emt before job

Airway

Passage that allows air to move into and out of the lungs

Airway Obstruction

Anything blocking airflow (food, swelling, blood, vomit, etc.)

OPA (Oropharyngeal Airway)

Airway device used in an unresponsive patient without a gag reflex

NPA (Nasopharyngeal Airway)

Airway device inserted into the nose; can be used in patients with an intact gag reflex

Suctioning

Removal of blood, vomit, or secretions from the airway

Hypoxia

Low oxygen reaching body tissues

Hypoxemia

Low oxygen level in the blood

Ventilation

Movement of air into and out of the lungs

Respiration

Exchange of oxygen and carbon dioxide at the cellular level

BVM (Bag-Valve Mask)

Device used to provide positive-pressure ventilations

Tidal Volume

Amount of air moved in one normal breath

Minute Volume

Amount of air moved in one minute (tidal volume × respiratory rate)

Respiratory Distress

Difficulty breathing but still moving adequate air

Respiratory Failure

Inadequate breathing that cannot maintain oxygenation or ventilation

Signs of Respiratory Failure

Altered mental status, cyanosis, exhaustion, poor chest rise, slow or irregular breathing

Cyanosis

Bluish skin caused by inadequate oxygenation

Capnography

Measurement of exhaled carbon dioxide (ETCO₂)

Normal ETCO₂

35–45 mmHg

nasal cannula

2 - 6 LPM O2; check LoC, Sp O2 (give if 88% - 94%) and RR (give within normal range); if patient says this Sp O2 range is normal for them don’t give

non-rebreather

10 - 15 LPM O2; give if patient is AOx4, Sp O2 less than 87%, RR normal;

bag valve mask

15 LPM O2; give it Sp O2 is less than 95%, altered mental status, RR is not normal range (less than 12 or more than 20);

nebulizer

6 - 8 LPM O2; administered when patient had asthma attack (used to assist albuterol or atrovent)

CPAP (continuous positive airway pressure)

A device that pushes a constant flow of air into the lungs through a mask to help keep the airways and alveoli open, making breathing easier.

When EMTs use CPAP:

• Severe respiratory distress with the patient still breathing on their own

• Congestive Heart Failure (CHF) with pulmonary edema (“fluid in the lungs”)

• COPD exacerbations (if allowed by local protocol)

• Some cases of severe asthma (depending on protocol)

Signs a patient may need CPAP:

• Difficulty breathing

• Rapid breathing

• Low oxygen saturation

• Using accessory muscles to breathe

• Able to follow commands and tolerate the mask

Do NOT use CPAP if the patient:

• Is not breathing adequately or has stopped breathing

• Has a decreased level of consciousness and cannot protect their airway

• Is vomiting or likely to vomit

• Has severe facial trauma preventing a mask seal

head tilt chin lift

used to open airway; use when no obvious trauma;

jaw thrust

used to open airway; doesn’t engage neck so safe to use if trauma suspected

__% oxygen in air

21% oxygen

test capillary refill

grab finger tip/nail and see how long it takes for color to return; less than 2 seconds is good;

CO = SV x HR

cardiac output = stroke volume x heart rate

stroke volume

The amount of blood pumped out of the left ventricle with each heartbeat.

cardiac output

The total amount of blood the heart pumps in one minute.

minute volume = Tidal Volume x RR

mnemonic air movement in one minute

tidal volume

The amount of air moved into or out of the lungs with one normal breath; air per breath

minute volume

The total amount of air moved into or out of the lungs in one minute; air per minute

GCS (Glascow Coma Scale)

A scoring system used to measure a patient’s level of consciousness. Scores range from 3 (worst) to 15 (best).

eye opening GCS

4 = spontaneous, 3 = to speech, 2 = to pain, 1 = none

verbal GCS

5 = alert and oriented, 4 = confused conversation, 3 = inappropriate words, 2 = incomprehensible sounds, 1 = none

motor GCS

6 = obeys commands, 5 = reaches toward pain, 4 = withdraws from pain, 3 = abnormal flexion, 2 = abnormal extension, 1 = none

GCS good and bad

15 ideal, 8 or less is severe

when to use BVM vs nasal cannula vs nonrebreather

• patient can control airway and breath properly = nasal cannula or non rebreather

• patient not able to control their own breathing, RR greater than 30 or less than 10 = BVM

NPA contraindications

suspected facial trauma

can suction an adult and patient for …

• adult patient = 15 seconds max

• pediatric patient = 10 seconds max

rigid catheter (Yankauer Catheter)

Definition: A rigid suction device used to clear the mouth and upper airway.

Use for:

• Vomit

• Blood

• Secretions

• Food particles

Don’t use for:

• Deep nasal suctioning

• Tracheostomy suctioning

soft catheter (french catheter)

Definition: A soft, flexible suction catheter used for deeper suctioning.

Use for:

• Nasal suctioning

• Tracheostomy suctioning

• Secretions deeper in the airway

Don’t use for:

• Large pieces of vomit or food

mostly likely cause for snoring respirations…

tongue blockage

paradoxical motion of chest

one side of chest rises while the other one stays still/falls

flail chest

paradoxical motion of chest due to rib fractures

only hear air moving from one side of patient in trauma

suspect they are experiencing a pneumothorax

pneumothorax

Air enters the pleural space (the space between the lung and chest wall), causing the lung to collapse partially or completely.

simple (closed) pneumothorax

Air leaks into the pleural space, but there is no open chest wound.

Causes:

• Rib fractures

• Lung disease

• Spontaneous rupture of a bleb

Signs/Symptoms:

• Sudden chest pain

• Shortness of breath

• Decreased breath sounds on one side

open pneumothorax (sucking chest wound)

A hole in the chest wall allows air to move between the atmosphere and the pleural space.

Causes:

• Gunshot wounds

• Stab wounds

• Penetrating chest trauma

Signs/Symptoms:

• Open chest wound

• Sucking sound during breathing

• Shortness of breath

• Decreased breath sounds

Treatment:

• Occlusive dressing (usually vented)

tension pneumothorax

Air enters the pleural space but cannot escape. Pressure builds with every breath and begins compressing the lung, heart, and major blood vessels.

This is life-threatening.

Causes:

• Chest trauma

• Positive-pressure ventilation

• Progression of a simple or open pneumothorax

Signs/Symptoms:

• Severe respiratory distress

• Absent or greatly diminished breath sounds on one side

• Hypotension

• Tachycardia

• Jugular vein distention (JVD)

• Cyanosis (late sign)

• Tracheal deviation (very late sign)

laryngeal injury

Damage to the larynx (voice box) from blunt or penetrating trauma that can rapidly compromise the airway.

s/s:

1. Airway / Voice Changes

• Hoarseness or voice changes

• Difficulty speaking or speaking only in whispers

• Stridor (high-pitched, noisy breathing)

• Inability to speak (severe cases)

2. Breathing Problems

• Severe respiratory distress

• Dyspnea (trouble breathing)

• Cyanosis (late sign)

• Use of accessory muscles

3. Neck Findings

• Subcutaneous emphysema (crackling under skin)

• Swelling or bruising of the neck

• Pain in anterior neck

• Visible deformity

4. Bleeding / Trauma Signs

• Hemoptysis (coughing blood)

• Penetrating neck wound

• Blood in airway

5. Late / Critical Signs

• Hypoxia

• Altered mental status

• Respiratory failure

(check if they can talk)

patient with cherry bright red skin; light headed; dizzy; at home; Sp O2 is at 100%

carbon monoxide poisoning, normally during winter time

two important respiratory issues for children

croup and epiglottitis

croup

viral infection; noted by a seal or bark like cough

epiglottitis

caused by bacterial infection; severe drooling

tripod position

indication of respiratory distress or difficulty

patient with deep, rapid respirations, also diabetic

Kussmual respirations

Kussmual respirations is a sign with…

hyperglycemia, normal is diabetic ketoacidosis patients; high BP; trying to regulate PH balance by breathing heavy

blood flow chart

• Right atrium receives deoxygenated blood from:

• Superior vena cava (upper body)

• Inferior vena cava (lower body)

• Blood flows through the tricuspid valve → into right ventricle

• Right ventricle pumps blood through the pulmonary artery → to the lungs

• In the lungs:

  • Gas exchange occurs

  • Carbon dioxide is removed

  • Oxygen is added

• Oxygenated blood returns through the pulmonary veins → to left atrium

• Blood flows through the mitral (bicuspid) valve → into left ventricle

• Left ventricle pumps blood into the aorta

• Blood travels through:

  • Arteries → arterioles → capillaries

• In the capillaries:

  • Oxygen is delivered to tissues

  • Carbon dioxide is picked up

• Deoxygenated blood returns through:

  • Venules → veins → superior & inferior vena cava

• Cycle repeats continuously

pulmonary artery carries…

deoxygenated blood away from heart

pulmonary veins

brings oxygenated blood back towards the heart (left atrium)

if you are transporting a patient that goes into cardiac arrest, what should you do next?

pull over!!!!!! and start CPR. need partners help. request extra assistance

if the AED shocks your patient what should you do next?

need to start compressions

what are 2 (some consider it 3) EMT-B medications you can administer for a chest pain call?

aspirin, nitroglycerin, some consider oxygen as well

congestive heart failure (CHF)

where fluid builds up in lungs and may be caused by a left sided heart failure

pedal edema

fluid builds up to the lower extremities, and may be caused by right sided heart failure

sympathetic nervous system

causes fight or flight system. generally where body increases its heart rate and decreases intestinal activity

parasympathetic system

heart rate decreases but digestion starts to increase again. also known as “rest and digest”

what type of drugs can cause the parasympathetic response system?

opioids

what EMT-B drug can we administer to reverse an opioid overdose?

narcan/naloxone. administer intranasally (MAD device)

heart beat has four sounds (known as S1, S2, S3, S4)

EMT-B only really need to know S1 and S2

S1 heartbeat sound

makes the lub noise; when the atrio ventricular valve closes

S2 heartbeat sound

makes the dub noise, when the semi lunar valve closes

what depth do you want in compressions for an adult patient?

2-3 inches

what depth do you want in compressions for an child/infant patient?

1/3 of the depth of the chest

rate of CPR when by ourselves

30 compressions, 2 ventilations

what CPR ratio can you perform with a partner on an infant?

15 compressions for 2 ventilations

if placing AED on patient and they have an implanted pacemaker/defibilator you should place pads…

couple inches away from the implants

AED: if someone is wearing a medication patch

remove patch before placing AED

AED: if patient is pulled out of pool…

dry off before placing AED pad as best as possible

when we get a pulse back what is this called?

ROSC (return of spontaneous circulation)

if we shock someone with AED what do we immediately do next?

start CPR! for 2 minutes. then check to see if pulse is back in patient

3 different types of strokes

Ischemic, Hemorrhagic, and Transient Ischemic Attack (TIA)

Ischemic stroke

caused by clot that causes a lack of perfusion in either side of the brain (either right side or left side stroke). usually caused by clot in lower extremity that broke off and traveled up to the brain and is causing a lack of perfusion to the brain

Transient Ischemic Attack (TIA)

clot that forms just like Ischemic stroke but it dissipated by itself in less than 24 hours, reversing the stroke like symptoms.

• we can never tell if an Ischemic stroke is going to end up as a TIA

• get patient to hospital asap (preferably to 3-4.5 hours when they were last seen normal) so they can be administered something like TPA

Hemorrhagic stroke

also known as brain bleed; we can’t see what’s internally going on but basically let’s say they have an aneurysm and then blood starts to pool it’s going to compress the brain and causes a lack of perfusion because of the actual physical pressure as if you’re like pressing against your arm and now you’re not perusing to your extremity if you press hard enough like a tourniquet

• causes stroke like symptoms

• hallmark symptom = sudden acute like effects with really big spike in BP

T/F: in the field you can tell the difference between ischemic or hemorrhagic stroke

false

golden hour

if you have a stroke like patient from the time you get on scene generally want to spend 10 minutes or less on scene, get patient to hospital and into room to do a CT scan in less than an hour

T/F: strokes are a neurological issue, referring to damage of the brain either caused by clot (Ischemic/TIA) or a bleed (Hemorrhagic)

true

may see many different symptoms for strokes like altered mental status, numbness to an extremity , dizziness, but big sign is…

paralysis or weakness to one side

example: if a patient is having a stroke and the LEFT side of face is drooping…

RIGHT side of body weak

Cincinnati Prehospital Stroke Scale (CPSS)

facial droop, arm drift, speech abnormalities

FAST stroke assessment

facial droop, arm weakness, speech abnormalities, time it occurred

VAN stroke assessment

vision, aphasia, and neglect or loss of awareness one side of body

aphasia

difficulty speaking

T/F: be fast transporting stroke patients but make sure to stay on seen to get important medical information to find out when they were last seen normal, past history, etc

true

if someone has a seizure and your an EMT-B what should you do? if it’s an active seizure?

request ALS intercept!! we have no idea how long this seizure may last!

if someone has a TIA or stroke like symptoms and it went away before you got on scene (lasted like 2-5 minutes)

impending sign of a very serious stroke that’s about to occur. encourage patient to go to hospital and get a CT scan asap

hyperglycemia

very bad; deadly