EMT Midterm Full Notes

Vital Signs + Intro

Body Substance Isolation (BSI)

• Separates People From Bacteria

  • Hand Washing

  • Eye Protection (Goggles)

  • Gloves

  • Gowns

  • Masks

Best Prevention

• Gloves

• Hand Sanitizer

• Hand Washing

Vital Signs

Provides Internal Picture Of Patient

• Baseline Vitals = First Set

• Everything Else Is Compared To The First Set

Respirations

Rate

• Number Of Breaths In 30 Seconds*2

Quality

• Normal

• Labored (EX. After Running)

• Noisy (Wheezing/Sick)

Depth

• Shallow (Rapid And Slow)

• Deep (Normal??)

AVG Breathing Rates

• Adult (15+) = 12-20 Breaths/Min

• Child (2-14) = 15-30 Breaths/Min

• Infant (0-2) = 40-60 Breaths/Min

Pulse

• Pumping Of Blood

Rate

• Number Of Beats 30 Seconds*2

Strength

• Strong (Easy To Find)

• Weak (Hard To Find)

Regularity

• Regular

• Irregular

AVG Pulse Rates

• A = 60-100 BPM

• C = 80-100 BPM

• I = 100-120 BPM

Blood Pressure

• Pressure Of Blood Against Arteries

Systolic

• Heart Contracts

Diastolic

• Heart Relaxes

Sphygmomanometer (BP Cuff) & Stethoscope

• Used To Find BP

Units

• mm/Hg (Millimeters Of Mercury)

Written Format

• SYSTOLIC / DIASTOLIC

  • EX. $\frac{120}{80}$

Location

• Slightly Bent Elbow (LVL With Heart)

Normal BP Rates

• A = $\frac{90-140}{60-90}$

• C = $\frac{80-100}{\frac23\left(80-100\right)}$

• I = $\frac{70+}{\frac23\left(70+\right)}$

  • All Vary By Genetics, Weight, Time, Age, ETC

EXTRA

• Pulse In The Wrist = Radial Pulse

• AVG Newborn Is 18 IN

SKIN

Color

• Pale, Red, Blue, Or Yellow (Jaundice)

  • Blue Is Common In Infants Due To A Lack Of O2

  • Yellow Usually Caused By Liver Issues

Temperature

• Cold, Warm, Cool, Or Hot

Moisture

• Dry, Clammy, Moist, Or Wet

PULSE OXIMETRY

• Monitoring Of The Oxygenation Of A Patient’s Hemoglobin

Normal Level

• 95-99% SpO2

Hypoxic Drive Problem

• 88-94% SpO2 ( Saturation Of Oxygen )

Carbon Monoxide Causes This To Drop

BLOOD GLUCOSE

• Amount Of Glucose (Sugar) Present In The Blood

AVG Levels

• Normal - 70-120 mg/dL

• Elderly (50+) - Slightly Elevated

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PUPILS

P.E.A.R.L

• Pupils Equal And Round/Reactive To Light

Pupils Can Tell If Patient Has Head Injury

Abnormal Pupil Reactions

• Fixed (Not Moving) /Dilated/Sluggish/Unequal In Size

TEMPERATURE

Not Important For EMTS

AVG

98.6 F

Glasgow Coma Scale (GCS)

• Objective Way Of Recording The Conscious State Of A Person

• Eye Opening, Verbal, Motor

  • Highest = 15

  • Lowest = 3

CUPS

• Used As A Tool To Prioritize The Patient For Transport

• Critical, Unstable, Potentially Unstable, Stable

Critical

• ABT To Die

• Receiving CPR, ETC

Unstable

• Unresponsive But Still Alive

Potentially Unstable

• Difficulty Breathing

• Cannot Move At All

• Severe Pain

• Complicated Childbirth

Stable

• Minor Sickness

• Minor Injury

MILITARY TIME

• Time System That Prevents Confusion

  • EX. 12 AM = 0000 Hours

  • EX. 12 PM = 1200 Hours

  • EX. 6:07 PM = 1807 Hours

  • EX. 6:07 AM = 0607 Hours

Airway

Oxygen Needs

• 6-10 Mins W/O Oxygen (O2) = Likely Brain Damage

• 10+ Mins W/O O2 = Irreversible Damage

Hypoxia

Low Oxygen Level

• Signs = nervousness, rapid heartbeat, altered mental status

• Causes = stroke (blockage of blood vessel in brain), shock, etc

Inadequate Breathing

• Labored Breaths

• Accessory Muscle Use

• Pale/Blue Skin (Cyanosis)

• Cool & Clammy Skin

• Abnormal Lung Sounds

Opening Airway

Head Tilt/Chin Lift

• Used For Non-Trauma Patients

  

Jaw Thrust

• Suspected Spinal Injury (Prevents Moving/Hurting Spine Further)

  

Airway Adjuncts

Oropharyngeal (OPA)

Keeps Tongue From Blocking Airway

Inserting

1. select size (measure from earlobe to corner of mouth)

2. open mouth

3. hold upside down and insert

4. rotate 180 until flange rests on lips

   

Nasopharyngeal Airway (NPA)

Used If The Patient Has A Gag Reflex

Inserting

1. select airway (measure from earlobe to nose)

2. lubricate

3. insert into right nostril with bevel toward septum (bridge of nose)

Oxygen

Given To Any Patient With Respiratory/Cardiac Issues

Oxygen Delivery

Non-Rebreather (NRB)

• Provides 90% Oxygen

• Set At 10-15 Liters/Min (LPM)

• Unstable Patient

  

Nasal Cannula (NC)

• 35-50% Oxygen

• 2-6 LPM

• Stable PT

  

Suctioning

• Never Suction For More Than 15 Seconds At A Time

• Can Remove Patients Air Supply

  

Artificial Ventilation

• Bag Value Mask (BVM) - Manual Resuscitator That Helps Patients Who Are Not Breathing

  • Must Be Done Once Every 5-6 Seconds

  • Infants : 1-3 Seconds

Respiratory System

( IN ORDER )

1. Sinuses: Hallow spaces that warm and moisten air, produce mucus.

2. Nasal Cavity: Primary air entrance; warms, filters, and moistens air.

3. Nose: The external organ of smell and the primary physiological entry point for air into the respiratory system.

4. Larynx: The voice box, contains vocal cords for speech.

5. Pharynx: The throat; passageway for food and air.

6. Epiglottis: Covers trachea during swallowing to prevent aspiration.

7. Trachea: Windpipe; extends from larynx, supported by cartilage rings.

8. Bronchi: Main airways branching from trachea into lungs.

9. Bronchioles: Smaller branches leading to alveoli; regulate airflow.

10. Alveoli: Tiny air sacs where gas exchange occurs.

11. Diaphragm: Primary muscle of respiration; separates chest and abdomen.

Choking

Reasons For Choking (Ranking)

1. The Tongue Is Obstructing The Unconscious Victim’s Airway

2. Vomit → May Choke On Vomit Due To Age Or Drinking Heavily And Throwing Up While Passed Out

3. Foreign Body → Balloons & Food

4. Swelling → Allergic Reactions/Irritants

5. Spasm → Water Is Suddenly Inhaled

6. Chemicals & Fumes

NOTE

• Majority Are Extremely Young Or Old

Recognizing

• Audible Coughing/Breathing Sounds?

  • Are They High-Pitched?

• Strong Or Weak Cough?

• Can’t Speak, Breathe, Or Cough (Full Obstruction)

• Universal Distress Signal (Clutching Neck)

• Turning Blue (Cyanosis→ Lack Of O₂)

• Partial Obstructions With Bad Air Exchange Should Be Treated The Same As Complete Airway Blockages

• If Strongly Coughing, Do NOT Intervene → Victim Is Still Breathing Strong

Conscious Choking

• 5 Abdominal Thrusts

  • Place Fist Above Umbilicus

  • 5 Upward And Inward Thrusts

If Pregnant/Obese

• 5 Chest Thrusts

• Fist On Sternum

• If Unsuccessful, Support Chest With One Hand And Back Blows With Another

• Continue Until Success Or Victim Is Unconscious

Choking While Alone

• Use Fist

• Use Corner Of Furniture

• Be Creative

• Call 911

• Go To Large Area Where You Can Be Found

Conscious Choking Infants

• Position With Head Downward (Usually Lie On Thigh)

• 5 Back Blows (Check For Expelled Object)

• 5 Chest Thrusts (Check For Expelled Object)

• Repeat

Victim Becomes Unconscious

1. Call 911

2. Support Victim With Knees While Lowering To Floor

3. Assess Victim/Breathing

4. Begin CPR/Chest Compressions

5. Check For Object Before Giving Breaths

Empty Room With Victim Unconscious On Floor

1. Assess Victim

2. Give CPR If Needed

3. Compressions

4. Look For Object In Throat

5. Give Rescue Breaths

Order Of Unconscious Choking Rescue

1. A - Airway (HTCL)

2. B - Breathing

3. C - Compressions

Choking Unconscious Infant

• If Breaths Don’t Go In Check For Objects And Continue

• If Neither Go In Suspect Choking

• Begin 30 Compressions (2 Fingers)

• Check For Object In Throat (NO BLIND FINGER SWEEP)

• Give 2 Rescue Breaths

Notes

• Start Compressions The Second Heart Rate Starts To Decrease, Don’t Start When Fully 0

SIDS (Sudden Infant Death Syndrome)

• 5000 Cases/Year

• More Common In Males

• No Known Cause

  • Babies Have Elevated Level Of CO₂ In Blood During Autopsy

  • Believed That Airway Was Blocked Due To Plushies/Blankets Which Stopped Transfer Of CO₂ And O₂

• No Indication Of Problems

• Usually While Sleeping During First 6 Months

Prevention

• Place Baby On Back (Now, Side)

• Avoid “Fluffy” Blankets, ETC

Extra

• Higher CPR Success Rate For Choking/Drowning Compared To Heart Attacks BC Body Was Somewhat Healthy In The First Place

Defibrillation

• Sends An Electric Shock To The Heart To “Restart” It

  • Doesn’t Improve Heart Health, Just Saves Time

Location

Adults

• Below Right Clavicle To Under Left Armpit (Diagonal)

Child

• Right Shoulder To Under Left Armpit (Diagonal)

Baby

• One Pad In Front Other Pad In Back

Note

• Shocking Diagonally Increases Chances That The Heart Is Actually Shocked

• Still Give Pregnant Woman Defib → Living Life Over Future Life

Extra

• Do Not Touch Defibrillator When Shock Is Delivered

• Remove All Metal And Piercings From The Body

  • Will Burn Skin Due To Metal Ions

Cardiopulmonary Resuscitation

• If Effective Can Provide ¼ - ⅓ Normal Blood Flow

• Rescue Breaths Contain 16-21% O2

CPR Process

• Start Immediately

• Increases Chances Of Survival

• Brain Damage Starts After 4-6 Minutes

• Permanent Brain Damage After 10 Minutes W/O CPR

• Do Not Move/Stop Until Qualified Help Arrives

  • Exceptions - Threat Of Fire, Victim Not On Hard Surface, Victims Head Not Level Or Above Body

Checking Vitals

Airway

• Open Through Head-Tilt Chin-Lift

  • Jaw Thrust If Spinal Injury

Breathing

• Look, Listen, And Feel For 5-10 Seconds

• If Victim Not Breathing Give 2 Rescue Breaths

  • If They Don’t Go In Fix Airway And Try Again

    • If This Fails Again Suspect Choking

Compressions

• Find Proper Hand Position (Between Nipples, 2 IN Above Sternum)

Stopping CPR

• Victim Revives

• Qualified Help Arrives

• Too Exhausted To Continue

• Unsafe Scene

• Do Not Resuscitate Order

Circulatory System

• Passes Nutrients, Gases, Hormones, And Blood Cells To And From Cells In The Body

  • Done To Maintain Body Temperature And Homeostasis + Fight Disease

Blood Vessels

Arteries

• Carry Blood Away From The Heart

  • Usually Oxygenated Blood

  • Exceptions = Pulmonary (Going To Lungs) + Umbilical (Going To Placenta)

Major Arteries

• Aorta - Largest Artery, Distributes Oxygenated Blood To All Parts Of The Body, Originates At Left Ventricle And Extends To Abdomen

• Pulmonary - Carries Deoxygenated Blood From Heart To Lungs

• Brachial - Inside Upper Arm, Where Blood Pressure Is Measured

• Radial - Wrist, Where Pulse Is Measured

• Carotid - Located In The Neck

• Femoral - Medial Portion Of The Femur, Near Groin, Never Used

Veins

• Carry Blood Towards The Heart

  • Majority Of Blood Carried Is Deoxygenated And Back To The Heart

  • Exceptions = Pulmonary (Leaving The Lungs) + Umbilical (Leaving The Placenta)

Capillaries

• Only 1 Cell Thick

• Allow For Exchange Of H2O, CO2, O2, ETC + Waste Materials

Blood Flow Order

1. Right Atrium

2. Right Ventricle

3. Pulmonary Artery

4. Lungs

5. Pulmonary Vein

6. Left Atrium

7. Left Ventricle

8. Aorta

9. Arteries, Capillaries, Veins

Blood

Perfusion

• Circulation Within Tissues In Adequate Amount To Meet Cells Need For O2

Shock (Hypoperfusion)

• Failure To Provide Adequate Circulation (BLOOD IS NOT CIRCULATING)

Cardiogenic

• The Heart Loses Ability To Pump Blood/Not Circulating Blood And O2

Septic

• Infection (Usually Bacterial) Of Blood

  • EX. The Appendix (Appendicitis) → The Appendix Isn’t Moved And Does Not Receive Blood Or Flush Out Bacteria, Causes Inflammation

Anaphylaxis

• Severe Allergic Reactions

Hypovolemic

• Decreased Water Volume → Blood Gets Thicker And Slower

Hemorrhage

• Bleeding

• Average Adult = 6 Liters Of Blood

• Cannot Tolerate Greater Than 20% Blood Loss

Hemorrhagic Shock

• Low Blood Volume Results In Inadequate Perfusion

Signs And Symptoms

• Rapid, Weak (Thready) Pulse

• Clammy (Moist, Sticky, Cold) Skin

• Rapid & Shallow Respirations

• Hypothermia (Due To Decreased Perfusion And Evaporation Of Sweat)

  • Enzymes Cannot Function Under 94°F

• Thirst And Dry Mouth

Characteristics Of Bleeding

1. Arterial → Bright Red Spurting Blood (Oxygenated)

2. Venous → Dark Red Non-Spurting Blood (Deoxygenated)

3. Capillary → Easily Controlled Oozing Blood (Most Common)\

__ = More Dangerous Due To High Volume Of Blood Loss

EMS Treatment

• Control Bleeding

• Elevate Feet (If No Suspected Neck Injury)

• Cover With Blanket

  • If Body Is Too Cold, Patient Will Become Unconscious

• Oxygen (15 LPM Via NRB)

Controlling Bleeding

• Direct Pressure With Bandage

• Elevate Injury Above Heart

  • Blood Has To Go Uphill In Order To Get To Injury

• If Bleeding Continues, Add More Bandages (NEVER REMOVE)

• If Patient Is Punctured, Leave Object Inside

  • Object Is A Plug For The Injury

  • If Object Is Removed, Will Cut Patient Further

Tourniquet

• Wrap Bandage Around Injury And Twist

• Write “TK” And Time Applied On Patients Forehead

  • If Bleeding Does Not Stop, Patients Limb Might Be Amputated

MAST Pants

• Military Anti-Shock Trousers, Or Pneumatic Anti-Shock Garments (PASG)

• Created In Vietnam

• Stabilizes And Controls Blood Loss In Fractures Of Pelvis And Femurs

• Puts Pressure On The Wound Which Limits Blood Flow

  • When Being Removed, Pressure Has To Be Removed Slowly So That Patient Does Not Pass Out

• Limits Amount Of Pain

Nose Bleed

• Have Patient Lean Forward And Pinch Nostrils

• Apply Gauze Under Patients Upper Lip

• Apply Ice Over Nose

Internal Bleeding

Hematoma

• Bruise/Contusion

• Capillaries Are Damaged Allowing Blood To Seep Into Tissues

Hematemesis

• Blood In Vomit

• Blood Pools Up In Stomach, Usually Thick/Clotted And Dark When Coming Out

Hemoptysis

• Coughing Blood

• Usually Sign Of Organ Failure, Respiratory Issues, ETC

Signs

• Pain

• Tenderness (Hurts To Touch)

• Bruising

• Swelling

• Broken Ribs

• Bruises On Chest

• Distended Abs (Bloated)