Emergency Medical Services Review

Final Exam Review Notes

Emergency Medical Responders and Technicians

  • Emergency Medical Responder (EMR):

    • Definition: The first trained person to arrive on scene.

    • Responsibilities: Provides basic life-saving care (e.g., CPR, bleeding control, airway management) until Emergency Medical Services (EMS) arrives.

  • Emergency Medical Technician (EMT):

    • Definition: A licensed prehospital provider trained to assess and treat patients with basic life support (BLS) skills.

    • Skills includes:

    • Oxygen administration

    • Splinting

    • Patient transport

Standing Orders

  • Definition: Pre-approved medical protocols that allow EMTs to perform certain treatments without contacting medical control first.

Family Reactions to EMS Work

  • Families may exhibit the following reactions to a member working in the EMS profession:

    • Pride

    • Anxiety

    • Fear for safety

    • Resentment of time away

    • Stress

    • Emotional withdrawal

Positive Stress Management for EMS Workers

  • Effective strategies to deal with EMS work stress include:

    • Exercise

    • Peer support

    • Debriefing (Critical Incident Stress Debriefing - CISD)

    • Hobbies

    • Adequate sleep

    • Professional counseling

    • Talking to colleagues

Role of the EMS System

  • Primary Function: To provide emergency medical care in the prehospital setting, stabilize patients, and transport them to appropriate medical facilities.

Scope of Practice

  • Definition: The specific skills and interventions an EMT is legally authorized to perform based on their level of training and state law.

Consent Types

  • Expressed Consent:

    • Definition: Patient verbally or in writing agrees to treatment.

  • Implied Consent:

    • Definition: Assumed consent for unconscious or unresponsive patients who cannot speak for themselves; assumed the patient would want care.

Newborn Reflexes

  • Sucking Reflex in Newborns:

    • Definition: An involuntary reflex where the newborn sucks when something touches the roof of their mouth; sign of neurological health.

Vascular Anatomy

  • Oxygen-Poor Blood Vessels:

    • The vessels that carry oxygen-poor blood to the right atrium are the superior and inferior vena cava.

Muscle Types

  • Voluntary Muscles (Skeletal):

    • Consciously controlled (e.g., arms, legs).

  • Involuntary Muscles (Smooth/Cardiac):

    • Not consciously controlled (e.g., intestines, heart).

Fight or Flight Response

  • Physiological Changes:

    • Activation of the sympathetic nervous system releases epinephrine, resulting in:

    • Increased heart rate

    • Dilation of airways

    • Redirection of blood to muscles

    • Increased blood pressure

    • Dilation of pupils

Respiratory Control

  • Brain Structure: The medulla oblongata (in the brainstem) is responsible for respiratory control.

  • Respiratory Drive Trigger: Normal triggers for respiratory drive are changing levels of carbon dioxide (CO_2).

Activated Charcoal

  • Definition: A powder made from charred wood that an EMT might give a conscious poisoning patient to bind to toxins in the stomach and prevent absorption.

Emphysema Management

  • Shortness of Breath Treatment:

    • Administer low-flow oxygen (2–4 L/min via nasal cannula).

    • Note: Emphysema patients may rely on hypoxic drive; excessive O₂ can suppress breathing.

    • Monitor the patient closely.

Patient Positioning

  • Recovery Position:

    • Best position for a patient to keep fluid or vomitus from occluding their airway (left lateral recumbent).

Oxygen Administration Techniques

  • Nonrebreather Mask Use:

    • Indicated for patients needing high-concentration oxygen (up to ~90%), such as carbon monoxide poisoning, respiratory distress, hypoxia; delivers 10–15 L/min.

  • Bag-Valve Mask (BVM) Use:

    • Indicated for patients not breathing adequately or apneic; provides positive pressure ventilation.

Chronic Obstructive Pulmonary Disease (COPD)

  • Definition: A chronic lung disease (which includes emphysema and chronic bronchitis) causing airway obstruction, characterized by:

    • Difficulty breathing

    • Chronic cough

    • Reduced oxygen exchange.

Respiratory Rate Ranges

  • Adults: 12–20 breaths/min

  • Children: 15–30 breaths/min

  • Infants: 25–50 breaths/min

Blood Pressure Ranges

  • Adults (Normal): ~120/80 mmHg

  • Children: Systolic ~80–110 mmHg

  • Infants: Systolic ~60–90 mmHg

Heart Rate Ranges

  • Adults: 60–100 bpm

  • Children: 70–120 bpm

  • Infants: 100–160 bpm

Patient Assessment Monitoring

  • Reassessment: This occurs post-intervention to determine whether the medicine administered was effective.

  • Trending in Patient Assessment: A pattern of improvement or deterioration in vital signs over time (e.g., if blood pressure is trending down, the patient may be getting worse).

Mechanism of Injury Evaluation

  • When to Evaluate: This should occur during the scene size-up, prior to approaching the patient.

Verbal Reports to Hospital Staff

  • Information to convey includes:

    • Patient age/sex

    • Chief complaint

    • Patient history

    • Vital signs

    • Treatment given

    • Patient response.

Abdominal Pain Assessment

  • Post-History: After completing a history for someone with abdominal pain, perform a physical exam by palpating all four quadrants for:

    • Tenderness

    • Rigidity

    • Guarding

    • Provide a position of comfort, monitor vitals, and transport the patient.

Chief Complaint Definition

  • Definition: The patient's primary reason for calling EMS, expressed in their own words (e.g., "chest pain," "can't breathe").

Unconscious Patient History Gathering

  • Sources: If patients are unconscious, gather a history from bystanders, family members, medical alert bracelets, or previous records (utilizing the SAMPLE history by proxy).

Secondary Assessment Purpose

  • Definition: Appropriate for stable patients where time allows for a head-to-toe physical examination to identify additional injuries or conditions.

Signs of Myocardial Infarction

  • Heartburn vs. Myocardial Infarction: If a patient is struggling with heartburn, the following symptoms would lead to suspicion of a more serious condition:

    • Radiation to the arm/jaw

    • Diaphoresis

    • Nausea

    • Shortness of breath.

Reassessment Timing for EMTs

  • Unstable Patients: Every 5 minutes.

  • Stable Patients: Every 15 minutes.

Clarification with Medical Control

  • If unsure about information from medical control:

    • Respectfully clarify by restating what you heard and asking for confirmation and never ignore orders.

    • Important: Document everything.

Aortic Aneurysm

  • Definition: A bulge/weakening in the wall of the aorta.

  • Patient Description of Pain: Patients may describe the pain as a "tearing" or "ripping" sensation in the back or abdomen.

Anaphylaxis Treatment

  • Best Treatment for Patient Having Difficulty Breathing, Swollen Tongue, and Hives: Administering epinephrine (EpiPen), high-flow O₂, positioning of comfort, and rapid transport.

Albuterol

  • Definition: A bronchodilator that relaxes smooth muscle in the airways, helping patients with:

    • Asthma

    • COPD

    • Bronchospasm.

Epinephrine in Patient Care

  • Definition: A sympathomimetic drug that causes bronchodilation, vasoconstriction, and increased heart rate, commonly used in:

    • Anaphylaxis

    • Cardiac arrest.

Myocardial Infarction Symptoms in Females

  • Common Symptoms: Women often experience atypical symptoms such as:

    • Nausea

    • Fatigue

    • Jaw/back/shoulder pain

    • Shortness of breath.

Psychiatric Emergency Medical History

  • Importance: A thorough medical history is needed to rule out medical causes (e.g., hypoglycemia, hypoxia, drugs, head injury) that can mimic psychiatric illness.

Suctioning Differences by Patient Age

  • Adults: Use standard suction pressure.

  • Pediatrics: Use lower suction pressure and limit suction time to:

    • 5 seconds for infants/children

    • 10 seconds for adults.

BP Cuffs and Dialysis Patients

  • Protocol: Use the other arm for blood pressure measurements if the patient has a tube or shunt (e.g., dialysis shunt or IV) to avoid damage.

Airway Differences by Age

  • Pediatric Airway Characteristics: Smaller, shorter, more anterior, and more flexible; proportionally larger tongue which makes them more prone to obstruction.

Drug Naming

  • Differences in Drug Names:

    • Generic Name: Official chemical name (e.g., acetaminophen).

    • Brand/Trade Name: Manufacturer's name (e.g., Tylenol).

Inhalers for Asthma Management

  • Mechanism: Prescribed inhalers deliver bronchodilators directly to the airways, relaxing smooth muscle and opening airways to improve airflow.

Relationship of Glucose to Insulin

  • Definition: Insulin is a hormone that helps cells absorb glucose from the blood. Without insulin, glucose builds up in the bloodstream (hyperglycemia).

Transient Ischemic Attack (TIA)

  • Definition: A "mini-stroke" due to temporary blockage of blood flow to the brain; symptoms resolve within 24 hours and serve as a warning for potential stroke.

Toxins

  • Definition: A poisonous substance produced by living organisms (bacteria, plants, animals) that causes harm when introduced to the body.

Pneumonia

  • Definition: An infection causing inflammation and fluid accumulation in the alveoli of the lungs, impairing gas exchange; symptoms include:

    • Fever

    • Cough

    • Difficulty breathing.

Cholecystitis

  • Definition: Inflammation of the gallbladder, usually due to gallstones; causes right upper quadrant pain, especially after eating fatty foods.

Dialysis Complications

  • Common Complications:

    • Hypotension

    • Air embolism

    • Bleeding from the fistula

    • Infection

    • Electrolyte imbalances

    • Clotting of the shunt.

Contraindications for Nitroglycerin Use

  • Indications:

    • Systolic BP < 90 mmHg

    • Use of Viagra/Cialis/Levitra (PDE5 inhibitors) within the last 24–48 hours

    • Head injury

    • Hypotension or bradycardia.

Diabetes Management

  • For Hypoglycemic Patients:

    • If conscious: Administer oral glucose.

    • If unconscious: ALS intervention (IV dextrose or glucagon).

    • Monitor blood sugar levels.

Altered Mental Status and Glucose Levels

  • Protocol: If the patient has altered mental status and it’s unclear whether they have too much or too little sugar:

    • Administer oral glucose if they can swallow and protect their airway.

    • Treat for hypoglycemia when in doubt, as it is more immediately dangerous.

Medication Forms

  • Distribution:

    • Oral glucose: Gel

    • Nitroglycerin: Tablet (sublingual) or spray

    • Epinephrine: Auto-injector (EpiPen).

Anaphylaxis Treatment Protocols

  • Treatment for Allergic Reactions: If a patient presents with itching in the throat and difficulty breathing, treat as anaphylaxis regardless of confirmed cause.

Histamine Reactions in Allergic Reactions

  • Mechanism of Breathing Difficulty: Histamine release leads to bronchospasm and airway edema, which narrow the airways.

Poison Absorption Treatment

  • Most Important Treatment Step: Remove the patient from the source of poison (decontamination) and prevent further absorption by removing contaminated clothing and brushing/washing off the substance.

Alcohol and Sleeping Pills Ingestion

  • Action for Inadequate Breathing: Assist ventilations with a BVM, administer oxygen, rapid transport, and notify medical control.

Varicella Zoster

  • Definition: Chickenpox (primary infection) / Shingles (reactivation), caused by the varicella-zoster virus; symptoms include a blistering rash.

CPR Guidelines

  • Partner Switching During CPR: Switch every 2 minutes (at the end of each cycle of compressions) to prevent fatigue and maintain quality compressions.

Foreign Body Airway Obstruction in Infants

  • Finger Sweep Protocol: Never perform a blind finger sweep on an infant; only remove an object if visibly seen.

CPR Compression Depth for Adults

  • Depth Requirement: At least 2 inches (5 cm), but no more than 2.4 inches.

Child Ventilation Rates During Rescue Breathing

  • Ventilation Rate for a 6-Year-Old: 1 breath every 3–5 seconds (~12–20/min).

  • Ventilation Rate for an Adult: 1 breath every 5–6 seconds (~10–12/min).

Hallucinogen Ingestion Protocols

  • Action for Patient Refusing Transport: Document refusal, ensure decision-making capacity, have the patient sign a refusal form, and advise calling back if they change their mind.

Hostile Patient Characteristics

  • Signs to Watch For:

    • Clenched fists

    • Pacing

    • Loud voice

    • Invading personal space

    • History of violence

    • Wide eyes

    • Rapid breathing

    • Threatening language.

Vascular Definitions

  • Artery vs. Vein:

    • Artery: Carries blood away from the heart (usually oxygenated).

    • Vein: Carries blood towards the heart (usually deoxygenated).

Internal Bleeding Management in Patients on Blood Thinners

  • Care Protocol:

    • Keep the patient calm and still, administer high-flow O₂, treat for shock (lay flat, keep warm), ensure rapid transport as blood thinners create a high priority situation.

Unresponsive Child with Airway Obstruction

  • Action in CPR: Initiate CPR. When opening the airway for breaths, look for the object and only remove it if visible; continue CPR and arrange transport.

Crushing Injuries

  • Definition: An injury resulting from prolonged compression of the body, which can lead to crush syndrome, releasing myoglobin into the bloodstream, potentially causing kidney failure.

Internal Bleeding and Shock Indicators

  • Monitoring for Shock: Signs include:

    • Tachycardia

    • Hypotension

    • Pale/cool/clammy skin

    • Altered mental status

    • Rapid breathing.

Treatment for Burns

  • Full Thickness Burns on Hands/Forearms: Use dry sterile dressings; do NOT apply water or ice, cover loosely.

  • Partial Thickness Burns on Chest: Cool with water if recent/small area, use sterile dressings, administer O₂, and transport.

Consequences of Loose Splinting

  • Complications: Loose splinting may fail to immobilize a fracture leading to:

    • Increased pain

    • Continued movement

    • Bleeding

    • Nerve/vessel damage

    • Fat embolism.

Traction Splint Definition and Contraindications

  • Definition: A device that applies longitudinal pull to stabilize a mid-shaft femur fracture.

  • Contraindications Include:

    • Hip/pelvis fractures

    • Knee injuries

    • Lower leg/ankle fractures

    • Partial amputations.

SAM Splint Use

  • Indications: Consider using a SAM splint for wrists, ankles, fingers, and any extremity with a suspected fracture or sprain requiring rigid splinting.

Nervous System Components

  • Components:

    • Central Nervous System (CNS): Brain and spinal cord.

    • Peripheral Nervous System (PNS): All nerves outside the CNS (including somatic and autonomic systems).

Antidepressants

  • Definition: Medications that treat depression by affecting neurotransmitters (serotonin, norepinephrine, dopamine). Examples include SSRIs (Prozac), SNRIs, and tricyclics.

Kendrick Extrication Device (KED)

  • Definition: A short spinal immobilization device used to stabilize the spine when removing a patient from a vehicle.

Child Definition for CPR Purposes

  • Age Range for CPR Definition: A child is defined as being from 1 year to puberty (approximately 12–14 years old).

Air Embolism

  • Definition: Occurs when air enters the bloodstream, causing blockages in blood vessels, which can result from IV lines, trauma to neck veins, or decompression sickness.

Arterial Bleeding Management

  • Management for Bright Red Blood Spurting:

    • Bright red spurting indicates arterial bleed; apply direct pressure immediately.

    • If it's a limb with uncontrolled bleeding, apply a tourniquet 2–3 inches above the wound.

Post-Seizure Management in Children

  • Context: A child with a high fever who just had a seizure.

  • Treatments include:

    • Ensure safety during the seizure (do NOT restrain).

    • After the seizure, place in the recovery position, administer O₂, keep cool, and transport for evaluation.

Asystole Definition

  • Definition: A state where there is no electrical activity in the heart, presenting as a flatline on cardiac monitoring; requires CPR and administration of epinephrine (ALS level); not shockable.

Childbirth Kit Components

  • Supplies Include: Sterile gloves, drapes/towels, bulb syringe, clamps (x2), scissors, sterile gauze, blanket for the baby, biohazard bags, and sterile cord.

Prenatal Care Considerations in Labor

  • Caution with Patients: Be wary of women in labor who have had no prenatal care due to the potential for undiagnosed conditions such as:

    • Pre-eclampsia

    • Placenta previa

    • Breech presentation

    • Multiple births

    • Infections

    • Drug use.

Hypovolemic Shock

  • Definition: Shock caused by significant fluid/blood loss, leading to inadequate tissue perfusion.

  • Treatment Includes: Positioning, O₂ administration, keeping the patient warm, and rapid transport.

Quality CPR Guidelines for Adults

  • Key Elements Include:

    1. Compression rate of 100–120/min

    2. Compression depth of at least 2 inches

    3. Allowing full chest recoil

    4. Minimizing interruptions of less than 10 seconds

    5. Avoiding excessive ventilation.

HAZMAT Standards for First Responders

  • Standard: NFPA 472 — standard for the competence of responders to hazardous materials/WMD incidents.

START Triage Guidelines

  • Simple Triage And Rapid Treatment:

    • Immediate (Red): Life-threatening but salvageable

    • Delayed (Yellow): Serious but stable

    • Minor (Green): "Walking wounded"

    • Expectant/Deceased (Black): Unsurvivable or no pulse/breathing after repositioning airway.