Emergency Medical Services Study Notes (copy)

Key Terms

• Standing Orders: Pre-established protocols that allow EMS personnel to perform certain procedures without prior consultation for every patient.

• Protocols: Specific guidelines defining how EMS personnel should respond to various scenarios.

• On-line Medical Direction: Immediate guidance provided by medical personnel via communication devices during EMS operations.

• Off-line Medical Direction: Standing orders or protocols that allow EMS personnel to act without immediate contact with medical personnel.

• Emergent Move: A technique for quickly moving a patient from an unsafe environment to a safer one.

• Vital Signs: Measurements of bodily functions, used to assess a patient's health status (includes heart rate, blood pressure, respiration rate, and temperature).

• Initial Assessment: The first evaluation of a patient to determine a general impression of their condition and quickly identify life-threatening issues.

• Secondary Assessment: A more thorough examination that occurs after the initial assessment, focusing on specific bodily systems.

• General Impression: An overall assessment of the patient’s condition based on visual observations and initial contact.

• Chief Complaint: The primary issue or symptom reported by the patient.

• AVPU Scale: A scale for measuring a patient's level of consciousness: Alert, Verbal response, Painful response, Unresponsive.

• Pulse Locations and When to Use Them: Common pulse points include:
    - Radial Pulse: Used in conscious patients to assess HR.
    - Carotid Pulse: Useful in unconscious patients or when assessing perfusion in critical situations.
    - Femoral Pulse: Often applied in severe hemorrhaging.

• Patient Care Report (PCR): A document detailing the care given to the patient, including vital signs, assessment findings, and treatment administered.

• Rapid vs Focused Trauma Assessments:
    - Rapid Trauma Assessment: A quick evaluation for major injuries in patients with altered consciousness or life threats.
    - Focused Trauma Assessment: A detailed assessment focused on specific injuries based on mechanism of injury or complaints.

• Pertinent Negatives: Key information that rules out certain conditions (e.g., absence of pain in areas typically affected by injury).

• Tachycardia: A condition with an increased heart rate, typically defined as a heart rate above 100 beats per minute.

• Arterioles: Small blood vessels that lead from arteries to capillaries.

• Capillaries: Tiny blood vessels where gas and nutrient exchange occurs.

• Veins: Blood vessels that return deoxygenated blood to the heart.

• Arteries: Blood vessels that carry oxygenated blood away from the heart.

• Coo contra coo injury: An injury mechanism often referred to as a deceleration injury from rapid head movement.

• Battle's Signs: Bruising behind the ears, indicating a possible skull fracture.

• Grey Turner’s Signs: Bruising on the flanks indicating retroperitoneal bleeding.

• Cullen’s Sign: Bruising around the umbilicus indicating possible internal bleeding.

• Raccoon Eyes: Periorbital bruising that can indicate basilar skull fracture.

• Traumatic Asphyxia: A condition resulting from severe chest trauma.

• Narrowing Pulse Pressure: A sign of potential shock indicating the difference between systolic and diastolic blood pressure is decreasing.

• Ecchymosis: Bruising or discoloration of the skin resulting from blood leaking into the tissue.

• PMS/CSM: Acronyms for checking Pulse, Movement, Sensation (PMS) and Circulation, Sensation, Movement (CSM), important for assessing peripheral circulation and nerve function.

• Paralysis: Loss of the ability to move a body part.

• Priapism: A medical condition where a male has a prolonged, often painful erection not associated with sexual desire or stimulation.

• Helmet Removal: Should be done after careful consideration and is usually indicated for patients with altered level of consciousness, respiratory distress, or when airway management is needed.

• Glasgow Coma Scale (GCS):
    - A scale used to assess consciousness levels in patients (total score ranges from 3 to 15).
    - Extra Value Meal 456: Mnemonic to remember the scores of each scale (Eye: 4, Verbal: 5, Motor: 6).
    - 4 Eyes: Refers to maximum score for visual response.
    - V: Represents the Roman numeral for 5, indicating verbal response.
    - Motor 6: Refers to the motor response score.

Signs/Symptoms/Treatments

• Epistaxis: Nosebleed, often treated by pinching the nostrils together and leaning forward.

• Hypotension: Defined as blood pressure less than 90 systolic, indicating potential shock or severe blood loss.

• Irreversible Shock: A terminal state of shock where body systems fail, often leading to death.

• Subdural Hematoma: A collection of blood on the brain’s surface beneath the outer membrane, often due to trauma.

• Epidural Hematoma: A collection of blood that forms between the outer membrane and the skull, usually associated with skull fractures.

• Avulsion Wound: A wound where a portion of skin and tissue is forcibly detached.

• Amputated Part: Body part that has been severed; should be wrapped and cooled for reattachment.

• Shoulder Injury: May involve a dislocation or fracture; requires immobilization.

• Femur Fracture: A serious injury typically requiring surgical intervention and immobilization.

• Bleeding and Shock Control: Includes direct pressure on wounds, use of hemostatic agents, and tourniquet application if needed.

• Sprain/Strain: Injuries to ligaments or muscles requiring rest and ice.

• Abrasions: Superficial wounds often treated with cleaning and dressing.

• Evisceration: When internal organs protrude from a wound, requiring immediate cover and transport.

• Impaled Objects: Should only be removed if they obstruct the airway or cause additional injury; otherwise stabilized.

• Hypovolemic Shock: Caused by significant blood or fluid loss.

• Paradoxical Motion: Discrepancy in movement during respiration, often seen in flail chest patients.

• Flail Motion: Movement of a section of the chest wall that is opposite to the rest of the chest during breathing, indicating a serious injury.

• Puncture Wounds: Treat differently based on location; extremities may often be stabilized, while chest/abdomen require immediate care.

• GSW (Gunshot Wound): Severe injury likely requiring emergency intervention.

• Pneumothorax:
    - Spontaneous Pneumothorax: Occurs without trauma, often caused by blebs in young individuals.
    - Tension Pneumothorax: A medical emergency due to air trapping in the pleural cavity, leading to collapse of lung.

• Pericardial Tamponade: Pressure on the heart caused by fluid accumulation within the pericardial cavity.

• Cardiac Contusion: Bruising of the heart muscle often complicated by arrhythmias.

• Solid vs Hollow Organ Injuries:
    - Solid organs (like the liver and spleen) can bleed heavily if injured.
    - Hollow organs (such as the stomach and intestines) can spill contents, leading to infections.

• Direct vs Indirect Injuries: Direct injuries result from external force, while indirect injuries occur because of transmitted forces.

• Decorticate Posturing: Abnormal flexion indicating severe brain injury.

• Decerebrate Posturing: Extension indicating more severe brain damage.

• Impaired Breathing: An emergency requiring immediate interventions such as positioning and airway management.

• Hypothermia: A critical condition that occurs when body temperature drops below the required level for normal metabolism and bodily functions.

• Marine Animal Sting: Treatment may include rinsing with vinegar for certain stings to neutralize venom.

• Air Embolism: A critical condition that can occur during scuba diving or certain medical procedures requiring immediate management.

• Cervical Spine Distraction Injury: Often associated with hanging; requires careful assessment and management.

• Burns:
    - Superficial Thickness: Affecting only the outer skin layer.
    - Partial Thickness: Involve deeper layers of skin, may appear red and blistered.
    - Full Thickness: Extend through all skin layers, may appear white or charred.
    - Chemical Burns: Different management based on whether the agent is dry or wet.
    - Electrical Burns: Risk for internal damage, monitoring and treatment for rhythm disturbances required.
    - Circumferential Burns: Can compromise circulation, may require escharotomy.
    - Rule of Nines: Method for estimating burn surface area; divided into sections (e.g. head = 9%, arms = 9% each).
    - Rule of Palms: Uses the patient's palm size (approx. 1% of body surface area) for smaller burns for estimation.
    - When to refer to a burn center vs traditional hospital: Based on burn severity, depth, and location.

Extra Review: Trauma Assessment Sheets

• Include structured evaluations and assessments for documenting patient care and response to treatment, standardized to ensure thorough documentation and communication among EMS providers.