Comprehensive Emergency Medical Technician (EMT) Training and National Registry Review Notes

Foundational Medical Definitions and Biology

  • Allergen: A foreign substance responsible for causing an allergic reaction. This is distinct from antibodies, histamines, or leukokines.
  • Central Nervous System (CNS): Comprised of exactly two components: the brain and the spinal cord.
  • Mechanism of Injury (MOI): Used by practitioners to predict the severity of a patient's injuries and understand the biomechanics of what happened to the patient.
  • Disease Prevention: The simplest and most effective way to prevent the spread of disease from patient to patient is for the provider to wash their hands.
  • Infection Control and Liver Function:
    • The liver is responsible for filtering blood and removing toxins (e.g., from alcohol consumption).
    • Jaundice: Indicated by yellowing of the sclera (the white part of the eyes), which signifies liver dysfunction.
  • Anatomy Orientation:
    • Anterior: The front of the body.
    • Posterior: The back of the body.
  • Abdominal Anatomy:
    • The liver is located in the Upper Right Quadrant.
    • Injury to hollow abdominal organs often results in the leaking of contents into the peritoneal cavity, leading to Septic Shock or Peritonitis.

Clinical Pharmacology

  • Nitroglycerin Contraindications:
    • Low blood pressure (hypotension).
    • Use of erectile dysfunction enhancement drugs within the previous 48 hours48\,hours (National Registry standard).
    • Standard Blood Pressure Threshold: Most testing (National Registry) uses a threshold of 100 mmHg100\,mmHg systolic, though some local protocols (e.g., Libra) may use 90 mmHg90\,mmHg.
  • Epinephrine (EpiPen):
    • Indicated for anaphylaxis involving two or more body systems, OR a life threat involving an airway obstruction or low blood pressure.
    • Physiological effects include increased heart rate and patient anxiety.
  • Aspirin: Administered to cardiac patients to stop the clotting process (platelet aggregation) so blood can flow more freely.
  • Activated Charcoal: The dosage is 1 g1\,g per kilogram of body weight. For a child weighing 20 kg20\,kg, the dose would be 20 g20\,g.
  • Drug Contraindication: A drug is contraindicated when it is determined to be harmful or have negative effects on the patient's specific condition.

Cardiovascular Emergencies and Shock

  • Ventricular Fibrillation (V-Fib): A rhythm where the patient is unconscious and unresponsive. This is one of the two rhythms (along with pulseless V-Tach) that an Automated External Defibrillator (AED) is designed to treat.
  • Ventricular Tachycardia (V-Tach): Can cause hypotension because the atria do not have enough time to refill with blood and the ventricles push too fast.
  • Cardiogenic Shock: Occurs when the heart fails as a pump, leading to a decrease in force. It can result from poor contractility, heart attacks, or increased preload. However, it is generally NOT characterized by increased afterload in the context of causes listed.
  • Congestive Heart Failure (CHF): Often presents with:
    • Pedal Edema: Fluid accumulation in the legs and feet (associated with right-sided heart failure).
    • Pink Frothy Sputum: Associated with pulmonary edema (left-sided heart failure).
    • Crackles/Rales: Lung sounds indicative of fluid in the alveoli.
  • Angina Pectoris: Occurs when the heart's myocardial oxygen demand exceeds its supply, often during exercise or due to a blockage.
  • Aneurysm: A ruptured aneurysm may be indicated by a sudden, severe headache.
  • Pulse Palpation: A pulse is felt when an artery is pressurized over a bony part of the body, indicating a sufficient blood pressure.

Respiratory Assessment and Management

  • Healthy Respiratory Drive: In a healthy individual, the brain stem stimulates breathing based on high levels of $CO_2$ ($CO_2$ drive).
  • Hypoxia: Defined as inadequate tissue perfusion or a lack of oxygen.
  • Stridor: A high-pitched, crowing sound heard in the upper airway, indicating a blockage or croup.
  • Subcutaneous Emphysema: A crackling or bubbling sensation felt underneath the skin, indicating air trapped in the tissues.
  • Emphysema and COPD:
    • Alveoli in emphysema patients lose elasticity and may appear stretched out or collapsed.
    • Patients often use pursed-up lips to force air out through the capillary membrane.
  • Carbon Monoxide Poisoning:
    • Presents with cherry red skin.
    • Pulse Oximetry ($SpO_2$) may give a falsely high reading (e.g., 98%98\%) because the device only measures what is bound to hemoglobin (it cannot distinguish between oxygen and carbon monoxide).
  • Ventilation: For patients with shallow, slow, or inadequate respirations, the provider must assist with ventilation (e.g., BVM).
  • Lung Anatomy: Humans have a total of 55 lung lobes (33 on the right, 22 on the left).

Traumatic Injury Management

  • Thoracic Cage and Flail Chest: A flail chest occurs when a segment of the thoracic cage (rib cage) is detached from the chest wall, usually involving three or more broken ribs.
  • Moving Patients: Moves should be planned, controlled, and smooth. The person at the head of the patient always gives the commands.
  • Spinal Injury Suspicion: High suspicion should be maintained in scenarios involving deceleration (like a motor vehicle accident) or significant head lacerations. Manual stabilization of the T-spine is required.
  • Burn Classification:
    • Depth and Extent: How burns are primarily classified.
    • Superficial (First-Degree): Characterized by redness and pain.
    • Full-Thickness (Third-Degree): May have no pain in the center because the nerves have been destroyed.
  • Cushing’s Triad (Intracranial Pressure):
    • High Blood Pressure (Hypertension).
    • Low Heart Rate (Bradycardia).
    • High/Irregular Respirations (such as Cheyne-Stokes breathing, which is fast breathing followed by absence of breath).
  • Extrication: Defined as the removal of a patient from a dangerous situation or position. Rapid extrication requires maintaining spinal stabilization.
  • Axial Loading: If a person jumps and lands on their feet, the energy transmission can travel through the legs and cause injury to the spine.
  • Battle Signs: Bruising behind the ears indicating a potential skull fracture or head injury.
  • Crush Syndrome: Typically occurs when a body part is trapped for longer than 4 hours4\,hours.

Diabetes and Metabolic Disorders

  • Diabetes Type 1: Characterized by the body's total inability to produce insulin.
  • Diabetes Type 2: Characterized by insulin resistance; the body produces insulin but cannot utilize it properly due to lifestyle or comorbidities.
  • Polyuria: Frequent urination caused by excessive glucose/protein buildup processed by the kidneys.
  • Polydipsia: Excessive thirst.
  • Diabetic Ketoacidosis (DKA): Occurs during severe hyperglycemia.
    • Kussmaul Respirations: Deep, rapid breathing associated with DKA used to blow off ketones/acid.
  • Stroke vs. Hypoglycemia: The primary clinical difference is that hypoglycemia patients almost always have an altered mental status or lower level of consciousness, while stroke patients may have a clearer consciousness but localized deficits (like speech issues).

Obstetrics and Pediatric Emergencies

  • Amniotic Fluid: Serves to protect and insulate the fetus.
  • Braxton Hicks Contractions: These are "false labor" cramps that are typically irregular and alleviate when the patient walks around.
  • Supine Hypotension Syndrome: Occurs in pregnant patients when the weight of the uterus compresses the inferior vena cava. Patients should be tilted or placed in a side-lying position.
  • Eclampsia: Defined as seizures resulting from maternal hypertension.
  • Nuchal Cord: When the umbilical cord is wrapped around the baby's neck during delivery.
  • Pediatric Cardiac Arrest: Most often caused by respiratory issues/failure rather than primary cardiac disease.
    • Pediatric CPR Threshold: Start CPR if the heart rate is less than 60 bpm60\,bpm.
  • Pelvic Inflammatory Disease (PID): Should be suspected in females with lower abdominal pain. It can lead to ovarian abscesses or ectopic pregnancy.

Medical Operations and Ethics

  • Medical Director: The individual responsible for authorizing EMTs to perform emergency medical care in the field.
  • Duty to Act: A legal obligation that exists whenever you are on duty, regardless of how much time is left in the shift.
  • Refusal of Care: An adult must be alert, oriented times four (A and O×4A\,and\,O\times 4), and possess all mental faculties (not under the influence of alcohol or drugs) to refuse care. If alcohol is present, PD may need to be involved.
  • Transfer of Care: Officially occurs only when you give a report to the nurse/staff at the hospital.
  • Medical Air Transport: Used in situations involving heavy traffic or the need for rapid transport to a specialty center.
  • Situational Awareness: The act of recognizing and being aware of the specific circumstances and hazards of a scene.
  • Golden Hour: Begins at the moment the injury occurs and ends when the patient reaches definitive care at the hospital.
  • Glasgow Coma Scale (GCS):
    • Scenario: Patient opens eyes (4), moans (2), and pulls away/withdraws from pain (trapezius pinch).
    • The instructor identifies this score as an 88.

START Triage System (RPM Method)

  • RPM: Stands for Respirations, Pulse, and Mental Status.
  • Triage Criteria:
    • Immediate (Red Tag): Respirations > 30 bpm30\,bpm, or if the patient starts breathing only after the airway is opened.
    • If a patient is unresponsive and has a respiration rate of 34 bpm34\,bpm, they are tagged Red (Immediate).
    • Recovery Position: Patients who begin breathing after an airway maneuver should be placed in the recovery position.

Questions & Discussion

  • Instructional Dialogue: The instructor emphasized that every student should leave with a certificate after their hard work.
  • Question on Communicating Death:
    • Question: If a patient asks if their spouse (who died on scene) is alright, what do you say?
    • Response: The Registry-preferred answer is to focus on the patient's injuries and let the clergy or hospital staff relay the bad news later. Note: Instructors and students (Amadine) noted this is a "goofy" but correct answer for testing purposes.
  • Classroom Banter: The instructor joked with Amadine about her answering all the questions and suggested he might get hit by a thrown object if he didn't pay attention.
  • Blood Pressure Cuffs: There was a discussion about automatic cuffs being inaccurate. A joke was made that some brands (Life Packs) are so sensitive they would give a reading if wrapped around a 2-liter bottle.
  • Anecdote on Emphysema: The instructor shared that his mother claims her emphysema is "gone," despite showing clear symptoms like difficulty breathing.
  • Neck Wounds: A question was asked about a stab wound to the neck; the primary concern is avoiding an air embolism.