Paramedic Chapter 4-7 review

Not everyone has the same 10 - code system o Use plain language and only use radio codes that are specifically approved by your system and that everyone will understand.

.10 - code communication. Do we use it? No. Why?

Sagittal (lateral) plane

Divides body vertically, slicing it from front to back. Also called the lateral plane. Midsagittal plane (midline): Divides the body into equal left and right halves. Your nose and navel are found along this imaginary line.

a medical deficit not them being an *******

If you ask a patient a basic question and the patient is not accurate we have to assume that this is due to?

entire chain of custody; what do you do when you don't use the whole vile - waste it with a witness. 2 signatures will be needed.

If you use a narcotic, what do you dodocument the

hypoxia o If pulse oximetry and blood glucose measurements are outside normal ranges, these can provide information about the patient's ability to understand and communicate. If a patient is unable to tell you who he or she is, where he or she is, and what day of the week it is, you should suspect decreased blood flow to the brain.

If you're assessing level of mentation, what's the first issue with mentation

Transverse plane

Passes horizontally through the body at the waist, creating top and bottom portions. Also called the axial plane

Negligence

Professional action or inaction on the part of the health care practitioner that does not meet the standard of ordinary care expected of similarly trained and prudent health care practitioners and that results in injury to the patient

Coronal plane

Slices the body vertically, from ear to ear, dividing it into front (ventral) and back (dorsal) portions . Also called the frontal plane

Certain situations in your paramedic practice may require special communication techniques. Some of these situations may include uncommunicative patients, hostile or violent patients, older people, young children, and patients with special challenges. Avoid stereotyping any these groups of patients, which will impair effective communication.

Stereotyping - does it benefit or inhibit communication (inhibits)

Costochondritis

Swelling of part of the ribs

carrier wave

The basic radio wave onto which a signal is encoded is called a?

res ipsa loquitur

Theory of negligence that assumes an injury can only occur when a negligent act occurs.

Nonfeasance

When a paramedic fails to perform an act that he or she is required or expected to perform. Example: Failure to perform CPR when a patient goes into cardiac arrest

Poli/o

Word root for gray

transceiver

a radio containing both a transmitter and a receiver, a two-way radio

Landline

communications system liked by wires, usually in reference to a conventional telephone system

trunked radio system

computerized sharing of radio frequencies by multiple units, agencies, or systems.

Synonym

pairs of word roots, prefixes, or suffixes that have the same or almost the same meaning

Suffix

the portion of that appears after the word root

Time of call Time of dispatch Time of arrival at the scene Time with patient Time of medication administration Time of medical procedure Time of departure from the scene Time of arrival at medical facility Time of transfer of care Time back in service

• What times are documented on a PCR

Place yourself between the patient and the door o Hostile patients may present a threat to you or others. Always approach with caution, maintaining eye contact. Try not to interview an angry patient by yourself. Identify escape routes from the scene. Approach the patient from the front, with hands visible and open. If safe, get on the patient's level. Ask permission to ask questions and touch the patient. Be honest. Watch for signs of possible attack such as violent language, or body language such as clenched fists, intense staring, breathing heavily through clenched teeth, and other threatening gestures.

• When assessing a patient who is violent, have an escape route. Place yourself between the patient and the door

Common Law

A decision that has been made by a judge through a court case based on his or her interpretation of the statues and constitutions; can be overturned either by another court with a higher authority o the issuing court at a later time; also called case law.

base station

A radio at a fixed location (such as a hospital or dispatch center) consisting of a transmitter, recevier, and antenna

Modesty matters - no matter how acute the medical condition or injury may be. It is especially important to older adults, adolescents, and young children. If the patient is not personally sensitive to modesty, the his or family members most certainly will be.

Always be considerate of a patient's modesty - the patient may be altered but the family is not

DNR orders

An advance directive that describes which life-sustaining procedures should be performed if a patient's medical condition suddenly deteriorates. Some states rely on written physician orders.

Clarification

Ask patients to explain what they mean if you do not understand.

Must clearly state the patient's medical condition(s) Must contain the signature of the patient or legal guardian Must contain the signature of one or more physicians Must be dated in the preceding 12 months to be valid, if there's an expiration date

DNR orders must meet certain requirements to be valid.

Amount used versus wasted Patient to whom it was given Date and time it was administered By whom it was given

Documentation of controlled substances in the PCR includes:

Appellate courts

Establish precedent and become the law of the state in which you live and practice as a paramedic. In most cases, these court decisions establish the standards of negligence what will apply if you are sued by patient.

Good rapport with your patient is essential for obtaining good medical information. If patients are reluctant to share personal information:

Explain why you need their name and date of birth. Reassure them that all information is confidential and protected by law.

The patient is orient to person , place, time, and event The patient responds to questions appropriately There is no significant mental impairment from alcohol, drugs, head injury, or other organic illness. The patient demonstrates to you that he or she understands the nature of his or her condition and the risks of not going to the hospital for immediate care. The patient can describe a reasonable plan for follow-up care Oxygen saturation levels and blood glucose levels are within normal limits. The patient does not appear to have serious, distracting injuries that might impair rational decision making.

General criteria for establishing mental competence

Older people tend to have more complex illnesses because they may have multiple diseases or conditions. Older people may be taking more medications

Geriatrics, why do simple chief complaints become more complicated

Force can only be used in response to a patient's use of force against you. The amount of force allowed by law is either equal to or slightly greater than the force offered by the patient and it must be in response to the patient's actions.

How can a medic respond to a violent patient

. A "drop report" or "transfer report" is a single-page, abbreviated form used as a memory aid during an EMS call. Leave a copy of a drop report or transfer report with a nurse or physician at the hospital if a PCR report cannot be completed

How to handle if you can't finish a PCR before departing from hospital

Follow up with your physician

If a patient asks about something their personal physician told them what do we say?

Yes. o When you encounter a patient who has trouble communicating, remember that family members or caregivers can facilitate your efforts. Caregivers may take classes in sign language or lip reading to aid communication.

If a patient has a problem communicating; can a family member or bystander help you communicate?

If patients mention something in passing or avoid a certain question, politely redirect their attention to it until you get an answer.

If a patient is avoiding answering a question, how do you handle it

Decision-making capacity: The ability of patients to understand the information that is being provided to them and make a choice regarding appropriate medical care. If a patient with decision-making capacity refuses medical care, that person may not be treated without a court order. Consult with medical control for instructions. Inform the patient in a calm and sympathetic manner of the potential consequences of refusing treatment. Remember, many people who refuse medical treatment do so out of fear and emotional distress.

If a patient is experiencing a medical emergency but are refusing transport what do we do?

Note the date and time of the revised report. Include the purpose for writing the revision or making the correction. Never discard or destroy the original PCR. Only the person who wrote the original report can revise it.

If a revision or correction must be made to a PCR:

Redirection

If patients mention something in passing or avoid a certain question, politely redirect their attention to it until you get an answer.

Silence

If patients seem to be trying to put something into words, be patient and do not say anything for a few seconds.

Simplification and summarization

If the patient's response is confusing or disorganized, try summarizing his or her comments in simpler terms and see if the patient agrees.

negligence per se

Inexcusable violation of a statue, such as practicing paramedicine without a valid license or certification.

Subjective information

Information that is that told to you, but that cannot be seen, such as symptoms patients describe (like degree of pain)

Touching with the left hand: Islamic and Hindu cultures avoid touching with the left hand; it is rude and offensive to use the left hand in greeting

Islamic and Hindu cultures

Duty

Legal obligation of public and certain other ambulance services to respond to a call for help in their jurisdiction

o Frequencies are grouped into bands by the Federal Communications Commission (FCC) for specific purposes. Two most commonly used bands for medical communication are the very high frequency (VHF) band and the ultrahigh frequency (UHF) band. The VHF band extends from 30 to 300 MHz. The UHF band extends from 300 MHz to 3.0 GHz. o The VHF has been arbitrarily divided into a low band (30 to 50 MHz) and a high band (150 to 175 MHz). The low band frequencies may have ranges up to 2,000 miles but are unpredictable because changes in ionospheric conditions may cause "skip interference," with patchy losses in communication. The high-band frequencies are almost wholly free of skip interference, but have a much shorter transmission range.

Low frequency bands v. High frequency bands

Objective information

Measurable signs that are observed and recorded, such as blood pressure

Negligence occurs when: The paramedic or EMS system had a legal duty to the patient. Example: Paramedic hired to serve the community has a legal duty to the citizens of that community. There was a breach of duty. The person accused of negligence failed to act as another person with similar training would have acted under the same or similar circumstances. The breach may involve doing less than the person was trained to do or doing more than the person was trained to do. The failure to act appropriately was the proximate cause of the plaintiff's injury. Harm resulted.

Negligence occurs when

Gross negligence

Negligence that is willful, wanton, intentional, or reckless; a serious departure from that accepted standards

Silence: If patients seem to be trying to put something into words, be patient and do not say anything for a few seconds.

Patient is really worked up and not answering questions?

You may feel the physician's orders are detrimental to the patient's best interests. Immediately discuss your feelings with the physician. You are in a better situation to understand. Your job is to communicate fully with the physician. Never perform a procedure or administer a medication you believe will harm the patient. Example: If a physician asks you to perform a procedure in which you are not trained obtain clarification from the physician, communicate your objections, discuss your current standing orders, offer a feasible alternative within your scope of practice, and request that the physician speaks with your medical director. Always act in the patient's best interest as his or her advocate.

Physician gives online medical control - when do you say no? Also, confirm the order to make sure you and they heard correctly.

Empathy

Putting yourself in the patient's position. Example: If patient expresses sadness or despondency about a situation, such as a recent death, you may say something like, "I am terribly sorry. I don't know how I would feel in that situation, but I am sure I would feel similarly."

Duplex

Radio system using paired frequencies to permit the use of emote repeaters or simultaneous transmission and reception

Reflection

Repeating a word or phrase a patient has used to encourage more detail. Example: Patient says, "I can't catch my breath." You say, "You said you can't catch your breath." Patient may then respond more fully, explaining the condition and circumstances in more detail. This technique can produce more information than the patient originally gave.

Some systems have a tiered response. Basic life support (BLS) providers reach the patient quickly. Advanced life support (ALS) providers follow. If BLS responds and makes an improper determination, the system may be exposed to liability. Work with every provider involved and set up protocols providing guidance for these situations.

Review tiered-response EMS system

Provisions of the Medical Practices Act

The Medical Practice Act: Enables physicians and other health care practitioners to function. Defines the minimum qualifications of those who may perform various health services and the skills that each type of practitioner is legally permitted to use. Establishes a means of licensure or certification for different categories of health care professionals. May contain requirements for relicensure or recertification based on continuing education. May require a physician to assume responsibility for competency of the paramedic's training, skill competency testing, and run review.

surrogate decision maker

The ____________ decision maker is legally obligated to make decisions as the patient would want, and has presumably discussed these decision with the patient. The surrogate decision maker has no authority until the patient becomes incapable of making decisions.

Maintaining license or certification, attending continuing education courses, and maintaining your skill.

The concept of duty extends to?

Confrontation

This involves making your patients aware that you understand something is inconsistent about their story. Remain professional and nonjudgmental. Example: If a patient is in a motor vehicle accident, and denies drinking alcohol, say, "Anything you tell me is confidential, and I detect the smell of alcohol on your breath. There were also some empty bottles in your vehicle. It is important you tell me the truth so I can make sure that we and the hospital staff can take proper care of you." This technique helps you assess the patient's level of distress and/or aggressiveness.

Facilitation

Use phrases to encourage patients to provide more information. Examples: "Please say more," or "Please feel welcome to tell me about it."

Interpretation

Vocalize what you think the patient is saying and invite the patient to correct you. This can be used when: you are not sure what a patient is telling you, and a patient refuses to give needed information. Example: If a teenager acts distressed and says she is afraid she might hurt her parents if she tells them what is wrong and says her parents don't like her boyfriend, you might ask a question like, "This may be totally wrong, but I must ask the question so I can inform the doctor for your well-being. Do you think you are pregnant?" Interpretation requires your best intuition and diplomatic skills. Possible phrase to begin with is, "So if I understand what you are saying correctly . . ."

Standard of care

What a reasonable paramedic, in the same or similar situation, would have done

Generally, you should notify the police of all coroner cases, including the following situations: Obvious or suspected homicide Obvious or suspected suicide Violent or sudden, unexpected death Death of a prison inmate

What constitutes a medical examiners case in most states

GPS Communicate wirelessly using voice, text, and video Take and send photographs or videos to other devices Use GPS receivers with mapping software Access a huge range of medical applications

What is the advantage of a cell phone vs. a radio

The concept of consent refers to patients who are of legal age and who possess decision-making capacity, the capacity to make appropriate medical care decisions for themselves.

What is the concept of consent?

Misfeasance

When a paramedic performs an act that he or she is legally permitted to do, but improperly carries it out. Example: Administering medication that is clearly within the scope of practice but accidentally calculating an incorrect dose

Malfeasance

When a paramedic performs an act that he or she was never authorized to do. Example: Medical intervention outside the scope of practice

Assault

When a person (the EMS provider) instills the fear of immediate bodily harm or breach of bodily security to another person (the patient), regardless of whether the threat of harm is actually carried out. Example: threatening to restrain a patient.

False imprisonment

When a person is unintentionally and unjustifiably detained against his or her will. Examples: If a paramedic transports a patent without his or her consent or uses restraints in a wrongful manner.

Destination facility and estimated time of arrival (ETA) Patient's age and sex Patient's chief complaint Brief history of present illness or injury Medications and important allergies Anything else from patient's medical history relative to current situation, including major underlying medical conditions Patient's level of consciousness and degree of distress Patient's mental status Patient's vital signs Pertinent physical findings in head-to-toe order ECG findings Treatment given so far and response to treatment

When giving a radio report what do you say according to the text book

Use the same format as your radio report, but with additional detail as required, and include any updates to the information provided in your radio report. Make sure you have answered all questions from the medical and nursing staff. Transfer of patient care, or handoff, is one of the highest risk aspects of emergency medical care. It is easy for errors or omissions to occur during hand offs. Studies have demonstrated loss of key clinical information during handoff, such as changes in vital signs (e.g., transient hypotension), medications administered, and changes in ventilator settings - all of which may directly lead to patient harm.

When talking to a physician in person you need to be more descriptive than you're radio report, be as descriptive as possible

Battery

When the defendant (the EMS provider) touches another person (the patient) without his or her consent. Example to distinguish the difference: Saying "I'm going to kick your teeth in" is assault. Actually kicking in someone's teeth is battery.

o Every decision should be based on the standards of good medical care, not on the possible legal consequences. "First, do no harm" Take all due care to ensure: your patient receives the best possible care and your actions do not harm the patient. In assessment, treatment, and transport to avoid exacerbating the illness or injury. To act in good faith To act in the patient's best interest.

When we have the decision of whether or not to resuscitate

- in a neutral area Some people do not like to be touched, while it is reassuring to others. Start by touching a shoulder or arm to reassure or mitigate fear. If they react positively, use touch to help reassure. If not, use other strategies

When you touch a patient, where do you touch them

encoded radio signals

an embedded signal that permits controlled access to the radio transmission.

Head

cephal/o

Brain

encephal/o

Face

faci/o

Tongue

gloss/o

Active listening

involves repeating back the key parts of a patient's responses to questions. repeating this information back helps to assure the patient that you are really listening, and confirms the information the patient is providing.

Abandonment

is a form of negligence that involves the termination of care without the patient's consent. Abandonment implies the patient had continuing need for medical treatment. The abrupt termination of treatment caused injury or death. You may not leave a patient in need of medical treatment until another competent health care professional with equal or higher level of training has taken responsibility. You must notify an appropriate health care professional of the patient's presence in the ED. Notify that person that you are transferring responsibility for care to him or her.

Defamation

is intentionally making a false statement through written or verbal communication that injures a person's good name or reputation. To be considered defamation, the statement must be a false statement. Truth is an absolute defense against any type of defamation claim.

Libel

making a false statement in the written form that injures a person's good name. When writing the patient care report, avoid using terms that may be considered insulting or offensive.

Ordinary negligence

negligence that is failure to act, or a simple mistake that causes ham to a patient.

Gross negligence

negligence that is willful, wanton, intentional, or reckless; a serious departure from the accepted standards.

. It implies that the injury or harm could have been predicted and could have been avoided if proper precautions were taken. Example: Giving an incorrect dosage of a drug will foreseeably result in harm to the patient.

one aspect of negligence is foreseeability

Antonym

pairs of word roots, prefixes, suffixes that have the opposite meaning of another word

simplex

radio communication using a single frequency

repeater

remote radio transceiver that receives radio signals and broadcasts them at a higher power, extending the rang of radio communications system

multiplex

simultaneous transmission of multiple data streams, most often voice and electrocardiogram gram signals.

Word root

the foundation of the term

frequency

the number of cycles (oscillations) per second of a radio signal

very high frequency (VHF) band

the portion of the radio frequency spectrum between 30 and 300 megahertz

ultra high frequency (UFH) band

the portion of the radio frequency spectrum between 300 and 3,00 megahertz

Prefix

the proportion that appears before the word root

digital radio

the transmission of information via radio waves using native digital (computer) data to a digital signal and compressed

hertz (Hz)

unit of measure of a frequency equal to 1 cycle pe second; 1 million Hz equals one megahertz and 1000 megahertz equal one gigahertz

Slander

verbally making a false statement that injures a person's good name. Avoid using terms that could be considered offensive when transferring patient care. Remember the patient is likely someone's son, daughter, husband, wife, brother, sister, father, or mother.

Combining vowels

vowel that links one or more word roots to an other component of a term