EMR Class Notes

Temp Check!

What are the medical terms for these skin conditions?

Pink:

Blue:

White:

Yellow:

Gray:

Red:

• Normal

• Cyanotic

• Pale

• Jaundice

• Ashen

• Flushed

What is the ideal respiration rate per minute

12-20

What pulse point is this?

Temporal

What is this pulse point called?

Carotid

What is this pulse point called?

Apical

What is this pulse point called?

Brachial

What is this pulse point called?

Radial

How many pulse points do humans have?

nine

What is this pulse point called?

femoral

What is this pulse point called?

Popliteal

What is this pulse point called?

Posterior Tibial

What is this pulse point called?

Dorsalis Pedis

What are the skin moisture levels used in EMR in order?

• Dry

• Moist

• Clammy

• Diaphoretic

• Profusely

What does PENMAN stand for? When do you use PENMAN?

-used during initial size up of scene dispatched to

P:ppe and safety

E:environmental, bio, human hazards

N: number of patients

M: mechanism of illness/injury

A: additional resources needed

N: need for c-spine, immobilization, extrication

What do you check for during a neural exam?

Can they respond to commands? Do their eyes react to light? Can they feel sensations?

What are the 4 components to contracting a disease?

1. The disease itself has to exist in that moment

2. Does the disease have a host?

3. How much of the disease exists in this moment? Is it enough to spread to a new host?

4. Is the victim immune to the disease or not?

What does it mean if one is absent of lung sounds?

collasped lung

What can abnormal pupils symbolize? (Hint, 4 things!)

1. Seizure

2. Trauma

3. Drug overdose/use

4. Stroke

What does hypoxia mean?

Low oxygen (less than 94%, minor hypoxia, less than 90 is severe hypoxia and needs oxygen assist)

What are the three components of moving a sharps container?

1. Container must be fully closed

2. puncture and leak resistant

3. decontaminated ASAP

What is an exposure control plan?

A standard to minimize the spread of pathogens that meets OSHA standards

What are some standard precautions?

1. PPE

2. Work place control

3. proper cleaning

4. Proper personal hygiene

What are 6 severe signs of grief?

1. lack of focus'

2. tears

3. stressed induced cardiomyopathy (rapid flow of adrenaline) c

4. lowered immune system

5. lethargy

6. decreased digestion/appetite; OR eating more than usual

What is the number one cause of death for first responders?

cardiac arrest

What is CISM?

Critical Incident Stress Management; program many public safety jobs have

-includes stress management, and on sight debrief with team after rough calls (CISD)

What does CISD stand for?

Critical Incident Stress debrief

• 24-72 hrs after bad call

WHAT is CRW?

Crew Resource Management

-all first responders have a different set of skills and you should collaborate to provide the best patient care

What does PACE stand for? What is it used for?

Communicating with other first responders when you do not agree w current treatment plan/ also basiccommunication

P: probe (ask to make sense of situation)
A: alert (alert team leader of risks)
C: challenge (ex: leader, I think we should do this bc xyz)
E: emergency (if problem is clear and critical, alert whole team)

all ________________ are __________, not all __________ are easily ___________

communicable, infectious, infectious, communicable

Donning

Putting on full PPE

wash hands, gown, mask, goggles, gloves

Doffing

Taking off full PPE

gloves, gown, goggles, mask, wash hands

For yours and the patient’s safety, should you assume all blood and secretions are infectious?

According to federal regulations, yes

What are the standard precautions for bloodborne pathogens (4)

1. always wear latex/nitrile gloves

2. gown up and shoe covers if there’s splattering blood ALWAYS WEAR GLOVES MASK GOGGLES AND FACE SHIELD

3. wash hands/skin immediately if contact w blood or secretions

4. used needles immediately go in sharps container

what are the standard precautions airborne? (7)

1. be aware of community disease outbreaks

2. assess pt’s on arrival 6 ft away if possible

3. mask pt is coughing, sneezing, fever

4. wear a N95 mask if needed

5. wash hands before and after treating pt

6. inquire abt exposure to flu, COVID, anything relevant

7. use googles, mask, face shield, for splatter of bodily fluids

What type of gloves should you use on scene if there are sharp objects?

leather gloves over ppe gloves

What are the principles for moving pt’s? (6 principles)

1. don’t harm pt

2. only move pt if necessary

3. move pt as little as possible

4. move pt’s body as a unit

5. use proper techniques

6. rescuer at the pt’s head gives commands

what is the recovery position and when to use it

when pt’s is unconscious but breathing and no trauma

what should you assume anytime a pt experiences a traumatic injury?

pt might have a neck/head/spine injury

what should you do if pt on backboard starts vomiting?

tilt the board sideways until vomiting stops

what are the two components of standard of care

1. treat pt’s to the best of my ability

2. provide care that any other reasonable emr would provide

what is an advanced directive?

a legal document created for a person specifying what treatments you consent to in the event that you cannot verbally consent to treatment in an emergency

What is a living will (type of advanced directive)

written document created by a doctor and lawyer and pt to determine what treatment the pt consents to in the event that they cannot consent to treatment during an emergency

what is a durable power of attorney?

a person that pt has designated to make medical decisions for them in the event that pt cannot consent to treatment

what needs to happen for it to be classified as negligence?

1. duty (obligation to do xyz)

2. breach (didn’t do obligation)

3. causation (did your actions cause damage?)

4. damages

actual cause vs. proximate cause

in law, actual cause answers the question of what physically caused such event to take place; proximate cause answers the question if the defendant should be held responsible for the event

what is a POLST?

Physician Orders for Life Sustaining Treatment

DOES NOT OVERPOWER ADVANCED DIRECTIVE

if you cannot conclude if a DNR is legally binding or not, you should;

keep doing life saving treatments. doctors on scene or at hospital can figure out if DNR is legally binding it is not your job

what is EMR abandonment

leaving a pt without handing them off to another capable provider after beginning you care

you can assume death ONLY IF

1. decapitation

2. rigor mortis

3. tissue decomposition

4. dependent lividity (red/purple coloring, like blood pooling where pt is making contact w ground or hard surfaces)

What is HIPAA?

Health Insurance Portability and Accountability Act of 1996

1. improving contuinity of health insurance coverage, waste, fraud in health care

2. protection of patient privacy and confidentiality

How to call for more med personnel? (6 stages)

1. call for backup

2. response to scene (they should alert you when they respond)

3. arrival at scene (they should alert you when they arrive)

4. you should update new EMS on pt condition

5. transfer of pt care

6. post run activities

how to update dispatched EMS (7 things)

1. age and sex

2. chief complaint

3. level of responsiveness

4. airway status'

5. breathing and circulation status

6. equipment and treatment used

7. treatment and equiopment needed

How to give pt report to a hospital (9 things)

1. age and sex

2. history of incident

3. chief complaint

4. level of responsiveness

5. how you found patient

6. vitals, airway, circulation, breathing status

7. phys exam results

8. SAMPLE report

9. interventions provided + pt response

what is SAMPLE?

S: signs and symptoms
A: allergies
M: medications taken
P: pertinent past medical treatment
L:last oral intake
E: events leading to injury/illness

what is postrun?

report status to communication center

1. how long until your rig is ready again

2. when you’re next available

What do the following prefixes mean?

1. Brady

2. Tachy

3. Hypo

4. Hyper

5. Naso

6. Oro

7. Arterio

8. Cardio

9. Hem/Hemo/Hema

10. Neuro

11. Vaso

1. slow

2. rapid/swift

3. temperature

4. low/defficient

5. above/excessive

6. nose

7. mouth

8. related to the arteries

9. heart

10. blood

11. nerve/nervous system/tissue

12. vessels/blood vessels

What to document for a pt’s chart (17)

1. age and sex'

2. pt history of incident

3. pt condition when found

4. pt description of illness/injury

5. chief complaint

6. pt responsiveness

7. initial vitals and following vitals

8. phys exam results

9. SAMPLE

10. treatment given

11. change in pt’s condition after treatment

12. agency and personnel that took over pt care

13. time dispatched, time arrived at scene, time care transferred over, time of scene departed

14. reportable conditions present

15. infectious disease exposure

16. anything unusual abt situation

17. any other helpful information