Preparatory HW

Lateral recumbent

Patient lying on their side

Orthostatic vital signs

Performed on patient with suspected volume loss

Off-line medical direction

Permission to perform treatment based on protocols

On-line medical direction

Permission to perform treatment from doctor via phone

Distal

Away from point of reference

Lateral

Away from the midline

O2 device for inadequate ventilation

Bag-valve mask (BVM)

List 4 circumstances wherein minors can consent to treatment for themselves

-Emancipated by court -Active duty in armed forces -16 yoa, lives away from parents, manages own finances -Wants treatment for infectious disease -Unwed/pregnant wants treatment related to pregnancy (Except for abortion) -Wants treatment/help with drug problem/addiction -Unwed and wants treatment for biological child

Bilateral

Both sides of the midline

A BVM CAN / CANNOT be used without the bag being at least half inflated.

Can

If an adult patient is confused or unable to answer questions, they CAN / CANNOT refuse treatment.

Cannot

Standard of care

Care expected of any EMT under similar circumstances

Artery

Carries blood away from heart

Vein

Carries blood to the heart

Name the 5 parts of the spinal column

Cervical Thoracic Lumbar Sacral Coccyx

Expressed consent

Clear granting of permission by patient

Modified focused exam

Coherent patient complaining of isolated injury

Sign of severe hypoxia

Cyanosis

What three things does the letter 'D' stand for in the primary assessment?

D- Deformity D- Disability D. Disorientation

When the diaphragm and intercostal muscles contract, the intrathoracic pressure INCREASES / DECREASES and causes INHALATION / EXHALATION

Decreases, Inhalation

Perfusion

Delivery of oxygen/nutrients and removal of wastes by blood

Why we obtain several sets of VS

Determine if treatment is effective, or see trends

Pulse pressure

Difference between systolic and diastolic BP

Pulse pressure

Difference between systolic and diastolic blood pressures

Medical director

Doctor who is legally responsible for clinical aspects of an EMS system

The size of the blood pressure cuff DOES / DOES NOT matter.

Does

An OPA is only used when a patient is unresponsive and DOES / DOES NOT [a] have an intact gag reflex.

Does not

If the scene becomes dangerous after you have made contact with your patient, your duty to act STILL REQUIRES / DOES NOT REQUIRE you to remain with your patient.

Does not require

If your patient is in respiratory distress, you should try to position them SUPINE / SITTING UP

Sitting up

Bradypnea

Slow rate of breathing

Anaerobic metabolism occurs in the absence of oxygen, and produces a SMALL / LARGE amount of ATP, a SMALL / LARGE amount of lactic acid, and DECREASES / INCREASES the pH of the body.

Small, Large, Decrease

When the tongue of an unconscious patient falls back against the oropharynx and partially occludes the airway, this produces CROWING / SNORING respirations, and you should perform a maneuver to open the AIRWAY / MOUTH. One way to do this is the CROSSED FINGER TECHNIQUE / JAW THRUST.

Snoring, Airway, jaw thrust

Symptom

Subjective info given by patient

Pertinent negative

Symptom denied by patient

LIGAMENTS / TENDONS attach muscle to bone.

Tendons

Sign of mild hypoxia

Anxious/restless

Sign

Observable/objective patient info

Assault

Putting another person in fear of harm

Posterior/Dorsal

Toward the back

List 3 people who can consent to treat a minor if the parent or legal guardian is not present:

-Parents/Grandparents -Adult brother/sister -Adult aunt/uncle -Adult written authorization -A representative of a court having jurisdiction -PD officer who has lawfully taken minor in custody

The liter flow for an NC is 1-6 / 4-8 lpm. The liter flow for a NRB is 15 / 8-15 lpm. The liter flow for a BVM is 10-15 / 15 lpm.

1-6, 8-15, 15

List 5 elements of the minimum data set required by the DOT on all Patient Care Reports.

1. Chief complaint AVPU 2. Pulse rate Respiratory rate/effort BP cap refill 3. Skin color/temp/condition 4. Times (incident, dispatch, arrival, depart, destination, transfer care) 5. Demographics (age, sex, race, weight)

What are the 5 stages of death/dying/grief that patients and families might experience?

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

What 3 elements must a patient demonstrate in order for a refusal to be lawful?

1. Informed 2. Legal capacity 3. Mental capacity

List the two main things you should assess to determine whether your patient is adequately breathing.

1. Respiratory rate 2. Tidal volume

Based on the EMT Assessment Steps, list 3 situations that would require you to do a rapid head-to-toe physical exam instead of a modified focused one.

1. unresponsive patient 2. serious MOI 3. poor historian

If your patient has vomit in the airway you should suction them for no more than 15 / 20 seconds, and after this time if vomit remains in the airway you should CONTINUE TO SUCTION / VENTILATE.

15, Continue to suction

What does AVPU stand for?

A- Alert V- Verbal stimulus P- Painful stimulus U- Unresponsive

Scope of practice

Actions that an EMT can perform as defined by law

Tidal volume

Amount of air taken into lungs with each inhalation

Cardiac output

Amount of blood ejected by left ventricle in one minute

Stroke volume

Amount of blood ejected by left ventricle with each contraction

Breach of duty

EMT with duty to act fails to live up to standard of care

How to open the pediatric airway

Extend head slightly with towel under body/shoulders

INTERNAL / EXTERNAL respiration takes place in the lungs, and INTERNAL / EXTERNAL [b] respiration takes place in the tissues.

External

Tachypnea

Fast rate of breathing

Debriefing (CISD)

Formal meeting 2-3 days after a critical call attended by mental health professionals to help responders deal with stress reactions

How to measure an OPA

From corner of mouth to angle of jaw

How to measure an NPA

From nostril to angle of jaw

Capnometry (EtCO2)

Gauge on how well lungs are being ventilated/perfused

HAND WASHING / WEARING GLOVES is the single most effective thing you can do to prevent the spread of disease.

Hand washing

Purpose of secondary assessment

Identify additional serious injuries/conditions

Purpose of primary assessment

Identify/treat immediate life threats

Ischemia

Inadequate delivery of oxygenated blood to tissues

Agonal respirations

Inadequate/irregular gasping breaths

When the diaphragm and intercostal muscles relax, the intrathoracic pressure INCREASES / DECREASES and causes INHALATION / EXHALATION

Increase, Exhalation

Defusing

Informal session following a critical call that allows responders to vent their emotions

Proximate cause

Injury was direct result of EMT's negligence

Hypoxia

Insufficient or low oxygen

The person who is the patient's Medical Power of Attorney IS / IS NOT allowed to make decisions for the patient if the patient currently has mental capacity.

Is not

What does OPQRST stand for?

O- Onset P- Provocation/Palliation Q- Quality R- Radiation S- Severity/Score T- Time

Abandonment

Leaving a patient without ensuring proper transfer of care

LIGAMENTS / TENDONS attach bone to bone.

Ligaments

How to insert an NPA

Lubricate then straight back with bevel toward septum

What does MEDIC stand for? (These are ways of labeling the patient category.)

M- Minimal E- Expectant D- Delayed I- Immediate C- Contaminated

Gross negligence

Malfeasance: willful and wanton action that causes harm

Pulse oximetry

Measures percent of bound hemoglobin

Based on the EMT Assessment Steps, list 6 components of a patient radio report to the hospital.

Medic Unit Transport code Pt age/gender Chief complaint Brief history Major findings Treatments ETA

If a patient is elderly, you ALWAYS / MIGHT need to speak to them more loudly and slowly.

Might

Simple negligence

Misfeasance: no intent to do harm, but treatment deviates from standard of care

Capillary refill is a MORE RELIABLE / LESS RELIABLE predictor of shock in children, and a MORE RELIABLE / LESS RELIABLE predictor of shock in patients who are diabetic or elderly.

More reliable, Less reliable

O2 device for SOB when can't tolerate mask

Nasal cannula (NC)

Proximal

Nearer to the point of reference

In NEWBORNS / GERIATRICS bradycardia may often be an early sign of hypoxia.

Newborns

Apnea

No breathing

Duty to act

Obligation of EMT to respond and provide care

Patient restraints

Only used when needed for safety

Informed consent

Patient agrees to treatment after being told risks and consequences, and indicates they understand

Prone

Patient lying face down

Supine

Patient lying face up

Oropharynx

Portion of pharynx from soft palate to epiglottis

Nasopharynx

Portion of pharynx superior/posterior to uvula

Systolic BP

Pressure exerted against walls of arteries when heart contracts

Diastolic BP

Pressure exerted against walls of arteries when heart is at rest

Good Samaritan law

Protects off-duty medic from liability for acts performed in good faith unless gross negligence is involved

When the patient is unresponsive and cannot answer questions about their condition, you should perform a RAPID HEAD-TO-TOE / MODIFIED FOCUSED exam.

Rapid Head-to-toe

Damage

Real, recognizable, and demonstrable injury

Baroreceptor

Receptors that detect changes in blood pressure

Chemoreceptor

Receptors that monitor pH, CO2, and O2 levels in blood

Assuming an anterior view with the lines intersecting at the navel, Label the abdominal areas (quadrants)

Right upper quadrant Left upper quadrant Right lower quadrant Left lower Quadrant

What does SAMPLE stand for?

S- Signs/Symptoms A- Allergies M- Medications P- Pertinent past history L- Last oral intake E- Events leading to injury or illness

Based on the Blackboard lecture notes (not the text), what does SOAPE stand for?

S- Subjective O- Objective A- Assessment P- Procedures E- En route

Cyanosis is a sign of MILD / SEVERE hypoxia, and can best be seen in the FINGERNAILS / CHEEKS

Severe, fingernails

If your patient is unconscious, cyanotic, and breathing very rapidly, you SHOULD / SHOULD NOT begin ventilating them at that same rapid ventilatory rate.

Should

Battery

Touching another person without their consent

Inferior

Toward the feet

Anterior/Ventral

Toward the front

Superior

Toward the head

Medial

Toward the midline

Kidnapping

Transporting a patient against their wishes

List 2 kinds of general situation in which you would need to do an emergency move (the text talks about 3), and then describe 3 examples of how you might accomplish an emergency move

Two Situations: 1. Unsafe scene 2. Patient between you and more critical patient; CPR Three examples: 1. Armpit-forearm drag - cross pt's arms, grab forearms from under armpits and pull 2. Shirt drag—grasp neck and shoulders of shirt, support head, drag 3. Blanket drag - spread a blanket, roll pt onto it, wrap the blanket around the pt, drag

Rapid head-to-toe exam

Unresponsive trauma patient

How to insert an adult OPA

Upside-down then turn 180 degrees

Implied consent

Used when a patient is unconscious or not competent

Involuntary consent

Used when a patient refuses treatment but is in custody