Supine hypotensive syndrome

o Pregnant lady lying supine; uterus compresses descending aorta and inferior
vena cava, thus reducing amount of blood that is returned to
hearthypotension results (patients in third trimester should be
transported on left side)
Signs of inadequate breathing
o RR less than 12 breaths/min or more than 20 breaths/min in presence of
dyspnea
o Irregular rhythm (Cheyne-Stokes, Kussmaul)
o Diminished, absent, or noisy auscultated breath sounds
o Reduced flow of expired air at nose and mouth
o Unequal or inadequate chest expansion (reduced tidal volume)
o Increased effort or breathing (accessory muscles)
o Shallow depth (reduced tidal volume)
o Pale, cyanotic, cool, or moist (clammy) sin
o Retractions
Acceptable methods of restraining a patient
o At least 4 people (extremities)
o Never put face down
o Access pulse on extremities
o Often use police to help
Meds you can assist with
o Epi-pen
o Nitroglycerin
o Inhaler
Who can start an IV
o AEMT
o Paramedic
o BEMT under Medical control
Most frequently transplanted organ
o Kidney
Define poison
o Substance whose chemical action can damage body structures or impair
body function
How many parts in a standard radio report
o 12
Geriatric patients face what kind of challenges
o Debilitating illnesses
o Numerous health problems
o Fear of being alone/of hospital
o Many medications a day
o Cannot regulate body temperature as well
o Bleeding more
o Thinner skin
o Bruise easier
Signs of shock
Rapid ascent problem for divers
o Decompression sickness (the bends)
o Nitrogen bubbles (sort of air embolism) thus cutting off blood flow
o Nitrogen goes into tissues during increased pressure, and then turns back
into bubbles when pressure decreases
Define hypertrophy
o Increase in volume of an organ or tissue due to enlargement of its component
cells
Positive stroke scale means what percent chance of a stroke
What to do if an airbag is deployed
Rule of nines for children and infants head
o 18 for infant
o 12 for children
o 9 for adult
Purpose of quality improvement
o Designed to identify areas of improvement and, if necessary, assign remedial
training or develop some other educational activity
How to verify adequate ventilation on a tracheostomy patient
o Chest expansion
o Bag and oxygen put together appropriately
Types of chemical weapons
o Respiratory agent
o Metabolic agent
o Nerve agent
o Vesicant
Trauma assessment order
Medical assessment
MOI
Patient to a trauma center
Medical identification devices
o Bracelet
o Necklace
o Card
o DNR order, allergies, diabetes, epilepsy
When to cut an umbilical cord
o Deliver baby and suction mouth then nostrils
o Keep baby at level of umbilical cord
o Clamp 2 to 4 apart and cut between them
Volatile chemicals
o Lewisite (L)vesicant
o Phosgene oxime (CX)vesicant
o Sarin (GB)nerve
Personal safety at a MVC
o Surroundings (power lines)
o Compressed bumpers (approach from side)
o Airbags (deactivate first/wear protection, e.g., from gases)
Types of muscle
o Skeletal (striated) musclevoluntary
o Cardiac
o Smooth (vessels, bronchioles, tube-like structures)
Hazardous material training levels
o HAZWOPER
o First Responder Awareness Level
Dose of inhalers
o 2 breaths spaced 5 minutes apart on standing order
How to do a log-roll
o Crossed hands
o 4 EMTs
o On head persons count
Treatment of shock
Vial-of-life
o Allows individuals to have complete medical information ready in their home
for emergency personnel to reference during an emergency
o Used when patient is unable to speak or remember this information
o Commonly used by Senior citizens
Considerations when responding to terrorist incidents
o Secondary devices
o Type of location
o Type of call
o Number of patients
o Victims statements
o Preincident indicators
CPR compression rate
o 100 per minute
Most common type of rescue in the US
o Vehicle response
Pertinent past history
Respiratory problems in children
o Airway obstruction (pneumonia, croup, epiglottitis, bacterial tracheitis)
Epiglottitisabove vocal cords
Croupbelow vocal cords caused by virus
o Obstruction by foreign object (upper airwaystridor)
Lower airwaywheezing, whistling sound
o Asthma
o Pneumonia
o Bronchiolitis
Desirable characteristic of a dressing
o Sterile
Standard precautions
o Hand hygiene
o PPE
Gas exchange problems with COPD
o Air continues to get into alveoli when lung expands during inhalation, but It
is often unable to escape during exhalation because the air passages tend to
collapse during exhalation
o Fresh air cannot reach areas where there is good blood flow
o Tires respiratory musclesunable to get enough air to alveoli
o Critical step for removing CO2 from blood is adequate alveolar
airflowairflow to alveoli is insufficient, CO2 builds up in the blood and
blood oxygen diminishes
o Hypoventilation: inadequate supply of fresh air to alveoli
o Breathing oxygen can correct blood oxygen levels, but cannot help remove
CO2
Protecting a patient during extrication
Signs of adequate breathing in a newborn
o Breathing spontaneously 15-30 seconds after birth
o Heart rate 120 beats/min
o Vigorous crying
o Cyanosis of only the hands and feet
Compartment syndrome
o Swelling in a confined space that produces dangerous pressure; may cut off
blood flow or damage sensitive tissue; frequently seen in fractures below the
elbow or knee in children
o Hallmark sign: pain out of proportion to the injury
Why do we need ALS when using an AED
What is trending
o Documenting changes in a patients condition over time
Common groups suffering from TB
o Homeless people
o Prison inmates
o Nursing home residents
o Dense populations
o People who abuse IV drugs or alcohol
o People whose immune systems are compromised by HIV
o Health Care providers
Tourniquets on an AV fistula
o Ensures uniform dilation of vessel prior to needle insertion
Organs of the endocrine system
o Pineal gland
o Pituitary gland
o Thyroid gland
o Thymus
o Adrenal gland
o Pancreas
o Ovary
o Testes
o Hypothalamus
High risk pregnancies
CSF
o 150 mL
o sub-arachnoid space
When to use an epi-pen
o Anaphylactic shock
o (Airway is closed)
Role of an EMT at a hazardous materials scene
Personal traits on an EMT
Hazardous of improperly fitted neck collars
o Hyperextension of neck
o Prevents patient from opening mouth
o Flexion of neck
Time, distance, and shielding
o Time: amount of radiation exposure increases and decreases with the time
people spend near the source of radiation
o Distance: farther away people are from a radiation source, the less exposure
o Shielding: greater the shielding around a radiation source, the smaller the
exposure
Alpha: thin piece of light material (paper or dead cells in outer layer of
skin)
Beta: additional covering (heavy clothing)
Gamma: Thick, dense shielding, such as lead
Hot, cold, and warm zones
o Hot: hazardous
o Warm: decontamination
o Cold: EMS/IC
Assessment of a patient with spinal injury
o Maintain C-spine stabilization and never let go
Applying a cervical collar
ALS intercept
AVPU
Visceral pain
o Pain that results from the activation of nociceptors (sensory neuronsignals
to spinal cord and brain) of the thoracic, pelvic, or abdominal viscera
(organs)
o Visceral structures highly sensitive to distension, ischemia, and inflammation
PASG used to splint what types of injuries
o Injuries to lower extremities or pelvis (not groin injuries)
Anterior fontanelle close at what age
o 9-18 months
MCI tag priorities
o Red (immediate)
o Yellow (delayed)
o Green (minimal)
o Black (expectant)
Height an adult must fall for trauma triage criteria
o Greater than 15 or 3 times the patients height
Rate of compressions on a newborn
o 120 cpm
Signs and symptoms to a hollow organ
o Delayed
o infection
Parts of the respiratory system
EMD stands for
o Emergency Medical Dispatching
Steps for starting CPR
Common cause of seizures in adults
Sympathetic nervous system response (fight-or-flight response)
o Dilate pupil
o Increase rate and force of contraction of heart
o Dilate bronchioles
o Constricts blood vessels
o Activates sweat secretion
o Inhibits peristalsis
o Increases renin secretion (regulates arterial blood pressure)
o Promotes ejaculation
How to lift properly
Dermatome
o Area of skin that is mainly supplied by a single spinal nerve
Mottled skin
o Blood vessel changes in the skin that cause a patchy appearance
o Late stage of respiratory arrestassisted ventilations
4 year old categorized as
o Pre-school age
Heuristic
o Refers to experience-based techniques for problem solving, learning, and
discovery that gives a solution which is not guaranteed to be optimal
o Speeds up diagnoses
o E.g. of heuristic: availability, search satisfying, illusory correlation
o Heuristic: short cut to diagnosis
Bleeding from a large vein may cause
Traumatic condition that may cause signs and symptoms of a behavioral emergency
o Internal hemorrhage
o Head trauma
o Mind-altering substances
o Excessive cold
o Excessive heat
o Inadequate blood to brain or stroke
o Lack of oxygen
o Low blood sugar
Why do EMTs give aspirin?
o Anti-inflammatory agent and anti-fever agent
o Prevents platelets form clumping, thereby decreasing formation of new clots
o Relief of mild pain, headaches, muscle aches; chest pain when considering
myocardial infarction
Crush injuries
o An injury that occurs when a great amount of force is applied to the body
o Crush syndrome: significant metabolic derangement that develops when
crushed extremities or body parts remain trapped or prolonged periods.
This can lead to renal failure and death
Treatment for blood loss
How to clamp an umbilical cord when you have no kit
o Shoe lases
Causes of heat cramps
o Sweat in warm environment causes a change in bodys electrolyte balance
o Dehydration also plays a role (large amounts of water loss)
Questions for female patients with abdominal pain
o Pregnancy
Consequence of hypoperfusion
Symptoms of a heart problem
o Chest pain
o Tightness in chest
o Referred pain (left arm, abdomen, jaw, back)
o Pink, frothy sputum
o Shortness of breath
o Palpitations (irregular heart beats)
o Faster heartbeat
o Weakness or dizziness
o Nausea
o Sweating
Ethical decisions
Rough handling of a hypothermic patient
o Ventricular fibrillation
o Arrhythmia
Differences in adult and pediatric vital signs
o Children
BP: 90-110/50-70
Hypertension (>120/80)
Pulse: 80-100 bpm
RR: 15-30 rpm
o Adult
BP: 100-140/60-90
Hypertension (>140-159/90-99)
Pulse: 60-100 bpm
RR: 12-20 rpm
o Infant
BP: 60-90/30-55
Hypertension (>90/60)
Pulse: 100-130 bpm
RR: 25-50 rpm
Pediatric airway differences
o Larger, rounder occiput
o Proportionately larger tongue relative to size of mouth and a more anterior
location of the mouth
o Tongue larger relative to small mandible
o Long, floppy, U-shaped epiglottis in infants and toddlers is larger than an
adults, relative to size of the airway
o Less well-developed rings of cartilage in trachea (collapse easier)
o Narrowing funnel-shaped (wide to narrow) upper airway compared to that
of a cylinder-shaped lower airway
Aspirin contraindications
o Hypersensitivity to aspirin
o Pre-existent liver damage
o Bleeding disorders
o Asthma
o Children during episodes of fever-causing illnesses
Safe distance if unknown chemical exposure
o 500?
o 2 blocks
o uphill and upwind
Child with obstructed airway becomes unresponsive
o Person saw child eat something and child is responsivecough
o Person can breath adequately on ownonly oxygen
o Signs of severe airway obstruction
Ineffective cough (no sound)
Inability to speak or cry
Increasing respiratory difficulty, with stridor
Cyanosis
Loss of consciousness
o Unconscious child (no suspected spinal injury)
Open airway using head tilt-chin lift maneuver and look inside mouth
to see if object is visible
If visibletry to remove it with finger sweeps
Never finger sweep if object is nonvisiblemay push it further
back
Chest compressions are recommended
Increase pressure in chest, creating artificial cough that may
force a foreign body from the airway
How to apply an occlusive dressing to an open chest wound
o 3 sides
Function of the skin
o Temperature
o Water
o Pathogen protection
Importance of vital signs
o Determine treatment protocols
What contributes to ambulance crashes?
o Excessive speed
o Not anticipating motorists
o Impatient
o Bad parking
Urgent moves
o Scene factors cause a decline in patient condition (treatment of patients
condition requires a move)
o Urgent moves with spinal precautions
Log-roll
Epi-pen doses
o 0.30 mg for adults
o 0.15 mg for pediatrics
Medical radio report parts
o 12 parts in a radio report
Stroke
Considerations for patient who fell
Inferior portion of the sternum
o Xiphoid process
When to start CPR
Staging
o Area where ambulances go during MCI
o Ambulances do not drive into scene of MCI without staging supervisors
direction
o Established away from sceneprevents parked vehicles from getting in the
way
o Stages equipment and responders, tracks unit arrivals, and sends out
vehicles as needed
o Releases by command
Steps to reach diagnosis
o Critical thinking: analytic process that can help a person think through a
problem in an organized and efficient manner
o Common in all clinicians: Strong foundation of knowledge
o Differential diagnosis: list of potential diagnoses compiled early in
assessment of patient
o Red flag: sign or symptom that suggest the possibility of a particular problem
that is very serious
Standard precautions with SARS (Severe Acute Respiratory Syndrome)
o Gloves
o Mask and shield (droplet nuclei)
o Hand hygiene
o Gown if necessary
Vial-of-life sticker
o Gives location to find medical data
o Gives contents of medical data
o Gives link to website and phone number
Splinting an elbow
Heuristic (shortcuts to diagnosis)
o Representiveness
When you encounter a patient with certain signs that resemble a
particular condition, you assume that patient has that condition
o Availability
A particular condition is assumed or preferred due to recent exposure
to another patient with a similar condition
o Confirmation bias
Where an EMT expects a specific diagnosis and goes on to overlook
evidence that refutes or reduces probability of that diagnosis
o Illusory correlation
Where an EMT draws an overly complex preemptive diagnosis due to
multiple issues being found from one source, when they might merely
be coincidence
Syllogism
o Ice cream is eaten in summer
o Most drowning occur in summer
o Therefore, ice cream causes drowning
Anchoring and adjustment
o Where EMT forms a hypothesis based on experience and has difficulty
reaching any conclusion that doesnt coincide with that hypothesis
Search satisfying
o Reach conclusionbecomes relaxed about looking for other causes
EMTs using field diagnosis
Steps of traditional diagnosis
o Asses patient
o Draw up list of conditions
o Further evaluation or tests
o Results of diagnosis
Steps for MET diagnosis
o Field diagnosis, Presumptive diagnosis, or working diagnosis
Information for a radio medical report
o Unit identification and level of provider
o ETA
o Patients age and sex
o Chief complaint
o Brief history of present illness
o Major past illness
o Mental status
o Baseline vital signs
o Findings of physical exam
o Emergency medical care given
o Response to emergency medical care
o Contact made with medical direction if required or if you have questions





























About cherry
Martha Marcy May Marlene
Fatal trust
Borne legacy
In time
The last resort
Thrill of the kill
Enough
Wrath of the titans
We need to talk about kevin
The secrets of the comfort house
The Return
Rest stop (1 and 2)