EMT Study Guide Notes

Vital Signs

• Blood Pressure (BP)

  • Normal systolic range $100-139\,\text{mmHg}$; clinical "ideal" $120/80\,\text{mmHg}$

  • Hypertensive >$139$; Hypotensive <$100$

  • Examples: $136/82$ (still normal); $102/64$ (normal)

• Heart Rate (HR)

  • Normal $60-99\,\text{bpm}$

  • Tachycardia >$100$; Bradycardia <$60$

• SpO$_2$

  • Normal $94-100\%$ (some texts $95-100\%$)

  • $98\%$ vs $96\%$ → both normal

• Respiratory Rate (RR)

  • Normal $12-20\,\text{breaths/min}$ (upper limit recently reduced from $24$)

  • <$12$ → agonal; >$20$ → hyperventilation/panic, poor perfusion

• Temperature

  • Normal $96.8-98.9^{\circ}\text{F}$; hypothermia ≤$95^{\circ}\text{F}$

• Finger-Stick Blood Glucose (FSBG)

  • Normal $70-120\,\text{mg/dL}$

  • <$70$ = critical hypoglycemia; >$350-400$ concerning hyperglycemia

EMT-B Scope Medications (follow local protocol)

• Chest Pain

  • Aspirin: up to $324\,\text{mg}$; check salicylate allergy

  • Nitroglycerin: contraindications—systolic <$100$, ED drugs (Viagra/sildenafil, Cialis/tadalafil) within 24 h

• Airway/Bronchodilators

  • Albuterol: $2.5\,\text{mg}/3\,\text{mL}$ via nebulizer @ $6-8\,\text{L/min}$ O$_2$

  • Atrovent (ipratropium): $0.5\,\text{mg}/3\,\text{mL}$; watch peanut allergy; same flow

• Anaphylaxis

  • Epinephrine auto-injector $1:1000$

  • Adult $0.3\,\text{mg}$

  • Child $0.15\,\text{mg}$ (or $0.01\,\text{mg/kg}$)

• Opioid Overdose

  • Naloxone (Narcan) IN via MAD; indicators: pinpoint pupils, slow RR

• Hypoglycemia

  • Oral Glucose tube; ONLY if A&O x4 and airway protected; otherwise request ALS

• Ingested Poisons

  • Activated Charcoal; same airway contra’s; call Poison Control first

• Fever

  • Acetaminophen (Tylenol) for $101-102^{\circ}\text{F}$; oral route shares same airway precautions

Oxygen Delivery Devices

1. Nasal Cannula: $2-6\,\text{L/min}$ | SpO$_2$ $88-93\%$ | conscious, stable

2. Non-Rebreather: $10-15\,\text{L/min}$ | SpO$_2$ $70-87\%$ | A&O

3. Nebulizer: $6-8\,\text{L/min}$ | delivers albuterol/atrovent | A&O

4. BVM: $15\,\text{L/min}$ | RR <$12$ or failing airway (usually unconscious)

Airway Management & Respiratory Notes

• Head-Tilt/Chin-Lift: no suspected trauma

• Jaw-Thrust: suspected C-spine injury/trauma

• Suction timing: Adults ≤$15\,\text{s}$ | Children ≤$10\,\text{s}$

• NPA contraindicated in facial/basilar skull fracture

• Snoring → tongue obstruction; consider OPA

• Paradoxical chest motion = flail segment

• One-sided breath sounds post-trauma → think pneumothorax; request ALS

• Ambient air ≈ $21\%$ O$_2$

• Capillary refill <$2\,\text{s}$ = good perfusion

• Carbon Monoxide: cherry-red skin, falsely high SpO$<em>2$; give high-flow O$2, transport (possible hyperbaric chamber)

• Pediatric infections

  • Croup (viral) → seal-bark cough

  • Epiglottitis (bacterial) → drooling, tripod; minimize agitation

• Kussmaul respirations: deep/rapid breathing in DKA (severe hyperglycemia)

Cardiovascular & Resuscitation

• Blood Flow Path

  • Rt atrium → tricuspid → rt ventricle → pulmonary artery → lungs → pulmonary vein → lt atrium → bicuspid/mitral → lt ventricle → aorta → body → veins → S/IVC → rt atrium

• CPR Essentials

  • Pull ambulance over BEFORE starting CPR in transit

  • Post-shock: resume compressions immediately (no pulse check)

  • Compression depth: Adults 2-3''$| Child/Infant$\tfrac13$chest</p></li><li><p>Rate:$100-120$cpm</p></li><li><p>Ratio: Single-rescuer any age$30:2$; Two-rescuer infant$15:2

  • ROSC = Return Of Spontaneous Circulation

• CHF

  • Left-side failure → pulmonary edema; Right-side → pedal edema

• Heart Sounds: S1 "lub" (AV valves), S2 "dub" (semilunar valves)

Stroke & Neuro

• Types

  1. Ischemic (clot)

  2. TIA (symptoms resolve <24\,\text{h}$)</p></li><li><p>Hemorrhagic (bleed; often severe HTN ~$190/108+)

• Signs: hemiparesis, facial droop, speech issues, altered mentation

• Scales: Cincinnati, FAST, VAN

• Time-critical: <3-4.5\,\text{h} to CT/thrombolytics if no bleed

• Seizure management: protect patient, NEVER place objects in mouth, request ALS for benzodiazepines

Endocrine / Diabetes

• Hypoglycemia (<70\,\text{mg/dL}) is immediately life-threatening

• Only give oral glucose if A&O x4 & airway protected; else ALS

• Hyperglycemia/DKA → Kussmaul respirations, fruity breath, dehydration

Abdominal & GI

• Quadrants: RUQ | RLQ | LUQ | LLQ

  • RLQ pain → appendicitis; palpate LUQ first

  • LUQ pain + shoulder referral → spleen injury

• Sudden tearing abdominal pain radiating to back → AAA; rapid transport Code 3

• Stiff neck + fever + headache (esp child) → rule out meningitis

• Jaundice (yellow skin/sclera) → liver failure/hepatitis

• Pink/frothy sputum → suspect tuberculosis (PPE!)

Obstetrics & Gynecology

• Terminology: Gravida (pregnancies) | Para (births)

• Placenta Previa: painless bright-red bleed >20 wks

• Abruptio Placenta: painful abdomen + bleed (often trauma)

• Ectopic Pregnancy: implantation in tube (life-threatening)

• Pre-eclampsia: HTN + edema/headache → risk of seizures → ALS

• Eclampsia: pre-eclampsia + seizure

• Imminent Delivery (<2 min contractions) → stop transport, prepare

• Complications

  • Nuchal cord: unwrap or clamp/cut if no slack

  • Prolapsed cord: hand lifts head off cord; hips elevated; rapid transport

  • Breech (legs/butt) may deliver; single-limb cannot → rapid transport

• Meconium staining: suction mouth first, then nose

• APGAR at 1 min and 5 min; scale 0-10 (see chart)

Trauma Essentials

• XABC (Exsanguination → Airway → Breathing → Circulation)

• Never remove impaled objects; stabilize

• Eye impalement: cover BOTH eyes

• Brain injuries: coup-contrecoup; subdural bleeds may evolve over days

• Fractures

  • Greenstick = partial (common in kids)

  • Traction splint ONLY for closed mid-shaft femur; never open

• Arterial bleed: direct pressure → tourniquet proximal ≥2''$above wound (not over joint)</p></li><li><p>Cardiac tamponade: fluid around heart → obstructs pump</p></li><li><p>Burns</p><ul><li><p>1° red/pain; 2° blisters; 3° white/leathery/no local pain → burn center</p></li><li><p>Adult Rule of Nines: Head 9, Arm 9 each, Leg 18 each, Anterior 18, Posterior 18, Perineum 1</p></li><li><p>Pediatric: Head 18, Leg 13.5 each (others same)</p></li><li><p>Rule of Palm: patient’s palm =$1\% TBSA

Environmental & Infectious

• Heat Exhaustion: sweating present; Heat Stroke: no sweat + AMS

• Near-drowning: encourage hospital eval; risk of secondary pulmonary edema/pneumonia

• Snakebite: limb below heart, circle swelling, no ice/tourniquet

• Tick-borne

  • RMSF (7-10 d: N/V, HA, paralysis)

  • Lyme (days-weeks: bullseye rash, joint pain)

• Excited Delirium: violent, diaphoretic; request ALS for sedation

HazMat & EMS Operations

• NFPA 704: Blue health | Red fire | Yellow reactivity | White special (4 = worst)

• Zones: Hot (techs) | Warm (decon) | Cold (EMS)

• Uphill & upwind from incident

• Ambulance crashes: most at intersections; use spotter when reversing

• Helicopter LZ: 100'!\times100', flat, free of debris

• Radios

  • Portable (on-person), Mobile (in unit), Repeater (boosts signal)

  • Simplex = one speaker at a time; Duplex = simultaneous (phone-like)

• Incident Command

  • Span of control 3-7 (ideal 5)

  • START triage: Red 1 (critical) | Yellow 2 | Green 3 (walking) | Black 4 (dead)

  • Unified Command = multiple agencies cooperate

  • Personal safety → life safety → incident stabilization → property conservation

Legal & Consent

• Battery: physical contact without consent causing harm

• Assault: verbal threat/intimidation

• Abandonment: terminate care or transfer to lower provider level

• Negligence: deviation from standard causing harm

• Advanced Directive (e.g., DNR)

• Implied Consent: unresponsive or life-threat scenario implies permission

Formulas & Calculations

• CO = SV \times HR$(Cardiac Output)</p></li><li><p>$Minute\ Volume = Tidal\ Volume \times Respiratory\ Rate$</p></li><li><p>Pediatric Systolic BP</p><ul><li><p>$\text{Max}=90+2(\text{age})$</p></li><li><p>$\text{Normal}=80+2(\text{age})$</p></li><li><p>$\text{Min}=70+2(\text{age})

Scales & Assessments

• Glasgow Coma Scale (3–15)

  • Eye (4), Verbal (5), Motor (6); Decorticate 3, Decerebrate 2

• APGAR (0–10) at 1 & 5 min: Activity, Pulse, Grimace, Appearance, Respiration

• Stroke: Cincinnati / FAST / VAN

• Acronyms: SAMPLE, OPQRST, SLUDGEM, DUMBELLS, DCAP-BTLS

Pharmacology Recognition

• Antihypertensives: Lisinopril, Amlodipine, Losartan, Labetalol, Metoprolol (succinate/tartrate)

• Diabetic: Metformin, Januvia, Humalog, Novolog, Novolin, Lantus, Toujeo

• Anticoagulants: Eliquis, Plavix, Xarelto (bleeding risk)

• ED meds: Viagra (sildenafil), Cialis (tadalafil) → contraindicate Nitroglycerin

• Opioids: Hydrocodone, Tramadol, Oxycodone, Morphine, Fentanyl, Codeine, Heroin → treat with Naloxone

Pediatric & Age-Specific Notes

• Age Groups: Neonate 0-28 d | Infant 1 m-1 y | Toddler 1-3 y | Preschool 3-5 y | School 6-12 y | Adolescent 13-18 y | Adult 18 +

• Younger child → higher HR/RR, lower BP

• Two-rescuer Infant CPR ratio 15:2$$

Key Terminology

• Anaphylaxis: severe allergic reaction → Epinephrine

• Ecchymosis: bruising (think trauma)

• Urticaria: hives

• Diaphoresis: sweating

• Priapism: non-aroused erection (suggests spinal injury)

• Epistaxis: nosebleed

• Hemiparesis: one-sided weakness (stroke)

• Jaundice: yellow skin/eyes (liver issue)

• "-itis" suffix = inflammation (e.g., hepatitis)

Always follow local medical direction, protocols, and scope of practice when applying these concepts.