emt final pt 2

red priority

immediate= airway + breathing compromise, severe burns, shock, open chest or abdominal injuries, altered mental status

yellow priority

burns without airway compromise, major bone/joint injuries, back injuries

green priority

walking + talking wounded

black priority

little chance of survival, cardiac arrest, respiratory arrest (no HR or breathing), obvious life ending injury

standing orders

what you can do yourself

standard of care

your actions in a situation

scope of practice

boundaries of ems care

negligence

failure to provide care

when to preform abdominal thrust

responsive pts with severe airway obstruction in adults and children over 1 year

what to do for airway obstruction of pregnant women and obese people

chest thrust

responsive choking pts who become unresponsive

give CPR and chest compressions

unresponsive choking pts (adults, children) when you arrive on scene

check for pulse + breathing

• pulse + no breathing = open airway and ventilate

• reposition airway if no response, no response = 30 chest compressions

• if still no response, open airway and look in mouth

• repeat cycle

what to do if s/s of infection in children while choking

transport immediately

responsive children with mild airway obstruction + can cough

do not interfere or make worse

when to interfere for choking children

• weak cough, cyanosis, stridor, decreased LOC

• stand/kneel behind child and preform abdominal thrust

responsive choking infants

do not use abdominal thrusts, use back slaps or chest thrusts

unresponsive choking infants

• CPR, dont check for pulse

• open airway to look in mouth

• same sequence as adults

slight gastric distention

not a concern, be careful and continue monitoring chest rise and fall

3 things to ensure when seeing gastric distention

• ensure airway is appropriately positioned

• ventilate at appropriate rate

• ventilate at appropriate volume

BLS treatment for gastric distention

put pt onto side and manually decompress (last resort)

assisting with albuterol administration

• assess ABCs (lung sounds, wheezing, tachypena, acessory muscle use)

• if hypoxic, check SPO2 and give O2 via NRB or nasal cannula

• assist with albuterol/prescribed inhaler

• assess vital signs + breathing

pt is unable to coordinate inhalation with trigger or is too confused

contraindications for albuterol administration

• not prescribed

• no permission from medical control

• pt has taken max dose before arrival

when to not extricate a pt

if the vehicle is not stable + hazards are not controlled

simple access to a pt

getting pt out without the use of tools or force

complex access to a pt

using tools to get pt out

what to do before extricating a pt (that does not need rapid transport)

1. assess bleeding w/ direct pressure

2. stabilize cspine

3. open airway w/ high flow O2

4. assist or provide ventilation

5. treat all critical injuries

6. then extricate pt

when to rapidly extricate

when there are life threats to pt

• vehicle scene is unsafe

• pt cannot be assessed before moving

• pt has a life threat

• pt blocks access to a critical pt

how to splint while extricating a pt

splint injured extremity to rest of body, leg can be splinted to other leg

rapid extrication technique

support c-spine, support torso and move legs (spine stability), rotate pt, pull to backboard

when is a KED (short board) permitted for extricating a pt

Patient is seated

Patient is stable and cooperative

Scene is safe

You have time for controlled extrication

You need torso stabilization before moving the patient to a long board

use a long board when

Patient is supine

Patient is unstable (ABC issues, shock, altered mental status)

Rapid extrication is needed

Scene is unsafe (fire, traffic, hazmat)

You need to move the patient quickly to the stretcher

what to do if baby is not breathing after delivery

provide tactile stimulation: rubbing back/trunk and flicking the soles of feet

what to do if baby’s HR is below 100 bpm

ventilate (with room air) 1 breath every 3 sec, 40-60 breaths/min

what to do if baby’s HR is below 60 bpm

if ventilation has already been given for at least 30 seconds, (we are under the impression that baby’s HR has gone down since starting ventilations) start compressions at a 3:1 ratio of 3 compressions and 1 breath on 100% O2

if baby is still blue after ventilation and HR is normal

give blow by oxygen via nasal cannula

supine hypertensive syndrome

compression on inferior vena cava, place pt leaning on left side

what does an AED usually detect

• VF: life-threatening heart rhythm disorder in which the heart’s lower chambers quiver instead of contracting normally, preventing effective blood circulation and leading to cardiac arrest.

• Pulseless ventricular tachycardia

• NO AFIB: you would still have a pulse

what is not shockable on AED

pulseless electrical activity, asystole

when to apply an AED

unresponsive pulseless pts

what to do if pt has a nitroglycerin patch

remove patch with glove on, wipe area, apply pads as normal

what to do if a pt is too hairy for AED patches

use razor to shave or use patches as a wax strip

what to do if pt has chest implant (pacemaker, ICD, LVAD)

place pad at least 1 inch away from device

what to do after 5 cycles of CPR

reanalyze and continue CPR if no shock advised

when is transport advised for pts using an AED

• after 6-9 shocks on AED is applied

• after AED gives 3 consecutive “no shock advised”

where to place AED

place pad below R collarbone, place other pad on lateral middle of left side

cardiogenic shock

• cause: bad heart function, bad electrical system, injury/disease

• s/s: chest pain, irregular pulse, weak pulse, low BP, cyanosis, cool/clammy skin, anxiety, crackles, pulmonary edema

obstructive shock

• cause: tension pneumo, cardiac tamponade, PE

• s/s: dyspnea, rapid/weak pulse, rapid/shallow breaths, decreased lung function, unilateral/decreased/absent breath sounds, low BP, JVD, emphysema, cyanosis, tracheal deviation

septic shock

• cause: severe infection

• s/s: warm skin/fever, tachycardia, low BP

neurogenic shock

• cause: damaged c-spine causing blood vessel dilation

• s/s: bradycardia, low BP, signs of neck injury

psychogenic shock

fainting, rapid pulse, normal/low BP, generalized weakness

hypovolemic shock

• cause: loss of blood/fluid

• s/s: rapid/weak pulse, low BP, change in mental status, cyanosis, cool/clammy skin

compensated shock

s/s: anxiety, restlessness, feeling of impending doom, weak pulse, thirsty

decompensated shock

everything drops and declines

what to put on an abdominal wound

sterile, moistened gauze and occlusive bandage

how to dress an impalement

control bleed, stabilize object, wrap in dressing (can put on occlusive dressing if item is no longer there)

neck wounds

apply occlusive dressing and apply pressure by securing a pressure bandage, then secure c-spine, be on lookout for subcutaneous emphysema

what to apply for burns

• if area is still burning: put cool water on area

• if area is no longer burning: apply dry sterile dressing

what to apply for chest wounds

occlusive or vented chest seal, flutter valve

becks triad

JVD, muffled heart sounds, low BP. associated with cardiac tamponade

cushings triad

hypertension, bradycardia, irregular respirations. associated with ICP

should you splint straight or position found

splint in position found UNLESS no pulse (then you will apply manual traction)

24‑year‑old male, supine, pale, diaphoretic. Obvious open tib-fib fracture with heavy bleeding. RR 32, shallow. HR 132, weak. BP 88/50. SpO₂ 92% on room air. A/O × 2, confused. Key findings: Bone visible, Major hemorrhage, Signs of hypoperfusion. High‑risk MOI

Splinting Plan:

• Control life threats first, Direct pressure, Pack wound, Pressure dressing

• Rapid extrication if unsafe scene or airway/breathing issues

• Apply a long board only for extrication, not transport

• Use a padded rigid splint or traction splint ONLY if closed fracture

• Because this is open, traction splint is contraindicated

• Immobilize above and below the injury

Reassess PMS before and after splinting

Treat for shock: High‑flow O₂ and Keep warm

30‑year‑old female. RR 28, HR 120, BP 100/60, SpO₂ 95%, A/O × 1. Obvious mid‑shaft femur deformity

Manual stabilization of leg: Traction splint indicated (closed mid‑shaft femur)

Contraindications check: No pelvic injury, No knee injury, No ankle injury

Apply traction splint

Reassess PMS

Rapid transport due to AMS (altered mental status)

how to apply a traction splint

Position splint, Secure ischial strap, Apply mechanical traction, Secure ankle hitch, Secure support straps

Scene: Fall from roof. Presentation: 50‑year‑old male, RR 24, HR 118, BP 90/58, SpO₂ 94%. Left leg shortened and externally rotated

Splinting Plan: Do NOT traction splint (suspected pelvic fracture)

Apply pelvic binder (or sheet wrap), Minimal movement, Long board only for extrication

Treat for shock

Immediate transport

55‑year‑old female. RR 18, HR 90, BP 130/78, SpO₂ 98%. Mid‑shaft humerus deformity. PMS intact.

Splinting Plan:

PMS check

Rigid splint along humerus, Immobilize shoulder and elbow, Sling + swathe

Reassess PMS

Non‑emergent transport

Fall from ladder, 15 ft, landed on left side Scene: Warehouse. Patient conscious but in pain. Presentation: Female, 45, Sitting, leaning forward. RR 24, HR 110, BP 104/70SpO₂ 95%. Left wrist deformity, Left rib pain with crepitus, Left ankle swelling, PMS intact in all extremities, No head injury symptoms, No abdominal pain

SMR not indicated (no neuro deficits, no distracting injury preventing neck assessment, no midline tenderness)

Splint wrist (rigid or SAM splint), Pillow splint for ankle

Encourage slow breathing for rib fractures, Monitor for pneumothorax

Transport

PMS checks before/after each splint

s/s for heat exhaustion

dizziness/fainting, heavy sweating, cold, pale, clammy skin, nausea/vomiting, fast, weak pulse, weakness/muscle cramps, excessive thirst

s/s for heat stroke

headache, confusion/delirium, possible loss of consciousness, dry skin, hot, red skin, nausea/vomiting, body temp above 104 F

s/s of basilar skull fracture

• associated with high energy traumas (falls, vehicle crash)

• fracture on base of skull

• CSF drainage from nose/ears, rupture of tympanic membrane, raccoon eyes, Battle sign

the most important reason to use a traction splint is

to reduce nerve and blood vessel damage

how would you open the airway of an infant compared to a child

• infant: neutral position

• child: sniffing position

what to do when you approach scene while bystanders are giving CPR

• feel for pulse to determine if pt still needs CPR

• asses that they are doing quality chest compressions

• if they do, take over chest compressions and apply AED

how to immobilize a child that was sitting in a car seat during a car crash

If the child is stable and already in a car seat, immobilize in the seat and transport. Using towels to fill gaps, tape or straps to secure the head and torso. Keep the child in the position found unless unsafe

signs vs symptoms

• signs: evidence of a condition that can be observed by the emt (rash, fever, sweating, bleeding, unequal pupils)

• symptoms: experiences that a pt reports to you (pain, tiredness, headache, stiff neck, dizziness, nausea)

order of placing straps with a patient on a long board

chest, abdomen, legs, head

informal debriefing

an informal talk with the crew about a distressing call after it was completed