EMT Study notes 2015 – Flashcards
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Norm range for Adult BP
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120/80
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N0rm Range for Adult Pulse/Heartrate
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60-100 beats pm
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Norm Resp Rate Adult
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12-20 breaths pm
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Medical Director
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Physician who assumes ultimate responsibility for the patient care aspects of the EMS system
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Standing Orders
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Protocol issued by Med Director to EMT in certain circumstances
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Off-line Med Direction
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Standing orders issued by the Med Dir to EMTs WITHOUT speaking to Med Dir
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On-Line Med Direction
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Orders given DIRECTLY to EMT by on duty physician by radio or telephone
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Expressed Consent
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Given by adults of legal age and mental competency-must be informed consent
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Implied Consent
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Patient physically or mentally incapacitated but in need of emergency care. -Unconscious patient -Parent cannot be contacted
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Ventilation
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movement of gases to and from ALVEOLI
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Inhalation
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Active process; negative pressure, Diaphragm moves downwards, ribs up and out
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Exhalation
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Passive process; positive pressure;
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Respiration
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Process of moving Oxygen and Carbon Dioxide between circulating blood and cell Internal: between Cells and blood aka Cellular respiration External: between Alveoli and circulating blood aka Pulmonary Respiration
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Right Atrium
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Receives deoxygenated blood from Body via the Sup. and Inf. Venae Cavae Send to R Ventricle
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R. Ventricle
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Pumps this Deoxy blood to Lungs via Pulmonary arteries
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Left Atrium
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receives Oxygenated blood from lungs contracts/send to L Ventricle
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L. Ventricle
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Oxy rich blood to Body via Aorta. Most muscular and strongest part of heart.
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Coronary Arteries
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Branch off Aorta; supply Heart muscle
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Where to find Pulse
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1. Carotid Pulse; lateral Neck 2. Femoral; Medial groin 3. Brachial; Med upper arm..Infants 4. Radial; thumb side of wrist 5. Post Tibial artery; post med malleolus 6. Dorsalis Pedis artery; top of foot, lat to large tendon of big toe
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Perfusion
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Cellular Level ; Supply of oxygen to AND removal of wastes from, the cells and tissues as a result of blood flow through the capillaries
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Hypoperfusion / SHOCK Compensated Shock - HR inc. RR inc. + deeper Decompensated - AMStatus HR inc. BP dec. <90 Irreversible - altered mental status, GCS <11
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Inadequate perfusion of the cells and tissues due to insufficient flow of blood through capillaries; Bodys' inability to adequately circulate blood to the cells to supply them with oxygen and nutrients Severe bleeding/hemorrhage is major cause ... Signs of: 1 Altered Mental Status 2 Pale, cool, clammy skin 3 Nausea and vomiting 4 Vital signs change: - Pulse inc in attempt to to pump more blood. Tachycardia - Respirations will inc initially then..gradually becoming shallow and labored - BP last to change...when drops patient in life threatening cond. 3 major types of shock: - Hypovolemic; uncontrolled bleeding ...'hole' - Cardiogenic; MI Heart failure; CHF - Neurogenic; CNS haemorraghic stroke/trauma
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Minute Volume
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Tidal volume multiplied by RR norm Min Vol; 5000mL (TV 500mL X 10 breaths pm)
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Seat of Respiratory Control
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Medulla Oblongata
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Chemoreceptors
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Sensors in brain that detect low or inadequate levels of Oxygen and high levels of Carbon dioxide-compensation will occur: Respiratory rate will change...increase
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Hypoxia
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Body tissues hungry for oxygen; Oxygen shortage in body
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Vital signs INFANT Age newborn to 12 months
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HR/Pulse 140-160 bpm RR 30-40 breaths pm BP systolic 90mmHg at 1yr old - usually not looking for as their hearts can only beat faster NOT harder!
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Vital signs TODDLER Age 1-4
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HR/Pulse 80-130 bpm RR 20-30 bpm BP systolic 70-100mmHg
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Early Adulthood Ages 19-40 Middle Adulthood Ages 41-60 Late Adulthood Ages 61+
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HR/Pulse 70 bpm RR 16-20/minute BP 120/80
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Diffusion
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Process by which molecules move from area of high to area of low concentration
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Hypercapnia
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High levels of CO2 in body
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Respiratory Distress WOB
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There is a challenge but body is COMPENSATING to meet its needs; inc RR, inc HR, body positioning - pulse oximetry reading within norm limits
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Respiratory Failure
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reduction of breathing to point where O2 intake not sufficient to support life Hypoxia is profound CO2 at dangerous levels reduced level of responsiveness shallow ventilations... precursor to Resp Arrest (stoppage of breathing)
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Primary Assesment
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- General Impression - Assess Mental Status - AVPU - Assess Airway ; Breathing - Circulation - Determine Priority for Treatment - " " " for Transport
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Diabetes Type 1
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Diabetes Mellitus Cells in Body have inability to use Insulin OR underproduction of Insulin by Pancreas Insulin dependent Ages 8-12 Hyperglycemia; Chronic >140mg Too much Glucose in body - Gradual onset Starving at the cellular level infection/sepsis chronic thirst and hunger inc urination NORM range; 60-120mg Hypoglycemia; Acute <60mg Low Blood sugar V quick onset Slurred speech/ can pass out/appear drunk/altered mental status Caused by; not eating, overexercising, vomiting
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Diabetes Type 2
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Adult Onset Non-Insulin dependent DM Given Glucophage to help body utilize the insulin
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Diabetes Type 3
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IDDM Adult on set - due to bad dietary habits Usually have Insulin pump
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Hydrostatic Pressure
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That which makes capillary bed exchange occur; Arterial Blood gives up O2 and nutrients to the surrounding cells. Cells in turn give up CO2 and other waste products back to blood..venous system.
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Internal bleeding
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MOI is imp to determine (if any) Definitive care at hosp. Immediate transport Signs: Tender/rigid/ distended abdomen coffee grounds vomit tarry stools bleeding frm mouth/rectum/vagina or other orifice Typically no fever!!...Low BP w/High Heart rate
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Embryonic Stage
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From fertilization to 8 weeks
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Fetal Stage/gestation period
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From 8 weeks to birth
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Supine Hypotensive Syndrome
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Compression of inferior Venae Cavae by baby's weight, placenta and amniotic fluids while Supine Transport on L side { L Lat recumbant}
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Stages of Labor;
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1. First: Beginning contractions to Full Dilation Lightening ( Baby turns head down) Duration of contraction timed; from beginning of contraction to relaxation of Uterus Contraction Interval/Frequency: time from start of one contraction to the beginning of the next (start to start) 2. Second: Baby enters Birth Canal and is Born 3. Third: Delivery of Placenta (10-20 mins)
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Gravita Para
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How many viable births/Pregnancies has patient had ?
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Neonate
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Newborn less than 1 month old Norm Vitals: 120 BPM/HR 30-50 RR Therefore: for NEONatal Resusitation If <100 beats per min...Use Rescue Breathing - at rate of 40-60 breaths pm w/BVM If <60 do Full CPR - at rate of 3 compressions:1 breath
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APGAR scale
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Appearance Pulse Grimace Activity Respiratory effort
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Breech delivery
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initiate Rapid Transport High conc O2
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Limb presentation
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Rapid Transportation ONLY!
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Seizures in Pregnancy
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maybe caused by preEclampsia-Pregnancy induced Hypertension usually patient is already aware. usually during Late pregnancy Presents with: Altered Mental status Swollen hands and feet High Blood Pressure LOAD AND GO!
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Newborn 0-1 Toddler Age 1-3 Preschool 3-6 School age 6-12 Adolescent 12-18
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Dependant/No sending Facial reading/no sending/dependant reads Facial expressions/words/sends signals Min. dependant/rec'ing and sending info good believe indestructible/uncomfortable with own body
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Toxidrome for Opiates NARCAN
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Dec breathing pinpoint pupils Altered Mental Status AVPU
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Continuum of Care
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Document what you were told/saw/did and result
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Stress
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1. Acute - HR inc. RR inc. BP inc. Sweaty, Pale, Dilated pupils, Vasoconstriction, Sympathetic system kicks in. 2. Delayed - Habits change GI issues at a Systems level 3. PTSD - flshbcks triggered by one of 5 senses
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For proving negligence;
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1 Duty to Act 2 Breach of Duty - standard of care not given 3 Proximate Causation
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Stages of Grief
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1 Anger 2 Denial 3 Bartering 4. Depression 5. Acceptance
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R sided Heart failure symptoms;
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Edema in lower extremities and weeping from the tissues
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L sided Heart failure symptoms;
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damaged tissue from MI or hypertension: blood, unable to be pumped out effectively ;pressure builds up as this blood backs up...goes back to lungs; fluids cross the thin cell membrane and build up in the alveoili - Pulmonary Edema..presenting with Dyspnea
