c

EMT-B Study Guide

Intro to EMS:
Certification Agencies
NREMT: National Registry forms the national certification test in accordance with
DOT standards but not affiliated with DOT
State DHS: Sets state standards; has state requirements for certification and licensing
,they either accept your national registry test or make you take a state test
DOT: formed the 1994 national standards; a nat'l standard all EMT's abide by
Medical Direction
Medical control: is the person whose license you work under, authorizes what an
EMT-B can do with either online or offline protocol
On-line(direct): direction given over phone/radio given from med control/physician
Emotional Aspects of the Job
Grieving Process
Stages of Grieving
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
V
 



  
Burnout
Definition:chronic fatigue and frustration that results from mounting stress over
time
Stress Management
To deal with stress you can:
Make healthy lifestyle changes
Good Nutrition
Exercise and Relax
Keep balance between work, family, and health
Personal Protection
BSI Levels:
Minimum Requirement: Gloves and Goggles
Gowns and Masks: extensive blood splatter
Masks and Respirators: if suspected airborne disease
Communicable Diseases:
Hepatitis:
inflammation of liver
S/S: fever, loss of appetite, jaundice, fatigue
HIV:
S/S: not many symptoms if any
Very difficult to transmit
Tuberculosis (TB):
chronic mycobacterial disease that affects the lungs
transmits through the airborne
S/S: cough
Meningitis
inflammation of meningeal coverings of the brain
S/S: fever, headache, stiff neck, altered mental status, and sometimes red skin
blotches

c
c

Being an EMT
Levels of EMT-
Basic-BLS
Intermediate-Some ALS
Paramedic-All ALS
Continuous Quality Improvement (CQI):
system of internal/external reviews and audits of all aspects of the EMS system
Continuing Education
certain number of hours of CE needed to maintain, update, and expand
knowledge
Med/Legal Issues:
Abandonment
termination of care by EMT w/o patient consent or med control direction
Once you begin care you've assumed a duty to the patient
Types of Consent
Expressed
patient acknowledges the need for care/transport
must be Informed Consent- patients been informed of the risks, benefit, and
alternatives to treatment
Implied
assumed that the patient would want care
only applicable when pt is :
unconscious
delusional
unresponsive due to drugs/alcohol
otherwise physically unable to provide expressed consent
Minors
Parents give consent and if kid is old or mature enough they can also provide
consent
If patient is emancipated, married, or pregnant then they should be treated as
adults in most cases
If parent is unavailable treat child under implied consent
Mentally Incompetent Adults
Not able to give informed consent
similar to kids in consent giving
Advanced Directives
specific medical orders
To be considered valid must:
clearly state patients medical problem
be signed by patient or legal guardian
be signed by physicial
must not be expired
Duty to Act
an individuals responsibility to provide patient care
Once your ambulance responds to a call you have a duty to act
Standard of Care
how someone with your level of training in your situation would've acted
Negligence
Failure to provide standard of care
To prove negligence the following must be present:

c
c

Duty to Act
Breach of Duty
Damages
Causes
Human Body
Anatomical Terms:
Anterior: Toward front of body
Posterior: Towards back of body
Supine: Lying face up
Prone: Lying face down
Midline: Vertical line drawn down middle of body from anterior aspect
Medial: Toward middle of body
Proximal: Structures close to trunk of body
Distal: Structures further from the trunk
Inferior: Towards the feet
Superior: Toward head
Types of Muscle:
Skeletal
attaches to the skeleton
Voluntary muscle striated
Smooth
Involuntary
Found in the walls of tubular structures in the body
Cardiac
Involuntary
Has automaticity (sets its own rate and rhythm with no help from brain)
Very rich blood supply
Requires constant O2 and glucose
Blood Flow
c c Inferior/Superior Vena Cavaå Right Atrium å Tricuspid Valve å Right
Ventricle å Pulmonary Artery å lungs å pulmonary veins å Left
Atrium å Mitral Valve å Left Ventricle å Aorta åArteryå arterioles å
capillaries å venules å vein
Heart
Has 2 pumps, 4 chambers
SA Node (main electrical stimulation)
Lungs
5 Lobes (3 in the right two in the left)
Passage of Air
In through the naso or oropharynx to the pharynx, through epiglottis, into larynx,
through trachea, passed the carina, into the bronchi then the bronchioles to the
alveoli
Components of Blood
1.Plasma-sticky yellow, carries blood cells and nutrient along with transporting
waste, also helps blood clot
2.Red Blood Cells- carry O2
3.White Blood Cells- aide in immune system
4.Platelets- Help in initial blood clot formation
Arteries
Always carry blood away from heart usually to other tissues

c
c

Contract to accommodate blood loss and raises BP

Veins
Always carries blood to heart, usually deoxygenated
Bones
206 bones in the body
Refer to bone test for further information

Basics of Patient Assessment

Vital Signs:
Baseline Vitals:
First set of vitals taken.
This includes the following:
Pulse
Blood Pressure
Respirations
Skin Condition
Pupils
Capillary Refill
Pulse
Tachycardia means fast heart beat
Bradycardia means slow heart beat
You take an adults at the radial and an infants in the brachial
Blood Pressure
A blood pressure represents the amount of pressure on the artery walls
Two Techniques:
Auscultation
Palpation
It is systolic over diastolic
Hypotension is low BP
Hypertension is high BP
Normal Range is the systolic between 90-140
Respiration
Always watch chest rise and fall and listen to bilateral breath sounds
Unusual Respiration Sounds
Stridor
harsh, high pitched crowing sound
Wheezing
heard on expirations
high pitched whistling breath sound
Hypoxia
not enough 02 as a result of inadequate breathing
Tachypnea
fast rate of breathing
Apnea
no breathing
Dyspnea
difficulty breathing
Skin Condition
Unusual Skin Conditions
Jaundice

c
c

where patients skin turns yellow resulting from liver disease

Palor/Ashen
Resulting from poor perfusion
Cyanosis
not enough 02 in blood, in sufficient air exchange
Skin appears blue
Diaphoretic
excessive sweating
Diffusion
how air passes into the blood stream
molecules go from a area of high concentration to an area of low concentration
Perfusion
circulation of blood with organ and tissue
lack of perfusion is hypoperfusion
Capillary Refill
should be less than two seconds
checks perfusion in limbs
Pulse Oximetry
checks level of 02 in blood
should be between 95-100%
Blood Glucose
normal levels are 80-120 mg/dL
Chief Complaint
What the patient tells you is wrong with them
Signs vs. Symptoms
Signs
Objective- something that could be measured, seen, or felt
Symptoms
Subjective-based on patients interpretation and tolerance
Reassessment of Vitals
On a stable patient retake vitals every fifteen minutes
On an unstable patient retake every five minutes
Lifting and Moving Patients
Safe Lifting Techniques
Always keep back straight and upright
Spread legs shoulder width
Lift with legs
Keep weight close to body
Use power grip
Types of Lifts
Rapid Extrication Technique
only use when patient is unstable
Diamond Carry
you know how this works all EMT's face forward so they can walk
Stair Chair
used with conscious seated patient
Scoop Stretcher
used to filled around a patient lying on ground or other flat surface
Basket Stretcher
rigid stretcher used in technical/water rescues

c
c

c
Extremity Lift
used for patient who is supine sitting patient with no extremity or spinal injuries
Wheeled Stretcher
can be rolled and has collapsable undercarriage
Direct Ground Lift
used for patient lying supine on ground with no spinal injury
Backboard
used on patient with suspected hip, pelvic, spinal, lower extremity injury
Airway
Inhalation
active process
diaphragm intercoastal muscles contract
Thoracic cage expands, ribs lift up and out
Exhalation
passive process
diaphragm, intercoastal muscles relax
thorax size decreases
Neurological Emergencies
TIA vs. Stroke
TIA- when stroke symptoms go away in less than 24 hours
usually signify impending stoke
Stroke- loss of brain function that results from CVA occurs when part of blood flow
to brain is cut off
Definitions
Thrombus-clotting of cerebral arteries
Aneurysm- weakness in the artery wall
Embolism-obstruction cause by a clot that travels to the brain
Syncope- fainting
Seizures
Types
Grand Mal
Petit Mail
Treatment
Protect from harm, maintain airway, provide 02
If patient is in status epilepticus: suction airway, BVM, transport quickly,
connect with ALS
Status Epilepticus
seizure that continues every few minutes without regaining consciousness, or last
longer than 30 minutes
Abdominal Emergencies
Organ Location
Right Upper Quadrant
liver, gall bladder,bile duct
Left Upper Quadrant
stomach, spleen
Left Lower Quadrant
large intestine, rectum
Right Lower Quadrant
small intestine,appendix

c
c

Acute Abdomen
S/S: pain(can be localized), tenderness, anorexia, guarding, patient in position of
comfort,
Treatment: oxygen, proper positioning, transport
Peritonitis
S/S: ileus, emesis, nausea, distention, decreased BP, shock, tachycardia, fever
(sometimes), constant abdominal pain, referred pain, constipation, bloody diarrhea,
rebound tenderness
Treatment: oxygen, positioning, treat for shock if necessary, transport
Definitions
Hernia
protrusion of loop of an organ or tissue through an abnormal body opening
Guarding
involuntary muscle spasm of abdominal wall to protect the inflamed area
Emesis
vomiting
Ileus
paralysis of the bowel, stop contractions in the intestine, causes emesis of crap
PID
pelvic inlammatory disease, infection of fallopian tubes and tissues
Cystitis
inflammation of bladder
Colic
acute intermittent cramping abdominal pain
Diabetic Emergencies
Definitions
hypoglycemia
low blood sugar levels
hyperglycemia
high blood sugar levels
DKA
form of acidosis in uncontrolled diabetes where certain acids accumulate
Insulin Shock
unconsciousness in a patient with diabetes cause by significant hypoglycemia
Diabetic Coma
unconsciousness caused by dehydration, very high blood glucose, and acidosis
Polydipsia
excessive constant thirst
Polyphasia
excessive eating
Polyuria
excessive urination
Acidosis
pathologic condition resulting from accumulation of acids in the body
Hormone
chemical substance that regulates the activity of body organ/tissues, made by
glands
Insulin
hormone produced on pancreas that enables glucose to enter cells

c
c

Types of Diabetes
Type I- early onset, juvenile, insulin dependent
Type II- late onset, non insulin dependent
Allergic Reactions
Definitions:
Anaphylaxis-extreme life threatening allergic reaction involving airway
Allergic Reaction-body's exaggerated immune response to an internal or surface agent
Urticaria-hives
Allergen-substance that cause allergic reaction
Wheal-raised swollen well define area
Anaphylaxis
Treatment:Epi pen, ventilatory support, take away allergen,elevate feet, keep body
warmth
Substance Abuse and Poisoning
Definitions:
Hematemessis- vomiting blood
Stimulant-agent that produces an excited state
Opiod-drug with effects similar to morphine
Tolerance-need for increasing amounts of drug to obtain same effect
Poison-substance whose chemical action could harm body functions or structures
Routes of Poisoning-
Inhalation-require oxygen, decontamination,immediate transport
Absorption(surface contact)-wash substance off,remove contaminated
clothing,prompt transfer, 02
Ingestion-give activated charcoal, asses ABS's, provide ventilatory support,transport
Injected-monitor airway give oxygen, be alert for nausea vomiting, take bottles
Environmental Emergencies
Body Temperature
Ability to handle temperature changes depends on following factors:
1. Physical Condition
2. Age
3. Nutrition and Hydration
4. Environmental Conditions
Body can gain or loose heat in following ways:
Conduction-direct transfer of heat
Convection- heat transferred through circulating air
Evaporation-natural mechanism in which sweating cools body
Radiation-transfer of heat by radiation, example:fire
Respiration-body heat gained/loosed as warm air in lung exhales
Hypothermia
low temperature below 95 degrees
S/S:shivering, foot stamping, loss of coordination, muscle stiffness, coma, cyanosis
Treatment: remove from environment,remove any wet clothing, place dry blankets
over and under patient, don't handle extremities, give warm o2, apply heat packs
Hyperthermia
high temperature above 101 degrees
S/S: tachycardic and tachypneic, muscle cramps
Treatment:Remove patient from environment, passive cooling, fluids by mouth, cover
with wet sheet, place AC on high, place cold packs on groin and armpits
Heat Cramp-painful muscle spasm

c
c

Heat Exhaustion-hypovolemia due to loss of water and electrolytes due to lots of

sweating
Heat Stroke-most serious, body is subjected to more heat than it can handle, body temp
rises and destroys tissues.
Trench Foot
pale skin, cold to touch, wrinkled foot skin, loss of feeling
TX: remove from cold, rewarm foot slowly, remove wet shoes
Frostnip
non painful, same signs as trench foot
TX: same as trench foot
Frostbite
hard frozen feel, hard and waxy area, blisters and swelling, mottled skin
TX: remove patient from cold, handle injured part gently, administer 02, remove wet
clothing, cover injury with dry sterile dressing, don't pop blisters, don't rewarm
area
transport promptly
Drowning vs. Near Drowning
Drowning- suffocation after submersion in water
Near Drowning- survival of at least 24 hours after suffocation in water
Diving Emergencies
Descent Emergencies
usually due to sudden increase in pressure
Bottom Emergencies
rare due to inadequate mixing of 02 an co2 in the divers air supply
Ascent Emergencies
Air Embolism
bubbles of air in blood vessels
s/s: blotching, froth, sever pain, dyspnea, chest pain, dysphasia, difficultly with
vision, paralysis, irregular pulse, cardiac arrest
Decompression Sickness aka The Bends
bubbles of gas obstruct blood vessels
s/s: severe abdominal pain, joint pain, occur after several hours
Behavioral Emergencies
Risk Factor for Suicide
-depression, history of attempt, expression of wanting to commit suicide, family
history of suicide,older than 40(single, widowed, divorced, alcoholic),recent
loss, recent terminal diagnosis, holidays, social embarrassment, financial issues,substance
abuse, severe mental illness
Definitions
Behavior
Persons response to environment
Behavioral Crisis
any reaction to events that interferes with daily life or become unacceptable to
patient, family, or community
Organic Brain Syndrome
temporary or permanent dysfunction of brain cause by disturbance in brain tissue
Functional Disorder
abnormal operation of an organ can't be traced to an obvious A+P change of
organ
Depression

c
c

persistent feeling of sadness and despair

Obstetric Emergencies
Definitions
Cervix
lower third or neck of uterus
Perineum
area of skin between vagina and anus
Placenta
tissue attached to the uterine wall that nourishes the fetus through umbilical cord
Amniotic Sac
fluid filled, bag like membrane in which fetus develops
Fetus
developing unborn infant inside the uterus
Birth Canal
the vagina and cervix
Uterus
muscular organ where the fetus grows(womb) responsible for contractions
Umbilical Cord
conduit connecting mother to infant via placenta, contains two arteries, one vein
Vagina
outermost cavity of a woman's reproductive system, lower part of birth canal
Placenta Previa
placenta develops over cervix
TX: treat for shock if necessary, transport
Abruption Placenta
premature separation of placenta from uterine wall
TX: cover vagina with sterile pad keeping them to estimate blood loss, transport
Eclampsia
seizures resulting from severe hypertension
TX:lay on left side, maintain airway, provide 02, if vomiting suction, rapid transport
Preeclampsia
S/S: headache, visual changes, swelling of hands and feet
TX:lay on left side
Supine Hypotensive Syndrome
low BP because of the compression of the inferior vena cava by weight of belly
TX:transport on left side
Ectopic Pregnancy
pregnancy developed outside of uterus usually in the fallopian tubes.
TX:ALS,transport
Prolapsed Cord
umbilical cord comes out of vagina before infant
TX:transport, must be handled at the hospital
Nochal Cord
umbilical cord wrapped around infants neck
TX:slip cord gently over patients head, if unable you must cut the cord
Limb Presentation
delivery in which present part is a limb
TX:transport quickly, delivery impossible
APGAR Score
Appearance

c
c

Pulse
Grimace
Activity
Respiration
*look at chart on page 614*