Emergency Health Services 1040
Early respiratory distress, in children...
Displaying the signs, but still maintaining adequate respiratory depth and rate Compensated respiratory distress Signs a.) Increase in respiratory rate b.) Nasal flaring, intercostal retractions in inspiration c.) Supraclavicular and subcostal restrations on inspiration d.) Neck muscle use e.) Audible breathing sounds f.) See-saw respirations Provide oxygen, BVM if needed
What is ventricular fibrillation (VF, V-Fib)?
Disorganized cardiac rhythm Produces no pulse Associated with CAD 50-60% of arrests during the first 8 minutes of pulselessness
What special considerations should be made for motor vehicle crashes?
Dispatch a.) Must evaluate whether there obstacles to patient extrication b.) Trauma patients may be found anywhere under any circumstances, begin to plan ahead Location a.) Consider the location of the incident b.) Know your territory c.) Most injuries are the result of gravity d.) People can crawl, climb, and walk to many locations Motor Vehicle Collisions a.) Present the most frequent rescue problems b.) Accidents are greater during high traffic times c.) As traffic thins, speeds increase
What is a dislocation?
Displacement of a bone from its normal position in a joint
What are the side effects of epi-pens?
Increased heart rate Pale skin Dizziness Chest pain Headache Nausea or vomiting Excitability and anxiousness
What is rhonchi?
Snoring or rattling noises Obstruction of the respiratory tract by thick mucus Chronic bronchitis, emphysema, aspiration, pneumonia
What is hemoglobin?
Found on the surface of red blood cells Is responsible for picking up the majority of oxygen in the blood (97%)
How many chambers does the heart have?
Four
What is orthopnea?
Inability to breathe or shortness of breath while lying flat
What is considered a regular pulse?
Normal pulse that occurs at regular intervals with a smooth rhythm
What is the parathyroid gland?
Produce a hormone necessary for the metabolism of calcium phosphorus in the bones
What are the gonads?
Produce the hormones that govern reproduction and sex characteristics
What are hydrocarbons?
Produced from crude oil, coal, plant sources
What are toddlers?
1-3 years Do not like to be touched Do not like to be separated from caregiver Do not like having clothing removed Do not like having oxygen mask Do not like needles
What are nasal canulas usually set at?
1-6 lpm
What is diaphoresis?
Profuse sweating
What are some indications of a partial airway occlusion?
Snoring Gurgling Crowing and Stridor
What does the prefix angio mean?
Blood vessels
What are the effects of aging on the renal system?
Become smaller in size and weight Decrease in the surface area to filter blood Electrolyte imbalance Loss of bladder control
Explain the injection route of poisonings...
Poison injected under skin, into muscle, or directly into blood vessel Also includes bites or stings
What is the administrative purpose of documenting?
Becomes a part of the patient's permanent hospital record Will be used in preparing bills and submitting records to insurance companies
What are high risk groups for geriatric abuse?
Bedridden, demented, incontinent, frail, disturbed sleep patterns Bruises, bites, bleeding from scalp, lacerations, broken bones
How should a patient in shock be transported and positioned?
Supine Legs elevated 8-12 inches Improves ventilation
What are neonates?
0 to hospital discharge Totally dependent on others for survival Birth defects and unintentional injuries are common causes of emergencies
What are infants?
0-1 year Will let you undress they, lay them on a flat, warm surface and touch them Can recognize their caregivers face Allow the caregiver to hold the infant if possible
What is a brain laceration?
Can occur in either open or closed head injury Results in bleeding and massive disruption of the nervous system BP may go up and pulse down
What is preeclampsia/eclampsia?
1 in 20 pregnant women Toxemia or poisoning of blood Occurs in last trimester Women with history of diabetes, heart disease and kidney problems are at risk Eclampsia a.) More severe, includes coma or seizures
Unstable patient needs to be in an ambulance in ___ minutes
10
The body's response to epinephrine is rapid, within seconds. The duration only lasts...
10-20 minutes
What is considered a normal pulse for a newborn?
100-180 for newborn
A child's temperature can reach up to ___F.
106.9F
What are adolescents?
12-18 years Believe they are invincible Use a relaxed, not professional approach Mass hysteria
What is considered a normal pulse for an infant?
120-150 for infant
What are the phalanges?
14 on each foot form the toes Two in big toe, three in other toes
Only ___-___% of patients who have spinal column Fx or Dx will have a spinal cord injury that results in neurological deficit
14-15%
You should suction for no longer than ___ seconds at a time.
15
What is a normal respiratory rate for children?
15-30 per minute
What are nonrebreather masks generally set at?
15lpm
What is the spinal cord?
18 inches long, an extension of the brain stem Conduction of nerve impulses
What is HIPAA?
1996 law that protects the privacy of patient health care information and gives the patient control over how the info is distributed and used Limited to discussing patient specific info only with individuals with whom it is medically necessary to do so You and patient are informed of policies and procedures A privacy officer will oversee HIPAA regulations
What is an epidural hematoma?
2% of head injuries Extreme emergency Arterial or venous bleeding between the skull and dura a.) Bleeding is rapid, profuse or severe b.) Increases intracranial pressure c.) 66% arterial bleeding Immediate surgical repair is needed
How should you administer emergency medical care for marine life bites and stings?
2,000 poisonous marine animals Venom of marine life may cause more extensive tissue damage than that of land animals Venoms of aquatic animals are destroyed by heat, heat should be applied Emergency Medical Care a.) Use forceps to remove material, then irrigate wound b.) Do not attempt to remove spines c.) Remove dry tentacles and pour vinegar on the affected area d.) Apply heat for at least 30 minutes e.) Transport
Most reactions are apparent within ___ minutes of exposure.
20
Oxygen is present in the atmosphere at ___%.
21%
Air is ___% oxygen, ___% nitrogen, and ___% CO2.
21% O 78% N 1% CO2 Only 5% of oxygen is used in the body 16% is exhaled
The face is made of ___ bones, 8 of which form the cranium and 14 that comprise the face.
22 bones
What is acute aging?
Aging body has fewer resources and leads to incidence of acute medical and traumatic emergencies
What is a normal respiratory rate for infants?
25-50 per minute
Child seats restrain a child at __ points or ___ points.
3 or 5
The brain weighs ___ pounds.
3 pounds.
What are preschoolers?
3-6 years Concrete thinking and interprets what they hear Vivid imaginations Have a caregiver present if possible
What is a normal respiratory rate for newborns?
30-60 per minute
What is cyanosis?
Bluish gray-color Late sign of hypoxia and may be found in several areas of the body a.) Lips, mouth, around the nose, fingernail beds, the conjunctiva, oral mucosa
Strokes are the ___ leading cause of death in America.
3rd
What is cyanosis?
Bluish or blue gray tone of the skin seen around the lips, nose and fingernail beds indicating inadequate circulation
Body can only store oxygen for a few minutes. Brain cells will begin to die in about ___ minutes.
5 minutes
___% of children who die in the US are found dead on the scene or in the ED.
50%
What is a school aged child?
6-12 years More cooperative, even curious Treat them with respect and make sure that they are partners in care
What is considered a normal pulse for an adolescent?
60-105 for adolescent
What is considered a normal pulse for a school aged child?
60-120 for a school aged child
Diaphragm contributes ___-___ percent of the effort to breath Intercostal muscles contribute the remaining ___-___ percent.
60-70% 30-40%
Coma occurs when the body reaches ___ F.
79
What is considered a normal blood glucose level?
80-120 mg/dL Average blood glucose level reading in a diabetic is 200 mg/dL Hypoglycemia a.) Under 50 mg/dL Hyperglycemia a.) Over 120 mg/dL
What is considered a normal pulse for a preschooler?
80-150 for preschooler
Mortality from hypothermia can be as high as ___%.
87%
Where are lethal gunshot wounds usually located?
90% head, thorax and abdomen
Thermal control is lost once the body temp is lowered to ___ degrees F.
95 degrees farenheit
How should you ventilate a patient with facial injuries?
Blunt injury can cause swelling a.) OPA or NPA Bleeding into the pharynx may be severe
Core body temperature is approximately ___.
98.6 or 37C
What are the different types of WMDs? Hint: CBRNE
Chemical, biological, radiological, nuclear and explosive
What is the Homeland Security Presidential Directive #5 (HSPD5)?
?Authorized the Secretary of Homeland Security to develop and administer the National Incident Management System (NIMS) Provides for a consistent approach to managing disasters by all responders to the incident Two major components a.) Flexibility b.) Standardization Every agency was required to be NIMS compliant Same terminology and standardize knowledge Must participate in preparedness and standardization a.) Planning, training, mutual aid agreements, preparedness exercises
What are some signs and symptoms of shock?
A blood loss of greater than 15% will affect vital signs Mental Status a.) Restlessness b.) Anxiety c.) Altered mental status Peripheral perfusion and perfusion of the skin a.) Pale, cool and clammy skin b.) Weak, thready or absent peripheral pulses c.) Delayed capillary refill Vital signs a.) Increased pulse rate (early sign) with weak and thready pulse (early sign) b.) Increased breathing rate (early sign) that may be deep or shallow, labored and irregular c.) Decreased BP (late sign) d.) Narrow pulse pressure Other signs and symptoms a.) Dilated pupils and sluggish reaction b.) Marked thirst c.) Nausea and vomiting d.) Pallor with cyanosis to the lips
What is a laceration?
A break of the skin in varying depth May be linear (regular) or stellate (irregular) May bleed more than other
What is circumduction?
A combination of all four above movements
What is a medication?
A drug or other substance that is used as a remedy for illness
What are some special significant mechanisms of injury for infants and children?
A fall of greater than 10 feet or 2 times the height of a child Bicycle collision Vehicle collision Any vehicle collision where the infant was unrestrained Children will deteriorate very rapidly
What is drug withdrawal? What are the signs and symptoms?
A habitual drug user may develop a tolerance to drugs, physical and psychological dependence Commonly produce physical dependence a.) Narcotics, sedatives, hypnotics, barbiturates, cocaine, marijuana Common signs and symptoms of withdrawal a.) Anxiety and agitation, confusion, tremors, profuse sweating b.) Elevated heart rate and BP, hallucinations, tactile hallucinations c.) Nausea, abdominal cramping
What is tachycardia?
A heart rate greater than 100 beats per minute
What is cavitation?
A hollowing out of tissue along the path of the bullet that is much greater in diameter than the bullet itself
What is the transverse line?
A line drawn horizontally through the waist a.) A line drawn through the waste front to back is called the tranverse plane b.) Divides the body into the superior plane (above the waist) and the inferior plane (below the waist)
What is the midline anatomical plane?
A line drawn vertically through the middle of the patient's body beginning at the top of the head, continuing by the nose and naval The sagittal plane divides the body into right plane and left plane
What is a normal blood volume?
A loss of 500ml of blood may not be as severe as in a small child An adult has 70ml/kg of blood volume a.) (Around 5 liters in total) b.) A loss of 15% would be considered a significant blood loss and can lead to shock Infants and children have about 80ml/kg of blood volume a.) Around 800mL in total b.) A 15% blood loss would be 120 mL
When are you allowed to accept patient refusal of treatment or transportation?
A patient must fully understand the treatment and consequences of refusal Have the patient repeat back to you the consequences You must attempt to get the patient to sign an official release from liability form Before you leave the scene: a.) Try again to persuade the patient to accept treatment or transportation to a hospital b.) Make sure that the patient is competent and able to make a rational, informed decision c.) Consult medical direction as required by local protocol d.) If the patient still refuses, clearly document what was told to the patient, his response and have the patient sign a refusal form e.) Encourage the patient to seek help if certain symptoms develop f.) If you are unsure, contact medical direction
What is unresponsiveness?
A patient who does respond to painful or verbal stimuli Lose their gag reflexes and ability to control the tongue and epiglottis Priority for transport The patient who is not alert but responds to painful or verbal stimulus is considered to have an altered mental status
Does a patient who is responsive automatically have a patent airway?
A patient who has stridor on inspiration or exhalation or who is having difficulty in speaking, gasping between words, using extremely short sentence or not talking at all should be examined closely for a blocked or partially blocked airway or causes of respiratory distress
How do you know if a patient has a patent airway?
A patient who is alert, responsive and talking can be assumed to have a patent airway
What does dry skin indicate?
A patient who is dehydrated or suffering from severe heat exposure (heat stroke) Or from some medical emergencies
How do you immobilize a seated patient?
A short spinal immobilization device will be used Use manual and in line stabilization and apply a c collar Position the short spinal device behind the patient Secure the device to the torso Pad behind the patient's head to ensure neutral alignment of the head and neck with the remainder of the spine Secure the patient's head to the device Position a long backboard under or next to the patient's buttocks and rotate him until his back is in line with backboard Follow the guidelines for immobilizing a patient to a long backboard given above Proceed with care Special considerations a.) Do any assessment of the back, scapula, arms, or clavicles before you apply the board b.) Angle the board to fit between the arms of the rescuer who is stabilizing the patient's head without jarring the rescuer's arms c.) As mentioned, above, push the spine board as far down into the seat as possible d.) Never place a chin cup or chin strap on the patient e.) When applying the first strap to the torso, take care not to apply the strap too tightly, which could cause abdominal injury or impair breathing f.) Always tighten the torso and leg straps before securing the patient's head to the device g.) Never allow buckles to be placed midsternum where they would interfere with proper hand placement if CPR becomes necessary h.) Never pad between the cervical collar and the board i.) Assess PMS before applying device
What is negligence?
A tort in which there is no intent to do any harm to the patient but in which a breach in the duty to act occurred The plaintiff has to prove the following a.) The EMT had a duty to act b.) The EMT breached that duty to act c.) The patient suffered an injury or harm that is recognized by the law as compensable injury d.) The injuries were the result of the breach of the duty (proximate cause)
What is defusing?
A version of CISD held within 1 to 4 hours of the incident It is attended only by those most directly involved Less structured
Explain constriction and clotting?
A vessel that has been cut across or perpendicular to the vessel, will have a tendency to retract and clot off A cut along the length of the vessel will cause the wound to open wider when it contracts
What is assault?
A willful threat to inflict harm on a patient Can occur without touching the patient
How should you reassess a patient after injecting an epi-pen?
ABC a.) Decreased mental status b.) Decreased BP c.) Increased breathing difficulty If so a.) Provide a second dose b.) Treat for shock c.) Initiate positive pressure ventilation d.) Be prepared to initiate CPR
What are acids and alkalis?
Acids a.) Liquid plumbing, bathroom cleaners b.) Will burn on contact c.) Will burn for about 1 to 2 minutes Alkalis a.) Will burn, but it will take a longer period of time to realize b.) Will burn for minutes to hours after exposure
What does 10-4 mean?
Acknowledging that message was received and understood
What is an intentional tort?
Action knowingly committed by an individual that is considered to be civilly wrong according to the law Abandonment, assault, battery, false imprisonment, and defamation
What is the sympathetic nervous system?
Activated when the body is challenged by stressors Actions known as the fight or flight response
What is hemophilia?
Clotting disorder Congenital disease that prevents activation of the normal clotting mechanisms found in the blood Bleeding in this patient is always serious
What is the pons?
Acts as a bridge that connects the three
What are the effects of aging on the neurological system?
Actual decrease in the mass of the brain, increased amount of cerebral spinal fluid Nerve cells begin to degenerate and die as early as the mid-20s Slowing of reflexes a.) Harder time perceiving body position b.) Increased falls Sight and hearing diminishes
What is referred pain?
Actually visceral pain felt elsewhere in the body Usually poorly localized but is felt consistently in the part of the body it is referred to Occurs when organs share a nerve pathway with a skin sensory nerve a.) Brain becomes confused
What are the three types of subdural hematomas?
Acute a.) Begin immediately Subacute a.) Signs and symptoms 3-7 days later Chronic a.) 2-3 weeks after injury
What is behavioral emergency?
Abnormal behavior Unacceptable or intolerable to the patient, family, community May display panic, agitation, bizarre thinking and actions
What are some visual signs of inadequate breathing?
Abnormal respiratory rate a.) Bradypnea b.) Tachypnea Inadequate tidal volume Retractions Use of neck muscles on inhalation Nasal flaring Excessive abdominal muscle mass Tracheal tugging Pale, cool, clammy skin Cyanosis A pulse ox of less than 95% Asymmetrical movement of the chest wall
How do EMTs assess the level of responsiveness?
AVPU mnemonic Children and infants a.) Note whether the child is following movements with his eyes b.) Crying may replace speech as a response Alertness and Orientation a.) If the patient's eyes are open and he is able to speak as you approach him b.) A patient can be alert but disoriented Responsiveness to Verbal Stimulus a.) Opens his eyes, attempts to respond, or makes an attempt to respond only when you speak to him, hi is responsive to verbal stimulus b.) See if they'll obey your commands i.) Squeeze my finger
What are common locations of injury in frontal impacts?
Abdomen a.) should cause you to suspect abdominal injury b.) Hollow organs i.) Liver, spleen ii.) Easily displaced, liver and spleen bear the brunt of the compression Chest a.) Ribs and sternum may break and the cartilage connecting the ribs may separate i.) A torn intercostal artery can bleed 50ml per minute b.) Heart and the lungs are the major organs affected i.) Compression and shear of the heart ii.) Paper bag injuries can rupture a lung Face, Head and Neck a.) Check for spider webbing b.) Penetrating bone shards or a depressed skull fracture may lacerate brain tissue c.) The force of the impact may damage the brain d.) Deployment of the airbag may cause injury to the face, head, and neck
What are vascular structures?
Abdominal aorta and inferior vena cavae Primarily stationary, very large, and carry large amounts of blood Will bleed massively and lead to severe shock and death
What are the signs and symptoms of appendicitis?
Abdominal pain and cramping a.) Around the umbilicus and diffuse b.) Localized to the lower right quadrant medial to the iliac crest (also called McBurney's pont) Nausea and vomiting Low-grade fever and chills Lack of appetite (anorexia) Abdominal guarding Positive Markle (heel drop or heel jar) test
What are the signs and symptoms of internal obstruction?
Abdominal pain, crampy Nausea and vomiting Constipation Abdominal distention Abnormally prominent, high pitched bowel sounds with auscultation
Should you use abdominal thrusts when resuscitating a drowning victim?
Abdominal thrusts are not necessary during resuscitation of drowning victim May lead to regurgitation and aspiration Suction if necessary
What is abruptio placentae?
Abnormal separation of the placenta from the uterine wall prior to birth of the baby Occurs in 1 of 120 births Small arteries bleed and cause placenta to separate from the uterine wall Two major problems a.) Poor gas, nutrient, waste exchange b.) Severe maternal blood loss Two types of abruption a.) Complete i.) Completely separates, 100% fetal mortality rate b.) Partial i.) Associated with 30-60% fetal mortality rate Predisposing factors a.) Hypertension, cocaine, preeclampsia, multiparity b.) Previous abruption, smoking, short umbilical cord c.) Premature rupture of amniotic sac d.) Diabetes mellitus
What is noisy breathing?
Abnormal sound of breathing Snoring, wheezing, gurgling, crowing, or stidor, rhonchi, rales
What is considered labored breathing?
Abnormal sound, grunting or stridor (high pitched harsh sound) Use of accessory muscles, nasal flaring, gasping
What is a normal respiratory volume?
About 1 inch
What does the prefix hyper mean?
Above normal
what is apnea?
Absence of breathing No chest movement and no sensation or sound of air
What is asystole?
Absence of electrical activity and pumping Registers as flatline Defibrillation is not appropriate
What is hypothyroidism?
Absence or severe deficiency in a hormone secreted by the thyroid Metabolic processes slow Speech may be slow and drawn out Hair is coarse, skin dry Weight gain Mental status may become altered and forgetfulness is common Sudden psychosis
What is the action of activated charcoal?
Absorbs poisons in the substance
___ has been the only major cause of infant and child death to increase in the last 30 years
Abuse
Large nuclear weapon will cause concentric rings of complete destruction, severe devastation and areas of limited damage...
Access to scene is limited Destroys emergency services, shelters, food, clean water, hospitals Electrical equipment will be destroyed Radioactive fallout fays tor weeks after detonation
What is aspiration pneumonia?
Accidental aspiration of food or vomitus into lungs
What is a pneumothorax?
Accumulation of air in the pleural cavity, causing a collapse of a portion of the lung Paper bag injury, lung ruptures Lung on the injured side collapses, either partially or fully Signs and symptoms a.) Chest pain b.) Dyspnea c.) Tachypnea d.) Decreased of absent breath sounds Spontaneous pneumothorax a.) Without cause b.) Usually the result of a congenitally weak area on the surface of the lung (bleb) c.) Common among smokers and emphysema patients
The hip joint is made up of the pelvic socket called the ___, which fits the rounded top, or head of the ___(thigh bone)
Acetabulum Femur
What is a poison?
Any substance that impairs health or causes death by its chemical actions More than 1 million poisonings every year
What are the three basic types of stress reactions?
Acute Stress Reaction a.) Results from exposure to a high stress situation b.) Cognitive, physical, behavioral or psychological functions c.) Nausea, elevated heart rate, sweating, tremors, loss of appetite Delayed Stress Reaction a.) Post traumatic stress disorder i.) Typical delayed stress reaction that occurs from exposure to a high stress situation ii.) Symptoms are not evident immediately iii.) Produces night terrors, irritability, insomnia, inability to think clearly or concentrate, flashbacks, increased interpersonal conflicts, decreased ability to relate to others Cumulative Stress Reaction a.) Result of constant exposure to stressful situations that build over time b.) Burnout i.) Common cause of burnout ii.) State of exhaustion and irritability iii.) May include an increase in anxiety and irritability
What are oxygen humidifiers?
Add moisture to oxygen Container filled with sterile water, connected directly to the regulator
What is a normal blood pressure for an adult male?
Add the patient's age to a hundred (if under 40) for systolic Normal range for diastolic is between 60 and 85mmHg
How should you assess the chest during a rapid medical assessment?
Adequate rise and fall Retraction of the intercostal muscles Auscultate the breath sounds Crackles Wheezing
What is aspirin?
Administered to a patient who is having chest discomfort or pain that is related to the lack of oxygen getting to the heart May keep the vessels that deliver blood to the heart from completely closing shut
What is oral glucose?
Administered to the patient with a history of diabetes who is suspected of having a low blood glucose level Absorbed through the mouth and intestines and eventually in the blood Improvement of mental status Glucose is a simple sugar that is found in the blood a.) Primary energy source for the body cells b.) Brain cells can only use glucose for energy
What is pharming?
Adolescents who raid their parent's medical cabinets for prescriptions
How should you initially assess a spinal injury?
Adopt a high index of suspicion and must initiate in line stabilization Don't release until the patient is securely attached with head and neck to backboard Look for changes in mental status Don't get distracted from other injuries Spinal cord damage from a C spine injury can block nerve impulses traveling fro the brain to the diaphragm and intercostal muscles a.) Little to no movement in the chest or excessive abdominal muscle movement b.) Apply positive pressure ventilation with oxygen An injury to C3 to C5 may injure the phrenic nerve that controls the function of the diaphragm Categorize the patient as high or low priority
What are the National Fire Protection Association (NFPA) symbols?
Adopted an internationally recognized diamond shaped symbol which has four smaller diamonds Identifies potential danger with the use of background colors and numbers ranging from 0 to 4 (0 is little hazard, 4 is severe) Blue diamond - Gauge and health hazard Red - Fire hazard Yellow - Reactivity hazard White - Additional information
How should you ventilate a patient without a pulse?
Adult, 30 compression to 2 ventilations Infant and child, 30 to 2 for one person Infant and child with 2 people, 15 to 2 Newborn, 3 compressions to 1 ventilation
What are the advantages and disadvantages of using radio codes?
Advantages a.) Can shorten air time and provide clear and concise information b.) Can allow transmission of information in a way that cannot be understood by the patient, family members or bystanders Disadvantages a.) Codes are useless unless everyone understands them b.) Oftentimes medical info is too complex for codes
What are the advantages and disadvantages of mouth to mask ventilation?
Advantages a.) One EMT can do two handed mask seal technique b.) Eliminates direct contact c.) One way valve d.) Adequate tidal volumes e.) Supplemental oxygen can be administered Disadvantages a.) Mask has some risk of infection b.) EMT may fatigue c. ) Doesn't allow for the highest possible concentration of oxygen d.) Should be able to fit tightly on the face e.) Must have an oxygen inlet f.) Should be available in multiple sizes e.) One way valve
What is drug toxicity?
Adverse or toxic reaction to a drug May be caused by error Airway, oxygenation, prevention of aspiration
What is chronic bronchitis?
Affects the bronchi and bronchioles Associated with cigarette smoking Productive cough that persists for at least three consecutive months a year for two consecutive years Overview of the Disease Process a.) Involves inflammation, swelling and thickening of the lining of the bronchi and bronchioles and excessive mucus production b.) Alveoli remain unaffected c.) The inflamed and swollen bronchioles and thick mucus restrict airflow to the alveoli so that they do not expand fully d.) Leave scar tissue that narrow the airways
What does 'break' mean on the radio?
Afford a pause
Reducing stress after MCIs...
Approximately 2/3 of rescuers suffer long term reactions Any rescuer who becomes hysterical should be removed
What are the symptoms of withdrawal?
After a period of abstinence from alcohol or drugs Does not require that the patient stops taking substance completely a.) Alcohol withdrawal is dose dependent Alcohol withdrawal symptoms a.) Insomnia, muscular weakness, fever b.) Seizures or tremors, disorientation, hallucination c.) Anorexia, nausea or vomiting d.) Sweating, rapid heartbeat, hyperthermia
What is an initial assessment?
After scene safe, BSI Conducted on every patient regardless of the MOI or NOI Will find out a.) If patient is injured or ill b.) Identifying and managing life threatening conditions c.) Determining priorities for further assessment d.) Care on the scene vs immediate transport Identify and manage immediately life threatening conditions to the airway, breathing and circulation Form a general impression and assess mental status, airway, breathing, and circulation a.) Any life threatening condition that is identified must be treated immediately as found, before moving on to the next portion of the initial assessment Steps of the initial assessment a.) Form a general impression of the patient b.) Assess mental status c.) Assess the airway d.) Assess the breathing e.) Assess the circulation f.) Establish patient priorities
How should you perform a focused history on burn victims?
After treating all life threatening injuries, conduct the focused history and physical exam a.) Reassess the MOI and c/c Ask the following questions a.) How did the burn happen? b.) What caused the burn? c.) Was the patient exposed to an explosion or other significant MOI? d.) Did the patient lose consciousness at any time? e.) Was the patient confined in an enclosed space or found to inhale copious amounts of smoke? f.) How long ago was the patient burned? g.) What care was given by bystanders? h.) If the burn involved chemicals, what chemical? i.) If the burn was a scald, how did it happen? j.) Does the patient have any history of significant heart disease, pulmonary problems, diabetes, or any other condition that might increase the burn severity or complicate treatment?
What is active rewarming?
Aggressively applying heat to warm the patients body a.) Blankets, heat pack, hot water bath Heat should be added to patient gradually and gently
What is the pharynx?
Air entering the body through the mouth and nostrils travels into the pharynx (throat) Air from nasal passages enters through what is referred to as the nasopharynx a.) Air entering from the mouth enters through the oropharynx Nasopharynx and oropharynx enter into the pharynx at the back of the throat
How does air enter the nose and mouth?
Air enters into the nose where it is warmed, moistened and filtered as it flows over the damp, sticky mucous membrane lining of the nose Air also enters the mouth, where there is less filtration and warming
What is a pneumothorax?
Air in the chest cavity Can be caused even when there is no open wound to the chest
What is dead air space (VD)?
Air that fills the respiratory tract and never reaches the alveoli Take the tidal volume and subtract the dead air space and then multiply by the respiratory rate Dead air space does not change, therefore, changes in the other factors could be quite troublesome Must determine if the tidal volume is adequate or not
When should you consider requesting advanced life support?
Airway trauma, occluded airway, or indication that air from an injured lung is trapped in the chest cavity These decisions should not delay transport to the facility
What are some common medication names for bronchodilators?
Albuterol (proventil, ventolin) Metaproterenol (metaprel, alupent) Isoetharine (bronkosol) Bitolterol mesylate (tornalate) Salmeterol xinafoate (serevent) Ipratropium (atrovent) Levalbuterol (xoponex) Pirbuterol (maxair)
The digestive system is composed of the ___ ___, the passage through which food travels, and the ___ ___, organs that help prepare food for absorption
Alimentary tract Accessory organs
What is Charle's Law?
All gases will expand equally upon being heated As diver ascends, temp increases, gases will expand
What are precautions that should be taken to prevent drowning?
All pools should be fenced Children should constantly be supervised Water and alcohol do not mix PFDs must be worn when boating Avoid diving into shallow water Those with seizure disorders must be careful when in or around bodies of water
What is a paramedic?
All skills of the EMT and AEMT with addition of field impression, invasive and drug interventions as well as transport Reduce disability and death of patients
What is the incidence of drowning?
Approximately 4,500 deaths per year in US Third most common cause of accidental death a.) 40% are less than 5 b.) 85% of drownings are males c.) Often, alcohol is involved
How should you administer emergency medicare care to a infant with a mild foreign body obstruction?
Allow the child to cough Attempt to remove the object Provide blow by oxygen
What is the purpose of the muscular system?
Allows for movement Muscles work and contract when stimulated by a nerve impulse The cells of a muscle are called fibers, very threadlike
What is a pivot joint?
Allows for turning and motion Joints between the head and neck and the first and second cervical vertebrae and those in the wrist
Cardiac arrest in children...
Almost all is caused by respiratory arrest Provide PPV if breathing is inadequate Assume CPR and AED Signs a.) Unresponsiveness b.) Gasping or no respiratory sounds c.) No audible heart sounds d.) Chest is not moving e.) Pallor or cyanosis f.) Absent pulse Management a.) PPV with oxygen b.) CPR and AED c.) Call for ALS backup d.) Transport
What is a wheeled stretcher?
Also called a gurney or cot Most commonly used by rescue personnel Designed to accommodate up to 400 pounds Rescuer at the head pushes and the rescuer at the foot guides 4 rescuers can carry the stretcher over rough grounds Two basic types a.) Lift in cot i.) Requires two workers, one on each side and then loading and unloading from the ambulance b.) Roll in cot i.) Uses special wheels at the head to simplify the loading and unloading procedure Composition a.) 70 pounds, made of aluminum alloy The stretcher should never be left unattended
Considerations for patients using PCP...
Also called angel dust, killer weed, supergrass, crystal cyclone, hog, elephant tranquilizer, PeaCe Pill, embalming fluid, horse tranquilizer, mintweed, mist, monkey dust, rocket fuel, goon, surfer, KW, scuffle Stored in body fat a.) If a person suddenly loses weight, it can be realized again
What is an involuntary muscle?
Also called smooth muscle Made up of large fibers that carry out the automatic muscular functions of the body Move through rhythmic, wavelike movements Found in the walls of tubelike organs, ducts, blood vessels, etc
What is the large intestine?
Also called the colon The parts that cannot be absorbed by the body are passed as waste products from the small intestine to the large As this wastes move through the large intestine, water is absorbed Stool passes through the rectum and the anus
What is a health care durable power of attorney?
Also known as a health care proxy Designates a person who is legally empowered to make health care decisions for the signer of the document is unable to do so for himself
What is the mitral valve?
Also known as the bicuspid valve Between the left atrium and the left ventricle
Oral glucose may be administered only if the patient meets all of the following three criteria...
Altered mental status History of diabetes controlled by medication Ability to swallow
What medical problems can come from drug and alcohol emergencies?
Altered mental status Respiratory depression Damage to organs Seizures Cardiac arrest Hypo or hyperthermia Chronic a.) Cirrhosis, peritonitis b.) Alcohol crashes
What are some signs and symptoms of blunt trauma from falls, MVCs in the elderly?
Altered mental status Slower reflexes Failing eyesight and hearing Medication effects Arthritis Activities that exceeded physical limitations Blood vessels that are less elastic Fragile tissues, brittle bones, stiffer joints General loss in muscle tone and strength
What are some contraindications for activated charcoal?
Altered mental status Swallowed acids or alkalis Unable to swallow Overdoses on cyanide
When should you proceed with a rapid trauma assessment?
Altered mental status Unsure of the extent of the injury Cannot clearly identify the MOI Multiple injuries Critical findings were identified in the initial assessment If the patient is conscious, he can aid in identifying problems Make sure there is spinal immobilization first
What are the signs and symptoms of head injuries?
Altered mental status Decreasing metnal status Irregular breathing pattern Obvious signs of injury/visible scalp damage Pain, tenderness or swelling CSF from ears or nose Discoloration around the eyes Discoloration behind the ears Absent motor or sensory function Nausea or vomiting, forceful Unequal pupil size Diplopia - double vision Non-pursposeful movement Retrograde amnesia - patient is unable to remember circumstances leading up to the event Anterograde amnesia - patient is unable to remember circumstances after the incident
What are some signs and symptoms of methanol poisoning?
Altered mental status, seizures, nausea and vomiting Abdominal pain, blurred vision Dilated pupils that are sluggish to respond to light Seeing spots, blindness, dyspnea, tachypnea
What is a squat lift?
Alternative technique you can use if you have one weak leg, ankle Avoid bending at the waist Procedure a.) Place weaker leg slightly forward i.) Should stay flat on the ground the entire lift b.) Squat until you can grasp the cot using the power grip c.) Push yourself back up with your stronger leg i.) Make sure back is locked and upper body goes up before hips
What are some problems with some types of painful stimuli?
Always assess a central painful stimuli in a patient who isn't responding to verbal stimuli a.) Peripheral pulses may just send the signal back and make it appear like a purposeful movement Sternal rub is controversial a.) May not give accurate results
What safety measures should you take when approaching a scene with downed electrical lines?
Always assume that a downed power line is electrically alive The area must be secured to avoid accidental contact Area should be secured greater than 75 feet in all directions from the pole Advise patients that the electric company is in route Tell them to stay inside of the vehicle
What are the basics of good driving?
Always where seat belts Keep 2 hands on steering wheel Become familiar with the ambulance's acceleration and deceleration Maintain safe following distance Understands the capacity and limitations of vehicle Evaluates weather and road conditions
What happens during daily pre-run preparation?
Ambulance maintenance a.) Oil and filter changes, transmission, wheel, brake check Daily Inspection of Vehicle a.) You may be legally reliable for damage caused by a malfunctioning ambulance if you are aware of problem Ambulance Equipment a.) Must contain supplies and equipment b.) Should be checked every day Personnel a.) In most cases, one EMT in back b.) Sometimes two Dispatch a.) Should provide you with the following information i.) Location of call ii.) Nature of call iii.) Name, location, and callback number of call iv.) Location of patient or patients v.) Number of patients vi.) Any other problems or circumstances
The length of time the poison remains in the stomach depends on the ___.
Amount and effect of the poison
What is a respiratory volume?
Amount of air a patient takes in and out Also known as the tidal volume (Vt)
What are some factors that the severity of wounds depends on?
Amount of blood loss Other existing injuries or conditions Patient's existing medical problems Patient's age
What is a focused trauma assessment?
An exam focused on a specific injury site Followed by on-scene emergency care
What is inadequate breathing?
An insufficient or ineffective respiratory rate Signs of inadequate oxygenation, such as deteriorating mental status, pale, cool, clammy skin or cyanosis Difficulty in breathing (dyspnea), poor chest wall movement, retractions, nasal flaring, use of neck muscles, poor air exchange from the nose and mouth
How should you address impaled objects?
An object still embedded in the wound Should never be removed in the field unless in the cheek or neck where it is obstructing air flow through the trachea Procedure a.) Manually secure the object b.) Expose the wound area c.) Control bleeding d.) Use a bulky dressing to help stabilize the object
What is a sucking chest wound?
An open chest wound that can pull air into the thoracic cavity, sometimes with a noticeable sucking sound Prevent the air from being sucked into the chest cavity Avoid trapping the air that's already in the chest cavity Cover with a gloved hand a.) Apply a nonporous dressing and tape it on three sides
What is the anterior chamber (front chamber) of the eye?
Anterior to the iris and is filled with a watery fluid called the aqueous humor
What are the causes of tachycardia?
Anxiety, blood loss, shock, abnormal heart rhythms, heart attack, drug overdose, early hypoxia, fever
What is stress?
Any change in the body's internal balance Occurs when external demands become greater than personal resources
What are some limitations of a pulse oximeter?
Any condition that interferes with blood flowing to the attached area may produce an erroneous reading Shock or hypoperfusion Hypothermia Excessive movement Seizures Nail polish Carbon monoxide Cigarette smokers Anemia
What is a splint?
Any device used to immobilize a body part Can be soft or rigid
What are some indications for oxygen use?
Any patient in cardiac arrest or respiratory distress Signs of hypoxia Medical conditions like stroke, heart attack, OD, toxic inhalation, suffocation, allergic reactions, seizures, poisoning , asthma Any patient with altered mental status Injuries to body cavity Multiple fracture and soft tissue Severe bleeding Shock Toxins such as CO and cyanide
What are some emergency procedures for hazardous materials rescues?
Anyone entering the warm zone or the hot zone must be wearing the proper protective equipment Initial gross decontamination will be performed at the entry of the warm zone An initial assessment will be performed in the warm zone All of the PPEs will be removed before entering the cold zone If you are accidently exposed to hazardous materials, decontaminate yourselves fully All rescuers should have a thorough medical examination and medical surveillance to treat any exposure Decontaminate equipment and vehicle
The left ventricle pumps oxygen rich blood to the ___ and the rest of the body.
Aorta
Cold application in bleeding wounds...
Application of ice or a cold pack to the site of injury will facilitate the clotting process, promote vasoconstriction and reduce swelling Never apply ice packs directly to the skin
Safety measures for water ice...
Apply sand, salt or gravel to walks, steps or roads Avoid walking onto frozen ponds, lakes or other bodies of water If the surface is safe, a tarp, rug or other nonskid surface should be brought to the patients side
What is the one person technique for bag valve mask ventilation?
Apply the mask with one hand EC Head tilt chin lift Squeeze with the other hand
What are the symptoms of s stroke?
Are associated with the area of the brain that has been affected Most often affects speech, sensation and muscle function Often sudden and may be accompanied by seizure, headache and dysphagia or dyspnea Paralysis is a common sign a.) Facial droop b.) Monoplegia or hemiplegia c.) Side opposite of the affected area d.) If both sides are affected, facial droop on one side and hemiplegia on the other Altered mental status a.) Confusion to dizziness to unresponsiveness b.) Speech may be slurred (dysphasia) or absent (aphasia) c.) May utter nonsensicalwords (fluent aphasia) d.) Double vision in one eye, or loss of a visual field
What are some types of emergency moves?
Armpit-forearm drag Shirt drag Blanket drag
What does the prefix 'peri' mean?
Around
Bright red blood spurting from the wound is a grave sign of...
Arterial bleeding
What is arteriosclerosis?
Arteries lose their elasticity Drop in baroreceptor sensitivity a.) Monitor the blood pressure b.) Orthostatic hypertension
What are the dorsalis pedis arteries?
Artery of the foot Can be felt on the top surface of the foot on the big toe side
How do burns affect the gastrointestinal system?
As blood flow is decreased, blood will be rerouted from this system to the rest of the body Nausea or vomiting are common in burns of greater than 10% BSA a.) Long term stress can cause ulcers
If a puncture occurs to the visceral pleura, the parietal pleura or both occurs, the seal is broken and air is sucked into the pleural space each time the chest wall expand...
As the pleural space expands, it creates pressure on the lung and the lung collapses leading to a pneumothorax Air that flows in is not contributing to gas exchange Patient becomes hypoxic
What is the bends? What causes it?
Ascending to rapidly Nitrogen bubbles In blood and tissue May occur up to 72 hours after dive
What does 'spell-out' mean on the radio?
Asking sender to spell
How should you assess the extremities during a rapid trauma assessment?
Assess first the lower and then the upper extremities Inspect for DCAPBTLS Major bleeding will be concern Check for PMS
How should you assess the extremities during a detailed physical exam?
Assess the Lower Extremities a.) Look for DCAPBLS b.) Edema in the ankles may be a sign of cardiac failure c.) Assess PMS Assess the Upper Extremities a.) Inspect from shoulder to finder tip b.) Look for DCAPBLS c.) Assess PMS
How should you assess eye injuries?
Assess the eyes separately Orbits - BSLR The lids - BLS The conjunctivae a.) Redness, pus, and foreign bodies The globe a.) Redness, abnormal coloring, and laceration The pupils for size, shape, equality, and reactivity to light Follow your finger and you move it left and right, up and down a.) Look for abnormal gaze, paralysis of gaze, or pain on movement Suspect serious damage if the patient has a loss of vision that does not improve when he blinks, loses part o the field of vision, has severe pain in the eye, has double vision, or unusually sensitive to light
How should you perform a focused history and physical exam on a seizure patient?
Assess the head and pupils You may find weakness or paralysis on one side of the body If the weakness does not subside, seek medical care Some muscle contractions are so severe that a bone injury or dislocation may result Assess and record baseline vitals a.) Heart rate and respirations may be elevated b.) Skin is commonly warm and moist Check BGL and administer glucose if indicated Gather sample history a.) Was the patient awake? b.) Was the muscle activity twitchy or jerky? c.) Was the muscle activity isolated or generalized? d.) When did the seizure start and how long did it last? e.) Did the patient have an aura? f.) Did the patient fall or hit his head? g.) Did the patient bite tongue? h.) Was there loss of bowel or bladder control? i.) History or fever, headache or stiff neck? j.) Any allergies, what medications do they take? k.) Did the patient take his seizure medication? l.) Was this seizure typical m.) When was the last time they ate? n.) Events prior?
How should you assess a person with altered mental status?
Assess the level of orientation (time, place, person) a.) Do you know what year, month and day it is? b.) Can you tell me where you are right now? c.) Who is this person with you? d.) What is your full name? e.) If he can answer all of the question, this is documented as alert and oriented x 3 i.) Orientation of time is usually the first to be lost Verbal stimulus a.) Respond with inappropriate words b.) With incomprehensive sounds c.) Eye opening or obeying a command d.) No response to verbal stimulus Painful stimulus a.) Purposeful movements aimed at attempting to remove the stimulus b.) Non purposeful movements noted by flexion or extension c.) No response
When should you remove or leave a helmet in place?
Assess the patient's airway and breathing Assess the fit of the helmet and the likelihood of head movement Determine your ability to gain access to the patient's airway if intervention should be necessary to assist his breathing You should leave the helmet in place if your assessment reveals the following a.) The helmet fits well and there is little movement b.) There are no impending airway or breathing problems c.) The removal would cause further injury to the patient d.) You can immobilize the patient without removing it e.) The helmet doesn't interfere with your ability to assess and reassess airway and breathing You should remove the helmet if your assessment reveals the following a.) Interferes with ability to assess A and B b.) Helmet does not fit well c.) The helmet will interfere with proper spinal immobilization d.) The patient is in cardiac assess
Safety measure for crash scenes...
Assess the total crash scene a.) Is the vehicle stable? b.) If not, can you safely make it stable? c.) Are power lines involved? d.) Does jagged metal or broken glass pose a threat? e.) Is there fuel leaking? f.) Is there a fire? g.) Are there hazmat involved? Protecting Yourself and Others at the Crash Scene from Being Struck by Traffic a.) Always remain alert i.) Limit your time on scene ii.) Shut down traffic iii.) Place flares or cones iv.) Place apparatus and vehicles strategically so that they protect the scene v.) Wear bright and reflective clothing vi.) Do as much work as possible away from traffic flow vii.) Don't turn your back to moving traffic viii.) Don't jump highway dividers ix.) Reduce unnecessary scene lighting x.) Turn the wheels of the parked emergency vehicles so they are pointed away from the scene xi.) Avoid stopping and standing between vehicles
How is breathing rate assessed?
Assessed by looking at the rise and fall of the chest
How do you assess for and treat emphysema with emergency medical care?
Assessment a.) Malaise and decreased appetite b.) Fever c.) Cough d.) Dyspnea, tachypnea e.) Chest pain f.) Decreased chest wall movement g.) Patient may splint his thorax with his arm h.) Crackles and rhonchi may be heard on auscultation i.) Altered mental status j.) Diaphoresis k.) Cyanosis l.) SpO2 < 95% Emergency Medical Care a.) Ensure oxygenation b.) Not expect a patient to have an MDI
How should you approach a child with a high fever?
Assessment Considerations a.) Degree is not always big concern, how fast did the temperature spike b.) Dehydration due to abnormal loss of fluids i.) Nausea, loss of appetite, vomiting, possible fainting i.) Rapid and weak pulse, pale skin, sunken eyes, dry mucous membranes i.) Sunken fontanelle Emergency Medical Care a.) Administer oxygen b.) Remain alert for seizures
What is scene safety?
Assessment of a scene to ensure the well being of the EMTs their patient or patients and any bystanders It is dynamic and ongoing The EMT must take control of the scene
What is pediatric field scoring?
Assigning a numeric score to each major body system Takes weight into account
What is a home artificial ventilators? How should the EMT deal with one?
Assist breathing in a patient who cannot breathe adequately on their own Manually ventilate with BVM Establish airway Provide PPV every 3 seconds Transport to the hospital
What do dilated pupils indicate?
Pupils that are dilated (too large) may indicate cardiac arrest or the use of certain drugs
What are the signs and symptoms of altered mental status with unknown history?
Associated with trauma a.) Signs of trauma b.) Abnormal respiration pattern c.) Increased or decreased heart rate d.) Unequal pupils e.) High or low BP f.) Discoloration around eyes or behind ears g.) Pale, cool, moist skin h.) Flexion or extension i.) Decorticare or decerebrate Associated with illness a.) Abnormal respiration pattern b.) Dry or moist skin c.) Cool or hot skin d.) Pin-point, midsize, dilated or unequal pupils e.) Stiff neck f.) Lacerations to tongue indicating seizure activity g.) High systolic BP, low heart rate h.) Loss of bowel or bladder control i.) High or low glucose reading
How would you administer emergency medical care to a child with altered mental status?
Assure airway patency Be prepared to suction Administer oxygen Transport
How should you administer emergency medicare care to a child with severe foreign body obstruction?
Assure the patient you're there to help Position yourself behind the patient and reach your arms around abdomen Locate the naval and place the thumb side of one clenched fist between naval and the xiphoid process Wrap the other hand over clenched hand Deliver five abdominal thrusts inward and upward at 45 degree angle Continue
What are the four type of drowning categories?
Asymptomatic a.) No signs of drowning Symptomatic a.) Altered mental status and vitals b.) Dyspnea c.) SpO2 reading, low d.) Persistent cough Cardiac Arrest a.) No pulses, apnea b.) Approximately half are asystole c.) One third are vfib or vtach Obviously dead a.) Rigor mortis b.) Dependent lividity
What are non-shockable rhythms for an AED?
Asystole Pulseless electrical activity (PEA)
What is Boyle's Law?
At a constant pressure, the volume of gas is inversely related to pressure When suddenly ascending, air in lungs will expand (baraotrauma or rupture of alveoli)
What is the pituitary gland?
At base of the brain Regulates growth, thyroid and p thyroid, the pancreas, the gonads, metabolism of fatty acids and some basic proteins, blood sugar reactions and urinary excretion
What is Henry's Law?
At constant temp, the amount of gas that dissolves in a liquid it is in contact with is proportionate to the pressure of the gas around it a.) Bubbles form in blood and tissues
What is the aortic valve?
At the base of the aortic artery in the left ventricle
What is the pulmonary valve?
At the base of the pulmonary artery in the right ventricle
At what level of government is the EMS system controlled?
At the state level, each state controls it's own EMS system. The National Highway Traffic Safety Administration (NHSTA) provides a set of standards called the Technical Assistance Program Assessment Standards.
Electrical impulse in the hearts starts at the sinoatrial (SA) valve, then travels to the __ node, which is located between the atria and the ventricles.
Atrioventricular (AV)
Oxygen is carried to the blood in two ways...
Attached to hemoglobin and dissolved plasma 97% vs 3%
What is the fibula?
Attached to the tibia at the top and is located at the lateral side of the leg parallel to the tibia
In could water drownings, you should...
Attempt resuscitation on any pulseless, nonbreathing patient who has been submerged in cold water a.) Not pronounced dead until after warming
What are the two methods of measuring blood pressure?
Auscultation Palpation
What is the autonomic nervous system?
Automatic and influences the activities of involuntary muscles and glands Partly independent of the rest of the nervous system
What is the automatic nervous system?
Automatic and influences the activities of involuntary muscles and glands.
What is considered normal breathing?
Average chest wall motion Does not use accessory muscles of the chest, neck or abdomen Rate is normal and inhalations are neither prolonged or short Breathing is quiet
What are some general rules for hazardous materials rescues?
Avoid contact with any unidentified material, regardless of the level of protection offered by your clothing and equipment Three general priorities a.) Protect the safety of rescuers and victims b.) Provide patient care c.) Decontaminate clothing, equipment and vehicle Avoid risking your health and life if the only threat is to the environment Secure the scene and limit the exposure of rescuers and bystanders a.) Make sure there is enough additional equipment and personnel b.) Make sure that every rescuer has adequate PPE
How should you perform scene size up, initial assessment, and rapid trauma assessment in patients with external bleeding?
BSI, scene safety Take notice of the MOI and the number of patients Gather a general impression a.) Mental status and significant bleeding b.) Control the bleeding immediately with direct pressure Ensure patient has a patent airway a.) Apply nonrebreather mask b.) Assess central and peripheral pulses, skin and capillary refill Control the bleeding, but be sure to continue the initial assessment Perform the rapid trauma assessment Obtain two sets of baseline vitals
What is diabetic ketoacidosis (DKA)?
BGL is elevated (typically greater than 350mg/dL) due to an inadequate amount of glucose Cells begin to burn fat for energy as the glucose collects in the blood a.) Excess glucose begins to spill into the urine drawing water with it b.) In place of the glucose they cant take in, the cells are burning fat for energy which produces a byproduct called ketones i.) Produce a form of a strong acid
How to deal with an injury to the globe (eye)?
BLA, foreign objects Overnight use of contact lenses a.) Corneal abrasions b.) Inflammation c.) Corneal ulcers Signs and symptoms a.) Pear or irregular shaped eyeball b.) Blood in the anterior chamber of the eye (hyphema) c.) Treatment d.) Apply patches to both eyes e.) Avoid the use of cold packs
How should you conduct a scene size up and initial assessment for musculoskeletal injuries?
BSI and determine MOI and scene size up General impression ABCs Puslelessness or cyanosis distal to an injured extremity is a serious condition a.) If this is apparent, transport after immobilizing b.) Can indicate an arterial compromise which may cause impaired tissue perfusion, possible tissue death and limb loss Immobilize en route if necessary
How should you perform scene size up and initial assessment in a shock patient?
BSI and scene safety Take note of MOI Assess ABC Provide oxygen or positive pressure ventilation
What is an electrical burn?
Because bones, muscles, and other tissues offer resistance to the electrical energy passing through them, the byproduct is heat which results in internal burns The clothing may ignite
How should you ventilate a patient with a stoma or tracheostomy tube?
BVM to tracheostomy tube ventilation a.) Can connect directly to the tracheostomy tube b.) May be necessary to seal mouth and nose c.) Suction with a soft catheter d.) Attempt to seal the stoma and ventilate through the mouth and nose BCM to stoma ventilation a.) Remove all coverings b.) Clear the stoma c.) You will not need to perform a head tilt chin lift d.) Select a mask and seal e.) Deliver breaths Mouth to stoma ventilation a.) Not recommended b.) Use a barrier device if there is no other option
Poor posture can fatigue ___ and ___ muscles.
Back and abdominal muscles
Where should you assess skin temperature?
Back of your gloved hand to the abdomen, face or neck
What is a disaster communication system?
Backup system in case one fails
What is the amniotic sac?
Bag of waters Insulate and protects baby Usually carries around 500-1000 mm of liquid Usually tears at the onset of labor Lubricates the birth canal and removes any bacterial
What is a bandage? What are different types?
Bandage used to secure a dressing Self adhering Gauze rolls Triangular bandage Air splint
Safety measures for barroom scenes...
Barrooms are dark a.) Might consider wearing sunglasses before hand Have partners stand and survey the scene at all time
What are the four types of responders...
Basic Life Support a.) First Responder - The first person on scene with emergency medical training b.) EMT-Basic i.) Control of life threatening situations ii.) Stabilizing non life threatening situations iii.) Using non medical Skills Advanced Life Support a.) EMT-Intermediate - Human systems, pharmacology, etc b.) Paramedic - IV Lines, medication, breathing tube, etc
How should patients be packaged for air transport?
Be sure that the contaminated patient is decontaminated Have the airway managed with an endotracheal tube prior to the arrival of the aircraft Leave the chest accessible Be sure the backboard can be accommodated Be sure the patient is well secured to the backboard Secure loose equipment Communicate to the patient what you are doing Cover the patient's eyes, ears and exposed winds Consider having wet the landing zone Have rescuers remove loose clothing Do not approach the aircraft with the patient until instructed Lay an IV bag on the chest in stead of holding it up Minimize the number of people under the rotors at one time
What is the one handed carry technique?
Be sure to keep your back licked Avoid leaning to the opposite side too much to compensate for the imbalance Procedure a.) Stagger your feet with one knee up and one pointing toward the ground b.) Bend at the hips, not the waist and don't let your trunk go farther than 45 degrees c.) Drive upward through the arch and heel of the front foot and the ball of the back foot
How should you perform a focused history and physical exam for a patient with a chest injury?
Begin with a rapid trauma assessment Assess breathing status Assess the neck and chest a.) Subcutaneous emphysema i.) Air trapped under the skin giving it a bubbly appearance and makes a cracking sign when palpated Apply a c collar Expose the chest Palpate for symmetry and crepitation Auscultate breath sounds bilaterally Inspect the abdomen for excessive muscle movement during breathing Assess baseline vitals Immediate transport
What is the first stage of labor (dilation)
Beginning of contractions to complete cervical dilation First and longest stage, fully dilated at 10cm Usually begin with aching sensation in small of back a.) Evolve into cramps in lower abdomen Regular intervals a.) 30 to 60 seconds b.) At first 10 to 20 minutes apart Appearance of the plug of mucus (blood show) may happen during this phase Amniotic sac may rupture before May continue up to 18 hours a.) Typically between 8 and 10 hours for first time mother b.) Can be 5 to 7 for women who had child before Dilation ends when contractions are at 3 to 4 minute intervals (60 seconds each)
What is the second stage of labor (expulsion)?
Begins with complete cervical dilation and ends with delivery of baby Contractions are between 2 to 3 minutes apart and last 60 to 90 seconds Mother feels pressure in her rectum, like a bowel movement (imminent delivery) May feel back pain and more bloody discharge Perineum a.) Area of skin between the vagina and the anus bulges Crowning
What is the third stage of labor (placental)?
Begins with delivery of baby and ends with delivery of placenta Usually delivered 5-20 minutes following birth Will continue t have less severe contractions Sudden increase in bleeding, uterus becomes smaller, umbilical cord lengthens, mother has an urge to push Never pull on cord
What is the vitreous body?
Behind the lens is the large vitreous body Filled with a clear jelly called the vitrous humor
Where can the posterior tibial artery pulse be felt?
Behind the medial ankle bone
What does the prefix hypo mean?
Below normal
What is flexion?
Bending toward the body or decreasing the angle between the bones or parts of the body
What is a metered dose inhaler?
Beta 2 specific bronchodilator metered dose inhaler (MDI) is commonly prescribed Need to contact medical direction before administering Administration a.) Breathe slowly and deeply i.) Hold breath, breathe out slowly through pursed lips Medication Form a.) Aerosolized metered dose inhaler Dosage a.) Total number of times is determined my medical direction (3) b.) One puff is one post Actions a.) Beta 2 agonist relaxes the bronchiole smooth muscle and dilates lower airways Reassessment a.) Reassess vital signs b.) Questions the patient about the efficacy c.) Perform focused history and physical exam d.) Constantly monitor the airway and breathing status e.) If the medication has had no or little effect, consider another dose f.) Document any findings during the reassessment
What are heart valves?
Between the chambers of the heart Keep the blood flowing in one direction and prevent the backflow of blood
What is the potential space?
Between the pleural layers Pressure between the pleura acts like a vacuum
What is the tricuspid valve?
Between the right atrium and the right ventricle
What is the peritoneal cavity?
Between the two layers is a small amount of fluid that serves as a lubricant to reduce friction
What are Battle Signs?
Purplish bruising behind the ear Delayed sign of basilar skull fracture
What types of WMDs can be detected?
Biological agents and radiation are odorless and colorless Will be identified only after the onset of effects
What is precipitous delivery?
Birth of the fetus occurs with less than 3 hours of labor Seen most often in patients who have delivered several children (multipara) Increased risk of trauma to fetus Same delivery
What is ecchymosis?
Black and blue discoloration
What are some side effects of activated charcoal?
Blackening of the stools Vomiting
What is pericardial tamponade?
Bleeding into the tough fibrous sac that surrounds the heart Inward compression of the heart which causes cardiac output to drop and blood to back up into the venous system Life threatening condition
How should you assess the nose during a rapid trauma assessment?
Bleeding or leakage of cerebrospinal fluid Suction if necessary
What is a subarachnoid hemorrhage?
Bleeding that occurs between the arachnoid membrane and the surface of the brain Can be fatal in minutes
What is epidural bleeding?
Bleeding that occurs between the dura mater and the skull, involves the brain's most outermost arteries May have no permanent effects
What is a pulmonary embolism?
Blockage in the arteries of the lungs Dyspnea, chest discomfort, syncope Oxygen, monitor breathing, PPV is necessary
What is an intestinal obstruction?
Blockage of the inside of the intestine Can be caused by adhesions (sticking together or the sides of the intestines), hernia, fecal impaction or overloading, or tumors a.) Blockage of small intestine (adhesions or hernia) b.) Blockage of large intestine (tumors, impaction)
What is an arterial gas embolism? What are the signs and symptoms?
Blocking of blood vessels by an air bubble Interferes with perfusion Air in lungs rapidly expands, rupturing the alveoli and damaging vessels Signs and Symptoms a.) Itching, mottled skin b.) Difficulty in breathing c.) Dizziness, chest pain d.) Severe deep muscle pain e.) Blurred or distorted vision f.) Partial deafness g.) Nausea or vomiting h.) Weakness and numbness i.) Staggering gait j.) Numbness or paralysis k.) Coma l.) Swelling and crepitus in neck m.) Frothy blood in nose or mouth n.) Loss of memory o.) Behavioral changes p.) Cardiac or respiratory arrest
What does cool, clammy skin indicate?
Blood loss, fright, nervousness, anxiety, pain or other medical conditions Shock (hypoperfusion)
What are abdominal injuries?
Blunt trauma to the abdomen is especially lethal because of the large number of organs that can be affected Can be open or closed Open wounds to the abdomen are much more dramatic and easier to find upon assessment than closed wounds Have a very high index of suspicion
What are some types of internal bleeding?
Blunt trauma, abnormal clotting, rupture of a blood vessel or vascular structure and certain fractures (especially fractures) Can result in severe blood loss with shock and even death all in a matter of minutes
What is compensatory shock?
Body is able to use normal defense mechanisms to maintain perfusion and function No signs or symptoms Body detects a drop in BP, signals heart to increase rate and blood vessels to constrict Increase in heart rate and strength of contractions (cardiac output) Vasoconstriction (increase in systemic vascular resistance) Release of epinephrine and norepinephrine from the adrenal medulla gland Closing of peripheral capillary sphincters, preventing blood from entering the capillaries in the peripheral tissue a.) Helps shunt blood to the core of the body but causes the peripheral cells to become ischemic (hypoxic) Signs and symptoms a.) Normal BP b.) Narrow pulse pressure c.) Slight elevation of heart rate (<100) d.) Weaker pulse e.) Anxiousness f.) Slightly pale and cool skin
A traction splint accomplishes two goals...
Bone ends will be realigned which will prevent further injury and reduce pain The diameter of the thigh will be decreased which will allow less blood to accumulate which will indirectly put pressure on the bleeding bones
What do ligaments do?
Bone to bone
What are some anatomical differences in the extremities of children?
Bones will fracture from bending or splintering Motor development occurs from the head to the toes
What are orbits?
Bony structures around the eyes or eye sockets
What are some general rules for splinting?
Both before and after application, apply PMS and cap refill Immobilize the joints above and below a long bone injury a.) Immobilize the bones above and below a joint injury Cut around clothing Cover all wounds with sterile dressing before applying a splint Never intentionally replace protruding bones Pad each splint to prevent pressure and discomfort Apply the splint before trying to move the patient When in doubt, splint If the pt shows signs of shock, align in normal anatomical position and transport immediately If there is severe deformity or the distal extremity is cyanotic or lack pulses, align the injury with manual traction before pulling a.) Make one attempt to align the extremity b.) Stop if pain, resistance or crepitus c.) Generally, don't try to align a wrist, elbow, knee, hip or shoulder
What are airway adjuncts?
Both extend near, but do not pass the larynx Things to remember a.) Adjunct must be clean and clear of obstructions b.) Proper size must be chosen c.) Do not protect the airway from secretions d.) Mental status of the patient will determine whether or not an adjunct can be used e.) A head tilt chin lift must still be maintained
What does bilateral mean?
Both left or right
What is a consensual reflex?
Both pupils will have the same response
What is the parasympathetic nervous system?
Returns body processes to normal or depresses body function
What is diastolic blood pressure?
Bottom, number The amount of pressure on the artery walls while the ventricle is at rest Recorded when Korotkoff's sound disappears or changes drastically
Where should you assess the pulse in a child of 1 year old or less?
Brachial pulse
What results when the patient who has an adequate tidal volume but has respiratory rate that is too slow?
Bradypnea
What does the prefix cerebro mean?
Brain
What is the central nervous system (CNS)?
Brain and spinal cord
Which organs are especially vulnerable to hypoperfusion?
Brain and spinal cord, only 4-6 minutes Kidneys only 45 minutes Skeletal muscle, 2 hours Heart, lungs, brain, lungs, kidneys
What is the skull?
Brain occupies 80-90% of the space inside the skull Surrounded by large plates of fused bone called the cranial skull Composed of 14 irregularly shaped bones
What is an open head injury?
Break in the skull Direct local damage and brain damage due to infection, laceration, or punctures of the brain
What as an encoder?
Breaks down sound waves into unique digital codes, like those used in CD players
What does the prefix pne mean?
Breathing
What is respiration?
Breathing Cold air from atmosphere and warm air from the lungs 10-20% of heat loss
What are the key components of baseline vitals?
Breathing a.) Assess rate, tidal volume, and quality of breathing b.) Normal, shallow, labored, deep or noisy Pulse a.) Radial pulse and in brachial pulse b.) If no radial, move to carotid Skin a.) Color, temperature and condition b.) Cap refill Pupils a.) Look for size and reactivity Blood pressure a.) Auscultation b.) Pulse pressure Should be reassessed and recorded every 5 to 15 minutes
Explain the inhalation route of poisonings...
Breathing a poison Transported down respiratory tract More immediate effect than ingestion
What are some anatomical differences in the respiratory system of children?
Breathing is inadequate after rate reaches 60 breaths per minute Will breathe at a rate two to three times faster than adults
What is considered an abnormal respiratory rate?
Breathing that is too fast or too slow (ranges of 10-24 for an adult, 15-30 for a child, 25-50 for an infant
How do you know bleeding is arterial?
Bright red and spurting (rich in oxygen) Spurting coincides with the pulse or contraction of the heart Hard to control because of the high pressure in the artery
How can the EMT reduce the patient's anxiety?
Bring order to the environment a.) Quiet scene, contain pets b.) Remain calm and non-confrontational Introduce yourself a.) Address them formally Gain patient consent a.) Necessary before providing care b.) Try to convince the patient if they refuse Position yourself a.) Position yourself at a comfortable level b.) Eye level are equal c.) Not too close Be courteous a.) Resist yielding to stresses b.) Try to understand why people behave as they do Use communication skills a.) Maintain eye contact b.) Speak calmly and deliberately c.) Talk confidently d.) Body movements should be purposeful e.) Actively listen Use touch when appropriate a.) Touching the patient is a powerful comfort measure b.) Use eye contact c.) Hold a hand, pat a shoulder, or lay your hand on the forearm
What is in line stabilization?
Bringing the patient's head into a neutral in-line position and holding it there Place one hand on each side of the patient's head Gently bring the head into a position in which the nose is in line with the patient's navel Position the head neutrally so the head is not extended or flexed
What is a fracture?
Broken bone
What is bronchoconstrition or bronchospasm?
Bronchioles of the lower airway are significantly narrowed from inflammation, swelling, and constriction of the muscle layer Drastic increase in resistance to air flow in the bronchioles
What is the brown recluse spider? What are the effects of its bite?
Brown, can range from yellow to dark chocolate brown Brown, violin shaped marking on back Bite does not usually heal and needs surgical repair Several hours after bite, becomes bluish surrounded by a white periphery, red halo, bulls eye Within 7 to 10 days, bite becomes an ulcer
What is a contusion?
Bruise Injury to the tissue and blood vessels contained within the dermis Will cause localized swelling and pain at the injury site Discoloring at the site caused by blood leaking from damaged vessels and accumulating in the surrounding tissue
What is a brain contusion?
Bruising and swelling of the brain May causes bleeding in surrounding tissue Usually caused by coup-contrecoup acceleration/deceleration injury Coup-contrecoup injury a.) Damage at the point of a blow to the head and damage to the opposite side Acceleration/deceleration injury a.) Head comes to a sudden stop but the brain continues to move back and forth in the skull
What is a brain contusion?
Bruising or swelling
How should you deal with eyelid injuries?
Bruising, burns, lacerations Richly supplied with blood vessels Treatment a.) Control bleeding with light pressure b.) Cover the lid with sterile gauze soaked in saline c.) If eyeball injury is not suspected, cover in cold compress
What is an esophageal varice?
Bulging, engorgement or weakness of the blood vessels in the lining of the lower part of the esophagus Common to alcohol drinkers or patients with liver disease Caused by increased pressure in the venous blood supply system of the liver, stomach and esophagus Painless bleeding in the digestive tract Can be profuse and lead to shock
What kind of items cause penetrating injuries?
Bullets, darts, nails, knives Kinetic energy is biggest factor
After traveling to the sinoatrial valve, and the atriventricular valce, electrical impulses in the heart travel finally to the __ __ __ to the ___ ___ to the ventricles.
Bundle of His Purkinje fibers
How do burns affect the circulatory system?
Burn injuries can cause extreme fluid loss and increased stress on the heart Burns increase capillary permeability, or the ability of fluid to exit from the vessels abnormally a.) Decreases the fluid volume inside the cells As fluid leaks from the damaged tissue cells to areas between the cells, it creates edema (swelling), which can further compromise tissue perfusion to local capillary beds as well as perfusion to distal tissues
What are particularly difficult burns to deal with?
Burns to the face are considered critical because of respiratory compromise as are injuries to the eyes and ears Hands and feet because of loss of function Genital and groins Joints
What are some signs and symptoms of acid and alkali poisoning?
Burns, dysphagia Pain to lips, mouth and throat Abdominal pain Hoarseness and dysphagia Stridor Dyspnea Evidence of shock
What are the signs and symptoms of abdominal injuries?
CALP Pain that may be initially be mild, then worsening Tenderness or palpation to areas other than the site of injury Rigid abdominal muscles Patient lies with his legs drawn up to the chest Distended abdomen Discoloration around the umbilicus or to the flank Rapid, shallow breathing Signs of shock Nausea and vomiting Abdominal cramping possibly present Pain may radiate to either shoulder due to irritation of the diaphragm Weakness
What are the keys to dealing with multiple casualty incidents?
Call for plenty of help early Getting enough help, positioning vehicles properly, giving appropriate emergency medical care, transporting patients efficiently, providing follow up care
What is the cerebellum?
Called the small brain Located in the posterior and inferior aspect of the cranium Coordinates muscle activity and maintains balance It can hold muscles in a stat of partial contraction
What is the purpose of assessing breathing rhythm?
Can be affected by speech, activity, emotions and other factors Irregular pattern in a patient with an altered mental status is a serious concern
If there is no response when you speak to the patient, you should try painful stimulus...
Can be applied either centrally or peripherally... Central a.) Core of the body b.) Trapezius pinch i.) Pinch it by grasping 1 to 2 inches of the trapezius and squeeze the muscle c.) Supraorbital pressure i.) Slide your finger under the upper ridge of the eye socket and apply upward pressure d.) Sternal rub i.) Apply downward pressure to the center of the sternum with knuckles e.) Armpit pinch i.) Pinch the skin and underlying tissue along the margin of the armpit Peripheral painful stimuli a.) Nail bed pressure i.) Cuticle of the nailbed b.) Pinch the web between thumb and index finger c.) Pinch the finger, toe, hand or foot
How do we assess skin temperature? What do the various temperatures mean?
Can be assessed by placing the back of your hand against the patient's skin Hot - Fever or exposure to heat Cool - Inadequate circulation, shock, exposure to cold Cold - Extreme exposure to cold
How should you deal with injuries to the neck?
Can be blunt or penetrating Air bubbles may enter a lacerated vein Fractured larynx and collapsed trachea Do not overlook c spine injury a.) Signs and symptom i.) Obvious swelling ii.) Difficulty speaking iii.) Loss of voice iv.) Airway obstruction v.) Crepitation vi.) Displacement of trachea Jugular vein laceration could permit development of an air embolism a.) Must apply occlusive dressing
How are tendons and ligaments injured?
Can be bruised, crushed, cut, or torn
How should infants and toddlers be positioned and transported?
Can be carried in a car seat
What is heat exhaustion?
Can be caused by extreme physical exertion Mild state of shock Pooling of blood in the vessels just below the skin Loses large amounts of water and salt In such cases, patient's skin will be normal to cool in temperature, either pale or ashen gray in color and sweaty
What is a SAMPLE history?
Can be conducted when the assistant is doing rapid trauma assessment or vital signs Signs and Symptoms Allergies Medications Pertinent past medical history Last Oral Intake Events Prior to
What are the signs and symptoms of active labor?
Can be expected in a few minutes if a.) Crowning has occurred b.) Contractions 2 minutes apart and 60-90 seconds c.) Patient feel's infant head moving d.) Strong urge to push e.) The patient's abdomen is hard If delivery does not occur within 10 minutes, request permission to transport a.) Take BSI b.) Do not touch vaginal area c.) Do not allow the patient to use the bathroom d.) Do not hold legs together e.) Use sterile obstetrics (OB kit) i.) Scalpel or scissors ii.) Cord clamps or cord ties iii.) Umbilical tape iv.) Bulb syringe v.) Towels vi.) Gauze sponges vii.) Sterile gloves viii.) One infant blanket ix.) Large plastic bag x.) Germicidal wipes
Examples of heart injuries...
Can be hurt by open and closed injury Can lead to ineffective pumping or to severe blood loss
What is pulse quality?
Can be strong or weak, regular or irregular
How should you perform bag valve mask ventilation with a patient with no suspected spinal injury?
Can be used by one or two EMTs One holds a tight seal and the other delivers the pump
What are pressure dressings?
Can be used to maintain control of bleeding Types a.) Cover the wound with several sterile gauze dressings or a sterile bulky dressing b.) Apply direct pressure c.) Bandage firmly d.) If the blood soaks through the original dressing and bandage, indicating severe continued severe bleeding, remove them and apply direct finger tip pressure
What are the effects of tick bites?
Can carry rocky mounted spotted fever or Lyme Disease Removal of the tick
How do you remove soft contact lenses?
Can cause damage if they are in for a long time Can adhere to the cornea Place several drops of saline on lens, then gently lift off the eye by pinching the lens between thumb and index Procedure a.) With your middle finger, pull the lower lid down b.) Place your fingertip on the lower edge of the lens, then slide the lens down the sclera c.) Compress the lens between thumb and index finger d.) Store in water or saline solution
What is the tongue?
Can cause obstruction when the muscles (submandibular muscles) relax
What is Alzheimer's disease?
Can cause patient to stop eating, become immobile and eventually subject to numerous infections Can cause confusion, emotional depression, irritability, violence
How should you care for electrical burns?
Can cause severe damage not only to soft tissue but to the body as a whole Electric energy will always seek to flow to the ground and as it enters the body, it will seek the path of least resistance to exit the body Can disturb or destroy the functions of the heart causing irregular heartbeat or even cardiac arrest Always assume the electrical source is still charged Care a.) Never attempt to remove a patient from an electrical source unless trained and equipped to do so b.) Never touch a patient still in contact with the electrical source c.) Administer oxygen through a non-rebreather d.) Monitor the patient for cardiac arrest e.) Assess the patient for muscle tenderness with or without twitching and any seizure activity f.) Always assess for an entrance and exit burn injury g.) Transport the patient as soon as possible
How do burns affect the nervous and musculoskeletal systems?
Can destroy nerve injuries and loss of function
What is cyanide poisoning?
Can enter the body through inhalation, ingestion, injection and absorption Can be a byproduct of incomplete combustion of plastics, silk, and synthetic carpets Interferes with the use of oxygen at the cellular level
What does automaticity mean?
Can generate a cardiac impulse on their own
How should EMTs use poison control centers?
Can help you set priorities and formulate a treatment plan Toll free and 24 hours Tell patient's age and weight
What are the challenges of facial injuries?
Can hemorrhage profusely Many are the result of assault May need to treat emotional trauma as well as physical trauma
What is hypertension?
Can lead to heart damage and failure, stroke and ruptured blood vessels
What are the stages of hypothermia?
Can occur with little warming and can progress rapidly Initial reactions a.) Increase in basal metabolic rate b.) Shivering c.) Goosebumps Late reactions a.) Confused
What is cricoid pressure (or the Sellick Maneuver)?
Can reduce complications associated with positive pressure ventilation Only used on an unresponsive patient Reduces incidence of gastric irritation, regurgitation and aspiration Warrants an additional EMT Collapses the esophagus against the cervical vertebrae a.) Will not allow fluids up or air down into the stomach b.) Reduce the maneuver if you see vomitus in the airway
What are some signs and symptoms of food poisoning?
Can start hours to days after ingestion Cramping, nausea, vomiting, gas, diarrheal, increase body temp, blood disorders, muscle cramping, passing blood in stool
How do you immobilize or extricate a child in a car seat?
Can use the car seat to stabilize the child Procedure a.) Apply manual in line cervical stabilization b.) Assess the infant or child to ensure that there are no life-threatening injuries or other reasons for removal from the car seat c.) Apply an appropriately sized cervical collar to a child (but not to an infant) d.) Carefully place towel rolls on both sides of the child's head and the car seat to support the head e.) Determine that the child is secure in the seat and that there is not a lot of room between the child and the seat i.) If there is too much room, fill the spaces with padding and secure f.) Transport the child in a regular seated position with the car seat securely belted to the ambulance seat
How should the EMT assess for SIDS?
Cannot be diagnosed in the field Will find the patient in cardiac arrest Physical appearance of infant Position of infant in crib Physical appearance of crib Presence of objects in crib Appearance of room Presence of medication Circumstances concerning discover of the unresponsive child Time that infant was put to bed Problems at birth General health Recent illness Date of last physical
How can you improvise splints?
Cardboard box, cane, ironing board, umbrella Light in weight but firm As wide as the thickest part of the fractured limb Long enough to extend past the joints and prevent movement Padded well
What are the two types of pulmonary edema?
Cardiogenic a.) Related to inadequate pumping function of the heart that drastically increases the pressure in the pulmonary capillaries which forces fluid to leak into the space between the alveoli and capillaries and eventually into the alveoli themselves Noncardiogenic a.) Known as acute respiratory distress syndrome (ARDS) b.) Results from destruction of the capillary bed that allows fluid to leak out c.) Causes are pneumonia, aspiration of vomit, near drowning, narcotic overdose, inhalation of smoke, high altitude and trauma
What are populations that are especially vulnerable to subdural hematomas?
Clotting disorders Alcoholics a.) Prolonged clotting times Patients on anticoagulants Hemophiliacs
How can you prevent false accusations?
Carefully and completely document Have witnesses throughout the course of treatment Whenever possible, have a witness write a written report
What is a central pulse?
Carotid and femoral, located closer to the heart
Wrist consists of eight bones called the ___.
Carpals
How do EMTs stabilize vehicles?
Carried out by specialized personnel using equipment such as wood, cribbing and wedges, step chocks, airbags, hydraulic tools and rams, comealongs and jacks, chains and winches
What is the purpose of the trachea and larynx?
Carries air from the nose and mouth to the lungs
What are arteries?
Carries blood away from the heart All arteries except the pulmonary arteries carry oxygen rich blood
What is a vein?
Carries blood back to the heart All veins except pulmonary veins carry oxygen depleted blood
What is the urethra?
Carries the urine from the bladder out of the body
What are veins?
Carry deoxygenated blood from the capillaries where blood picks up CO2 and other waste products through the venules and back to the right ventricle
What are the pulmonary arteries?
Carry oxygen
What are venae cavae?
Carry oxygen depleted blood back to the right atrium Superior vena cava, enters the top of the right atrium carrying oxygen depleted blood from the upper body Inferior vena cava enters the bottom of the right atrium, carrying oxygen depleted blood from the lower body
What are the pulmonary veins?
Carry oxygen rich blood from lungs to left atrium
What are arteries?
Carry oxygenated blood to arterioles and then to capillaries
What are ureters?
Carry wastes from the kidneys to the bladders
What is congestive heart failure?
Caused by a heart that becomes weakened over time as a result of aging, hypertension, arteriosclerosis, valve damage a.) No longer pump correctly b.) Fluid leaks out of cells c.) Edema, JVD, altered mental status, fatigue, rales or crackling Oxygen, Fowler's, transport
What is obstructive shock?
Caused by a mechanical obstruction or compression that prevents blood from reaching the heart Pulmonary embolism, tension pneumothorax (air in the chest), cardiac tamponade (fluid leaking into the sac around the heart)
What is distributive shock?
Caused by abnormal distribution of blood in the vessels Insufficient amount of blood returning to the heart Results from massive vasodilation or leakage of fluid from the capillaries
What is radiation sickness?
Caused by exposure to large amount of radiation Starts day after exposure and can last 7 to 8 weeks Nausea, vomiting, diarrhea, hemorrhage, malaise, weight loss, appetite loss, malaise, fever, sores in the throat and mouth
What is a febrile seizure?
Caused by high fever Most common between 6 months and 6 years of age Are very short and may not require emergency care
What is an abrasion?
Caused by scraping, rubbing or shearing away of the epidermis Is considered superficial, but an be extremely painful because of the presence of exposed nerve endings Blood will ooze from the wound and can be easily controlled with direct pressure Large abrasions may be cause for concern
What is epiglotitis?
Caused by swelling of the epiglottis 50% mortality rate if left untreated Majority previously caused by Hib Treatment a.) Do not place anything in mouth, no suction, no OPA, not fingers b.) Allow the child to assume position of comfort c.) Apply oxygen at 15lpm in nonrebreather d.) Call ALS e.) Transport
What is neurogenic shock?
Caused by the loss of sympathetic stimulation to the vessels below the site of the injury BP low and heart rate high Skin is warm and dry
What is conduction (temperature)?
Causes body heat to be lost to direct contact Water conducts heat 240 times fast than air Conduction and convection, 15% of heat loss
What is histamine?
Causes bronchoconstriction, vasodilation and an increase in capillary permeability (leakage)
What is convection (temperature)?
Causes cold air molecules that are in immediate contact with the skin to be warmed
What are key considerations in a feet-first fall?
Causes energy to travel up the skeletal system a.) Fractures of the heels, dislocation of the ankle b.) If the knees are flexed, energy dissipated c.) Pelvic and hip, femur fractures, spinal fractures Internal organ damage a.) Liver, spleen, kidney, heart Wrist fracture (silver fork), elbow, shoulder injury Head back and pelvis
What is the thoracic cavity?
Cavity rounded by the ribs which form a bony cage area around the organs of the respiratory and circulatory systems
What is aerobic metabolism?
Cells require energy to survive a.) Main source is glucose that is metabolized inside the cell b.) Final products are water and CO2 c.) CO2 is transported away from the cell and blown off by the lungs
The spinal column is composed of 35 vertebrae divided into the following five parts...
Cervical spine a.) C1-C7 Thoracic spine a.) T1-T12 b.) 12 pairs of ribs are attached here Lumbar spine a.) L1-L5 b.) Least mobile of the vertebrae Sacral spine a.) S1-S5 b.) Back wall of the pelvis Coccyx a.) Tailbone o Last four vertebrae that are fused together
What is diabetes mellitus?
Characterized by an altered relationship between glucose an insulin
How should you check pupils during a rapid trauma assessment?
Check for equality of pupil size and reactivity Unequal pupils and those that do not respond to light usually indicate a severe head injuries Sluggish pupils, poor perfusion and hypoxia Anisocoria a.) Unequal pupils, 6-10% of the population
How should you use a automatic transport ventilator (ATV)?
Check that it is properly functioning Attack the ATV to the mask, seal the mask Select the appropriate tidal volume and rate Observe the chest for adequate rise and fall Continuously monitor
How should you deliver oxygen?
Check the cylinder to make sure it is oxygen Remove the protective seal Open and shut the cylinder Place the yoke on the therapy regulator a.) Be sure the washer is present Screw on the regulator Open the main cylinder one half of turn Attach the oxygen mask Open the flowmeter to desired lpm Apply the oxygen mask or nasal cannula
What should you do if you encounter problems with bag valve mask ventilation?
Check the position of the head and chin Check the mask seal Assess for obstruction Check the bag valve mask system Use alternative method Insert and OPA or NPA
How should you ventilate using a flow restricted oxygen powered ventilation device (FROPVD)?
Check the unit to make sure it is properly working Open the airway a.) Insert NPA or OPA Apply the mask and start oxygen Activate the valve by triggering the button a.) Release as soon as the chest begins to rise
What should you do while en route to the scene?
Check the vehicle Fasten seatbelt Write down dispatch information Confirm dispatch information Listen for status reports from other units Remain relaxed Think about what materials you might need on scene Call for ALS if needed
What are the zygomatic bones?
Cheek bones
What is an anaphylactoid reaction?
Chemical mediators can be released from the MAST cells and basophils the first time the antigen is introduced into the body without the patient being sensitized Same symptoms as an anaphylactic reaction
What is a drug?
Chemical substance that is used to treat or prevent a disease or condition
What are chemical agents/weapons?
Chemical weapons are among the most feared WMD Can be manufactured relatively easily Most chemicals for military use are stored in munitions as liquids a.) When the munitition explodes, the liquid is converted to an aerosol Chemical agents in aerosolized form can enter the body through respiratory tract, skin and eyes a.) Liquid can be absorbed through the skin and eyes
What is a weapon of mass destruction (WMD)?
Chemical, biological and radiological nuclear threats Conventional bombs, explosives and incendiary devices are the most commonly used terror devices Intended to cause widespread and indiscriminate death and destruction Small amount of chemical agent may kill hundreds or thousands of people if spread over a densely populated area A nuclear device that can fit inside a foot locker can obliterate 10 blocks of area Nuclear and bomb detonations last for a brief moment and have immediate effects on the individuals a.) Nuclear weapon may have long lasting effects that last days to weeks b.) Chemical agents may take a few minutes to take effect and may last from minutes to hours c.) Biological weapons may take hours and days for onset and may last days to weeks
What is Tularemia?
Chest pain that worsens with breathing, headache, malaise, nonproductive cough, weight loss
Chest wall and diaphragm anatomy in children...
Chest wall is much softer and more pliable Leads to a greater compliance or movement during ventilation When you perform artificial ventilation, the chest should expand and rise easily a.) It is easy for the EMT to overinflate the lungs
What is the thorax?
Chest, composed of the ribs, the sternum and the thoracic spine 24 ribs a.) The first seven pairs are attached to the sternum by cartilage and are called true ribs b.) The next three are attached to the ribs above them with cartilage c.) The last two are not attached to the sternum i.) These are called false or floating ribs
What is mechanical digestion?
Chewing, swallowing, peristalsis (rhythmic movement of matter through the digestive tract) and defecation (elimination of wastes)
What does CHART stand for?
Chief complaint History Assessment RX a.) Treatment provided Transport
What does CHEATED stand for?
Chief complaint History Exam - Information that was found in the physical examination Assessment - Impression from history and physical findings Treatment Evaluation - Ongoing assessment or deterioration Disposition Transfer of care
What are some anatomical differences in the skin and body surface area of children?
Child's skin surface is larger compared to his body mass Skin is thinner and much more delicate
Age is a major factor in determining the severity of a burn injury...
Children under five, adults over 55 - less tolerance of burn injuries Children - Potential for greater fluid loss in burn injuries than adults Older adults a.) Have a more lengthy healing process and may have underlying medical conditions that may affect their response to burn injuries b.) Preexisting conditions i.) Respiratory illness - May be further compromised from a burn ii.) Cardiovascular illness - Increased complications and resulting fluid loss iii.) Diabetes - Compromise the patient's ability to heal from the burns Special Considerations for Illness and Children a.) Infants and children have a larger body surface in relation to mass than adults i.) Burns can have increased effects b.) Fluid and heat loss are greater in children c.) Higher risk of shock, airway difficulties, and hyperthermia d.) Consider the possibility of abuse
Considerations for children when assessing head trauma...
Children's heads are larger Weight of head will carry it forward Common findings a.) Nausea and vomiting b.) Respiratory arrest c.) Facial and scalp injuries Keep an eye open for tongue
What are some anatomical differences in the heads of children?
Children's heads are larger adults Under 9 months, cannot support heads Infants have soft spot on their head a.) Fontanelle
How can EMTs help disaster patients?
Children, elderly, those in poor health, the handicapped, those with past loss or crisis Reactions of children depend on their age, individual disposition, family support, community support Preschoolers a.) Tend to cry, lose control of bowel and/or bladder, become confused, and suck their thumbs Elementary age children a.) Suffer extreme fears about their safety and show confusion, depression, headache inability to concentrate, withdrawal, poor performance, and the tendency to with their peers Preadolescents and adolescents a.) May show the same reaction as elementary age children, coupled with extreme aggression and stress that is severe enough to disrupt their lives Encourage patient to do necessary chores Provide a structure for the emotionally injured and let them know your expectations Help patients confront the reality of the disaster Don't give false assurances A patient may refuse offers of help Identify high risk patients a.) Elderly, children, bereaved, those with prior psychiatric illness, those with multiple stresses, those with low or no support systems, those from low economic backgrounds, and those with severe injuries Identify people who are in a unique position to help people in need and recruit them for psychological emergency care Arrange for all those involved in the disaster - including rescuers - to get good follow up care and support
What are industrial chemicals?
Chlorine, anhydrous ammonia Signs and Symptoms, Emergency Medical Care a.) Many behave like pulmonary agents i.) Chlorine, phosgene, methyl isocyanate b.) Others act like cyanide i.) Salts of cyanide and cyanogens c.) Others act like nerve agents i.) Insecticides
How do you measure blood pressure through auscultation?
Choose the proper size Position the arm Palpate the radial pulse Place the stethoscope in your ears Close the thumb valve and inflate the cuff Slowly turn the thumb valve to release air As soon as you hear first sound, record pressure Continue releasing air from the bulb After you have recorded the blood pressure, leave the cuff in place but deflated
What is epilepsy?
Chronic brain disorder characterized by reoccurring seizures
What bones form the shoulder girdle?
Clavicle Scapula - Shoulder blade Acromion - The tip of the shoulder girdle
What should the EMT do while en route to the station?
Clean and inspect ambulance Wash hands Radio dispatch that you are available Refuel if needed
Cleaning v. Disinfecting v. Sterilization...
Cleaning a.) Simply the process of washing a soiled object with soap and water Disinfecting a.) Involves using hospital grade disinfectant or germicide to kill many of the microorganisms that may be present on the surface of the object Sterilization a.) The process by which an object is subject to a chemical or physical substance that kills all microorganisms
What is cerebrospinal fluid (CSF)?
Clear fluid that surrounds and cushions the brain and spinal cord
What is the cornea?
Clear front portion of the eye Covers the pupil and iris Window through which light enters the eye Sensitive and susceptible to injury
What are some predisposing factors to heat related injuries?
Climate Exercise and strenuous activity Age, extremes of age Illnesses a.) Heart, kidney, cerebrovascular, Parkinson's disease b.) Thyroid disorders, skin diseases c.) Dehydration, obesity, infections d.) Fatigue, DM, malnutrition, alcoholism e.) Mental retardation
What is a pulse oximeter?
Clipped onto a patient's finger, toe, ear lobe or bridge of nose Shines through the tissue to a photosensor on the other side Measures the hemoglobin in the blood Percent of hemoglobin saturated with oxygen a.) Read as % SpO2
What are the signs and symptoms of musculoskeletal injuries?
Closed a.) Overlying skin is intact Open a.) Bone may or may not protrude through open wound Signs and Symptoms a.) Difference in size, shape, or positioning b.) Pain and tenderness c.) Grating or crepitus, the sound or feeling of broken fragments of bone d.) Swelling e.) Disfigurement f.) Severe weakness or loss of function g.) Bruising h.) Exposed bone ends i.) Joints locked into position
What is an occluded airway?
Closed or blocked airway Immediately life threatening problem
What is the circulatory system?
Closed system composed of the heart, blood vessels and blood Blood brings nutrients, oxygen and other essential chemical elements a.) Removes CO2 and other waste products
How should you assess a patient with a seizure or altered mental status?
Closely assess ABC When assessing patients in the postictal state a.) If the patient is talking without distress, open airway b.) Heart rate is commonly elevated, skin warm and moist When assessing patients who are not responsive and are actively seizing a.) If the seizure has lasted more than 5 minutes, it is vital that you assess the airway, breathing and pulse b.) Open the airway with jaw thrust or head tilt chin lift i.) Consider NPA c.) Suction any secretions Note skin temperature and color Ensure the presence of pulse Patient is priority if a.) The patient remains unresponsive following seizure b.) The ABC is inadequate c.) A second seizure occurs without a period of responsiveness d.) The seizure lasts longer than 5 minutes e.) Patient is pregnant, has diabetes or is injured f.) Seizure occurred in water g.) Evidence of head trauma h.) No history of epilepsy
What is an embolus?
Clot or other matter that has traveled from another part of the body
What is full turnout gear?
Coat, bright colored and highly visible vest, bunker parts, and steel toed boots Head protection, standard fire helmet Goggles, heavy leather gloves
What are some predisposing factors to hypothermia?
Cold environment Age a.) Infants, toddlers and the elderly b.) Larger surface area increasing the amount and speed of heat loss c.) Ability to shiver is compromised and not developed d.) Less body fat e.) Impaired recognition of cold Medical conditions a.) Recent surgery, shock, head injury, burns, infection, spinal cord injuries, thyroid disorders, diabetic emergencies Drugs and poison a.) Especially alcohol
What are the clavicle?
Collarbone, attached to the superior portion of the sternum called the manubrium
What are subdural hematomas?
Collection of blood between the dura mater and the arachnoid layer of the brain 33% of head injuries Due to low pressure venous bleeding Associated with cerebral contusion Most common type of severe head injury More common in patients older than 60 because of fragile veins
What is the iris?
Colored portion of the eye
What is oxygen?
Colorless, odorless gas Present in the atmosphere at 21% 2,000 psi
Explain carbon monoxide in ambulances...
Colorless, odorless, tasteless, deadly May come from a.) The vehicle's exhaust gas b.) Supplemental gasoline c.) Greater outside pressure which forces CO into ambulance Symptoms a.) Yawning, dizziness, dimmed vision, headache, irregular heart rhythm, nausea, or vomiting b.) Seizures, coma, death
What are some warning devices on an ambulance?
Colors and Markings a.) To aid to traffic safety, avoid need for sirens and light b.) Standard color is white with an orange stripe on body c.) Blue lettering Warning Lights a.) Activate emergency lights t all times b.) Should be used even when not using sirens c.) Use only minimal lighting during heavy fogged Using Siren a.) New insulation can reduce interior decibel level of approaching siren b.) Never pull directly behind care and blast siren c.) Can create emotional stress for patient d.) Siren can have effect on ability to drive Using Your Horn a.) Avoid overuse of the horn b.) Do not sound horn close to other vehicles
What is a mobile transmitter/receiver?
Come in a variety of power ranges, and the power output determines the distance over which the signal can be transmitted
What is pneumonia?
Common cause of death in the US HIV patients and other immunocompromised Cigarette smoking, alcoholism, and exposure to cold temperatures Overview of the Disease Process a.) Acute infectious disease carried by bacteria or a virus that affects the lower respiratory tract b.) Lung inflammation or pus filled alveoli
What is Type I diabetes?
Commonly acquired during childhood Pancreas usually does not produce any insulin and must inject or inhale insulin daily Insulin dependent diabetes mellitus (IDDM) Required to inject insulin Pancreas does not secrete insuline 10-14 year old peak onset BGL are extremely high Prone to hypoglycemia and diabetic ketacidosis (DKA)
What is ethylene glycol?
Commonly found in detergents, antifreeze, coolants
What is late compensation in shock?
Compensatory mechanisms can no longer maintain pressure and perfusion of core organs Vasoconstriction is maximal but fails to maintain an adequate cardiac output BP drops Capillary sphincters open and allow blood to rush into and eventually exit the capillary and with it carry clumped blood that is high in acid and CO2 into the main circulation
Respiratory arrest in children...
Compensatory mechanisms designed to maintain oxygenation of the blood have failed Respiratory rate less than 10 Irregular respirations, limp muscle tone Unresponsiveness, slower than normal heart rate Weak or absent peripheral pulses Hypotension
What are the stages of progressive shock?
Compensatory shock Decompensated (progressive) shock Irreversible shock
What is an EMT-Basic (EMT-B)?
Complete a course based on the US Department of Transportation curriculum Have been certified as EMT-B by the state EMS division Duties a.) Control life threatening situations i.) Open airway, artificial ventilation, defibrillation, controlling bleeding, administering medications, treating shock b.) Stabilizing life threatening situations i.) Dressing and bandaging wounds, splinting injured extremities, delivering infants, psychological stress c.) Using nonmedical skills i.) Driving, maintaining supplies, good communication
What is an EMT-Intermediate (EMT-I)?
Completes additional training by the US department of transportation Includes a.) Human systems, emergency pharmacology, venous access and medication, emergency pharmacology, venous access and medication administration, patients assessment, medical conditions, traumatic injuries, obstetrics, neonatal resuscitation, pediatrics, geriatrics b.) IV therapy, manual defibrillation, medication administration, endotracheal intubation, alternative advanced airway devices, ECG interpretation
What is the subcutaneous layer (hypoepidermis)?
Composed of fatty connective tissue and contains large blood vessels
What is the spinal cord?
Composed of nervous tissue, exits the brain through an opening at the base of the skull Cord surrounded by a sheath of protective membranes (meninges) and a cushioning layer of CSF Fills 95% of the spinal column in the C spine, only 60% in the lumbar area
What is the peripheral nervous system?
Composed of the nerves located outside of the spinal cord and the brain Carries sensory info from the body to the spinal cord and brain Carries motor information from the brain and spinal cord to the body
What are some of the hazards of improper splinting?
Compress the nerves, tissues and blood vessels Delay the transport of a patient who has a life threatening injury Reduce distal circulation Aggravate the bone or joint injury by allowing movement Cause aggravate damage to tissues, nerves, blood vessels or muscles
What are some common mechanisms of injury for spinal injuries?
Compression Flexion Extension Rotation Lateral bending Distraction Penetration
What are crush injuries?
Compression forces causing crush syndrome a.) Is associated with entrapment for 4 hours or more May inflict direct blunt and penetrating injury, dust and smoke can cause respiratory and eye injuries Once the pressure to the crushed area s relieved, the by products are released into the circulation causing serious problems
What are some common causes of altered mental status?
Compromised airways, inadequate breathing, hypoxia, blood loss, poor perfusion, poor oxygenation, brain injuries Result from a.) Bleeding or trauma to face, mouth or neck b.) Head injuries c.) Chest injuries d.) Abdominal injuries e.) Bone injuries associated with blood loss
How should you assess nuclear detonation and radiation injuries?
Concentric circles of injury Important to realize that it is multiple casualty team a.) Assessment and quick triage Radiation injury symptoms i.) Bone marrow and blood cells 1.) Nausea, fatigue, malaise, clotting disorders, possible uncontrolled hemorrhage ii.) Bowel 1.) Nausea, vomiting, loss of appetite, diarrhea, fluid loss, malaise, dehydration iii.) Skin 1.) Reddening (erythema) iv.) Nervous and CV systems 1.) Incapacitation, CV collapse, confusion, burning sensation
What does the suffix -a mean?
Condition
What does the suffix -ia mean?
Condition
What does the suffix emia mean?
Condition of the blood
What is respiratory distress?
Condition where the pt is working harder to breathe Needs oxygen but not ventilation
What are the key steps in the focused history and physical exam?
Conduct a physical exam Take baseline vital signs Obtain a SAMPLE history
Airway functions and considerations...
Conduit that allows air to more from the atmosphere into the alveoli for gas exchange The airway must remain patent at all times Any obstruction will result in less air movement and poor gas exchange/hypoxia The degree of the obstruction will affect the amount of air available Mental status usually is correlated with the status of his airway Unresponsive a.) Tongue relaxes and falls back, blocking the pharynx b.) Epiglottis can relax and obstruct the airway at the level of the larynx Inspect for vomitus, blood, secretion, broken teeth, or foreign bodies Suction or turn onto side
What can cause excessive peripheral edema?
Congestive heart failure, fluid overload, or a clot blocking a vein in that extremity
What are ligaments?
Connect bone to bone
What are tendons?
Connect muscles to bones and other connective tissues
How do you perform mouth to mask ventilation on a patient with no suspected spine injury?
Connect one way valve to ventilation mask and connect to oxygen at 15 lpm Position yourself at the top of the head a.) Cephalic technique b.) Lateral technique Place mask on patients face a.) Secure with C and E Place mouth around the one way valve and blow a.) Give one breath over 1 second
How do you get a SpO2 reading on a patient?
Connect the sensor to the SpO2 monitor Attach the probe to the fingertip Turn on the device a.) Match the pulse to your pulse reading Reassess every 5 minutes in unstable patient, every 15 in stable
How should you provide mouth to mask ventilation on a patient with a suspected spine injury?
Connect valve and oxygen Position yourself at top of the patient's head Place mask on face without tilting the head back Deliver ventilation
What is consent?
Consent is permission to treat In most states, those over 18 are considered an adult Implied consent
What is a pulmonary contusion?
Consequence of a flail segment Bleeding occurs in and around the alveoli and into the interstitial space that separates the alveoli and capillaries Reduces the exchange of oxygen and carbon dioxide leading to severe hypoxia Signs and symptoms a.) Dyspnea, cyanosis, blunt trauma to the chest Positive pressure ventilation with supplemental oxygen
What is the musculoskeletal system?
Consists of a bony framework or skeleton, held together by ligaments and tendons
What is the reproductive system?
Consists of complementary organs that accomplish reproduction Sperms and ovum contribute the genes that determine heredity Fertilized sperm and ovum forms a fertilized ovum which grows into an embryo then a fetus
What makes up the central nervous system?
Consists of the brain and the spinal cord
What is an epi-pen?
Constrict the vessels, increasing BP, will dilate the bronchioles allowing the patient to move more air into the alveoli and will decrease capillary permeability to reduce the leakage of fluid
How is heat conserved in the body?
Constricting blood vessels and sending warm blood from the surface of skin to internal organs Hair erects, thickening the warmth under the skin Little or no perspiration is produced by the skin
What is bronchospasm?
Constriction of the smooth muscle in the bronchioles
How should you administer activated charcoal?
Consult medical direction Shake well Cover if possible Shake or stir again before finishing does Record the time and the patient's response If the patient vomits, notify medical direction to authorize one repeat of the dose
What is a scald burn?
Contact with hot liquids The more viscous the liquid, the more severe the burn Intentional burns, accidental are splattered
What is a contact burn?
Contact with hot object Localized to the area of contact
What is a hollow organ?
Contain some type of substance that may leak out into the abdominal cavity if the organ is perforated or injured May lead to chemical or bacterial peritonitis Do not have the same amount of blood supply as solid organs and do not bleed as much
What is a hematoma?
Contained collection of blood One the size of a fist accounts for 10% of total blood volume Femur fractures, abdomen
What is the cervix?
Contains a plug of mucus that seals the uterine opening Prevents contamination form entering the uterus Plug is discharged when the cervix dilates Expulsion of the plug signals the first stage of labor and is known as the bloody show
What is chitosan?
Contains a substance called chitin which is found in shrimp shells Can promote clotting
What is food poisoning?
Contains bacteria or toxins Can result from the bacteria themselves or from the toxins released by the bacteria Conditions a.) Salmonella b.) Campylobacter c.) Escherichia coli d.) Staphylococcus aureus
What is the neck?
Contains numerous vital structures in a very small space Cardiovascular, musculoskeletal, central nervous, respiratory, digestive, and endocrine Neck contains the major arteries and veins that carry blood to the head Contains trachea and larynx
What is the dermis?
Contains small capillary beds as well as the sensory structures of the skin
What is the abdominal cavity?
Contains the major organs of the digestive, urinary, and endocrine systems Separated from the chest with the diaphragm Inferior border is the pelvic ring Tough, thick, flat muscles form the bulk of the rib cage Posterior, the spinal column and strong muscles provide protection
What is the brain stem?
Contains the mesencephalon, pons and medulla oblongata Medulla oblongata a.) Respiratory center i.) Controls the rate and depth of respiration b.) Cardiac center i.) Regulating heartbeat and force of ventricle contraction c.) Vasomotor center i.) Produces dilation and constriction of the blood vessels
What is a hot zone (exclusion zone)?
Contamination is actually present The area that is immediately adjacent to the accident site and where contamination can still occur An emergency exit is designated Should be restricted a.) Only as many trained rescuers as absolutely necessary should enter it
What are chemoreceptors?
Continuously monitor levels of oxygen, carbon dioxide, and hydrogen in the arterial blood
What is the nervous system?
Controls the voluntary and involuntary activity of the human body Coordinates the responses of the body to stimuli Nerves carry impulses
What is a nasopharyngeal (nasal) airway?
Curved hollow tube of soft or plastic runner with a flange or flare at the top end and a bevel at the distal end Patients to whom the oral tune cant be inserted Less likely to stimulate vomiting Avoid in patients with facial trauma Still necessary to maintain head tilt chin lift or jaw thrust
What is chronic obstructive pulmonary disease?
Disease complex that includes a number of individual pulmonary disease processes Respiratory distress, accessory breathing Oxygen, Fowler's, PPV if necessary
What are pathogens?
Diseases caused by pathogens Microorganisms such as bacteria and viruses Can spread by way of blood and other body fluids, in the air
What is kyphosis?
Disks located between the vertebrae of the spine start to narrow Curvature of the spine
What is cerebrospinal fluid?
Cushion of fluid around and within the brain and spinal cord
How should you deal with injuries to the ear?
Cuts and lacerations are common (pinna - outer portion of the ear) Does not bleed significantly Do not attempt to remove objects
What does cool skin indicate?
Decreased perfusion a.) Exposure to cold, fright, anxiety, drug overdose, other medical conditions
What is epsilon toxin?
Cough, wheezing, SOB 6 hours after exposure Respiratory failure and death, liver damage
What is hemoptysus?
Coughing up blood stained sputum
What are signs and symptoms of hydrocarbon poisoning?
Coughing, choking, crying Burns, stridor, dyspnea, wheezing, tachypnea Cyanosis, abdominal pain, nausea and vomiting Belching, fever, seizures Coma, altered mental status, headache, dizziness Slurred speech, cardiac dysrhythmias
What is a dressing? What are some common types of dressings?
Covers an open wound to aid in the control of bleeding and to prevent further damage or contamination Should be sterile, free of any organisms Common types of dressings a.) Gauze pad b.) Self adhering dressing c.) Universal or multitrauma dressing d.) Occlusive dressing
What is parietal pleura?
Covers the internal chest wall
What are incendiary devices?
Create different injury patterns from conventional explosives a.) Include napalm, thermite, magnesium, white phosphorus b.) Designed to burn at extremely high temperatures
What is sudden infant death syndrome (SIDS)?
Crib or cot death Sudden and unexpected death of an infant under 1 in which an autopsy fails to reveal a cause of death Leading cause of death between 1 month and 1 year a.) Spike between 2 and 4 months No indication of struggle
The most inferior part is called the ___ ___, a firm, full right of cartilage that forms the lower edge of the larynx
Cricoid cartilage
What is the legal use of documenting?
Crime or lawsuit May be an element in your defense
What are the two types of liability?
Criminal a.) The government, on behalf of the public, brings legal action against the EMT Civil a.) The plaintiff files a lawsuit against an EMT b.) The defendant is accused of committing a tort i.) A wrongful act, injury, or damage
What are the signs and symptoms of a brain contusion?
Decreasing mental status or unresponsiveness Paralysis Unequal pupils Vomiting Alteration of vital signs Profound personality changes
What are the signs and symptoms of a chest injury?
Cyanosis Dyspnea Breathing rate that is faster or slower CLPS Hemoptysus i.) Coughing up blood stained sputum Signs of shock Tracheal deviation Paradoxical movement Open wound that may produce a sucking sound Subcutaneous emphysema JVD Absent or decreased breath sounds Pain at the injury site, especially that increases with inhalation and exhalation Failure of the chest to expand normally Peripheral pulses that become deep during inhalation Systolic blood pressure drops by 10mmHg or more during inhalation
What are the various types of oxygen cylinders?
D, 350 liters E, 625 liters M, 3,000 liters G, 5,300 liters H, 6,900 liters
How should assess the pelvis during a rapid trauma assessment?
DCAPBLS Do not palpate the pelvis if an injury is suspected Place each hand on the iliac crest and gently compress the pelvis inward and downward Also compress the symphysis pubis for any tenderness, facial grimace, or instability
How should you assess the neck during the detailed physical exam?
DCAPBLS Cover any large lacerations with an occlusive dressing Do in line stabilization Reassess JVD, tracheal deviation A hematoma could compress the airway or trachea and cause obstruction Look for subcutaneous emphysema a.) Look for tension pneumothorax, pericardia tamponade Check that the trachea is midline Look for excessive neck muscle use
How should you assess the nose during a detailed physical exam?
DCAPBLS Leaking CSF can be a sign of brain injury Nasal flaring, respiratory distress
What is a coup-contrecoup injury?
Damage at the point of a blow to the head and damage to the opposite side
How should you care for large open neck injuries?
Danger of air being sucked into the neck vein and into the heart Bleeding control and prevention of an air embolism Bright red blood spurting from the wound is a grave sign a.) Arterial bleeding Venous bleeding a.) Dark red and flowing very steadily from the wound Procedure a.) Place a gloved hand over the wound to control bleeding b.) Apply an occlusive dressing c.) Cover the occlusive dressing with a regular dressing d.) Apply only enough pressure to control the bleeding e.) Once bleeding is controlled, apply a pressure dressing f.) If there is a suspected spinal injury, provide appropriate immobilization
What is the pupil?
Dark center of the eye Opening that expands or contracts to allow more or less light into the eye through the lens just behind the pupil a.) Lens focuses light on the retina i.) Back of the eye
How do you know bleeding is from capillary?
Dark or intermediate color of red, slowly oozing blood Easily control because the wound usually spontaneously clots
What is a sign of venous bleeding?
Dark red and flowing very steadily from the wound
How do you know bleeding is venous?
Dark red blood that flows steadily (depleted in oxygen) Veins are under less pressure than arteries May be profuse but easier to control than arterial bleeding
You should have high index of suspicion in the following situations...
Death of another occupant of the vehicle a.) Even if another passenger does not appear to be badly injured, maintain a high level of suspicion An unresponsive patient or patient with an altered mental status a.) One of the earliest sign of brain injury is altered mental status or unresponsiveness b.) Patients who are dazed or staring into space c.) A brief period of unconsciousness followed by a return of alertness
What is schizophrenia?
Debilitating distortions of speech or thought, bizarre delusions, hallucinations, social withdrawal, lack of emotional expressiveness Multiple personality disorder
When can you confidently recognize death on the scene?
Decapitation Rigor mortis (body becomes stiff within 2-12 hours) Decomposition of the body Dependent lividity (discoloration of the skin due to pooling blood)
How do burns affect the renal system?
Decrease in blood flow will cause decreased blood flow to the kidneys and a consequent decrease in urinary output a.) Wastes to form in the blood because of cell destruction such as myoglobin from muscle destruction
What are the effects of aging on the respiratory system?
Decrease in the size and strength of the muscles used for respiration and calcium deposits begin to form where the ribs join the sternum (becomes less pliable) a.) Decrease in diffusion and CO2 elimination Chemoreceptors become less sensitive a.) Inability to detect oxygen depletion or increased CO2 levels (hypercapnea) Decrease in the number and strength of smooth muscle fibers a.) Diminishes airflow to alveoli Cough and gag reflexes decrease a.) Dehydration is common
What is pulsis paradoxus?
Decrease in the strength of the pulse during inspiratory phase May be an indication of severe cardiac or respiratory illness or injury or significant blood loss If a pulse weakens or disappears during inhalation
What safety measures should be taken in water-related emergencies?
Deep water accidents require special equipment Never go into water to attempt rescue unless a.) You are a good swimmer b.) You are specially trained c.) You are wearing a PFD d.) You are accompanied by other rescuers Reach, throw, row, go strategy a.) Reach b.) Throw a PFD c.) Row a boat d.) Swim
What is the immune system?
Defense mechanism to fight off invasion by foreign substances
What does DCAP-BTLS stand for?
Deformities Contusions Abrasions Punctures and penetrations Burns Tenderness Lacerations Swelling
What is an index of suspicion?
Degree of your anticipation that the patient has been injured or injured in a specific way High index of suspicions a.) Falls, automobile crashes, motorcycle crashed, recreation vehicle crashes, contact sports, recreational sports, pedestrian collision with motor vehicle b.) Blast from an explosion c.) Stabbing d.) Shooting e.) Burns
What is perfusion?
Delivery of oxygen and nutrients from the blood through the thin capillary walls into the cells and the removal of CO2 and other wastes
What is perfusion?
Delivery of oxygen and other nutrients to the cells of all organ systems and the elimination of CO2 and other waste products, results from the constant adequate circulation of blood through the capillaries
What is spontaneous abortion or miscarriage?
Delivery of the fetus and placenta before the fetus is viable Viability after 20th week of pregnancy 15-20% of recognized pregnancies a.) Genetic causes, drugs, infection, maternal disease Patient history is important Signs and symptoms a.) Cramp like lower abdominal pain b.) Moderate to severe vaginal bleeding, bright or dark red c.) Passage of tissue or blood clots As when last period began, emotional support
What are the five stages of grief?
Denial Anger Bargaining Depression Acceptance
What is cerebrospinal fluid (CSF)?
Dense, serous substance that cushions the brain Produced by the brain Clear and colorless, circulates through the skull and spinal column and reabsorbed by the circulatory system Combating injection and cleansing the brain and spinal cord Leaks out through the nose and ears
What are the signs and symptoms of pulmonary embolism?
Depend on the size of the obstruction Sudden onset of unexplained dyspnea and chest pain and signs of hypoxia but who has normal breath sounds and adequate volume Sudden onset of unexplained dyspnea Signs of difficulty in breathin or respiratory distress Sudden onset of sharp or stabbing chest pain Cough Tachypnea and tachycardia Syncope Cool, moist skin Restlessness, anxiety, or sense of doom Decrease in blood pressure Cyanosis (may be severe) Crackles Fever SpO2 < 95%
Considerations for vehicle-pedestrian collision...
Depends on how fast the vehicle was going, what body part was hit, how far the pedestrian was thrown, the part that struck the ground Child, turn towards the vehicle a.) Femur, chest, abdomen, and head b.) Is usually thrown into the vehicle and is subsequently run over Adult, turns away from the car a.) Impact on the side of the body b.) Fractures of the tibia and fibula c.) Falls backward and lands on the hood
What is botulinum?
Descending paralysis, ptosis, double vision, dry mouth, dysphasia and dysphagia, respiratory failure and death Symptoms 24-36 after exposure
What is a scoop stretcher? How do you use it?
Designed for patients weight 300 pounds Can be used in confined areas Can be used for pelvic fractures or bilateral femur fractures Not used for patients with spinal injuries Procedure a.) Adjust the stretcher to the length of the patient b.) Separate the halves and place on each side c.) Keeping the patient's spine in line, gently roll the patient to one side d.) Slide half under the patient e.) Examine the back f.) Assemble the head of the scoop stretcher g.) Roll the patients body on the other side i.) Swing the remaining half of the stretcher into a closed Latch the food end h.) Pad the patient's head and any bony prominences with a pillow i.) Secure the patient with at least three straps
What is a rigid splint?
Designed in specific shapes for arms and legs and are equipped with Velcro
What is secondary triage?
Designed to reevaluate patient categorization Patient may be upgraded or downgraded Will occur as patients are brought into triage unit
What is a bronchodilator?
Designed to relax and open the bronchioles
What are bariatric stretchers and devices?
Designed to transport obese patients Designed to hold patients up to 1,600 in a wheels down position Includes ramp and winch
How should you perform a detailed physical exam and an ongoing assessment in a patient with a spinal injury?
Detailed Physical Exam a.) Perform en route to the hospital if time and conditions permit b.) Avoid unnecessary movement Ongoing Assessment a.) Perform every 5 minutes en route b.) Keep the airway clear and that the patient's breathing is inadequate c.) Reassess and record the baseline vitals d.) Look for signs of shock i.) Pale, cool, and clammy ii.) BP falls iii.) Heart rate increases vi.) Mental status decreases
What are the 7 D's to describe the best care for the stroke patient?
Detection - recognition of signs and symptoms Dispatch - recognize symptoms to be stroke Delivery - prompt assessment, emergency care, and transport of the patient Emergency care a.) Door b.) Data c.) Decision d.) Drug
Body position in blast injuries...
Determines the extent of blast injury Victims standing or lying perpendicular to the bomb will suffer greatest injury Victims lying directly toward or away from blast will suffer least amount of injury Drop prone away from detonation
What is critical incident stress?
Develop many of the signs and symptoms of burnout Repeated mental images of the incident, fear in continuing the job
What is a repeater?
Devices that receive transmission from a relatively low powered source such as a mobile or portable radio and rebroadcast them at another frequency and a higher power
What is radiation?
Differs from light, heat, sound radiation because it can change the structure of the molecules it passes X-ray radiation and gamma radiation a.) Same type, created by different processes b.) Can travel long distances Neutron radiation a.) Powerful and very damaging b.) Greatest threat is close proximity to an active nuclear reactor or bomb explosion Beta radiation a.) Low speed, common product of fallout b.) Serious threat from contaminated food and air Alpha radiation a.) Heavy and slow moving b.) Serious internal contaminant
What is fecal impaction and constipation?
Diminishment of smooth muscle contractions of digestive tract Loss of bowel control
What are the three mechanisms of injury for muscular and skeletal injuries?
Direct Force a.) Direct blow, occurs at the point of impact Indirect force a.) Force impacts on one end of a limb, causing an injury some distance away Twisting force a.) One part remains stationary while the rest twists
What are some examples of nonurgent moves?
Direct ground lift Extremity lift Direct carry method Draw sheet method
What is shock or hypoperfusion?
Direct result of inadequate perfusion of tissue When the cells of the body do not receive the oxygen , glucose and other nutrients they need, they begin to fail and die Shock must be recognized and promptly treated Immediate transport is necessary Blood may be shunted away from less important organs to more important organs Should be suspected in any patient who has suffered or may have suffered trauma
What are radiological dispersal devices?
Dirty bomb Conventional explosive attached to radioactive materials
What are radiological dispersal devices (RDDs)?
Dirty bombs Made by combining conventional device with radioactive material
Between each two vertebrae is a fluid-filled pad of tough elastic cartilage called a ___ that acts as a shock absorber
Disc
What is the cause of mottling?
Discoloration similar to cyanosis Blotchy pattern May be seen in shock patients
What is an auto-injector?
Disposable delivery package Epi-pen and Twinject Spring activated, concealed needle Twinject has two doses Both come in two different doses a.) 0.3 mg for patients 66 pounds or greater b.) 0.15 mg for infants and children up to 66 pounds Use a.) Activated by pressing against the patient's thigh b.) Pressure releases the spring activated plunger c.) No precise location is needed, but the lateral portion of the thigh midway between the hip and knee i.) Not into a vein or buttocks d.) Preferable to remove clothing, but not necessary
What is an amputation?
Disruption in the continuity of an extremity or other body part The result of ripping or tearing Bleeding may be massive a.) However, in most cases, elasticity of the blood vessels, very little bleeding occurs An incomplete amputation typically bleeds more than a complete amputation Consider shock
How should you assess the abdomen during a rapid medical assessment?
Distension or discoloration Look for scars from previous surgeries Look for rigidity or pulsating masses Rebound tenderness a.) Lining of the abdomen is irritated b.) Peritonitis i.) Irritation from leakage of a substance from a ruptured organ or from an infection of the peritoneum Markle, test, heel drop test
Effects of lap belts in car accidents...
Distribute force across the iliac crest of the pelvis If the seat belt is worn too low, it can dislocate the hips If worn too high, it can cause abdominal compression and spinal fracture
What is diabetes mellitus (DM)?
Disturbance in the metabolism of carbs, fats and proteins Either lack of insulin or inability of the cell receptors to recognize the insulin and allow the glucose to enter at a normal rate Although the cells in the body are deprived of glucose, the brain is not, because insulin is not required for glucose to cross over into the brain cells Will usually have an abnormally elevated BGL due to a lack of insulin a.) Hyperglycemia, 185mg/dL b.) Glucose will spill into the urine c.) Dehydration
What is a concussion?
Disturbances of brain function Momentary confusion to complete loss of responsiveness, causes headaches Loss of consciousness is usually brief Mild diffuse axonal injury Should improve A loss of consciousness that occurs several minutes or hours after the impact is a head injury and not a concussion
What are the five different parts of the spine?
Dived into five parts (7-12-5-5-4) Cervical spine a.) First 7 vertebrae b.) Most mobile and delicate c.) Most common cause of spinal cord injury Thoracic spine a.) 12 vertebrae directly below the C spine b.) Comprise the upper back Lumbar spine a.) 5 vertebrae b.) Lower back Sacral Spine a.) Sacrum b.) Five vertebrae, fused together and form the rigid posterior portion of the pelvis Coccyx a.) Tailbone b.) Four fused vertebrae that form the lower end of the spine
What are the signs and symptoms of Type II Decompression Sickness?
Diverse symptoms Onset is usually immediate, but can be delayed up to 36 hours Signs and Symptoms a.) Lower back pain that progresses to weakness b.) Headache, visual disturbances, dizziness, tunnel vision c.) Altered mental status d.) Nausea, vomiting, vertigo, tinnitus, partial deafness e.) Substernal burning f.) Nonproductive cough g.) Respiratory distress "called the chokes" h.) Hypovelemic shock i.) Formation of thrombus j.) Fatigue k.) Signs and symptoms of shock l.) Papillary changes m.) Pallor to the tongue n.) Bloody sputium o.) Nasal flaring, retraction p.) Tachypnea q.) Crackles r.) Low Sp02 s.) Vomiting, urinary bladder distension t.) Uncoordinated movement (ataxia) u.) Joint pain v.) Edema w.) Cyanosis, pallor, itching, mottling
Examples of how to deal with a dying patient, family, and bystanders...
Do everything possible to maintain the patient's dignity a.) Avoid negative statements about their condition b.) Talk to the patient, even if they are unresponsive Show the greatest possible respect for the patient a.) Allow family members to stay with the patient during resuscitation efforts, explain what you are doing b.) Make sure they know that you never gave up Communicate a.) Help the patient become oriented to surroundings b.) Explain what has happened and where it has happened Allow family members to express themselves a.) Should be able to scream, cry or vent grief in a way that is not hazardous to yourself or others Listen empathetically a.) Most dying people want messages delivered to survivors b.) Take notes and assure that patient that you will do so Don't give false assurances a.) Let the patient know that everything that can be done will be done b.) Allow for some hope c.) Be honest but tactful Use a gentle tone of voice with patient and family a/_ Explain as kindly as you can in terms that the family can understand Take the appropriate steps if the family wants to touch or hold the body after death a.) Allow it to happen b.) Try to improve the appearance of the body Do what you can to comfort the family a.) Even if death is imminent, arrange for them briefly to see and talk to the patient
How should you transfer the oxygen source from portable to on-board?
Do not disconnect the tubing from the regulator while the mask is still on the patient a.) Remove the mask before switching
Enter the scene carefully and decide whether it is safe to approach the patient...
Do not enter unstable crash scenes Managing patients at crash scenes place the EMT at high risk Take extra precautions at rime scenes Be sure to bring your portable radio with you Call for help from the appropriate agencies Remove yourself if a scene turns hazardous
What is persistence (chemical weapons)?
Do not evaporate quickly and tend to remain as a puddle for long periods of time
Considerations for children when assessing abdominal trauma...
Do not offer as much protection from blunt trauma Diaphragmatic breathers Slow respirations and cricoid pressure
How do you immobilize a standing patient?
Do not permit them to sit down or to walk to the cot and lie down on a backboard One EMT should immediately take normal manual in-line spinal stabilization measures while another EMT applies a cervical collar Position the long board behind the patient a.) Examine the back carefully Two EMT's should stand on either side of the patient to support him The EMT's at the side of the patient should each place a leg behind the board a.) They should then slowly tip the board backward and begin lowering it to the ground while the third EMT maintains stabilization Once the board is lying level on the ground, one EMT maintains manual stabilization while the others perform the necessary assessment and care Proceed with care
How should you deal with an object impaled in the eye, or an extruded eyeball?
Do not remove During a serious injury, the eye may be forced or extruded out of the socket a.) Never attempt to replace Treatment a.) Place patient supine and immobilize the head and spine b.) Encircle the eye and the impaled object with gauze or dressing c.) Do not apply pressure d.) Place a metal shield, crushed paper cup, or cone over impaled object or eyeball
What is a secondary seizure?
Do not result from genetic cause but from an insult to the body a.) Fever, infection, hypoxia, hypoglycemia, hyperglycemia, drug intoxication or withdrawal
Confidentiality of EMTs...
Do not speak to the press, your family, friends or other members of the public about details of the emergency care provided to the patient Releasing confidential information requires a written release form signed by the patient or legal guardian Exceptions a.) Another health care provider needs to know b.) Requested by the police c.) A third party billing form
What emergency medical care should you give for abdominal evisceration?
Do not touch or attempt to replace the protruding organs Expose the wound Position the patient on his back and flex the legs toward the chest if no spinal injury is not suspected Prepare a clean, sterile dressing by soaking it in saline or sterile water Cover the moist dressing with an occlusive dressing Administer high flow oxygen
What are some important questions to ask when performing a SAMPLE history on a spinal injury patient?
Does your neck or back hurt? Where does it hurt? Can you move your hands and feet? Do you have any pain or muscle spasms along your? back or to the back of your neck? Do you have any numbness or tingling sensations in any of your arms or legs? Was the onset of pain associated with a fall or other injury? Did you move or did someone move you before our arrival? Were you up walking around before our arrival?
How should you deal with animal bites?
Dog bites Complications a.) Infection, cellulitis (inflammation of skin cells) and septicemia (blood infection) b.) Rabies and tetanus (lock jaw) c.) Hepatitis (inflammation of the liver) Combination of penetrating/puncture and crush injuries Should always be evaluated by a medical facility Always secure scene safety
What is the pelvis?
Donut shaped structure that consists of several bones including the sacrum and the coccyx Forms the floor of the abdominal cavity a.) Supports and houses the intestines, bladder, rectum and internal reproductive organs
What are some other methods of access and disentanglement?
Door Removal a.) Always check that none are able to be opened normally before forcing entry b.) Protect the patient from falling debris Windshield Removal and Roof Rolling Special Disentanglement Procedures a.) When a patient's foot is caught under the brake pedal b.) A patient may be trapped in a way that requires the seat to be moved or be removed
What is diplopia?
Double vision
What is the pericardium?
Double walled sac that encloses the heart, gives support and prevents friction Produce small amount of fluid lubrication needed to facilitate movement
What is the mammalian diving reflex?
Drastically slow down metabolism and make patient more likely to be resuscitated When the face is submerged in cold water, the larynx spasms a.) Breathing is inhibited, the heart rate slows, and the blood vessels constrict b.) Blood flow to the heart and brain is maintained
How should you dress a burn?
Dressing a burn a.) Avoid using any material that shreds of leaves particles since this may further contaminate the burns b.) Never apply any ointments or lotions i.) May cause heat retention c.) Never break or drain blisters Burns of the Hands and Toes a.) Remove all rings and jewelry b.) Separate digits with dry, sterile dressing material Burns of the eyes a.) Do not attempt to open eyelids b.) Determine if the burn is thermal or c.) Thermal i.) Apply sterile dressing to both eyes c.) Chemical burns i.) Should be flushed with water for at least 20 minutes while on route ii.) Wash from medial to lateral side
What is responsible for more water related deaths, drowning or diving/boating/water skiing incidence?
Drownings related to swimming account for a small number of water related deaths
What is the injection route of medication administration?
Drug injected into muscle mass Relatively rapid Epinephrine
What is epinephrine?
Drug of choice for the treatment of severe allergic reactions Mimics the responses of the sympathetic nervous system a.) Alpha 1 - Causes vessels to constrict b.) Alpha 2 - Regulates the amount of vasoconstriction c.) Beta 1 - Increases the heart rate, force of contraction, and speed of electrical impulses d.) Beta 2 - Causes the bronchiole smooth muscle to dilate Three major responses to the chemical mediators by the body causing anaphylactic shock is a.) Capillary permeability (alpha 1 and 2), vasodilation (alpha 1 and 2) and bronchoconstriction (Beta 2) Reduces the effects of histamine
What are the signs and symptoms of full thickness burns?
Dry, hard, tough, and leathery skin that may appear white-waxy to dark brown or black and charred (eschar) Inability to feel pain because of damaged nerve endings Pain on peripheral edges of burns
What is a primary seizure?
Due to a genetic or unknown causes Generalized or partial seizures Generalized a.) Involve both hemispheres and typically result in a loss of consciousness b.) Rhythmic, tonic clonic muscle contractions Partial a.) Related to abnormal activity in one hemisphere b.) Remain conscious
What are the signs of ectopic pregnancy?
Dull, aching pain, poorly localized that worsens Vaginal bleeding Lower abdominal pain Tender, bloated abdomen Palpable mass Weakness or dizziness when standing Shock, increased pulse Decreased blood pressure Discoloration of navel, urge to defecate Usually occurs 5-9 weeks after fertilization
What are the layers of the meninges?
Dura mater a.) Hard mother b.) Double layer of tough, fibrous tissue Arachnoid Pia mater a.) Soft mother Enclose the brain stem and spinal cord
What is meconium?
During a difficult labor, baby may defecate in the amniotic fluid Turning clear to green or brownish yellow Meconium staining a.) Indication that fetus experienced a hypoxic event b.) May cause aspiration pneumonia Suction immediately
What are the signs and symptoms of acute pulmonary edema?
Dyspnea Difficult in breathing when lying flat (orthopnea) Frothy sputum Tachycardia Anxiety, apprehension, combativeness, confusion Tripod position with the legs dangling Fatigue Crackles and possibly wheezing Cyanosis or dusty color Pale or moist skin JVD Swollen lower extremities Cough Symptoms of cardiac compromise SpO2 < 95%
What are the signs and symptoms of asthma?
Dyspnea Nonproductive cough Wheezing on auscultation Tachypnea or tachycardia Anxiety or apprehension Possible fever Typical allergic signs and symptoms Chest tightness Inability to sleep SpO2 < 95% before oxygen administration Extremely severe, need positive pressure ventilation a.) Extreme fatigue or exhaustion b.) Inability to speak c.) Cyanosis to the core of the body d.) Heart rate > 150 or slow rate e.) Quiet or absent breath signs f.) Tachypnea g.) Excessive diaphoresis h.) Accessory muscle use (neck, chest or abdomen) i.) Confusion j.) SpO2 < 90% with patient on oxygen
How can the EMT determine the severity of a burn?
EMT must classify the severity of the burn to provide optimal care Burns are classified to critical, moderate, minor Consider other factors a.) Source or agent of the burn b.) Type and strength of chemical burn c.) Inhalation injuries of the airway d.) Percentage of body surface area involved e.) Location of the burn f.) Patient's age g.) Preexisting medical conditions
What is a scene size up?
EMT's initial evaluation of a scene to which has been called Three basic goals a.) Identify possible hazards at the scene and ensure the safety of yourself, your partner, and other bystanders b.) Identify what left to your being called to the scene c.) Determine whether any factors such as the number of patients or unusual characteristics of the scene might require additional assistance
What are bronchioles?
Each bronchi divides into smaller bronchioles Lined with smooth muscle and have the ability to constrict (bronchoconstriction) or dilate (bronchodilation)
Special considerations for multiple births...
Each may have its own placenta Prepare for multiple delivery if a.) Abdomen is still very large after one infant is delivered b.) Uterine contractions continue to be strong after delivery c.) Uterine contractions begin 10 minutes after one infant has been delivered d.) The infant's size is small in comparison to abdomen Follow general guidelines a.) Call for assistance b.) 1/3 of second births will be breech c.) Many will need resuscitation
What are alveoli?
Each sac is wrapped in a web of thin walled capillaries Site for gas exchange Bronchioles terminate into thousands of tiny air sacs in the lungs
What is the iliac crest?
Each side of the pelvis Form the wings of the pelvis
What are the signs and symptoms of meningitis?
Ear or respiratory infection High fever Lethargy Irritability Vomiting Fontanelle might be bulging Rash may be present
What are early and late signs of cyanide poisoning?
Early a.) Headache, confusion, agitation, burning sensation in mouth, dyspnea, hypertension, brady or tachy cardia, smell of bitter almonds Late a.) Seizures, coma, hypotension, pulmonary edema, cardiac dyshythmias, acidosis
What are the stages of local cold injury/frostbite?
Early or superficial cold injury a.) Tips of ears, nose, cheekbones, toes or fingertips b.) Unaware of injury c.) Will lose feeling and sensation d.) Waxy gray or yellow e.) Skin remains soft but cold f.) Will feel tingly feeling until circulation improves Late or deep cold injury a.) Involves both the skin and tissue beneath it b.) White and waxy and completely solid c.) May involve the whole hand or foot d.) Swelling and blisters e.) May become blotchy or mottled as it thaws f.) Move from white to purple and grayish blue g.) Can result in permanent loss
What is medication action?
Effect the drug has on the body Therapeutic effect a.) Intended positive response Mechanism of action a.) How the drug works to create an effect on the body
What are some common foods that cause food poisoning?
Eggs, chicken, ready to eat foods Untreated water or unpasteurized milk Fish
What are some examples of significant mechanisms of injury?
Ejection from the vehicle Crash that causes death to a person in the same passenger compartment Fall of greater than 15 feet or three times the patient's height Rollover of the vehicle Vehicle collision that was at high speed Pedestrian struck by a vehicle Motorcycle crash with a separation of rider from motorcycle Blunt or penetrating trauma that results in an altered mental status, from confusion to unresponsiveness Penetrating injuries from an explosion Seat belt injuries Collisions in which seat belts are not word Impact causing deformity to the steering wheel Collision that requires in prolonged extrication
What is a hinged joint?
Elbow, knee, finger Permit flexion and extension
Muscle responds to ___ ___.
Electrical impulses
How should you deliver emergency medical care to patients with severe allergic reactions?
Emergency Medical Care a.) Distinguish between mild and severe b.) Mild i.) Open airway, give oxygen and transport c.) Severe i.) Maintain patent airway ii.) Suction any secretions iii.) Maintain oxygen therapy iv.) Be prepared to assist ventilation v.) Administer epinephrine by a prescribed auto injector vi.) Consider calling ALS vii.) Initiate early transport Ongoing Assessment a.) Look for changes in vitals b.) Monitor treatment c.) Reassess 2 minutes after administering epi-pen
How should you administer emergency medical care to patients who have ingested poisons?
Emergency Medical Care a.) Maintain the airway b.) Provide oxygen or PPV c.) Prevent future injury d.) During transport, contact medical direction e.) Bring suspected poisons to the receiving facility Detailed Physical Exam and Ongoing Assessment a.) Vitals, ABCs, mental status
What emergency medical care/ongoing assessment should you perform during drug and alcohol emergencies?
Emergency Medical Care a.) Establish and maintain an airway b.) Administer oxygen c.) Position the patient d.) Maintain body temp e.) Assess the blood glucose f.) Retrain only if needed Ongoing Assessment a.) May lose gag or cough reflex b.) Suction secretions c.) Heart rate and BP rate may fluctuate
How should you administer emergency medical care to patients with a diabetic emergency with altered mental status?
Emergency Medical Care a.) Establish h and maintain open airway b.) Determine if the patient is alert enough to swallow oral glucose c.) Administer oral glucose d.) Transport Ongoing Assessment a.) Reassess mental status b.) May take 20 minutes to see improvement in mental status after oral glucose c.) Retest blood glucose d.) If BGL increases and so does mental status, most likely low BGL e.) If BGL increases, but the mental status does not improve, can be stroke f.) If the BGL is low, the oral glucose has not yet reached the blood stream
How should you administer emergency medical care to patients who have inhaled poisons?
Emergency Medical Care a.) Get patient out of toxic environment b.) Place in supine position c.) Assure an open airway d.) Start PPV if needed e.) Bring all containers with you Detailed Physical and Ongoing Assessment a.) Reassess vitals
How should you provide emergency medical care and a detailed physical exam/ongoing assessment for musculoskeletal injuries?
Emergency Medical Care a.) If bone is significant, splint during initial assessment b.) Procedure i.) Use BSI ii.) Administer oxygen if needed iii.) Maintain in-line stabilization if spinal injury is suspected iv.) Splint bone and joint injuries 1.) Check OMS and cap refill v.) Apply cold packs vi.) Elevate the extremity vii.) Transport Detailed Physical Exam and Ongoing Assessment a.) You may do this on route b.) Perform ongoing assessment, including recheck of vital signs and interventions c.) Check PMS and cap refill
How should you provide emergency medical care to SIDS patients?
Emergency Medical Care a.) Immediately try to resuscitate b.) Encourage the caregivers to talk and tell their story c.) Do not provide false assurances d.) Transport e.) Deliver the infant into the hands of emergency room staff Aiding Family Members in SIDS Emergencies a.) Shock and disbelief b.) Some may act out with extreme reactions Presence of Parents During Pediatric Resuscitation a.) Beneficial to both parents and patients b.) Minimal effects on the success rates of rescuers
How should you administer emergency medical care to a stroke patient?
Emergency Medical Care a.) Maintain patent airway b.) Suction secretions and vomit c.) Be prepared to assist ventilation d.) Maintain oxygen therapy e.) Position the patient f.) Check blood glucose level g.) Protect any paralyzed extremities h.) Rapid transport Detailed Physical Exam a.) Reassess the sensory, motor function b.) Document any changes Ongoing Assessment a.) Perform every 5 minutes b.) Pay special attention to the airway status, breathing, circulation and mental status
How should you provide emergency medical care to patients with altered mental status and unknown history?
Emergency Medical Care a.) Maintain spinal stabilization b.) Maintain patent airway c.) Suction any secretions d.) Maintain oxygen therapy e.) Be prepared to assist ventilation f.) Position the patient i.) Lateral recumbent or supine g.) Transport Ongoing Assessment a.) Every 5 minutes b.) Changes in ABC
How should you provide emergency medical care to patients who have absorbed poisons?
Emergency Medical Care a.) Protect yourself b.) Carefully assess airway and breathing c.) Brush any dry chemicals or solid toxins from the patient's skin d.) If the poison is liquid irrigate all parts of the body with clean water for at least 20 minutes e.) Irrigate the affected eye for at least 20 minutes Detailed Physical a.) Vitals, ABCs, mental status
How should you provide emergency medical care and a detailed physical exam and ongoing assessment on a patient with closed soft tissue injuries?
Emergency Medical Care a.) Small contusions do not require treatment, usually heal by themselves b.) Procedure i.) Take standard precautions, BSI ii.) Assure an open airway and adequate breathing iii.) Treat for shock (hypoperfusion) if necessary iv.) Splint suspected fractures (painful, swollen, deformed extremities) Detailed Physical Exam and Ongoing Assessment a.) If time persists, conduct a detailed physical exam b.) Repeat the initial assessment, reassess and monitor vital signs, and recheck all interventions
How should you provide emergency medical care and ongoing assessment on patients with external bleeding?
Emergency Medical Care a.) Take BSI b.) Apply direct pressure to the site of the bleeding c.) Elevate the injured extremity d.) Use pressure points to help stop bleeding e.) Immobilize all injured extremities f.) As a last resort, use a tourniquet g.) Provide care for signs and symptoms of shock Ongoing Assessment a.) Ensure that bleeding is still under control b.) Repeat the initial assessment and obtain a set of vitals
How should you perform emergency medical care and a detailed physical exam/ongoing assessment to a patient with internal bleeding?
Emergency Medical Care a.) Take BSI b.) Maintain an open airway and adequate breathing c.) Administer oxygen by nonrebreather at 15 lpm d.) Control external bleeding and splint any fractures e.) Provide immediate transport f.) Provide care for shock Detailed Physical Exam and Ongoing Assessment a.) Get vitals and perform ongoing assessment every 5 minutes
How should you administer emergency care to a patient with a head injury?
Emergency Medical Care a.) Take standard precautions b.) In line stabilization c.) Maintain a patent airway, adequate breathing and oxygenation i.) Consider hyperventilation at rate of 20 per minutes if severe head injury symptoms are present d.) Monitor ABC and mental status e.) Control bleeding f.) Be prepared to provide emergency care for seizure g.) Transport immediately Detailed Physical Exam and Ongoing Assessment a.) Vitals and mental status
What emergency medical care should you give to a patient with a behavioral emergency?
Emergency Medical Care a.) Your safety is of utmost importance b.) Assess p[patient for trauma or medical conditions c.) Calm the patient and stay with patient d.) If it's necessary, use restraints e.) Transport to patient to proper facility Detailed Physical Exam and Ongoing Assessment a.) Detailed on route to the hospital b.) Monitoring the patient's airway, breathing, oxygenation, circulation
Medication name: epinephrine autoinjectors...
Epinephrine is generic Trade name is Adrenalin, Epi-pen, Twinject
How should you perform emergency medical care and a detailed physical exam/ongoing assessment on a patient with open soft tissue injuries?
Emergency Medical Care a.) Take standard precautions b.) Assure an open airway and adequate breathing c.) Expose wound d.) Control bleeding with direct pressure e.) Prevent further contamination f.) Dress and bandage the wound g.) Keep the patient calm and quiet h.) Treat for shock (hypoperfusion) i.) Transport Detailed Physical Exam and Ongoing Assessment a.) Perform a detailed physical exam en route b.) Perform an ongoing assessment by repeating the initial assessment, monitoring vital signs, and rechecking interventions
How should you provide emergency medical care to a patient who has injected poisons?
Emergency Medicare Care a.) Maintain the patient's airway b.) Administer oxygen at 15 lpm by NRB or PPV c.) Be alert from vomiting d.) Protect yourself from injury an the patient from injury e.) Bring all containers to the facility Detailed Physical Exam a.) Vitals, change in mental status
What is prehospital care?
Emergency medical treatment given to patients before they are transported to a hospital
What are signs and symptoms of hyperventilation syndrome?
Emotionally charged state Fatigue Nervousness and anxiety Dizziness SOB, chest tightness Numbness and tingling around the mouth, hands and feet Tachypnea, tachycardia Spasms of fingers and feet Seizures in a patient with seizure disorders
Explain refusal of care...
Emotionally disturbed patients commonly refuse treatment Depending on law, patient who is disoriented, in shock, mentally ill or under the influence may not be considered competent
What are the three most common obstructive pulmonary lung diseases?
Emphysema Chronic bronchitis Asthma
What are circumferential burns?
Encircle body areas such as an arm, leg, or the chest Especially ones that encircle joints a.) Circulatory compromise and nerve damage the result from constriction or from swelling tissues b.) May impede respiratory function
What does 'over' mean on the radio?
End of message, awaiting reply
What does 'clear' mean on the radio?
End of transmission
How should you ventilate a pulseless patient with an advanced airway in place?
Endotracheal tube, esophageal tracheal combitude, laryngeal mask airway, the ventilation in the patient without a pulse is 8-10 per minute (every 7.5 to 6 seconds)
What is kinetic energy?
Energy contained in a moving body How a person is injured depends on the force with which he collides with something Force depends on the energy contained in the moving bodies
How does energy change form and direction?
Energy travels in a straight line unless it meets and is deflected by some kind of interference Interruption may be a curve in a bone, an organ that is caught between two hard surfaces or tissue that is pulled against a fixed point Energy is forced to change form because it can no longer travel in straight lines
How should you care for patients with traumatic amputations?
Enlist others to look for the missing body part Procedure a.) Remove any gross contamination by flushing with sterile water or saline b.) Wrap the part in dry sterile gauze c.) Wrap the part in plastic d.) Keep the amputated part cool e.) Transport the part with the patient if possible Do not complete the amputation
How should you administer metered dose inhalers?
Ensure 6 rights Obtain order Assure that the inhaler is room temp, shake for 30 minutes Remove nonrebreather a.) Hold inhaler upright b.) Place finger on canister Have the patient exhale fully Place lips on mouthpiece Slowly and deeply inhale over 5 seconds as you depress the inhaler Remove the inhaler and hold breather for 10 seconds Have the patient exhale slowly through pursed lips Replace oxygen, breathing status, and baseline vitals Reassess patient and decide if another dose is needed a.) Wait 2 minutes before administering another dose If there is a spacer a.) Remove the space cap and attach it to inhaler b.) Depress the medication canister to fill the canister c.) Inhale the medication
How should you perform emergency medical care on patients with predelivery emergencies?
Ensure adequate A, B, Cs a.) Mental status Care for bleeding from vagina a.) Never pack the vagina b.) Place pad over opening c.) Never touch the vaginal area d.) Save and transport pads Treat for shock Provide emergency medical care as you would for others Transport on left side
How should you deliver emergency medical care for emphysema and chronic bronchitis?
Ensure open airway and adequate breathing Place in position of comfort and administration of supplemental oxygen are key elements in managing these patients May have an MDI May develop a hypoxic drive a.) Respond to low levels of oxygen b.) Oxygen administration should take c.) If the patient is not in significant distress or is not a high priority, place on nasal canula
How do you immobilize a supine or prone patient?
Ensure that ABCs are established Maintain in line manual stabilization Apply a c collar Move the patient onto the spine board by log rolling the patient Position the long spine board under the patient by sliding the board under the patient during the log roll Place padding in the spaces between the patient and the board Immobilize the patient's torso to the board with straps Immobilize the patient's head to the board with a commercial head/cervical immobilization device or through the use of blanket rolls and tape Secure the patient's legs to the board with straps Proceed with care as described earlier under Emergency Care
How should you administer emergency medical care to patients with lightening strike injuries?
Ensure that scene is safe Put out fire on close In line stabilization Airway CPR or AED if needed Immobilization Transport
What is a transport unit in MCIs?
Ensures that ambulances are accessible At the highest priority, patients are stabilized before transport High priority patients should be transported first Should radio the hospital that the ambulance is en route a.) Individual EMTs should not communicate with the hospital Consider putting ambulatory patients on a bus
Explain the absorption route of poisonings...
Enter when it comes in contact with skin Local irritation or systemic effect
What is chemical digestion?
Enzymes or digestive juices break down food into simple components Carbs to glucose, fats into fatty acids, and proteins into amino acids
What are the three layers of the skin?
Epidermis Dermis Subcutaneous layer (hypoepidermis)
What are the three skin layers?
Epidermis Dermis Subcutaneous layer
Epinephrine and norepinephrine...
Epinephrine also known as adrenalin a.) Both secreted by the adrenal gland b.) Produce many of the symptoms seen in patients when the sympathetic nervous system is stimulated Alpha 1 a.) Cause the vessels to constrict b.) The skin becomes cool and pale c.) Causes sweat glands to release sweat making the skin become moist or clammy Alpha 2 a.) Effects thought to regulate the release of alpha 1 Beta 1 a.) Relates to the heart b.) Increases heart rate, increase the force of cardiac contraction and speed up the electrical impulses traveling down the heart's conduction system Beta 2 a.) Will cause smooth muscle to dilate, especially in the bronchioles and in some vessels Epinephrine a.) Has all four above properties b.) Used to treat patients with severe allergic reactions to combat vasodilatation and bronchoconstriction Norepinephrine a.) Causes primarily alpha 1 and 2 b.) The majority of the effects are seen in the blood vessels and skin
At its lower end, the pharynx divides into the ___ which leads to the stomach and the ___ which leads to the lung. The trachea is anterior to the trachea.
Esophagus Trachea
What are platelets?
Essential to the formation of blood clots
How should you deal with injuries to the eye orbits?
Establish and maintain C spine Check DCAP-BTLS Symptoms a.) Diplopia i.) Double vision b.) Decrease in vision c.) Loss of sensation above the eyebrow, over the check or in the upper lip d.) Nasal discharge e.) Bony stepoff f.) Paralysis of upward gaze in the involved eye Treatment a.) Place cold packs over the injured eye b.) Transport in sitting position
What kind of emergency medical care should you provide to a patient with diabetic ketoacidosis?
Establish and maintain a patent airway Provide oxygen or positive pressure ventilation Determine BGL Administer oral glucose a.) Even if you are unsure if it is hypo or hyperglycemia Contact medical direction for further orders
What are the key elements of managing the poison patient?
Establish and maintain a patent airway, oxygen, assess circulation Can deteriorate quickly Place in lateral recumbent a.) Suction if necessary
How should you provide emergency medical care to children with respiratory emergencies?
Establish and maintain patent airway Suction any secretions Use PPV if needed with OPA or NPA Initiate PPB Ventilate at 12-20 per minute Maintain oxygen therapy Blow by method Position the patient Transport
How should you remove an infant or child from car seat?
Establish cervical spinal stabilization Apply collar Position seat in center of the backboard Support head, trunk, neck Pad areas of the body that are off the board Place towels on both sides of patient Secure the patient to board using straps Apply cervical immobilization device on each side of head
How should you provide emergency medical care to a child trauma patient?
Establish in line stabilization Suction as necessary Provide oxygen Provide spinal immobilization Transport
How should you do bag valve mask ventilation on a patient with suspected spinal injury?
Establish in line stabilization Do jaw thrust maneuver Same procedure
How should you administer emergency medical care to patients with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?
Establish open airway Provide oxygen or positive pressure ventilation Determine the BGL Administer oral glucose Contact medical direction for further oders May need rehydration or ALS
What emergency medical care should you provide in deep water emergencies with decompression sickness?
Establish spinal stabilization if needed a.) Do not place in Trendelenburg or head down Open the airway and assess breathing a.) Give oxygen b.) Begin PPV if needed Initiate CPR or AED if needed Transport
How should you deliver emergency medical care to a patient with asthma?
Established and maintain open airway Oxygen or positive pressure ventilation with supplemental oxygen Watch for chest rise and fall
What is a safety zone?
Established early in the emergency In which rescue operations and a specific sequence of decontamination procedures take place
What does ETA mean?
Estimated time of arrival
Evacuation and EMTs...
Evacuation can prevent injury, preserve life and protect property Nature of the disaster and estimated time of impact on the area Safe routes to exit Appropriate destinations for those who evacuate
Special considerations for children...
Evaluate the quality of cry for A and B Cap refill time can be considered Look at the interest of the child Use AVPU Listen for hoarseness, look for nasal flaring, look for grunting Obtain respiratory rate Heart rate will normally increase when inhaling Use proper BP cuff
Always try to use an ___ number of rescuers to maintain balance
Even
What are some basic principles for dealing with behavioral emergencies?
Every person has limitations Each person has a right to his feelings Each person has more ability to cope with crisis than he might think Everyone feels some emotional disturbance when involved in a disaster or when injured Emotional injury is just as real as physical injury People who have been through a crisis don't just get better Cultural differences have special meaning
How should you perform a focused history and physical exam for patients with drug and alcohol emergencies?
Examine the patient for trauma CNS stimulants a.) Dilated pupils b.) JVD Narcotics a.) Pinpoint pupils b.) JVD The membranes may be swollen if volatile chemicals have been inhaled Obtain a new set of vitals and get SAMPLE Signs and Symptoms CNS stimulants a.) Excite the CNS b.) Excitability, elevated mood, agitation, apprehension, uncooperativeness, tachycardia, dilated pupils, dry mouth, sweating, increased blood flow, increased BP, loss of appetite Hallucinogens a.) May cause the face to flush CNS depressants a.) Depress the CNS b.) Euphoria, drowsiness, sleepiness, decreased breathing, bradycardia, hypotension, dilated pupils Narcotics a.) Derived from opium or synthetic opium b.) CNS depressants c.) Bradycardia, hypotension, lethargy, inadequate breathing, constricted pupils, nausea Hallucinogens a.) Motor disturbance, paranoia, anxiety, visual or auditory hallucinations, tachycardia, dilated pupils Volatile Inhalants a.) Excitement, euphoria, drunkenness, aggressiveness, nausea, drowsiness, depression, headache
Most states give ambulances the privileges to do the following...
Exceed the speed limit Drive the wrong way on a street Turn in any direction at intersection Park anywhere Leave the ambulance in street or intersection Cautiously proceed through red lights Pass other vehicles in no passing zone Must meet following qualifications before you can exercise those privileges a.) Must have valid license b.) Must be responding to emergency situation c.) Must use warning devices d.) Must exercise regard for safety of others e.) Many EMS systems provide additional guidance f.) Several states require special licenses
What is an automatic transport ventilator?
Excellent at providing and maintaining a constant rate and tidal volume Less likelihood of causing gastric inflation EMT is free to use both hands to hold the mask Device can be set up to provide specific tidal volume, rate and minute ventilations Alarms indicate low pressure One can hold in line stabilization One can apply cricoid pressure Disadvantages a.) Once oxygen is depleted, it will not work b.) Some cant be used in children under 5 c.) Not possible to feel an increase in airway resistance Recommended Features a.) Some have a demand valve built in
What is a bronchodilator?
Except ipratropium (anticholinergic agent) Beta 2 agonists, mimic the effects of the sympathetic NS Relaxes the bronchiole smooth muscle a.) Improves air movement Work almost immediately and can last 8 hours or more In aerosol form Spacer a.) Chamber that holds the medication until it is inhaled Allows a greater amount of medication to be delivered to a patient
When should you use a full body spinal immobilization device?
Exist to provide stabilization and immobilization of the head, neck, torso, pelvis, and extremities Used to immobilize patients who are found in a lying down or standing position Also need padding, straps, and cravats are also used with the long board
What are some hazards of oxygen administration?
Explosion Ignitable Oil and oxygen is a no no Oxygen toxicity Damage to the retina of the eye COPD a.) Respiratory arresst or distress in COPD patient b.) Body responds to low levels of oxygen to breathe c.) Takes a longer period of time to knock out the COPD's oxygen drive (hypoxic drive)
What items cause blast injuries?
Explosions, gasoline, natural gas, fireworks, rain elevators
What are blast injuries?
Explosively expanding gas cloud Shockwave and blast produce typical shockwave injuries
How should you assess the chest during a rapid trauma assessment?
Expose the chest Any open wounds to the chest must be covered by a gloved hand and covered with an occlusive dressing tapes on three sides over the wound Inspect for D, C, A, B, K, S, lack of symmetry and any other evidence of trauma Paradoxical movement Inspect the intercostal muscles Use a stethoscope to listen for breath sounds a.) Present and equal Tension pneumothorax
How should you assess the chest in a detailed physical exam?
Expose the chest Look for DCAPBLC Look for retractions Asymmetrical movement is a sign of significant pneumothorax or flail segment Palpate the sternum by pushing Look at the shoulder girdle Auscultation
How should you splint long bone injuries?
Exposed bone ends Joints in locked position Paresthesia, prickling or tingling feeling Paralysis Pallor of the injury site Assess PMS and cap refill If the limb is severely deformed, cyanotic, or lacks distal pulses, align it with gentle traction a.) Provide steady, gentle traction b.) If pain or crepitus increases, stop
What are advance directives?
Express the patient's wishes should they experience a significant change in health
What is extension or decerebrate positioning?
Extend both arms down at their sides, extend their legs and arch their backs Lowest level of nonpurposeful movement Lower level brain stem injury
What is a fourth degree burn?
Extends completely through the epidermis and dermis and deep into the tendons, ligaments, muscle, bone, blood vessels and nerves Electrical injuries
What are shunts? How should the EMT deal with one?
Extends from the brain to the abdomen to drain extra fluid Signs and symptoms of headaches and brain injury Mental status changes, seizures, loss of motor or sensory function, respiratory distress, vomiting Maintain airway PPV if needed Position on left and be prepared to suction Transport
What is the lower airway?
Extends from the cricoid cartilage to the lower edge of the larynx to the alveoli of the lungs
What is the upper airway?
Extends from the nose and mouth to the cricoid cartilage
External v. internal hypothermia...
External a.) Do not have access to warm environment Internal a.) When the person is indoor b.) Typically the elderly
What are the signs and symptoms of PCP and cocaine use?
Extreme agitation, horizontal and vertical eye movement Unresponsiveness to pain, muscle rigidity Excessive bronchial and oral secretions Hypertension, seizures, decreased urine Respiratory depression or arrest Vivid visual hallucinations MI, aortic dissection, chest pain Stroke, severe headache Respiratory or neurological problems Psychiatric problems
What is the hypertonic phase of a seizure?
Extreme muscle rigidity and hyperextension of the back
What is kyphosis?
Extreme slouch Shoulders rolled forward Fatigue of the lower back and increases spinal pressure
What are the two types of asthma?
Extrinsic asthma a.) Allergic asthma b.) Results from a reaction to dust, pollen, smoke, or other irritants in the air c.) Typically seasonal Intrinsic a.) Nonallergic b.) Common in adults and results from infection, emotional stress, or strenuous exercise
How do you perform mouth to mouth ventilation?
Forms a seal with mouth around the mouth or nose and uses exhaled air to ventilate Nose is pinched Barrier device must be used If the mouth cannot be opened, severe soft tissue or bone injury or infants
What is the Glasgow coma scale?
Eye opening a.) Spontaneous, 4 b.) To verbal command, 3 c.) To pain, 2 d.) No response, 1 Verbal Response a.) Oriented and converses, 5 b.) Disoriented and converses, 4 c.) Inappropriate words, 3 d.) Incomprehensible sounds, 2 e.) No response, 1 Motor Response a.) Obeys verbal commands, 6 b.) Localizes pain, 5 c.) Withdraws from pain, 4 d.) Abnormal flexion in response to pain, decorticate, 3 e.) Extension, decerebrate 2 f.) No response, 1
Example of personal protective equipment (PPE)?
Eye protection a.) Protect against blood and other fluids from splashing into your eyes Protective gloves a.) High quality, vinyl, latex free Wash hands a.) Put on a different set for each patient Gowns a.) Wear a gown where there may be significant contact with blood and other fluids Masks a.) May put a mask on patient with an airborne disease b.) TB
What are the orbits?
Eye sockets
What is the Cincinnati Prehospital Stroke Scale?
Facial droop by having the patient smile Arm drift by having the patient close his eyes and hold both arms straight out for 10 seconds Abnormal speech pattern and muscle paralysis by having the patient say you can't teach an old dog new tricks Specificity and sensitivity a.) If you have one of Cincinnati scale, 72% probability of stroke b.) 93-97% of people who have positive LAPSS will have suffered a stroke
What are the signs and symptoms of a stroke?
Facial droop, arm drift, speech disturbances Altered mental status Sudden onset of paralysis Numbness or loss of sensation Loss of control of bladder or bowel Unequal pupils, deterioration of vision Eyes turned away from side of the body that is paralyzed Nausea or vomiting Severe headache, stiff neck, seizure activity Sensory or receptive aphasia a.) Patient doesn't understand what you are telling him Unable to form words to talk a.) Expressive or motor aphasia Incoordination of the extremities Poor balance Hearing loss to one side Light or sound sensitivity Vertigo or dizziness
What is drag?
Factors that slow a bullet down, wind resistance
What is syncope?
Fainting, sudden and temporary loss of consciousness Temporary lack of blood flow into the brain Things become dark, then they become unresponsive May confuse syncope with seizure
What is a glucometers?
Fairly accurately determine the blood glucose level (BGL) Device analyzes a drop of capillary blood and provides a numerical reading that indicates the concentration of glucose in the blood a.) Measured in milligrams per decileter (mg/gl)
MOI considerations for falls...
Fallen ladders, collapsed scaffolding, ropes in a tree, stairs, balconies, roofs, windows Distance fallen Surface the patient landed on Body part that impacted first
What are Braxton-Hicks Contractions?
False labor Painless, short duration, irregular contractions As early as 13th week No cervical dilations All should be transported
True or false: EMT can administer medications on their own.
False, they need permission. Must attain medical direction permission, whether as a standing order or as an online order, before administering or assisting patient with medication
What does distal mean?
Far from the point of reference
What does the prefix tachy mean?
Fast
What is tachypnea?
Fast breathing
What is tachycardia?
Fast heart rate
How do head injuries effect pulse?
Fast or increasing, suspect hemorrhage Slow or decreasing, pressure inside skull or severe hypoxia
What are some anatomical differences in the metabolism of children?
Faster metabolic rate
What is the subcutaneous layer?
Fatty tissue Varies in thickness a.) Eyelid, thin b.) Abdomen and buttocks, thick
What are some symptoms of psychological impact of disasters?
Fear, shake, perspiration, confusion and irritability, fatigue, restlessness, night mares, difficulty concentrating, moodiness, suspiciousness, depression, nausea, vomiting and diarrhea Survivors a.) Fear, anxiety, anger, guilt, shock, depression, denial, feelings of isolation and vulnerability
___ ___ ___ has jurisdiction over all radio operations in the US
Federal Communications Commission (FCC)
What is palpation of blood pressure?
Feeling for the return of the pulse as the cuff is deflated
What is a apical pulse?
Felt on the left side of the chest Only feel contraction, no pressure or volume
What are the four most common methods of suicide?
Gunshot Hanging Poisoning Carbon monoxide poisoning
What is staphylococcus enterotoxin 13( SEB)?
Fever, chills, headache, cough 3-12 hours after exposure Shock and death at high doses
What is brucellosis?
Fever, malaise, joint and body pain, headache, cough
What is hemostatic dressing?
Fibrinogen and thrombin on the surface of the dressing that promotes clotting and stops bleeding when applied to wounds
What should the EMT do post-run?
Fill out and file reports Check fuel and fill tank Complete inventory of equipment Change soiled uniforms Say you are available for another call Infection control procedures a.) Dispose of sharps b..) Make sure that needles and blades have been properly disposed of c.) Wash hands d.) Clean Disinfect and Sterilize Contaminated Equipment e.) Clean visible contamination f.) Disinfect reusable equipment g.) Launder Soiled Clothing h.) Dispose of Infectious Wastes
What are kidneys?
Filter waste from the bloodstream and help control fluid balance
What is the function of the urinary system?
Filters and excretes waste from the blood, plays an important role in blood pressure regulation
What is activated charcoal?
Fine black powder that is used in the emergency care of some patients who have swallowed poisons Designed to absorb, or bind, the poison to the charcoal Will be carried to the digestive tract and eliminated
What is a superficial burn?
First degree burn Only involves the epidermis Usually caused by a flash, sudden occurrence of heat lasting only a few seconds, hot liquid, or the sun Skin will appear pink to red and will be dry a.) May be swelling, but no blisters b.) Skin will be soft and tender May be very painful because the pain receptors in the underlying dermis of the skin are still intact General will take only several days to heal May cause the epidermis to peel, but no scaring Sunburn and minor scald injury
What is Korotkoff's sound?
First distinct sound when measuring blood pressure
What are the necessary standard precautions EMT must take when approaching a scene?
First goal is to ensure the safety of the EMT Consider contact with all body fluids to be a true safety hazard The call from dispatch can help you begin to plan your standard precautions ] a.) Prior to arriving on scene, anticipate what BSI will be necessary b.) Personal protective equipment You should not use any PPE for which you have not been specially trained a.) Should use the same level of BSI that is required for other personnel on the scene
What is primagravida?
First pregnancy
What is the cranium?
Forms the back, top and sides of the skull plus the forehead Lobes are occipital, parietal, temporal, frontal Outer level is thick and tough Inner layer is thinner and brittle Can lacerate the brain or bruise it and cause it to swell
What are signs and symptoms of ethylene glycol poisoning?
First stage (30minutes-12 hours) a.) Uncoordinated movement b.) Slurred speech c.) Altered mental status d.) Nausea and vomiting e.) Seizures, hallucinations Second stage (cardiopulmonary) a.) 12-24 hours after ingestion b.) Tachypnea c.) Crackles d.) Cyanosis e.) Respiratory distress f.) Heart failure Third stage (renal) a.) 24 to 72 hours b.) Production over very little urine, oliguria c.) Bloody urine d.) Pain to the flank area
What are the coronary arteries?
First two arteries that originate off the aorta and are associated with cardiac emergencies May lead to heart attack or heart failure and cause abnormal electrical cardiac rhythms
How do you remove hard contact lenses?
Fit over the cornea Separate the eyelids Position the visible lens over the cornea Place your thumbs on the top and bottom eyelids and open Gently press the eyelids down and forward to the edges of the lens Press the lower eyelid slightly harder and move it under the bottom edges of the lens Moving the eyelids together, slide the lens out between them
What are the metatarsals?
Five on each foot Form the substance of the foot
What are mounted suction devices?
Fixed or installed units should be part of the required on-board ambulance Powerful enough to provide an airflow of >40lpm
What is the sternum?
Flat, narrow bone and the center of the anterior chest The ribs are attached to the middle segment or body of the sternum
What is the pancreas?
Flat, solid organ Inferior and posterior to the stomach Secretes pancreatic juices that aids in the digestion of fats, starches, and protein Islets of Langerhans produce insulin that regulates the amount of sugar in the blood stream
How should you assess the pelvis during a detailed physical exam?
Flex and compress the pelvis Inspect for DCAPBLS Do not palpate if there is obvious injury or if the patient is complaining a.) Note any loss of bladder control, priapism
What is a soft catheter (suctioning)?
Flexible tubing called a French catheter Used in suctioning the nose and nasopharynx Measure from the tip of the nose to the ear
What are some various movements of the joints?
Flexion Extension Abduction Adduction Circumduction Pronation Supination
What is the basilar skull?
Floor of the skull Made up of separate pieces of bone and is the weakest part of the skull Many bony ridges
How should you deal with foreign objects in the eye?
Flow of foreign tears often washes out these substances before any harm is done Globe will be red, determine if the patient or others made any attempt to remove the object Safer to transport the patient for further medical evaluation than to attempt to remove foreign particles from the eye in the field a.) Only attempt to remove an object from the conjunctiva i.) Flush the eye with clean water, holding the eyelids apart ii.) If you have to remove an object from the white of the eye, pull down the lower lid while the patient looks up or pull up on the upper lid while the patient looks down iii.) Remove object with gauze or sterile swab If the object is under the upper lid, saw the upper lip down over the lower lid May remove the object over the eyelashes If it remains, grasp the lashes of the upper eye and turn the lid upward over the cotton swab or similar object If a foreign object gets caught into the eyeball, do not attempt to disturb it a.) Place a bandage over both eyes and transport
What is pulmonary edema?
Fluid in the lungs, gradual or sudden onset CHF, heart attack, valve damage Left ventricle ejects less blood Fluid leaks into space between alveoli and capillaries Assessment a.) Severe dyspnea, coughing, altered mental status, CHF Oxygen, Fowler's transport
What are the main causes of shock?
Fluid loss a.) Fluid can be lost from the circulatory system from injury that causes bleeding, burns that cause plasma loss and dehydration b.) When the brain detects fluid loss, it releases hormones that cause the heart to beat faster and blood vessels to constrict Pump failure a.) If the heart is damaged and cannot pump enough blood to the body Vasodilation a.) The blood vessels will increase in size (dilate) the hear is unable to keep perfusion and blood pressure at normal levels Hypoxia a.) A severe chest injury, airway obstruction may prevent an adequate amount of oxygen from entering the bloodstream
What are predisposing factors to decompression sickness?
Flying too soon after dive Failure to take necessary safety stops when ascending Inadequate surface intervals Inadequate decompression or passing the no decompression limit Cold water Rough sea conditions Heated diving suits Heavy work
What is a detailed physical exam?
Following the focused history and physical exam and only after life threatening injuries and conditions have been effectively managed Sometimes in the back of the ambulance
What is cardiac contusion?
Follows severe blunt trauma Heart is compressed between the sternum and the spinal column Bruise may occur to the heart wall and could be ruptured Right ventricle most frequently injured Signs and symptoms a.) Chest pain and discomfort b.) Bruising, swelling, crepitation, deformity, tachycardia, irregular pulse
What is the postictal state?
Follows the seizure and is the recovery period for the patient Patient may be unresponsive, sleepy, weak and disordered and experience paralysis May last up to 30 minutes Recovery phase Altered mental status
What is the esophagus?
Food and water are routed here and go to the stomach
What is sensitization?
For an allergic reaction to occur, the patient must have been sensitized to the exposure to the substance at least once before Allergic type or anaphylactoid reaction a.) Can occur the first time an allergen is introduced to the body When allergen enters the body, the body views it as foreign and antibodies are formed to fight off the antigen a.) Antibodies attach themselves to two types of cells in the body i.) MAST cells ii.) Basophils b.) Once an antibody attaches to the MAST cells and basophils, the patient is said to be sensitized i.) Can be for minutes, days, weeks or years When the antigen is reintroduced into the body, it attached to the antibodies that are now located on the MAST cells and basophils a.) Membranes breakdown and release chemical substances referred to as chemical mediators Primary chemical mediator released from MAST cells and basophils is histamine a.) Causes bronchoconstriction, vasodilation and an increase in capillary permeability (leakage)
What is a penetrating injury?
Force that pierces the skin and body tissues, often caused by gunshots and knives
What are antigens?
Foreign substances are recognized by the cells of the immune system and eventually destroyed Can enter through the skin, GI tract, or respiratory tract
What is carbon monoxide poisoning?
Formed by the incomplete combustion of gasoline, kerosene, coal, plastic, wood, natural gas Lack of oxygen a.) Less carried by the bloodstream b.) Inhibits the ability of body cells to utilize what oxygen is delivered
When should you use traction splinting?
Fractures of the femur can be successfully immobilized with a traction splint Reduce the diameter of the thigh and realign the fractured femus Don't use if a.) The injuries is within 1 to 2 inches of the knee or ankle b.) The knee has been injured c.) The hip has been injured d.) The pelvis has been injured e.) Partial amputation
What is a local cold injury, or frostbite?
Freezing of body tissues Requires colder temperatures than that is needed to create generalized hypothermia Ice crystals form between the cells of skin and expand as they extract fluid from the cells Circulation is obstructed Heat, feet, ears, nose, cheeks
What is polyphagia?
Frequent hunger
What is polydipsia?
Frequent thirst
What are some general symptoms of diabetes?
Frequent thirst (polydipsia) Frequent urination (polyuria) Frequent hunger (polyphagia)
What is polyuria?
Frequent urination
What is a thromobotic stroke?
From a clot that forms in a cerebral artery
What is an embolic stroke?
From material carrier to and lodging in the cerebral circulation from another area of the body
What is the midaxullary line?
Frontal plane a.) Drawn side to side through the body Divides the body into the anterior plane (the patient's front) and the posterior plane (the patient's back)
What does cold skin indicate?
Frostbite, significant cold exposure The skin may appear to be firm or stiff
What is considered a strong pulse?
Full and normally strong Bounding pulse is one that is abnormally strong
What are protocols? What are the two types of protocols?
Full set of guidelines that define the scope of medical care May consist of off line and on line medical direction a.) Off line medical direction i.) Provided through a set of predetermined, written guidelines that allow the EMT to use his or her judgment to administer care without contacting a physician b.) On line medical direction i.) Requires the EMT to acquire permission via cell phone, radio
What are trimesters? What is considered full term?
Full term 280 days from the first day of the last normal menstrual cycle Trimester a.) 3 month period b.) Towards end of third trimester, baby moves into a head down position c.) Uterus moves down and forward i.) 'Baby has dropped'
What is physiology?
Function of the living body and its parts
What are the functions of the nervous system?
Functions a.) Communication b.) Control Enables the individual to be aware and react to the environment Coordinates body responses of the body to changes in the environment and keeps the body systems working together Most nerve centers are in the brain and spinal cord
What is the maxillae?
Fused bones of the upper jaw
How should you approach a potential child abuse or neglect situation?
Gain entry a.) Low and firm voice b.) Request law enforcements Dealing with child a.) Speak softly, call by fist name Examining child a.) Head to toe rapid trauma b.) Keep suspicions to yourself Dealing with caregivers a.) Child should be taken to hospital for further care Transporting a.) Do not allow child to be left alone with parent Providing documentation a.) Privately convey suspicions to physician b.) Document everything
What is the inhalation route of medication administration?
Gas or aerosol Deposits the medication to the target site Patient must be spontaneously breathing Oxygen Metered dose inhaler Liquid/vaporized fixed dose nebulizer
What is agonal breathing?
Gasping type breaths Usually appear soon after the person goes into cardiac arrest
What is the procedure for restraining a patient?
Gather enough people to overpower the patient rapidly Plan your activities before restraining Use only as much force as needed Estimate range of motion Act quickly One rescuer talk the patient through the process Approach with at least four rescuers Secure the patient's limbs Secure the patient to the stretcher If patient is spitting, cover face with surgical mask Do not remove restraints Document
How should you perform a focused history and physical exam on a child with a respiratory emergency?
Gather history first Baseline vitals SAMPLE, OPQRST Respirations a.) Respiratory rate Pulse a.) May be difficult to feel carotid pulse b.) Use the radial or brachial pulse c.) Ausculation of the apical pulse Skin a.) Color, temperature, condition, cap refill Pupils BP a.) Do not take on children under 3 b.) Use the right size cuff
How should administer emergency medical care to a general chest injury?
General Emergency Medical Care - Chest Injury a.) Maintain open airway i.) Take in line stabilization b.) Continue oxygen therapy c.) Reevaluate breathing status d.) Stabilize an impaled object in place e.) Completely immobilize the patient if spinal injury is suspected f.) Treat the patient for shock (hypoperfusion) if signs are present Detailed Physical Exam and Ongoing Assessment a.) If time permits, perform detailed physical exam b.) Ongoing assessment c.) Evaluate effectiveness of treatment d.) Signs and symptoms i.) Increasing breathing difficulty ii.) Decreasing mental status iii.) Decreasing breath sounds iv.) Worsening cyanosis v.) Shock (perfusion) e.) Reassess and record the baseline vital signs f.) Decreasing blood pressure, increasing heart rate, increasing respiratory rate, and cyanotic, cool, moist skin may indicate a worsening chest injury or shock (hypoperfusion)
What emergency medical care should you provide to a patient with preeclampsia/eclampsia?
General procedure Administer oxygen, keep suction at hand Prepare for PPV Transport quietly
What are skull injuries?
Generally deformed only if trauma is extreme Can be open or closed Deformity itself does not cause disability or death, it is underlying damage
What are the signs and symptoms of snakebites?
Generally immediate Determined by a.) Location of bite b.) Whether pathogens are present c.) Patient's size and weight d.) Patient's health and condition e.) How much physical activity before the bite
How should you treat insects, bites, and stings?
Generally treated like any other injury Only need medical help if itching last longer than two days Sharp, stinging pain, itchy painful swelling
How should a normal patient be positioned and transported?
Generally, a patient is placed supine or sitting
What is the proper technique for reaching?
Generally, a person can sustain a 100 percent effort for 6 seconds and a 50% effort for 1 minute before becoming fatigued Get closer to the object Reach no more than 15-20 inches in front of body Do not twist and keep back locked Log roll a.) Lean from hips, not waist and keep back straight b.) Use shoulder muscles to assist
Drugs can have up to four names...
Generic a.) Nonproprietary name b.) Reflects the chemical characteristics of the drug Brand name a.) Trade name b.) Assigned when the drug is released for commercial distribution c.) Name is short and easy to recall d.) May be based on chemical name of the type of problem it treats Chemical a.) Describes the drug's chemical structure Official a.) Generic name followed by USP or NF b.) Drugs that meet the requirements of the US Pharmacopoeia
What are red blood cells?
Give the blood its color, carry oxygen to the body calls, carry CO2 away from the cells Hemoglobin carry CO2 and O2
What is the function of the skeletal system?
Gives body shape Protects vital organs Allows for movement Stores minerals and produces blood cells
What is the skeletal system?
Gives the body its framework, supports and protects vital organs, and permits motion
What are the metacarpals?
Gives the strength of the hand
What are the signs and symptoms of an abdominal aortic aneurysm?
Gradual onset of lower lumbar, groin, and abdominal pain Rupture associated with sudden onset of severe, constant abdominal pain a.) May radiate to lower back, flank or pelvis b.) May be described as a tearing pain c.) Testicular pain in the male patient d.) Possible nausea and vomiting e.) Mottled or spotty abdominal skin f.) Pale, cool and clammy g.) Absent or decreased femoral or pedal pulses h.) Pulsating abdominal mass 1.) If it has burst, the abdomen will be rigid and tender i.) If the aneurysm is starting to rupture, the skin below the waistline will be cyanotic, cold and mottled
Poisonings in children...
Greatest incidence of poisoning occurs between 1 and 2 Assessment Considerations a.) Gather as much information as possible regarding the poison Emergency Medical Care a.) If patient is alert i.) Contact medical direction of poison control ii.) Provide oxygen iii.) Transport b.) If patient is unresponsive i.) Maintain open airway ii.) Oxygen iii.) Transport iv.) Rapid trauma
What are signs of placenta previa?
Hallmark sign is painless bleeding in third trimester Uterus remains soft Look for hypovolemic shock
Considerations for performing the head tilt-chin lift in infants and children...
Hand positions and procedures for performing them are the same except for a variation in head positioning With an infant, the head should be tilted back gently into a sniffing or neutral position a.) May be necessary to put a pad behind the shoulders to keep the airway open Child a.) Head is only tilted back slightly b.) Only use one finger
What is stridor?
Harsh, high pitched sound heard during inspiration Characteristic of a significant upper airway obstruction from swelling of the larynx
What is the Markle test?
Has been shown to be just as reliable Patient stand on his feet with knees straight The patient should raise himself onto his toes and drop down suddenly on his heels, flat footed a.) Will elicit pain Can be performed on a supine patient by lifting both of the ankles and knocking the heels together or by making a fist and striking the bottom of the heel a.) Will elicit pain Watch the patient's face for a grimace
Oxygen reserves in children...
Have smaller and more limited oxygen reserves Less oxygen in their lungs during periods of inadequate breathing Twice the metabolic rate of adults
How should you follow up after delivering an intervention?
Have the vitals improved? Is the airway still patent? Is the oxygen accurate? If the chest rising and falling adequately? Has the patient lapsed into arrest again? Is the ARD indicating that a shock is needed? Is the pressure dressing controlling the bleeding? Is the spine immobilized? Are bone or joints immobilized?
Patients with a head injury or those with spinal cord injuries may respond to a painful stimulus but may not respond appropriately or normally...
Having no purpose relative to the patient painful stimulus Flexion posturing a.) Decorticate posturing i.) The patient arches the back and flexes the arms inward towards the chest ii.) Compression of the brain at the upper portion of the brain stem Extension posturing a.) Decerebrate posturing i.) The patient arches the back and extends the arms straight out parallel to the body ii.) Lower portion of the brain stem is being compressed Both are signs of serious head injury
Safety measures for scenes with toxic substances and low-oxygen areas...
Hazard may be obvious, others may not Spill, leak or fire a.) You should call for assistance A confined space a.) Caves, wells, tankers, vats, manholes, sewers, culverts, underground utility vaults, closed garages b.) May be low in oxygen and high in toxic substances like methane c.) Made with a self contained breathing apparatus in place (SCBA) Multiple patients with similar symptoms a.) Faulty furnaces b.) Blocked flue on a gas hot water tank
How should you perform a rapid trauma assessment on a patient with a suspected head injury?
Head The Eyes, pupils a.) Consensual reflex Check eye movements Is there any discoloration? a.) Raccoon eyes i.) Indication of intracranial injury ii.) May not appear till 4 to 6 hours after the injury Ears and Nose • Leakage of CSF Battle's sign a.) Purplish bruising behind the ear b.) Delayed sign of basilar skull fracture Check the nose for leakage of blood or clear fluid, which can indicate skull fracture skull facture or intracranial Motor/Sensory Assessment a.) Ability to move fingers and toes b.) Squeeze finger tips simultaneously c.) Which toe am I touching
Effects of gunshot wounds to various locations of the body...
Head a.) Brain tissue is severely compressed b.) Face threatens airway Chest a.) Lung tissue i.) Pneumothorax ii.) Rib fractures b.) Heart i.) May be able to seal themselves off from low velocity projectile c.) Diaphragm i.) Suspect both thoracic and abdominal injury Abdomen a.) Large and contains fluid filled structures, solid structures, air filled structures and bony structures Extremities a.) Bone, muscle, blood vessels and nerves b.) Bony fragments become secondary missiles c.) Capillary tears and swelling
What is an acceleration/deceleration injury?
Head comes to a sudden stop but the brain continues to move back and forth in the skull
How to assess for trauma or shock in the elderly?
Head injuries are harder to detect in the elderly a.) May take weeks or days to develop b.) Was it produced by dizziness, faintness, palpitations Shock progresses more rapidly
MOI considerations for motorcycle crashes...
Head on a.) Propelled forward Angular impact a.) Rider strikes an object Ejection a.) Rider is thrown forward from the motorcycle Laying down the bike a.) Purposefully lays down the bike
What are two manual airway maneuvers?
Head tilt/chin lift Jaw thrust
What does the prefix pneo mean?
Heart
What are the leading causes of death in the elderly?
Heart disease Cancer Stroke COPD Pneumonia Diabetes Trauma Drug misuse
What is cardiac arrest?
Heart is not pumping effectively or not at all and no pulses can be felt Cells become deoxygenated Brain cells begin to die in 4 to 6 minutes following cardiac arrest
What is bradycardia?
Heart rate less than 60bpm
What are some anatomical differences in the cardiovascular system of children?
Heart rate will increase in response to fear, anxiety, etc Bradycardia is a late response to hypoxia Smaller circulating blood volume Hypotension will not develop until 30% blood lost Limited ability to increase strength of cardiac contraction
What is the cause of flushing, or red skin?
Heat exposure, vessel dilation, late carbon monoxide poisoning
What are thermal burns?
Heating is of very short duration, but is extremely intense Eye injuries may be associated with brilliant light flash a.) Retina can be permanently damaged
What is the Markle test?
Heel jar test With the patient supine, strike the bottom of the heel sharply with your clenched first, using enough force to shake and jar the abdomen The result of the heel strike will be a sharp pain in the abdomen
What are infectious diseases of concern for EMTs?
Hepatitis B Hepatitis C Tuberculosis HIV/AIDS SARS West Nile Virus Multi-Drug Resistant Organisms (MRSA, VRA, PRSP, DRSP)
What is hyperglycemia?
High BGL Two different conditions a.) Diabetic ketoacidosis (DKA) i.) Type I b.) Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) i.) Type II
What is hypertension?
High blood pressure
What are signs of preeclampsia/eclampsia?
High blood pressure Swelling in extremities History of hypertension First pregnancy History of poor nutrition Sudden weight gain Altered mental status and abdominal pain Blurred vision Decreased urine output Severe, persistent headache or vomiting Elevated blood pressure During seizure, placenta can separate from uterine wall
What is hyperglycemia?
High blood sugar
What is hyperthermia?
High body temperature
What is hyperthermia?
High body temperature Most commonly in situations where the air temperature is high, the humidity is high, and there is little breeze Brought on by increase in body's heat production or inability to eliminate heat
Does unconscious patient or a patient with an altered mental status have a patent airway?
High incidence of airway occlusion resulting from the relaxation of the muscles in the upper airway
What is hyperglycemia?
High level of glucose in the blood
What is stridor?
High pitched harsh sound when breathing
What is wheezing?
High pitched musical whistling best heard on inhalation Indication of swelling and constriction of the inner lining of the bronchioles Heard in asthma, emphysema, and chronic bronchitis, pneumonia, congestive heart failure, and other conditions
What is stridor?
High pitched sounds produced on inspiration Associated with the swelling or muscle spasms that result from conditions such as airway infections, allergic reactions or burns to the upper airway For children with a suspected infection of the epiglottis (patient who complains of a sore or hoarse throat and is leaning forward with his neck jutted out and is drooling, epiglotitis) placing anything in the mouth can cause deadly spasms and complete airway obstruction a.) May be necessary to begin with a bag valve mask
Elderly individuals generally have ___ resting heart rates than younger people.
Higher
Patient tagging in MCIs...
Highest Priority, Red, Immediate a.) Quick treatment and transport b.) Most of the red categories are correlated with the initial assessment Second Priority, Yellow, Delayed a.) Patients who are suffering from severe injuries, but some delay is okay b.) Rapid trauma assessment Lowest Priority, Green, Minor a.) Fractures and soft tissue injuries, no threat to life Black, Deceased a.) Who will not survive or who are already dead b.) Do the most good for the most people
What is the heart?
Highly efficient pump Resembles a closed fist Two thirds located to the left of the midline of the body Apex lies just above the diaphragm
What is paranoia?
Highly exaggerated or unwarranted mistrust or suspiciousness Often hostile and uncooperative Delusions Cannot accept fault or blame
Primary chemical mediator released from MAST cells and basophils is ___.
Histamine
For a noncritical patient, patient can be transported after ___.
History and physical exam
What are risk factors for suicide?
History of depression or mental disorders Previous attempts Family history Feelings of hopelessness Unwillingness to seek mental health care Feeling of being isolated Local suicide epidemic History of impulsive or aggressive behavior Recent serious diagnosis Inability to access health care Loss of job, loved one, money, social loss
What are signs of a ruptured uterus?
History of uterine rupture History of abdominal trauma or large fetus Having borne more than 2 children History of difficult labor History of prior C section Tearing sensation Abdominal pain, nausea, shock Cessation of contractions Ability to palpate infant
How should you take a history in children?
History should be sought from the parent until child reaches 4 If the child does not seek out caregiver, suspect abuse Gain the child's trust Use a calm voice Get down to eye level with the patient Avoid yes or no rapid fire questions Keep the child with the parent Perform physical exam from feet to head Do not explain things to far in advance Let the child handle equipment Be honest and don't lie
What is the gallbladder?
Hollow pouch Part of the bile duct, the gallbladder is a reservoir for bile Bile aids in the digestion of fats Empties in the small intestine
What is a tracheostomy tube?
Hollow tube made out of rubber, inserted to hold the stoma open
What cases will require investigation by a medical examiner?
Homicides Suicides Violent deaths Crash related deaths Unusual scene characteristics SIDS Dead on arrival Special Reporting Situations a.) Abuse b.) Crime c.) Drug Related Injuries
What is insulin?
Hormone secreted by the pancreas that is needed to promote movement of glucose from the blood into the cells Move glucose into the cells for energy Move glucose into the liver where it can be stored and used later
What does hot skin indicate?
Hot environment or extremely elevated body core temperature
What are steam burns?
Hot steam causes severe burns, often more severe than flame burns Found in industrial accidents Can cause thermal burns to the distal airways in the lungs
What is a mechanism of injury (MOI)?
How a person was injured
What is medication dose?
How much of the drug should be given Dosages for infants and children Nitro - one tabled or one spray every 3 to 5 minutes a.) Max three doses
What is medication route?
How the medication is given Method controls how fast the medication is absorbed by the body
What is the mechanism of injury?
How the patient was injured Includes strength, direction and nature of the forces that caused the injury
What results when a patient has an adequate respiratory rate, but an inadequate tidal volume?
Hypopnea
Body temperature is monitored by the ___.
Hypothalamus Contains a temperature control center called the thermoregulatory center Receives inputs from two different receptors a.) Central thermoreceptors on or near the anterior hypothalamus b.) Peripheral thermoreceptors found in the skin and mucous membrane
What results when a patient has a reduced minute volume due to inadequate rate or tidal volume?
Hypoventilation
What are the causes of bradycardia?
Hypoxia, head injury, drug overdose, heart attack
Where can the femoral pulse be felt?
In the crease between the lower abdomen and the upper thigh
What is a critical incident stress debriefing (CISD)?
Ideally held within 24 to 72 hours of the incident A team of peer counselors and mental health professionals help emergency service personnel work through seven phases Help review the facts of the events, share their feelings, and identify signs and symptoms Typically includes anyone involved in the incident
What are retractions?
Identified by a sunken in appearance of tissues that are pulled inward on inhalation at the a.) Suprasternal notch b.) Intercostal spaces c.) Supraclavicular spaces
What should you do to gain access to residential buildings?
If a door is locked, check for opened windows or doors i.) Attempt to shout through the doors and look through windows The easiest and least costly way to get into a house is braking a window Once police and fire are on scene, proceed as follows a.) Check all windows for one that is unlocked or opened b.) If a window is open but blocked by screen, cut the screen c.) Break a window d.) If the patient is awake and responsive, inform him of what you are going to do e.) Wear eye protection, heavy work gloves and coat f.) Stand alongside the window g.) Using a tire like a flashlight or tire iron, strike the top corner of the pane nearest to you h.) Clear the broken pieces of glass out of the frame before reaching in to unlock the window or door
What are some general vehicle safety tips?
If a fire department is not on scene yet, remove the fire extinguisher from your vehicle A vehicle is considered stable when it is secured and can no longer move, rock or bounce Turn off the battery/turn off the ignition a.) First lower windows, door locks and move the seat
What is an armpit forearm drag?
If a patient is on floor or ground Insert hands under armpits from back Grasp left forearm with your right are and the right forearm with your left Drag, pull patient in the direction of the long axis of the body
How should you deliver emergency medical care to a newly delivered infant?
If above, need to resuscitation a.) Most do not require aggressive treatment b.) Approximately 80% require no resuscitation Procedure a.) If infant is bluish, provide blow by b.) Provide PPV at the rate of 40-60 per minute if i.) Breathing is shallow ii.) Heart rate less than 100 iii.) Core body remains cyanotic c.) If heart rate drops to less than 60, begin chest compressions i.) 1/3 depth of chest ii.) 120 compressions per minute iii.) 3:1 ratio of compressions to ventilations
How should you deliver emergency medical care to patients with emergency medical care?
If breathing is inadequate, begin PPV Will force oxygen across the alveoli and into the capillaries If adequate, NRB Keep the patient upright
What are splints?
If left unsplinted, movement of the broken bone ends can cause damage to surrounding structures and blood vessels Movement can allow clots to be broken Sometimes the source of bleeding in fractures is the bone itself and not surrounding tissues a.) Especially for the pelvis and femur b.) Traction splint serves as a splint but as a bleeding control method
How should you perform a focused history and physical exam to patients with shock?
If multiple injuries, internal bleeding or shock is suspected or if the patient has an altered mental status, perform a rapid trauma assessment Monitor for peripheral perfusion and skin color, temp and condition
When should you consider restraining a patient?
If no one is able to communicate with the patient and you believe that he may present a danger to himself, you must notify the police Never leave the patient Should be avoided unless the patient is a danger to himself or others Do not restrain a patient prone a.) Never hogtie or hobble restrain a patient Necessary to restrain in a supine position a.) Lateral, if secretions are a problem Humane restraints a.) Padded and wide
What is fixed pupil? What does it indicate?
If one of both pupils do not constrict to light Cardiac arrest, severe hypoxia, severe head injury, or extremely poor perfusion to the brain Fixed and dilated
What is anaerobic metabolism?
If oxygen is not available, very little energy is produced and the end product is acid A patient who is common and calm a.) Doesn't have enough energy to scream and complain
Special considerations when suctioning...
If pieces are too large, logroll and use finger 15 seconds of suctioning, give oxygen for 2 minutes then apply oxygen again Before suctioning mucus and small amounts of secretions in a patient who is being artificially ventilated, ventilate at a rate of 12 respirations per minute for 5 minutes to wash out the residual nitrogen and increase the functional oxygen reserve
What is the jaw-thrust maneuver?
If suspected head and neck injury Used to open the airway in such a patient because the head and neck are not tilted back The mandible is displaced by the EMT fingers a.) Cased the tongue to be pulled forward Procedure a.) Kneel at the top of the patient's head i.) Place your elbows on the surface on which the patient is lying, putting your hands at the side of the patient's head Grasp the angles of the patient's lower jaw on both sides a.) Move the jaw forward with both hands b.) Will move the tongue forward Retract the lower lip with your thumb if the lips close
What should you do if you cannot feel a catotid pulse?
If the carotid is absent, begin CPR and set up the AED
What are some general guidelines when dealing with eye injuries?
If the eye is swollen shut, avoid any unnecessary manipulation Do not try to force the eyelid open unless you have to wash out chemicals Consult medical direction before irrigating Do not put salve or medicine in an injured eye Do not remove blood or blood cots from the eye a.) Sponge blood from the face to help keep the patient comfortable Have the patient lie down and keep quiet Limit the use of the uninjured eye Cover it along with the injured eye Give the patient nothing by mouth in case general anesthesia is required at the hospital Every patient with an eye injury must be transported for evaluation by a physician Never apply direct pressure to an injured eye
How should you ventilate a patient with a pulse?
If the patient has a pulse, the amount of air should b approximately 10 ml/kg (700-1000ml), enough to make the chest rise with each ventilation Rate is one breath every 5 to 6 seconds a.) For pediatric, 3 to 5 seconds b.) For infant, 3 to 5 seconds c.) Newborn, 40 to 60 ventilations per minute d.) Ventilation is delivered over a 1 second period
What should you do if a patient is sick or injured, but their breathing is adequate?
If the patient is responsive, but ill or injured, administer oxygen at 15 liters per minute with a nonrebreather
How should an EMT address hypoxia?
If the patient is showing signs, immediately assess the airway and adequacy of breathing If the airway is open and the patient is breathing, apply a nonrebreather If the airway is not open, immediately open it and assess the breathing status a.) Immediately begin positive pressure ventilation
How often should you assess vital signs?
If the patient is stable, every 15 minutes If not, every 5 minutes
What is inadequate capillary refill?
If the refill takes longer than 2 seconds, tissue perfusion may be inadequate a.) Upper limit for females is 3 b.) Upper limit for elderly is 4
How should you size up the scene for a behavioral emergency?
If you cannot guarantee your own safety, call the police and wait for them to arrive before you leave your vehicle Locate the patient before enter the scene Never turn your back on the patient Determine whether you can handle the situation on your own Scan for MOI or NOI Do not forget about medical or trauma causes Suicide pact
What are the islets of langerhans?
In the pancreas Make insulin which allows sugar to enter the cells and produces glucagon, a hormone that will increase the glucose level
When should you establish in line stabilization?
If you determine or suspect that the patient has been injured, it is necessary to ask yourself if the mechanism of injury has been significant enough to injure the spine You must manually stabilize the patient's spine before moving on Once manual in line stabilization is established, it must be maintained, even after a cervical spinal immobilization color (CISC) is applied until the patient is completely immobilized to a backboard with backboard straps and a head immobilization device
How should you position a patient for the initial assessment?
If you find the patient in a prone position, it is necessary to quickly log roll him into a supine position Prior to rolling, quickly assess the posterior thorax and lumbar regions, the vertebral column, buttocks, and posterior aspects of the lower extremities If an open wound to the posterior thorax is present, quickly occlude the wound with a nonporous or occlusive dressing prior to log rolling Maintain in line stabilization first
What should you do if you identify immediate life threats during the general impression?
If you identify an obvious life threatening condition during the general impression, you must immediately treat it Examples a.) An airway that is compromised by blood, vomitus, secretions, the tongue, bone, teeth, or other substances or objects b.) Obvious open wounds to the chest c.) Paradoxical movement of a segment of the chest d.) Major bleeding
What is abandonment?
If you stop treatment of the patient without transferring the care to another competent professional of an equal or higher level or training
How should you perform a focused history and physical exam on a patient with internal bleeding?
If you suspect to internal bleeding, proceed to rapid trauma assessment a.) If there is contusions, abrasions, deformity, impact marks, or swelling, treat the patient for internal bleeding Signs and symptoms a.) Pain, tenderness, discoloration of the suspected site b.) Bleeding from mouth, rectum, vagina or other orifice c.) Vomiting bright red blood or blood the color of dark coffee grounds d.) Dark, tarry stools or stools with bright red blood e.) Tender, rigid or distended abdomen Signs and symptoms that also indicate shock a.) Anxiety, restlessness, combativeness or altered mental status b.) Weakness, faintness, or dizziness c.) Thirst d.) Shallow, rapid breathing (>22/minute in an adult) e.) Rapid, thready pulse (>90/minute in an adult) f.) Pale, cool, clammy skin g.) Delayed cap refill h.) Dropping BP i.) Narrow pulse pressure j.) Dilated pupils that are sluggish in response to light k.) Nausea and vomiting
What is battery?
If you were to touch a patient's body or clothing without consent
What are basophils?
Immature MAST cells and circulate in the blood
What is a warm zone (contaminant reduction zone)?
Immediately adjacent to the hot zone Still danger of contamination All personnel must wear appropriate protective gear All supplies must be decontaminated
What is a cold zone (support zone)?
Immediately adjacent to the warm zone Rescuers should shed contaminated gear before entering
How should you perform a focused history and physical exam on a patient with acute abdominal pain?
Immediately begin transport and take SAMPLE and gather vitals en route a.) Ask OPQRST b.) Allergies/Medications c.) Past medical history d.) Last Oral Intake e.) Vomiting f.) Color of the patient's stools g.) Events Prior Assess the chest as well Assess the abdomen a.) Point to the area that is the most painful b.) Begin with the area that is least painful and farthest from the site of the pain c.) Determine if the patient is restless or quiet and whether the pain increases with movement d.) Palpate the abdomen i.) Assess if it feels soft or rigid 1.) Rigid a.) Determine if the patient can relax the abdominal muscles upon request b.) Note any involuntary guarding an abdominal wall muscle contraction that the patient cannot control, resulting from inflammation of the peritoneum c.) Referred to as rigidity d.) Voluntary guarding is when a patient contracts the abdominal muscles, usually in anticipation of pain or an unpleasant sensation i.) When a patient takes a deep breath, it should relax ii.) Assess if it is tender or nontender when touched iii.) Are there any pulsating masses iv.) Is there pain anywhere else? vi.) Document the quadrant where the pain is located Obtain vitals and history a.) Expect to find increasing respiratory rate and shallow breathing in patients with increased acute abdominal pain
How should you protect yourself from radiation?
Immediately contact expert Consider a.) The amount and type of personal shielding b.) Strength of radiation source c.) Type of radiation d.) Distance from the radiation source e.) How long you are exposed f.) How much of body is exposed
What kind of emergency medical care should you provide to patients with carbon monoxide poisoning?
Immediately remove patient from environment Transport, give oxygen
What is the ischium?
In the posterior and inferior portions
What emergency medical care should you administer for an open chest wound?
Immediately seal the open wound with your gloved hand Apply an occlusive dressing to the sealed wound Continuously assess the patient's respiratory status Signs and symptoms that indicate a complication associated with the sealed wound and a developing tension pneumothorax a.) Dyspnea b.) Tachypnea c.) Severely decreased or absent breath sounds on the injured side d.) Cyanosis e.) Tachycardia f.) Decreasing blood pressure with a narrowing pulse pressure g.) JVD h.) Tracheal deviation i.) Unequal movement of the chest wall j.) Extreme anxiety and apprehension k.) Increased resistance to positive pressure ventilation Lift the corner of the dressing to allow the air to escape
When should you apply the cervical spinal immobilization collar during the rapid trauma assessment?
Immobilize as soon as the assessment of the neck is completed Do not move or manipulate the neck
How should a patient with a suspected spinal injury be transported and positioned?
Immobilized on a long backboard
What is the face?
Immovable bones a.) 13 of these bones b.) Facial bones, the orbits of the eyes, the nasal bones, the zygomatic bones, and the maxillae Movable bones a.) Mandible b.) Moves on hinged joints Face is extremely vascular a.) Facial injuries may bleed profusely b.) May compromise the airway c.) The facial bones are part of the skull A mechanism of injury that causes trauma to the face is likely, as well, to have caused injury to the spine
What are antibodies?
Immune system detects the antigen and produces antibodies Proteins that search for the antigen, combine with it, and help to destroy it a.) This is known as sensitization
What is bullet profile?
Impact point of the bullet
What is a blunt force injury?
Impacts or is applied to the body but is not sharp enough to penetrate it Usually results from blows (as in a vehicle crash, falls and fights) or crushing
What is an ectopic pregnancy?
Implanted outside uterus a.) Fallopian tube (90%) b.) On the abdominal peritoneal covering (6%) c.) Outside wall of uterus, ovary or cervix (1%) Leading cause of maternal death in first trimester 1 in every 200 pregnancies Predisposing factors a.) Previous ectopic pregnancies b.) Pelvic inflammatory disease c.) Adhesions from surgery d.) Tubal surgery, elective tubal ligation
How should you provide emergency medical care to patients with hypoglycemia?
Important to give sugar to increase BGL If the patient is unresponsive, unable to swallow, or is unable to obey commands a.) Establish open airway b.) Apply oxygen or positive pressure ventilation c.) Contact ALS d.) Assess the BGL If the patient is responsive, able to swallow and able to obey commands a.) Ensure open airway b.) Assess BGL c.) Administer glucose
What is physical abuse (in children)?
Improper or excessive action is taken as to injure or cause harm
Airway obstruction in children...
In a partial airway obstruction a.) Patient may still be alert b.) Skin may be normal or slightly pale, peripheral pulses present c.) Stridor may be present d.) Retractions of intercostal, supraclavicular, subcostal tissues e.) Patient may by crying, crowing or other noises f.) Forceful cough Complete airway obstruction a.) No crying or talking b.) Ineffective or absent cough c.) Altered mental status d.) Cyanosis possible
What is the pleural space?
In between the two layers, negative pressure Contains a small amount of serous fluid a.) Lubricant to reduce friction
Where does drowning most often occur?
In children less than 1, most often in the bathtub In adolescents and young adults, most often ponds, lakes, rivers and oceans a.) May be associated trauma Adults, consider a.) Diabetes, heart attack, seizure, depression or suicide attempt, arthritis, Parkinson's
If you are off duty, is there a duty to act?
In most states you have no more legal obligations to act than any other citizen In these states you can a.) Stop and help the accident b.) Pass the scene and call for help c.) Pass the scene and make no attempt Some do require EMTs to stop
What is the pubis?
In the anterior and inferior portion of the pelvis
Where can the popliteal artery pulse be felt?
In the crease behind the knee
What is hypoxia?
Inadequate amount of oxygen being delivered to the cells Can result from an occluded airway, inadequate breathing, inadequate delivery of oxygen to the cells by blood (hyperperfusion or shock) inhalation of toxic gases, lung and airway diseases, drug overdose, stoke, injury to the chest or respiratory structures, head injury
What are some complications of spinal injuries?
Inadequate breathing effort a.) Paralysis of the respiratory muscles may occur with injury to the cervical spine b.) The diaphragm may continue to function even if the chest wall muscles are paralyzed c.) Will display shallow, inadequate breathing with little movement of the chest or abdomen d.) Continuous positive pressure ventilation is necessary Paralysis a.) May occur below the site of injury Inadequate circulation due to Spinal Shock a.) Blood pressure and perfusion may be poor in the patient with spine injury b.) Blood pressure control center (vasomotor center) can no longer maintain the muscle tone in the blood vessels
How should you deliver emergency medical care to a patient with breathing difficulty?
Inadequate breathing, (respiratory failure) a.) Poor chest rise and fall, poor volume heard or felt b.) Diminished or absent breath sounds c.) Inadequate rate d.) Severely altered mental status e.) Establish open airway i.) OPA, NPA f.) Positive pressure ventilation g.) Rapid transport Adequate breathing (respiratory distress) a.) Adequate chest rise and fall, good volume of air, good breath sounds, adequate rate b.) Continue oxygen administration c.) Assess vitals d.) Determine if the patient is prescribed a beta 2 metered dose inhaler e.) Complete focused history and physical exam f.) Place the patient in position of comfort
What is spinal shock?
Inadequate circulation due to Spinal Shock a.) Blood pressure and perfusion may be poor in the patient with spine injury b.) Blood pressure control center (vasomotor center) can no longer maintain the muscle tone in the blood vessels Temporary concussion-like insult to the spinal cord that causes effects below the level of the injury Below the level of injury there is a loss of muscle tone, patient is unable to feel light touch and unable to move Will lose control of the bladder and bowel, man might have an erection called priapism Decreased blood pressure Usually resolves 24 hours after the incident, but may take longer
What is respiratory failure?
Inadequate oxygenation of the blood and an inadequate elimination of carbon dioxide from the blood
What is cardiogenic shock?
Inadequate pumping of the heart Coronary artery disease, myocardial infarction, heart rhythm abnormalities and heart valve disease
What is non-purposeful movement?
Inappropriately moving parts of his body, reacting to pain but not trying to stop it Indicates a deeper state of unresponsiveness
What is the role of the EMT at the WMD incident?
Incident command a.) Quickly size up the scene b.) Begin to communicate the essential information to the communications center to organize an adequate response Sector leader Officer role a.) Treatment, supply, triage, transportation
What is an incident command system (ICS)?
Incident management concept that has become the standard for on scene management of disasters and multiply casualty incidents Features a.) Common terminology is used, including standardization of titles for facilities and positions i.) Plain English is used in all communication ii.) Codes have been eliminated b.) Common designations are assigned to all organizational resources including personnel, facilties, equipment and supplies c.) Manageable spans of control are used to maintain control of the incident d.) Incident facilties are identified b common terminology with specific activities and functions performed at each faciltitiey e.) Distinct titles are used i.) Incident commander is called commander 1.) Coordinating all aspects of the incident f.) Incident action plans (IAPs) identify the objectives to be accomplished during the incident g.) An integrated communications approach is organized h.) Accountability applies at all levels and within all functional areas Several designated sections a.) Command b.) Finance/administration c.) Logistics d.) Operations e.) Planning
What is COPD?
Includes emphysema and chronic bronchitis The CO2 level in arterial blood is typically chronically elevated Rely on hypoxic (low oxygen) drive Breathe to increase their oxygen levels and not to reduce their carbon dioxide levels
How do head injuries effect BP?
Increase systolic, high pressure in skull Low, blood loss that has lead to shock a.) Cannot maintain adequate blood pressure due to brain stem failure
What is hypercarbia?
Increased CO2 levels
What are early signs of inadequate breathing (respiratory failure) in the infant or child?
Increased use of accessory muscles to breathe Sternal and intercostal retractions during inspiration Tachypnea (increased breathing rate) Tachycardia (increased heart rate) Nasal flaring Prolonged exhalation Frequent coughing may be present rather than wheezing in some children Cyanosis to the extremities Anxiety Child relies heavily on the diaphragm and abdominal muscles to breathe Retractions seen early in respiratory distress a.) Retractions are considered SEVERE in adults
Explain roadway incident safety...
Increasing number of incidents in which emergency personnel are getting injured or killed at scene of accident Do not trust approaching traffic Do not turn back on approaching traffic Position the first arriving vehicle to create a block and barrier between scene and traffic Turn off vision impairing lights Use other vehicles to slow down traffic Use advance warning signs and other traffic control measures to reduce traffic speed Use traffic cones for traffic control Assign a person to monitor oncoming traffic
What is anthrax?
Incubation period 1-6 days Fever, malaise, fatigue, cough, dyspnea, stridor, cyanosis, shock and death can occur within 24-36 hours
What is the plague?
Incubation period 2-3 days Headache, hemoptysis, dyspnea, fever, stridor, cyanosis, death
What does red skin indicate?
Indicates an increase in the amount of blood circulating in the blood vessels in the skin Could indicate anaphylactic or vasogenic shock, poisonings, overdose, or some diabetic or other medical conditions Alcohol ingestion, local inflammation, cold exposure, or a severe heat emergency (heat stroke)
What is the purpose of assessing skin color?
Indicates how well the blood is being oxygenated and circulated to the skin and therefore how the lungs, heart, respiratory and circulatory system are functioning Check the colors of the nail bed, oral mucosa, and conjuctiva (mucous membranes of the eyelid)
What is the cause of cyanosis, or blue-grey color of the skin?
Indicates inadequate oxygenation or poor perfusion Often appears in the fingertips and around the mouth Suffocation, inadequate respirations, lack of oxygen, heart attack, poisoning
What is low blood pressure? What is the cause?
Indicates that there is not enough pressure in the arteries to keep the organs supplied with an adequate amount of blood Known as hypoperfusion Blood loss, cardiac pump failure, blood vessel dilation Severe bleeding, heart attack, heart failure, spinal injuries
What is gurgling?
Indicates the presence of blood, vomit, secretions or other liquid in the airway Suction immediately
What are raccoon eyes?
Indication of intracranial injury May not appear till 4 to 6 hours after the injury
What is gurgling?
Indication that a liquid substance is in the airway Open the mouth and suction Place a bit stick between the teeth
What is meconium staining?
Indication that fetus experienced a hypoxic event May cause aspiration pneumonia
What is snoring?
Indication that the tongue and likely the epiglottis are partially blocking the airway Use head tilt, chin life or jaw thrust maneuver insert an OPA if needed or NPA if needed
What are essential medication characteristics?
Indications Contraindications Actions
What is urban hypothermia?
Individuals who have a predisposition, disability, illness, or medication usage that makes them mores susceptible to hypothermia Very young or very old, altered mental status, limited mobility
Decompensated respiratory failure in children...
Infant is failing to compensate for the impaired respiratory condition and unable to maintain adequate breathing Immediate ventilation with BVM Signs and symptoms a.) Respiratory rate over 60 per minute b.) Cyanosis c.) Decreased muscle tone d.) Accessory muscle use e.) Poor peripheral perfusion f.) Altered mental status g.) Grunting and head bobbing
What is cholecystitis?
Inflammation of the gallbladder a.) Associated with gallstones More common in women than men a.) Ages of 30 to 50 Some may block the opening of the gallbladder to the small intestine a.) Causes increased pressure and intense pain Hospitalization and sometimes surgical intervention
What is premature birth?
Infant weighing less than 5 pounds or born before its 38th week of development Susceptible to hypothermia and respiratory distress Thinner, smaller, skin is reddened and wrinkled a.) Single crease across the sole of the foot b.) Fuzzy scalp hair Dry the infant thoroughly Use the suction Prevent bleeding from umbilical cord Administer supplemental oxygen by blow by Prevent contamination Wrap the infant
What are some anatomical differences in the airway of children?
Infants have a proportionally larger tongue than adults Trachea is much narrower Trachea is more pliable Pressure on the soft tissue under the chin can cause the tongue to be displaced Obligate nose breathers Narrowest portion of the airway is cricoid cartilage Epiglottis is much higher in airway
What is pneumonia?
Infection of the lungs caused by bacterium, virus or other pathogen Aspiration pneumonia a.) Accidental aspiration of food or vomitus into lungs Increased respiration, congestion, fever, chills, altered mental status Oxygen, Fowler's
What is croup?
Infection of the upper airway Slow onset of symptoms, low grade fever, 6 months and 4 years of age Causes swelling beneath glottis and narrows the airway Seal bark cough, nasal flaring, tugging at throat, retraction of muscles, restlessness, tachycardia, cyanosis Procedure a.) Apply humidified oxygen by a nonrebreather mask b.) Keep patient in position of comfort c.) Transport patient to hospital with little disturbance
What is the inferior vena cavae?
Inferior vena cava enters the bottom of the right atrium, carrying oxygen depleted blood from the lower body
What does the suffix 'itis' mean?
Inflammation
What is appendicitis?
Inflammation of the appendix a.) Small worm shaped structure extending at the beginning of the large intestine If left untreated, the inflammation will cause the tissue to tie and rupture a.) This will result in abscess formation or inflammation of the abdominal lining and shock
What is pancreatitis?
Inflammation of the pancreas Severe pain in the middle of the upper quadrants May be triggered by ingestion of alcohol or large amounts of food a.) Located in the retroperitoneal structure
How do you measure blood pressure through palpation?
Inflate the cuff rapidly a.) Until you can no longer hear it Slowly deflate the cuff a.) Make note of when the radial pulse returns Approximately 7mmHgs lower than auscultation
When should you use pressure splints?
Inflated air splint exerts pressure that provides an extra measure of bleeding control Pneumatic antishock garment (PASG) a.) Can be used and inflated to only a certain extremity b.) If the pelvis is injured, the entire garment can be inflated PSAG is controversial due to the potential of complication of compartment syndrome
What is the voluntary nervous system?
Influences the activity of skeletal muscles and movements throughout the body
What is the voluntary nervous system?
Influences the activity of voluntary (Skeletal) muscles and movements
What are the key principles for recording prehospital care report (PCR) data?
Info should be complete and accurate Two basic rules a.) If it wasn't written down, it wasn't done b.) If it wasn't done, don't right it down
What is the function of the digestive system?
Ingest and carry food so that absorption can occur and waste be eliminated
What are the four routes by which a poison can enter into the body?
Ingestion Inhalation Injection Absorption
Considerations for patients using cocaine...
Inhaled through the nose, injected into veins and muscles Crack - smoked Highly addictive and an overdose can be fatal
What is passive rewarming?
Inhibiting further heat loss by wrapping the patient with blankets than increase the heat in the patient compartment of the ambulance
How should you perform an initial assessment and focused history/physical exam on a patient with abdominal injuries?
Initial Assessment a.) Form a general impression b.) May find him with knees drawn into the chest (decrease the tension on the abdominal muscles and reduce the abdominal pain) c.) Ensure an open airway and adequate breathing d.) Deliver oxygen e.) Assess circulation f.) Look for signs of shock Focused History and Physical Exam a.) Consider complaints and MOI b.) Do not get distracted by abdominal injuries c.) Apply a c-spine if needed d.) Inspect the abdomen e.) Assess the extremities for injury f.) Assess baseline vital signs, especially for indications of blood loss and shock g.) Obtain SAMPLE and OPQRST
How should you perform an initial assessment on a child with a respiratory emergency?
Initial assessment should begin at the doorway Well versus sick child Assessment mental status and open airway a.) Count respirations and monitor circulation Rapid breathing a.) Normal ranges, 25-30 for infants, 15-30 for children b.) Look for breathing through mouth, cyanosis c.) Possible causes i.) Oxygen deficiency ii.) Head injury iii.) Lung infection iv.) Fever, diabetes v.) Aspirin overdose vi.) Stress or fear Noisy breathing a.) Coughing, gagging, gasping with airway obstruction b.) Crackles, fluid in lungs c.) Wheezing, asthma, aspiration d.) Stridor, severe obstruction in upper airway, swelling to larynx Diminished breathing a.) Loss of breath sounds b.) Obstruction, medical problems, traumatic injuries Circulation a.) Cap refill b.) Pulse rate and strength c.) Strength of peripheral pulses d.) Warmth and color of hands and feet e.) Urinary output f.) Mental status
What are some signs and symptoms of carbon monoxide poisoning?
Initial signs are like the flu Headache, tachypnea Nausea and vomiting High pulse ox reading Altered mental status
What emergency medical care should you administer for a flail segment?
Initially splinted in an inward position by placing your hand over the unstable flail segment Initiate positive pressure ventilation if needed Bulky dressing over the segment or by securing the arm to the chest
Allergic reactions may be caused by foreign objects entering the body through...
Injection - Directly into the body by bites, stings, needles or infusions Ingestions - Swallowing the substance Inhalation - Breathes the substance into lungs Contact (absorption) - Absorbed through the skin
How can you determine if a patient is injured or ill?
Injured patients a.) Have suffered some form of trauma Medical patients a.) Bottle of pills b.) Patient in bed in the afternoon c.) Bucket or pail next to the bed
Are chest injuries urgent?
Injuries to the major arteries can cause immediate death Patients with chest injuries will deteriorate rapidly Rapid transport is necessary
What are common causes of seizures?
Injuries, medical conditions High fever, infection, poisoning Hypo or hyperglycemia Head injury, shock, hypoxia Stroke, drug or alcohol withdrawal Dysrhythmias, hypertension Pregnancy complications, blood electrolyte imbalance, idiopathic
What are brain injuries?
Injury can cause swelling of brain tissue of bleeding within the skull Can cause increased pressure in the skull May be from direct (penetrating trauma) or indirect (blow to the skull) or secondary (lack of oxygen)
What is a penetration spinal injury?
Injury from gunshots, stabbings or other types of penetrating trauma
What is a sprain?
Injury to a joint with possible damage to or tearing of ligaments
What is a strain?
Injury to a muscle or a muscle and tendon Overextension or stretching
What is a wound?
Injury to the skin and underlying tissue
What is the conjunctiva?
Inner surface of the eyelids and the exposed portion of the sclera are lined with a paper-thin covering call the conjunctiva Does not cover the cornea
What is the visceral pleura?
Innermost covering of the lung
What is the visceral peritoneum?
Innermost lining Adheres to and supports the organs
During a trauma assessment, you should...
Inspect (look) for a.) Deformities, contusions (bruises), abrasions, punctures, penetrating wounds, burns, lacerations, swelling, unusual chest walls movement, angulated extremeties, bleeding, discoloration, open wounds, significant bleeding Palpate for a.) Tenderness, deformities, swelling, masses, muscle spasms, skin temperature, pulsations b.) When palpating for tenderness in the unresponsive patient it is important to watch the patient's face for grimacing Auscultate for a.) Presence and equality of breath sounds Listen for a.) Sucking sounds, gurgling, stridor, and crepitation Use your sense of smell a.) To detect any unusual odors on the patient's breath, body, or clothing such as alcohol, feces or urine Expose the patient
What is the purpose of a rapid trauma assessment?
Inspect and palpate the patient to identify signs and symptoms of potential injuries
How should you assess the neck during a rapid trauma assessment?
Inspect for D, C, A, P, B, L, S A large collection of blood under the skin in the neck might occlude the airway Any large puncture wound or laceration must be covered with occlusive dressing and taped on all 4 sides Look for subcutaneous emphysema Look to determine if the trachea is midline Assess the jugular vein for distention Inspect the posterior portion of the neck for evidence of trauma a.) Look for D, C, and S b.) Muscle spasms in the posterior cervical region are important to note i.) Occur in cervical injuries in an attempt to maintain support Inspect the larynx for evidence of deformity and swelling a.) Typically hoarse or cant speak, is showing signs of respiratory distress, and may be coughing up blood b.) Provide positive pressure ventilation c.) Make sure the stoma is not occluded
How should you assess the abdomen during a rapid trauma assessment?
Inspect for DCAPBL and any evidence of trauma Look for discoloration of the umbilicus (naval) and In the flank areas (sides) a.) A sign that blood has collected in the abdomen b.) Look for distension Palpate each four quadrants a.) Tenderness, guarding, rigidity Markle test a.) Heel jar test b.) With the patient supine, strike the bottom of the heel sharply with your clenched first, using enough force to shake and jar the abdomen c.) The result of the heel strike will be a sharp pain in the abdomen
How should you assess the head in a rapid medical assessment?
Inspect for evidence of trauma Inspect the inside of the mouth Reassess the airway and ensure that it is patent Inspect the nose and ears for fluid discharge or blood Inspect pupils
How should you ventilate a patient with foreign body airway obstruction?
Instruct patient to cough Do not perform abdominal thrusts or other foreign body maneuvers Place patient on high flow oxygen and begin transport Signs of complete or partial airway obstruction a.) Cough that becomes silent b.) Stridor on inhalation c.) Increase in labored breathing Child, abdominal thrust Infant, back blows
How should you administer emergency medical care for those with immersion hypothermia?
Instruct the patient to make the least effort needed to stay afloat Lift the patient from the water in a horizontal position Remove the patient's wet clothing carefully Signs and Symptoms of Local Cold Injury a.) Early i.) Blanching of the skin ii.) Loss of feeling and sensation in the injured area iii.) Continued softness of the skin iv.) Tingling sensation during rewarming b.) Late or deep local injury i.) White, waxy skin ii.) Firm to frozen feeling iii.) Swelling iv.) Blisters v.) Flushed with areas of purple and blanching of the skin appears mottled and cyanotic
What is an advance directive?
Instructions written in advance against resuscitation, signed by the patient A legally recognized document Legally allows the health care provider to withhold resuscitation
What is shock or hypoperfusion?
Insufficient supply of oxygen, glucose, and other nutrients to some of the body's cells and ineffective elimination of carbon dioxide and other waste products Results from inadequate circulation of blood
During respiration, the diaphragm and the ___ muscles contract, increasing the size of the thoracic cavity
Intercostal muscles
What is an evisceration?
Internal abdominal organs protruding through the wound Do not touch the abdominal organs or try to replace the exposed organs Cover the exposed organs with moistened sterile water or saline Flex the patient's hips and knees, if they are uninjured and if spinal injury is not suspected
Between each vertebrae is a filled pad of tough elastic cartilage called the ___ ___.
Intervertebral disc
When should you reach out for police and medical direction in a behavioral emergency?
Involve chain of command Seek medical direction before restraint Law enforcement serve two purposes a.) Can protect from injury b.) Can be a credible witness
How should you communicate with patients?
Introduce yourself and ask for the patient's name and what they would like to be called Make sure you say, I am going to help you, is that alright? Don't be surprised if a patient refuses care or says she's okay Maintain eye contact Speak calmly and slowly a.) Speak normally and simply Think about the position you assume in relation to the patient Be courteous a.) Allow the patient to answer a question before you ask another Be sensitive to the power of touch
Considerations for motorcycle collisions...
Introduction a.) Account for a significant number of MVC b.) Incidence of mortality and death are greatly affected by whether the rider is wearing a helmet Head on Impact a.) Motor cycle tends to tip forward ejecting the rider Angular impact a.) Object comes in contact and breaks or amputates body part Ejection a.) Continues until something stops it b.) Boots, leather clothing and helmet are used to prevent injury and road rash Laying the bike down a.) Designed to prevent ejection b.) Bike moves away from driver c.) Abrasions and burns All terrain vehicles a.) Easily tipped over
How should you assess baseline vitals in an unresponsive medical patient?
Introduction a.) Breathing i.) CNS disorder, respiratory distress, cardiac problem, anxiety, poisoning, overdose, high blood sugar, abdominal disorder, pulmonary problem b.) Pulse c.) Skin d.) Pupils e.) Blood pressure Pulse Oximeter a.) 95-99% b.) Be careful in using pulse oc in suspected shock patients i.) You might not get an accurate reading Blood Glucose Test a.) Guide your treatment and provide you with an indication of whether to administer glucose to the patient or not
How should you perform a focused history and physical exam/detailed physical exam on an elderly patient?
Introduction a.) Conduct focused and physical b.) Diminished sight or blindness i.) Talk calmly and be positioned so they can see you d.) Diminished hearing or deafness i.) Do not assume the patient is deaf without asking ii.) Make sure hearing aid is turned on For the Geriatric Trauma Patient a.) Note the MOI b.) Conduct rapid trauma c.) Decreased sensitivity to pain i.) Maintain high index of suspicion d.) Obtain SAMPLE and detailed physical For the Geriatric Medical Patient a.) Patient's memory, hearing, sight and orientation may be altered b.) Not all geriatric patients are deaf, blind, or altered mental status i.) Do not assume, ask c.) Approach the patient with concern and compassion d.) Patient may not report everything that is wrong e.) Clearly explain what you are going to do i.) Patient may minimize or deny symptoms ii.) Peripheral pulses may be difficult to feel iii.) Distinguish chronic from acute pain f.) Scan for medications
Safety measures for crime scenes...
Introduction a.) Fire arms are only second to cars as a cause of death by trauma b.) Ensuring your own safety is the first step Arriving at the Scene a.) Turn off the sirens and lights several blocks away from the scene b.) Park three houses away from the scene c.) Park away from the killing zone i.) 120 degrees in front of the house Studying the crowd a.) Be aware the size of the crowd and its moved Approaching the Scene a.) Be alert b.) Walk on the grass, not on the sidewalk for a quieter less obvious approach c.) Hold the flashlight beside you, not in front of you so that your body is not a target d.) If you are walking with a partner, walk single file, the last person in line should carry the jump kit e.) Only the first person should carry a flashlight f.) Look at windows and corners g.) Stand aside the door, not in front of it At the patient's side a.) Limit the number of responders on the scene b.) Do not allow bystanders to touch the scene c.) Introduce yourself to the patient and say that you are there to help him d.) Be alert that the patient may not be a victim, but a perpetrator e.) Have one EMT watch the crowd while you work f.) Don't disturb evidence on a patient g.) Wear gloves the entire time h.) Never touch or move suspected weapons i.) Don't cut through bullet or knife hole in clothing j.) Document who is at the crime scene when you arrive k.) Don't disturb a dead person
How should you perform a focused history and physical exam on a patient who is having difficulty breathing?
Introduction a.) If patient is responsive, obtain SAMPLE b.) If unresponsive, rapid trauma assessment History a.) Does the patient have known allergies b.) What medications are they taking? c.) Does the patient have preexisting respiratory or cardiac disease? Has the pt ever been hospitalized for chronic conditions? Physical Exam Indicate the severity of the breathing distress Posture of patient is important • Posture relaxes over time Alterations of mental status Inspect lips and around nose and mouth for cyanosis Assess the neck for JVD and tracheal deviation Look for retraction or paradoxical movement Auscultate the lungs • Wheezing o Narrowing of the airway o Primarily during exhalation Baseline Vitals a.) Systolic BP may drop during inhalation i.) Pulsus paradoxus 1.) Severe respiratory condition b.) Heart rate may be increased or decreased i.) Low pulse oxygen
How should you perform a focused history and physical exam on a patient with difficulty breathing?
Introduction a.) If patient is responsive, obtain SAMPLE b.) If unresponsive, rapid trauma assessment History a.) Does the patient have known allergies b.) What medications are they taking? c.) Does the patient have preexisting respiratory or cardiac disease? d.) Has the pt ever been hospitalized for chronic conditions? Physical Exam a.) Indicate the severity of the breathing distress b.) Posture of patient is important i.) Posture relaxes over time c.) Alterations of mental status d.) Inspect lips and around nose and mouth for cyanosis e.) Assess the neck for JVD and tracheal deviation f.) Look for retraction or paradoxical movement g.) Auscultate the lungs i.) Wheezing 1.) Narrowing of the airway 2.) Primarily during exhalation Baseline Vitals a.) Systolic BP may drop during inhalation i.) Pulsus paradoxus 1.) Severe respiratory condition b.) Heart rate may be increased or decreased i.) Low pulse oxygen
What are pulmonary agents?
Introduction a.) Include phosgene, other halogen compounds, nitrogen compounds b.) Cause lung injury and referred to as choking agents c.) Transported to liquid but converts into gas d.) Odor of newly mown hay e.) Attacks the airway and lung tissue i.) Will leak fluid leading to pulmonary edema, inflammation, hypoxia and potentially respiratory failure Signs and Symptoms a.) Irritate the mucous membranes of mouth, eyes, nose and throat b.) Tearing, runny nose, throat irritation c.) Dyspnea, wheezing, cough, crackles d.) Stridor, secretions Emergency Medical Care a.) Manage airway and breathing b.) Suction and PPV if necessary c.) Calm the patient, beta 2 agonist can be administered
How should you perform a scene size up, initial assessment, and focused history/physical exam on a child with breathing difficulty?
Introduction a.) Indication of respiratory distress may be part of the dispatch Scene size up a.) Look for clues to rule out trauma Initial assessment a.) Labored or noisy breathing b.) Child in tripod position c.) Lying limply or unresponsive d.) Assess A, B, C mental status Focused History and Physical Exam a.) Signs and symptoms of distress will precede respiratory failure b.) Body attempting to compensate for the poor oxygen and carbon dioxide exchange
What are some procedures for radiation exposures?
Introduction a.) Limit your stay in a contaminated area to as little time as possible b.) Protect the safety of rescuers and victims c.) Provide patient care d.) Decontaminate clothing, equipment, vehicle Scene Safety a.) Determine location of radiation b.) Park vehicle upwind c.) Out on SCBA, leave no skin or hair exposed Personal Protection a.) Time b.) Distance c.) Shielding d.) Quantity Patient Care a.) Remove patient from source b.) Conduct initial assessment Personal Decontamination a.) After providing patient care and transporting, decontaminate yourself and equipment Vehicle/Equipment Decontamination a.) If things cannot be decontaminated, they need to be disposed of
Seizures in children...
Introduction a.) May be caused by epilepsy, head injury, meningitis, oxygen deficiency, drug overdose, low blood sugar, febrile seizures Assessment considerations a.) Muscle spasms prevent the child from swallowing b.) Did patient have seizures prior? c.) Did he take anti-seizure medications Emergency Medical Care a.) Assess airway and open b.) Position patient on side c.) Be prepared to suction d.) Provide oxygen e.) Transport f.) PPV if needed
What are nerve agents?
Introduction a.) Most deadly known chemicals b.) Relatively easy to make c.) Most are in liquid form until released when the agents become liquid and vapor d.) Block the action of an enzyme called acetylcholinesterase (AChE( i.) Found in the plasma of the blood, red blood cells and nervous system tissue ii.) Stops the action of acetylcholine (Ach) 1.) A neurotransmitter e.) When nerve agent enters body, it allows Ach to accumulate i.) The skeletal muscles, smooth muscles, glands and nerves remain in a steady on state with uncontrolled and uncoordinated movement of muscle fibers ii.) Seizures may occur iii.) Muscles will fatigue, stop working and begin to die f.) Death from respiratory muscle failure Signs and symptoms a.) Dependent on exposure, dose and route b.) Nervous system, airway and respiratory effects c.) Interfere with the brain's ability to function i.) Rapid loss of consciousness, seizures, apnea ii.) Difficulty concentrating, inability to sleep, impaired judgment, depression d.) Pulmonary system i.) Failure as a result of paralysis of muscles ii.) Copious airway secretions leading to airway obstruction e.) Miosis (pinpoint pupils) f.) Rhinorrhea (runny nose) g.) Excessive salivation, tearing, blurry vision, nausea and vomiting, diarrhea, sweating, loss of bladder control h.) SLUDGE i.) Salivation, lacrimation, urination, defecation, gastric emptying Emergency Medical Care a.) Establish an open airway and provide PPB b.) May be necessary to suction c.) Position in lateral recumbent d.) Monitor breathing and airway e.) Antidote is next step i.) Atropine ii.) Pralidoxime iii.) Diazepam may be used to combat seizures
How should you perform a focused history and physical exam on a patient with heat-related injuries?
Introduction a.) Move to cool area b.) Gather SAMPLE and OPQRST c.) Vitals i.) Blood pressure will be normal or low ii.) Pulses may be bounding or weak iii.) Skin could be cool, normal, or hot Signs and symptoms a.) Elevated core temperature b.) Muscle cramps, weakness or exhaustion c.) Dizziness or faintness d.) Rapid pulse e.) Initial deep breathing that becomes shallow and weak f.) Headache and seizures g.) Loss of appetite, nausea or vomiting h.) Altered mental status i.) Skin may be moist or pale, dry or moist
How should you conduct a focused history and physical exam on a drowning victim?
Introduction a.) Perform a rapid assessment if the patient has altered mental status b.) Conduct SAMPLE if alert Signs and Symptoms a.) Airway obstruction b.) Absent or inadequate breathing c.) Pulselessness d.) Spinal injury e.) Soft tissue injury f.) Musculoskeletal injuries g.) External or internal bleeding h.) Shock i.) Hypothermia j.) Alcohol or drug abuse k.) Drowning or submersion
What is cyanide?
Introduction a.) Rapid acting agent that disrupts the ability of the cell to use oxygen, leading to severe cellular hypoxia and death i.) Effects are on cell and not blood b.) Absorbed by inhalation or ingestion c.) Targets the brain and heart i.) The patient may lose consciousness within 1 minute and die within 6-8 minutes Signs and symptoms a.) Anxiety, weakness, dizziness b.) Nausea, muscular trembling, tachycardia, tachypnea c.) Pale, cyanotic, or normal skin color d.) Apnea, unresponsiveness e.) The classic cherry red skin color is unreliable and is a very late sign Emergency Medical Care a.) Manage airway and breathing with PPV b.) An anecdote may be necessary i.) Nitrite, amyl nitrite, sodium nitrite, sodium thiosulfate
What is vesicants?
Introduction a.) Result in damage to exposed skin, lungs and eyes b.) May produce systemic effects like generalized illness c.) Include sulfur, nitrogen mustards, lewisite, phosgene oxime i.) Will cause blistering, burning, tissue damage d.) Thick, oily liquids, low volatility and tend to be persistent e.) Odor or onions, garlic or mustard i.) Newly mown grass or hay Signs and Symptoms a.) Burning, redness, blistering, necrosis of skin b.) Stinging, tearing, development of ulcers in the eye c.) Shortness of breath, coughing, wheezing, pulmonary edema d.) Nausea and vomiting e.) Fatigue Emergency Medical Care a.) Immediate irrigation b.) Crucial to prevent damage i.) Irrigate with water or chemical decontamination kit ii.) Apply a dry sterile dressing once the area has bee adequately flushed, patch eyes
How should you perform a focused history and physical exam on a suicidal patient?
Introduction a.) SAMPLE, take care to note medications b.) Inform the patient what you are doing c.) Allow the patient to tell you what happened d.) Practice active listening e.) Determine the chief complaint Suicidal Patients a.) Injuries or medical conditions related to suicide is primary concern b.) Listen carefully c.) Accept patients complaints and feelings d.) Do not trust rapid recoveries e.) Never show disgust or horror when you care for a patient f.) Do not try to deny that a suicide attempt has occurred g.) Never try to shock patient out of attempt Signs and symptoms a.) Fear, confusion, behavioral changes, anger, mania, depression, withdrawal, loss of contact with reality, sleeplessness, loss of appetite, loss of sex drive, constipation, crying, tension, irritability
How should you perform a focused history and physical exam on a violent patient?
Introduction a.) SAMPLE, take care to note medications b.) Inform the patient what you are doing c.) Allow the patient to tell you what happened d.) Practice active listening e.) Determine the chief complaint Violent Patients a.) Take history b.) Look at posture c.) Listen to patient d.) Monitor physical activity e.) Be firm and clear f.) Be prepared to use restraints, but only if necessary Signs and symptoms a.) Fear, confusion, behavioral changes, anger, mania, depression, withdrawal, loss of contact with reality, sleeplessness, loss of appetite, loss of sex drive, constipation, crying, tension, irritability
How should you perform a focused history and physical exam on patients with cold-related injuries?
Introduction a.) Should be conducted in the back of the warmed ambulance b.) Gather SAMPLE if necessary c.) Treat any trauma found d.) Vitals i.) BP may decrease with falling core body temperatures Signs and Symptoms of Generalized Hypothermia a.) Decreasing mental status i.) Amnesia, memory lapses, incoherence ii.) Mood changes iii.) Impaired judgment iv.) Reduced ability to communicate v.) Dizziness vi.) Vague, slow, slurred speech vii.) Drowsiness b.) Decreasing motor and sensory function i.) Joint or muscle stiffness ii.) Lack of coordination iii.) Apparent exhaustion or inability to get up iv.) Uncontrollable fits of shivering v.) Reduced or loss of sensation c.) Changing vitals i.) Rapid breathing at first, then shallow ii.) Rapid pulse at first, then shallow iii.) Skin from red to pale, then cyanotic than gray and waxen iv.) Slow pupils, typically dilated v.) Low to absent BP
What are riot control agents?
Introduction a.) Tear gas is not a gas but an aerosolized solid b.) Derived from the capsicum family of peppers Signs and Symptoms a.) Irritation of nose, mouth, skin and respiratory tract b.) Involuntary eye closing, temporary blindness c.) Usually lasts about 30 minutes after exposure Emergency Medical Care a.) Primarily supportive b.) Removing patient from environment c.) Flush with water or saline d.) Remove contact lenses e.) Provide oxygen if needed or MDI
What is the JumpSTART Pediatric Triage System?
Introduction a.) Dr. Lou Romig b.) Used on any patient who seems to be a child c.) Infants under a year could be triaged using JumpSTART d.) Physiological differences i.) Respiratory failure due to traumatic event usually occurs after severe blood loss in adults ii.) Child will go into respiratory arrest followed by circulatory failure and cardiac arrest e.) Same categories of START f.) Should take no more than 15 seconds Jumpstart ambulatory a.) Should be escorted into the green area Jumpstart breathing assessment a.) If child is breathing, assess respiratory rate b.) If breathing rate is between 15 and 45, assess pulse c.) If less than 15 or more than 45, tag as red d.) If there is no breathing, try to open airway i.) Tag the patient as red Jumpstart Perfusion assessment a.) If peripheral pulse is palpable, assess the mental status b.) If no peripheral pulse is present, tag red and move on Jumpstart Mental Status Assessment a.) Quickly assess AVPU b.) If A, P, the patient is yellow c.) If child is unresponsive to all stimuli, tag as red
Special considerations for children and altered mental status...
Introduction a.) Just isn't acting right b.) Assess and treat any conditions associated with altered mental status c.) Hypoglycemia, poisoning, post-seizure, severe blood infection, head injury Assessment Considerations a.) AVPU and Glasgow Coma Scale b.) Inflict pain, never shake a child
Children and drownings...
Introduction a.) Main cause is hypoxia, not aspirated fluids b.) Glottic closure reflex c.) Dry drownings Assessment Considerations a.) Be aware of trauma and hypothermia Emergency Medical Care a.) Remove patient from water b.) Spinal immobilization c.) Clear airway, PPV if needed d.) Check circulation, CPR and AED as needed e.) Maintain and transport
Special considerations with children and shock...
Introduction a.) Unusual because their blood vessels constrict efficiently, which helps maintain BP b.) Newborns have gone into shock due to lose of body heat c.) Can be precipitated by diarrhea, dehydration, trauma, vomiting, blood loss, infection, abdominal injuries, allergic reaction, poisoning, cardiac events Assessment Considerations a.) Rapid respirations, pale, cool, clammy, skin, mottling, decreased mental status, lengthened cap refill, weak or absent peripheral pulses b.) Deteriorate faster than adults
What are phobias?
Irrational fears of specific things, places or situations May show evidence of intense fear a.) Tremors, pace, tense, restless, irregular heartbeat, dyspnea, sweating, diarrhea
What are dysrhytmias?
Irregular contractions of the myocardium secondary to electrical disturbances in the heart
What is peritonitis?
Irritation and inflammation of the peritoneum Associated with severe, constant pain Blood, pus, or other substances containing bacteria and chemical substances may leak into and circulate in the abdomen making pain diffuse Areas a.) Duodenum i.) Highly acidic substance ii.) Cause immediate, severe, sharp, intense and constant pain b.) Ileum i.) Contains digestive material with a neutral pH ii.) It may cause no immediate pain c.) Stomach i.) Hydrochloric acid ii.) Produces an immediate onset of pain 1.) Peritonitis due to bacteria may caused delayed pain 2.) Chemical or bacterial peritonitis
What is peritonitis?
Irritation from leakage of a substance from a ruptured organ or from an infection of the peritoneum
What is a clamping injury?
Is a body part that is caught or strangled by some piece of machinery Finder of hand time is a factor Apply lubricant Elevate to decrease circulation
How can you stabilize a vehicle on its side?
Is inherently unstable and therefore, particularly dangerous Attach a stabilizing pole, pulling device, cable or chain from the undercarriage of the car to another vehicle or strong immovable object
How should you perform a scene size up on a patient having difficulty breathing?
Is it due to trauma or medical condition Scan for MOI Look for oxygen
What are some considerations for lateral impacts?
It can be crushed inward, impinging on the occupants Who took the brunt of the collision? Head and Neck a.) The body is pushed laterally, out from under the head b.) Causes the head to move in the opposite direction c.) Results in frequent muscle tears and ligament injuries Chest and Abdomen a.) When the door strikes the side of the chest and abdomen b.) Flail segments and fracture Pelvis a.) Causes lateral impact to the pelvis
What is a rib injury?
It can cause life threatening damage to structures and organs Most commonly fractured are the third through the eighth rib a.) Lateral aspect of the chest The intercostal artery or vein may be lacerated Less common in children Patient usually presents in the guarded position You can use the arm to splint the injury (sling and swathe) Hold a pillow over the injury site
How can you stabilize a vehicle on its roof?
It will be held up by roof posts or it may be resting on the hoot, trunk or both Airbags under either the front or rear of the vehicle can be used to stabilize the vehicle
How should you assess the neck in a rapid medical assessment?
JVD Orthopnea a.) Inability to breathe or shortness of breath while lying flat Excessive accessory muscle use Look for medical ID necklace Check for a tracheostomy tube at the base of the neck
When is there the highest incidence of lightening strikes?
June, July, and August
Infants and hypoxia...
Keep in mind that infants have a faster heart rate than adults Bradycardia would be a sign of severe hypoxia
How should you provide emergency medical care to patients with acute abdominal pain?
Keep the airway patent (may be in left lateral recumbent) Place the patient in the position of comfort Administer oxygen at 15 lpm via nonrebreather Never give anything by mouth Calm and reassure the patient If signs and symptoms of hypoperfusion are present, treat for shock Initiate a quick and efficient transport
How can the EMT protect bystanders?
Keep the crowd out of the way Bystanders who do not disperse should be dealt with by the police
What is the patella?
Knee cap, protects the knee joint
What is the cross finger technique?
Kneel above and behind the patient Cross the thumb and forefinger Place the thumb on the patient's lower incisors and your forefinger on the upper incisors Use a scissors motion or finger snapping to open the mouth
What is the guarded position?
Knees up, hands clenched over his abdomen
What kind of items cause low-velocity penetrating injuries?
Knife Slash marks on hands ad arms Length of the object
What is a simple partial seizure?
Known as focal motor seizure or Jacksonian motor seizure Produces jerky muscle activity in one area of the arm, leg, or face May spread from one area of the body to another Emergency medical care a.) Emergency care may not be necessary b.) If first time, transport
What is the respiratory rate?
Known as frequency The number of times that the pt breaths in one minute
What is crackles?
Known as rales Bubbly or crackling sounds during inhalation Fluid around the alveoli or small bronchioles a.) Popping open with each inhalation Bases of the lung May indicate pulmonary edema or pneumonia
What is the stomach?
Large and hollow Main organ of the digestive system Digestion begins in the mouth, the majority takes place in the stomach Gastric juices convert ingested food into a form that can be absorbed
What is dyspnea?
Labored difficult breathing
What are some examples of injuries to the male genitalia?
Lacerations, abrasions, avulsions, penetrations, amputations, and contusions The penis is very vascular and can bleed excessively Injury should be treated as soft tissue injury which can be controlled with direct pressure, cold compress Provide oxygen and look for shock
What is a heart attack?
Lack of oxygen and nutrients to the heart a.) May have a silent heart attack b.) No or little chest discomfort i.) Weakness, fatigue, trouble breathing Nitroglycerine Oxygen, and nitro, transport
What is the disease process in drowning?
Lack of ventilation when submerged a.) Leads to severe and prolonged hypoxia b.) Accumulation of CO2 in the blood i.) Acidosis and hypoxia may lead to cardiac arrest c.) Prognosis dependent on submersion duration
What is a vascular structure?
Large vessels in the abdominal cavity Rupture will result in major bleeding, rapid blood loss and death
What is the cerebrum?
Largest part of the brain ¾ of volume Made up of four distinct lobes Responsible for most conscious and sensory functions, emotions and personality Not attached to the inside of the skull
What is the liver?
Largest solid organ in the abdomen Beneath the diaphragm and right upper quadrant Produces bile which aids in the digestion of fat Stores sugars Produces components necessary for immune function, blood clotting and the production of plasma Detoxifies harmful substances
What is a rotation spinal injury?
Lateral movement of the head or spine beyond its normal rotation
How do you position the patient for airway contro?
Lateral recovery position, also known as the coma position Place the patient's arm that is closest to you flat on the ground at a right angle to the body a.) Log roll onto side b.) Place the opposite arm under his lateral face and cheek Bend the hip and knee to stabilize the body Only used in patients without spinal injury Turn him to the other side after 30 minutes
What are the meninges?
Layers of tissues that enclose the brain
Trauma in children...
Leading cause of death in children Automobile, bicycles, homicide, suicide Blunt trauma most common injury
What is inadequate breathing?
Leads to inadequate oxygen exchange and inadequate oxygen delivery Brain, heart and kidneys are sensitive to hypoxia
What are heat cramps?
Least serious form of heat related injury Cramping is made worse when not enough salt is taken int the body
How should you ventilate a patient with dental appliances?
Leave dentures in place to maintain a tight seal If the plate is loose, remove it
Cricoid cartilage anatomy in children...
Less developed and less rigid The narrowest part of the upper airway
What are viral hemorrhagic fevers (VHFs)?
Malaise, headache, vomiting, flushing, edema, petechiae, hypotension, shock
Explain seizures during pregnancy...
Life threatening emergency for mother and fetus Same care as regular patient Transport on left side, calm and quiet manner May be associated with eclampsia
How should you splint joint injuries?
Ligaments that gold the bones are stretched and sometimes torn loose Cause serious pains because joints are rich in nerves Signs and symptoms a.) Pain, swelling, deformity, and possible rigidity and loss of function Assess PMS and cap refill Look for paresthesia or paralysis or cyanosis
The lightening strike disease process...
Lightning is neither alternating current (AC) or direct current (DC) a.) Much more like DC than AC Not commonly associated with major burns Head, neck, chest, abdominal, pelvic, spinal injury must be suspected Four major types of strikes a.) Direct, direct contact with patient b.) Contact strike, strokes an object the patient is in contact with c.) Splash or side flash strike, lightning strikes an jumps to person d.) Ground current, lightning energizes the ground Nervous and heart tissue are the most sensitive to lightening strikes a.) Brain is also sensitive, respiratory center is shut down
How should you size up the scene of a spinal injury?
Likely Mechanism of Spinal Injury a.) Motorcycle crashes b.) MVC c.) Pedestrian-vehicle collisions d.) Falls e.) Blunt trauma f.) Penetrating trauma to the head, neck or torso g.) Sporting injuries h.) Hanging i.) Diving or other water related accidents j.) Gunshots wounds to the head, neck, chest, abdomen, back or pelvis k.) Unresponsive trauma patient l.) Electrical injuries Clues to Mechanism of Injury a.) Open the airway with jaw tilt
What are the various forms of medication?
Limits administration to one specific route Some drugs have a local effect and others systematic Compressed powder or tablet a.) Nitroglycerin tablets, aspirin tablets Liquid for injections a.) Liquid substance with no particulate matter Gel a.) Patient swallows b.) Oral glucose Suspension a.) Drug particles mixed into liquid b.) Must be shaken well c.) Charcoal Fine powder for inhalation a.) Crystalline solid mixed with liquid b.) Meter dosed inhaler Gas a.) Oxygen b.) Systematic effects on cells and organs Spray a.) Spray droplets may be deposited under the tongue b.) Nitro Liquid/vaporized fixed dose nebulizer a.) Uses a compressed gas that is forced into a chamber containing medication b.) Deposited in the mucosal lining
What is rebound tenderness?
Lining of the abdomen is irritated
What is meningitis?
Lining of the brain and spinal cord are infected Can be rapidly fatal Fever in child under 3 months should be considered meningitis until otherwise proven
What is evaporation?
Liquid or solid changes to a liquid When air temp equals or exceeds skin temp, evaporation is the only way to lose heat Humidity will reduce the effectiveness of evaporation
What is plasma?
Liquid part of the blood Carries blood cells and transports nutrients Also transports waste products to excretory organs
How should you auscultate the chest?
Listen just below the second rib at the midclavicular line and listen to the apices of the lungs and below the second rib at the midclavicular line to listen to the apices of the lungs and just below the fourth rib at the midaxillary line for breath sounds in the bases Wheezing a.) Exhalation, narrowing of the bronchiole Crackles or rales a.) Fluid collections in the lungs Rhonchi a.) Mucus is in the larger airways within the lung Stridor a.) High pitched sign from the upper airway Coughing a.) Response to bronchial irritation Mucus a.) Usually white or clear b.) Yellow or green is a sign of possible infection c.) Note any blood tinged sputum
What is auscultation?
Listening for the systolic an diastolic sounds through a stethoscope
What is the cerebellum?
Little brain Controls equilibrium and coordinates muscle activity Controls muscle movement and coordination, predicts when to stop movement, and coordinates posture
What does yellow skin indicate?
Liver dysfunction
What are solid organs?
Liver, spleen, pancreas, kidney Contain a rich blood supply Major bleeding and severe shock
What is radiation injury?
Local injury by large amount of less penetrating articles Hair loss, skin burns and lesions
How do you perform cricoid pressure (or the Sellick Maneuver)?
Locate the thyroid cartilage (Adam's apple) by starting at the chin and sliding your index and middle finger slowly toward the feet Below the thyroid cartilage, you will feel a small midline indentation which is soft which is cricoid membrane, below that is the cricoid cartilage Place your index finger on one side and the thumb on the other and apply firm backward pressure
How do you check the carotid pulse?
Locate the thyroid cartilage and slide your fingers down the neck laterall on the same side which yo are positioned until you feel the groove between the larynx and the bulk muscles of the neck Do not assess both carotid arteries at the same time
What is the abdominal cavity?
Located below the diaphragm and extends to the top of the pelvis
What are MAST cells?
Located in connective tissue and are concentrated around the heart, lungs, and vessels
What is the mediastinum?
Located in the middle of the thoracic cavity between the right and left lungs Houses the trachea, the venae cavae, the aorta, the esophagus, and the heart
What is an advair diskus?
Long acting beta 2 specific drug that also contains a steroid Used as a maintenance drug Not to be used as a rescue inhaler for the patient experiencing an acute asthma attack
Asthma in children...
Long term inflammatory process that targets the lower airways Increased production in mucus, acute narrowing of the airways Pay attention to a.) Position b.) Mental status c.) Vital signs d.) Skin color and condition e.) Respirations Treatment a.) Apply oxygen b.) Position of comfort c.) Use inhaler if prescribed d.) Transport
What is a central line? How should the EMT deal with one?
Long term venous access device May be necessary to transport Infection or not flushing properly Correct and maintain inadequacies in child's breathing, airway circulation Apply pressure directly to the device to control bleeding Transport to hospital
How can you assess for adequate breathing?
Look (inspect) a.) Observe for chest expansion and rise and fall b.) Retractions i.) Pulling inward of the intercostal muscles of the chest wall as well as excessive use of the neck muscles c.) Observe the patient's general impression i.) Does he look anxious, uncomfortable, or in distress? ii.) How is the patient sitting? iii.) Does it appear that the patient is struggling to breathe? d.) Decide if the breathing pattern is regular i.) Injuries to the brain produce irregular breathing e.) Look at the nostrils to see if they open wide during inhalation Listen a.) How does the patient speak? b.) Listen for air exchange Feel Feel the volume of air escaping during inhalation Auscultate a.) Stethoscope at the second intercostal space, 2 inches below the clavicle b.) Determine that sounds are present and equal bilaterally Assess rate, rhythm, quality and depth
How should you check the eyes during a detailed physical exam?
Look for DCAPBLS Do not attempt to remove foreign bodies Do not force the eyelid open or apply pressure to the eye Remove lenses if they are not properly position Check for papillary response Check visual acuity a.) How many fingers are you holding up b.) Read my name tag c.) Follow the finger d.) Should move together (conjugate movement) and smoothly e.) Jerky eye movements (nystagmus) f.) Dysconjugate gaze Check the sclera (white of the eye) a.) For redness or yellow color b.) Yellow sclera (icterus) indication of possible liver damage or failure Check for blood in the eye a.) Forceful blow
How should you assess the mouth during a detailed physical exam?
Look for DCAPBLS Look for cuts to tongue Remove objects from the mouth Smell for unusual odors a.) Alcohol b.) Chemicals Look for black sputum and burns inside of the mouth a.) Fire
How should you perform a scene size up and initial assessment on a patient with internal bleeding?
Look for MOI, suspicion of internal bleeding is based on that Ensure scene safety Assess mental status Assess the airway Apply oxygen Assess the pulse, skin and capillary refill Skin will become pale, cool and clammy
How do you perform a scene sign up for a seizure, or altered mental status?
Look for a MOI if head injury is expected Look for pills, medical bracelets Patient may refuse care if they frequently have seizures If the patient is still seizing when you arrive, you may find bystanders trying to restrain the convulsions a.) Patients movement should be guided not restrained b.) Move objects away from the patient c.) Don't place anything in mouth d.) Patient may bite tongue or lose control of bladder and bowel Can result in short periods of apnea Proceed with AED and CPR if needed
How should you assess the face during a detailed physical exam?
Look for bleeding and displacement Inspect and monitor the airway Look for burns to facial hairs
How should you assess the face during a rapid trauma assessment?
Look for evidence of trauma and bleeding that may be obstructing the airway Look for D, C, A, P, L, S Palpate for deformities, instability and swelling Trauma to the mid face is especially troubling a.) Between the lower lip and the bridge of the nose b.) Carefully assess the airway for possible occlusion c.) May increase the risk of aspiration of the blood d.) Insert an OPA and suction Look for singed or burned nasal or facial hair Reassess the airway for stridor and adequate air movement
How to assess for environmental temperature extremes in the elderly?
Look for hypothermia or hyperthermia Lack of heat or air condition Airway, breathing, circulation, oxygen, remove from source of problem
MOI considerations for blast injuries...
Look for injuries caused by the pressure wave, by flying debris and the collision that results when the patient is propelled Look for burns
How should you assess the scalp and skull during a rapid trauma assessment?
Look for obvious deformities, contusions, abrasions, punctures, burns, lacerations, swelling, depressions, protrusions, impaled objects, or bleeding Palpate for any crepitation, depressions, protrusions, swelling, bloody areas, instability, or lack of symmetry Listen for sounds and grimacing Periodically look at your gloves for evidence of bleeding Pay attention to places that feel warm that indicates leakage of blood or cerebrospinal fluid (CSF) Brain herniation Do not remove a wig or hairpiece
How should you assess the pelvic region in a rapid medical assessment?
Look for signs of incontinence
How should you assess the abdomen during a detailed physical exam?
Look for swelling or distention from air, fluid or blood Note any discoloration around the navel or the flank areas Start far away and move inward Palpate the least painful quadrant last A pulsating mass in the abdomen may indicate that the abdominal aorta is weakened and bulging
How should you assess the ears during a detailed physical exam?
Look for trauma Look inside the year for blood and other fluids Look behind the ears for a discoloration of the bony process known as the mastoid process a.) Ecchmosis (black and blue) b.) Known as battle signs c.) Late sign of possible skull or head injury that may not appear till hours after
How should you assess ears during a rapid trauma assessment?
Look inside for leakage of blood, cerebrospinal fluid or other fluids
What is an avulsion?
Loose flap of skin and underlying soft tissue that has been torn loose (partial avulsion) or pulled completely off (total or complete avulsions) Bleeding may be severe due to blood vessel injury, but some blood vessels may tamponade (compress) themselves by retracting into the soft tissue Most commonly the result of accidents with industrial or home machinery and motor vehicles
What is osteoporosis?
Loss of minerals in the bones Makes the bones more brittle, susceptible to fractures
What are the signs and symptoms of epidural hematomas?
Loss of responsiveness Decreasing LOC Severe headache Fixed and dilted pupils Seizures Increasing systolic BP Vomiting Apnea or abnormal breathing Hypertension, bradycardia and bradypnea Posturing
What is syncope?
Loss of responsiveness Airway, oxygen, PPV if necessary Treatment for trauma if they fell
What is pulseless electrical activity (PEA)?
Lost so much blood, there is nothing to pump
What is hypoglycemia?
Low BGL More common in Type I Most dangerous complication of DM Overview of the Disease Process a.) When the amount of glucose in the blood falls below the normal limit b.) Less than 60mg/dL c.) Altered mental status Causes a.) Patient takes his insulin and does not eat a meal b.) Patient takes his insulin, eats a meal, but drastically increases activity beyond normal c.) Patient takes too much insulin Referred to as insulin shock a.) BGL drops b.) Epinephrine is secreted at higher levels
What is hypotention?
Low blood pressure
What hypoglycemia?
Low blood sugar
What is hypothermia?
Low body temperature
What is hypoxia?
Low oxygen
What is the mandible?
Lower jaw
What is the vagina?
Lower part of the birth canal 8 to 12 cm in length Originates at the cervix and extends to the end of the body Stretches to prepare for birth
What is serous fluid?
Lubricant to reduce friction
What are injuries commonly caused by conventional weapons and incendiary devices?
Lungs a.) Altered mental status, dyspnea, chest pain, blood tinged sputum, respiratory distress, stroke like signs and symptoms b.) PPV may convert pneumothorax to tension pneumothorax c.) May injure alveolar capillary wall and PPV may force air bubbles into vessels creating air emboli Abdomen a.) Bleeding to the bowel or laceration b.) Evisceration Ears a.) Eardrum may rupture b.) Ears of the bone may fracture or dislocate c.) Temporary or permanent hearing loss
What is prone?
Lying face down on his stomach
What is supine?
Lying face up on back
What is Fowler's position?
Lying on back with his upper body elevated at a 45 to 60 degree angle
What is the Trendelenburg Position?
Lying on his back with the leg elevated higher than the head and body on an incline plan Head down, legs up Sometimes used in shock management
What is Semi Fowler's position?
Lying on his back with the upper body elevated at an angle less than 45 degrees
What is the lateral recumbent, recovery position?
Lying on his right or left side Monitor the airway Turn the patient every 30 minutes
What is minute volume?
MV The amount of air a person breathes in and out in one minute Depth x rate (f x Vt) Example a.) 12 bpm x 500ml per breath b.) 6,000 ml of 6 liters a minute
What is a portable stretcher? What are the different types?
Made of a continuous tubular metal frame, canvas or coated fabric bottom and straps Used when the patient must be moved from a confined space Available in three types a.) Basic i.) Auxiliary stretcher ii.) Can be placed on the squad bench or suspended from hanging hardware inside the ambulance iii.) Very light and has a load weight of 350 lbs b.) Basic with wheels and posts c.) The breakaway Pole stretcher and canvas litter a.) Has been used worldwide for centuries b.) Lightweight and folds completely c.) Easy to clean d.) Should not be used with spinal immobilization
What is a Reeves flexible stretcher?
Made of canvas and synthetic materials Has six large lifting and carry handles Moves down stairs
What are lungs?
Made of elastic tissue Causes the lungs to react like a rubber band (recoil and collapse) Surrounded by two layers of connective tissue a.) Visceral pleura b.) Parietal pleura c.) Pleural space Collapsing lung, creates a vacuum and sucks air into the pleural space
What is the endocrine system?
Made up of ductless glands, the body's regulators Secretions from these glands are call hormones a.) Substances that have effects on the activity of the activity of certain organs
What are biological agents?
Made up of living organisms or the toxins produced by the living organism and are used to cause disease in target population Can take several days to detect a biological assault The respiratory tract is the most common and efficient port of entry a.) Can also be ingested in contaminated food and water Distinguish a number of cases and the timing of the cases from the isolated case of an expected illness
What is the small intestine?
Made up of the duodenum, jejunum, and ileum Receives food from the stomach and secretions from the pancreas and the liver Digestion continues here where food is completely broken down
How should you administer emergency medical care and ongoing assessment to an elderly patient?
Maintain a patent airway Insert an airway Assess and be prepared to assist ventilations Establish and maintain oxygen therapy Position the patient a.) If medical, Fowlers b.) If altered mental status, left lateral recumbent c.) If trauma, supine immobilized Transport
What emergency care should you give to a patient with abdominal injuries?
Maintain airway and appropriate spinal protection Continue oxygen therapy Reassess the breathing status Treat for shock (hypopoerfusion) Control any external bleeding Position the patient Stabilize impaled objects Apply the pneumatic antishock garment (PASG) if indicated and allowed by local protocol a.) If closed, pain is noted to the pelvis and signs and symptoms of shock are present b.) Do not apply or inflate the abdominal compartment if an impaled object or evisceration is found Transport as quickly as possible
How should you assess the posterior body during a detailed physical exam?
Maintain c-spine Note pain and tenderness Look for muscle spasms along the vertebrae, sign of injury
How do you deal with injuries to the nose?
Maintain open airway and position so that blood does not drain into throat Cartilaginous septum a.) Deformity, swelling, pain, minor hemorrhage Ethmoid bones a.) Significant hemorrhaging can occur
How should you administer emergency medical care for anaphylactic shock?
Maintain patent airway Administer oxygen Administer epi-pen if on hand Call ALS Transport
What is an emergency move?
Maintain the patient's airway and breathing, circulation When scene is unstable, you must move patient first Examples a.) Immediate environmental danger to patient or EMT i.) Fire or danger or fire ii.) Exposure to explosives or hazardous materials iii.) Inability to protect patient from other hazards b.) Inability to gain access to other patient who need life saving care c.) Inability to provide life saving care because of the patient's location or position Make effort to protect the spine as much as possible
When should you continue spinal stabilization?
Maintain until pt is completely immobilized to a backboard While one performs rapid assessment, the other should hold Cspine It should not be released until immobilization is complete
What is the aorta?
Major artery from the heart Lies in front of the spine At the navel, the aorta divides into the iliac arteries to each leg
What are the radial arteries?
Major artery of the arm distal to the elbow joint Can be felt proximal to the thumb on wrist
What are the femoral arteries?
Major artery of the thigh and supplies the groin and leg with blood
What are the brachial arteries?
Major artery of the upper arm Can be felt in front of the elbow
What is the role of glucose?
Major source of fuel for cells Brain cells can only use glucose for energy a.) Lack can cause changes in mental status Tendency to attract water when it moves a.) Acts similarly to sodium b.) If a large amount moves across a membrane, a large amount of water will follow it c.) Glucose not advised for patients with head injury or stroke i.) Will cause brain cells to swell Excess glucose a.) Will spill off into the urine b.) Patient may eventually become dehydrated (common in diabetes)
How should handle a patient refusal of treatment?
Make extra efforts to ensure that the patient fully understands what he is doing Try to perform as much as an assessment as possible Make one more effort to persuade the patient to go to the patient Inform the patient why he should go to the hospital Discuss the situation with medical direction a.) The patient may consider that the medical director's opinion is more important than the EMTs b.) The doctor can give EMT directions You must document that the patient is alert and oriented to time, place and person a.) Then have the patient sign a refusal of care dorm If the patient refuses to sign, get a bystander to do it Before leaving scene, offer alternative methods of getting care Explain that another EMT crew will be happy to come back
Tips for driving an ambulance at night...
Make sure ambulance has halogen headlights Have headlights on whenever traveling in emergency Keep headlights clean Replaced burned out bulbs Dim high beams when approaching other vehicles Never stare into high beams Do not flick high beams up Never use high beams around a curve Keep windshield clean Keep your eyes moving
How do you set up a landing zone for air medical support?
Make sure it's clear of obstruction Stop traffic on highway Consider wind direction Mark each corner with highly visible device Keep patient and crew clear Assign one person to guide the pilot Be cautious of rotor blades Secure all loose items No smoking within 50 feet of aircraft
What should the EMT do while en route to the receiving facility?
Make sure patient is secured to cot Begin ongoing assessment Notify dispatch that you are en route to hospital Check any interventions Focus on the patient Notify the receiving facility
What are the phalanges?
Make up the fingers and thumbs Three per finger, two per thumb
What are the tarsals?
Make up the proximal portion of the foot
What is dementia?
Malfunctioning of normal brain activity Chronic, irreversible Medication, Alzheimer's, brain tumors, heart disease, constipation, urinary retention, depression, infection, alcohol use, chronic pain
What is bipolar disorder?
Manic-depressive disorder Inflated view of self a.) Deliriously happy, elated, and powerful Depressive state a.) Worthless, worries, suicidal Delusions or hallucinations
What is a bag valve mask?
Manual resuscitator used to provide pressure ventilation Volume of 1600 ml a.) 21% with no oxygen b.) 100% with oxygen
Characterize scalp injuries?
May be CLAA Tend to bleed very heavily Underlying fascia may be torn while the skin stays intact
What is paleness or palor?
May be a sign of vasoconstriction or blood loss It may indicate shock, heart attack, fright, anemia, fainting and emotional distress
Considerations for stab wounds...
May be easily detected or may be small and hidden Assess for underlying internal injuries and shock (hypoperfusion)
Where should you assess skin color?
May be observed at the mucous membranes of the mouth, the eyelids, under the tongue and the nail beds
Explain violence to others that an EMT might encounter. What are signs?
May be ready to fight with anyone who approaches Can be caused by patient mismanagement, psychosis, alcohol or drug intoxication, fear, panic, head injury Signs a.) Nervous pacing b.) Shouting and threatening c.) Cursing d.) Throwing object e.) Clenched teeth or fists
How should you deal with injuries to the midface, upper jaw, or lower jaw?
May be simple or extensive Signs and symptoms a.) Numbness or pain b.) Distortion of facial features c.) Crepitation d.) Irregularities to the facial bones e.) Severe bruising and swelling f.) Distance between the eyes g.) Bleeding from nose or mouth h.) Diplopia i.) Limited jaw movement j.) Palpable movement to the maxilla k.) Teeth not meeting l.) Hematoma m.) Limited jaw motion n.) Mouth open or unable to be closed o.) Saliva mixed with blood p.) Drooling q.) Painful or difficult speech r.) Missing, loosened or uneven teeth s.) Pain around the ears
Considerations for gun shot wounds...
May cause both an exit and entrance wound In general, the entrance wound is smaller than the exit wound If at a close range, the entrance wound will be surrounded by powder burns
What are shrapnel injuries?
May cause injury to solid organs, hollow organs, connective tissue, bone
What is a gas burn?
May cause upper airway burns It is not likely that the hot gas will cause distal airway burns
How should you perform a focused history and physical exam on a patient who has ingested poisons?
May have ingested more than one poison at a time Obtain a SAMPLE history Do rapid assessment if needed Signs and symptoms a.) History of ingestion b.) Swelling of mucosal membranes in mouth c.) Nausea d.) Diarrhea e.) Altered mental status f.) Abdominal pain g.) Burns or stains around the mouth h.) Unusual breath or body odors i.) Respiratory distress j.) Altered blood pressure or pulse k.) Dilated or constricted pupils l.) Warm and dry or cool and moist skin
What is the cause of jaundice, or yellow skin?
May indicate liver disease
What does cyanotic skin indicate?
May indicate reduced oxygenation from chest injuries, blood loss, or conditions like pneumonia or pulmonary edema that disrupt gas exchange in the lungs
Explain hypothermia and drowning...
May occur as a result of extremely cold water a.) Primary hypothermia b.) May protect tissues against hypoxia Secondary hypothermia a.) May occur from heat loss through evaporation once the victim is removed from the water Body temp of 95 or less a.) If less than 86 during resuscitation, maximum of one shock i.) Must be rewarmed before another shock is given
What are some causes of breathing difficulty?
May occur from injuries to the head, face, neck, spine, chest or abdomen Shortness of breath is usually caused by one of the following a.) Mechanical disruption of the airway, lung or chest wall i.) Flail chest, chest muscle weakness, lung collapse b.) Stimulation of the receptors of the lung i.) Will produce a sensation of shortness of breath ii.) Asthma, pneumonia, congestive heart failure c.) Inadequate gas exchange at the level of the alveoli and capillaries causing decrease in the oxygen content in the blood, known as hypoxemia, or a rise in the level of CO2 i.) Ventilation disturbance ii.) Perfusion disturbance iii.) Both a ventilation and perfusion disturbance in the lungs leading to hypoxia and hypercarbia (increased CO2 levels)
What is compartment syndrome?
May occur when a fracture or injury to an extremity has occurred May occur in the buttocks and abdomen When an injury occurs, swelling and bleeding in the space between the tissues is usually present If the pressure in the space around the capillaries exceeds the pressure needed to perfuse the tissues, the blood flow is cut off and cells become hypoxic, leading to compartment syndrome The hypoxic cells will release chemicals that cause the capillaries to leak, leading to further swelling Cells eventually die resulting in loss of muscle, nerves and vessels Usually develops over time Commonly associated with fractures, arterial and venous bleeding, crush injuries, and high energy trauma Signs and symptoms a.) Severe pain or burning sensation b.) Decreased strength c.) Paralysis of the extremity d.) Pain with movement e.) Extremity feeling hard f.) PMS normal Immobilize and splint a.) Elevate and place cold pack b.) Transport immediately
How should you address chest injuries?
May prevent adequate respiration by causing the lung to collapse Use an occlusive dressing to prevent air from entering the chest cavity through the wound If there is no suspected spinal injury, the patient can assume a position of comfort
What is considered a respiratory emergency?
May range from dyspnea to apnea Typically involve the respiratory tract or the lungs Hypoxia a.) Shortness of breath b.) Abnormal upper airway sounds c.) Faster or slower breathing rates d.) Poor chest rise and fall
What is a panic attack?
May show intense fear, tension or restlessness Often feel overwhelmed and cant concentrate Often hyperventilate a.) Dizziness, chest tightness, tingling, spasms, tremors, carpal-pedal spasms, irregular heartbeat, palpitations, diarrhea, choking, smoothing, SOB
Vaginal bleeding during pregnancy...
May sometimes occur late with or without pain May be due to abruptio placentae or placenta previa Place sanitary pads over vaginal opening Treat for shock
How do you insert a nasopharyngeal (nasal) airway?
Measure the airway a.) Placing it next to the face b.) From the tip of the patient's nose to the tip of earlobe Lubricate the outside with sterile, water soluble lubricant Insert the device in the larger open nostril a.) Bevel should be facing the septum Check to make sure that air is flowing through the tube
How is blood pressure measured?
Measured in millimeters of mercury (mmHg) Also recorded as an even number
What is a nontraumatic brain injury, or stroke?
Medical injury to the brain that is not related to trauma
What is the medication form and correct dosage of activated charcoal?
Medication form a.) Premixed in water b.) Powder Dosage a.) 1 gram of activated charcoal per kg of body weight b.) Adult dose, 30-100 grams c.) Children, 12.5-25 grams
Oral glucose overview...
Medication name a.) Glucose, insta-glucose Indications a.) Three criteria Contraindications a.) Unresponsive, unable to swallow Medication Form a.) Gel, in toothpaste type tubes Dosage a.) Typical dosage is one tube Administration a.) Obtain medical direction b.) Assure signs and symptoms of altered mental status c.) Assure that the patients is responsible and able to swallow d.) Either direct to area between cheek and gum or on tongue depressor Actions a.) Increases blood glucose level and available glucose to the brain Side Effects a.) No side effects b.) If too much, the patient can gag Reassessment a.) If the patient loses responsiveness or has a seizure b.) May take 20 minutes to see a change
What is oral glucose?
Medication of choice in the emergency medical care of the diabetic patient with an altered mental status a.) Raises the amount of glucose circulating in the blood b.) Improvement in mental status
Epidemiology of suicide...
Men 4 times more likely to die but women make 3 times as many attempts a.) 55% with firearms - lethal b.) Unsuccessful attempts, drugs and wrist slashing 8th leading cause of death in US among males a.) 3rd leading cause of death between 15 and age 24 At least half who succeed have attempted suicide before a.) 75% give clear warning
What is a pulse oxygen saturation level?
Method of detecting hypoxia by measuring oxygen saturation levels in the blood Also measures the effectiveness of airway management and oxygen therapy
What is the myocardium?
Middle layer of muscle Contracts and ejects blood from the heart
What are the actions of epinephrine autoinjectors?
Mimics the responses of sympathetic nervous system Constrict blood vessels and reduce leakage a.) Smooth muscles in the bronchioles b.) Increase heart rate and contractility
What is a transient ischemic attack?
Mini stroke, reversed within 224 hours No permanent damage Same treatment as stroke
What is reasonable force?
Minimum amount of force required to keep patient from injuring himself or others Depends on a.) Size and strength of patient b.) Type of behavior exhibited c.) Mental state of the patient d.) Method of restraint
What is the minimal level of personal protective equipment?
Minimum includes eye protection, and gloves
What is normal blood pressure for a child older than 10 years old?
Minimum systolic of 90mmHh and expected diastolic of 60mmHg
Explain trauma to pregnant women...
Minor trauma to the abdomen is usually okay Treat trauma the same a.) Shock, signs may be minimal b.) Will quickly deteriorate c.) Deliver oxygen d.) Position patient on left side
What are some signs and symptoms of predelivery emergencies?
Miscarriage, seizures, vaginal bleeding, trauma Predelivery emergency if a.) Abdominal pain, nausea, vomiting b.) Vaginal bleeding, passage of tissue c.) Seizures d.) Altered mental status e.) Swelling of face and extremities f.) Abdominal trauma g.) Shock h.) Hypoperfusion i.) Elevated BP May mask early signs of shock a.) Will shunt blood away from the baby
What is condyloid joint?
Modified ball and socket joint that permits movement in two directions Wrist
What are the signs and symptoms of a concussion?
Momentary confusion Confusion that lasts for several minutes Inability to recall events before and after Repeated questioning about what happened Mild to moderate irritability or resistance to treatment Combativeness Irritability Inability to answer questions
How can you ensure adequate ventilation?
Monitor frequently Do not interrupt ventilation for more than 30 seconds Indications a.) Rate of ventilation is sufficient b.) Infants and children, every 3 to 5 seconds c.) Adult with a pulse, once every 6 seconds d.) Adult with no pulse, 30 compressions to 2 ventilations i.) In newborn with a pulse, 40-60 ventilations per minute ii.) In a newborn without a pulse, 3:1, 9- compressions to 3 ventilations e.) Tidal volume must be consistent and sufficient f.) The patient's heart rate returns to a normal rate g.) Color improves
Where should you assess capillary refill?
More reliable in children and infants under are 6 In adults, depress the nailbed, ulnar margin, forehead, cheeks of patient In children, depress the forearm or over the knee cap
What is heat stroke?
Mortality rate of 20-80% heat regulating mechanisms break down Sweating ceases Brain cells become damaged Commonly unresponsive Can occur independently Nonexertional heat stroke (NEHS) a.) Elderly patients with sedentary lifestyles Exertional heat stroke a.) Younger individuals engaging in strenuous exertion
Facts on falls...
Most common MOI Depends on distance, surface and body part that impacted first Fall of 15 feet onto an unyielding surface is considered severe for an adult, 10 feet for a child
Explain the incidence of snakebites...
Most common between April and October Symptoms generally occur immediately if venomous Poisonous snake characteristics a.) Large fangs b.) Elliptical pupils or vertical slits c.) Pit between eye and mouth d.) Blotches on backgrounds e.) Triangular head that is larger than neck
What are the most common causes of spinal injuries?
Most common cause are automobile crashes (48%) Next is falls (21%) Then gunshots, recreational activities such as diving and football a.) Any patient with a gunshot wound to the neck, anterior lateral or posterior chest, the abdomen, the patient must be suspected of having a spinal injury
What is an absence (petit mal) seizure?
Most common in children Characterized by a blank stare, beginning and ending abruptly Lasting only a few seconds No emergency care is needed
What is depression?
Most common psychiatric condition Deep feelings of sadness, worthlessness, discouragement Crying spells, apathetic behavior Don't seem connected to specific events Factor in 50% of suicides Appetite loss, sleeplessness, fatigue, despondence, restlessness
What is a generalized tonic-clonic seizure?
Most common type of seizure Called a grand mal seizure Rarely last more than a few minutes
What are medication indications?
Most common uses of the drug Relief of signs, symptoms or specific conditions Nitro- chest pain
Communication and MCI...
Most difficult aspects of MCI Tasks are not always clear Radio communications can be altered
How can you ensure that you locate all patients?
Most involve a single patient who is easily accessible Some incidents involve more than one patient, and they are not always easy to identify or find a.) In explosions or building collapses, trench or confined space rescues and hazardous material incidents, it is often difficult to locate patients Look for clues to missing patients a.) Get information from witnesses b.) Empty child's car seat
What is a do not resuscitate (DNR) order?
Most often governs resuscitation issues only
What is the brain stem?
Most primitive and best protected part of the brain Tethered to the skull by numerous nerves and vessels Controls most automatic functions of the body, including cardiac, respiratory, vasomotor and other functions of life Made of the a.) Pons b.) Midbrain c.) Medulla oblongata i.) Connects the brain to the spinal cord
Explain inhaled poisons...
Most result from fire Commonly inhaled poisons a.) CO, CO2 b.) Chlorine gas c.) Fumes from liquid chemicals and sprays d.) Ammonia e.) Sulfur dioxide f.) Anesthetic gases g.) Solvents used in drycleaning h.) Industrial gases i.) Incomplete combustion of natural gas j.) Hydrogen sulfide More immediate than ingested poisons
What are the two formats of the prehospital care report (PCR)?
Most traditional form is the written report a.) Combines check boxes and write on lines for vital signs Computerized report a.) Could be filed out on paper and then scanned by a computer b.) You make put information directly into laptop c.) Can check the spelling and use of abbreviations
How should you address the ABCs in burn patients?
Most who die in the prehospital setting die from airway, toxic inhalation or other trauma and not from the soft tissue trauma EMT should establish a patent airway, adequate ventilation and adequate oxygenation Make sure bleeding has been controlled
Three main types of tracts within the spinal cord that will be tested in the assessment to determine if spinal cord injuries exist...
Motor tract a.) Carries impulses down the spinal cord and into muscles b.) Have the patient move Pain tract a.) Carries impulses from pain receptors up to the brain b.) Apply pain to the patient Light touch tracts a.) Applying light touch to the patient b.) Sensory receptors up to the spinal cord and to brain Since light touch and pain are carried by different tracts a.) Possible for the patient to be unable to feel light touch but be able to feel pain b.) May be present if the spinal cord is partially but not completely injured
When should you use urgent moves/rapid extrication?
Motor vehicle collisions Used in patients with abnormality of the airway, breathing, oxygenation or circulation Procedure a.) One rescuer bring the PTs head into a neutral in line position and provide manual stabilization b.) Second rescuer apply cervical spine immobilization collar as third places long board by the door i.) 3rd driver moves to the passenger seat c.) 2nd rescuer should support thorax is third frees the legs from the pedals or from under the dashboard d.) Direction of 2nd rescuer, he and third rescuer rotate until patient is in open door e.) Another support the head until the first rescuer exits and returns f.) Long backboard placed on seat next to patient's buttocks g.) Slide the patient into the proper position
Most common rescue situations encountered by the EMT are ___.
Motor vehicle crashes (MVCs)
What are the three main causes of intersection collisions?
Motorist approaches the intersection as light is changing and sails through Two emergency vehicles when motorists only expect one Vehicles waiting at intersection may block view of pedestrians
What is a mobile data terminal?
Mounted in the cab of the ambulance Receives a signal from the digital radio and displays the info on the terminal screen
Differences in the anatomy in infants and children...
Mouth and nose are smaller, more easily obstructed The tongue takes up more space in the pharynx Narrower tracheas a.) Trachea is softer and more flexible b.) Hyperextension of the head can occlude the trachea Cricoid cartilage is less developed and much less rigid Rely more heavily on breathing
If the patient is not breathing or not breathing adequately, you must begin positive pressure ventilation with supplemental oxygen with...
Mouth the mask Bag valve mask Flow restricted, oxygen powered ventilation device
What are some methods of positive pressure ventilation (PPV)?
Mouth to mouth Bag valve mask operated by 2 people Flow restricted oxygen powered ventilation device (FROPVD) Bag valve mask operated by one person Considerations a.) Make a good make seal b.) Device must be able to deliver an adequate volume of air c.) There must be a connection to oxygen
What is an extremity lift?
Move a patient from the ground to a patient carrying device Should not be used on a patient with suspected spinal or extremity injuries Procedure a.) First rescuer should kneel by the patient's head i.) Second rescuer kneel at side b.) First rescuer should place one hand under each shoulder i.) Second rescuer grasps wrists c.) First rescuer slips his hands under patient's arm and grabs wrists d.) Second slips hands under knees e.) Both move up to a crouching position f.) On signal, they should stand up
How should you administer emergency medical care to a patient with moist, pale, and normal to cool skin?
Move the patient to a cool place Administer oxygen at 15lpm Remove as much of the patient's clothing as you can Cool by applying cool compress Place in supine and raise feet Have him drink cool water No not give fluids if altered mental status, or is vomiting Transport
What are some factors that may increase bleeding?
Movement a.) Can disrupt the clotting process and allow continual bleeding Low body temp a.) May make the clotting process slower and less effective Medications a.) Coumadin (warfarin) and other anticoagulant drugs, aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDS) will interfere with the clotting process Intravenous fluids a.) May increase blood pressure causing clots to break free of the water or other properties may interfere with clotting
What is abduction?
Movement away from the midline
What is adduction?
Movement toward the midline
What is the dermis?
Much thicker than the epidermis Contains the network of blood vessels Composed of dense connective tissue a.) Gives skin its elasticity and strength
What are signs of physical abuse or neglect in children?
Multiple abrasions, incisions, bruises Multiple injuries in various stages of healing Injuries on front and back Unusual wounds Fearful child Injuries to the genitals Injuries to the brain or spinal cord, shaken baby syndrome Injuries to do not match MOI explained Lack of adult supervision Untreated chronic illness Malnourishment Delay in reporting injuries Implausible explanations
What is irreversible shock?
Multisystem organ damage May be several days after the initial injury or illness Death will result All compensatory mechanisms have been exhausted and the patient fails fast Highly acidic, cold, sludged blood dumps into core circulation Signs and symptoms a.) Barely palpable central pulses b.) Extreme tachycardia that begins to slow and eventually drops to 0 c.) Rapid, shallow and ineffective respiration d.) BP is extremely low e.) Mottling of the skin f.) Unresponsiveness g.) Bleeding that may occur from every orifice and begin to leak from once controlled wounds
What does the prefix 'myo' mean?
Muscle
What is the tonic phase of a seizure?
Muscle rigidity Muscles become contracted and tense Arching of the back
What is the clonic phase of a seizure (convulsion)?
Muscle spasms that alternate with relaxation Violent and jerky muscle activity
What happens when calcium is progressively deposited in areas of deterioration (the valves of the heart)?
Muscle tissue becomes fibrous
What is crowing?
Muscles around the larynx spasm and narrow the opening of the trachea
What are intercostal muscles?
Muscles between the ribs, contract
What is the diaphragm?
Muscles that separates the chest cavity from the abdominal cavity Responsible for approximately 60-70 percent of the effort of ventilation
What do tendons do?
Muscles to bones
What are some anatomical differences in the abdomens of children?
Musculature less well developed Liver and spleen are more exposed and less protected
What is wheezing?
Musical type sound on inhalation and exhalation Higher resistance in the bronchioles with restricted air flows Occurs in asthma, allergic reactions and emphysema
Drugs are available that can make a difference if administered to stroke patients promptly...
Must be administered within 3 ours from the first sign or symptoms Must be brought to ER within 2 hours Other therapies can be extended t 6 hours
What safety measures should you take when approaching a scene with high traffic?
Must be controlled for scene safety Directing traffic is primarily the responsibility of police Stop all traffic and reroute it to different roads Position the ambulance so that the patient loading doors are angled away from incoming traffic Flares can be placed
What is a proximal cause?
Must be determined that the injuries suffered were a direct result of the EMT's negligence
What are suction catheters?
Must be disposable and capable of bring connected to the suction unit's tubing Hard or Rigid Catheter a.) Called a yankeuer cateter b.) Referred to as a tonsil tip or tonsil sucker c.) More effective for more particulate matter d.) Don't insert further than the base of the tongue e.) The vagus nerve may be stimulated allowing the patient to become bradycardic
Minor consent or consent for a mentally incompetent adult...
Must be obtained from a parent or legal guardian A minor is usually any person under age 18 or 21 If a parent is not present, implied consent is considered Clearly document
What is expressed consent?
Must be obtained from every conscious, mentally competent adult before treatment is started Good to document the patient's approval
US DOT regulations require vehicles containing hazmat to be marked with specific hazard labels or placards
Must have shipping papers which identify the exact substance, origin and destination Usually four sided, diamond shaped sign Often will have a four digit UN identification number that can be used to identify hazmat a.) Color also gives clue
What are portable suction devices?
Must produce adequate vacuum Oxygen powered units only function as long as the source of oxygen is available Hand powered require no energy
What is an adequate respiratory rate?
Normal between 10-24 or between 12-20
What are the four accessory structures of the skin?
Nails, hair, sweat glands, oil glands
What information is needed when requesting air medical transport?
Name Department name Call back number Nature of incident Exact location Radio frequency you use Exact location of landing zone
What are shipping papers and material safety data sheets?
Name of substance, classification, 4 digit UN identification number Required to be in the cab of a motor vehicle
Trachea and lower airway anatomy in children...
Narrower, softer and more flexible than adults Airway obstructions occur more easily The head tends to tilt forward, flexing the neck and potentially collapsing the trachea Padding under the shoulders may be necessary to keep the airway aligned
Air from the nose enters the nasal portion of the pharynx or the ___.
Nasopharynx
What are some operational security measures?
National association of Emergency Medical Technicians (NAEMT) a.) Recommended guidelines to ensure better operational safety and security Personnel a.) Security briefings should be conducted at the beginning of each shift Vehicle a.) All EMS vehicles must be tracked at all times b.) They should never be left running with keys in ignition Tracking or Vehicle Access a.) A comprehensive key log must be kept to account for all keys b.) Salvaged vehicles must have EMS markings removed Uniforms and ID Items a.) ID cards should be counterfeit resistant and include photo of EMS members
What does proximal mean?
Near the point of reference
What is 'trauma'?
Nearly always the result of two or more bodies colliding with each other
What is a patent airway?
Necessary for breathing
What is a normal respiration rate for an adult?
Normal for adult is between 12 and 20 Typically less than 10 and more than 24 are of concern
What is a normal respiration rate for an elderly person?
Normal for elderly, average of 20 Decreased tidal volume
What is considered a normal pulse for an adult?
Normal is between 60-80 for adult
How should you reassess a patient following medication administration?
Necessary to perform an ongoing assessment Following should be assessed and changes documented following drug administration a.) Mental status b.) Patency of the airway c.) Breathing rate and quality d.) Pulse rate and quality e.) Skin color, temperature, and condition f.) Blood pressure g.) Change or relief of the complaints of the patient h.) Relief or signs and symptoms associated with the complaints of the patient i.) Medication side effects j.) Improvement or deterioration in the patient's condition following medication administration Check the adequacy of oxygen administration
What are some common reasons for behavioral change?
Need to make sure you are dealing with a behavioral and not a physical emergency Low blood sugar Hypoxia Inadequate blood flow to brain Head trauma Mind altering substances Psychogenic substances Excessive heat or cold Infections of the brain
What are late signs of inadequate breathing (respiratory failure) in the infant or child?
Need to provide positive pressure ventilation Respiratory distress a.) Condition where there are no respirations or respiratory effort, however a pulse is present Altered mental status Bradycardia Hypotension Extremely fast, slow, or irregular breathing pattern Cyanosis Loss of muscle tone Diminished or absent breath sounds Head bobbing Grunting a.) During exhalation, indication lung collapse See saw or rocky breathing Decreased response to pain Inadequate tidal volume
How should you provide emergency medical care to a patient with shock?
Needs to occur early in the initial assessment Maintain standard precautions Maintain an open airway, administer oxygen Control external bleeding If signs of shock are present, the lower abdomen is tender with a suspected pelvis injury and these is no evidence of chest injury, apply and inflate the PASG Elevate the lower extremities about 8-12 inches a.) Not if pelvis, lower extremity, head, chest, abdomen, neck or spine injuries Splint suspected bone or joint injuries Use a blanket to cover patient Transport immediately
What are some hazards of over-ventilation?
Negative pressure creates a vacuum like condition that draws blood into the superior and inferior vena cavae a.) Increases blood flow to the right side of the heart b.) Can lead to decrease in the volume of blood being ejected by the left ventricle Large amounts of air can be trapped in the alveoli a.) Can become obstructed and stop blood flow to the left atrium
Different types of negligence in breaches of duty to act...
Negligence a.) Deviation from the standard of care Simple negligence a.) When an EMT fails to perform care of when a mistake is made in treatment Gross negligence a.) Willful, wanton, or extremely reckless patient care b.) Intentionally causing harm to a patient
How do you determine whether or not you need to ventilate?
Neither the rate or depth is enough to decide Both rate and depth must be adequate, if not five positive pressure ventilation Adequate respiratory rate and adequate tidal volume with each breath is adequate breathing Inadequate respiratory rate and an adequate tidal volume = inadequate breathing
What is sarin?
Nerve agent Immediate death or permanent disability
What are the six major types of chemical agents?
Nerve agents Vesicants Cyanide Pulmonary agents Riot control agents Industrial chemicals
What is the peripheral nervous system?
Nerves located outside of the brain and spinal cord
How should you assess a lightening strike patient?
Nervous system a.) Altered mental status, retrograde amnesia, anterograde amnesia b.) Weakness, pain tingling, numbness c.) Pale cool clammy skin d.) Temporary paralysis e.) Dizziness, loss of papillary function f.) Vertigo g.) Seizures Cardiac system a.) Asystole or vfib b.) Irregular pulse Respiratory system a.) Apnea Skin a.) Burns b.) Linear burns c.) Feathering d.) Thermal burns e.) Punctuate burns Musculoskeletal a.) Dislocations b.) Fractures Ophthalmic a.) Unequal pupils b.) Drooping eyelids Otologic a.) Ruptured tympanic membrane (eardrum) b.) Tinnitits (ringing in ear) c.) Deafness
What are some safety precautions when using oxygen cylinders?
Never allow combustible materials such as oil or grease to tough the cylinder Oil and oxygen under pressure will explode a.) Petroleum based jelly and some adhesive tape Never smoke or allow others to smoke Store the cylinders below 125 degrees F Never use without a valve Keep them secure Never place body part over the oxygen valve
What is a closed injury?
No break in the continuity of skin
What is a nonurgent move? When should you perform one?
No immediate threat to life Lift the patient as a unit Keep the head and neck in a neutral position
When should you perform a non-urgent move?
No immediate threat to life exists
What is anoxia?
No oxygen
What is a normal blood pressure rate for a child age 1-10 years?
Normal systolic, take the child's age, multiply by 2 and adding 80mmHg a.) Upper limit, 90 + 2(age) b.) Lower limit, 70 + 2(age) Diastolic is normally two thirds the systolic
What is the normal condition of skin?
Normally, skin is dry Wet or moist skin may indicate shock, poisoning, heat related, cardiac or diabetic emergency Clammy a.) Cool and moist skin Diaphoresis a.) Profuse sweating Skin that is abnormally dry may be a sign of spinal injury or severe dehydration
When should the trauma patient be prepared for transport?
Normally, the critical trauma patient is prepared for transport as the rapid trauma assessment is being conducted SAMPLE can be taken now or in the ambulance Trauma assessment is a period of 2-2.5 minutes a.) Head to toe assessment, baseline vital signs, and SAMLPE history However, life threatening injuries and conditions must be appropriately managed as found at the scene prior to transport
What is jugular vein distention?
Normally, they are slightly engorged in a patient lying supine At a 45 degree angle, the neck veins should be flat If they are flat while supine, it may indicate a decreased blood volume If they are engorged when 45 degree are considered to be distended a.) JVD is a sign of serious injury to the chest, lungs, or heart
What is epitaxis?
Nosebleed May result from injury, disease, or environment In extreme cases, shock can develop
What is a nasal canula?
Not a preferred method, for patients who do not tolerate the nonrebreather Low flow For every minute of flow, the ox concentration increases by 4% 1-6 lpm Concentration ranges from about 24% to 44% Applying the Nasal Canula a.) Explain the procedure, breathe normally b.) Prepare the tank and regulator, 1-6 lpm c.) Insert the two prongs with the prongs curving downward d.) Position the tubing behind each ear
What is dry drowning?
Not all patients who are involved in a drowning aspirate water into their lungs 10-20% do not Result of the spasm and tightening of the larynx a.) Dry drowning
What are some considerations in rotational or roll over crashes?
Not as easy to predict as those from other crashes Occupants strike mirrors, posts, and doors Multiple system injury is common Ejection is common Crushing injuries to ejected occupants are common
How should you administer emergency medical care to patients with acid and alkali poisoning?
Not effective in these cases, rapid transport Wear necessary PPE Remove contaminated clothing, flush repeatedly Open and maintain patent airway Assure breathing status Rapidly transport patient
What is hypoglycemia?
Not enough glucose in the blood Brain cells absorb glucose directly from the blood a.) Store very little glucose, only about 2 minutes, constant supply is necessary b.) Blood dysfunctions when not enough glucose in the blood c.) Rapid onset of altered mental status
What are biological toxins?
Not living organisms but can be products of living organisms Cannot be transferred from one individual to another
What is direct ground lift?
Not recommended for a heavier patient Procedure a.) 2 or three line up on same side b.) Kneel on one knee c.) Second rescuer should place the patient's arm on chest d.) First rescuer cradle the patient's head by placing one arm under the patient's neck and shoulder i.) Other arm on lower back e.) 2nd rescuer should place one under knees, the other under buttocks f.) 3rd place both arms under waist g.) Lift the patient to their knees and roll the patient toward chest h.) On signal, stand up and move patient
What emergency medical care should you give to those with spinal injuries?
Not the role of the EMT to attempt to diagnose a.) When in doubt, immobilize the patient Procedure a.) Take necessary standard precautions b.) Establish manual in-line stabilization immediately upon making contact with the patient c.) When performing initial assessment, open and maintain the airway with the jaw thrust d.) Assess the pulse, motor function, and sensation (both pain and light touch) in all extremities e.) Assess the cervical region and the neck before applying the collar f.) Apply a spinal stabilization collar g.) Immobilize the patient to a long backboard h.) Once the patient is immobilized, RPM in all extremities i.) Transport to the hospital
How should you assess the extremities during a rapid medical assessment?
Note any excessive peripheral edema a.) Congestive heart failure, fluid overload, or a clot blocking a vein in that extremity b.) Assess PMS
What should the EMT do while at the scene?
Notify dispatch of arrival Park ambulance in safest place Do not park in alongside other vehicles Take BSI Determine scene safety Determine the MOI or NOI Determine number of patients Determine care priority Spinal immobilization Transfer the patient to ambulance
What should the EMT do while at the receiving facility?
Notify dispatch of arrival Make an official transfer of care Transfer all records Give complete oral report Make sure that belongings are with patient Write the PCR before leaving hospital
What is a drowning?
Now the only recommended term to be used to describe a submersion event When someone is submersed or immersed in a liquid that results in primary respiratory impairment Regardless of the outcome, it is called a drowning
What types of WMDs cause the most destruction?
Nuclear weapons cause the greatest amount of structural damage along with environmental contamination Chemical and biological weapons cause little structural damage but have impact on environment
What is a respiratory rate?
Number of breaths per minute
What is gravida?
Number of pregnancies
What is a trauma score?
Numerical way to identify the severity of trauma Includes the Glasgow Coma Scale Number is assigned to each parameter and each subset are added The lower the scale, the more severe Major components a.) Respiratory rate b.) Systolic blood pressure c.) Glasgow Coma Score (GCS)
What is the physiology of respiration?
O2 and CO2 exchanged through the alveoli and the capillaries O2 rich air enters the alveoli and passes through the capillary walls into the blood stream
What is implied consent?
Occurs when you assume that a patient who is unresponsive, or who is not competent or who is unable to make a rational decision would consent to emergency care if he could A patient who initially refuses, but then becomes unresponsive
What is a pulmonary embolism?
Obstruction of blood flow in the pulmonary arteries leads to hypoxia Long periods of immobility, heart disease, recent surgery, long bone fractures, venous pooling associated with pregnancy, cancer, deep vein thrombosis, estrogen therapy, smokers Sudden blockage of blood flow through the pulmonary artery Caused by a blood clot, air bubble, fat particle, foreign body, or amniotic fluid Prevents blood from flowing into the lung Hypoxia
How should you obtain a set of baseline vitals from a patient with a spinal injury?
Obtain a set of baseline vitals May develop neurogenic hypotension or neurogenic shock a.) Caused by the loss of sympathetic stimulation to the vessels below the site of the injury b.) BP low and heart rate high c.) Skin is warm and dry
What is oxygen?
Odorless, tasteless, colorless gas that is found in the ambient atmosphere at a concentration of approximately 21% Can be administered at 100% Indications a.) Any patient who is experiencing medical or trauma condition and may become hypoxic
What are the key steps in administering medications?
Obtain an Order from Medical Direction a.) On line or offline b.) Know the protocols c.) Verify by restating the drug, dose, and route Select the Proper Medication a.) Responsibility of the EMT to ensure that the proper medication has been selected b.) Carefully read labels Verify the Patient's Prescription a.) Must be obtained by the patient b.) Must belong to the patient c.) Verify the patient's name d.) The EMT should never administer medication that is not prescribed for the patient unless ordered to do so by medical direction Check the Expiration Date a.) The expiration date is either printed on the container itself or on the prescription label b.) Do not administer expired medication Check for Discoloration or Impurities a.) Especially liquid, epinephrine b.) If the medication appears to be cloudy, discolored or if any particulate material is found, don't use it c.) Discard the medication Verify the Form, Route, and Dose a.) Closely examine the label b.) Administering an adult dose to a child can be bad or deadly
How should an EMT administer an epi-pen?
Obtain order Obtain injector a.) Prescription for patient b.) Medication is not expired Remove safety cap Place the tip on thigh Push firmly and hold for ten seconds Dispose of pen Record and document
What are agonal respirations?
Occasional gasping breaths
What is an ischemic stroke?
Occur when the cerebral artery is blocked by a clot or other matter Clot at site of occlusion is thrombus, process is thrombosis
What is subdural bleeding?
Occurs beneath the dura and is usually venous
What is primary triage?
Occurs immediately upon arrival Conducted at the site of the incident Done very quickly and provides very basic categorized Tagged as red, yellow, green or black
What is placenta previa?
Occurs in 1 in 250 births Major cause of third trimester bleeding Abnormal implantation of placenta over or near opening of the cervix When the fetus changes position, the placenta is prematurely torn away from the uterine wall a.) Results in bleeding Three types a.) Total i.) Completely covers the birth canal ii.) Prevents deliver b.) Partial i.) Partially covers the cervix ii.) May obstruct delivery c.) Marginal i.) Near the neck of cervix Predisposing factors a.) Multiparity (more than 2 deliveries) b.) Rapid succession of pregnancies c.) Greater than 25 years of age d.) History of early vaginal bleeding e.) Bleeding immediately after intercourse
What is myexedema coma?
Occurs late in the progression of hypothyroidism, can be fatal Common in elderly women who present with extreme hypothermia, seizures, slow reflexes, respiratory distress
What is burn shock?
Occurs only after the first few hours Results from extensive vascular bed damage that allows both fluid from extensive vascular bed damage that allows both fluid and protein molecules in the plasma to leak into surrounding tissues a.) Loss of plasma causes the normal fluid balance of the rest of the vascular system to become disturbed and blood plasma starts to seep from the capillary beds b.) Large fluid shift outside of the cells and to the spaces surrounding the cells to a point where the total vascular volume itself is insufficient to meet the body's needs c.) Explains the extensive swelling d.) Can lead to shock
What is primary radiation exposure?
Occurs shortly after detonation Occurs only the first minute immediately after detonation Most injury caused by blast and burns Can result in life threatening injuries a.) Depends on strength, duration of exposure, shielding, distance from source
What is a tension pneumothorax?
Occurs when the injured lung is completely collapsed from air trapped in the pleural space
What is an inhalation chest injury?
Occurs when the muscles between the ribs (intercostals) pull the ribs upward to increase the size of the rib cage The diaphragm contacts and moves slightly downward and flares the bottom portion of the ribs outward Expands the space in the thoracic cavity, thus creating negative pressure which causes the lungs to pull in air Higher pressure to lower pressure flow
What is visceral pain?
Occurs when the organ itself is involved Most organs do not have a large number of sensitive nerve fibers, therefore the pain is less severe, poorly localized, dull or aching, and may be constant or intermittent Mild or intermittent pain does not mean a mild or insignificant condition Associated with nausea or vomiting
What is a power lift?
Offers you the best defense against injury and protects the patient with a safe and stable move Keep back locked and avoid bending at the waist Procedure a.) Place feet at comfortable distance b.) Turn fleet slightly outward c.) Bend your knees to bring your center of gravity closer to the object d.) Tighten the muscles of the back and abdomen to splint the vulnerable lower back e.) Straddle the object with your feet flat f.) Place hands a comfortable distance from each other to provide balance g.) Always use a power grip to get maximum force from the hands h.) As lifting begins, your back should remain locked 1.) Your upper body should come up before the hips i.) Reverse these steps to lower the wheeled stretcher or other object
How should you immobilize an infant or child in a car set?
Often the child is reassured by seat Consider immobilizing in safety seat as long as the plastic shell is not cracked and the metal tubes do not have jagged mental edges and the child is not in need of resuscitation Applying a cervical collar to child Stabilizing head between two rolled towels Two solid points of contact a.) Tape across forehead b.) Over upper lip
What is a living will?
Often used to cover more general health care issues Includes the use of long term life support equipment such as ventilators and feeding tubes
Where can a carotid pulse be felt?
On either side of the neck in the groove between the trachea and the muscle mask
Where can the brachial artery pulse be felt?
On the medial aspect of the arm midway between the shoulder and the elbow In 1 year and younger, assess a brachial pulse
Where can the dorsalis pedis artery pulse be felt?
On the top of the foot on the greater side
Once you start providing care, do you have a legal obligation to continue?
Once you start, you cannot leave until someone with appropriate expertise - typically one with equal or high level of training - takes over care You are also legally responsible for any of the patient's property you pick up
What is a dysconjugate gaze?
One eye that is fixed or has a gaze in one direction Injury to the obit, ocular muscles or nerves
What is a crush injury?
One in which force is great enough to cause injury has been applied to the body Can cause serious damage to the underlying soft tissues with associated internal bleeding and may result in shock (hypoperfusion) Internal organs may rupture Can be open or closed Usually they may not appear to be serious a.) Painful, swollen and deformed b.) External bleeding may be minimal and absent c.) Always suspect that there may be severe internal bleeding Patients may appear to be unaffected at first a.) Can deteriorate rapidly into shock b.) Usually happens when the object causing the crushing is removed c.) The object will initially tamponade, or restrict while it against the body
What is a breech birth?
One in which the fetal buttocks or lower extremities are low in the uterus and are the first to be delivered a.) Delivery may be prolonged b.) Mother is at risk for delivery trauma c.) Increased risk of prolapsed cord
What is the law of inertia?
One of the laws of motion described by Sir Isaac Netwon A body at rest will remain at rest and a body in motion will remain in motion unless it is acted upon by an outside force
What are carotid arteries?
One on each side of the neck Supply the brain and head
What is considered a weak pulse?
One that doesn't feel full or may be difficult to find May be quite rapid Also called thready
What is hazardous material?
One that in any quantity poses a threat or unreasonable risk to life, health or property if not properly controlled during manufacture, processing, packaging, handling, storage, transportation, use, and disposal Include chemicals, wastes, and other dangerous products Principal dangers a.) Toxicity, flammability, reactivity Can asphyxiate, irritate and increase the risk of cancer, cause loss of coordination or altered mental status a.) Skin irritation, burns, respiratory distress, nausea and vomiting, tingling, or numbness, double vision
What is considered irregular pulse?
One that occurs at irregular intervals
Over ___ of all deaths due to trauma occur from vehicle collisions
One third
What is an allergen?
One type of antigen Enters the body and the effect is quite different Foreign substances, often normal and harmless in most individuals, that cause an abnormal response by the immune system known as an allergic reaction a.) Misdirected and excessive response by the immune system to a foreign substance or allergen b.) Immune system over estimates the danger of the allergen Allergen itself is harmless but the response can be life threatening
What is chronic aging?
People are living longer with long term or progressing gradually illness Most will have a combination of chronic diseases
What is the direct carry method?
One way of transferring a supine patient from a bed to a wheeled stretcher Procedure a.) Position the wheeled stretcher perpendicular to the bed with the head of the device at the foot of the bed b.) Prepare the stretcher i.) Both rescuers stand between the bed and stretcher, facing the patient c.) First rescuer slides arm under neck and cups shoulders d.) Second slides hand under hips and lifts slightly, the second rescuer puts a hand under the back i.) Second puts arms under hips and calves e.) Rescuers slide the patient to the edge of the bed, lift and curl to chest, then rotate to stretcher
What is a medical patient? How should you treat a medical patient?
One who has not suffered any type of injury or trauma Perform focused and physical exam History comes first in responsive patient a.) Focused medical assessment Physical exam first in the unresponsive patient a.) Rapid medical assessment
What is cardiac muscle?
Only found within the walls of the heart Has the property of automaticity a.) The ability to generate an impulse on its own, even when disconnected from the central nervous system b.) Smooth but striated
What is considered shallow breathing?
Only slight chest or abdominal wall expansion upon inhalation
How should you assess the complaints of a medical patient using OPQRST?
Onset a.) When and how did the symptoms begin Provocation/palliation a.) What makes the symptoms better/worse? Quality a.) How would you describe the pain? Radiation a.) Where do you feel pain, where does it go? Severity a.) How bad is it? b.) Scale of one to ten Time a.) How long have you had the symptom?
How can you tell that behavioral change is physical rather than psychological?
Onset was sudden Patient has visual hallucinations Patient has memory loss or impairment Pupils are dilated, constricted, or unequal Excess salivation Incontinence Unusual odor on his breath
How should you administer emergency medical care to patients with ethylene glycol poisoning?
Open airway Assess breathing status Administer charcoal rapidly transport
How should you administer care to an unresponsive child with a foreign body obstruction?
Open airway Look for foreign body and attempt to remove Provide 2 ventilations over 1 second 30 chest compressions Look in mouth and attempt to remove Provide two ventilations, 30 compressions Continue
How should you administer emergency medicare care to an unresponsive infant with a foreign body obstruction?
Open airway Open mouth and look for object a.) Attempt to remove it Apply two ventilations over 1 second Provide 30 chest compressions at rate of 100 per minute Look in mouth for obstruction, attempt to remove it Provide two ventilations and compressions Continue
How should you provide emergency medical care to a child in shock?
Open airway and give oxygen PPV if needed Control bleeding Have child lie supine with legs raised Keep patient warm and calm Transport to the ED immediately
How should you administer emergency medical care to patients with methanol poisoning?
Open and assess airway Assess breathing status Rapid transport
How should you administer emergency medical care to patients with isopropanol poisoning?
Open and maintain airway Assess breathing status Begin transport
Explain flame burns...
Open flame, clothing may ignite Natural clothing fibers typically will burn, whereas synthetic fibers will usually melt, which causes a contact burn in addition to the flame burn
How should you deliver emergency medical care for patients with pulmonary embolism?
Open the airway and initiate positive pressure ventilation Administer oxygen early on and monitor for respiratory arrest
What is an open pneumothorax?
Open wound created by a penetrating object Air may be heard escaping or entering the wound Sucking chest wound Signs and symptoms a.) Same as closed pneumothorax b.) Place occlusive dressing
What is an ulcer?
Open wounds or sores within the digestive tract, usually in the stomach or the beginning of the small intestine Breakdown in the lining that normally protects the inside of the digestive tract
What is glucagon?
Opposite of insulin Secreted when blood glucose is low and will work to increase blood glucose level Major functions a.) Coverts glycogen stored in the liver back into glucose and releases it into the blood b.) Coverts other, noncarbohydrate substances into glucose c.) Increases and maintains the blood glucose level by the actions listed in 1 and 2, converting glycogen and other substances into glucose Secreted when the BGL goes under 70mg/dL
What does contralateral mean?
Opposite side
What is the placenta?
Organ of pregnancy Disk shaped inner lining of the uterus Sole organ through which the fetus receives oxygen and nourishment from the mother and discharges carbon dioxide and waste products Exchange is made between the mother's and infant's blood streams within the placenta a.) The blood of the fetus and the blood of the mother do not mix, except during birth or miscarriage After the infant is born, the placenta seperates from the uterine wall and is delivered as after birth a.) Usually weighs about a bound
Air from the mouth enters through the ___.
Oropharynx
What is the parietal peritoneum?
Outer lining that adheres to the walls of the abdominal cavity
What is the epidermis?
Outer most layer that provides an airtight and resilient barrier from the external environment
What is the epidermis?
Outermost layer Composed of four layers a.) Outer two are dying and dead cells b.) Melanin located in the deepest layers of the epidermis
What is the cerebrum?
Outermost part of the brain Controls functions a.) Sensation, thought, associative memory Manages motions that are on the conscious control of the individual
How can muscles be injured?
Overexerting a muscle may break fibers Can be bruised, crushed, cut, torn, or otherwise injured Swollen, tender, painful, or weak
What are some common medications carried on the EMS unit?
Oxygen Activated charcoal Oral glucose Nitroglycerine Metered dose inhalers Epi-pen
What are some signs and symptoms of epiglotitis?
Pain on swallowing High fever Drooling Mouth breathing Changes in voice Patient sits up, leans forward Chin and neck are thrusted forward Inspiratory stridor Respiratory distress
What are the signs and symptoms of acute abdominal pain?
Pain or tenderness Anxiety or fear Position Rapid and shallow breathing Rapid pulse Blood pressure changes Nausea, vomiting, and or diarrhea Rigid abdomen Distended abdomen Other signs of shock Signs of internal bleeding a.) Vomiting blood, blood in the stool
What are some signs and symptoms of a bite or sting?
Pain that is immediate and severe, burning, numbness Redness and discoloration Weakness or faintness, swelling around the bite Chills, dizziness, fever, vomiting, nausea Bite marks, stingers
What are the signs and symptoms of a rib injury?
Pain with movement and breathing Crepitation Tenderness Deformity of the chest Inability to breathe deeply Coughing Tachypnea that may be shallow
What is trichothecene mycotoxins (T2)?
Pain, itching, redness, lesions, pain, dyspnea, wheezing, chest pain, hemoptysis
What is shock (hypoperfusion)?
Pale, cool, and clammy Treatment needs to begin during the initial assessment Control any serious bleeding, splint any bone or joint injuries Consider elevating the patient's feet approximately 8 to 12 injuries Apply positive pressure ventilation or nonbreather Keep them warm
What does palmar mean?
Palm of the hand
How should you assess the extremities during a rapid medical assessment?
Palpate the back for discoloration, edema and tenderness Edema to the sacral region may be from fluid collection associated with congestive heart failure
What are white blood cells?
Part of the body's immune system and help defend infection
What organs are in the left lower quadrant (LLQ)?
Part of the large intestines and the female reproductive organs
What is the olecranon?
Part of the ulna that forms the bony prominence of the elbow
What is ventilation?
Passage of air into and out of lungs
What is the trachea?
Passageway for air traveling to the lungs Known as the laypipe a.) Extends from the larynx to the carina i.) The point where the trachea splits into right and left bronchi
How should you assess the mouth during a rapid trauma assessment?
Patency of the airway Inspect for bleeding, bone fragments, or dislodged teeth Inspect for swelling, lacerations to the tongue Look at the color of the mucous membranes
Patient will not survive without a ___ airway
Patent (open)
What is a bullet trajectory?
Path or motion of a projectile during its travel
What is cavitation?
Pathway expansion Cavity in the body tissues caused by pressure wave
What is the order of an assessment of a responsive medical patient?
Patient Complaints with OPQRST SAMPLE history Focused Medical Assessment Baseline Vitals Provider Emergency Care Transport Decision
What are the elements of DOTs minimum data set?
Patient Information Gathered by the EMT-B a.) Chief Complaint b.) Level of responsiveness (AVPU) c.) Systolic blood pressure (for patients greater than 3) d.) Skin perfusion (capillary refill) for patients less than 6 e.) Skin color and temperature f.) Pulse rate g.) Respiratory rate and effort Administrative Information a.) The time the incident was reported b.) Time the unit was notified c.) Time of arrival at the patient d.) Time the unit left the scene e.) The time the unit arrived at destination f.) Time of transfer of care Administrative Information a.) Sometimes referred to as the run data b.) Includes information listed in the minimum data set i.) The EMS unit number and the run or call number ii.) Names of crew members and their levels of certification iii.) The address to which the unit is dispatches Patient Data a.) Legal name, age, sex, DOB b.) Home address c.) Social security number and additional insurance or billing information d.) The location of the patient e.) Any care given before the arrival of the EMTs Vital Signs a.) Boxes are provided for checking off and writing information b.) Ideally, at least two sets are taken and recorded Patient Narrative a.) More detailed info about the patient and his problem i.) Will set the tone for the entire treatment b.) Includes i.) Patient's chief complain in the words of the patient or bystander 1.) Use quotation marks ii.) Patient's SAMPLE history b.) Brief but thorough picture of the patient a.) Include objective and subjective information b.) Pertinent negatives i.) Signs or symptoms that might be expected, but are absent Treatment a.) Treatment provided to patient b.) Should be in chronological order
What is a detailed physical exam?
Patient and injury specific An unresponsive patient requires a complete, detailed exam Use inspection, palpation, and ausculatation to further identify signs, symptoms or complaints Injuries will be manages as they present Steps a.) Perform the detailed physical exam b.) Reassess the vital signs c.) Continue emergency care
Explain the modern EMS system...
Patient care used to begin upon arrival at the hospital The funeral home was the ambulance provider Permits patient care to begin at the scene Part of a continuum of care that extends until discharge or rehab
What is an overdose?
Patient has been exposed to an excessive dose of drug Intentional, unintentional
What are some indications for metered dose inhalers?
Patient has signs and symptoms of respiratory distress The patient has been prescribed metered-dose inhaler EMT has received approval
Indications for epinephrine autoinjectors...
Patient has sings of severe allergic reaction Medication is prescribed to the patient EMT has received medical injection
When should you perform an urgent move?
Patient is experiencing an immediate threat to life
What is radiation exposure?
Patient is in presence of radiation without it touching his body
What are some contraindications for metered dose inhalers?
Patient is not responsive MDI is not prescribed for the patient Permission has not been granted by medical direction Patient has taken maximum dose
What is anterograde amnesia?
Patient is unable to remember circumstances after the incident
What is retrograde amnesia?
Patient is unable to remember circumstances leading up to the event
What is informed consent?
Patient must be informed of the care and of the risks and consequences Ask the patient if he understand and has any questions Ask the patient for explicit permission before proceeding, even if he was the one who call 9-11
What is hyperventilation syndrome?
Patient sis upset or excited, panic attacks Can be caused by a serious medical problem Pt breathes faster and deeper causing signs of hyperventilation Blow off excessive CO2 a.) Body needs some to function b.) Tries to take in more air, breathing faster Calcium decreases and causes cramps
What are some factors that cause hyperglycermia in diabetic?
Patient suffering from an infection that has upset the insulin and glucose balance Patient takes an inadequate dose of insulin Patient is taking medications such as Thiazide, Dilantin or steroids Patient has suffered some type of stress such as surgery, trauma, pregnancy or heart attack Patient has had change in diet
What is respiratory distress?
Patient who is having difficulty breathing but has adequate tidal volume and respiratory rate Needs supplemental oxygen via a nonrebreather at 15 lpm
How do you test orthostatic vital signs?
Patient with suspected volume loss Place the patient in a supine position and measuring his blood pressure and heart rate, then standing him up and after two minutes, reassessing the blood pressure a.) If when standing up, the heart rate increases by 10-20bpm and the systolic decreases by 10-20mmHgm it is considered to be a positive orthostatic test i.) Indicates significant loss of blood Also known as the tilt test a.) If patient cannot stand, you can try from supine to sitting
How is the severity of internal bleeding determined?
Patient's condition, age, other medical condition, and source of the internal bleeding Most common sources are injured or damaged internal organs and fractured extremities, especially fractures of the femur or pelvis
How can the EMT determine the nature of illness?
Patient, relatives or bystanders can give you close You are not trying to diagnose The physical position of the a patient may provide clues a.) Tripoding, cardiac or respiratory distress Patient lying still with his legs to his chest a.) Severe abdominal pain Fruity odor from the patient may indicate diabetic condition Loss of bowel or bladder control a.) Stroke or seizure
What are huffers?
Patients who inhale paints or propellants in order to get high a.) Presence of paint or other materials in the nose Toluene a.) Commonly used for huffing b.) Paints, chemicals, household chemicals c.) Can cause structural damage to the alveolar surface Poisons that are commonly used a.) Paints that contain toluene b.) Paints c.) Freon d.) Gas propellants e.) Glue More immediate effect than injected poisons
What is apnea?
Pause in breathing
What is the uterus?
Pear shaped organ that contains the developing fetus Allows for great expansion during pregnancy and forcible contractions during labor and delivery Capable of rapid contractions after delivery a.) Used to prevent hemorrhage Portions a.) Fundus, top portion b.) Body or corpus, middle portion c.) Cervix narrow tapered neck
Most fractures are not considered critical except...
Pelvis and femur Serious bleeding and potential for shock Bones themselves have a tendency to bleed heavily Close to other vessels that may be lacerated and cause major bleeding Pelvis a.) Two liters of blood can be lost from a fractured pelvic bone b.) Application of the pneumatic antishock garment (PSAG)
What is tracheal tugging?
Pendulum motions of the trachea in the anterior neck during inhalation
How should you communicate with special populations?
People hard of hearing a.) Make sure they can see your lips People who do not speak English a.) Ask if bystanders can interpret Elderly People a.) Be sure to take extra time to communicate b.) Never appear impatient Children a.) Extra patience and effort b.) If parents are calm, they can help c.) Make sure they are not distressed d.) Place yourself close to eye level
Explain driving emergencies...
People sustain injuries as a result of diving into pool or other shallow bodies of water You should always assume that a diver has sustained spine and neck injuries, even if conscious Possible Spinal Injury a.) Always suspect spinal injury b.) Goal is to support the back and stabilize the head and neck c.) Do not remove from the water until a backboard is available
How should you assess an unresponsive medical patient?
Perform a rapid medical assessment on the unresponsive patient to determine the possible nature of the medical illness Should be conducted systematically, beginning at the head and covering all major portions of the body
What is the Markle, heel drop, or heel jar test?
Performed for the patient with suspected peritonitis Rebound tenderness EMT push down on a quadrant of the abdomen and then suddenly release the pressure When the contents resumed normal position, it would make the peritoneal surfaces rub together It would elicit pain Failed to be objective
What is withdrawal?
Period of abstinence from the drug or alcohol to which the body has become accustomed to
What are the parts of the abdominal cavity lining?
Peritoneum Visceral peritoneum Parietal peritoneum Peritoneal cavity Potential space between the visceral and parietal peritonia (peritoneal cavity) Retroperitoneal
What is peritoneal pain?
Peritoneum is highly sensitive to stimulation from blood, irritation, bacteria, and other substances Intense and steady pain early in the illness Maintain a high index of suspicion a.) May not be noticed for a long time because the bleeding or leakage is happening in the peritoneal space
How should you deal with chemical burns to the eye?
Permanent damage can occur within seconds Begin treatment immediately Signs and symptoms a.) Irritated or swollen eyelids b.) Redness of the eye c.) Streaks across the surface of the eye d.) Diminished vision e.) Excruciating pain in the eyes f.) Irritated, burned skin around the eyes Treatment a.) Irrigation with water or saline b.) Hold eyelids open c.) Irrigate for at least 20 minutes d.) Contact lenses must be removed or flushed out e.) Place the patient on his side on the stretcher
What is emphysema?
Permanent disease process that is characterized by obstruction of the alveolar walls and distension of the alveolar sacs More common in men than women Cigarette smoke and environmental toxins Overview of the Disease Process a.) Lung tissue loses elasticity i.) Alveoli becomes distended with trapped air, walls of alveoli are destroyed b.) Reduces the surface area c.) Patient becomes hypoxic and begins to retain carbon dioxide d.) Greatly increased airway resistance in distal airways e.) Exhaling is active not passive process f.) Barrel chest appearance
What is a saddle joint?
Permit combinations of limited movements along perpendicular planes Ankle a.) Can turn inward slightly as it moves up and down
What is a ball and socket joint?
Permits widest range of motion Shoulder and hip
What are the symptoms of drowning?
Persistent cough Dyspnea Altered mental status Vomiting Drug or alcohol use Pertinent past medical history
What do the suffix -ac, -al, -ary, -eal, -ic, -ous mean?
Pertaining to
What does the suffix emic mean?
Pertaining to the blood
What is the function of the skin?
Physical barrier against external environment Barrier against infection Protection from bacteria Insulates and protects underlying structures and body organs Aids in the regulation of body temperature Provides for sensation transmission (hot, cold, pain, touch) Aids in elimination of some of the body's wastes Contains necessary fluids
What is trauma?
Physical injury or wound caused by external force or violence Can be blunt, penetrating, blast, burns
What are the signs and symptoms of superficial burns?
Pink or red, dry skin Slight swelling Pain and tenderness to touch
How should you ventilate infants and children?
Place infant's head in neutral position Avoid excessive ventilations Use a small BVM Insert and OPA or NPA Ventilation rate is 12-20 per minute every 3 to 5 seconds
What is the direct pressure method of controlling external bleeding?
Place sterile gauze over wound and apply fingertip pressure directly to the point of bleeding Large, gaping wounds may require packing with sterile gauze and the application of direct hand pressure if fingertip pressure fails
How should you position an unresponsive medical patient?
Place the patient in the recovery position also known as a coma position or the modified left lateral position Secretions will flow out of the mouth If the patient has to be ventilated, keep him supine
Jaw thrust in infants and children...
Place two or three fingers of each hand at the angle of the jaw to lift up and forward while the other fingers guide the movement
What is a tracheostomy tube? How should the EMT deal with one?
Placed through surgical incision in neck into the trachea to secure airway Natural ability to filter air and rid airway of secretions are absent Need to be suctioned Suction for only 3 to 4 seconds at a time Bleeding, infection around site, air leak around tube, dislodgement of tube a.) Maintain airway b.) Suction c.) Provide supplemental oxygen d.) Maintain position of comfort e.) Transport for evaluation
What is endotracheal intubation?
Placement of a tube in the trachea to facilitate breathing May be performed by an ALS team
What is thrombosis?
Plaque buildups in the inner form of the inner wall or arteries a.) Process called atherosclerosis Hypertension can wear away the inner lining of the artery leaving rough area a.) Common sites for thrombus formation Onset is much slower Most common type of stroke Severe headache is not a symptom
What are some poisonous plants?
Poison ivy, poison sumac, poison oak Other plants can cause mild to severe dermatitis, stinging nettle, crown of thorns, buttercup, Pay apple, marsh marigold, candelabra, brown eyed susan, Shasta daisy, chrysanthemum ABCs mental status, oxygen
What is an overdose?
Poisoning by drug or alcohol
What is methanol (wood alcohol)?
Poisonous form of alcohol found in antifreeze, windshield washer fluids, shellac May ingest to get drunk Onset is between 40 minutes to 72 hours
What are the signs and symptoms of diabetic ketoacidosis (DKA)?
Polyuria Polyphagia Polydipsia Nausea and vomiting Poor skin turgor Tachycardia Rapid deep respirations (Kussmaul's respirations) Blowing off alarge amounts of CO2 Fruity or acetone odor on breath Positive ortostatic tilt test BGL > 35mg/dL Muscle cramps Abdominal pain Warm, dry, flushed skin Altered mental status Coma (very late) a.) Progresses slowly over a period of a few days
What is a brain laceration?
Pooling of blood within the brain
How should you perform an initial assessment on a patient with breathing difficulty?
Position a.) Sit upright and slightly forward b.) Supporting themselves with their arms c.) Tripod position d.) If found supine or reclining e.) The patient is in mild distress f.) The patient is such severe distress that he is too exhausted to hold himself up Face a.) Agitated or confused facial expression Speech a.) May speak one to two words and then pause for a gasp Altered mental status a.) Confusion b.) Eyes begin to droop and head bobs with each respiration Use of muscles in the neck and retractions of the muscles between the ribs (intercostal muscle) a.) Indications of significant increased inhalation effort with each breath Cyanosis b.) Sign of hypoxia Diaphoresis a.) Sweaty and moist skin Pallor • Sign of hypoxia and severe respiratory distress Nasal flaring a.) Flaring of the nostrils with inhalation Pursed lips a.) Puts his lips together during exhalation b.) Done to keep airway pressure in the smaller bronchioles higher during exhalation Mental status a.) Restlessness, agitation, confusion and unresponsiveness Airway a.) Look for obstruction, secretions b.) Snoring, stridor, gurgling or crowing Breathing a.) Carefully assess the breathing b.) Looks for oxygen or positive pressure ventilation c.) Look for high or slow respiratory rates i.) Rates outside of 8-24 for adults 1.) 15-30 for children 2.) 25-50 for infants d.) Adequate breathing i.) Both adequate rate and adequate tidal volume ii.) If both are not, positive pressure ventilation Circulation a.) Skin and mucous membranes b.) Tachycardia, pale, cool, moist skin Priority a.) Consider ALS backup and expeditious transport b.) Altered mental status
What is the two person technique for bag valve mask ventilation?
Position at top of head Use head tilt chin lift Select correct size mask and BVM Insert an OPA or NPA Place the mask over the mouth and nose Seal Begin ventilation as soon as possible
How should handicapped patients be transported and positioned?
Position patient to have the greatest comfort
How should you administer emergency medical care to a seizure patient?
Position the patient a.) Lateral recumbent Maintain patent airway Suction Assist ventilation Prevent injury to the patient Maintain oxygen therapy Transport
How should you administer emergency medicare care to a infant with a severe foreign body obstruction?
Position the patient prone on forearm in head down position Deliver five sharp back slaps Transfer patient to supine head down and deliver five chest thrusts Continue the steps
What emergency medical care should you give to a patient in active labor with a prolapsed cord?
Position the patient with head down in a knee chest position a.) Or place in Trendelenberg Insert a sterile gloved hand into the vagina and gently push the baby away from the cord a.) Don't try to push cord back into vagina Cover the umbilical cord with moistened sterile dressing Transport the patient rapidly while maintaining pressure on the head
How can you stabilize an upright vehicle?
Position the plastic step chocks under the vehicle parallel to the wheel The air should be removed from the tires
How do you suction?
Position yourself at the patient's head Turn on the suction unit Select the appropriate type of tubing Measure the catheter and insert it into the oral cavity without suctioning Apply suction only on the way out a.) Suction for no longer than 15 seconds a time If necessary, rinse the catheter with water to prevent obstruction
How should a patient pregnant in the third trimester be positioned and transported?
Positioned on left side
How should you address bleeding from the nose, ears, or mouth?
Possible causes of bleeding from the nose, ears or mouth a.) Skull injury b.) Facial trauma c.) Digital trauma - Nose picking d.) Sinusitis and other upper respiratory tract infections e.) Hypertension f.) Clotting disorders g.) Esophageal disease Any time you observe bleeding from a patient's ears or notes, suspect skull fracture Do not attempt to stop the bleeding a.) Apply a loose dressing around the area to collect the drainage Method a.) Place the person in a sitting position and have them lean forward b.) Apply direct pressure to the fleshy part of the nose
What is the potential space?
Potential space between the visceral and parietal peritonia (peritoneal cavity)
What are hemostatic agents?
Poured directly into the wound Used with pressure dressing Quick clot
What is a flow restricted oxygen powered ventilation device (FROPVD)?
Powered by oxygen and will deliver 100 percent oxygen Can be used by one EMT Disadvantage a.) Only on adult patients b.) Gastric distention and lung rupture Problems a.) Reevaluate the position if the chest doesn't rise
What is the diaphragm?
Powerful, dome shaped muscle essential to breathing Separates the thoracic cavity from the abdominal cavity During respiration, the diaphragm and the intercostal muscles contract, increasing the size of the thoracic cavity
What is a nonrebreather?
Preferable method Has an oxygen reservoir One way valve in between them that prevents the patient's air from mixing with the oxygen Mask has rubber washers that cover the exhalation ports Typically set at 15 lpm Inflate the bag before applying Have various sizes In children, has a person they trust hold the mask close to them
What are some requirements of effective disaster assistance?
Preparation Careful planning Quick implementation Application of triage skills Effective communication Application of triage skills Ability to organize and utilize fully all emergency personnel Adapt and plan Contingency plan Greatest good for the greatest number
What are some commonly ingested poisonous substances?
Prescription medication Over the counter medication Illicit drugs Household products Cleaning agents Foods Insecticides Petroleum products Plants
How do we assess capillary refill?
Press firmly on the skin or nail bed When you remove your finger, it will be white Count how long it takes to return it to normal color Upper limits a.) 2 seconds for infants, children and male adults b.) 3 seconds for females c.) 4 in elderly
What is systolic blood pressure?
Pressure exerted against the walls of the arteries when the left ventricle contracts Measures the effectiveness of the pumping function of the left ventricle
What is exhalation or expiration?
Process of breathing air out Diaphragm and intercostal muscles relax Move the diaphragm upward and the ribs and sternum downward and inward Size of chest cavity is reduced and the pressure in the chest cavity becomes positive a.) Forces air outside of the lungs b.) Considered to be passive
What is a staging unit in MCIs?
Process of transporting priority patients to appropriate facility Monitors, inventories and directs available ambulances to the treatment
What are some reasons for splinting a bone?
Prevents movement of any bone fragments, bone ends, or dislocated joints, reducing the chance for further injury Reduce pain and minimize a.) Damage to muscles, nerves, blood vessels b.) Conversion of a closed fracture to an open fracture c.) Restriction of blood flow d.) Excessive bleeding e.) Increased pain f.) Paralysis of extremities from damaged spine
What is paresthesia?
Prickling or tingling feeling
What is the appropriate emergency medical care for biological agents?
Primarily supportive Contact necessary resources Isolate infectious patients Secure airway, breathing a.) PPV or NRB Use of antibiotics and antitoxins
What are the three phases of blast injuries?
Primary a.) Pressure wave of the blast b.) Affect the gas containing organs, stomach, lungs, intestines, inner ears, sinuses c.) Are often overlooked or unsuspected and go untreated Secondary a.) Flying debris b.) Injuries are obvious c.) Lacerations, fractures, impaled objects, burns Tertiary a.) When the patient is thrown from the source of the blast
What are the primary, secondary, and tertiary effects of explosives?
Primary - Blast of explosion Secondary - Flying debris, shrapnel, other projectiles Tertiary effects - Patient propelled by blast or shock wave
What is the medical use for documenting?
Primary use is high quality patient care Helps ensure the continuity of care for the patient Gives the emergency department personnel the information they need to give care
What is the spinal column?
Principal support system of the body Ribs originate from it and form the thoracic chest cavity Made up of vertebrae
What are the lungs?
Principle organs of respirations
What is the spinal column?
Principle support system of the body The rest of the skeleton is directly or indirectly connected to the spine Made up of 33 irregularly shaped bones called vertebrae a.) Bound firmly together by strong ligaments Between each two vertebrae is a fluid-filled pad of tough elastic cartilage called a disc that acts as a shock absorber
What is the alcoholic syndrome?
Problem drinking and used frequently to relieve tension or other problems Abstinence is likely to produce withdrawal, DTs Wernicke-korsakoff syndrome a.) Paralysis of eyes, dementia, hypothermia
What is labor?
Process of birth Can be divided into three phases a.) Dilation b.) Expulsion c.) Placental
What is inhalation or inspiration?
Process of breathing air in The diaphragm and the intercostal muscles or muscles between the ribs, contract Diaphragm moves slightly downward and flares the lower portion of the rib cage outward a.) Pulls the ribs and sternum outwards and upward b.) Increase the size of the chest cavity creating negative pressure inside the chest cavity c.) Draws air in until the pressure inside the lungs is equal to the pressure outside of the body Active process because it requires energy to contract the muscles
How is heat produced in the body?
Processes of metabolism, food digestion Shivering, 400% increase a.) Will cease when the body drops below 90F
How to injuries to the face?
Prone to injuries Can be permanently and irreversibly damaged 75% in MVC sustain minor facial trauma Assessment and Care Guidelines a.) Consider the MOI b.) Suspect C-spine injury c.) Manage A, B, C and assess mental status d.) In patient with a significant MOI, conduct a rapid trauma assessment e.) Care i.) Maintain c-spine ii.) Inspect the mouth for teeth iii.) Open the airway with jaw thrust iv.) Suction any blood, vomitus or secretions v.) Request ALS if needed vi.) Apply oxygen vii.) Control severe bleeding viii.) If nerves, tendons or blood vessels have been exposed, cover them with moist, sterile dressing ix.) If a tooth has been lost, try to find it 1.) Rinse with saline 2.) Transport in a cup or wrapped in gauze 3.) Never handle the tooth by the root 4.) If you cannot find teeth, assume that the patient has swallowed or aspirated them 5.) Control bleeding
What should you do after delivering an infant?
Protect against heat loss Dry, and cover Wrap and suction
Providing emergency care to a patient using PCP or cocaine...
Protect yourself and crew Keep the patient in quiet, nonstimulating environment Administer emergency medical care Monitor vital signs and transport
What are some guidelines for radiation emergencies?
Protect yourself and others No EMT should ever attempt to decontaminate a radiation patient a.) Wait for Radiation Safety Office (RSO) b.) Transport patient i.) Body back up to neck ii.) Cover hair with cap or towel c.) Times is a critical factor
What is body substance isolation (BSI)?
Protecting yourself from disease transmission through exposure to blood and other body fluids Also called standard precautons The equipment is called personal protective equipment (PPE)
What are good samaritan laws?
Protects a person who is not being paid for his services from liability for acts performed in good faith unless these acts are in gross negligence Does not prevent you from being sued, although it may provide you some protection against losing the lawsuit if you have performed according to the standard of care for the EMT
What is the Americans with Disabilities Act (ADA)?
Protects individuals who have documented disability from being denied initial or continued employment based on their disability The employer must make necessary reasonable adjustments
What are the functions of skin?
Protects the body from the environment, bacteria and other organisms and helps to regulate the body's temperature Serves as a receptor organ that senses heat, cold, touch, pressure and pain and aids in the elimination of water and various salt
What is the purpose of backboards? What are common types?
Protects the patient from rocky ground surfaces and acts as a spinal immobilizer Straps and a head immobilizer can be used Made of lightweight plastic or composite Common styles a.) Farrington (rectangular with round corners) b.) Ohio (mitered corners and tapering sides) Short backboards a.) Immobilize noncritical sitting patients before moving them b.) Vest type or corset (Ferno Kendrick Extrication Device) KED Full body vacuum mattress a.) Can be used as a backboard or a moving device
What is the epiglottis?
Protects the trachea Usually this flap automatically covers that entrance of the larynx during swallowing If blood, vomit, or another substance gets aspirated into the lungs and cause impaired exchange of oxygen and carbon dioxide
What are the three major food sources for the body's cells?
Protein Fats Carbohydrates a.) Primary energy souce b.) Sucrose (table sugar), lactose (milk and dairy products) and starches c.) Complex sugars broken into simple sugars i.) Glucose, galactose, fructose
What is a hernia?
Protrusion or thrusting forward of a portion of the intestine through an opening or weakness in the abdominal wall Associated with increased pressure in the abdominal cavity during heavy lifting or straining, causing the peritoneum to be pushed into the weakness Not life-threatening and can be easily related May become incarcerated or strangulated, causing the portion of the intestine to be pinched or cut off, producing obstruction
What is traction?
Provide a counterpull, alleviating pain, reducing blood loss and minimizing further injury Not intended to correct fracture
What is an emergency medical technician (EMT)?
Provides basic medical care and transportation Responsibilities of the EMR and advanced oxygen therapy and ventilation, pulse oximetry, automatic blood pressure monitoring, limited medication administration
What is an advanced emergency medical technician (AEMT)?
Provides both basic and limited advanced EM Care and transportation Provides all skills of EMT with the addition of advanced airway devices, monitoring glucose levels, initiation of IV and intraosseous (in the bone) infusions, and medications
What is the educational and research use of documenting?
Provides data for researchers studying issues Positive and negative effects of certain interventions at certain parts
What is a sling and swathe?
Provides stability to a painful and tender shoulder, elbow or upper humerus Sling - Supports patients arm Swathe - Holds arm against the side of chest
How should you provide emergency care and make a transport decision in an unresponsive medical patient?
Providing Emergency Care a.) Must receive oxygen via nonrebreather at 15 liters or positive pressure ventilation Make A Transport Decision a.) Altered mental status b.) Monitor the ABCs
What is neglect (in children)?
Provision of inadequate attention or respect to someone who has a claim to that attention
Where can the radial artery pulse be felt?
Proximal to the thumb on the palmar surface of the wrist Radial pulse should be assessed in all patient 1 year and older, if not, use a carotid pulse
What is a complex partial seizure?
Psychomotor or temporal lobe seizure Usually lasts 1-2 minutes Usually starts with a blank stare followed by chewing, lip smacking or rolling the fingers Patient is unaware of surroundings and will not respond to commands Post seizure confusion may last much longer Emergency medical care a.) Speak calmly and reassuringly b.) Guide the patient away from objects c.) Stay with the person until he is aware of his surroundings
What are retractions?
Pulling inward of the intercostal muscles of the chest wall as well as excessive use of the neck muscles
All veins except ___ veins carry oxygen depleted blood.
Pulmonary
The right ventricle pumps oxygen depleted blood to the ___ ___.
Pulmonary arteries
The left atrium receives oxygen rich blood from the ___ ___.
Pulmonary veins
What are the main points to check when assessing circulation?
Pulse Possible major bleeding Skin color, temperature, and condition Capillary refill
What special things should you look out for during the rapid trauma assessment of patients with spinal injuries?
Pulse a.) Check for presence and strength of radial pulses for upper extremities and pedal pulses for the lower extremities Motor Function Assessment: Upper Extremities a.) Flex arms (bend at elbow) across chest, C6 b.) Extend arm (straighten to side of body), C7 c.) Spread your fingers out on both hands and don't let me squeeze them together, TI d.) Hold out both arms and don't let me push your hands down, C7 Motor Function Assessment: Lower Extremities a.) Push down against my hands with your get, S1 and S2 a.) Pull up against my hands with your feet, L5 Test for Pain Perception a.) Have the patient close his eyes b.) Sharp end of the wooden Q-tip, poke one of the hands c.) Ask where does it hurt d.) Do the same on the feet Test for Light Touch Perception a.) Have the patient close his eyes, lightly touch the patient's fingers on one hand then test for light touch to fingers i.) Can you feel me touching your finger? ii.) Which finger/hand? iii.) Repeat for toes b.) Posterior exam i.) Palpate the spine ii.) DTCLPS iii.) Muscle spasms are a protective reflex and a common indicator of spinal injury
What are two additional assessments that are not technically vital signs, but are very important?
Pulse Oximeter a.) Sometimes used as a 6th vital sign b.) 95-99% is normal Blood Glucose Test a.) Patient with altered mental status may be suffering from low blood glucose (hypoglycemia) b.) Electronic glucometer
What are the two ways of determining the adequacy of circulation?
Pulse and blood pressure
When is a pulse ox concerning?
Pulse oximeter greater than 95% is considered adequate A patient who has been on a nonrebreather but is still around 95% is a concern
What is a pulse?
Pulse reflects the rhythm, rate and relative strength of the contraction of the heart as well as the volume Can be felt at any point where an artery crosses over a bone or near the surface of the skin
What are ventricles?
Pump blood to the arteries R ventricle pumps oxygen depleted blood to the pulmonary arteries Left ventricle pumps oxygen rich blood to the aorta and the rest of the body
What do constricted pupils indicate?
Pupils that are constricted (too big) may indicate a central nervous system disorder, the use of narcotics or a brightly lit environment
What is the purpose of the SOAP assessment? What does it stand for?
Purpose a.) Can be used to organized the information that need to be documented on the PCR Subjective - The info that the patient must tell you Objective - Information that you identify in the physical examination through inspection, palpation and auscultation Assessment - Refers to the field assessment Plan - Plan of action and the emergency care provided SOAPIE - Intervention and evaluation
What is libel?
Putting false or damaging statement in written form or via mass media
EMT symbols and acronyms...
R with circle - Right L With circle - Left RUQ - Right upper quadrant LUQ - Left upper quadrant RLQ - Right lower quadrant LLQ - Left lower quadrant C with line - With S with line - Without A with line - Before P with line - After PT - Patient c/c - Chief complaint c/o - complains of Bilateral - Both sides
What are peripheral pulses?
Radial, brachial, popliteal, posterior tibial, dorsalis pedis
What is a peripheral pulse?
Radial, brachial, posterior tibial, dorsalis pedis
What is radiation exposure?
Radioactive dust and particles Most immediate danger occurs within 48 hours of detonation Most sensitive cells are bone marrow, blood, bowel, skin, nervous and cardiovascular tissue Damage the DNA
Tips for driving in bad weather...
Rainy or Wet Weather a.) 6 rimes more traffic fatalities b.) Roads are most slippery as a rain storm begins c.) Hydroplaning i.) If you do, old the wheel steady and take foot off of accelerator, gently pump brakes d.) Avoid sudden braking Winter Driving a.) Decreased vulnerability and increased skidding b.) Make sure engine is tuned c.) Carry emergency weather equipment d.) Stay aware of the temperature Fog, Mist, Dust Storms, Smog a.) Slow down but avoid decelerating suddenly b.) Watch road ahead and behind c.) Turn on lights d.) Use the defroster
What are hives?
Raised, red blotches usually accompanied by severe itching
What are crackles?
Rales, fine crackling sound Indication of fluid in and around the alveoli
What are pressure regulators?
Range from 30 to 70 psi Controls from 1 to 15 lpm Connect by a series of pins (yoke) a.) In green or aluminum grey Two types of regulators a.) High pressure (50 psi) b.) Therapy regulator (0.5 to 25lpm) i.) Has two gauges
What is a rapid trauma assessment?
Rapid head to toe exam Followed by prompt transport or on scene emergency
What is Narcan?
Reverse the effects of a narcotic overdose Blocks the effects of the narcotic cell receptor sites May relapse
What are the signs and symptoms of a diabetic emergency with altered mental status?
Rapid onset of altered mental status after missing or vomiting a meal, unusual exercise, physical work Intoxicated appearance Tachycardia Cool, moist, skin Hunger Seizure activity Bizarre behavior, combativeness Anxious or restlessness Bruising at injection sites Stroke like signs Blood glucose reading < 60mg
How should you perform a rapid trauma assessment for patients with spinal injuries?
Rapid trauma assessment Cut clothing away Pay attention to the following a.) Injuries associated with spine injury i.) Trauma to head, posterior cervical region, anterior neck, chest, abdomen, back and pelvis b.) Cervical spine immobilization collar i.) Apply the cervical spine immobilization color (CSIC) i.) Does not provide complete immobilization c.) Assessing Pulses, Motor and Sensor Functions i.) Do PMS for each extremity
What are the key components of pulse?
Rate Presence Regularity Strength
What is 'adequate' breathing?
Rate a.) Adult, 10-24 b.) Children, 15-30 c.) Infant, 25-50 d.) Elderly, 20 e.) Assess the whole patient when determining rate Rhythm a.) Regular, each breath the same volume Quality a.) Breath sounds are equal and full bilaterally b.) No accessory muscle use Depth a.) Tidal volume
What are some signs of inadequate breathing?
Rate a.) Too fast (tachypnea) or too slow (bradypnea) b.) Assess mental status Rhythm a.) Irregular, brain injury or medical illness Quality a.) Use of accessory muscles b.) Abdomen may move excessively c.) Infants may display a seesaw breathing patter in which the abdomen and chest move in opposite directions d.) Nostrils may flare Depth a.) Slowing and inadequate i.) Shallow breathing
What is tachypnea?
Rate that is too hast When the rate is excessive, the lungs do not have enough time to gill adequately Consider the mental status and other signs Conditions a.) Hypoxia, fever, pain, drug overdose, stimulant drug use, shock, head injury, chest injury, stroke, other medical conditions
What is a normal glucose rate?
Rate, person who has fasted for 8-12 hours would read 80-90mg/dL After a meal 120-140mg/dL a.) Pancreas releases insulin b.) 2/3 taken up by the liver which converts it to glycogen to be stored by the liver and muscle for later use c.) Glycogen stored in the liver can last up to 24 to 48 hours
What are signs of inadequate breathing?
Rates that are too slow or too fast Irregular pattern Diminished or absent breath sounds Unequal chest expansion Inadequate chest expansion Pale or bluish mucous membranes Use of accessory muscles Nasal flaring Seesaw breathing, chest and abdomen move in different directions Head bobbing Agonal respirations a.) Occasional gasping breaths Grunting
Why would you perform a rapid extrication?
Reasons a.) The scene is not save b.) The patient's condition is so unstable that you must transport immediately c.) The patient blocks your access to a second, more seriously injured patient Requires constant stabilization
How should you repeat the initial assessment?
Reassess Mental Status a.) Changes in speech patterns b.) Repeat Glasgow Coma Scale c.) Reassess AVPU Reassess the Airway a.) If the patient is talking and in no distress, the airway is patent b.) Look for blood, secretions and vomit in the mouth c.) Reassess NPA and OPA positioning d.) Remove the OPA or NPA if gag reflex returns Reassess Breathing a.) Look listen and feel Reassess Circulation a.) Reassess Pulse b.) Reassess Bleeding i.) Blood seeping through dressing c.) Reassess Skin i.) Cap refill
What is delirium?
Recent and sudden onset of dementia Disjointed thought processes, incoherent speech, declines in mental status, increased or decreased psychomotor activity
What is a decoder?
Recognizes and responds to only those codes
What do red, yellow, green, or black tags mean in multiple casualty incidents?
Red a.) Immediate care and transport b.) Priority 1 Yellow a.) Delayed emergency care and transport b.) Priority 2 Green a.) Minor injuries and ambulatory patients b.) Priority 3 Black a.) Deceased or fatal injuries b.) Priority 4
What are the main components of the blood?
Red blood cells, white blood cells, platelets, plasma
What are the effects of fire ant bites?
Red to black in color Fiery stinging at bite site Produce painful vesicles that are filled with fluid, first clear, than cloudy
What is malnutrition?
Reduction in sense of taste or smell Deterioration in structures in the mouth Decrease of saliva Contractions of the esophagus decrease a.) Chronic heartburn Liver decreases in size, weight and substance Peristalsis is slowed Nutrients are not readily absorbed
What does the prefix broncho mean?
Referring to the bronchi of the lower airways
What is the thyroid gland?
Regulates metabolism, growth and development, and the activity of the nervous system
What is epinephrine?
Released when the adrenal glands when the BGL is decreasing to a dangerously low level Will stop the secretion of insulin and promote the release of stored glucose from the liver
What is defamation?
Releasing information to the public in written or spoken form that can damage their reputation
What type of emergency medical care should you provide to a drowning victim?
Remove patient from water a.) Apply c collar b.) Float the board to shore Place the patient on left side if no spinal injury Suction as needed Establish airway and begin PPV with oxygen a.) Begin CPR If indicated Gastric distention a.) Stomach fills with water b.) Place patient on side c.) Cause regurgitation with pressure d.) Suction Manage other trauma Transport as quickly as possible Detailed Physical Exam and Ongoing Assessment a.) Perform detailed physical exam b.) Be alert to deterioration
How should you terminate oxygen therapy?
Remove the mask or cannula Turn off the oxygen Open the regulator valve
How should you provide emergency medical care to a patient with cyanide poisoning?
Remove the patient Removed contaminated clothing Open and assess airway Assess breathing status Consider ALS Rapidly transport
How should you administer emergency medical care for those with local cold injury/frostbite?
Remove the patient from environment Never initiate thawing procedures if there is dancer of refreezing Administer oxygen Prevent further injury a.) Remove jewelry b.) Immobilize the affect extremity c.) Cover the affected skin with dressings or dry clothing d.) Never rub or massage e.) Never re-expose injured skin to cold f.) Do not break blisters g.) Never apply heat to skin To rewarm tissue a.) Immerse the affected tissue in warm water bath b.) Monitor water to make sure it stays even c.) Continuously stir the water d.) Keep the tissue in water until soft and color returns e.) Dress the area with dry sterile dressing f.) Elevate the affected extremity g.) Protect against refreezing h.) Transport as soon as possible
How should you provide emergency medical care to patients with hydrocarbon poisoning?
Remove the patient from environment Remove all contaminated clothing and decontaminate the patient Open and maintain the airway Assess the breathing status Rapidly transport the patient
How should you administer emergency medical care to a patient with heat cramps?
Remove the patient from heat Consult medical direction before giving patient sips of low concentration salt water Apply moist towels to the forehead Explain the patient what happened Do not have to necessarily transport unless has other illnesses
How should you administer emergency medical care to a patient with hot skin, moist or dry?
Remove the patient from heat Remove as much of clothing as possible Administer oxygen Immediately cool the patient a.) Pour water over the patient, cold packs b.) Fan the patient, keep the skin wet Be prepared to manage seizures, suctioning Transport
How do you deliver emergency medical care to patients with hyperventilation syndrome?
Remove the patient from source of anxiety Close mouth and breathe through nose Do not have the patient breathe into a paper bag or oxygen mask not connected to oxygen to allow them to rebreathe CO2 a.) Can be fatal if an underlying problem is causing the hyperventilation Give oxygen and monitor pulse ox
What type of emergency medical care should you provide to burn patients?
Remove the patient from the source of the burn and stop the burning process a.) Saline or sterile water Establish and maintain an airway and breathing Classify the severity of the burn and transport immediately if critical a.) BSA, source or agent, location of burn, age of patient, preexisting medical conditions Cover the burned area with a dry sterile dressing a.) Or a burn sheet b.) 10% or less BSA can get a moist dressing Keep the patient warm and treat other injuries as needed Transport the patient to the appropriate facility Detailed Physical Exam and Ongoing Assessment a.) Perform a detailed physical exam en route b.) Perform ongoing assessment c.) Monitor vital signs d.) Continually evaluate the airway, especially if there are any burns to the face
How should you administer emergency medical care for patients with a bite or sting?
Remove the stinger Wash the area around the bite or sting Remove an jewelry or constructing objects before swelling Lower the injection site below the heart Apply a cold pack Constricting band in treatment of snake bite Observe the patient for allergic reaction Transport
How should you perform and ongoing assessment on a patient with a pre-delivery emergency?
Repeat vital signs, check any interventions If pregnant patient dies as result of accident CPR immediately and be maintained until delivery Prevent the mother's condition from deteriorating in field
What is an EMS branch director?
Report to a section chief who reports to incident commander Responsible for managing all triage, treatment and transportation of patients within operation Would assign a unit leader to the triage unit, treatment unit, transport unit, staging unit, and morgue unit Responsibilities a.) Triage unit - Sorts patients by criticality and assigns priority for care and transport b.) Treatment unit - Care is provided c.) Transport unit - Patients are moved to ambulances or helicopters d.) Staging unit - Held in area unit they are needed e.) Morgue unit - Deceased casualties are moved to this unit where they are held and processed
What should you do if mouth to mask results in ineffective ventilation?
Reposition the head and neck Change from the head tilt chin life to the jaw thrust Readjust the mask Administer a greater tidal volume Insert an OPA or NPA
How to care for chemical burns?
Require immediate care Protect yourself first a.) Wear gloves and eye protection Dry chemicals should be brushed off before flushing with water Most chemical burns can be flushed with copious amounts of water
What is a gastronomy tube? How should the EMT deal with one?
Require long term feeding Feeding button a.) Small silicon device that protrudes from the abdominal wall accepts a feeding tube through one way valve b.) Maintain airway and breathing status c.) Be prepared to suction d.) Be alert for changes in mental status e.) Provide oxygen as necessary f.) Transport in Fowlers or on right side with head elevated
How should you deliver emergency medical care to patients with spontaneous pneumothorax?
Requires supplemental oxygen a.) Adequate, NRB b.) Inadequate, PPV i.) Use most minimal tidal volume possible If cyanosis, hypotension and resistance, suspect tension pneumothorax
What does complex access mean?
Requires the use of tools and specialized equipment
What are signs and symptoms of isopropanol poisoning?
Respiratory distress Altered mental status Slow respirations Abdominal pain Bloody vomitus Signs of shock
How is respiration control?
Respiratory organs do not have the ability to control their functions from within the respiratory system Respirations are controlled by the nervous system in a variety of ways a.) Uses sensors located on the carotid arteries, aorta and within the medulla of the brain stem b.) Sensors measure chemical changes in the body, they are termed chemoreceptors i.) Continuously monitor levels of oxygen, carbon dioxide, and hydrogen in the arterial blood Primarily responds to changes in the carbon dioxide levels a.) People breathe on a hypercarbic (high carbon dioxide) drive Oxygen is muss less of a stimulus
What is bradypnea?
Respiratory rate that is too slow Will lead to hypoxia Consider the mental status and other signs Conditions a.) Hypoxia, drug overdose, head injury, stroke, hypothermia, toxic inhalation
What is the skull?
Resting at the top of the spinal column Two parts a.) Cranium (brain case)
What is the skull?
Rests on top of the spinal column and houses the brain
What is hypovolemic shock?
Result of a decrease in the volume of blood available for perfusion Caused by internal or external bleeding May result from profound fluid loss from burns, dehydration, diarrhea, vomiting or excessive urination Hemorrhagic shock, blood loss
What is a flash burn?
Result of a flammable gas or liquid that ignites quickly Areas of the body covered by clothes are usually not burned Inhalation injury may occur
What is a penetration/puncture wound?
Result of a sharp object being pushed or driven into the soft tissues Entry wound may appear small and cause little bleeding Some may cause deep, damaging and cause severe internal bleeding Severity depends on location, size of penetration object, depth, forces involved, and structures in the path of the injury
What are closed chest injuries?
Result of blunt trauma Can cause extensive damage to the ribs and internal organs
What is anaphylactic shock?
Result of the body's abnormal reaction to a foreign protein Body reacts by releasing chemicals that cause the blood vessels to dilate and leak and the bronchioles to constrict
What is immersion hypothermia?
Result of the lowering of body temperature from immersion in cold water Body temp can drop to water temp in 10 minutes
What is septic shock?
Result of toxins produced by a severe infection Cause a reaction that dilates the blood vessels and allows the blood to pool in the extremities and fluid to leak from the vessels into the surrounding tissue
What is an open chest injury?
Results from a penetrating wound
What causes jerky eye movements (nystagmus)?
Results from drugs or CNS effects
What is a tension pneumothorax?
Results from pneumothorax that continues to trap air in the cavity with no relief Completely compresses the injured lung and begins to press the mediastinum over to the injured side Death can occur rapidly Signs and symptoms a.) Rapid deterioration b.) Severe respiratory distress c.) Signs of shock d.) Absent breath sounds e.) Cyanosis f.) Unequal movement of the chest g.) Tracheal deviation h.) JVD i.) Diminished breath sounds
What is a diffuse axonal injury (DAI)?
Results from shearing, tearing and stretching of nerve fibers Interferes with the communication and transmission of nerve impulses Mild, moderate or severe Concussion is mild diffuse injury
What is a hemorrhagic strokes?
Results from the rupture of an artery People with hypertension are likely candidates a.) Common cause of subarachnoid hemorrhages Signs and symptoms a.) Sudden and often occurs during physical activity b.) Headache is common and severe c.) Rapidly deteriorating mental status d.) Seizures and stiff neck are common
What organs are located behind the peritoneal space?
Retroperitoneal space Kidneys, ureters, and abdominal aorta
Considerations for children when assessing chest trauma...
Ribs are more pliable Less likely to have rib fractures, more likely to have internal fractures
What are some anatomical differences in the chests and lungs of children?
Ribs are much more pliable Child's ribs are more horizontal than they are rounded Lung tissue is more fragile Chest will move minimally with respiration a.) Normal for abdomen to move with inhalation Chest muscles are underdeveloped, accessory muscle use
What are the bronchi?
Right and left, two major branches of the trachea Continue to divide into bronchioles a.) Lined with smooth muscle and mucous membranes b.) Can become inflamed and swollen
What are the six rights of medication administration?
Right patient a.) Make sure the medications belong to the patient Right medication a.) Check label Right Route a.) Oral, sublingual, inhalation or intramuscular injection Right Dose a.) Must know appropriate dose b.) Adult vs. children c.) No way to retract drugs Right Date a.) Check expiration date Right documentation a.) Document drug, dose, route and time
What are the four abdominal quadrants?
Right upper quadrant Left upper quadrant Left lower quadrant Right lower quadrant
MOI considerations for recreational vehicle crashes...
Roll-overs Crush injuries are common Be alert for close line injuries a.) Pulled off by low branch, rope, wire or other low-hanging object
What is medication administration?
Route and form in which drug is given Nitro - sublingually
What is isopropanol?
Rubbing alcohol As a substitute for ethanol
What is a hemorrhagic stroke?
Rupture of a vessel in the brain that allows blood to leak and collect or around the brain tissue Can not receive the drug because it may increase the amount of bleeding
How should you perform a focused history and physical exam on a patient who has inhaled poisons?
SAMPLE Look for signs of trauma Vitals Signs and symptoms a.) History of inhalation b.) Dyspnea c.) Chest pain or tightness d.) Cough, stridor, wheezing, crackles e.) Hoarseness f.) Copious secretions g.) Oral or pharyngeal burns h.) Dizziness, headache, confusion, seizures i.) Altered mental status, cyanosis j.) Respiratory failure k.) Nausea or vomiting l.) Paint on lips m.) Singed nasal hairs n.) Soot in sputum o.) Soot in throat
How should you provide a focused history and physical exam to a patient with a predelivery emergency?
SAMPLE, OPQRST Have you ever been pregnant before? a.) If so, how many? b.) How many were live births? c.) Were they vaginal or by C-section? d.) Any complications? Gravida and para a.) Gravida i.) Number of pregnancies ii.) Primagravida (first pregnancy) b.) Para i.) Woman who has given birth ii.) Number of delivery events, not the number of children Are you experiencing pain or discomfort? a.) Quality? b.) Acute or gradual onset? c.) Does it radiate? d.) Can you point to it with your finger? e.) Is it constant or intermittent? f.) What is the duration of cramps? How often? g.) Are you nauseated? h.) Is the pain associated with menstrual cycle? When was your last menstrual cycle? a.) Date, volume and color? b.) Any spotting? c.) Have you been regular? Have you missed a menstrual period? a.) Is there chance of pregnancy? b.) Is there breast tenderness, increase in urination, vomiting, fatigue? Have you had unusual vaginal discharge? a.) What color? b.) Did it have an abnormal or foul odor? c.) How much? When is due date? a.) Have you had prenatal care? b.) How many pregnancies? c.) How many children? d.) Any complications?
What are body mechanics?
Safest and most effective methods of using your body to gain a mechanical advantage
How should you provide emergency care to a patient with a ruptured uterus?
Same as other, oxygen, shock, transport
How should you provide emergency care to patients with ectopic pregnancy?
Same as others Treat for shock, oxygen, vitals, transport
What kind of emergency medical care should you provide to patients with abruptio placentae?
Same as placenta previa Treat for shock and transport
How should you provide emergency medical care to patients with placenta previa?
Same guidelines Hypoxia and transport
What does ipsilateral mean?
Same side
What is a closed head injury?
Scalp may be lacerated, but the skull remains intact Can be extensive Depends on MOI
How should you administer emergency medical care to a patient in active labor?
Scene Safe, BSI Position the patient a.) Have patient lie on firm surface, knees up and spread b.) Elevate buttocks c.) Patients feet flat on surface d.) Support mother's head Create sterile field around vaginal opening a.) Remove patient's clothing b.) Place on sheet under hips c.) Other sheet over abdomen and legs Monitor patient from vomiting a.) If vomits, turn head or suction Continue assessing for crowning a.) Vaginal wall and perineum will bulge with each contraction Place gloved finger on the body part of the infants skull when it crowns a.) Do not exert pressure on face or fontanelle b.) Exert gentle pressure horizontally across the perineum to reduce risk of traumatic tears Tear the amniotic sac if not already ruptured Determine position of umbilical cord a.) If wrapped around neck (nuchal cord), untangle it or cut the cord between two clamps Suction fluid from infants airway a.) As soon as head is delivered b.) First mouth, then nose c.) Not any dark greenish substance (meconium) in amniotic fluid or on baby or airway As the torso and full body are expelled, support the baby with both hands a.) Will be slippery with vernix caseosa (cheeselike substance) b.) Do not put pressure in baby's armpit Grasp the feet as they are born Clean the mouth and nose a.) Wipe with gauze, suction again Dry, wrap, warm and position the infant a.) Keep the baby at or above the level of vagina until the cord is cut Assign partner to monitor and complete emergency care of newborn a.) You'll be in charge of mother Clamp ties, and cut umbilical cord as pulsations stop a.) Clamps 3 inches apart b.) 6-9 inches from abdomen Observe for delivery of placenta a.) Usually within 0 minutes b.) Grasp it gently, never pull Transport the delivered placenta Place one or two sanitary napkins over vaginal opening a.) Direct pressure if perineum is torn b.) Lower the patient's feet and help her hold them together c.) Elevate feet if necessary Record time of delivery and transport mother, infant and placenta Up to 500 ccs of blood loss is normal, if not, provide oxygen a.) Massage helps to stimulate contractions b.) Place medial edge of hand horizontally across the abdomen c.) Cup hand around uterus d.) Allow infant to suck on breast i.) Hormone will cause contractions e.) If bleeding continues, check technique, continue and transport immediately
How should you perform a scene size up, initial assessment, and focused history/physical exam on a patient who has absorbed poisons?
Scene Size UP a.) Make not of open containers b.) Wear gloves and mask Initial Assessment a.) Assess ABCs and mental status Focused History and Physical Exam a.) SAMPLE history b.) Obtain baseline vitals c.) Signs and symptoms i.) History of exposure to substance ii.) Traces of liquid or powder on skin iii.) Burns iv.) Itchiness and irritation v.) Redness, swelling vi.) Possible pain vii.) Rash
How should you perform a scene size up and initial assessment on an elderly patient?
Scene Size Up a.) Any scene hazards? b.) Heat or cold extremes c.) Numerous patients might be present d.) Is it trauma or medical? Initial Assessment a.) Mental status i.) Baseline of consciousness b.) Airway and breathing i.) Diminished gag reflex ii.) Pay close attention to breathing patterns iii.) Be prepared to give PPV c.) Circulation i.) Assess central and peripheral pulses 1.) Strength, rhythm, quality ii.) Absence of radial pulse is not necessarily bad d.) Skin Condition and Temperature i.) Does not express same signs of dehydration 1.) Look at mucous membranes 2.) They will be dry ii.) Skin temperature 1.) Depressed response to infection
How should you perform a scene size up and initial assessment on a patient who has inhaled poisons?
Scene Size Up a.) Be sure you are wearing breathing apparatus b.) Do not enter unless it is absolutely safe Initial Assessment a.) Airway and ventilation status b.) Mental status c.) Oxygen d.) Circulation
How should you perform a scene size up, initial assessment, and focused history/physical exam on a patient who has injected poisons?
Scene Size Up a.) Consider possibility of bite or sting Initial Assessment a.) Assess ABC b.) Give oxygen Focused history and physical exam a.) SAMPLE b.) Signs and symptoms c.) Weakness, dizziness, chills d.) Fever, vomiting nausea, euphoria e.) High or low BP f.) Pulpillary changes g.) Trouble breathing abnormal skin values h.) Possible paralysis i.) Swelling and redness at site of injection
Explain the scene size up and initial assessment process in a drowning...
Scene Size Up a.) Consider wearing a PFD b.) Not MOI c.) Decide if you need any additional assistance d.) Determine number of patients Initial Assessment a.) Responsive or unresponsive? b.) Assess the airway i.) Suction, turn over c.) Breathing i.) Present and equal ii.) Assess for open wounds in the chest iii.) Supply oxygen d.) Circulation i.) Pulse present, bleeding? ii.) Assess for shock e.) What is the priority?
How should you perform a scene size up and initial assessment on a patient with a chest injury?
Scene Size Up a.) Do not enter the scene of a shooting or stabbing until the police secure it and tell you it is safe to enter b.) Concentrate on mechanism of injury c.) Was the patient in a sports accident? d.) Did the patient fall? e.) Was there a fight? f.) Is there any evidence that a shooting took place? g.) Was the patient involved in an auto collision? h.) Was the patient crushed between two objects? i.) Was an explosion involved? Initial Assessment a.) Form a general impression of the patient b.) Make sure to cut back clothing c.) Determine the mental status d.) Note speech pattern e.) Assess breathing status f.) Patient is high priority
How should you perform a scene size up and initial assessment on a patient with allergic reactions and anaphylaxis?
Scene Size Up a.) Ensure personal safety b.) Look for medications or foods found at scene Initial Assessment a.) General impression i.) Not feeling well ii.) Malaise 1.) General feeling of weakness or discomfort iii.) Mental status b.) Airway i.) Assess for obstruction 1.) Stridor or crowing ii.) Positive pressure ventilation 2.) May have to deactivate or remove pop off valve iii.) Wheezing, swollen tongue c.) Endotracheal intubation i.) Placement of a tube in the trachea to facilitate breathing ii.) May be performed by an ALS team d.) Pulse i.) May be weak and rapid ii.) Radial pulse may not be present because of low BP iii.) Edema or swelling iv.) Skin, red and warm or cyanotic v.) Hives 1.) Raised, red blotches usually accompanied by severe itching
How should you perform a scene size up and initial assessment on a patient with acute abdominal pain?
Scene Size Up a.) Look for threats b.) Take BSI c.) Look for MOI d.) Smell for distinct smalls from gastrointestinal causes Initial Assessment a.) Will assume a guarded position i.) Knees up, hands clenched over his abdomen b.) Assure airway i.) Vomiting and aspiration c.) Assess circulation i.) Pulse, skin color, major bleeding d.) Look for signs of shock e.) Patient should be treated as priority transport if i.) Poor general appearance ii.) Unresponsive iii.) Responsive, not following commands iv.) Shock v.) Severe pain
How should you perform a scene size up and initial assessment on a patient with heat-related injuries?
Scene Size Up a.) Look to clues for strenuous activity b.) Patients found in cars c.) Look for medications or drugs d.) Drink enough water and stay hydrated Initial Assessment a.) Mental status b.) Assess airway and breathing c.) Begin PPV and oxygen if indicated d.) Pulse may be weak and rapid, even absent e.) Skin may be moist and pale
How should you size up the scene and perform an initial assessment during drug and alcohol emergencies?
Scene Size Up a.) Make sure the scene is safe b.) Note the presence of potential weapons or needles c.) Take BSI d.) May mimic stroke, hypoglycemia, etc Initial Assessment a.) Mental status i.) From excitability to unresponsiveness b.) Alcohol, narcotics and other CNS depressants could easily cause inadequate breathing c.) Check for peripheral pulses d.) Odor of alcohol on breath i.) May be fruity DKA smell
How should you perform scene size up and an initial assessment on a patient who has ingested poisons?
Scene Size Up a.) Overturned or empty pill bottles, containers, suicide note Initial Assessment a.) If patient has altered mental status, the poison has already into the blood b.) Open and clear the airway i.) Insert OP or NP if necessary ii.) PPV if needed c.) Apply oxygen
How should conduct a scene size up, initial assessment, and focused history/physical exam on a patient with bites and stings?
Scene Size Up a.) Protect yourself b.) Examine scene before entering Initial Assessment a.) General impression and mental status b.) ABCs Focused History and Physical Exam a.) Treat for anaphylactic shock if needed b.) Signs and symptoms of Anaphylactic Shock i.) Hives, flushing, upper airway obstruction ii.) Faintness, dizziness, generalized itching iii.) Swelling, dysphagia, labored breathing, SOB iv.) Abdominal cramps, confusion, loss of responsiveness v.) Convulsions, hypotension
How should you perform a scene size up and initial assessment on a patient with altered mental status and unknown history?
Scene Size Up a.) Trauma or illness b.) Look for clues such as oxygen tanks, alcohol, drugs, chemicals c.) If more than one person at the scene is experiencing altered mental status, suspect hazardous gas or poisons Initial Assessment a.) Stabilize the spine if necessary b.) Pay attention to AB i.) Breathing rate and depth may be inadequate ii.) Apply high flow oxygen
How should you perform a scene size up and initial assessment for a stroke patient?
Scene Size Up a.) Try to determine if deficit is related to medical or trauma i.) Look for alcohol, drugs, etc b.) Note where the patient is found i.) Many strokes occur at night c.) Bucket or icepack next to a patient Initial Assessment a.) Inspect airway and suction b.) Place in lateral recumbent if no spinal injury i.) Gag reflex may be lost ii.) Muscles of the throat may be paralyzed c.) Insert an OPA or NPA d.) Begin positive pressure ventilation if needed
How you perform a scene size up, initial assessment, and mental status exam on a patient with a suspected head injury?
Scene Size Up a.) Unresponsiveness or altered mental status b.) Bleeding from the scalp or face or apparent MOI Initial Assessment a.) Be alert for spinal injuries b.) Establish an airway with jaw thrust Mental Status a.) Decreasing mental status b.) Using the AVPU method
How should you perform as scene size up and initial assessment on patients with cold-related injuries?
Scene Size Up a.) Wait for the arrival of other services b.) Put on layered clothing Initial Assessment a.) Is the posture stiff? b.) Altered mental status? c.) Check airway and breathing rate d.) Be prepared to administer PPV if needed e.) Administer oxygen f.) OPA or NPA g.) Check the peripheral and carotid pulses h.) Early, the pulse rate may be elevated i.) Late, the pulse falls j.) Transport immediately
How should you perform the scene size up and initial assessment on a burn victim?
Scene Size Up a.) Is the scene safe to enter? b.) Wait until personnel arrives c.) Begin by assessing the mechanism of injury and number of patients Initial Assessment a.) Removing the patient from the burning source, does not completely stop the process i.) Cool down the burn within the first 10 minutes ii.) Use water or saline b.) Attempt to remove any smoldering clothing or jewelry c.) If any clothing still adheres to the patient, cut around the area d.) Continue initial assessment i.) ABC and mental status ii.) Look for sooty deposits in the mouth or nose 1.) Singed facial or nose hairs 2.) Sings of smoke inhalation 3.) Facial burns e.) Provide oxygen at 15 lpm by nonrebreather f.) Assess the circulation i.) Make estimate of the burn and BSA g.) If signs of shock are present, look for other sources of blood loss
How should you deal with a patient with active labor and and abnormal delivery?
Scene Size Up and Assessment, Focused History and Physical Exam a.) Same as with a normal patient b.) Signs and symptoms i.) Any fetal presentation other than normal crowning ii.) Labor before 38 weeks iii.) Abnormal color or smell of the amniotic fluid iv.) Recurrence of contractions after the first infant is born Emergency Medical Care and Ongoing Assessment a.) Similar to that of a normal delivery
How should you assess and provide care to a patient with a gynecological emergency?
Scene Size Up and Initial a.) Note mechanism of injury b.) Consider having female EMT examine c.) Do not approach until scene is safe if sexual assault Focused History and Physical Exam a.) SAMPLE and OPQRST b.) Protect patient's privacy c.) Estimate the blood loss d.) Obtain baseline vitals e.) Discourage victim from taking bath, douching, urinating, washing hands, cleaning wounds i.) Gently handle clothes ii.) Bag all items Emergency Medical Care a.) Ensure ABCs, give oxygen, treat for shock b.) Care for bleeding, never pack c.) Provide normal emergency care d.) Transport Detailed Physical Exam and Ongoing Assessment a.) Repeat initial assessment and focused history b.) Check interventions c.) Support emotionally
How should the EMT perform a scene size up and focused history/physical exam on a diabetic emergency patient with altered mental status?
Scene Size Up and Initial Assessment a.) Look for clues that lead you to suspect a diabetic (medical ID) Focused History and Physical Exam a.) SAMPLE b.) Medications i.) Insulin (Humulin, Novolin, Iletin, Semilente) ii.) Actos iii.) Diabanese, Glucamide iv.) Orinase, Micronaise, Diabeta v.) Tolinase, Glucotrol, Humalog, Glucophage, Glynase, Exubra c.) Questions i.) Did the patient take medication today? ii.) Did they skip any regular meals on that day? iii.) Did the patient vomit after eating a meal? iv.) Did the patient do unusual exercise? v.) How long for signs and symptoms? vi.) Was altered mental status fast or slow? vii.) May injury be the cause of mental status? viii.) Did the patient regain normal mental status? ix.) Did the patient have a seizure? x.) Does the patient have a fever?
How should you perform a scene size up and initial assessment and focused history/physical exam in patients with open soft tissue injuries?
Scene Size Up and Initial Assessment a.) Make sure the scene is safe b.) Take notice of MOI c.) Get a general impression of the patient and mental status d.) Assure an open airway e.) Provide oxygen if needed f.) Control any bleeding Focused History and Physical Exam a.) Rapid trauma assessment b.) Assess baseline vitals and take a SAMPLE history i.) Or perform a focused trauma assessment c.) Signs and Symptoms i.) Break in skin and external bleeding ii.) Localized swelling, pain, and discoloration at the injury site iii.) Possible signs and symptoms of internal bleeding and shock (hypoperfusion)
How should you assess and care for eye, face, and neck injuries?
Scene size up a.) Mechanism of injury will guide your treatment b.) May be difficult to obtain information from the patient Initial assessment a.) Severe trauma to the face and neck can cause altered mental status, airway compromise, severe bleeding and spinal injury b.) Establish manual in line stabilization c.) Control major bleeding with direct pressure d.) Open the airway with jaw thrust e.) Provide oxygen Focused History and Physical Exam a.) For any patient who is unresponsive or with a significant MOI, begin the focused history and physical exam by conducting a rapid trauma assessment b.) Conduct a focused trauma assessment of the injury if the patient is responsive, the MOI is not significant or the injury is isolated c.) Check for DCAPBTLS and crepitation d.) Record baseline vitals and patients with severe bleeding, treat for shock e.) SAMPLE and OPQRST Detailed Physical Exam and Ongoing Assessment a.) If the patient is unresponsive or the mechanism of injury was significant and if time and the patient's condition permit, conduct a detailed physical exam to identify any additional injuries b.) Conduct an ongoing assessment repeating the initial assessment and vital signs
How should perform a scene size up, initial assessment, and focused history on a patient with closed soft tissue injuries?
Scene size up and initial assessment a.) Scan for the MOI b.) Approach the patient and perform an initial assessment c.) C-spine d.) Assess ABC e.) Administer oxygen by nonrebreather at 15 lpm Focused History a.) Introduction i.) Reconsider the MOI to estimate the potential number and sites of impact to the patient ii.) Perform rapid trauma assessment iii.) Take baseline vitals and SAMPLE history iv.) For patients without a significant MOI, without altered mental status and without multiple injuries, the exam should be a focused trauma assessment b.) Signs and Symptoms i.) Closed soft tissue injury 1.) Swelling, pain and discoloration at the injury site 2.) Signs and symptoms of internal bleeding and shock (hypoperfusion) if the underlying organs are injured
How should you perform a scene size up, initial assessment, and focused history/physical exam on a patient in active labor?
Scene size up, initial and focused are the same Will need to determine if the patient is in active labor a.) Assist mother and provide care to neonate Best to transport a mother in labor so baby can be delivered in a hospital a.) If delivery is imminent, deliver on scene b.) How many times pregnant? c.) How many deliveries? d.) How long has patient been pregnant? e.) Has there been bleeding or discharge? f.) Any contractions or pain present? g.) Frequency and duration? h.) Crowning occurring? i.) Does the patient feel the need to push? j.) Does the patient feel as if she is having a bowel movement? k.) Is the abdomen hard upon palpation? Three conditions in which you will have to deliver a.) No suitable transportation b.) Hospital cannot be reached c.) Delivery is imminent
What is the role of the EMT during extrication?
Scene size up, stabilization, gaining access, disentanglement and patient removal Patient care always precedes removal from the vehicle unless delaying removal would endanger the life of the patient, EMT or other rescuers First priority is always your own safety Provide the same care that you would with any trauma patient a.) Stabilize the C spine, complete the initial assessment, and provide critical interventions Establish a rapport Use heavy blankets, tarp or salvage cover to protect the patient from glass and debris Continuously monitor the patients condition Prepare the patient for the rescue operation a.) Make him aware of the amount of time it might take
What is a pocket mask?
Seal around the patient's mouth and nose
What is a partial thickness burn?
Second degree burn Involves the epidermis and part of the dermis Occur from contact with fire (flame or flash), hot liquids, or objects, chemical substances, or the sun Damage to the small blood vessels causes plasma and tissue fluid to collect between the layers of skin and form blisters, and since pain receptors are still intact the patient will again complain of the pain from the burn Will cause intense pain Thermal flame burns or severe scalding
What is insulin?
Secreted when the blood sugar level is elevated a.) Increases movement of glucose out of blood into cells b.) Causes the liver to take up the glucose out of the blood and convert it into glycogen, the stored form of glucose c.) Decreases the blood glucose level by the actions listed in 1 and 2, facilitating the movement o the glucose into the cells and the liver Will attach to the cell at a specific site and will cause another channel on the cell membrane to open a.) Protein will carry the glucose into the cell through the channel b.) Insulin facilitates movement into the cell Brain a.) Does not need insulin to help move glucose into the brain b.) Glucose will cross the blood brain barrier readily, whether insulin is present or not
Safety measures for unstable surfaces and slopes?
Secure the patient to the hillside to prevent him from sliding downslope during assessment, treatment and stabilization Be sure that vehicles that have gone over an embankment have been secured Be aware of loose rocks and stones
What is croup (laryngotracheobronchitis)?
Seen in children Causes breathing difficulty Does not feel well, sore throat, fever at night Sound like a barking seal Apply oxygen
What is acute pulmonary edema?
Seen in patients with cardiac dysfunction leading to congestive heart failure Hypoxia An excessive amount of fluid collects in the spaces between the alveoli and capillaries a.) Increase in fluid disturbs normal gas exchange and leads to hypoxia
What is status epilepticus?
Seizures that last more than 5 minutes or seizures that occur consecutively without a period of responsiveness between them
How should you insert the oropharyngeal (oral) airway?
Select the proper size a.) Hold it next to the patient's face b.) Extend the distance from the level of the front teeth to the angle of the jaw Open the patient's mouth using the cross finger technique a.) Insert the tube upside down with the airway pointing toward the roof of the mouth Rotate it at 180 degrees once it hits the roof of the mouth Can also use a tongue depressor a.) Preferred for children and adults
What is your duty to self, to your partner, and your equipment as an EMT?
Self a.) Obtain credentials, maintain skills Partner a.) Ensure that he is physically and mentally fit to provide emergency treatment b.) Must report drug/alcohol abuse to supervisor Equipment a.) Must be in working order, and clean
What is drug abuse?
Self administration of drugs in a manner that is not in accord with approved medical or social patterns
What is an oropharyngeal (oral) airway?
Semi-circular device of hard plastic or rubber that holds the tongue away from the airway Allows for suctioning of secretions Two styles a.) Tubular b.) One channeled size Do not use in responsive patients with a gag reflex
What is a thermoreceptor?
Sensory nerve ending that receives various types of stimuli Responsible for sending nerve impulses to the hypothalamus
What is the diaphragm?
Separates the chest cavity from the abdominal cavity
What is the function of the skin?
Separates the outside environment from the tissues, organs and systems Functions a.) Protects the body from the environment, bacteria and other foreign organisms b.) Regulates body temperature c.) Serves as a receptor for heat, cold, touch, pain and pressure d.) Aids in the regulation of water and electrolytes (sodium and chloride)
What is a base station?
Serves as a dispatch and coordination area Ideally is in contact with all other elements of the system Should be on a high and equipped with a suitable antenna within a short distance
What is an immune response?
Set of reactions when an antigen enters the body
What is asthma?
Severe SOB Many patients know how to manage their disease a.) If they call, its not working Increased sensitivity of the lower airways to irritants and allergens, causing bronchospasm Resistance to airflow and difficulty in breathing a.) Bronchospasm i.) Constriction of the smooth muscle in the bronchioles b.) Edema i.) Swelling of the inner lining of the airways c.) Increased secretion of mucus that causes plugging of the smaller airways Exhalation is difficult and prolonged a.) Wheezing heard upon exhalation b.) Air becomes trapped in the alveoli c.) Exhalation is active process d.) Loss of wheezing can be an ominous sign
What is anaphylactic shock?
Severe allergic reaction The entire body is affected by the release of chemical substances by the threatening reactions in the airway, lungs, blood vessels and heart Swelling in the upper airway can cause obstruction and a reduction of air to the lungs Swelling in the lower airways and bronchoconstriction Blood vessels dilate and capillaries begin to leak, decreasing BP and causing shock
What is a brain herniation?
Severe and detrimental condition that may occur Significant amount of swelling and/or bleeding to or around the brain creates excessive pressure within the skull and causes the brain to be compressed and pushed downward toward the brain stem at the base of the skull Results when a portion of the brain is pushed out, usually through the foramen magnum
What is traumatic asphyxia?
Severe and sudden compression of the thorax causes rapid increase in the pressure in the chest Backflow of blood out of the right ventricle and into the veins of the head, shoulders and upper chest The patient looks as if they have been strangled Signs and symptoms a.) Bluish or purple color b.) JVD, bloodshot eyes c.) Cyanotic and swollen tongue and lips d.) Bleeding of the conjunctiva
What is status asthmaticus?
Severe asthmatic attack that does not respond to either oxygen or medication Require immediate transport
What is an extension spinal injury?
Severe backward movement of the head in which the neck is stretched, or when the torso is severely arched backward
What is a flexion spinal injury?
Severe forward movement of the head in which the chin meets the chest, or when the torso is excessively curled forward
What is Cushing's reflex?
Severe head injury Systolic blood pressure increases, the heart rate decreases, and the respiratory pattern changes
What are delirium tremens?
Severe, life threatening condition with a mortality rate of 5-15% Can occur between 1 and 14 days after the patient's last drink Severe confusion Loss of memory, tremors, restlessness and irritability, extremely high fever, dilated pupils, profuse sweating Insomnia, elevated BP, tachycardia, nausea and vomiting Diarrhea, hallucinations Seizures are not common Psychological and physical support
What is the peritoneum?
Sheathing like membrane
What is indicated by a trachea that is not midline?
Shifted to one side is a later indication of a significant amount of air trapped in the pleural space of the chest cavity Is a tension pneumothorax
What is the tibia?
Shin Weight bearing bone located at the anterior and medial side of the leg Top receives the rounded end of the distal femur The smaller distal end form the medial knob of the ankle
What is the black widow spider? What are the effects of its bite?
Shiny black body, thin legs, crimson red markings on abdomen Females only bite when hungry, agitated or protecting the egg sac Leading cause of death from spider bites in the US Signs and symptoms a.) Pinprick sensation at bite site, dull ache in 30 minutes b.) Severe muscle spasms c.) Rigid, boardlike abdomen d.) Dizziness, nausea, vomiting, respiratory distress
What is hypoperfusion?
Shock Inadequate circulation Cells become starved for oxygen, overloaded with CO2 Can occur from low blood volume, insufficient pumping or dilated and leaking vessels, spinal cord damage
What is hypoperfusion?
Shock Insufficient supply of oxygen and other nutrients to some of the body's cells and the inadequate elimination of CO2 and other wastes
What are some conditions that may cause an altered mental status?
Shock, poisoning or drugs Post seizure Infection Traumatic head injury Stroke and diabetes Decreased oxygen levels, hypoxia Alcohol, drug intoxication
MOI considerations for penetrating trauma...
Shooting or stabbing Log roll the patient to the posterior to look for wounds
What is obstructive pulmonary lung disease?
Shortness of breath Can cause an obstructive lung disease causes an obstruction of airflow through the respiratory tract, leading to a reduction of gas exchange a.) Most severe consequence of reduced airflow is hypoxia May have a continuous positive airway pressure (CPAP) or a bilevel positive airway pressure (BiPAP) machine a.) Assist in keeping airway passages open and providing adequate oxygenation while the patient is sleeping b.) Also in patients with sleep apnea
When should a patient receive pulse ox monitoring?
Should be applied in any situation where the patient's oxygen status is a concern
What is the general procedure for applying dressing and bandages?
Should be as clean as possible Do not bandage a dressing in place until bleeding has stopped A dressing should adequately cover the entire wound If possible, remove all jewelry from the injured body part Do not bandage a wound too loosely Bandage wounds snugly, but not too tightly If you are bandaging a small wound on an extremity, cover a large part with the bandage Always place the body part to be bandaged in the position in which it is to remain Apply a tourniquet only as a last resort
What is a treatment unit (in MCIs)?
Should be close to the area where ambulances arrive Should be on high ground Immobilize all patients before moving them Treat only salvageable patients Provide only necessary
How long should the initial assessment take?
Should be conducted in about 60 seconds
What is the Apgar Score?
Should be determined 60 seconds after birth and repeated at the 5th minute Change may indicate improvement or worsening Appearance a.) If blue or pale, 0 b.) If blue hand and feet and pink core, 1 c.) If pink, 2 Pulse a.) If no pulse, 0 b.) If heart rate under 100, 1 c.) If heart rate over 100, 2 Grimace (flick the soles of feet) a.) If no reflex, 0 b.) If some facial grimace, 1 c.) If newborn grimaces, coughs, sneezes or cries, 2 Activity a.) If limp, 0 b.) If flexion without active movement, 1 c.) If actively moving, 2 Respiration a.) If none, 0 b.) If slow or irregular with weak cry, 1 c.) If strong and cries, 2 Scale a.) 7-10 i.) Provide routine care b.) 4-6 i.) Moderately depressed, stimulation and oxygen c.) 0-3 i.) Severely depressed ii.) Oxygen, bag valve mask, CPR
How should you perform a focused history and physical exam on a stroke patient?
Should be expected as having a stroke if a.) Weakness of face, hand, leg or arm b.) Trouble speaking c.) Difficulty speaking d.) Problem walking or coordination e.) Confusion, dizziness, headache Remain confident and calm Physical exam would be rapid rather than focused a.) Inspect and palpate the head Inspect the face for drooped appearance a.) Smile Listen for garbled sounds or slurring a.) Have them say, you cant teach an old dog new tricks Note the patient's ability to obey commands Note walking abnormalities Check equality of strength Strongly suggestive of a stroke a.) Facial droop b.) One arm that does not move or drifts downward c.) Slurs words or speech disturbances d.) Weak or no grip on one side Blood pressure a.) High blood pressure may have caused the injury or may be a sign of increased pressure in the brain i.) Unequal pupil size Hypoglycemia a.) Can produce similar signs to stroke b.) Check the blood glucose level c.) Seizures may also cause similar results i.) But a stroke can cause seizures
Who should receive blood pressure monitoring?
Should be measured in all patients under age three a.) Look for drop of more than 10mmHg b.) May be another sign of pulsus paradoxus
What does asymmetrical movement of the chest wall indicate?
Should be moving symmetrically and smoothly Indication of significant chest injury
What is an ongoing assessment?
Should be performed on both trauma and medical patients New develops in the patients condition Assess, Intervene, Reassess Three basic reasons a.) To detect any change in condition i.) Look for signs of deterioration or improvement b.) To identify any missed injuries or conditions, especially those that are life threatening i.) Reassess for injuries in a more favorable environment c.) Adjust the emergency care as needed i.) Reassess the effectiveness of the emergency care that you are providing Steps of the Ongoing Assessment a.) Repeat the individual assessment b.) Reassess and record vital signs c.) Repeat the focused assessment for other complaints or injuries d.) Note trends in the patient's condition
How should an unresponsive patient (with no suspected, neck or spinal trauma) be transported and positioned?
Should be placed in a left lateral recumbent position Will drain fluids or vomit from mouth
How should a patient with chest pain or discomfort with breathing be positioned?
Should be placed in a position of comfort, usually sitting up
When should you use a cervical spine immobilization collars?
Should be used any time you suspect injury to the spine based on MOI, the patient's history, or the signs and symptoms Never use a soft collar, it permits too much movement The collar itself does not immobilize the patient Sizing of the collar to the patient is based on the design of the device Should be applied by two rescuers
What is the elevation method of controlling external bleeding?
Should be used in conjunction with direct pressure Elevate the arm or leg above the heart If the extremity is painful, swollen or deformed, elevate the extremity only after splinting
What are the priorities when treating patients?
Should have identified any immediately life threatening conditions The airway must be opened, high flow oxygen should be administered a.) Positive pressure ventilation Control any major bleeding Begin CPR when appropriate Treat for shock Decide whether the patient is load and go or stay and play If it is immediate transport a.) Conduct a quick head to toe focused exam of the patient b.) (Rapid trauma or rapid medical assessment) c.) Can be accomplished in no more than 60 to 90 seconds Indicates where the remainder of the assessment and treatment will occur
What should be included in the oral report?
Should summarize the info you've already given to the facility Keys a.) Chief complaint b.) Vital signs en route c.) Treatment given en route and response d.) Pertinent history not given in the earlier report Prehospital Care Report a.) Written copy of report
What is the four point immobilization of an infant or child...
Shoulder, three points Strap across the chest, at the waist, above the knees Secure arms and legs
What is an altered mental status?
Sign of injury or illness May range from disorientation to complete unresponsiveness Change is an indication that the CNS has been affected in some manner Causes a.) Trauma, blood sugar level, oxygen level
What are the signs and symptoms of inhalation injuries?
Signed nasal hairs Facial burns Burned specks of carbon in the sputum Sooty or smoky smell on breath Respiratory stress accompanied by restriction of the chest wall movement, restlessness, chest tightness, stridor, wheezing, difficulty swallowing, hoarseness, coughing and cyanosis
How do you splint pelvic fractures?
Significant pain or bleeding PSAG splint Improvised pelvic wrap a.) Fold a sheet lengthwise to an 8 inch width b.) Slide it under the small of the back and then down under the pelvis c.) Cross the tail ends over the patient and twist until the sheet is tightly secured around the patient d.) Tuck the ends under the patient or tie e.) Place the patient on backboard
What are the late signs and symptoms of compensation in shock?
Significant systolic bp drop (<90) Peripheral pulses becoming absent Significant tachycardia (>120 bpm) Unresponsiveness Extreme pale, cold, and clammy skin with waxy appearance
How should you provide a SAMPLE history in an unresponsive medical patient?
Signs Symptoms Allergies Medications Pertinent Past Medical History Last Oral Intake Events Leading to Illness
What does SAMPLE stand for in a sample history?
Signs and symptoms Allergies Medications Pertinent past history Last oral intake Events leading to injury or illness
What are the signs and symptoms of pancreatitis?
Signs and symptoms a.) Nausea and vomiting b.) Abdominal tenderness and distention c.) Severe abdominal pain with radiation from the umbilicus to the back and shoulders d.) Extreme cases will have fever, rapid pulse, and signs of shock
What are the signs and symptoms of Type I Decompression Sickness (mild)?
Signs and symptoms a.) Pain, itching and burning sensation b.) Skin rash, skin has orange peel appearance c.) Painless pitting edema Pain a.) Seen in approximately 75-85% of patient b.) Dull, aching, throbbing c.) Shoulder d.) Gradually intensifies
What is a sample history?
Signs and symptoms a.) Signs - Objective physical evidence that you can see, hear or feel b.) Symptoms - Conditions that are described by the patient c.) What are you feeling? When and where did the symptoms first occur? What were you doing at the time? d.) OPQRST (onset, provocation/palliation, quality, radiation, severity, time Allergies a.) Determine whether they have any allergies b.) Check for a medical tag Medications a.) Has the patient taken any medication lately i.) Prescription ii.) Non-prescription or over the counter iii.) Birth control iv.) Illicit drugs v.) Herbal medication Pertinent past history a.) Underlying medical problems b.) Past surgical history Last oral intake a.) When was the last time they ingested food Events leading to injury or illness a.) What occurred before the patient became ill
What are the signs and symptoms of hypoglycemia?
Signs and symptoms caused by epinephrine release a.) Diaphoresis b.) Tremors c.) Weakness d.) Hunger e.) Tachycardia f.) Dizziness g.) Pale, cool, clammy skin h.) Warm sensation Signs and Symptoms of Brain Cell Dysfunction a.) Confusion, drowsiness b.) Disorientation c.) Unresponsiveness d.) Seizures e.) Stroke like symptoms, hemiparesis
What are vital signs?
Signs of life, outward signs that give clues about what is happening inside Breathing (respiration), pulse, skin, pupils, blood pressure, pulse oximetry Take two or more sets and compare them a.) Will reveal patient's condition
What are pertinent negatives?
Signs or symptoms that might be expected, but are absent
What is a hematoma?
Similar to a contusion, except that is usually involves damage to a larger amount of tissue Large lump with a bluish discoloration May separate tissue and pool in the pockets the form Hematoma the size of a patient's fist can be equal to 10% blood loss, causing minimal signs of shock or hypoperfusion
What is an ischemic stroke?
Similar to a heart attack Do to an inadequate amount of blood being delivered to a portion of the brain caused by a blood clot obstructing a blood vessel in the brain Described is a brain attack Cerebral artery is occluded a.) Atheroscleosis is a contributing factor Can receive the drug, a fibrinolytic, to break up the clot and restore perfusion
What is hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?
Similar to diabetic ketoacidosis Hyperglycemic condition that causes the blood glucose level to increase drastically a.) Will rise to 600-1,200 mg/dL b.) Kidneys spill off large amount of glucose in the urine c.) Patient will suffer from dehydration More common in Type II
What are the signs and symptoms of pericardial tamponade?
Similar to pericardial tamponade Breath sounds remain normal because the lungs are not involved JD, signs of shock, tachycardia, decreased blood pressure, weak pulse, radial pulses diminishing
What is an emergency medical responder (EMR)?
Similar to the first responder Provides immediate lifesaving care to patients Basic airway, ventilation and oxygen therapy devices, takes vital signs, provides stabilization of the spine and extremities, CPR, automated defibrillation, emergency child birth
What is the START triage system?
Simple Triage and Rapid Transport Developed by Newport Beach Fire and Marine Department and Hoag Memorial Hospital in Newport Beach, California Can be used for adults and children greater than 100 pounds The first assessment that you perform that falls into the immediate category should cause you to stop triage, tag the patient as red and move to the triage unit Should not take more than 30 seconds per patient Four basic categories (ARPM) a.) Ability to get up and walk (ambulatory) i.) Should be collected and moved to a safe area ii.) Considered to be a green iii.) Moved to one site and confined there b.) Respiratory status i.) Look, listen and feel ii.) If patient is breathing and respiratory rate is greater than 30, tag the patient as red and move on to the next patient iii.) If respirations are less than 30, assess perfusion iv.) If no respirations are present, open the airway 1.) If the patient begins to breath, determine the respiratory rate 2.) Greater than 30, tag red 3.) Less than 30 and shallow, tag red c.) Perfusion status i.) Assess capillary refill and radial pulse ii.) If cap refill is less than 2 seconds and pulse is present, do avpu iii.) If cap refill is greater than 2 or radial pulse is absent, tag as red d.) Mental status i.) If the patient has respirations less than 30 with adequate respirations, a radial pulse and cap refill under 2 ii.) Ask the patient to squeeze fingers, if yes, tag yellow iii.) If doesn't respond, tag red
What are some various types of oxygen masks?
Simple face mask a.) No reservoir, can give up to 60% oxygen b.) Exhaled air can exit through the holes c.) Flow rate of 10 lpm but must not be set less than 6 lpm Partial rebreather a.) Two way valve that lets the patient to rebreathe one third of his exhaled air b.) Flow rate between 6 to 10 lpm c.) Can provide between 35% and 60% concentration Venturi mask a.) Low flow oxygen b.) Precise concentrations at preset flow rates c.) Used for a patient with COPD
What is glucose?
Simple form of sugar and the body's main source of energy
What is a gliding joint?
Simplest movement Small bones of the hands and feet
Dosage for epi-pens...
Single dose of 0.3 mg, 0.15 in children
Electrical impulse in the heart starts at the ___ node
Sinoatrial (SA)
How can an EMT ensure a smooth transition of the scene from police or bystander to EMT?
Smooth from police, bystander to EMT Identify yourself
What are the adrenal glands?
Sit top the kidneys Secrete epinephrine and norepinephrine, postpone muscle fatigue, increase in the storage of sugar, control kidney function, and regular the metabolism of salt and water
What is the tripod position?
Sit upright and slightly forward Supporting themselves with their arms
How should a patient who is alert, but nauseated or vomiting be positioned and transported?
Sitting or recovery position
What are medication contraindications?
Situations in which the drug should not be administered No benefit Nitro - low blood pressure
Why is communication critical to EMT work?
Size up the scene immediately and accurately Consider the weight of the patient and recognize need for additional help Be aware of the abilities and limitations of each team member Select the most appropriate equipment for the job Explain the plan to the patient before the action is taken
What are the signs and symptoms of allergic reactions and anaphylaxis?
Skin a.) Warm and tingly feeling in face, outh, chest feet and hands b.) Intense itching (pruritus) c.) Hives (urticaria) d.) Flushed or red skin e.) Swelling to face, lips, neck, hands, feet and tongue f.) Cyanosis Respiratory System a.) Lump in throat b.) Tightness in chest c.) High pitched couch d.) Tachypnea e.) Labored breathing f.) Noisy breathing g.) Impaired ability to talk or hoarseness h.) Excessive amounts of mucus i.) Partially or completely occluded airway j.) Difficulty breathing Cardiovascular system a.) Tachycardia b.) Hypotension c.) Irregular pulse d.) Absent radial pulse CNS a.) Increased anxiety b.) Lightheadedness c.) Unresponsivesness d.) Disorientation e.) Restlessness f.) Seizures g.) Headache GI System a.) Nausea/vomiting b.) Abdominal cramping c.) Diarrhea d.) Difficulty swallowing e.) Loss of bowel control Genitourinary System a.) Need to urinate b.) Uterus cramping Generalized Symptoms a.) Itchy, watery eyes b.) Runny or stuffy nose c.) Sense of doom d.) Malaise e.) General weakness or discomfort
What are the effects of aging on the integumentary system?
Skin becomes thinner Less attachment tissue between the dermis and the epidermis Much more prone to injury Less perspiration, sense of touch is dulled
What does pale or mottled skin indicate?
Skin that is pale or mottled typically indicates a decrease in perfusion and the onset of shock (hypoperfusion) If the skin is pale or mottled, suspect that the patient is losing blood internally or externally or suffering another cause of shock
What are the six basic components of the skeletal system?
Skull Spinal column Thorax Pelvis Lower extremities Upper extremities
What does the prefix brady mean?
Slow
What is bradypnea?
Slow breathing
What is bradycardia?
Slow heart rate
What do sluggish pupils indicate?
Sluggish pupils may indicate a poor oxygen state, drug overdose, or inadequate perfusion
What is the epiglottis?
Small, leaf shaped flap of cartilaginous tissue Acts as the valve that closes the larynx while food and drink are being swallowed At times the epiglottis may fail to close and food or liquids can enter the larynx and other parts of the trachea, causing choking a.) Head tilt chin lift/jaw lift can move the epiglottis and allow air to go into the trachea
What is gastric inflation/distention?
Smaller tidal volume reduces inflation Stomach may enter contents into the esophagus Aspiration Can restrict movement of the diaphragm
What is a venule?
Smallest branch of the veins Connected to the distal ends of capillaries and from which is transported into larger veins
What are pressure (air or pneumatic) splints?
Soft and pliable before being inflated but rigid once they are filled with air Cannot be sized PSAG a.) Used as a pressure splint to immobilize an injury to a lower extremity or pelvis
What are vacuum splints?
Soft and pliable that are easily formed to deformed extremities
What is the spleen?
Solid organ, left upper quadrant Helps in the filtration of blood and serves as a reservoir of blood that the body can use in an emergency Has no digestive function
What are the three types of abdominal structures?
Solid organs Vascular structures Hollow organs
How should the EMT deal with caregivers?
Some are calm, cooperative and helpful a.) Others may be a hindrance i.) Let them verbalize their feelings Need to see that you are competent, calm and confident Keep them informed as to what you are doing Do not lie to the caregiver
What is retroperitoneal?
Some organs lie partially or completely outside of the peritoneum
What is acute abdominal pain?
Sometimes called acute abdomen, or acute abdominal distress Some causes will be obvious, but most will not be apparent 100 different causes of pain May arise from the cardiac, pulmonary, gastrointestinal, genital, urinary, reproductive, or other body systems
What is a multiple casualty incident or MCI?
Sometimes called mass casualty incident or multiple casualty situation Three or more patients MVC, gang related violence, apartment fires Do not always involve victim of trauma a.) Food poisoning, toxic gas inhalation, refugee influx
What is parietal pain?
Sometimes called somatic pain Associative with irritation of the peritoneal lining Has a larger amount of highly sensitized nerve endings Pain is more severe and more localized a.) Sharp, typically constant, usually found on ones side Patient will be found lying supine with the knees flexed up to the chest Lying still and breathing shallowly
What is hypoglycermia unawareness?
Sometimes, patients may not recognize the change May cause them to allow their BGL to drop significantly
What is snoring?
Sonorous sound Occurs when the airway is partially blocked by the tongue or relaxed tissues in the pharynx Can be corrected by head tilt chin lift or jaw thrust
What are some key techniques for treating behavioral emergency patients?
Speak in calm and reassuring voice directly to the patient Maintain a comfortable distance between yourself and the patient Seek the patient's cooperation a.) Encourage them to explain the problem Maintain good eye contact Do not make quick movement Respond honestly to patient's questions, but don't foster unrealistic explanations Never threaten, challenge, or belittle any disturbed patient Always tell the truth Do not play along with visual or auditory disturbances When you can involve trusted family or friends Be prepared to spend time at scene Never leave patient alone Avoid the use of restraint Do not force the patient to make decisions Encourage the patient to participate in motor activities, which helps reduce anxiety If the patient has attracted a crowd, try to disperse it
What is activated charcoal?
Special distilled charcoal treated with superheated steam Extremely porous and can absorb many time its weight in contaminates Should be administered between 1 hour of ingestion Brand names a.) Superchar, instachar, actidose, liqui-char Should be used in patient who has ingested poisons by mouth
What is wind chill?
Speeds cooling process The amount of heat that would be lost in an hour from a square meter of exposed skin surface with a normal temp of 91.4F
What is the eye?
Sphere approximately one inch in diameter Covered with a tough outer coat called the sclera (the white of the eye)
What equipment do you need to take vitals?
Sphygmomanometer Stethoscope Wristwatch Penlight Pair of shears Pen and pocket notebook BSI
What is an incomplete spinal cord injury?
Spinal cord is injured but not completely though all of the three major tracts a.) The motor tract b.) The light touch tract c.) The pain tract Weakness or paralysis in upper extremities, but not in the bottom extremities a.) Differences between the left and right extremities
What is neurogenic shock (or spinal shock) and how do you treat it?
Spinal vascular shock Results from injury either to the brain or to the spinal cord Results in an interruption of nerve impulses fro the brain and spinal cord, they relax and vasodilate Causes a related hypovolemia within the circulatory system Patient becomes hypotensive (lowered blood pressure) Interruption of nerve impulses to the arteries, there is also an interruption of impulses to the peripheral nervous system, causing paralysis and loss of sensation a.) Prevents the release of epinephrine and norepinephrine b.) Causes vessel dilation (red skin) and sweat gland malfunction (dry skin) c.) Skin will be warm and dry and may appear slightly pink or red d.) Pulse is typical 60-100 beats per minute Treatment a.) Is much the same as any other shock b.) Maintain c spine control and keep the patient warm and immobilized
What is slander?
Spoken form of defamation
What is a blanket drag?
Spread blanket alongside patient Poll the patient away from you onto his side a.) Tuck the blanket beneath the patient Roll the patient back on the center of the blanket Wrap the blanket around the patient Grab the part of the blanket beneath the patient's head and drag
How should you deal with objects impaled in the cheek?
Stabilize it with bulky dressing and transport If it is lose, you need to remove it
What is the golden hour?
Standard parameter for emergency care because studies have shown that a severely injured patient has the best chance for survival if surgical intervention takes place within 1 hour of injury EMS a.) Platinum 10 minutes b.) Devoted to on scene activities Maintain a high suspect of suspicion
What is anxiety?
State of painful uneasiness about impending problems Most common form of mental illness Mimic other disorders
What are oral hypoglycemic drugs?
Stimulate insulin secretion by the pancreas and promote increase in the number of insulin receptors on the cells or reduce the amount of sugar absorbed into the blood from the small intestines
Considerations for patients using methamphetamines...
Stimulatory type of drugs, psychological arousal Crystal meth Can be swallowed or snorted a.) Quick high called a flush or rush Can cause patient to remain awake for prolonged periods a.) Can result in brain impairment, memory loss, body movement impairment, possible hyperthermia, convulsions, death Ensuring scene safety, using talk down, ABCs, mental status, transport
What are the effects of scorpion stings?
Sting of only one scorpion is fatal 90% on hands Sharp pain at injection site, drooling, poor coordination, incontinence, seizures
What is a tracheostomy?
Stoma is created by cutting into the trachea to relieve an obstruction higher in the trachea
What is gastric distention?
Stomach fills with water Place patient on side Cause regurgitation with pressure Suction
What are hollow organs?
Stomach, gallbladder, urinary bladder, small intestine, and large intestine Contain few blood vessels, do not bleed very much, but they spill their contents causing irritation and inflammation called peritonitis
The majority of organs are enclosed by the visceral peritoneum...
Stomach, spleen, liver, gallbladder, pancreas, small intestine, part of the large intestine Called intraperitoneal
What organs are in the left upper quadrant (LUQ)?
Stomach, spleen, pancreas, and part of the large intestine Left kidney is behind the abdominal lining
What is the bladder?
Stores the urine
What are some examples of injuries to the female genitalia?
Straddle injuries, sexual assault, blunt trauma, abortion attempts, childbirth, foreign body insertion Can cause great pain and can bleed profusely Direct pressure and moistened compresses Never pack the vagina Look for shock and apply oxygen
What are signs and symptoms of gynecological emergencies?
Straddle or sexual assault Can cause severe pain and considerable bleeding Abdominal pain, vaginal bleeding, soft tissue injuries Treat for shock if need be
What is extension?
Straightening away from the body
What are other types of immobilization equipment that you can use for spinal injuries?
Straps or cravattes Do not interfere with the patients breathing and avoid applying the straps across the knees
What is basket/Stokes stretcher?
Stretcher is shaped like a long basket and comes in two styles a.) Welded metal frame with a contoured chicken wire web b.) Tubular aluminum frame rivet to a polyethylene shell Advantages a.) Enable you to completely immobilize a patient who is already on a backboard
What are the key causes of stroke?
Stroke caused by an interruption of blood flow to the brain Blockage or artery that is carrying blood to a specific area in the brain
What is anatomy?
Structure of the body and the relationships of its parts to each other
What is pharmacology?
Study of drugs
What are the routes of medication administration?
Sublingual Oral Inhalation Injection
What are baseline vital signs?
Subsequent measures can be compared
What are standing orders?
Subset of protocols that do not require real time physician input Refers specifically to treatments that can be performed if communication cannot be established or is lost with medical direction
What is the superior vena cavae?
Superior vena cava, enters the top of the right atrium carrying oxygen depleted blood from the upper body
What is a surfactant?
Substance that is responsible for maintaining surface tension in the alveoli to keep them from collapsing If the surfactant is washed out the alveoli will have a tendency to collapse leading to respiratory distress and ventilation complication
How you remove foreign objects, secretions, blood, vomit from the airway?
Suction or finger sweeps
What is a seizure?
Sudden and temporary alteration in brain function caused by massive, continuing electrical discharges in a group of nerve cells in the brain Produces changes in mental activity and behavior including convulsions Not a disease itself but a sign of underlying defect, injury or disease
What is a seizure?
Sudden and temporary alteration in mental status caused by massive electrical discharge in a group of cells in brain Oxygen, recovery position, transport
What is a disaster?
Sudden catastrophic event that overwhelms natural order and causes great loss of property, and or life Great disparity between casualties and resources
What is Venezuelan Equine Encephalitis?
Sudden onset malaise, fever, headache, rigor, nausea, coughing, sore throat, diarrhea Recovery in 1-2 weeks
What are the signs and symptoms of spontaneous pneumothorax?
Sudden onset of SOB without evidence of trauma to the chest and with decreased breath sounds upon assessment Sudden onset of SOB Sudden onset of chest or shoulder pain Decreased breath sounds to one side of the chest Subcutaneous emphysema Tachypnea Diaphoresis Pallor Cyanosis may be seen late SpO2 < 95%
What are the signs and symptoms of a hernia?
Sudden onset of abdominal pain Fever Rapid pulse Tenderness at point of hernia Others similar to intestinal obstruction
What are the signs and symptoms of ulcers?
Sudden onset of abdominal pain n the LUQ and epigastric area Burning or gnawing type pain before meals or during stressful events Nausea and vomiting Signs of shock Peritonitis with rigid abdomen in cases of perforation
What are the signs and symptoms of cholecystitis?
Sudden onset of pain located from the middle of upper quadrants (epigastric area)to RUQ areas a.) Pain more common at night and after ingestion of fatty foods Tenderness and pain upon palpation of the RUQ Low grade fever Nausea and vomiting (contents may be greenish)
What is smallpox?
Sudden onset, malaise, fever, headache, vomiting, backache Rash in 2-3 days
What is spontaneous pneumothorax?
Sudden rupture of a portion of the visceral lining o the lung that causes the lung to partially collapse Males 5x more likely at risk a.) Tall, thin, and lanky, 20 and 40 y/o b.) History of cigarette smoking or Marfan's syndrome or Ehlers Danlos syndrome c.) History of COPD i.) Weakened lung tissue called blebs Portion of the visceral pleura ruptures Allows air to enter the pleural cavity, disrupting negative pressure and causing the lung to collapse
What is perfusion?
Sufficient supply of oxygen to the body's cells Capillary refill is a typically a more reliable indicator of perfusion status in infants and children less than 6 years of age
What does the prefix 'glyco' mean?
Sugar
What are the classifications of burns?
Superficial (first degree), partial thickness (second degree), full thickness (third degree burns) A fourth degree burn also exists and is commonly associated with electrical injuries
What is the larynx?
Superior to the trachea a.) Houses vocal chords (voice box) b.) The adams apple or the thyroid cartilage is anterior cartilage that covers the larynx The most inferior part is called the cricoid cartilage, a firm, full right of cartilage that forms the lower edge of the larynx
What is the larynx?
Superior to the trachea and inferior to the epiglottis Also called voice box which contains the vocal cords The anterior portion of the larynx, the large, bulky thyroid cartilage (Adam's apple) can be felt in front of the throat The cricoid cartilage is the only completely circular cartilaginous ring of the upper airway a.) Found just below the thyroid cartilage b.) Obstruction of this can help prevent air from filling the stomach
What is the procedure for testing blood glucose level with a glucometer?
Supplies a.) Glucose meter b.) Glucose test strips c.) Lancet d.) Lancet device e.) Alcohol swabs Procedure a.) Prepare the lancet and lancet device b.) Let the arm hand down on the patient's side if possible c.) Remove a new test strip from the vial, inset the test strip d.) Match the code number of the LED screen to the code number on the test strip vial e.) Grasp the finger site to be pricked f.) Prick the side of the fingertip and squeeze gently g.) Drop the blood onto the test strip h.) The blood glucose value will be displayed i.) Remove the test strip and place in a biohazard container
What is the purpose of the skeletal system?
Supports the body, allowing it to stand erect Must be strong to provide support and protection Major element in the motion is the joints
What is a stoma?
Surgical opening in the front of the neck
What kinds of cases may require special documentation?
Suspected abuse of a child or elderly person Possible exposure to infectious disease Injury to EMS team member Other situations that may require special documentation
What is the oral route of medication administration?
Swallowed Absorbed from the stomach or intestinal tract Patient must be responsive Activated charcoal Oral glucose Aspirin
Explain the ingestion route of poisonings...
Swallowed through gastrointestinal tract Most common route Manage the poison before it empties from the stomach
What is lordosis?
Swayback The stomach is too anterior and the buttocks are too posterior causing stress on the lumbar region of the back
What does moist skin indicate?
Sweating, exercise, exertion or fever Heart attack, hypoglycemia, shock
How do burns affect the respiratory system?
Swelling in the dace or throat may cause airway closure a.) May cause the lining of the larynx to swell and may cause fluid to accumulate in the lungs
What is edema?
Swelling in the tissues
What is epiglotitis?
Swelling of the epiglottis Sits upright, neck out and drools History of sore throat, fever and stidor
What is edema?
Swelling of the inner lining of the airways
What are the signs and symptoms of injuries to muscle and bone injuries?
Swelling, pain, deformity Discoloration Bones might break through the skin Usually associated with falls, collisions, disease
Safety measures for water scenes...
Swimming pools a.) Retrieving a patient should never be attempted alone b.) A personal flotation device and a line or pole to assist the rescuer and patient to the pool's edge should be used Open water a.) Specialized technique b.) Must wear a personal floatation device c.) Don't wear boots or heavy clothing Moving water a.) Never walk or wade into water
What is triage?
System for sorting patients to determine the order in which they will receive medical care or transportation Which need emergency care, which will live with a delay and care, and who will die regardless
What are the early signs and symptoms of decompensated (progressive) shock?
Systolic BP decreases, diastolic stays steady Tachycardia (>100 bpm) Tachypnea (>22 breaths/min) Peripheral pulses are weak or absent Skin pale, cool and clammy Thirst Agitation and anxiety increases
What are signs of severe hypoxia?
Tachypnea Dyspnea Cyanosis (bluish gray color to the skin, mucous membranes, and nail beds) Tachycardia that may lead to dysrhythmias (irregular heart rhythms) and eventually bradycardia (slow heart rate) Confusion Loss of coordination Sleepy apperance Head bobbing a.) Falling asleep while sitting upright Slow reaction time Altered mental status
Rate that is too fast (___) and leads to an inadequate tidal volume (___)
Tachypnea Hypopnea
What are the signs and symptoms of Hyperglycermic hyperosmolar nonketotic syndrome (HHNS)?
Tachycardia Fever Positive orthostatic tilt test Dehydration Thirst Dizziness Poor skin turgor Altered mental status Confusion Weakness Dry oral mucosa Dry, warm skin Polyuria Nausea and vomiting NO Kussmaul's respirations or fruity odor, no built up of ketones
What are some side effects of metered dose inhalers?
Tachycardia Tremors, shakiness Nervousness Dry mouth Nausea, vomiting
What are signs of mild to moderate hypoxia?
Tachypnea (increased breathing) Dypsnea (shortness of breath) Pale, cool clammy skin Tachycardia (increases in heart rate) Hypertension Restlessness and agitation Disorientation and confusion (from high carbon dioxide levels in the blood) Headache
What is the coccyx?
Tailbone Four fused vertebrae that form the lower end of the spine
What is the scene size up procedure?
Take Body Substance Isolation a.) Gloves, eye protection, surgical mask, HEPA or N-95 mask, gown, helmet, turnout gear Evaluate the scene for hazards a.) If the scene is not safe, do not enter until it is made sage b.) Protect yourself, your crew, the patient and bystanders c.) Retreat if necessary if the scene becomes unsafe Determine the mechanism of injury or the nature of illness (NOI) a.) Is the patient injured, ill or both? b.) Determine the mechanism of injury c.) Determine the nature of the illness d.) Is the MOI of NOI unknown at this time and unable to be determined until further assessment is done? Determine the number of patients at the scene Determine the need for additional resources to effectively manage the scene or the patient a.) Additional EMS units b.) Law enforcement c.) Fire department d.) Hazmat team
How should you perform a focused history and physical exam on patients with altered mental status and unknown history?
Take SAMPLE and OPQRST history Obtain baseline vitals a.) Rapid heart rate or slow heart rate, poor perfusion b.) Low BP or high BP c.) Low pulse ox, hypoxia d.) Check blood sugar
If a patient is experiencing chest pain, how should you take blood pressure?
Take the blood pressure in both extremities
How do you remove a helmet on a patient with a suspected spinal injury?
Take the patient's eyeglasses off first One rescuer should stabilize the helmet by placing hands on both sides of the helmet with fingers on the mandible A second rescuer should loosen the chin strap The second rescuer should place one hand anteriorly on the mandible at the angle of the jaw and the other hand at the back of the head The rescuer holding the helmet should pull the sides of the helmet apart and gently slip it off the patient's head and stop The rescuer who is maintaining in line stabilization should reposition sliding his hands under the patient's head Remove the helmet completely The patient should then be immobilized as described earlier Football Injury a.) Leave the helmet on the patient unless it is absolutely necessary b.) Face mask should be removed at the earliest possible point, but before transportation c.) Removal of the Face Mask i.) Have the proper tools ii.) Cut straps and remove, don't unscrew d.) Immobilization of the Player i.) One will take in line stabilization ii.) Every attempt must be made to apply a c collar
How should elderly patients be transported and positioned?
Take time to make sure the patient knows what is happened
What is the Los Angeles Prehospital Stroke Screen (LAPSS)?
Takes into consideration other possible causes of altered mental status a.) Hyperglycemia, seizures, hypoglycemia Age greater than 45 years History or seizures or epilepsy Duration of symptoms Wheelchair or bedridden status of a patient Blood glucose level Asymmetry a.) Facial smile, grip, arm strength
What is the respiratory system?
Takes oxygen from the air, transports it to the alveoli where the oxygen crosses over into the capillary and attaches the oxygen to the hemoglobin on the red blood cell or dissolves it in the plasma of the blood Blood transports the oxygen to body cells through the arteries and capillaries of the circulatory system The oxygen leaves the blood in the capillary and crosses over into the cell Also responsible for eliminating carbon dioxide, the major waste product of cell metabolism a.) Brought back to the lungs to be exhaled
What is false imprisonment?
Taking the patient to the hospital or medical care facility against his wishes Transferring a patient without consent
How should you perform a scene size up for patients with abdominal injuries?
Talk to bystanders Do not expect abdominal injuries to jump out of you (expose patient) When motor vehicle collision is involved a.) Type of vehicle b.) Approximate speed the vehicle was traveling (fast, slow, stationary c.) Type of collision and point of impact d.) Whether the patient was the driver, passenger, or a pedestrian e.) Where the patient is found and his position f.) Whether the patient was thrown from the vehicle g.) Impact marks to the windshield, steering wheel, and dashboard h.) Whether the seat belt was used Alcohol, head injuries, drugs may reduce a patient's response to pain
What is a brain laceration?
Tearing of the brain tissue
What are some common muscular injuries?
Tears, bruises, cut, crushed, torn Symptoms a.) Swollen, tender, painful, weak
What is a concussion?
Temporary loss of the brain's ability to function
What is volatility?
Tendency of the chemical agent to evaporate Volatile liquid evaporates easily and creates a dangerous breathable vapor
What are the signs and symptoms of a spinal injury?
Tenderness in the area of injury, specifically along the spinal column Pain associated with movement from the spine a.) Ask the patient to pinpoint the location verbally Pain independent from movement Deformity of the spine upon palpation Soft tissue injuries Numbness, weakness, tingling, or loss of sensation in the arms or legs Loss of sensation or paralysis below the suspected level of injury or in the upper or upper and lower extremities Loss of bowel or bladder control Priapism, a persistent erection Impaired breathing
How should you deal with car passengers?
The EMTs uniform or the emergency lights on the ambulance may be misinterpreted as the police by the occupants of a vehicle who may be intoxicated on alcohol or drugs Park the ambulance at least one car length behind the vehicle a.) Park with wheels turned to the left Align your headlights in the middle of the trunk of the vehicle and turn them to high beam Write down the license number of the vehicle Notice how many people are in the vehicle Be alert to the possibility of unseen patients Have your partner open the passenger door a split second before you open the driver's door Keep behind the center post If you have to retreat, immediately get in your vehicle and back up rapidly
What is automaticity?
The ability to generate an impulse on its own, even when disconnected from the central nervous system
What is battery?
The act of touching a patient unlawfully without his consent
What is the scope of practice?
The actions and care that are legally allowed by the state in which he or she is providing emergency medical care Also identifies which activities would be deemed illegal if performed without licensure or certification Establishes boundaries among professionals Were you allowed by law to do what you did How is it defined? a.) National Highway and Safety Administration's National EMS Scope of Practice Model b.) The US Department of Transportation's Standard curriculum
What is alveolar ventilation?
The amount of air breathed in that reaches the alveoli
What is the thyroid cartilage?
The anterior portion of the larynx The Adam's Apple
What organs are in the right lower quadrant (RLQ)?
The appendix, part of the large intestine, and the female reproductive organs
What is the subarachnoid space?
The arachnoid membrane and the pia mater are separated by a lattice of fibrous, spongy tissue filled with CSF
What is the face? What are the bones of the face?
The area between the brow and the chin Has 14 bones, 13 of which move Orbits - Eye sockets Nasal bones - The bed of the nose Maxillae - Fused bones of the upper jaw Zygomatic bones - Cheek bones Mandible - Lower jaw
What are arterioles?
The arteries are smaller the further they are from the heart The smallest kind of artery Carry blood from arteries to capillaries
What is capillary/cellular exchange?
The blood entering the capillaries surrounding the body's cells hs a high oxygen content and a very low carbon dioxide content Blood that is low in oxygen and high in CO2 and moves out of the capillaries and into the venous system where it is transported back to the lungs for gas and exchange
What is alveolar/capillary exchange?
The blood moving into the capillaries is deoxygenated a.) Lower concentration of oxygen b.) High in carbon dioxide Oxygen diffuses from the alveoli into the capillaries and the CO2 diffuses from the capillaries into the alveoli From this point, the blood in the capillaries is oxygenated
What is decompensated (progressive) shock?
The body will work to maintain adequate perfusion Blood will be shunted away from less vital organs and redirected to the heart, brain and lungs a.) Cannot correct itself without outside intervention Body's own protective mechanisms can no longer maintain and adequate blood pressure to the core organs Drop in systolic BP Early Compensation a.) Further increases in heart rate (>100 bpm) b.) Vasoconstriction that is more severe that shuts off more tissues, decreased urine output c.) Release of more epinephrine and norepinephrine from the adrenal medulla causing heart rate, contraction force of the heart, vasoconstriction to become more profound d.) Stagnation and build up of toxic waste products in cells and capillaries shut off from circulation
The amount of kinetic energy a moving body contains depends on two factors...
The body's mass (weight) The body's velocity (speed) Mass - Weight in lbs Velocity - Speed in feet per second Formula (mass x velocity(2))/2 Velocity is a much more significant factor than mass (because it's squared) The kinetic energy of the two vehicles will be combined
What is the femur?
The bottom of the femur is flat with two projections that form the hinged knee joint
What is kinetics?
The branch of mechanics dealing with the motions of material bodies
What is the standard of care?
The care that is expected to be provided by an EMT with similar training managing a patient in a similar situation The reasonable person standard a.) What would a reasonably prudent EMT with similar training do in the same situation b.) Also asks whether the EMT-B provided the care properly i.) Did the EMT provide the right assessment and emergency care for the patient ii.) Did the EMT-B perform the assessment and emergency care properly? Defined by a.) EMT Textbooks b.) Local and state protocols c.) US DOT's EMT Basic National Standard Curriculum d.) THE EMS system's operating policies and procedures
What does midclavicular mean?
The center of each of the collarbones down the anterior thorax
What does midaxillary mean?
The center of the armpit to the ankle
What are the three main subdivisions of the brain?
The cerebrum, cerebellum, and brain stem
How do you assess for chronic bronchitis?
Typically overweight Chronic cyanotic complexion Difficulty in breathing, less prominent than with emphysema Vigorous productive cough with sputum Coarse rhonchi usually heard upon ascultation Wheezes and possible crackles
What are the two parts of the skull?
The cranium The face
What is perfusion?
The delivery of oxygen and other nutrients to the cells of all organ systems and the effective elimination of carbon dioxide and other waste products
What is pulse pressure?
The difference between the systolic and diastolic pressure Minus diastolic from systolic If it is less than 25% of the systolic, it would be considered narrow If it was greater than 50% it would be considered widened
What are some considerations in frontal impacts?
The driver will continue to move forward at the same speed the vehicle is moving Will proceed to go up and over the steering wheel, causing injuries to the head, neck, chest and abdomen and possible ejection Or he will go down and under the steering wheel causing injuries to the knees, femurs, hips, acetabulum and spine Partial ejection is also possible a.) Severe soft tissue injuries
What is the Shock Position?
The feet and legs are elevated approximately 12 inches
What is blood pressure?
The force exerted by the blood on the interior walls of the arteries
What is hydrostatic pressure?
The force exerted on the inside of the vessel walls as a result of the blood pressure and volume an increase may cause the blood to force fluid out of the capillary wall
What is oxygenation?
The form of respiration in which oxygen molecules move across a membrane from an area of high concentration to low concentration
What is the calcaneus?
The heal bone
What is the xiphoid process?
The inferior portion of the sternum
What is the humerus?
The largest bone of the upper extremity Round head of the humerus fits into a shallow cup in the shoulder blade forming a ball and socket joint
In the ankle, what is the knobby surface landmarks of the ankle joint?
The lateral and medial malleolus
What is the radius?
The lateral bone of the forearm The thumb side
What is the peritoneum?
The lining of the abdominal cavity Has two layers, the visceral (innermost) and parietal (outer) pleura Two layers are separated by a space that contains fluid that acts as a lubricant
What organs are in the right upper quadrant (RUQ)?
The liver, gallbladder, part of the large intestines Right kidney is behind the abdominal lining
What is ventilation?
The mechanical process by which air is moved in and out of the lungs Primarily based on changes in pressure inside the chest that causes air to flow in or out of the lungs
What is ventilation?
The mechanical process of moving air in and out of the lungs
What is the ulna?
The medial bone of the forearm The little finger side
History taking precedes the physical exam and vital signs for a responsive medical patient for two reasons...
The most significant information will usually be obtained from what the patient tells you If the patient loses responsiveness, you will have lost the opportunity to get the history, whereas you can conduct the physical exam and obtain vital signs whether the patient is responsive or not For the trauma patient, the physical exam and vitals are done before history
How should you document during multiple casualty incidents (MCIs)?
The needs of patients can conflict with complete documentation Often, basic information like c/c, vital signs, and treatment provided is recorded on a triage tag that is attached to the patient
What is the cricoid cartilage?
The only completely circular cartilaginous ring of the upper airway Found just below the thyroid cartilage Obstruction of this can help prevent air from filling the stomach
When should you request air medical support?
The patient needs to be transported to a trauma center that is distant Patient is entrapped and a prolonged extrication is expected Air transport will save time Patient is in remote area Shock Acute stroke Head injury Chest or abdominal trauma Serious MOI Penetrating injury Time critical illness
What are some considerations in a rear end impact?
The patient's head and neck are whipped back If a head rest is properly positioned and a seatbelt is on, injury is minimized Whiplash a.) Hyperextenson and tearing of the anterior spinal ligaments
What is a laryngectomy?
The patient's larynx has been removed
What are key considerations in a head first fall?
The pattern of injury begins with the arms and extends up to the shoulders a.) Head may be hyperextended, hyperflexed or compressed b.) Cervical spine injury c.) Chest, lower spine and pelvic injuries are common
What are medical directors in the EMT field?
The physician who is legally responsible for the clinical and patient care aspects of the EMS system Also involved in EMS education Responsible for providing medical direction
What is the carina?
The point where the trachea splits into right and left bronchi
What is diastolic blood pressure?
The pressure exerted against the walls of the arteries when the left ventricle is at rest or between contractions Measures the resistance in the arteries between contractions
What is oxygenation?
The process by which the blood and the cells become saturated with oxygen Happens as a result of respirations
What is respiration?
The process in which fresh oxygen replaces waste CO2
What is respiration?
The process of moving oxygen and CO2 across membranes Deals with the actual gas exchange process
What is deceleration?
The rate at which a body in motion decreases its speed
What is acceleration?
The rate at which a body in motion increases its speed
What is vasogenic or neurogenic shock?
The result of head or spinal cord injury Causes the nervous system to lose control over the vascular system Blood vessels dilate causing blood to pool in periphery and BP decreases
What is the sagittal plane?
The sagittal plane divides the body into right plane and left plane
What are the kinetics of trauma?
The science of analyzing mechanisms of injury Helps you to predict the kind and extend of injuries as a basis for your priority decisions regarding continuing assessment, care and transport
What are the signs and symptoms of breathing difficulty?
The severity of complaint of shortness of breath does not correlate with hypoxia Shortness of breath (dyspnea) Restlessness, agitation, anxiety Increased heart rate or irregular heart rate, sudden decrease in heart rate Faster or slower than normal breathing Cyanosis Abnormal airway sounds Difficulty speaking Retractions Excessive use of diaphragm Shallow breathing, coughing Irregular breathing Tripodding, barrel chest Altered mental status, nasal flaring, tracheal indrawing Paradoxical motion Indications of chest trauma Pursed lips
What is a bone injury?
The sharp fragments may injure surrounding tissues such as nerves, vessels, and connective tissue If a bone is injured, the vessels within the bone may be torn or ruptured Look for signs and symptoms of bleeding at the fracture site
What is the scapula?
The shoulder blade
What does plantar mean?
The sole of the foot
What is barotrauma? What are the signs and symptoms?
The squeeze When air pressure in the body's air cavities becomes too great Air cavities are injured (sinus or eardrum) Signs and symptoms a.) Mild to sever pain b.) Clear or bloody discharge from nose or ears c.) Extreme dizziness d.) Nausea e.) Disorientation
What is the pediatric assessment triangle?
Used to determine the severity of an illness in a child Appearance, overall mental status, body position, muscle tone Work of breathing, visual effort or audible sounds Circulation, skin color
What is toxicology?
The study of toxins and antidotes
What are the meninges?
The three layers of protective membranes enclosing both the brain and the spinal cord
What is the pharynx?
The throat and the common passageway for food and air Air from the mouth enters through the oropharynx Air from the nose enters the nasal portion of the pharynx or the nasopharynx At its lower end, the pharynx divides into the esophagus which leads to the stomach and the trachea which leads to the lung The trachea is anterior to the trachea
What is capillary refill?
The time it takes for compressed capillaries to fill up again with blood More reliable in infants and children less than 6 years
What is the acromion?
The tip of the shoulder girdle
Pharynx anatomy in children...
The tongue is relatively large in portion to the size of the mouth Much more prone to airway obstruction by displacement of tongue at the level of the pharynx The epiglottis can protrude into the pharynx
MOI considerations for automobile crashes...
The type of collision will dictate the types of injuries to expect Types a.) Head on or frontal b.) Rear end c.) Side or lateral impact d.) Rotational impact collision e.) Rollover External impact to the vehicle from outside forces and internal impact to the vehicle by the patient's body External vehicle impact a.) Deformity to vehicle greater than 20 inches b.) Intrusion into the passenger compartment c.) Displacement of a vehicle axle d.) Rollover Patient impact a.) Impact marks on the windshield b.) Missing rearview mirror c.) Collapsed steering wheel d.) Broken seat e.) Side door damage f.) Cracked dashboard g.) Deformed pedals h.) Use of restraint devices and deployment of airbags
What is a rip and blitz disentanglement?
The vehicle is cut from around the patient Sequence a.) EMT enters vehicle and gains c-spine control i.) Chocks are put under the wheels b.) Ignition should be shut off i.) The patient should be covered with a retardant blanket c.) Hydraulic spreaders are used to poop the rear door i.) The in between post should be cut d.) The roof should be removed e.) Jacking the dash or performing a dash roll
What are signs of inadequate ventilation?
The ventilation is too fast or too slow a.) Gastric distention The chest does not rise and fall with artificial ventilation The heart rate does not return to normal Color does not improve
What is behavior?
The way a person acts or performs All of a person's activities and responses
How should you provide emergency medical care to patients with nuclear detonation and radiation injuries?
Thermal burns, blunt trauma, pressure injuries, radiation exposure Primary concern is personal safety Manage airway and breathing a.) PPV and oxygen Manage burns a.) Sterile dressing or sterile burn sheets Irrigate contaminated wounds and apply sterile dressings
What are vertebrae?
These bones are irregular shaped and bound together by strong ligaments Between each vertebrae is a filled pad of tough elastic cartilage called the intervertebral disc
What are some special considerations for side impact or head protection airbags?
These deployment systems may utilize high pressure stored gas cylinders to deploy the airbag, which can cause serious injuries to rescue personnel
What is a deep partial thickness burn?
Thick walled blisters that often rupture a.) Tend to rupture with body motion Skin is red and blanched white a.) Deeper levels are injured Patient can still feel pressure at sight a.) Pressure receptors are still intact Poor capillary refill to burn sight a.) Increased edema compromises capillary beds
What is the parietal pleura?
Thicker more elastic layer that adheres to the inner portion of the chest wall Retains the lungs structure and prevents them from collapsing
What is visceral pleura?
Thin layer of connective tissue Covers the outer surface of the lungs
What is a superficial partial thickness burn?
Thin walled blisters a.) Result from superficial dermal layer damage Skin is pink and moist a.) Moisture is caused by small leaks in the capillary beds caused by the burn Skin is soft and tender to the touch a.) Skin resiliency and hydration are normally preserved
How do assess for emphysema?
Thin, barrel chest appearance Coughing but with little sputum Prolonged exhalation Diminished breath sounds Wheezing and rhonchi Pursed lip breathing Extreme difficulty breathing Pink complexion Tachypnea or tachycardia Diaphoresis Tripod position May be on home oxygen
What is a full thickness burn?
Third degree burn Involves all layers of the skin Contact with extreme heat sources such as hot liquids or solids, flame, chemicals or electricity Skin will be dry, hard, tough and leathery May appear white and waxy to dark brown or black and charred Eschar a.) Tough and leathery dead soft tissue Will not be very painful because nerve endings have been destroyed a.) There will be surrounding burns of varying thickness that can cause intense pain Trapped in confined space with flames or exposed to a high heat source or chemical contact
What is a hemothorax?
Thoracic cavity is filled with blood, the lung is compressed Hemopneumothorax a.) Blood and air May be the result of blunt or penetrating trauma Bleeding originates from large blood vessels in the chest Severe shock can result Signs and symptoms a.) Similar to shock b.) Respiratory distress c.) Pink, frothy spitum Treatment a.) Same for pneumothorax and shock
What are alveoli?
Thousands of air sacs enclosed in a network of capillaries At the ends, site of gas exchange in the lungs
How should you administer emergency care for hypothermia?
Three basic principles a.) Preventing further heat loss b.) Rewarming patient as quickly as possible c.) Staying alert for complications Remove the patient from the cold Handle the patient gently Administer oxygen CPR or AED if needed If the patient is alert and responding properly, actively rewarm him a.) Active rewarming i.) Aggressively applying heat to warm the patients body 1.) Blankets, heat pack, hot water bath ii.) Heat should be added to patient gradually and gently b.) No more than 1 degree increase per hour If the patient is unresponsive, do not actively rewarm, use only passive rewarming a.) Passive rewarming i.) Inhibiting further heat loss by wrapping the patient with blankets than increase the heat in the patient compartment of the ambulance Do not allow the patient to eat or drink stimulants Never rub or massage the patients arms or legs Transport as quickly as possible
How does the body cool itself?
Three organs a.) The skin b.) Cardiovascular system c.) Respiratory system As core temperature rises, warmed blood travels to the periphery and blood vessels near the skin's surface dilate Increase in cardiac output, maintain the BP Respiratory system will contribute to cooling by eliminating heat through evaporation during exhalation
What are the two types of ischemic stroke?
Thrombotic stroke Embolic stroke
When should you consider immediate transport?
Throughout the focused history and physical exam, continually keep in mind the possibility of initiating immediate transport if evidence is discovered
The adams apple or the ___ ___ is anterior cartilage that covers the larynx
Thyroid cartilage
What is respiratory failure?
Tidal volume or respiratory rate becomes inadequate Requires immediate bagged valve ventilation
What are capillaries?
Tiny blood vessel that connects an arteriole to a venule Has walls that allow for exchange of gases, nutrients, waste
What is the pleural cavity?
Tiny space with negative pressure that allows the lungs to stay inflated
When should you communicate with dispatch?
To acknowledge the dispatch info To estimate your time of arrival at the scene To announce your units arrival at the scene To announce the unit's departure and the destination hospital, the number of patients and ETA of hospital To announce your arrival at the hospital To announce that you are clear and available for another assignment To announce your arrival back to base
What is the talk down technique?
To be used for managing violent drug or alcohol abuse patients Intense anxiety or panic, mood changes, bad trip, disorientation, inability to distinguish between reality and fantasy Make the patient feel welcome Identify yourself clearly Reassure the patient that his condition is caused by the drug and will not last forever Reiterate the patient that his condition is caused by the drug and won't last forever Help the patient verbalize what is happening to him Reiterate simple and concrete statements Forewarn the patient about what will happen as the drug beings to wear off Once the patient has calmed, transport
When should you remove contact lenses?
To detect lenses, shine a penlight into the eye at an angle a.) Soft lenses with show up as a shadow on the outer portion of the eye b.) Hard lenses will show up as a shadow over the iris Remove if a.) There has been a chemical burn to the eye b.) The patient is unresponsive, is wearing hard contacts, and transport time will be lengthy or delayed Don't remove if a.) The eyeball is injured b.) Transport time is short enough to low ED to remove
What is the function of the muscles and skeleton?
To give the body shape To protect the internal organs To provide for movement
What is the purpose of a focused history and physical exam?
To identify any additional injuries or conditions that may also be life threatening
Effects of frontal air bags in car accidents...
To reduce injury with front and broad side impact Do not work well in multiple collisions or roll overs Significant injury may result from deployment a.) Head, spine, eye, facial, and arm injuries
What does lateral mean?
To the left or right of the midline
What does simple access mean?
Tools are not required
What is systolic blood pressure?
Top number Amount of pressure exerted on the walls of the arteries during contraction and ejection of blood from the left ventricle Korotkoff's sound a.) First distinct sound when measuring blood pressure
What is Dalton's Law?
Total pressure of a mixture of gases equals the sum of the partial pressures of the individual gases that make up the mixture Nitrogen dissolves in blood
What is eschar?
Tough and leathery dead soft tissue
What are ligaments?
Tough fibrous connective tissue Bony framework is held together by ligaments
What does inferior mean?
Toward the feet or below the point of reference
What does ventral mean?
Toward the front or belly (abdomen)
What does posterior mean?
Towards the back
What does dorsal mean?
Towards the back or spine
What does anterior mean?
Towards the front
What does superior mean?
Towards the head or above the point of reference
What does medial mean?
Towards the midline or center of the body
What is an EMT-Paramedica (EMT-P)?
Trained in all aspects of prehospital emergency care Can start iv lines, administer medication, inserting endotracheal tubes, decompressing the chest cavity, reading EKGs, using manual defibrillator, needle jet insufflation, advanced cardiac life support
What is radiation (temperature)?
Transfer of heat from the surface of one object to the surface of another without physical contact Mostly through feet, head, and hands Accounts for approximately 55-65% of heat loss
What is the draw sheet method?
Transferring supine patient from bed to a wheeled stretcher Procedure a.) Loosen bottom of the sheet b.) Position the stretcher next to the bed, adjust height c.) Reach across the stretcher and grasp sheet firmly at the head, chest, hips and knees d.) Slide the patient onto stretcher
What are the benefits and disadvantages of using cell phones as an EMT?
Transmit and receive through air rather than over wires Benefits a.) Excellent sound quality, availability of channels, easy maintenance, increased privacy of communications Disadvantages a.) They are part of the public phone system and can easily be overwhelmed during multiple casuality disasters
How should you deliver emergency medical care to a breech birth patient?
Transport immediately a.) Administer oxygen b.) Keep mother supine and head down with pelvis elevated Do not attempt to deliver in the field Procedure a.) Position mother with buttocks at edge of surface b.) Have her hold her legs in a flexed position c.) As the infant delivers, do not pull on the legs d.) Allow the entire body to be delivered as you simply support it e.) Insert fingers into vagina and form a V where baby can breathe f.) Transport in this position
Carbon dioxide is carried in three ways...
Transported in blood as bicarbonate, attached to hemoglobin and dissolved plasma 70% in bicarbonate
What is a tension pneumothorax?
Trapped air can collapse the lung on the injured side and compress the large vessels in the heart
What is subcutaneous emphysema?
Trapped under the lower layer of the skin Indicator of significant chest or neck injury Feels like bubble package wrap
What are predisposing factors to frost bite?
Trauma Extremes of age Tight or laced footwear Alcohol use Wet clothing High altitudes Loss of blood Atherosclerosis
How should you conduct a focused history and physical exam for musculoskeletal injuries?
Trauma Assessment a.) If pt is unresponsive, there are multiple injuries, of the MOI is significant Focused physical exam a.) If pt is responsive and multiple injuries are not suspected b.) The MOI is not significant Inspect and gently palpate the bone a.) Assess joint above and below injury b.) Check DCAP-BTLS c.) Check cap refill and PMS Check vitals and obtain SAMPLE
What are the posterior tibial arteries?
Travels from the calf to the foot Can be felt posterior to the medial malleolus (ankle bone)
What is purposeful movement?
Try to move away from the pain
What is a first responder?
Typically the first person on the scene with EM care training May be a police officer, fire fighter, truck driver Trained to provide immediate medical care Responsible for controlling the scene, preparing for EMS arrival, relaying information to EMS
What is the minimum data set of prehospital care report (PCR) data?
US DOT making an effort to standardize the information collected on PCRs Higher level of patient care
What are some ground rules for radio communication?
Turn on radio and choose the correct frequency Listen before transmitting Push the press to talk button before speaking Speak with your lips 2 to 3 inches away Address the unit being called by its name and number, then identify your unit The unit will signal you to begin Keep the transmission brief Keep your transmission organized and to the point When transmitting a number, say the number and then the individual digits Avoid offering a diagnosis When receiving orders or info from dispatch, use the echo method a.) Immediately repeat the order word for word Write down any important information Protect your patient's privacy Use we rather than I Use affirmative and negative rather than yes or no When you are finished, say over
How can the EMT help to improve the environment?
Turning off TV Provide light Consider moving furniture Consider moving the patient to a more conducive environment Maintain an escape route and keep it open Pay attention to bystanders Control the scene Stay calm Use tact and diplomacy Be flexible Be open minded Be alert Be compassionate
What is pronation?
Turning the forearm so the palm is turned toward the back
What is supination?
Turning the forearm so the palm of the hand is turned toward the front
Death from hypothermia can occur within ___ hours of the first signs and symptoms.
Two hours
What are the bronchi?
Two main tubes that the distal portion of the trachea branches into Each bronchi divides into smaller bronchioles a.) Lined with smooth muscle and have the ability to constrict (bronchoconstriction) or dilate (bronchodilation)
What is a flail segment?
Two or more ribs have been fractured in two or more places Free moving section of the chest wall Paradoxical movement Underlying contusion to the lung is a more serious injury Stabilization a.) Reduces paradoxical movement and improves ventilation b.) Splinting the flail segment c.) Positive pressure ventilation with supplemental oxygen
What is the female reproductive system?
Two ovaries Two fallopian tubes Uterus Vagina External genitals
What is the male reproductive system?
Two testes Duct system Accessory glands (prostate) Penis
If an injury to the chest is ____, a significant amount of air will be sucked in
Two thirds the internal diameter of the trachea About the size of nickel
What is a normal blood pressure for an adult female?
Typically 8 to 10 mmHG lower than adult male, add 90 to a patient's age Diastolic is normally 60-85mmHG
What is a prolapsed cord?
Umbilical cord is the first to present Umbilical cord may get compressed against the wall of the vagina and the bony pelvis by the pressure of the infant's head a.) Oxygen supply can be cut off Predisposing factors a.) Prematurity, multiple births, premature rupture of amniotic sac
What is the umbilical cord?
Unborn infant's lifeline Attaches the fetus to the placenta One vein and one artery in spiral arrangement Wharton's jelly a.) Protective substance Veins carry oxygenated blood, arteries deoxygenated blood 22 inches long, 1 inch in diameter
What is a voluntary muscle?
Under control of the brain and nervous system Can be contracted and relaxed by will Deliberate movement Often referred to as skeletal muscle Can be broad and flat or long and rounded
What is the sublingual route of medication administration?
Under the tongue Patient does not swallow Dissolved across membrane Patient must be alert Nitroglycerin tablets Nitroglycerin spray
What are medication side effects?
Undesired effects Some are predicable and some are not Nitro - lowered BP, headache, pulse rate changes
What do unequal pupils indicate?
Unequal pupils may indicate a stroke, head injury, disease of the eye, use of certain eye drops, injury to the eye or pupil nerve
What is anisocoria?
Unequal pupils, 6-10% of the population
What are atria?
Upper chambers, receive blood from the veins R atrium receives oxygen depleted blood from the veins L atrium receives oxygen rich blood from the pulmonary veins
What are some pressure points in the upper and lower extremities?
Upper extremities a.) Use brachial artery pressure points b.) Midway between the shoulder and the elbow c.) Use the flat surface of your finger to compress the artery against the bone Lower extremities a.) Use the femoral artery b.) Located in the crease between the abdomen and the groin
When should you consider using a tourniquets?
Used only as a last resort to control bleeding It can cause all blood flow to cease and should only be used for an injury that cannot be controlled by any other method It can cause permanent damage to nerves, muscles and blood vessels Precautions a.) Always use a wide bandage b.) Once applied, secure the tourniquet tightly i.) Do not remove it or loosen it c.) Never apply a tourniquet directly over a joint, but as close to an injury as possible d.) Make sure the tourniquet is in open view
How do you apply a tourniquet?
Use a bandage 4 inches wide and four to six layers thick Wrap it around the extremity twice at a point proximal to the bleeding but as distal on the extremity and as close to the injury as possible Tie a knot in the bandage material and place a stick object on top of it a.) Tie the ends of the bandage over the stick Twist until the bleeding stops After the bleeding has stopped, secure the stick type object in place Notify other emergency personnel that a tourniquet has been applied Document the use of the tourniquet and the time it was applied In some cases, a blood pressure cuff can be used
How to immobilize a child or an infant?
Use a rigid board appropriate for the child's size Pad from the shoulders to the heels of an infant or child Make sure the c collar fits properly a.) If not, use rolled towel
How do you protect confidentiality when working with patients?
Use care and discretion when answering questions about the patient
What are police escorts?
Use police or other emergency vehicles for an escort Should be last resort cause it is very dangerous
How should you assess an infant after delivery?
Use the Apgar score Stimulation a.) Flicking feet, rubbing back Signs and symptoms a.) Severely depressed newborn i.) Heart rate over 60 per min ii.) Diminished breath sounds iii.) Heart rate over 180 or under 100 iv.) Obvious signs of trauma v.) Poor or absent muscle tone vi.) Respiratory arrest or distress vii.) Heavy meconium staining viii.) Weak pulses ix.) Cyanotic body x.) Poor peripheral perfusion xi.) Lack of or poor response to stimulation xii.) Apgar score under 4
To move a heavy object...
Use the leg, hip, and gluteal muscles plus contracted abdominal muscles a.) Will create a huge amount of power safely b.) Avoid using back muscles Keep the weight of the object as close the body as possible a.) Back injury is more likely while reaching a great distance than reaching a short distance Stack a.) Visualize the shoulders as stacked on top of the hips and the hips stacked on the feet b.) Avoid twisting forces Reduce the height or distance through which the object must be moved a.) Get closer to the object b.) Lift in stages if necessary
Considerations for children when assessing extremity trauma...
Use the proper immobilization device
What is a shirt drag?
Use the shirt to support the head and pull Procedure a.) Fasten the patients hand or wrist loosely together b.) Grasp the neck and shoulders of the shirt so that the patient's head rests on your wrists c.) Using the shirt, pull the patient toward you i.) Don't strangle the patient
What are metered-dose inhalers (MDIs)?
Used by patients who have some type of respiratory disease Asthma, emphysema, chronic bronchitis Bronchconstriction in the bronchioles in the respiratory tract will constrict, increasing the resistance to air flowing into the lungs and down the alveoli The only MDI that you are able to administer to assist the patient is one that contains a beta 2 agonist drug a.) Will cause the bronchioles to dilate, decreasing airway resistance
What is the head tilt-chin lift?
Used for opening the airway of a patient who has no suspected spinal injury May be supplemented with a mechanical airway device Procedure a.) Place one hand on the patient's forehead and apply firm, backward pressure with the palm of the hand to tilt the head back i.) Place the tips of the fingers of the other hand underneath the bony part of the lower jaw b.) With the head tilted back, lift the jaw upward to bring the patient's chin forward c.) Continue to press the other hand on the forehead to keep the head backward d.) Lift the chin and jaw so they are brought nearer together e.) If the patient has loose dentures, hold them in position making obstruction by the lips less likely Needed in a.) Unresponsive patient with no suspicion of spinal trauma b.) Cardiac arrest not due to trauma c.) Apneic (not breathing) patient with no signs of trauma
What is the Glasgow Coma Scale?
Used to rank level of consciousness by assigning a numerical score from 3 to 15 A GCS of 8 or less indicates a severe alteration in the brain function
What is nitroglycerin?
Used to treat cardiac patients with diseases of the coronary arteries that deliver blood to the heart Vasodilator a.) Reduces the workload of the heart Side effect a.) Hypotension, low blood pressure b.) Must not be administered to patients taking medications for erectile dysfunction c.) Serious drops of blood pressure and death
What is epinephrine?
Used to treat patients suffering from severe allergic reactions known as anaphylaxis The patient's blood vessels will dilate, decreasing the BP and perfusion, the bronchioles will constrict increasing the airway resistance and making it difficult to move air into the alveoli and the capillaries will leak fluid out causing the blood volume to decrease
What is stair chair? How do you use it?
Useful when wheeled stretchers cannot traverse narrow doorways, small elevators and stairways Do not use when the patient a.) Has altered mental status, suspected spinal injury or injuries to the lower extremities Procedure a.) One rescuer should stand behind the chair and another should stand at the foot facing the patient i.) Third should be prepared to spot b.) Chair is tilted back by the rescuer at the head and the rescuer at the foot should grasp the chair by its legs c.) Both should lift and carry simultaneously d.) Spot should count the steps
What is a portable transmitter/receiver?
Useful when you are out of your vehicle May be used at medical direction when they are stationed at a hospital that has no radio
How do we determine the abdominal quadrants?
Using the navel or umbilicus as the central reference point Four imaginary lines, much akin to a tic-tac-toe board Umbilicus in the center of the middle box From the patients right to left from the top row down a.) Right hypochondriac, epigastric, left hypochondriac b.) Right lumbar, umbilical, left lumbar c.) Right iliac, hypogastric, left iliac
What is a flail segment?
Usually a closed injury that occurs when two or more adjacent ribs are broken in two or more places May result from more than one rib being fractured and separated from the cartilage along the edge of the rib cage Central or sternal flail segment may result from the ribs being separated from the cartilage on both sides
What are some characteristics of syncope (fainting)?
Usually begins in a standing position Patient remembers feeling faint or lightheaded Patient becomes responsive almost immediately after becoming supine Skin is pale and moist
What is Type II diabetes?
Usually develop in adulthood Typically secrete insulin, but it may not be effective in triggering the receptor cites on the cells to open the channels that allow glucose the enter the cells Other Type IIs don't secrete enough insulin Glucose accumulates in the blood raising blood glucose levels Can control by diet, exercise and oral medication, or insulin Will typically take oral hypoglycemic drugs a.) Stimulate insulin secretion by the pancreas and promote increase in the number of insulin receptors on the cells or reduce the amount of sugar absorbed into the blood from the small intestines Non insulin dependent diabetes mellitus (NIDDM) Do not have to take insulin Regulate through diet and oral drugs to help pancreas secrete more insulin Usually middle aged or older and overweight Prone to hyperglycemia and hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
What are the common causes of abdominal pain?
Usually due to one of the following three mechanisms a.) Mechanical forces (stretching) b.) Inflammation c.) Ischemia (organ and tissue hypoxia) Usually do not cause a perception of tearing or cutting sensation, except for the aorta a.) Pain is from the blood irritating the peritoneum b.) Inflammation or swelling of the capsule The rapid distention of an organ will cause a rapid onset of pain a.) If the distention of the organ is gradual, the patient experiences little pain Stretching of the peritoneum will also cause pain a.) May be due to distention that tugs on the peritoneum, adhesions (scar tissue) from surgery or a previous injury or forceful movement of the small intestine associated with a bowel obstruction b.) Pregnant woman in third trimester might not feel stretching Pain from the stretching of a solid organ is usually a steady type of pain Inflammation of a hollow organ may irritate the lining of the walls of the organ causing a crampy type of pain Pain associated with ischemia (hypoxia) to an abdominal organ will be steady and severe and will worsen
What is a normal pulse ox?
Usually high 90s, 97% and 100% Any reading under 95% is worrisome
Mouth and nose anatomy in children...
Usually smaller than those of adults More easily obstructed by foreign bodies Infants are obligate nose breathers Especially important to keep the nose clear of obstructions
What is a ruptured uterus?
Uterine wall becomes thin during pregnancy Lead to spontaneous or traumatic rupture Fetus released in abdominal cavity Mortality for mother is 5-20%, for fetus, over 50% Needs immediate surgery
What are the signs and symptoms of abruptio placentae?
Vaginal bleeding associated with constant abdominal pain Pain in lower back Abdomen is tender Bleeding can be dark bright or red Bleeding may be severe Signs and symptoms of shock
What is acute coronary syndrome (ACS)?
Variety of conditions in which coronary arteries are narrowed or occluded by fat deposits a.) Unstable angina b.) Myocardial infarction Myocardial ischemia a.) Lack of blood supply b.) Deficient supply of oxygen c.) Discomfort and chest pain
In a car accident, there are three collisions...
Vehicle collision a.) The vehicle is suddenly stopped and gets bent out of shape Body Collision a.) The patient comes to a quick stop on some part or parts of the inside of the vehicle, such as the steering wheel, causing injury to the chest Organ collision a.) The patient's internal organs, which are all suspended in their places by tissue, come to a quick stop
The right atrium receives oxygen depleted blood from the ___.
Veins
What are some common causes of allergic reaction and anaphylaxis?
Venom a.) Insect bites or stings b.) Snake or spider venom Foods a.) Peanuts, nuts, milk, eggs, shellfish, whitefish, food additives, chocolate, cottonseed oil, berries Pollen a.) Plants, especially ragweed and grasses Medications a.) Anesthetics, aspirin, seizure medications, muscle relaxants, nonsteroidal anti inflammatory agents, vitamins b.) Side effect is not an allergic reaction Other substances a.) Glue Exercise a.) Certain foods close to the time of exercise Latex
What are shockable rhythms for an AED?
Ventricular fibrillation (VF, V-Fib) Ventricular tachycardia (V-tach)
The spinal column is made up of 33 irregularly shaped bones called ___
Vertebrae
What is ventricular tachycardia (V-Tach)?
Very fast heart rhythm Heart does not fill properly and output is reduced Can degenerate into V-fib a.) Heart beats above 180 Some are still responsive, they are not defibrillation candidates Only to patients who are pulseless, not breathing and unresponsive
What is a solid organ?
Very vascular Some are covered by a thick fibrous capsule (liver, spleen, and gallbladder) Tends to bleed profusely, leading to severe shock
What are the coronary arteries?
Vessels that supply the heart with blood
When should you use a short spinal immobilization devices?
Vest type device with supplied straps for the head, chest and legs Require a significant amount of time to apply
What are the three types of abdominal pain?
Visceral pain Parietal pain Referred pain
What is the pleural lining of the thorax?
Visceral pleura a.) Innermost layer and is contact with the lung Parietal pleura a.) Outermost layer and is in contact with the thoracic wall Two pleural layers are separated by serous fluid that provides lubrication to reduce the friction between them
What does the prefix 'vol' mean?
Volume
What are the three kinds of muscles?
Voluntary (skeletal) Involuntary (smooth) Cardiac (heart)
What are the signs and symptoms of an esophageal varice?
Vomiting large amounts of bright red blood Absence of pain or tenderness in the abdomen Rapid pulse Breathing difficulty Pale, cool and clammy skin Signs and symptoms of shock Jaundice
What is cholera?
Vomiting, abdominal distention, watery diarrhea, dehydration, death, hypovolemic shock
What is tidal volume?
Vt The depth or the amount of air breathed in with each breath
What is cardiac hypertrophy?
Walls of heart become thickened Heart unable to hold as much blood, less blood ejected with each contraction Decrease in cardiac output
What is thermal gradient?
Warmer temperatures moving toward cooler temperatures The amount of heat lost by the body must equal the amount of heat gained by the body
What is an aura?
Warning that a seizure is coming May be a sound, abnormal twitch, anxiety, dizziness, smell or odor, unpleasant feeling in the stomach, visual disturbances, odd taste
What is water chill?
Water and wet clothing will conduct heat away from the body much faster than the body can produce
What is the rule of nines?
Way to quickly determine the amount of skin surface or body surface area (BSA) percentage Applied to burns that are partial thickness or full thickness Adult a.) 9% i.) Head and neck ii.) Each upper extremity iii.) Lower back iv.) Anterior of each lower extremity v.) Upper back vi.) Chest vii.) Abdomen viii.) Posterior of each lower extremity b.) 1% i.) Genitals Infants and Children a.) 18% i.) Head and neck ii.) Chest and abdomen iii.) Entire Back b.) 9% i.) Each upper extremity c.) 14% i.) Each lower extremity For children over the age of 1 year, fore each year beyond 1, add 0.5% to each leg and subtract 1% for the head Will be used until the rule of 9s are reached Palm is 1%
What is an abdominal aortic aneurysm?
Weakened, ballooned, and enlarged area of the wall of the abdominal aorta One of the most lethal causes of abdominal pain a.) Approximately 2 percent of the population and 205 of men over age 50 will have an abdominal aortic aneurysm Palpate the abdomen very gently
What are the signs and symptoms of a subdural hematoma?
Weakness or paralysis to one side of body Deterioration in LOC Vomiting Dilation of one pupil Abnormal respirations Decreased pulse rate Possible increase in systolic BP Headache Seizures Confusion Personality change
What is ricin?
Weakness, fever, cough, hypothermia 36 hours after exposure Death in next 12 hours by hypotension and CV collapse
What is the brain?
Weighs about 3 pounds Does not store glucose and requires a constant supply
What is a compression spinal injury?
Weight of the body is driven against the head Common in falls, diving accidents, MVC, or other accidents when a body falls head first
What are three types of abdominal breath sounds?
Wheezing Rhonchi Crackles
What is paradoxical movement?
When a section of the chest sinks inward upon inhalation while the rest is moving outward, and upon exhalation bulges outward while the rest of the chest is moving inward May be seen when two or more adjacent ribs are fractured in two or more places a.) Termed a flail segment Must immediately place your hand over the section to stabilize it in an inward position
Follow up during MCIs...
When all patients have been moved, personnel should go to hospital and help out Incident manager should remain at scene
How do you correct errors in a prehospital care report (PCR)?
When an error in filling out the PCR is discovered, draw a single horizontal line through the error, initial it, and write down the correct information When an error of omission or commission occurs, the EMT should not try to cover it up Falsification of data will compromise patient care Commonly, vital signs and treatment are falsified
What is a stroke?
When blood vessel in the brain becomes blocked or ruptures Increases intracranial pressure (ICP) Level of CO2 in brain increases, cerebral vessels dilate Oxygenation, ventilation, transport, Fowler's or lateral recumbent
What is hypothermia?
When body loses more heat than it gains Less than 95F Increase in body's heat loss, a decrease in body's heat production, or both Can be sudden or gradual
What is respiratory arrest?
When breathing effort ceases completely Can lead to cardiac arrest in minutes
How should you take SAMPLE history on a patient with a suspected head injury?
When did the incident occur? What is the chief complaint? How did the incident occur? Did he lose consciousness at any time? Was the patient moved after the incident? Is there a history of previous blow to the head?
What are some key questions to ask with a stroke patient?
When did the symptoms begin? a.) Drugs need to be administered in 3 hours Is there any recent history of trauma to the head? Does the patient have a history of previous stroke Was there any seizure activity noted prior to your arrival? What was the patient doing at the onset of symptoms? Does the patient have a history of diabetes Has the patient complained of a headache or stiff neck? Has the patient complained of dizziness, nausea, vomiting or weakness? Has the patient experienced any slurred speech? Does the patient take anticoagulants? Does the patient have history of hypertension? Has the patient taken amphetamines, cocaine or other drug? Was the onset gradual or sudden? Did the symptoms get worse or better? Does the paralysis effect one part of the body then progress? Doe s the patient have history or a fib or irregular heart beat?
What is the disease process of diving emergencies? What is the main complication?
When diving, drastic increase of pressure on body Major complication is coma a.) From asphyxiation, head injury, heart attack, air tank contamination, intoxication, aspiration, decompression sickness, arterial gas embolism, barotraumas
What is bronchiolitis?
When mucosal layer within bronchioles in the lungs becomes inflamed by a viral infection Child will wheeze loudly Apply oxygen Let child assume position of comfort, in a Fowler's position Monitor pulse rate and mental status
What should you do if a birth presents with a limb presentation?
When one arm or leg is first to protrude Never attempt to deliver in the first, transport immediately Oxygen and knee-chest position Never pull on limb, tell mom to pant
What is radiation poisoning?
When patient has been exposed to dangerous amounts of internal radiation Cancer, anemia
What is a supine hypotensive syndrome?
When patient is supine, combined weight of uterus and fetus press on the vena cava (sends blood from lower body to heart) Drop in cardiac output, be alert for syncope Place patient in a seated position or laying on left side to relive pressure
What is respiratory failure?
When respiratory rate and tidal volume are insufficient Results in hypoxia
What is blood pressure?
When the L ventricle contracts, it ejects blood through the aorta and throughout the arteries of the body The pressure that is exerted on the walls of the arteries is the blood pressure
What is a lateral bending spinal injury?
When the body is bent severely from the side
What is an open injury?
When the continuity of the skin is broken Risk for bleeding and contamination First indicator of a deeper, more serious injury
What is shoulder dystocia?
When the fetal shoulders are larger than head Head will be delivered, but retract because the shoulders are caught Turtle sign Seen in mothers with diabetes and those past due dates Do not pull on the head Transport and have mother pant
What is crowning?
When the infant's head appears at the opening of the birth canal Push with each contraction 50-60 minute duration for first time mother (20-30 for mothers who have delivered before)
What is a pulse?
When the left ventricle contacts, it sends a wave of blood through the arteries Can be felt at pulse points Can be felt where an artery passes over a bone
What is radiation contamination?
When the patient comes in direct contact with radiation
What is respiratory arrest?
When the patient completely stops breathing Apnea Causes a.) Stroke, heart attack, OD, toxic inhalation, electrocution and lightening strike, suffocation, trauma to head, spine chest or abdomen, infection of the epiglottis, airway obstruction
What is neorologic deficit?
When the patient loses awareness of surroundings, alertness, speech, and brain and nervous functions Deficiency in the functioning of the brain or nervous system Altered mental status, slurred or absent speech, paralysis, weakness, and numbness
What is a distraction spinal injury?
When the vertebrae and the spinal cord are stretched and pulled apart Common in hangings
When should you perform an emergency move?
When there is immediate danger to patient or EMT
What is the proper technique for pushing and pulling?
Whenever possible, push rather than pull If an object must be pulled, keep the load close to your body and between your shoulder and hips Keep back straight and bend knees Push a.) Push from the areas between waist and shoulders b.) Use the kneeling position to avoid bending
What is the purpose of the nose and mouth?
Where air enters the body It is warmed, moistened and filtered
What are joints?
Where one bone connects to another Some are immovable and some are slightly movable
What are the signs and symptoms of partial thickness burns?
White to cherry red skin Moist and mottled skin Blistering and intense pain
What is a chief complaint?
Why did you call the EMS? a.) If the patient is unable to answer, the c/c may be the response of the family member who made the call b.) May have to do with the pain, abnormal function, changes in function from a normal state, or an observation made by you c.) Quickly ascertained during the general impression phase of the initial assessment d.) Do not always assume that the original complaint is the true chief complaint e.) It is important to ask addition questions that may refine the chief complaint Why did you call the EMS today? a.) What has changes to make him more concerned b.) In unresponsive patients, the chief complaint may need to be established through family, friends, or bystanders at the scene
How do the pupils react to light?
Will constrict when light is shone in them The pupils will dilate in a dark environment
What is a transient ischemic attack (TIA)?
Will experience the same symptoms as stroke but will disappear between 10 and 15 minutes but always between 1 hour a.) Does not make permanent damage Important to recognize and report A third of those who suffer from TIA will eventually have a stroke a.) Many within a month of the TIA
How can the EMT protect the patient?
Will expose the patient to the curiosity of the public Fall on a sidewalk on a hot, sunny day a.) Place the patient on the backboard as soon as possible Fall in a wet, slushy parking lot in mid winter a.) Place he patient on backboard as soon as possible Shade a patients face from snow or precipitation Ask the bystanders to stand with their back to patient and hold up a sheet
What is paradoxical movement?
Will flail around and move in the opposite direction to the rest of the rib cage during respiration
What is flexion or decorticate posturing?
Will flex their arms around their chest and extending their legs Indicates an upper level brain stem injury
What is an antidotes?
Will neutralize the effects of poisons Only available for a small number of poisons ALS may have medication on hand
What is decompression sickness?
Will occur as the result of bubbles formed by expansion of nitrogen in the blood and tissues a.) Can cause cell damage and lead to organ dysfunction b.) Act as emboli and cause obstruction c.) Compress or stretch the blood vessels and nerves d.) May cause coagulation to occur
What will breathing quality tell you?
Will tell you the volume of air moving and how well its moving Abnormal, shallow, labored, noisy
What is an embolism?
Will usually originate from the carotid artery Will lock blood flow in the brain Often made of clotted blood but may consist of air bubbles, tumor fragments or fat particles Often occurs when the patient is awake a.) Onset is usually more sudden b.) Headache, seizure or brief unconsciousness is common
What is suicide?
Willful act design to end one's own life Every suicidal act or gesture should be taken seriously, patient should be transported
How should you assess the posterior body during a rapid trauma assessment?
With in line spinal stabilization, the patient will be rolled to inspect and palpate the posterior aspect of the body
What does the prefix 'endo' mean?
Within
What are the four stages of alcohol withdrawal?
Within 8 hours, nausea, insomnia, sweating, tremors Within 8 to 72 hours, worsening of stage 1, hallucinations Early as 48 hours, major seizures Stage 4, delirium tremens
What does the prefix A- mean?
Without
What is para?
Woman who has given birth Number of delivery events, not the number of children
What are explosives?
Work by igniting fuels that burn rapidly causing hot gases to displace air in a violent fashion creating a shock wave or blast Shock wave causes blast injuries Further away from explosions, severity of injury diminishes
Is there a duty to act?
Your legal obligation to provide service whether you think the patient needs and ambulance or not While you are on duty, you are obligated to care for a patient who requires and consents to it
What are some special considerations when dealing with patients in a motor vehicle crash?
Your main function is patient care Try to approach from front to reduce neck movement Tell the patient everything you are going to do before you do it
What should you communicate to the receiving facility?
Your unit's ID and level of service Patients age and sex Chief complaint Brief, pertinent history of the illness, including scene assessment and mechanism of injury Major past illnesses Mental status Baseline vital signs Pertinent findings of physical exam Description of the care you've given Patient's response ETA
When communicating with medical personnel, you should include the following information...
Your unit's ID and level of service (BLS or ALS) The patient's age and sex The patient's chief complaint A brief, pertinent history of the present illness Major past illnesses Patient's mental status Patient's baseline vital signs Pertinent findings on the physical exam Description of the medical care your have provided The patient's response to the emergency medical care Request for further actions Estimated time of arrival
