extremities [COME ON YOU KNOW THIS]
PMSC before and after if PMSC not there then there is a circulation problem
Route of entry
PO IN injection cutaneous
*2.* Initial Assessment (this is when you treat immediate dangers and life threatening situations first)
PURPOSE: to assess for immediate and life threats and to assess vital signs (CAB, 1. *develop a general impression*: e.g. could person be hiding a weapon in his hand CUSP: Critical Unstable Potentially Unstable Stable 2. *assess mental status* 3. *assess CAB* 4. *establish patient rapport* 5: *identify patient priority* After this you determine if patient is trauma or medical
5150 (72 Hour Hold) [what r the 3 requirements]
Patients may be placed on a hold if 1. danger to self 2. danger to others 3. gravely disabled due to mental disorder
PMSC
Pulse Movement Sensation Ciculation
The quadrants of the abdomen [What does retroperitoneal mean?]
RUQ liver pancreas gall bladder small intestine large intestine LUQ stomach spleen large intestine small intestine RLQ L/I intestine appendix kidneys (retroperitoneal: in the back) bladder (retroperitoneal: in the back) LLQ kidneys (retroperitoneal) bladder (retroperitoneal)
Consent (3)
Required for *conscious, mentally competent adult* before care can be started!!!!!!!!!!!!!!!!!!! 1. *Expressed Consent* -patient expressly authorize you to provide medical care and transport -patient must be informed of all risks and benefits -*MUST BE 18+* -emancipated minors (kids that don't have legal parents) 2. *Implied Consent* -assumption that *unconscious* patient would consent to life saving procedures 3. *Minors and mentally incompetent adults* -UNDER 18, consent must be obtain from parents -*in loco parentis*: if UNDER 18 and emergency exists and parents no there then consent is implied -*ALOC (Alternate Level of Consciousness)* doesn't have to ability to give consent e.g. hypotensive, DUI, voice in the head
Ventilation
Rescuer assisted breathing
EMT role - Attendant
Responsible for medical supplies 1. back boards 2. oxygen 3. splints 4. bandages, etc Note: go by county equipment list CLEAN EVERYTHING
Early signs of shock (compensated)
SKIN SIGNS ARE EARLIEST 1. pale, cool, moist skin 2. tachycardia 3. delayed capillary refill 4. tachypnea 5. agitation/anxiety/restlessness 6. ALOC 7. nausea vomitting
Rx
Safety support CAB suction high flow oxygen rapid transport may be HazMat
Under the direction of ALS personnel
Set up for .....
SAMPLE
Signs and Symptoms Allergies Medications Past medical history Last oral intake (for purpose of surgery) Events leading to episode Alternate: HAM History Allergies Medications
Systolic and Diastolic Pressure
Systolic: higher number during ventricular cxn diastolic: lower number: pressure at ventricular relaxation measured in *mmHg* Recording as Systolic/diastolic
How to approach patient (IMPORTANT)
TREAT THE PATIENT NOT THE NUMBERS 1. Size up the scene 2. ASK: "Is this my only patient?" -*if no* ask for *ADDITIONAL RESOURCES* 3. When your eyes *identifies patient (with eye contact)* then you *begin assessing* 4. Look for *life threats* when you walk up to patient a. airway issues (if he is moving then OK) b. breathing issues (if he is moving then OK) c. circulatory issues (if he is moving then OK) d. extenuating bleeding 5. Look at *face* a. facial expression b. color c. moisture 6. Look for breathing problems
Immunizations
Tetanus-diphtheria boosters MMR Influenza Hepatitis B
Who can activate state of emergency?
The governor
Acetaminophen
Treat pains and aches 1. common OD 2. not very toxic 3. liver failure
Goals of triage (3 T's)
Triage Treatment Transportation
Title 22 *State* Scope of Practice
What 2 drugs? 1. oxygen 2. glucose 3. we can monitor IVs as long as we don't manipulate them
DIslocation [What happens to the bone ends? What happens to the ligaments?]
a disruption of a joint, in which the *bone ends are no longer in contact* and the *supporting ligaments are torn* (could spontaneously reduce itself but sometimes you need to pop it back into place)
trendelenburg
a more aggressive *shock position*
reverse trendelenburg
a patient in which you don't want blood to go to his or her head
UN or NA identification
a specific identification number given to a specific chemical
suprapubic
above the pubis
Bicarbonate (HCO3)
acid and base buffer for carbon dioxide determines pH of blood *kidney regulate bicarbonate*
PNS
all of network of nerve
Fever Tx
alternate between Tylenol and moltrin every 2 hours until subside
stroke volume
amt of blood pumped by the left ventricle in one cxn
epidural
an anesthetic
Fetal demise (still born baby)
an infant that has died in the uterus before labor 1. very emotional situation 2. infant may be born with skin blisters, skin sloughing, and dark discoloration (obviously dead) 3. do not resuscitate 4. caused by interuterine infection
sternal retractions
are common in respiratory problems of pediatrics
perineum [What is done to it during regular pregnancy?]
area between vagina and the buttt hole Note: during hospital delivery, the perineum is cut so that stretching can be relieved
periorbital
around the eye
cerebellum
balance, muscle, coordination 4 lobes
pleural space
between parietal and visceral pleura
Cardiac output
blood by ventricle per minute CO=SV x BPM
The skull
bones that are fused to your face houses and protect the brain *KNOW** nasal bone maxilla mandible zygomatic
The neck
carotid artery (next to jugular vein) Jugular vein thyroid (adam's apple; superior to cricoid cartilage) cricord cartilage
Cerebrum
center of intellect
Pulse checks
check after *5 cycles* then a few minutes after that *PULSE CHECK WITH CPR IN PROGRESS*
CBRNE
chemical biological radiological nuclear explosive
Other considerations
chest hair: shave em medication patches: peel pacemaker: avoid piercings: avoid
Trachea
conducts air into lungs (left and right bronchus) hard cartilage
ligaments
connect bone to bone Injury: sprain
Bronchi
connects trachea to each lung *ANGLE DIFFERENCE* -STRAIGHT into right lung (3 branches) -SHARP ANGLE into left lung (2 branches)
Brown recluse bite [What kind of toxin?]
cytotoxic: kills tissues 1. minimal pain 2. local tissue reaction (*necrotic*) 3. rare spider 4. skin can open up and hallow out
Rescuer well being (introductory slide)
death & dying critical incident stress CISM scene safety and personal protection
vasodilation
decrease BP
hyperventilation
deep tidal volume
Pulse Pressure
def: difference between systolic and diastolic readings e.g. 120/80 Pulse Pressure= 40
Heat Stroke definition and S/S *HOT AND DRY*
definition: failure of body's cooling mechanism S/S 1. *hot (fry an egg on them hot), dry, flushed skin* 2. ALOC 3. hypotensive- tachycardia 4. seizure
fetus
developing unborn baby 8 weeks and on
The question is
do I have a critical patient?
With ALL burns
do not miss other problems (other trauma) do not over irrigate don't forget CAB!!
W with line through it
don't put water in it
Addtional notes [BP, pulse, and in case of trauma]
during pregnancy.... 1. blood volume almost doubles 2. resting pulse is faster 3. during trauma mother's body will attempt to save itself; you have to aggressively save mother to save baby
SEMS 5 organizational levels
e.g. when you are in an emergency and you need something you get it from the field level and move up until you get what you need
biggest cali danger
earthquake
prone position
easy to stop breathing tho... not preferred. unless if they got a knife stabbed on their back
CODE 3
emergency operate as an emergency vehicle Note: Must be able to justify why you're driving like this 1. airway obstruction 2. respiration distress 3. shock
tachypnea
fast breathing
tachycardia
fast pulse
Federal Resources
federal resources just start coming now, it doesn't require the requests like the old times
How to spot closed mid-shaft femur fracture
femur balloons up because of bleeding
ovum
fertilized egg until 2 weeks gestation
Additional resources
fire police ALS etc
coral snake marks
fixed fangs tiny scratches in semi circlar pattern S/S cardiac arrest
intracellular
fluid in cell
interstitial fluid
fluid in spaces between tissue cells *16% of body weight is made of interstitial fluid*
Mental Status (can do/ command)
follows: *DELAYED* doesn't follow: IMMEDIATE
Traction splints [3 requirements]
for closed, mid-shaft femur fracture WITHOUT hip, knee or ankle injury *LAC exception*: distal deficit or extenuating bleeding coming out of OPEN femur fracture
Potassium
for electrical function
CUPS
for general impressions critical unstable potentially unstable stable
high fowler
for patients with respiratory problems
C pap device
forces air down your throat
upper airway [what the fx?]
from *nose/mouth* to *epiglottis* FX: filter air warm and humidifies air provide sense of smell
embryo
from 2 weeks of gestation to 8 weeks of pregnancy
lower airway
from epiglottis to alveoli contains larynx FX: exchange of oxygen (O2) & carbon dioxide
radiation
get yo ass outta there
perfusion
good flow of blood through body tissue or organs to meet the needs of the cell
BSI
hand washing gloves gowns goggles hand washing turnout gear hazmat suit
haz mat
hazardous materials
Heat emergencies
heat cramps heat exhaustion heat stroke
*Cardiovascular disease (CVD)* factors that cannot be change
heredity gender age race (African Americans, American Indians, Mexicans) [cultural diets]
hypertension
high BP
osmosis
how *fluid* travels between compartments of semipermeable cell walls water goes from low [Na+] to hi [Na+] until equilibrium is reached
diffusion
how gases are exchanged
sliding scale
how insulin users give them various amount of insulin a day
Involved anatomy
if on head, abdomen or chest then you done dawg
shock position
if the patient is in shock due to volume loss (dehydration, blood loss) lift legs because legs don't really need blood but your upper body does
BP Indicators (machines)
if you can get this pulse then BP is Carotid: at least 60 systolic Femoral: at least 70 systolic Radial: at least 80 systolic
triage categories
immediate (red) delayed (yellow) minor/walking wounded (green) dead/expectant (black) [these people are unsalvagable
HYPOVOLEMIC
inadequate blood/ fluid volume 1. trauma: e.g. get stabbed 2. hemorrhage: e.g. aneurysm 3. burns: dehydrates you; plasma leak out of skin 4. dehydration
vasoconstriction
increase BP
unconscious pulse locations (based on NREMT app)
infant: brachial child: carotid adult: carotid
cholecystitis [What is it? What rocks does it produce? What causes it? (Specific food component) What pain? What onset?]
inflammation of gall bladder 1. gall stones 2. recent ingestion of fatty good? Bile from Gall bladder is needed to digest fat 3. RUQ pain 4. gradual onset 5. not colicky pain
confidentiality
information can only be disclosed if the patient signs a written release
Crush injury [What's definition with 2 key terms? What 2 complication does it cause?]
injury sustained from a *compressive force* sufficient to interfere with the *normal metabolic function* of the involved tissue
Bioterrorism
intentional use of microorganism (bacteria, virus, and fungi) or toxins to produce death or disease in humans, animals, or plants
ecchymosis
is the discoloration of the skin hematoma and contusion have characteristics of ecchymosis
First 6 minutes
is when more patients achieve success of recovery
visceral pleura
layer of smooth tissue that covers each lung smooth b/c it provides friction free movement
Parietal pleura
layer of smooth tissue that lines the inside of your chest cavity smooth b/c it provides friction free movement
Basic incident command structure
logistics: they get stuff (e.g. bulldozers planning: plan how to do things finance: money money operations: the actual on scene people
insulin pump
looks like pager and pumps insulin inside of you
hypotension
low BP
MCI
mass casualty incident
Crushing Open Wound
may involve damaged internal organs or broken bones
Where are most RBC and WBC made?
mostly in the bone marrow some in spleen and lymph nodes
How to give breath somebody
mouth to mouth mouth to nose mouth to stoma (trachea) mouth to mask mouth to snout (for dogs)
Calcium
muscle function
Taking a patient in 5150
must be in 4 point or 2 point restraint
narcan
narcotic antagonist
Transfer patients with...
nasogastric tube (through the nose for breathing) gastronomy tube (in stomach for feeding) heparin locks & saline locks foley catheter (drains your urine)
Black widow spider bite [What kind of toxin? 4 S/S that has to do with rigidity]
neurotoxic: poisonous to nerve tissues 1. muscle cramps 2. abdominal rigidity 3. chest tightness and dyspnea 4. very common spider -bite can be nasty -but not gonna kill you -have black widows in every state except Alaska -When you get bit the site becomes numb so you don't even realize it bit you
Respiratory Arrest
no breathing yes pulse
Notes [What not to do?]
no ice no incision no constricting band
clinical death (reversible)
no pulse not breathing
Cardiac Arrest
no pulse no breathing
CODE 2
non emergency normal driving
The grieving process (created in the 60s)
normal expected response to death 1. denial: people refuse to accept the reality of the situation 2. anger: blaming others (patients blame others for their illness) 3. bargaining: they promise to change their behavior to avert death 4. depression: openly expressing hopelessness 5. acceptance people may not experience all of these phases
men usually experience
normal signs of heart attack and women don't Atypical signs: 1. referred pain 2. atypical pain 3. no pain
apnea
not breathing
NBC
nuclear, biological, chemical
Challenge & Reciprocity
nurses can take the EMT test without the class because their position is already higher than EMT
crushing injury
occurs when a great amount of force is applied to the body for a long period of time
left later recovery position
on the left because thats the position in which they are facing you
MCI is declared when resources are
overwhelmed by number of patients
gases
oxygen 21% nitrogen 78% other 1%
palmar and plantar
palmar is the palm of your hand plantar is the bottom of your feet
quadriplegia
paralysis of all extremities NOTE: higher the injury the more the damage
paraplegia
paralysis of lower extremities
birth canal
passage way from womb to cervix to vagina, then to vuvlva Note: when you have C section baby doesn't get into birth canal
colostomy
patient's rectum is removed
biological death (irreversible)
permanent brain death begins *4-6 minutes after arrest* because brain does not get enough oxygen
EXTRA: for log roll who is commanding
person at thoracic area has count for LAC, and at head for everywhere else
hematoma (bulges up)
pool of blood that has collected in the body
hypoventilation
poor tidal volume
Capillary Refill
press your finger tip to see how fast the finger turns from white to red again more than 2 seconds of refill is *poor perfusion* evaluates the ability of the circulatory system to restore blood to the capillary system (*perfusion*)
Bones
protection and shape
CSF
protections (fights infection too) if you have this leaking out of ear then you're in critical condition
muscles
provide movement and generate heat
inter-facility transport (IFT)
provide transport between medical facilities
3 results may occur after shock
pulse regain (DO NOT remove AED) no pulse: AED indicates "no shock" (when it is in a non shockable rhythm) no pulse: AED indicates "shock"
crofab
rattlesnake antivenom
True Core temperature
rectal temperature
ileostomy
rectum and colon is removed
START priority (RPM)
respirations pulse mental status
what causes pediatric cardiac arrest?
respiratory arrest Rx: aggressive ventilation and high flow of O2
penetrating wound
results from a sharp pointed object
contusion (teeny bit of swelling)
results in blunt force that strikes the body small vessels underneath skin tears and causes discoloration
flail chest [What is it? What could be broken and
ribs broke in multiple places might break sternum free floating chest wall segment paradoxical chest movement dyspnea- poor tidal volume
*tinnitus*
ringing in ears
Sodium
saline solutions plays important role in nerve fx
how to *triage*
separate walking wounds and disabled wounds!!
How to est. unresponsiveness?
shake and shout
transient pain
short-lived pain
Signs vs symptoms
signs: observed or measured symptoms: told to you by the patient people are sometimes vague about their symptoms or stupid
Old terminology
simple and compound
avulsion
skin is either torn completely off or hanging as a flap just imagine an apple getting scooped
bradypnea
slow breathing
bradycardia
slow pulse
laceration [What is a clear cut laceration called? A: *incision*]
smooth or jagged out
Title 22 California Code of Regulations (CRR)
state law defining the scope of practice for EMT-B's
The golden hour
studies have shown the golden hour is important to survival first 20 minutes is EMS intervention 1. 10 is assessment and intervention 2. other 10 is transport
coronary arteries
supple blood to heart muscle itself 1. the 2 main coronary arteries have openings immediately above the *aortic valve* at the beginning of the aorta where the pressure are highest
main job of the cardiovascular system
supply oxygenated blood to all cells in the body
Note [________ leads to myocardial infarction]
systemic vs pulmonary circulation pulmonary arteries (carries unoxygenated blood)/veins coronary arteries (*ischemia* [inadequate blood supply to a body part] leads to myocardial infarction) pericardium: where heart is enclosed myocardium (heart muscle)
What happens after you take bronchodilator?
tachycardia
EMS System
the organization of community resources and personterm-3nel ate provide rapid medical care
apices
the tip or the top most portion of a structure
Burns
thermal chemical electrical
Nuclear/radiological agents
these rays can be shielded by 1. alpha: skin 2. beta: clothing 3. Gamma: lead (as thick a concrete wall
semi fowler
this is the most comfortable position
Best friend
time distance and shielding
protection
time, distance, shielding
meninges [What does it cover?]
tissue layers that cover brain and spinal cord 1. dura mater 2. arachnoid mater 3. pia mater(deepest) *CSF is between arachnoid and pia mater*
tendon
tough rope like cords of fibers that connect bone to muscle injury: strain
spinal cord
transmit impulses
unilateral and bilateral
unilateral: something you have one of and lie on either side of the midline e.g. heart bilateral: something you have 2 of one both sides of the midline e.g. eyes
GSW
unique
Respiratory system is divided into
upper airway and lower airway
S.T.A.R.T. (for adults)
used all over the world Simple Triage And Rapid Treatment
nitroglycerine
vasodilator for people with high blood pressure *WE CANNOT ADMINISTER BUT WE CAN ASSIST*
2 SHOCKABLE symptoms
ventricular tachycardia [tachy: fast] ventricular fibrillation
inner ear infection
vertigo
crowning [When do you not see this?]
visualization of the crown of the head *during vaginal delivery* Note: no crowning during C-section
Cholinergic Poisoning
water comes out of every hole DUMBELLS SLUDGE defecation urination miosis bronchorrhea emesis lacrimation salivation salivation lacrimation urination defecation GI irritation Eye constriction
Sudden Infant Death (crib death)
we always pretend to resuscitate even if we know what the outcome is so we can get the baby out of there
When we are talking about long bones (the whole arm/leg)
we need to break it into *THIRDS* 1. proximal 2. medial 3. distal
WMD
weapon of mass destruction
manual head stabilization
when C collar is not available
bleve (Boiling liquid expanding vapor explosion)
when gasoline truck sets on fire and explodes
Hollow organs
when lacerated, bleeds stomach intestines bladder
Solid organs
when lacerated, sbleeds liver speen kidneys pancreas
Flush eyes
with normal saline or water for 5 minutes
Intravascular
within a vessel -determines BP & perfusion
endotracheal
within the trachea
You are NEVER exempt from operating safely
you can be charged with a crime if you operate unsafely