EMT Review
Basically everything you need to
know without outwardly giving you
all the answers
Legalities
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Scope of Practice
Standard of Care
Duty to Act
Abandonment
Assault
Battery
5150
Legalities
• Negligence
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Duty to Act
Breach of Duty to Act
Proximate Cause
Compensatable Injury
Legalities
• Consent
• Expressed
• Implied
• Minor/mentally
incompetent
Patient Assessment
• Initial Assessment
– BSI/Safety
– Number of patients
– MOI/NOI
– Additional resources
– Cspine
Patient Assessment
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General Impression
AVPU
Chief Complaint
ABC
Respiratory
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Pulmonary Embolism
Acute Pulmonary Edema
COPD
Asthma
Hyperventilation
Pneumonia
Emphysema
• Characterized by the
destruction of the
alveolar walls and the
distention of the
alveolar sacs.
• Patients trap air and
are unable to exhale.
Emphysema
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Thin, barrel chest appearance
Cough, little sputum
Prolonged exhalation
Diminished lung sounds with wheezes
Pursed lip breathing
Pink complexion (pink puffers)
Home oxygen
Chronic Bronchitis
• Affects primarily the
bronchus and the
bronchioles.
• Characterized by a
productive cough that
persists for at least 3
consecutive months 2
years in a row.
Chronic Bronchitis
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Typically overweight (blue bloaters)
Chronic cyanotic complexion
Dyspnea, but not as bad as emphysema
Coarse rhonchi
Wheezes and crackles in lungs
Asthma
• A reactive airway
disease that affects
the bronchial tree and
bronchioles
• An increased
sensitivity of the lower
airways to irritants
and allergens
Asthma
• Bronchospasm
• Edema of the inner lining of the airways
• Increased secretion of mucus that causes
plugging of the smaller airways.
Pulmonary Embolism
• An obstruction of blood flow in the
pulmonary arteries.
• Impedes the delivery of oxygenated blood
back into the cardiovascular system.
• Can be caused by blood clots, fat
particles, foreign body, or amniotic fluid.
Pulmonary Embolism
• Causes include:
– Sedentary lifestyle
– Recent surgery
– Long bone fractures
– Smokers
– Birth control pills
Pulmonary Embolism
• Signs/Symptoms include:
– Sudden onset pinpoint chest pain
– Shortness of breath
– Poor skin signs
– Possible diminished lung sounds
Acute Pulmonary Edema
• Excessive amounts of fluid collect in the
spaces between the alveoli and the
capillaries.
• Cardiogenic: increased pressure in the
pulmonary veins push fluid out of the
capillaries.
• Non cardiogenic: destruction of capillary
beds causes fluid to leak out. (ARDS)
Acute Pulmonary Edema
• Signs/Symptoms include:
– Dyspnea and orthopnea
– Frothy sputum
– Crackles in lungs
– Cyanosis, or pale wet skins
– JVD
– Swollen lower extremeties
– Hypertension
Acute Pulmonary Edema
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Oxygen via NRB or BVM
Sit upright
Dangle feet
Rapid transport
Hyperventilation Syndrome
• Most often caused by anxiety or emotional
distress.
• Can also be caused by:
– Methanphetamine OD
– Hyperglycemia
– ASA OD
Hyperventilation Syndrome
• Signs/Symptoms include:
– Dizzy
– Shortness of breath
– Numbness/tingling to hands, feet, perioral
– Spasms of fingers and toes
Assessment of Newborn
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Appearance
Pulse
Grimace
Activity
Respiration
Appearance
• Trunk and extremities pink = 2 points
• Trunk pink with blue extremities = 1 point
• Trunk and extremities blue = 0 points
Pulse
• Heart rate over 100 = 2 points
• Heart rate under 100 = 1 point
• Heart rate absent = 0 points
Grimace
• AKA Reflex irritability
• Facial grimace plus cry = 2 points
• Only facial grimace = 1 point
• No reflex activity = 0 points
Activity
• Active movement = 2 points
• Some flexion w/o active movement = 1
point
• Limp = 0 points
Respiration
• Good respiration + strong cry = 2 points
• Slow or irregular breathing = 1 point
• Apnea = 0 points
APGAR Scores
• 0-3 points = aggressive resuscitation
(BVM, CPR, etc.)
• 4-6 points = Provide stimulation and O2
• 7-10 points = Provide routine care
Spontaneous Abortion
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AKA Miscarraige
Can occur for many reasons
Viability usually considered after 20 weeks
Check for severe lower abdominal pain,
severe vaginal bleeding, passing of tissue
or blood clots
Pre-Eclampsia
• Last trimester emergency, usually first
pregnancy, with a history of hypertension
or diabetes
• Characterized by high blood pressure and
swelling of the extremities
• Seizures from pre-eclampsia is called
Eclampsia
Placenta Previa
• The placenta attaches itself to the uterus
over the cervix
• Fetus pushes on placenta, causing severe
bleeding, but little or no pain
Abruptio Placentae
• When the placenta tears away from the
uterine wall prematurely
• Causes fetal distress due to poor gas and
nutrient exchange
• Severe abdominal pain, although little or
no external bleeding may occur.
Ruptured Uterus
• As the uterus expands and thins out,
especially around the cervix, can cause
spontaneous or traumatic rupture.
• Usually more than 2 previous pregnancies,
or history of C-section.
• Mothers mortality rate is 5-20%, Fetal
mortality rate is 50%.
• Severe pain, minor vaginal bleeding.
Ectopic Pregnancy
• When the ovum is implanted outside the
uterus.
• 90% fallopian tube
• 6% in peritoneum
• 1% in cervix
Acute Coronary Syndromes:
Angina Pectoris
• Literally “pain in chest”
• From a decrease of oxygen to the cardiac
tissues (cardiac tissue ischemia)
• Normally from an increased workload on
the heart
• Will feel a crushing or squeezing type pain
radiating to the jaw, arm, or back
• Normally relieved with rest, O2, NTG
Acute Coronary Syndrome:
Myocardial Infarction
• A portion of the heart muscle dies from the
lack of an adequate supply of oxygenated
blood.
• Usually from coronary artery disease.
• Heart muscle dies, leading to a build up of
lactic acid, which causes the “pain.”
• Can cause irregular heart rhythms and
sudden death.
Assessment of ACS
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(O)nset: Sudden or Gradual?
(P)rovocation: What caused the pain?
(Q)uality: What does it feel like?
(R)egion: Where does it hurt?
(R)adiation: Does the pain travel?
(R)eoccurance: Have you had before?
(S)everity: Rate on 1-10 scale
(T)ime: How long have you had pain?
Pertinent Negatives of ACS
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Nausea
Vomiting
Diaphoresis
Dizziness
Weakness
Syncope
Palpitations
Shortness of Breath
Acute Coronary Syndromes:
Treatment
• Rest. Do not make
your patient move
more than they have
to.
• O2 15l/m NRB
• Nitroglycerin SL
• ASA
Nitroglycerin (NTG)
• Class: Nitrate
• Action: Dilates Coronary Arteries allowing
blood to oxygenate ischemic tissues.
• Dose: 1 on SO, to a max of 3 on BHO
• Side Effects: Headache, hypotension,
tachycardia
• Contraindications: Use of sexual
enhancing drugs in last 48 hours
Aspirin (ASA)
• Class: Platelet Aggregation Inhibitor
• Action: Reduces the ability of the platelets
to bind to eachother.
Heart Failure
• AKA “CHF”
• Inability for one or both Ventricles to pump
blood effectively
• Several Causes
Heart Failure
• Main Causes:
– AMI
– Hypertension
– Valve disorders
– Pulmonary Embolism
– Drug use
Right Heart Failure
• Right ventricle accepts de-oxygenated
blood and ejects it to the lungs for
oxygenation.
• Fluid (blood) backs up in the venous
system causing JVD, Liver enlargement,
peripheral edema.
• Normally not an emergent condition.
Left Heart Failure
• Left ventricle accepts oxygenated blood
from the lungs, and ejects it out to the
bodies arteries.
• Left ventricle cannot eject all its blood,
which causes a build up of pressure.
• The pressure causes Pulmonary Edema
• Left Ventricular failure is an emergent
condition
Signs of Heart Failure
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Severe Shortness of breath with crackles
Tachycardia and Tachypnea
Orthopnea and PND
Fatigue with little movement
Pale, cool, sweaty skins
Cyanosis
Severe hypertension
JVD
Treatment for Heart Failure
• Sit patient upright and dangle legs
• O2 15l/m by NRB or BVM
• Positive Pressure Ventilation
Diabetes mellitus types
– Type I—Insulin dependent diabetes mellitus
– Type II—Non-insulin dependent diabetes
mellitus
Hypoglycemia
• Emergencies related to diabetes mellitus
• More common with Type I diabetics
• Most dangerous complication of diabetes mellitus
• Most common cause of coma in the diabetic
patient
Causes/Signs & Symptoms
Insulin Shock
• Too much insulin
• Too little food
• Too much
exercise or stress
• May be
precipitated by
increased ETOH
without CHO
intake
Hyperglycemia
• Emergencies related to diabetes mellitus
– Usually presents as either DKA or HHNS
• Both syndromes have elevated BGL in the body
– DKA usually > 350 mg/dl
– HHNS usually > 600 mg/dl
• Altered physiology leads to dehydration and
acidosis
Causes/Signs & Symptoms
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Too little insulin
Too much food
Illness
Infection
Transient Ischemic Attack (TIA)
• A TIA looks just like a CVA symptomatically
• TIA disappears within 24 hours of onset,
without any permanent neurological
changes
• Usually, symptoms subside within 15–30
minutes
Cerebral Vascular Accident (CVA)
• General
signs and
symptoms
of a stroke or
TIA
• Progressive
worsening of
symptoms as
stroke evolves
Types of seizures
• Primary seizures
– Seizure disorder
• Secondary seizures
– Insult to body
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Fever
Infection
Hypoxia
Hypoglycemia
Hyperglycemia
Drug intoxication
Drug withdrawal
Eclampsia in pregnancy
Degenerative brain diseases
Imbalances in the electrolytes in the body
Cardiac arrest
– Generally full body seizures
Generalized tonic-clonic
• Grand Mal
• What we most
commonly think of
• Most self limiting
• Occurs in phases
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Aura
Tonic phase
Hypertonic phase
Clonic phase
Postictal phase
• Status
– Greater than 5 minutes
– Recurrent with no lucid
interval
Partial Seizures
• Simple partial seizure
– Focal motor or Jacksonian seizure
– Patient is usually awake
– Results in an area of the body (face, arm, leg, or
body) demonstrating the seizure-like motions
– May progress to grand mal seizure
• Complex partial seizure
– Psychomotor or temporal lobe seizure
– Due to the region of the brain involved with the
seizure, the patient’s orientation may be altered
– Usually lasts 1-2 minutes, characterized by repetitive
type motions
– Post-seizure confusion usually longer than seizure
itself
Absence or petit mal seizure
• Most common in children
• Characterized by a blank stare
• Rarely necessitates emergency care
Febrile seizure
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Common to kids 6 months to 6 years
Usually self limiting
Due to rapid rise or fall of temperature
Gentle cooling
Routes of Exposure
• Ingestion
• Inhalation
• Injection
• Absorption
CNS Stimulants S/S
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Excitability
Agitation
Tachycardias
Tachypnea
Dilated Pupils
Hypertension
Lack of sleep
CNS Depressants S/S
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Euphoria
Drowsiness
Hypoventilation
Bradycardias
Hypotension
Dilated, sluggish pupils
Narcotics S/S
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Hypotension
Bradycardia
Inadequate respirations
Cool, clammy skins
Pinpoint Pupils
Withdrawal S/S
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Anxiety
Confusion
Tremors
Sweating
Elevated V/S
Hallucinations
Abdominal Pain
Delerium Tremens
• Occurs 1-14 days after the patients last
drink
• An episode may last 1-3 days
• S/S p. 589
Causes of Shock
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Fluid loss (not just blood loss)
Pump Failure
Vasodilation
Hypoxia
Hypovolemic Shock
• Results from a decrease of the volume of
blood available for perfusion to the body’s
organs.
– External or Internal Bleeding (hemorrhagic
shock)
– Plasma loss from burns
– Dehydration from vomiting or diarrhea
Obstructive Shock
• Mechanical obstruction or compression
that prevents blood from reaching the
heart.
– Pulmonary embolism
– Tension pneumothorax
– Cardiac tamponade
Distributive Shock
• Abnormal distribution of blood in the
vessels or throughout the body.
• Causes and insufficient amount of blood to
reach the heart.
• Massive dilation of vessels or leakage of
fluid from the capillaries.
– Neurogenic
– Anaphylactic
– Septic
Neurogenic Shock
• Also known as Vasogenic Shock
• Usually the result of a spinal cord or
severe head injury.
• Causes the nervous system to lose control
of the vascular system.
• Blood pools in the periphery.
Anaphylactic Shock
• Results from the body’s abnormal reaction
to a foreign protein.
• Normally from bee stings, foods, certain
medications.
• The body releases chemicals causing the
blood vessels to dilate and leak.
• Bronchioles constrict.
• Without immediate care, the patient will
die.
Septic Shock
• Results from toxins produced by a severe
infection (usually bacterial).
• Toxins cause a reaction that dilates the
blood vessels and allows blood to pool in
the extremities and fluid to leak from the
vessels.
Cardiogenic Shock
• Results from inadequate pumping of the
heart.
– CAD
– AMI
– Heart rhythm abnormalities
– Heart valve disease
– CHF
Stages of Shock
• Compensatory
• Decompensated (progressive)
• Irreversible
Treatment of Shock
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Recognition is the most important key.
Lay patient flat.
Elevate legs 10-12 inches (shock position)
Keep patient warm.
O2 15l/m NRB
Treat patient gently.
Pneumothorax
• Defined as an accumulation of air in the pleural
cavity, causing collapse of a portion of the lung.
• Causes?
• Results in a decrease in gas available within the
alveoli.
• Signs and symptoms include: chest pain worse
with inspiration, tachypnea, decreased or absent
breath sounds.
Open Pneumothorax
• AKA “Sucking Chest Wound”
• Caused by an open wound to the chest.
• Treatment includes immediate occlusion to
the opening with a 3 sided occlusive
dressing.
Tension Pneumothorax
• An immediately life-threatening condition.
• Results from a pneumothorax that continues to
trap air in the thoracic cavity with no release of
the air.
• Air accumulates in the thoracic cavity on the
injured side.
• The lung completely collapses and compresses
and shifts the mediastinum to the uninjured side.
Tension Pneumothorax
• Uninjured lung, heart, and large veins are
compressed, resulting in reduced CO, ineffective
ventilations, and severe hypoxia.
• Signs include: cyanosis, unequal movement of
the chest, distended neck veins, deviation of the
trachea to the uninjured side.
• Can this be caused by an open chest wound?
Pericardial Tamponade
• Trauma causes bleeding in the pericardium.
• The pericardium cannot expand, so the blood
causes pressure on the heart, resulting in
reduced CO, blood backup into the venous
system.
• This is a life threatening condition.
• Signs similar to a tension pneumothorax, but
with normal breath sounds.
Pericardial Tamponade
• Signs include: JVD, shock, tachycardia,
hypotension, narrowing pulse pressures,
weak pulses.
• Symptoms progressively worse as the
pericardium continues to fill with blood.
• Normally causes from a penetrating injury.
Heat Cramps
Caused by electrolyte imbalances by overexerting muscles
Normally in the large flexor muscle
groups: abdominal, gluteus, hamstrings
Heat Exhaustion
The body has maximized its heatdissipating mechanisms and is beginning
to shut down
Pale and very sweaty
Mild aloc, dizzy
Normal body temperature
Heat Stroke
The Body’s heat dissipating systems shut
down
Body becomes over heated, and keeps
heating
Damages brain cells, causes seizures
Hot, red skin. May or may not sweat
(50%)
Up to 80% mortality rate if not treated
Major Signs/Symptoms
Elevated Core Temperature
Muscle Cramps
Weakness/Exhaustion
Dizziness
Tachycardia
Tachypnea
Nausea/Vomiting
Seizures
Headache
Care and Treatment
Normal to Cool skin
Move to cool place
Oxygen
Remove clothing
Apply cold compresses
Shock position
Fluids
Care and Treatment
Hot/dry skin
Remove from heat
Remove clothing
Oxygen
Cold packs to groin, neck, armpits, behind
knees
Spray tepid water on patient
Fan patient
Keep skin wet