final

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1. Compare and contrast the scopes of practice for each of the nationally recognized EMS certification levels.

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1. EMR: wait for EMT or paramedics to arrive scene, obtain vitals and airway
2. EMT: oxygen therapy, ventilation equipments, limited medication
3. AEMT: advanced airway device, monitor glucose, more medication
4. Paramedic: highest level 

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1. Discuss the roles and responsibilities of the EMT and how the EMT can best meet these expectations.

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1. Proper PCR
2. Do not leave patient

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Identify the stages of grief experienced by patients and their families, and explain principles for interacting with these individuals in situations involving death and dying.

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1. Denial
2. Anger
3. Bargaining
4. depression
5. acceptance

explain the care you are providing, show great respect, keep communicating, allow family members to vent, scream, cry, listen carefully, do not give false assurance, comfort family

Compare and contrast the characteristics of acute, delayed, and cumulative stress reactions

acute stress: right after exposure to high stress situation. Nausea, sweat, loss epithet

delayed stress: days or years after incident, PTSD

cumulative stress: “burnout” anxiety

Discuss the components of a comprehensive system of critical incident stress management.

CISD: after a day or two, mental counsling

defusing: couple hours after, EMT’s vent out emotion in small groups

Describe ways EMTs can protect themselves from exposure to diseases caused by pathogens, as well as from accidental and work-related injuries.

hand washing

eye shields

protective gloves

N-95 masks

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Define key terms introduced in this chapter.

DNR- do not rescue

POLST: patient terminal, only life sustain

Differentiate between the concepts of scope of practice and standard of care*.*

scope of practice: actions EMT is legal allowed to perform

standard of care: care expected to be provided by EMT

Be able to recognize situations in which an EMT would have a duty to act.

Duty to act: legal obligations to provide service

Once you start care tho, you have to finish it

Discuss the actions an EMT should take when a patient refuses care.

false imprisonment: taking patient against his will

make em sign refusal form

List and describe the purpose and typical contents of each section in a PCR.

* chief complaint
* vitals
* demographics
* mechanism of injury
* medical history
* \

Be able to recognize examples of each type of information common to the narrative portion of a PCR.

s/s: signs/ symptoms

NTG: nitroglycerin

PE: physical exam

SOB: shortness of breath

Discuss how to handle special reporting situations with respect to the PCR and patient documentation.

if you don’t know, look up spelling or just use normal language

Accurately and completely record pertinent patient and EMS call information using the SOAP, CHART, and CHEATED methods.

SOAP

* subjective
* objective
* assesment
* plan

CHART

* chief complaint
* historuy
* assesment
* treatment
* transport

Cheated

* chief complaint
* history
* physical exam
* assessment
* treatment
* evaluation
* disposition

Describe the responsibilities of the Federal Communications Commission

regulates interstate and international communications through cable, radio, television, satellite and wire

Describe the standard rules and expectations for using a transmitter/receiver during radio communications.

* turn to correct frequency
* 2 inches away from microphone
* keep it short
* speak individual digits
* repeat
* \

Discuss how to provide a concise radio report to medical direction or the receiving facility, and when to update that report while still enroute.

* The patient’s current condition
* The patient’s age and gender
* The patient’s chief complaint
* A brief, pertinent history of what happened
* A description of how you found the patient
* Any major past illnesses
* Vital signs you obtained from the patient
* Pertinent findings of the physical exam
* Any emergency medical care that was given
* The patient’s response to any emergency medical care that was provided

Discuss teamwork and communication considerations for lifting and moving patients.

Use commands that are easy for team members to understand. Verbally coordinate each lift from beginning to end

Discuss the advantages, disadvantages, and steps for each of the recommended lifting and moving techniques.

power lift: safe and stable, used by weak rescuers

squat lift: strong legged rescuers,

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positions

supine: lying on back

lateral recumbent position: lying on side

flowers position: 45 degrees

trendelenburg position: feet elevated than head

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cavities

directional terms

anterior: front

superior: towards head

dorsal: back

medial: towards center of body

proximal: near point of reference

plantar: feet

Identify important anatomic and physiologic differences in children’s respiratory systems as they relate to oxygenation, airway maintenance, and ventilation skills.

* mouth and nose a lot smaller, thus easier to be obstructed by tongue or objects
* chest wall softer so rely more on diaphragm for breathing
* breath more through nose not mouth

Describe the basic mechanics and physiology of normal ventilation, respiration, and oxygenation.

ventilation: flow of air in and out of lung; diaphragm does most work

respiration: oxygen and CO2 exchanged through alveoli

Describe the anatomy and physiology of the heart.

Discuss the anatomy and physiology of the circulatory system, blood, perfusion/capillary exchange, and metabolism.

artery: carries blood away from heart

perfusion: delivery of nutrients to cells

capillary: connects arteriole to venue, exchanges nutrients and waste

Explain the overall function of the endocrine system, and discuss the locations and general functions of each component that comprises the endocrine system.

made of ductless glands which produce hormones.

explain the importance of understanding basic pathophysiology as it relates to `emergency` patient care

it helps you recognize and treat things faster and at the right order of criticalness

Differentiate between the processes of aerobic and anaerobic cellular metabolism, and outline the consequences of cellular sodium/potassium pump failure.

cellular metabolism: break glucose and gain ATP

if pump fails, cell swells and dies, leading to organ failure

Explain the concept of perfusion, including components necessary to maintain perfusion.

perfusion: deliver oxygen nutrients, take waste from cells.

* airway
* BP
* \

Explain how changes in compliance of the lungs and chest wall and changes in airway resistance affect ventilation.

compliance: ability of chest wall and lung to stretch

airway resistant: ease of airflow to alveoli

decrease of compliance or increase of airway resistant can lead to complications in breathing, less oxygen, hypoxia

Describe and differentiate between tidal volume, alveolar

ventilation, and minute ventilation

tidal volume: volume of air each breath

alveolar ventilation: volume of air in n out of alveoli 1 min

minute ventilation: volume of air in n out of lung 1 min

Identify and discuss the numeric age range, key physiological and psychosocial developments, and normal \n vital signs for neonates and infants.

neonates: 100-205 heart beat, 30-60 respiratory rate, 67-84BP,

infant: 100-180 heart beat, 20-30 respiratory rate, 70-104 BP, 98-100F

Describe the physiological changes that occur immediately after birth.

lose weight first 2 weeks. immune system don’t exist. reflexes (blinking, sucking, swallowing)

Identify and discuss the numeric age range, key physiological and psychosocial developments, and normal vital signs for school-age children.

6-11 yrs old

75-118 heart beat, 18-25 respiratory rate, 07-115 BP, 98.6F

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Identify and discuss the numeric age range, key physiological and psychosocial developments, and normal

vital signs for adolescence

12-15 yrs old

60-100 beats, 12-20 respiratory rate, 110-131 BP

2-3 year growth spurt, puberty, want to be adults,

Recognize the progressive assessment findings of mild, moderate, and severe hypoxia in pediatrics and adults

*Signs of Mild to Moderate Hypoxia*

* Tachypnea (increased respiratory rate)
* Dyspnea (shortness of breath)
* Pale, cool, clammy skin (early)
* Tachycardia (increase in heart rate)
* Elevation in blood pressure
* Restlessness and agitation (from hypoxic brain cells)
* Disorientation and confusion (from high carbon dioxide levels in the blood)
* Headache

*Signs of Severe Hypoxia*

* Tachypnea
* Dyspnea
* Cyanosis (bluish gray color to skin, mucous membranes, and nail beds)
* Tachycardia that may lead to dysrhythmias (irregular heart rhythms) and eventually bradycardia (slow heart rate)
* Severe confusion
* Loss of coordination
* Sleepy appearance (from high carbon dioxide levels in the brain)
* Head bobbing (head bobs upward with inhalation and downward with exhalation, as if falling asleep while sitting upright) with droopy eyelids (from high carbon dioxide levels in the brain)
* Slow reaction time
* Altered mental status
* Seizure

Explain the causes and presentation for each abnormal upper airway sound.

snoring: partially obstructed

crowning: muscle around larynx is narrowing airway

gurgling: blood, vomit, in airway, suction it out

stridor: swelling in larynx

Discuss the procedure for airway assessment and opening of the airway with manual maneuvers and patient positioning.

headtilt, chin lift: use when no spinal injury

jaw thrust: when spinal injury is suspected

place sideways if no spinal injury and patient may throw up

Discuss the function and performance of fixed and portable suction devices

mounted device: much stronger suction, greater than 300mmHg

portable device: up to 300mmHg pressure,

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Explain the difference between rigid and soft suction catheters, how to use both, and special considerations when suctioning patients.

rigid: suction used on mouth of unresponsive patient

soft catheter: suction through nose, measure using nose to ear

Discuss normal and abnormal findings when assessing a patient’s breathing, how to determine oxygen needs, and indications of respiratory distress or failure.

wheezing: inflammation in bronchioles in lung

crackles: fluid surrounding and filling the alveoli

rhonchi: mucus blocking bronchioles

Differentiate between normal and abnormal respiratory rates for each age bracket.

elder respiratory rate at rest is usually higher

Describe normal and abnormal findings in the assessment of skin color, temperature, condition, capillary refill, and color of the mucous membranes.

white: loss blood

cyanosis (blue): shock

yellow: liver disease

cool: shock

capillary refill: under 2 sec, 3 female, 4 elders

Explain factors that can cause abnormalities to skin color, temperature, condition, capillary refill, and mucous membrane color.

slow capillary refill indicate: shock

dry skin: spinal injury

high fever: infection

When assessing the pupils, recognize normal findings versus abnormal findings, and associate these with potential underlying causes.

dilated pupils: drugs

unequal size: stroke

consensual reflex: reaction to light

contrsticed: nervous system disorder

In relation to blood pressure measurement, explain systolic and diastolic blood pressure, pulse pressure, and causes of abnormal findings.

kids have lower BP

pulse pressure = systolic - diastolic BP

hypertension: high BP

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Use the mnemonics SAMPLE and OPQRST to ensure a complete prehospital patient history.

SAMPLE

* Signs and symp
* allergies
* medications
* past histories
* last oral intake
* events leading to illness

OPQRST

* onset
* provocation
* quality
* radiation
* severity
* time
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Explain the purposes and goals of performing a scene size-up on every EMS call.

make sure scene is safe

Identify factors involved in determining the number of patients

call for back up

Explain the importance of developing a systematic patient assessment routine, and list the four main phases of the patient assessment process

scene size up

primary assesment

secondary assesement

reassessment

Review the steps of the scene size-up phase of the patient assessment process.

* ensure safety
* determine mechanism of injury
* establish number of patients
* call for back up as needed

State the main purpose of the primary assessment, and list the components of the primary assessment phase.

identify and manage immediately life-threatening conditions to the airway, breathing, oxygenation, or circulation. If anything found, musts treat b4 moving onto next

“ABCs”

Discuss ways to determine if a patient is injured or ill and how to obtain the chief complaint.

“why did you call EMS today?”

Differentiate between patients who do and do not need spinal motion restriction techniques, and discuss proper patient positioning for assessment.

If patient prone, log roll to supine. if spinal suspected, spine motion restriction b4 log roll.

Using the AVPU method, describe how to assess and document the level of responsiveness.

AVPU

* Alert
* response to verbal stimulus
* response to Painful stimulus
* unresponsiveness

Determine airway status in responsive versus unresponsive patients, and identify methods for establishing and maintaining an open airway for each.

If talking or crying without much effort, patent airway may be assumed.

snoring: headtilt

gurgling: suction

crowning: begin ventilation bag valve mask

Describe how to assess the rate and quality of breathing, and, based upon findings, identify how to manage the ventilatory insufficiency.

bradypnea: rate too slow

tachypnea: rate too fast

apnea: not breathing

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List the medications in the EMT’s scope of practice that are carried on the ambulance.

* oxygen
* oral glucose
* activated charcoal
* aspirin
* inhaled bronchodilators
* nitroglycerin
* epinephrine

List the medications in the EMT’s scope of practice that the EMT is permitted to assist the patient to administer.

MDI

SVN

Explain the roles of off-line and on-line medical direction with regard to medication administration.

online order: medical direction to administer or assist medication

offline: protocols or standing orders

List in order the key steps of medication administration for each of the medications used by the EMT, based on the medication packaging or form.

select correct medication, verify with patient’s prescription, check expiration date, check for contamination, verify route and dosage, document

Five rights

* patient
* medication
* route
* dose
* date

Describe the reassessment of a patient after the EMT has administered or assisted the patient in

measure vitals and asses for changes in condition

document

Discuss the physiology of adequate perfusion and the pathophysiology of hypoperfusion (shock), including the consequences of cellular hypoxia and death.

Shock: not enough blood flow (hypoperfusion)

not enough oxygen = cell death = organ failure

Describe the features, functions, advantages, disadvantages, uses, and precautions related to automated external defibrillators (AEDs).

older than 8 yrs

CPR first, get AED ready

Advantage: fast, efficient, safe

Not useful for trauma arrest

Given a series of cardiac arrest scenarios involving infants, children, and adults, discuss appropriate assessment and resuscitative techniques.

30/2 compression to ventilation

asses for 5-10 sec for pulse

lower charge for infants and less than 8 yrs of age

go deeper in children, 2 in for adults, 1 1/2 for baby

Identify assessment and management techniques of a post-cardiac-arrest patient with return of spontaneous circulation.

If tidal volume or respiratory rate is inadequate, continue CPR

do not hyperventilate; adult 10-12 child 12-20

Define and differentiate between respiratory distress, respiratory failure, and respiratory arrest.

distress: normal rates, difficulty breahting (provide supplmental oxygen)

failure: more extreme distress, not enough oxygen for cells (positive pressure ventilation)

arrest: no tidal volume and breahting (ppv)

Discuss the pathophysiology, symptomatology, and management goals of a patient suffering from an obstructive pulmonary disease.

airflow limitation and difficulty in exhaling air from the lungs

Symp: wheezing, tripod posture, tachypnea

treatment: Bronchodilation

Discuss the pathophysiology, symptomatology, and management goals of a patient suffering from cardiogenic and noncardiogenic pulmonary edema.

accumulation of fluid in the lungs

cariogenic: heart related

crackles, wheezing, cold clay skin

Discuss the pathophysiology, symptomatology, and management goals of a patient suffering from epiglottitis, pertussis, cystic fibrosis, poisonous inhalations, and viral respiratory infections.

epiglottitis: top of neck, can block airway

pertussis: whooping cough

cystic fibrosis: hereditary

Describe special considerations in the assessment and management of pediatric and geriatric patients with respiratory emergencies.

pediatric: have healthy heart, mostly respiratory issues. Nasal flaring (early sign)

gediatric: place sitting up position, if distress, administer oxygen via nasal cannula

Discuss proper assessment and clinical decision making skills regarding treatment plans for patients when using an assessment-based approach to respiratory distress

tripod: indicate respiratory distress

cyanosis (blue): indicate hypoxia

moist skin: indicate distress

nasal flaring

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Describe the relationships among chest pain or discomfort, heart disease, and cardiac arrest.

chest pain: symptom indicating heart problem

heart disease: heart can’t pump enough blood, narrowed arteris

cardiac arrest: heart not pumping blood at all

Explain the pathophysiology, symptomatology, and prehospital management for myocardial ischemia.

heart muscle not receiving adequate oxygenated blood

Symp: crushing chest pressure “dull aching”

treat: oxygen, aspirin, nitroglycerin

Discuss the current understanding and guidelines for oxygen administration in a patient with an acute coronary syndrome.

Administer supplemental oxygen if the patient is dyspneic, hypoxemic, has obvious signs of heart failure, has an of or the is unknown

Explain the pathophysiology, symptomatology, and prehospital management for cardiogenic shock and hypertensive emergencies.

when one side of ventricle fails to pump out enough blood.

right: low BP Left: high BP

high heart beat

Explain the indications, contraindications, forms, dosage, administration, actions, side effects, and assessment for nitroglycerin.

relieve chest pain

contraindication: hypotensive, allergic

side effect: headache, increased heart rate

dosage: tablet, usually .3mg

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Describe the relationship between stroke and transient ischemic attack.

transient ischemic attack resolve on its own; similar symptoms

Describe the way to use the Cincinnati Prehospital Stroke Scale, the Los Angeles Prehospital Stroke Screen, the Miami Emergency Neurologic Deficit scale, and the Rapid Arterial Occlusion Evaluation (RACE) scale.

determine if it is a stroke

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Identify the assessment-based approach to the assessment and management of a stroke or transient ischemic attack.

if no spinal injury, place lateral recumbent position

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Differentiate the types of generalized seizures: tonic clonic, absence, myoclonic, tonic, atonic, simple, partial seizure with secondary generalization, and febrile seizures.

tonic clonic: loss of consciousness, muscle rigidity

absense: brief loss of consciousness, common in children

myoclonic: jerking of muscle on both sides, children, sleep

atonic: patient drop to ground, loss of muscle strength

partial seizure: one brain hemisphere

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Delineate between the care goals for seizure patients who are unresponsive, actively seizing, or in status epilepticus.

if snoring: nasopharyngeal airway

epilepticus: insert oropharyngeal airway to prevent tongue bite

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Discuss the role of insulin and glucagon in glucose regulation and the effects of epinephrine on glucose levels.

Insulin: decreases glucose level

glucagon: increases glucose level

epinephrine: releases stored glucose in liver and stop insulin

Discuss the pathophysiology and symptomatology of a hypoglycemic emergency.

hypoglycemia: low glucose level (less than 70mg/dl)

sign: altered mental status,

patio: brain lacks glucose to burn

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Describe the clinical findings that would be consistent with a mild, moderate, and severe allergic reaction.

mild: runny nose, watery eyes. hives

severe: anaphylactic reaction,

Explain the assessment-based approach to assessment and management of an anaphylactic reaction and a biphasic anaphylactic reaction.

administer epinephrine

biphasic: second allergic reaction within 6hrs of first

Describe the pathophysiology, assessment findings, and management principles for a patient who has ingested a poison.

look for container

may administer activated charoal

reassess 5 min

Discuss the indications, contraindications, action, side effects, dosage, and administration of activated charcoal

* only through medical direction
* SuperChar
* InstaChar
* Actidose
* Liqui-Char
* contradiction: altered mentalstatus
* dosage 1 gram per 1kg body weight
* side effect: vomit

Describe the pathophysiology, assessment findings, and management principles for a patient who has inhaled a poison.

safety first

ABC

was it suicidal attempt? closed or open space? how long exposed

Explain the assessment-based approach to acute abdomen, including the incorporation of assessment findings into a field impression and the appropriate prehospital emergency care.

determine trauma or medical or ingestion of medicine

if responsive, collect history OPQRST

if unresponsive, collect physicals, vitals, then history

palpale abd away

pale cool skin, tachycardia, narrow pulse pressure = shock

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Explain the assessment-based approach to genitourinary/renal emergencies, including the incorporation of assessment findings into a field impression and the appropriate prehospital emergency care.

respect privacy

watch out for shock

explain the assessment-based approach to cold-related emergencies, including the incorporation of assessment findings into a field impression and the appropriate prehospital emergency care

hypothermia: body mucho cold

warmed humidified supplement oxygen

conduct secondary in warmed ambulance

For common terrestrial bites and stings seen by EMS providers, discuss the corresponding pathophysiology, symptomatology, and management principles.

black widow spider: pinprick sensation at bite site. become dull ache within 30min. Severe muscle spasm in shoulder back.

brown recluse spider: bites painlesss at first

scorpion: sharp pain at injection site, drooling, poor coordination, seizure

Fireant: painful vesicles filled w fluid, swelling

toll: can carry fever, stick to head, remove tick rehospital

lower site of injection below heart, apply cold pack, constrict

List factors that affect the likelihood of survival from submersion incidents.

infants: bathtub

quick rescue, temp of water

List actions you should take to protect your own safety when responding to a water emergency.

only jump in water if ur trained and have a partner

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List and discuss psychiatric emergencies encountered prehospitally that commonly result in ==behavioral== changes

phobia: fear of specific event or object

agitated delirium: tolerance of pain, unusually speech, drug

paranoia: mistrust

psychosis: out of touch with reality

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Discuss how an assessment-based approach can be used to assess, determine a field impression from assessment findings, and properly manage a psychiatric-emergency patient.

Don’t enter unless you see patient

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