EMT Unit 2

What does the Federal Communication Commission do?

this government organization regulates communications in the United States, including radio, television, cable, satellite, and wire. They assign the amount of bandwidth you have, they prevent interference with emergency radio traffic, and they prohibit profanities and offensive language

What factors should you include in your medical radio report?

1. Unit identification and level of provider

2. estimated time of arrival

3. patients age and sex

4. chief complaint

5. brief, pertinent history of present illness/injury

6. major past illnesses

7. mental status

8. baseline vital signs

9. pertinent findings of physical exam

10. emergency care given

11. response to emergency medical care

objective information

information that is observable, measurable, or verifiable

subjective information

information that is subject to interpretation or opinion - normally in the patient’s words

What are some examples of special situation reports?

1. Exposure to infectious diseases

2. Injury to yourself or another EMT

3. Hazardous or unsafe scenes

4. Referrals to social service agencies

5. Mandatory reports for child or elderly abuse

What does RAS stand for and what does it do?

Reticulate Activating System and it is a network of neurons located in the brainstem that regulates wakefulness, arousal, and attention

alpha cells

cells of the pancreas the secretes glucagon

glucagon

a hormone that increases blood glucose level by stimulating glycogen breakdown in the liver. It works in the opposite way to insulin by releasing more glucose into the bloodstream

beta cells

a type of cells in the pancreas that secrete insulin

delta cells

cells of the pancreas that secrete somatostatin

type I diabetes

an autoimmune disorder in which the body attacks the body’s insulin receptors, so they need to take supplemental insulin

Type II diabetes

a condition in which insulin resistance occurs and insulin can no longer bind to insulin receptors, allowing glucose into the cells.

hypoglycemia

a condition in which there is too little glucose in the bloodstream due to:

• too little sugar intake

• too much insulin secretion

• overexercising

what are some signs and symptoms of hypoglycemia?

1. sudden onset

2. abnormal behavior mimicking a drunken stupor

3. tachycardia

4. rapid breathing

5. seizures

what is administered in the event of hypoglycemia?

oral glucose buccaly or or sublingually

hyperglycemia

high blood sugar level in the blood stream caused by insulin deficiency. Signs and symptoms include:

• chronic thirst and hunger

• increased urination

• dehydration

Kussmaul’s breathing

a type of breathing that is characteristic of people with diabetes. They are rapid, deep breaths that is characteristic of hyperglycemia

type I respiratory failure

a type of respiratory failure characterized by hypoxia

type II respiratory failure

a type of respiratory failure characterized by hypercapnia

BiPAP

Bilevel positive airway pressure - a machine that provides a higher pressure when the patient inhales and a lower pressure when they exhale

PINSP

Positive inspiratory Pressure - referring to the higher pressure level delivered during inhalation on a BiPAP ventilator. It is the maximum pressure applied when you breathe in contrasting with the lower EPAP

flow trigger

the amount of effort the patient needs to exert to trigger the BiPAP’s positive pressure

what does an ineffective trigger lead to?

an infective trigger can lead to the patient feeling like they need to try very hard before they are rewarded with a breath

Positive End Expiratory Pressure (PEEP)

the pressure that remains in the alveoli after expiration and improves oxygenation

End Tidal Carbon Dioxide (ETCO2)

a measurement of the amount of carbon dioxide in an exhaled breath

P Ramp

the speed at which the BiPAP machine delivers the peek respiratory pressure; adjust if the patient feels like they are not getting air quickly enough

SLUDGEM - signs and symptoms of organophosphate exposures

1. salivation

2. lacrimation

3. urination

4. diarrhea

5. gastrointestinal cramping

6. emisis

7. miosis

What are the 3 B’s of organophosphate poisoning?

1. bradycardia

2. bronchorrhea

3. broncospasm

Atropine

an anticholinergic medication that blocks the acetylcholine in the case of organophosphate exposure

praladoxime

a cholinesterase activator used to treat organophosphate poisoning and nerve agent exposure. It works by restoring AChE activity, which reverses excessive acytelcholine buildup caused by organophosphates

duodote

an auto-injector that contains both atropine and praladoxime and is administered to first responders to treat organophosphate poisoning and nerve agent exposure

Organophosphate induced Delayed Neuropathy (OPIDN)

a reemergence of un-metabolized organophosphate compounds and an onset of symptoms

therapeutic index

a ratio that compares the blood concentration at which a drug becomes toxic and the concentration at which a drug is effective

MOANS

1. mask seal

2. obstruction/obesity

3. age/atrophy

4. no teeth/no neck

5. stiff lungs

DOPE

1. displaced/dislodged tube

2. obstructed tube

3. pneumothorax

4. equipment failure

At which speed should oxygen be administered through a nasal cannula?

2 L/min

At which speed should oxygen be administered through an aerisolizer?

6 L/min

At which speed should oxygen be administered through a Non-rebreather mask?

15 L/min

MARCH - the order of things needed to be addressed when you arrive on the scene of a trauma

1. Massive Hemorrhage

2. Airway

3. Respiratory

4. Circulation

5. Hypothermia

hemostatic dressing

gauze with proteins and chemicals that help to facilitate clotting

bioavailability (F)

The percentage of a drug administered that reaches the systemic circulation

albumin

a protein locating in the plasma that acts as a transport protein for drugs and nutrients in the blood. The binding of a drug to _______ is a major determinant of its pharmacokinetic and pharmacodynamic profile

What does a blue stripe mean on a gauze pad?

the blue side is the side that you can touch. The other side is white and it is sterile and it can be touched to the patient

What is the dose of aspirin?

162-325 mg

what is the recommended dose for Diphenhydramine

20 mg for adults; 15 mg for children

what are some contraindications for aspirin?

pregnancy, recent GI bleed, taking blood thinners, cannot swallow

what is the recommended dose for nitroglycerin?

0.4 mg 1-3 tablets

what is the recommended dose for epinephrine?

0.3 mg for adults and 0.15 mg for children

therapeutic level

the level of medicine in your blood that is medically helpful but not dangerous

off-line medication

medication that is administered using standing orders from protocol

on-line medication

medication administered from directions given to you directly by a physician

anaphylaxis

a severe, life-threatening allergic reaction where blood vessels dilate rapidly, causing a drop in blood pressure, cells leak fluid into the interstitial space, and tissues swell. Two body systems must become involved if it is to be considered anaphylaxis

Name 5 signs and symptoms of an allergic reaction?

1. coughing

2. wheezing

3. hives

4. increase heart rate

5. itchy, watery eyes

DCAPBTLS

1. deformities

2. contusion/crepitus

   1. look behind the ear for sings of Battles

3. abrasions/avulsions

4. puncture/penetration

5. burns

6. tenderness

7. lacerations

8. swelling

glasgow coma scale eyes

4 - open and tracking

3 - verbal to open

2 - pain to open

1 - does not open

glasgow coma scale verbal

5 - oriental

4 - confused speech

3 - inappropriate words

2 - nonsensical words

1 - nonverbal

glasgow coma scale motor

6 - able to follow commands

5 - localized

4 - flex/withdrawal from pain

3 - abnormal flexion

2 - abnormal extension

1 - no movement

VAN assessment

step 1: is there any arm weakness present?

If yes, step 2: positive if any of the following are present:

1. visual disturbance - double vision, loss of vision, blurred vision

2. aphasia - expressive or receptive aphasia

3. neglect - when patients neglect a part of their body

what is the location of the most common large vessel occlusion (LVO)?

middle cerebral artery

FASTED

1. face

2. arms

3. speech

4. time

5. eyes

6. dizziness/denial

receptive aphasia

a speech impairment characterized by an inability to understand speech

expressive aphasia

a speech impairment characterized by an inability to come up with the words you want to say

nystagmus

a condition characterized by involuntary, rhythmic eye movements

dysmetria

the inability to approximate distance

trunkal ataxia

a condition in which the patient’s proprioception has been impaired and the patient cannot balance without the use of their arms

cardiogenic shock

shock caused by lack of heart function

distributive shock

shock that is a consequence of vascular tone irregularities

hypovolemic shock

a type of shock characterized by an inadequate circulating volume

obstructive shock

a type of shock characterized by the failure of the myocardial pump due to extrinsic compression of obstruction to outflow

stages of shock

1. non progressive shock

2. compensated shock state

3. decompensation shock state

4. irreversible stage

non progressive shock state

the first stage of shock in which the compensatory mechanisms have been set in motion and are taking effect

compensated shock stage

the second stage of shock in which the compensatory mechanisms are being overwhelmed and are failing

decompensation shock state

the third stage of shock in which the shock symptoms will progress rapidly - hypotension, acidosis, an altered mental state

irreversible stage

the fourth and final stage of shock in which the shock as progressed to such a degree that the patient is inevitably headed for death

what is the trifecta of shock?

hypothermia, acidosis, and coagulopathy

AHORA stroke scale

1. andar

2. hablar

3. ojos

4. rostro

5. amos brazos

opioids

CNS depressants that were made to relive pain but are overused. Examples include heroin, oxycontin, morphine, coedine, and fentanyl. Treatment includes administration of Narcan every 2-3 minutes u to 16 g

buprenirophine

a medication that can be administered to help with opioid withdrawal

carbon monoxide

a colorless, odorless gas that is highly flammable and can cause nausea, lightheadedness, and near-syncope

sympathomimetics

a classification of drug that mimics the effects of the sympathetic nervous system. Includes cocaine, amphetamines, and adderall

marijuana

a psychoactive drug made from the Cannabis plant, commonly used for recreational and medicinal purposes. Patients may be hallucinating, paranoid, or highly sensitive and emotional.

marijuana sativa

a strain of the cannabis plant that is higher in THC leading to more mental effects

marijuana indica

a strain of the cannabis plant that has higher CBD leading to more physical effects

anticholinergics

a classification of drug that blocks the parasympathetic nervous system leading to agitation, dilating pupils, seizures, and cardiac complications

what should you do in the event of a femur fracture

Use a traction splint; you have one chance to align

Check CSM before and after realignment