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Medical Direction

Oversight of the patient-care aspects of an EMS system by the Medical Director.

Protocols

lists of steps, such as assessments and interventions, to be taken in different situations. Protocols are developed by the Medical Director of an EMS system

Offline Direction

consists of standing orders issued by the medical director that allows EMTs to give certain medications or perform certain procedures without speaking to the medical director or another physician.

Online Direction

consists of orders from the on-duty physician given directly to an EMT-B in the field by radio or telephone.

Standing Orders

A policy or protocol issued by a Medical Director that authorizes EMT-Bs and others to perform particular skills in certain situations.

HEPA Mask

High Efficiency Particulate Air respirator; used for patients with suspected TB; worn by the EMT provider to prevent airborne transmission

Hepatitis B

infectious inflammation of the liver caused by the hepatitis B virus (HBV) that is transmitted sexually or by exposure to contaminated blood or body fluid

Hepatitis C

inflammation of the liver caused by the hepatitis C virus, transmitted by exposure to infected blood (rarely contracted sexually)

Tuberculosis

Infectious disease caused by the tubercle bacillus, Mycobacterium tuberculosis. Most commonly affects the respiratory system and causes inflammation and calcification of the system.

Acute Stress

short term ; fight or flight response ; effects disappear quickly after it is over

Scope of Practice

What we are allowed to do or trained to do

Standard Care

the degree of care that a reasonably prudent person should exercise under the same or similar circumstances

Duty to Act

an obligation to provide care to a patient

Good Samaritan

a person who voluntarily offers help or sympathy in times of trouble

Expressed Consent

Permission that must be obtained from every conscious, mentally competent adult before emergency treatment may be provided

Implied Consent

The consent it is presumed a patient or patient's parent or gaurdian would give if they could, such as for an unconscious patient or a parent who cannot be contacted when care is needed.

Treatment of a Minor

Must be given by legal guardian

Involuntary

Mentally incompetent person

Advanced Directive

a legal document prepared by a living, competent adult to provide guidance to the health care team if the individual should become unable to make decisions regarding his or her medical care; may also be called a living will or durable power of attorney for health care

Polst

Physicians orders for life sustaining treatment. May include order for DO NOT RESUSCITATE

PCR

Prehospital care report

Emergency Move

a move made when there is an immediate danger to the patient.

Urgent Move

Move used if a scne factor causes a decline in patient's condition, or if the treatment of a patient requires a move.

Non urgent move

No immediate threat to life, are carried out in such a way as to prevent injury and to avoid discomfort and pain.

bariatric stretcher

Stretcher for obese patients

scoop stretcher

this cot splits in tow or four sections, so it can be used where larger stretchers cannot fit.

basket stretcher

designed to surround and protect the patient, this stretcher is used to move a patient from one level to another to over rough terrain.

flexible stretcher

made of canvas or rubberized or other flexible material, often with wooden slats sewn into pockets and three carrying handles on each side. can be useful in restricted areas or narrow hallways

anatomical planes

1. coronal (vertical cut into front and back halves) 2. transverse (horizontal cut into upper and lower) 3. sagittal (vertical cut into left and right halves)

fowler position

a bed sitting position with the head of the bed raised to 45 degrees

semi fowler position

the head of the bed is raised 30 degrees; or the head of the bed is raised 30 degrees and the knee portion is raised 15 degrees

shock position

feet elevated 12 inches higher than head

anterior

Toward the Front

posterior

Toward the back

superior

toward the head or above point of reference

inferior

away from the head or below point of reference

dorsal

Toward the back/spine

ventral

Toward the front/ belly

medial

Toward center of body

lateral

Away from center of body

bilateral

Both sides

unilateral

One side

ipsilateral

Same side

contralateral

opposite side

proximal

Near the point of reference

distal

Far from point of reference

mid clavicular

the line through the center of the clavical

mid axillary

line drawn veritcally from the middle of the armpit to the ankle

plantar

Sole of foot

palmar

Palm of hand

quadrants of the abdomen

Describing where an abdominal organ or pain is located is made easier by dividing the abdomen into four imaginary quadrants.

*Right upper quadrant (RUQ)
*Left upper quadrant (LUQ)
*Right lower quadrant (RLQ)
*Left lower quadrant (LLQ)

vertebrae

the 33 bones of the spinal column

Ribs

Vertebrosternal = 'True ribs" -ribs 1-7 attach directly to the sternum through their costal cartilage. Vertebrochondral = "False ribs" =ribs 8-10 costal cartilage articulate indirectly with the sternumb by joing the costal cartilages of ribs above. Vertebral Ribs = "Floating ribs" ribs 11 and 12 no anterior attachment.

upper airway

(Nose, mouth, pharynx, larynx)FUNCTION:Conducts air to lower airway Protects lower airways *Warms, filters & humidifies air

lower airway

trachea, bronchi, bronchioles, and aveoli (gasses travel through the structers to and from the blood)

cricoid cartilage

the ring-shaped structure that forms the lower portion of the larynx

diaphragm

muscular partition that separates the thoracic cavity from the abdominal cavity and aids in respiration by moving up and down

phrenic nerve

stimulates the diaphragm

edema

swelling

perfusion

The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries.

hypo perfusion

Also known as shock (decreased blood flow through an organ, as in hypovolemic shock; if prolonged, it may result in permanent cellular dysfunction and death.)

cerebrum

large part of the brain that controls the senses and thinking

cerebellum

the "little brain" attached to the rear of the brainstem; its functions include processing sensory input and coordinating movement output and balance

brain stem

the part of the brain continuous with the spinal cord and comprising the medulla oblongata and pons and midbrain and parts of the hypothalamus

epinephrine

adrenaline; activates a sympathetic nervous system by making the heart beat faster, stopping digestion, enlarging pupils, sending sugar into the bloodstream, preparing a blood clot faster

noepinephrine

A neurotransmitter from nerve endings and a hormone from the adrenal gland. It is release in times of stress and is involved in hunger regulation, blood glucose regulation and other body processes.

alpha1 and Alpha2

Alpha1 vessels constrict and release sweat
Alpha2 try's to regulate alpha1

beta 1

increases HR, inotrophy (forced contraction of heart) increases electrical impulse in heart

beta 2

relaxes smooth muscle such as bronchioles and some vessels

pulse pressure

difference between systolic and diastolic pressure no more than 25%

respiration

..., the bodily process of inhalation and exhalation

pulmonary ventilation

..., Movement of air into and out of the lungs

internal respiration

..., exchange of gases between the blood and the cells of the body

external respiration

..., exchange of gases between the lungs and the blood

cellular respiration

..., process that releases energy by breaking down glucose and other food molecules in the presence of oxygen

carina

..., the fork at the lower end of the trachea where the two mainstem bronchi branch.

bronchioles

..., smallest branches of the bronchi

pleura

..., membrane surrounding the lungs

visceral pleura

..., inner layer of pleura that surrounds each lung

parietal pleura

..., pleura that lines the inner chest walls and covers the diaphragm

pleural space

..., the small potential space between the parietal and visceral layers of the pleura

intercostal muscles

..., Muscles which move the rib cage during breathing

signs of mild hypoxia

Tachypnea
Dyspnea
Pale cool clammy skin ( early)
Elevation of blood pressure
Agitation
Disorientation and confusion ( from high carbon dioxide levels)
Headache

signs of severe hypoxia

Tachypnea
Dyspnea
Cyanosis
Tachycardia may lead to dysrhythmias and eventually bradycardia
Confusion
Loss of coordination
sleepy appearance
Head bobbing
Slow reaction time
Altered mental status

dyspnea

..., difficult or labored respiration

cyanosis

..., A bluish discoloration of the skin and mucous membranes

patent airway

..., An airway that is open and clear of obstructions.

snoring sounds

..., airway blocked, open patients airway promt transport

crowing

..., A breathing sound similarto the cawing of a crow; may indicate that muscles around the larynx are in spasm.

gurgling

..., indicates presence of fluid in the upper airway, need for suctioning

stridor

..., a whistling sound when breathing (usually heard on inspiration) upper airway

n-95

..., Mask used for a patient with TB

tonsil tip

... Rigid suction

french tip

...Soft suction

oropharyngeal

..., -curved plastic device used to establish an airway in a patient by displacing the tongue from the posterior wall of the oropharynx
-used in unconscious patients who do not have a gag reflex

nasopharyngeal

..., flexible airway inserted through the patients nose

retractions

..., Movements in which the skin pulls in around the ribs during inspiration.

respiratory failure

..., a condition in which the level of oxygen in the blood becomes dangerously low or the level of carbon dioxide becomes dangerously high

respiratory arrest

..., When breathing completely stops.

agonal respiration

..., Shallow, slow or infrequent breathing

tachypnea

..., fast breathing, an abnormally rapid rate of respiration, usually >20 breaths per minute

bradypnea

..., slow respiratory rate, usually below 10 respirations per minute

methods of artifical ventilation

...Mouth to mask
Two person bag valve
Fropvd
One person bag valve

cricoid pressure

..., Pressure on the trachea, prevents air from entering the esophagus/stomach and vomiting

FROPVD

..., flow-restricted, oxygen-powered ventilation device: a device that uses oxygen under pressure to deliver artifical ventilations. Its trigger is placed so that the rescuer can operate it while still using both hands to maintain a seal on the face mask. Has automatic flow restriction to prevent overdelivery of oxygen to the patient.

rales

..., abnormal crackling sound made during inspiration

rhonchi

..., lower-pitched sounds like snoring or rattling, secretions in larger airways (pneumonia, bronchitis, aspiration)

paradoxus pulsus

blood pressure declines as one inhales and increases as one exhales

capillary refill

..., tested by pressing the nail tip briefly and watching for color change. A normal finding is the pink tone returns immediately when pressure is released. An abnormal finding is slow (greater than 2 seconds) return of pink tonewith respiratory or cardiovascular diseases that cause hypoxia.

Penetrating truma

Made a cut through

Blunt force trauma

No cut but internal problem

Hypercapnia

Too much carbon dioxide

Flexion posturing

(Formerly known as decorticate posturing). Client flexes one or both arms on the chest and may extend the legs stiffly. Indicates nonfunctioning cortex. Lesions of cerebral hemispheres or internal structures of brain cause this posturing.

Extension posturing

A posture in which the pt arches the back and extends the arms straight out parallel to the body. A sign of serious head injury

Occluded

closed off

Dyspnea

difficult or labored respiration

Hypoperfusion

inadequate perfusion also known as shock

Secondary assessment

after immediate life- or limb-threatening injuries/illnesses have been identified, this more thorough evaluation is performed to identify more subtle, yet still important, injuries

Physical exam, Baseline vitals, History

Three major steps in secondary assessments

Cerebrospinal fluid

clear liquid produced in the ventricles of the brain

Jugular vein distention

the visible bulging of the jugular vein when the Pt is in semi-fowlers position or full fowlers position. this is indicative of inadaquate blood movement through the heart and/or lungs

Tension pneumothorax

a pneumothorax with rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessels

Pericardial tamponade

filling of the pericardial sac with fluid, which in turn limits the filling and function of the heart.

Sputum

material expelled from the lungs by coughing

What is PMS

Pulses
motor function
Sensation

MOI falls

Adults 20 feet
children/infants more than 10 feet or 2or3 times their height

Glasgow coma scale

Used for head trauma- Score 3-15, based on Eye opening, Verbal response and Motor response.

less than 13

Rapid transport (what's the number on the GCS)

Brain herniation

Increasing intracranial pressure related to the presence of lg pocket of blood (hematoma)

Ruq

contains majority of liver, gallbladder, small portion of pancreas, right kidney, small intestines, and colon.

Luq

stomach
spleen
left lobe of liver
body of pancreas
L kidney and

Llq

contains parts of the small and large intestines, left ovary, left fallopian tube, left ureter

Rlq

contains parts of the small and large intestines, right ovary, right fallopian tube, appendix, right ureter

Sublingual

beneath the tongue

Oral

Swallowed

Inhalation

breathing in

Intramuscular

into the muscle

Right date, right patient, right drug, right dose, right route

the 5 rights

Shock

Inadequate tissue perfusion
Also know as hypoperfusion

Types of shock

Hypovolemic
Distributive
Cardiogenic
Obstructive

Hypovolemic shock

shock caused by severe blood or fluid loss

Distributive shock

less distribution of blood to areas = venous pooling, most common in general anesthesia and spinal cord injuries and septic shock (bacterial infection where toxins in blood). cause: general anesthesia and spinal cord injuries and septic shock

Cardiogenic shock

shock that results from failure of the heart in its pumping action.

Obstructive shock

mechanical obstruction or compressing that prevents blood from reaching the heart

Tension pneumonthorax

A type of pneumothorax in which air can enter the pleural space but cannot escape via the route of entry. This leads to increased pressure in the pleural space, resulting in lung collapse. The increase in pressure also compresses the heart and vena cavae, which impairs circulation.

Pericardial tamponade

filling of the pericardial sac with fluid, which in turn limits the filling and function of the heart.

Stages of shock

1. Compensatory Shock 2. Decompensatory Shock 3. Irreversible Stage

If patient been in cardiac arrest for more than 5 min and no CPR has been done what do you do

Provide 2 min of CPR before ard

aed shock then pulse check?

No aed shock then 2min CPR then pulse check

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