NREMT Cognitive Exam Prep Questions And Answers, Exams of Health sciences

Download NREMT Cognitive Exam Prep Questions And Answers and more Exams Health sciences in PDF only on Docsity! NREMT Cognitive Exam Prep Where does the modern EMS system have its origin? – The modern EMS system has its origins in funeral homes, which often operated ambulances. However, funeral home operators were often serving competing business interests and patients received little trained care until the hospital. What is considered the "birth" of EMS? - In 1966, a paper titled "Accidental Death and Disability: The Neglected Disease of Modern Society" is published by the National Academy of Sciences. This paper is widely known in the EMS profession as the White Paper. The White Paper is widely considered the birth of modern EMS. It spotlighted inadequacies of prehospital care in the United States, particularly related to trauma. Who developed the first EMT National Standard Curriculum? - Early in the 1970s, the US Department of Transportation developed the first EMT National Standard Curriculum. What are the levels of EMS training? - Emergency Medical Responder (EMR): provides basic, immediate care including bleeding control, CPR, AED and emergency childbirth. Emergency Medical Technician (EMT): includes all EMR skills, advanced oxygen and ventilation skills, pulse oximetry, noninvasive blood pressure monitoring, and administration of certain medications. Advanced Emergency Medical Technician (AEMT): includes all EMT skills, advanced airway devices, intravenous and intraosseous access, blood glucose monitoring, and administration of additional medications. Paramedic: includes all preceding training levels, advanced assessment and management skills, various invasive skills, and extensive pharmacology interventions. This is the highest level of prehospital care outlined in the National EMS Education Standards. What are EMT roles and responsibilities? - Equipment preparedness Emergency vehicle operations Establish, maintain scene safety Patient assessment and treatment Lifting and moving Strong verbal and written communication skills Patient advocacy Professional development Quality improvement Illness and injury prevention Maintain certification/licensure What is the role of the medical director? - The medical director is a physician responsible for providing medical oversight. The medical director oversees quality improvement. What are the two types of medical direction? - Online medical direction: direct contact between the physician and EMT via or radio. Offline medical direction: written guidelines and protocols. What is an EMT's first priority? - The EMT's first priority is always his or her own safety. Scene safety is always the top priority! The EMT's safety priorities after personal safety are for his/her partner(s), patients and bystanders. What are the types of stress? - Acute stress: an immediate physiological and psychological reaction to a specific event. Delayed stress: a stress reaction that develops after the stressful event. It does not interfere with the EMT's ability to perform during the stressful event. PTSD is an example of delayed stress. Cumulative stress: the result of exposure to stressful situations over a prolonged period of time. What are the stages of grief? - Denial Anger Bargaining Depression Acceptance How can you prevent the risk of infection? - Immediately report exposures to the designated infection control officer. Handwashing is the single most important way to prevent the spread of infection. Hand sanitizers can be effective, but soap and water is preferred when available. What are the two types of PPE? - Minimum PPE: gloves and eye protection should be used during any patient contact situation. Expanded PPE: use disposable gown and mask for significant contact with any body fluid--for example, during childbirth. Use a high-efficiency particulate air (HEPA) mask o N-95 respirator for suspected airborne disease exposure, such as tuberculosis. What are emergency moves? - These are used when the scene is dangerous and the patient must be moved before providing patient care. Types of emergency moves include the armpit-forearm drag, shirt drag, and blanket drag. -Minor consent is not required for emancipated minors. Criteria for emancipation varies but usually includes minors who are married or pregnant, already a parent, a member of the armed forces, financially independent, or emancipated by the courts. What is involuntary consent? - Involuntary consent is used for mentally incompetent adults or those in custody of law enforcement. Consent must be obtained from the entity with the appropriate legal authority. What are advance directives? - Advance directives are written instructions, signed by the patient, specifying the patient's wishes regarding treatment and resuscitative efforts. There are several types of advance directives. -Do Not Resuscitate (DNR): DNRs are specific to resuscitation efforts and do not affect treatment prior to the patient entering cardiac arrest. -Living will: Living wills are broader than DNRs. They address health care wishes prior to entering cardiac arrest. This may include use of advanced airways, ventilators, feeding tubes, etc. How do Good Samaritan Laws affect EMTs? - Good Samaritan laws are designed to protect someone who renders care as long as he or she is not being compensated and gross negligence is not committed. -Each state has some form of Good Samaritan laws. Some protect health care providers, but some do not. -Some states extend their Good Samaritan law to publicly employed EMS providers but not to those in the private sector. What is assault? - A person can be guilty of assault even if another person only perceived that they intended to inflict harm. Physical contact is not required to be guilty of assault. What is battery? - Battery is physically touching another person without their consent. What is negligence? - Negligence is the most common reason EMS providers are sued civilly. -The plaintiff has the burden of proof, not the EMT. -With negligence, the EMS provider is accused of unintentional harm to the plaintiff. What are the four components of negligence? - The plaintiff must prove all four of the following: 1. Duty to act: the EMT had an obligation to respond and provide care. 2. Breach of duty: the EMT failed to assess, treat, or transport patient according to the standard of care. 3. Damage: the plaintiff experienced damage or injury recognized by the legal system as worthy of compensation. 4. Causation: the injury to the plaintiff was, at least in part, directly due to the EMT's breech of duty. What is gross negligence? - Gross negligence exceeds simple negligence. Gross negligence involves an indfference to, and violation of, a legal responsibility. Reckless patient care that is clearly dangerous to the patient is grossly negligent. Gross negligence can result in civil and/or criminal charges. What is abandonment? - Once care is initiated, EMS providers cannot terminate care without the patient's consent. Some patient encounters may also require direct contact with medical direction prior to terminating care. Most EMS agencies have written protocols for terminating care without transporting the patient to a higher level of care. Abandonment is the termination of care without transferring the patient to an equal or higher medical authority. Transfer of care must include a verbal report to an equal or higher medical authority. Most EMS systems allow EMTs to accept care from a paramedic or advanced EMT for transport if an advanced-level assessment or advanced care is not needed. What is false imprisonment? - You may be guilty of false imprisonment if you transport a competent patient without consent. What factors influence hospital determination? - Destination factors include: -The patient's request or medical direction -The closest appropriate facility or specialty facility -Written protocols or triage guidelines -Hospital diversion or bypass A patient's ability to pay should NOT factor into where a patient is transported. When in doubt, consult medical direction. Thoroughly document why the destination was chosen. This is especially true if you bypass a closer hospital capable of managing your patient. What are patient refusals? - Competent patients may refuse treatment regardless of the severity of their condition. -Refusals present high liability risk for EMS providers. -Negligence or abandonment can be much easier to provide if the patient is not transport. -Consider requesting advanced life support personnel or contacting medical direction per local protocols. -During a refusal, the patient must be fully informed of the treatment recommended and the possible consequences of refusing treatment. -The patient is rarely, if ever, fully informed the first time he or she conveys the intent to refuse treatment. Documentation should reflect both the initial refusal and the second refusal after being fully informed. What factors determine whether a patient is competent or not? - Typically, competency requires awareness of at least four things: -Person: the patient knows his or her name. -Place: the patient knows where he or she is. -Time: the patient is aware of the date and time. -Event: the patient is aware of his or her present circumstances. How can an EMT reduce liability on patient refusal? - 1) The EMTs best protection from liability is to provide excellent care and convince the patient to accept transport. 2) The second best way for an EMT to protect himself or herself is to ensure the patient is fully informed, contact medical direction, and document extremely well. When can EMTs release confidential patient information? - EMTs can release confidential patient information without consent when: -The information is necessary for continuity of care -The information is necessary to facilitate billing for services -The EMT has received a valid subpoena -Reporting possible crimes, abuse, assault, neglect, certain injuries or communicable diseases What is HIPAA? - Health Insurance Portability and Accountability Act (HIPAA) -HIPAA is a federal law established in 1996 and has had a huge impact on health care. HIPAA improved privacy protection of patient health care records. -HIPAA gives patients greater control over how health care records are used and transferred. -EMS agencies are mandated to provide HIPAA training to all employees who have any contact with patients or patient records. -EMS providers must provide patients with privacy practices and obtain signature of receipt. What are COBRA and EMTALA? - Consolidated Omnibus Budget Reconciliation Act (COBRA) and Emergency Medical Treatment and Active Labor Act (EMTALA) -COBRA and EMTALA include federal regulations guaranteeing public access to emergency care. -COBRA and EMTALA are also intended to stop the inappropriate transfe of patients, known as a patient "dump." What are considered obvious signs of death? - The following are typically considered obvious signs of death indicating that resuscitation should not be initiated: -Decomposition -Rigor mortis -Dependent lividity -Decapitation On what kind of scenes must law enforcement be notified? - 1. Any scene where the patient is dead on arival 2. Suicide attempts 3. Assault or sexual assault How many bones are there in the human body? - There are 206 bones in the human body. How many vertebrae are in the spinal column? - 33 vertebrae -7 cervical -12 thoracic -5 lumbar -5 sacral -4 coccygeal What are the components of the upper airway? - Components of the upper airway include: -Nose and mouth -Nasopharynx -Oropharynx -Larynx -Epiglottis What is the most common cause of upper airway obstruction? - The tongue. What are the components of the lower airway? - Components of the lower airway include: -Trachea -Carina -Left and right mainstem bronchi -Broncioles -Alveoli How is lung expansion achieved? - During inhalation, as the chest expands, the parietal pleura pull the visceral pleura, which pull the lungs. What is the diaphragm? - The diaphragm is the primary muscle of respiration. It separates the thoracic cavity from the abdominal cavity. It is usually under involuntary control but can be controlled voluntarily. The esophagus and the great vessels pass through the diaphragm. The diaphragm is dome shaped until it contracts during inhalation. During inhalation, it moves down and expands the size of the thoracic cavity. What is inhalation through negative pressure breathing? - The diaphragm and intercostal muscles contract, the thoracic cage expands, pressure in the chest cavity decreases, and air rushes in. Inhalation is an active process and requires energy. Atmospheric (inhaled) oxygen contains 21% oxygen. What is exhalation? - The diaphragm and intercostal muscles relax, the thoracic cage contracts, pressure in the chest cavity rises and air is expelled. Exhalation is normally passive and does not require energy. Exhaled air contains 16% oxygen. What are the different types of respiration? - External respiration: the exchange of oxygen and carbon dioxide between the alveoli and pulmonary capillaries. Internal respiration: gas exchanged between the body's cells and the systemic capillaries. Cellular respiration: also known as aerobic metabolism, uses oxygen to break down glucose to create energy. What is the primary mechanism of breathing control? - Carbon dioxide drive is the primary mechanism of breathing control for most people. The brain stem monitors carbon dioxide levels in the blood and CSF. High carbon dioxide levels will stimulate an increase in respiratory rate and tidal volume. What is hypoxic drive? - Hypoxic drive is a backup system to the carbon dioxide drive. Specialized sensors in the brain, aorta and carotid arteries monitor oxygen levels. Low oxygen levels will stimulate breathing. The hypoxic drive is less effective than carbon dioxide drive. What is the minute volume? - Respiratory rate times tidal volume. What are normal breathing rates for adults, children and infants? - Normal adult rate: 12-20 breaths per minute Normal pediatric rate: 15-30 breaths per minute Normal infant rate: 25 to 50 breaths per minute Non-labored Regular rhythm Clear and equal breath sounds bilaterally What are the three layers of heart muscle and pericardium? - Endocardium: smooth, thin lining on the inside of the heart Myocardium: thick muscular wall of the heart Epicardium: outermost layer of the heart and innermost layer of the pericardium Pericardium: fibrous sac surrounding the heart What is the heart's electrical conduction system? - The primary power plant, the sinoatrial (SA) node, normally generates impulses between 60 and 100 times per minute in the adult. The atrioventricular (AV) junction is the backup pacemaker and generates electrical impulses at about 40 to 60 per minute. The bundle of His is the final pacemaker for the heart. It generates impulses only at about 20 to 40 per minute. What is preload? - Preload is the precontracting pressure based on the amount of blood coming back to the heart. Increased preload leads to increased stretching of the ventricles and increased myocardial contractility. What is afterload? - Afterload is the resistance the heartm ust overcome during ventricular contraction. Increased afterload leads to decreased cardiac output. What are the components of blood? - Plasma: the liquid component of blood, made mostly of water Red blood cells: the oxygen-carrying component of blood White blood cells: fight infection by defending against invading organisms Platelets: essential for clot formation to stop bleeding What is perfusion? - Perfusion is the flow of blood throughout the body. What is the central nervous system? - The central nervous system consists of the brain and spinal cord. What are the parts of the brain? - Cerebrum: largest part of the brain; controls thoughts, memory and senses Cerebellum: coordinates voluntary movement, fine motor function and balance Brain stem: includes midbrain, pons and medulla; controls essential body functions such as breathing and consciousness What are the two epidermal layers? - The germinal layer produces new cells and pushes them to the surface. the cells die en route to the surface. The stratum corneal layer is the top epidermal layer and consists of dead skin cells. What are normal vital signs for infants? - Respirations: normal respiratory rate is about 30-60 breaths per minute for newborns and about 25-50 breaths per minute for infants. Pulse: normal pulse rate is about 140-160 beats per minute for newborns and about 100-140 beats per minute for infants. Blood pressure: a newborn's blood pressure is about 70 systolic and will increase to about 90 systolic by one year of age. -Mild physical decline typically develops in the middle adult age group -Women typically experience menopause during middle adulthood -Continued physical and mental decline is common in late adulthood -Older adults frequently have extensive medical histories and are on multiple medications What is ventilation? - Ventilation is the moving of air in and out of the lungs. What is hypoxia? - Inadequate delivery of oxygen to the cells. Early indications of hypoxia: restlessness, anxiety, irritability, dyspnea, tachycardia. Late indications of hypoxia: altered or decreased level of consciousness. How long quickly does hypoxia damage the heart and brain? - The heart and brain become irritable due to lack of oxygen almost immediately. Brain damage begins within about 4 minutes. Permanent brain damage is likely within 6 minutes. Irrecoverable injury is likely within 10 minutes. What is notable about suction units? - Portable and fixed suction units should be able to generate a vacuum of 300 mmHg when tubing is clamped. What is proper suctioning technique? - Suction time cannot exceed: -15 seconds for adults -10 seconds for children -5 seconds for infants The recovery position reduces risk of aspiration. Unresponsive patients with adequate breathing and no c-spine injury should be placed in the recovery position. When is supplemental oxygen needed? - The goal of supplemental oxygen is to maintain a pulse oximetry reading of at least 94%. -Supplemental oxygen is not needed if there are no signs of symptoms of respiratory distress and the pulse oximetry is at least 94%. -When oxygen is administered, it should be titrated to maintain a pulse oximeter reading of at least 94%. Indications: -Any patient in cardiac arrest -Any patient receiving artificial ventilation -Any patient with suspected hypoxia -Any patient with signs of shock -Any patient with a pulse oximetry below 94% -Any patient that may benefit from it -Any patient with an altered or decreased LOC What is notable about oxygen cylinders? - A full cylinder is about 2000 psi. The cylinder should be taken out of service and refilled if below 200 psi. What are non-rebreather masks? - Usually the preferred method of oxygen administration in prehospital. Referred to as "high-flow" oxygen administration. Flow rate: 10-15 L/min Oxygen delivered: up to 90% Cautions: -The reservoir must be full before applying mask to patient -Never administer less than 10 L/min -If the reservoir completely deflates during inhalation, the flow rate must be increased -Immediately remove mask if oxygen source is lost What are nasal cannulas? - Referred to as "low-flow" oxygen administration Indications: -Patient will not tolerate a non-rebreather -Patient is on long-term oxygen therapy via nasal cannula and there is no indication high-flow oxygen is needed Flow rate: 1-6 L/min Oxygen delivered: 24-44% Cautions: prolonged use can dry and irritate nasal passages if oxygen is not humidified What is a simple face mask? - The simple face mask is similar to a nonrebreather, but without the oxygen reservoir. These are rarely used in the pre-hospital environment. Flow rate: 6-10 L/min Oxygen delivered: 40-60% What are Venturi masks? - A mask that delivers precise concentration of low-flow oxygen. Rarely used in the prehospital environment. How do you administer supplemental oxygen in patients with a tracheostomy or stoma? - Patients with a tracheostomy ventilate thorugh their stoma, not the mouth or nose. Supplemental oxygen should be applied over the stoma using a tracheostomy mask or a nonrebreather mask. What are the hazards of oxygen administration? - Oxygen is highly combustible Pressurized gas Oxygen toxicity: the alveoli can collapse due to a long-term exposure to high concentrations of oxygen Respiratory depression: a risk for COPD patients on the hypoxic drive Retinal damage: can occur in newborns with long-term exposure to high-concentration oxygen When is artificial ventilation indicated? - Artificial ventilations are indicated for any patient with *inadequate spontaneous breathing* leading to severe respiratory distress or respiratory failure. This could be caused by: -CNS injury, disease or impairment -Foreign-body airway obstruction -Chest trauma, such as a flail chest or a sucking chest wound -Increased airway resistance due to bronchoconstriction, pulmonary edema or inflammation Consider providing artificial ventilations for any patient breathing less than 8 times per minute or for any adult patient breathing more than 24 times per minute. Any unresponsive patient receiving artificial ventilations should have an airway adjunct in place to prevent the tongue from obstructing the airway. What are the risks of artificial ventilation? - Artificial ventilations are accomplished through positive pressure ventilations (PPV) whereas normal spontaneous breathing is done through negative pressure. Complications of PPV: -Increased intrathoracic pressure, which reduces circulatory efficiency -Gastric distension, which increases the risk of vomiting and can compromise ventilatory efficiency -Hyperventilation How do you know you're performing correct artificial ventilations? - The best way to determine appropriate tidal volume is rise and fall of the chest. -Artificial ventilations should cause gentle rise and fall. -It should take at least one second to inflate the chest. Correct rates of artificial ventilation for apneic patients with a pulse: -Adults: one breath every 5-6 seconds (10-12 times per minute) -Infants and children: one breath every 3-5 seconds (12-20 times per minute) -Newborns: one breath every 1 to 1.5 seconds (40-60 times per minute) What is the difference between pharmacokinetics and pharmacodynamics? - Pharmacokinetics is the study of how drugs enter the body, and are metabolized and eliminated. Pharmacodynamics is the study of a drugs' effects on the body. What are the routes of medicine administration? - Oral (PO): slow onset of action, safe but unpredictable absorption. -Aspirin, activated charcoal, oral glucose Intramuscular (IM): rapid absorption, but less reliable. -EpiPen Inhalation: rapid onset -Albuterol Sublingual: faster onset than oral -Nitroglycerin What are the six "rights" of drug administration? - Right patient, right drug, right route, right dose, right time, right documentation. What information do you need to know about activated charcoal? - Class: adsorbent MOA: adheres many drugs and chemical, preventing their absorption into the GI tract Indication: recently ingested poision Contraindications: decreased LOC, inability to swallow, ingestion of acids, alkalis or hydrocarbons, expired medication or lack of medical direction Dose and route: -Adult: 1 g/kg of body weight -Pediatric dose: 25-50 grams -Administered orally Side effects: Nausea, vomiting, dark and tarry stool Considerations: -Shake before administering -Use caution if you suspect patient's LOC will change -Have suction ready What information do you need to know about aspirin? - Names: acetylsalicylic acid Class: anti-inflammatory, anti-platelet aggregate, antipyretic MOA: reduces inflammation, decreases platelet aggregation, reduces fever Indication: chest pain Contraindications: allergy, decreased LOC, inability to swallow, recent bleeding or active ulcer, pediatric, expired medication, lack of medication Dose and route: -324 mg orally Side effects: nausea, vomiting, stomach pain, bleeding, allergic reaction, Reye's syndrome in pediatric patients What information do you need to know about a metered dose inhaler? - Names: albuterol, ipratropium bromide Class: bronchodilator MOA: relaxes bronchial smooth muscle, improving air exchange Indications: dyspnea, wheezing, asthma , reactive airway disease Contraindications: allergy, patient unable to follow commands, expired medication, medication not prescribed to patient, lack of medical direction Dose and route: one to two inhalations Side effects: tachycardia, hypertension, restlessnessm, anxiousness What information do you need to know about the EpiPen? - Names: epinephrine Class: sympathomimetic, bronchodilator MOA: peripheral vasoconstriction, increased heart rate, bronchodilation Indication: anaphylaxis (wheezing, swollen upper airway, hives) Contraindications: expired medication, lack of medical direction Dose and route: 0.3 mg adult, 0.15 mg pediatric administered IM Side effects: tachycardia, hypertension, restlessness, anxiousness What information do you need to know about nitroglycerin? - Class: antianginal, vasodilator MOA: vasodilation, decreased myocardial oxygen demand, increased myocardial oxygen supply Indications: chest pain, suspected angina or MI Contraindications: expired, not prescribed to patient, hypotension, recent use of Viagra, Cialis, Levitra or another ED medication, head injury, lack of medical direction Dose and route: 0.4 mg sublingual Side effects: tachycardia, hypotension, headache, burning under tongue, nausea, vomiting What information do you need to know about oral glucose? - Class: oral hyperglycemic MOA: increases blood glucose levels Indication: hypoglycemia Contraindications: -Decreased LOC -Inability to swallow -Expired medication -Lack of medical direction Dose and route: one tube administered orally Side effects: nausea and vomiting What are the components of the scene size-up? - 1. Scene safety 2. Standard precautions (PPE) 3. Number of patients/additional resources 4. Mechanism of injury/nature of illness What are the components of the primary assessment? - 1. Manual cervical spine stabilization 2. General impression 3. Level of consciousness (AVPU and orientation; person, place, time and event) 4. Airway, Breathing, Circulation 5. Transport priority What are the appropriate managements for life-threatening conditions associated with breathing? - Flail chest: initiate artificial ventilations Pulmonary edema Pulmonary embolism Respiratory syncytial virus (RSV) Hyperventilation syndrome Sucking chest wound Thoracic trauma Toxic substance exposure What is croup? - Croup is inflammation of the pharynx, larynx, and trachea. It is highly infectious and usually occurs in children up to about 3 years of age. Signs and symptoms: -Croup is usually preceded by a cold and usually occurs in winter -Croup often presents with a unique "barking" sound -Croup often presents with stridor (a high-pitched sound in the upper airway) What is cystic fibrosis? - Genetic disorder leading to thick mucus production and chronic lung infections. Cystic fibrosis often causes death prior to entering adulthood. Signs and symptoms include asthma-like symptoms and GI problems. What is RSV? - Respiratory syncytial virus is a respiratory infection very common in infants and children. It is extremely contagious. The virus can survive on surfaces, clothing, etc. Signs and symptoms include cold-like symptoms, poor fluid intake, and signs of dehydration. What are cardiac emergencies? - Acute Coronary Syndrome (ACS) Angina Pectoris Acute Myocardial Infarction Congestive Heart Failure Hypertension Cardiogenic shock What is acute coronary syndrome? - Symptoms of ACS are caused by myocardial ischemia. ACS includes angina pectoris and acute myocardial infarction. What is angina pectoris? - Angina is transient chest pain caused by a lack of oxygen to the heart muscle. The heart's oxygen demand temporarily exceeds its supply. -Angina is usually caused by atherosclerosis in the coronary arteries. -Angina usually occurs during physical activity or stress and resolves with rest, oxygen, or nitroglycerin. Angina does not usually last longer than 10 minutes. Angina does not cause permanent cardiac damage. What is acute myocardial infarction? - MI is death to an area of the myocardial muscle due to lack of oxygenated blood flow through the coronary arteries. Dead myocardial muscle cells become scar tissue and cannot contribute to cardiac contraction. Time to restoration of blood flow through coronary arteries is critical to minimizing cardiac damage. Signs and symptoms: chest pain or pressure, nausea, weakness or fatigue, dyspnea, diaphoresis, abnormal vital signs, sudden cardiac arrest. Geriatric patients, women, and diabetic patients may have atypical MI presentations. Complications of MI include cardiac dysrhythmias, sudden cardiac arrest, congestive heart failure, and cardiogenic shock. What is congestive heart failure? - CHF occurs when the ventricles are unable to keep up with the flow of blood coming to them. Right ventricular failure: if the right ventricle pumps inefficiently, blood backs up into the venous system that feeds into the right heart. Signs include JVD, pedal edema. Left ventricular failure: if the left ventricle pumps inefficiently, blood backs up into the lungs. Signs include pulmonary edema. Signs and symptoms: dyspnea, chest pain, pulmonary edema, JVD, pedal edema, orthopnea What is hypertension? - Systolic greater than 140 and/or diastolic greater than 90 Signs and symptoms: headache, tinnitus, nausea, dizziness, nosebleed. What are strokes? - Death to brain tissue due to an interruption in blood flow. Also called cerebrovascular accident or "brain attack." Modern treatment can dramatically reduce the amount of damage and resulting disability if received in time. Signs and symptoms: severe headache, slurred speech, facial droop or drooling, unilateral numbness or weakness or paralysis, altered LOC, vision problems What are ischemic strokes? - Blood flow to the brain is compromised due to a blockage. Ischemic strokes are often due to atherosclerosis. Overwhelming majority of strokes are ischemic in nature. What are hemorrhagic strokes? - Caused by bleeding within the brain. The bleeding robs the brain of oxygen delivery, and can apply pressure to surrounding brain tissue, further compromising oxygenation. Hemorrhagic strokes limit certain interventions and are often fatal. Prevention through modification of risk factors, especially hypertension, is key. What is the Cincinnati Prehospital Stroke Scale? - Facial droop: ask the patient to smile Arm drift: ask the patient to close eyes and hold arms out in front Speech: ask the patient to say "the sky is blue in Cincinnati." What is a TIA? - Transient ischemic attacks (TIAs) have the same presentation as CVAs. However, the signs and symptoms self-correct within about 24 hours with no permanent brain damage. They are a warning sign of an impending stroke. What are the types of seizures? - Generalized seizures -Also called grand mal seizures -Patient is unresponsive and experiences full-body convulsions Absence seizures -Also called petit mal seizures -Patient does not interact with environment, but there is no convulsive activity Partial seizures -Simple partial seizure: no change in LOC, possible twitching or sensory changes but no full-body convulsions -Complex partial seizures: altered LOC, isolated twitching and sensory changes possible Status epilepticus -Prolonged seizure (about 30 minutes) or recurring seizures without the patient regaining consciousness in between -Highly dangerous, possibly leading to permanent brain damage and death What are the phases of a seizure? - Not every stage is present for every type of seizure or every patient. 1. Aura phase -Warning stage -Patient may sense onset 2. Tonic phase -Muscle rigidity -Possible incontinence 3. Tonic-clonic phase -Patient experiences uncontrolled muscle contraction and relaxation -Patient may be apneic during the tonic or tonic-clonic phase. Sensitization: patients can develop sensitivity to a substance that did not previously cause a reaction. Following sensitization, the severity of reactions can get progressively worse each time. What is anaphylaxis? - Anaphylaxis is a severe, life-threatening form of allergic reaction. Anaphylaxis is always systemic and impairs the airway, respiratory, and cardiovascular systems. Anaphylaxis causes upper and lower airway swelling, bronchoconstriction, vasodilation, hypotension, capillary permeability and increased mucus production. Signs and symptoms: -Skin: flushed, hives, swelling -Respiratory: wheezing, upper airway swollen -Cardiovascular: hypotension What causes anaphylaxis? - Medications Environmental triggers Foods Insect bites and stings Latex What are the routes of exposure to drugs and toxins? - Ingestion, inhalation, injection and absorption What are ingested toxins? - *Ingestion is the most common route of exposure.* Ingestion of poisons by children is usually accidental, but most incidences involving adults are intentional. Common accidental overdose medications include cardiac medications, psychiatric medications, and acetaminophen. Signs and symptoms include: -Burning to the mouth and airway -Stomach pain, cramps, nausea, vomiting -Altered LOC, -Seizures Sedatives, narcotics and barbiturates are commonly abused drugs. Treatment: consider activated charcoal per medical direction. What are inhaled toxins? - Examples of inhaled poisons include various chemicals, pesticides, carbon monoxide, and natural gas. Signs and symptoms: -May be rapid or delayed -Dyspnea, coughing, dizziness, headache, abnormal lung sounds Treatment: ensure scene safety, be alert for multiple victims. Administer high-flow oxygen and monitor lung sound and respiratory status. What are injected toxins? - It is difficult to diminish, dilute, or inhibit the effects of injected toxins. Most injected poisonings are due to drug abuse. Onset of effects from injected drugs is typically rapid and can be long-lasting. Signs of injected stimulants (cocaine, meth): -Mood elevation, euphoria, -Restlessness, excitability -Tachycardia, rebound depression -Seizures, heart attack, stroke, death Signs of injected narcotics (morphine, heroin): -Decreased LOC, respiratory depression -Pupillary constriction What are absorbed toxins? - Signs and symptoms include burns to the skin, rash or blister, itching or burning. Interventions: -Decontaminate patient appropriately before initiating care or transport -Most chemicals on the skin or eye should be irrigated with water continuously for about 20 minutes. -When irrigating the eyes, be sure not to irrigate toxin into unaffected eye. What do you need to know about alcohol? - Alcohol is the most widely abused drug in the US Most long-term alcoholics will develop hepatitis. Alcohol is a CNS depressant and a sedative hypnotic. Ingestion of alcohol increases risks of vomiting. Alcohol withdrawal may cause delirium tremens (DTs). -Restless, irritable, agitated -Hallucinations, tremors or seizures What do you need to know about narcotics? - Narcotics are widely abused. They are typically ingested or injected. Narcotics, or opioids, include morphine, codeine, heroin, oxycodone, and many more. Narcotics are CNS depressants that can cause coma and severe respiratory depression. Most ALS providers are able to administer Narcan (naloxone), which rapidly reverses the CNS effects of narcotics. What do you need to know about sedative hypnotic drugs? - Sedative hypnotics are CNS depressants. Sedatives have a calming effect, and hypnotics induce sleep. Sedative hypnotics are usually taken orally but can be injected. Barbiturates such as Amytal, Seconal, and Luminal are sedative hypnotics. Benzodiazepines such as Valium, Xanax, and Rohypnol are sedative hypnotics. What do you need to know about inhalants? - Abused inhalants may include acetones, glues, cleaning chemicals, paints, hydrocarbons, aerosols, and propellants. These chemicals are inhaled to achieve sedative hypnotic effects. The difference between an effective dose and a lethal dose is very narrow. Brain damage and/or cardiac arrest due to abuse is common. Prescription and over-the-counter bronchodilators are also abused. They are taken for stimulant effects or perceived advantage in competitive sports. What do you need to know about stimulants? - Stimulants include caffeine, cocaine, amphetamines, methamphetamines, among others. They are taken for stimulant and euphoric effects. They can be taken by any route and are commonly injected, ingested, and inhaled. What do you need to know about marijuana? - Marijuana (cannabis) is typically smoked. It is taken to induce euphoria, relaxation, drowsiness. Marijuana use does not usually create an acute medical emergency; however, marijuana users often take other illicit drugs. -Right upper quadrant pain -Increased pain at night -Increased pain after eating fatty foods -Referred pain to the shoulder is common -Nausea and vomiting What is diverticulitis? - Diverticulitis develops when small pouches (diverticula) along the wall of the intestine fill with feces and become inflamed and infected. Typically affects people over age 40 and is associated with a low-fiber diet. Signs and symptoms: -Usually abdominal pain in the lower left quadrant -Fever -Weakness -Nausea and vomiting -Bleeding NOT common What is GI bleeding? - Most often occurs in middle-aged patients Most often fatal in geriatric patients Upper GI bleeds: often due to ulcers Lower GI bleeds: often due to diverticulitis Signs and symptoms: -Hematemesis: vomiting blood -Hematochezia: bloody stool -Dark, tarry stool -Signs and symptoms of hypovolemic shock What is gastroenteritis? - Gastroenteritis is an infection with associated diarrhea, nausea and vomiting. It is usually due to contaminated food or water and is not contagious. Prolonged vomiting and diarrhea can lead to hypovolemic shock. Gastroenteritis is a common cause of shock in children. What are esophageal varices? - Esophageal varices are a weakening of the blood vessels lining the esophagus. The condition is frequently associated with alcoholism. Signs and symptoms: -Vomiting large amounts of bright red blood -History of alcohol abuse or liver disease -Signs and symptoms of hypovolemic shock What are ulcers? - Ulcers are open wounds along the digestive tract, often the stomach. Signs and symptoms: -History of ulcers -Abdominal pain in the left upper quadrant -Nausea and vomiting -Often elicits and increase in pain before meals and during stress What is an abdominal aortic aneurysm? - AAA is a weakening of the wall of the aorta in the abdominal region. Weakened area is prone to rupture. A ruptured AAA will likely cause rapid, fatal bleeding. Signs and symptoms: -AAA most common in geriatric males -Tearing back pain -Signs and symptoms of hypovolemic shock -Possible pulsating abdominal mass Patients with a suspected AAA should be transported to an appropriate facility without delay. What is the most common symptom of a gynecologic emergency? - Gynecologic emergencies relate to female patients and their reproductive systems. Abdominal pain is the most common symptom of most gynecologic emergencies. What are specific gynecologic emergencies? - 1. Sexual Assault: sexual assault patients have been victimized physically and psychologically. Management of sexual assault victims: -Request law enforcement and victim's assistance. -Do not touch the patient without consent. -Request a same-sex provider if one is not already on scene. -Encourage the patient not to change clothes, shower, etc. -Treat clothing as evidence. Do not touch unless necessary. -Touch only those things that are necessary. 2. Pelvic inflammatory disease (PID) PID is painful and requires treatment. Nonemergency transport is recommended. Signs and symptoms: -Abdominal pain -Fever -Pain during urination -Often, increased pain while walking 3. Vaginal bleeding. This condition has many potential causes, including spontaneous abortion, PID, and sexually transmitted diseases. 4. Signs and symptoms of gynecologic problems: -Abdominal pain -Vaginal bleeding or discharge -Signs and symptoms of shock -Fever, nausea and vomiting What are genitourinary and renal emergencies? - A. Urinary Tract Infection (UTI) Signs and symptoms: -Abdominal pain -Hematuria: blood in urine -Painful or frequent urination -Fever, nausea, and vomiting B. Kidney Stones Kidney stones are crystals formed in the kidneys that can cause an obstruction in the urinary tract, causing severe pain. Males are much more likely to develop kidney stones. Signs and symptoms: -Severe abdominal pain, groin pain -Painful urination, fever, nausea, and vomiting C. Kidney failure Kidney failure is when the kidneys are no longer able to function sufficiently. Water and toxins accumulate and dialysis may be needed. Dialysis artificially removes excess fluid and waste products from the blood. What is a behavioral emergency? - A behavioral emergency is an abnormal behavior that is unacceptable to patients, family members, or society. What causes behavioral emergencies? - Causes of behavioral emergencies can be physiological or psychological. 1. Physiological causes include diabetic emergency; hypoxia; head injury; drugs, alcohol and toxins; environmental emergencies; and seizures. 2. Psychological causes include: -Anxiety: unusual level of stress about an event or problem. -Bipolar disorder: also known as manic depression; characterized by drastic mood swings. -Depression: deep sadness not associated with a specific event. Traffic conditions delay ground transport Distance to trauma center greater than 20 miles What is the Glasgow Coma Scale? - What are the trauma center designations? - Level 1 Trauma Center: Capable of handling all types of trauma 24/7. This includes on-site trauma teams, surgical capabilities, trauma intensive care units (ICU), and rehabilitation services. Level 2 Trauma Center: Capable of stabilizing trauma patients and transferring to a level 1 trauma center. Level 3 and 4 Trauma Centers: Limited services and ability to stabilize trauma patients. What are the types of bleeding? - 1. External bleeding -May be obvious only if the patient is exposed -More manageable than internal bleeding 2. Internal bleeding -Harder to identify and more difficult to manage than external bleeding -Signs and symptoms include bruising, hematoma, hematemesis, fractured bones, abdominal distension, bloody or dark stool, signs of shock. What are the various sources of bleeding? - Arteries: spurting, bright red blood. Veins: steady flow of dark red blood. Capillaries: slow oozing of dark red blood. May be mixed with clearish fluid. Note that bone fractures can lead to significant arterial and venous bleeding. A liter of blood can be lost from a single femur fracture. What are the three types of soft tissue injuries? - 1. Open injuries -Abrasion: a scrap to the skin due to surface friction -Laceration: a jagged cut -Penetrating wound: puncture wound -Incision: a sharp, clean cut -Avulsion: injury caused by a flap of skin being torn partially or completely loose -Crush injury: may be open or closed -Amputation: when part of the body is severed completely from the rest Management of open soft tissue injuries is the same as for external bleeding. 2. Closed injuries -Contusion -Hematoma: a collection of blood beneath the skin -Crush injury: may be open or closed Management of closed soft tissue injuries involves RICES: rest, ice, compression, elevation, splinting. 3. Burn injuries What is compartment syndrome? - Compartment syndrome is caused by compression of nerves, blood vessels, and muscle in a closed space within the body. The tissue cannot receive adequate blood supply and may die. Crush injury can lead to compartment syndrome. Severe pain is the primary symptom. What is evisceration? - Open abdominal injury with external organs (usually intestine) protruding. Management of evisceration: -Cover with moist sterile dressing. -Cover moist dressing with occlusive dressing. -Flex legs if possible to reduce abdominal contraction. -Treat for shock. -This is a high-priority transport. How should impaled objects be managed? - Impaled objects should be stabilized in place. There are only two indications for removing an impaled object: -The object creates an airway obstruction or inability to manage the airway, such as an impaled object in the cheek. -The object is in the chest and prevents CPR for a patient in cardiac arrest. How should open neck injuries and bite wounds be managed? - Open neck injuries should be covered with an occlusive dressing to prevent air embolism. All bite wounds that break the skin pose a high risk of infection. Small animal bites may lead to rabies. -Rabies is an acute, deadly viral infection of the CNS. If the animal responsible for the bite is not tested for rabies, the patient typically must receive a series of painful injections. -All bites that break the skin should be evaluated by a physician for infection and hte need for a tetanus shot. What are the five factors of burn severity? - 1. Depth of burn -Superficial (first degree burn): epidermal damage only. Painful, red, no blisters. -Partial thickness (second degree burn): epidermal and partial dermal injury. Painful, blisters present. -Full thickness (third degree burn): injury completely through dermal layer. Dry, leathery skin; no pain. 2. Amount of body surface area burned -Rule of nines: totals 100% of body surface area 3. Burns to critical areas: the critical areas are the respiratory tract, hands, face, feet and genitalia. 4. Associated trauma or preexisting medical conditions. Associated trauma, poor health, and certain medications complicate body's ability to handle a burn injury. 5. Age of patient. Under 5 or over 55 years of age are at greater risk. What determines the severity of burn injuries? - Severe Burn Injuries -Burns with respiratory compromise -Full-thickness circumferential burns -Partial-thickness burns covering more than 30% of TBSA -Burns with associated trauma, such as fractures -Full-thickness burns to the airway, hands, face, feet or genitalia -Full-thickness burns covering more than 10% of the TBSA -All moderate burn criteria for patients under 5 or over 55 years of age Moderate Burn Injuries -Full-thickness burns cover 2-10% of TBSA -Partial-thickness burns cover 15-30% of TBSA -Superficial burns covering more than 50% of TBSA Minor Burn Injuries -Full-thickness burns covering less than 2% of TBSA -Partial-thickness burns covering less than 15% of TBSA -Superficial burns covering less than 50% TBSA What are life-threatening complications of burn injuries? - The life-threatening complications related to burn injury are sepsis, hypothermia, hypovolemic shock, and airway compromise. What are thermal burns? - Thermal burns are caused by heat, such as from water, steam, or fire. Management of thermal burns include: -Stop the burning process with a moist sterile burn sheet until skin is no longer hot to the touch. 4. Basal skull fracture: these fractures occur at the base of the skull. Cerebrospinal fluid may leak from nose or ears. Signs include Battle's sign (bruising behind the ears) and raccoon eyes (bruising under the eyes). What are the types of brain injuries? - 1. Concussion 2. Cerebral contusion 3. Epidural hematoma 4. Subdural hematoma 5. Subarachnoid hemorrhage 6. Intracerebra hemorrhage 7. Herniation syndrome What is a concussion? - A concussion causes brain function to be disrupted in some manner. Signs and symptoms typically occur rapidly and gradually improve. Signs and symptoms may include altered LOC that gradually improves, brief loss of consciousness, nausea, vomiting, irritability, repetitive questioning, vision problems, and amnesia. What is a cerebral contusion? - Cerebral contusion is often accompanied by edema and/or concussion injury. Signs and symptoms of cerebral contusion may include signs of concussion and at least one of the following: decreasing mental status, unresponsive, pupillary changes, changes in vital signs, or obvious behavioral abnormalities. What is an epidural hematoma? - Bleeding beneath the skull but above the dura mater. Typically includes significant arterial bleeding. Extremely dangerous due to increase in intracranial pressure. Often accompanied by a temporal skull fracture. Signs and symptoms: -Patient experiences a brief loss of consciousness, wakes up, then LOC deteriorates. -Worsening LOC, headache, seizures, vomiting, posturing, hypertension, bradycardia, changes in respirations, pupillar changes. What is a subdural hematoma? - Bleeding above the brain (beneath the dura mater and above the arachnoid meningeal layer). Often caused by venous bleeding following a cerebral contusion. Signs and symptoms: vomiting, decreasing LOC, pupillary changes, unilateral weakness or paralysis, hypertension, changes in respirations, headache and seizures. What is a subarachnoid hemorrhage? - Bleeding within the subarachnoid space. This type of injury allows blood to enter the cerebrospinal fluid (CSF). Can be due to trauma or a ruptured aneurysm. Signs often include headache and stiff neck, and neurological impairment such as decreased LOC and seizures. What is an intracerebral hemorrhage? - Bleeding within the brain tissues. Patients can deterioriate rapidly. High mortality (risk of death) rate. What is herniation syndrome? - The pressure within the skull is called intracranial pressure (ICP). Herniation is when the brain is compressed due to extensive ICP. Remember, the brain is in an enclosed space. There is little extra space to accommodate swelling, bleeding, etc. Severe herniation will force the brain down toward the foramen magnum. Signs of increased ICP are called *Cushing's reflex*: -Hypertension -Bradycardia -Altered respiratory pattern Mortality rates are high for ICP patients. In an attempt to temporarily reduce dangerously high ICP, higher ventilation rates may be indicated. Consult local protocol and medical direction. How can the spine be immobilized? - 1. Manual immobilization -Manual c-spine precautions must be taken immediately if spinal injury is suspected. -Manual c-spine cannot be released until the patient's head is completely immobilized by other means. -A cervical collar is not a substitute for manual immobilization. 2. Spinal immobilization techniques -Long spine board: can be use for supine or standing patients, often used if rapid extrication is needed. -Half spine board: can be used for seated patients, use of these devices may require additional time to apply. What are the types of chest injuries? - 1. Pneumothorax 2. Tension pneumothorax 3. Sucking chest wound 4. Hemothorax 5. Cardiac tamponade 6. Clavicle and rib fractures 7. Flail chest What is pneumothorax? - Pneumothorax is the accumulation of air in the pleural space. This can compress lung space, prevent gas exchange, and lead to hypoxia. Can be due to trauma or nontraumatic injury to lung tissue. Lung sounds may be diminished or absent over injured area. What is tension pneumothorax? - A tension pneumothorax causes a progressive collapsing of lung tissue. The entire lung and great vessels can be compressed to the other side of the chest. Lung sounds will be absent over the affected area. The patient will develop severe respiratory distress and eventually respiratory failure. Compression of the great vessels can restrict blood flow, leading to shock and death. Tracheal deviation toward the unaffected side is a late and ominous sign. What is a sucking chest wound? - If an open chest injury penetrates the pleural space, it can draw air during inhalation. Penetrating thoracic injuries should be covered with a three-sided occlusive dressing to prevent air from entering the chest cavity. What is a hemothorax? - A hemothorax is bleeding into the pleural space. Watch for signs and symptoms of shock. Surgery is frequently required to control bleeding. What is cardiac tamponade? - Cardiac tamponade occurs when blood or other fluid accumulates in the pericardial sac and compresses the heart. Cardiac function can be severely compromised, leading to circulatory collapse. Beck's triad (indicative of cardiac tamponade): -JVD -Muffled heart sounds -Narrowing pulse pressure B. General Health and Nutrition: Those in good health, adequately nourished, and hydrated are better able to maintain homeostasis. C. Environmental Conditions: Temperature, humidity, and wind can help or hurt the body's ability to protect itself from environmental emergencies. D. Medications and Alcohol: Medications and alcohol can hinder the body's ability to regulate body temperature. How does the body lose heat? - 1. Conduction: direct transfer of heat through contact with a colder structure. 2. Convection: loss of heat to passing air. 3. Evaporation: loss of heat through evaporation of water from the skin. 4. Respiration: in a cold environment, exhaled air has been warmed within the body. That heat is lost on exhalation. 5. Radiation: transfer of radiant heat. What is hypothermia? - Hypothermia is a systemic cold emergency. It affects the entire body, not just an isolated area. Hypothermia develops when the body's core temperature falls below that needed to maintain homeostasis. Signs and symptoms of hypothermia: -Cold skin even at their core -Pale or cyanotic skin -Shivering (note: ceases with extreme hypothermia) -Loss of coordination -Altered LOC -Bradycardia -Bradypnea -Hypotension How should hypothermia be managed? - Pulse check should be extended to determine if patient is in cardiac arrest or severely bradycardic. Remove patient from cold environment. Remove wet clothing; prevent further heat loss. -Prehospital warming is often limited to passive rewarming measures only. What are local cold emergencies? - Frostnip -Frostnip develops when body parts get very cold but are not yet frozen. -Signs and symptoms include pale and cold skin , and loss of sensation in affected areas. Trenchfoot: Also called immersion foot, trenchfoot can develop when the feet have prolonged exposure to cold and water. Frostbite -The most dangerous local cold emergency. -The tissue is frozen, which frequently leads to permanent damage. -Can lead to gangrene. -Signs and symptoms include hard, frozen tissue, possible blistering and mottling. How should local cold emergencies be managed? - Remove patient from cold environment. Remove wet clothing. Protect affected areas from further injury. Remove any jewelry. Bandage, splint affected areas. Keep patient immobile. Do NOT rub affected areas. Do NOT apply direct heat unless authorized by medical direction. What are the types of heat emergencies? - Heat Cramps -Heat cramps are a local heat emergency. -Heat cramps typically occur during prolonged exertion and are likely caused by an electrolyte imbalance and dehydration. -Management of heat cramps includes rest, dehydration, and restoration of electrolytes. Heat Exhaustion -Heat exhaustion is a systemic heat emergency and occurs frequently. -Heat exhaustion is caused by a combination of heat exposure and hypovolemia. -Signs and symptoms include: history of exertion in a warm environment, dizziness, weakness, nausea, vomiting, headache, possible cramps, thirst, tachycardia. Heat Stroke -Heat stroke is an uncommon, extremely dangerous systemic heat emergency. -The body loses the ability to regulate body heat. Body temperature rises rapidly and will lead to death if untreated. -Heatstroke can develop due to exertion, or from passive exposure to a hot environment. -Signs and symptoms are similar to those of heat exhaustion and include: altered LOC, dry skin, seizures. How should systemic heat emergencies be managed? - 1. Move patient to a cooler environment. 2. If patient is completely alert, water can be administered. 3. If heatstroke is suspected, cooling measures must be rapid and aggressive. -Expose patient to improve dissipation of heat. -Cool patient with water, wet towels, cold packs, etc. -Cold packs are best applied to groin, neck, armpits. -Rapid transport is indicated. -Prepare for vomiting and/or seizures. How long is a full-term pregnancy? - A full-term pregnancy lasts about 9 months or 40 weeks. What changes take place during pregnancy? - A. Reproductive Changes -The uterus requires a much larger blood supply during pregnancy. -The enlarging uterus displaces other internal structures. B. Respiratory Changes -Respiratory rate increases slightly, but oxygen demand increases significantly. -In third trimester, the diaphragm frequently is compressed by the enlarging uterus. -The pregnant patient is at risk for developing hypoxia rapidly. C. Cardiovascular Changes -Cardiac workload increases, resulting in faster resting heart rate. -Blood volume increases, but plasma increase is greater. This leads to relative anemia. -Signs and symptoms of shock are masked during pregnancy. -Postural hypotension is common, increasing the risk of syncope. D. Gastrointestinal and Urinary Changes -The pregnant patient typically has undigested food in the stomach. -Pregnancy increases the risk of nausea and vomiting. -Pregnancy increases urinary frequency, and the pregnant patient is at risk of bladder injury due to displacement. E. Musculoskeletal Changes -The woman's center of gravity changes, increasing the risk of a fall injury. What are the different types of obstetrical emergencies? - A. Hemorrhage B. Placenta previa C. Abruptio placenta D. Ectopic pregnancy E. Uterine rupture F. Spontaneous abortion G. Seizures H. Preeclampsia and eclampsia I. Pregnancy-induced hypertension (PIH) J. Supine hypotensive syndrome What is hemorrhage in an obstetric patient? - Hemorrhagic shock can develop quickly in the pregnant patient. Signs and symptoms may not be evident until the pregnant patient is in severe shock. Bleeding can occur with little or no external blood loss. What are indicators of imminent delivery? - The mother has strong, frequent contractions under 2 minutes apart with little break between contractions. The abdomen is rigid during contractions. The mother feels the urge to push. Crowning. How do you care for a newborn? - Immediately upon delivery, place on clean, dry sheets or towels. Dry baby, including the head, and immediately replace wet linen with dry. Warm the baby, including the head. Placing the baby on the mother's abdomen will provide a radiant heat source. Suction the baby's mouth first, then nose. If the baby is not active and crying, attempt tactile stimulation by rubbing the baby's back or tapping the soles of the feet. Assess respirations. If the baby is not breathing adequately, begin ventilations (40-60 per minute) with an appropriately sized bag and mask for 30 seconds with high-flow oxygen. Do not overinflate the newborn's chest. Assess heart rate. 1. Heart rate below 60 beats per minute -Begin chest compressions and ventilations at a 3:1 ratio -Reassess every 30 seconds 2. Heart rate above 60 but below 100 -Provide ventilations -Reassess every 30 seconds 3. Heart rate above 100: assess skin color. Assess skin color. If central cyanosis is present, provide blow-by oxygen at about 4-6 Lm/in with oxygen tubing near the baby's face until color improves. APGAR Score What is the APGAR score? - Attempt to obtain APGAR score at 1 minute and 5 minutes after delivery of the baby. Appearance -0: cyanotic all over -1: core pink, hands and feet cyanotic -2: pink all over Pulse -0: no pulse -1: heart rate under 100 -2: heart rate over 100 Grimace (stimulation reflex) -0: no response to stimulation -1: minimal (facial grimace) response to stimulation -2: responds vigorously, such as crying Activity (extremity movement) -0: limp -1: limited active movement -2: actively moving Respirations -0: not breathing -1: slow or irregular breathing -2: adequate breathing What are potential delivery complications? - A. Meconium B. Multiple Births C. Prolapsed cord D. Breech presentation E. Limb presentation F. Postpartum hemorrhage What is meconium? - Meconium is the presence of fetal stool in the amniotic fluid. This turns the amniotic fluid yellow, green, or brownish. The risk of infection and pneumonia increases if the baby inhales meconium. If meconium is present, suction the mouth and nose promptly when the head clears the birth canal. Once the baby delivers, immediately suction the mouth and nose prior to stimulating the baby to breathe. What are multiple births? - Multiple births can have their own placenta, or share a placenta. Be prepared for multiple births any time it has not been ruled out by the ultrasound. Request additional units. Prepare additional supplies. If second baby does not deliver within about 10 minutes after first, transport immediately. What is a prolapsed cord? - A prolapsed cord occurs when the cord is the presenting part in the birth canal. A prolapsed cord can become compressed and cut off oxygen to the baby. Instruct the mother not to push. This will increase pressure on the cord. Place mother in knee-chest position. Carefully push the presenting part of the baby away from the cord. V finger Transport immediately. What is breech presentation? - A breech birth occurs when the baby's buttocks or legs are the first presenting part in the birth canal. Transport immediately. Breech births present significant dangers for mother and baby. If delivery occurs, there is a high risk the head will become stuck in the birth canal. If the head is trapped, use fingers to form a "V" along vaginal wall to create space allowing the baby to breathe. What is limb presentation? - A limb presentation is when a single arm or leg is the first presenting part in the birth canal. Do not attempt delivery of a limb presentation in the field. Place the mother in the knee-chest position and transport immediately. What is post-partum hemmorhage? - Postpartum hemorrhage is excessive bleeding following delivery. Blood loss of greater than 500 ml is considered abnormal. Management of postpartum hemorrhage includes uterine massage, breastfeeding and treating for shock. What is the significant anatomy and physiology of pediatric patients? - Airway/Respiratory -Infants have proportionally larger tongues than adults -The pediatric airway is smaller -Newborns and infants are obligate nosebreathers Head -The pediatric patient's head is proportionally large and is a source of heat loss -Padding is often required behind the shoulders to maintain a neutral, in-line position -Sunken fontanelles may indicate hypovolemia in infants, whereas bulging fontanelles may indicate increased ICP -Children require greater cerebral blood flow; hypoxia develops rapidly Chest -Ribs are more pliable in pediatric patients -Smaller lungs increase risk of overinflation -Pediatric patients are often abdominal breathers Abdomen -Notify dispatch you're responding -All emergency vehicle operators must drive with due regard for the safety of others Arrival at Scene/Patient Contact -Notify dispatch you are on scene -Ambulance in a safe position/as a barrier Patient Transfer to Ambulance Transport to Receiving Facility -Notify dispatch where you are taking patient -Notify receiving hospital Arrival at Hospital/Transfer of Care -Notify dispatch you've arrived -Provide verbal report to appropriate personnel -Provide written copy of PCR -Obtain transfer of care signature Postrun Phase/Return to Service What are defensive driving tactics? - Emergency vehicles should usually travel in the far left lane What vehicle safety systems should you be aware of? - Shock-Absorbing Bumpers -Most vehicles today are equipped with shock-absorbing bumpers (front and rear). They can become compressed during an accident and spontaneously release, injuring anyone standing in front of them. -Approach vehicles from the side, not the front. Simple access: gaining access to the patient without any tools or need to break the glass. Complex access: requires the use of special tools and training. What are hazardous materials? - Hazardous materials are solids, liquids or gases that pose a threat to people, property or the environment. Risks of exposure depend on the dose, concentration, route of exposure, and duration of contact. The EMT's primary responsibilities at a hazardous materials incident are personal safety, notification of appropriate authorities, and the safety of the patient and public. What are the diamond placards? - Blue diamond: provides information about health hazards. Red diamond: provides information about fire hazard. Yellow diamond: provides information about reactivity hazards. White diamond: displays symbols indicating special hazards such as radioactivity or reactivity with water. The higher the number within the blue, red or yellow diamonds, the greater the hazard is within that category. What are the "zones" of a HazMat site? - Hot Zone -This is the contaminated area -Appropriate PPE is required, as determined by HazMat personnel -Regardless of patient condition, those without proper training and PPE are not permitted in the hot zone. -Patient care does not take place in the hot zone. Warm Zone -This is area between the hot and cold zones. -Appropriate PPE is required. -Only life-threatening conditions are treated in the warm zone. -Everyone must be decontaminated in the warm zone before entering the cold zone. Cold Zone -Most treatment is performed in the cold zone. -Typically, EMS providers remain in the cold zone. What is decontamination? - Decontamination is essential to prevent spreading the hazardous material. Any of the following may become contaminated and require decontamination: 1. The patient's body, hair, clothes, possessions, etc. 2. Medical equipment 3. Emergency vehicle Decontamination should be performed by those properly trained and equipped to do so. What is the National Incident Command System? - NIMS provides an adaptive, standardized approach to any domestic incident. What are the components of NIMS? - Preparedness: This component helps agencies and responders proactively prepare for an incident. Communications and Information: This component coordinates effective communication and information sharing. Command and Management: This component provides oversight of the incident for all participating agencies. Resource Management: This component coordinates acquisition, tracking, and recovery of resources and equipment needed during an incident. Ongoing Management: This component coordinates continuous quality improvement of EMS. What are the NIMS roles and responsibilities? - Command Section: This section includes the incident commander (IC), public information officer (PIO), safety officer, and liaison officer. Finance Section: This section tracks all expenditures during an incident. This section is usually needed only on large incidents. Logistics: The logistics section is responsible for most of the things that actually allow an IMS to function. This includes the necessary communications equipment, medical supplies, food, water, facilities, shelter, etc. Operations: This section is responsible for tactical operations on larger incidents. On smaller incidents, this responsibility usually rests with the IC. Planning: This section helps to develop an action plan for the incident and solve problems as they arise during the incident. What are the EMS functions of IMS? - Preparedness -EMS agencies should have written disaster plans that are routinely practiced, reviewed, and improved. -EMS facilities should have adequate resources to be fully self-sufficient for at least 72 hours. -A plan should be in place to assist families of EMS responders so responders can focus on their job. Scene Size-Up -What is the incident? -What do you need to do? -What resources do you need to do it? Medical Incident Command Functions -Triage: the sorting of patients based on the severity of injury. The triage supervisor identifies the number and severity of patients. Treatment does NOT begin until all patients are triaged. -Treatment: Secondary triage should be completed within each treatment area. -Transportation -Staging -Rehabilitation: safe location for the rest and recovery of responders. -Extrication and Special Rescue