Section 1 test

PSAP (public safety answering point)

a designated 911 emergency dispatch center

EMS is under what government agency

Department of Transportation

When did EMS legislation start

1973 or early 1970's

Good Samaritan Law

Article 30; can't be paid, can't be in a health care facility, can't be grossly negligent

Abandonment

Leaving a patient after care has been initiated and before the patient has been transferred to someone with equal or lesser medical training.

Expressed (actual) Consent

A type of consent in which a patient gives verbal or nonverbal authorization for provision of care or transport.

Informed Consent

A decision made with knowledge of condition and consequences of treatment refusal

Implied Consent

Type of consent in which a patient who is unable to give consent is given treatment under the legal assumption that he or she would want treatment. (Not alert, a minor, pt. Is not competent, danger to themselves or others, ill or injured affecting judgement)

Involuntary Consent

Minors, Incarceration, Mental Health

Consent Rule

If you cannot consent to care, you cannot refuse care

RMA

Refusal of Medical Assistance

Spine Segments

7 - Cervical

12 - Thoracic

5 - Lumbar

5 - Sacrum

4 - Coccyx

Skull Bones

Mandible (lower jaw), Maxilla (upper jaw), Zygomatic Bone (cheek bone), Orbit (eye socket), Frontal (forehead), Parietal (sides and top of back of the head, Occipital (lower back of head), Foramen Magnum (opening for spinal cord)

Thoracic Bones

Ribs (12 pairs), Sternum (breast bone), Clavicles (collar bones), Scapulas (shoulder blades, Costal Cartilage (connect ribs to sternum (flexible)

Pelvic Bones

Ilium (hip bone), Pubis (pubic bone), Ischium (sit bone)

Lower Extremities

Femur (thigh bone), Patella (knee cap), Tibia (front of lower leg), Fibula (back of lower leg), Talus (ankle bone), Calcaneus (Heel bone), Metatarsals (lower ankle bones), Tarsals (foot bones), Phalanges (Toe bones)

Upper Extremities

Humerus (upper arm), Radius (forearm - thumb side), Ulna (forearm - pinky side), Carpals (wrist), Metacarpals (hand bones), Phalanges (fingers)

Cartilage

Fibrous tissue that pads joints and bone ends

Muscles

Skeletal (voluntary), Cardiac (involuntary/automasticity), Smooth (organs)

Automasticity

Ability of the heart to beat without the brain. Creates its own charge

Tendons

Connect muscle to bone

Ligaments

Connects bone to bone

Arteries

Carry blood away from heart

Arterioles

Between larger arteries and capillaries (where vasoconstriction occurs)

Capillaries

Smallest vessel where cells are fed and gas exchange occurs

Venules

Between capillaries and larger veins

Veins

Carry blood to the heart

Peripheral Arteries

Femoral (groin/upper thighs), Popliteal (behind knees), Anterior and Posterior Tibial (front and back of lower legs), Peroneal/Fibular (outer side of lower legs), Dorsalis (top of foot), Plantar (sole of foot), Subclavian (below the collar bone), Axillary (armpit area), Brachial (upper arm/inside of upper elbow), Radial (thumb side of wrist), Ulnar (pinky side of wrist), Iliac (lower abdomen and pelvis), Renal (branching off of kidney area), Mesenteric (supplying the Intestines and GI tract), Carotid (sides of neck)

Inspiration

breathing in (inhalation), active

Expiration

breathing out (exhalation) passive

Respiration

Inhalation and exhalation of air. (Total process)

Tidal Volume

air exchanged during normal breathing

Residual Volume

Air remaining in lungs after exhalation.

Minute Volume

Tidal volume and respiratory rate together

Vital capacity

Total lung exchange capacity

Functional Volume

air that actually reaches the respiratory zone

Inspiratory Reserve Volume

Amount of air that can be forcefully inhaled after a normal tidal volume inhalation

Expiratory Reserve Volume

Amount of air that can be forcefully exhaled after a normal tidal volume exhalation

Cardiac Cycle

Blood enters the heart through the Inferior and Superior Vena Cavas into the Right Atrium, to the Right Ventricle, to the Pulmonary Arteries, into the Lungs, then into the Pulmonary Veins, back to the heart in the Left Atrium, to the Left Ventricle, to the Aorta, and out to the body.

Central Nervous System (CNS)

brain and spinal cord

Peripheral Nervous System (PNS)

Nerves in the rest of the body

Autonomic Nervous System (ANS)

a set of nerves that carries involuntary and automatic commands that control blood vessels, body organs, and glands

Sympathetic Nervous System (SNS)

fight or flight, prepares body for action

Homeostasis

A tendency to maintain a balanced or constant internal state; the regulation of any aspect of body chemistry, such as blood glucose, around a particular level

ATP (adenosine triphosphate)

main energy source that cells use for most of their work (Oxygen, Water, Glucose).

Without ATP

cell dies (necrosis) and eventually the person dies

The Bohr Effect

Allows for tissues that are working hard, creating more CO2 (which is acidic), to get more oxygen that they need to maintain their function!

The Haldane Effect

The less oxygen in the bloodstream, the more affinity for CO2 the blood has and more capacity to carry it

Hydrostatic pressure

Physical pressure in the arteries and capillaries

Oncotic pressure

Chemical pressure created from proteins in cells

The hearts three steps

Preload: amount of blood returning to the heart

Contractility: the hearts innate ability to contract

Afterload: pressure that the heart has to pump against

Blood volume

12 pints or 6 Liters based on 150 lb person

Blood volume affected by

External hemorrhage

Internal hemorrhage (third spacing: fluid not found in cells or vasculature)

Burn

Excessive permeability

Ascites: plasma in belly

Peripheral Resistance

Peripheral Resistance

Controlled in arterioles; sign from arteries to arterioles to constrict or dilate

Blood Pressure

HR: heart rate

BV: blood volume

PR: peripheral resistance

CO: cardiac output

SV: stroke volume

Pumps: Heart, Arteries, Arterioles

Pipes: Veins, Venules, Capillaries

Fluid: Blood

Ambient Air contains

21% oxygen

Humans use how much oxygen

4%-5%

Lung Lobes

Left lung has 2 Lobes, Right Lung has 3 Lobes

Normal Respiratory Rate (Eupnea)

12-15 respirations per minute

Tachypnea

Increase respiratory rate due to increased oxygen needs

Brainstem

Controls respiratory rate and depth

Vertebrae C3, C4, C5

Phrenic nerve exits to lungs

Agonal Respirations

Not considered breathing, irregular; random gasps of air

Signs of inadequate breathing

Breathing rate /= 22

O2 saturation < 92%

Absent, minimal, or uneven chest rise

Children: nasal flaring and sternum retractions

There are more!!!

Oropharyngeal Airway

Indications:

Needs patent airway

Contraindications:

Positive gag reflex and oral trauma(preventing use

**must be unconscious**

**corner of mouth to ear lobe**

Nasopharyngeal Airway

Indication:

Needs patent airway

Positive gag reflex

Can't use OPA

Contraindications:

Basilar Skull Fracture

Nasal trauma

**must be unconscious**

**edge of nostril to tip of earlobe**

oxygen cylinder

Never oil (don't tape and don't grease)

Non-Rebreather Mask High-Flow Oxygen

**Preferred Device**

Used for:

Hypoxic patients

Delivers:

80-90% oxygen at 12-15 LPM (Liters Per Minute)

Nasal Cannula Low-Flow Oxygen

**Only used if patient refuses Non-Rebreather Mask**

Delivers:

2-6 LPM (Liters Per Minute)

NYS Oxygen Administration Protocol

1. Provide oxygen to pt.'s with O2 under 92%

2. Oxygen should be titrated to maintain 92% + oxygen levels and to prevent dyspnea

3. EMT's choice of delivery devices (NRM vs. NC)

4. Unstable patients where oxygenation changes may be miss can be placed on oxygen preemptively

Ventilation pros vs. cons

Pros:

Provides oxygen to non-breathing patients or inadequately breathing patients

Cons:

Gastric distention

Vomiting/FBO/Aspiration

Ventilates opposite of body

Decreased cardiac output

Potential for hyperventilation

Pop-off valve

If there is a pop-off valve, DISABLE IT

CPAP

continuous positive airway pressure

BIPAP

bilevel positive airway pressure

infectious Disease (Methods of Transportation)

Airborn: Saliva or fluids in the air

Droplets: Saliva or fluids in the air

Direct Contract: coming in contact with an infected person

Vector: spread from living organism

Vehicle: spread from not living thing

Healthcare acquired infections (HAI's)

**1:31 patients contract**

MRSA: Methicillin-Resistant Staphylococcus Aureus

C-Diff: Clostridioides difficile

Catheter Associated UTI:

Septicemia: blood poisoning

pn.

Pain

PRN

as needed

c̄

With

s̄

Without

q.

every

Superior

above; toward the head

Inferior

Below; lower

Cephalic

pertaining to the head

Medial

toward the midline

Lateral

away from the midline

Midaxillary

middle of the armpit

Anterior (ventral)

front of the body

Posterior (dorsal)

back of body

Proximal

closer to the trunk of the body

Distal

Farther from the trunk of the body

Abduction

Movement away from the midline of the body

Adduction

Movement toward the midline of the body

Supination

movement that turns the palm up

Pronation

movement that turns the palm down

Supine

lying on the back

prone

lying face down

lateral recumbent

lying on either the left or right side

Fowler's position

90 degrees sitting position

Semi-Fowler's Position

45 degrees sitting position