Major Exam #1

Exam 1

(Rita) EMS systems:

1. Licensure / Certification

• EMR (CPR first responders)
  • Have very basic training
  • Provide care before ambulance arrives
  • may assist in ambulance
  • provide immediate care
• EMT (Emergency medical technician)
  • have training in basic life support (BLS)
  • Automated external defibrillation (AED)
  • Airway adjuncts
  • assist patients with certain medications
• AEMT (advanced EMT)
  • Have training in specific aspects of advanced life support (ALS)
  • Intravenous (IV) therapy
  • administration of a limited number of emergency medications
• Paramedics
  • have extensive ALS training
  • Endotracheal intubation
  • Emergency pharmacology
  • Cardiac monitoring
  • Other advanced assessment and treatment skills

1. Medical Director

• Local level
• a physician who assumes ultimate responsibility for the patient care aspects of the EMS system
• provide oversight and support
• Act as liaison
• Responsible for maintaining quality control

1. Dispatcher

• Obtains information and dispatch resources
• Trained dispatchers obtain information about the call and send responders to the scene as needed

1. Quality Assurance
2. Quality improvement

• A process of continuous self-review with the purpose of identifying and correcting aspect of the system that require improvement

1. Continuing medical education

• measure intended to maintain and update and EMT’s skills and knowledge
• Refresher courses, computer-based or manikin-based self-education exercises

1. Online medical support

• Direct
• Physician directions give over the phone or radio

1. EMT role in the EMS system

• Keep vehicles and equipment ready
• ensure safety
• be familiar with emergency vehicle operation
• provide on-scene leadership
• perform scene evaluation
• call for additional resources as needed
• gain patient access
• perform a patient assessment
• give emergency medical care while awaiting additional medical resources
• and so much more

Medical Terminology

o Anatomical Positions/directions

• Prone and Supine - the body is in the prone position when lying face down; the body is in the supine position when lying faceup
• Fowler Position - placing patients in a semi-reclining position with the head elevated to help them breathe easier and to control the airway.

Palmar and Plantar - the front region of the hand is referred to as the palm or palmar surface. The bottom of the foot is referred to as the plantar surface

Apex - The (plural apices) is the tip of a structure. The apex of the heart is the bottom of the ventricles in the left side of the chest

o Medical Suffixes

o Medical Prefixes

o Common medical terminology

o Abbreviations (common ones, universally accepted ones)

• When using abbreviations on PCR use only standard accepted abbreviations to avoid confusion and errors.
• Be familiar with accepted use of abbreviation in your local jurisdiction or service area.

o Patient care reports (What are they? Why are they important?

• prehospital care report, the legal document used to record all aspects of the care your patient received, from initial dispatch to arrival at the hospital.

How do I handle mistakes?

• Write down what did or did not happen and the steps that were taken to correct the situation. Falsifying info on the PCR may result in suspension of certification/license

What is included in them?

• The chief complaint, nature of illness, level of consciousness, patient demographics (age, sex, ethnic background), transport information (how the patient was moved)

What shouldn’t be included?

• Stating personal judgment that may not be supportable.

Who gets them?)

o Abbreviations (What should I remember about using them)

• EMS personnel are not the only people reading the documents; Be sure to spell words correctly, especially medical terms. Try to avoid using abbreviations

o KNOW ABBREVIATIONS FOR SOME COMMON TERMS/OBJECTS

• ABCs : Airway, breathing, and circulation
• LOC: level of consciousness
• PCR: patient care report
• NOI: nature of Illness

(Rita) Communications

1. Types of communications

• Verbal communication
  • Asking questions is a fundamental aspect of prehospital care
  • Open-ended questions require some level of detail
  • Closed-ended questions can be answered in very short responses
• Nonverbal communication
  • body language provides more information than words alone
    • Even without changing any words, you should be able to tell the mood of your patient
  • Facial expressions, body language, and eye contact are powerful communication tools
    • Help people understand messages being sent
  • When treating a potentially hostile patient, be aware of your body language
  • Stay calm and try to defuse the situation
    • Assess the safety of the scene
    • do not assume an aggressive posture
    • make good eye contact, but do not stare
    • speak calmly, confidently, and slowly
    • never threaten the patient, either verbally or physically
  • Physical factors
    • Literal noise, or sounds in the environment, lighting, distance, or physical obstacles may affect your communication
    • Cultural norms often dictate the amount of space, or proximity, between people when communicating
    • Gestures, body movements, and attitude toward the patient are critically important
    • personal space
  • Ethnocentrism: considering your own cultural values more important than others
  • cultural imposition: forcing your values onto others
  • After receiving an order from medical control over the radio, the EMT should repeat the order to the physician word for word. After confirming the order, the EMT should obtain the necessary consent from the patient.

1. Communicating with hearing-impaired patients

• most have normal intelligence and are not embarrassed by their disability
• position yourself so the patient can see your lips
• hearing aids
  • Be careful that they are not lost during an accident
  • they may be forgotten if the patient is confused
  • ask family about use of a hearing aid
• Steps to take to efficiently communicate with patient who are hard of hearing:
  • Have paper and pen available
  • if the patient can read lips, face the patient and speak slowly and distinctly
  • never shout
  • listen carefully, ask short questions, and give short answers
  • learn some simply sign language

1. Communicating with visually impaired patient

• ask the patient if he or she can see at all
  • Visually impaired patients are not necessarily completely blind
  • expect the patient to have normal intelligence
• explain everything you are doing as you are doing it
• Stay in physical contact with he patients as you being your care
• guide dogs
  • Easily identified by special harnesses
  • if possible, transport dog with patient (alleviates stress for both patient and dog)
  • otherwise, arrange for care of the dog

1. Open/closed-ended questions

• Open-ended questions require some level of detail
  • Use whenever possible
  • Ex. What seems to be bothering you?
• Closed-ended questions can be answers in very short responses
  • Response in sometimes a single word
  • use if patients cannot provide long answers
  • ex. Are you having trouble breathing?

1. Radio communication

• Base station radios
  • Contain a transmitter and a receiver in a fixed place
  • dedicated line, aka hotline, is used for specific point-to-point contact
• Mobile and portal radios
  • Mobile radio is Installed in a vehicle
  • used to communicate with: dispatcher, medical control
  • ambulances often have more than one
  • Portable radios are hand-held devices
• Repeater-based systems
  • A repeater is a special base station radio
  • receives messages and signals on one frequency
  • automatically retransmits them on a second frequency
  • allow to mobile or portable units that cannot reach each other directly to communicate
• Repeater: receives a low-frequency signal and then transmits it at a relatively high frequency

1. Communicating with Children

• fear is most obvious and severe in children
• children may be frightened by
  • Your uniform
  • the ambulance
  • a crowd of people gathered around them
• Let a child keep a favorite toy, doll, security blanket
• if possible, have a family member or field nearby
  • If practical, let the parent or guardian hold the child during evaluation and treatment
• be honest
• tell the child ahead of time if something will hurt
• be approachable, friendly
• please refer to “general approach to safety restraining devices” in NYS protocol

(Rita) Shock

1. What is it?

• hypoperfusion, inadequate cellular perfusion
• Shock is a state of collapse and failure of the cardiovascular system that leads to inadequate circulation
• Three basic causes:
  • Pump failure
  • poor vessel function
  • low fluid volume

1. Stages of shock (definition of each, how can you tell a person is moving from one stage to the next)

• Compensated shock: early stage when the body can still compensate for blood loss
• Decompensated shock: late stage when blood pressure is falling

1. Different types of shock (names, what cause each)

• Cardiogenic shock
  • Caused by inadequate function of the heart
  • a major effect is the backup of blood into the pulmonary vessels
  • resulting buildup of pulmonary fluid is called pulmonary edema
  • develop when the heart cannot maintain sufficient output to meet the demands of the body
• Obstructive shock
  • Caused by mechanical obstruction that prevents an adequate amount of blood from filling the heart chambers
  • Cardiac tamponade
    • Signs and symptoms are referred to as Beck triad (low BP, JVD, muffled heart sounds)
  • Tension pneumothorax
  • Pulmonary embolism
    • A blood clot that blocks the flow of blood through pulmonary vessels
• Distributive shock
  • Results from widespread dilation of small arteries, small venules, or both
  • Septic shock
    • Occurs as a result of severe infections in which toxins are generated by bacteria or by infected body tissues
  • Neurogenic shock
    • Usually the results of high spinal cord injury
  • Anaphylactic shock
    • Occur when a person reacts violently to a substance to which he or she has been sensitized
    • Sensitization means becoming sensitive to a substance that did not initially cause a reaction
  • Psychogenic shock
    • cause by a sudden reaction of the nervous system
    • result in fainting (syncope)
• Hypovolemic shock
  • Results of an inadequate amount of fluid or volume in the circulatory system
  • Hemorrhagic causes (excessive bleeding) and no hemorrhagic causes (excessively reduce body fluid)

1. Signs & symptoms of shock

• Compensated shock sign and symptoms
  • Agitation
  • Anxiety
  • Restlessness
  • feeling of impending doom
  • weak, rapid (threads) pulse
  • clammy (pale, cool, moist) skin
  • pallor, with cyanosis about the lips
  • shallow, rapid breathing
  • nausea or vomiting
  • capillary refill of longer than 2 seconds in infants and children
  • marked thirst
  • narrowing pulse pressure
• Decompensated shock
  • Falling blood pressure (systolic blood respire < 90)
  • declining mental status, altered level of consciousness
  • Labored or irregular breathing
  • Ashen, mottled, or cyanotic skin
  • threads or absent peripheral pulses
  • dull eyes, dilated pupils
  • poor urinary output

1. Early signs vs late signs

• early sign: increase respiratory rate
• Late sign: falling blood pressure

1. How do you treat a patient in shock?

• Cardiogenic shock:
  • Place the patient in a position that eases breathing as you give high-flow oxygen
  • assist ventilations as necessary
  • provide prompt transport
  • considering meeting ALS en route to hospital
• Septic shock
  • Hospital management is required
• Neurogenic shock
  • Obtain and maintain a proper airway
  • provide spinal immobilization
  • assist inadequate breathing
  • conserve body heat
  • ensure the most effective circulation
• Anaphylactic shock
  • Administer epinephrine
• Psychogenic shock
  • Transport the patient promptly
• Hypovolemic shock
  • Control all obvious external bleeding
  • keep the patient warm
  • recognizes internal bleeding and provide aggressive support
  • secure and maintain an airway, and provide respiratory support
  • transport as rapidly as possible

(Grace) Workforce Safety & Wellness

PPE (What is it? What should I wear and when?)

• Personal Protective Equipment
• Gloves: wear if there is any possible for exposure to blood or body fluids
  • vinyl , nirtle and latex gloves are effective protection
  • Removing gloves requires a special technique
  • Avoid contamininating yourself with materials ont eh outside of the gloves
• Eye protection and face shields: protects from blood splatters
  • Prescription glasses are not adequate
  • Googles or face shields are best
• Masks, respirators and barrier Devices
  • Standard surgical masks for fluid spatter
  • Surgical mask on patient with communcaitable diease
  • Mask with particular air respirator on yourself if diese is tubericilosis
  • Mouth - to mouth resuscitation may transmit disease
    • With infected patients use
      • Pocket mask
      • Bag mask device

o BSI (What is it? Why is it important?)

• Body Substance Isolation
  • Prevents the spread of disease

o Stages of grief/anger (What are they? How to recognize them?)

• Denial
• Anger/ hostility
• Bargaining
• Depression
• Acceptance

o Death and dying (what are they, how does this affect people, how does it

affect me)

• Death occurs:
  • Quite suddenly
  • After a prolonged, terminal illness

o Stress (What is it? How do I reduce it?)

• Stress: a state of worry or mental tension cause by a difficult situation
  • Eustress: (good stress) creates a positive response
  • Distress: causes a negative response
• Ways to reduce stress
• Minimize or eliminate stressors.

▪ Change partners to avoid a negative or hostile personality.

▪ Change work hours.

▪ Change the work environment.

▪ Cut back on overtime.

• Change your attitude about the stressor.

▪ Talk about your feelings.

▪ Seek professional counseling if needed.

▪ Do not obsess over frustrating situations.

▪ Try to adopt a relaxed, philosophical outlook

o Scheduling (what works best? Why?)

(Grace) Pharmacology

Trade name vs Brand name vs Generic name (what does each mean?)

Generic name: a simple clear, nonproprietary name

Ex: ibuprofen

Trade name: manufacturer’s brand name (same as brand name)

One drug may have more than one trade name

Ex: tylenol

o What drugs can the EMT give? (Why do we give each one? How do we

administer each drug?)

Oxygen

• Any dispia
• Nasal canlia (2-6 LPM)
• Non breather (10-15 LPM)
• Oxygen is inhaled

Abuteral Sulfate

• 2.5mg/3mg
• Beta 2 agonist- bronchi dialator
• Can only be given 3 times

Epinephrine

• Given IM
• Anaphylactic shock (exposed to allergen)
• 2 or more of the body systems affected
• Under 66lbs .15 mg of epi
• Over 66lbs .30mg
• Only use twice after calling medical control, respitory distress

Narcane (Naxalone)

• Used for opioid overdoes
• Come prescribed & recreationally
• Pinpoint pupils
• Hypoventalate
• Given intranasally (IN)
• 4mL or 2mL depending on delivery

Glucose

• Given orally (PO)
• Given to diabitic patients who are consious for hypoglicemic

Asprin

• Used for chest pain
• Given orally
• Cardiac related chest pain
• 324 mL or 4 81mL pills (baby aspirin)
• Max 325mL
• NEVER GIVE TO STROKE PATIENTS

o What drugs can an EMT assist a patient with?

Nitrogylcerin

• Not supplied on ambulance
• Must be the patients medication (not a spouse or family members)
• Helps thin blood and open vessels
• <120 sys BP
• Can be given 3x every chest pain episode
  • Must reassess blood pressure

o Indications and contraindications for each drug

Asprin

Indications: relief of mild pain, headache, muscle aches, fever; chest pain of cardiac origin

Contraindications: hypersensitivity; recent bleeding

Albuterol

Indications: Asthma/ difficulty breathing with wheezing

Contradictions: hypersentitivties, tachycardia, chest pain of cardiac origin

Epinephrine

indications : anaphylactic reaction

Contradictions: chest pain of cardiac origin; hypothermia; hypertension

Naxolone

Indications: opioid posioning

Contraddictions: hypersensitivity

Nitroglycerin

Indications: chest pain of cardiac origin

Contradictions: hypertension, use of sildenafil (viagra) or another treatment for erectile dysfunction within the previous 24 hours

Oral Glucose

Indictions: low blood glucose

Contradictions: chest pain of cardiac origin

Oxygen

Indications: reverse hypoxia; provides oxygen to be absorbed by lungs

Contradictions: hypoxia or susptected hypoxia

o Doses for each drug an EMT can give

Listed above

Drug administration routes

PR: Per Rectum - Rapid

PO: oral - slow

IV: Intravenous - immediate

IO: intraosseous - (into the bone) immediate

SC: subcantaneous (beneath the skin) - slow

IM: intramuscular - moderate

Inhalation - rapid

SL: sublingual - ( under the tongue) rapid

Transdermal: transcutaneous (through the skin) - slow

IN: Intranasal - rapid

o What does each drug do? (Expected results)

Listed above

Anatomy & Physiology (Chapter 5)

Body systems (What are they? What is the role of each?)

Body Systems: Groups of organs & tissues that work together to fufill a common goal/function

-Integumentary System:

Thermal Regulation

Initial barrier of immune-protection/responses

Sensory & Vitamin D Absorbtion

-Digestive system

Digestion begins within the mouth and ends with fecal defecation excruciating from the rectal sphincter.

Mouth - Digestion BUT NO ABSORBTION

1. Mechanical Digestion via mastications
2. Amylase starch digestive enzyme stemming from the salivary glands
3. Esophagus-Transportation route for the bolus (masticated food ball) to the stomach

Stomach-Site of major digestion via HCl formed via chief cells; pushes lysed food particles into the Duodenum

Duodenum- Sphincter between stomach and small intestine introductory site of enzymes and hormones such as bile from the gall bladder

Small Intestine- (Anatomically longer in length than large intestine but shorter in width) Site of major absorption via microvilli pushes Chyme - (HCL- Stomach digested food) throughout its entirety via Peristalsis via haustra to the Cecum

Cecum: Site of major microbiota storage

Large intestine: Enters via the ileocecal valve and pushes waste material throughout its entire length towards recum for extrication

Cardiovascular: Contained in the thoracic cavity posterior the lungs responsible for circulation of blood ; circulation of oxygen via i concave shaped hemoglobin cells that carry o2 and removal of carbon dioxide

Work in conjunction with the lungs & respiratory system

Endocrine system: Hormone Production /regulation

Pituitary gland is the master gland of hormones regulation

posterior pituitary

Thalamus

Thyroid/parathyroid hormone

Male & Female reproductive

Adrenal glands

Pancrease

thymus

Nervous System:

Lymphatic system: Nodules & pathways throughout the body of which transport lymph; essential in hormone, nutrients, & antibody transprotation. Also essential in adipose tissue creation (Fatty tissue)

Lymph nodes are found throughout the entire body but converge at the thoracic duct and empty into the subclavian veins

Reproductive:

Males: Triggered during adolescence by FSH & LH

Testicals: Beginning site of Spermatagonia; meiosis (23 Chromosomes)

Responsible for the production of testosterone and androgenic hormones responsible for giving men masculine features

Epididymis: Stores & completes the process of spermatagonia

Vas Deferens: Transports matured sperm cells in preparation of ejaculation

prostate: Provides sperm cells with rich nutrients for protection, energy & sustainable

Penis: Corpus Cavernosum & spongiosum tissue responsible for errections

Females:

Fallopian tube: Receiving site of oocytes during menstration

Ovaries: (Bilateral) maturation site for Oocytes responsible for estrogen & progesterone production

Uterus: Site of fetal development

Vagina:

Respitory: Three Lobes Right | Two Lobes Left

Avioli are the sites of gas exchange via diffusion stemming from negative gradient

Urinary:

Site of excretion & filtration of nitrogenous waste

Skeletal system:

Bones (What is their purpose? How are they classified?

What connects them to other parts of the body? Which bones make up a larger part of the anatomy?)

Connective tissues (What are they? Where are they? What do they connect?)

Blood

Cartilage

Solid vs. Hollow organs (What’s the difference between them? Where are they located)

Oxygen (What is it? How does it move through the body? How much is there around us)

Blood vessels (Types of vessels? What are the main ones of each type?

Pulse points

Groin

Radial

Popliteal

brachial

temporal

dorsalis pedis

Cells (What are they? What do they create when combined? What is their source of nutrition?)

Skin layers (What are they? What is contained in each?)

Physiology-definition