EMR FINAL STUDY FLASHCARDS - AHASTI

[Ch 1] What does NOCP stand for?

National Occupational Competency Profile (Paramedic Association of Canada)

[Ch 1] The 4 paramedic practitioner levels in Canada

EMR, PCP, ACP, CCP

[Ch 1] Who regulates EMRs in Alberta?

Alberta College of Paramedics; you must be registered to practise

[Ch 1] Online vs offline medical direction

Online = real-time direct contact with a physician; offline = protocols, standing orders, training, QI

[Ch 1] Standing order

Pre-authorized written order allowing care without contacting medical control

[Ch 1] Core roles of the EMR

Personal and scene safety, assessment, care, safe handoff, documentation, patient advocacy

[Ch 1] Quality improvement (QI)

Ongoing review of care and calls to find and fix problems

[Ch 1] Scope of practice

The legally defined set of skills and actions an EMR may perform

[Ch 1] Components of an EMS system

Public access (911), dispatch, first responders, ambulance, hospitals, medical direction, training, QI

[Ch 2] Kubler-Ross stages of grief

Denial, anger, bargaining, depression, acceptance (not always in order)

[Ch 2] Signs of stress/burnout

Irritability, sleep problems, withdrawal, fatigue, loss of interest, increased substance use

[Ch 2] Acute vs cumulative stress

Acute = single critical incident; cumulative = gradual build-up over time (leads to burnout)

[Ch 2] Operational stress injury (OSI)

Persistent psychological difficulty from operational duties (includes PTSD, anxiety, depression)

[Ch 2] Critical incident stress management (CISM)

Structured support after traumatic calls: defusing, debriefing, peer support, referral

[Ch 2] Routine practices / standard precautions

Treat all blood and body fluids as potentially infectious; use PPE based on risk

[Ch 2] Airborne vs droplet vs contact transmission

Airborne: tiny particles stay in air (TB, measles, chickenpox); droplet: larger, within ~2 m (influenza); contact: touch/surfaces (MRSA, C. diff)

[Ch 2] Which PPE for airborne diseases like TB or measles?

Fit-tested N95 respirator

[Ch 2] Which bloodborne disease has a vaccine?

Hepatitis B

[Ch 2] Main bloodborne pathogens

Hepatitis B, hepatitis C, HIV

[Ch 2] Sharps safety

Never recap needles; dispose in sharps container immediately

[Ch 2] After a body fluid exposure

Wash/flush immediately, report right away, follow post-exposure protocol (possible prophylaxis)

[Ch 2] When to use soap and water instead of sanitizer

Visibly soiled hands, C. difficile, norovirus

[Ch 2] Common scene hazards

Traffic, violence, fire, hazmat, electrical, unstable vehicles/structures, animals, weather

[Ch 2] Most effective infection control measure

Hand hygiene

[Ch 2] PPE donning order

Gown, mask/respirator, eye protection, gloves

[Ch 2] PPE doffing order

Gloves, gown, hand hygiene, eye protection, mask, hand hygiene

[N95] How often is N95 fit testing required?

Before first use and regularly after (commonly every 1-2 years or per employer); redo if face changes

[N95] Seal check vs fit test

Seal check = user checks seal every time it's put on; fit test = formal test that the model/size fits you

[N95] Things that break an N95 seal

Facial hair, wrong size, bent nose clip, damaged straps

[N95] Aerosol-generating procedures needing N95

BVM ventilation, suctioning, nebulizer, CPR (per protocol)

[Ch 3] Duty to act

Legal obligation to provide care (on-duty responder)

[Ch 3] 4 elements that must be proven for negligence

Duty to act, breach of duty (standard of care), damages/harm, causation

[Ch 3] Standard of care is based on…

What a reasonably prudent EMR with similar training would do in the same situation

[Ch 3] Define abandonment

Ending patient care without handing off to a provider of equal or higher training

[Ch 3] Expressed consent

Patient verbally or physically agrees to care after being informed

[Ch 3] Implied consent

Assumed consent when patient is unconscious/unable to consent and faces a threat to life or limb

[Ch 3] Informed consent requires the patient to understand…

Nature of care, risks, benefits, alternatives, and risks of refusal

[Ch 3] Requirements for a valid refusal

Competent, informed of risks, not impaired; try to persuade, document thoroughly, advise to call back

[Ch 3] Consent in minors in Alberta

No fixed age; mature minor can consent if they understand; otherwise parent/guardian. Emergency = implied

[Ch 3] Assault vs battery

Assault = threat/fear of unwanted touching; battery = actual unwanted touching

[Ch 3] Alberta law protecting volunteer good-faith emergency aid

Emergency Medical Aid Act (Good Samaritan)

[Ch 3] Alberta law governing health information privacy

Health Information Act (HIA)

[Ch 3] Alberta document showing goals of care / resuscitation wishes

Goals of Care Designation (GCD), kept in the Green Sleeve

[Ch 3] Personal directive

Legal document naming an agent and stating wishes for care if the person loses capacity

[Ch 3] Confidentiality exceptions

Other care providers, mandatory reporting (e.g., child abuse), court order/subpoena

[Ch 3] Mandatory reporting example

Suspected child abuse or neglect

[Ch 3] Crime scene care

Patient care first; disturb as little as possible, don't cut through holes in clothing, document what you moved

[Ch 3] Golden rule of documentation

If it isn't documented, it wasn't done

[Ch 4] Anatomical position

Standing, facing forward, arms at sides, palms forward

[Ch 4] Proximal vs distal

Proximal = closer to trunk; distal = farther from trunk

[Ch 4] Medial vs lateral

Medial = toward midline; lateral = away from midline

[Ch 4] Superior vs inferior

Superior = toward head; inferior = toward feet

[Ch 4] Anterior vs posterior

Anterior = front; posterior = back

[Ch 4] Supine vs prone

Supine = face up; prone = face down

[Ch 4] Fowler's position

Sitting up at 45-60 degrees (semi-Fowler's ~30-45)

[Ch 4] Recovery position

Lateral (usually left) side-lying to protect airway in unresponsive breathing patient

[Ch 4] Number of bones in adult skeleton

206

[Ch 4] Vertebrae count by region

Cervical 7, thoracic 12, lumbar 5, sacral 5 (fused), coccygeal 4

[Ch 4] Three muscle types

Skeletal (voluntary), smooth (involuntary, organs/vessels), cardiac

[Ch 4] Blood flow through the heart

Vena cavae > RA > tricuspid > RV > pulmonic valve > pulmonary artery > lungs > pulmonary veins > LA > mitral > LV > aortic valve > aorta

[Ch 4] Arteries vs veins

Arteries carry blood away from the heart; veins carry blood toward it

[Ch 4] Blood components

Plasma, red cells (carry O2), white cells (fight infection), platelets (clotting)

[Ch 4] Define perfusion

Adequate delivery of oxygenated blood to tissues and removal of wastes

[Ch 4] Central vs peripheral pulses

Central: carotid, femoral; peripheral: radial, brachial, posterior tibial, dorsalis pedis

[Ch 4] CNS vs PNS

CNS = brain and spinal cord; PNS = nerves outside them

[Ch 4] Function of the epiglottis

Covers the trachea during swallowing to prevent aspiration

[Ch 4] Primary muscle of respiration

Diaphragm

[Ch 4] Ventilation vs respiration

Ventilation = moving air in/out; respiration = gas exchange

[Ch 4] Adult tidal volume

About 500 mL

[Ch 4] RUQ organs

Liver, gallbladder

[Ch 4] LUQ organs

Stomach, spleen

[Ch 4] RLQ organ commonly tested

Appendix

[Ch 4] Skin layers

Epidermis, dermis, subcutaneous layer

[Ch 4] Pediatric airway differences

Larger tongue and occiput, narrower trachea, floppy epiglottis, diaphragm breathers, infants are nose breathers

[Ch 5] Six rights of medication administration

Right patient, drug, dose, route, time, documentation

[Ch 5] Generic vs trade name

Generic = official chemical name (salbutamol); trade = brand (Ventolin)

[Ch 5] Indication vs contraindication

Indication = reason to give; contraindication = reason NOT to give

[Ch 5] Side effect

Predictable unintended effect of a drug

[Ch 5] Common routes

Oral, sublingual, inhaled, intramuscular, intranasal, transdermal

[Ch 5] Common EMR-level medications (verify ACP/AHS scope)

Oxygen, ASA, oral glucose, nitroglycerin, salbutamol, epinephrine auto-injector, naloxone, Entonox

[Ch 5] ASA action

Antiplatelet; slows clot formation in ACS. Chewed

[Ch 5] ASA contraindications

Allergy, active GI bleed, bleeding disorders, per protocol (e.g., age limits)

[Ch 5] Nitroglycerin action

Vasodilator; decreases preload and heart workload

[Ch 5] Nitroglycerin contraindications

SBP below protocol threshold, PDE-5 inhibitor (sildenafil/vardenafil 24 h, tadalafil 48 h), suspected RV infarct, allergy

[Ch 5] Nitro side effects

Headache, hypotension, dizziness

[Ch 5] Salbutamol action

Beta-2 agonist bronchodilator

[Ch 5] Salbutamol side effects

Tachycardia, tremor, anxiety

[Ch 5] Epinephrine effects in anaphylaxis

Vasoconstriction (raises BP) and bronchodilation

[Ch 5] Epi auto-injector dose adult / child

0.3 mg / 0.15 mg, anterolateral thigh

[Ch 5] Naloxone action

Opioid antagonist; reverses opioid respiratory depression. Ventilate first if needed

[Ch 5] Oral glucose requirement

Patient must be alert enough to swallow and protect own airway

[Ch 5] Entonox

50:50 nitrous oxide and oxygen, self-administered for pain

[Ch 5] Entonox contraindications (verify protocol)

Altered LOC, suspected pneumothorax, bowel obstruction, diving/decompression injury, can't follow instructions

[Ch 5] Helping a patient with their own medication

Confirm it's theirs, not expired, right drug/dose, indicated, and within your protocol

[Ch 6] Body mechanics basics

Power lift, straight back, legs do the work, load close, no twisting, communicate

[Ch 6] Power grip

Palms up, hands ~25 cm apart, full hand contact

[Ch 6] When is an emergency move indicated?

Immediate danger (fire, traffic, hazmat) or need to reach a life threat

[Ch 6] Examples of emergency moves

Clothes drag, blanket drag, shoulder/arm drag, firefighter's drag/carry

[Ch 6] Why pull along the long axis in an emergency move?

Minimizes spinal movement

[Ch 6] Urgent move example

Rapid extrication for an unstable patient in a vehicle