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EMT Study Notes: Vital Signs, Devices, Medications, Conditions, and Protocols

Page 1 — Vital Signs and Pediatric Reference

  • Adult resting heart rate (HR): Range 60-100\ \text{bpm}; athletes may have lower resting HR. Tachycardia defined as >100 bpm; bradycardia <60 bpm.
  • Adult respiratory rate (RR): Range 12-20\ \text{breaths/min}. Normal often cited as 12-16\ \text{breaths/min}. Tachypnea defined as >20\ \text{breaths/min}.
  • Adult blood pressure (BP): Normal around 120/80\ \text{mmHg}. Hypotension defined as systolic pressure <90\ \text{mmHg} (EMT shock threshold varies).
  • Pulse oximetry (SpO2): Normal range 95-100\%. SpO2 <94\% may indicate need for oxygen; <90\% emergency; consider clinical context (e.g., COPD).
  • Temperature (oral): Normal range 97-99\ \text{°F} (36.1-37.2\ \text{°C}). Fever often defined clinically as \ge 100.4\ \text{°F} (38\text{°C}).
  • Glasgow Coma Scale (GCS): Range 3-15. Components: Eye (4) + Verbal (5) + Motor (6). GCS <8 may necessitate intubation consideration.
  • Capillary refill: Normal <2\ \text{seconds}. Delayed refill suggests poor perfusion in shock (especially in children).
  • Pediatric vitals: Age-based values differ; refer to pediatric chart (neonates to adolescents) for age-specific norms.

Page 2 — Oxygen Delivery Devices and Indications

  • Nasal cannula: 1-6\ \text{L/min} → ~24-44\%\ \text{FiO2}.
    • Indications: Mild hypoxia; telemetry patients. Humidify at higher flow rates.
  • Simple face mask: 6-10\ \text{L/min} → ~40-60\%\ \text{FiO2}.
    • Indications: Moderate hypoxia when nasal cannula insufficient. Not for precise FiO2.
  • Non-rebreather mask (NRB): 10-15\ \text{L/min} → up to ~90\%\ \text{FiO2}.
    • Indications: Severe hypoxia or respiratory distress with low SpO2.
    • Ensure reservoir bag inflated before use.
  • Bag-valve-mask (BVM) with oxygen reservoir: 10-15\ \text{L/min} → high FiO2.
    • Indications: Respiratory arrest or inadequate ventilations.
    • Technique: use two-person method if possible; consider airway adjuncts.
  • CPAP / NIPPV: Provides positive pressure; settings per device.
    • Indications: Pulmonary edema; acute COPD/asthma exacerbation in alert patients.
    • Contraindications: Decreased LOC, facial trauma, vomiting.
  • High-Flow Nasal Cannula (HFNC): Up to 60\ \text{L/min}; FiO2 variable.
    • Notes: Often hospital use; prehospital availability varies; agency dependent.

Page 3 — Medications: Indications, Administration, and Notes

  • Oxygen (medical gas): Indications — hypoxia, respiratory distress, shock, cardiac arrest.
    • Administration: Titrate to target SpO2 per protocol (often 94-99\% in adults; COPD may be lower, e.g., 94-98\%).
    • Note: Universal EMT intervention.
  • Aspirin (chewable, 160-325\ \text{mg}): Indication — suspected acute coronary syndrome (ACS).
    • Administration: Chew unless contraindicated (active bleed, allergy).
    • Rationale: Antiplatelet effect; per many protocols; typical dose 160-325\ \text{mg}.
  • Oral glucose (PO): Indication — hypoglycemia; patient able to swallow and protect airway.
    • Administration: Give chewable glucose or gel per protocol.
    • Important: If altered mental status (AMS) and cannot swallow, do NOT give PO.
  • Naloxone (IM/IN/Auto-injector): Indication — suspected opioid overdose with respiratory depression.
    • Administration: Intranasal (IN) or intramuscular (IM) per device; repeat per protocol; monitor for withdrawal and agitation.
  • Epinephrine auto-injector (EpiPen): Indication — anaphylaxis with airway/breathing/circulation compromise.
    • Administration: IM to lateral thigh; may carry multiple doses per protocol.
    • Follow with airway support and rapid transport.
  • Nitroglycerin (SL spray/tablet): Indication — chest pain of suspected cardiac origin (no hypotension).
    • Administration: Sublingual per protocol; contraindicated with phosphodiesterase-5 inhibitors.
    • Notes: Often left to ALS/medical control; agency dependent.
  • Albuterol (inhaled): Indication — bronchospasm/asthma/COPD exacerbation (if allowed).
    • Administration: MDI or nebulized per protocol.
    • Note: Scope varies by state/agency; check standing orders.
  • Activated charcoal: Indication — certain oral poisonings within a specified timeframe per protocol.
    • Administration: Oral suspension if indicated and patient able to swallow.
    • Notes: Many systems restrict or rarely use; state dependent.
  • Ipratropium bromide (Atrovent) and Tylenol (acetaminophen) listed as meds in some protocols; details vary by system.

Page 4 — Shock Types: Definitions and Signs

  • Hypovolemic Shock: Low circulating volume (bleeding, dehydration).
    • Signs: Tachycardia; hypotension; cool/clammy skin; weak pulses.
  • Cardiogenic Shock: Pump failure (myocardial infarction, arrhythmia).
    • Signs: Hypotension; possible JVD; pulmonary edema; cool/clammy skin.
  • Distributive Shock (e.g., septic, anaphylactic, neurogenic): Vasodilation and relative hypovolemia.
    • Signs: Warm skin in early sepsis; flushing in anaphylaxis; hypotension.
  • Obstructive Shock: Circulatory obstruction (tension pneumothorax, massive PE, tamponade).
    • Signs: Hypotension; JVD; respiratory distress; unequal breath sounds (tension).

Page 5 — Prehospital Treatment Principles

  • General approach: Control bleeding; provide high-flow oxygen; keep patient warm; rapid transport.
  • Airway, breathing, circulation (ABCs); IV/fluids per ALS protocol.
  • Oxygen and airway support; epinephrine for anaphylaxis as indicated; rapid transport; fluids per ALS/protocol.
  • Recognize signs requiring decompression for tension pneumothorax within scope/training or ALS interventions.
  • Rapid transport decisions based on stability and protocol; employ ALS interventions as appropriate.

Page 6 — Seizures: Types and Features

  • Generalized tonic-clonic seizure:
    • Loss of consciousness with tonic then clonic phases.
    • Signs: Stiffening then rhythmic jerking; possible cyanosis; tongue bite; incontinence.
  • Focal (partial) seizure:
    • Starts in one brain area; may have preserved consciousness.
    • Signs: Unilateral twitching; sensory changes; automatisms.
  • Absence seizure:
    • Brief impairment of awareness (seconds); often in children.
    • Signs: Blank stare; subtle automatisms; short duration.
  • Status epilepticus:
    • Seizure lasting >5 minutes or recurrent without regaining consciousness.
    • Signs: Ongoing convulsions; hypoxia risk.

Page 7 — Prehospital Seizure Management

  • First-line actions: Protect airway; loosen clothing; suction PRN; give oxygen.
  • Benzodiazepines per protocol if seizure prolonged (>5 minutes) or status epilepticus; rapid transport.
  • Monitor airway; assess for focal deficits; administer ALS medications if prolonged.
  • Airway management with high-flow oxygen; administer benzodiazepines per protocol (e.g., midazolam, lorazepam, diazepam); rapid transport to ED.

Page 8 — Respiratory and Cardiac Conditions I

  • Asthma exacerbation: Bronchospasm causing airflow limitation.
    • Signs: Wheezing; dyspnea; tachypnea; use of accessory muscles.
  • COPD exacerbation: Exacerbation of chronic bronchitis/emphysema.
    • Signs: Wheezing; productive cough; chronic baseline differences; possible CO2 retention.
  • Pulmonary edema (CHF): Fluid in alveoli due to heart failure.
    • Signs: Severe dyspnea; crackles; pink frothy sputum; JVD.
  • Pneumothorax / Tension pneumothorax:
    • Signs: Sudden pleuritic chest pain; respiratory distress; decreased/absent breath sounds unilateral; hypotension in tension pneumothorax; mediastinal shift.
  • Pulmonary embolism (PE): Thrombus obstructing pulmonary circulation.
    • Signs: Sudden dyspnea; pleuritic chest pain; tachycardia; hypoxia; syncope in massive PE.

Page 9 — Respiratory Treatments and Scene Management

  • Treatment options (as allowed): Oxygen; inhaled bronchodilators (albuterol) via nebulized therapy; CPAP if severe and responsive; rapid transport.
  • Oxygen management: titrate carefully; bronchodilator per protocol; CPAP if indicated; avoid over-oxygenation in some COPD patients per local protocol.
  • High-flow O2 and CPAP are used if conscious and able; position upright; rapid transport.
  • Nitroglycerin and diuretics may be ALS/hospital treatments (not routine on EMT rigs on scene).
  • In some protocols, decompression is limited to those within scope and trained; many EMTs do not perform decompression.
  • General emphasis: O2, airway/ventilations support; rapid transport; definitive diagnosis/treatment often in hospital.

Page 10 — Cardiovascular Emergencies

  • Acute Coronary Syndrome (ACS) / Myocardial Infarction (MI): Ischemia from coronary artery occlusion.
    • Signs: Chest pain; diaphoresis; nausea; radiating pain; dyspnea.
  • Congestive Heart Failure (CHF) / Pulmonary Edema: Heart failure with fluid overload in lungs.
    • Signs: Dyspnea; crackles; orthopnea; peripheral edema; JVD.
  • Arrhythmias (SVT, AF, VT): Abnormal heart rhythms.
    • Signs: Palpitations; syncope; hypotension; chest pain.
  • Cardiac arrest: Absence of effective cardiac mechanical activity (no pulse).
    • Signs: Unresponsive; apnea or agonal respirations; no pulse.

Page 11 — Prehospital ACS Management and ACLS

  • Aspirin (chewable) if no contraindication; oxygen if hypoxic; monitor; nitroglycerin per protocol; rapid transport to PCI center if indicated.
  • Management adjuncts: High-flow oxygen; CPAP if indicated; position upright; prompt transport.
  • Support ABCs; oxygen if hypoxic; administer ALS meds/cardioversion per protocol; vagal maneuvers for SVT if trained.
  • Cardiac arrest protocol: Start high-quality CPR; attach AED/defibrillator; follow ACLS/CPR algorithms (BLS for EMTs: early defibrillation, cycles of CPR, airway management); rapid ALS.

Page 12 — Assessments: Primary/Secondary Survey, Stroke, Diabetes, Allergic Reactions

  • Primary Survey (ABCs): Airway, Breathing, Circulation; c-spine control if trauma mechanism.
  • Secondary Survey: Head-to-toe exam; SAMPLE history: Signs/Symptoms, Allergies, Meds, Past history, Last oral intake, Events.
  • Stroke recognition: Use FAST or BE-FAST; time of onset is critical for hospital therapy; rapid transport to stroke center.
  • Diabetic emergencies:
    • Hypoglycemia: AMS, diaphoresis; give oral glucose if able.
    • Hyperglycemia / DKA: polyuria, polydipsia; gradual presentation; fluids and hospital care.
  • Allergic reaction vs Anaphylaxis:
    • Allergic: localized reaction.
    • Anaphylaxis: airway/breathing/circulatory compromise → epinephrine IM + airway support.

Page 13 — MOI, Spinal Precautions, Bleeding Control, Trauma Shock

  • Mechanism of Injury (MOI) importance: High-energy MOI raises suspicion for occult injury; guides transport and immobilization decisions.
  • Spinal precautions: Suspected spinal injury → in-line stabilization; full immobilization per local protocol; use clinical judgment.
  • Control of external hemorrhage: Direct pressure; tourniquet for life-threatening extremity hemorrhage; hemostatic dressings if available.
  • Shock in trauma: Assume hypovolemia from bleeding until proven otherwise; rapid transport; control bleeding; limit on-scene time for unstable patients.
  • Open chest wound / sucking chest wound: Apply occlusive dressing sealed on three sides (vented) and rapid transport; tension physiology requires immediate ALS/hospital care.

Page 14 — Obstetrics and Neonatal Care

  • Stages of labor:
    • 1st stage: Dilation from onset to 10 cm.
    • 2nd stage: Delivery of baby.
    • 3rd stage: Delivery of placenta.
  • Imminent delivery signs: Contractions <2 minutes apart; strong urge to push; crowning — prepare for delivery.
  • Basic prehospital delivery steps:
    • Maintain sterile field; support head and shoulders; deliver slowly; clear airway (bulb suction mouth then nose); clamp/cut cord per protocol; keep baby warm.
  • Postpartum hemorrhage: Uterine massage; manage bleeding; rapid transport; oxytocin is typically hospital/ALS protocol.
  • Umbilical cord prolapse: If cord prolapses, relieve pressure from cord (elevate presenting part); rapid transport; ALS/OR care; do NOT push cord back in.

Page 15 — References and Resources

  • National EMS Scope of Practice Model (2019) – NREMT.
  • Oxygen device flows and FiO2 references (NCBI Bookshelf).
  • Vital signs references (Medscape, Hopkins).
  • Shock overview (StatPearls).
  • Seizure types (Epilepsy Foundation, CDC).
  • Prehospital deliveries (StatPearls).
  • Note: The page lists the above sources for further reading and scope of practice guidelines.