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